Retrospective study of 121 cases of adnexal masses which were managed laparoscopically was carried out. The aim of study was to evaluate the safety and effectiveness of laparoscopic management of adnexal masses. In 120 cases, procedure was completed safely with minimum morbidity. In one case laparotomy had to be done to complete the procedure. In 76 cases cystectomy was done, 26 required salpingo-oophorectomy and 19 required only salpingectomy. Histologic evaluation revealed 30 functional cysts, 36 endometriotic cysts, 11 dermoids, 9 serous cystadenomas, 3 mucinous cystadenomas, 11 parovarian cysts, 19 cases of hydrosalpinx and 2 cases of tuberculosis.

To compare the laparoscopic approach with laparotomy in the treatment of ectopic pregnancy, a retrospective analysis involving 52 patients with ectopic pregnancies was done. The aim of this study was to evaluate the safety and efficacy of laparoscopic surgery for ectopic pregnancies. 30 patients underwent laparoscopic management while 22 patients were managed by conventional laparotomy. In the laparoscopic group, the postoperative morbidity and post-hospital stay were significantly less. Although laparoscopic surgery for ectopic pregnancies is a new approach and it is not widely practised in service hospitals, it has more advantages than open surgery and it has been well accepted by the surgeons and patients. It is a safe and feasible approach.

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This increase in multifoetal pregnancy has been from 1.25% in spontaneous pregnancies to 5-8% with clomiphene induced cycles 1,2 and is nearly 30% in patients using exogenous gonadotrophins for super ovulation for sub-fertility. [3][4][5][6] Various measures have been taken to reduce the incidence of multifoetal gestation by making single embryo transfer the norm. 7,8 Multiple pregnancies being high-risk pregnancies are frequently complicated by preterm delivery, low birth weight, preeclampsia and increased perinatal morbidity and mortality. 9,10 Such patients also require more operative interference and prolonged hospital stay for both the mother and the preterm baby thus mounting hospital expenditures.Multifoetal pregnancy reduction, although a well tried technique for preventing the above complications, is a difficult choice for the couples in anguish, to make or agree upon.11 Two-third of the couples who have to undergo this procedure suffer from acute emotional pain, stress, fear, and 20% have a feeling of guilt and anger.12 Therefore adequate counselling is a must before undertaking this procedure.With this primary aim of preventing the myriad complications associated with multifoetal gestation, a policy was adopted at our centre to reduce the higher order pregnancies to a twin gestation.Multifoetal pregnancy reduction can be carried out both transvaginally and transabdominally under ultrasound guidance after proper patient selection and pre-operative counselling. 9,13 Therefore this study was carried out to assess the efficacy of multifoetal pregnancy reduction by transvaginal route, the procedure exclusively carried out at our centre. MATERIALS AND METHODFour thousand four hundred and ninety nine in-vitro fertilisation (IVF) and 7142 intrauterine insemination (IUI) cycles were carried out at this centre till December 2009 with successful outcome in 1630 IVF cycles and 1421 IUI procedures. Embryo reduction was carried out in 52 cases of triplets or higher order pregnancies.Out of the above, 49 patients had triplet pregnancy, two had quadruplet pregnancies, and one quintuplet pregnancy which resulted from IUI. Multifoetal pregnancy reduction was carried out with aim of having two live foetuses after the procedure. Being IVF pregnancies these were diagnosed very early, at 5-6 weeks of gestation. All the patients were offered luteal support with micronized progesterone. Patient and relatives were counselled and preanaesthetic check-up was carried out. Each patient was informed about the potential risks of the technique and written consent was obtained before the procedure was carried out.

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