Women Attending Gynecology Outpatient Department Research Articles

Role of Host Cervicovaginal Microbiota in Persistence of High-Risk HPV Infection in Women Attending Gynecology Outpatient Department in a Tertiary Hospital

Role of Host Cervicovaginal Microbiota in Persistence of High-Risk HPV Infection in Women Attending Gynecology Outpatient Department in a Tertiary Hospital

Colposcopic Findings in Patients of Cervical Erosion at Tertiary Center

Background: India has a population of approximately 450 million women 18 years of age and older who are at a risk of developing cervical cancer. Recent studies state that nearly every year 122844 women are diagnosed with cervical cancer and approximately 67477 die from cervical cancer. Cervical cancer ranks as the 2nd most frequent cancer among women in India. Cervical erosion is one of the commonest clinical finding in women attending Gynecology outpatient department for various reasons. Cervical erosion which is an abnormality of the cervical epithelium covering ectocervix, has a varied significance. It could be a premalignant or a malignant lesion. Persistent inflammation leads to increased cellular turnover. Cervical cancer can be prevented by detecting precancerous lesions by screening and treating them in time. Inspite of the overall high incidence and mortality rates, cervical cancer is considered as the most preventable and treatable form of major cancer through early diagnosis and appropriate treatment of pre invasive and invasive disease. Early detection of cervical epithelial abnormality is important as it helps to prevent progression to CIN and invasive cancer thereafter. Aim: To study the colposcopic findings in patients of cervical erosion. Material and methods: A prospective observational study was carried out in the time interval from October 2019 to September 2021 at Rural Medical College, Loni. Women diagnosed to have cervical erosion on per speculum examination were enrolled for the study. A total 140 females were studied. Women attending gynecological Outpatient department for various complaints and diagnosed to have cervical erosion on per speculum examination were enrolled in the study. Colposcopy was done using 3% acetic acid and 50% Lugol’s iodine. Colposcopy was done and it was interpreted using the Reid’s Colposcopic Index which is an objective method of colposcopically grading the severity of premalignant cervical lesions. ................

Correlation of preoperative and intraoperative assessment of pelvic organ prolapse by pelvic organ prolapse quantification system.

To correlate the measurements of pelvic organ quantification (POP-Q) score obtained preoperatively with Valsalva maneuver with POP-Q score obtained intraoperatively under anesthesia in the assessment of pelvic organ prolapse. A prospective observational study included 25 women attending gynecology outpatient department with symptomatic pelvic organ prolapse in Midnapore Medical College, India and planned for vaginal operative treatment between March 2019 and February 2020. The preoperative examination was performed in the outpatient department using the POP-Q system with Valsalva maneuver and final examination was performed under spinal anesthesia with mechanical traction. The correlation was performed using the preoperative and intraoperative measurements. All intraoperative POP-Q measurements showed a significantly higher descent compared with preoperative measurements (mean difference Aa 0.72cm, Ba 1.08cm, C 1.66cm, Ap 0.26cm, Bp 1.6cm, D 1.6cm, Gh 0.6cm,) except for Pb and Tvl. Among all nine measurements, the greatest difference between the preoperative and intraoperative values was observed for points C, D, and Bp. Preoperative POP-Q scores significantly differed when assessed intraoperatively under spinal anesthesia with traction. The patient should be informed that the surgical plan may change depending on the intraoperative findings. Our study is an alert for both surgeons and patients.

A study on Hyperprolactinaemia and associated factors among women attending Gynecology outpatient department at a tertiary teaching hospital in West Bengal

Background: Prolactin has multiple biological functions and hyperprolactinaemia is a common condition in clinical practice in both females and males. It has many etiologies and may present with variable symptoms to health care workers. Aims and Objectives: To study the various etiologies and clinical presentation of patients presenting with hyperprolactinaemia in a tertiary care medical college and hospital in West Bengal to aid in quick decision management. Materials and Methods: The current study was a cross-sectional study with follow up conducted over a period of one year in the Department of Gynecology and Obstetrics, Jagannath Gupta Institute of Medical College and Hospital. Following sample size calculation, a total of 1824 women were enrolled for the study of which 53 were found to have raised prolactin level (after following proper inclusion and exclusion criteria) They were subsequently further examined and followed up. Results: Majority of the subjects studied belonged to 20-29 age group (49.05%) followed by 30-39 years age group (35.85%). The most common cause of hyperprolactinaemia in our study were idiopathic (24.53%) followed by drugs (22.64%) and pituitary adenoma. Most of the patients with hyperprolactinaemia, presented with complain of infertility (56.6%), menstrual abnormality (50.94%) and galactorrhoea (18.87%) in our study. Therapeutic drugs used for various reasons were one of the main cause of hyperprolactinaemia (22.64%) and mainly due to use of proton pump inhibitor with prokinetics use. Conclusion: Hyperprolactinaemia is very much common in patients with infertility, menstrual abnormality or galactorrhoea and mostly are due to idiopathic or drug induced causes. With early initiation of treatment most of the causes and effects can be cured.

Anti-mullerian hormone as an emerging promising marker in the prognosis of PCOS

Aims: To correlation of AMH with clinical, hormonal and ultrasound findings; and determine the role of AMH as prognostic marker.
 Methods: This was a prospective cross sectional study on women attending Gynaecology outpatient department of Medial College and Hospital, Kolkata, from January 2018 to June 2019. Study comprised of 70 newly diagnosed cases of PCOS using Rotterdam criteria 2003. Clinical history included menstrual complaint, hirsutism and weight gain; examination included BMI and Ferriman-Gallwey score; and investigations included FBS, 2hr PPBS, TSH, Prolactin, total testosterone, LH, AMH level and pelvic USG before starting intervention and same parameters were rechecked after 3 months of treatment completion.
 Results: A total of 70 PCOS patients were included in a study conducted within 1 year time period. The most common Phenotype in our study is Phenotype A (O+H+P) which was almost 85.71%, followed by Phenotype B (O+H) 7.14% and the least we got Phenotype C (H+P) that is 2.86%. There was statistically significant (p<0.05) decrease in AMH level following treatment of PCOS (before treatment mean AMH level was 9.634.42 and after treatment the level was 5.812.77).
 Conclusions: The most frequent PCOS phenotype in Indian women is A (O+H+P). Therapy in PCOS women with raised AMH reduces the AMH levels. Measurement of serum AMH provides a high specificity and sensitivity by which it can act as a prognostic marker for PCOS.

Factors Associated with Knowledge Regarding Uterine Prolapse among Women Attending Gynecology Outpatient Department of Tertiary Care Teaching Hospital

Background: Uterine prolapse (UP) is a common reproductive health problem in low-mid-income countries such as Nepal. The current study aimed to explore the factors associated with knowledge regarding UP among women attending the gynecology outpatient department of tertiary care teaching hospital. Methods: A cross-sectional study was conducted among patients visiting the gynecology outpatient department of tertiary care teaching hospital in Nepal from July to September, 2016 using a purposive sampling technique. A suitably designed and validated questionnaire of knowledge consisting of 20 questions was used to determine the knowledge scores. Descriptive statistics and bivariate analysis were used; a p-value <0.05 was taken as significant in multivariate analysis.

A prospective study of incidence of cervical HPV infection & its association with aetiological factors & cervical cancer in adult women of Jamnagar

Introduction: Etiological link between cervical cancer & HPV is independent of other risk factors but their geographic variations need to be explored. Cervical cancer with profile of Sexually Transmitted Disease has consistent causal connection with persistent cervical HPV infection, so such carrier women are at High risk. Thus, study evaluate risk of HPV infection in women of Jamnagar region by exploring aetiological determinants related to their sexual life. Aim: To explore incidence of cervical HPV infection along with its association with cervical cancer as well with commonly proposed aetiological factors in adult women of Jamnagar Materials and Methods: The study was conducted in 2004 on random 110 women attending Gynecology out patient department of GG Hospital at MPSGMC Jamnagar by taking their cervical smear and administering them questionnaires about their sexual life. HPV infection was diagnosed based on cytopathic effects of HPV, by Microbiological staining techniques. Association of cervical HPV positive status of women in relation to common aetiological factors and carcinoma cervix were analyzed. Results: 10.9% of women exhibited cervical HPV infection out of them 20% belonged to higher age group (50-59 years) followed by 16.6% of young age group (20-29). 15.3% of women with HPV infection were having 6 -10 years of active married life. Accordingly 18.18% HPV infected women were multipara - bearing 3 - 4 children whereas nullipara had no HPV infection. 75% of women with carcinoma cervix were positive for cervical HPV which endorse strong causal connections. Conclusions: Study concludes that cervical HPV is prevalent in 10.9% adult women of Jamnagar region and is significantly attributable to cervical cancer. HPV positive woman have profile of sexually active life of initial years, early age at first coitus or had longer but active married life, so sexual transmission happens to be the predominant mode of HPV acquisition. Similarly, multiparity has aetiol

Profile of Cervical Smears in Andaman and Nicobar Island

Background: About one million deaths amongst world’s women population are attributed to cancer cervix every year. Pap smear is a widely accepted screening method used to detect potentially precancerous and cancerous processes in the cervix. Objective: To find out the prevalence of abnormal pap smear conditions in women attending Gynaecology out-patient department. Methods: This retrospective study was carried out in the Gynaecology unit during January 1st 2018 to December 31st 2018 on 537 pap smear samples. The data was entered in excel and was presented in percentages. Results: 43.45% had complaints of white discharge. 5.5% had epithelial cell abnormality; around 85% were negative for intraepithelial lesion or Malignancy. 4.35% of the study population had Atypical squamous cells high grade cannot be excluded ASC-H and also Adenocarcinoma. None had atypical glandular cells. Conclusion: Regular screening camps should be organized by local government and medical fraternity to benefit women to reach the whole community.

Correlation of Clinical Presentations with Endometrial Pathologies in Women Presenting with Abnormal Uterine Bleeding. A Prospective Descriptive Study

Introduction: Abnormal uterine bleeding (AUB) is one of the common presenting symptoms in women attending gynaecology outpatient department and has remained one of the most frequent indications for hysterectomy in developing countries. Endometrial sampling is used as the first diagnostic step in AUB.Objectives: To correlate the clinical presentations with endometrial pathologies in women presenting with abnormal uterine bleeding.Methodology: This was a hospital based descriptive study carried out on one hundred and nineteen women who presented with AUB and planned for endometrial biopsy. Clinical profile of the patient was recorded and the histopathology of the sampled endometrial tissue was retrieved. Correlation of abnormal uterine bleeding with histopathology report was done using appropriate statistical test.Results: The mean age of presentation of women with abnormal uterine bleeding was 46.56 yrs ± 9.525. Irregular menstrual cycle was the commonest reason seeking treatment for AUB. The commonest histopathology among women who underwent endometrial biopsy was secretory endometrium (39.5%). Other causes identified were proliferative endometrium (21.8%), mucus flakes with hemorrhage (16%), disordered proliferative endometrium (10%), pill endometrium (5%) ,endometritis (5.9%), endometrial carcinoma (1.7%),endometrial hyperplasia without atypia (1.7%).Conclusion: The nature of endometrial pathology is varied across the entire spectrum of women presenting with abnormal uterine bleeding. Knowledge of endometrial pathology helps in directing specific management and can provide better care to women presenting with abnormal uterine bleeding. BJHS 2018;3(1)5 : 354-356

A study of menopausal symptoms and its impact on lives of Nepalese perimenopausal and postmenopausal women

Background: Menopausal health has not been given any consideration till the recent years in developing countries. With the improving status of women in the society, more and more women are seeking help for their menopausal problems.Objectives: The study aimed to find out the prevalence of menopausal symptoms and its impact on life of perimenopausal and postmenopausal women attending gynecology outpatient department at Kathmandu Medical College Teaching Hospital.Methods: A hospital based cross sectional study was done at Kathmandu medical college teaching hospital among 100 perimenopausal and postmenopausal women attending gynecology outpatient department in the month of August 2016. A pretested questionnaire was administered to the women selected by convenience sampling. Data was analyzed by SPSS version 20 and presented in percentage and frequency table.Results: The mean age of the women in the study population was 49.98 years(SD±6.18) and mean age at menopause was48.02 years (SD± 2.12). Ninety four percent of the women had one or more of the menopausal symptoms. The commonest menopausal symptom was mood swings and irritability (80% and 68% respectively) followed by vasomotor symptoms like hot flashes in 42% and night sweats in 24% of the women. These symptoms interfered with the women’s daily work performances in 46% of the cases, affected family life in 28% and affected social life in 32% of the cases.Conclusion: Majority of the women have menopausal symptoms during perimenopause and postmenopausal period. These symptoms have major impact on women’s personal, social, and family lives. Journal of Kathmandu Medical CollegeVol. 6, No. 1, 2017, page: 4-8

Gender-based Violence in Women attending Gynecology Outpatient Department in a Hospital of Western Nepal: An Issue of Endurance and Invisibility

ABSTRACTIntroductionGender-based violence (GBV) is faced by many women in Nepal but health-seeking behavior is rare. A reproductive health facility may be the only place where a woman comes for a health visit. So, health care providers, especially gynecologists, play an important role to identify women suffering from GBV as they see clients suffering from the reproductive health effects of GBV on a daily basis. The purpose of this study was to find the prevalence and severity of GBV in women attending the outpatient department (OPD) and to compare their clinical diagnosis with those not facing GBV.Materials and methodsThis is a prospective study conducted at Lumbini Medical College Teaching Hospital for a period of 3 months enrolling 741 nonpregnant women attending the OPD. A structured questionnaire was used for interview to identify women facing abuse and to assess their gynecological problems.ResultsOut of 741 women, 172 faced GBV, so the prevalence was 23.21%. Emotional and physical abuse was the most common type of abuse faced by 56 (32.56%), but the severity was reported more in sexual abuse [8 (57.14%)]. Pain abdomen was the most common symptom [69 (40.12%)], and chronic pelvic pain (CPP) [60 (34.89%)] was the commonest clinical diagnosis made in these women. Chronic pelvic pain was diagnosed more in women facing abuse (p < 0.001).ConclusionIn this study, about one in four women in reproductive age group had experienced GBV. Gynecology OPD of a tertiary hospital could be used as a screening setting that can assist in early detection and prevention of GBV in Nepal.How to cite this articleAryal S, Pant SB, Baniya S. Gender-based Violence in Women attending Gynecology Outpatient Department in a Hospital of Western Nepal: An Issue of Endurance and Invisibility. J South Asian Feder Obst Gynae 2017;9(3):225-229.

Awareness about cervical cancer screening among reproductive aged women attending gynaecology outpatient department in ESI PGIMSR & ESIC medical college & Hospital, Joka, Kolkata

Background: Cervical cancer is a leading cause of morbidity and mortality in women especially India. The mainstay of prevention rests on early detection of cases through screening. So, this study aims to determine the knowledge of cervical cancer screening, Human papilloma virus & its vaccination status. Methods: This was an observational study of cross-sectional design conducted among the adult reproductive aged women (18-45 years) visiting Gynaecology OPD at ESI-PGIMSR and ESIC Medical College and Hospital, Joka. A pre-designed and pre-tested interview schedule was prepared. Face to face interview was conducted in local language. Data was compiled & computed in SPSS software version 20. Results: Total respondents were 97. Majority of the respondents (62.9%) belong to the age group of 21-30 years. 8 in 10 participants follow Hinduism. Almost equal percentages of participants were from urban & rural areas (51.5% & 48.5% respectively). 6 in 10 participants had heard about cervical cancer. Majority of the respondents (55%) mentioned friends & family as a source of information. 48.3% of the respondents knew poor genital hygiene as a predisposing risk factor for cervical cancer. Very few knew about other factors like multiple sexual partner (20%), early marriage (33.3%), young age (20%), repeated childbirth (35%), OCP usage (26.7%) as risk factors for cervical cancer. Only one participant had undergone screening test for cervical cancer (1.7%). 46.7% of the respondents were aware about association of HPV infection with cervical cancer. But none of the participants had received vaccine against cervical cancer & they cited lack of awareness as a reason for not receiving the vaccine. Conclusions: A well-designed health education program focusing on effective multipronged IEC strategies utilizing pictorials, audio-visual and personal communication on cervical cancer could yield beneficial results.

Study of Vitamin D Status among Postmenopausal Women

ABSTRACT Aims To evaluate vitamin D, serum calcium, and serum phosphorus levels in postmenopausal women attending gynecology outpatient department in Lady Goschen and Kasturba Medical College Attavar hospitals. Objective To study the prevalence of vitamin D deficiency among the studied group. To correlate vitamin D levels with diet and environmental factors. Materials and methods The study was conducted in 100 postmenopausal women attending Lady Goschen hospital and Kasturba Medical College Attavar hospital, Mangaluru. It was a hospital-based, prospective cross-sectional study conducted over the period between August 2014 and June 2016. Levels of vitamin D and serum calcium and phosphorus were assessed in them. Results A total of 11% were found to have vitamin D deficiency, 38 and 48% had insufficient levels and sufficient levels of vitamin D respectively, 53% had normal levels of serum calcium, and 47% had inadequate levels. About 70% were found to have normal levels of serum phosphorus and 24% had inadequate levels. Dietary intake was found to be inadequate in 61% of the studied population. Serum calcium and phosphorus deficiency had significant corelation with vitamin D deficiency. Also significant corelation was noted with sun exposure and dietary intake in relation to vitamin D. No corelation was established between hypertension, diabetes and vitamin D. Conclusion This study helped us to assess basal levels of vitamin D, serum calcium, and serum phosphorus among postmenopausal women, giving us an idea regarding prevalence of vitamin D deficiency among South Indian postmenopausal women. We should consider counseling all postmenopausal patients regarding the benefit of vitamin D supplementation, adequate dietary intake, and sun exposure. How to cite this article Jayakumar NP, Rao B, Shetty N. Study of Vitamin D Status among Postmenopausal Women. J South Asian Feder Menopause Soc 2017;5(1):28-34.

Knowledge, Awareness and Prevention of Cervical Cancer among Women Attending a Tertiary Care Hospital in Puducherry, India.

Cervical cancer is one of the most common cancers among women worldwide, with highest mortality in India. The incidence and mortality of cervical cancer can be reduced by screening women for precancerous lesion and by administration of human papilloma virus vaccine to adolescent girls. Knowledge of the women about cervical cancer and awareness about its prevention are the key factors that determine their utilization of screening services. A cross sectional survey of women attending Gynaecology Out-Patient Department (OPD) in a tertiary care hospital in Puducherry was conducted. Information about their knowledge of cervical cancer, awareness of its prevention and their socio demographic characters were collected. Mean age of the study population was 40.45 ± 12 years. Less than half of the study population (178, 44.5%) knew about cervical cancer. Less than one-fourth of the population knew about screening services for prevention of cervical cancer, and majority (389, 97.2%) were not aware of vaccination as prevention for cervical cancer. Our study population shows poor knowledge about cervical cancer and is unaware of the concept of prevention. Hence extensive health education to the public is needed regarding cervical cancer and its prevention.

Reproductive tract infections among women attending gynaecology outpatient department

BACKGROUND: Women often suffer silently with reproductive tract infections (RTIs) and sexually active young women are particularly susceptible to sexually transmitted Infections (STIs). The study aimed to know the prevalence of reproductive tract infections among married women attending Gynecological Outpatients Department of Tribhuvan University Teaching Hospital (TUTH), Kathmandu, Nepal. MATERIALS AND METHODS: A hospital based crosssectional design was used to investigate RTIs among women attending outpatients department of Gynae and Obstetrics, TUTH from July to November, 2006. A total of 208 samples from 104 women were examined microscopically and culture using standard microbial technique to investigate etiological agents of RTIs. Study samples were selected and examined on the basis of either having discharge or complaints of lower abdominal pain. RESULTS: A total of 208 samples collected from 104 patients were examined and 26% samples were positive for different causative agents of RTIs. Thirty percent of women reported having symptoms related to RTIs and was common in young married women. Nineteen percent had STIs. Thirteen percent had trichomonasis and 7% had gonorrhoea identified in Gram stained smears and cultures. Many women had endogenous RTIs. Bacterial vaginosis was diagnosed in 15% and vaginal candidiasis in 25% of women. CONCLUSIONS: Young married women have a high prevalence of RTIs. Education and outreach programs are needed to reduce embarrassment and lack of knowledge related to RTIs. The low socio?economic status of women appears to have influence on high rate of infections. DOI: http://dx.doi.org/10.3126/ijim.v1i1.6940Int J Infect Microbiol 2012;1(1):29-33

Screening of cervical cancer by VIA among women in Rajshahi Medical College Hospital

Objective To find out different grades of cervical intraepithelial lesions of cervix with visual inspection of cervix with acetic acid (VIA). Methods VIA was carried out in 540 eligible women attending Gynaecology Outpatient Department for gynecological problems. The women underwent a complete clinical evaluation. All screened women (540) were evaluated by colposcopy and biopsies which were taken from different quadrants of the cervix. The final diagnosis was based on histology, which allowed direct estimation of sensitivity, specificity, and predictive values of VIA and colposcopy. Those with abnormal lesions diagnosed by histology were considered as true positive. Results Out of 540 patients screened, 212 (39.27%) were VIA positive. More patients with cervical lesions were detected by VIA than colposcopy. There were 63 (11.67%) women with histologic cervical intraepithelial neoplasia (CIN I), which was found in 150 (27.78%) by VIA and 138 (25.56%) by colposcopy. VIA and colposcopy yielded high grade CIN II in the same number of patients. Biopsy proven cancer was found in 24 (4.45%) which was detected in 18 (3.33%) by VIA and colposcopy. Sensitivity and specificity of VIA were 68.50% and 70.45% respectively. Positive predictive value was 41.04% and negative predictive value was 90.85%. Conclusions VIA can differentiate a normal cervix from a precancerous cervix with reasonable accuracy. The sensitivity and specificity of VIA are comparable to the other studies. So VIA may reduce the cervical intraepithelial lesions both in urban and rural areas.

Assessment of Knowledge and Perceived Barriers to Prevention of Cervical Cancer among Women Attending Gynecology OPD at KLE's Dr Prabhakar Kore Hospital and Medical Research Center, Belgaum, Karnataka, with a View to Develop an Information Booklet

ABSTRACT Background Globally, cervical cancer is the second most common type of cancer among women leading to rise in death toll among women. Without urgent action, deaths due to cervical cancer are projected to rise by almost 25% over the next 10 years. Objectives To assess the knowledge and perceived barriers to prevention of cervical cancer among women attending gynecology outpatient department (OPD) and to find an association between knowledge and perceived barriers with sociodemographic variables. Methods This descriptive study at a tertiary care teaching hospital in India, enrolled 200 women attending gynecology OPD between 30 and 55 years. The research approach for the study was correlational and the subjects were selected by purposive sampling technique. The data on knowledge was collected using a structured knowledge questionnaire and perceived barriers by using 5 point Likert scale. Results The analysis demonstrated majority of women (65%) had an average knowledge regarding prevention of cervical cancer and their perceived barriers toward prevention of cervical cancer were neutral (70.5%). Chi-square test yielded p value < 0.05 suggesting a significant association between the sociodemographic variables with knowledge and perceived barriers. Interpretation and conclusion The study concluded that the level of knowledge among the women was average. The general attitude, even though is showing positivity, there are still women out there who have a more negative attitude toward cervical cancer and Pap smear screening and these women need to be targeted planning to start. How to cite this article Castillino RB, Raddi SA, Dalal A. Assessment of Knowledge and Perceived Barriers to Prevention of Cervical Cancer among Women Attending Gynecology OPD at KLE's Dr Prabhakar Kore Hospital and Medical Research Center, Belgaum, Karnataka, with a View to Develop an Information Booklet. J South Asian Feder Obst Gynae 2012;4(3):169-171.

Integrated care pathways: The way forward for continence services?

Objectives To assess if an integrated care pathway improves the services provided for continence care. Study design This was a prospective cohort study. At Worcester Royal Hospital, a UK district general hospital, an integrated care pathway was developed for the management of women presenting in primary care with continence problems. Sixty-five women referred through this pathway were compared to women referred directly to outpatients with similar problems. The outcomes compared were the time in days from referral to (1) the first medical contact, (2) diagnosis (3) physiotherapy/continence advisory review and (4) surgery or discharge. Statistical significance of the difference in outcomes was established using the Mann–Whitney U-test. Results The mean time from referral to first medical contact, urodynamic studies, physiotherapy/continence advisory team review and to surgery or discharge for the direct access patients compared to clinic patients was significantly less ( p < 0.05). Thirty-five percent (7/20) patients were discharged without seeing a doctor. Conclusion The implementation of integrated care pathways enables a more efficient service provision for patients with incontinence problems. Thirty-five percent of women attending gynaecology outpatient department with incontinence problems could be effectively managed by urogynaecology specialist nurses.