ABSTRACT
Vesicouterine fistula represents a rare urogenital fistula, accounting for approximately 1-4% of genitourinary fistulas. Iatrogenic reasons have been shown to be most common cause. Surgical excision is the mainstay of treatment. Less than 5% patients respond to conservative management. Authors report a case of successful conservative management of vesicouterine fistula.
ABSTRACT
Background: During the last few decades hysteroscopy has become a tool of choice for evaluation of uterine cavity due to its “see and treat “benefits. It is more accurate and less invasive. Introduction of hysteroscopy in gynecological practice is the need of time. Aim of our study is to share the experience of hysteroscopy, its learning curve and limitations in a rural tertiary care center of Haryana.Methods: We retrospectively analyzed all the hysteroscopy procedure done from January 2016 to December 2018 from the hospital records.Results: Total 118 hysteroscopy were done but record of only 110 was available. Out of 110, 37(33%) were operative and 73(67%) were diagnostic. 36% were done for AUB, 33% for infertility, 15% for misplaced cu t, 6% for amenorrhea, 2% in cases of RPL and rest for some less common indications. Out of operative hysteroscopy major procedures done were polypectomy and removal of misplaced Cu-T. Septal resection was also done in 3 cases. Number of operative hysteroscopy has increased over the time period of study.Conclusions: Hysteroscopic evaluation of uterine cavity is a reliable method for both diagnostic and treatment purpose. Proportion of hysteroscopy procedures and its learning curve will improve with persistent effort.
ABSTRACT
Normal pregnancy is associated with intense alterations in the maternal cardiovascular system. The aim of the present study was, to assess the influence of normal pregnancy on maternal central aortic pressures, arterial stiffness, and arterial wave reflection using non-invasive PC based cardiovascular risk analysis system (PeriscopeTM). The current study was conducted on 137 women with, normotensive, healthy, singleton pregnancies at first trimester (n=42), second trimester (n=48), third trimester (n=47) of pregnancy and 35 age matched non-pregnant controls. There was no significant correlation between the estimated means for age and systolic and diastolic blood pressure. There was progressive and significant increase in BMI as pregnancy progresses (p=0.0001). Heart rate rose significantly from Pre-pregnant to second and second to third trimesters (P<0.003). There were no significant changes observed in central aortic diastolic pressure (AoDiaBP) as pregnancy progressed (p=0.235) however Post Hoc comparisons showed a significant increase in central aortic systolic blood pressure (AoSysBP) and central aortic pulse pressure (AoPP) during first trimester when compared with non pregnant control group (p=0.039 and 0.048 respectively). There was significant increase in central aortic augmentation pressure (AoAugP) in first trimester compared to non pregnant control group (p=0.024). All the parameters of central aortic pressures were increased in the first trimester but decreased in the second trimester and again increased in the third trimester of pregnancy. There was a significant drop in Brachial-Ankle Pulse wave Velocity (baPWV) during first trimester of pregnancy compared to non-pregnant control group (p=0.0001) after that there is a progressive increase in baPWV in second and third trimester of pregnancy. In the third trimester baPWV is increased to more than non-pregnant control group but it was non significant (p=0.562) however it was significantly higher than first trimester (p=0.0001). Carotid-femoral Pulse wave velocity (cfPWV) also followed the same sequence as BaPWV but the drop in cfPWV during first trimester was not significant (P=0.135). All of the variables of hemodynamic and arterial compliance differed between participants with various trimester of pregnancy and non-pregnant control group. A significant up and down changes in Augmentation index (Aix) was observed from control to first, second and third trimester of pregnancy (3.14 to 6.74 to 2.63 to 10.51 respectively, P<0.0001). To summarize our report show that normal pregnancy is associated with a significant cardiovascular adaptation indicated by alteration in central aortic blood pressure, augmentation index and pulse wave velocity.