Abstract

Fertility preservation is one of the major concerns of young patients diagnosed with gynecological cancer. With newer treatment regimens and better surgical techniques, survival rates after cancer treatment have improved, hence preservation of fertility has recently become an important issue in the treatment of gynecological cancers. Fertility sparing surgery may be an option for early-stage cervical cancer with the development of loop excision techniques and radical trachelectomy which allows a radical approach to cervix cancer at the same time preserving the uterus and thus fertility. Fertility preservation is possible in Stage 1 epithelial ovarian cancers, germ cell ovarian tumors, and borderline cancers. Hormonal therapy with progestin agents is effective in early endometrial cancer. In patients desiring future pregnancy, fertility sparing options must be explored before starting treatment for gynecologic cancers.

Abstract

Objectives: To compare the cesarean delivery rates over the last decade and to examine the indications contributing to changed trends, if any.

Methods: To compare the rate and indications of cesarean delivery over the last decade, the data were collected in a retrospective manner from all the deliveries that occurred between January 1 and December 31 in 2001, 2006, and 2011, in the department of obstetrics and gynecology, Seth G.S. Medical College and K.E.M. Hospital, a large tertiary care municipal hospital in Western India. A cohort of 20853 delivered women was studied. The rates and indications of primary and repeat cesarean sections were analyzed among the live births to estimate the relative contribution of each indication to the overall increase in rate.

Results: The cesarean delivery rate increased from 171.70 to 289.30 per 1,000 live births, with an increase in primary cesarean delivery rate from 118.53 (69.03 %) in 2001 to 210.09 (72.62 %) in 2011 per 1,000 live births. Fetal distress, arrest of descent, multiple gestations, and fetal indications contributed to this increase.

Conclusions: There is a significant increase in the total cesarean rate with primary cesarean accounting for most of the increase.

Abstract

Objective: The present study aims to analyze perinatal outcomes in twins given special care during pregnancy and labor and to compare fetal and neonatal outcomes in dichorionic twins with monochorionic twins.

Study Design: Eighty eight (88) twin pregnancies booked for care at a tertiary care Fetal Medicine centre were included in this study. The maternal demographic variables, course of pregnancy, fetal problems, and specialized fetal therapeutic and diagnostic interventions were noted. The above parameters were compared in the sub-groups of dichorionic and monochorionic twin pregnancies and related to the perinatal outcome. Statistical analysis was done using the student’s t test and the two-tailed chi sqaure tests with Yate’s continuity correction. A p value \0.05 was considered as significant.

Results: Mean maternal age was 30.34 ? 4.81 years (range 19–48). 81 % of the twins were DCDA, and 19 % were MCDA. The mean gestational age at delivery was 34.4 ± 3.5 weeks, and this was not significantly different in MCDA and DCDA groups. Serious fetal problems warranting intervention at the time of initial referral were significantly higher in MCDA twins although overall perinatal outcome in both groups were not different.

Conclusion: Specialized care during pregnancy and labor including active fetal surveillance and therapeutic intervention when indicated improves the perinatal outcome in twin pregnancies and ensured at least one healthy live birth in over 90 % cases, although with an increase in late prematurity.

Abstract

Objective: Cervical cancer is the commonest cancer among Indian women. High-risk human papilloma virus (HPV) detection holds the potential to be used as a tool to identify women, at risk of subsequent development of cervical cancer. There is a pressing need to identify prevalence of asymptomatic cervical HPV infection in local population. In our study, we explored the prevalence of HPV genotypes and their distribution in women with cervical lesions.

Methods: Scrape specimens were obtained from 100 women (study group) with cervical abnormalities. HPV was detected with amplicor HPV tests, and the individual genotypes in these specimens were identified by Hybribio Genoarray test kit. Fifty specimens were also collected from females with healthy cervix (control group). The present study also aimed to determine the status of HPV prevalence and its association with different sociodemographic factors.

Results: Out of the total number of 100 samples, 10 (10 %) women tested positive for HPV DNA. Among them, HPV 18 was observed in 6, HPV 16 in 2, HPV 52 and HPV 39 in one each. Fifty specimens collected from patients with healthy cervix were not infected with any of the HPV genotype.

Conclusions: Our study generates data of HPV prevalence in patients with cervical lesions visiting tertiary care institute. The data generated will be useful for laying guidelines for mass screening of HPV detection, treatment, and prophylaxis.

Abstract

Objective: To study the incidence of septic abortion, reasons for that, sociodemographic profile, abortion providers, complications faced, and treatment given and its outcome.

Methods: All the women with septic abortion admitted at Government Maternity Hospital, Tirupathi, over a period of 2 years 4 months duration from July 2007 to October 2009 were studied prospectively.

Observations and results: Incidence of septic abortion in our study was 6.78 %. 72 % of cases were performed by qualified medical personnel. Fourteen patients had complications, among them peritonitis, pelvic abscess, renal failure, and septic shock were common. Twenty-six patients had Grade-I sepsis, Grade-II: 8, Grade-III: 4, and Grade-IV: 4. Laparotomy was done in six cases. There was no mortality in our study.

Conclusion: The tragedy of septic-induced abortion is totally preventable. It only needs definitive commitment to women’s health by providing effective contraception, strengthening the family welfare services, and discouraging repeated terminations of pregnancy as contraceptive method.

Abstract

Introduction: Cervical cancer is the most common cancer among Indian women. Only 5 % of women in developing countries have ever been screened for cervical abnormalities.

Objectives: To study the correlation of cytology and colposcopy in VIA-positive women attending the Gynaecology clinic.

Materials and Methods: This prospective cross-sectional study on 200 symptomatic women compares the role of cytology and colposcopy in the assessment of subjects testing positive for acetowhite lesions on the cervix after application of 5 % acetic acid (VIA).

Results: 200/637 women screened in OPD tested VIA positive, giving a positivity rate of 31 %. Six smears were reported as LGSIL or HGSIL giving a cytological abnormality rate of 3 %. The association between cytology and Reid’s score was statistically significant at a p value of 0.02. Of the 4 cases with biopsy-confirmed invasive cancer, cytology reported 2 as LGSIL and 2 as HGSIL. Colposcopy reported all these women as CIN 2/3.

Conclusion: The accuracies of Pap smear cytology and colposcopy in the diagnosis of precancerous and cancerous lesions of cervix were good.

Abstract

Objectives: To study the various predictors of success for vaginal birth after cesarean (VBAC) and to study the maternal and fetal outcomes in them and their comparison with control group.

Methods: This prospective observational study included 100 women with previous cesarean section in the study group and 100 primigravidas in the control group. Various predictors for success of VBAC were analyzed and maternal and fetal outcomes were compared with the control group using student t test, Pearson v2 test, and Mann–Whitney U test.

Results: Of 100 women with prior cesarean Sect. 65 had successful trial of labor, while 35 underwent a repeat cesarean section. Maternal complications in the previous CS group were 15 % as compared to only 2 % in the control group (p\0.001).

Conclusion: Maternal pre-pregnancy BMI, non-recurring indications of previous cesarean section, good Bishop’s score at the time of admission, spontaneous onset of labor, and neonatal birth weight were significantly related to high chances of success of vaginal birth after previous cesarean section. Maternal complications were more common in study group, but the fetal outcomes were similar.

Abstract

Objective: To compare the efficacy and safety profile of two methods of labor induction i.e., intracervical dinoprostone gel (0.5 mg 8 h) and misoprostol (50 lg 4 h) for induction of labor in women with a poor Bishop’s score.

Design: Observational study.

Study Period: January 1st, 2009 to December 31st, 2010.

Population: A total of 329 women with unfavorable cervices induced at or near term.

Methods: Two cervical ripening agent study armswere used: dinoprostone gel (193women) and misoprostol (137women).

Main Outcome Measures: Induction to delivery interval, cesarean section, incidence of meconium stained liquor, FHR pattern, incidence of uterine hyperstimulation, and neonatal outcomes.

Results: The induction to delivery interval was significantly shorter in the misoprostol group as compared to the dinoprostone group (p\0.001). There was no difference in cesarean section rates between the two groups (dinoprostone gel 43 %; misoprostol 33 %; p = 0.144). The incidence of non-reassuring fetal heart rate pattern, meconium stained liquor, and uterine hyperstimulation were equivalent in both the groups (p = 0.529; 0.733; and 0.321, respectively). The neonatal outcomes in both the groups were comparable in terms of Apgar scores at birth (p = 0.160) and NICU admissions (p = 0.951).

Conclusions: Labor induction in women with unfavorable cervices results in high caesarean section rates. However, the use of misoprostol significantly reduces the induction to delivery interval, without adversely affecting the caesarean section rates and neonatal outcomes. Hence it may become a cost-effective alternative to dinoprostone gel in resourcepoor settings like India.

Abstract

Purpose: Preterm labor is a leading cause of neonatal morbidity and mortality. Ascending lower genital tract infection leads to preterm labor and adverse pregnancy
outcomes. This prospective case–control study was performed to see the association between preterm labor and urogenital infections.

Methods: A total of 104 women were observed for urogenital infections and their association with preterm labor. Case Group I included 52 women with preterm labor after 26 weeks and before 37 completed weeks of gestation with or without rupture of membranes. Control Group II included 52 women at completed or more than 37 weeks of gestation with no history of preterm labor, matched to the case group with respect to age and parity. Midstream urine was sent for cytology and culture sensitivity. Samples from posterior fornix of vagina were taken with two sterilized swabs under direct vision using Cusco/Sims speculum before first vaginal examination and were studied for gram stain characteristics and culture sensitivity by standard methods. Microorganisms isolated on culture were noted, and antibiotics were given according to sensitivity. Data collected were analyzed according to the groups by v2 test for categorical variables.

Results: In our study, urogenital infection was seen in 19 women in Case Group I (36.54 %) compared with 9 women in Control Group (17.3 %), and the difference was statistically significant (p 0.027).

Conclusion: Recognizing and treating the women having urogenital infections at a stage, when it has not become clinically evident, will decrease the percentage of women going into preterm labor and will improve the perinatal outcome.

Abstract

Objective: To determine the influence of ‘‘structured contraception counseling’’ on Indian women’s selection of contraceptive methods.

Methods: Women (C18 and B40 years) requesting contraception were enrolled at 36 sites. ‘‘Structured contraception counseling’’ was provided by a health care professional on the available contraceptive methods. Questionnaires on the women’s pre- and post-counseling contraceptive choice, her perceptions, and the reasons behind her post-counseling decision were filled.

Results: Significant reductions were observed in the proportion of women who were indecisive (n = 260; 31.5 % pre-counseling vs. n = 30; 3.6 %, post-counseling [P\0.001]) and women opting for non-hormonal method (24.6 % pre-counseling vs. 6.8 % post-counseling, [P\0.001]). Of all the women counseled (n = 825), 89.6 % (739/825) of women chose a hormonal contraceptive method. There were significant difference (P\0.001) in the women’s choice of contraceptive in the pre- and post-counseling sessions, respectively (combined oral contraceptive: 30.8 vs. 40.7 %; vaginal ring: 1.8 vs. 14.1 %; progestogen only pills: 1.6 vs. 7.9 %; injectabledepot medroxyprogesterone acetate: 5.9 vs. 13.6 %; levonorgestrel- intrauterine system: 3.8 vs. 13.3 %).

Conclusions: Structured contraception counseling using standardized protocol and aids resulted in a significant increase in the selection of modern contraceptive methods. Post-counseling majority of women opted for hormonal methods with an increase in selection of pills and newer alternatives.