Gynecological Morbidity Research Articles

Disease Pattern of Out-Patient Department Visits in The Department of Obstetrics and Gynecology at A Tertiary Care Hospital

Background: Department of obstetrics and gynecology is one of the busiest departments amongst hospital visits. The aim of this study was to determine the disease pattern prevailing in out-patients of department of obstetrics and gynecology and their segregation with respect to infectious and non-infectious etiology.
 Methods: This hospital based cross-sectional study was conducted in outpatients attending obstetrics and gynecology department of Kathmandu National Medical College, Kathmandu, Nepal from 17th August 2017 to 16th August 2018. A sum of 1504 patients attending the department was enrolled in the study which included cross referrals for out-patient consultations as well. Diagnosis was based on history, examination and/or investigations (urine, cervical discharge, blood and/or ultrasonography- abdomen and pelvis).
 Results: More than half (n=803, 53.4%) out-patient department consultation was observed in age group of 20-30years with mean age of 24years. Noninfectious etiology accounted for most out-patient visits (n=1016, 67.6%). The top five out-patient department visits noted were vaginal discharge syndrome (n=325, 21.6%) followed by abnormal uterine bleeding (n=202, 13.4%), ante-natal visits (n=147, 9.8%), non-specific pain lower abdomen/backache (n=108, 7.2%) and urinary tract infection (n=98, 6.5%). Among the total 82 cross-referrals, the order for referral was Medicine (n=34, 41.5%), Dermatology (n=22, 26.8%), Pediatrics (n=12 14.6%), Surgery (n=8, 9.8%) followed by Dental (n=6, 7.3%).
 Conclusions: The patterns of gynecological problems observed were vaginal discharge followed by abnormal uterine bleeding, non-specific pain lower abdomen/backache and urinary tract infection in descending order. The most common infectious problem being vaginal discharge and non-infectious being abnormal uterine bleeding. The result of this study will be helpful for health planners and policy makers for launching programs to reduce gynecological morbidity and improve overall women’s health.

A prospective ultrasound study of cigarette smoking and uterine leiomyomata incidence and growth

Uterine leiomyomata (fibroids) are common, benign neoplasms that contribute substantially to gynecologic morbidity. Some existing epidemiologic studies indicate that cigarette smoking is associated with lower uterine leiomyomata risk. However, no prospective studies have systematically screened an entire study population for uterine leiomyomata using transvaginal ultrasound or evaluated the association between cigarette smoking and uterine leiomyomata growth. This study aimed to examine the association between cigarette smoking and uterine leiomyomata incidence and growth in a prospective ultrasound study. We enrolled 1693 residents from the Detroit metropolitan area into the Study of Environment, Lifestyle, and Fibroids during 2010 to 2012. Eligible participants were aged 23 to 34 years, had an intact uterus but no previous diagnosis of uterine leiomyomata, and self-identified as Black or African American. We invited participants to complete a baseline visit and 4 follow-up visits over approximately 10 years. At each visit, we used transvaginal ultrasound to assess uterine leiomyomata incidence and growth. Participants provided extensive self-reported data throughout follow-up including exposures to active and passive cigarette smoking in adulthood. We excluded participants who did not return for any follow-up visits (n=76; 4%). We fit Cox proportional hazards regression models to estimate hazard ratios and 95% confidence intervals for the association between time-varying smoking history and incidence rates of uterine leiomyomata. We fit linear mixed models to estimate the percentage difference and 95% confidence intervals for the association between smoking history and uterine leiomyomata growth. We adjusted for sociodemographic, lifestyle, and reproductive factors. We interpreted our results based on magnitude and precision rather than binary significance testing. Among 1252 participants without ultrasound evidence of uterine leiomyomata at baseline, uterine leiomyomata were detected in 394 participants (31%) during follow-up. Current cigarette smoking was associated with a lower uterine leiomyomata incidence rate (hazard ratio, 0.67; 95% confidence interval, 0.49-0.92). Associations were stronger among participants who had smoked for longer durations (≥15 years vs never: hazard ratio, 0.49; 95% confidence interval, 0.25-0.95). The hazard ratio for former smokers was 0.78 (95% confidence interval, 0.50-1.20). Among never smokers, the hazard ratio for current passive smoke exposure was 0.84 (95% confidence interval, 0.65-1.07). Uterine leiomyomata growth was not appreciably associated with current (percent difference,-3%; 95% confidence interval,-13% to 8%) or former (percent difference,-9%; 95% confidence interval,-22% to 6%) smoking. We provide evidence from a prospective ultrasound study that cigarette smoking is associated with lower uterine leiomyomata incidence.

Gynecological morbidity and treatment-seeking among older adult (aged 45–59) women in India

BackgroundWomen’s gynecological health needs are not limited to the reproductive years of their life. Women are at risk of hormonal changes, gynecological malignancies, and various genitourinary conditions as they move toward menopause and beyond. Concerns about older women’s sexual and reproductive health and rights (SRHR) continue to be taboo in many countries, of little interest to researchers and professionals in the field of healthcare, and a “blind spot” in discussions about policy as a whole. Despite the widespread agreement, the life course approach to addressing SRHR concerns has received minimal attention. The study estimates the prevalence, assesses the correlates, and treatment-seeking of gynecological morbidity (GM) among older adult women aged 45–59 years (N = 18,547) in India.MethodThe analysis was based on the nationally representative Longitudinal Ageing Study (2016–2017) data that adopted a multistage stratified area probability cluster sampling to select respondents. The outcome variables used in this analysis were ‘had any GM’ and ‘sought treatment for any GM.’ Women with any morbidity such as per vaginal bleeding, foul-smelling vaginal discharge, uterus prolapses, mood swings/irritability, fibroid/cyst, and dry vagina causing painful intercourse were considered to have any GM. Of the respondents with GM, who sought a doctor’s consultation or treatment were considered ‘sought treatment for any GM.’ Binary logistic regression was conducted to examine the adjusted effect of socioeconomic and demographic predictors of GM and treatment-seeking. Stata (V 16) was used for statistical analyses with a 5% significance level.ResultsFifteen percent of the women had any GM, and only 41% of them sought treatment. Age, marital status, education, number of pregnancies, hysterectomy, involvement in household decision-making, social group, religion, wealth status, and region were significantly associated with GM. The odds of treatment-seeking were higher among women with 10+ years of schooling (OR 1.66, CI 1.23, 2.23), with hysterectomy (OR 7.36, CI 5.92, 9.14), with five-plus pregnancies (OR 1.25, CI 0.96, 1.64), and those from the richest (OR 1.91, CI 1.40, 2.60) households than their respective counterparts.ConclusionMany older adult women experience GM, and treatment-seeking is inadequate. The GM prevalence and treatment-seeking vary considerably by socioeconomic and demographic characteristics. Results suggest community-level awareness generation and the inclusion of this otherwise ignored group in programs targeting better health and wellbeing of women.

Diabetes and anti-diabetic interventions and the risk of gynaecological and obstetric morbidity: an umbrella review of the literature

BackgroundDiabetes has reached epidemic proportions in recent years with serious health ramifications. The aim of this study was to evaluate the strength and validity of associations between diabetes and anti-diabetic interventions and the risk of any type of gynaecological or obstetric conditions.MethodsDesign: Umbrella review of systematic reviews and meta-analyses.Data sources: PubMed, Medline, Embase, Cochrane Database of Systematic Reviews, manual screening of references.Eligibility criteria: Systematic reviews and meta-analyses of observational and interventional studies investigating the relationship between diabetes and anti-diabetic interventions with gynaecological or obstetric outcomes. Meta-analyses that did not include complete data from individual studies, such as relative risk, 95% confidence intervals, number of cases/controls, or total population were excluded.Data analysis: The evidence from meta-analyses of observational studies was graded as strong, highly suggestive, suggestive or weak according to criteria comprising the random effects estimate of meta-analyses and their largest study, the number of cases, 95% prediction intervals, I2 heterogeneity index between studies, excess significance bias, small study effect and sensitivity analysis using credibility ceilings. Interventional meta-analyses of randomised controlled trials were assessed separately based on the statistical significance of reported associations, the risk of bias and quality of evidence (GRADE) of included meta-analyses.ResultsA total of 117 meta-analyses of observational cohort studies and 200 meta-analyses of randomised clinical trials that evaluated 317 outcomes were included. Strong or highly suggestive evidence only supported a positive association between gestational diabetes and caesarean section, large for gestational age babies, major congenital malformations and heart defects and an inverse relationship between metformin use and ovarian cancer incidence. Only a fifth of the randomised controlled trials investigating the effect of anti-diabetic interventions on women’s health reached statistical significance and highlighted metformin as a more effective agent than insulin on risk reduction of adverse obstetric outcomes in both gestational and pre-gestational diabetes.ConclusionsGestational diabetes appears to be strongly associated with a high risk of caesarean section and large for gestational age babies. Weaker associations were demonstrated between diabetes and anti-diabetic interventions with other obstetric and gynaecological outcomes.Trial registrationOpen Science Framework (OSF) (Registration https://doi.org/10.17605/OSF.IO/9G6AB).

Аналитический обзор состояния репродуктивного здоровья девочек и девушек Московской области. Анализ работы

Introduction. The protection of the reproductive health of the younger generation is one of the most significant problems due to the steady growth of various gynecological diseases, including those that are asymptomatic, which has a significant impact on the reproductive potential of the young population. Purpose to reveal the prevalence of gynecological pathologies among girls in the Moscow region. Material and methods. We have analyzed the main gynecologic diseases among patients aged 0–17 years according to the results of preventive examinations and data of visits to the pediatric gynecologist in the outpatient clinic for the year 2021. Results. Recent analytical data on the prevalence of gynecological morbidity of girls and young women in Moscow region showed that in children aged 0–4 years and 5–9 years, inflammatory diseases of the vulva and vagina (vulvitis) and labia minora adhesions predominate. In patients aged 10–14 years gynecological pathology is represented by various menstrual cycle disorders, dysmenorrhea, inflammatory diseases of the vulva and vagina (vulvitis), non-inflammatory ovarian diseases (follicular cysts and cysts of the yellow body of the ovary) and also mammary gland diseases. The predominant gynecological pathology in girls aged 15–17 is inflammatory diseases of the vulva and vagina, menstrual disorders, non-inflammatory ovarian diseases (follicular cysts, cysts of the corpus luteum), fallopian tubes and the vagina, breast diseases, and sexually transmitted infections are also frequent. Conclusion. We can talk about the general trends in the prevalence of gynecological morbidity among girls and young women in Moscow region and in the whole territory of the Russian Federation. Following the order of the Russian Ministry of Health of 20.10.2020 № 1130n «On approval of the Order of medical care in the profile „obstetrics and gynecology“», we can achieve a reduction in gynecological morbidity among girls and young girls in the Moscow region by improving specialized gynecological care

Репродуктивное здоровье девочек и девушек Москвы. Развитие специализированной помощи

Due to a steady trend towards an increase in the incidence of various gynecological diseases, one of the most significant problems of modern society is the protection of the reproductive health of girls and adolescents. Diseases that are asymptomatic or with an erased clinical presentation but have a significant impact on the reproductive potential of the young population deserve close attention. Purpose. To reveal the prevalence of gynecological diseases among the female population of the neutral, prepubertal and pubertal period in Moscow and to determinate ways to reduce incidence of preventable diseases. Material and methods. An analysis of the data on gynecological morbidity of girls and adolescents in Moscow is presented based on the data of the annual report of the chief freelance specialist gynecologist of childhood and adolescence in Moscow in 2021 (n = 925 632). According to the report, the prevalence of gynecological pathologies during examinations in 2021 is (n = 82 517): delayed puberty (n = 182), premature thelarche (n = 779), menstrual disorders (n = 11 748), other endocrine disorders (n = 15), premenstrual tension syndrome (n = 353), dysmenorrhea (n = 5265), inflammatory diseases of vulva and vagina (n = 18 796), ovarian cysts (n = 2384), labial adhesion (labia minora) (n = 6261), disorders of breast (n = 1136), anogenital warts (n = 26), congenital disorders of female genital organs (n = 71), unspecified injury of external genitals (n = 223), sexual transmitted diseases (n = 39), Turner’s syndrome (n = 21), unspecified malignant primary neoplasms (n = 5). Results. An analysis of the prevalence of gynecological diseases in girls and adolescents in Moscow in 2021 (n = 925 632) has revealed that the highest incidence among all diseases of the reproductive system (n = 82 517) is: inflammatory diseases of the external and internal genital organs – 23% (n = 18 796), as well as menstrual disorders – 14% (n = 11 748), including dysmenorrhea – 6% (n = 5265), and labial adhesions – 8% (n = 6261). Reducing the incidence of gynecological diseases among girls and adolescents in Moscow can be achieved through regular full well-child examinations and improving the quality of specialized gynecological care. Conclusion. Providing regular preventive physical examinations and educational activities among adolescents and parents is one of the ways to timely detect various diseases of the reproductive system. The incidence of gynecological diseases among this age group can also be significantly reduced by increasing the coverage of the population with medical care and improving the quality of its provision

Магнито-ИК-свето-лазер и озон в профилактике осложнений после медицинского аборта

Artificial abortion is one of the leading causes of gynecological morbidity, infertility, negatively affects the course of subsequent pregnancy and childbirth. 124 patients were examined and treated after abortion (average age 34.8±1.7 years). The examined were divided into 3 groups. 52 (42.0%) women were assigned to the main group I, for whom antibiotics with magneto-IR light laser and ozone were used for prophylaxis. The main group II included 24 (19.3%) patients who received magneto-IR light-laser and ozone therapy, without antibiotics. The control subgroup consisted of 48 (38.7%) patients without prevention of complications. During bacterioscopy, the number of leukocytes above 30 in the field of vision was detected in 28 (53.9%) of the main group I, 13 (54.1%) of II and 25 (52.0%) of the control group. Gram-positive and gram-negative rods were detected in 9 (17.3%), 4 (16.7%) and 8 (16.7%); coccal flora in 12 (23.0%), 6 (25.0%) and 11 (23.0%), respectively. Mycelium and spores of Candida albicans fungus were isolated in 10 (19.2%) patients of the main group I, 5 (20.9%) II and 9 (18.8%) of the control group; "key" cells – in 6 (11.5%), 3 (12.5%) and 5 (10.4%), respectively. Gonococci and trichomonas were not detected. With the method "Femoflor 16" Lactobacillus spp. It was found in about half of the examined patients, after treatment it increased in all groups (96.1%, 91.7% and 85.4%, respectively). Facultative anaerobic organisms were identified in the main group I: Enterobacteriaceae spp. in 17.3% of observations; Streptococcus spp. in 7,7%; Staphylococcus spp. in 7.7%; main group II Enterobacteriaceae spp. in 16.7%; Streptococcus spp. in 8.3%; Staphylococcus spp. in 4.1%. The frequency of microorganisms in the control group was 16.7%, 8.3% and 8.3%, respectively. After treatment, the number of microorganisms was reduced by 2–3 times. Among obligate-anaerobic microorganisms, associations were found: Gardnerella vaginalis + Prevotella bivia + Porphyromonas spp. in 13.4%, 12.5% and 14.5%. After treatment, the frequency of their detection decreased by 2–3 times – to 3.9%, 4.1% and 6.2%, respectively.

Contribution of the uterine cavity microbiota to the development of pathological endometrial processes

Introduction. In the structure of gynecological morbidity intrauterine pathology occupies a leading position because of its high frequency and negative impact on the reproductive health of a woman. Endometrial pathology is numerous and includes endometrial hyperplasia and polyps, endometrial cancer, abnormal uterine bleeding and dysmenorrhea, endometriosis and Asherman's syndrome. Pathological changes of the endometrium in women with reproductive problems, such as infertility, habitual miscarriage, are particularly relevant.The aim of the work is to estimate the contribution of endometrial microbiota in the development of endometrial pathological processes and identify possible pathogens for the development of this process on the basis of scientific literature data.Materials and methods. Data analysis and systematization were performed on the basis of scientific publications in the PubMed, Google scholar, and Scopus databases for the period 2010–2021. For the final scientific review 65 sources were selected.Results and discussion. This article presents findings on the role of the uterine cavity microbiota and its contribution to endometrial pathology such as endometrial polyps and hyperplasia, adenomyosis and uterine bleeding, infertility and intrauterine synechiae. The correction of an altered microbiota opens up new insights into the development of uterine diseases and new therapeutic options.Conclusion. Numerous studies of the uterine cavity microbiota show its undoubted role in the development of uterine cavity pathology. However, the data obtained are quite contradictory. Further study of the uterine microbiota is necessary for a deeper understanding of the pathogenesis of endometrial pathological processes.

НЕОБХОДИМОСТЬ СОЗДАНИЯ ИНДИВИДУАЛЬНОГО ПРОГНОСТИЧЕСКОГО КРИТЕРИЯ ОЦЕНКИ СОСТОЯНИЯ ЗДОРОВЬЯ БЕРЕМЕННОЙ

Due to the clear depopulation trends in the country, the problem of protecting the health of mother and child, preserving the reproductive potential has become extremely acute. The current situation causes reasonable concern of the state and the medical community for the quality of health of future generations. The increase in extragenital and gynecological morbidity, the negative nuances of the reproductive behavior of adolescent girls and women creates a real threat to the successful implementation of their reproductive function and replenishment of the country's demographic reserve in the near future.The real improvement in statistics was due to the rationalization of the prevention of full-term pregnancy. The purpose of the study: to improve the outcomes of gestation for the mother and fetus based on the creation of an individual prognostic criterion for assessing the state of health. Results and discussion. In order to determine the effectiveness of the proposed set of measures to reduce the risk of adverse pregnancy outcomes, a prospective study was conducted in the "organizational modeling" group in 174 pregnant women. In order to determine the predictors of gestational complications in the process of a comprehensive examination of patients during pregnancy registration, it was found that the predictive factors for the development of pregnancy complications that subsequently affect the realization of reproductive potential are: menstrual dysfunction, somatic and gynecological pathology, previously transferred infectious diseases, as well as neuro-metabolic-endocrine diseases. The main methodological principle of the stage-by-stage monitoring of pregnancy management is the inseparable unity of the implementation of all points, control of the full scope of a single strategy and evaluation of the result obtained. The specified components of the methodology are mandatory. Conclusions: the informational significance of evaluative and prognostic predictors (calculation of pregnancy health indices by trimesters) determines the possibility of stratifying tactics by perinatal risk groups: exclusion of obstetric aggression at a low degree (index I), therapeutic and preventive measures at an average (index II, III) and high degree of risk (index IV, V).

Pelvic Ultrasound Imaging-Based Prevalence of Gynecological Morbidity in a Population of Asymptomatic Reproductive-Age Women Attending a Healthcare Outreach Program in the Andaman and Nicobar Islands of India.

Gynecological morbidity in the reproductive age is defined as any condition, disease, or dysfunction of the reproductive system that is not related to pregnancy, abortion, or childbirth. Common gynecological symptoms include irregular menstruation, white vaginal discharge, burning urination, itching of the vulva, inguinal swelling, and nonmenstrual bleeding or spotting and chronic pelvic pain. Masses of the reproductive tract, adnexal masses, and polycystic ovary syndrome also occur in the reproductive age group. Gynecological disease contributes to nearly 4.5% of the overall global disease burden and exceeds the prevalence of other major global diseases such as malaria, tuberculosis, ischemic heart disease, and maternal conditions. Ultrasound is a painless, noninvasive imaging modality that can be used for the detection of gynecological abnormalities. This study uses pelvic ultrasound imaging to estimate the prevalence of gynecological morbidity in a population of asymptomatic reproductive-age women attending a healthcare outreach program in the Andaman and Nicobar Islands of India.

Hysterectomy and women’s health in India: evidence from a nationally representative, cross-sectional survey of older women

BackgroundHysterectomy, particularly when conducted in women younger than 45 years, has been associated with increased risk of non-communicable diseases. In India, research indicates that hysterectomy is a common procedure for women, but there have been no studies on its long-term effects. We examined patterns of hysterectomy amongst women in India and associations with their health and well-being in later life.MethodsThis analysis utilised the first wave of the Longitudinal Study on Aging in India, a nationally representative study of adults that included a module on health and well-being.We analysed data on 35,083 women ≥45 years in India. We estimated prevalence of hysterectomy and performed multivariable logistic regression to identify associated risk factors and to examine the association between hysterectomy status and eight self-reported chronic conditions, hospitalisation and mobility.ResultsThe prevalence of hysterectomy among women >=45 years was 11.4 (95% CI: 10.3, 12.6), with higher odds among urban women (aOR: 1.39; 1.17,1.64) and higher economic status (highest compared to lowest quintile: aOR: 1.95; 1.44, 2.63). Hysterectomy history was associated with four chronic conditions: hypertension (aOR: 1.51; 95% CI: 1.28, 1.79), high cholesterol (aOR: 1.43; 1.04, 1.97), diabetes (aOR: 1.69; 1.28, 2.24), and bone/joint disease (aOR: 1.54; 1.20, 1.97) and higher odds of any hospitalisation in the past year (aOR: 1.69; 1.36, 2.09).ConclusionsIn India, evidence suggests that hysterectomy is associated with major chronic conditions. The assessment for hysterectomy as a treatment option for gynaecological morbidity should consider potential health consequences in later life.

Domestic Violence and its Associated Factors among Married Women of Varanasi

Background: Domestic violence experienced by married women with mental illness, with physical illness (obstetric and gynecological morbidity) and with no illness (normal healthy women), is a nearly universal phenomenon. Materials and Methods: The study design was cross-sectional case–control study. A total of 165 married women (group: mental illness, with physical illness and with no illness) between the ages of 16 and 45 were randomly selected. The study was conducted in the hospital, which is a tertiary care center with a huge catchment area that extends from Uttar Pradesh, to Bihar, and parts of Madhya Pradesh and Nepal. People living in this area largely come from middle, lower, and poor socioeconomic strata and have low level of literacy. Results: Perceived factors were reported exclusively by the married women with mental illness: alleged disrespect to elders, considers wife as property of husband, disability, instigated by family members, violating family norms, tradition of wife abuse in the family, unacceptable abnormal wife, unacceptable wife/daughter-in-law with mental illness, antisocial personality traits, and cannabis use dependence. Conclusions: Domestic violence (spousal) is most frequent and severe in married women with mental illness, then in married women with physical illness, and least in healthy married women. Higher husband's age and lower wife's age were predictors of domestic violence perpetrated by husbands in married healthy women.

Гиперпластические процессы эндометрия у пациенток с хронической болезнью почек: выбор тактики ведения

This article provides a literature review demonstrating modern paradigms concerning etiology, pathogenesis and management of endometrial hyperplasia processes in female patients with chronic kidney disease (CKD). Endometrial hyperplasia (EH) is a pathological process with various phenotypic cell changes and a characteristic predominance of glands over the stromal and epithelial components in the endometrium. Untimely diagnosis and treatment of EH can cause the pathology progression and the development of endometrium malignant transformation. Endometrial cancer (EC) refers to one of the most common malignant tumor forms of the female reproductive system, and EH, as a rule, is its precursor. In the gynecological morbidity structure, EH is 10 to 55%, and its incidence is steadily increasing. EH occurs as a result of excessive estrogen stimulation, when it is not compensated by the progesterone action. In addition, patients with CKD develop "immunosuppressive states" due to the use of various types of renal replacement therapy (hemodialysis, peritoneal dialysis, taking immunosuppressive drugs in patients with kidney transplant). Every year there are more and more such female patients. Over the past decade, there has been no reference in the Russian literature concerning a systematic approach to the diagnosis and treatment of EH in female patients with CKD. Considering that these were female patients of the reproductive period to a greater extent, who wanted to perform the childbearing function in the future, therefore, this problem is very relevant for the world medical community. KEYWORDS: endometrial hyperplasia, abnormal uterine bleeding, chronic kidney disease, hemodialysis, kidney transplant, peritoneal dialysis, immunosuppression. FOR CITATION: Dobrokhotova Yu.E., Lysenko M.A., Grabovsky V.M., Shevchenko N.A., Zapolskaya N.P. Endometrial hyperplasia process in female patients with chronic kidney disease: the choice of treatment tactics. Russian Journal of Woman and Child Health. 2023;6(4):380–384 (in Russ.). DOI: 10.32364/2618-8430-2023-6-4-9.

Incidence and determinants of hysterectomy among North Indian women: An 8-year follow-up study.

Despite indications of a rapid increase in the number of hysterectomies performed in India, very few studies have methodically investigated the rate and determinants of the incidence of hysterectomy. The present study aims to estimate the rate of incidence of hysterectomy and identify predictors/determinants of incident hysterectomy in a cohort of North Indian women. In the present study, a cohort of 1,009 ever-married North Indian women (aged 30-75 years) was followed up after a median of 8.11 years. Those hysterectomized at the baseline (63) were excluded; and of the rest 946 participants, 702 (74.2%) could be successfully followed-up. During the baseline assessment, data about sociodemographic variables, reproductive history, menopausal status, physiological health, and selected blood biochemicals were collected. During the end-line assessment, data about sociodemographic variables, current menopausal status, and incident hysterectomy were recorded. The overall rate of incidence of hysterectomy was found to be 11.59 per 1,000 women-years, in the study population. Interestingly, the incidence rates were found to be similar among pre- and post-menopausal women. Further, while late age at menarche was found to be negatively associated with incident hysterectomy, folate repletion and high triglyceride (TG) at the baseline were found to be positively associated. High rate of incident hysterectomy in the studied population points toward the huge burden of gynecological morbidity and the unavailability of non-invasive protocols. Such a situation warrants immediate policy intervention. Further, maintaining TG and folate within normal physiological ranges may be beneficial in gynecological ailments necessitating hysterectomy.

Attitude and Perceived Barriers Among Highly Educated Women Towards Cervical Cancer Screening by Pap Smear: An Online Survey

BackgroundCervical cancer continues to pose a heavy burden on developing countries like India. Early detection of precancerous lesions via Pap smear screening can greatly avert cervical cancer deaths. However, the uptake of cervical cancer screening is poor, and several barriers exist to adequately utilizing screening services. Knowledge of women’s attitudes in the target community is essential for successfully implementing a cervical cancer screening program.AimThis study aimed to provide insight into the attitude and perceived barriers among highly educated women and determine the association between the sociodemographic characteristics and their attitude towards screening.MethodsIt was an online descriptive study using a questionnaire conducted among highly educated women. Sociodemographic details and the perceived gynecological morbidities were enquired upon. The attitude was measured on a 5-point Likert scale, while practice was assessed by response towards ever screened. Significant barriers to not undergoing cervical cancer screening and determinants of attitude towards screening were evaluated.ResultsA total of 150 women participated, with a mean age of 36.9+9.7 years. Most (85.33%) women were apparently asymptomatic. Overall, the majority (82.67%) of participants had a favorable attitude toward cervical cancer screening, but only 5.33% of women were ever screened in the past. A major impediment to adequate practice identified was that a Pap test is ‘not required.’ In addition, the women’s age, marital status, and education were found to be significantly associated with women’s attitudes towards screening.ConclusionThe study revealed that educated women do possess a favorable attitude towards cervical cancer screening. However, a major gap is still a hindrance between women’s perception and practice. This reiterates the need for a well-designed health educational program focusing on effective information, education, and communication (IEC) strategies and strengthening the national screening program by effectively incorporating it into the health system.

ОРГАНИЗАЦИЯ МЕДИЦИНСКОЙ ПОМОЩИ ЖЕНЩИНАМ С БЕСПЛОДИЕМ ПРИ НИЗКОМ ОВАРИАЛЬНОМ РЕЗЕРВЕ

Abstract. Currently, the low efficiency of treatment of women with infertility with a low ovarian reserve (decrease in the number and quality of eggs) remains an urgent problem in practical healthcare. Every fifth married couple faces the problem of infertility, while the number of cycles of assisted reproductive technologies, both in our country and abroad, increases annually. A decrease in the ovarian reserve naturally occurs in women after 35 years, but this is not only a problem of late reproductive age, in young women it occurs after inflammatory diseases of the ovaries; transferred operations on the ovaries for cysts, endometriosis; intoxications of various etiologies. The study is devoted to the development and evaluation of the effectiveness of the program of medical and organizational measures for women with infertility and low ovarian reserve, when using assisted reproductive technologies. The following methods were used: analytical, sociological, statistical, organizational experiment. The object of the study is the organization of medical care for women with infertility who have a low ovarian reserve. The subject of the study is the indicators of gynecological morbidity, medical activity of women with infertility and low ovarian reserve; the effectiveness of the use of specialized medical care using assisted reproductive technologies for this group of patients. The main group included 150 women (age 37,3 + 0,23 years), 120 women - the comparison group (age 37,4 + 0,35 years). Results: a program of medical and organizational measures was developed for women suffering from infertility and having a low ovarian reserve, which can significantly increase the effectiveness of infertility treatment by 2.6 times, recommended for implementation.

Biomarkers for Early Diagnosis of Ovarian Carcinoma.

The leading cause of gynecological cancer-related morbidity and mortality is ovarian cancer (OC), which is dubbed a silent killer. Currently, OC is a target of intense biomarker research, because it is often not discovered until the disease is advanced. The goal of OC research is to develop effective tests using biomarkers that can detect the disease at the earliest stages, which would eventually decrease the mortality, thereby preventing recurrence. Therefore, there is a pressing need to revisit the existing biomarkers to recognize the potential biomarkers that can lead to efficient predictors for the OC diagnosis. This Perspective covers an update on the currently available biomarkers used in the triaging of OC to gain certain insights into the potential role of these biomarkers and their estimation that are crucial to the understanding of neoplasm progression, diagnostics, and therapy.

Patients’ Perspectives on Clinical Responses to Primary Dysmenorrhea: A Qualitative Analysis of Online Narratives

Primary dysmenorrhea (PD) is a leading cause of gynecological morbidity, but it is often accepted as a normal part of menstruation, and few women report PD or seek medical care. Using modified grounded theory, we examined the accounts of patients with PD via online narratives. Uncertainty and isolation emerged as extra-medical dimensions that worsened the experience of PD. Clinical encounters in which patients felt that their pain was dismissed or clinicians did not know much about PD may inadvertently exacerbate the experience of challenging menses. We found that people experiencing PD have an unmet need for social and emotional support and that clinicians have an opportunity to address the social dimensions of PD.

COVID-19 in patients with gynecologic cancer: A preliminary report from the COVID-19 and Cancer Consortium (CCC19).

5508 Background: Limited information exists regarding the severity of short-term outcomes among patients with gynecologic cancer who are infected with SARS-CoV-2. Methods: Patients with gynecologic cancer and laboratory confirmed SARS-CoV-2 infection were identified from the international CCC19 registry. We estimated odds ratios (OR) from ordinal logistic regression for associations with severity of COVID-19 outcomes, defined from least to most severe as hospitalization, intensive care unit (ICU) admittance, mechanical ventilation, and 30-day mortality. Results: Of 842 patients identified, 48% had endometrial cancer, 24% had ovarian cancer, 22% had cervical cancer, and 6% had dual primary/other gynecologic cancers. The majority were from the United States (86%), most were non-Hispanic White (46%), and the median age was 62 years (IQR 52-72). The majority were diagnosed with localized disease (68%); only 18 (2%) and 15 (2%) were fully or partially vaccinated, respectively. In the 3 months prior to COVID-19, 36% had any cancer treatment, with chemotherapy the most common (23%). When diagnosed with COVID-19, most patients were in remission (50%), while 37% had active disease, including 22% with metastatic disease. Most patients presented with typical COVID-19 symptoms (76%); few had a poor ECOG performance status (PS ≥2, 14%). Outcomes included hospitalization (50%), ICU admittance (12%), mechanical ventilation (8%), and death within 30 days of testing positive for SARS-CoV-2 (10%). In unadjusted models, increasing age (OR: 1.03 1.02-1.04) and Black race (OR 1.91, 1.31-2.77) were associated with increased severity of COVID-19 outcomes. Compared to patients in remission for ≥5 years, those with progressive disease had increased severity (OR 1.88, 1.25-2.82), while those in remission for < 5 years or with stable disease had decreased severity of COVID-19 outcomes (OR 0.55, 0.39-0.76). In multivariable models that included adjustment for age, race, and cancer status, additional factors associated with increased COVID-19 outcome severity included cardiac (OR 1.57, 1.13-2.19) and renal (OR 2.00, 1.33-3.00) comorbidities, an ECOG PS ≥2 (OR 5.15, 3.21-8.27), having pneumonia or pneumonitis (OR 4.08, 2.94-5.66), venous thromboembolism (OR 4.67, 2.49-8.75), sepsis (OR 14.2, 9.05-22.1), or a co-infection within ±2 weeks of SARS-CoV-2 (OR: 4.40, 2.91-6.65); asymptomatic SARS-CoV-2 infection was associated with decreased severity of outcomes (OR: 0.25, 0.16-0.38). The overall case fatality rate was 15.7%. Conclusions: Patients with gynecologic cancer experience significant morbidity and mortality related to infection with SARS-CoV-2. Age, race, cancer status, co-morbidities, and COVID-19 complications were associated with more severe COVID-19 outcomes, along the continuum from least to most, of hospitalization, ICU admittance, mechanical ventilation, and 30-day mortality.

Influence of Female Genital Mutilation/Cutting on Health Morbidity, Health Service Utilization and Satisfaction with Care among Somali Women and Teenage Girls in the United States

IntroductionThere is scant evidence on the health morbidities experienced by Somali women and girls affected by female genital mutilation/cutting (FGM/C) and their resultant health-seeking behavior in the USA as compared to those who have not undergone the procedure. To fill this gap, we conducted a comprehensive examination of health morbidity among women and teenage girls with and without FGM/C in a Somali migrant community.MethodsUsing a comprehensive community-based participatory research approach, a cross-sectional survey was administered to 879 Somali women and teenage girls in Phoenix and Tucson, Arizona. We employed Chi-square and analysis of variance to disentangle health and healthcare use among those with and without FGM/C.ResultsThe majority of respondents had undergone FGM/C (79%). Respondents with FGM/C experienced significantly more health concerns compared to uncut women and girls, with those possessing Type III FGM/C experiencing significantly more obstetric, gynecologic, sexual, and mental health morbidity than those with Type I or Type II. Rates of service use, while varied, were low overall, particularly for mental health services, even with health insurance. The majority of respondents who sought care indicated that their concerns were resolved, and they were satisfied with the healthcare received.ConclusionsCommunity-engaged strategies that build upon satisfaction with care of women who seek care to enhance trust, nurture community embeddedness and facilitate peer navigation, while equipping health and social service providers with the competency and tools to provide respectful, trauma-informed care, will be critical to advance health equity for FGM/C-affected communities.