title: Gynecological diseases in rural India: A critical appraisal of indications and route of surgery along with histopathology correlation of 922 women undergoing major gynecological surgery.
abstract: OBJECTIVE
  The aim of the study was to generate baseline data for indications of gynecological surgeries, and to assess route of surgery and histopathology correlation in women undergoing major gynecological surgery in a rural tertiary level teaching hospital in India.
  
  
  METHODS
  Surgical indications, route of surgery and histopathology findings were reviewed and analyzed retrospectively, in 922 patients (≥35 years age) who underwent gynecological surgery at Dr. Rajendra Prasad Government Medical College, Kangra, Himachal Pradesh, India from January 1, 2011 to May 31, 2013.
  
  
  RESULTS
  Of 922 surgeries, 65 had malignancy (7%). Pelvic organ prolapse (POP) (32.3%) and leiomyoma uterus (29%) were two most common benign indications for hysterectomy. Ovarian tumors were present in 13% (25% of these were malignant). Postmenopausal bleeding (PMB) was seen in 5.5% (55% of these were malignant).
  
  
  CONCLUSIONS
  All except 10% surgeries were done in the absence of definite histopathology diagnosis that is dysfunctional uterine bleeding (n = 42 [45%]), chronic pelvic pain/severe dysmenorrhea (n = 34 [36%]) and recurrent PMB (n = 17 [19%]). Majority of surgeries had histopathological correlation except for six cases (0.6%) of malignancy, which were missed on initial work-up. Majority of the surgeries were done abdominally. In rural areas of developing countries poverty, lack of regular follow-up, resource constraints and lack of technical skills (with respect to laparoscopic/robotic surgeries) pose major challenge in providing quality health care.
authors: Department of Obstetrics and Gynecology, Dr. Rajendra Prasad Government Medical College, Kangra at Tanda, Himachal Pradesh, India.
authors: Chanderdeep
authors: C
authors: Sharma
authors: Department of Pathology, Dr. Rajendra Prasad Government Medical College, Kangra at Tanda, Himachal Pradesh, India.
authors: Manupriya
authors: M
authors: Sharma
authors: Department of Pathology, Dr. Rajendra Prasad Government Medical College, Kangra at Tanda, Himachal Pradesh, India.
authors: Rashmi
authors: R
authors: Raina
authors: Department of Obstetrics and Gynecology, Dr. Rajendra Prasad Government Medical College, Kangra at Tanda, Himachal Pradesh, India.
authors: Anjali
authors: A
authors: Soni
authors: Department of Pathology, Dr. Rajendra Prasad Government Medical College, Kangra at Tanda, Himachal Pradesh, India.
authors: Bal
authors: B
authors: Chander
authors: Department of Obstetrics and Gynecology, Dr. Rajendra Prasad Government Medical College, Kangra at Tanda, Himachal Pradesh, India.
authors: Suresh
authors: S
authors: Verma
keywords: Developing countries; histopathological correlation; hysterectomy; rural