Comparison between the Outcomes of Short Term Versus Long Term Catheterisation after Anterior Colporraphy with or without Other Vaginal Procedures: A Hospital based Prospective, Comparative, Randomised Study

Introduction: Defects in the pelvic supporting structuresresult in a variety of clinically evident pelvic relaxationabnormalities. The present study was aimed to assess whetherremoval of an in-dwelling catheter 24 hours after surgery affectthe rate of re-catheterization, symptomatic or asymptomaticurinary tract infections and hospital stay in comparison to 72hours of catheterization.Material and methods: Interventional, Prospective, hospitalbased study was done in Department of Obstetrics andGynaecology of R.G. Kar Medical College and Hospitalduring July 2016- June 2017. All women under gone anteriorcolporrhaphy with or without other vaginal procedure wereincluded and divided into two groups randomly. Group Aincluded 195 patients with Foley catheter kept in situ for 24hours following surgery and Group B included 195 patientswith Foley catheter placed in situ for 72 hours followingcompletion of surgery.Results: Mean duration of catheter removal to voidingduration in group A (2.3077±1.2301 hours) and in groupB (2.2308±1.1090 hours) was statistically insignificant(p=0.5170). Difference between post-void residual urine ineach group was insignificant (p=0.1021). Need and attempts ofre-catheterisation in either group was statistically insignificant(p=0.1184). Presence of UTI and Asymptomatic Bacteriuriawere statistically significant (p=0.0002 for UTI and p=0.0115for asymptomatic bacteriuria) in two groups and found less ingroup A compared to group B. Mean hospital stay in group A(2.533±0.8572 days) was less than Group B (3.7487±1.0762days) and was statistically significant (p<0.0001).Conclusion: Early removal of catheter is associated with lesshospital-stay, less complication like UTI or asymptomaticbacteriuria but has no effect on post void residual volume,voiding duration, attempts and need of re-catheterisation.

A Comparative Study To Assess Blood Loss During Abdominal Myomectomy By Tourniquet Application Versus Intramyometrial Vasopressin Injection

Objective: The objective of this study was to determine the efficacy of applying uterine artery tourniquet and intramyometrialvasopressin injection to reduce intraoperative blood loss during abdominal myomectomy.Methods: A comparative interventional study comparing parameters in the two groups of patients containing 24 each whereone received tourniquet application and other received intramyometrial vasopressin.Results: Pre-operative hemoglobin (Hb) was comparable in both mean 10.5 ± 0.50 g/dl in tourniquet group and 10.5 ± 0.47 g/dlin vasopressin group. Pre-operative hematocrit (Hct) was also comparable in both mean 31.8 ± 1.44% in tourniquet groupand 31.7 ± 1.51% in vasopressin group. Mean operative time was 49.0 ± 10.33 min in tourniquet group and 48.8 ± 9.62 min invasopressin group which was statistically indifferent. Amount of mean blood loss in the tourniquet group was 467.9 ± 74.50 cc and356.45 ± 58.35 cc in vasopressin group which is significantly higher in former. Post-operative day 3 Hb was lower in tourniquetgroup 8.94 ± 0.52 g/dl than 9.45 ± 0.52 g/dl in vasopressin group. Reduction in Hb postoperatively was more in tourniquetgroup 1.43 ± 0.45 g/dl than vasopressin group 0.92 ± 0.20 g/dl. Reduction in Hct postoperatively was more (4.82 ± 1.4%) intourniquet group than in vasopressin group (2.74 ± 0.62%). Blood transfusion was required 5 (20.83%) cases in tourniquetgroup, but only in 2 (8.33%) cases of vasopressin group though it was statistically indifferent between both groups.Conclusion: Application of tourniquet had more mean operative time, intraoperative blood loss, and requirement of bloodtransfusion. There is more reduction in Hb and Hct postoperatively in tourniquet application.

A novel approach to meet the unmet need for family planning

Background: Post-partum intra-uterine contraceptive device is one of the important methods of spacing to meet up the unmet need of family planning. The low complication rate, ease and certainty of insertion and one-time adoption advantages made it an option of family planning by Government of India. In the background of recent trends in family planning, the study aims to establish the efficacy and draw-backs of PP-IUCD among the clients in a tertiary care hospital of West Bengal.Methods: Prospective observational study on 1680 women during January 2016 to December 2016, where the PP-IUCD was given to the patients after vaginal delivery or Cesarean section and were followed up to 3 months.Results: During the study 1.37% patients did not turnup in either follow-up. The most common complication encountered was missing thread (4.64% at 6th week follow-up and 6.67% at 3rd month follow-up). Expulsion rate was much lower (2.02% at 6th week and 2.5% at 3rd month). Heavy bleeding per-vagina was in 1.55% at 6th week and 2.08% at 3rd month. Pain abdomen was .83% at 6th week and 1.67% at 3rd month. Incidence of perforation and failure was both nil at either follow-up. Dysmenorrhea was complained 2.44% at 6th week and 3.33% at 3rd month. Overall satisfaction rate at 6th week (86.05%) was higher than non-satisfaction (13.95%). This was also true for 3rd month where satisfaction rate (77.85%) was higher than non-satisfaction rate (22.15%).Conclusions: PP-IUCD appears to be a safe, efficacious, acceptable and accessible method of contraception.

An Observational Study on Uterine Myoma in Search of Factors Contributing to its Symptoms

Introduction: Uterine fibroid, the most common benign tumor,contributes significantly on quality of life if symptomatic.The study evaluates the factors which possibly contribute tothe symptoms. Objective: To identify the parameters whichpossibly play a role in symptoms of myoma.Material and Methods: An observational study on 48 subjectsafter taking written informed consent selected randomly fromwomen of reproductive age group attending at GynaecologyOut Patient Department.Results: Different age groups had comparable incidencesof fibroids. Most of the patients complained of Menorrhagia(54.2%). Metrorrhagia was complained in 6.2%, dysmenorrheain 10.4% patients, infertility and pain abdomen each wascomplained in 14.6% subjects. Most of the study subjectshad myoma of 14-week of gestation (39.6%) and 31.2% had16-week size myoma. The commonest location is found tobe fundo-anterior (33.3%), type is intramural (54.2%). Mostfibroids had volume of 95.1-125 cc (54.2%). One or twomyomas are more common than three or more myomas.Conclusion: Myoma is common in reproductive ages andthroughout the reproductive period incidences in differentage groups are comparable. Commonest symptom of myomais menorrhagia. Most myomas had volume of 95.1-125 cc,situated in fundo-anterior position, are of intramural type.Most myomas, if present as an abdominal lump, are of 14-week gravid uterus size. One or two myomas in uterus aremore common than number of myomas more than that

Study of Estradiol, Testosterone and DHEA-S Status in Women After Surgical Menopause.

Aims and Objectives : The study was done to assess the hormones namely Estradiol, Testosterone, and Dehydroepiandrosterone-sulphate (DHEAs) one day before operation and on ninth post-operative day following surgical menopause. Materials and Methods : This is a cross sectional observational study. The study was done amongst the thirty four women aged between 40-48 years with functioning uterus and at least one ovary, not using any exogenous hormone preparations affecting ovarian function for last three months and having at least one menstrual period in three previous months were included in this study. They had under gone hysterectomy with bilateral salpingooophorectomy due to non-ovarian pathology. Fasting venous blood samples were taken one day before operation and on ninth post-operative day of surgical menopause Serum concentration of estradiol, testosterone, and DHEAS were determined. Results : The circulating estradiol level decreased significantly (p = 0.043) from 161 pg/ml preoperatively to 108 pg/ml. on ninth post-operative day after surgical menopause. In spite of reduction in mean testosterone level from 0.11 ng/ml. to 0.09 ng/ml. following surgical menopause, which is statistically insignificant (p = 0.247).There was no significant difference between the serum DHEA-S level before and after surgical menopause. A significant positive correlation was observed between pre-operative circulatory levels of DHEA-S with that of estradiol while there was absence of any significant co-relations corelations between any of the other pairs of values. Conclusion : The circulating estradiol level decreased significantly on ninth day after surgical menopause and significant positive correlation between pre-operative circulatory levels of DHEA-S with that of estradiol, but there was no significant co-relation between post-operative circulating estradiol with that of DHEA-S. Testosterone did not show any significant relation with estradiol neither in pre-operative period nor in post-operative condition.

Level of Maternal Awareness Amongst Mothers who had Undergone Elective C/S.

Caesarian section (C/S) is a very common obstetric procedure. It had many advantages and disadvantages. In this age of consumer awareness, patient has to give an informed consent before the procedure – means merits and demerits of the procedure shall be known to the patient. She also has the right to choose between different procedures, type of incision and anesthesia, where possible. We have studied that status amongst 100 such patients, only 7% of them being illiterate, who had undergone elective C/S in SNP Hospital, a two tier hospital of Kolkata. The result was shocking. 65% of the mothers did not have any idea regarding the procedure they are undergoing. 1/3rd of the patients even did not know why they are having C/S. None of them was given any choice regarding anesthesia and only 9% regarding incision. A detail of the study is presented.