Our experience on non-descent vaginal hysterectomy: a forgotten skill

Background: Hysterectomy is the most commonly performed major gynecological procedure. It can be done by different routes like abdominal or vaginal or laparoscopic route. Vaginal route of hysterectomy is undoubtedly less popular these days due to inclination towards laparoscopic route by both surgeon as well as patients. Keeping this is mind we have planned this paper to share our experience of Non Descent Vaginal Hysterectomy at a tertiary level hospital. Methods: A retrospective study was conducted at the department of obstetrics and gynecology of Vardhmann Mahavir Medical College & Safdarjung hospital, New Delhi over the period of one year. All the patients undergoing non -descent vaginal hysterectomy for benign indication with adequate vaginal access, without suspected adnexal pathology, who did not have any uterine descent were included in the study. In bigger size uterus morcellation techniques like bisection, debulking, myomectomy, slicing was used to remove the uterus. Intraoperative findings and post-operative complications were recorded. Statistical analysis was done. Results: During the study period total 138 hysterectomies were performed. Most of the women were in the age group of 46 to 50 years (50%). All patients were parous. In 56% patients, uterine size was 8-10 weeks. Fibroid uterus (37%) followed by adenomyosis (27%) was the commonest indication for hysterectomy. The most common complication was febrile morbidity (n=13) followed by urinary tract infection (n=9). Conclusions: Non descent vaginal hysterectomy procedure in hand of a skilled surgeon can be done upto 14 weeks uterine size

Misplaced IUCD: a case report

In a developing country like India where population census is crossing the limits, contraceptive methods are the necessary measures for the population control. Intrauterine Contraceptive devices (IUCDs) are the second most commonly used method of contraception after sterilization. Misplaced IUCDs usually present with the missing thread and remain asymptomatic in most of the cases. A case of a misplaced IUCD in the pouch of Douglas is reported which was managed laparoscopically

Large Nabothian Cyst: A Rare Cause of Nulliparous Prolapse

Genital prolapse is commonly observed in postmenopausal and multiparous women, However, nulliparous women contribute to 2% of prevalence. We report a case of 21-year-old female who presented with a large nabothian cyst contributing to prolapse. This is the first case reported in the literature

Rare cause of stillbirth: a true knot and loop of cord: case report

True knot is an extremely rare condition of the umbilical cord. It affects around 0.3-1.3% of all the pregnancies. It can be loose without obstructing the blood flow to the foetus or can be tight enough to exsanguinate the foetus by compromising the blood flow towards the foetus. A 26 years old, gravida 2, para 1, live 1, with previous 1 caesarean section with hypothyroidism came at 40 weeks POG in labour. No complaints. Antenatal history was uneventful. On examination, patient was stable. Patient was explained risk and demits of TOLAC verses ERCD and opted for TOLAC. Delivered a limp baby. There was presence of one tight loop of cord around neck and one tight true knot over the umbilical cord leading to stillbirth. The umbilical cord is the only blood supply to the foetus during the antepartum and intrapartum period. If the true knot is loose, it will not lead to foetal compromise since foetal circulation is maintained. However, at the time of fetal descent through the birth canal, the knot could be tightened. The tightening knot can occlude fetal circulation resulting in an intrauterine demise. The process of delivery should be very careful and if any fetal distress or non-reactive CTG is present, then an emergency caesarean section must be done. Routine continuous cardiotocography can be the best modality to pick distress at the earliest and to achieve a good outcome of the neonate. A good ultrasonologist can detect nuchal cord and true knot during the antenatal scan.

Comparison of low dose Dhaka regimen of magnesium sulphate with standard pritchard regimen in eclampsia

Background: The purpose of this study was to determine the effects of altitude on severe preeclampsia and eclampsia and subsequent perinatal outcome.Methods: This prospective study was carried out during 1st March 2011 to 29th February 2012 in Department of Obstetrics and Gynaecology, Kamla Nehru State Hospital for Mother and Child, Indira Gandhi Medical College, Shimla situated at a height of 2200m from sea level. All the subjects with severe preeclampsia or eclampsia were included in the study and their perinatal outcome was noted.Results: There were a total of 5897 deliveries. There were 423 cases of PIH making an incidence of severe preeclampsia and eclampsia 15.4% and 7.3% among PIH, respectively. Majority of cases (60.4%) belonged to age group 18-25 year with mean systolic blood pressure in eclampsia was 184.3±18.6 mm of Hg and in severe preeclampsia was 171.5±13.9 mm of Hg. Mean diastolic blood pressure was 125.8±12.6 mm of Hg in eclampsia and 118.6±4.3 mm of Hg in severe preeclampsia. Various other complications in eclampsia and severe preeclampsia cases included IUGR (35.1%) cases, abruptio placentae (15.9%), HELLP syndrome (9.6%) cases, spontaneous preterm labour (21.3%) and intrauterine death (6.4%). Live births were 85.1%; fresh still births were 8.5%. Mean birth weight was 2192.5±572grams. Respiratory distress syndrome was seen in 21.3% neonates, Hyperbilirubinemia was seen in 26.2% neonates intracranial bleeding was seen in 7.5% neonates. Perinatal mortality was 27.7% which constitute14.9% still birth neonatal deaths.Conclusions: Efficacy of MgSO4 in prevention and treatment of eclamptic convulsions is time tested and supported with a variety of studies. Since its narrow therapeutic and toxicity is major concern, the use of low dose MgSO4 protocols is a viable alternative to standard dose therapy. However, because of small study design further studies on the larger scale are required to support routine clinical use of low dose protocols

Stability of soil plant analytical development (SPAD) chlorophyll meter reading (SCMR) and specific leaf area (SLA) and their association across varying soil moisture stress conditions in groundnut (Arachis hypogaea L.)

The complex nature of physiological traits associated with drought tolerance and the difficulties associated with their measurements in segregating populations and large number of genotypes inhibited their use in the past in developing water-use efficient genotypes in breeding programmes. With new knowledge of easily measurable surrogates of transpiration efficiency (TE), a trait associated with drought tolerance—specific leaf area (SLA) and soil plant analytical development (SPAD) chlorophyll meter reading (SCMR), it is now possible to integrate TE through the surrogates in breeding and selection schemes in groundnut (Arachis hypogaea L.). As a noninvasive surrogate of TE, SCMR is easy to operate, reliable, fairly stable and low cost. However, in a large-scale breeding program, it is difficult to complete SCMR observations within a specified time. The present study addressed the issue as to what extent the SCMR measurements can be spread over time by evaluating 18 diverse groundnut genotypes for two physiological traits, SCMR and SLA in two postrainy (Nov–Apr) seasons (2002/2003 and 2003/2004) in India. Observations were recorded at different times during and after the release of moisture deficit stress. There was general agreement in genotype and trait performance in both the seasons. Interaction between SCMR and time of observation was significant in only one season (2002/2003) but its variance relative to genotypes and time of observation was very small. ICGV 99029 and ICR 48, which recorded higher SCMR and lower SLA values in both the seasons, will make good parents for water-use efficiency trait in breeding programmes. Other good parents include ICGS 76, TCGS 647 and TCGP 6. SCMR recorded at three different times under differing soil moisture deficit in each season showed highly significant correlation with each other. Similarly, SLA at different times also correlated significantly with each other. SCMR and SLA were significantly negatively correlated with each other and the relationship was insensitive to time of observation. The results of the present study indicated that SCMR/SLA observations can be recorded at any time after 60 days of crop growth, preferably under moisture deficit conditions. This gives groundnut breeders a large flexibility to record these observations in a large number of segregating populations and breeding lines in the field. Thus, making it easy to incorporate these physiological traits associated with drought tolerance in breeding and selection scheme in groundnut

Emergency contraception: knowledge, attitude and practices among women in South Delhi, India

Background: Objective of the study was to assess the awareness of emergency contraception (EC) amongst women attending the routine antenatal outpatient services.Methods: It was a hospital based cross sectional study for one year. 550 women were enrolled in the study after written informed consent. Socio demographic characteristics, knowledge, attitude and practice towards EC were analyzed.Results: Majority of the women were between 20 to 29 years, and had a basic level of education. 60.4% women were housewives, and 70.5% of them had an urban place of residence. 94% women knew about some method of contraception. Only 34.5% women knew EC; amongst them 54.2% knew about EC pills and 12.5% had used it at least once. 40.5% women knew that there are methods of EC but did not know how what these methods were. 67.9%of women did not know how long after unprotected intercourse EC should be taken.Conclusions: Majority of the women were between 20 to 29 years, and had a basic level of education. 60.4% women were housewives, and 70.5% of them had an urban place of residence. 94% women knew about some method of contraception. Only 34.5% women knew EC; amongst them 54.2% knew about EC pills and 12.5% had used it at least once. 40.5% women knew that there are methods of EC but did not know how what these methods were. 67.9% of women did not know how long after unprotected intercourse EC should be taken