OBJECTIVE(S) : To study the safety and feasibility of performing myomectomy during cesarean section.
METHOD(S) : Nine cases of cesarean myomectomy are presented. Our technique comprised of a lower segment transverse incision. Myomectomy was done after delivering the baby. This was followed by suturing with adequate hemostasis.
RESULTS : No significant difference was found in relation to mean time taken for surgery, amount of blood loss, post- operative pain and mean duration of hospital stay.
CONCLUSION(S) : Myomectomy with cesarean section, in selected cases with proper indication is safe and feasible.
OBJECTIVE(S) : To evaluate and compare the side effects and tolerability of nifedipine and ritodrine in preterm labor.
METHOD(S) : Seventy consecutive women with clinical features of preterm labor fulfilling designated inclusion and exclusion criteria were enrolled in the study. They were alternately allocated to receive nifedipine or ritodrine. Tocolytic efficacy, maternal side effects, and tolerability were evaluated.
RESULT(S) : Both drugs caused an increase in pulse rate and fetal heart rate, and decrease in systolic and diastolic blood pressure. These changes were statistically significant in the ritodrine group. Side effects were seen in 5.7% women in the nifedipine group and 34.2% women in the ritodrine group. In the ritodrine group 85. 7% women had completed therapy with 8.57% having intolerable side effects and 14.28% having failed in arresting preterm labor. In the nifedipine group, 97.14% had completed therapy and 2.8% had failed in arresting preterm labor.
CONCLUSION(S) : Nifedipine was more successful in arresting preterm labor with less side effects and better tolerability as compared to ritodrine.
OBJECTIVE(S): To study the experience of Indian doctors in the use of manual vacuum aspiration (MVA) for voluntary termination of pregnancy (MTP) during the 1st trimester and in particular after 8 weeks of pregnancy.
METHOD(S): Twenty seven purposively selected centers in nine cities and towns across the country reported on 1686 MVA procedures done over a 4-6 month period during 2004. Of the 1686 MVA procedures reported 1203 (71.3%) were for MTP and 36% of the MTPs were for pregnancies of over 8 weeks.
RESULTS: Incomplete abortions and other complications were reported in 2.9% of cases (2.1% of cases below 8 weeks and 4.5% above 8 weeks). Most procedures irrespective of gestation period were completed in less than 15 minutes. Over half of all the cases were successfully managed under local anesthesia and/or sedation. Use of check curettage did not decrease the rate of incomplete abortion.
CONCLUSION(S): Even in diverse service delivery settings, MVA is a safe and effective procedure that can be used throughout the first trimester of pregnancy.
OBJECTIVE(S) : To study the effect of hormone replacement therapy (HRT) on fibrinogen (1+2) and antithrombin III levels.
METHOD(S) : Forty consecutive consenting menopausal (surgical menopause 20 and natural menopause 20) women were recruited for this study. Fibrinogen and antithrombin III levels were determined before, and 3 and 6 months after initiation of HRT. Paired t- test was used to study the alterations with time.
RESULTS : Though, the subject characteristics in both groups were similar, the preHRT lipid profile of those with natural menopause had significantly higher triglyceride (159 + 27 vs 138+31; P<0.05) and lower high-density lipoprotein levels (44+7 vs 54+9; P<0.01) than those of the subjects with surgical menopause. Both groups showed significantly increased fibrinogen values at 6 months of HRT use and the rise in levels appeared to increase significantly with duration of use whereas antithrombin III levels showed significantly decreasing trend with the duration of use of HRT.
CONCLUSION(S) : In the early part of use of HRT, alterations in fibrinogen and antithrombin III levels, towards more thrombogenic state occur.
menopausal changes ● hormone replacement therapy ● fibrinogen levels, ● antithrombin III levelsOBJECTIVE(S): To determine the major causal factor of vesicovaginal fistula (VVF) and the outcome of treatment.
METHOD(S): The study period was from 1st January, 1993 to 31st December, 2002. Total number of patients included in the study was 77. They were analyzed with regard to age, parity, causal factor, mode of treatment, and the outcome.
RESULTS: Obstetric complications were the leading causes of VVF. Majority of the cases were treated surgically by layered method of closure vaginally. Success at primary attempt was 93.33%.
CONCLUSION(S): Vesicovaginal fistula mainly results from low level of intranatal care and improperly conducted deliveries. Primary closure is successful in 93.33%.
OBJECTIVE(S) : To determine whether concurrent chemo-radiotherapy with cisplatin and gemcitabine can change the poor outcome in locally advanced cervical carcinoma.
METHOD(S) : Eight hundred sixty-seven previously untreated patients with locally advanced cervical carcinoma (FIGO stage II B to IVA) were eligible to enter the study. They were intended to receive external beam radiotherapy and concomitant weekly chemotherapy with cisplatin and gemcitabine to be followed by intracavitary brachytherapy.
RESULTS : Sixty-seven patients included in the study had withdrawn themselves mainly due to diarrhea, which was the most common nonhematological toxicity. Anemia and leukopenia were the most important hematological toxicities. Complete local control rate was 67 % at 3 months after completion of treatment, which was subsequently reduced to 60 % at a median follow up of 10.5 months.
CONCLUSION(S) : Concurrent chemo-radiotherapy with cisplatin and gemcitabine has shown promising result in locally advanced cervical carcinoma that otherwise has a dismal prognosis.
OBJECTIVE(S) : To assess the role of laparoscopy in vaginal hysterectomy for nonprolapsed uterus.
METHOD(S) : Seventy eight cases requiring hysterectomy for benign gynecological disorders without uterine prolapse were studied over a period of 5 years from June 2001 to June 2006. In all cases laparoscopic assistance was taken either at the end of vaginal hysterectomy for diagnostic purpose or in difficult situations during surgery.
RESULTS : Vaginal hysterectomy could be done in 83.33% cases and laparoscopic assistance was required in the remaining 16.66% cases. The mean time taken for diagnostic laparoscopy was 6.5 minutes. Different intraabdominal pathologies and complications were detected in 36.76% cases.
CONCLUSION(S) : Laparoscopy is an important tool to detect undiagnosed complications and intraabdominal pathologies during vaginal hysterectomy on nonprolapsed uterus.
OBJECTIVE(S): To study the incidence and epidemiological factors of urinary incontinence among the patients attending the gynecological outpatient department.
METHOD(S): A prospective study of 800 women attending the out patient department from March 2003 to December 2005 was done. Out of these, 272 had different types of incontinence and were studied for various factors like age, parity, mode of delivery, menopausal status, and prolapse of genital organs. Relevant clinical examination was carried out.
RESULTS: Stress incontinence was the commonest type of incontinence. Increasing age, menopause, increasing parity, and complicated vaginal deliveries were common amongst the women having incontinence.
CONCLUSION(S): Urinary incontinence is a chronic, bothersome, and growing problem in women. Since they may not come with the problem of incontinence leading questions regarding incontinence should be a routine part of history taking in gynecology.
OBJECTIVE(S) : To find out whether sonosalpingography, which is a less invasive method, can be used for assessment of tubal factor in cases of primary and secondary infertility initially instead of the invasive methods like hysterosalpingography and diagnostic laparoscopy with chromopertubation which are associated with significant morbidity and even some mortality.
METHOD(S): A total of 100 patients, 73 with primary infertility and 27 with secondary infertility, attending our infertility clinic were studied from January 2004 to December 2004. All underwent sonosalpingography, hysterosalpingography, and laparoscopic chromopertubation. Chi square charts were used for statistical analysis to find out the sensitivity and specificity of the tests.
RESULTS : Sonosalpingography has 97.3% sensitivity and 92% specificity in comparison to laparoscopic chromopertubation whereas hysterosalpingography has 94.6% sensitivity and 84% specificity.
CONCLUSION(S) : As sonosalpingogrpahy has high sensitivity and specificity and is less invasive. It should be used initially to assess tubal patency in cases of infertility.
