ABSTRACT
OBJECTIVE: To determine the diagnostic accuracy of visual inspection of cervix using 3% acetic acid as a screening test for early detection of cervical cancer taking histopathology as the gold standard. METHODS: The cross-sectional study was conducted at Civil Hospital Karachi from July 1 to December 31, 2012 and comprised all sexually active women aged 19-60 years. During speculum examination 3% acetic acid was applied over the cervix with the help of cotton swab. The observations were noted as positive or negative on visual inspection of the cervix after acetic acid application according to acetowhite changes. Colposcopy-guided cervical biopsy was done in patients with positive or abnormal looking cervix. Colposcopic-directed biopsy was taken as the gold standard to assess visual inspection readings. SPSS 17 was used for statistical analysis. RESULTS: There were 500 subjects with a mean age of 35.74 ± 9.64 years. Sensitivity, specifically, positive predicted value, negative predicted value of visual inspection of the cervix after acetic acid application was 93.5%, 95.8%, 76.3%, 99%, and the diagnostic accuracy was 95.6%. CONCLUSION: Visual inspection of the cervix after acetic acid application is an effective method of detecting pre-invasive phase of cervical cancer and a good alternative to cytological screening for cervical cancer in resource-poor setting like Pakistan and can reduce maternal morbidity and mortality.
Subject(s)
Acetic Acid , Carcinoma/diagnosis , Cervix Uteri/pathology , Uterine Cervical Dysplasia/diagnosis , Uterine Cervical Neoplasms/diagnosis , Adult , Biopsy , Carcinoma/pathology , Colposcopy/methods , Early Detection of Cancer/methods , Female , Health Resources , Humans , Indicators and Reagents , Middle Aged , Pakistan , Papanicolaou Test , Sensitivity and Specificity , Uterine Cervical Neoplasms/pathology , Vaginal Smears , Young Adult , Uterine Cervical Dysplasia/pathologyABSTRACT
OBJECTIVE: To determine the risk factors in pregnancies complicated with abruptio placenta METHODS: Case-control study. The study was conducted at department of Obstetrics and Gynecology Unit 3, Civil Hospital, Dow University of Health Sciences Karachi. The study period was from January to December 2008. All pregnant women who were diagnosed with abruptio placenta after 28 weeks of gestation were included in the study. They were compared with women who had live birth during the study period. This group was taken as controls. Both groups were identified from the admission, labour room registers. RESULTS: Total number of deliveries during the study period was 2610. Patients identified with abrupio placenta were 81, giving a frequency of 3.75%. Majority (44%) of women were between 26-30 years of age group. Forty three (54%) of the women were second, third or fourth gravida. The mean gestational age was 34 +/- 4.21 weeks. Forty one (51%) delivered preterm before 37 weeks and 40 (49%) delivered at or after 37 completed weeks of gestation. Vaginal delivery was the main mode of delivery, followed by Caesarean section. Vaginal bleeding was the most common clinical finding seen in 80% (68/81) women, followed by blood stained amniotic fluid in 45% (37/81). Foetal heart sounds were absent on admission in 65% (53/81). There were two maternal deaths due to postpartum haemorrhage. The perinatal mortality rate was 66% (54/81). Parity and gestational age were found to be significant risk factors for abruptio placentae (p < 0.031 and p < 0.001 respectively). CONCLUSION: Abruptio placenta is associated with poor maternal and foetal outcomes.
