Evaluation of who guided pain management protocol in cases of carcinoma cervix

Background: Pain in patients with cancer cervix is a complex process that occurs from many causes. Opioids, the major class of analgesic used in management of moderate to severe pain, are usually effective and have favorable benefit to risk ratio. Morphine is the most effective and commonly used opioid in cancer pain management.Methods: Patients of cancer cervix attending the Obstetrics and Gynecology Department, KRH for a period January 2016 to December 2016. 200 patients were included in the study. Pain intensity was measured by visual analogue scale.Results: Maximum number of subjects were in stage IIB (46%) followed by stage IIIB (42%). Minimum number of subjects were in stage IA and stage IVB. In stage I, 55.6% patients had mild pain, 27.8% had moderate and 16.7% patients had severe pain.  In stage II, carcinoma cervix patients 80.4% patients had moderate pain and only 12% patients had severe pain and stage III, 47.6% patients had severe pain and stage IV all patients had severe pain. Most common site for pain was lower abdomen in carcinoma cervix patients. The pain was recorded as moderate in maximum (49%) subjects followed by severe (39%). Mild pain was seen only in 12% subjects. Maximum response was seen for Step III (95.1%) while minimum for Step II (44.1%).Conclusions: Pain is a common symptom in cancer cervix patients. Morphine is most useful drug in cancer pain management. It is easily titratable and has a favorable benefit to risk ratio

Clinico-pathological study of vaginitis in peri and post-menopausal women

Background: Menopause is universal phenomena which has adverse effect on health of women. The vaginal cytology by maturation value is an inexpensive mean to evaluate hormonal influence in women. Objective was to diagnose atrophic by vaginal pH and vaginal maturation value in peri and post-menopausal women symptomatic as well as asymptomatic. Methods: This study conducted on 100 peri and post-menopausal women who attended in Department of Obstetrics & Gynaecology, Kamla Raja Hospital, and G.R. Medical College Gwalior from August 2015 to August 2016. They were divided into three groups: Group A (Cases) - subjects having VMV < 64 with or without symptoms, Group B (Suspects) - Symptomatic subjects with VMV > 64 and Group C (Controls) - Asymptomatic subjects with VMV > 64. Results: The detection rate of vaginitis in total 100 peri and post-menopausal women in this study was 36% while detection rate in symptomatic peri and postmenopausal women was 36/65 i.e., 55.38%. To our surprise 13/35 (37.14%) had VMV < 64 (mild estrogen deficiency) in control group (asymptomatic postmenopausal women). They became true cases as VMV was taken as gold standard for diagnosis of vaginitis. It means that detection rate of vaginitis in asymptomatic peri and post-menopausal women were 37.14%. Conclusions: There is a lack of awareness of symptoms and signs among both in population and physicians for early detection of vaginitis

Prevalence of ovarian tumours among ovarian mass lesions in Gajra Raja Medical College, Gwalior, India

Background: Ovarian tumor is one of the most common gynecological tumors seen in female although there are different types of ovarian tumor but epithelial ovarian cancer is the fifth most common cause of cancer death in women. It is often called the “silent killer” because the disease is not often detected until it reaches an advance stage.Methods: This observational study conducted on 130 patients from February 2015 to March 2017 in the Department of Obstetrics and Gynaecology in Gajra Raja Medical College, Gwalior. Clinical details of the patients included age, gynaecological and obstetric history, presenting symptoms, and surgery details. Histopathological reporting was done at our Pathology department.Results: Out of total 130 patients with ovarian tumours studied 49.2% were > 60 years of age group, most of them were nullipara (53.8%), 54.6% with ovarian tumours presented after one-year development of symptoms. most of the symptoms were vague and nonspecific. Benign tumours were the most prevalent (79.2%), 19.2% were malignant tumours and 1.5% were borderline. Histological pattern of distribution of ovarian tumour shows that most of ovarian tumour were surface epithelial tumour (72 patients) followed by germ cell tumour (58 patients). Age wise distribution of study population showed that most of the surface epithelial tumour were more common in 3rd to 5th decade while most of germ cell tumour were more frequent in 2nd and 3rd decade.Conclusions: For better prognosis and patient survival, early detection and treatment is mandatory, which may reduce mortality. There is need to increase awareness of population. Abdominal and pelvic bimanual examination should be carried out in every patient presenting with gynecological problem. Appropriate investigations in post-menopausal women in early period to diagnose the disease at an early stage

Comparative study of causative organism in erosive cervicitis, cervical intra epithelial neoplasia and carcinoma cervix using Pap smear

Background: Cervical cancer is the third largest cause of cancer mortality in India after cancers of the mouth and oropharynx, and oesophagus, accounting for nearly 10% of all cancer related deaths in the country.Methods: The present study carried out 300 patients in Gajra Raja Medical College in the Department of Obstetrics and Gynaecology, OPD and indoor admitted patients from July 2016 to December. 2016. The selected patients were examined with care to note any cervical lesion, appearance of cervix, nature of any cervical/ vaginal discharge. Then a cervical scrape was taken with an Ayre’s spatula and slide stained and then examined.Results: The maximum cases of HPV were seen in CIN, LSIL and HSIL. Maximum incidence of all cases was seen in the age group of 30-50 yrs. The women married before 18 years had the highest incidence of CIN and HPV infection. Majority of the cases of cervicitis were co-infected with H-Vaginalis and Trichomonas. Most women opted for a sterilization procedure rather than any other method of contraception. Use of no contraception puts these women at a high risk of acquiring HPV infection from infected partners.Conclusions: Occurrence of HPV infection declines with increasing grades. Most of the patients with HPV infection had presented with non-specific symptoms of discharge P/V or lower abdominal pain

A clinical study to compare drain versus no drain in post cesarean section

Background: Cesarean section is one of the commonest hospital based surgical procedure in obstetric mainly done to facilitate delivery in case where vaginal delivery is either not feasible or poses undue risk to mother, baby or both. The most common complications of CS are superficial surgical site complications including sepsis, seroma formation and breakdown.Methods: A prospective study done on 100 patients admitted in labour room of Department of Obstetrics and Gynaecology, Kamla Raja Hospital, G.R.M.C., Gwalior between November 2015 to March 2016. Study divided into two groups: group I, including women who had no subcutaneous drain left and group II, including women who had a subcutaneous drain left before closure of the skin; Each group has 50 patients. The study included term pregnant women with pre-operative Hb >9 gm%, BMI >30 kg/m2 and were taken for emergency cesarean sections (for cephaloppelvic disproportion, fetal distress, abnormal presentations) with no intraoperative complications (hemorrhage, blood transfusion).Results: VAS median grade in patients without drain was G3 (46%), followed by G2 (28%), G4 (14%). VAS median grade in with drain group was G2 (68%), followed by G1 (24%) and then G3 (08%). Wound infection was noted in 4 (08%) patients in both the groups. Both groups were administered same group of intravenous antibiotics for 5 days. The mean hospital stay in patients without drain were 9.4 days and patients with drain were 8.2 days. The mean haemoglobin in patient with drain was 8.6 gm% and patients without drain was 9.4 gm%. Wound seroma in 13 cases and superficial breakdown in 4 cases in non-drain group versus 5 cases and 2 cases in drain group respectively. There is significant difference in postoperative pain and non-significant difference in postoperative fever.Conclusions: Patients in with drain group have reduced rates of wound seroma, postoperative pain, shorter hospital stay, but there is insignificant benefit regarding post-operative fever, superficial SSI, wound breakdown and hemoglobin concentration

Study of maternal mortality trends: 10 years retrospective and comparative analysis at a tertiary teaching hospital of Gwalior Chambal region

Background: Maternal death is a preventable calamity. The aim of this study was to analyze the causes of maternal mortality in a tertiary teaching hospital.Methods: The present study was done at Kamla Raja Hospital, G R Medical College and JA Group of Hospitals, Gwalior. We reviewed the records of antenatal patients admitted from January, 2005 to December, 2015. The records were analyzed for parameters related to maternal mortality. The change in trends and causes of maternal mortality in patients between 2005-2010 was compared with the patients admitted from 2010 to 2014.Results: During 2005-2009 a total of 28370 antenatal patients were admitted and 27711 live births took place, whereas in 2010-2014 a total 30355 patients were admitted and 29305 live births took place. A total 188 (0.66%) and 251(0.83%) maternal death took place from 2005-2009 and 2010-2014 respectively. Maternal death was more common in unbooked, low socioeconomic status and illiterate patients. The common causes of maternal death were eclampsia, hemorrhage and anemia.Conclusions: Delay in seeking emergency obstetric care and not having regular antenatal checkups by pregnant females are the major contributors for maternal mortality. Dedicated obstetric intensive care units at referral centers for prompt and comprehensive care may help in reducing the maternal morbidity and mortality

Visual inspection of cervix with acetic acid in early diagnosis of cin and early cervical cancer

Background: The cervix is the commonest site of female genital tract cancer worldwide. Cancer cervix has a long pre-invasive stage, giving an opportunity for its early detection and treatment.Methods: The present study conducted on 400 patients in OPD and Indoor admitted patients during the period of June 2015 to Sept. 2016. Pap's smears were studied and reported according to the Bethesda classification. On next visit patient attended with cytology report and VIA, VILI was performed and then subjected to colposcopy.Results: The mean age of our population and VIA positivity were 38.2 and 36.8 years. Majority of VIA positive cases had white discharge or pain in lower abdomen as their presenting complaints. The majority of patients who were VIA positive either had cervical ectropion or a hypertrophied cervix. 22 cases were positive on Pap smear and 66 cases were positive on VIA. Only 2 cases positive on Pap smear were missed by VIA. VIA is more sensitive than pap smear. 93.33% of cases, positive on colposcopy were detected by VIA testing. VIA is more sensitive and pap smear more specific in screening of cancer cervix sensitivity ratio of VIA with pap smear is 1.55%.Conclusions: VIA is an attractive test in low resource settings like India. It is simple, inexpensive, low technology test that requires minimal infrastructure for use. It is comparable to cytology in detecting low as well as high grade lesions in terms of sensitivity, specificity and positive predictive value

Maternal and perinatal outcomes in eclampsia: a retrospective analysis in a referral hospital

Background: Eclampsia is defined as the development of convulsions and / or unexplained coma during pregnancy or postpartum in patients with signs and symptoms of preeclampsia. The objective of present study was to investigate the incidence of eclampsia, the clinical profile, maternal and perinatal outcomes in eclamptic patients in our hospital setting.Methods: The retrospective analysis of case records of all eclampsia cases was done over a period of one year, in department of Obstetrics and Gynaecology, Gajra Raja Medical College, Gwalior, Madhya Pradesh, India.Results: The incidence of eclampsia was13.04/1000 deliveries. Eclampsia was more common in the age group 20-24 years (55.64%), primigravidae (62.90%) and patients from rural areas (76.61%). Majority (91%) of women were referred from different hospitals. 112 (90.32%) patients were unbooked. 74 (59.67%) patients developed eclampsia during antenatal period before onset of labor. 67.01% patients presented at gestational age > 37 weeks. Lower segment caesarean section was the predominant mode of delivery in 66 (68.04%) patients. 11.29% patients required ventilatory support and pulmonary edema developed in 4.83% of cases. Maternal death occurred in 7.25% of cases.with a case fatality rate of 16.07%. Pulmonary edema was the commonest cause of death. 7 (5.6%) patients presented with intrauterine death on admission. There were 5 (4.06%) perinatal deaths reported in present study.Conclusions: Eclampsia is still a common and serious complication of pregnancy. Proper antenatal care, detection of preeclampsia with early management and timely referral of high - risk patients, administration of MgSO4 in correct doses and properly timed caesarean section in selected cases would reduce the incidence of eclampsia associated maternal and perinatal morbidity and mortality in our facility

To study pattern of obstetric cases referred at tertiary care centre in Central India

Background: Maternal morbidity and mortality remains a major challenge to health systems worldwide. Referral services for identification and referral of high risk pregnancies are an integral part of maternal and child health services. Timeliness and appropriateness of referral are challenge to obstetricians, since delay in referral affects maternal outcome adversely, hence the identification of at risk patients and obstetric emergencies and their timely referral is of immense importance. The aim of this study was to review the pattern of obstetric cases referred to tertiary care centre, to identify their clinical course, mode of delivery and maternal outcomes.Methods: It was prospective observational study carried out from January 2015 to July 2016. Study population was all Obstetrics patients referred to Department of Obstetrics and Gynecology of Kamla Raja Hospital, G.R. Medical College, Gwalior, Madhya Pradesh, a tertiary care centre during the study period.Results: The total number of referred cases in above study period was 4085.The proportion of referred cases in the tertiary care hospital was 20.86%. Mode of transport used by the referred patients were hospital ambulances (38%) and private vehicles (62%). Most common diagnosis at the time of referral was anaemia (27.8%). Out of the total referred cases, 48% had vaginal delivery (either spontaneous or induced), 28% had caesarean section and 24% were managed conservatively. Hypertensive disorders (25.4%) constitutes the leading cause of maternal deaths amongst the referred cases.Conclusions: Peripheral health care system needs to be strengthened and practice of early referral needs to be implemented for better maternal outcome

Evaluation of cerebral venous thrombosis by computed tomography/MRI and magnetic resonance venography in pregnant and postpartum women: a prospective study

Background: Diagnosis of Cerebral venous thrombosis (CVT) is challenging as it is an uncommon cause of stroke with varied clinical presentations, predisposing factors, imaging findings, and outcomes. Prompt and accurate diagnosis is important for timely intervention in order to reverse and significantly reduce the acute and long-term sequel. Aims and objectives was to study cerebral venous thrombosis in pregnant and post-partum women.Methods: Hundred pregnant and postpartum women having CVT were studied at Kamla Raja Hospital and JA Group of Hospital at GR Medical College, Gwalior Madhya Pradesh for study period of 2016 to 2017. All the women had undergone CT/MRI and MRV.Results: Age of CVT patients ranged from 18-35 years with a maximum incidence (84%) in the 2nd decade (20-30 years). Sixty two percent women had infarction; out of that 53% had hemorrhagic infarction. Frontal lobe (10%) and temporal lobe (10%) were more affected. Superior sagittal sinus (SSS) was most commonly involved (71%) followed by transverse sinus (66%) and sigmoid sinus (45%). Superficial venous system was involved in 32 patients while deep venous system was involved in 20 patients. Majority of (82%) patients had combination of sinuses and venous involvement.Conclusions: CVT was more prevalent in young pregnant and postpartum women. Hemorrhagic infarction were common and affecting frontal and temporal lobe. SSS were mostly affected in CVT. MRV should be the first line diagnostic tool for diagnosis of CVT in pregnant and postpartum women