Patients’ attitude and factors influencing the acceptance of medical students’ participation in pelvic examination

Introduction: Pelvic examination of patients in the department of obstetrics and gynaecology (Ob-Gyn) is an important skill for medical students. Because it involves a physical assessment of the patients' genitalia, patients may refuse medical students to participate in the examination, affecting the medical students' clinical skills. Methods: This cross-sectional study was conducted at Naresuan University Hospital to determine the factors that influence the acceptance of medical student participation in the pelvic examinations. A total of 198 out-patients from the Ob-Gyn department were included. A Likert scale questionnaire was designed which featured topics on patients’ attitudes and circumstances related to medical student involvement in gynaecological procedures. Results: The majority of outpatients (71.7%) accepted the participation of medical students in pelvic examinations. Patients with prior experiences in physical and pelvic examination by medical students had a significant impact on the patients' acceptance (P-value<0.001). The patients’ impressions had an influence on the decision to accept students in pelvic exam participation. Approximately 40% of patients were concerned about the breach of confidentiality. However, most patients strongly agreed that allowing medical students to perform pelvic examination would benefit their medical education. Conclusion: Most of the participants permitted medical students to participate in pelvic examinations and preferred that the medical instructor be the one to request permission. The patients’ impressions of medical students were crucial factors that significantly influence their decision whether to allow or deny them to participate in the procedure. Disclosure of confidentiality was found to be matters of concern to most patients.

Privacy, Self-Esteem, Anxiety in Women Having Pelvic Examination

This study aims to determine the privacy perception, self-esteem and anxiety levels of women undergoing pelvic examination and influencing factors. This web-based cross-sectional study was conducted with 415 women who underwent pelvic examination. The data were collected using a Personal Information Form, the Body Privacy Scale for Gynecology and Obstetrics, the Rosenberg Self-Esteem Scale and the State Anxiety Inventory. It was found that self-esteem ( R2 = .055, p < .0001) and state anxiety ( R2 = .037, p: .004) were significantly related to body privacy perceptions. The results of the study showed that making a statement to the women before the examination positively affected their perception of privacy. It is recommended for health professionals to be trained on the importance of privacy and communication during pelvic examination to increase their awareness on the topic.

Patients’ Perception towards General and Pelvic Examination by Male Medical Students: A Cross-sectional Study in a Multi-ethnic Population

Introduction Male medical students globally have difficulty in obtaining consent to perform pelvic examination. We sought to identify independent factors influencing women consenting to male medical students performing general and pelvic examination under supervision. Methods This cross-sectional study conducted at a tertiary hospital and a public health care centre in Johor Bahru, Malaysia recruited 369 women above 18 years old who have had sexual intercourse before and no prior hysterectomy. A validated self-administered bilingual questionnaire was used to collect data on factors that influence them consenting to male medical students examining them and performing pelvic examination when indicated. Results The respondents were largely below 30 years old (52.9%), Malays (73.4%) and Muslims (75.3%). The consent rates for general and pelvic examination were 27.4% and 18.9%, respectively. Being a Muslim, having an occupation and being introduced by a male medical specialist increased the likelihood of women consenting to general examination. However, a history of being examined by male students decreased the likelihood by 64%. Believing that male doctors should have the skills to treat patients in women's health was the only independent factor that increased the likelihood for women to consent for pelvic examination to be conducted by male medical students. Conclusion Believing that male doctors should be skilled in treating women positively influences decision to consent. Explaining earnestly to women on how they aid in developing the skills of future doctors should be prioritised. Keywords: patients’ perception; male medical students; pelvic examination

Neonatal Outcome in Patients with Meconium Stained Liquor

Objective: determine the neonatal outcome in patients with meconium stained liquor. Setting: Gynaecology Deptt, Unit-III, Jinnah Hospital, Lahore. Methodology: In this study we included a total of 150 cases with singleton pregnancy (on USG), Cephalic presentation (on USG), Gestational age 37 completed weeks to 42 weeks (calculated from LMP) with meconium stained liquor observed during labour by the attending doctor whereas those with breech presentation, they were excluded by clinical examination and ultrasound, Still birth, they were excluded by ultrasound, and Congenital fetal anomalies, they were excluded by ultrasound. Complete abdominal pelvic examination was done. The subjects were followed till delivery and neonatal outcome i.e. birth asphyxia & meconium aspiration syndrome by the researcher herself. Results: In our study, most of the patients i.e. 64.67%(n=97) were between 18-30 years of age range, mean age was 27.93+4.82 yrs while frequency of neonatal outcome in patients with meconium stained liquor reveals as 2.67%(n=4) having Birth asphyxia while 34.67%(n=52) had Meconium aspiration syndrome. Conclusion: The frequency of meconium aspiration syndrome(MAS) is higher among patients with meconium stained liquor. Keywords: Meconium stained liquor, neonatal outcome, birth asphyxia, meconium aspiration syndrome, frequency.

Diagnosis and Management of Female Paraurethral Cysts: A Tertiary Hospital Experience

Objective: To report a case series of female paraurethral cysts (FPCs) at a tertiary hospital. Materials and Methods: Sixteen proximal- and distal-FPC cases treated between 2010 and 2019 were retrospectively evaluated. Demographics, clinical presentations, diagnostic methods, treatments, and outcomes were analyzed. Results: The mean age and BMI of the 11 proximal-FPC patients were significantly higher than those of the five distal-FPC patients [55.6 versus 39.8 years (p=0.008); 27.6 versus 21.5 kg/m² (p=0.036)], respectively. Comorbidity and parity statuses did not differ. The most common presenting symptoms were palpable mass (31.3%) and lower urinary tract symptoms (LUTS) (31.3%). There were palpable masses in four distal-FPC cases (80%), significantly more than in proximal-FPC at one case (9.1%) (p=0.013). Normal urinalyses were found in all five distal-FPC cases, significantly higher than in proximal-FPC at two cases (18.2%) (p=0.005). Diagnosis was confirmed solely by pelvic examination in three distal-FPC cases (60%) with palpable masses at the distal urethra, but in only one proximal-FPC case (9.1%) (p=0.063), otherwise, translabial ultrasound, CT, MRI, or VCUG was used. Patients were managed by transvaginal excision and urethral injury occurred in six (42.9%). While the groups’ operative times, blood losses, and catheter indwelling times were similar, proximal-FPC hospital stays were longer at three versus two days (p=0.019). Disease recurrence, transient stress urinary incontinence (SUI), and urethral stricture occurred in one, two and one of proximal-FPC cases, respectively. One distal FPC developed overactive bladder. The symptom-free success rate was 64.3%. Two proximal-FPC patients had adenocarcinoma. Conclusion: The FPC patients had various presentations. Diagnosis of FPC could be made clinically by pelvic examination. Further investigative imaging might be performed in the equivocal cases to confirm the diagnosis. Transvaginal removal was the mainstay treatment. Keywords: Case series; Management; Paraurethral cyst; Skene’s gland cyst; Urethral diverticulum

CLINCIAL PRESENTATION AND ULTRASONOGRAPHIC MARKERS OF PID

INTRODUCTION: Pelvic inammatory disease (PID) comprises a spectrum of inammatory disorders of the upper female genital tract, including any combination of endometritis, salpingitis, Tubo-ovarian abscess, and pelvic peritonitis. The CDC has estimated that more than I Million women experience an episode of PID every year. Studies have reported prevalence ranging from 5.2% to 17.2% PID in various parts of India. Ultrasound:- TAS was initially used followed by use of TVS with Doppler in diagnosis of PID, although there are no large studies evaluating its sensitivity and or overall usefulness. Itis a frequentlyordered study in patients with classic symptoms of PID or who have unexplained, acute pelvic pain. MATERIAL AND METHODS:A retrospective analysis of medical records of patients with a complaint of lower abdominal pain was included in the study. Diagnosis of PID was made and patient was followed in the outdoor clinic. Pelvic examination was made. USG was done. According to symptoms and clinical examination for PID patients, the data was recorded. Medical record of 120 patients from 1 January 2020 to 31 May 2021 from a private clinic in Dist. Shivpuri were studied. RESULTS: In our study out of 120 cases, most of the patients 50.83% belonged to 26-30 years of age, a maximum number of patients were rural 83.33%. Most of the patients were educated below HSC 56.66%. Most of them 85% were married and most of them were multipara 56.66%. The most common presenting complaint was a pain in the abdomen (100%), followed by per vaginal discharge (65%), pain in the lower back (43.33%), abnormal uterine bleeding (40%), dysmenorrhoea (31.66%), dyspareunia (24.16), fever (17.5%) and others. On clinical examination abnormal PV discharge was present in 61.66% of cases, xed and retroverted uterus with or without thickend appendages were found in 55% of cases. Cervical motion tenderness was found in 78.33% of cases. Adnexal tenderness was found in 80% of cases but adnexal mass was found in 10.83% of cases. The most common nding on ultrasound scan was uid in the pouch of douglas 48.33%, followed by distal hydrosalphinx 28.33%, endometritis 18.33%, pyosalpinx 15%, TO Mass 13.33% and Pelvic collection in 10.83% of cases. CONCLUSION:The focus of this study was to identied socio-demographic characteristics of PID, to see the variety of presenting complaints and pelvic examination ndings and to correlate the clinical ndings with the USG ndings of PID. Much studies about the sensitivity & specicity of USG are not available, but this is denitely the most frequently ordered investigation in cases of PID. Transabdominal ndings of 'incomplete septa' 'cog wheel' 'beads on a strings' signs helps in distinguishing a dilated fallopian tube from other cystic adnexal masses To prevent long term sequelae PID should be the part of differential diagnosis in all patients aged 15-44 year with non specic abdominal pain.

O-006 Diagnosis debate – USG vs endoscopy

text MULLERIAN ANOMAIES – DEBATE USG OR ENDOSCOPY Mullerian duct anomalies are a complex spectrum of congenital anomalies resulting from defective fusion or canalization leading to different uterine anomalies. Early detection and proper diagnosis of uterine anomalies are paramount for proper management. Outflow obstruction defects like transvers septal defects or non canalised functional horn present early with complaint of pain while rest of patients present with amenorrhoea , infertility, repeated first-trimester abortion, fetal intrauterine growth restriction, and obstetric complications.The prevalence of uterine malformations is variable depending on the population studied , 0.4% , 4 % respectively in the general population and in infertile women while a high prevalence between 3 and 38% is reported in patients with repeated spontaneous miscarriages. Imaging plays an important role in diagnosis and treatment planning in mullerian duct anomalies. There are different imaging and endoscopic modalities that can be used for the diagnosis and confirmation of uterine malformations. All modalities are having limitations and one need to select and combine various modalities depending on the clinical presentation of patient and pelvic examination. In younger patients or acute cases, trans abdominal ultrasonography (US) is the preferred method because it is readily available, inexpensive, and rapid and does not use ionizing radiation. However it may not give the complete picture because of poor demarcation especially in fatty patient and owing to complex nature of defects , Field-of-view restrictions with US, patient body habitus, and artefact from bowel gas. Pelvic magnetic resonance imaging (MRI) is an excellent tool in the diagnosis of Mullerian duct anomalies due to high soft tissue resolution. But it is more expensive and less available. 3D ultrasound may be a valid alternative to pelvic MRI as It is less expensive and better tolerated by patients however in doubtful cases of complex nature , hysteroscopy combined with laparoscopy may be considered to confirm the diagnosis. Another advantage of endoscopy is the opportunity to correct the defect in the same sitting in most of the cases. Hysterosalpingography (HSG) and hysteroscopy are considered good modalities to assess the uterine cavity. Hysteroscopy provide the direct visualisation of the defect and considered as gold standard for cavity evaluation in doubtful cases of septate and bicornuate uterus and for simultaneous correction. However outer contour cannot be visualised so one need to use laparoscopy for complete evaluation which is a major drawback. Three-dimensional transvaginal sonography provides image quality like those provided by MRI and is being extensively used for diagnosis of all sorts of mullerian defects. it has got the advantage of realtime imaging which is helpful in distorted pelvic anatomy , visualisation of outer contour is possible ,which is considered very important to differentiate between bicornuate and septate uterus and unicornuate uterus with rudimentary horn. however it may not be possible in all cases to get a definitive diagnosis inspite of using a high end 3D machine specially in presence of artefacts , distorted contour and retroverted uterus. In such cases both modalities including MRI and endoscopy may be required to reach to a definitive diagnosis. It can be concluded that primary imaging tool is still 2d ultrasound but 3D TVS should be included in all suspected anomalies along with complete careful pelvic examination to corroborate the findings of USG. In doubt ful or complex cases, MRI should be performed particularly for cervical and vaginal atresia and septum. endoscopy should be reserved for all doubtful cases for confirmation and for acute cases where a corrective surgery can also be planned to relieve the distress.

Lateral decubitus position to facilitate pelvic examination of the patient with severe obesity

Background Patients with elevated BMI pose a number of challenges for the gynecologist. Pelvic examination may be more difficult due to adiposity in the perineum and labia, increasing the distance between the vulva and cervix. The objective of the current work was to describe use of the lateral decubitus position to improve visualization of the cervix in women with severe obesity. Methods A case series was collected. From 7/1/2010 until 1/31/2020, all records of patients with obesity and unsuccessful cervical visualization during pelvic exam in the dorsal lithotomy position in the author’s clinical practice were reviewed after obtaining Mayo Clinic Institutional Review Board approval. For the lateral decubitus position, the patient was asked to lie on her side on the exam table, facing away from the examiner with knees bent. An assistant elevated the upper bent leg 45 degrees from horizontal, exposing the perineum. A vaginal speculum was then placed in the vagina with the posterior blade toward the anus. The speculum was opened gently as would be done with examination in dorsal lithotomy position until the cervix was visualized. Results Eleven patients with severe obesity in the gynecologic practice of the author with prior unsuccessful cervical visualization in dorsal lithotomy position were examined in the lateral decubitus position. In all but one case the cervix was successfully visualized in the lateral decubitus position and all intended intrauterine procedures were successfully performed. Conclusions In this case series, the use of the lateral decubitus position appears to improve visualization of the cervix in the outpatient setting among women with severe obesity. Consideration should be given to use of the lateral decubitus position when the cervix cannot be visualized in the dorsal lithotomy position.