A Rare Case of Vault Angiofibroma

A 52-year-old female patient, para 2 live 2, who attained surgical menopause 10 years back, presented to the outpatient department (OPD) with complaints of white discharge per vagina for 6 months, which was watery in consistency and was not associated with foul smell or itching vulva. She had history of hysterectomy done for fibroid uterus 10 years back. On examination, she was afebrile and vital signs were within normal limits. Per abdomen examination, was normal, while, per speculum examination revealed a watery discharge per vaginum. The per vaginal examination revealed a firm, non-tender, globular mass felt arising from the vaginal vault and the mass did not bleed on touch. A globular mass of size 3 x 4 cms, pinkish white in colour, was seen occupying the whole of the vaginal vault with curdy white precipitates in the vaginal rugosities as well as over the mass.

Secondary vaginal atresia following caesarean section: an unreported entity

Postpartum genital tract adhesions are infrequent and exact incidence is not reported. Severe dystocia, obstructed labour and frequent pelvic examinations have been proposed as possible causes of vaginal adhesion following vaginal delivery. Atresia/adhesions of vagina following caesarean section is very rare. Here, we report a rare case of 21-year-old P1L1 woman presenting with secondary amenorrhoea associated with cyclical abdominal pain following caesarean section. Per speculum examination showed a blind vagina with no communication with the upper one-third. We created a neovagina after adhesiolysis. We hope to increase the awareness of the obstetricians around the globe about postpartum genital tract adhesion, which may even occur as a rare secondary complication of caesarean section. We also wish to bring to the light of obstetricians that numerous pelvic examinations or difficult vaginal delivery may lead to genital tract trauma, and thus, must be minimised in an attempt to prevent postpartum genital tract adhesions.

Characteristics of Pathological Fluor Albus on Outpatient in Permata Serdang Mother and Child Hospital Year 2019

Background: Based on Indonesia Ministry of Health in 2010, about 75% of woman ever had a vaginal discharge at least once in a lifetime and 45% of woman had vaginal discharge twice or more. The most common risk factor that causing pathological fluor albus is genital organ hygiene. Purposes: The objective of this study is to determine the characteristics of pathological fluor albus on outpatient in RSIA Permata Serdang in 2019. Methods: This was an observational study based on medical record samples in 74 patients with pathological fluor albus between January 2019 and December 2019. Results: From 74 patients with pathological fluor albus, the highest age range occurred 25-29 years age category (24.3%), with the most marital status was married (97.3%), and the most dominant occupation was housewife (51.4%) and mostly living in Serang (52.7%). Clinical manifestations were itching and odor (28.4%), itching (27%), itching with pain and odor (14.9%), odor (10.8%). The secret color is clear (86.5%) followed by white-coloured secret (13.5%). Physical examination have been done with speculum examination (77%). Management provided for the patients are metronidazole (86.5%) and fluconazole (13.5%). Conclusion: Pathological fluor albus at RSIA Permata Serdang occurs often aged 25-29 years in a married woman with the common characteristic complaint was itching with odor.

Characteristics of Pathological Fluor Albus on Outpatient in Permata Serdang Mother and Child Hospital Year 2019

Background: Based on Indonesia Ministry of Health in 2010, about 75% of woman ever had a vaginal discharge at least once in a lifetime and 45% of woman had vaginal discharge twice or more. The most common risk factor that causing pathological fluor albus is genital organ hygiene. Purposes: The objective of this study is to determine the characteristics of pathological fluor albus on outpatient in RSIA Permata Serdang in 2019. Methods: This was an observational study based on medical record samples in 74 patients with pathological fluor albus between January 2019 and December 2019. Results: From 74 patients with pathological fluor albus, the highest age range occurred 25-29 years age category (24.3%), with the most marital status was married (97.3%), and the most dominant occupation was housewife (51.4%) and mostly living in Serang (52.7%). Clinical manifestations were itching and odor (28.4%), itching (27%), itching with pain and odor (14.9%), odor (10.8%). The secret color is clear (86.5%) followed by white-coloured secret (13.5%). Physical examination have been done with speculum examination (77%). Management provided for the patients are metronidazole (86.5%) and fluconazole (13.5%). Conclusion: Pathological fluor albus at RSIA Permata Serdang occurs often aged 25-29 years in a married woman with the common characteristic complaint was itching with odor.

Evaluation of cervical erosion in symptomatic women

Background: The objective of this study was evaluation of symptomatic women with cervical erosion.Methods: Prospective clinical study done in the department of obstetrics and gynecology, VIMS, Ballari for one-year period from June 2016 to May 2017. All patients with symptoms of white discharge, post coital bleeding and menstrual irregularities were examined by per speculum examination and all those who had cervical erosion (112 Patients) were included in the study. Pap smear and colposcopy were done in all subjects. Colposcopic guided biopsy was done in women with abnormal findings on colposcopy. Histological prediction of colposcopic findings was done according to the Reid’s modified colposcopic index. The result of the biopsy was correlated with the predicted histology of the Reid’s modified colposcopic index and statistical analysis done to calculate diagnostic efficacy of colposcopy in the evaluation of symptomatic women with cervical erosion.Results: Out of the 112 patients, 5.35% (6/112) had abnormal Pap smear. All patients underwent colposcopy and colposcopic guided biopsy, 11.6% (13/112) had abnormal colposcopic findings. Histopathology confirmed CIN I in 6.25% (7/112) and CIN II in 1.78% (2/112) patients. The sensitivity, specificity, PPV, NPV and accuracy of PAP smear was found to be 22.22%, 96.11%, 33.33%, 93.39% and 90.17%. The above values for colposcopy were found to be 88.89%, 95.15%, 61.54%, 98.99% and 94.64%.Conclusions: Colposcopy should be done in all symptomatic patients with cervical erosion as it is a good diagnostic tool for premalignant conditions of the cervix and correlates well with histopathological findings.

Self-Collection for Cervical Screening Programs: From Research to Reality

In 2018, there were an estimated 570,000 new cases of cervical cancer globally, with most of them occurring in women who either had no access to cervical screening, or had not participated in screening in regions where programs are available. Where programs are in place, a major barrier for women across many cultures has been the requirement to undergo a speculum examination. With the emergence of HPV-based primary screening, the option of self-collection (where the woman takes the sample from the vagina herself) may overcome this barrier, given that such samples when tested using a PCR-based HPV assay have similar sensitivity for the detection of cervical pre-cancers as practitioner-collected cervical specimens. Other advantages of HPV-based screening using self-collection, beyond the increase in acceptability to women, include scalability, efficiency, and high negative predictive value, allowing for long intervals between negative tests. Self-collection will be a key strategy for the successful scale up of cervical screening programs globally in response to the WHO call for all countries to work towards the elimination of cervical cancer as a public health problem. This review will examine self-collection for HPV-based cervical screening including the collection devices, assays and possible routine laboratory processes considering how they can be utilized in cervical screening programs.

Peritoneovaginal Fistula and Appendicitis-Related Pelvic Abscess in Pregnancy

Appendicitis in pregnancy is the most common nonobstetric surgical emergency. Pregnancy causes changes in anatomy, which could lead to uncertainty regarding the diagnosis of appendicitis. This case report describes a case of appendicitis presenting with peritoneovaginal fistula in a pregnant woman in the second trimester, with interesting finding of isolated appendiceal endometriosis on pathology. The importance of complete physical examination, including speculum examination, is emphasized in the pregnant patient presenting with acute-onset abdominal pain. Imaging criteria for diagnosis of appendicitis should be adjusted to account for the gravid uterus, which may cause appendiceal abscess to appear in a variety of locations, such as posterior to the cervix, as in this case.