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Background: Unhealthy cervix is a very common finding in our country due to poor genital hygiene, malnutrition and multiparity. The cervix is the commonest site for female genital cancer. Gynaecologists who work in tertiary care institutes in the developing countries to get referrals from practitioners and peripheral health centres for patients with a clinical diagnosis of an “unhealthy cervix. An “unhealthy cervix” or grossly abnormal cervix can harbour premalignant cervical lesions or invasive carcinoma. That’s why present study was planned to evaluate colposcopy role in relation to PAP smear in symptomatic patients.Methods: The present study was a prospective, analytical study. After institutional committee approval this study was conducted from January 2021 to January 2022 in department of obstetrics and gynecology at RNT Medical college, Udaipur. Total 140 women were assessed for this study.Results: Our study results based on combined cytology and colposcopy with histopathology- sensitivity =100%, specificity =87.03%, PPV=84.09%, NPV=100%, accuracy =92.30%. The result of current study supports that, PAP smear demonstrates premalignant and malignant lesions, whereas colposcopy shows the exact site for biopsy for histopathological diagnosis and for further management.Conclusions: Colposcopy and cytology are complementary to each other. Best result in early detection of pre-invasive carcinomas could be obtained by combined use of cytology, colposcopy and colposcopy guided biopsy. So, use of ‘single visit approach’ in which cytology, colposcopy and guided biopsy all are done in one setting and treated accordingly in resource poor countries will enable maximum utilization of scarce medical resources.
RESUMO
Background: Unhealthy cervix is a very common finding in our country due to poor genital hygiene, malnutrition and multiparity. The cervix is the commonest site for female genital cancer. Gynaecologists who work in tertiary care institutes in the developing countries to get referrals from practitioners and peripheral health centres for patients with a clinical diagnosis of an “unhealthy cervix. An “unhealthy cervix” or grossly abnormal cervix can harbour premalignant cervical lesions or invasive carcinoma. That’s why present study was planned to evaluate colposcopy role in relation to PAP smear in symptomatic patients.Methods: The present study was a prospective, analytical study. After institutional committee approval this study was conducted from January 2021 to January 2022 in department of obstetrics and gynecology at RNT Medical college, Udaipur. Total 140 women were assessed for this study.Results: Our study results based on combined cytology and colposcopy with histopathology- sensitivity =100%, specificity =87.03%, PPV=84.09%, NPV=100%, accuracy =92.30%. The result of current study supports that, PAP smear demonstrates premalignant and malignant lesions, whereas colposcopy shows the exact site for biopsy for histopathological diagnosis and for further management.Conclusions: Colposcopy and cytology are complementary to each other. Best result in early detection of pre-invasive carcinomas could be obtained by combined use of cytology, colposcopy and colposcopy guided biopsy. So, use of ‘single visit approach’ in which cytology, colposcopy and guided biopsy all are done in one setting and treated accordingly in resource poor countries will enable maximum utilization of scarce medical resources.
RESUMO
Background: Labor induction is one of the common interventions in obstetric practice. Assessment of cervix has been used as a predictor of the successful vaginal delivery. The traditional method of predicting whether an induced labour will result in successful vaginal delivery is based on the pre induction favourability of cervix as assessed by the Bishop score. Now we used transvaginal sonography (TVS) as an objective method of assessment of cervical length to evaluate the role of the pre-induction transvaginal ultrasonographic (TVS) cervical length in predicting labour outcome and comparing it to the Bishop score in patients undergoing induction of labour.Methods: This observational prospective study included 100 pregnant women in which induction of labour was performed at 37-42 weeks of gestation. Cervical length on transvaginal ultrasound and bishop score by digital examination is assessed prior to induction in cases according to standard protocol.Results: In our study though the sensitivity of the Bishop score in predicting the successful labour induction was higher (75.6%) compared with that of cervical length measured trans vaginally (69.35%). The specificity and positive predictive value for the cervical length (2.7 cm) was 77.78% and 91.49% compared with the Bishop score (4) 55.55% and 81.82% respectively.Conclusions: Bishop score and transvaginal cervical length both are good predictors of successful induction of labour. Transvaginal cervical length provides a better prediction of the likelihood of vaginal delivery within 24 hours of induction.
RESUMO
Background: Labor induction is one of the common interventions in obstetric practice. Assessment of cervix has been used as a predictor of the successful vaginal delivery. The traditional method of predicting whether an induced labour will result in successful vaginal delivery is based on the pre induction favourability of cervix as assessed by the Bishop score. Now we used transvaginal sonography (TVS) as an objective method of assessment of cervical length to evaluate the role of the pre-induction transvaginal ultrasonographic (TVS) cervical length in predicting labour outcome and comparing it to the Bishop score in patients undergoing induction of labour.Methods: This observational prospective study included 100 pregnant women in which induction of labour was performed at 37-42 weeks of gestation. Cervical length on transvaginal ultrasound and bishop score by digital examination is assessed prior to induction in cases according to standard protocol.Results: In our study though the sensitivity of the Bishop score in predicting the successful labour induction was higher (75.6%) compared with that of cervical length measured trans vaginally (69.35%). The specificity and positive predictive value for the cervical length (2.7 cm) was 77.78% and 91.49% compared with the Bishop score (4) 55.55% and 81.82% respectively.Conclusions: Bishop score and transvaginal cervical length both are good predictors of successful induction of labour. Transvaginal cervical length provides a better prediction of the likelihood of vaginal delivery within 24 hours of induction.
RESUMO
Background: Peripartum or obstetric hysterectomy is the removal of the corpus uteri alone or with the cervix at the time of a caesarean section or shortly after a vaginal delivery. On one hand, it is the last resort to save a woman's life and on the other hand, her reproductive capability is sacrificed. Many times it is a very difficult decision and requires good clinical judgment. Most of the time the operation is carried out when the condition of patient is too critical to withstand the risks of anesthesia or surgery, but proper timing and meticulous care may reduce or prevent maternal complications.Methods: The study is prospective study and was conducted on cases of peripartum emergency hysterectomy performed at PDZH, Udaipur, during the period from April 2021 to October 2022.Results: Our study depicts following results on the basis of 31498 deliveries during the study period (April 2021 to October 2022), so the overall incidence of peripartum hysterectomy is 1 in 1049 (0.095%). Incidence of hysterectomy following vaginal delivery found to be 0.15%, whereas following caesarean incidence found to be 0.24%.Conclusions: Increase in caesarean section rates may lead to a rise in the number of peripartum hysterectomies required in the future because of increased chances of scar dehiscence and morbidly adherent placenta and Thus, there is a need for institutions to reassess their indication for first caesarean section to decrease the incidence of caesarean sections.
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Background: Induction of labor (IOL) is one of the most frequent obstetric procedures require for various obstetrics indications in 13-20% of term. Traditionally success of induction has been determined by Bishop score, but this score is observer based and significant inter observer disagreements have been noted. Ultrasound can help obstetricians in counselling patients before induction of labour and explain the probability of successful induction. So in this study we did ultrasound assessment of foetal head-perineum distance prior to induction of labour as a predictor of successful vaginal delivery.Methods: All eligible women who are planned for induction of labour will undergo ultrasound assessment of foetal head–perineum distance prior to induction of labour. Transvaginal ultrasound will also be performed using ultrasound probe to measure cervical length. After the scans, prevaginal examination will be performed to assess the various components of modified Bishop score (min 0, max 10). If cervix is found unfavourable, induction of labour will be done. If patient did not go into active labour, then induction will be considered unsuccessful) or else oxytocin drip in cases where cervix is found favourable. The patients will be followed up till delivery.Results: Out of 125 patients enrolled for the study, 101 women delivered successfully vaginally and 24 had to undergo caesarean delivery. Of these 24 cases of caesarean delivery, 11 cases were excluded as the operative procedure was performed for indication not related to unsuccessful induction such as occurrence of foetal distress in labour, thick meconium-stained liquor with unfavourable cervix. The final analysis was performed from 114 subjects (101 vaginal births and 13 caesarean births).Conclusions: Transperineal fetal head–perineum distance is less painful as less time consuming and less acceptable by patients compare to Transvaginal measurement of cervical length and painful digital examination for bishop score.
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Background: Twin pregnancy refers to the presence of two fetuses in the uterus. The phenomenon of twinning has fascinated mankind throughout its recorded history. The major problems occurring in twin pregnancy are prematurity, Lbw, IUGR, birth trauma, birth asphyxia and congenital anomalies. The most serious risk is preterm delivery, which accounts for most of the increased perinatal mortality, neonatal morbidity, and long-term morbidity of twins.Methods: This prospective observational study included analysis of 250 women with twin pregnancies, over a period from 01st November 2021 to 31st October 2022 with 28 completed weeks of gestation, admitted at PDMC, Udaipur, Rajasthan.Results: In our study 250 twin pregnancies delivered Out of total 15209 deliveries were studied in our institute. incidence of twin pregnancy was 1.64%. The majority of study participants were in the age group 20 to 29 year and delivered between the gestation age 34-37week, multigravida was 51.2% and in primi it was 48.8%. The 4% patients underwent caesarean section and 48% delivered by vaginal delivery.Conclusions: Twin pregnancy is a great challenge to the concerned obstetricians. Complications associated with twin pregnancies cannot be prevented but can be detected early and controlled adequately by proper and prompt management. Timely diagnosis and treatment of nutritional anaemia and pre-eclampsia helps in preventing additional complications. Hence the need for better obstetric care, neonatal care, health services to get a better fruitful outcome.
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Genital myiasis is an infestation by fly larvae in genital organs, where they feed and develop as parasites. They can cause severe infection, inflammatory reaction and can be linked to psychiatric disturbances. Commonly cutaneous, ophthalmic, auricular and nasopharyngeal myiasis are seen, with genital myiasis being a rare condition. We reported a case of an 82-year-old postmenopausal female who presented with the complaint of intense pain in genital region. After clinical evaluation she was clinically diagnosed as a case of genital myiasis of prolapsed uterus. Myiasis of the genital organ is a rare clinical entity. Good personal hygiene and proper sanitary conditions are very crucial for prevention of myiasis.