Introduction: It is well established that the graduating medical practitioner must have knowledge and expertise in women's health. A list of competencies has been developed for specialist training, and however, expected competencies have not been defined for undergraduate medical students in India.
Aims and objectives: To assess the competencies of the students in conducting normal delivery and common clinical tasks using various tools.
Methods: Forty-four final year medical students and 26 teachers participated in the study that was conducted over 4 months. Planned curriculum, teaching methods, and assessment plans were displayed prominently. Faculties and students were sensitized regarding assessment using multiple choice questions (MCQS), short answer questions (SAQS), objective structured clinical examination (OSCE), and direct observation of procedural skills (DOPS). Self-assessment by the students was also done in each competency.
Results: All the faculties liked the teaching-learning-assessment method > 3 on the Likert scale. Each student assisted in conducting 20–40 deliveries. Mean score in MCQ and SAQ was 63.6%, 71.7% in OSCE, and 70.7% in DOPS. Mean score in assisting normal delivery by all methods was 77%. Lower than expected score was observed in partogram interpretation (61.3%), and postpartum care (55%). Student self-assessment is lower than faculty expectations in postpartum care (34.3%), family planning services (50.3%), and newborn resuscitation and care (58.7%).
Conclusion: Students are confident in assisting normal delivery. They are less confident in partogram interpretation, neonatal resuscitation and care, postpartum care, and family planning service. Assessment using various tools and student self-assessment is important in the identification of thrust areas in curriculum planning.
Oral submucous fibrosis (OSMF) is an insidious, chronic disease affecting any part of the oral cavity and rarely pharynx. It has a high malignant transformation rate. Juxta epithelial inflammatory reaction with subsequent fibroelastic changes of lamina propria can be seen frequently with OSMF. It may cause significant abnormalities of blood such as anemia and a decline in serum iron levels. Therefore, various studies have been conducted which correlate the hemoglobin and iron serum levels in a patient suffering from OSMF. This article discusses the association between iron deficiency anemia and OSMF and how it can act as a marker for early diagnosis and prognosis of this condition.
Fanconi anemia (FA) is an infrequently occurring autosomal recessive disorder that is genetically and phenotypically heterogeneous. The main features include myriad of congenital malformations, progressive pancytopenia, and predisposition to both hematologic malignancies as well as solid tumors. Here, in this article, topics such as the association of FA with other syndromes, FA-associated genes and cancer susceptibility, researches in FA, gynecological concerns, management, and diagnostic strategies have been discussed elaborately.
Aims and objectives: Early diagnosis and management of a case of B12 and folic acid deficiency, as there is no gold standard protocol for diagnosis of this type of anemia.
Case report: A 24 years G2P1L1A0 with 32 weeks gestation presented with: Hb: 3 g%, red blood cells (RBCs: 1700 cells/ mm3, white blood cells (WBCs): 2700 cells/mm3, platelets: 80000 cells/mm3.
Ultrasound is suggestive of single live intrauterine pregnancy of 32.4 weeks, with cephalic presentation with symmetrical intrauterine growth restriction, amniotic fluid index (AFI): 7–8 cm. Obstetric Doppler suggestive of increased SD ratio in umbilical artery, reduced periodontal index (PI) in the right uterine artery.
Patient treated with 3 units of packed cell colume (PCV) with 3 doses of intravenous B12 and vitamin C injections followed by oral iron, oral B12, and folic acid.
Patient advised follow-up after 15 days.
Reports after 15 days:
Hb: 8.6 g%, RBCs: 3.07 x 1012/L, WBCs: 10.2 x 109/L, Pletlets: 33.2 x 109/L
Ultrasound is suggestive of single live intrauterine pregnancy of 33.3 weeks gestation with cephalic presentation, AFI: 8–9 cm.
Obstetric Doppler: No significant abnormality in obstetric Doppler indices in the present scan.
Conclusion: Early intervention and diagnosis of megaloblastic anemia in late pregnancy reduce significant maternal and fetal morbidity and mortality.
Anemia refers to a medical condition wherein the red blood cell count or hemoglobin is lower than normal. It is the most common disease affecting humankind and is responsible for morbidity and mortality among the general population. In men, anemia is typically defined as hemoglobin less than 13.5 g/100 mL and in women less than 12.0 g/100 mL. Dimorphic anemia is mainly caused due to two deficiencies, iron-deficiency, and nutritional macrocytic anemia. It is, therefore, iron-deficiency anemia complicated by nutritional macrocytic anemia or may be regarded as vice versa condition. Herein, I present a case of 30 years of the third gravida who had been anemic through the entire course of pregnancy even after many blood transfusions. Peripheral smear revealed dimorphic macrocytic anemia. Purpose of this study is to understand the causes, affect and treatment of dimorphic anemia.
Growing teratoma syndrome (GTS) is seen in young women following surgery for immature teratoma of the ovary. It needs management with adjuvant chemotherapy following debulking procedures for residual disease.
Aim: To highlight the complications of partial transverse vaginal septum.
Background: The transverse vaginal septum is one of the rarest anomalies of the female genital tract with an incidence of 1:70,000 women. Most often the diagnosis of the partial transverse vaginal septum is first made in labor. In an inexperienced hand, the partial transverse vaginal septum can be initially mistaken as a well effaced and partially dilated OS.
Case discussion: A 22-year-old unbooked primigravida, presented at 38 weeks in latent labor. On examination, her gestational age corresponded to term, fetus in cephalic position. Fetal heart rate 140–150/minutes. Per vaginal examination raised suspicion of the partial transverse vaginal septum as the finding was a blind pouch with 1 cm aperture and consistency of septum differed from the effaced cervix. Cervix could not be separately felt. Speculum examination revealed a transverse septum at upper one-third of the vagina with a central opening of 1–2 cm. The patient was reevaluated in active labor, and the septum felt thick, she was posted for emergency LSCS to prevent extensive vaginal lacerations or obstructed labor. Postoperative period she was reexamined and it revealed a blind pouch with a central opening, anterior lip of cervix was seen partially through the aperture. Lochia was draining through the opening. Uterus involuted in two weeks.
Conclusion: Antenatal assessment of septal thickness by trans vaginal sonography can aid in planning the mode of delivery. Women with thin transverse vaginal septum can safely undergo a trial of labor. Diagnosis of the thick partial transverse vaginal septum is necessary to prevent the patient from having extensive vaginal lacerations or obstructed labor by posting for emergency LSCS.
Aim: To report the occurrence of an adherent placenta in the absence of prior risk factors and discuss the various management options especially conservative management.
Background: Morbidly adherent placenta (MAP) refers to any placental implantation with abnormally firm adherence to myometrium. Morbid adherence of placenta has evolved into one of the most serious problems in obstetrics. The incidence has increased tenfold in the past 50 years due to the increasing number of cesarean sections and has reached seemingly epidemic proportions. The American College of Obstetricians and Gynaecologists cites the incidence to be as high as 1 in 533 deliveries.
Case report: We report a case of the placenta increta in a primigravida successfully managed by a conservative method with injection methotrexate followed by uterine artery embolization.
Conclusion: Selected cases of the morbidly adherent placenta can be successfully managed conservatively. With proper selection of cases and adequate monitoring, modern conservative techniques have made preservation of fertility possible.
Clinical significance: Only four cases of the adherent placenta in primigravida without any risk factors have been reported in the literature. Fertility preservation is a major concern in the management of these patients.