Laparoscopic evaluation of female genital tuberculosis in infertility: An observational study

Background & objectives: Female genital tuberculosis (FGTB) is an important variety of extrapulmonary TB causing significant morbidity, especially infertility, in developing countries like India. The aim of this study was to evaluate the laparoscopic findings of the FGTB. Methods: This was a cross-sectional study on 374 cases of diagnostic laparoscopy performed on FGTB cases with infertility. All patients underwent history taking and clinical examination and endometrial sampling/biopsy for acid-fast bacilli, microscopy, culture, PCR, GeneXpert (only last 167 cases) and histopathological evidence of epithelioid granuloma. Diagnostic laparoscopy was performed in all the cases to evaluate the findings of FGTB. Results: Mean age, parity, body mass index and duration of infertility were 27.5 yr, 0.29, 22.6 kg/m2 and 3.78 years, respectively. Primary infertility was found in 81 per cent and secondary infertility in 18.18 per cent of cases. Endometrial biopsy was positive for AFB microscopy in 4.8 per cent, culture in 6.4 per cent and epithelioid granuloma in 15.5 per cent. Positive peritoneal biopsy granuloma was seen in 5.88 per cent, PCR in 314 (83.95%) and GeneXpert in 31 (18.56%, out of last 167 cases) cases. Definite findings of FGTB were seen in 164 (43.86%) cases with beaded tubes (12.29%), tubercles (32.88%) and caseous nodules (14.96%). Probable findings of FGTB were seen in 210 (56.14%) cases with pelvic adhesions (23.52%), perihepatic adhesions (47.86%), shaggy areas (11.7%), pelvic adhesions (11.71%), encysted ascites (10.42%) and frozen pelvis in 3.7 per cent of cases. Interpretation & conclusions: The finding of this study suggests that laparoscopy is a useful modality to diagnose FGTB with a higher pickup rate of cases. Hence it should be included as a part of composite reference standard.

Comparison of efficacy of oral drotaverine plus mefenamic acid with paracervical block and with intravenous sedation for pain relief during hysteroscopy and endometrial biopsy.

Background : Office hysteroscopy with endometrial biopsy is usually the first investigation for abnormal uterine bleeding and other uterine diseases. Aims: To evaluate the effect of oral drotaverine with mefenamic acid on pain perception during hysteroscopy and endometrial biopsy and to compare it with that of paracervical block using 1% lignocaine and with that of intravenous sedation using diazepam with pentazocine. Settings and Design : Outpatient gynecological department and open randomized trial. Materials and Methods : One hundred twenty women undergoing hysteroscopy and endometrial biopsy were randomized into 3 groups. Group I received tablet containing drotaverine hydrochloride (80 mg) + mefenamic acid (250 mg), group II received lignocaine paracervically and group III received intravenous diazepam. The intensity of pain during the procedure, 30 and 60 minutes later on visual analog scale (VAS) was assessed. Statistical Analysis : Statistical analysis was performed using Kruskal-Wallis test, with the Bonferroni correction, the t test, and the χ2 test. Results: Groups were similar in age, parity, vaginal birth or relevant medical history. A statistically significant difference in pain scores was noted among the 3 groups during the procedure (group I, 4.13± 1.28; group II, 5.93± 1.26; group III, 5.58± 1.51), (P< 0.001); as well as 30 minutes later (group I, 1.78± 0.89; group II, 2.53± 0.81; group III, 2.23± 0.94), (P< 0.001) and 60 minutes later (group I, 1.2± 0.46; group II, 1.98± 0.83; group III, 1.68± 0.75), (P< 0.001). VAS at different time intervals among the groups was also statistically significant. No adverse effects were observed. Conclusions : Oral drotaverine with mefenamic acid is effective in women undergoing hysteroscopy and endometrial biopsy.

Comparison of Ofloxacin & Ornidazole with Probiotic versus Doxycycline & Metronidazole for the Outpatient Treatment of Pelvic Inflammatory Disease

The aim of the study was to compare the efficacy and cost effectiveness of ofloxacin, ornidazole, serratiopeptidase and Saccharomyces Boulardii combination with traditional doxycycline and metronidazole combination with serratiopeptidase in the outpatient management of pelvic inflammatory disease. A total of one hundred and ninety three women presenting with symptoms of pelvic inflammatory disease (PID) confirmed to be a case of PID on clinical examination were randomized to one of the two treatments. No investigations were performed to cut the cost and to avoid loss of follow up. A total of 98 women (Group I) were prescribed ofloxacin (400mg), ornidazole (500mg), Serratiopeptidase (10mg), Lactic acid bacillus 60 million spores and Saccharomyces Boulardii 2 million spores once a day for 10 days while a total of ninety five women (group II) were given a 10 day course of doxycycline (100 mg BD) with metronidazole (400mg TDS) along with 10mg of serratiopeptidase once daily. All women were seen after 2 weeks for relief of symptoms and possible side effects. The results were then analyzed. It was found that although the efficacy of both drug regimens was similar. The incidence of gastrointestinal side-effects mainly were less in group I. This was probably due to the addition of probiotic Saccharomyces Boulardii and lactic acid bacillus. The once daily administration led to better compliance in the first group.

Comparison of perinatal outcome of growth-restricted fetuses with normal and abnormal umbilical artery Doppler waveforms.

AIMS: To evaluate the role of umbilical artery Doppler in growth- restricted fetuses. MATERIALS AND METHODS: In a prospective observational study, 70 pregnant women with growth-restricted fetuses confirmed by ultrasound, were followed up with Doppler studies of the umbilical artery. The study group consisted of 35 women, where the Doppler waveform in the umbilical artery was compromised (either absent end diastolic flow [AEDF] or reversed end diastolic flow [REDF]). These were compared with an equal number of controls, where growth- restricted fetuses had normal doppler waveforms. Outcome measures were evaluated in both groups and analyzed. RESULTS: The periods of gestation at delivery were 27.2 +/- 3.5 weeks in group 1 and 37 +/- 3.3 weeks in-group II, respectively. Perinatal morbidity and mortality was significantly increased in the group with compromised umbilical artery blood group. Birth weight in group I was 742 +/- 126 grams and in group II was 1680 +/- 259 grams. This difference was statistically significant (P=0.0001). In comparison to AEDF, REDF fetuses had more morbidities. Perinatal mortality was also significantly increased in this group (P=0.001). CONCLUSION: Umbilical artery Doppler should be used in the management of growth-restricted fetuses. In those fetuses in normal Doppler, pregnancy can be prolonged. REDF is an indication for termination of pregnancy.

Genitourinary Fistula - An Experience from a Tertiary Care Hospital

Genito urinary fistula remains a frustrating condition for patients in the developing world. We retrospectively analysed twenty three women who underwent fistula repair over the last 5 years in one unit at Department of Obstetric and Gynaecology, All India Institute of Medical Sciences. Twenty-seven fistulae were repaired in 23 women of which 78.2% were vesecovaginal fistula. Majority of these fistula (73.9%) were obstetric in origin, as a result of neglected, mismanaged labour. Surgical repair was the mainstay with 100% success for those undergoing primary repair and an overall success rate of 83.3% for vesico vaginal fistula. Though principles of fistula repair were adhered to by the operating surgeon, each patient was unique. Surgeons trained in such repair can individually vary approach and technique to suit each patient giving high success rate.