Comparison and correlation of visual inspection with acetic acid, papanicolaou smear and colposcopy in detection of precancerous cervical lesions

Background: Cervical cancer is a huge emotional and financial burden on society. To curb the disease, there is a need to develop a screening test that has good sensitivity and specificity. The present study is aimed to compare the effectiveness of the Pap smear, visual inspection with acetic acid (VIA) and colposcopy for mass screening of premalignant and malignant lesions of the cervix. The objective of this study was to screen women of 30-45 years of age for precancerous cervical lesions with VIA, Pap smear and colposcopy. And compare and correlate the findings of Pap smear, colposcopy and VIA in detecting precancerous lesions of cervix.Methods: This was a prospective observational study conducted from 1 January 2015 till 1 June 2016 (36 months) in OPD, department of obstetrics and gynaecology among 500 women of 30-45 years. of age group. Pap smear was performed by the conventional method and then VIA was carried out for all; colposcopy was done in all VIA positive patients.Results: Out of 500 study group, 364 (72.8%) women were VIA negative and 136 (27.2%) were VIA positive. Pap results in VIA negative women were either NILM or normal, none was with intraepithelial lesions. Out of 136 VIA positive women 42 (34%) pap results were LSIL or HSIL and on colposcopy 59 (44.7%) women had CIN I/II/III.Conclusions: These results establish VIA as an effective screening test for cancerous and precancerous conditions of the cervix and thus VIA can be implemented as a single primary screening method. Colposcopy can further interpret the VIA positive lesion with almost 100 % sensitivity, specificity, NPV in high grade lesions.

The effect of preventive measures to reduce the decision to delivery interval in women undergoing emergency caesarean section

Background: Time interval between the decision to perform an emergency caesarean (ES) section and the actual delivery is known as decision delivery interval (DDI). A third phase delay in the delivery of emergency obstetric care is caused by prolonged DDI. In an effort to reduce maternal morbidity and neonatal morbidity and mortality, it is essential to implement interventions designed to reduce DDI. Methods: This study was carried out to reduce DDI by setting benchmarks for all categories according to Royal College of Obstetricians and Gynaecologists (RCOG) guidelines 2010, in our setup. The study carried out in 2 phases; first phase was a pilot study comprising of 143 women who underwent ES section. The deviation in DDI with possible causes were noted. The benchmarks were set to 8%, 30% and 20% for categories 1, 2, and 3 respectively. Corrective actions were taken including both hospital and patient causes for delay and were discussed at each level. Second phase included total 460 women from January to December 2021 and evaluated for DDI. Results: Out of 460, 87 (18.91%) women had deviated from the set DDI. The percentages in individual categories 1, 2 and 3 were 17.22%, 30.50%, and 29.50%, respectively. The deviation percentage of DDI in category 2, was achieved as per benchmark set in a pilot study, however, it was not achieved for other categories. Conclusions: Since the result that was obtained didn’t reach the set deviation percentage, we have observed that achieved deviation cannot be further reduced as our clinical setup is a teaching institute

Efficacy of MgSO4 to prevent eclampsia in women with severe pre-eclampsia and impending eclampsia

Background: Preeclampsia is a multi-system disorder that is frequently accompanied by proteinuria and new-onset hypertension. Poor placental perfusion and a general disease process that may affect multiple organ systems are the hallmarks of the syndrome. While eclampsia is a complicated condition brought on by cerebral dysrhythmia due to various pathogenesis steps that include abnormal trophoblastic invasion which led to vasospasm, endothelial dysfunction, and platelet aggregation. Maternal complications of severe preeclampsia/eclampsia can lead to maternal, fetal, and neonatal morbidity and mortality. One of the anticonvulsants MgSO4 is known to reduce the risk of eclampsia. The present study was conducted with the aim to analyse the effect of MgSO4 to reduce the incidence of eclampsia in pregnant women with preeclampsia and impending eclampsia. Methods: A total of 114 women with preeclampsia and impending eclampsia were included in present study. Mgso4 was given as a loading dose and the Zuspan regimen as required. Women were categorised based on raised blood pressure (>140/90 mmHg), deranged lab parameters which includes renal function tests (urea, uric acid, creatinine), coagulation profile (PT, APTT, INR, LDH, platelet count), liver function tests (total bilirubin, SGOT/SGPT) and clinical symptoms which include headache, blurring of vision, epigastric pain.  The incidence of eclampsia even after a dose of MgSO4 was calculated. Results: The mean age of the women was 28.17±4.69 years. The diagnosis of pre-eclampsia was made based on systolic and diastolic blood pressure. Out of 114 pregnant women with severe preeclampsia or impending eclampsia who were given a dose of MgSO4, only 2 women have developed eclampsia. Conclusions: The incidence of eclampsia after the dose of MgSO4 among women with preeclampsia or impending eclampsia was reported to be only 1.75% which confirms MgSO4 therapy as an effective tool in preventing perinatal morbidity and mortality

Comparison and correlation of visual inspection with acetic acid, papanicolaou smear and colposcopy in detection of precancerous cervical lesions

Background: Cervical cancer is a huge emotional and financial burden on society. To curb the disease, there is a need to develop a screening test that has good sensitivity and specificity. The present study is aimed to compare the effectiveness of the Pap smear, visual inspection with acetic acid (VIA) and colposcopy for mass screening of premalignant and malignant lesions of the cervix. The objective of this study was to screen women of 30-45 years of age for precancerous cervical lesions with VIA, Pap smear and colposcopy. And compare and correlate the findings of Pap smear, colposcopy and VIA in detecting precancerous lesions of cervix.Methods: This was a prospective observational study conducted from 1 January 2015 till 1 June 2016 (36 months) in OPD, department of obstetrics and gynaecology among 500 women of 30-45 years. of age group. Pap smear was performed by the conventional method and then VIA was carried out for all; colposcopy was done in all VIA positive patients.Results: Out of 500 study group, 364 (72.8%) women were VIA negative and 136 (27.2%) were VIA positive. Pap results in VIA negative women were either NILM or normal, none was with intraepithelial lesions. Out of 136 VIA positive women 42 (34%) pap results were LSIL or HSIL and on colposcopy 59 (44.7%) women had CIN I/II/III.Conclusions: These results establish VIA as an effective screening test for cancerous and precancerous conditions of the cervix and thus VIA can be implemented as a single primary screening method. Colposcopy can further interpret the VIA positive lesion with almost 100 % sensitivity, specificity, NPV in high grade lesions.