Background: Postmenopausal bleeding is a condition where endometrial carcinoma is to be ruled out. Traditionally, D and C is the preferred method for diagnosis in such condition. Other diagnostic modalities like trans vaginal ultrasonography (TVS) and hysteroscopy are being used for diagnosis in the cases of PMB. The objective of this study is to evaluate the efficacy and accuracy of TVS and hysteroscopy in women with postmenopausal bleeding (PMB).Methods: One hundred postmenopausal women with vaginal bleeding underwent TVS and hysteroscopy. Endometrial tissue was obtained by curettage and sent for histopathology examination. The results of TVS and Hysteroscopy were compared against HP report.Results: Hysteroscopy was successful in 98 patients. Endometrial histopathology revealed proliferative, secretory and atrophic endometrium in 26, 7 and 23 patients respectively. Polyp was diagnosed in 13 patients. Endometrial hyperplasia was detected in 11 patients and endometrial malignancy in 14 patients. All patients with endometrial hyperplasia and malignancy had ET (endometrial thickness) more than 4 mm, except one patient with endometrial malignancy who had 4 mm ET. The sensitivity and specificity of TVS for suspecting endometrial pathology at ET 4mm were 93% and 69.6%, respectively. Hysteroscopy had sensitivity of 95.2%, specificity of 92.8%, with diagnostic accuracy of 93.8%.Conclusions: Hysteroscopy was found to be the more sensitive and specific than Transvaginal sonography for diagnosing endometrial pathologies. Hysteroscopy is safe and effective for detecting endometrial pathologies in patients with PMB.

. Swim up semen preparation technique was used in all cases. Insemination was performed in both groups 34e37 h after hCG administration. Standard IUI was performed using 0.5 ml of inseminate. In FSP 4 ml inseminate was used. Results: In group A (184 IUI cycles in 100 patients), 22 clinical pregnancies (presence of gestational sac with fetal cardiac activity) occurred (11.95% per cycle over four cycles). In group B, (220 cycles of FSP in 100 patients), 48 clinical pregnancies occurred (21.81% per cycle over four cycles) and this difference was statistically significant (p < 0.05). Conclusions: For non-tubal sub fertility, the results indicate clear benefit for FSP (Fallopian tube sperm perfusion) over IUI (Intrauterine insemination).

INTRODUCTIONRecurrent second trimester abortions and preterm delivery, continue to haunt as two major problems for modern obstetrics and perinatal medicine. Cervical insufficiency or incompetency is defined as the inability of the uterine cervix to retain a pregnancy in the absence of contractions or labor.1 It is characterized by a painless opening and shortening of the cervix uteri between 16 to 28 weeks of gestation resulting in pregnancy wastage. 2This operation for repair of cervical internal os was first described by Palmer and Lacomme.3 Lash and Lash published a paper on habitual abortions due to cervical incompetence. 4 Shirodkar described his new operative technique for managing cervical incompetence. The incidence reported by various authors for this entity differs from 1:54 to 1:222 pregnancies. [6][7][8][9] In the second trimester, it is responsible for 15-20% of the total abortions. Cervical encerclage is considered as a simple but useful minor surgical procedure for improving the fetal salvage in proven cases of cervical incompetence. ABSTRACT Background:The two major problems for modern obstetrics and perinatal medicine are recurrent second trimester abortions and preterm delivery. Cervical insufficiency or incompetency is defined as the inability of the uterine cervix to retain a pregnancy in the absence of contractions or labor. Cervical encerclage is a simple but a resourceful procedure for improving the fetal outcome in cases proven with cervical incompetence, is a boon to modern obstetrics. Methods: A prospective analytical study was carried out at tertiary care teaching hospital for a period of ten years. Three hundred and twenty cases of bad obstetric history (repeated abortions, preterm labor) with previous pregnancy losses probably due to cervical incompetence or ultrasonographical evidence of short cervix were included in the study. These cases were subjected to cervical encerclage operation in the second trimester. Results: Out of the 289 cases, who underwent McDonald's procedure, 12 women had abortion, 66 had preterm labor and 211 women reached term. Out of the 31 cases who underwent Wurm's procedure; 4 had abortion, 17 had preterm delivery and 10 women reached to term. In the present study, the average interval from cerclage to delivery was 115 days. It was observed that the fetal salvage rate was unsatisfactory in women having short cervix with open internal os before encirclage. Infant salvage rate in this study after encerclage operation was 86%. Conclusions: Cervical encerclage when done in properly selected cases, results in improvement in fetal salvage up to eighty percent.

Background: Missing CuT thread is a worrisome complaint for a woman. The string may be curled in or the Cu T might have expelled or migrated.Methods: It was a retrospective study. Authors collected the data between January 2017 to December 2017. Data was collected from OPD, OT register and Indoor patient record file. The objective was to ascertain the symptomatology, type of insertion, investigations and mode of retrieval of CuT.Results: There were 63 cases of missing CuT thread, out of which, 42 were postpartum. 33 patients were asymptomatic. Irregular vaginal bleeding (19 patients) was commonest complaint, followed by abdominal pain (10 patients). Pregnancy was detected in one patient. Transvaginal ultrasonography (TVS) detected intrauterine location of CuT in 60 cases. X-ray abdomen erect was needed in 3 cases, which detected intra-abdominal migration of CuT in two cases. CuT was expelled in third case. In 31 patients, CuT was removed by artery forceps in OPD. In 17 cases, hysteroscopic Copper T removal was needed. Two cases with migrated CuT underwent laparoscopy for retrieval of CuT. One patient had to be converted to laparotomy to rule out bowel injury.Conclusions: Missing CuT thread is commonest with postpartum IUCD. TVS should be first investigation in missing CuT thread. X-ray abdomen is needed only if CuT is not visualized on TVS. Hysteroscopy can be used in patients where CuT retrieval with artery forceps fails. Laparoscopy and laparotomy may be required in migrated CuT cases.

Background: To study the awareness and efficacy of Mirena (Levonorgestrel intrauterine system) in treatment of abnormal uterine bleeding.Methods: A prospective analytical study was conducted from January 2012 to June 2018 at Smt. Kashibai Navale medical college and general hospital, Pune, Maharashtra, India. Total 30 women between age of 35 to 45 yrs age were included in the study. Mirena was inserted post-menstrually in the operation room under sedation was done. The women were called for follow-up after 1 month, then 4 months, and then yearly (for maximum 2 years); and asked regarding the relief they have obtained from the antecedent menstrual complaints.Results: At end of study, Overall satisfaction rate among women was 76.67% and decrease menstrual blood flow observed in 20 (74.07%) cases. Most common side effect observed was irregular menses in 6 (22.22%) cases. Hysterectomy was required in 3 (11.11%) cases.Conclusions: Menorrhagia is a common gynaecologic problem often needing hysterectomy. The LNG-IUS reduces bleeding in women with menorrhagia due to benign causes. The patient acceptance and satisfaction is high. Main problem is irregular bleeding especially for the first 3 months after insertion. If the patients can be counseled before insertion, continuation rates for LNG-IUS are high. It has the potential to replace hysterectomy as treatment of choice in certain patients.

Background: Instrumental or assisted vaginal birth is commonly used to expedite birth, for the benefit of either mother, baby or both. Objective of present study was to evaluate risk factors for unsuccessful vacuum delivery when variability between individual accoucheurs is taken into account.Methods: We conducted a retrospective cohort study of attempted 687 vacuum deliveries over a 10-year period (2008–2017 inclusive) in a tertiary care center at Smt. Kashibai Navale Medical College and General Hospital, Narhe to account for inter-accoucheur variability, we matched unsuccessful deliveries (cases) with successful deliveries (controls) by the same operators. Multivariate logistic regression was used to compare successful and unsuccessful vacuum deliveries.Results: During the study period of 10 years, there were 29861 deliveries, of which 19831 (66.4%) were vaginal deliveries. 8802 (29.47%) were cesarean deliveries and 1228 (4.1%) were instrumental deliveries. Among instrumental deliveries, 687 (56%) were vacuum deliveries and 541 (44%) were forceps deliveries. Six hundred and eighty-seven ventouse deliveries of vertex presenting, single, term infants were attempted, of which 38 were unsuccessful (5.5%). Increased birth weight (OR=1.11 p<0.001), second-stage duration (OR=1.01 p<0.001), rotational delivery (OR=1.52 p<0.05) and use of ventouse versus forceps (OR=1.33 p<0.05) were associated with unsuccessful outcome. When inter-accoucheur variability was controlled for, instrument selection and decision to rotate were no longer associated with vacuum delivery success. More senior accoucheurs had higher rates of unsuccessful deliveries (12% v. 5%, p<0.05), but undertook more complicated cases. Cesarean delivery in the second stage without prior attempt at ventouse delivery was associated with higher birth weight (OR=1.07 p<0.001), increased maternal age (OR=1.03 p<0.01), and epidural analgesia (OR=1.46 p<0.001).Conclusions: Careful selection of cases and adequate training of post graduate students during residency under direct supervision of senior experienced obstetrician can reduce the rate of failed vacuum delivery and related complications Results suggest that birth weight and head position are the most important factors in successful vacuum delivery, whereas the influence of patient selection and rotational delivery appear to be operator-dependent. Risk factors for lack of vacuum delivery success are distinct from risk factors for requiring vacuum delivery, and these should not be conflated in clinical practice.