Ultrasound predictability of lower uterine segment cesarean section scar thickness

Objective: The objective of this study is to find out association between scar thickness, assessed sonographically, and intraoperative findings [IOF]. Study Design: Descriptive study. Place and Duration of Study: Department of Gynecology and Obstetrics, Sharif Medical and Dental College, Lahore, from June 2016 to April 2017

Methodology: A total of 70 pregnant patients were included in this study. Transabdominal ultrasound was done for scarred uteri. Sonographic findings were co-related with introperative findings. All the given data were entered on SPSS version 23. Age was expressed as mean +/- SD. Parity, gestational age, and interval between cesarean sections were expressed as frequencies with percentages. Statistical analysis was done by using Chi-square test for categorical data for association between sonographic scar thickness and intraoperative findings. The statistical significance was set at p-value <0.05

Results: The age range of the patients was 20-36 years with a mean of 27.91 +/-3.690 years. Gestational age at the time of cesarean section was between 27-40 weeks of gestation with a mean of 37 +/-2.126 weeks. The interval from previous cesarean was 10 months at the minimum, and 6 years at the maximum with a mean of 2.29 +/-1.0 months. Mean scar thickness was 2.5 mm. Association between scar thickness [<1-3mm] and intaoperative findings of dehiscence and rupture showed a p-value of<0.001

Conclusion: Sonographic assessment of a uterine scar has a practical application to determine the thickness of previous scar, and assess its integrity

Functioning uterus with absent cervix, short vagina and transverse septum

A 25-year-old married lady with primary amenorrhea, infertility, lower abdominal pain and dyspareunia underwent vaginoplasty, total abdominal hysterectomy with right adnexal clearance for congenital absent cervix, vaginal septum with functioning uterus and right sided endometrioma. Mould was kept in vagina for 2 weeks followed by intermittent vaginal dilatation for one week. Couple was advised normal coital function and intermittent vaginal dilatation at home. Patient was followed regularly in OPD for 4 months and there was no complaint regarding sexual life

Symplastic leiomyoma of uterus: a rare histological variant

Symplastic leiomyoma is a rare histological variant of leiomyoma. This is a case report of a young nulliparous patient who presented with primary infertility for 2 years and swelling in lower abdomen for 6 months. Intramural fibroid was diagnosed during a pelvic ultrasound. Histopathology of that myomectomy showed symplastic leiomyoma with absent mitotic figures. The patient was managed as for a benign tumor

Pregnancy with macroprolactinoma

A macroprolactinoma recurred in a 25-year-old lady, who had initially presented with inability to conceive, secondary amenorrhea, galactorrhea and persistent headache. She was diagnosed as a patient of pituitary macroadenoma of 1.7 cm with elevated serum prolactin level. She was given Bromocriptine, which normalized her menstruation as well as the prolactin level followed by conception during treatment. Pregnancy remained uneventful till 27 weeks when she developed severe headache and total loss of vision from left eye and partial from right eye at 27 weeks. MRI showed enlargement of macroadenoma upto 2.5 cm with compression on optic chiasma. Transsphenoidal adenectomy was performed. After surgery visual field defect improved but plasma prolactin level remained elevated. She delivered vaginally at 39 weeks. Later, treatment with Bromocriptine [15 mg/day] failed to keep prolactin level normal and Lisuride hydrogen [0.8 mg/day] reduced the prolactin levels

Infertile female; laparoscopic evaluation

To highlight the role of laparoscopy in the diagnosis and management of problems related to infertility. Retrospective, descriptive study. Department of Obstetrics and Gynaecology, Shaikh Zayed Hospital, Federal Postgraduate Medical Institute, Lahore between 15t January 2003 to December 2003. Forty three women were selected for laparoscopy, 25 having primary infertility and 18 having secondary infertility. Laparoscopy diagnosed significant number of previously undiagnosed [unexplained] cases. In laparoscopy multiple procedures like laparoscopic ovarian diathermy, adhesiolysis, cauterization of endometriotic spots, and removal of endometriomas, salpingostomy and cauterization of fibroids can be performed in women with primary as well as secondary infertility while having minimal complications, short hospital stay and no mortality. Laparoscopy is a valuable diagnostic tool for female infertility. Laparoscopy is less invasive and more convenient

Profile and repair success of vesico-vaginal fistula in Lahore

To describe the profile of patients with vesico-vaginal fistula [VVF] and success rate of the surgery. Design: Descriptive study. Place and Duration of Study: Sir Ganga Ram Hospital and Ghurki Trust Hospital, Lahore, between 1998 and 2002. Patients and All patients diagnosed as cases of vesico-vaginal fistula were included in the study. Those patients, who had previous unsuccessful surgery for vesico-vaginal repair, whether done in the hospital or outside, were also included. Their demographic profile and repair success was determined. Out of 2570 gynaecological admissions, 14 women had vesico-vaginal fistulae showing the prevalence of 0.55 / 100 gynaecological admissions. Obstetrical cause was found in 71.4% of the cases. The mean age of the patients was 34.85 +/- 6.3 years [range 25-45] with parity varying from 0-9 [median 4]. The position of majority of the fistulas [57.2%] was high [vault, juxta-cervical]. Success rate of the surgery in the study was 85.7%. Majority of the repairs [78.6%] were done through vaginal route. The most common cause of vesico-vaginal fistula in this study was obstetrical, either prolonged labour or caesarean hysterectomy. Although the success rate of repair was high, yet the attempt should be focussed on prevention