Gut in the Womb

Dilatation and curettage is one of the common minor procedures with minimal complications but it can cause major complications like perforation of uterus, which is a surgical emergency and the delay in diagnosis and treatment has deleterious consequences for the mother. We are reporting this case of intestinal evisceration & its strangulation in puerpera after surgical evacuation for retained product of conception. This case is reported as evacuation is a commonly done procedure in puerperium for management of secondary PPH, hence want to emphasize that delay in the diagnosis of complications and management can lead to grave prognosis of the mother

Level of acceptance of IUCD insertion in Indian women - a cross-sectional mixed research from central India

Background: In India, knowledge & awareness of IUCD is inadequate. Many misconceptions are present in the society. Health care providers promote sterilization more than temporary methods or IUCD. The objective was to study the acceptance level of IUCD insertion in Indian women.Methods: We conducted a cross sectional study in the dept. of Obstertrics & Gynaecology, Chirayu Medical College & Hospital, Bhopal on 267 women, interviewing them whether they had accepted IUD in past, if yes continued how long. If no, then causes of non-acceptance found out. They were counseled for IUCD insertion at present. IUCD insertion done for those who were willing. Causes of refusal noted for those who did not accept it. Statistcal analysis of results done.Results: 113 women were users of temporary contraception, in general they used it for 178 spacings. IUCD was used for 19.10% of spacings. Out of 267, 11.98% accepted IUCD, 10.48% in past & 1.49% at present; 88% did not accept, p=0.001. Continuation was done by 2.62%. Menstrual problem was the commonest reason for discontinuation. From the total, 231 women eligible for IUCD did not accept IUCD in past. 160 eligible women refused IUCD insertion at present.The difference between temporary & permanent contraceptives was not statistically significant, p=0.82. In the acceptor group, significant difference was found in housewives & working women, p=0.02 & that between BPL card holders & nonholders, p=0.0009.Conclusion: IUCD acceptance was very poor in our study. People consult their relatives/friends more than the healthcare providers in this regard, who tend to spread misconceptions. Healthcare providers need to look into the matter seriously. Promotional activities need to be focused on IUCD

Pyocolpos at puberty: a very rare entity

This is a case report of a 12 year girl who reported with a H/O incomplete bladder evacuation & burning in micturition since one month, urinary incontinence once only. She had no abdominal pain or fever & had not attained menarche. The stature was short, thelarche attained 4 months back. No bulge in abdomen. Other general examination features normal. Urine examination was normal. USG suggested hematocolpos with imperforate hymen. On this basis local examination was done. Imperforate hymen with otherwise normal external genitalia found. Pubic & axillary hair absent. Preoperative diagnosis was imperforate hymen & hematocolpos with ? androgen insensitivity syndrome. She could not afford serum DHEAS levels. With this diagnosis it was worrisome to think that patient had attained menarche (cryptomenorrhoea) with androgen insensitivity as pubic & axillary hair had not appeared even after the presumed menarche, which should have appeared well before menarche. Her short stature was also not expected to change after menarche. Hymenotomy under GA done, 490 ml of mucopurulent discharge was drained. Postoperative period uneventful. Now she is expected to have a growthspurt, adrenarche & menarche. In prepubertal girls with urinary complains, the possibility of imperforate hymen with hematocolpos/pyocolpos should be considered as differential diagnosis. Incorporating an examination of external genitalia into routine practice of clinicians caring for children can prevent the significant delay in the diagnosis of imperforate hymen