RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, …



RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

BANGALORE, KARNATAKA

Synopsis of Dissertation

“A PROFILE OF GYNAECOLOGICAL PROBLEMS

OF ADOLESCENT GIRLS”

Submitted by:

Dr. JYOTIRMOY HAJRA, MBBS

Postgraduate Student in Obstetrics and Gynaecology

[pic]

Department of Obstetrics and Gynaecology

Adichunchanagiri Institute of Medical Sciences,

B.G. Nagar, Nagamangala Taluk, Mandya District -571 448

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

BANGALORE, KARNATAKA

ANNEXURE II

PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

| | | |

|1 |NAME OF THE CANDIDATE |Dr. JYOTIRMOY HAJRA |

| |AND ADDRESS |POSTGRADUATE STUDENT IN OBSTETRICS AND GYNAECOLOGY, |

| |(in block letters) |ADICHUNCHANAGIRI INSTITUTE OF |

| | |MEDICAL SCIENCES, B.G.NAGARA, |

| | |MANDYA DISTRICT – 571448. |

|2. |NAME OF THE INSTITUTION |ADICHUNCHANAGIRI INSTITUTE OF MEDICAL SCIENCES, B.G.NAGARA |

|3. |COURSE OF STUDY AND SUBJECT |M.S. IN OBSTETRICS & GYNAECOLOGY |

|4. |DATE OF ADMISSION TO COURSE |1ST JUNE 2007 |

| | |“A PROFILE OF GYNAECOLOGICAL PROBLEMS |

|5. |TITLE OF THE TOPIC |OF ADOLESCENT GIRLS” |

| | |

|6. |BRIEF RESUME OF INTENDED WORK |

| |6.1 NEED FOR THE STUDY |

| | |

| |Adolescence is the most vital period of growth. This is the age group when a girl child grows into an adult woman. It’s a period of dynamic change. In India very |

| |little attention is given to the specific needs of the adolescent girls, who comprise 22% of the female population. Patients in this age group seek gynaecological|

| |services for many specific problems that demand empathetic and professional care. Moreover, data is also lacking regarding the exact magnitude of the |

| |gynaecological problems of adolescents, as studies conducted in this field have been very few. A few studies that have been done have not covered all the |

| |gynaecological problems and their correlation with various psychological, cultural and environmental factors. The present study aims to assess the magnitude and |

| |variety of gynaecological problems in this region, so that effective guidelines can be set regarding clear-cut management protocols for this special group of |

| |patients. |

| | |

|6.2 |REVIEW OF LITERATURE |

| | |

| |Adolescence is the time period between 10 and 19 years of age (1), (2), (22), (23) during which, along with physiological changes, psychological and |

| |socio-behavioural changes also occur. It is imperative to have a thorough knowledge of the normal changes occurring in this age-group, as also of the |

| |demographic pattern of distribution and prevalence of specific gynaecological problems in order to offer quality medical/surgical services to this group of |

| |patients. |

| | |

| |Timing of pubertal changes are influenced by many factors including general health, nutrition, exercise, genetic influences and socio-economic conditions (3).|

| | |

| |The major changes are appearance of secondary sex characters and also those due to the maturation of reproductive system (4) |

| | |

| |(a) Thelarche and Puberche (Breast and hair development): |

| |Breast development is one of the first secondary sexual characteristics to be noticed. One useful tool used for measuring this is Tanner Sexual maturity |

| |Rating (SMR) Scale (4). Normal puberty involves a fairly regular sequence of events between the ages of 10 and 16 years and abnormal puberty can be defined as|

| |any disturbance in this.(5) |

| | |

| |(b) Menarche: |

| |Menarche usually occurs between SMR 3 and 4. The chronological onset of menarche may range from 10 to 16.5 years (4). |

| | |

| |The various gynaecological disorders in adolescents are as follows: |

| |Menstrual Problems: |

| |Dysmenorrhoea: |

| |Dysmenorrhoea is the most common gynaecological problem occurring in about 52% of post pubescent women with 10% of them missing school regularly because of |

| |this problem. |

| | |

| |Premenstrual Syndrome: |

| |The premenstrual syndrome is a group of interrelated symptom-complexes with different pathophysiologic mechanisms (5). In a survey of 207 adolescents, |

| |however, 89% reported at least one PMS symptom that the teens considered moderately severe, 59% reported at least one symptom considered severe, and 43% |

| |reported at least one symptom considered extreme. (6) |

| | |

| |Abnormal uterine bleeding: |

| |Abnormal uterine bleeding is a relatively common menstrual problem during adolescence. Menorrhagia is a frequent presentation. In a study group 74% of |

| |adolescents with bleeding sufficient to require hospitalization did not have any organic pathology. (7). Among the rest, 19% were secondary to coagulopathies |

| |and 7% included pregnancy complications, OCP use etc. Polymenorrhoea or too frequently occurring periods cause great inconvenience for the girls in this age |

| |group and hampers with social and academic performance. |

| | |

| | |

| |Amenorrhoea: |

| |The incidence of primary amenorrhoea has been reported to range from 0.65% to 83.3% in different series (8) (9) in the adolescents. |

| | |

| |Leucorrhoea: |

| |This is frequent and embarrassing problem especially in low socio-economic population. Infection is the most likely cause and vaginitis is more commonly |

| |diagnosed than that caused by physiologically excess discharge. Increased levels of endogenous estrogen lead to marked overgrowth of the endocervical |

| |epithelium which may encroach outward, and produce ectocervical erosion leading to excess discharge. (10) |

| | |

| |Ovarian Tumours in Adolescents: |

| |Ovarian tumour in childhood and adolescence rare, accounting for approximately 1% of all malignant neoplasms found in the age group 0-17 years (11). In a |

| |review literature, ovarian tumours in the 0-20 year’s age group comprised 6% of all ovarian tumours (12). |

| | |

| | |

| |Benign Lesions of Vulva and vagina: |

| |Different benign lesions of vulva and vagina also presents in this age group, such as cysts: Gartner’s and Paraurethral, Inclusion cysts and Paramesonephric |

| |cysts; and Polyps. |

| | |

| | |

| |Malignant tumors of Vulva and Vagina: |

| |Malignant tumors of Vulva are rare and most of them are sarcomas. A report describes the first known case of Endodermal sinus Tumour of the vulva in a 14 year|

| |old girl whose uterus, tubes and ovaries were normal (13). Malignant tumours comprise carcinoma of Vagina and sarcoma of Vagina. |

| | |

| | |

| |Benign tumours of Uterus and cervix: |

| |These lesions are rare in adolescents. Benign papillomas of cervix (14) have been reported. A cervical leiomyoma was reported by Snyder in 1976. Uterine |

| |leiomyoma also have been reported (14). |

| | |

| | |

| |Malignant Tumors of Uterus and Cervix: |

| |Carcinoma Of Cervix: |

| |Carcinoma of cervix is rare in this age group, and when it occurs, it is often glandular or adenomatus. In most reported cases, the lesions were invasive at |

| |the time of detection (13). However, with the age of initial intercourse having decreased, squamous cell carcinoma may become more prevalent in future. This |

| |has been reflected in the number of intraepithelial neoplasms found in young adolescents (15) |

| | |

| |Carcinoma of body of uterus: |

| |The world’s literature contains less than 10 cases of this lesion (14). |

| | |

| |Pelvic Inflammatory Disease: |

| |The incidence of Pelvic Inflammatory Disease is on the rise. Acute salpingitis has been reported as 20 per 1000 in association with STDs, Multiple or |

| |frequently changed partners, Inrauterine device use, and probably poor socioeconomic factor. The use of condoms, diaphraghm, Spermicidals and OCPs has |

| |increased the chance of PID. The topic of IUD-use and upper genital tract infection has recently been reviewed in some literatures. |

| | |

| |Vulvo-vaginitis: |

| |In recent years, with increasing and earlier onset of sexual activity, STDs, Vulvovaginitis and pregnancies have become common problems (16). The adolescents |

| |tend to have herpetic vulvovaginitis and more than one STDs at one time. Current leading causes of vaginal discharge are Hemophilus Vaginalis Vaginitis, |

| |endocervicitis (Chlamydia, Gonnorrhoea, Trichomonas), Herpetic Ulcer, Candida-vaginitis and Trichomonal vaginitis. |

| | |

| |Foreign Bodies: |

| |In adolescents, the most common foreign body is a forgotten tampon. A patient may use paraffin candle, electric vibrators etc for masturbation. |

| | |

| |Vulval Skin Diseases: |

| |Generalized skin diseases have a vulval expression, since this area is exposed to warmth, moisture, maceration and secondary infection due to scratching. |

| |Seborrhic dermatitis and Condylomas may involve vulva. |

| | |

| |Breast problems: |

| |Breast problems of teenagers remain an often neglected aspect of adolescent care. All growing female children develop some concern about their changing |

| |bodies, particularly with reference to their breasts. Congenital anomalies like polythelia, polymastia; inverted nipples, breast asymmetry, mammary |

| |hyperplasia, atrophy of the breasts and benign lesions of the breast are commonly observed. Carcinoma of the breasts is very rare in adolescents, although it |

| |should be kept in mind when an adolescent presents with a suspicious breast lesion (17). Infection of the breasts, non-lactational mastitis, Mondor’s disease,|

| |duct ectasia, galactorrhoea and premature breast development comprise the other forms of presentation. |

| | |

| |Premarital sex: |

| |With the advent of globalization, the topics of premarital and adolescent sexuality deserve special consideration. Earlier age at first intercourse is |

| |experiencing an increasing trend. As a consequence, sexually transmitted diseases and failed contraception have increasingly being encountered in |

| |gynaecological practices. |

| | |

| |Adolescent pregnancy: |

| |This is a common problem of developing countries like India. Enough data is currently lacking to measure the exact extent of this problem in our country, |

| |where this is a prevalent practice among the uneducated and low socio-economic population. In the US at least 75% of adolescent pregnancies are unintended |

| |(18), one half of which ends in abortion (19). |

| | |

| |Approximately one in three young women will experience a pregnancy before 20 years of age (20). In a study recently conducted in Banaras Hindu University |

| |Institute of Medical science, teenage pregnancy was found to be associated with a significantly higher risk of PIH, PET, and eclampsia, premature onset of |

| |labor, fetal deaths and premature delivery. Increased neonatal morbidity and mortality were also seen in babies delivered to teenage mothers. Younger teenager|

| |group (< 17 years) was most vulnerable to adverse obstetric and neonatal outcomes (21). |

| | |

|6.3 |OBJECTIVES OF THE STUDY |

| | |

| |The main objective of this study is to identify presence of the gynaecological problems in adolescent girls in this part of Karnataka. |

| | |

| |To study the extent or enormity of the problems of adolescent girls of rural Karnataka, as this institution is the only one in Karnataka that caters the |

| |health care needs of the rural population. |

| | |

| |To analyze the relationship of the gynaecological problems to the socio-economic, psychological, cultural and environmental factors. |

| | |

|7 |MATERIALS AND METHODS |

| | |

|7.1 |Source of Data : |

| |The study involves all adolescent girls aged 10 to 19 years with gynaecological problems attending the outpatient department of Obstetric and Gynaecology, Sri|

| |Adichunchanagiri Hospital and Research Centre, BG Nagara, including those getting admitted for treatment and/or investigations. |

| | |

|7.2 |Method of Collection of Data : (Including the Sampling Procedure if any) |

| |The proposed study will be conducted at Sri Adichunchanagiri Hospital and Research centre, BG Nagara from December 2007 onwards. Data will be collected by: |

| |Detailed history taking, including socio-economic, cultural and environmental history. |

| |General physical examination. |

| |Systemic examination. |

| |Gynaecological examination. |

| |Obstetrical examination. |

| |Baseline and Special investigations. |

| | |

| | |

| | |

| | |

| | |

| | |

| | |

| | |

| | |

| | |

| |Inclusion Criteria : |

| |All women aged between 10 and 19 years presenting with gynaecological problems. |

| | |

| | |

| | |

| |Exclusion Criteria : |

| |Women aged less than 10 years or more than 19 years. |

| | |

| | |Routine and special investigations to arrive at a correct diagnosis, without affecting the |

| | |management of the patient. This is not an interventional study. |

| | | |

| | | |

| | | |

|7.3 |Does the study require any investigations or interventions to | |

| |be conducted on patients, if so please describe briefly | |

| | | |

| | | |

| | | |

| | | |

| | |NA |

| | | |

| | | |

| | | |

| | | |

| | | |

| | | |

|7.4 |Has the ethical clearance been obtained from your institution | |

| |in case of 7.3 | |

| | | |

| | | |

| | | |

| | | |

| | | |

| | | |

| | | |

| | |

|8. |LIST OF REFERENCES |

| |(1)World health Organization; 1998: Proceedings of the WHO South Asia Conference on Adolescence. |

| |(2) World Health Organization, Internet: Website of DEPARTMENT OF CHILD AND ADOLESCENT HEALTH AND DEVELOPMENT; () |

| |Accessed November 9, 2007 |

| |(3) Rees M, Menarche when and why? Lancet 342: 1375-1376, 1993 |

| |(4) Marshall WA, Tanner JM. Variations in patterns of pubertal changes in girls; Arch Dis Child 1969;44:291-303 |

| |(5) Adam Balen, Disorders of puberty. In: Shaw RW, Soutter WP, Stanton LS; Gynaecology. Philadelphia: Churchill Livingstone, 2003:215 |

| |(5) Chakmakijan ZH: A critical assessment of therapy for the premenstrual tension syndrome. J. Reprod. Med. 28:532-538, 1983 |

| |(6) Fisher M, Trieller K, Napelitano B: Premenstrual Syndrome in Adolescents; Journal of Adolescent Health Care; 10:369-375, 1989 |

| |(7) Claessens EA, Cowell CA: Acute Adolescent Menorrhagia; American Journal of Obstetrics and Gynaecology; 139:277-228, 1981 |

| |(8) Radhwanska E, Dwyer GM: Journal of Obs. Gynaec, British Commonwealth; 81:107; 1974 |

| |(9) Goswami S, Dutta R, Sengupta S, A profile of adolescent girls with gynaecological problems; Journal of Obstetrics and gynaecology of India; 55:4:353-355 |

| |(10) Datta DC, Konar H, Textbook of Gynaecology; Kolkata, India: Central, 2007:504 |

| |(11) Acosta a, Kaplan A, Kauffman R: Gynecolocic cancer in children; Am J. Obstet. Gynecol; 112:944, 1972 |

| |(12) Norris H, Jensen R: Relative frequency of ovarian neoplasm in children and adolescents: Cancer; 30:713; 1972 |

| |(13) Beller FK et al.: Endodermal germ cell carcinoma in infant girls. J. Cancer Res. Clin. Oncol. 3:94, 1979 |

| |(14) Huffman JW: The Gynaecology of Childhood and Adolescence; Philadelphia, Saunders, 1968 |

| |(15) Synder RN et al. Dysplasia and carcinoma in situ of the uterus in very young women; Am J Obstet. Gynaecol.; 124: 751-756; 1976 |

| |(16) Altcheck A: Adolescent Vulvovaginitis, Pediatr. Clin. Of North Am.; 19:735, 1972 |

| |(17) Dudgeon BL: Pediatric breast lesions: take the conservative approach; Contemporary paediatrics; 2:61-73;1985 |

| |(18) Henshaw SK.: Unintended pregnancy in the United States. Family planning perspectives: 30:24-29;1998 |

| |(19) Teen sex and pregnancy (fact-sheet) New York: The Alan Guttmatter Institute; 1999 |

| |(20) National campaign to Prevent Teenage Pregnancy. Fact sheet: available at: ; February |

| |2004; Accessed November 29, 2004 |

| |(21) Kumar A, Singh T, Basu S, Pandey S, Bhargava V: Outcome of teenage pregnancy; Indian Journal of Pediatrics: 74.10:927-931; 2007 |

| |(22) World Health Organization: Young people’s health – a challenge for society: Report of a Study Group on Young People and Health for All by the Year 2000, |

| |Technical Report Series, No. 731. Geneva: World Health Organization, 1986. Available at: ; (Accessed September 8, |

| |2003). |

| |(23) American Academy of Paediatrics: Council on Child and Adolescent Health. Age limits of paediatrics. Paediatrics; 81:736; 1988 |

|9. |SIGNATURE OF THE CANDIDATE | |

|10. |REMARKS OF THE GUIDE | |

| | |The number of adolescent girls attending gynaecological clinic is increasing all over the |

| | |world. This study is going to give an insight into the problems faced by them. As this |

| | |institution is a rural-based institition, it may be interesting to know the variety, profile |

| | |and enormity of the gynaecological problems of the adolescents. |

|11. | | |

| |NAME & DESIGNATION OF |Prof. Dr. NAGALAKSHMI BHTTACHARYYA, |

| |(IN BLOCK LETTERS) |MBBS, DGO, MD |

| | |PROFESSOR, |

| |11.1 GUIDE |DEPARTMENT OF O.B.G., |

| | |A.I.M.S., B.G.NAGARA. |

| |11.2 SIGNATURE | |

| | | |

| | | |

| | | |

| | | |

| |11.3 CO-GUIDE (IF ANY) |NA |

| |11.4 SIGNATURE | |

| | |NA |

| |11.5 HEAD OF DEPARTMENT |Prof. Dr. S. VIJAYALAKSHMI, |

| | |PROFESSOR AND HEAD, |

| | |DEPARTMENT OF O.B.G., |

| | |A.I.M.S., B.G.NAGARA. |

| |11.6 SIGNATURE | |

| | | |

| | | |

| | | |

|12. |12.2 REMARKS OF THE CHAIRMAN AND PRINCIPAL | |

| | | |

| | | |

| | | |

| | | |

| |12.2 SIGNATURE | |

| | | |

| | | |

APPENDIX-IID

PROFORMA APPLICATION FOR ETHICS COMMITTEE APPROVAL

| |SECTION A | |

|A |Title of the study |“A PROFILE OF GYNAECOLOGICAL PROBLEMS |

| | |OF ADOLESCENT GIRLS” |

|B |Principle investigator |Dr. JYOTIRMOY HAJRA |

| |(Name and Designation) |POSTGRADUATE STUDENT IN OBSTETRICS AND GYNAECOLOGY, |

| | |ADICHUNCHANAGIRI INSTITUTE OF |

| | |MEDICAL SCIENCES, B.G.NAGARA, |

| | |MANDYA DISTRICT – 571448. |

|c |Co-investigator |Prof. Dr. NAGALAKSHMI BHTTACHARYYA, |

| |(Name and Designation) |MBBS, DGO, MD |

| | |PROFESSOR, |

| | |DEPARTMENT OF O.B.G., |

| | |A.I.M.S., B.G.NAGARA. |

|d |Name of the Collaborating |NO |

| |Department/Institutions | |

| |Whether permission has been obtained from the heads of the collaborating |NA |

|e |departments & Institution | |

| |Section – B |Kindly see Sl. No. 6 in Annexure II |

| |Summary of the Project | |

| |Section – C |Kindly see Sl. No. 6.3 in Annexure II |

| |Objectives of the study | |

| |Section – D |Kindly see Sl. No. 7 in Annexure II |

| |Methodology | |

|A |Where the proposed study will be undertaken |DEPARTMENT OF O.B.G. |

| | |S.A.H. & R.C., B.G. NAGARA |

|B |Duration of the Project |18 MONTHS |

|C |Nature of the subjects: | |

| |Does the study involve adult patients? |YES |

| |Does the study involve Children? |YES |

| |Does the study involve normal volunteers? |NO |

| |Does the study involve Psychiatric patients? |NO |

| |Does the study involve pregnant women? |YES |

|D |If the study involves health volunteers | |

| |Will they be institute students? | |

| |Will they be institute employees? |NA |

| |Will they be Paid? | |

| |If they are to be paid, how much per session? | |

|E |Is the study a part of multi central trial? |NO |

|F |If yes, who is the coordinator? |NA |

| |(Name and Designation) | |

| | | |

| |Has the trail been approved by the ethics Committee of the other centers? |NA |

| | | |

| |If the study involves the use of drugs please indicate whether. | |

| | |NA |

| |I. The drug is marketed in India for the indication in which it will be | |

| |used in the study. | |

| | |NA |

| |II. The drug is marketed in India but not for the indication in which it | |

| |will be used in the study | |

| | |NA |

| |III. The drug is only used for experimental use in humans. | |

| | | |

| |IV Clearance of the drugs controller of India has been obtained for: |NA |

| | | |

| |Use of the drug in healthy volunteers | |

| |Use of the drug in-patients for a new indication. |NA |

| |Phase one and two clinical trials | |

| |Experimental use in-patients and healthy volunteers. | |

| | |NA |

| | | |

| | |NA |

| | |NA |

| | |NA |

| | | |

| | | |

|G |How do you propose to obtain the drug to be used in the study? |NA |

| |Gift from a drug company | |

| |Hospital supplies | |

| |Patients will be asked to purchase | |

| |Other sources (Explain) | |

|H |Funding (If any) for the project please state |NONE |

| |None | |

| |Amount | |

| |Source | |

| |To whom payable | |

|I |Does any agency have a vested interest in the out come of the Project ? |NO |

|J |Will data relating to subjects /controls be stored in a computer? |NO |

|K | Will the data analysis be done by | |

| |The researcher? |YES |

| |The funding agent |NO |

|L |Will technical / nursing help be required form the staff of hospital. |YES |

| | | |

| |If yes, will it interfere with their duties? | |

| | |NO |

| |Will you recruit other staff for the duration of the study? | |

| | | |

| |If Yes give details of |NO |

| |Designation | |

| |Qualification | |

| |Number | |

| |Duration of Employment |NA |

| | |NA |

| | |NA |

| | |NA |

|M |Will informed consent be taken? If yes |YES |

| |Will it be written informed consent: |YES |

| |Will it be oral consent? Will it be |NO |

| |taken from the subject themselves? |YES, (ADULTS) |

| |Will it be from the legal guardian? If no, give reason: | |

| | |YES,( MINORS) |

|N |Describe design, methodology and techniques |Kindly see Sl. No. 7 in Annexure II |

Ethical clearance has been accorded.

Chairman,

Postgraduate Training–Cum Research Committee,

A.I.M.S., B.G. Nagara

Date :

Abbreviations used :

NA – Not Applicable;

OCP: Oral Contraceptive Pills;

PIH: Pregnancy Induced Hypertension;

PET: Pre-Eclamptic Toxaemia

STD: Sexually Transmitted Diseases;

(NOTE: PREVIOUS REGN NO: 01_M009_186)

................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download