Case series: transverse vaginal septum with vaginal atresia

This study includes case series of three cases of transverse vaginal septum with vaginal atresia. Cases presented with either primary amenorrhea or hypomenorrhea or secondary amenorrhea with complaints of cyclical abdominal pain. On examination, all cases had well developed secondary sexual characters, blind vaginal pouch with enlarged uterus felt on per rectal examination. Hormonal profile of all three cases was within normal limit. Karyotyping was done for all three cases, results were 46 XX. Radiological findings were that all cases had hematocolpos and one case had OHVIRA syndrome i.e.; absent right kidney with didelphys uterus with right hemivagina transverse septum. Management of all three cases included resection of transverse vaginal septum with vaginoplasty. Transverse vaginal septum was dissected and was used to create neovagina. Post-operatively, patients were advised to use phantom dilator, for 3-4 times in a day for atleast 3 months, to avoid vaginal stenosis. Cases were followed in OPD every monthly for 3 months, dysmenorrhea was relieved and patients were menstruating regularly with moderate flow for 3-4 days

Medical management versus surgical management in fibroid uterus

Background: Uterine fibroids (leiomyomas) are most common tumours of the uterine smooth muscles, appear to increase in incidence with age during reproductive years, with a peak in incidence between 35 to 40 years. Signs and symptoms of uterine fibroids include heavy or prolonged menstrual bleeding, pain and pregnancy complications. Current management strategies mainly involve surgical interventions, but choice of treatment is guided by patient’s age and desire to preserve fertility or avoid ‘radical’ surgery such as hysterectomy.Methods: It is the prospective observational study conducted in inpatients of department of OBGY at tertiary care hospital, admitted during the period of June 2019 to May 2021. Outcome measured in terms of relief of symptoms, decrease in size of fibroid, requiring subsequent surgery, quality of life, blood transfusion requirements, length of stay in hospital, successful pregnanciesResults: Of patients treated with ulipristal, 78.57% had improved quality of life, in patients treated with leuprolide, 57.14% showed improved quality of life, with mifepristone 80% patients showed improved quality of life and with LNG 100% patients responded to it. All patients treated surgically, showed relief of symptoms.Conclusions: Medical line of management is best for patients in younger age group, small size fibroid, desire for future fertility. Uterus sparing option like myomectomy is done in patients not responding to medical line of management and desire for future fertility. Hysterectomy is definitive line of management for patients with fibroid uterus