A prospective study on the role of Hysterolaparoscopy in the evaluation of infertility

Background: Infertility affects about 10-15% of couples of reproductive age groups. The current evidence indicates a 9% prevalence of infertility with 56% of couples seeking medical care. Hysterolaparoscopy provides a comprehensive investigative procedure in which various factors causing female infertility can be assessed at one sitting.Methods: A total 100 infertile women between 20-40 years of age including primary and secondary infertility were evaluated. Patients would be investigated thoroughly for infertility and in preparation for anaesthesia. Tests include follicular study, Ultrasound pelvis. Hysterolaparoscopy was performed in the pre ovulatory period between days 6-10 of the cycle for infertility evaluation.Results: In the present study out of 100 cases for infertility evaluated, primary infertility were 57(57%) and secondary infertility were 43(43%). In our study out of 100 patients, Hysterolaparoscopy showed tuberculosis in 24 (24%) patients, remaining were endometriosis, polycystic ovarian syndrome, congestion, intra-pelvic adhesions, hydro-salpinx.Conclusions: It is concluded that while treating the causes of female infertility combined simultaneous diagnostic laparoscopy and hysteroscopy should be performed in all infertile patients as” seeing is believing” and if any pathologies found to be operable the gynaecologist can perform operative hystero-laparoscopy at that time, hence anticipating the pathologies after pre-operative work up is very important.

Isolated twisted hematosalphinx misleading with ovarian cyst torsion

Normal or chronically inflamed fallopian tube can undergo torsion and present as acute abdomen, simulating clinically as ectopic gestation. Torsion of the fallopian tube is less frequent but significant cause of lower abdominal pain in reproductive age women that is difficult to recognize preoperatively. Authors present a rare case of hematosalpinx with torsion at its pedicle with hemoperitonium who presented as 28 years old female with acute abdomen that was successfully treated. In cases presenting with hemoperitoneum diagnosis of ruptured ectopic pregnancy should be made unless proved otherwise during reproductive age. Rarely ruptured ovarian cyst may also be a cause. Unfortunately, hematosalpinx sometimes can undergo torsion due to circulatory imbalance and can present as hemoperitoneum and circulatory collapse due to rupture. There have been no specific symptoms, clinical findings, imaging or laboratory characteristics identified for this condition. Imaging findings are non-specific in the preoperative diagnosis of torsed fallopian tubes. Therefore, most of cases with isolated fallopian tubal torsion had a delayed diagnosis and a subsequent delay of timely intervention that may result in failure to save tubal function. Torsion of tube can lead to hematosalpinx, hemoperitonium and necrosis of tube which necessitates urgent surgical management. This case report describes a twisted hematosalpinx presentation without any predisposing high-risk factors. A tubal torsion should be suspected in females with acute pelvic pain, of any age group. An early diagnosis and treatment are required to prevent complications. This rare case may highlight a new insight into pathogenesis of tubal torsion associated with hematosalpinx.

Pre-operative diagnosis of ovarian ectopic pregnancy: a challenge to practicing clinician

The first case of primary ovarian ectopic pregnancy was reported by St. Maurice in 1689. Primary ovarian ectopic pregnancy is rare entity, with incidence of around 3% of all ectopic pregnancies. The aim of present case report is to study the role of different modalities like clinical findings, biochemistry, sonography, surgery and histopathology in diagnosis of primary ovarian ectopic pregnancy. Authors present a case of a 24 years old female with history of 2 months amenorrhoea, per vaginal spotting and mild intermittent abdominal pain in RIF. Examination was unremarkable and serum βHCG was 2007.5IU/ml. An ultrasound scan showed an ectopic mass in the right adnexa suggestive of a tubal ectopic pregnancy and she underwent surgical management at our institute.  At laparoscopy, both fallopian tubes were noted to be normal with an ectopic mass attached to the right ovary with a pedicle. With these unusual laparoscopic findings, possibilities of tubal miscarriage, ovarian pregnancy, or abdominal pregnancy were suspected. Ectopic mass was coagulated and cut through the pedicle with bipolar cautery and specimen was sent for HPE. Our patient made an uneventful recovery and no further medical management was indicated. The diagnosis of right ovarian ectopic pregnancy was finally confirmed by histopathological evidence of the presence of chorionic villi in a background of ovarian stromal tissue, in consideration with Spigelberg’s criteria. Present case highlights the importance of considering non-tubal ectopic pregnancies when making a diagnosis based on ultrasound scan. Pre-operative diagnosis of ovarian ectopic pregnancy still remains a challenge in spite of current medical advances. Despite the benefits and reliability of ultrasound scanning, there will still be situations where the definitive diagnosis can only be made at surgery. However, histopathological examination is confirmatory and always mandatory.

Total laparoscopic hysterectomy: why surgeon teachers must learn and train residents

Background: The purpose of the present study is to demonstrate the feasibility of laparoscopic surgery for hysterectomy and elaborate our experience.Methods: Between September 2017 and April 2018, 15 patients who were counselled for and opted for total laparoscopic hysterectomy our hospital enrolled in this study. Surgeons used a four-port system with, one 10mm and three 5-mm trocars. All surgical procedures were performed with 30°, 10-mm laparoscope and conventional laparoscopic instruments including monopolar and bipolar cautery system and the LigaSure system.  Patient’s history, clinical findings and surgical outcomes were prospectively tabulated, evaluated and analyzed.Results: Out of 15 patients under the study with age range of 40-55years, only 2 patients had hypertension and diabetes mellitus and 2 had anaemia. All 15 patients underwent conventional laparoscopic surgery. Operative time was in a range of 6O–240 min.  There were no intra operative complications in 6 patients (40%) and no post op complications in 11 women (73%).Conclusions: The results from our 15 women show that, in experienced hands, laparoscopic hysterectomy is not associated with any increase in major complication rates.

Study of socio-economic determinants in family planning.

Background: India is a populous country with a diverse population belonging to different religions, cultures and geographical locations. Due to these variations, factors like education, economic background, cultural and religious beliefs influence various walks of life including family planning practices. This study was done to ascertain these influences in the working lower middle class society. Methods: The research design was prospective and exploratory and carried out in a public hospital over a period of 3 months. 90 patients were studied and a prestructured proforma was used to analyse the awareness and use of family planning methods in the study group. Results: Our study showed that awareness as well as use of family planning methods are affected by various factors such as age, education level, economic status, religion & joint family system. The reasons for not using contraception were side effects, religious reasons, space constraints, limited privacy and in some cases to try for a male child. Conclusions: The government thus needs to implement strategies aimed at addressing these influences for the national family planning programs to be successful.

Multiple Fibroids in a Case of MRKH Syndrome with Absent Uterus: Recommendations for Management.

Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome is a rare congenital anomaly characterized by aplasia or hypoplasia of uterus and vagina in women with normal development of secondary sex characteristics. It affects one in 4,000-5,000 female births. Women with this syndrome present in their teens with primary amenorrhea. MRKH syndrome may be associated with renal, skeletal, cardiac and auditory anomalies. Although, very rare women with MRKH syndrome may develop leiomyomas from a rudimentary uterus. Initial investigation in women having MRKH syndrome with leiomyoma is ultrasonography (USG). However, magnetic resonance imaging (MRI) is more accurate for diagnosis. Complete removal of the masses with the uterine remnant is recommended.