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Background:Certain life-threatening complications and morbidities may occur following consensual sexual intercourse which may not be commonly experienced in clinical practice. One of such complications is hypovolaemic shock resulting from profuse bleeding.AbstractMethods:Two cases of vaginal laceration complicated by hypovolaemic shock following consensual sexual intercourse are presented.Results:Both patients had resuscitation with intravenous fluid, blood transfusion and subsequent examination under anaesthesia with repair of laceration in theater. Post-operative recovery period was uneventful and they were both discharged after proper counselling. Conclusion:Bleeding from coital laceration could be life threatening. Prompt treatment should be instituted in such cases
Subject(s)
Therapeutics , Coitus , Peritonitis , Shock , Inflammatory Bowel Diseases , Morbidity , LacerationsABSTRACT
Background: The objective of the study was to study the prescribing pattern of the antibiotics in postoperative patients admitted in gynaecology and obstetrics.Methods: Current prospective observational study was conducted in the department of pharmacology, Government Medical College, Kathua in collaboration with department of gynaecology and obstetrics for a period of six months duration from 1st May 2019 to 31st October 2019. The case sheets of all post operated patients above eighteen years of age admitted were studied and analyzed.Results: Total of 1807 case sheets were analyzed and showed that 4245 antibiotics were prescribed with an average of 2.3 antibiotics prescribed. Oral cefuroxime (17.3%) was maximally prescribed in patients who delivered normal presentation with episiotomy and injection ceftriaxone along with tinidazole and gentamycin were prescribed (58.4%) where caesarean section was done. While injection ceftriaxone and sulbactum along with tinidazole and gentamycin (17.09%) was prescribed in patients who were operated for gynaecological diseases. Maximum (80%) of the antibiotics were prescribed under brand name.Conclusions: Cephalosporin’s are commonly prescribed antibiotic and in eighty percent brand names were prescribed. Results underscore that antibiotic in generic name should be encouraged.
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O aborto é um importante tema sob a perspectiva da saúde pública e permeia a prática de diversas especialidades. Enfocamos a assistência a processos de abortamento e sua relação com a formação recebida em Ginecologia e Obstetrícia (GO) e Medicina de Família e Comunidade (MFC) por residentes de duas faculdades públicas paulistas. A pesquisa seguiu a metodologia qualitativa, e a produção dos dados empíricos se norteou pela técnica de entrevista em profundidade (13 residentes). Os residentes em GO relatam pautar-se nas experiências práticas para condução dos casos de abortamento. Os residentes em MFC relatam discussões sobre o tema e suas conexões com questões de gênero. O conhecimento clínico, o desenvolvimento de habilidades e técnicas e a maior inserção da abordagem de gênero na formação se revelam fundamentais para o exercício do cuidado integral às mulheres em processo de abortamento.(AU)
Abortion is a major public health issue that cuts across various specialities. This study focused on abortion care and its relatioship with the training received in Gynecology and Obstetrics and Family and Community Medicine by residents of two public Colleges in Sao Paulo. A qualitative research design was adopted consisting of the administration of in-depth interviews with 13 residents. The obstetrics and gynaecology residents reported that they relied on practical experience to provide abortion care, while the family and community medicine residents recounted that they discussed the theme and its connection with gender isssues. Clinical knowledge, the devlopment of skills and techniques, and adopting a gender-sensitive approach in training were revealed to be vital components of comprehensive abortion care.(AU)
El aborto es un tema importante bajo la perspectiva de la salud pública y está presente en la práctica de diversas especialidades. Enfocamos la asistencia a procesos de aborto y su relación con la formación recibida en Ginecología y Obstetricia (GO) y Medicina de Familia y Comunidad (MFC), de residentes de dos facultades públicas de São Paulo. El estudio siguió la metodología cualitativa y la producción de los datos empíricos se rigió por la técnica de entrevista en profundidad (13 residentes). Los residentes de GO relatan que se rigen por las experiencias prácticas para la dirección de los casos de aborto. Los residentes de MFC relatan discusiones sobre el tema y sus vínculos con cuestiones de género. El conocimiento clínico, el desarrollo de habilidades y técnicas y la mayor inserción del abordaje de género en la formación se revelan como fundamentales para el ejercicio del cuidado integral a las mujeres en proceso de aborto.(AU)
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@#Introduction Women as patients is a normal situation. However, women patients of the obstetric and gynaecology category are of a different category. This is because obstetric and gynaecology patients will be warded in the maternity ward and labour room according to the needs of their care and treatment. The care and treatments in the maternity ward and labour room involving the care and treatments by a special team of trained medical doctors, midwives and nurses in obstetrics and gynaecology areas of expertise. Hence, the importance of scutinising the relevant laws and legislations pertaining to the protection of female patients’ rights when they are utilising the maternity ward and labour room are fundamental in determining whether such rights existing in our healthcare services pertaining to pregnant women. Healthcare laws relating to women’s healthcare and government health policy on pregnant women are scrutinised to ascertained whether the laws and policy give impact or effect to the healthcare services rendered, including scrutinising the qualification, capability and the quantity of obstetric and gynaecology doctors on whether it fulfils the requirement of the government hospitals’ maternity ward and labour room. Methods Doctrinal research method is adopted with applying the empirical approach whereby interviews and a focus group discussion were held with the O&G specialist doctors and selected medical officer and staff nurses of Maternity Hospital Kuala Lumpur. Results The finding shows that there are already in placed a policy of the Ministry of Health Malaysia outlining the women patients’ rights in maternity ward and labour room. However, there are deficiencies from the aspect of law and government policy wherein there is no specific laws in relation to pregnant patient rights nor is there a clear policy on women health. Conclusions The writing concludes that there is a need for a new policy to re-establish governance in maternity ward and to further enhance health care quality for women patients hence, to appropriately define the position of women patients’ rights in the government hospital’s maternity ward.
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Background: The alarming increase in caesarean section rates worldwide has led to a shift of focus to caesarean section rates and indications for caesarean section. The main objective of the study was to analyse the indications for caesarean section with the aim of finding viable interventions which could help decrease the caesarean rates. Methods: A retrospective study from 1st January 2017 to 31st December 2017 was conducted in which we analysed patient records of those delivering in unit III of our institute. Analysis of patient records was done and indication for caesarean was analysed. Results: A total of 496 women delivered in our unit in 2017, of these, 303 (61.09%) had a vaginal delivery and 193 (38.91%) had caesarean section. 108 patients (21.77%) had a history of at least one previous caesarean section and of these 94 (87.03%) underwent a repeat caesarean section. The primary caesarean section rate was 25.51%. Section was done for breech presentation in eleven primigravidae (5.7% of sections) and in fifteen multigravidae (7.77% of sections) including those with a previous section. Four patients had multiple pregnancy (2.04% of all sections). Eleven patients had a preterm section (5.7% of sections). Conclusion: In order to decrease caesarean rates the group that requires most focus is those in whom a primary section is being done. Few patients who have undergone at least one prior surgery are willing to take the risk inherent to a trial of labour (TOLAC). Classification and reporting of caesarean section according to the Robson ten point criteria will help in a better understanding of the indication, comparison and auditing and help to establish guidelines that can help decrease the caesarean rates.
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Background: The alarming increase in caesarean section rates worldwide has led to a shift of focus to caesarean section rates and indications for caesarean section. The main objective of the study was to analyse the indications for caesarean section with the aim of finding viable interventions which could help decrease the caesarean rates. Methods: A retrospective study from 1st January 2017 to 31st December 2017 was conducted in which we analysed patient records of those delivering in unit III of our institute. Analysis of patient records was done and indication for caesarean was analysed. Results: A total of 496 women delivered in our unit in 2017, of these, 303 (61.09%) had a vaginal delivery and 193 (38.91%) had caesarean section. 108 patients (21.77%) had a history of at least one previous caesarean section and of these 94 (87.03%) underwent a repeat caesarean section. The primary caesarean section rate was 25.51%. Section was done for breech presentation in eleven primigravidae (5.7% of sections) and in fifteen multigravidae (7.77% of sections) including those with a previous section. Four patients had multiple pregnancy (2.04% of all sections). Eleven patients had a preterm section (5.7% of sections). Conclusion: In order to decrease caesarean rates the group that requires most focus is those in whom a primary section is being done. Few patients who have undergone at least one prior surgery are willing to take the risk inherent to a trial of labour (TOLAC). Classification and reporting of caesarean section according to the Robson ten point criteria will help in a better understanding of the indication, comparison and auditing and help to establish guidelines that can help decrease the caesarean rates.
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Background and objectives Hemolysis, elevated liver enzymes and low platelets (HELLP) syndrome is a dangerous and life threatening complication in severe preeclampsia. It remains as an important cause of maternal and perinatal morbidity and mortality globally. The objective of this study was to find out the incidence of HELLP syndrome in pregnancies complicated by severe pre eclampsia and to assess the maternal and perinatal morbidity and mortality in women with HELLPsyndrome secondary to severe pre eclampsia. Methodology A one year Cross sectional study was conducted in the labour room of KLE Academy of Higher Education and Research (KAHER), Belagavi for the period of one year from January 2016 to December 2016. Ethical clearance was obtained from the JNMC Institutional Ethics committee. The primary objective was to determine the incidence of severe pre eclampsia and HELLPsyndrome in patients of severe pre eclampsia. The secondary objective was to study the associated maternal and perinatal morbidity and mortality. Results During the study period, a total of 6236 number of deliveries were conducted in the hospital. Among them, 312 (5%) pregnant women developed severe preeclampsia and 33 women developed HELLPsyndrome(10.57%). The mean age was 25.18±3.81 years. Labour was induced in 21.21% of the women. Majority (66.67%) of the women had vaginal delivery, while the rest had caesarean section (33%) . The most common indication for LSCS was HELLP 81.82%. Majority (84.85%) of the women had complications of HELLP alone while 9.09% of the women had HELLP syndrome associated with abruption. The mean birth weight was 2.27±0.69 Kgs. All cases had live births. The requirement of NICU admission was noted in 18.18% and the most common cause of NICU admission was Meconium aspiration syndrome with fetal distress (50%). The perinatal mortality rate was 16.67%. Conclusion and interpretation HELLPsyndrome is one of the rare complications of severe pre eclampsia. This study shows 5% incidence of severe preeclampsia and incidence of HELLP syndrome in pregnancy complicated by severe preeclampsia as 10.57%. The incidence in our study is high as our hospital is a tertiary care centre that receives referral cases (high risk with poor prognosis) from North Karnataka for further management.
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Background: Premenstrual syndrome is a multifactorial psychoneurendocrine disorder. Etiology of PMS is still not demarcated & research continues in this area. Role of corelates age, parity, marital, educational & occupational status of PMS is being explored in various regions. Objective: To study sociodemographic correlates of psychological symptoms of premenstrual syndrome in woman of reproductive age group. Material and Methods: Prospective observational study was carried on 247 females in the reproductive age group. The participants were given the list of 18 preliminary symptoms and asked to encircle the symptoms they suffer during later part of the menstrual cycle in any of the last 3 cycles. In participants reporting ≥3 symptoms, the psychological symptoms were analysed and their association was observed with various sociodemographic parameters (age, location- rural/urban, marital status, parity, education, occupation). Results: 155(62.57%) reported 3 or more symptoms during later part of the menstrual cycle in the last 3 cycles. 149(96.1%) females reported at least one psychological symptom. These women showed following demographic correlates. 74.5% of females belonged to 18-26 years age group. 75.8% were unmarried. 81% had no child. 87.2% were from urban area. 71.1% were senior secondary. 96% females had mental work occupation. Conclusion: On retrospective screening there was 62.57% prevalence but on prospective follow up with PMTS & daily diary prevalence was found to be only 4.05%. Most common psychological symptom reported was irritability & there was significant association of irritability with educational status, type of work & parity. Mood swings were significantly more in females doing mental work.
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Ovary is one of the common sites of neoplasm in females. They manifest in wide spectrum of clinical, morphological and histological features. Ovary is the second most common site of primary malignancy in female genital tract.
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A sebaceous cyst is a retention cyst. The classical management of scrotal sebaceous cysts is complete surgical excision and in the current era and as expected from the patient from the doctor and as the duty of the doctor, excellent outcome, minimal morbidity with good cosmetic results.
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Background: Bacterial vaginosis is a common cause of vaginal infection worldwide in women of child bearing age. It can be asymptomatic or mild infection but can lead to many complications especially during pregnancy. Recurrence is also frequently seen in women suffering from bacterial vaginosis. This infection usually occurs when normal lactobacillus flora in vagina is disrupted and replaced by pathogens. Administration of probiotics will restore normal vaginal flora and maintain normal pH and it could prove to be a reliable alternative to antibiotics in future. Objective: To assess the effect of supplementation of standard antibiotic therapy with oral probiotics (Lactobacillus) for treatment of bacterial vaginosis. Material Methods: It was an open labeled prospective study in which 100 women diagnosed with bacterial vaginosis were randomly divided into two groups. Diagnosis was made using Amsel’s criteria and Nugent scoring was done. Group A was given Oral Metronidazole, 400 mg BD for 7 days along with oral probiotic tablet containing Lactobacillus rhamnosus BD for 6 weeks whereas Group B was administered Oral Metronidazole, 400 mg BD for 7 days. Patients were assessed at 7 days for symptomatic improvement and again at the end of 6 weeks using Nugent scores. Results obtained were then compared. Results: Out of all patients 2 patients in Group A and 5 patients in Group B could not complete the study. At the end of 7 days, there was improvement in symptoms ie decrease in itching, odour and discharge. There was a significant difference in mean Nugent score before and after treatment between group A and group B at the end of 6 weeks. Conclusion: This study concluded that improvement in patients taking probiotics along with standard antibiotic therapy was significantly more as compared to antibiotics alone.
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Background: Premenstrual syndrome is a multifactorial psychoneurendocrine disorder. Etiology of PMS is still not demarcated & research continues in this area. Role of corelates age, parity, marital, educational & occupational status of PMS is being explored in various regions. Objective: To study sociodemographic correlates of psychological symptoms of premenstrual syndrome in woman of reproductive age group. Material and Methods: Prospective observational study was carried on 247 females in the reproductive age group. The participants were given the list of 18 preliminary symptoms and asked to encircle the symptoms they suffer during later part of the menstrual cycle in any of the last 3 cycles. In participants reporting ≥3 symptoms, the psychological symptoms were analysed and their association was observed with various sociodemographic parameters (age, location- rural/urban, marital status, parity, education, occupation). Results: 155(62.57%) reported 3 or more symptoms during later part of the menstrual cycle in the last 3 cycles. 149(96.1%) females reported at least one psychological symptom. These women showed following demographic correlates. 74.5% of females belonged to 18-26 years age group. 75.8% were unmarried. 81% had no child. 87.2% were from urban area. 71.1% were senior secondary. 96% females had mental work occupation. Conclusion: On retrospective screening there was 62.57% prevalence but on prospective follow up with PMTS & daily diary prevalence was found to be only 4.05%. Most common psychological symptom reported was irritability & there was significant association of irritability with educational status, type of work & parity. Mood swings were significantly more in females doing mental work.
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Ovary is one of the common sites of neoplasm in females. They manifest in wide spectrum of clinical, morphological and histological features. Ovary is the second most common site of primary malignancy in female genital tract.
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A sebaceous cyst is a retention cyst. The classical management of scrotal sebaceous cysts is complete surgical excision and in the current era and as expected from the patient from the doctor and as the duty of the doctor, excellent outcome, minimal morbidity with good cosmetic results.
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Background: Bacterial vaginosis is a common cause of vaginal infection worldwide in women of child bearing age. It can be asymptomatic or mild infection but can lead to many complications especially during pregnancy. Recurrence is also frequently seen in women suffering from bacterial vaginosis. This infection usually occurs when normal lactobacillus flora in vagina is disrupted and replaced by pathogens. Administration of probiotics will restore normal vaginal flora and maintain normal pH and it could prove to be a reliable alternative to antibiotics in future. Objective: To assess the effect of supplementation of standard antibiotic therapy with oral probiotics (Lactobacillus) for treatment of bacterial vaginosis. Material Methods: It was an open labeled prospective study in which 100 women diagnosed with bacterial vaginosis were randomly divided into two groups. Diagnosis was made using Amsel’s criteria and Nugent scoring was done. Group A was given Oral Metronidazole, 400 mg BD for 7 days along with oral probiotic tablet containing Lactobacillus rhamnosus BD for 6 weeks whereas Group B was administered Oral Metronidazole, 400 mg BD for 7 days. Patients were assessed at 7 days for symptomatic improvement and again at the end of 6 weeks using Nugent scores. Results obtained were then compared. Results: Out of all patients 2 patients in Group A and 5 patients in Group B could not complete the study. At the end of 7 days, there was improvement in symptoms ie decrease in itching, odour and discharge. There was a significant difference in mean Nugent score before and after treatment between group A and group B at the end of 6 weeks. Conclusion: This study concluded that improvement in patients taking probiotics along with standard antibiotic therapy was significantly more as compared to antibiotics alone.
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Patient with compressive cervical myelopathy sometimes present with localized girdle sensation in the mid trunk (called false localizing sign). This symptom often confuses physicians, but the clinical features and mechanism are still unclear. We present a male patient presented with localized girdle sensation in the middle trunk following fall. Later on diagnosis of compressive cervical myelopathy was made after MRI cervical spine
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Preterm birth is a leading cause of perinatal mortality and long term morbidity as well as the long term health consequences and neurodevelopmental outcome
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This paper attempts to utilise clinical scenarios where ethical issues are embedded and requires appropriate application of the steps of the framework mentioned. A step by step sequential approach is adopted to illustrate how the ‘ethical decision model ‘can be used to resolve ethical problems to arrive at a reasonable conclusion. The UNESCO ethical method of reasoning is used as the framework for decision making. Physicianeducators should be competent to use ethical decision models as well as best available scientific evidence to be able to arrive at the best decision for patient care as well as teach health professional trainees how reasonable treatment decisions can be made within the perimeter of medical law and social justice.
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Obstetrics , Education, MedicalABSTRACT
Objective To screened out items with large proportion of technical analysis in obstetrics and gynecology physical examination by using statistical parameters Kappa index and to evaluate effect and clinical significance of Kappa index based on objective data and students' and teachers' subjective feeling.Methods We made Kappa index screening with double-blind method and established the Kappa index table for teachers and students.Students were randomly divided into conventional teaching group (n =26) and teaching reform group (n =29).Students in conventional teaching group traditionally followed the teacher to carry on the practice while those in teaching reform group received training according to the numerical value index and had examination after training.We paid attention to each student's weak points,provided personalized guidance and communicated with students actively.Results We found that it was uneasy for beginners to quickly grasp four step obstetrics palpation in-spection according to Kappa index.There were statistical differences in operation of gynecological physical examination between two groups (P =0.016).Conclusions Application of Kappa index can help us screen out skills in the operation suitable for training for eight-year program medical students.With quantitative evaluation,we can improve quality of clinical practice teaching in department of obstetrics and gynecology and guide educational reform.
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In order to perfect teaching method,strengthen the teaching effect,we apply the multimedia teaching mold.We will give some positive suggestions for the optimization of the field and track teaching process for improving teaching quality.The multi-media aided-teaching should be better utilized for the requirements of teaching and learning to improve the teaching quantity.