We have described a modification of the B-Lynch uterine compression suture which is simple and effective. This technique apposes the anterior and posterior uterine walls, obliterating the cavity and thereby provides effective control of post-partum haemorrhage as a result of uterine atony. It comprises of vertical compression sutures and is distinct from B-Lynch and Haymen's suture by having an additional firm puncture just below the uterine fundus. This means that the suture is transfixed at the uterine fundus, thus eliminating the risk of the sutures sliding off at the uterine fundus.

A prospective observational study was performed to evaluate the performance of a modified uterine compression suturing technique for the management of refractory post partum hemorrhage (PPH) at two leading tertiary referral centers in Colombo, Sri Lanka. An modified anchored B-Lynch suture was done in 17 women with PPH due to uterine atony. In 13 of the women (76%), bleeding was arrested and the uterus conserved. Four women (24%) did not respond to the anchored compression sutures, necessitating emergency post partum hysterectomy. Mean age was 31.2 years. Nine of the women (53%) were primiparous and eight (47%) parous. Mean estimated blood loss was 1994 ml (range 1200-3300 ml). This newly modified anchor B-Lynch compression suture appeared effective in controlling about 75% of PPH due to uterine atony, which allowed uterine conservation. This simple modification can provide a first line surgical step to control PPH.

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TVS is a more accurate method of assessing the thickness of the LUS compared with TAS.

A combination of clinical and TVS-based ‘soft marker’ of ovarian mobility provides a valid method for identifying fixed ovaries secondary to endometriosis.

A 32-year-old pregnant woman underwent laparotomy for suspected intra-abdominal mass lesion obstructing the biliary tree. Imaging studies revealed a mass in the fourth segment of the liver. Microscopic examination of the biopsy revealed a cholangiocarcinoma. The clinical course of the malignancy was worsened by her gravid state.

A healthy 26-year-old woman was noted to have residual uterine inversion after manual replacement of puerperal uterine inversion under general anaesthesia. This was corrected by the insertion of a balloon tamponade device. A cervical suture was applied to prevent ballooning of the device through the cervix. This little modification was immediately successful in preventing ballooning of the tamponade device. The whole idea was to overcome the need for a laparotomy. A review of the literature and the mechanism of action are discussed here.

Buccoliero AM et al. (1) should be credited for their study on liquid-based endometrial cytology in the management of a subpopulation of asymptomatic postmenopausal women. Their conclusion that liquidbased endometrial cytology may reduce unnecessary, more invasive, and expensive procedures is striking. However, they have obtained a specificity of 94% for endometrial cytology after categorizing the cases studied as nonpathologic and pathologic. If we were to categorize them as malignant and nonmalignant cytology, the resultant sensitivity would only be 83%. Cytohistologic correlation had been possible only in 94 cases (29%) of the study population, a fact that demands concern on the two techniques. Two hundred twenty-two biopsies (69%) were inadequate, a figure which is surprisingly high when compared to other similar studies (2) . It may be related to the prevalence of nonneoplastic or hyperplasic cases or due to the sequence of endometrial sampling: first the cytology and then the biopsy as hypothesized by the authors. A brief note on the time gap between endometrial cytology and biopsy is appreciated. We observed the possibility of bias of the investigators who were keen to highlight the efficacy of endometrial cytology in comparison to biopsy.This exercise adds some valuable information to the excising body of knowledge on managing asymptomatic postmenopausal women with liquid-based endometrial cytology. Low cost, good tolerability, and the fact that it can be carried out as an outpatient procedure (3) makes it an excellent option for women with other comorbid factors. It opens the door for future trends and advances in this method such as immunohistochemical staining rather than routine Papanicolaou stain of the cytology obtained. Gynecologists should be made aware of the advantages of liquid-based endometrial cytology in assessing the endometrium.