Cervical cancer screening by visual inspection with acetic acid--interobserver variability between nurse and physician.

OBJECTIVES: The objective of the study was to evaluate and compare the test performance of visual inspection with acetic acid (VIA) by a physician and nurse so as to evaluate the feasibility and efficacy of training a nurse in interpreting VIA. METHODS: It was a cross sectional study conducted in the colposcopy clinic at the University teaching hospital. 406 women who fulfilled the selection criteria underwent VIA done by both physician and nurse and the findings were interpreted independently. This was followed by colposcopy done by a gynecologist blinded to the results of VIA and directed biopsy was taken if indicated. The diagnostic efficacy was calculated separately for physician and nurse using threshold of cervical intraepithelial neoplasia (CIN) 2 and above and concordance of results between the physician and nurse was determined by kappa statistics. RESULTS: VIA by physician had a higher sensitivity (88.89% versus 80%) and a higher specificity (69.81% versus 54.85%) with disease threshold of CIN 2 and above. The concordance of results showed moderate agreement (kappa=0.366). CONCLUSION: Trained nurses can be an effective alternative human resource for cervical cancer screening using VIA as a preliminary screening method. Intensive training and periodic reinforcement sessions are needed so as to reduce the false positive results.

Cervical cancer screening by visual inspection with acetic acid - interobserver variability between nurse and physician.

OBJECTIVES: The objective of the study was to evaluate and compare the test performance of visual inspection with acetic acid (VIA) by a physician and nurse so as to evaluate the feasibility and efficacy of training nurses in interpreting VIA. METHODS: This cross sectional study was conducted in the colposcopy clinic at the University teaching hospital. A total of 406 women who fulfilled the selection criteria underwent VIA done by both physician and nurse and the findings were interpreted independently. This was followed by colposcopy carried out by a gynecologist blinded to the results of VIA and a directed biopsy was taken if indicated. The diagnostic efficacy was calculated separately for physician and nurse using threshold of cervical intraepithelial neoplasia (CIN) 2 and above and concordance of results between the physician and nurse was determined by kappa statistics. RESULTS: VIA by physician had a higher sensitivity (88.9% versus 80.0%) and a higher specificity (69.8% versus 54.9%) with a disease threshold of CIN 2 and above. The concordance of results showed moderate agreement (kappa=0.366). CONCLUSION: Trained nurses can be an effective alternative human resource for cervical cancer screening using VIA as a preliminary screening method. Intensive training and periodic reinforcement sessions are needed so as to reduce false positive results.

Cyclopia with shoulder dystocia leading to an obstetric catastrophe: a case report.

INTRODUCTION: Cyclopia is a rare fetal malformation characterized by a single palpebral fissure and a proboscis associated with severe brain malformations. Approximately 1.05 in 100,000 births including stillbirths are identified as cyclopean. The prevalence is about one in 11,000 to 20,000 in live births and one in 250 during embryogenesis. CASE PRESENTATION: A 30-year-old Indian woman of Asian origin, sixth gravida, was referred to the labor room of our hospital. There were no ultrasound examinations performed during this pregnancy as our patient had not received regular antenatal care. We found out that the head of her baby was already outside the vulva but the remaining parts of the baby were not yet delivered. Further examination was carried out and a diagnosis of shoulder dystocia with intrauterine fetal demise was made. A stillborn baby boy of 3.5 kg was delivered using McRoberts' maneuver. The baby was suspected of having features of cyclopia and this was later confirmed by autopsy and anatomic correlation. The mother had a cervical tear which extended into the lower segment of her uterus, thus leading to the rupture of her uterus. There was a massive broad ligament hematoma on the left side of her uterus. A total abdominal hysterectomy was carried out. CONCLUSION: Prenatal diagnosis by ultrasound examination might help in detecting cyclopia and preventing complications associated with this condition. However, in developing countries where women do not receive regular antenatal care and do not undergo prenatal diagnosis, such cases will go undetected. In our case report, the occurrence of shoulder dystocia could be coincidental, as no risk factors were previously noted.

Correlation of colposcopy using Reid colposcopic index with histopathology- a prospective study.

OBJECTIVE: To estimate the diagnostic efficacy of colposcopy & determine the strength of correlation between colposcopic impression using the Reid Colposcopic Index (RCI) and histopathology. MATERIAL AND METHODS: This was a prospective cross sectional study carried out in the colposcopy clinic at KLES Dr. Prabhakar Kore Hospital & Medical Research Centre, Belgaum from January 2008 to June 2009. A total of 268 women who fulfilled the selection criteria were included in the study. All women underwent colposcopy and a diagnosis was made based on RCI. Colposcopy directed biopsy was obtained from the abnormal areas. In cases where colposcopy did not reveal any lesion, a four quadrant biopsy from the squamocolumnar junction was taken, which served as a gold standard. RESULTS: Three women who had an unsatisfactory colposcopy & eleven women with the diagnosis of cervical cancer were excluded from the analysis. The sensitivity, specificity, positive predictive value & negative predictive value of colposcopy with CIN 1 as a disease threshold was 88.5%, 86.2%, 77% & 93.5% respectively. With CIN 2 as a disease threshold the sensitivity, specificity, positive predictive value & negative predictive value of colposcopy were 85.2%, 99.6%, 95.8% & 98.3% respectively. The degree of correlation between colposcopic impression using RCI & histopathology was high (k=0.73). CONCLUSION: Colposcopy is an indispensable tool in the diagnosis of precancerous lesions & the good correlation between colposcopic impression using RCI & histopathology makes it a reproducible technique which is easy to implement in colposcopy clinics.