ABSTRACT
This article reports the case of a 40 year old woman who presented to the gynaecologic outpatient clinic with pain lower abdomen and an abdominopelvic lump. Clinical assessment, biochemical and radiological investigations revealed bilateral complex ovarian masses. Surgical exploration and histology of ovarian masses confirmed a rare bilateral borderline seromucinous cystadenoma. The purpose of this paper is to highlight the importance of thorough examination of women with symptoms of ovarian tumour which can be vague and to emphasize the necessity of a good collaboration between various medical specialties (primary physician/gynaecologist, oncosurgeon, radiologist and histopathologist) for correct diagnosis, optimum care and best outcome. This article also provides overview of the pathology and biology of borderline ovarian tumours, diagnosis, principles of surgical management and to appreciate the value of follow up.
ABSTRACT
Background: Hysterectomy, the most common gynaecologic surgery performed around the world. however, repeat gynaecologic intervention / surgery may be required for some conditions, adding cost and morbidity for patients and posing a burden on healthcare systems. The objective of the present study was to find out the incidence of and types of surgical intervention required post hysterectomy.Methods: A retrospective analysis of hospital records was done for gynecologic operative procedures done in post hysterectomy patients 2014-2016.Results: Out of a total of 1028 in the year 2014-2016 in our centre, 75 (7.3%) surgeries were performed for benign conditions in hysterectomized women. Hydrosalpinx(29%) was most common condition for surgery, followed by endometriosis(24%) with 31-40 years age group women undergoing the maximum surgeries. Vault prolapse(16%) in elderly and vaginal vault granulation(16%) in younger women also underwent a repeat gynecological procedure post hysterectomy.Conclusions: Some measures can be taken during the primary surgery(hysterectomy) to prevent a repeat gynaecological surgery in these women. Concurrent salpingectomy can prevent benign and malignant fallopian tube lesions and ovarian cancer . Endometriosis surgery should be precise to prevent any remnant ovarian or endometriotic foci. McCall’s culdoplasty in primary hysterectomy is proven to prevent vaginal vault prolapse. Most genitourinary fistulas can be prevented by detailed knowledge of pelvic anatomy, preoperative risk stratification of patients at higher risk of ureteric and urinary bladder injuries, meticulous surgical technique and judicious use of electrosurgical energy. Prevention is always better than a repeat surgery.
ABSTRACT
Background & objectives The length of cervix predicts the risk of preterm delivery. The objective of this study was to assess cervical length in pregnancy by transvaginal ultrasonography for generating normative data for nulliparous women at no special risk of preterm labour. Methods An observational study was carried out in a tertiary care teaching hospital in eastern India in nulliparous women who delivered at term. A single sonologist assessed 224 women (once per subject) between 20 and 34 wk of gestation. Nulliparous women carrying a single foetus of confirmed gestational age were included; 216 subjects were finally considered for generation of normative data, excluding those delivering earlier than 37 or later than 42 wk. Other exclusion criteria were history of cerclage, any previous cervical surgery, smoking, or any medical disorder complicating pregnancy. Results Cervix length at each week of gestation gradually decreased over the study period. Length at 20 and 34 wk was 40.5 ± 1.14 mm (mean ± SD) and 34.8 ± 1.34 mm respectively. The overall shortening over this 14 wk period was 5.7 mm, with 0.58 mm per week median rate of shortening. Pearson's correlation coefficient was - 0.69 (95% CI - 0.75 to - 0.60; P< 0.001) for cervical length vis-à-vis gestational age. Interpretation & conclusions The serial normative data generated in our setting can be used to decide cut-off points for predicting risk of preterm labour in future studies. Validity of such prediction needs to be tested in larger cohorts of women assessed at specific gestational ages.