Gynecology OPD Research Articles

A REVIEW ON UNDERSTANDING KASHTARTAVA THROUGH DYSMENORRHOEA: AN INTEGRATED CONCEPTUAL APPROACH

Menstruation, a complex cyclic phenomenon, is an inevitable natural occurrence in women’s life and is considered as landmark of homeostatic condition of reproductive system. In Ayurvedic classics all gynecological problems are described under the broad term Yoni Vyapat. Painful menstruation is called Kashtartava. The present article explores the cause – mechanism effect of Symptom Kashtartava and it is critically reviewed under the light of modern disease Dysmenorrhea. Primary Dysmenorrhoea is considered as Kashtartava and is a common complaint seen in all gynecological OPD’s.

Evaluation of Leptin and HOMA-Adiponectin in Hypothyroid Infertile Females

Introduction:Thyroid hormones and leptin is a perfect pair that maintains homeostasis of metabolic profile and abnormality in thyroid hormone levels potentiates insulin resistant state.The intriguing relationship between obesity and hypothyroidism is related by the key element leptin leading to consequent clinical implications. The severity of insulin resistance in hypothyroid and adipocytokine levels relate to the chance of pregnancy in infertile women. Aim:To assess the Leptin, insulin resistance and HOMA-adiponectin in Hypothyroid infertile women. Settings and Design:It is an Observational Cross-sectional work conducted in women with 20 to 40 years of age. About 180 infertile females were screened at the Obstetric& Gynecology OPD. 86 married women were categorized as groups: Euthyroid (A) –included fertile women who had TSH and FT4 within normal reference range. Subclinical Hypothyroidism (B) - infertile women with raised TSH ranging from 4.6 – 20 mIU/ml and normal FT4 Overt hypothyroid (C)- includedinfertile women with elevated TSH greater than 20 mIU/ml and decreased free T4 level. Methods and Material:Measurement of adiposity indices that includes calculated parameters such as BMI, WHR, waist circumference / height ratio and body roundness index. Fasting serum sample was collected and analysed for FT3, FT4, TSH, prolactin, insulin. Using Biovendor and DRG Human kit based on ELISA; Adiponectin and Leptin levels was estimated respectively. HOMA-IR and HOMA-adiponectin were calculated. Results:Mean Leptin concentrations and HOMA-adiponectin were significantly increased (p < 0.01) in Overt hypothyroid infertile women as compared to euthyroid and subclinical hypothyroid infertile women. Leptin had significantly positive correlation with TSH, FT3/FT4 ratio whereas negatively correlated with FT4. Significant positive correlation was observed with HOMA-IR and HOMA- adiponectin in hypothyroid infertile women. Conclusions:The study concludes that in hypothyroid infertile women having high leptin levels with reduced insulin sensitivity as related with increased HOMA-adiponectin. Analysis of thyroid profile, insulin sensitivity state along with leptin is mandatory to regulate ovulatory process in infertile women.

Socio-demographic Characteristics of Women with Reproductive Tract Infection Attending a Military Hospital

Introduction: Reproductive tract infections (RTIs) are being increasingly recognized as a serious global health problem with impact on individual women and men, their families and communities. RTIs are a group of disease that cause infection of the genital tract and include both those that are sexually transmitted and those that are not. RTIs are a significant cause of morbidity and mortality in both men and women, especially in women of reproductive age.
 Objectives: To determine the socio-demographic characteristics among women with RTIs attending at gynecology outpatient department, CMH, Dhaka.
 Materials and Methods: This descriptive cross-sectional study was carried out with a view to find out the socio-demographic characteristics of women with RTIs and their common clinical presentations. The study was conducted among women of reproductive age group of Bangladesh Armed Forces attending at Gynecology OPD, CMH Dhaka, for the period of 1st march to 30th June 2011. A total of 128 women (114 married and 14 were unmarried) were interviewed with the help of structured question and checklist. Data was collected through clinical diagnostic approach made by gynecologists.
 Results: It was found that highest percentage of respondents (32.8%) were in the age group of 30-34 years, mean age at marriage was 17.79 years. The highest percentage of respondents (46.5%) was married at the age range of 16-18 years. Among the respondents, 89.1% were married and 10.9% were unmarried. The women with higher education level had lower occurrence of RTIs than women with lower education. In relation to status of spouse of married women, RTIs were significantly more among the wife of other ranks. Practice of personal hygiene during menstruation showed safe positive impact on RTIs. It was found that 50% respondents were presenting with vaginal discharge (Leucorrhoea). Most of the causes were vaginitis (38.3%).
 Conclusion: Study findings indicate that high prevalence of RTIs among women is due to the influence of less educational status, low income and also husband's educational background and employment status.
 JAFMC Bangladesh. Vol 15, No 2 (December) 2019: 218-220

Assessment of determinants of polycystic ovarian syndrome in women in reproductive age group attending tertiary healthcare facility in southern Maharashtra

Introduction: Pathophysiology of PCOS reveals excessive ovarian and/or adrenal androgen secretion results in hyperandrogenism and is associated clinical manifestations ranging from hirsutism, acne, male-pattern baldness to irregular menses, infertility. This study aims at assessing the prevalence and clinical presentations of PCOS among women of the reproductive age group attending the OPD of a tertiary care centre. Materials and Methods: The study was carried women of reproductive age group (15-45yrs) attending Obstetrics and Gynaecology OPD of a tertiary care hospital presenting with relevant symptoms from July 2015 to July 2017. Results: In the present study, the average age of participant was 22.47 + 3.44 years, we also found that menstrual abnormalities were observed among all the study participants followed by skin discolouration (32.4%). Average BMI in kg/m2 was 22.22 + 2.22. Conclusions: PCOS in a common disorder among young women. Menstrual problems are the commonest reason for gynecological OPD consultation among adolescent girls. Evaluation of bleeding problems in adolescents is justified, before considering them as normal physiological transition. Keywords: Polycystic ovarian syndrome (PCOS), Menstrual abnormalities, Hyperandrogenism in women, Reproductive age women, Infertility.

Study of serum calcidiol level in pregnancy and its association with fetal outcome

Introduction: Presently there are no guidelines for routine screening of vitamin D deficiency in antenatal women, therefore this study was planned to find the association of maternal vitamin D level with fetal outcomes. Materials and Methods: The subjects were 100 pregnant women between 12 to 24 weeks of gestation selected from Obstetrics and Gynecology OPD. In the total number of subjects, serum 25 hydroxyvitamin D [25(OH) D] level was estimated by direct ELISA method and its association with fetal outcome - birth weight, length, head circumference and knee-heel length was studied. Results and Conclusion: In the present study a significant association was found between maternal vitamin D status and neonatal birth weight but not with other birth parameter. Keywords: Maternal Vit D, Birth weight.

Non-invasive pre-natal testing vs amniocentesis and karyotyping: A David vs Goliath story

Introduction: Chromosomal anomalies constitute a potentially burdening and distressing group of illnesses which if screened/diagnosed in time can offer respite to the expectant family. Currently detection is based on a host of screening tests followed by Chorionic villous sampling or amniocentesis which are invasive procedures associated with a mild risk of pregnancy loss and have a long turnaround time. Non-invasive pre-natal testing uses sensitive and specific techniques to overcome the issue and has the potential to replace the conventional diagnostic tests. Materials and Methods: A total of 700 consecutive Ante natal cases reporting to Gynaecology OPD in two centres over a duration of two years were screened using protocols applicable as per gestational age. 39 screen positive high risk positive cases were further subjected to NIPT and CVS/amniocentesis and the detection rates compared. Results: In the primary outcome it was found that the detection rates were comparable with NIPT and conventional diagnostic tests and both showed equivocal results. Conclusion: The study suggests no significant difference in the detection rates on NIPT vs the conventional karyotype. However, the results need to be interpreted in the light of low incidence rates of chromosomal anomalies in general population. While a universal application of the test is desirable cost factor needs to be permissive for it to be beneficial in a holistic manner. Keywords: Chromosomal anomalies, Non-invasive Pre-natal testing (NIPT), Chorionic villous sampling, Amniocentesis, karyotyping, Cell free DNA, Quantitative polymerase chain reaction.

Detection of Chlamydia Trachomatis infection among symptomatic women of reproductive age group attending the gynaecology OPD in a tertiary care centre and risk factors associated with the infection

Chlamydia trachomatis infection is the most common sexually transmitted bacterial infection worldwide, affecting women more than men. Majority being asymptomatic, this infection goes unnoticed and will have a major impact on the reproductive health of women resulting in morbidity. It also increases the risk of HIV. Objective:To detect the Chlamydial infection in symptomatic women of reproductive age group and to identify the possible risk factors. Materials and Methods: An endocervical swabs were collected from 100 symptomatic patients of reproductive age group and subjected to direct fluorescent antibody test (DFA). Results: The C.trachomatis infection was 20%, with a higher positivity in the age group of 26- 30 years. The most presenting complaint was vaginal discharge. A significant past history of PID, coppet T insertion, IUD/still birth was noted. A 20% coinfection with candiadiasis was also observed. Conclusion: As the occurence of Chlamydia trachomatis was substantially high in our study, effective strategies to implement screening programmes should be initiated as a routine diagnostic test for all women of reproductive age group, thereby preventing severe sequelae by providing timely management. Keywords: Chlamydia trachomatis, Percentage, occurrence, Direct fluorescent antibody test, Risk factors

A Comparative study of the etiology of symptomatic vaginal discharge based on WHO syndromic diagnosis and microbiological diagnosis

Introduction: Vaginal discharge is the most common complaint with which women of reproductive age group present to the gynecological outpatient. WHO syndromic approach algorithm helps in identifying the etiology based on the gross appearance of discharge but it often fails to detect the etiology correctly. Addition of simple microbiological tests helps to diagnose the etiology accurately. Objective: To compare the diagnosis of symptomatic vaginal discharge based on WHO syndromic algorithm and microbiological tests. Materials and Methods: 100 Women in the age group of 18 to 45 years with symptomatic vaginal discharge attending the gynecological OPD of Apollo Institute of Medical Science and Research, Hyderabad were examined in the outpatient and a clinical diagnosis made using WHO syndromic algorithm for vaginal discharge. Under aseptic precautions, vaginal discharge was collected and subjected to simple lab tests such as Gram’s stain and direct microscopy (wet mount). The lab results were compared with the clinical diagnosis. Results: Among 100 women, bacterial vaginoses was the most common diagnosis. In 55% of patients etiological agent could be identified by lab investigations. By WHO syndromic approach, bacterial vaginosis was over diagnosed (70 vs. 44 cases confirmed by lab) and candidiasis was slightly under diagnosed (8 vs. 10 cases by lab). The sensitivity of WHO syndromic approach in diagnosing bacterial vaginosis is 100% while specificity is only 53%. The difference in diagnosis rate of candidiasis clinical versus microbiological diagnosis was marginal (10% vs. 11%). Trichomoniasis was accurately diagnosed by WHO syndromic approach. Conclusions: WHO syndromic algorithm for vaginal discharge over diagnoses bacterial vaginosis but has a high sensitivity and specificity in diagnosing candidiasis and trichomoniasis. Simple microbiological test such as Gram stain and wetmount will increase the accuracy in diagnosis thereby preventing overtreatment. Keywords:

Study of thyroid stimulating hormone among obese women with polycystic ovarian syndrome

To investigate the relationship of thyroid stimulating hormone (TSH) in patients with PCOS. Present cross sectional study was carried out in 120 patients detected with PCOS, attending gynaecology OPD for menstrual problems. Control group consist of total of 120 normo-ovulatory and norm androgenic women with parallel age were enrol as a control group for thyroid hormones levels. After an all night fast of 12 hours, venous blood was collected from the antecubital vein for the assessment of Thyroid stimulating hormone as biochemical parameters. The mean of Thyroid stimulating hormone in the control group was found to be 1.81 ± 0.74, while in patients with PCOS the mean value of TSH was found to be 4.23 ± 1.98. While the assessment for Thyroid stimulating hormone was through among the case and control groups, the values of thyroid stimulating hormone was establish to be improved in case groups and the raise in the disparity was found to be statistically significant. It was concluded that advanced prevalence of TSH in young women with PCOS contrast with that reported for the residents of young women in common. Additional future studies with big sample sizes are necessary to raise accepting of the relationship between these diseases and to grant management on which to base curative conclusions.

Knowledge, attitude, and practices of family planning methods among women of reproductive age attending OPD in tertiary care centre, Lucknow, Uttar Pradesh

Introduction: India, with 1.34 billion people is the second most populated country in the world, while china is on the top with over 1.41 billion people. Total fertility rate of India is 2.2 and the current total fertility rate of U.P is 3.72 which is still lagging behind other states like Kerela, Tamilnadu. Since the inception of program, several knowledge, attitude and practices studies have been conducted. Materials and Methods: A cross sectional descriptive study was done in department of obstetrics and gynaecology, Era’s Lucknow medical college, Lucknow, Uttar Pradesh. The study group include 523 married women of reproductive age group attending Gynaecology OPD. The results are presented in frequencies and percentages. Chi-square test is used for comparisons. The p-value

Contraceptive awareness, and practices among rural women in Lucknow

Objective: This cross sectional observational study was done to asses awareness regarding family planning methods and the practice of contraceptives among rural women in Lucknow. Materials and Methods: Five hundred women between the ages of 15-45 years, living with their husbands and coming from rural area, attending gynecology OPD of integral institute of medical sciences and research, Dasauli, Lucknow were included in this study. Women who were pregnant, had a child younger than 2 years, or had any medical disorder were excluded. Their knowledge, source of knowledge and practice of contraceptives were evaluated with the help of a predesigned questionnaire. The other variables used were the age of women, parity, religion and educational status. Results were expressed as percentages. Results: Out of 500 interviewed majority of women (49.2%) were between 22-25 years of age. 61% were illiterate belonging to low socioeconomic status, 63.3% belonged to Hindu religion. In the present study, it was observed that, 94.4% had some knowledge about family planning methods, and almost all (94.4%) of them were aware about Cu T and oral pills. The media and social circle were provided information of contraceptives in 46.6% women. Regarding the usage of contraceptive methods, 41.2% of the respondents were using some sort of contraception. Barrier method (condoms) was in practice by 26.8%, pills in 5.6%. Cu T users were 3.2% and 1.2% were using DMPA for contraception. 4.4% of women had already undergone tubal ligation. It was noted that awareness about pills and Copper was good, but their practices were very low. There were multiple reasons for non use like fear of side effects, no support from the husbands, low fertility, inhibition to ask about the contraceptives. Conclusion: There is need for strong motivation of couples through media and health personnel to achieve effective use of contraceptives, specially for Cu T and oral pills. Keywords: Contraception, Awareness, Prac

Status of uterine cervical dysplasia in District Ghaziabad, U.P; India

Introduction: Cancer of cervix is a common cancer that affects Indian women physically psychologically, socially and financially. The disease affects not just the women but also her family and society. Aims and Objective: This study was designed to study status of uterine cervical dysplasia amongst women attending gynaec OPD of CHC Muradnagar, Ghaziabad, U.P. Materials and Methods: This study was done at the community health centre (CHC), Muradnagar. It was a cross-sectional study done by using VIA (visual inspection using acetic acid) technique on uterine cervix on 1250 women aged above 30 years of age attending gynaecology OPD of CHC Muradnagar, Ghaziabad U.P. Purposive sampling was used to enroll all the women who were attending the gynaecology OPD at CHC and were coming in the eligibility criteria. Result: Out of 1250 women 14 were found to be VIA positive, out of which 4 cases came out to be positive for dysplasia after doing biopsy under colposcopy. Three biopsy positive cases were found in the age group of 41 to 50 years and one case in age group of 51-60 years, two biopsy positive cases were found amongst participants who had no literacy and two were found positive amongst females who had at-least taken intermediate level or higher education, all the four biopsy positive cases were found amongst participants who were Hindu by religion, two biopsy positive cases were found amongst participants who were not working and two were found positive amongst females who were working, two biopsy positive cases were found amongst participants whose husbands were working as a professional and two cases were found positive amongst females whose husbands were working as either skilled/semi-skilled/unskilled labour or unemployed, two biopsy positive cases were found amongst participants who belonged to Class I Socio-economic status and two cases were found positive amongst females who belonged to Class III Socio-economic status. Conclusion: Our epidemiological study reveale

Reusable sanitary napkins-time to revisit.

To assess knowledge, attitude and practices (KAP) of women regarding menstrual hygiene and to evaluate the use of reusable sanitary napkins as an alternative to disposable sanitary napkins. A community-based cross-sectional study was done in two phases. In the first phase, 50 married women attending Gynecology OPD were asked to use reusable sanitary napkins for 2months. A pre- and post-usage vaginal swab testing was done to rule out genital infection. This study was extended in the second phase to another 534 women after confirming that reusable sanitary napkins do not cause genital infection and are acceptable. KAP analysis regarding menstrual hygiene was done for all women. In phase 1 of the study, the microbiological evaluation revealed no pathological organisms on vaginal swab culture after 2months of usage. KAP analysis of 584 women revealed that only 26% women had awareness about menstruation before attaining menarche; in 51.88%, the primary source of information was their mother; 76.54% women in the study used disposable sanitary pads of which 15% were disposing of them unhygienically; 80.49% women found the reusable napkins comfortable and easy to use and 83.6% women confirmed recommending these napkins to others. Reusable sanitary pads are an effective, environment friendly, and cost-effective alternative to disposable napkins.

Prevalence of HPV Strains in Cervical Samples of Women Older than 30 Years of Age

To know the prevalence of HPV strains in women older than 30 years of age. This observational study was carried out in a tertiary care hospital where women older than 30 years of age attending the gynecology OPD were enrolled for the study. Cervical samples were sent for HPV DNA testing and genotyping. All HPV positive women were subjected to PAP smear test with colposcopy and directed biopsy if required and were further managed according to histopathology reports. The prevalence of HPV was 8.53%. Among 150 HPV positive women, HPV 16 was most common type with prevalence of 54.1%, followed by HPV 33 and HPV 52 with prevalence of 8.78% and 7.8%, respectively. Other HPV types found were HPV 18 (6.8%), HPV 6 (4.8%), HPV 45 (4.8%) HPV 58 (4.8%), HPV 39 (2.93%), HPV 11 (2.93%) and HPV 31 (1.95%). It was observed that the majority of women had infection with single type of HPV (70.67%), while 44 (29.33%) harbored infection with more than one type. In women who had infection with multiple types of HPV, the most common combination was found to be with HPV 16 and 33 (31.8%) followed by HPV 16 and 52, HPV 16 and 58 and HPV 18 and 45 in 22.72%, 13.63% and 9.10% women, respectively. The combination of HPV 16 and 18 and HPV 6 and 11 was found in 9.10% women each. Two women were found to have infection by 3 types of HPV together, i.e., HPV 16, 18, 52 in one and HPV 16, 33, 45 in other. Out of 94 women in whom biopsy was taken in view of abnormal colposcopy, cervical intraepithelial neoplasia 1 (CIN 1) was reported in 58.55 followed by CIN 2 in 18%. Five cases of invasive squamous cell carcinoma and 4 cases of CIN 3 with focal areas of microinvasion were detected. The prevalence of HPV infection found in women older than 30 years of age was 8.53%. HPV 16 was the most common genotype. The number of HPV strains decreased as the severity of lesion increased from premalignant to malignant.

Factors Associated with Pelvic Organ Prolapse in Eastern Region of Nepal: A Case Control Study.

Pelvic organ prolapse is a significant public health problem in Nepal affecting a large number of women. This study was carried out to identify the factors associated with pelvic organ prolapse among the women of eastern part of Nepal. This was a matched case-control study. Cases were women aged ?15 years with at least one parity having stage 2 and above pelvic organ prolapse attending Gynecology OPD of BP Koirala Institute of Health Sciences, Dharan and the control were the women without prolapse with at least one parity in neighborhood matched with age. A total of 230 respondents (1 Case:1 Control) were included in the study. A semi structured interview was carried out to obtain the information for both groups. Bivariate analysis along with conditional logistic regression analysis was carried out to identify the association between selected variables with pelvic organ prolapse. We found a significant association between age at first child birth (OR 1.98, CI 1.06-3.68), heavy load carrying during pregnancy (OR 3.97, CI 1.93-8.16), smoking (OR 3.49, CI 1.42, CI 8.61) and history of constipation (OR 3.57, CI 1.13-11.22) with pelvic organ prolapse. The finding showed that the significant factors for prolapse were age at first child birth, heavy load carrying during pregnancy, smoking and history of constipation.

EFFICACY OF AGNIKARMA WITH SWARNA SHALAKA IN THE MANAGEMENT OF KARNINI YONIVYAPAD (CERVICAL EROSION) - A CASE REPORT

Nowadays Gynaecology OPD is full of cervical erosion patients, due to symptoms present in erosion are very much annoying. Erosion is the replacement of the stratified squamous epithelium of the ectocervix by the columnar epithelium of endocervix. The cervical erosion can be correlated with Karnini Yonivyapad. The case of cervical erosion was taken to evaluate the effect of Agnikarma with Swarna Shalaka. Present case study was undertaken in the OPD of Stree Roga and Prasuti Tantra Department L.N. Ayurved College and Hospital Bhopal, M.P. One sitting was given after 7th day of menstruation and the patients were fol-lowed up for two months. The effect of therapy was assessed on the basis of relief in signs and symptoms. The result shows that Agnikarma is an effective procedure for the management of cervical erosion, and Swarna Shalaka is a convenient medium having high efficacy in reliving the symptoms of erosion. So, this may be positively helpful in treating the cervical erosion.

Knowledge and Attitude Regarding Cervical Cancer Screening in Women attending Obstetrics and Gynaecological Opd at Birat Medical College Teaching Hospital

Introduction: Cervical cancer is the most common Gynaecological cancer in Nepal which is preventable if appropriate screening and prevention measures are employed. Considerable reduction in cervical cancer incidence and cervical cancer related deaths can be achieved by effective screening. However, lack of knowledge and awareness can result in underutilization of the preventive measures. 
 Objectives: The objective of this study was to assess the knowledge and attitude regarding cervical cancer screening in women visiting Obstetrics and Gynaecology OPD at tertiary care Hospital in Eastern Nepal. 
 Methodology: A cross-sectional questionnaire-based study was conducted in Obstetrics and Gynaecology outpatient department of Birat Medical College Teaching Hospital from 1 January 2019 to 31 December 2019. Women were enrolled in the study by convenient sampling methods. Structured questionnaire was used to collect the data. The collected data was entered in Microsoft excel and analyzed by using SPSS version 22. 
 Results: Among 374 participants, the mean age was 31.13 years. More than three fourth (89.6%) of participants were literate. Regarding occupation, 89.8% of participants were housewives, and 82.9 % of participants were married. As per the findings, only 43.27 % of participants i.e. less than the mean, had adequate knowledge of cervical cancer and its screening. 65.50 % of participants had a negative attitude towards cervical cancer screening. Literate participants had good knowledge and positive attitude regarding cervical cancer screening than illiterate participants (P value less than 0.05). 
 Conclusion Considerable proportions of participants had inadequate knowledge and negative attitude regarding cervical cancer screening in Gynaecological patients visiting tertiary care Hospital in Eastern Nepal.

Knowledge and Practice Regarding Cervical Cancer Screening Among Women Attending Gynecology OPD, B.P. Koirala Institute of Health Sciences, Dharan, Nepal

Knowledge and Practice Regarding Cervical Cancer Screening Among Women Attending Gynecology OPD, B.P. Koirala Institute of Health Sciences, Dharan, Nepal

Role of Colposcopy in Evaluation of Abnormal Cytology a Tertiary Care Centre Experience

International Journal of Medicine and Public Health,2020,10,3,130-134.DOI:10.5530/ijmedph.2020.3.28Published:September 2020Type:Original ArticleRole of Colposcopy in Evaluation of Abnormal Cytology a Tertiary Care Centre ExperienceSachan Rekha, Shukla Ayushi, Sachan Pushpalata, Patel ML, and Shankhwar Pushpalata Sachan Rekha1,*, Shukla Ayushi1, Sachan Pushpalata2, Patel ML3, Shankhwar Pushpalata1 1Department of Obstetrics and Gynaecology, King George Medical University, Lucknow, Uttar Pradesh, INDIA. 2Department of Physiology, Career Institute of Medical Sciences, Lucknow, Uttar Pradesh, INDIA. 3Department of Medicine, King George Medical University, Lucknow, Uttar Pradesh, INDIA. Abstract:Background: Evidence for using colposcopy in the absence of a squamous intraepithelial lesion on conventional cytology has important position in cervical cancer screening. Aim of this study to evaluate sensitivity, specificity and diagnostic accuracy of colposcopy and cytology in unhealthy cervix to know role of colposcopy in concurrent use with cytology or replacing to cytology at tertiary centre experience. Methods: Prospective study was carried out over a period of one year, in patients attending Gynaecology OPD, King George’s Medical University, Lucknow, Uttar Pradesh. After informed consent and ethical clearance from institutional ethics committee, total 664 diagnostic colposcopy were performed in women presenting with gynaecological complaint. These women were called for concurrent colposcopy and pap smear. 41 women were lost to follow up, only 623 women were subjected for concurrent colposcopy and cytology. 99 women who had high grade colposcopy with Swede score ≥5 underwent colposcopic guided biopsy and tissue were sent for histopathological examination and cytology of same patients were compared for analysis. Results: Mean age of women was 42.68±11.69 years and mean age of consummation of marriage 20.94±3.21years. Cervical erosion was most common finding (41.4%) followed by hypertrophy of cervix (33.3%) and cervix bleeds on touch (17.2%). 24.14% (n=7) women with ASCUS cytology had high grade HPE (CIN2+) while 42.3% (n=11) women with LSIL had high grade HPE (CIN2+). Taking ASCUS and above as cut-off, the sensitivity, specificity, of Pap smear was 97.8%, 14.6% and diagnostic accuracy was 55.3%. For overall analysis of Colposcopy Swede Score at ≥5, colposcopy was 100% sensitive and 41.2% specific and diagnostic accuracy was 69.7%. At swede score ≥7, colposcopy was 64.6% sensitive and 100% specific and diagnostic accuracy was 82.8%. Conclusion: Colposcopy has good sensitivity and specificity as compared to cytology and can be used in evaluation of abnormal or controversial cytology to obtain better outcome. Keywords:Cervical cancer, Cervical intraepithelial neoplasia, Colposcopy, Cytology, Swede ScoreView:PDF (155.52 KB)

Comparison of Visual-Based Cervical Cancer Screening Tests with Pap Smear in a North Indian Tertiary Centre: A Prospective Randomised Observational Study

Cervical cancer is the second leading cause of female cancers in India. Considering the latency of the disease, screening of precancerous lesions of cervix forms a key aspect of disease prevention and control. Limited research has been conducted in the region of Uttarakhand where estimated incidence of cervical cancer is quite significant. There is no provision available for mass or regular screening for cervical cancer in the state as well. With this background, the present study was planned to compare the diagnostic accuracy of visual-based methods with conventional Pap smear in order to provide an affordable and feasible screening modality in the subserved population of hilly terrains of Uttarakhand. In the present study, we aim to study the comparability of diagnostic accuracy of visual-based screening tests (VIA, VILI) and Pap smear. Total 195 consenting participants were recruited from Gynaecology OPD, AIIMS Rishikesh from January to December 2018. All participants were subjected to standard Pap smear testing and then randomly allocated to 3 groups namely (A) Pap smear only group, (B) VIA group and (C) VILI group. Colposcopy was performed on all the participants as a standard diagnostic test to confirm the screening test findings keeping the cutoff as CIN 2 + lesions in the three groups, and guided biopsy was performed on those with Reid’s Colposcopic Index (RCI) ≥ 6. Observations were analysed using OpenEpi Version 7.0 software to compute the tests of validity for individual screening tests and combination of visual tests with Pap smear. The tests of validity for VIA, VILI, and Pap smear were as follows: sensitivity of, 50%, 50%, 25%, specificity of 95%, 98%, 95%, for VIA, VILI, and Pap smear, respectively. Diagnostic accuracy was 92.3%, 92.31%, and 90% for VIA, VILI and Pap smear, respectively. Visual-based screening tests demonstrated comparable accuracy as Pap smear. All three screening tests had diagnostic accuracy to the tune of 90%. Thus visual tests can be used in resource poor settings to screen cervical cancer where Pap smear is not feasible logistically without compromising accuracy.