Obstetrical anal sphincter injuries and outcome of primary repair

Background: OASIs (obstetrical anal sphincter injuries) involve third and fourth degree perineal tears during the process of vaginal birth. It is a grave complication as it can affect quality of life. Incidence of OASIs is on rise in developed countries. We have analyzed OASIs data from a teaching institute in India.Methods: It was a retrospective study. Data was collected from delivery register, postnatal care OPD register and case sheets of patients with OASIs. Data was analyzed to determine incidence and risk factors. The outcome of primary suturing was assessed as per records in postnatal OPD.Results: OASIs was detected in 35 patients (incidence 0.42%), third degree perineal tear was seen in 31 patients, while four patients had forth degree tear. Out of these 35 patients 21 were nullipara. Sixteen patients were instrumental deliveries, 13 and 3 delivered by outlet forceps and ventouse respectively. Primary suturing of the tear was done in 34 patients under anaesthesia. Out of 24 patients who followed up in postnatal clinic at six weeks, 14 patients were asymptomatic. Two had faecal incontinence, while eight had perineal pain.Conclusions: Nulliparity, instrumental delivery, increasing birth weight were high risk factors for obstetrical anal sphincter injuries. Obstetrician needs to be more careful while delivering a patient with multiple risk factors for OASIs. Primary suturing of anal sphincter injury with good post-operative care has a favorable outcome

Hysteroscopy: an effective tool in post-menopausal bleeding

Background: Postmenopausal bleeding is a condition where endometrial carcinoma is to be ruled out. Traditionally, D and C is the preferred method for diagnosis in such condition. Other diagnostic modalities like trans vaginal ultrasonography (TVS) and hysteroscopy are being used for diagnosis in the cases of PMB. The objective of this study is to evaluate the efficacy and accuracy of TVS and hysteroscopy in women with postmenopausal bleeding (PMB).Methods: One hundred postmenopausal women with vaginal bleeding underwent TVS and hysteroscopy. Endometrial tissue was obtained by curettage and sent for histopathology examination. The results of TVS and Hysteroscopy were compared against HP report.Results: Hysteroscopy was successful in 98 patients. Endometrial histopathology revealed proliferative, secretory and atrophic endometrium in 26, 7 and 23 patients respectively. Polyp was diagnosed in 13 patients. Endometrial hyperplasia was detected in 11 patients and endometrial malignancy in 14 patients. All patients with endometrial hyperplasia and malignancy had ET (endometrial thickness) more than 4 mm, except one patient with endometrial malignancy who had 4 mm ET. The sensitivity and specificity of TVS for suspecting endometrial pathology at ET 4mm were 93% and 69.6%, respectively. Hysteroscopy had sensitivity of 95.2%, specificity of 92.8%, with diagnostic accuracy of 93.8%.Conclusions: Hysteroscopy was found to be the more sensitive and specific than Transvaginal sonography for diagnosing endometrial pathologies. Hysteroscopy is safe and effective for detecting endometrial pathologies in patients with PMB

Stings of the missing string: missing Copper T thread

Background: Missing CuT thread is a worrisome complaint for a woman. The string may be curled in or the Cu T might have expelled or migrated.Methods: It was a retrospective study. Authors collected the data between January 2017 to December 2017. Data was collected from OPD, OT register and Indoor patient record file. The objective was to ascertain the symptomatology, type of insertion, investigations and mode of retrieval of CuT.Results: There were 63 cases of missing CuT thread, out of which, 42 were postpartum. 33 patients were asymptomatic. Irregular vaginal bleeding (19 patients) was commonest complaint, followed by abdominal pain (10 patients). Pregnancy was detected in one patient. Transvaginal ultrasonography (TVS) detected intrauterine location of CuT in 60 cases. X-ray abdomen erect was needed in 3 cases, which detected intra-abdominal migration of CuT in two cases. CuT was expelled in third case. In 31 patients, CuT was removed by artery forceps in OPD. In 17 cases, hysteroscopic Copper T removal was needed. Two cases with migrated CuT underwent laparoscopy for retrieval of CuT. One patient had to be converted to laparotomy to rule out bowel injury.Conclusions: Missing CuT thread is commonest with postpartum IUCD. TVS should be first investigation in missing CuT thread. X-ray abdomen is needed only if CuT is not visualized on TVS. Hysteroscopy can be used in patients where CuT retrieval with artery forceps fails. Laparoscopy and laparotomy may be required in migrated CuT cases

Obstetrical anal sphincter injuries and outcome of primary repair

Background: OASIs (obstetrical anal sphincter injuries) involve third and fourth degree perineal tears during the process of vaginal birth. It is a grave complication as it can affect quality of life. Incidence of OASIs is on rise in developed countries. We have analyzed OASIs data from a teaching institute in India.Methods: It was a retrospective study. Data was collected from delivery register, postnatal care OPD register and case sheets of patients with OASIs. Data was analyzed to determine incidence and risk factors. The outcome of primary suturing was assessed as per records in postnatal OPD.Results: OASIs was detected in 35 patients (incidence 0.42%), third degree perineal tear was seen in 31 patients, while four patients had forth degree tear. Out of these 35 patients 21 were nullipara. Sixteen patients were instrumental deliveries, 13 and 3 delivered by outlet forceps and ventouse respectively. Primary suturing of the tear was done in 34 patients under anaesthesia. Out of 24 patients who followed up in postnatal clinic at six weeks, 14 patients were asymptomatic. Two had faecal incontinence, while eight had perineal pain.Conclusions: Nulliparity, instrumental delivery, increasing birth weight were high risk factors for obstetrical anal sphincter injuries. Obstetrician needs to be more careful while delivering a patient with multiple risk factors for OASIs. Primary suturing of anal sphincter injury with good post-operative care has a favorable outcome