No abstract

BACKGROUNDThe caesarean delivery (CD) rates are increasing worldwide. The CD rate in our hospital is around 32%. As CD rate increases the complications due to a caesarean delivery also increase. There is an increase in the serious and rare complication of caesarean delivery-that is caesarean scar pregnancy (CSP). This condition can present in a serious state if not detected early and can cause serious complications including hysterectomy which hampers a woman's future reproductive capacity. Hence, we decided to look into the details of CSP cases presenting in our hospital.The aim of our study was to discuss the clinical presentation, diagnosis and management of caesarean scar pregnancy cases admitted to the Department of Obstetrics and Gynaecology, during a period of two years from January 01, 2014 to December 31, 2016. MATERIALS AND METHODSA cross sectional study was conducted and all cases of CSP during the study period were included. The data were collected using a proforma by interviewing the patients and reviewing the medical records. RESULTSThere were 11 cases of CSP admitted during the study period. Mean gestational age at presentation was 8.96 ± 1.6 weeks. Most common symptom was painless bleeding which was present in 9 cases. 4 cases were referred due to excessive bleeding during curettage without suspecting CSP. 3 cases were diagnosed as CSP and referred. 7 patients received Methotrexate infusion intravenously one day before attempted evacuation or laparotomy. 1 patient received systemic Methotrexate alone. 5 patients received oral Mifepristone also one day prior to intervention. In 3 patients, re-evacuation was attempted and they had to undergo emergency laparotomy. In this study group, 8 patients had laparotomy, excision and repair and 2 patients had to undergo hysterectomy. CONCLUSIONHigh index of suspicion is to be maintained when women with prior caesarean delivery present with bleeding per vaginum and imaging should be done stressing on this aspect. In cases where CSP is diagnosed an early management should be ensued. Planned excision and repair can be helpful in reducing the morbidity of patients in low resource settings and conserving the reproductive potential of such women. KEYWORDSCaesarean Scar Pregnancy, Excision and Repair, Methotrexate, Mifepristone. HOW TO CITE THIS ARTICLE: Mathews D, Sathi MS. Caesarean scar pregnancy-the experience in a medical college in government sector.

BACKGROUNDIn contrast to female sterilisation in India, a very less percentage of the couples opt for male sterilisation. This is in spite of male sterilisation being a shorter, simpler procedure fraught with lesser complications, having a shorter recovery time and has less failure rate. The barriers to adoption of male sterilisation in India are profound with reasons ranging from unfounded fears among males characterising vasectomy with physical weakness, loss of virility, manhood and inability to enjoy intercourse.The aim of the study is to compare the effectiveness of No-scalpel vasectomy (NSV) with fascial interposition of the stumps of vas with non-interposition

BACKGROUND Maternal cardiac disease contributes to a significant proportion of maternal mortality cases and severe maternal morbidity. The proportion of cardiac disease such as Congenital Heart Disease (CHD) and Rheumatic Heart Disease (RHD) varies in different countries. This is a descriptive study in which we retrospectively analysed all women with cardiac disease who delivered in Government Medical College, Kottayam, from 01/01/2011 to 31/12/2013. Aims and Objectives-1. To study the proportion of different types of cardiac disease complicating pregnancy in parturients who delivered in Government Medical College and Hospital, Kottayam during the study period of three years. 2. To study the maternal and foetal outcome in parturients with cardiac disease during pregnancy, delivery and first postpartum week.

BACKGROUND It is recommended that greater use of imaging of the pelvis and tumour markers preoperatively is essential for evaluation of adolescent ovarian masses. There should be greater use of conservative expectant management or ovarian-sparing surgery in view of the low risk of malignancy in adolescent age group. The practice of removing ovaries for benign cysts may be overcome by appointing more gynaecologists with advanced training skills training in paediatric and adolescent gynaecology. The objectives of the study are-1. To study the age related proportion, clinical and sonographic morphology of various ovarian masses in adolescence. 2. To correlate clinical, sonographic with Doppler velocimetry, tumour marker status, operative findings and the histopathology. 3. To identify the role of preoperative sonographic evaluation in deciding on the management. 4. To study the role of sonography in morphologic characterisation of benign versus malignant tumours of ovary and the extent to which it has influenced the management. MATERIALS AND METHODS The study which is an observational case series study was conducted in the Department of Obstetrics and Gynaecology, Government Medical College, Kottayam, during the period from January 2011-June 2014. The age, sex and IP no. of adolescents of age 10-19 yrs. presenting at OPD and casualty with sonological evidence of ovarian masses are noted. If found with suspicious features, then only tumour markers and Doppler velocimetry are mentioned. The conservative or surgical managements done for them are recorded. If surgically managed, HPR are collected and analysed. RESULTS A total of 46 patients were included in the study. More number of cases fall in the age group of 17-19 yrs. and the most common presenting complaint was pain abdomen. 50% of the study group has a mass abdomen. Majority are benign masses and the commonest type was serous cystadenoma, which appear as simple cystic in USG. 87% of the solid and cystic masses in sonography came out as malignancy. Multiloculated cyst in USG turned out to be teratoma (60%) and mucinous type (30%). Only 50% of dermoid cyst correlated with ultrasound. Doppler was done in 33.3% of malignancies and was abnormal. Only 66.7% of abnormal results of tumour markers depicted malignancies. The intraoperative and pathological report correlate most in endometriotic cyst and yolk sac tumour (50%) and least with serous tumours (20%). 54.3% of them were benign epithelial tumours. All malignant tumours were germ cell tumours. Yolk sac tumours and mucinous tumours were distributed in early adolescence and teratoma and serous in late period. CONCLUSION Sonography is a simple, quick and non-invasive investigation found to be most accurate among the other tests for accounting the type of tumours. Most common histologic type in my study is serous cystadenoma. Clinical examination can clinch the diagnosis only to some extent in this age group.