Postcoital Bleeding Research Articles

Prevalence, Clinical Features, and Management of Cervical Polyps: A One-Year Study at Rabia Balkhi Hospital in Afghanistan.

Background Cervical polyps are benign growths from the cervical epithelium, found in 2% to 5% of the population. They usually appear as small, stalk-attached lesions ranging from pea to cherry size. Contributing factors include cervical infections, congestion, and elevated estrogen levels. During pregnancy, these polyps may increase the risk of late abortion and preterm birth. While malignancy is rare, histopathological examination after removal is advised to rule out cancer. Materials and methods This current study, the first of its kind in Afghanistan, aimed to assess the scope of cervical polyps among Afghan women presenting to Rabia Balkhi National Hospital in 2018. We conducted a descriptive study of cervical polyps, exploring the prevalence, symptoms, complications, and procedures used to remove them. Data were collected from 3730 cases admitted to the hospital. Results Out of 3730 cases, 50 patients (1.34%) were diagnosed with cervical polyps. The polyps varied in size and were typically attached to the cervix by a slender stalk. Symptoms reported included inter-menstrual, post-coital, and post-menopausal bleeding. Histopathological examinations were performed following polyp removal to rule out malignancy. Conclusion This study provides a comprehensive overview of the prevalence and clinical presentation of cervical polyps among Afghan women. The findings highlight the importance of recognizing and managing cervical polyps to prevent potential complications, especially during pregnancy. Further research is needed to understand this population's epidemiology, pathogenesis, and optimal management strategies for cervical polyps.

Presentation of a Locally Advanced Cervical Cancer with Hydrometrocolpos: A Case Report

Introduction: Early stages of cervical cancer remain asymptomatic. Its common symptoms are postcoital bleeding, postmenopausal bleeding, heavy menstrual flow and foul smelling blood stained discharge. Presentation of locally advanced cervical cancer with hydrometrocolpos is unusual. Case report: An 83-year-old woman who presented with a large abdomino-pelvic mass was diagnosed as benign bilateral ovarian tumour with left sided hydroureteronephrosis. During laparotomy, the mass was confirmed to be a hydrometrocolpos with left hydroureteronephrosis secondary to a locally advanced cervical cancer (FIGO IIIB). Histology confirmed the diagnosis of invasive squamous cell carcinoma of the cervix. Conclusion: Besides thorough evaluation via symptoms and signs, radiologists have an important role in guiding surgeons to the most probable diagnosis. In an elderly woman with a stenosed vagina and a pelvic mass with hydroureteronephrosis, gynecologists need to be aware of the possibility of locally advanced cervical cancer, and perform relevant preoperative assessments and plan management.

Distribution of human papillomavirus in women by genotype, age, education, and geography in Baghdad, 2021-2022

Background: Human papillomavirus (HPV) is the main causative agent of cervical cancer and genital warts. HPV infection can be persistent with high-risk HR-HPV genotype. Objective: Investigate the distribution of HPV genotype in Baghdad province, to afford a scientific source for initial detection policies and immunization for cervical tumors in the province. Methodology: From January 2021 to September 2022, 400 women who were tested for HPV genotyping, were referred to the Central Public Health Laboratory (CPHL) in Baghdad province. They have one or more of the following (intermenstrual bleeding, post-menopausal bleeding, post-coital bleeding, vaginal discharge, and warts). Results: The prevalence of HPV infection showed a high percentage in Rusafa about 74.17%, however, Al-karkh showed about 25.83%. Both regions appeared high distribution for genotypes (16&18) as predominant types for HR-HPV. Two major rates of HPV infection have been found in women aged group (20-30) years, about (45.31%) and (36.72%) in women aged (30-40) years, these groups consider reproductive age therefore HR-HPV risking persistent infection. In comparison, HPV infections show (13.28%) among women aged 40-50 years. finally, HPV infection in the elderly group 50-65 years was (4.69%) showing the lowest percentage, also women with secondary education level appeared higher percentage of HPV infection about (42.63%) compared with primary and higher education. Conclusion: The prevalence of high-risk-HPV infection showed a high percentage in Baghdad providence and there was an important for age specificity, in addition to an inverse relationship with the education level.

Evaluation of Cervix by Colposcopic Directed Histopathology: A Single Center Study

Background: The most common malignancy among women worldwide is cervical cancer. With the right screening, it is a disease that can be prevented and cured. Colposcopy is a useful method for identifying and treating precancerous cervical lesions after primary screening. The most reliable method for identifying precancerous lesions is histopathology. Objectives: Purpose of This study aims to evaluate the cervix by colposcopic directed histopathology in a tertiary care hospital. Methods: This Cross-sectional study was conducted among 67 patients from North east medical college and Hospital, Sylhet. The study was done for the period of “January 2022 to June 2023 “. Patients having the following complaints: positive visual inspection of the cervix (VIA + ve) with 3-5% acetic acid, post-coital bleeding, postmenopausal bleeding, and intermenstrual bleeding were recruited for the study. Written informed consent was obtained from the participants. Results: Out of the total cases, 23 (34.33%) had squamous cell carcinoma, 14 (20.89%) had LSIL, 11 (16.42%) had adenocarcinoma, 9 (13.43%) had HSIL, and 7 (10.45%) had cervical intraepithelial neoplasia. Adenosquamous was 4.48% in 3 instances. Conclusion: The colposcopic guided histological investigation found squamous cell carcinoma to be the most common cervical neoplasia in this study. Afterwards, a large proportion of cases are attributed to LSIL, adenocarcinoma, HSIL, CIN, and adenosquamous carcinoma.

The effect of Henna (Lawsonia inermis) vaginal suppository combined with antibiotic therapy in the treatment of cervicitis: An RCT.

Cervicitis is a prevalent gynecologic disease, which does not usually respond to conventional treatments. Long-term cervicitis can cause serious health problems such as inflammation, infertility, and cancer. Henna oil, an herbal product in Persian medicine, is recommended for uterine diseases like cervicitis. This study aims to evaluate the efficacy of Henna oil as a vaginal suppository in combination with an antibiotic regimen in the treatment of cervicitis. This randomized placebo-controlled trial, included 92 non-menopausal women with cervicitis at the Baqaipur Clinic of Shahid Sadoughi hospital in Yazd and the Persian Medicine Health Center in Ardakan, Yazd, Iran. Participants were further divided into either the Henna oil vaginal suppository group or the placebo group (n = 46/each group). During the study, the antibiotic treatment was administered to both groups. Cervicitis symptoms were compared between the groups and within each group. Of 92 included individuals, 41 in each group completed the study. Results revealed that significant differences were observed in some outcomes, including vaginal discharge (p 0.001), cervical ulcer size (p 0.001), dyspareunia (p = 0.046), and postcoital bleeding (p 0.001), indicating that the treatment was more effective in the henna group compared to the placebo group. Findings supported that the vaginal suppository of Henna oil in combination with antibiotic therapy could be effective in the improvement of clinical symptoms of cervicitis regardless of its pathology.

Effect of Marham-i-Bāsalīqūn on Cervical Erosion (Qurūḥ al-Raḥim)): A Randomized Comparative Clinical Study

Background and Objective: Cervical erosion (Qurūḥ al-Raḥim) is one of the most frequent gynecological conditions seen in clinical practice. Therefore, the objective of the current study was to assess the impact of the topical application of Marham-i-Bāsalīqūn in Qurūḥ al- Raḥim. Material and Method: A randomized comparative clinical study was carried out at the Institute Hospital in Bengaluru. Diagnosed cases (n=40) of cervical erosion were randomly assigned to test (n=20) and control (n=20) groups. A total of 6 g ointment of Marham-i-Bāsalīqūn (test drug) and tested Unani formulation (control drug) was applied with an applicator per vaginum over the eroded area of the cervix daily once at bedtime for 14 days. A single dose of the antibiotic regimen (azithromycin-1g and cefixime-400 mg) was administered orally in both groups. Subjective parameters like vaginal discharge, pruritus vulvae, low back ache, lower abdominal pain, and postcoital bleeding were assessed during the trial. The main outcome measure was an improvement in the cervical erosion grading score. The inference was executed with appropriate statistical analysis. Result: Improvement in the cervical erosion grading score was achieved in 50% and 40% of patients in the control and test groups, respectively, after 2 weeks of treatment with P<0.0001, which was considered highly significant. A highly significant improvement in subjective parameters was observed during the trial with P<0.0001. Conclusion: Considering the high prevalence of cervical erosion among women of reproductive age group, effective treatment and safe strategies are highly recommended. Marham-i-Bāsalīqūn is cost-effective and has several therapeutic actions that can help to promote the healing of erosion and relieve the associated symptoms. The clinical trial was registered at the Clinical Trial Registry of India (CTRI) with registration number CTRI/2022/02/040419.

An observational study to assess awareness of cervical cancer among the adult women of field practice area of urban health training center in Kolkata

Background: Cervical cancer is a major public health problem, especially worldwide. Lack of awareness about the risk factors, signs and symptoms, and danger signs has led to a rise in the prevalence of the disease in countries like India. Aims and Objectives: The aim of the study was to assess the awareness of cervical cancer and its risk factors among the adult female population residing in the urban slum of Kolkata Municipal Corporation area and their attitude toward the disease. Materials and Methods: A cross-sectional study was conducted among 720 adult female residents of the field practice area of the urban health training center of NRS Medical College using a predesigned pretested questionnaire. Results: In the current study, 58.3% of subjects were married at <18 years of age and 38.3% with >2 children. A significant association was found among inter-menstrual bleeding and persistent low back pain with a family history of cancer, persistent vaginal discharge, and postmenopausal bleeding with education, dyspareunia showed significant association with age, education, and family type, heavy menstruation with religion. Furthermore, the association between postcoital bleeding with education and blood in the urine or stool with marital status was found to be significant. A significant association was found between confidences about noticing a symptom with marital status (P<0.05). Conclusion: Unsatisfactory knowledge about cervical cancer among adult women in an urban slum poses the risk of the disease. Awareness of risk factors of cervical cancer, along with early diagnosis and treatment, can decline the burden of the disease.

Efficacy of a Triticum vulgare Extract as a Treatment of Cervical Ectropion: A Prospective Observational Cohort Study.

To assess the effectiveness of a topical treatment for cervical ectropion with vaginal ovules containing aqueous extract of Triticum vulgare . Prospective observational cohort study conducted between November 2020 and November 2022 at the colposcopy clinics of 2 different hospitals. Sexually active patients with a colposcopic diagnosis of cervical ectropion, awaiting ablative procedure, were included in the study and prescribed medical therapy with vaginal T. vulgare ovules (group 1) or wait-and-see therapy (group 2). At both enrollment and 2-month follow-up, a symptomatologic evaluation recording the intensity of postcoital bleeding, leucorrhea, and dyspareunia was performed with a Visual Analog Scale (VAS) questionnaire, and a colposcopic examination was performed, calculating the size of the ectropion area. A total of 116 patients (58 in group 1 and 58 in group 2) were included. Topical treatment with vaginal ovules containing aqueous extract of T. vulgare for 2 months resulted in significant decrease of symptoms related to cervical ectropion and significant reduction of the size of the ectropion area. Our results support the efficacy of topical treatment with vaginal ovules containing aqueous extract of T. vulgare for symptomatic cervical ectropion; our study also suggests that expectant management, despite being widely practiced, seems to lead to a worsening of the natural history of ectropion.

The Incidence of Cervical Intraepithelial Neoplasia or Cervical Cancer in Women Referred With Postcoital Bleeding.

The incidence of cervical cancer among patients with postcoital bleeding (PCB) was the primary objective of this study. Furthermore, the proportion of cervical intraepithelial neoplasia requiring treatment and the correlation between PCB and the presence of high-risk human papillomavirus (HPV) was determined. Lastly, the study aimed to identify risk factors among the referred women. A retrospective cohort study was conducted at a university hospital in Denmark between January 1, 2017 and December 31, 2019. Women referred with PCB were identified with the ICD diagnosis codes "DN930 Postcoital and contact bleeding" and "DN930B Contact bleeding." Demographic and paraclinical data were extracted from the journals and the supportive systems: Patoweb and the Danish Microbiology Database. A total of 789 women were included in this study, with only 0.25% ( n = 2) diagnosed with cervical cancer and 2.5% ( n = 20) diagnosed with cervical intraepithelial neoplasia II-III and adenocarcinoma in situ. Human papillomavirus testing was only conducted in a minority of cases, and a low incidence of high-risk human papilloma virus was detected in the 22 cases, n = 5. A very low incidence of cervical cancer and high-grade cervical intraepithelial neoplasia reported among women referred with PCB. Prognostic factors as body mass index, smoking, and HPV vaccination status may predict the risk of cervical cancer. Selection criteria like primary testing for hrHPV and cytology as cotests before referral to colposcopy may reduce the number of unnecessary colposcopies.

Could tranexamic acid be a suitable alternative to cryotherapy for symptomatic cervical ectopy? Results from a randomized clinical trial.

Cervical ectropion occurs due to the eversion of the endocervix that exposes glandular cells to the vaginal milieu. The aim of the present study was to evaluate and compare the clinical efficacy of effervescent vaginal tablets of tranexamic acid and cryotherapy in women with symptomatic cervical ectopy. The current randomized clinical trial was conducted on 92 samples of women with cervical erosive ectropion from March 20, 2022 to August 27, 2022. Participants were divided into two groups; the intervention group (n = 46) was treated with a 400 mg effervescent vaginal tablet of tranexamic acid and the control group (n = 46) underwent cryotherapy. All the patients were requested to visit weekly in the first month and then monthly for the next 3 months, and the outcomes encompass improvement of symptoms (leukorrhea, dyspareunia, pelvic pain, post-coital bleeding, and suprapubic pain) and cervical erosive ectropion view were monitored based on repeated examinations. In this study, no statistically significant difference was observed in cure rate of symptoms between study groups (P value > 0.05). Women in both the tranexamic acid and cryotherapy groups reported significant improvements in dyspareunia (34 [75%] vs 31 [67%]), pelvic pain (34 [75%] vs 34 [74%]), post-coital bleeding (37 [81%] vs 31 [67%]), leukorrhea (36 [78%] vs 36 [78%]), suprapubic pain (32 [71%] vs 33 [73%]) disappearance of cervical ectropion tranexamic acid (40 [86%], vs 39 [84%]). Our findings highlighted the equal effect of tranexamic acid and cryotherapy for treating cervical ectropion. Due to the ease of use, availability, and fewer side effects of tranexamic acid, it can be a suitable alternative to cryotherapy. IRCT20220115053719N1. The name of the registry: Iranian Registry of Clinical Trials. URL of registration: https://en.irct.ir/trial/61483.

Nursing care for patients with cervical endometriosis in the gynecology service of a national hospital in Huánuco

Introduction: Endometriosis is the abnormal expansion of endometrial glands and stroma in other areas of the body, these can cause hemorrhage, inflammation and fibrosis. The main complication is decreased fertility, between 50% to 75% of women. Objective: Determine the nursing activities for a patient with cervical endometriosis. Methodology: Qualitative publication, with a single clinical case design based on the nursing care process (PAE) method, Marjory Gordon's assessment guide was applied to a 39-year-old patient who presented with pain in the lower abdomen, postcoital bleeding and pruritus. Results: Eight nursing diagnoses were identified, prioritizing (00132) Acute pain r/c biological harmful agent m/p analgic position, expression of pain, moaning, defensive behavior and VAS 8/10. The interventions carried out improved the bleeding process; Given the problem of hemorrhage complication, the results are still indefinite due to the few hours of intervention and evaluation. Conclusion: The clinical characteristics of the patient corresponding to cervical endometriosis and the risk factors that increase the possible complication were identified. It is important to apply preventive actions against the risk of bleeding caused by endometriosis. This entire process framed in the PAE that identified main problems and risks allowed the development of a personalized care plan to provide adequate, timely care that covers basic needs, improving the skills of the nursing professional using the NANDA I, NOC, NIC, and the collaboration problems of Linda Carpenito's Area Model

Human Papilloma Virus Typing as a Triage Tool for Women with Postcoital Bleeding: A Retrospective Cohort Study.

Objective: To investigate the performance of human papilloma virus (HPV) typing as a triage tool in the management of patients with postcoital bleeding (PCB). Methods: All patients referred for colposcopy at a cervical pathology clinic of a nationwide health insurance organization, due to PCB and had a preceding high-risk HPV (hrHPV) test between 2018 and 2020, were retrospectively located. Demographic and pathologic data were collected from electronic medical files. Sensitivity, specificity, and negative and positive predictive value of hrHPV test according to final pathology were calculated. Results: Three hundred ninety patients referred for colposcopy due to PCB with a preceding hrHPV test were located. HrHPV-positive patients were significantly younger (33.7 ± 10 vs. 37.2 ± 9, p < 0.006) with a higher proportion of nulliparous, nonmarried, and smokers compared with hrHPV-negative patients (75% vs. 47%, p < 0.001; 75.4% vs. 45.1%, p < 0.001; and 24.6% vs. 12.8%, p < 0.028, respectively). No case of high-grade cervical intraepithelial neoplasia (CIN2/3) was identified among hrHPV-negative patients. The sensitivity and NPV of the hrHPV test for high-grade cervical lesions were both 100%, decreasing to 36% and 95%, respectively, for any cervical dysplasia (CIN1/CIN2/CIN3). Adding cytology to HPV typing had a negligible effect on test performance. At univariate analysis, age, HPV vaccine status, nulliparity, and positive HPV typing were independently associated with cervical dysplasia. At multivariate analysis, only positive HPV typing remained significantly associated with cervical dysplasia (hazard ratio 2.75, confidence interval 1.1-6.5, p = 0.023). Conclusion: A negative HPV test even in the presence of PCB may rule out cervical dysplasia with extremely high accuracy and may save unnecessary colposcopies.

STUDY OF ENDOMETRIAL PATHOLOGY IN ABNORMAL UTERINE BLEEDING

Objective: Endometrial pathology is becoming the most common issue that affects women of reproductive age group worldwide. AUB encompasses a wide variety of presentations, for example, frequent menstrual cycles, frequent and heavy cyclical bleeding, irregular bleeding, and postcoital bleeding. This study was done to evaluate the endometrial causes of AUB and to determine the specific pathology in different age groups.&#x0D; Methods: This study was a prospective cross-sectional study conducted on 200 patients from January 2023 to October 2023 in the department of pathology in a reputed teaching hospital and research centre. All the endometrial biopsies/curretages and hysterectomy specimens sent for Histopathological examination with history of AUB were included in the study.&#x0D; Results: Age of the patients with AUB ranged from 17 to 71 y in our study. Out of 200 cases, 90 cases (45%) were seen in Perimenopausal group followed by 68 cases (34 %) in Reproductive age group and 42 cases (21%) in Postmenopausal age group. Menorrhagia was the most common bleeding pattern seen in 54% pf patient with AUB. In 28% in reproductive age group, hormonal imbalance was observed in 13% of reproductive age group and 6% in perimenopausal age group. Atrophic endometrium was observed in 7.5% of women in post-menopausal age group. Chronic endometritis was seen 3% of reproductive age group.&#x0D; Conclusion: Abnormal uterine bleeding in women belonging to different age group show variable endometrial pattern on histopathological examination. They are valuable in early detection of pre-cancerous endometrial lesions as well as malignancy.

Diagnostic Performance between Colposcopy Findings and Histopathology Reports

Background: Cervical cancer is the most frequent cancer in women worldwide. With appropriate screening, the condition can be prevented and treated. Colposcopy is a useful tool in the diagnosis and management of precancerous cervical lesions following primary screening. The gold standard for identifying precancerous lesions is histopathology. Objective: The aim of this study is to evaluate the diagnostic performance between colposcopy findings and histopathology reports Methods: The cross-sectional observational study was conducted in the Department of Colposcopy Clinic of Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, from July 2022 to June 2023. A total of 62 subjects were included in the study. The questionnaire was pretested, corrected and finalized. Data were collected by face-to-face interview and analyzed by appropriate computer based programmed software Statistical Package for the Social Sciences (SPSS), version 24. Results: In this study, the mean age was found to be 36.8±11.9 years, with a range from 20 to &gt;51 years maximum 44 (71.0%) of the patients were within the age group of 20 - 40 years. The majority 37 (59.7%) of patients completed SSC and most of the patients 56 (90.3%) were housewives. Most of the patients 59 (95.2%) were Muslims and about 32 (51.6%) came from middle-income families. About 25 (40.3%) patients were married between the ages of 15-17 years. About 25 (40.3%) were between 16-18 years during their first delivery and about 26 (41.9%) had 3-4 children and 21 (33.9%) had more than 4 children. Most of the patients 43(69.4%) had history of received OCP. Regarding colposcopic diagnosis, 12.9% (n=8) were normal, 69.4% (n=43) were CIN I, 9.7% (n=6) were CIN II and 8.1% (n=5) were CIN III and 30.6% (n=19) chronic cervicitis, 46.8% (n=29) CIN I, 6.5% (n=4) CIN II, 6.5% (n=4) CIN III, 4.8% (n=3) carcinoma in situ and 4.8% (n=3) were invasive squamous cell carcinoma by the histopathological diagnosis. Conclusion: Colposcopy had a rather high diagnostic accuracy for histopathologically verified precancerous cervical lesions. Even if the results of the screening tests are normal, patients who report with postcoital and postmenopausal bleeding should have colposcopies and biopsies. Colposcopy also has a high sensitivity, therefore it is simple to use the "see and treat" approach to lower dropout rates.

Pap smear in Early Detection of Cervical Precancerous Lesions in Erbil

Background and objectives: Cervical cancer remains common. This may be because Iraq has no cervical cancer screening or human papilloma virus vaccination program. The goal of the study is to figure out how well the Pap smear works as a way to find cervical precancerous lesions also identify the prevalence of cervical cancer among women and to identify the potential risk factors for cervical cancer. Methods: A prospective cross-sectional study conducted using closed end questionnaire tool for the purpose of data collection which started from 1st of October 2021 until 1st of September 2022. Convenient type of sampling was used in collecting data which include 470 women attending to cervical screening unit in Maternity Teaching Hospital, Erbil, Kurdistan Region /Iraq. The questionnaire composed of two main parts including the socio-demographic data of the patients such as age, gender, occupation, education level, religion, income status, age at the marriage, duration of marriage…etc. The result of pap smear and cone biopsy performed during colposcopy procedure to match the accuracy of pap smear. Results: The findings revealed that 36% of the women aged between 40-49 years, the majority (80%) of them were married at the age of 15-24 years, 30% of their marriage lasted from 4-14 years, and most (72.6%) of them were housewives. The result of sensitivity, accuracy, positive and negative predicted value was equal to 45.6%, 97.7%, 80%, 89.9% respectively. The kappa test was 0.52 which indicate agreement between screening and gold standard test is a diagnosis of cervical cancer is still colposcopy-guided biopsy, which is then staged on the basis of the clinical examination and the outcome of imaging procedures, most obtained results were statistically significant. Conclusion: Pap smear had a lower sensitivity, but a higher specificity in the current study. The most common complaint of the women was post-coital bleeding. Severe acute cervicitis was the most common finding for the Pap smear.

Socioclinical risk factors for cervical dysplasia and presence of human papillomavirus among women attending a tertiary care teaching hospital of Central Odisha

Abstract Introduction: Carcinoma cervix being the second-most common gynecological malignancy in India contributes nearly 14% of all cancers in females. Cervical dysplasia and presence of human papillomavirus (HPV) DNA are the two most important factors for developing cervical cancer. Hence, our study aims to be a flag bearer to raise the awareness for cervical screening with the main objective (i) to estimate the magnitude and distribution of cervical dysplasia among the women of 21–65 years and (ii) to find association between different socio-clinical risk factors and cervical dysplasia and HPV infection among the study subjects. Methods: It was a cross-sectional study carried out in a tertiary care hospital of Central Odisha, with a sample size of 176. Purposive sampling was done. Predesigned pretested questionnaire along with Pap smear and endocervical smear sample for HPV determination were used for data collection. Results: Nearly 62% of women suffered from cervical dysplasia. Women aged ≥35 years were found to have nearly thrice the risk of having cervical dysplasia. Nearly 20% of women tested positive for HPV DNA and these women were found to be 11 times more prone for developing cervical dysplasia compared to women tested negative for HPV DNA. Conclusion: Women with repeated genital infection with HPV and aged more than 35 years were more susceptible to cervical dysplasia. Those with early age at menarche, itching per vaginum, postcoital bleeding, and postmenopausal bleeding, etc., had a significant risk for developing cervical dysplasia. Hence, such symptomatic women should be made aware to undergo screening for cervical cancer at the earliest.

Assessing the Clinical Significance of Third-Trimester Post-Coital Bleeding.

This study aimed to evaluate the impact of third-trimester post-coital bleeding (PCB) on pregnancy outcomes. A retrospective cohort study was conducted at two tertiary medical centers, including all pregnant women between 24 and 34 weeks of gestation referred due to vaginal bleeding over an 11-year period. The study population includes all singleton deliveries; within this population, women were further classified into three groups: those admitted due to vaginal bleeding related to PCB, those admitted due to vaginal bleeding not related to PCB, and those who did not report vaginal bleeding. The primary outcome measure was delivery prior to 37 weeks of gestation, while secondary outcome measures included maternal and neonatal complications. Baseline characteristics of the two groups were compared. During the study period, there were a total of 51,698 deliveries. Among these, 230 cases involved bleeding between 24 and 34 weeks of gestation, 34 (14.8%) were identified as PCB, and 196 as bleeding unrelated to intercourse. In addition, 51,468 pregnancies without bleeding were analyzed as the general population for comparison. The incidence of preterm labor before 37 weeks of gestation was notably higher in both women with PCB (14.7%) and those with bleeding unrelated to coitus (20.9%) compared to the general population (5.6%); however, there was no statistically significant difference between the two bleeding groups (p = 0.403) while both were significantly different from the general population (p &lt; 0.001). The odds ratio for preterm birth before 37 weeks of gestation after PCB was 3.29 (95% CI: 1.26-8.56, p = 0.0149). There were no significant differences between the PCB and bleeding unrelated to intercourse groups in terms of maternal and neonatal complications. This study found that third-trimester PCB is a risk factor for preterm delivery, with rates similar to other causes of third-trimester bleeding but significantly higher than the general population without bleeding. These findings challenge the assumption that PCB is benign.

Cervical Cancer Screening Coverage at Tertiary Care Institutes Across India.

The 70% screening coverage target proposed in the global cervical cancer elimination strategy is not achieved even at tertiary centres in India. A situational analysis was done to assess the currently existing facilities and barriers in tertiary care institutes. This cross sectional multicentric study was conducted from August to September 2021 in six tertiary care institutes across India. Women aged 30-49 years attending outpatient services (OPD) were invited for cervical screening. Women and health care professionals (HCPs) were administered structured questionnaires to assess knowledge, attitude and practices regarding cervical cancer screening services. Out of 6709 eligible women who attended OPD, 1666 (24.8%; range:19-57%) received screening. Availability of screening kits was limited to 10-25 Pap/HPV tests per day. Visual inspection with acetic acid (VIA) and HPV testing were offered only at certain centres. Colposcopy and treatment facilities were optimal at all centres. Knowledge, attitude and practices were analysed for 1800 women: 45.7% had heard of cervical cancer, 78.0% did not know that it is preventable, 75.8% never heard about screening. Common symptoms correctly identified included postmenopausal bleeding (4.8%), postcoital bleeding (5.7%), intermenstrual bleeding (5.8%) and vaginal discharge (12.4%). Risk factors were identified by minority: poor menstrual hygiene (6.6%), oral contraceptive pill use (6.4%), multiparity (4.4%), and HPV infection (3.0%). Out of 21, mean total knowledge score (MTKS) was 2.07± 2.67. Out of 317 HCPs, 96.5% knew that cervical cancer is caused by HPV infection, is preceded by premalignant stage, and that it is preventable by screening and treatment (80.1%). Knowledge about screening modalities was present in 87.4% for cytology, 75.1% for VIA, 68.8% for HPV test. MTKS of HCPs was 20.88±6.61 out of 32. Even at tertiary centres, limited availability of HPV tests, reluctance to implement VIA and lack of awareness among women remain the major barriers.

Colposcopy-A Valuable Diagnostic Tool for Pregnant Women With Unexplained Vaginal Bleeding.

We aimed to examine the diagnostic value of colposcopy in a large cohort of pregnant women with unexplained vaginal bleeding during the second or third trimester. This retrospective study included women who underwent colposcopy due to vaginal bleeding in the second and third trimesters during 2012-2022 at a tertiary care hospital. Demographics, obstetric data, bleeding characteristics, colposcopy results, cervical cytology testing, a sonogram directed at the placenta, and birth details were collected. In total, 364 women were included. The mean maternal age was 29.7 years and the mean gestational age at examination was 30.7 weeks. Vaginal bleeding was mild in 80.8%, moderate in 14.6%, and severe in 4.7%. Only 3.3% had been vaccinated against human papilloma virus and 25.5% underwent a Pap smear study before pregnancy. Colposcopy diagnosed the bleeding source in 83 women (22.8%). The colposcopic examination revealed vaginal bleeding due to contact bleeding from ectropion in 46 (12.6%), a decidual/cervical polyp in 37 (10.2%), acetowhite epithelium in 12 (3.3%), herpes genetalis in 2 (0.5%), and bleeding from vaginal varices in 2 (0.5%). Of those who were recommended a follow-up examination after the postpartum period, only 49.1% completed such.Among women with compared to without postcoital bleeding ( N = 72), the risk of abnormal colposcopic findings was higher (24 [33.3%] vs 54 [19.7%], p = .017) and the rate of abnormal Pap smear was higher (7 [13.2%] vs 7 [3.2%], p = .008). Colposcopy can be a valuable diagnostic tool for women with unexplained vaginal bleeding in the second or third trimester.

The cytological pattern of cervical papanicolaou smear in a tertiary hospital of India

Background: Cervical cancer continues to be listed among the top gynecologic cancers worldwide. According to current data, it is ranked fourteenth among all cancers and fourth-ranked cancer among women worldwide. In India alone 1,30,000 new cases occur with the death toll of 70,000 per year. A “PAP’ test should be performed during the second half of the menstrual cycle (Day 14). The patient is placed in lithotomy position and the cervix is visualized by means of a speculum. The smaller end of the Ayre’s spatula is introduced through the external os and the squamocolumnar junction is scraped by rotating the spatula to 360°. Aims and Objectives: The objective of the study is to evaluate the use of the Pap smear screening method for detection of precancerous lesions. Cervical cancer accounts for 15% of all cancers in females. If treated or detected earlier, cervical cancer can be prevented. Materials and Methods: This study was done on 1000 patients during reproductive and later age groups (postmenopausal), attending Obstetric and Gynaecological Outpatient Department of Panna Dhai Hospital associated with RNTMC, Udaipur during the period of November 2012–April 2014 with history of white discharge per vagina, bleeding per vagina, pain in lower abdomen and post coital bleeding. Results: Most of the smears (90.1%) were NILM and 9.9% of smears showed cytological abnormality. Majority 834 (83.4%) of smears were inflammatory, Bacterial vaginosis was seen in 119 cases (11.9%), Candidiasis in 78 cases (7.8%), Trichomoniasis in 35 cases (3.5%), Atrophic vaginitis in 4 cases (0.4%) and Radiation changes in 4 cases (0.4%). There were 99 samples reported as having epithelial cell abnormality. Out of which 75 were LSIL, 14 were high grade squamous intraepithelial, 5 were atypical squamous cells (ASC)-US, 1 was ASC-H and 4 were squamous cell carcinoma. Conclusion: Due to high sensitivity, specificity and accuracy found in this study Pap test is proved to be highly useful to detect precancerous and cancerous lesions of cervix. From the above facts, it can be concluded that early diagnosis and prompt specific treatment of preinvasive or early stages of the disease (mainly in high risk women), reduces the prevalence of invasive carcinoma of uterine cervix.