Trends and patterns in total laparoscopic hysterectomy in tertiary care hospital

Background: Due to technical advances in the field of laparoscopy, there has been an increase in total laparoscopic hysterectomies all over the world in last decade. This study was conducted to analyse the technique and surgical outcome of total laparoscopic hysterectomy in tertiary care hospitalMethods: This is a retrospective cohort (observational) study, which included all patients who underwent Total Laparoscopic Hysterectomy (TLH) for benign conditions from January 2012 to December 2017 at the tertiary Care Hospital. The data so obtained was analysed for various parameters like indication for surgery, mean operating time, length of hospital stay, complications and conversion to abdominal route.Results: Total number of 2307 hysterectomies were performed over a period of 5 years. Of these, TLH were 270 (11.70%). Amongst those undergoing TLH, the mean age was 45±7.84 years. The most common indication for the surgery was fibroid uterus (38.14%), followed by dysfunctional uterine bleeding (28.88%), and adenomyosis (15.1%). The mean estimated blood loss was 106±4.34 ml. Hemorrhage (n = 2) and bladder injury (n = 4) were most common surgical complications.Conclusions: TLH is safe and effective procedure for most of the benign pelvic conditions. With adequate training TLH can be used more widely in tertiary care hospital and teaching institute

Comparison of maternal and fetal morbidity between Patwardhan method of second stage lower segment caesarean section and conventional "push and pull" method

Background: To compare Maternal and fetal morbidity between Patwardhan method of second stage LSCS and conventional "push and pull" method.Methods: A retrospective study of all LSCS performed in second stage of labour consisted of all cases delivered by Patwardhan method compared with cases delivered by Push method during 3 years from January 2016 to December 2018 in Smt. Kashibai Navale Medical College Pune, Maharashtra, India.Results: A total of 89 patients underwent second stage LSCS from January 2016 to December 2018. A total of 37 patients were delivered by Patwardhan’s method and 52 patients were delivered by Push method. Uterine incision extension was more in the push and pull method when compared to Patwardhan technique. Same was true for the traumatic PPH blood transfusion which was significantly high in push and pull method as compared. Neonatal morbidity was significantly less in Patwardhan’s method as compared to Push method.Conclusions: As the maternal and fetal complications are seen to be considerably less in Patwardhan’s method than the conventional Push method our study concludes that Patwardhan’s method for delivering baby in second stage LSCS confers greater advantage

Prospective comparative study between colposcopy and histopathology for diagnosis of CIN and carcinoma cervix

Background: Cervical cancer develops from precursor lesions and detection of these lesions is of utmost importance. The detection of precancerous lesions is made with help of screening tests most important include PAP smear and colposcopy. So we conducted this study to understand the role of colposcopy in down staging of Carcinoma cervix.Methods: We performed a prospective study between Jan 2018 to Dec 2018 on 180 subjects chosen from patients who sought consultation for various gynaecological complaints between age group of 18-60 years. A Pap smear followed by a colposcopy was performed and colposcopic directed biopsies were taken and subjected to histolopathological examination.Results: Colposcopy had a sensitivity of 83.3%, specificity of 78.5%, PPV of 68.9% for CIN 1. It had a sensitivity of 90.9%, specificity of 95.2%, PPV of 83.33% for CIN 2 and 3 when co related with gold standard histopathology which is much higher as compared to Pap smear.Conclusions: Colposcopy is an effective tool in down staging of Carcinoma cervix

Bilateral internal iliac artery ligation: the procedure of choice in life threatening postpartum haemorrhage

Background: The present study was to assess the indication and study the intraoperative and postoperative complications of bilateral internal iliac artery ligation. Aim of this study was to evaluate the effectiveness of internal iliac artery ligation in arresting postpartum haemorrhage.Methods: This is a retrospective study carried out between January 2015 to December 2018 at Shrimati Kashibai Navale Medical College and General Hospital, Pune. This study included 48 patients with life-threatening PPH. Bilateral internal iliac artery ligation was done by anterior approach in 7 patients and by posterior approach in 41 patients.Results: Intraoperative and postoperative complications were noted in all patients. Of the total patients, 10 required massive blood transfusion and 12 underwent obstetrical hysterectomies (n=12; 25%). Internal iliac vein injury was seen in 1 patient (n=1; 2.08%) and external vein thrombosis was noted in 3 patients (n=3; 6.25%). Maternal mortality was observed in 1 patient due to DIC on day 9 (n=1; 2.08%). The uterine salvage rate was 75%.Conclusions: Internal iliac artery ligation (IIAL) safe, rapid, effective, time tested method of controlling bleeding from genital tract

Complications of gynaecologic laparoscopy: an audit

Background: Minimal access surgery as a modality of treatment for various gynecologic conditions is rapidly gaining grounds in the recent years1. Approximately 30 years after its introduction; the use of laparoscopy in gynecology has evolved from diagnostic purposes into a more coordinated system for the repair or removal of diseased abdominal and pelvic organs. The rapid increase in the number of procedures being performed, the introduction of new equipment, and variability in the training of surgeons all contribute to the complication rate. The objective is to review complications associated with laparoscopic gynecological surgeries and identify associated risk factors.Methods: Hospital based descriptive observational study performed between January 2013 to December 2017 which included all gynecologic laparoscopies performed in present institute. Variables were recorded for patient characteristics, indication for surgery, length of hospital stay (in days), major and minor complications, conversions to laparotomy and postoperative complications. The laparoscopic procedures were divided into three subgroups: Diagnostic cases, tubal sterilization and Advanced operative laparoscopy.Results: Of all 3724 laparoscopies included, overall frequency of major was 1.96 %, and that of minor complications was 3.51%. Of 3724 laparoscopic procedures, 214 complications occurred (5.8% of all procedures) and one death occurred. The level of technical difficulty and existence of prior abdominal surgery were associated with a higher risk of major complications and conversions to laparotomy.Conclusions: Laparoscopic surgery has many advantages, but it is not without complications. Despite rapidly improving technical equipment’s and surgical skill; complication rates and preventable injuries demonstrate continuous pattern. Delayed recognition and intervention add to morbidity and mortality. Each laparoscopic surgeon should be aware of the potential complications, how they can be prevented and managed efficiently

A study of different contraceptive methods: need of the hour during COVID 19 pandemic

Background: COVID-19 disease is the pandemic caused by a single-stranded RNA virus that belongs to the coronavirus family known as 2019-nCoV (SARS-Co V). The disease is highly contagious and transmitted mainly by droplets or close contact. In this time of pandemic it is need of the hour to prevent more and more unwanted pregnancies. This study was to evaluate the contraceptive methods of choice which are easily available, cost effective and suitable to most of the patients during this terrible period of pandemic.Methods: This was a prospective observational study done from April 2020 to December 2020. Women coming to the OPD for contraceptive advice after medical termination of pregnancy and patients desiring postpartum contraception were included in the study. All data were collected from the OPD and IPD of our hospital. Different contraceptive methods available, their costs, hospital visits, complications, failure rate and reason for its discontinuation was analysed.Results: In this study 76.5% patients (n-459) accepted Inj. DMPA as compared to 10 % used Cu T and 13% used OC pills as a method of contraception. Inj DMPA is easily available, cost effective, has lesser side effects and need less hospital visits.Conclusions: DMPA should be made available as a first line method to all those who wishes to opt for reversible method of contraception. This study concludes, during the period of pandemic Inj DMPA was most preferred method of contraception

A prospective study to compare levonogestrol intrauterine system and trans-cervical resection of endometrium for treatment of abnormal uterine bleeding

Background: This article is a study comparing the two most accepted forms of treatment for abnormal uterine bleeding - levonorgestrol intrauterine treatment and transcervical resection of endometrium, with regards to its acceptability, efficacy, adverse effects and user satisfaction. Aim of this study was to compare the acceptability, efficacy, adverse effects and user satisfaction of LNG-IUS and TCRE for treatment for AUB.Methods: A prospective observational study conducted in SKNMC and GH. Forty-nine women with abnormal uterine bleeding after hysteroscopic evaluation were included in this study; where 17 opted for LNG-IUS; 32 opted for TCRE with bipolar electrode. 15 patients in LNG-IUS group and 28 pts in TCRE group completed follow up. Menstrual pattern, pictorial blood loss assessment chart score, adverse effects, acceptability, satisfaction and reason for discontinuation were recorded at 6 weeks, 6 months and 12 months after the procedure. Prior to LNG-IUS insertion or endometrial ablation, endometrial and cervical pathology were excluded by D and C and cervical smear, respectively. TVUS was used to exclude possible causes of menorrhagia, including myomas and endometrial polyp as well as adnexal pathology. LNG-IUS insertion was performed as an office procedure one day after cessation of menstrual bleeding with a negative urine pregnancy test.Results: Menstrual blood loss reductions in TCRE and LNG-IUS groups were by 85.7% and 87.6% respectively after a year. Amenorrhoea was more common in TCRE group while spotting and systemic effects were more common in LNG-IUS group. Satisfaction and acceptance rates are higher in TCRE group.Conclusions: The TCRE and LNG-IUS are equally effective in reducing bleeding in AUB patients. Acceptance and satisfaction are better with TCRE, as a modality of treatment for AUB