Role of hysterolaparoscopy for the evaluation of primary infertility: An experience from a tertiary care hospital

Background: Infertility is one of the most common problem for which couple seeks medical attention. The main objective of the study was to assess the role of diagnostic hysterolaparoscopy in the diagnosis and treatment of primary infertility patients.Methods: For this retrospective study, patient with the diagnosis of primary infertility were recruited. Patients admitted between the periods 2014 to 2016 were included. Pertinent data related to infertility were collected from the case records and entered in predesigned performa.Results: Patients with primary infertility 246 (82%) diagnosed to have pelvic pathology. The most common cause of infertility was ovarian 122 (36.63%), Uterine 66 (19.82%), tubal 84 (25.22%) and unexplained infertility in 103 (30.93%) women. Patients with PCOS 76 (22.82%) and endometriosis 46 (13.81%) treated with drilling and endometriotic cystectomy. In 32 (9.60%) of patients hysteroscopic cannulation was done. For distal tubal blockage fimbrioplasty was performed in 38 (11.41%) of women. Pelvic adhesions diagnosed in 26 (7.80%) women. patients diagnosed with uterine septum 42 (12.61%) required hysteroscopic septal resection. During the evaluation of infertility 70 (21%) of women diagnosed to have incidental pelvic pathology treated according to pathology.Conclusions: Hysterolaparoscopy is emerging as a valuable technique for complete assessment of female infertility and also helps in treatment according to the cause

A prospective observational study for the evaluation of maternal and fetal outcome in patient with eclampsia

Background: Eclampsia continues to be a measure health issue in developing country. In order to get a comprehensive data on eclamptic patients we conduct a prospective observational study to address the maternal and fetal complication during pregnancy.Methods: It is a prospective observational study conducted in a tertiary care medical college between the periods September 2016 to February 2017. During the period all patients with eclampsia admitted to the labour room were taken. Any patients with known epilepsy were excluded from the study.Results: During the period 3780 women were admitted to the labour room, out of which 56 women had eclampsia with an incidence of 1.48%. Out this antenatal eclampsia was most common with an incidence of 91.08% followed by intra partum 4 (7.14%) and postpartum eclampsia 1 (1.78%). Majority of patients 54 (96.43%) were unbooked or inadequately supervised. Most of the patient had normalization of blood pressure after oral nifedipine 46 (82.14%), only 10 (17.86%) patient required additional injection labetalol for control of blood pressure. The maternal complications were placental abruption 8 (14.28%), HELLP 6 (10.71%), pulmonary edema 1 (1.78%), acute renal failure 1 (1.78%), DIC 1 (1.78%) and maternal death 2 (3.57%). Out of fifty six babies delivered 42 (75%) had live birth and 14 (25%) had still birth. A total of 17 (40.42%) had IUGR, 17 (40.47%) require SNCU admission post-delivery.Conclusions:Eclampsia still remains the major cause of maternal and fetal morbidity. In low resource countries improvement in health care facility, adequate antenatal supervision, and timely referral will reduce the maternal and fetal complication.

A prospective study to evaluate the risk malignancy index and its diagnostic implication in patients with suspected ovarian mass

Abstract Background There is no universal screening method for discrimination between benign and malignant adnexal masses yet. Various authors have tried tumor markers, imaging studies, cytology but no one yet is a definite method for screening of cancer ovary, for which a combined diagnostic modality has come to practice in form of RMI. With this background we conducted our study “Evaluation of risk malignancy index and its diagnostic value in patients with adnexal masses”. Methods The aim of the study was to determine the effectiveness of risk of malignancy index (RMI-3) in preoperative discrimination between benign and malignant masses and also to reveal the most suitable cut off value. We have conducted a prospective study between November 2014 to October 2016. We included the parameters like menopausal status, ultrasound features, and serum levels of tumor marker like CA-125 for calculating RMI 3. Then RMI was compared with the histopathological report which was taken as gold standard. Results In the present study malignant tumors constitute 54.76% (69/126) & benign tumors 45.24% (57/126). Bilaterality in adnexal masses and multilocularity is higher in malignant tumors than benign tumor, but a P –value >0.005 failed to be proved significant in our study. Solid area is seen in 24.69% (20/81) of benign and 75.30% (61/81) of malignant tumor. Similarly ascites was found in 38.09% (48/126) of cases. Out of which 18.75% (9/48) cases were found to be benign and malignancy was confirmed in 81.25% (39/48) patients. There is statistically significant number of malignant ovarian cancer patients where ascites and solid area is seen in USG findings (p = 0.000). Risk of Malignancy Index compared with individual parameters of Ultrasound score, CA-125 or menopausal score and a cut-off point of 236 shows a very high sensitivity (72.5%), specificity (98.2%), positive predictive value (98.1%), negative predictive value (74.7%) and diagnostic accuracy (84.13%) for discriminating malignant and benign pelvic masses. Conclusion Simplicity and applicability of the method in the primary evaluation of patients with pelvic masses makes it a good option in daily clinical practice in non-specialized gynecologic departments and also in developing countries where access to a gynaecologist oncologist is limited