Abstract

The diagnosis of an unsuspected leiomyosarcoma after hysterectomy for the treatment of a presumed benign leiomyoma is a rare but highly clinically significant event. In order to facilitate removal of large uterine specimens using a minimally invasive surgical approach, morcellation with extraction in pieces is often performed. In the event of unsuspected malignancy, this may result in abdominal dispersion of the tumor and contribute to poorer survival. Modern surgical innovations always work toward improving minimally invasive strategies. Laparoscopy, rooted in practices for years, supplanted laparotomy for many indications. For extraction of large uteri, morcellation is currently the only way to externalize surgical specimens (myomas, uteri), without increasing the skin opening while allowing to reduce postoperative complications when compared to laparotomy. However, in 2014, the Food and Drug Administration warned against the use of uterine morcellation because of an oncological risk. Some practicing academicians have challenged this recommendation. The incidence of uterine sarcomas is still poorly identified and preoperative diagnostic facilities remain inadequate. The small number of retrospective studies currently available do not reinforce any recommendation. The evaluation of morcellation devices and the improvement of preoperative diagnostic modalities (Imaging, preoperative Biopsy) are being improvised continually so as to minimize the oncological risks. Even during conventional myomectomy, tissue spillage occurs during resection of leiomyoma(s). Adverse oncologic outcomes of tissue morcellation should be mitigated through improved patient selection, preoperative investigations, and novel techniques that minimize tissue dispersion. Preoperative endometrial biopsy and cervical assessment to avoid morcellation of potentially detectable malignant and premalignant conditions is recommended.

Abstract

Endometrial polyps are frequently seen in subfertile women, and there is some evidence suggesting a detrimental effect on fertility. How polyps contribute to subfertility and pregnancy loss is uncertain and possible mechanisms are poorly understood. It may be related to mechanical interference with sperm transport, embryo implantation or through intrauterine inflammation or altered production of endometrial receptivity factors. Different diagnostic modalities such as two- or three-dimensional transvaginal ultrasound, saline infusion sonography or hysteroscopy are commonly used to evaluate endometrial polyps with good detection rates. The approach of clinicians towards polyps detected during infertility investigations is not clearly known, and it is quite likely that there is wide variation amongst different groups. Most clinicians suggest hysteroscopy and polyp removal if a polyp is suspected before stimulation for in vitro fertilisation or a frozen embryo transfer cycle. However, the clinical evidence and benefit of different management options during assisted reproduction technology cycles are conflicting. Currently, there is insufficient evidence to recommend one particular option over others when a polyp is suspected during stimulation for in vitro fertilisation. A properly designed randomized controlled trial is needed to determine the best treatment option. In this article, we present the available evidence and our practice related to different diagnostic modalities and management options. We also discuss the available literature relevant to the management of endometrial polyps in relation to natural conception, intrauterine insemination and in vitro fertilisation.

Keywords Endometrial polyps, Infertility, Ultrasound, Hysteroscopy, In vitro fertilisation

Abstract

Female cosmetic genital surgery (FCGS) is the latest and fastest growing sub-specialty in the broad specialty of gynecology. It encompasses procedures designed to change aesthetic and/or functional aspects of women’s genitalia. In case of FCGS, there is difficulty in separating purely aesthetic concerns from medical concerns, because there is much overlap. The initial controversies over FCGS have almost settled down in the light of the mounting scientific evidence suggesting that a number of procedures that currently exist are safe, effective, and capable of treating to a considerable extent the suite of conditions associated with course-of-life vulvo-vaginal changes. Also, the rapidly expanding demands that have arisen for FCGS procedures from women across the globe have made it imperative for the reconstructive pelvic surgeons to master the cosmetic genital procedures so as to deliver the women what they want, in the most scientific manner. The issue of asking for and provisioning of FCGS is essentially a matter of individual patient and physician decision-making.

Keywords Cosmetic gynecology  Cosmetic vaginal surgery  Vaginal rejuvenation  G-spot  Labiaplasty  Vulvo-vaginal rejuvenation

Abstract

Background There is an overwhelming body of evidence strongly suggesting that periodontal infection may have a significant negative impact on pregnancy outcome in some women. The aim of this study was to determine the association between periodontal disease and preterm low birth weight of babies.

Materials and Methods A total of 300 pregnant women, between 20 and 24 weeks of gestation i.e., second trimester, were considered for the study. The periodontal status was recorded using the following parameters: probing pocket depth, clinical attachment level, oral hygiene index and plaque index. After initial examination in the second trimester, the pregnant women were followed till delivery of the baby. Postpartum data i.e., weight of baby, gestational age of pregnancy and type of delivery, were recorded.

Results Out of 300 pregnant women, 248 women had fullterm delivery (12 low birth weight and 236 normal birth weight) while 52 had preterm delivery (6 normal birth weight and 46 low birth weight). There was significant association between body mass index and level of periodontal disease severity of pregnant women with birth weight of babies, gestational age of pregnant women and mode of delivery, respectively. As the level of periodontal disease severity increased, the proportion of delivering preterm and low birth weight babies also increased.

Conclusion The conclusions obtained revealed that Periodontal disease is a potential risk factor for preterm low birth weight babies of pregnant women.

Abstract

Background and Objectives The incidence of congenital diaphragmatic hernia (CDH) in India is 1 in 1000. About 60 % of these are isolated, and the survival prognosis in them depends upon the quantum of contralateral functional lung. Out of the various pulmonary and extrapulmonary sonological predictors, observed to expected lung–head ratio (O/E LHR) is an efficient gestation-independent predictor of pulmonary function. This study was carried out to see the correlation of this prenatal predictor with the postnatal outcome depending on the pulmonary function.

Methodology This study was carried out at Apollo Center of Fetal Medicine, New Delhi, from January 2009 to December 2015. Atotal of 14 fetuses with isolated left-sidedCDH were included. The contralateral lung area was measured in 2D transverse view of the thorax at the level of four-chamber view of the heart by tracing method. The obtained value (square mm) was then divided by the expected mean lung area at that gestation and multiplied with 100 to express O/E LHR as percentage. These were then classified as severe (O/ E LHR < 25 %), moderate (25–45 %) or mild (> 45 %) varieties of CDH. The parents to be were counselled for termination or continuation of pregnancy based on severity of CDH and total lung area. The patients were followed up for obstetrical and neonatal outcome till the time of first postoperative visit (diaphragmatic repair).

Results The survival correlation in mild cases was 100 % (n = 5 out of 5) and 50 % in moderate cases (n = 2 out of 4), and both severe cases were terminated. There was a significant difference (p < 0.01) in the survival rate in the mild versus severe cases.

Conclusions The prenatal predictor for postnatal pulmonary function correlates well with the neonatal outcome and hence is an important tool in prenatal counseling and triaging those who require termination of pregnancy versus expectant management. An obstetrician who is a first point of contact to the pregnant women can understand this and use it for counseling and differentiating the patients who need termination with regard to CDH.

Abstract

Objectives To study the complications and consequences including maternal morbidity and mortality following indiscriminate self-consumption of abortion pills reporting to a tertiary care center.

Methodology This is an observational study conducted at Vanivilas hospital between January 2012 to December 2013 for 24 months. After applying inclusion and exclusion criteria, 104 women were studied with respect to period of gestation, parity, clinical features at presentation and management in the institution. An analysis of maternal morbidity and mortality was done with respect to surgical interventions, ICU admissions, need for blood transfusions and maternal deaths.

Observations and results In this study, there were 75 (72.2 %) cases of incomplete abortion, 10 (9.6 %) cases of missed abortion, 2 (1.9 %) cases of ruptured ectopic and 2 (1.9 %) cases of rupture uterus. Seventy-eight (75 %) cases received blood transfusion, 7 (6.7 %) were admitted to ICU, and 2 (1.9 %) developed acute kidney injury. There were 2 (1.9 %) maternal deaths in the study group.

Conclusion This study shows urgent need for legislation and restriction of drugs used for medical termination of pregnancy. Drugs should be made available via health care facilities under supervision to reduce maternal mortality and morbidity due to indiscriminate use of these pills.

Abstract

Objectives: The aim of the study was to identify the risk factors predisposing to morbidly adherent placenta and to study the different modes of management and the obstetric and neonatal outcome of these patients.

Methods: This was a retrospective cum prospective observational study conducted in the Department of Obstetrics and Gynaecology in a tertiary care referral hospital in Mumbai from January 2012 to November 2014.

Results: The incidence of morbidly adherent placenta was 1.32 per 1000 pregnancies with patient profile comprising second gravida in the age group 26–28 years; 90 % of the patients in this study had previous Caesarean section and co-existing placenta praevia was diagnosed in 63 %. Fiftythree per cent of the women delivered between 35 and 38 weeks and 40 % had elective deliveries. Caesarean section was the mode of delivery in 90 % of the patients. Prophylactic balloon placement in the internal iliac artery followed by classical Caesarean section, uterine artery embolization and post-operative methotrexate was done in 27 % which preserved the uterus and was associated the blood loss of 1000–2000 mL

Conclusion: Antenatal diagnosis of morbidly adherent placenta allows for multidisciplinary planning in an attempt to minimize potential maternal or neonatal morbidity and mortality.

Abstract

Objective To evaluate salpingoscopic tubal mucosal grading and to find out correlation between laparoscopic external tubal appearance and salpingoscopic mucosal appearance.

Design Prospective observational study.

Intervention Salpingoscopy and laparoscopy.

Materials and Methods Thirty-seven infertile women between 21 and 40 years of age group who attended infertility clinic at IKDRC, Ahmedabad, from May 2015 to August 2015, were enrolled in the study. Laparoscopic tubal morphology was classified as regular, convoluted and hydrosalpinx. Salpingoscopic findings were graded (Grade I–Grade V) according to Brosens classification.

Results Laparoscopic appearance of tube was regular in 18 (48 %), convoluted in 17 (45.94 %), and hydrosalpinx in 2 (5.4 %) women. Salpingoscopic findings were graded as Grade I in 14 (37.83 %), Grade II in 10 (27.02 %), Grade III in 8 (21.62 %), Grade IV in 3 (8.10 %), and Grade V in 2 (5.4 %) women. Discordance between laparoscopic and salpingoscopic findings, i.e. regular appearance on laparoscopy and Grade III–Grade V appearance on salpingoscopy, was found in 38.88 % women.

Conclusion Laparoscopy alone might not be sufficient to predict tubal integrity and salpingoscopic endotubal grading may help in infertility treatment selection decisions. Early counselling towards IVF-ET can be encouraged in cases with higher grade.

Abstract

Introduction: Cervical cancer is one of the leading cancers among Indian women with estimated 123,000 new cases and 67,477 deaths in 2012. Cervical cancer is a multietiological disease. Factors such as low socioeconomic status, tobacco use, sexual and reproductive factors, HIV and other sexually transmitted diseases and long-term oral contraceptive use have been suggested as determinants. Assessment of socio-demographic profile and reproductive history gives a better picture of the determinants of cervical carcinoma in low-resource settings.

Methods: This hospital-based cross-sectional study was undertaken at a tertiary healthcare institute at New Delhi, India. Sixty-seven newly diagnosed women with advanced cervical cancer (stage 2B–4B), who were undertaking radio- and/or chemotherapy, were included to assess their socio-demographic, reproductive and clinical profile.

Results: The mean age of women at the time of detection of cervical cancer was 52.28 ± 11.29 years (range 30–75 years). More than 60 % of patients were illiterate and belonged to middle socioeconomic status. Thirty-nine percentage of the study subjects had their first sexual experience before 15 years of age. Nearly 54 % women had 5 or more pregnancies. Nearly 73 % of women had all deliveries at home. Majority (69 %) of women had symptoms suggestive of reproductive tract infection. Among them, unusual discharge from vagina (73.13 %) followed by bleeding after menopause (55.10 %) and pain in abdomen (44.77 %) were the most common presenting complaints. Pallor was present in nearly two-third (63.93 %) study subjects. More than half (56.72 %) study subjects had moderate anemia, and 7.46 % had severe anemia before treatment. Mean hemoglobin level of the study subjects was 10.35 ± 1.72 gm% before treatment and 9.69 ± 1.29 gm% after treatment. This difference was statistically significant. Around 97 % of the study subjects had squamous cell carcinoma of the cervix. Majority (53.73 %) of the study subjects were in stage 3B of cervical cancer. Combination of radiotherapy and chemotherapy was the most common (77.67 %) modality of treatment.

Conclusions: and Recommendations Illiteracy, low socioeconomic status, early sexual debut, high fertility, home delivery, reproductive tract infections, use of insanitary clothes during menstruation and anemia were observed in majority of women with advanced cancer cervix. Presence of these factors indicates possible risk of cervical cancer and should be kept in mind when women seek health services. Early diagnosis through high risk or opportunistic screening and timely management of cervical cancer needs to be ensured for better outcomes.

Abstract

Objective To find the prevalence of thyroid autoimmunity in PCOS women of reproductive age group.

Methods Study design: Observational study was done at ESIMC and PGIMSR K.K. Nagar March 2013–Feb 2014. Ninety cases of women with PCOS based on Rotterdam’s criteria and an equal number of age-matched controls (women without PCOS) were included in the study. Thyroid profile, antithyroid peroxidase titre, serum progesterone, testosterone and fasting blood sugar were estimated using standardised techniques.

Results Menstrual irregularity (oligomenorrhoea and amenorrhoea) was the most common abnormality found in patients with PCOS compared with non-PCOS (p < 0.0001). Hyperandrogenism was the second most common manifestation present in PCOS of our study group. Hirsutism was the striking hyperandrogenic feature that was present in study group. PCOS patients had higher BMI compared to controls (p < 0.0001). The prevalence of thyroid dysfunction was not significantly different in both the groups (p < 0.80). Anti-TPO titre was higher in PCOS patients (25.8 ± 2.9 IU/ml) compared to the controls (14.5 ± 2.3 IU/ml) (p< 0.009).

Conclusion The present study shows that PCOS was associated with increased anti-TPO titres, thus emphasising the importance of screening all PCOS patients for anti-TPO along with routine thyroid profile.