A rare case of cervical agenesis with agenesis of the upper 2/3rd vagina with hematometra

Cervical agenesis is an extremely rare form of congenital Mullerian anomaly. Due to the rarity of the cases with different presentations ranging from cervical agenesis to dysgenesis (fragmentation, fibrous cord, obstruction of external os), along with the functionality of the uterus, there are numerous conservative surgical options involving uterovaginal anastomosis, cervical reconstruction, and cervical canalization, and total hysterectomy in cases where conservative surgical procedures fail or not feasible. In our case, the patient was a 32-year-old female with primary amenorrhea with, a history of marriage for 6 years and a history of surgery for primary amenorrhea during adolescence. During the present visit, she had severe abdominal pain due to massive hematometra with a short blind vagina. She was planned for laparoscopic Uterovaginal anastomosis but converted to abdominal hysterectomy due to the large size of uterus, lack of uterine supports, and high length of the defect between the lower end of the uterus and vaginal end. Due to the lack of proper guidelines and variations in clinical presentation, a case-based approach is required

Uterine preservation with Cho suture in localized multifocal atonicity of uterus with failed medical management and uterine tamponade

Postpartum haemorrhage (PPH) is a major cause of maternal morbidity and mortality, and one of the common obstetrical emergencies. Quite commonly, it occurs in patients where PPH is not expected. Management has to be swift and precise according to the steps and the response initiated by the uterine musculature during the management. In our patient, we had a localized multifocal atony of the uterus, at points where the uterine sinuses were bleeding due to atony, and medical management and uterine tamponade failed, with a raised D-dimer level. As the stepwise management failed with uterine devascularisation failing to control PPH, a decision for uterine compression suture (UCS), Cho suture was taken

Evaluation of abnormal uterine bleeding: role of diagnostic hysteroscopy and its correlation with histopathology

Background: The objective was to assess the accuracy of diagnostic hysteroscopy in evaluation of abnormal uterine bleeding and to correlate hysteroscopic findings with histopathology reports.Methods: A prospective study was carried out at our institute from January 2010 to December 2013. Ninety cases were included in this study. Patients’ age varied from 20 to 60. Those women with the history of abnormal uterine bleeding were admitted. In all cases diagnostic hysteroscopic examination and dilatation and curettage were carried out. Endometrium was sent for histopathology and correlation of hysteroscopic findings with histopathology reports was studied.Results: Various findings on hysteroscopy are as following: proliferative endometrium 36.66%, secretary endometrium 17.77% endometrial hyperplasia 24.44%, atrophic endometrium 5.55%, endometrial polyp 8.88%, submucous fibroid 4.44%, and endometrial carcinoma 2.22%.Conclusions: Hysteroscopy is an eye in uterus and it provides more accurate diagnosis than dilatation and curettage alone in patients with abnormal uterine bleeding.