Combination of mifepristone and misoprostol: an effective method of medical abortion upto gestational age of 49 days

Background: A combination of antiprogesterone mifepristone and prostaglandin analogue misoprostol provides an effective non surgical method for termination of pregnancy up to gestational age of 49 days. Objective of present study was to assess the efficacy of this medical regimen for termination of pregnancy up to 49 days of pregnancy.Methods: A hospital based retrospective study was carried out in Department of Obstetrics and Gynecology in Sassoon General Hospital, Pune, India for a period of one year where 30 women requesting for medical abortion were studied. The medical regimen used was mifepristone 200 mg orally followed 48 hours later by misoprostol 800 microgram administered in posterior vaginal fornix.Results: The overall success rate of this regimen was 90%. Where success was defined as achieving complete abortion without needing surgical evacuation. Surgical evacuation was needed in 3 (10%) patients i.e. for incomplete abortion.Conclusions: Combination of oral mifepristone 200mg followed 48 hours later by vaginal misoprostol 800mcg is an effective method of medical termination of pregnancy

Rare case of huge rectal and uterovaginal prol

A case of combined genital prolapse and rectal prolapse in a 60-year-old multipara is reported. The treatment of mixed prolapse remains surgical and should be treated the genital prolapse by vaginal hysterectomy with pelvic floor repair and the rectal prolapse by means of the Delorme operation. The mortality and morbidity rates are zero if this operation is used and the relapse rate is only 8 to 11% for the rectal prolapse. It would appear that the two approaches are rarely associated by the authors and would seem to be interesting to reconsider this question by indicating mixed treatment of the two prolapses whenever possible

Comparative Study of Laparoscopic Cholecystectomy Techniques: Traditional Clipping versus Harmonic Scalpel Closure

Background: Laparoscopic cholecystectomy (LC), a widely used surgical procedure to remove the gallbladder, can vary in how the cystic duct and artery are closed. This study compared the safety and effectiveness of LC performed using the standard method (TM) with LC performed with harmonic scalpel assistance (HLC). Methods: A prospective comparison research with 30 patients in each group (LC and HLC) of 60 patients scheduled for LC was conducted. The length of the hospital stays, the number of antibiotics used, the number of surgical problems, postoperative bile leakage, and the length of the operation were all recorded. Suitable tests were used in the statistical analysis. Results: When compared to LC, HLC showed considerably shorter operating times (35.1 4.079 vs. 47.933 8.026 minutes, p0.0001) and less frequent need for antibiotics (3.267 0.691 vs. 4.367 0.809 days, p0.0001). Surgery-related complications were comparable between groups (LC 10% vs. HLC 6.67%, p=0.549). Postoperative bile leakage in HLC (0%) were trending lower than LC (6.67%, p=0.157). A shorter hospital stay was the result of HLC (3.1 + 0.547 vs. 4.4 + 0.855 days, p0.0001). Conclusion: In comparison to LC, HLC offers benefits such as faster recovery times, less need for antibiotics, and shorter hospital stays. Although there were no appreciable differences in postoperative problems in HLC, there was a tendency towards less intraoperative complications. These results back up the use of HLC as a secure and effective cholecystectomy option. It is need to do additional study with larger cohorts and longer follow-up

Laparoscopic bilateral gonadectomy in a case of turner syndrome with 45XO/46XY genotype

Turner syndrome is one of the common chromosomal aberrations which manifests in a female as multiple phenotypic disorders usually presenting as a case of primary amenorrhea. Many of these patients display mosaicism on karyotyping and a presence of Y chromosomal material indicates high risk of gonadoblastoma and gonadectomy is indicated which is best achieved by laparoscopy. This is a case of 21-year-old female phenotype referred as a case of primary amenorrhea diagnosed as Turner syndrome with 46XY mosaicism. Laparoscopic bilateral salpingoophorectomy was done. In patients of primary amenorrhea karyotyping should be evaluated and if Y chromosome detected these patients should be subjected to gonadectomy after proper risk counselling about malignancy

Laparoscopic management of heterotopic pregnancy in an IVF conception

Heterotopic Pregnancy cases are on the rise in the era of Artificial Reproductive Techniques and managing these pregnancies can be challenging especially in safeguarding the precious intrauterine pregnancy. These were traditionally managed by laparotomy and there are few cases reported wherein salpingectomy is done laparoscopically. We would like to report this case of a 7 weeks intrauterine pregnancy with 5 weeks tubal ectopic treated by laparoscopic salpingectomy under spinal anaesthesia while safeguarding the intrauterine viable gestation. In the light of increased incidence of abnormal implantations and growing demand and expertise of minimally invasive surgeries, laparoscopy is the treatment of choice for heterotopic pregnancies, especially in the interest of the intrauterine pregnancy

A study of morbidity pattern in Misgav Ladach technique of caesearean section

Background: There has been progressive increase in C-section (CS) rate globally since last 10 years. Issues related to maternal choice, Mode of delivery for non-cephalic presentation at term, vaginal delivery after previous scar have been the focus of attention. The objective of the study was to determine whether Misgav Ladach caesarean section technique offers benefits over Traditional Method of caesarean section with regards to Duration of surgery, Time taken for abdominal entry, Total operation time, Amount of blood loss and Postoperative morbidity.Methods: A randomized control study was carried out on 460 patients who underwent Caesarean section at Krishna hospital, Karad, Maharashtra, India between November 2013 to June 2015.Results: 460 cases of caesarean section admitted to Krishna institute of medical sciences, karad during the period of November 2013 to June 2015 were studied with respect of clinical pattern, majority of the cases who underwent, caesarean section by both the methods were in the age group of 21-25 years. The main indication for caesarean section was fetal distress. Fetal distress accounts for 29% in Misgav Ladach method and 31% in traditional method, failed induction accounts for 6% in Misgav Ladach and 8% in traditional method. The total operation time was 31 min average in Misgav Ladach and 37 min in traditional group. The mean blood loss for the Misgav Ladach group was 486 ml and 521 ml for the traditional group, which was significantly different (p<0.001). The postoperative morbidity due to fever was 4% in the both groups.Conclusions: Substantial reductions in operating time and blood loss were noted in the study, which may benefit the women in reducing the exposure time to anesthesia

Comparative study of programmed labor and traditional management of labor

Background: Prolongation of labor leads to dehydration, ketoacidosis, infection, fetal asphyxia. Programmed labor aims at reducing the duration of labor, labor pain and incidence of cesarean section with improved maternal and neonatal outcome.Aims and Objectives:1)       To evaluate the effect of programmed labor on duration of labor.2)       To assess efficacy of analgesics in reducing pain of labor.3)       To find out maternal and neonatal complications.4)       To study impact of programmed labor on LSCS rates.Methods: Prospective randomized study of primigravida in active labor (after 4 cm cervical dilatation) for which 100 women were selected for programmed labor (cases) and 100 women were selected for traditional management of labor (controls). Cases were subjected to interventions to improve uterine contractions (ARM, Dinoprostone tablets, and Oxytocin drip), to facilitate cervical dilatation (Inj. Drotaverine), to relieve labor pains (Inj. Pentazocine & Diazepam). All labors were monitored by partogram.Results: Programmed labor reduced duration of first and second stage of labor. There was faster cervical dilatation (1.8 cm/hour against 1.2 cm/hour). Majority of the patients had better pain relief. There was no impact on LSCS ratesConclusions: Programmed labor significantly reduced duration of labor with good pain relief without compromising maternal and fetal/neonatal safety. But it had no impact on LSCS rates

Aggressive angiomyxoma of broad ligament: an uncommon mesenchymal tumor

Aggressive angiomyxoma is a rare mesenchymal tumor occurring predominantly in the pelviperineal region. Authors present a case of a 70 years female presented with history of distention of lower abdomen with recurrent pain since 6 months. On clinical examination there was suspicion of fibroid. On USG it was reported as huge fleshy, soft tissue mass measuring 20x10x9 cm in lower abdominal flanks and pelvis with vascular pedicle attached to right parametrium. Pan-hysterectomy was performed. Right broad ligament showed mass measuring 18.5x10x6 cm. On histopathological examination it was diagnosed as a case of Aggressive angiomyxoma of broad ligament. We are presenting this case for its extreme rarity, clinicohisto-pathological and radiological findings

Study of prevalence and determinants of polycystic ovarian syndrome among adolescent girls in rural area: a prospective study

Background: Polycystic ovarian syndrome (PCOS) is the most frequent endocrinological disorder affecting 5-10% of women in the reproductive age. This prevalence ranging from 2.2% to 26% in adult women from 18-45 year. In a recent study the prevalence of a confirmed diagnosis of PCOS in adolescents aged 10 to 19 years was 5-15%, which increased to 10-22%. When undiagnosed cases with documented symptoms qualifying for PCOS according to NIH (National institute of Health) criteria were included. PCOS is a complex endocrine disorder which is most common in women of reproductive age. PCOS may first present in adolescence, but the incidence of PCOS in adolescence is not known, as diagnostic criteria for PCOS in the adolescent age-group is still not defined, PCOS symptoms tend to overlap with normal pubertal changes making the diagnosis even more challenging. The objective is to study prevalence and symptomatology of polycystic ovary syndrome (PCOS) in adolescent girls.Methods: Prospective Cross sectional study between April 2018 and March 2019. 150 adolescent girls aged 10 to 19 years attending OPD with oligomenorrhea, irregular menstrual cycle, obesity and/or hirsutism were advised for biochemical, hormonal, and ultrasonographic evaluation for diagnosis of PCOS on the basis of Rotterdam's criteria at the Department of Obstetrics and Gynaecology, Krishna Institute of Medical Sciences, Deemed University, Karad, Maharashtra, India.Results: Prevalence of PCOS in the study was 17.33% in the study group.Conclusions: PCOS is increasingly encountered during adolescence, although the overall prevalence is low and evaluation of PCOS in adolescents is challenging. At this age, lifestyle modification is imperative to prevent long-term metabolic and reproductive complications