Evaluation of outcome following paracervical infiltration with or without saline and adrenaline during vaginal hysterectomy

Background: Paracervical infiltration is used in vaginal hysterectomy to facilitate dissection. Use of paracervical infiltration however can be associated with local ischemia and infection. We did a study to find out its benefits during vaginal hysterectomy.Methods: It was a prospective case control study. Patients were divided into two groups. In the first group, no paracervical infiltration was given. In the second group paracervical infiltration was given before hysterectomy. The operating time, blood loss and postoperative infection were noted in each group.Results: The operating time was slightly higher in vaginal hysterectomy group without infiltration (p=0.025) The operating time in laparoscopic assisted vaginal hysterectomy group was not significant (p=0.0296). There was significant difference in Hemoglobin after surgery in both groups (p value 0.614 for vaginal hysterectomy and 0.173 for laparoscopic assisted vaginal hysterectomy). There was no case of infection in both groups.Conclusions: From our study, we concluded that paracervical infiltration offers no distinctive advantage during vaginal hysterectomy or laparoscopic assisted vaginal hysterectomy.

Covid 19, the Kerala experience: an observational, single centre retrospective study of outcome in covid positive pregnancies

Background: Covid 19 has spread across the world at an alarming rate. Approximately 4.05 million people have got infected worldwide resulting in around 279,000 deaths. Over 1 million people have recovered worldwide. Aim of this study was to determine whether course and severity of covid 19 is altered in pregnant women and whether covid 19 seemed to worsen the prognosis in pregnant women.Methods: Around 50 covid positive patients were admitted to this study hospital, a tertiary care referral hospital and medical college, between march and May 2020, 11 were pregnant. Authors collected their data retrospectively to understand the course of their disease till the period of recovery.Results: There were 6 patients above 31 weeks of whom one had elective repeat caesarean section, one had full term vaginal delivery, one is under follow up. Three patients had foetal distress necessitating emergency caesarean section. Of the remaining 5 patients with periods of gestation between 9-13 weeks, 1 of 24 weeks, 6 patients above 31 weeks, one had a miscarriage. Rest pregnancies are continuing and under follow up. 6 women had been symptomatic at admission, with mild symptoms of low-grade fever, sore throat and rhinitis. All were treated with hydroxychloroquine (HCQs). Those with respiratory symptoms like cough were also treated with oseltamivir. In view of high prevalence of H1N1 in the region. None of the women developed severe disease. The disease did not appear to worsen prognosis in pregnant women. The rate of recovery in pregnant women was similar to that seen in non-pregnant women and also men under the age of 40 years admitted in this study hospital.Conclusions: Covid 19 did not seem to worsen the prognosis in pregnant individuals when compared to rest of the population. The foetal outcomes also seemed favorable. However larger studies are required before concrete guidelines could be formulated for management of the disease in pregnancy

COVID-19 symptoms-does pregnancy alter the course of the disease

Background: COVID-19 or corona virus 2 is a widespread pandemic taking a huge toll on the world population.it has a varied presentation in different age groups. Similarly, it has a poorer outcome in the elderly with various comorbidities and those who are immunocompromised. Though pregnancy is a relatively immunocompromised state studies have found that pregnant women have a less severe presentation. We have tried to assess this aspect of COVID-19 in pregnant women.Methods: We evaluated the records of 158 pregnant women who presented to our hospital from April 2020 till September 2020.Their symptoms at presentation were evaluated. we also noted the outcome of these pregnancies.Results: 16% of these were more than 34 weeks of period of gestation. 65.19% presented without any symptoms. 15.19% presented with fever. 10.75% presented with cough. 8.22% presented with headache. 5.69% presented with sore throat alone. 3.16% presented with breathlessness. 0.63% presented with anosmia alone, loss of taste, severe acute respiratory infection, vomiting, sore throat and breathlessness respectively. 54 patients delivered of which 7 delivered vaginally and there were 47 caesareans. Remaining patients after cure were discharged. There were 3 miscarriages. Two babies were found to be COVID-19 positive from nasopharyngeal swab taken on day 1, however this was a small number to indicate vertical transmission.Conclusion: Our study showed that a large proportion of pregnant patients presented without symptoms.it remains to be evaluated why this is so.it may provide us with clues on how to deal with disease in the general population

HIV and trans and non-binary people in the UK

Trans and non-binary people are key populations whose HIV prevention and treatment needs have been neglected. A 2013 meta-analysis of data from 39 studies conducted in 15 countries, reported a global HIV prevalence among trans women of nearly 20%, with trans women estimated to be 49 times more likely than other adults to be living with HIV. Moreover, mortality from HIV/AIDS among trans women in a large cohort study was just over 30 times that of age-matched population controls

Comparison between paracervical and intracervical block before procedures on uterine cavity and cervical dilatation

Background: Procedures like dilatation and curettage and manual vacuum aspirations are one of the commonest procedures conducted in the outpatient Department of Obstetrics and Gynecology. Objective of present study was to find out whether intracervical block is as effective as paracervical block in patients undergoing cervical dilatation and procedures on uterine cavity.Methods: Patients undergoing dilatation and curettage or manual vacuum aspiration were given either paracevrical block or intracervical block. The pain during cervical dilatation and curettage or manual vacuum aspiration were assessed on a 10 cm visual analogue scale.Results: Mean visual analogue score during dilatation was comparable in both groups. Mean visual analogue score were comparable during dilatation in both groups before curettage or manual vacuum aspiration. Mean visual analogue scores during manual vacuum aspiration or curettage was also comparable with both groups. One patient had a serious side effect of convulsion during paracervical block.Conclusions: Intracervical block is preferable to paracervical block during procedures like cervical dilatation and on procedures on uterine cavity as intracervical block requires less technical precision than paracervical block

Selective cauterization of supporting ligaments at Non Descent Vaginal Hysterectomy (NDVH)

Background: The objective of the study was to study the use of electrocautery selectively for cardinal uterosacral ligament complex during NDVH.Methods: We performed a series of NDVH where electrocautery was used selectively for the uterosacral cardinal ligament complex. Rest all stumps were clamped, divided and ligated.Results: We did a series of 21 cases using this technique and found this as a very effective method of doing NDVH. There were no major complications.Conclusion: Selective use of electrocautery for uterosacral and cardinal ligament complex makes NDVH easy

Transverse limb defect: a case report

Transverse limb defects are a relatively rare problem (3.5-6.9/10000 births) with a fairly low prenatal detection rate (55%). The possible etiology for this condition could be as part of a genetic condition or amniotic band syndrome. The detection rate can be improved with the use of careful anatomical survey during anomaly scan. In this case report, transverse limb defect was detected in the second trimester.

Successful maternal and fetal outcome in patients with Takayasu arteritis: two case reports of Type I and Type IV in stage 2

Takayasu's arteritis, is a rare, chronic, idiopathic, inflammatory disease of the large arteries, primarily involves the aorta, its main branches as well as the coronary and pulmonary arteries. It is mostly seen among women with child bearing age group (80%). During pregnancy, the increased intravascular volume impair circulation and exacerbate aortic regurgitation, hypertension, and congestive heart failure. Hypertension is one of the serious complication that can develop, leading to intrauterine growth restriction, maternal heart failure, and fetal haemorrhage and during postpartum period

Pelvic schwannoma mimicking as an adnexal mass

Schwannoma (neurilemmomas), a peripheral nerve sheath tumour generally occurs on the head and neck region, their pelvic occurrence is much rare. Retroperitoneal schwannomas are the rarest of all retroperitoneal tumours. We report a 45 year woman with a schwannoma in the retro peritoneum that was preoperatively diagnosed as an adnexal mass