Role of hysterolaparoscopy in the diagnosis and management of infertility

Background: Infertility is defined by WHO and ICMART as a disease of the reproductive system by the failure to achieve a clinical pregnancy after 12 months or more regular unprotected sexual intercourse. Objective of this study were to assess the role of hysteroscopy and laparoscopy in the evaluation of female infertility. To assess the therapeutic role of these endoscopic modalities in cases of infertility.Methods: A prospective study of 112 women coming with the complain of infertility to a tertiary care centre hospital in Ahmedabad over a period of 30 months from January 2017 to June 2019.Results: Of the 112 cases, 69.7% had primary infertility and 30.3% had secondary infertility. Septum was the most common hysteroscopic finding (7.1%) followed by polyps (5.4%) and synechiae (3.6%). Adhesions was the most common laparoscopic finding (23.2%) followed by tubal blocks (19.7%) and fibroid (17.9%). Polycystic ovaries were seen in 12.5% patients followed by endometriosis in 10.7% women. Myomectomy was most common therapeutic procedure (17.9%) followed by adhesiolysis in 14.3% women and PCO drilling in 8.9% women.Conclusions: Hysterolaparoscopy is useful as a diagnostic and therapeutic measure for women having infertility

Randomized control trial of intra-peritoneal instillation of bupivacaine versus placebo for post-operative analgesia after laparoscopic hysterectomy

Background: Laparoscopy is an established method to perform major surgeries, with many advantages over open surgeries. Hysterectomy is a common procedure performed with increased use of laparoscopy, having postoperative pain management is a major issue. Effective pain management promotes early ambulation, lowering the risk of DVT and PE.Methods: The present study aimed to assess effect of bupivacaine intraperitoneally during laparoscopic hysterectomy to reduce postoperative pain. 48 women undergoing laparoscopic hysterectomy under ASA I and II general anesthesia were included, divided into 2 groups, group A receiving 0.25% bupivacaine intraperitoneally; group B receiving saline. A blind observer observed both groups for 6 hours post-surgery or until the VAS was 4, whichever came first, need for rescue analgesia, side-effects, and total dose of analgesia required in 24 hours. Diclofenac sodium and paracetamol was used as rescue analgesia for both groups.Results: There was no significant difference reported in demographic parameters between two study groups. The VAS scores at 6, 12 and 24 hours after laparoscopy was significantly lower in group A than group B. There was significant increase in the time required for 1st analgesia, while amount of analgesia required was significantly low in group A as compared to group B. There were significantly more number of patients in group B who needed opioids than group A.Conclusions: Peritoneal bupivacaine instillation after laparoscopic hysterectomy was found to be useful to reduce the pain as compared to use of saline (placebo), significant reduction in need for analgesics in the postoperative period

A retrospective study of obstetric hysterectomy cases at tertiary care centre

Background: Postpartum haemorrhage (PPH) is a life-threatening condition. The objective of this study was to determine the incidence, demographic characteristics, indications, and feto-maternal outcomes associated with obstetric hysterectomy in a tertiary care centre.Methods: This is a retrospective analytical study conducted over a period of six years, from March 2014 to April 2020. A total of 68 cases of obstetric hysterectomy were studied at tertiary care centre in Ahmedabad, Gujarat, India.Results: Present study reported 68 obstetric hysterectomies per 44663 total deliveries (incidence - 0.15%), out of them 20 following 26446 vaginal deliveries (0.07%) and 48 following 18217 caesarean section (0.26%). Morbidly adherent placenta (29.41%) was the most common indication followed by atonic postpartum haemorrhage (25.00%) and uterine rupture (17.64%). The most frequent sequelae were disseminated intravascular coagulation (26.47%) and febrile morbidity (10.29%), maternal mortality was 16.17% whereas neonatal mortality was 26.47%.Conclusions: The incidence of obstetric hysterectomy has been found to be more following caesarean sections. There is a change in the indications of obstetric hysterectomy in the past two decades with placenta accreta spectrum being the commonest in present study. This is because of rising number of caesarean sections. Patients who underwent emergency obstetric hysterectomy due to atonic PPH had a higher mortality

Evaluation of complication during third stage of labour at tertiary care center

Background: The objective of the present study was to determine the maternal outcome of complications of third stage of labour and to determine the risk factors and evaluate the management protocols for these complications.Methods: This is retrospective study of maternal outcome with complications of third stage of labour carried out at tertiary care centre from June 2016 to December 2019. Patients who developed any complications of third stage of labour after vaginal delivery or caesarean section were included.Results: Complications observed during third stage of labour were atonic PPH 0.82% (74 cases), traumatic PPH 0.55% (50 cases), retained placenta (including placenta accreta spectrum) 0.21% (19 cases), secondary PPH 0.03% (3 cases), uterine inversion 0.03% (3 cases) and amniotic fluid embolism 0.01% (1 case). Maximum cases were seen in 18-24 years of age group. Only 36% patients having atonic PPH responded to medical treatment, 46% patients having atonic PPH responded to conservative surgery, 18% of patients required radical surgery.Conclusions: Third stage complications are potentially life threatening. Associated conditions for third stage complication are high parity, anemia, hydramnios, multiple pregnancy, malpresentation, placenta previa, and adherent placenta. Early anticipation and early intervention with proper planning is required to reduce the maternal morbidity and mortality in third stage complication

Prevalence of Indian Culture over Western Culture in 21st Century

Indian culture is not only one of the oldest and richest cultures in the world, but also serves as a base for the development of other cultures time and again. On the other hand, western culture is considered as one of the contemporary yet most advanced cultures that is influencing various other cultures across the globe. In this world of technological advancement, intermixing of various cultures is not new. Infact, it helps one adopt the positives of multiple cultures. But sometimes it becomes slightly far-fetched when one starts comparing and disregarding their own culture. A similar situation can be observed in India. Many complain about the influence of western culture over Indians to a great extent, especially in the 21st century, based on what is visible. But one needs to understand that it is just the tip of an iceberg, a superficial observation. The influence of any situation is determined by its impact on the psychology of a person. The following research conducted gives a deeper insight on the same. Roots are the beliefs, and customs of the family and culture that are carried on from generation to generation. Some rituals considered as ancient superstitions turn out to have actual benefits. For generations things were handed down from Father to Son, and Mother to Daughter. Hence, parents wish for their kids to be grounded to their cultural/familial roots. Though the changes are prevalent in various domains, such as political, social, economic, industrial and technological, the new generation still stick to their roots and prefer living in a joint family while celebrating Indian culture compared to western culture

Effect of early maternal newborn skin to skin contact in labour room on third stage of labour and success at breastfeeding

Background: Immediate postpartum period and birth pose many challenges for the mother and the new-born. Initiation of early skin to skin contact in the labour room can be beneficial to both of them.Methods: Randomized control trial conducted over a period of 7 months in a tertiary care centre enrolling 400 laboring women.200 in the control group were given routine care. In the 200women in the study group, the newborn was given immediate skin to skin contact by placing him/her on the mother’s chest.Results: Duration of third stage of labour was less than 10 minutes in 95%women of study group compared to 56% women in the control group(p<0.01). Placenta was expulsed as a whole in 98% cases in the study group compared to 81% in the control group. Successful breastfeeding was observed in 88% women in study group compared to 54%in the control group(p<0.01). Breastfeeding was initiated within 30 minutes of birth in 96%women in the study group compared to 41% in the control group.Conclusions: Uterus could contract faster with the complete expulsion of placenta and shortening of the third stage of labour with early skin to skin contact. The newborn showed early initiation, success at breastfeeding and longer first breastfeeding with early skin to skin contact

Changing trends in cesarean section: from 1950 to 2020

Caesarean section (C.S) is a part of the standard care in modern obstetrics. The indications for a caesarean section as an alternative to vaginal delivery have evolved over the centuries. Its practicality, disponibility, and apparent safety have placed caesarean section, a first-line procedure in many clinical scenarios. The awareness of perinatal mortality and morbidity associated with safety of caesarean, expert anaesthesia, potent antibiotics, blood transfusion facilities and better neonatal care have increased incidence of caesarean section very fast. Thus, there is fast, steady and definite rise in incidence of caesarean section everywhere. But the question is ‘Is a rising caesarean section rate is inevitable?’. Studies carried out to understand CS deliveries has adopted different framework. The issue treats elements of ethics in the medical profession, gender issues, choices of women, the quality of institutional services, etc. The findings of retrospective studies have suggested that the caesarean section rate could be reduced in certain categories. In this study, we discuss the various ways in which it can be achieved

Acute kidney injury and its outcome in obstetrics

Background: Acute kidney injury occurring during pregnancy, labour, delivery, and/or postpartum period. Proper management of AKI (acute kidney injury) is challenging because (i) both maternal and fetal health must be considered and (ii) the cardiovascular and renal adaptations of pregnancy add to the complexity for management.Methods: The objective of this study was to study association and contributing factors in AKI, a retrospective study of 20 cases of AKI complicating pregnancies carried out in department of obstetrics and gynecology, SVPIMSR over a period of 12 months and results were studied and analysed. Etiological factors, associated liver pathology, coagulation abnormality, thrombocytopenia, sepsis, recovery status and fetomaternal outcome were studied and tabulated. AKI was analysed in terms of maximal stage of renal injury attained as per risk, injury, failure, loss of function, and end-stage renal disease (RIFLE) criteria.Results: The incidence of ARF (acute renal failure) in pregnancy was about 0.3%. Hypertensive disorders were the major causative factor. Amongst the 20 cases, 8 cases were referred from outside and two of them died. Total 5 of 20 cases required hemodialysis and two of them had partial recovery.Conclusions: AKI complicating pregnancies are not uncommon. If recognized and treated promptly, recovery is assured in majority of cases. Early identification and prompt management of pre-eclampsia and sepsis can prevent majority of cases. Ultrasonography revelation of placenta previa or abruption helps in early management eventually decreases the chances of bleeding which is one of the causes of AKI (pre-renal cause)