Impact of Intrauterine Administration of Human Chorionic Gonadotropin before Intrauterine Insemination in Infertile Women: A Randomized Controlled Trial.

BACKGROUND: Implantation is the rate-limiting step in the success of both intrauterine Insemination (IUI) and in vitro fertilization cycles. Numerous interventions that target various local signals have been tried to improve the implantation and clinical pregnancy rate (CPR). The most significant of these signals is human chorionic gonadotropin (hCG) which acts as immunomodulator and improves implantation by decidualization of the endometrial stromal cells, trophoblast invasion, proliferation of uterine natural killer cells, stimulation of endometrial angiogenesis, and maintenance of progesterone secretion by the corpus luteum. AIM: The aim of the study is to evaluate the effect of intrauterine hCG administration before IUI on CPR. SETTINGS AND DESIGN: A prospective parallel randomized control study was done from September 2017 to February 2019. MATERIALS AND METHODS: A total of 200 eligible women planned for IUI were randomly divided just before IUI into 2 groups. A computer-generated randomization list with block size of 10 with 1:1 allocation was used to randomize the patients. Experimental group received 0.5 ml containing 500 IU hCG, on the other hand control group received 0.5 ml of normal saline 2-3 min before IUI in single sitting. The main outcomes were CPR, miscarriage rate, and ongoing pregnancy rate. STATISTICAL ANALYSIS: It was performed using statistical software version SPSS 17.0. RESULTS: Patient's demographic and baseline characteristics were comparable in both the groups. CPR in experimental group was significantly high compared to control group (26% vs. 9%, P = 0.002). Ongoing pregnancy rate was also significantly higher in experimental group (23%) compared to control group (7%) (P = 0.003). No significant difference in miscarriage rate was seen between the two groups. No cases of ectopic pregnancy, ovarian hyperstimulation syndrome, or multiple pregnancy were reported. CONCLUSION: Intrauterine hCG administration is a simple procedure that can be used to improve pregnancy outcome in IUI cycles.

Impact of Vitamin D Supplementation on Semen Quality in Vitamin D-Deficient Infertile Males with Oligoasthenozoospermia.

INTRODUCTION: Male factor contributes to almost 50% cases of infertility. There is evidence of the effect of serum vitamin D on male fertility by helping in spermatozoa maturation and initiating acrosomal reaction. In India, vitamin D deficiency has been documented to be in the range of 50-90% among all the age groups. OBJECTIVE: To study the levels of vitamin D and the impact of vitamin D supplementation in vitamin D-insufficient/deficient infertile males with oligoasthenozoospermia. MATERIAL AND METHODS: This study is a longitudinal observation study. Infertile men with either oligozoospermia or asthenozoospermia with vitamin D levels < 30 ng/ml were enrolled. Vitamin D and calcium supplementation was given, and semen and hormone parameters were assessed at the end of 3 and 6 months. RESULT: There is significant improvement in the mean sperm concentration and progressive sperm motility in infertile males with oligoasthenozoospermia after 6 months of vitamin D supplementation (p value < 0.001). The overall clinical pregnancy rate in the study was 8.33% after vitamin D supplementation (p value 0.24). CONCLUSION: Vitamin D supplementation plays a crucial role in regulating male fertility.

Evaluation of Reproductive Outcome in Infertile Hypothyroid Women on Thyroxine Therapy.

INTRODUCTION: Thyroid dysfunction is associated with increased risk of infertility. Serum thyroid stimulating hormone (TSH) screening in all women seeking infertility care is recommended and hypothyroid infertile women should be treated with thyroxine until the preconception serum TSH level is <2.5 mU/l.[1] However, insufficient evidence exist to determine if thyroxine therapy improves fertility in subclinical hypothyroid women who are trying to conceive naturally. OBJECTIVES: The objective is to study the effect of thyroxine therapy on reproductive outcome in infertile women with clinical and subclinical hypothyroidism (SCH). MATERIALS AND METHODS: The study is a descriptive cohort study with 72 subjects. Women between 20 and 40 years of age with primary or secondary infertility with hypothyroidism were studied and thyroid profile including free T3, T4, TSH, and thyroid antibodies were done. Thyroxine was given to clinical, subclinical hypothyroid subjects depending on TSH levels such that serum TSH levels are maintained < 2.5 mU/L. Serial thyroid function test was done every 6 weeks until the optimal levels were reached. Once normal TSH levels were reached subjects were followed up for 6 months. Reproductive outcome was analyzed in two groups. Group A included hypothyroid infertile women who conceived and Group B included those who did not conceive following thyroxine therapy. RESULTS: Thirty-eight out of 72 subjects (54%) conceived during thyroxine treatment (Group A) of which 4 cases had miscarriage. Maximum infertile women in Group A (20/38) conceived between 6 and 12 months (52.6%) of thyroxine therapy. Significant decrease was observed in mean TSH levels over a period of 6 months (P < 0.001). The infertility period until pregnancy in Group A reduced significantly from 5.2 ± 1.8 years to 0.5 ± 0.8 years after thyroxine treatment (P = 0.001). CONCLUSION: Thyroxine therapy enhances fertility in infertile women with clinical and SCH.

An Intrauterine Insemination Audit at Tertiary Care Hospital: A 4½ Years' Retrospective Analysis of 800 Intrauterine Insemination Cycles.

BACKGROUND: There are many variables that may influence the success rates of intrauterine insemination (IUI) treatment. Therefore, a regular audit program is needed for planning effective infertility treatment and improving pregnancy outcomes. AIMS AND OBJECTIVES: The main objective of this study was to identify the crucial predicting factors that can influence the IUI success. MATERIALS AND METHODS: A retrospective analysis of 800 IUI cycles done from January, 2013 to August, 2017 in 651 couples with various etiologies of infertility. The common etiologies included female factor of ovulatory dysfunction, tubal, endocrinal, male factor, male and female factors combined, and unexplained factors. Ovulation induction was done either by clomiphene citrate (CC) alone or in combination of CC with gonadotropins or pure gonadotropins only. Human chorionic gonadotropin trigger was given when at least one dominant follicle measuring ≥18 mm with an endometrial thickness of >7 mm was obtained. IUI was done post 36 h of trigger. The double-density gradient method was the preferred method of sperm preparation. RESULTS: In 800 cycles in corresponding 651 couples, the total outcome was 113 pregnancies (14.1%) per cycle with overall pregnancy rate (PR) per couple of 17.3%. The highest PR was observed in the patient with ovulatory dysfunction (21.2%), followed by patients with combined factor (15.1%) and male factor (14.7%). In the study, a higher PR was achieved in the female ≤25 years (18.9%) P < 0.04 with significant findings with duration of infertility ≤5 years (15.1%) having primary infertility (14.5%) with low body mass index <25 (14.1%). IUI success rate was highest in the first cycle (14.6%) followed by second cycle (14.0%) and third cycle (3.5%). CONCLUSION: IUI audit enables the characterization of prognostic factors to achieve improved PR. This study identifies the factors that can predict improved pregnancy outcome in women age ≤25 years and endometrium thickness between 9 and 11 mm. We also recommend IUI as a first line of infertility treatment for couples in low-income setting provided the women age and duration of infertility are acceptably low.

Therapeutic Efficacy of Endometrial Scratching in Repeated Controlled Ovarian Stimulation (COS) Failure Cycles.

OBJECTIVE: The objective of the study was (1) "to evaluate the therapeutic efficacy of endometrial scratching in repeated controlled ovarian stimulation (COS) failure cycles." And (2) "to compare differences in pregnancy outcome by endometrial scratching in early (D2-D4) and late follicular phases (D7-D9) of the same stimulation cycle." MATERIALS AND METHODS: Women attending infertility clinic in a tertiary care center and who have two or more repeated COS failure cycles and planned for COS with intrauterine insemination (IUI) were included in the study which is a prospective parallel, interventional, single-blinded, randomized control study, in 1:1 allocation ratio. A total of 165 patients were recruited and randomly allocated into three groups: Group A (n = 55) underwent endometrial scratching on D2-D4 of the same COS cycle, Group B (n = 55) on D7-D9, and Group C (n = 55) no intervention done. All the patients underwent COS according to standard protocol followed by IUI. RESULTS: Clinical pregnancy rate was 12.73% (odds ratio [OR] =0.87 95% confidence interval [CI] =0.288-2.55, P = 1), 16.36% (OR = 1.15; 95% CI = 0.40-3.23, P = 1), and 14.54%, respectively, in Group A, B, and C, respectively (P = 0.86), as per intention to treat analysis. Using Chi-square test, P value between Group A and B was 0.787, between Group A and C was 1.000, and between Group B and C was 1.000. As per protocol analysis, clinical pregnancy rate was 13.46% (OR = 0.83; 95% CI = 0.27-2.5, P = 0.74), 19.57% (OR = 1.3 95%; CI = 0.45-3.73, P = 0.41), and 15.69%. Using Chi-square test, Pvalue between Group A and B was 0.588, between Group A and C was 0.967, and between Group B and C was 0.815. No abortions and multiple pregnancies occurred in either of the groups. CONCLUSION: The effect found was of good quantum in Group B as per protocol analysis which could be of clinical relevance if larger sample size would have been taken. Endometrial scratching is a cost-effective and easy technique which may improve clinical pregnancy rates in previous COS failure cycles, but more trials are needed to be conducted using larger sample size to achieve the improved and significant outcome.

Comparative Prospective Study of Hysterosalpingography and Hysteroscopy in Infertile Women.

AIM: To compare the findings and diagnostic accuracy of Hysterosalpingography (HSG) and hysteroscopy in infertile women. SETTING AND DESIGN: Prospective comparative study in a tertiary care Centre. MATERIAL AND METHODS: 108 women with primary or secondary infertility were recruited. In all women after basic infertility workup, both HSG and hysteroscopy were performed. RESULTS: Out of 108 women, in 3 women HSG couldn't be done and in one woman there was uterine perforation on hysteroscopy. HSG showed normal uterine cavity in 77.8% (81/105) women and abnormal in 22.85% (24/105). Hysteroscopy findings were normal in 70.09% (75/107) and abnormal in 29.91% (32/107). Hysteroscopy detected incidental findings in 15.38% (16/104) cases. HSG showed irregular uterine cavity in 14.15% (15/105) women but on hysteroscopy; normal cavity was present in 6 (40%) women and abnormality was detected in 9 (60%) women. The sensitivity, specificity, positive predictive and negative predictive value of HSG in evaluating uterine cavity abnormalities were 44.83% (95% confidence interval (CI); 0.26-0.64), 86.67% (95% CI; 0.76-0.93), 56.52% (95% CI; 0.34-0.76) and 80.25% (95%CI; 0.69-0.88). Positive likelihood ratio and negative likelihood ratio of HSG in detecting uterine cavity abnormality was 3.36 and 0.64 respectively. The agreement between HSG and hysteroscopy was 75%. This was statistically significant (P value = 0.001) with fair strength of agreement between HSG and hysteroscopy. (k value= 0.336). CONCLUSION: Hysteroscopy should be performed in all infertile patients as it can detect significant number of incidental findings missed by HSG.

Successful Obstetric Outcome in Dextrocardia with Situs Inversus and Moderate Pulmonary Hypertension- Rare Case.

Situs inversus is a rare congenital anomaly, which is characterized by right sided heart (Dextrocardia) and inversely rotated visceral organs of abdomen. In present case, the patient reported with G3p2l2, 34 weeks of gestational period along with breathlessness accompanied and labour pains. On further investigation, she was diagnosed as dextrocardia with situs inversus and moderate pulmonary artery hypertension along with severe iron deficiency anaemia. Patient had normal vaginal delivery with intra-partum and post-partum period. Normally, any patient having situs inversus has a normal life expectancy and is not associated with any significant morbidity or mortality.

Evaluation of Role of GnRH Antagonist in Intrauterine Insemination (IUI) Cycles with Mild Ovarian Hyperstimulation (MOH): A Prospective Randomised Study.

AIMS AND OBJECTIVE: To evaluate the role of GnRH antagonist in prevention of premature LH surge and increasing pregnancy rates in IUI cycle with mild ovarian hyperstimulation (MOH). STUDY DESIGN: Prospective parallel, randomised controlled study. MATERIAL AND METHODS: Couples diagnosed with unexplained, male factor subfertility and with one or both tubes patent were randomised to receive either a GnRH antagonist (study group) or no intervention (control group). All women were treated with clomiphene citrate (D3-D7) followed by HMG. A GnRH antagonist was added when one or more follicles of 16 mm diameter or more were visualised in the study group. When at least one follicle reached a size of ≥18 mm, ovulation was induced by hCG injection. A single IUI was performed 36 h later. The primary outcome was premature LH surge and pregnancy rate. The secondary outcomes were the amount of gonadotropins used, duration of use of GnRH antagonist and incidence and severity of OHSS. RESULTS: A total of seventy patients attending the infertility clinic in the outpatient department of Obstetrics and Gynecology, of a tertiary care centre, were recruited in the study which was carried out from August 2011 to March 2013. The study group included 34 women and 36 in the control arm. The incidence of premature LH surge was significantly lower in the antagonist group as compared to the control group 2.9 vs. 13.9 %, with a p value of <0.001. The clinical pregnancy rates were similar in both the groups 8.8 vs. 11.1 %, p value being 1.000. The amount of gonadotropins used in GnRH antagonist group was lower than in control group but not statistically significant. Duration of GnRH antagonist was 1.85 ± 0.61 days in the study group. CONCLUSION: The delayed administration of GnRH antagonists in MOH with IUI cycles when follicle size is ≥16 mm is beneficial in terms of preventing the occurrence of premature LH surge but with no improvement in pregnancy rates.

A Rare Case of Flare-Up of PID in Infertility Treatment.

Case Presentation. Mrs. X, 35 years old, case of primary infertility, was diagnosed to have genital tuberculosis on the basis of PCR positive and hysterolaparoscopy findings and received category I ATT for 6 months. Following ATT completion, her USG revealed no evidence of tuboovarian mass or hydrosalpinx. Since her tubes were patent, she underwent 3 cycles of ovulation induction and 2 cycles of IUI. The women presented with acute PID, five days after IUI, and was conservatively managed. She again presented 24 days after IUI with persistent low grade fever and abdominal pain. Suspecting relapse of genital tuberculosis, she was started on category II ATT. She had acute episodes of high grade fever with chills 2 weeks after starting ATT and MRI revealed bilateral TO masses suggestive of pyosalpinx. Emergency laparotomy was done, pus was drained, and cyst wall was removed and HPE was suggestive of chronic inflammation with few granulation tissues. ATT was continued for one year and the woman improved. Conclusion. The possibility of flare-up of PID (pelvic inflammatory disease) in treated case of tuberculosis undergoing infertility management should be kept in mind and aggressive management should be done.

Effect of endometrial biopsy on intrauterine insemination outcome in controlled ovarian stimulation cycle.

OBJECTIVE: The objective was to evaluate the effect of endometrial biopsy (EB) on intrauterine insemination (IUI) outcome in controlled ovarian stimulation (COS) cycle. DESIGN: Prospective randomized control study. SETTING: Tertiary care center. MATERIALS AND METHODS: A total of 251 subjects were enrolled in the study. Subjects undergoing COS with IUI were randomly allocated into three groups. Group A: EB was taken between D19 and 24 of the spontaneous menstrual cycles that precedes the fertility treatment and IUI, which was done in next cycle (n = 86). Group B: EB was taken before D6 of the menstrual cycle, and fertility treatment and IUI was done in the same cycle (n = 90). Group C: (control group) no EB in previous 3 cycle (n = 75). MAIN OUTCOME MEASURE: Clinical pregnancy rate (CPR). RESULTS: Clinical pregnancy rate was 19.77%, 31.11%, and 9.3% for Group A, Group B, and Group C, respectively. The results show a highly significant value for the paired t-test of intervention Group B and control Group C of the cases (P = 0.000957). CPR was maximum after first cycle of ovulation induction and IUI following EB scratch in both Groups A and in Group B (P < 0.001). CONCLUSIONS: Endometrial biopsy done in early follicular phase in the same cycle of stimulation with IUI gives better CPR as compared with EB done in the luteal phase of the previous cycle.

Utility of ultrasound and magnetic resonance imaging in prenatal diagnosis of placenta accreta: A prospective study.

CONTEXT: Placenta accreta is the abnormal adherence of the placenta to the uterine wall and the most common cause for emergency postpartum hysterectomy. Accurate prenatal diagnosis of affected pregnancies allows optimal obstetric management. AIMS: To summarize our experience in the antenatal diagnosis of placenta accreta on imaging in a tertiary care setup. To compare the accuracy of ultrasound (USG) with color Doppler (CDUS) and magnetic resonance imaging (MRI) in prenatal diagnosis of placenta accreta. SETTINGS AND DESIGN: Prospective study in a tertiary care setup. MATERIALS AND METHODS: A prospective study was conducted on pregnant females with high clinical risk of placenta accreta. Antenatal diagnosis was established based on CDUS and MRI. The imaging findings were compared with final diagnosis at the time of delivery and/or pathologic examination. STATISTICAL ANALYSIS USED: The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated for both CDUS and MRI. The sensitivity and specificity values of USG and MRI were compared by the McNemar test. RESULTS: Thirty patients at risk of placenta accreta underwent both CDUS and MRI. Eight cases of placenta accreta were identified (3 vera, 4 increta, and 1 percreta). All patients had history of previous cesarean section. Placenta previa was present in seven out of eight patients. USG correctly identified the presence of placenta accreta in seven out of eight patients (87.5% sensitivity) and the absence of placenta accreta in 19 out of 22 patients (86.4% specificity). MRI correctly identified the presence of placenta accreta in 6 out of 8 patients (75.0% sensitivity) and absence of placenta accreta in 17 out of 22 patients (77.3% specificity). There were no statistical differences in sensitivity (P = 1.00) and specificity (P = 0.687) between USG and MRI. CONCLUSIONS: Both USG and MRI have fairly good sensitivity for prenatal diagnosis of placenta accreta; however, specificity does not appear to be as good as reported in other studies. Both modalities have complimentary role and in cases of inconclusive findings with one imaging modality, the other modality may be useful for obtaining the diagnosis. CDUS remains the first primary modality for antenatal diagnosis of placenta accreta, with MRI reserved for cases where USG is inconclusive.

Facility-based review of 296 maternal deaths at a tertiary centre in India: could they be prevented?

AIMS: The aim of this study was to identify causes of maternal mortality at the facility and to assess the standard of care, deficiencies in health services and preventability of these deaths using facility-based maternal death reviews. MATERIAL AND METHODS: This was a prospective study at a tertiary care hospital that included all women who died during pregnancy or within 42 days of being pregnant during 2005-2010. RESULTS: A review of 296 maternal deaths revealed that 59% of these occurred in medical wards. Indirect maternal deaths (54%) outnumbered the direct deaths (46%). Main causes were hepatitis (18%), hemorrhage (10%) and puerperal sepsis (10%). Only 5% of the women had received antenatal care at the facility. One-third (34%) were referred from other centers. The majority (74%) were critically sick at admission. Most of the women (62%) died postpartum. Substandard care and deficient health services were identified in 8% and 20% of the cases, respectively. Sixteen (5%) maternal deaths were deemed preventable and another 36 (12%) possibly preventable. Since most of the preventable deaths (12/16) were due to hemorrhage, measures to control postpartum hemorrhage were promoted at the facility. Findings of the maternal death reviews were regularly conveyed to the State Health Department for prioritization and resource allocation to prevent maternal mortality. CONCLUSION: More maternal deaths occurred in the medical than in the obstetrics wards at the facility. The leading causes were hepatitis, hemorrhage and puerperal sepsis. Most of the deaths were non-preventable as the women were critically sick at admission; however, substandard care and health service deficiency were contributory in some of the cases.

Complex mullerian duct anomaly in a young female with primary amenorrhoea, infertility, and chronic pelvic pain.

Mullerian duct anomalies, though rare, can be a treatable cause of pelvic pain and infertility. Various complex Mullerian duct anomalies may exist with combination of features of more than one class. Since there are no precise clinical or imaging criteria to enable specific categorisation, there is ambiguous classification of these anomalies by various radiologists and clinicians. A young female presented with complaints of chronic pelvic pain, primary amenorrhoea and infertility. The patient was evaluated by sonography and Magnetic Resonance Imaging and diagnosed as case of complex mullerian duct anomaly, a unicornuate uterus with cervical dysgenesis and cavitated, noncommunicating, rudimentary right horn. The findings were confirmed on laprohysteroscopy and the patient underwent hystertectomy. There should be an integrated clinico-radiological classification scheme and familiarity with rare and complex anomalies for appropriate diagnosis and management of complex Mullerian duct anomalies.

Prediction of mortality and morbidity by simplified acute physiology score II in obstetric intensive care unit admissions.

BACKGROUND: Critical care in obstetrics has received much attention in recent times. Despite progress in medical field and improvement in health facilities provided, maternal mortality is still very high in most of the developing countries. AIM: To study and analyze records of patients requiring intensive care in obstetrics and to assess utility of simplified acute physiology score (SAPS II) for predicting maternal mortality. SETTING: A multidisciplinary intensive care unit (ICU) at a tertiary care center. DESIGN: Retrospective review. MATERIALS AND METHODS: Fifty-seven consecutive obstetric patients' records requiring ICU admissions were studied for clinical picture, diagnosis, complications, morbidity and mortality over a period of 21/2 years - from 1st May 2002 to 31st Oct. 2004. SAPS II score was calculated according to the different variables for predicting mortality. STATISTICAL ANALYSIS: SAPS II scores were regressed on mortality status using logistic regression analysis. The predictability was assessed by goodness-of-fit test and receiver operated characteristic curve. RESULTS: Maternal mortality in obstetric ICU admissions was 1.15/1,000 deliveries, amounting to 40.35% of obstetric ICU admissions. The mean SAP II score was significantly higher (40.04 +/- 12.97 vs. 22.6 +/- 7.31) in those patients who died compared to survivors (P < 0.001%). CONCLUSIONS: The SAPS II accurately predicted mortality in obstetric patients admitted to ICU. Computation of the score as a routine in ICU may help in identifying those at high risk of mortality and then to reduce this risk.

Severity, affect, family and environment (SAFE) approach to evaluate chronic pelvic pain in adolescent girls.

BACKGROUND: Pelvic pain is common in adolescent girls in day-to-day practice. Severity, Affect, Family and Environment (SAFE) is a recent interview strategy to approach these patients and their families. AIM: 1. To find the prevalence of pelvic pain in adolescent girls. 2. To find out the feasibility and acceptability of "SAFE" approach in evaluating chronic pelvic pain in adolescent girls. SETTINGS & DESIGN: 200 adolescent girls aged 13-23 years were selected at random from school and colleges nearby hospital campus. METHOD: A questionnaire method was adopted. Adolescent girls selected were divided into two groups, group I (with pain) and group II (without pain). STATISTICAL ANALYSIS: It was performed using chi-square and Fischer tests with significance of p value being taken at 0.05. RESULTS: Out of 200 adolescent girls selected for interview, prevalence of pelvic pain was found to be 37.0%. Dysmenorrhoea was also found to have significant relationship with pelvic pain. Depression and anxiety, school absences and loss of weight were found to have significant association with pain. Pelvic pain was found to be more in adolescent girls with large family size (> 4 members), single parent, both parents working, ongoing marital problems at home and was less reported when there was good parent-child communication about sex and when the teenager was well prepared for menarche by the parents and the association with the above mentioned factors was found to be significant. CONCLUSION: "SAFE" approach contributes in identifying health problems in adolescent girls with chronic pelvic pain.

Prospective study of glove perforation in obstetrical and gynecological operations: are we safe enough?

OBJECTIVES: To assess the glove perforation rate, efficacy of double gloving, effect of duration of surgery, expertise of surgeon and operative urgency on the glove perforation rate in obstetrical and gynecologic operations. METHODS: From February to September 2002, double glove protocol was made necessary for all major obstetrical and gynecologic procedures. The operating surgeon, first and second assistant were included in the study. Gloves damage was noted (overt by inspection, occult by hydroinsufflation technique). RESULTS: Of the 156 procedures included in study, 32 procedures were performed (all emergency operations) single-gloved because surgeons found double gloving clumsy (56%), made it difficult to tie knots due to lack of dexterity (24%), or were too tight (20%). One thousand one hundred and twenty single gloves were examined after each procedure by hydroinsufflation. The overall perforation rate was 13.6% (single versus double outer gloves, 13.8% versus l3.2%, P > 0.05). Matching perforations were found in six cases (4.6%). Thus, the protection offered by double gloves was 95.4% even if the outer gloves were perforated. Four inner gloves had preexisting perforations. Sixty unused gloves checked similarly revealed a perforation rate of 1.6%. Emergency cases had higher perforation rate compared to elective surgeries (16.6% versus 10.8%, P < 0.00 1). Surgeries lasting for more than 40 min had a higher perforation rate compared to those finished in less than or equal to 40 min (18.6% versus 7.6%, P < 0.001). The middle finger of the left hand was the most commonly involved. The surgeon, first assistant and second assistant were involved in 73.6, 23.3 and 3.2% cases, respectively. CONCLUSION: Double gloving offers considerable protection against exposure to contaminants in the blood and body fluids of the patient and should be made routine, especially in developing countries where HIV, hepatitis B and C are widely prevalent. Double gloving should be made mandatory in emergency procedures, which have a higher perforation rate due to operative urgency, and gloves should be changed in operations lasting for more than 40 min to ensure integrity of barrier.

Mini laparotomy versus conventional laparotomy for abdominal hysterectomy: a comparative study.

BACKGROUND: Less traumatizing measures for hysterectomies are searched for to improve the recovery from surgery. AIM: Comparison of minilaparotomy abdominal hysterectomy with conventional abdominal hysterectomy in respect to per-operative and post-operative outcome and complications. SETTING AND DESIGN: In a medical college hospital patients undergoing abdominal hysterectomy were enrolled. It was a concomitant comparative study. METHODS AND MATERIAL: We are presenting our comparative data of 100 cases of minilaparotomy abdominal hysterectomy (group I, incision =< 6 cm) performed over last 4 years from January 1998 to December 2002 and comparing the outcome with 99 cases of abdominal hysterectomy (group II, incision > 6 cm) done by traditional method over the same duration. STATISTICAL ANALYSIS USED: Chi-square and Fischer test with significance of p value being taken at 0.05 were used for categorical data, while student's t test was used for continuous data. RESULTS: Mean age and parity of patients were similar in the two groups. Incision was transverse in 100% cases in-group I and 22.2% cases in-group II. Estimated blood loss was significantly higher (354 ml) in group II in contrast to group I (240 ml). Blood transfusion was also required more commonly (22.2%) in-group II than in-group I (9%). Mean operative time was significantly more in-group II (90 minutes) than in group I (41 minutes). Mean hospital stay, day of mobility, starting oral diet and days of injectable analgesics required were higher in group II than in group I. Major complications were rare in both the groups, but minor complications were significantly higher in group II (40.4%) than in group I (26%). CONCLUSION: Minilaparotomy abdominal hysterectomy appears to be an attractive alternative to traditional abdominal hysterectomy with fewer complications.

Huge localized vaginal neurofibromatosis: an unusual cause of postmenopausal bleeding.

A 55-year-old lady, menopausal for 8 years, presented with vaginal swelling for the preceding 6 months and with post menopausal bleeding (two bouts). Examination revealed a vaginal mass of 7 x 5 cm which was ultrasonically diagnosed as vaginal fibroid. The vaginal mass was excised and confirmed to be a vaginal neurofibroma on histopathology.