Subrata Das

Background: Heavy menstrual bleeding (HMB), is one of the most frequently encountered problem in the gynaecology OPD. It can significantly affect women’s quality of life and overburden health-care systems. The Levonorgestrel Releasing Intrauterine System (LNG-IUS) is a highly effective long-acting reversal contraceptive, also useful for controlling HMB and promoted by National Institute for Health and Care Excellence (NICE). Materials and Methods: This prospective interventional study conducted upon 30 women, with heavy menstrual bleeding, of 30-50 years’ age, reporting in the outpatient department of a tertiary health care facility unit “between” January 2018 to June 2019. Women, who met inclusion and exclusion criteria were our study population. Data was collected during follow up at 1, 3 and 6 month and all the association were tested by mean, proportion and percentages. Chi-square test was used for comparing categorical result and p-value of less than 0.05 was considered as statistically significant. Calculation was made by using IBM SPSS 26 version of statistical software. Results: Majority of women were from 40-45 years’ age group. Pictorial Blood Loss Assessment Chart (PBAC) score was calculated in 30 women who underwent LNG IUS insertion.There was significant reduction (p Conclusion: LNG IUS is effective and can be used as first line measure for treatment of HMB. Keywords : Heavy menstrual bleeding, Levonorgestrel Releasing Intrauterine System, Pictorial Blood Loss Assessment Chart, Visual Analogue Scale

Background: Female genital tuberculosis (FGTB) has a crucial role in many gynaecological complaint and delay in diagnosis can cause irreversible damages. The new diagnostic technique GeneXpert system is accurate and rapid test can make paradigm shift in FGTB treatment. Aim & Objectives: The aim of the study to estimate efficacy of different tests i.e. AFB BACTEC culture, molecular assay (TB-PCR) and histopathology in comparison to GeneXpert system to detect FGTB. Materials and Methods: The prospective observational study was conducted in between January, 2018 and June, 2019. Randomly selected total 62 patients were put under all four diagnostic tests from endometrial sampling. The positivity of genital TB and efficacy of the tests were compared with test result of GeneXpert assay. Results: In our study, out of 62 patients, most commonly 33.9% were each from age group of 21-30 and 31-40 years i.e. reproductive ages, 45.2% were overweight, primary infertility of 48.4% patients were predominant symptomatology. Overall positivity by GeneXpert test was 21% (3/62), histopathology 8.1% (5/62), AFB BACTEC culture 12.9% (8/62) and 24.2% (15/62%) by molecular assay (TB-PCR). On evaluating against our diagnostic tests, specificity of histopathology, AFB BACTEC Culture and TB-PCR was 97.96%, 95.92% and 75.51%. The diagnostic tests were analysed by Kappa measure agreement in comparison to GeneXpert assay. The histopathology and AFB BACTEC Culture showed fair and moderate agreement respectively, but on the contrary TB-PCR have not showed any agreement with GeneXpert assay. Conclusion: High degree of suspicion and battery of tests needed for diagnosis of genital TB. Rapid diagnosis by GeneXpert assay may play a crucial role in TB control programme. Key Messages: Female genital tuberculosis (FGTB) has a crucial role in many gynaecological complaint and delay in diagnosis can cause irreversible damages. The new diagnostic technique GeneXpert system is accurate and rapid test can make paradigm shift in FGTB treatment.   Keywords: Genital tuberculosis, Histopathology, Polymerase chain reaction, Genexpert, AFB, Infertility

Background: It has been since long, that severe postpartum haemorrhage (PPH) was surgically treated by peripartum hysterectomy. Bilateral ligation of Internal iliac artery is an emerging technique by which we can control PPH efficiently and can conserve uterus. Aim: The aim of our study, is to estimate the effectiveness of bilateral Internal iliac artery ligation (IILA) for conservation of uterus in the management of postpartum haemorrhage and outcome on the patients. Materials and Methods: This observational study was carried out on the admitted patients in between March, 2016 and February, 2020in a hospital having a tertiary obstetric care. Internal iliac artery ligation done to control postpartum haemorrhage of hospital admitted patients, was our study subject. Collected data were analysed in mean, median, percentage and proportion as applicable by using of SPSS version 24 statistical software. Results: In the study population, out of forty-one patients, uterine conservation was possible in thirty-six (87.8%) patients. Most commonly sixteen (39%) patients had an indication of uterine atony for Internal iliac artery ligation. Caesarean section, thirty-four (82.9%) was the most common mode of delivery and general anaesthesia was used most commonly, thirty-seven (90.2%) for Internal iliac artery ligation. Procedure related complications were e.g. relaparotomy one (2.4%), Internal iliac vein injury two (4.9%) and wound infection two (4.9%). Conclusion: Internal iliac artery ligation is an effective means to control PPH. It can effectively preserve reproductive potential of women by avoiding peripartum hysterectomy in many cases. Key Messages: Postpartum hemorrhage is a life threatening complication of child birth. Peripartum hysterectomy is the last resort to tackle such complications. Our study, confirmed that bilateral internal iliac artery ligation can be a good alternative to tackle such disaster from postpartum hemorrhage and also conserve uterus of women for future reproduction.   Keywords: Postpartum haemorrhage, Internal iliac artery ligation, Peripartum hysterectomy, Obsteatrics haemorrhage

Background: An accurate diagnosis of tubal occlusion is a crucial part of infertility management of women for which Hysterosalpingography is an integral part for this purpose. Objective: The study is designed to find out tubal occlusion by hysterosalpingography (HSG) and comparing the findings with diagnostic laparoscopy with chromopertubation (laparoscopy) by determining validity and agreement of findings in the study group. Materials and Methods: In this observational study, one hundred and ninety-seven women with infertility were recruited from an infertility clinic of a tertiary care hospital ofWest Bengal, in between April 2018 and March 2020, i.e. 24 months’ period. Women, who were exposed to both of the investigations i.e. HSG and laparoscopy tests, were our study subjects. HSG findings were compared with the findings of laparoscopy to detect tubal occlusion by analyzing sensitivity, specificity, positive predictive value, negative predictive value and kappa. Results: We found mean age of women with primary infertility (66%) was 27.23 years and with secondary infertility (34%) was 32.02 years. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of HSG in comparison to laparoscopy to detect tubal occlusion were 80.85%, 74%, 49.35%, 92.5% and 75.63% respectively. Findings showed statistically significant (p Conclusion: This study provides strong supportive evidence to utilise HSG as a screening test for diagnosing tubal occlusion in infertility work up with high accuracy, especially in low resourceful area of rural India. Keywords: Infertility, Hysterosalpingography, Laparoscopy, Chromopertubation.

Background: Antepartum haemorrhage (APH) is haemorrhage in or inside the genital tract after 28th weeks of pregnancy but before the delivery of baby. There are two main types of APH i.e. ‘placenta praevia’, ‘abruptio placentae’ and others are unexplained or extra-placental and local causes. Objective: Aim of our study was to know the different causes of APH along with foeto-maternal outcome. Materials and Methods: This observational study was carried out in a tertiary care hospital during the period of January, 2019 to December, 2019 i.e. the period of one year. Women with more than 28th weeks of gestation and presenting with bleeding per vagina were our study subject. Demographic data, cause of bleeding, mode of delivery and foetomaternal outcomes were tabulated. From the descriptive data, percentages, proportions and significance were calculated by using SPSS software of 24th version. Results: 112 women were studied, which was actually 1.2% of total delivered women in the study period. Study showed placenta praevia and abruptio placentae were 54.5% and 35.7% respectively as a cause of APH. It was seen that incidence of APH increased with age and parity and associated past history of uterine operations. Study showed adverse foetomaternal outcome was more prevalent in APH in the form of postpartum haemorrhage, retained placenta, puerperal infection, coagulation failure and preterm birth, neonatal jaundice, foetal asphyxia, sepsis and increased perinatal and maternal mortality. Conclusion: Women with past history of uterine operation have an increased risk of developing APH. Women with APH has to be considered as high risk pregnancy and needs institutional supervision. Keywords: Antepartum haemorrhage, Placenta praevia, Abruptio placentae, Past uterine operation, Foetomaternal outcome.