International Journal of Reproduction, Contraception, Obstetrics and Gynecology
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Laparoscopic myomectomy - a three year experience
Full text linkBackground: Fibroids are the most common benign tumor of the uterus to affect women of reproductive age. Many women opt for laparoscopic myomectomy to conserve their uterus for fertility. This study aimed at evaluating the complications, need for blood transfusion and the average time taken for Laparoscopic myomectomy.Methods: We conducted a retrospective observational study of laparoscopic myomectomy cases in a tertiary care hospital for a period of 3 years from July 2013.Results: A total of 31 cases of laparoscopic myomectomy were evaluated. Average time taken was 161 +/- 31.2 minutes. Most common type of fibroid encountered was intramural, 16 (51.6%). The chief presenting symptom was abnormal uterine bleeding, 16 (51%). 3 (5.8%) of the patients had intraoperative/immediate post-surgery blood transfusion. Major vessel injury occurred in one case (3.2%). In 25 (80.64%) cases power morcellation was used, minilap incision and colpotomy for fibroid retrieval in 2 cases each. There was no single case of febrile morbidity. Average period of hospital stay was 2 days.Conclusions: Laparoscopic myomectomy is a viable option in women with symptomatic fibroids who want to retain their uterus. The procedure is safe in the hands of skilled surgeon
Vaginoplasty in mayer Rokitansky-Kuster-Hauser syndrome using amnion: a case series
Full text linkBackground: Congenital absence of both uterus and vagina is termed Mullerian aplasia, Mullerian agenesis, or Mayer-Rokitansky-Kuster-Hauser syndrome. In classical mullerian agenesis patients have a shallow vaginal pouch, only measuring 1 to 2 inches deep. In addition the uterus, cervix, and upper part of the vagina are absent. One treatment goal for most of these women is creation of an artificial vagina either conservatively or surgically. McIndoe procedure is the most commonly employed surgical approach for creation of neovagina. The neovagina thus created is lined with skin graft, amniotic membrane, cutaneous and myocutaneous flaps, buccal mucosa, and absorbable adhesion barrier.Methods: This study was conducted on 8 patients presenting with MRKH syndrome over a period of 3 years from 2012-2015. All the patients were admitted in SVBP hospital associated to LLRM Medical College, Meerut, (UP). McIndoe procedure was the surgical treatment common to all patients, where the neovagina created was lined by amniotic membrane. The surgery was performed by two consultants using the standardized surgical technique.Results: In our study, all patients were followed for preferably 6 months (1,4,8,12 weeks and if possible 6 months) after surgery for following observations-vaginal caliber, presence of any stricture, vaginal sloughing, failure of graft uptake any urogenital complaints. Except for complication in one patient, all the rest had excellent results.Conclusions: Vaginoplasty using amnion as a graft is a safe, effective treatment in patients of MRKH Syndrome. When done by experienced gynecologist, major post operative complications seem to be very few
Evidence based approach to unani contraceptives: a review
Full text linkContraception is a process or technique for preventing pregnancy by means of medication, device or method that blocks or alters one or more of the processes of reproduction in such a way that sexual union can occur without impregnation. Promotion of family planning is central to the World Health Organization work on improving maternal health & is core to achieve the Millennium Development Goal. It is estimated that 90% of abortion related and 20% of pregnancy related morbidity and mortality, could be prevented by the use of effective contraception. Population explosion is the leading cause of poverty and pollution in developing countries which has detrimental effect on the life supporting system. Hence it is necessary to control the population by the use of contraceptives. Available contraceptives in conventional medicines have many adverse effects. Therefore, there is a need for research of newer, less expensive, less toxic, self-administered, completely reversible contraceptives. Much of these properties are observed in contraceptives as mentioned in classical Unani text. Unani physician has mentioned the various medicines & techniques of contraceptives. Scientific research has confirmed the efficacy of most of the herbal drugs like Ruta graveolans (Suddab), Juniperus communis (Abhal), Piper longum (Filfil daraz), Mentha arvensis (Pudina), Azadirachta indica (Neem), Punica granatum (Anar), Alium cepa (Piyaz) and Daucus carota (wild carrot) etc. Therefore, the aim of this article is to review the ancient concept of contraception in Unani System of Medicine in the light of available scientific research
Isolated short femur alone in the mid-trimester fetus is not associated with increased risk of aneuploidy: a clinical study in eastern India
Full text linkBackground: Identifying the soft markers during the anomaly scan improves the detection rate of fetal aneuploidy at the cost of increased false-positive rate and consequent increased interventions. Isolated short femur is one such soft marker that puts the clinician into a dilemma. The aim of this study is to assess the risk of aneuploidy in the fetus with isolated short femur, so that the data can be used for counseling the prospective parents in our population.Methods: In this retrospective study, all the fetuses of 43 mothers, at the time of ultrasound scan between 18-20 weeks of gestation for fetal anomaly, were found to have isolated short femur. Depending on the presence of other soft markers, the mothers were divided into two groups, group I containing mothers having fetus with only isolated short femur and group II containing mothers having fetus with one or more soft marker in addition to isolated short femur. The chromosomal status of all the fetuses was checked by either amniocentesis and karyotyping or birth of a phenotypically normal baby.Results: There was no aneuploidy in the group I containing fetuses with isolated short femur only. Our results are consistent with other international studies.Conclusions: Isolated short femur alone does not increase the existing risk of fetal aneuploidy
Obstetric outcomes in women with mullerian duct malformations
Full text linkBackground: Congenital uterine anomalies are associated with the highest incidence of reproductive failure and obstetric complications. This study aims to summarize the clinical characteristics and prenatal outcome of pregnancy in women with congenital uterine malformations.Methods: This retrospective study evaluates the obstetric outcome of 24 in patients with uterine malformations with pregnancy in Sapthagiri Hospital from August 2010 to August 2013. A total of 60 randomly selected pregnant women with a previously confirmed normally shaped uterus were taken as a control group.Results: A total of 2595 women were admitted for various obstetric reasons during August 2010-2013 (period of 3 years). Of them 24 cases had uterine anomaly, the rate of anomaly being 9.2 per 1000 pregnant women. A bicornuate uterus was present in 7 (29%) septate uterus in 6 (25%) arcuate in 5 (20.8%), and unicornuate with rudimentary horn in 2 (8.4%). Unicornuate uterus without rudimentary horn in 1 (4.2%) and uterus didelphys in 1 (4.2%). Transverse vaginal septum was seen in 2 (8.4%) patients. The rate of malpresentation was high in uterus didelphys, arcuate and bicornuate uterus. Abortion rates were equal in both septate and bicornuate uterus. A comparison of mode of presentation and termination of pregnancy is illustrated. Preterm deliveries (33.4%) and miscarriage rates (20.8%) were more common compared to controls. Less than half the women (45.8%) had term deliveries compared to controls where pregnancies which reached term were 86.7%. An assessment of mode of delivery, termination, period of gestation at delivery and birth weight between study group and control group is given.Conclusions: Women with congenital uterine malformation usually have higher incidence of complications during pregnancy and delivery. Early diagnosis and treatment can improve obstetric outcomes
Umbilical artery velocity and adverse neonatal outcome in sudanese pregnant women with severe preeclampsia
Full text linkBackground: Doppler umbilical artery waveform is an important imaging predictor of adverse neonatal outcome in patients with severe preeclampsia. The present study aims to evaluate the adverse neonatal outcome associated with abnormal umbilical artery velocity in patients with severe preeclampsia.Methods: In a prospective descriptive analytical hospital-based study, umbilical artery velocity and adverse fetal outcome of (104) patients with severe preeclampsia were evaluated by Doppler ultrasound. The study was conducted through the period (February to August 2015) in obstetric Sudanese population.Results: The umbilical artery end diastolic flow was reduced in 20.2 %, absent in 5.8%, reversed in 1.9% and normal in 72.1% of the study population. The end diastolic velocity was significantly abnormal and associated with low birth weight (P-value=0.001), early neonatal death (P-value= 0.00), fetal respiratory distress (P-value = 0.00) and Apgar score (P-value = 0.00). The abnormal end diastolic flow was not statistically associated with emergency caesarean delivery (P value=0.275).Conclusions: The end diastolic flow velocity of the umbilical artery was significantly associated with adverse neonatal and perinatal outcomes in Sudanese pregnant cases with severe preeclampsia.
Hystera Ektomia: not always called for
Full text linkUnsympathetic hysterectomies have seen a rising trend in India in the recent times, the unsuspecting folks being pushed into surgeries wrongly citing the austerity of the illness. We highlight a case of a 26 year old female patient with post-partum bleeding per vaginum for 6 months, who was initially treated conservatively at several hospitals. Later, histopathologically proven to be a case of Choriocarcinoma (WHO Stage I with FIGO prognostic score of 5), was hysterectomized hastily overlooking the reports and the patient discharged without further intervention. Few months later the patient presented with brain and lungs metastases. Had the patient been properly evaluated and treated appropriately initially, surgery was not indicated. Instead the patient was callously operated upon and histopathological report not followed which resulted in patient developing distant metastases (WHO Stage IV with FIGO prognostic score of 17). Unwarranted and unevaluated hysterectomies should be checked by appropriately evaluating the extent of the disease.
Intestinal obstruction in pregnancy: three case reports
Full text linkThe occurrence of intestinal obstruction is uncommon in pregnancy and so it is rarely considered as a cause for acute abdominal pain. It is also a life threatening condition to the mother if proper medical intervention is delayed. In this review we present three cases of intestinal obstruction during pregnancy and puerperium. The incidence in our tertiary care center over a period of last 5 years is 1 in 3196 deliveries. These cases were diagnosed preoperatively with x-ray and sonogram. Laparotomy with definitive surgical treatment was performed. The first patient had large bowel obstruction due to sigmoid volvulus, the second patient had a stricture in ileum leading to small bowel obstruction, and the third patient had ileocecal intussusception. There were no maternal deaths but one patient had fetal loss
Depot-medroxy progesterone acetate as an effective contraception method in lactating mothers
Full text linkBackground: Contraception is the deliberate use of artificial methods or other techniques to prevent pregnancy as a consequence of sexual intercourse. Depot medroxy progesterone (DMPA) injection 150 mg intramuscular was used for contraception in this study, once every 3 months±14 days. The objective was to establish safety and effectiveness of DMPA in lactating and non-lactating mothers, observe side effects related to usage of DMPA and also establish its effectiveness as contraception method.Methods: This is retrospective study performed at Family Planning Association of India’s Kutumb Sudhar Kendra. Mumbai Central.Result: Patients who had received first dose at 6 weeks of postpartum period and those who received between 6 weeks to one year showed lactation in 84.16% and non-lactation in 15.84%. 28.71% lactating patients had taken injection at 6 weeks of post-partum period and 71.29% had taken between 6 weeks to 1 year. Lactating patients who had taken injection at 6 weeks and continued DMPA for more than 4 injections were 48.27%. 36.84% non-lactating patients had continued for more than 4 injections. This signifies that acceptance and continuation rate of DMPA is more in lactating patients than in non-lactating patients.Conclusions: DMPA is an effective method of contraception in lactating mothers; proper counseling will increase awareness and acceptance of DMPA in lactating mothers