NEED FOR IMPROVING THE KNOWLEDGE AND PRACTICES OF ADOLESCENT GIRLS REGARDING MENSTRUAL HYGIENE AND REPRODUCTIVE HEALTH: A STUDY FROM URBANIZED VILLAGES OF NORTH INDIA

Context: In India nearly 71% of adolescent girls have no knowledge about menstruation until menarche. Menstrual practices still face several social, cultural, and religious restrictions and discouragement of open discussion on the topic acts like a major deterrent in the path of menstrual hygiene management. Moreover, lack of knowledge and incorrect practices during menstruation can sometimes have serious health outcomes. Hence, it becomes imperative to ascertain the knowledge of adolescent girls about menstruation and reproductive health and the practices adopted by them during menstruation so that health education programs can to tailored to address the gaps. The study Aims: aims to assess the knowledge of adolescent girls and their current practices with regard to menstrual hygiene and reproductive health and study the association of these with socio-demographic variables. This cross-sectional community based Methods: descriptive study was conducted among 181 adolescent girls selected from two urbanized villages of Meerut district of India using a semi-structured questionnaire. For assessment of level of knowledge a scoring system was developed. Both descriptive and inferential statistics were used for analysis. Based on the scoring, 77.3% of our study participants had overall poor Results: knowledge about menstruation and reproductive health, nearly 20% had satisfactory knowledge and only 2.2% had good knowledge. Most participants reported using sanitary napkins during menses (80.7%) and the remaining were using clean cloth (19.3%). 100% of the participants whose mothers were illiterate had poor knowledge about menstrual hygiene and reproductive health. Participants whose mothers were engaged in semi-skilled or skilled work were more likely to have satisfactory (39.4%) or good (4.3%) knowledge scores. Overall knowledge of our study participants regarding Conclusion: menstrual hygiene and reproductive health was poor; however the practices adopted by them during menstruation were good. The two main impediments in the path of menstrual hygiene management were lack of knowledge and non availability of services at affordable cost

Comparative evaluation of intravaginal slow release Dinoprostone insert, transcervical foley’s catheter, intracervical Dinoprostone gel for induction of labor in patients with poor Bishop’s score: a randomized control study

Background: Induction of labor is indicated when the continuation of pregnancy poses risk to the mother or fetus. A variety of mechanical and pharmacologic methods are available but the best method of labor induction still remains unknown, study aimed at comparing the efficacy and safety among the two agents: transcervical Foley’s balloon catheter (FBC) and intravaginal slow release Dinoprostone E2 insert (DVI) with dinoprostone gel as control.Methods: A total of 174 patients were randomized into three groups of 58 each (Group A: dinoprostone 10 mg slow release intravaginal insert, Group B: transcervical Foley’s 16 French catheters, and Group C as control: 0.5 mg intracervical Dinoprostone gel. The safety and efficacy was compared among the groups. A p value of < 0.05 was considered statistically significant.Results: The mean insertion to active labor time (in hours) was significantly lower in Group A as compared to Group B (5.88±3.06 versus 13.56±2.8, p < 0.0001). Meantime of insertion to delivery (in hours) was significantly lower in Group A as compared to Group B (10.91±5.24 versus 21.17±2.99, p < 0.0001). The requirement of oxytocin for induction and augmentation in Group A was significantly lower as compared to Group B. Majority of the patients had normal vaginal delivery (NVD) in all the three groups. Regarding safety profile we found that slow-release DVI had more incidence of uterine tachysystole, but none of the cases had any fetal heart rate abnormality. Maternal fever was more in the FBC group, however, neonatal outcomes were comparable in both groups.Conclusions: The study concludes that slow release DVI is better in terms of efficacy as compared to transcervical FBC for induction of labor as assessed by improvement in Bishop score, insertion to active labor time and insertion to delivery time and comparable in terms of safety profile.

Recurrent decidual cast with membranous dysmenorrhea

Decidual cast is the entire sloughed endometrium that takes the form of the endometrial cavity. It causes membranous dysmenorrhea because the intact cast passes through an undiluted cervix. It may be associated with ectopic pregnancy, incomplete abortion, non-pregnant state with use of progesterone, Depot medroxyprogesterone acetate (DMPA), rarely with oral contraceptive pills. Authors are reporting a case of recurrent decidual caste formation with membranous dysmenorrhoea in 33 years old women P3L3 who was on norethisterone acetate treatment for a typical uterine bleed (AUB). She presented with heavy menstrual bleeding with severe dysmenorrhea in Gynae causality of ESI Basaidarapur medical college, Delhi. She expelled decidual caste and required therapeutic Dilation and Curettage (D and C) to control bleeding per vaginum. Her histopathology report showed marked decidua like change of the stroma but no villi suggestive of endometrial caste.

Laparoscopic Tubal Ligation in Women with Previous Pelvic or Abdominal Surgery.

Objectives: Laparoscopic tubal ligation (LTL) is a surgical procedure done on women as a permanent method of contraception and the most prevalent form of contraception worldwide. Study design: We have prospectively collected and evaluated data for 50 women with previous pelvic or abdominal surgery who underwent LTL in the family planning clinic at our tertiary care referral hospital from October 2007 to July 2009. Results: The mean age of patients was 29 years and mean parity 3.2. The most common previous pelvic or abdominal surgeries were caesarean sections followed by open appendicectomy. Omental adhesions up to abdominal wall and in the pelvis were seen in 10 (20%) patients; adhesions to the bladder were observed in 4 (8%) and perihepatic adhesions in 3 (6%) patients; flimsy peritubal and periovarian adhesions were detected in 16 (32%) patients. Conclusion: In women with previous pelvic or abdominal surgery, keeping in mind the risk of postsurgical adhesions, LTL can be performed safely with low morbidity.

Highly Aggressive Small-cell Neuroendocrine Carcinoma Cervix: A Rare Case Report.

Neuroendocrine tumors consist of a spectrum of malignancies that arise from the diffuse neuroendocrine cell system. Prognosis is dependent on histologic subtype and site of origin. The family of well-differentiated neoplasms (carcinoid and atypical carcinoid) is morphologically and clinically distinct from high-grade neuroendocrine carcinoma (small cell and large cell). This latter entity is closely related to pulmonary small-cell carcinoma, is highly aggressive and is generally managed with a multimodality approach including platinum-based chemotherapy. Neuroendocrine tumors primary to the gynecologic tract are still considered to be uncommon, with limited prospective data available to guide decision making. We are reporting a case of a highly aggressive small-cell neuroendocrine carcinoma cervix in a 38-year-old female with good initial response with chemotherapy and is under our follow-up.

Pelvic Tuberculosis Mimicking Ovarian Malignancy: A Case Report.

Tuberculosis is a global health problem, primarily seen in developing countries, where there are insufficient health services and high prevalence of human immunodeficiency virus (HIV) has further increased the burden of disease. Pelvic tuberculosis can cause ascites and an abdominal mass that may masquerade as ovarian cancer. CA125 levels are raised in peritoneal tuberculosis. CT scan and MRI also give a similar picture and diagnosis is often difficult. We are presenting an unusual case of pelvic tuberculosis being referred to us as a case of adnexal mass with ascites and raised tumor marker.

Placental Site Trophoblastic Tumor of the Uterus: A Mistaken Diagnosis.

Placental site trophoblastic tumor (PSTT) is the rarest form of Gestational Trophoblastic Neoplasia (GTN). We present this case of uterine PSTT to illustrate the difficulties in the diagnosis of this tumor and how this led to delay in its appropriate management..

A survey of obstetricians' practice of using prophylactic antibiotics in vaginal deliveries and caesarean sections.

Antibiotics are prescribed in pregnancy but only few reports provide information about the actual practice of prophylactic antibiotics usage in various obstetrical conditions amongst obstetricians. The present study evaluates the practice of obstetricians of Delhi regarding prescription of antibiotics in vaginal deliveries and caesarean sections. The open-ended predesigned questionnaire study incorporated details of the obstetricians working in different hospitals of Delhi and their practice of prescribing antibiotics in vaginal deliveries, episiotomies and caesarean sections was filled by obstetricians. The data was analysed using Student's 't' test and Chi-square test. The mean age of obstetricians was 35.5 years; 90% were females and 48.9% were postgraduate students with 70% less than 5 years experience and 77.8% were working in a government hospital. In episiotomy, 18.9% obstetricians did not use antibiotics while 33.3%, 27.8% and 20% obstetricians used ampicillin, amoxicillin and cephalexin orally for 5 days respectively. Injection cefazolin was used intravenously, 1 g 12 hourly for 3 days by 34.4% and 33.3% obstetricians in elective and emergency caesarean sections respectively, while it was used for 5 days by 35.5% and 41.1% obstetricians respectively. A combination of ampicillin, gentamicin and metronidazole for 5 days was used by 30% and 25.5% obstetricians for elective and emergency caesarean sections respectively. In spite of clear evidence from Cochrane Database of Clinical Reviews that use of penicillin or first generation cephalosporins in single dose therapy is effective; the actual practice is contrary with use of multiagent antibiotics for long periods, being very rampant in actual clinical practice.

Symptomatic Postoperative Rectus Sheath Haematomas

We retrospectively reviewed six cases of post-operative rectus sheath haematoma (RSH) managed at our institute during last six years. Out of 6 patients (mean age 27 years) who presented with RSH, four preceded caesarean section and two abdominal hysterectomy. They presented clinically as pain abdomen (n-6), shock (n-3), DIC (n-2) and fever (n-1). Haemoperitoneum was observed in 3 patients with shock and the diagnosis was confirmed at surgery. Three clinically stable patients with an infraumbilical abdominal mass were managed conservatively. One required US guided aspiration of the infected haematoma. Massive RSH is an unusual potentially life threatening condition. The diagnosis should be considered in all patients with acute post-operative pain and free fluid in the abdomen.