Abstract

Background: Placenta previa is one condition, where the bleeding is from the thinned out lower segment, which faces difficulty in contracting as compared to the upper uterine segment. To combat postpartum hemorrhage and hysterectomy, there were various techniques adopted in obstetric practice. Here the aim is to study the bilateral internal iliac artery ligation (BIL) as a technique to minimize postpartum bleeding and preserve the uterus for future pregnancy.

Methods: This retrospective study was conducted in 31 patients with abnormal placentation. They underwent BIL during LSCS. The surgery was elective in non-bleeding patients and as an emergency in bleeding patients. The primary outcome is to minimize blood loss and postpartum blood transfusion. The secondary outcome is the prevention of hysterectomies after delivery and preservation of the uterus for the mother to have future pregnancies.

Results: Out of 31 women, 19 underwent elective surgery (61.3%) and 12 underwent emergency surgery (38.7%). Out of 12 emergency surgeries, 8 needed blood transfusion due to blood loss. Out of 19 elective surgeries, none required the blood transfusion. Blood transfusion was required in 50% of the patient in emergency BIL surgery, whereas none required blood transfusion in elective BIL surgery. Postpartum hysterectomy was avoided in all study participants except one elective surgery patient.

Conclusion: BIL surgery can be an effective procedure for handling high-risk obstetric hemorrhage in addition to the chances of future fertility through the preservation of uteri.

Abstract

Study: Carcinoma vulva is a rare cancer of the female genital tract. It mostly presents in postmenopausal women. The treatment of vulvar cancer is surgery, chemoradiation, radiotherapy or a combination of all modalities. Here, we present a study of 33 cases of carcinoma vulva over a period of 2 years at a Northeast India regional cancer institute describing its demographic features and treatment outcomes.

Methodology: A retrospective cohort study of vulvar cancer diagnosed at Northeast India regional cancer institute from January 2017 to December 2018.

Results: A total of 33 cases of biopsy proven carcinoma (Ca) vulva were studied. Maximum number of cases belonged to the age group: 60–69 years (39.4%). 66.67% cases had palpable inguinal lymph nodes at presentation, and 100% had squamous cell carcinoma on histopathology. Maximum number of cases belonged to stage III (44.8%), and least number of cases belonged to stage IV (10.3%) of FIGO 2009 staging of Ca vulva. 87.9% cases underwent treatment, and 12.1% were lost to follow-up. Out of the cases who underwent treatment, 55.2% cases were taken up for primary surgery and 44.8% cases for primary radiotherapy. 75% cases who underwent surgery received adjuvant radiotherapy. No complication was seen in patients post-radiation. But, 6.25% patients post-surgery developed lymphocyst and 18.75% patients developed wound necrosis (p > 0.05).

Conclusion: Vulvar cancer is not a common malignancy of the female genital tract that presents in sixth and seventh decades of life and often with palpable inguinal lymph nodes. Though early stages of Ca vulva are treated by surgery, the incidence of immediate postoperative complications in our study was more as compared to post-radiotherapy. Also, maximum patients in the present study post-surgery received adjuvant radiotherapy. Thus, radiotherapy can be considered as the primary treatment modality for patients with early as well as advanced vulvar carcinoma.

Abstract

Background and Objective: In modern obstetrics, around 30% of cases require induction of labour for various reasons. Misoprostol is gaining popularity as pharmacological inducing agent, though the route and dosage of administration are not standardised. The objective of the study is to compare the safety and efficacy of the two routes of misoprostol administration—oral (100 lg 4th hourly) and vaginal (25 lg 4th hourly), for induction of labour at term. 

Background and Objective: In modern obstetrics, around 30% of cases require induction of labour for various reasons. Misoprostol is gaining popularity as pharmacological inducing agent, though the route and dosage of administration are not standardised. The objective of the study is to compare the safety and efficacy of the two routes of misoprostol administration—oral (100 lg 4th hourly) and vaginal (25 lg 4th hourly), for induction of labour at term. Methods In this randomised trial, 104 women having crossed the expected date of delivery without going into spontaneous labour and cases which had premature rupture of membranes\12 h were considered for labour induction and were divided into two equal groups. Group A received 100 lg misoprostol orally 4th hourly, and group B received 25 lg misoprostol vaginally 4th hourly. Labour characteristics and maternal and foetal outcome were compared. Results In terms of maternal outcome, mean number of doses for oral group is 2.73 and vaginal group is 3.04. In oral group, mean induction to vaginal delivery interval was 13 h 43 min and in vaginal group interval is 13 h 26 min which was statistically not significant. The need for oxytocin augmentation was also statistically not significant. Both groups had equal number of failed inductions. Emergency LSCS done for foetal distress was more in vaginal group 2.9% compared to oral group which is 1%, but difference was not statistically significant (p value -0.55). Number of thick MSL in oral group was 3.2% as compared to vaginal group which is 10.7% which was statistically significant (p value -0.04). APGAR score at 5 min 7/10 was seen in 7.7% in vaginal group as compared to 0% in oral group which was also statistically significant (0.004). Number of NICU admissions was also more in vaginal group compared to oral group.

Conclusion: Misoprostol in either oral or vaginal route has proven to be equally effective for inducing labour in women at term pregnancy. However, occurrence of lesser incidence of meconium-stained liquor and NICU admissions and fewer caesareans with better neonatal outcome in women induced with oral misoprostol outweighs its advantages over the vaginal misoprostol. 

Abstract

Background: Carcinoma in the cervix is the most common malignancy and the fourth most common cause of death in females worldwide. It is the most common malignancy in India, the increasing incidence of cancer is escalating burden over radiation. This is a prospective randomized study comparing NACT followed by definitive chemoradiation versus chemoradiation.

Materials and Methods: This prospective randomized study analyzed 80 cervical cancer patients who were treated at our center during March 2017 and July 2018. Patients were divided into two arms: one received NACT and definitive CT/T and the other received definitive CT/RT. Statistical analysis was done using SPSS V.20 software.

Results: Overall response rate in our study was found to be 96.2%. In the study group, it was 97.5%, whereas in the control group, it was 95%. Majority of patients were in the age group 41–50 years, mainly stage IIb and IIIb. Tumor response in both the arms was similar and statistically significant ( Chi2 = 0.348; p > 0.05). The hematologic toxicities ( p > 0.05) were more in the NACT group than in the CCRT group, while gastrointestinal toxicities were slightly higher in the control (statistically insignificant).

Conclusion: NACT with taxane/platin followed by definitive CT/RT is as effective as the standard care in the treatment of locally advanced cervical cancer. It has even shown better results (p value > .005) and is also helpful in reducing systemic micrometastasis and bulk of the disease. It can be used as an alternative to the standard care at the places of long waiting time for the definitive treatment, without compromising the outcome.

Abstract

Objective: The present study outlines three cases of a Robertsonian translocation and the consequences for the initiation of pregnancy by intracytoplasmic sperm injection (ICSI). Three case histories are presented documenting structural chromosome abnormalities in infertile males.

Materials and Methods: Semen analysis was performed according to the World Health Organization guidelines. Chromosome analysis was performed using G-banding. Y chromosome microdeletions were detected by multiplex polymerase chain reaction assays.

Results: Cytogenetic analysis revealed Robertsonian translocation 45,XY,der(14;21)(q10;q10) in a male with severe oligoasthenoteratozoospermia (SOAT) after three subsequent ICSI treatments were unsuccessful. The second case involved a Robertsonian translocation 45,XY, der(13,14)(q10;q10) with SOAT detected in a male after one pregnancy loss. Third case involved a Robertsonian translocation 45,XY,der(13,14)(q10;q10) with SOAT.

Conclusion: This case series emphasize the necessity of cytogenetic analysis of couples with primary infertility and recurrent miscarriages before any assisted reproductive technology is performed. For couples in whom one or more partners have a translocation, prenatal genetic diagnosis/ preimplantation genetic diagnosis is recommended.

Abstract

Background: Increasing rate of Caesarean sections and inadequate pain relief following Caesarean section is seen in almost all parts of the world. Transversus abdominis plane block is gaining popularity as a part of multimodal analgesia for post-operative pain relief following abdominal surgeries.

Aim: To compare bupivacaine and bupivacaine with dexmedetomidine in transversus abdominis plane block for pain relief after Caesarean section.

Method: American Society of Anaesthesiologists I and II parturients with no comorbidities admitted for elective Caesarean section were included in the study. Thirty-five patients were in each study (with dex) and control (without dex) groups. At the end of Caesarean section done under spinal anaesthesia, transversus abdominis plane block was done bilaterally under ultrasound guidance using in-plane technique of needle insertion. 20 ml of 0.25% bupivacaine with 0.5 mcg/kg of dexmedetomidine in the study group and 20 ml of 0.25% bupivacaine in the control group were injected in the neurovascular plane.

Results: Eight patients from the study group and 15 from the control group were given opioids as rescue analgesia. The average time at which rescue analgesia was first sought was 14.25 and 7.73 h in the study and control groups, respectively. The P value of this difference was 0.0136 and was found to be statistically significant.

Conclusion: The addition of dexmedetomidine to bupivacaine in TAP block prolonged the duration of time at which first dose of rescue analgesia was sought and also reduced the total dose of opioid requirement in the first 24-h postCaesarean section.

Abstract

Objectives: Elective cesarean deliveries (ECD) are still performed prior to 39 weeks. This study aimed to identify risk of neonatal respiratory morbidity (NRM) following ECD near term, in a South Indian population. Specifically, study aimed to measure the additional healthcare burden due to large number of ECDs performed prior to 39 weeks, in this local population.

Methods: We analyzed NRM among 1329 deliveries (584 ECD and 745 spontaneous vaginal delivery, SVD) in a tertiary hospital over 2 years. Neonates were grouped into: A: 35?0 –36?6 weeks, B: 37?0 –38?6 weeks, and C: C39 weeks. NRM was compared between ECD versus SVD.

Results: Majority (433/584) of ECDs were performed between 37?0 and 38?6 weeks. Overall, 32% received steroid prophylaxis. Of 1329 newborns, 18/584 (3.82%) in ECD and 6/745 (0.8%) in SVD group developed NRM (p value of 0.004, OR 3.9, CI 1.54–9.93). Need of respiratory support among ECD was 4.28% compared to 0.53% in SVD (p\0.001, OR 8.28; CI 2.86–23.94). However, comparing neonates born by ECD between groups B Vs C; there was only a modest increase in NRM (2.07 vs 0.9%; p 0.48, OR 2.3 with CI 0.29–18.4) and in need of respiratory support (2.54 vs 0.9%; p 0.47, OR 2.84; CI 0.36–22.2).

Conclusion: NRM following early term ECD continues to be a healthcare burden in India. Interestingly in this South Indian population, early term ECDs caused only modest increase in NRM, and this ethnic variation requires further evaluation to determine ideal time for ECD in local population.

Abstract

Objective: Aim of study was to determine effect of epidural analgesia on progress of labour and mode of delivery, to find out its complications in labour and puerperium and to evaluate neonatal outcome in terms of APGAR score. Method The present study was conducted in Department of Obstetrics and Gynaecology at Government Medical College Aurangabad over period of 2 years from June 2014 to June 2016 after taking approval from institutional ethical board. Hundred low-risk primigravidas were included in the study, 50 women received epidural analgesia for relief of labour pain at 3–4 cm and 50 women served as control. The important outcome FACTORS studied were the following : (1) duration of active phase of I stage, and II stage, (2) mode of delivery, (3) APGAR scores, (4) untoward reactions and intrapartum complications, (5) overall satisfaction of the mother.

Results: The operative delivery rates were not significantly different in both the groups (8% in the control group and 6% in the study group: p value NS, i.e. [0.05). The duration of first stage (our study showed no significant difference in the duration of first stage in both the study and control groups p value[0.05) and second stage of labour (p value NS [0.05) and the need for oxytocin were comparable in the two groups. The side effects observed were minimal. It has given excellent pain relief and improved neonatal outcome (5 min). EA is associated with rates of vaginal delivery (88 v/s 84%) and LSCS rate (8 v/s 6%) which are comparable with control group.

Conclusion: Epidural analgesia is a very promising, safe and effective method of pain relief. No major complications and a good APGAR score make it a good option of care in modern obstetrics.

Abstract

Background: To evaluate role of AMH as a diagnostic tool for PCOS. Methods This was a prospective case–control study on women attending Gynae OPD of Dr RML Hospital, New Delhi, from 1 November 2015 to 31 March 2017. Study comprised of 45 women with PCOS, diagnosed using Rotterdam criteria and 45 women as controls. Clinical history included oligomenorrhea, hirsutism, examination included BMI, Ferriman–Gallwey score, investigations included blood for FSH, LH, estradiol, TSH, prolactin, total testosterone, AMH level and pelvic USG which was done for all women.

Results: Both PCOS cases and control were matched for age and BMI. Median AMH levels of 4.32 ng/ml in PCOS cases was almost twice that of 2.32 ng/ml in controls (p = 0.001). Maximum diagnostic potential of AMH alone for PCOS was at a cut-off of 3.44 ng/ml with sensitivity of 77.78% and specificity of 68.89%. AMH was used as an adjunct to existing Rotterdam criteria as the fourth parameter OA?HA?PCOM?AMH (any three out of four) yielded sensitivity of 80%. However, when PCOM in Rotterdam criteria was replaced by AMH, OA?HA?AMH (any two out of three) or OA/HA?AMH resulted in sensitivity of 86.67 and 71.11%, respectively.

Conclusion: AMH levels were significantly higher in PCOS than in controls. AMH as an independent marker could not effectively diagnose PCOS. However, AMH levels as an adjunct to existing Rotterdam criteria for diagnosis of PCOS had good diagnostic potential.

Abstract

Objective: The aim of the study was to find out the role of Serum lactate dehydrogenase in prediction of adverse outcomes of PE & E i.e., severity of disease and occurrence of complications.

Materials and Methods: This study was conducted in the Department of Obstetrics and Gynaecology, MGM Medical College, Indore. A total of 200 women were studied; they were divided into control (n = 100), severe preeclampsia (n = 32), eclampsia (n = 68). Demographic and hematological parameters were studied including LDH levels.

Results: The incidence of severe pre-eclampsia—1.2 % & Eclampsia 2.7 %, PE & E patients were significantly younger, with low gravidity and parity. They had significantly increased systolic and diastolic pressure, liver enzymes, uric acid, urine albumin, and LDH levels. Serum urea and creatinine were normal in majority of cases. The symptoms and complications of PE along with perinatal mortality were increased significantly in patients with LDH >800 IU/l compared with those who had lower levels. Complications like Retinopathy, ARF, Abruptio, DIC, CVA, MODS, Shock were also associated with high level of serum LDH>800 IU/L. Low birth weight of babies was also associated with high level of serum LDH levels in PE & E patients. The incidence of poor perinatal outcome was higher in PE & E patients with high serum LDH level (>600 IU/L).

Conclusion: LDH is the earliest marker seen in blood during hypoxia and oxidative stress. It is a useful biochemical marker that reflects the severity of and the occurrence of complications of PE & E; these are preventable if identified at an earlier stage and adequately managed at a higher center. Test is easily available, so screening of all cases of PE & E with LDH levels must be made mandatory.

Abstract

Objectives: To compare intravenous paracetamol and intramuscular tramadol as labor analgesics.

Methods: This prospective-randomized study conducted in 200 primigravidae in active labor, distributed into two groups of 100 women each with one receiving intravenous 1,000 mg Paracetamol and other 100 mg intramuscular tramadol. Pain intensity is recorded by McGills scale before, one and 3 h after drug administration. Perinatal outcome is recorded.

Results: No difference in pain intensity is seen before drug administration. After 1 h of drug administration, in paracetamol group, 4 % women had horrible pain, and 29 % had distressing pain, while in tramadol group, 30 % women had horrible pain, and 60 % had distressing pain. After 3 h of drug administration, in paracetamol group, 26 % had distressing pain, while in tramadol group, 51 % women had horrible pain, and 35 % had distressing pain. Labor duration in paracetamol and tramadol group was 4.3 and 5.9 h, respectively. In paracetamol group, nausea is seen in 2.2 % and vomiting in 1.1 %, while in tramadol group, nausea is seen in 6.4 % and vomiting in 4.3 %.

Conclusions: Intravenous paracetamol is more effective labor analgesic with fewer maternal adverse effects and shortens labor as compared to intramuscular tramadol.

Abstract

Objectives: To study the effect of antenatal breast milk expression at term pregnancy and subsequent effect on postnatal lactation performance.

Methods: A sample size of 200 pregnant women who had completed 37 weeks of gestational period was selected. The sample size was divided equally into study (group 1) and control (group 2). The pregnant women in study (group 1) were advised to gently manually express their breasts at least once daily at any time, preferably during bathing. The remaining women constituted the group 2. At the time of delivery, all the mothers were advised to initiate breastfeeding their baby within half an hour of delivery. The time from initiation of lactation to full lactation when no top feed is required was noted. Assessment of sufficient lactation was judged by the objective and subjective criteria.

Results: In the group 1, 89 % of the cases established full lactation within 6 h of delivery, whereas in the group 2 only 72 % of the cases had established full lactation within 6 h. The difference in the group 1 and the group 2 is statistically significant (P < 0.05) with regard to time interval from initiation of lactation to full lactation. Maternal perception of satisfactory lactation was statistically significantly higher in group 1 compared with group 2. In the group 1, 100 % of vaginal delivery (FTND) cases had established full lactation within 6 h compared with 81 % in the group 2. The result is statistically significant (P < 0.10). In the group 1, 80 % of the lower segment cesarean section deliveries established full lactation within 6 h, whereas in the group 2, it was 61 %. The result is statistically significant (P < 0.10). In objective criteria, the post-feed weight gain was higher in the group 1.

Conclusions: Antenatal manual breast milk expression at term shortens the time taken to from initiation to full establishment of lactation, thus significantly improving postnatal lactational performance by early establishment of plentiful milk secretion.

Abstract

Background: Maternal mortality and near-miss index reflect the quality of care provided by a health facility. The World Health Organization recently published near-miss approach where strict near- miss criteria based on markers of organ dysfunction are defined.

Objectives: The aim of the study was to determine the frequency of severe maternal complications, maternal nearmiss cases and maternal deaths, to analyze causes of nearmiss and maternal mortality and to determine the values of maternal near-miss indicators.

Methods: This was a prospective observational study conducted at a tertiary care centre in North India from January 2012 – March 2013. WHO’s near-miss approach was implemented for evaluation of severe maternal outcomes and to assess the quality of maternal health care.

Results: The number of women attending our facility with severe maternal complications was low (205 in 6,767 live births); as a result maternal near-miss ratio (MNMR) was low; 3.98/1,000 live births; Overall Maternal near-miss mortality ratio (MNM:1MD) was also low, 3.37:1, because of strict criterion of labeling near-miss and delay in referral to the hospital. Hypertensive disorder (37.5 %) was the commonest underlying cause for maternal mortality.

Conclusion: Basic implementation of WHO near-miss approach helped in the systematic identification and evidence- based management of severe maternal complications thereby improving the quality of maternal health in a developing country.

Abstract

Purpose: Postoperative nausea and vomiting (PONV) after spinal anesthesia for cesarean delivery are distressing to both patients and surgeons. This study was designed to evaluate the efficacy and safety of palonosetron and ramosetron (both newer and highly potent 5HT3 receptor antagonists) in nausea and vomiting in cesarean delivery after spinal anesthesia.

Methods: In this randomized, double-blind study, 109 women received either palonosetron (0.075 mg) or ramosetron (0.3 mg) intravenously immediately after clamping of the fetal umbilical cord. Nausea, vomiting, adverse events, and overall satisfaction were then observed for 48 h after administration of spinal anesthesia.

Results: A complete response (defined as no postoperative nausea and vomiting) during first 0–2 h postoperative after administration of spinal anesthesia was achieved in 85.5 % of patients with palonosetron and in 83.3 % of patients with ramosetron (p[0.05). However, the corresponding incidence during 2 to 24 h was 70.9 and 53.7 %, respectively (p\0.05), while it was 63.3 and 44.4 % at 24–48 h after anesthesia (p\0.05). Along with a more complete response, the severity of nausea was also lesser with palonosetron during the corresponding study periods (2–24 and 24–48 h, respectively; p\0.05). Patients who received palonosetron were also more satisfied than those who received ramosetron (p\0.05). No difference in adverse events was observed in any of the groups.

Conclusion: To conclude, prophylactic therapy with palonosetron is more effective than prophylactic therapy with ramosetron for the long-term prevention of PONV after cesarean section

Abstract

Background The purpose of this study was to assess the utility of Mycobacteria Growth Indicator Tube (MGIT) 960 culture medium for the diagnosis of genital tuberculosis (GTB) in women presenting with infertility.

Methods: The premenstrual endometrial biopsy samples in 300 women presenting with primary and secondary infertility were subjected to AFB smear method, histopathological examination and culture on LJ and MGIT 960 media. Detection rates were compared for diagnostic modalities and their combinations.

Results: In total, 30 cases were positive for genital tuberculosis by either of the four tests employed. The detection rates for AFB smear, MGIT culture, LJ culture and HPE were 50, 46.7, 3.3 and 33.3%, respectively. A combination of smear examination for AFB, MGIT 960 culture and histopathological examination was able to detect all the positive cases. A combination of MGIT and LJ media provided no added advantage over MGIT alone since the only case where LJ culture was positive had been detected by positive MGIT culture. In as many as five positive cases (16.7%), only MGIT culture was positive.

Conclusion: The addition of MGIT 960 culture medium to routine battery of investigations in infertility patients significantly improves the diagnosis.

Abstract

Objectives: Evaluation and comparison of safety and efficacy of vaginal and intra-cesarean insertion of Post- Partum Intrauterine Contraceptive device (PPIUCD).

Methods: An interventional prospective study conducted in the Department of Obstetrics and Gynaecology at NRS Medical College, Kolkata. PPIUCD were inserted in 263 mothers in 1-year study period. Among them, first 100 mothers who delivered vaginally and the first 100 who underwent cesarean section were regarded as study groups and were followed up for 1 year.

Results: Both modes of PPIUCD insertion were found to have very low rates of expulsion, vaginal bleeding, infection, missing strings, and also effective as contraceptive. Expulsion rate was 4 % in the vaginal group and 2 % in intra-cesarean group. Strings of PPIUCD were less visible after cesarean insertion than vaginal insertion (p = 0.028).

Conclusion: PPIUCD is an appealing approach and may become the best choice as post-partum contraception after vaginal as well as cesarean delivery.

Abstract

Background: Menopause is the permanent cessation of menstruation resulting from the loss of ovarian follicular activity. Bleeding that occurs 12 months after the last menstrual period is labeled as postmenopausal bleeding.

Aims & objectives: The aim of the present study was to study endometrial thickness by transvaginal sonography, and correlate it with the cytological pattern evaluated by endometrial aspiration and histopathological pattern of the hysteroscopic directed biopsy.

Results: Sixty patients presenting with postmenopausal bleeding in outpatient department, after applying both inclusion and exclusion criteria, were enrolled in the present study. Majority (38.33 %) of patients had atrophic endometrium or normal endometrium. Endometrium was hyperplastic in 18 (30 %) patients, polyp in 6 (10 %) patients, and growth in 7 (11.67 %) patients. On histopathology, majority of patients (38.33 %) had atrophic endometrium. Endometrial hyperplasia was detected in 14 (23.33 %) out of which 11 had simple hyperplasia while 3 had atypical hyperplasia. Endometrial cancer was detected in 8 (13.33 %) patients. Out of 8 cases of endometrial malignancy, one case was confirmed as endometrial adenocarcinoma on histopathology.

Conclusion: Role of endometrial thickness cannot be undermined for detecting patients at high risk especially with comorbid conditions. Histo-pathological evaluation is mandatory for ruling out malignancy in selected cases of PMB through hysteroscopy.

Abstract

Objective: To study the clinical and histopathological presentation of ovarian masses.

Method: Retrospective analysis of 205 cases from May 2009 to June 2013.

Results: Incidence of ovarian masses was 6.9 %. Among 205 cases, 68 % were neoplastic. Among the neoplasms, 87.8 % were benign, 10 % malignant, and 2.2 % borderline. Mean ages of malignant and benign neoplasm were 41 and 39 years, respectively. 42.9 % malignant tumors presented with non-specific abdominal and constitutional symptoms. Serous cystadenoma was the commonest benign tumor (67 %) followed by Mucinous (19 %) and Dermoid (11.6 %). Most common malignant ovarian tumor was Serous cystadenocarcinoma (42.9 %). Out of the malignant cases, all were primary except one secondary deposit from Non-Hodgkin’s Lymphoma. Only 28.6 % presented at stage I, remaining presented at stage III/IV.

Conclusion: Ovarian neoplasms have twice the incidence of non-neoplasms. Mean age of malignant tumors is decreased. Rising trend in Mucinous cystadenoma is noted.

Abstract

Purpose: We present the management of 17 cases of urethral diverticulum in our department. We describe the various clinical presentations of urethral diverticulum, which may mimic other pelvic floor disorders and result in diagnostic delay.

Materials and Methods: We reviewed 17 cases of urethral diverticulum presented to the urogynaecology department between January 2006 and February 2011 retrospectively. Patient demographics, history, clinical evaluation, diagnostic modalities, and management plans were reviewed. All of them underwent Magnetic Resonance Imaging (MRI) prior to the procedure.

Results: The mean time from onset of symptoms to diagnosis of a urethral diverticulum was 24 ± 5.6 months. MRI identified the urethral diverticulum in all cases while voiding cystourethrography confirmed the diagnosis in 4 (23.5 %). They have been divided into two groups: Group A, (4–6 mm largest axis range) 5 (29.41 %) cases; Group B, (6–33 mm largest axis range) 12(70.59 %). All in Group A were symptomatic with recurrent Urinary Tract Infection (UTI), whereas only 8 (66.6 %) in Group B were symptomatic. Transvaginal diverticulectomy was done in 12 women who were symptomatic (70.5 %). Postoperative evaluation revealed complete resolution of symptoms, such as recurrent UTI, dysuria, and dyspareunia. One patient was unsure of surgery, while conservative approach was opted for asymptomatic patients 4 (23.5 %). The use of preoperative MRI altered the management in 2 (11.7 %) women.

Conclusion: The diagnosis of urethral diverticulum should be considered in women with recurrent UTI, dysuria, dyspareunia, and irritative voiding symptoms not responding to conservative therapy.

Abstract

Background: Ideal time of Intrauterine copper device (IUCD) insertion either to space or limit births in Indian women should be known to check fertility effectively and safely. We therefore aimed to compare various IUCD related clinical factors to assess its acceptability, safety and efficacy in immediate postpartum vaginal insertion, intracaesarean insertion, delayed postpartum insertion and interval insertion at a tertiary-care centre in India.

Methods: It was a retrospective analysis of prospectively collected data from July 2013 to July 2014. Data was reviewed about maternal age, socioeconomic status, education, occupation and parity of a total of 1631 eligible mothers and was compared between postpartum group and interval group. Data about spontaneous expulsion rate of IUCD, proportion of patients not able to feel thread, reasons for removal and failure rate of IUCD up to a follow-up period of 6 months was also collected in these women and compared among immediate vaginal insertion, intra caesarean insertion, delayed postpartum insertion and interval insertion.

Results: Majority of women were between 20 and 35 years of age group, literate, multiparous, unemployed and belonged to middle/lower socio-economic strata in both postpartum and interval groups. Spontaneous expulsion rates were 1.84, 0.84, 2.83 and 1.63%; proportions of patients not able to feel thread were 3.07, 8.73, 4.45 and 1.63%; and removal rates were 7.99, 6.48, 7.69 and 3.47% in immediate vaginal, intra-caesarean, delayed postpartum and interval insertion groups, respectively. Failure was seen in only one case of delayed postpartum insertion.

Conclusion: IUCD was more acceptable among young, literate and multiparous women as a contraceptive method. Immediate postpartum period was the safest and most efficacious time for IUCD insertion with least expulsion rate, maximum continuation rate and no failure and, therefore, should be encouraged by adequate counseling of mothers.