Cervical cancer is a cause of significant disease worldwide. Human papillomavirus (HPV) infection is the cause of cervical cancer in almost 100% cases. HPV infection can also lead to genital warts, recurrent respiratory papillomatosis, vaginal, vulval, anal and penile cancers. HPV types 16 and 18 are responsible for more than 70% of HPV-related cancers whilst HPV types 6 and 11 cause approximately 90% of the cases of genital warts. Effective interventions to prevent HPV associated diseases can therefore prevent cervical cancers and genital warts.
Primary prevention of cervical cancer can be achieved by vaccination and secondary prevention by screening. Currently screening options of secondary prevention include visual inspection with acetic acid (VIA), cervical cytology and detection of high risk HPV-DNA viruses. Prophylactic HPV vaccines have been developed recently which will reduce the burden of HPV-related diseases in the community. For this primary preventive measure, two vaccines are available worldwide: quadrivalent HPV vaccine targeting HPV types -16, 18, 6 and 11 and a bivalent vaccine against HPV types 16 and 18. Clinical trials have shown that these vaccinations are safe, immunogenic and highly effective against type- specific HPV infections.
Objectives: To compare absorbable synthetic sutures with chromic catgut sutures for episiotomy repair with respect to pain analgesic requirement, nature of wound healing, and removal of residual suture material.
Methods: The study was conducted in a tertiary care hospital for Southern Railway patients. It is a prospective, comparative study between polyglactin 910 rapide 2-0 versus polyglactin 910 1-0 versus chromic catgut 1-0. For the present study, a total of 150 patients were selected. The patients were divided into 3 groups according to their turn. Outcome studies were pain assessment by visual analogue scale (VAS) in lying, walking and sitting postures, analgesic requirement, nature of wound healing, and removal of residual suture material.
Results: Compared with chromic catgut, and polyglactin 910, polyglactin 910 rapide group is associated with less pain in walking and sitting postures, and there was less need for analgesics (P<0.05). Removal of residual suture material was more common in polyglactin 910 (28%).
Conclusions: Polyglactin 910 rapide is the better suture material than polyglactin 910 and chromic catgut for episiotomy repair in pain perception resulting in less analgesic requirement in postpartum period.
Objectives: To determine the perinatal outcome in pregnancy with sickle cell anemia.
Methods: This is a comparative case control study, for which 1412 of pregnant women were chosen from ANC OPD obstetric ward and labor room. All of them were screened for sickle cell anemia, as the prevalence rate in this part of Orissa is 8% of the pregnant women, 112 women were found to be positive for either sickle cell disease or trait, confirmed by electrophoresis. Equal number of controls were randomly recruited in the study and matched for age, gravidity and other demographic factors. Perinatal outcome as regards birth weight, Apgar score, NICU admission and perinatal loss was compared in both the groups. Wherever applicable, chi- square test was applied.
Results: The overall incidence of sickle cell anemia was 7.93%. Out of 112, sickle cell disease (SS) was found in 25 cases (22.32%) and sickle cell trait (AS) in 87 cases (77.67%). Prematurity was detected in 44% of (SS), 26.42% of (AS) and 17.8% in control group. Low birth weight babies born to SS, AS and controls were 56%, 34.48%, and 23.21% respectively. Perinatal mortality was 20% in (SS), 8.04% in (AS) and 6.25% in controls.
Conclusions: The incidence of preterm deliveries, perinatal mortality and low birth weight babies are significantly high in women with sickle cell disease compared to controls. However the perinatal outcome in mothers with sickle cell trait is better as compared to sickle cell disease.
Objectives: To study the indications and maternal outcome of emergency cesarean hysterectomy.
Methods: A retrospective study of 30 emergency obstetric hysterectomies performed over a period of 5 years from January 1999 to December 2003 was carried.
Results: There were 30 cesarean hysterectomies amongst the 9526 deliveries over the 5 year study period giving an incidence of 0.31%. Seventy percent (21/30) were in the age group of 26 to 35 years, 56.6% (17/30) belonged to poor socioeconomic status and 40% (12/30) were booked cases who had pregnancy complications like placenta previa and uterine fibroids. Sixty percent (18/30) had reported with rupture uterus which was the commonest indication for peripartum hysterectomy. There was 10% maternal mortality and 100% perinatal mortality in rupture uterus cases.
Conclusions: Peripartum hysterectomy is potentially a life saving procedure and often puts the obstetrician in a dilemma at the time of decision making.
Objectives: To study the incidence of and type of surgical difficulties encountered in repeat cesarean sections.
Methods: An observational prospective study of cases of repeat cesarean sections in a district hospital setup catering services to rural low- mid socioeconomic group. The case histories and intra-operative findings of all cases of repeat cesarean sections over a period of 14 months were analyzed to know the difficulties that might be because of previous cesarean surgery.
Results: Out of the 1240 cesareans that were done during the study period 287 (23.14%) were repeat sections, abdominal wall cicatrisation (24.39%) and some degree of adhesions between various intra-peritoneal structures (25.43%) were the chief causes of intra- operative difficulties. This resulted into inaccessibility of lower uterine segment in 4.53% cases, bladder injury in two cases (0.69%), extensive ventrofixation of uterus causing direct entry into uterine cavity without clearly defining peritoneal cavity occurred in 1.74% cases. In 5.92% cases take over of surgical procedure by senior obstetrician was necessary.
Conclusion: Parietal wall and intra-peritoneal adhesions make repeat cesarean section a difficult procedure. It is prudent to involve a senior experienced obstetrician in the surgical procedure of repeat cesarean section.
Objectives: To evaluate the risk factors associated with vaginal discharge and the predictive value of cytologic smears and cultures in its clinical diagnosis.
Methods: This is an observational study. One hundred fifty consecutive women presenting for the first time to the Gynecology outpatient clinic of a Medical College hospital with complaints of vaginal discharge, lower abdominal pain and genital warts or ulcers were enrolled over a period of 4 months. Specimens were collected for laboratory investigation to aid in the etiological diagnosis of vaginal discharge. A risk factor assessment was performed.
Results: Univariate analysis of selected risk factors with three vaginal infections did not show any significant association between sociodemographic indicators and the occurrence of infection. Bacterial vaginosis (BV) was the most common pathogen associated with HIV seropositivity. Using greenish yellow frothy discharge and strawberry vagina as a clinical sign for the diagnosis of trichomoniasis, the sensitivity of detection was 68.8% with PPV and NPV exceeding 90%. When curdy white discharge was used as a clinical sign for candidiasis, the sensitivity was 61.9% and specificity 99.1%.
Conclusions: Syndromic management of vaginal discharge based on appearance and characteristics is likely to be more accurate in case of greenish yellow frothy and curdy white discharge as compared to homogeneous white discharge.
Objectives: To find out the prevalence of the suggestive symptoms of reproductive tract infections (RTI) and the relation of these symptoms with the different socio-demographic variables, reproductive characteristics, use of intrauterine devices (IUDs) and other contraceptives among the study population.
Methods: Two hundred and ten married women in the reproductive age group residing in a slum of Kolkata were interviewed. Data obtained was collated and analyzed statistically by proportions and tests of significance (chi-square test and Z-test). Results: Out of the total 210 women surveyed, 43.3% had symptoms suggestive of RTI. All of them had abnormal vaginal discharge. Among socio-demographic variables, statistically significant maximum prevalence was observed among the Muslims, illiterates and housewives. Among oral pill users, 65.38% and among condom users, 18.6% had abnormal vaginal discharge.
Conclusions: Prevalence of the suggestive symptoms of RTI was found to be quite high in the slum community. Therefore, it is necessary to increase awareness regarding the symptoms and complications of RTI/STI among women.
