Female sexual dysfunction-knowledge, attitude, practices, and barriers encountered by medical fraternity across the country: A web-based cross-sectional study.

Introduction: Sexual dysfunction in women is common yet often remains underdiagnosed due to the lack of adequate training and experience of the doctors to manage female sexual dysfunctions. This study was done to assess the knowledge and attitude of medical professionals toward female sexual dysfunction and the various practices and barriers they encounter while managing women with sexual dysfunction. Materials and Methods: A web-based cross-sectional study was done using the snowball sampling method. A well-structured, self-administered, and pre-validated questionnaire containing 27 items was administered through social media. Data was collected and evaluated to assess their knowledge, practices they follow, and barriers encountered while managing female sexual dysfunction. Results: A total of 513 doctors participated in the study. Out of all, only 11.1% of the doctors were often seeing patients with sexual dysfunction. Loss of desire (44%), painful intercourse (33%), lack of lubrication (18%), and anorgasmia (5%) are common symptoms with which women present. The majority of doctors (78.9%) were comfortable in starting a conversation, over half (52.6%) were confident in making a diagnosis, and 51.3% were confident in providing sexual counseling. Yet, only 11.1% were routinely screening women for sexual dysfunctions, and 33.8% were providing counseling regarding sexual issues. Lack of time (31.6%), lack of adequate training (57.3%), unavailability of effective treatment (11.9%), patient discomfort (60.62%), and patient's reluctance to seek treatment (15.8%) were the barriers encountered by doctors. When assessed for knowledge, around 30.9% had excellent knowledge (≥75th percentile) about female sexual dysfunction. Conclusion: Sexual dysfunction among women is an important health issue that significantly affects the social, mental, and physical well-being of those suffering from it. Screening for sexual dysfunction should be done routinely in day-to-day clinical practice to improve the overall quality of life of a couple.

Prevalence and risk factors of postpartum depression in sub-Himalayan region.

Background: Postpartum depression (PPD) is a common problem faced by women after childbirth. The adverse effects of PPD upon the maternal-infant relationship and child development reinforce the need for early identification and effective treatment models. This study intends to add to the existing knowledge about the prevalence of PPD and its associated risk factors in the hilly region in Himachal Pradesh. Methods: A hospital-based cross-sectional study was conducted on 426 women presenting for a postpartum visit at 6 weeks postpartum. Sociodemographic characteristics were recorded on a pretested questionnaire. Women were screened for postpartum depression using a validated EPDS (Edinburgh postnatal depression scale) prestructured questionnaire with 10 questions. Women were divided into two groups based on screening results. Results: The overall prevalence of PPD in the study was 17.4%. Out of sociodemographic factors, age (0.010) and family structure (0.008) were found to be significant. Nuclear family women were more prone to PPD. Domestic abuse (<0.001) is also a leading factor for PPD. By comparing obstetric and gender issues, it was found that the total number of previous living children (p-value <0.001), gender of previous living children (<0.001), and gender of newborns (<0.001) are the major determining factors of PPD. Another factor that was significantly related to PPD was an unwanted pregnancy. Conclusions: We have found a high prevalence of PPD in our region that does not have screening protocols for the screening of such patients. We, therefore, propose routine screening for postpartum depression at 6 weeks postpartum.

Comparison of Clonidine with Bupivaicaine vs Plain Bupivaicaine in Transversus Abdominis Plane (TAP) Block in Women Undergoing Cesarean Delivery Under Spinal Anesthesia: Randomized Clinical Trial.

Introduction: Transversus abdominis plane (TAP) block is a technique of regional anesthesia, introduced by Rafi in 2001. Various additives have been added to prolong the duration of effect of TAP block. We conducted this study to see if addition of clonidine to bupivacaine significantly increases the duration of effect of TAP block. Materials and Methods: This randomized, parallel group, placebo controlled double blind clinical trial was conducted on 100 healthy participants (ASAII) undergoing LSCS under Spinal anesthesia (SA) from Jan 2021 to July 2021 after consent of Institutional Ethics Committee. Women with contraindications to spinal anesthesia, allergy to any of the drugs or not-suitable for cesarean under SA were excluded. After written informed consent, eligible participants were randomly allocated into two groups using computer generated random number tables using serially numbered opaque sealed envelopes. 48 out of 50 participants in group A (Bupivacaine) were given TAP block with 20 ml of 0.25% bupivacaine bilaterally. 2 women were excluded because of conversion to General Anesthesia. Similarly, 47 out of 50 participants in Group B (Bupivacaine + Clonidine) were given TAP block with 20 ml of 0.25% bupivacaine plus 1.0 mcg/kg clonidine bilaterally after completion of surgery using 18 G Tuohy needle. Separate person used to fill the drugs for block. Participants were assessed for duration of analgesic effect of TAP block measured as the time to request for additional analgesia. Additional analgesic requirement was noted. Participants were assessed for side effects of clonidine like hypotension, bradycardia, sedation and dryness of mouth. Overall patient satisfaction was also noted. Data was analysed using Graphpad Prism 9, using Student's t-test for primary outcome and Mann-Whitney U test for secondary outcomes. Results: The mean 'duration of analgesic effect with TAP block' was 6.34 (SD1.26) hrs for 'Bupivacaine' group and 10.56 (SD2.12) hrs for 'Bupivacaine + Clonidine' group. None of the patients developed hypotension or bradycardia. 25% participants in Bupivacaine only group and 40.42% in Bupivacaine + Clonidine group were sedated (P < 0.05). 20.8% in 'Bupivacaine' group and 51.06% in 'Bupivacaine + Clonidine' group had dryness of mouth (P < 0.001). Patient satisfaction was equal in both the groups. Conclusion: Addition of clonidine to bupivacaine in the dose of 1 mcg/kg significantly increases the duration of analgesic effect of TAP block, decreases analgesic usage without significant increase in side effects.

Knowledge and Practice of Gynecologists About Tdap and Influenza Vaccination: A Cross-Sectional Study.

BACKGROUND: Infants are vulnerable to diphtheria and pertussis in their early months. In this initial period, maternally derived antibodies provide significant protection to newborns. Similarly, influenza poses a significant risk of morbidity and mortality for pregnant mothers and infants. It has been observed that, despite the evident recommendations, the uptake of these vaccines is still not optimal. METHODOLOGY: The current study was undertaken as a cross-sectional survey among the practicing gynecologists of North India voluntarily. A structured questionnaire was made available online to 300 practicing gynecologists either on their WhatsApp or email addresses. The data were compared based on urban and rural practices. A record was also made of the participants' type of practice setup, e.g., working in a primary health setting, a district hospital, or a teaching institute.  Results: Of the 148 participants who responded to the survey, 45.3% and 64.2%, respectively, administered influenza and Tdap vaccines to their patients. The main barriers cited by the respondent doctors were the non-affordability, non-availability, and non-inclusion of vaccines in the national immunization program and a lack of awareness among the practitioners (Spearman correlation 0.4; p<0.000). CONCLUSION: The results of this survey suggest that increasing awareness among gynecologists and the public and improving the availability of vaccines and their inclusion in the national program could most likely increase the practice of the recommendation or administration of the Tdap vaccine in pregnant females.

Knowledge, attitude, and practices of healthcare providers about perinatal depression in Himachal Pradesh-A cross-sectional study.

Introduction: Perinatal depression is defined as depression occurring in a woman during pregnancy or within 12 months of delivery. It has been associated with many poor outcomes, including maternal, child, and family unit challenges. This study aimed to assess the knowledge, attitude, and practices of obstetricians and primary healthcare professionals so that the knowledge gap could be assessed and they could be educated regarding the screening and treatment/referral of patients with peripartum depression. Methods: The study used a cross-sectional study design with convenience sampling. The data were collected through an online survey among healthcare providers using the Google Forms application. Submission of filled questionnaire implied consent for participation. Ethical approval for the study was obtained from the institutional ethics committee. The results were reported as mean and percentages. All data were analysed using Excel software 2019. Results: A total of 53 doctors responded to participate in the study. More than 98% of them were aware of an entity called perinatal depression. Around 89% of the participants do not screen patients for the perinatal period routinely using a screening questionnaire. About 90% of participants agreed with the need for screening for perinatal depression. Less than 50% of participants had heard about the screening questionnaire for the same. Around 89% agreed that all health professionals should have skills in recognising and managing depression. Conclusion: There is a need to educate healthcare workers including obstetricians about screening for perinatal depression, thus improving the quality of life of perinatal women and preventing complications due to untreated depression.

Incidence and Risk Factors of "Postdural Puncture Headache" in Women Undergoing Cesarean Delivery under Spinal Anesthesia with 26G Quincke Spinal Needle, Experience of Medical College in Rural Settings in India 2019: A Prospective Cohort Study Design.

Introduction: Almost every cesarean delivery is done under spinal anesthesia because of ease of doing, rapid onset, avoids maternal and fetal risk of general anesthesia, promotes early recovery. Major complication especially in young women undergoing LSCS under spinal anesthesia is post dural puncture headache (PDPH) which is caused by cerebrospinal fluid leakage. There is wide variation in reported incidence of PDPH (0.3% to 40 %) after spinal anesthesia being affected by various procedure and non procedure related risk factors like age, gender, needle size and type, numbers of spinal attempts and previous history of PDPH. Methods: Prospective cohort study was conducted in 335 patients posted for caesarean section under spinal anesthesia from January 2019 to September 2019 in medical College situated in rural India. Spinal anesthesia was given by 26 G Quincke spinal needle. All patients were evaluated for incidence and severity of PDPH from post operative day 1 to day 5. Result: Incidence of PDPH was 11.4% in this study. Majority of patients (62.5%) were having mild pain. All patients reported PDPH with 72 hours. Conclusion: Body mass index (BMI), h/o PDPH, multiple attempts for successful spinal anesthesia did not have any significant association with PDPH in our study.

The Etiology of Anemia Among Pregnant Women in the Hill State of Himachal Pradesh in North India: A Cross-Sectional Study.

Background and objective Anemia during pregnancy is a major cause of maternal and fetal complications including mortality. A study of the etiology of anemia is required to formulate guidelines for the prevention and treatment of the condition. To this end, we conducted a study among anemic women in northern India. Materials and methods A cross-sectional study was conducted among anemic antenatal women attending the outpatient department at a tertiary care hospital in Himachal Pradesh, India, involving 172 participants. Complete blood count, serum ferritin level, serum B12, serum folate levels, high-performance liquid chromatography (HPLC), liver function tests, and renal function tests were performed. Results The mean hemoglobin level among the subjects was 8.87 g/dl with a standard deviation of 0.79; 50% of women had serum ferritin levels of less than 15 ng/ml, 48.8% had serum B12 levels of less than 150 pg/ml. and 33.72% of women had serum folate levels of less than 3 ng/ml. Of note, 13.37% of women had either low or deficient levels for all three parameters; 14 women had abnormal results on HPLC. All nutrient deficiencies (ferritin, folate, and vitamin B12) were found in all morphological types of anemia. Significantly, 73.26% of iron-deficient anemic women had additional folate or vitamin B12 deficiencies, suggesting that additional methods would be required to decrease the prevalence of anemia. Two-thirds of the women in our study were vegetarians, a contributing factor towards a high percentage of vitamin B12 deficiency among women. ß-thalassemia trait was the most common abnormality found, consistent with the high prevalence of ß-thalassemia in north India. Conclusion Multiple deficiencies should be treated simultaneously in anemic women. Vitamin B12 deficiency is an important contributor to anemia, in addition to iron and folate deficiency.

Color Doppler ultrasound of spiral artery blood flow in mid first trimester (4-8 weeks) in cases of threatened abortion and in normal pregnancies.

INTRODUCTION: The aim of the study was to evaluate and compare the spiral artery flow in mid first trimester (4-8 weeks) in cases of threatened abortion and in normal pregnancies. MATERIAL AND METHODS: Spiral artery was sonographically evaluated in 50 patients comprising two groups of 25 women each. The first group included patients presenting with threatened miscarriage (vaginal bleeding/spotting with or without abdominal pain). The second group comprised of females who had no complications, but had no desire to continue the pregnancy. Spiral artery flow velocity measurements were performed using Color Doppler (Pulsatility Indices, Resistive Indices and Systolic/diastolic values) in mid first trimester (between 4-8 weeks of gestation), each measurement was performed twice. Statistical analysis was performed using Statistical package for social sciences software. Values were rounded off to two digits after decimal point. RESULTS: Significant differences were noted in the spiral artery Doppler values in the two groups. In particular, the Resistive Indices was higher in cases of women with threatened miscarriage. The difference in Pulsatility Indices was also statistically significant between the two groups. CONCLUSION: Doppler values of spiral artery may be used as a useful parameter in assessing the prognosis in cases presenting with threatened miscarriage.