Application of laparoscopy in current fertility practice

Background: The present study is carried out with the objective of establishing the role of diagnostic and operative laparoscopy as a simple, safe and accurate tool in the evaluation of infertility. The aims of current study were to study the application of laparoscopy in current fertility practice, to evaluate indications for diagnostic laparoscopy for infertility, to study findings of diagnostic laparoscopy and to study various operative procedures performed for correction of infertility.Methods: This is a prospective study of 50 women undergoing infertility workup in a private hospital from January 2011 to January 2012. All infertile women having primary or secondary infertility were included in the study. Couples having male factor infertility were excluded from the study. Data were collected and analyzed.Results: Our study is conducted in 50 cases of infertility patients out of which 74% were primary infertility and 26% were secondary infertility. Uterine factors were found in 16% of cases, tubal factors were found in 44% of cases, ovarian factors were implicated in 30% of cases out of which majority (12%) had PCOD. Among the peritoneal factors (18%) endometriosis and pelvic adhesions were found in 6% each. Inspite of thorough laparoscopic evaluation no cause (unexplained infertility) was found in 14% of cases and hence overall, the pelvic pathology was found in 86% of cases.Conclusions: Laparoscopy is the gold standard for diagnosing tubal and peritoneal disease, endometriosis, adhesions and other pelvic pathology, because no other imaging technique provides the same degree of sensitivity and specificity

Study of 50 cases of modern management of ectopic pregnancy

Background: In recent years, an increased incidence of ectopic gestation has been noted, which can be attributed to different reasons. Cases with ectopic gestation were studied and objectives were to study the incidence in various age groups, to study predisposing factors, to study different modes of clinical presentation, to study different sites of ectopic pregnancy and to study changing trends of modern management from radical surgical method to laparoscopic and medical management.Methods: A study of 50 cases of tubal ectopic pregnancy was carried out from May 2009 to June 2011 in tertiary health centre. Patients managed with following treatment modalities were selected for study. (1) Medical management (MTX), (2) Laparoscopic management: salpingostomy, salpingectomy, (3) Laparotomy management: salpingostomy, segmental resection, fimbrial expression, salpingectomy.Results: Lower abdominal pain was most common presenting symptom of ectopic pregnancy in 96% cases. The classical triad of symptoms (amenorrhea, abdominal pain and vaginal bleeding) was present in only 28% cases. PID contributed 24% cases and previous abortion contributed 28% cases indicating these two as the common risk factors. Ampulla was the commonest site for ectopic pregnancy, in 52% cases. Salpingostomy performed mainly at this site. In 6% cases ectopic pregnancy in infundibulum were treated with fimbrial expression and fimbriectomy. 22% patients were managed medically (methotraxte). These were the cases having unruptured ectopic pregnancy and ectopic mass <4 cm. Laparoscopy was done in 34% cases, in 2 cases it was converted to laparotomy. While open laparotomy was done in 40% cases.Conclusions: Ectopic pregnancy is a treatable problem. Ultrasonography plays central role in the diagnosis and management. Mode of therapy is determined by a combination of clinical symptoms, sonography findings and serum b-HCG values. Surgical management is still a cornerstone of management of ectopic pregnancy. But now scope of medical and laparoscopic management is also there. In recent years laparotomy has been replaced by laparoscopic surgery which is more conservative, minimally invasive and less time consuming which leads to quick recovery

The role of foetal assessment by ultrasound at 11-13+6 weeks of gestation

Background: The prevalence of congenital anomalies has been increasing over the years, and it is estimated that every year 1 in 33 infants are affected by some sort of congenital anomaly. At 12 weeks of intrauterine gestation, most of the major foetal structures complete their development and also proper delineation of the foetal anatomy is possible by the time of routine NT scan at 11-13+6 weeks. Methods: This was a prospective study of 110 cases who underwent a first trimester 11-13+6 weeks scan for congenital foetal abnormalities. The eligibility criteria for selection of cases were first trimester pregnancy between the 11-13+6 weeks gestation and CRL between 45 mm and 84 mm. Results: The study found that the detection rate of foetus abnormalities was 15.4% in mothers over 35 years old. Total 2.7% of the present study population were detected to be high risk for trisomy 21. All the 110 cases in present study were followed up till delivery/ termination. MTP was performed in 8.1% cases with lethal anomalies and in 1 cases of structural anomaly with missed abortion, D and E was done. 91% delivered live and healthy babies. There was no intrauterine foetal death or still born in present study. Conclusions: Ultrasound at 11-13+6 weeks must be mandatory, not only for the detection of major foetal anomalies but also for diagnosis of multiple pregnancy and abnormal pregnancy like missed abortion, molar pregnancy and ectopic pregnancy