Background: The reported incidence of GTD varies widely worldwide, from a low of 23 per 100,000 pregnancies (Paraguay) to a high of 1,299 per 100,000 pregnancies (Indonesia). The reported incidence of GTD in India is inconsistent therefore we planned to do an analysis of the GTD at our institute which is a referral tertiary center of Haryana.Methods: Records of patients of GTD admitted from January 2014 to June 2016 were analyzed and incidence per 1000 deliveries was calculated. The demographic profile, clinical presentation, management and complications were studied.Results: There were 38 patients of GTD with an incidence of 2.3 per 1000 deliveries. Out of 38 patients 33 (86.8%) were of molar pregnancy and 5 (13.16%) had GTN. Out of 33 molar patients 27 (81.8%) had complete mole and 6 (18.2%) had partial mole. All cases of GTN were low risk and received single agent methotrexate based chemotherapy. The mean age was 23.02±2.96 years and 47.4% were primigravida. The mean gestational age of presentation was 13.84 ± 3.24 weeks. There were no mortalities and no recurrences. Education in more than half i.e. 57.1% patients was below primary and 7 of the 19 patients with GTD, who could be followed telephonically, were found to have not followed the contraceptive advice and conceived within 6 months of the treatment of molar pregnancies, 5 had vaginal deliveries of live babies one of which was preterm and rest 2 had spontaneous abortions.Conclusions: In view of poor reporting from developing countries there is a need for a nodal centre exclusively for GTD in each state. Poor compliance and contraceptive practice due to uneducated population especially in rural India, warrants a need for prophylactic chemotherapy in high risk cases.
were multipara. As far as timing of insertion is concerned, 6 (20%) were postpartum, 8 (26.6%) were postabortal and 16 (53.3%) were postmenstrual. Twenty three (76.6%) IUD's were inserted at primary health center, 7 (23.4%) were inserted at civil hospital and none were inserted at tertiary center. Time interval between insertion and removal is depicted in Table 1. Of the 21 misplaced intrauterine devices 10 were found partially embedded in uterine wall and 6 of the misplaced 1UD's were found deeply embedded in the uterine cavity. In four patients the device was fragmented after history of partial removal outside (Table 2). After their location they were removed hysteroscopically. One patient reported with 8 weeks pregnancy and misplaced IUD. The device was confirmed to be intrauterine on transvaginal sonography. She decided to continue the pregnancy and had uneventful antenatal course. She had full term normal delivery and IUD was removed after 6 weeks hysteroscopically. Nine patients had extrauterine migration of the IUD as diagnosed by USG and abdominopelvic X-ray. Out of 9, successful laparoscopic removal was possible in 7 (77.7%) patients and 2 patients required laparotomy for the removal although their localization was done with laparoscopy.
Objective: Uterine pathologies are the cause of infertility in 15% of infertile couples and their correction is associated with improved pregnancy rates. This prospective study was carried out to compare hysterosalpingography (HSG) with hysteroscopy (HSC) in evaluation of uterine pathology.
Study design:The research was approved by the institutional review board. A total of 100 infertile women were included in the study. HSC and HSG were performed in the follicular phase and the findings were compared. Student's t-test and chi-square test were applied wherever applicable. Degree of agreement between the two procedures was calculated using kappa estimates.Results: Thirteen percent of the women had abnormal HSG regarding the uterine cavity while 20% had abnormal HSC findings (chi-square value 1.77, p > 0.05). Sensitivity of HSG in detecting uterine cavity abnormality was 50% and specificity 98.1%. Positive predictive value was 76.9% and negative predictive value was 88.5%. Result of HSG was false negative in 10% of women and false positive in 3%. In 77% of patients, both HSG and HSC were normal and in 10% of patients, both were abnormal. The degree of agreement between HSG and HSC as calculated by kappa estimates was 0.545.
Conclusion:Hysteroscopy should be considered essential while investigating infertile women. Since HSG provides valuable information about tubes, it may supplement the hysteroscopic assessment.
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