Background: Menopause is defined according to WHO as the permanent cessation of menstruation resulting from the loss of ovarian follicular activity. It is defined as uterine bleeding occurring after at least 1 year of amenorrhoea. Considering the high accuracy of hysteroscopy in evaluation of postmenopausal bleeding, the present study was carried out with an aim to evaluate hysteroscopic findings in women with postmenopausal bleeding in order to assess the causes of PMB and to determine their prevalence in our population.Methods: This was a prospective observation study, comprising of total number of 50 postmenopausal women attending gynae OPD at department of obstetrics and gynecology, Command Hospital (CH), Lucknow, Uttar Pradesh. The data obtained for the purpose of study was fed into computer using Microsoft excel 2013 software.Results: A total of 50 women with complaints of postmenopausal bleeding were enrolled in the study. Maximum number of women had achieved menopause between age 46 and 50 years. Hysteroscopy had an accuracy of 94% for detection of polyps. Hysteroscopy had an accuracy of 90% for detection of atrophy. For fibroid, hysteroscopy had an absolute sensitivity, specificity, positive predictive, negative predictive and accuracy value (100%).Conclusions: The findings of present study suggested that hysteroscopy has a useful role in evaluation of postmenopausal bleeding especially in the diagnosis of polyps and fibroids. Given fewer number of cases, the usefulness of hysteroscopy in evaluation of endometrial cancer and hyperplasia could not be established adequately. Further studies on larger number of sample size will help in providing more useful and confirmatory information.

INTRODUCTIONGlobally uterine atony is one of the commonest form of PPH and results in significant maternal mortality and morbidity.As one of the quick, effective and safe interventions for control of PPH, uterine compression sutures(UCS) were introduced by Christopher B Lynch. Since then many modifications of UCS has been practised. 1-3Combination technique of external compression incorporating the UCS and internal uterine tamponade (uterine sandwich) using a Bakri balloon has been employed which applies forces to both the external as well as the internal surfaces of the myometrium. 4 Since in low resource settings Bakri balloon is not available, we have used Foley's catheter (which is universally available), as a means of internal uterine tamponade. 5Since PPH results in significant maternal morbidity and mortality and at times in face of PPH refractory to ABSTRACT Background: Uterine atony is the most common cause (75%-90%) of primary postpartum hemorrhage (PPH) and Christopher B Lynch was the first to highlight the use of Uterine Compression Sutures (UCS) for the management of atonic PPH. In combination therapy, the (UCS) is combined with intrauterine balloon tamponade, known as (uterine sandwich), for combined external as well as internal compression for more effective hemostatic control of uterine bleeding. Methods: The uterine sandwich technique was used in a total of twelve patients managed in a tertiary care service hospital during caesarean deliveries. In four cases of uterine atony, the sandwich technique was used, for patients unresponsive to the conservative management. In eight patients the sandwich technique was used as a prophylactic measure, where according to the clinical profile of the patient there was high risk of PPH and where either blood was not available or availability was limited. Results: In the four cases of uterine atony, the uterine sandwich technique was used therapeutically. All the patients were multigravidae. The period of gestation ranged from 34 weeks to 37 weeks. Average operating time was 50-60 mts, average estimated blood loss was 1600 ml, average distension of Foleys catheter was 90 ml and average duration of the intrauterine Foleys catheter balloon being in situ was 12 hrs. In eight patients, the sandwich technique was used as a prophylactic measure, for varied indications. In all the cases there was successful outcome. Post-operative outcome was uneventful in all the cases. Conclusions: The uterine sandwich technique can be used either prophylactically or therapeutically for control of PPH. It is simple, safe, easy, effective and is easier to perform than internal iliac artery ligation and should be considered prior to proceeding for hysterectomy in a hemodynamically stable patient, in whom uterine conservation or fertility preservation is essential.

INTRODUCTIONCSP is an iatrogenic complication of a previous ceasarean delivery. The true incidence of CSP is unknown. Incidence of CSP is currently estimated at 1:1800-2200 pregnancies.1,2 With a history of a previous cesarean delivery, it is estimated that 0.15% of all pregnancies will be followed by a CSP in the woman's next pregnancy. 3Although rare , the possibility of a recurrent CSP is also possible and greater awareness on part of the clinician and the patient is essential .Unfortunately, CSPs are often misdiagnosed as abortions in progress, ectopic and cervical pregnancies .CSP can have grave consequences in all the three trimesters for the patient if not recognized early or appropriately treated.There are two types of CSP which have been reported. One in which there is a deep implantation in a cesarean scar defect towards the bladder and the abdominal cavity and the second type which involves an implantation ABSTRACT Background: Objective of present study was to describe evaluation and management of pregnancies implanted into uterine Cesarean section scars, Ceasarean scar pregnancies (CSP), is defined as gestational sac implanted in the myometrium at the site of a previous ceasarean scar. Also known as Ceasarean ectopic pregnancy. Methods: In all antenatal patients attending the antenatal outpatient department of a tertiary care service hospital a transvaginal sonography was done for determining the gestational age as well as the viability of the pregnancy. In all patients with a history of previous Cesarean section(s), special effort was made to assess the possibility of implantation into the uterine scar by means of an early transvaginal and colour doppler ultrasound. Results: Twelve Cesarean section scar pregnancies were diagnosed in a five-year period, of a tertiary care service hospital. Five (42%) patients with Cesarean scar pregnancies were treated surgically, four patients medically (33%), and two patients expectantly (17%) and one patient opted to continue the pregnancy. Surgical management was successful in all cases, although two of five (40%) women suffered bleeding (300-500ml). In the group of women who were managed medically the success rate was 3/4(75%). Expectant management was successful in one of two cases (50%). One patient who opted to continue pregnancy, underwent a ceasarean hysterectomy at 33 weeks of gestation for placenta accreta. Conclusions: Incidence of ceasarean section scar pregnancies is increasing as is the increasing rate of ceasarean deliveries. A high index of suspicion in all cases of post ceasarean pregnancies, coupled with early transvaginal ultrasonography along with colour doppler confirmation and institution of early and individualized treatment, optimizes the clinical outcome. Although rare, the patient and her relatives must be made aware of the possibility of recurrent CSP.

Gestational trophoblastic disease comprises of various pathologies with hydatid form mole bring a common etiology. Emergency admissions of patients of gestational trophoblastic disease is very rare. Here we present a case report of an emergency admission of patient with hydatidiform mole and severe bleeding and then was managed for the same during the course of hospital stay.

Background: Open access technique for laparoscopic surgery is used by the surgeons routinely, for gaining intraabdominal access safely, but is somehow underutilised by gynaecologists. The most important and dangerous part of laparoscopic surgery is while gaining access to the abdominal cavity, especially in the obese, thin and in patients with previous abdominal scars. Various access techniques have been described including Hasson and Fielding technique, transvaginal or transuterine insufflation, alternative sites for introducing Veress needle abdominally and insufflations with an optical trocar. Open access technique can minimize visceral and vascular injuries and ensures quick and easy intra-abdominal access.Methods: 250 patients were taken up for laparoscopic surgery at tertiary care service hospitals for open access technique for laparoscopic surgery for a variety of indications. The spectrum of patients ranged from thin, obese, single and multiple transverse scarsResults: A total of 250 patients, were taken up for laparoscopic surgery with the open access method successfully. The median age of the patients was 32 years, there were 77 patients (31%), with previous transverse laparotomy incisions. Median time for access was 100 seconds, and in 102 patients, there was prolonged access time ranging from 150-300 seconds, 37 (36%) of these patients were those with previous multiple transverse laparotomies and 65 (64%), patients were obese. There were no intra-abdominal organ or vascular injuries. Skin incisions healed well.Conclusions: This study describes the open access technique in patients, with transverse laparotomy scars and especially useful in thin and obese women, and where the chances of vascular and visceral injuries can be high while gaining intra - abdominal access. It is safe, effective, easy to learn and requires minimal instrumentation and can be used in the vast majority of the gynaecological cases.

Background: Generally misopristol alone is used in cases of early fetal demise successfully. However to further enhance the success rate a combination of mifepristone along with misopristol can be used. This results in avoiding anesthesia, surgery and operating theater resources, thus being economically viable and results in an overall greater patient satisfaction levels also. Globally, there is a general trend to grant patient greater autonomy in their treatment plan, minimize intervention levels, shorter hospital stay and quicker return to normal schedule and enhanced patient satisfaction levels.Methods: 100 patients with early fetal demise, who reported to a tertiary care service hospital were prospectively evaluated. An oral dose of mifepristone 200 mg stat and 48 hours later misoprostol 800 μg was inserted vaginally. Three hours following the first dose, two further doses of 400 μg misoprostol, was administered vaginally at 3 hours intervals. Repeat medical regime was offered with misoprostol patients who failed to pass products of conception. Success was defined as complete uterine evacuation within 3 days, without the need for surgical evacuation.Results: The overall success rate of medical management was 84%. Mifepristone alone induced natural expulsion of products of conception in (40%) patients complained of heavy bleeding within 48 hours of mifepristone administration alone and in 29 (29%) patients complete miscarriage was confirmed on ultrasound scan. Of the 68 women who were symptomatic at presentation the medical regime failed in 28 (41%), compared with five (16%) failures of the 32 who were asymptomatic. Of the 25 women who had surgical evacuation, eight required an emergency curettage for bleeding.Conclusions: Combination of oral mifepristone along with vaginal misopristol is a simple, safe and effective means of treating early fetal demise, and is an effective alternative method to expectant and surgical options.

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