This study is to evaluate the efficacy and safety of vaginoscopic incision of oblique vaginal septum in adolescents with Obstructed hemi-vagina and ipsilateral renal agenesis (OHVIRA) syndrome. It is about Fourteen adolescents with OHVIRA syndrome managed by vaginoscopic incision of the oblique vaginal septum using a “No-touch” technique over an 8-year period. In all fourteen adolescents with OHVIRA the oblique vaginal septum was incised successfully without any intraoperative complications. Postoperative pain was unremarkable and each patient’s symptoms resolved postoperatively. The 3-month postoperative follow up office vaginoscopy revealed that the vaginal septum had not reformed nor was any vaginal stenosis noted. Vaginoscopic incision of the oblique vaginal septum using a “No-Touch” technique is a safe, minimally invasive, and effective approach for treating OHVIRA syndrome in adolescents with hematocolpos. This technique may be utilized to minimize disruption to the undeveloped vaginal wall and postoperative pain while providing excellent surgical visualization throughout the procedure.

BackgroundIntra-uterine pregnancy coexisting with cervical pregnancy (heterotopic pregnancy) is a rare condition and its management is challenging because of the massive bleeding associated with cervical pregnancy. Uterine artery embolization followed by hysteroscopic removal of cervical and intra-uterine products of conception can theoretically prevent massive bleeding and provide a direct view during the removal. Hysteroscopic management following uterine artery embolization of heterotopic pregnancy after in vitro fertilization and embryo transfer is rarely reported.Case presentationA 33-year-old primigravida, Asian, married, nonsmoker, nonalcoholic woman presented with heavy vaginal bleeding 3 weeks after in vitro fertilization and embryo transfer with a documented history of two embryo implantations in her uterine cavity. Transvaginal ultrasonography revealed a gestational sac of 15 mm × 9 mm × 9 mm with cardiac activity, showing a 3.0-mm-diameter yolk sac in the uterine cavity and a 15 mm × 11 mm × 8 mm gestational sac with cardiac activity, showing a 2.9-mm-diameter yolk sac in the cervical canal. The bilateral uterine artery embolization followed by hysteroscopic removal of both the gestational products was successfully performed after our patient and her family chose to give up the intra-uterine pregnancy due to the risk of heavy bleeding associated with cervical pregnancy.ConclusionsUterine artery embolization followed by hysteroscopic removal of cervical and intra-uterine gestational products in the first trimester is safe and feasible, while preserving future fertility.

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INTRODUCTION Anemia is common nutritional deficiency disorder in pregnant women. It is important cause of morbidity and mortality among pregnant women. We evaluated pregnant women presenting to UCMS-TH with hemoglobin level less than 9 gm/dl with reference to maternal and fetal outcome. MATERIAL AND METHODS Total of 255 women presenting with moderate to severe anemia at our hospital were evaluated. Demographic profile of patients, maternal outcomes and fetal outcomes were evaluated. RESULTS Most of patients were from rural area (78%) of which majority (69.8%) were unbooked. Severe anemia was present in 16.5% cases. Maternal complications included preterm labor (23.1%), post partum hemorrhage (19.2%), wound infection (8.6%), ante partum hemorrhage (5.5%), intensive care unit admission (4.3%) and mortality (0.4%). Fetal outcomes included neonatal intensive care unit admission (29.8%), intrauterine growth restriction  (9%) and neonatal death (7.5%). CONCLUSION Severity of anemia associated with significant increase in PPH, preterm delivery, ICU admission and heart failure.