Effect of chewing gum on the postoperative recovery of gastrointestinal function after gynaecological laparoscopic surgery

Background: The incidence of postoperative ileus (POI) after gynaecological surgery is 10-15%. Chewing gum following general surgery improves outcomes, including early flatus, early bowel sounds, and shortening of the hospitalisation period. This study aims to investigate the effect of postoperative gum chewing on bowel motility after laparoscopic gynaecologic surgery.Methods: 101 women who underwent laparoscopic surgery for benign gynaecological conditions under general anaesthesia were recruited. 50 patients received sugar free chewing gum post operatively and the outcomes were compared with the control group. The study’s primary end points were the time to first regular bowel sounds and time to passage of flatus after surgery. Secondary end points were the time to first defecation, patient satisfaction, and potential side effects of postoperative gum chewing.Results: We found a significantly shorter interval between surgery and passage of flatus in the intervention group (median 10 hours compared with 13 hours p=0.0151) and a significantly higher rate of regular bowel sounds 3 hours (74% compared with 45%; p= 0.003) and 5 hours after surgery (91% compared with 78%; p=0.01). There was no significant difference in time to first defecation between groups (median 18 hours compared with 20 hours; p=0.222).Conclusions: Gum chewing seems to have beneficial effects on bowel motility when used in postoperative care after minimally invasive surgery. Gum chewing should be recommended to patients after gynaecological laparoscopic surger

Takayasu’s arteritis in pregnancy

We had the opportunity to manage a pregnant lady who presented for the first time at 34 weeks of amenorrhea with absent pulses in upper limbs on examination. She underwent Magnetic Resonance Angiography to confirm the diagnosis of Takayasu’s arteritis. Luckily she did not have complications of Takayasu’s such as hypertension, cardiac failure, neurological symptoms, visual disturbances. She proceeded to have a normal vaginal delivery after aggressive management which included a multidisciplinary team involving obstetrician, cardiologist, physician and rheumatologist

Knowledge, attitude and behaviour of women towards abnormal menstrual bleeding and its impact on quality of life

Background: Abnormal menstrual bleeding has a major impact on a woman's quality of life. Any intervention therefore should aim to improve this rather than focusing on the amount of menstrual blood loss. The aim of this study was to gain an in depth understanding of women’s current knowledge, attitudes and beliefs around abnormal menstrual bleeding. Also, to understand how it affects their lives, while identifying current misconceptions and gaps in knowledge and their expectations and attitudes towards the treatment so that treatment can address their most bothersome complaint.Methods: A total of 200 women, between 18-55 years of age, not on any hormonal treatment attending the gynaecology OPD at a tertiary care centre between Jan 2017 to May 2017 were interviewed by a questionnaire. Women who had undergone hysterectomy were excluded from the study.Results: Of the 200 women interviewed, 49 women felt that their bleeding was heavy and formed the heavy menstrual bleeding group (HMB) while 151 women who perceived their bleeding to be normal formed the normal bleeding group. In the (HMB) group, a significantly greater proportion of women identified their menstrual bleeding as being an inconvenience and a disruption to their lives. HMB also significantly affected their relationships, social life and productivity at work place.Conclusions: Despite its common occurrence, awareness and understanding of HMB and its treatment within the survey population was poor

Correlation between ultrasonographic, hysteroscopic and histopathological findings in patients with abnormal uterine bleeding

Background: Menstrual disorders are common indication for medical visits among women of reproductive age and heavy menstrual bleeding affects up to 30% of women throughout their reproductive lifetime. This study aims at evaluating the different causes and, the clinical presentation of AUB and to compare the role of hysteroscopy, ultrasonography and histopathology in patients with AUB.Methods: 100 women above 45 years of age, presenting with abnormal bleeding per vaginum were evaluated. All patients underwent transvaginal scan to note down the endometrial thickness and to rule out uterine and adnexal pathology. All the patients underwent diagnostic hysteroscopy, followed by a biopsy of the endometrium using a curette. The endometrium was sent to the pathologist. Findings of these diagnostic modalities then correlated.Results: Incidence of AUB was present between the age groups of 45-49 years of age (66%). The commonest presenting complaint in this series was menorrhagia or heavy menstrual bleeding (60%). The finding of thickened endometrium as the most common abnormality on USG (44%) and also on hysteroscopy (45%). As per present study the sensitivity of hysteroscopy is 97.78% and specificity was 34.55%, the negative predictive value of the test is 95%.Conclusions: TVS may be the first line of investigation while evaluating the endometrium in a perimenopausal AUB. It helps to triage the patients into high risk or low risk. Endometrial thickness >4mm as per the present study needs further evaluation. Patients with endometrial thickness less than 4 mm can be reassured. Hysteroscopy is the gold standard in the diagnosis of focal pathology like sub mucous fibroid, polyps or anomalies. Histopathology probably is an indispensable tool specially to rule out premalignant and malignant conditions. Thus, all the modalities instead of being competitive to one another, are complimentary to each other. For complete evaluation of patient with AUB all the three modalities should be used together to come at exact diagnosis

A study comparing vaginal misoprostol alone with vaginal misoprostol in combination with Foley catheter for cervical ripening and labour induction

Background: Induction of labor is a commonly practised intervention in modern obstetrics. The objective of this study was to compare the efficacy of vaginal misoprostol alone with vaginal misoprostol in combination with Foley catheter for labour induction. It aims to assess the induction delivery interval, the outcome of labour, the incidence of instrumental delivery and Cesarean section. The neonatal outcomes and maternal complications would also be assessed.Methods: 105 women with singleton viable pregnancies of 28 weeks or more gestation with cephalic presentation, intact membranes and an unfavorable cervix (Bishops score less than 6) were randomly assigned to induction of labor using vaginal misoprostol or Foley catheter in combination with vaginal misoprostol. Women in the misoprostol only group received 25 micrograms of misoprostol per vagina every 4 hours for a maximum of six doses. Whereas women in the combination group received vaginal misoprostol and in addition Foley catheter was introduced through the cervix for 12 hours. Interruption of the trial was done in case of failure to enter the active phase of labour after 24 hours of induction, fetal distress, hyperstimulation, hypersensitivity to drugs.Results: The induction to delivery time was shorter in misoprostol group as compared to the Foley with misoprostol group by 3 hours. There was no significant change in Bishops score after induction with Foley in combination with misoprostol as compared to misoprostol alone. There was no increase in the maternal and fetal complications in the misoprostol group as compared to Foley with misoprostol.Conclusions: Misoprostol alone was more efficacious for ripening and inducing agent as compared to Foley in combination with misoprostol

Primary ovarian pregnancy: rare site of ectopic gestation

Ovarian pregnancy is one of the rarest varieties of ectopic gestation. Intrauterine devices have evolved as probable risk factor. It is often difficult to distinguish it from tubal ectopic clinically. Diagnosis is generally retrospective during surgery with confirmation by histopathological examination. Hereby we are presenting a case of primary ovarian pregnancy in a multiparous female of reproductive age group using cu-t as contraception presented with acute abdomen managed by conservative surgery and diagnosis confirmed by histopathological examination

A study of the prevalence of gestational diabetes mellitus and its maternal and fetal outcomes in a tertiary care hospital

Background: The aim of this study was to study the prevalence of gestational diabetes mellitus (GDM) using Diabetes in Pregnancy Study group India (DIPSI) criteria to diagnose patients with GDM and to study the maternal and neonatal outcomes.Methods: 500 patients attending the antenatal clinic between January 2013 to September 2014 with singleton pregnancies between 24 and 28 weeks of gestation were evaluated by administering 75g glucose in a nonfasting state and diagnosing GDM if the 2-hour plasma glucose was more than 140 mg/ dl. Women with multiple pregnancies, pre-existing diabetes mellitus, cardiac or renal disease were excluded from the study.Results: 31 women were diagnosed with GDM (prevalence 6.2%). The prevalence of risk factors such as age more than 25, obesity, family history of Diabetes Mellitus, history of GDM or birth weight more than 4.5kg in previous pregnancy and history of perinatal loss were associated with a statistically significant risk of developing GDM. Though the incidence of Gestational hypertension, polyhydramnios and postpartum haemorrhage was higher in the GDM group, it did not reach statistical significance. More women in the GDM group were delivered by LSCS. There was no significant difference in the incidence of SGA or preterm delivery in the groups. The mean birth weight in GDM group was higher than in the non GDM group.Conclusions: Early detection helps in preventing both maternal and fetal complications. This method of screening is convenient to women as it does not require them to be fasting

Perinatal outcome in oligohydramnios and borderline amniotic fluid index: a comparative study

Background: Oligohydramnios is associated with adverse perinatal outcome in the form of meconium staining, intrauterine growth restriction (IUGR), caesarean section for abnormal fetal heart rate tracing, low Apgar score and neonatal intensive care unit (NICU) admission.Methods: This was a prospective study of 100 singleton pregnancies beyond 28 weeks of gestation with AFI< 8 cm, delivered within seven days of admission. Patients were divided in two groups, those with AFI ≤ 5 cm and borderline AFI of 5.1 to 8 cm. Perinatal outcome was studied in the form of onset of labor, mode of delivery, fetal heart rate variations, meconium staining  and lower segment caesarean section (LSCS) for fetal distress, Apgar score, birth weight, NICU admission and neonatal mortality.Results: Patients with oligohydramnios with AFI ≤5 cm were significantly associated with IUGR and presence of abnormal umbilical artery Doppler velocimetry (p <0.05). Adverse perinatal outcome was seen in higher percentage of patients having AFI ≤5 cm than with borderline AFI. The difference was statistically significant for overall caesarean delivery rate and LSCS for fetal distress (p <0.05).Conclusions: Oligohydramnios with AFI of ≤5 cm is associated with high caesarean delivery rate and LSCS for fetal distress

Effect of chewing gum on the postoperative recovery of gastrointestinal function after gynaecological laparoscopic surgery

Background: The incidence of postoperative ileus (POI) after gynaecological surgery is 10-15%. Chewing gum following general surgery improves outcomes, including early flatus, early bowel sounds, and shortening of the hospitalisation period. This study aims to investigate the effect of postoperative gum chewing on bowel motility after laparoscopic gynaecologic surgery.Methods: 101 women who underwent laparoscopic surgery for benign gynaecological conditions under general anaesthesia were recruited. 50 patients received sugar free chewing gum post operatively and the outcomes were compared with the control group. The study’s primary end points were the time to first regular bowel sounds and time to passage of flatus after surgery. Secondary end points were the time to first defecation, patient satisfaction, and potential side effects of postoperative gum chewing.Results: We found a significantly shorter interval between surgery and passage of flatus in the intervention group (median 10 hours compared with 13 hours p=0.0151) and a significantly higher rate of regular bowel sounds 3 hours (74% compared with 45%; p= 0.003) and 5 hours after surgery (91% compared with 78%; p=0.01). There was no significant difference in time to first defecation between groups (median 18 hours compared with 20 hours; p=0.222).Conclusions: Gum chewing seems to have beneficial effects on bowel motility when used in postoperative care after minimally invasive surgery. Gum chewing should be recommended to patients after gynaecological laparoscopic surger