ABSTRACT
Background: Expectant management as first line management of early pregnancy miscarriages is less accepted due to failure and increased complications reported in few studies. Proper selection of cases improves outcome of expectant management. Aim of this study was to compare success rate and complications in expectant management in three groups of early pregnancy miscarriages- Incomplete miscarriage, anembryonic pregnancy and early fetal demise.Methods: Prospective observational study conducted in tertiary care centre for 3 years, including 107 patients with USG confirmed pregnancy miscarriage <13 weeks. Patients preferring expectant management were managed as outpatient without intervention for 2 weeks after which repeat USG was done to ascertain complete miscarriage. Failed expectant management patients underwent planned surgical uterine evacuation. Emergency admission and evacuation was done, if symptomatic during waiting period. Success rate and complications like emergency evacuation, vaginal bleeding, abdominal pain, limitation of physical activity and patient satisfaction were assessed and compared in subgroups of anembryonic pregnancy, early fetal demise and incomplete miscarriage. Statistical analysis was done by chi-square test.Results: Incomplete miscarriage group had highest success rate of 88.46%. followed by anembryonic pregnancy (72.5%) and EFD (47.83%) p value = 0.007. Complication rate was highest in EFD, followed by anembryonic and the least in incomplete miscarriage all of which was statistically significant except vaginal bleeding.Conclusions: Expectant management should be offered as first line choice for all types of early pregnancy miscarriages. Proper selection of case as to type of miscarriage especially incomplete miscarriage and selected cases of anembryonic pregnancy and EFD ensures higher success rate with lesser complications. Reserving medical and surgical management for unsuitable/failed cases.
ABSTRACT
Background: Pelvic organ prolapse is a common condition and a major cause of gynecological surgery. The lifetime risk of having an operation for prolapse may be 11%. Uterine conserving surgeries using synthetic mesh, especially in younger age group can restore normal anatomy relieving their pelvic symptoms. To evaluate the safety, intra operative and postoperative complications and efficacy of the laparoscopic cervicopexy.Methods: This Prospective observational study was carried out on women aged below 45 years attending gynaecology outpatient department with uterine prolapse at MES Medical College, Perinthalmanna between January 1st and December 31st, 2015. 39 women underwent laparoscopic cervicopexy and follow up assessments was done among them at 2 weeks, 3 months and 6 months. Results: The mean operative time was 27.6 minutes and blood loss was 0.4 gm/dl. No intraoperative and postoperative complications occurred. Short duration of hospital stay with mean of 1.4 days. 7.7% patients and 5.5% had mersilene tape reaction at 3 months and 6 months. The POP Q score C was significantly away from hymen at 2 weeks,3 months and 6 months (+4.4 - -4.3). 7.7% and 2.6% had recurrence at 3 month and 6 months. 5.1% underwent vaginal hysterectomy to get relieved from symptom.Conclusion: Laparoscopic cervicopexy is an effective option for women with pelvic organ prolapse who desire uterine preservation.