Non-descent vaginal hysterectomy surgery associated with less complications and good prognosis

Background: Removal of the uterus through vagina when performed in a case without uterine descent or prolapse is known as “non-descent vaginal hysterectomy” or NDVH. Vaginal route is preferred as compared to laparoscopic and abdominal methods. The advantages of vaginal hysterectomy being fewer complications, less post-operative stay, cost effective, and useful in bulky uterus. Aims and Objectives: The aims of the study were as follows: (1) To study the intraoperative and post-operative complications encountered during NDVH and their management. (2) To assess the intraoperative blood loss, the operative time, and post-operative hospital stay. (3) To study and check the feasibility of vaginal route as the primary route for all hysterectomies in the absence of uterine prolapse. Materials and Methods: A total of 50 patients were included in the study. Detailed history was taken including obstetric history and menstrual history and clinical examination was performed. After taking written, informed consent and doing proper pre-operative preparation, the patient was posted for NDVH. Post-operative complications were noted. Patients were asked to come for follow-up after 15 days. Results: In 92% of cases operated, no intraoperative complications were found suggesting low morbidity associated with the procedure. Hemorrhage requiring blood transfusion was found in 4% of cases. Average operative time was 61.2 ± 27.89 min, average blood loss was 170 ± 81.44 ml, and average hospital stay was 5.94 ± 4.95 days. On histopathological examination, 40% were having leiomyoma and dysfunctional uterine bleeding was seen in 22% of cases. Pain was the most common complication seen in 30% of cases while vaginal discharge was seen in just 4% of cases. About 80% of patients were discharged on post-operative day 5. Conclusion: In 92% of NDVH cases, no intraoperative complications were found suggesting low morbidity associated with the procedure. The post-operative hospital stay was restricted to 5 days in 80% of cases which indicates early discharge of the patient. Post-operative complications such as vaginal discharge and fever were seen only in 4% of cases. NDVH should, therefore, be considered as the primary route for all hysterectomies unless contraindicated in the absence of prolapse.

Prediction of labor outcome by measuring the angle of progression using two dimensional trans-perineal Ultrasound: A prospective cohort study

Background: Failure of descent due to fetal malposition is one of the most common indications for performing surgical deliveries. It has recently been suggested that trans-perineal intra-partum ultrasonography may be useful in assessing fetal head engagement, position and station as well as it’s reliable, cheap, painless and effective tool. Measuring the ‘angle of progression’ could assist in the obstetrician’s decision regarding mode of delivery. Objectives: The primary outcome is to use the AOP to develop a predictive model for the probability of successful vaginal delivery. Secondary outcomes including assessment of possibly successful VBAC in previous one CS women. Methods: We recruited 500 women in labor. For each woman, a (TPU) was performed to measure the AOP in late first and second stages of labor. We compared AOP between women who delivered fetuses through vaginal route to those who delivered by CS. Results: Through 467 women included in the study, AOP was significantly Higher in spontaneous vaginal delivery group (with cut off 123°±8.5°) as compared with women delivered by vacuum or by CS (113°±10.5°) (P=0.003). The VBAC as another secodary outcome seems to be insignificant. Conclusions: TPU is safe, non-invasive and easily preformed technique which is useful to predict labor outcomes.

FIRST TRIMESTER MEDICAL ABORTION PRACTICE IN NORTH EAST INDIA

Objectives: This study is to compare the efficacy of Mifepristone combined with Misoprostol (Prostaglandin) administered through vaginal and sublingual route in termination of pregnancy of ≤63 days. Methods: Randomized comparative study comprised of 140 pregnant women of ≤63 days gestational age was conducted at Zoram Medical College, Mizoram. Women in group A received 200 mg of Mifepristone orally on day 1 followed by 800 μg of Misoprostol sublingually 36–48 h later, whereas women in group B received 200 mg of Mifepristone orally on day 1 followed by 800 μg of Misoprostol vaginally 36–48 h later. A 2nd dose of 400 μg Misoprostol was given through the same route if abortion process does not start within 4 h. All women who aborted were seen at follow-up and ultrasound pelvis done to confirm complete expulsion of products of conceptions. Results: The total number of primigravida was 34 (24.3%) and multigravida was 106 (75.7%). Complete abortion was seen in 91.4% and 94.28% of per sublingual and per vaginal route group, respectively (p = 0.51). Failure of abortion was 8.57% and 5.71%, respectively, in per oral and per vaginal route (p = 0.51). Conclusion: Sublingual and per vaginal misoprostol after pre-treatment with mifepristone are both an effective method for termination of pregnancy for gestational age of 63 days or less, but the tolerance for sublingual misoprostol was poorer.

Surgical repair of Vesico-Vaginal: Vaginal route versus abdominal route.

Objective: To determine outcomes and complications of vesico-vaginal fistula repair via vaginal and abdominal route. Study Design: Cross Sectional study. Setting: Department of Urology and Kidney Transplantation, Pir Abdul Qadir Institute of Medical Sciences Gambat. Period: January 2020 to December 2020. Material & Methods: Patients having vesicovaginal fistula irrespective of age and fulfilling our inclusion criteria were included in the study using non-probability consecutive sampling technique. Patients having very large fistula, fistula involving neck of urinary bladder, failure of previous operation, patients with malignancy or co-morbidities were excluded from the study. Vaginal and abdominal approaches were used for fistula repair depending upon the level of fistula. Those operated via vaginal route were kept in trans-vaginal group and those operated via abdominal route were assigned trans-abdominal group. Results: Total 35 cases were studied having age 16-45 years with mean age of 32.6 ± 4.2 years. Transvaginal fistula repair was done in 37.1% and transabdominal repair was done in 62.8% cases. Most common cause of VVF was previous gynecological surgery in 77% cases. Success rate was 100% in transvaginal fistula repair as compared to 95.4% success rate achieved in transabdominal repair of fistula. Conclusion: Trans abdominal and transvaginal route both are good approaches but Transvaginal route of fistula repair is associated with high success rate than transabdominal route with minimum complications and better outcomes but it needs expert surgeon.

Uterine volume measurement as a determinant in route of hysterectomy

Background: Objectives of the study were to determine the role of uterine volume rather than uterine length in assessing the route of hysterectomy; to estimate the cut-off of uterine volume for route of hysterectomy; and to correlate uterine volume measured preoperatively by ultrasound with post-operative uterine weight.Methods: This was a prospective observational study including a total of 101 women who underwent hysterectomies (vaginal, laparascopic assisted vaginal hysterectomy (LAVH), total laparascopic hysterectomy (TLH), abdominal) in a period of 2 years 2 months from July 2018 to August 2020 in Mehta Multispeciality Hospital, Chetpet, Chennai. Uterine size was measured by clinical examination. Ease of the procedure with various uterine volume and routes of hysterectomy were studied.Results: 51 (50.49%) underwent vaginal route (including laparascopic hysterectomy), 50 (49.50%) underwent abdominal hysterectomy. Mean uterine volume leading to removal vaginally was 168.09±139.28 cc whereas 309.12±182.47 cc for abdominal hysterectomy (p=0.001) which was statistically significant. vaginal hysterectomy was done without difficulty up to 300 cc. Postoperative complications were less with vaginal hysterectomy compared to abdominal hysterectomy was statistically significant (p=0.0001).Uterine volume measured pre operatively by ultrasound showed positive correlation (r=0.82) with post-operative uterine weight proved that uterine volume measurements was superior to the clinical estimate of uterine size in assessing the route of hysterectomy.Conclusions: Uterine volume on ultrasonography (USG) can be a good predictor in deciding whether hysterectomy via vaginal route is possible.

Evaluation of hysterectomy in a tertiary care hospital of central India: a retroprospective study

Background: Hysterectomy is the most common gynaecological surgical procedure after caesarean section. In India there is lower rate (4-6%) of hysterectomy has been reported, while there is higher frequency of hysterectomy (10-20%) in developed countries. Currently there are three main types of hysterectomy operations in practice for benign diseases abdominal hysterectomy, vaginal hysterectomy and laparoscopic hysterectomy. Abdominal hysterectomy remains the predominant method of uterus removal. The present study was planned t to analyse changes in the trends of hysterectomy from past 3 year in the study area.Methods: The present observational study was conducted in department of obstetrics and gynaecology and associated Dr. B.R.A.M. hospital Raipur (CG), India. Data was collected retrospectively from January 2009 to May 2012 from hospital medical records. Prospectively data was obtained from patient and his file from June 2013 to September 2014. Data was compiled in MS-excel and checked for its completeness and correctness, and then it was analyzed by using suitable software.Results: Total no of hysterectomy conducted in study duration was 1000. Study showed declining trend of hysterectomy in our institute. Most common age group of hysterectomy was 41-50 year. which 45.8% followed by age group 31-40 that is 32.5%. Most common indication of hysterectomy was fibroid uterus 33.6% followed by prolapse uterus 29.5%. 29% cases were operated via vaginal route for descent of uterus and 21% cases operated by vaginal route for non-descent uterus.50% cases were operated via abdominal route. Average operating time for TAH was 1.43±0.50, for VH was 1.08±0.03. Average hospital stay for TAH was 8.87±3.31 and VH was 5.27±1.07. Conclusions: In our study it had been seen that rate of hysterectomy is in decreasing trend as more conservative approach is now preferred. To minimize most of complications of hysterectomy second opinion fresh eyes and multi-disciplinary approach is recommend in all patients undergoing this procedure.

Diagnosis and Management of Uterine Fibromyomas in the Obstetric Gynecology Department of the Regional Hospital of Labe. Guinea

Objectives: To calculate the frequency of uterine fibromyomas, to describe the epidemiological profile, to describe the management and to establish the prognosis of women with uterine fibromyomas in the gynaecology-obstetrics department of the Regional Hospital of Labé. Methodology: This was a retrospective descriptive study lasting three (3) years from 1 January 2017 to 31 December 2019. All patients admitted and operated on in the department for uterine fibromyomas during the study period were included. Patients who were not operated for uterine fibromyomas in the department and incomplete records were not included. Our data were collected and analysed using Epi-Info software version 7.2.2.6. Word, Excel and Power point software from Pack office 2016 were used for data entry and presentation. The study involved a continuous series of 115 anaemic pregnant women. We proceeded with an exhaustive recruitment of pregnant women according to the criteria defined above. Results: The frequency of uterine fibromyomas among gynaecological pathologies was 44.75%. The epidemiological profile was that of a 30-39% (40.87%), housewife (53.91%) and nulliparous (40%) woman. Pelvic pain was the dominant reason for consultation (75.65%) and 46.08% of patients had no particular history. Intramural or interstitial uterine fibromyomas were the most common (49.57%) and ultrasound was performed in all patients. The surgical indications were dominated by large polymyomatous uterus 37.39%, followed by haemorrhagic fibroid 26.09%. Myomectomy was performed in 75.65% of cases, exclusively via the abdominal route (100%), while hysterectomy was performed via the abdominal route in 17.39% of cases and vaginal route in 6.96%. The postoperative course was simple in 75.65% of cases and complicated in 24.35%. Complications were dominated by anaemia (13.04). The average length of stay was 6.05 days with extremes of 3 and 13 days. Conclusion: The frequency of the uterine fibromyomas is raised in the region of Labé and the hold in charge is often surgical

Anesthetic management of a parturient with Eisenmenger’s syndrome: A case report

Eisenmenger’s syndrome results from certain uncorrected congenital abnormalities of the heart facilitating left to right shunt and chronic volume overload of the pulmonary vasculature, leading to irreversible changes in the pulmonary vasculature. Pregnancy in the patients of this syndrome is associated with a high risk of cardiovascular decompensation, thromboembolic complications, and sudden cardiac death. We present the case of a 25-year-old pregnant woman with Eisenmenger’s syndrome who delivered through the vaginal route at 37 weeks of gestation, under labor epidural anesthesia. A healthy male baby was delivered within 40 min of drug deposition in the epidural space. The postpartum period was essentially uneventful with successful maternal and neonatal outcomes.

PERINATAL OUTCOME OF VAGINAL BREECH DELIVERY VERSUS CAESAREAN BREECH DELIVERY

Background: The aim to find out any differences in outcome between vaginal breech delivery and cesarean breech delivery in our setup Methods: Data were collected from record book of Department of Gynecology and obstetrics. Data of 100 patients were analysed among which 36 underwent vaginal delivery for breech and 64 underwent cesarean breech delivery Results: Binary logistic regression was used to compare outcome among different groups. In our study only 5.56% of newborn delivered by vaginal route were admitted to NCU vs. 12.50% in cesarean group which was significant (odds ratio=0.07, P=0.01) Conclusion: Keywords: LSCS, Breech, NICU

Prolapse Surgery: What Kind of Antibiotic Prophylaxis Is Necessary?

<b><i>Introduction:</i></b> The aim of this study was to assess whether antibiotic prophylaxis or therapy is sufficient for laparoscopic or vaginal prolapse surgery with mesh. <b><i>Methods:</i></b> This is a single-center prospective study. The study was divided into 3 groups. Protocol A: metronidazole (15 mg/kg) and piperacillin-tazobactam (2 g) 1 h before surgery and, for postoperative treatment, gentamycin (160 mg) 1 h before surgery in a single dose. Metronidazole and piperacillin-tazobactam were administered until hospital discharge. Protocol B: gentamycin and piperacillin-tazobactam in the same manner as group A. Protocol C: clindamycin (600 mg) and gentamicin (160 mg) 1 h before surgery in a single dose. <b><i>Results:</i></b> We included 87 consecutive patients who underwent prolapse surgery involving mesh prostheses: 57 by the laparoscopic approach and 30 by the vaginal route. Of these, 30 patients were included in protocol A, 30 in protocol B, and 27 in protocol C. There were no statistically significant differences among the 3 protocols regarding any postoperative complications, except for urinary tract infections that were more in the vaginal approach than in the laparoscopic route, in protocol A (<i>p</i> = 0.002). <b><i>Conclusions:</i></b> One-shot prophylaxis can be successfully used in prolapse surgery regardless of the surgical approach.