Indian Journal of Obstetrics and Gynecology

Background: Cervical cancer is one of the most common cancers among women Worldwide and the leading cause of cancer mortality in women in India. Objective: The objective of this study is to assess the knowledge of cancer cervix and the practice of Pap smear test among women in a rural area. Methods: The awareness and screening for cancer cervix using Papanicolaou smear test among women were studied in 526 women at 9 different health centers in a rural area near Rajahmundry from March 5th, 2021 to March 10th, 2021 with a questionnaire survey of history, assessment of knowledge about cancer cervix, attitude and practice of Pap smear testing & HPV vaccination followed by clinical examination and screening using pap smear test. Results: During the study period, a total of 526 women were surveyed, out of which screening was done in only 394 women. Most of the women belong to 30-39 years (37.2%). Distribution of the women based on socio-economic class, occupation, parity, symptoms, clinical examination, knowledge about cervical cancer, and the results of pap smear tests were also studied out of which vaginal discharge seems to be the most common symptom (15.2%), the cervical examination was normal in 91.6%, 77.3% had awareness about cancer cervix and 41.4% of participants had adequate knowledge about Pap smear test. Conclusion: Awareness about cancer cervix was adequate but the awareness & the rates of pap smear testing and HPV vaccination in this area are far lower than in urban areas due to less exposure to health care information.

Aim: To analyze the requirement of HDU in Obstetric patients having Medical disorders & Intraoperative/Intrapartum complications & Postoperative/Postpartum complications.Study Design: It is a retrospective study conducted at DY Patil hospital, Kolhapurfrom June 2020 to June 2021, in the department of Obstetrics & gynecology. Methods: All the patients having associated Medical disorders, Intraoperative complications, Postoperative complications were admitted in HDU. Interventions required in HDU, duration of stay and outcome of the patient were collected & results were analyzed. Results: Out of 1967 deliveries, 144 patients required admission in HDU. Among Obstetric causes requiring HDU, Hypertensive disorders in pregnancy is the leading cause for HDU admissions. Among Non-Obstetric causes requiring HDU, Anemia in Pregnancy is the leading cause for HDU admissions. Conclusion: Regular ANC checkups, detection of high-risk pregnancies, proper antenatal care, early referral of high-risk pregnancies, correction of modifiable causes of high-risk pregnancies (Anemia) can reduce maternal morbidity and mortality. Introduction of High dependency unit & multidisciplinary approach in managing patients has brought down the maternal mortality in the Tertiary care referral centre.

Background: Hypertensive disorder of pregnancy (HDP) entails a risk of recurrence in a subsequent pregnancy. Several risk factors have been associated with recurrence of hypertensive disorder in pregnancy. There is also evidence that the different clinical forms of HDP may be related to each other. Therefore, in HDP studies, it may be preferable to include all clinical forms of the hypertensive disorder not only in the 1st pregnancy, but also in later pregnancies. Aim: To study recurrence of Hypertensive Disorder of Pregnancy in 2nd Pregnancy with regard to the type and time of onset of hypertensive disorder in 1st pregnancy. Methodology: The study was conducted at department of obstetrics & gynecology Lalla Ded Hospital GMC Srinagar. 250 patients with history and maternity records of hypertensive disorder of pregnancy (HDP) in first pregnancy were followed on OPD basis till final outcome of second pregnancy to observe the recurrence of hypertensive disorder in second pregnancy with regard to type of hypertensive disorder and time of onset of hypertensive disorder in first pregnancy. Paired t-test & Chi-square test was used. Recurrence rate of HDP was reported as percentage along with its 95% confidence interval. Two sided p-values were reported and a p-value of <0.05 was considered statistically significant. Results: Out of 250 patients, 142 (56.8%) had gestational hypertension in 1st pregnancy with recurrence of different types of HDP of 101(71.12%) in present pregnancy. 43(17.2%) patients having preeclampsia/eclampsia in 1st pregnancy had recurrence of 25(58.13%) in present pregnancy. 55(22%) patients having Chronic hypertension in 1st pregnancy had recurrence of 49(89.09%) in present pregnancy.7(2.8%) patients diagnosed as having superimposed preeclampsia in 1st pregnancy had recurrence of 6(85.7%). Out of 3(1.2%) patients diagnosed as having HELLP syndrome in 1st pregnancy, the recurrence was 3(100%). Women who had HDP in their 1st pregnancy had a high risk of repeated HDP in the 2nd pregnancy, but not necessarily the same type. This risk was higher if the onset of hypertension in the 1st pregnancy was early (<34 weeks) of gestation and was associated independently with higher age of pregnant women (> 30 years), women belonging to urban areas and family history of HDP. Conclusion: Women who had HDP in their 1st pregnancy had a high risk of repeated HDP in the 2nd pregnancy, but not necessarily the same type. This risk was higher if the onset of hypertension in the 1st pregnancy was early (<34 weeks) of gestation and was associated independently with higher age of pregnant women (> 30 years), women belonging to urban areas, women with family history of HDP and also associated with higher cases of preterm and caesarean section deliveries.

Identification of women at high risk for preeclampsia improves pregnancy outcome, early prediction of preeclampsia prevents dreadful maternal complication thereby reduces maternal mortality & morbidity and fetal complication. A prospective study conducted in Govt. Rajaji Hospital Madurai from January 2021 – September 2021. 300 antenatal women were interrogated between 11-14 weeks of GA with uterine artery Doppler. Out of which 55.3% of High risk women were predicted as preeclampsia & 27% of low risk women were predicted as preeclampsia. These patients were treated with T.Aspirin. So that maternal & perinatal morbidity & mortality reduced.

Background: Correlation between endometrial histopathology, ultrasound findings and clinical symptoms in patient of abnormal uterine bleeding. Aim: To study the histopathology report of endometrial tissue in patients with abnormal uterine bleeding who all underwent dilatation and evacuation. Objectives: (a) To compare the histopathology report with the ultrasonography findings and clinical symptoms. (b)To categorize Patients into benign and malignant disease. Settings and design: This observational study was carried out in a tertiary health care center of Pune. Materials and method: A retrospective observational study was conducted in 30 women having abnormal uterine bleeding, who presented to the department of obstetrics and gynecology, Bharati Vidyapeeth deemed university, Pune between Jan 2021 to October 2021. Histopathology reports were traced for all the patients who underwent dilatation and curettage. The relevant clinical symptoms were noted. Patients were categorized into benign and malignant disease based on their histopathology report and ultrasonography findings. Results: In this study, 6.6% of cases were confirmed to be of endometrial carcinoma. The maximum score of 16 in ultrasound was suggestive of malignancy.

Background: Preterm birth is the multifactorial condition of the pregnancy involving the same parturition pathway as term birth but the different outcome in terms of morbidity for both mother and fetus, various pathological process has been identified and need to be evaluated further. Aim: To evaluate the aetiopathogenesis of spontaneous preterm labour by analysis of maternal risk factors and placental abnormalities. Objectives: (a) To study the prevalence of spontaneous pre term labor in tertiary care centre. (b) To identify associated maternal factors both clinical as well as pathological as the probable cause of pre term labor. (c) To examine the placenta for any gross and his to pathological abnormalities associated with spontaneous pre-term labor. Settings and design: This is the cross sectional observational study carried out in a tertiary health care centre over 2 years from October 2019 to october 2021. Materials and methods: A cross sectional observational study consist of 255 pregnant women between the 20 weeks to 36 weeks 6 days of gestation fulfilling the inclusion criteria were selected excluding the women iatrogenically induced for preterm birth. The methodology and relevance of the study were explained to the women and valid informed written consent was recorded. The ethical clearance for the study obtained from ethical review committee of the tertiary care centre. During the study duration, women presenting with preterm labor were observed till delivery whether delivered or not in our tertiary care centre and finally were included in the study. The following data were collected under the heading of age, occupation, height, weight, body mass index, parity, presenting complaints of pain in abdomen per vaginal leak, par vaginal bleed, high grade fever, headache, edema, epigastric pain, blurring of vision, palpitations vomiting, weight gain, gum bleeding breathlessness, burning micturation, increased frequency of micturation, itching over genital region, dark coloured urine also including the co-morbidites such as asthma, anemia, valvular heart disease, diabetes, thyroid disorder and preeclampsia. Detailed physical examination was done, blood pressure was measured with sphygnometer, detailed per abdominal examination done with the use of measuring tape to measure fundal height, abdominal circumference, all fungal grip were palpated, per speculum examination was done to look for per vaginum discharge, per vaginal bleeding, and the high vaginal swab was taken for further evaluation. In per vaginum examination cervical changes were seen like dilatation, effacement, length. The necessary laboratory findings were done includes complete blood count to look for haemoglobin, total leucocyte count, platelet counts, urine microscopic and culture sensitivity was done to analyse the infection. Later, after the delivery the placenta was send and histopathology examination was done. Conclusion: In our study we made an attempt to identify the risk factors and associated factors involved in spontaneous preterm labor.The study able to identify the risk factors which can be potentially used for predicting outcome.

Aim and objective: To Categories women presenting with leiomyoma with respect to: • Age • Most common symptom • Location of leiomyoma. Settings and Design: This was an observational study carried out in a tertiary health center for a period of 1 year from September 2019 to September 2020. Materials and Methods: A retrospective observational study was conducted in 35 women having pain in abdomen, abnormal uterine bleeding, who were presented to the department of obstetric and gynecology, Bharati Vidyapeeth deemed university, Pune between sept 2019 and sept 2020. All the patient presented with above mentioned symptoms were studied after obtaining consent from participant. Ultrasound was done and location of leiomyoma was studied. Fibroid were studied in terms of its, location and most common presenting symptoms and age of occurrence of symptoms. Results: In our study, themost common age group of presentation was 36-40 years (reproductive age group.) Most common type of fibroid was intramural (62.8 %) Most common symptoms was menorrhagia (57.1%). Most commonly associated with nulligravida (49.5%).

Objective: The unicornuate uterus is a rare uterine malformation which may results in complications like ectopic pregnancy, infertility, miscarriages, preterm delivery, malpresentations, intrauterine fetal demise. Case Reports: We hereby discuss five cases of unicornuate uterus with non-communicating rudimentary horn and their pregnancy outcomes in tertiary care centre over span of 2 years. All the five cases came at different gestation.Two patients were out-registered and came at term for delivery and unicornuate uterus was diagnosed intraoperatively. Other three cases were registered and had successful pregnancy outcome after proper antenatal care and monitoring. Conclusion: Though unicornuate uterus is linked with adverse pregnancy outcomes. In all these five cases we describe how proper antenatal care and monitoring has resulted in successful pregnancy outcome.

Uterine inversion is a rare case in obstetrics and gynecology field ,but the incident can be life threatening event. In the present case, a 19 year old women presented with total and acute uterine inversion after the delivery in peripheral hospital. She presented with fourth degree uterine inversion with the severe degree of hypovolemic shock with active vaginal bleeding. Immediate resuscitation along with simultaneous successful manual repositioning of uterus was done in the labour room. Medical management for atonic uterus was done. Despite of medical management uterus was atonic so uterine packing done. In view of persistent atonicity of uterus decision for emergency laporotomy were taken and patient was reffered to higher centre were she underwent subtotal hysterectomy with right internal iliac artery ligation. Postoperatively broad spectrum antibiotic and blood and blood product transfusion were done according to investigations. These findings suggest that proper management of 3rd stage of labour and early diagnosis and proper management will save the life of patient.