Background: Hysteroscopy being the gold standard for evaluation of uterine cavity can be utilized for varied gynaecological indications. Conventionally, hysteroscopy is performed under general anaesthesia but with technical advances over years, it is now possible to do the procedure in ambulatory office setting with same diagnostic accuracy. Aim of this study was to assess the role of hysteroscopy as a diagnostic tool in office setting, to evaluate various gynaecological conditions.Methods: Study performed retrospective analysis on 1920 patients who underwent office hysteroscopy between Jan 2011 to Apr 2015, at outpatient department of a tertiary care centre at Maharashtra, India. The procedure was done in office setting without any sedation or anaesthesia. Approach used was vaginoscopic free hand technique with minimal instrumentation and the findings were documented after evaluation of uterine cavity, ostea and endocervical canal.Results: Office hysteroscopy could be successfully performed in 1920 out of 1938 patients. Most common indications were primary infertility (38.0%), secondary infertility (11.2%), abnormal uterine bleeding (36.6%) and postmenopausal bleeding (8.3%). The procedure done in office setting was tolerated well. The procedure was also used for evaluation in patients with breast and endometrial carcinoma.Conclusions: Office hysteroscopy by vaginoscopic approach is a simple and convenient method for evaluation of uterine cavity and cervical canal. It has the potential to come out from formal operation theatre to more patient friendly outpatient department.
Background: In patients with abnormal uterine bleeding (AUB), differentiating whether the cause is anovulation or anatomic lesions can be challenging. Transvaginal sonography (TVS) has limitation in form of high false negative rate for diagnosing focal intrauterine pathology. To improve the image in TVS, saline injected into uterine cavity can be used as a negative contrast agent. Aim of our study was to evaluate the clinical value of saline infusion sonography (SIS) by comparing its diagnostic accuracy with that of established gold standard i.e. hysteroscopy.Methods: The study was carried out in a referral and teaching public sector hospital in eastern India from July 2015 to June 2016. Study population consisted of 136 premenopausal women with AUB, who were scheduled to undergo diagnostic hysteroscopy. Patients were first evaluated by sis and then followed by hysteroscopy on a later date.Results: Both SIS and hysteroscopy could be successfully performed in 136 out of 144 patients. When all findings by SIS (any pathological findings in uterine cavity vs. none) were combined and compared with hysteroscopy (gold standard), both sensitivity and specificity of sis were 0.88 whereas PPV and NPV were 0.85 and 0.90 respectively.Conclusions: Because of comparable results obtained by evaluating patients by SIS as well as office hysteroscopy, we recommend saline infusion sonography as a valuable tool for evaluating premenopausal women with abnormal uterine bleeding, before consideration for hysteroscopy.
We report a case of complicated severe OHSS that developed spontaneous hemoperitoneum. This was a potentially fatal complication of pharmacological stimulation of ovary in assisted reproduction. Here the life was saved, oophorectomy was prevented and fertility preserved by timely diagnosis and conservative surgery.
Morbidly adherent placenta is a rare complication of pregnancy associated with high maternal morbidity. It may cause massive haemorrhage thereby requiring emergency hysterectomy. We present a case of placenta percreta which was manged succesfully by conservative management.
Background: Hypertensive disorders and intrauterine growth restriction are common complications encountered during pregnancy. This study was conducted to observe the usefulness of systolic/ diastolic (S/D) ratio in umbilical artery as compared with non-stress test (NST) to predict perinatal outcome in pregnancies complicated with hypertensive disorders and intrauterine growth restriction (IUGR).
Methods: It was a prospective observational which was conducted on patients undergoing antenatal visits at the department of obstetrics and gynaecology, Army hospital research and referral, New Delhi from May 2017 to April 2019. NST was started at 32 weeks twice weekly in all patients. All patients were subjected to umbilical artery Doppler velocimetry waveform on weekly basis or every third day in cases of nonreactive NST.
Results: Out of 140 patients, 53 patients (37.9%) had PIH and 44 (31.4%) had IUGR. 43 cases (30.7%) had both PIH and IUGR. Among the 140 patients, 40 patients (28.6%) had non-reactive NST and 60 patients (42.9%) of the patients had abnormal doppler. Abnormal doppler and non-reactive NST were associated with APGAR score of less than 7 at 5 minutes in the newborn. Abnormal perinatal outcome was more in abnormal doppler than normal doppler and the finding was statistically significant (p<0.05).
Conclusions: Overall sensitivity and diagnostic accuracy of Doppler is better as compared to that of NST in terms of detecting adverse perinatal outcomes.
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