Indranil Dutta

Abstract

Introduction: Approximately one in five recognized pregnancies are spontaneously miscarried in the first trimester and an additional 22% end in induced abortion. Incomplete abortion occurs when there are retained products of conception (POC) after induced abortion (whether by unsafe or safe methods) or after spontaneous abortion, also known as miscarriage. Some women may resort to self-induction. These conditions increase the likelihood that women will experience abortion complications and will seek treatment for incomplete terminations. Incomplete abortion can be treated with expectant management, which allows for spontaneous evacuation of the uterus, or active management, using surgical or medical methods. Expectant management is not preferred by many providers due to its relatively low efficacy and the fact that the time interval to spontaneous expulsion is unpredictable. Materials and Methods: The study was performed in a Durgapur Steel plant hospital, a tertiary care Hospital in West Bengal, India. The institute caters a huge area, both rural and urban. The study was done between 1st January2019 to 31st October 2020. Study population was drawn from patients attended OPD and patients admitted with incomplete abortions, either of spontaneous or, induced etiology in the Dept. Of Obst, & Gynae, Durgapur Steel plant hospital. A total of 80 women were randomised to either a single dose of 600 micrograms of oral misoprostol or MVA. Result: 160 women were recruited to the trial, of which 80 women were grouped into misoprostol group & another 80 to MVA group. Immediately after abortion, all the patients were available & data collected from all the patients. But during next follow-up after 1-2 wk, 33 in the MVA group & 27 in the misoprostol group did not come (Lost to follow up n=33) for follow-up. So, approximately 41% (33) of participants in MVA group & 34% (27) in the misoprostol group were lost to follow-up. In our study both MVA & Misoprostol groups had similar age distribution. Mean age in MVA group 23.5 years (±4.5) and in MISO group 23.4 Years (± 4.8). Conclusion: For treatment of first-trimester uncomplicated incomplete abortion, both manual vacuum aspiration and 600 mg oral misoprostol are safe, effective, and acceptable treatments. However, misoprostol appears to be somewhat better option than MVA, in regards to availability, low cost of therapy, less pain, less need of expert manpower or specialised instruments. Keywords: Misoprostol, Manual vacuam aspiration, Abortion.

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Objective: The objective of the study is to evaluate the safety and efficacy of the new uterine manipulator (Halder’s) in performing Total Laparoscopic hysterectomy (TLH) and to determine whether it prevents perforation of uterus due to forward pushing force. Introduction: Hysterectomy is one of the most common gynaecological operation performed worldwide of which laparoscopic approach is now a days preferred alternative route compared to open abdominal hysterectomy. According to U.S. Surgical data, there is a decrease of trend of abdominal hysterectomy from 65% to 54% in favour of laparoscopic route in between 1998 to 2010. It is because laparoscopic approach is associated with shortened hospitalization and postoperative recovery times and low morbidities. But it requires specialized training and skill to perform successfully. Manipulation of uterus during TLH is a vital step to avoid inadvertent injuries of vital organs like ureter, bladder and gut. Hence the newly designed uterine manipulator (Halder’s) is developed to simplify TLH with its inherent quality of ease of use and simplicity. Special feature of this manipulator is the Cervical Guard with rotational forward and backward movement which distinguishes it from the all available manipulators in the market. Material and Methods: From March 2018 to May 2019, three hundred forty six cases were done laparoscopically following a standard and simple technique using Halder’s uterine manipulator in different centres in West-Bengal of which two hundred cases were shortlisted as they fulfilled the inclusion criteria’s of Halder’s manipulator. After introduction of Halder’s uterine manipulator through cervix, the operation was performed using bipolar or ultrasound energy for coagulation and cutting the vascular pedicles and ligaments. The entire procedure was done laparoscopically and the uterus was removed vaginally. The vaginal cuff was closed by continuous suture in single layer with polyglactin material. Results: Most common indication was Abnormal uterine bleeding due to Leiomyoma(AUB-L), the average weight of uterus was 220±95gms. Mean operation time was 64.6±15.5 minutes. Estimated blood loss was 80ml±20 ml. There was no bowel injury but one ureteric injury, one Bladder injury and one uterine perforation were found. Great ranges of movement found during manipulation. Conclusion: The easy, smart and simple Halder’s uterine manipulator could be the option to do TLH, in reducing the complications and having more favourable operative outcomes. This manipulator can be used by inexperienced persons at vaginal end. Keywords: Total laparoscopic hysterectomy, Quality assessment questionnaire sheet, Halder’s uterine manipulator, Cervical guard, Utero-cervical insert, Colpotomy tube, Colpotomy tube fixation screw.

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Introduction: Over the past several years it has been proved that maternal thyroid disorders influence the outcome of mother and fetus, during and also after pregnancy. The most frequent thyroid disorder in pregnancy is maternal hypothyroidism.  Overt hypothyroidism (low serum free T4 & high TSH level) complicates from 2 to 3 pregnancies per 1000 whereas subclinical hypothyroidism (high serum TSH but normal free T4 level) is seen in 2.3% cases.2 Endemic iodine deficiency accounts for most hypothyroidism in pregnant women worldwide whereas chronic autoimmune thyroiditis is the most common cause of hypothyroidism in iodine sufficient parts of the world. Objectives: (1) To detect cases of overt or subclinical hypothyroidism in antenatal mothers in early weeks of gestation by screening methods, (2) To start early treatment in positive cases for reduction of deleterious effects on maternal and fetal outcome, (3) To study the maternal complications during antenatal, intranatal and postnatal period in hypothyroid mothers in comparison to euthyroid pregnancy. (4) To note any difference in incidence of low birth weight babies and early neonatal complications in hypothyroid women. Material and Methods: A prospective clinical study was conducted department of Obstetrics and Gynaecology, Calcutta National Medical College and Hospital, Kolkata, Study population included all pregnant mothers attending antenatal clinic in Calcutta National Medical College and Hospital, Study period was one year (June 2012-May 2013), Sample size is 500 in number. Results: Cases (hypothyroid, TSH>2.3 µU/ml) constituted 4.4% of the screening population, in which the incidence of overt hypothyroid (free T44 within normal range) was 4.4%. Controls (euthyroid, TSH Keywords: Hypothyroid, Pregnancy.

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