Nisha Singh

Prevalence and risk factors of urinary incontinence in Indian women: A hospital-based survey

Background and Objectives: Urinary incontinence is a problem that creates both physical and psychological nuisance to a woman. This problem needs to be studied in detail in Indian population because of lack of precise data. The objectives of this study were to study the prevalence and risk factors of urinary incontinence in Indian women. Materials and Methods: This hospital-based cross-sectional study conducted from August 2005 to June 2007 included women attending gynecology OPD (consulters) and hospital employees (nonconsulters). Subjects who were incontinent were asked a standard set of questions. Incontinence was classified as urge, stress, or mixed based on symptoms. A univariate followed by multivariate analysis was done to look for risk factors. Results: Of 3000 women enrolled, 21.8% (656/3000) women were incontinent. There was no significant difference in incontinence rate between consulters and nonconsulters [618/2804 (22.1%) vs. 38/196 (19.4%); P value = 0.6). Of the total women having incontinence, highest numbers were found to have stress incontinence [73.8% (484/656)] followed by mixed [16.8% (110/656)] and urge incontinence [9.5% (62/656)]. Age more than 40 years; multiparity; postmenopausal status; body mass index more than 25; history of diabetes and asthma; and habit of taking tea, tobacco, pan, and betel are risk factors found to be associated with increased prevalence of urinary incontinence in univariate analysis. On multivariate analysis, age more than 40 years, multiparity, vaginal delivery, hysterectomy, menopause, tea and tobacco intake, and asthma were found to be significantly associated with overall incontinence. Stress incontinence was separately not associated with menopause. Urge incontinence was not associated with vaginal delivery. Conclusion: Urinary incontinence is a bothersome problem for women. Simple questionnaire can help to detect this problem and diagnose associated risk factors, so that necessary steps can be taken in its prevention and treatment.

Ruptured bicornuate uterus mimicking ectopic pregnancy: A case report.

Ruptured uterus presenting in first trimester of pregnancy is extremely uncommon and should raise the suspicion of uterine malformations. We report a case of a 24‐year‐old primigravida with 10 weeks of gestation presenting with acute abdomen and hemoperitoneum. Laparotomy revealed bicornuate uterus with ruptured rudimentary horn. The incidence, diagnosis and management of such cases is discussed.

Efficacy of concurrent administration of mifepristone and misoprostol for termination of pregnancy

Abstract In this prospective randomized parallel group study, subjects with a pregnancy of less than 63 d were randomized to receive either (i) 200 mg oral mifepristone plus 400 μg misoprostol per vaginally concurrently (group A); (ii) or the administration of misoprostol after 48 h (group B). Transvaginal sonography was performed on the 14th day of misoprostol administration to confirm complete abortion. The primary outcome was to compare the rates of complete abortion in two groups. Secondary outcomes were to compare induction abortion interval, side effects and compliance. A total of 200 subjects included in the study were randomized into groups A and B (100 each). Both the groups were comparable for age, parity, gestational age and history of previous abortion. The complete expulsion rate in group A was 96% (95% confidence interval (CI) 95.1–98.2%) and group B was 95% (95% CI 93.0–96.8%) (p > 0.100). A gestational age of more than 56 d was found to predict failure of treatment in both groups. The adverse effect profile in the two groups was the same. Efficacy of concurrent mifepristone and misoprostol in combination is similar to that when misoprostol is given 48 h later (ctri.nic.in CTRI/2010/091/001422).

Comparative study of preinvasive and invasive lesions of the cervix in HIV-positive and HIV-negative women

Background: Evidence suggests that Human Immunodeficiency Virus (HIV) infection is a risk factor for preinvasive and invasive lesions of cervix but confusion regarding pathogenesis and progression of cervical neoplasia in HIV-positive women still prevails. Aims : To find the incidence of cervical neoplasia in HIV positive and HIV-negative women and to study the impact of CD4 counts, duration of HIV infection, and treatment with highly active antiretroviral therapy (HAART) on the incidence of cervical lesions in HIV positive women. Materials and Methods : It was an observational case control study carried over a period of one year at the Department of Obstetrics and Gynaecology and Department of Medicine, King George Medical University, Lucknow. Cases were HIV-positive women and controls were HIV negative women. Those with previous diagnosis or treatment for cervical neoplasia, history of total hysterectomy or coexistent immunosuppressive conditions were excluded. All subjects had cervical screening by Pap smear. Colposcopy and cervical biopsy were done if indicated. Statistical Analysis Used : Chi square test, univariate, and multivariate analysis. Results: The incidence of cervical lesions in HIV-positive women (159.66 per 1000 screened women) was higher compared to HIV-negative women (15.15 per 1000 screened women) (P < 0.001). CD4 counts less than 500/mm 3 were associated with an increased incidence of cervical neoplasia (P < 0.00I). The incidence of cervical lesions in HIV-positive women on HAART was 16.16% as compared to 15% in HIV-positive women not on HAART. Duration of HIV infection more than 2 years was associated with an increased incidence of cervical lesions in univariate analysis (P < 0.001). Conclusions: Seropositivity is associated with an increased incidence of cervical lesions. This risk is further enhanced by CD4 counts less than 500/mm 3 and duration of HIV infection of more than two years.

Progestogens/hCG Supplementation: A Vital Role?

Once a woman is labeled as a case of recurrent pregnancy loss, every effort is made to protect her from any adversity in her next pregnancy. Among the various preventive and therapeutic steps, hormonal supplementation in the form of progestogens or hCG is widely used. Most of the women with threatened abortion are given progesterone as a tocolytic [1, 2]. Though in developing countries, there is dearth of latest reliable information on effective care, yet progesterone is commonly prescribed in India for cases of threatened abortion and recurrent miscarriage [3]. Hence, it is important to justify their use with all pros and cons. There is a definite need to discuss and ascertain the role of progestogen and hCG supplementation for continuation of pregnancy and preventing another loss.

Comparative study between liquid-based cytology & conventional Pap smear for cytological follow up of treated patients of cancer cervix

Background & objectives: Cancer cervix is one of the most common forms of genital malignancy among Indian women. Recurrence is seen in a significant number of cases. The conventional cervical smear technique has inherent problems and screening and interpretation errors. This study was undertaken to assess the efficacy of liquid-based cytology (LBC) as a method for cytological follow up and detection of recurrence in treated cases of cancer cervix and to compare it with conventional Pap smear technique to find the best screening method for detection of recurrence in these patients. Methods: This cross-sectional study was conducted over a period of one year. Patients attending Gynecology and Radiotherapy outpatient departments for follow up after treatment of cancer cervix were included. Pap smear and LBC were taken in all cases. Colposcopy and biopsy were done for those having epithelial cell abnormality in cytology report. Colposcopy and biopsy were taken as gold standard for diagnosis of cancer cervix recurrence. Results: Ninety four treated patients of carcinoma cervix were studied. The diagnostic accuracy for detection of recurrence of conventional Pap smear was 79.16 per cent, and that of LBC was 97.6 per cent. The difference between the two methods was significant (P<0.001). Interpretation & conclusions: Our findings showed that LBC performed better than the conventional method of cytology to detect recurrence of squamous cell carcinoma. Its sensitivity, specificity as well as accuracy were much higher than conventional method. LBC can be a better method of cytological follow up of post-treated patients of cancer cervix.

Role of Chromo-hysteroscopy with Toluidine Blue in Diagnosing Endometrial Pathology after 40 years of Age

Objective: To evaluate diagnostic accuracy of Chromo hysteroscopy with Toluidine Blue for endometrial pathology in women with AUB after 40 years of age. Material and Methods: This cross-sectional interventional study was conducted in 50 cases with menorrhagia, metrorrhagia, polymenorrhagia or postmenopausal bleeding. After excluding thyroid disorders, coagulation disorders and cervical & vaginal causes, diagnostic hysteroscopy was done and findings recorded. Chromohysteroscopy was done by instillation of 1% toluidine blue dye. Hysteroscopic biopsy was taken from stained area & unstained area separately followed by endometrial aspiration biopsy. The histopathological results of these three samples were compared for each participant. Results: The ability of hysteroscopy to diagnose endometrial pathology was significantly higher (p=0.013) in comparison to TVS. 24% cases showed endometrial hyperplasia/carcinoma. 75% cases of endometrial hyperplasia/ carcinoma showed >50% endometrial surface staining while only 52.63% of cases with normal HPE showed similar staining but the difference was not statistically significant. The sensitivity, NPV and diagnostic accuracy of Stained biopsy (83.3%, 95% & 96%), unstained biopsy (83.3%, 95% & 96%) and endometrial aspiration (75%, 92.6% & 94%) did not show any statistically significant difference. Conclusions: Toluidine blue dye does not specifically stain endometrial hyperplasia or endometrial carcinoma and hence is NOT a useful stain for Chromo hysteroscopy guided biopsy in diagnostic evaluation of cases of AUB.

A cohort study of vulvar cancer over a period of 10 years and review of literature

OBJECTIVE The objective of this study was to study the risk factors, management protocols, and the outcome of vulvar cancer cases over a period of 10 years in a tertiary care hospital. METHODOLOGY It is a retrospective cohort study. The hospital records of 41 patients with histologically proven vulvar cancer were studied from the Department of Obstetrics and Gynaecology and the Department of Radiotherapy (RT). The presence of risk factors, stage of disease, treatment modalities used, and disease outcomes in terms of survival were studied. The data collected were analyzed and compared with the published literature. RESULTS The mean age for the diagnosis of vulvar cancer was 52 years and the peak incidence was seen in the age group of 50-70 years. Incidence was significantly more in multiparous (P = 0.001) and postmenopausal women (P = 0.007). An average of 4.1 cases were seen per year. Nearly, 97.56% of the cases were squamous cell carcinomas. Twenty cases belonged to the early stage of the disease (Stage I and II) whereas 21 cases had advanced disease (Stage III and IV). Nearly, 48.78% of the cases were primarily treated with surgery, 26.83% with RT, 7.3% with chemotherapy, and 17.07% with combined chemoradiation. Seventy-eight percent of the surgically treated cases had a mean survival of 5 years. Mean survival of 1 year was recorded in advanced disease cases. Limitation of the study was poor follow-up after treatment. CONCLUSION Incidence of vulvar cancer is significantly high in multiparous and postmenopausal women. Conservative surgical treatment is the best option in the early stage of the disease (Stage I and II) and gives high survival rates whereas advanced disease treated with chemoradiation has a poor survival.

Innovative non-surgical management of pelvic and anterior vaginal wall abscess following vaginal surgery

Surgical site infections remain a common cause of morbidity following gynaecological surgery. The widespread implementation of antibiotic prophylaxis prior to surgery, as well as cognizance of modifiable risk factors for postoperative infection, has led to a significant reduction in postoperative infection rates. However, in low resource settings where sepsis and infections are common, surgical site infections following vaginal hysterectomy are sometimes encountered. It is a challenge to treat these infections with minimal intervention avoiding repeat surgery. We report here a unique situation following vaginal hysterectomy and then laparotomy; where a pelvic abscess communicated with the vesicovaginal space and drained through an opening into the anterior vaginal wall. An innovative technique was used to drain this anterior vaginal wall abscess connecting to pelvic cavity using a 40 cm long disposable urinary catheter (made of polyvinyl chloride), which was inserted into the vaginal opening under ultrasound guidance.

Evaluation of WHO guided pain management protocol in cases of cancer cervix

Introduction and Aims: Pain is a common debilitating symptom of cancer cervix. It occurs in 25-50% patients with newly diagnosed malignancies and in more than 75% of those with advanced disease. Yet, it is one of the most unattended problem. Henceforth, this study was planned to assess pain and to evaluate the response to pain management according to WHO step ladder protocol in cases of cancer cervix. Materials and Methods: This was a prospective cohort study that included patients of cancer cervix with pain. Patients of cancer cervix with severe systemic debilitating illness and those who had undergone major surgery in past 2 weeks were excluded from the study. The severity of pain was assessed by using visual analogue scale. Pain was managed according to WHO step ladder protocol for pain. Result: Total 61.5% patients of cancer cervix presented with pain. Success rate of WHO pain management protocol was 95.3%. Conclusion: Pain management was done effectively using WHO guided step ladder pain management protocol in 95.3% of cases. Oral Morphine is an effective drug for pain management. It is easily titratable and has a favorable benefit to risk ratio.