Background: Hysterectomy is the most common operation performed by gynecologist, next to caesarean section. Currently, there are three main types of hysterectomy operations in practice for benign diseases-Abdominal hysterectomy (AH), vaginal hysterectomy (VH) and Laparoscopic hysterectomy (LH). Vaginal route for non-descent uterus is an acceptable method of hysterectomy. The objective of present study was to compare the operating time, intraoperative and postoperative complications between VH and TAH in non-descent uterus.Methods: The study was conducted in the Postgraduate department of Gynaecology and Obstetrics for a period of 18 months between April 2013 to October 2014 in the Government Lalla Ded Hospital - an associated hospital of Government Medical College, Srinagar; which is the sole tertiary care referral centre in the valley.Results: Over the study period 100 patients were taken, 50 patients underwent non-descent vaginal hysterectomy and labelled as group A and 50 patients were under went total abdominal hysterectomy and labelled as group B. It was seen that intraoperative complications and postoperative complications were less in group A patients and operating time is also less with group A patients when compared with group B patients.Conclusions: From the present study, it was concluded that NDVH is associated with less blood loss during surgery, quicker recovery, and early mobilization, less operative and less postoperative morbidity when compared to TAH. NDVH is a less invasive technique with shorter hospital stay and faster convalescence.

Background: The recurrent pregnancy loss (RPL) is defined as two and more failed pregnancies as documented by ultrasound and histopathological examination and suggested some assessment after each loss with a thorough evaluation after three or more losses. RPL is one of the most frustrating and difficult areas in reproductive medicine because the aetiology is often unknown and there are few evidence based diagnostic and treatment strategies.Methods: 150 Non pregnant females were taken as both cases and controls in the study. All the pregnancy losses were documented by ultrasound or histological examination after uterine curettage. The control group consisted of women with no RPL with at least one live birth. These two groups were matched on the basis of age and BMI. All the women underwent following examinations, viz. Hysterosalpingography, karyotype of both partners, serum TSH, FT4, prolactin and antibodies for APLA. In addition blood sample were taken for fasting serum glucose and serum insulin level later insulin resistance was calculate using three parameters Fasting insulin > 20IU/ml. Diagnostic of Insulin Resistance. (2) Fasting glucose / Fasting insulin. A ratio of < 4.5 being diagnostic of insulin resistance. (3) HOMA IR.        FG (mg/dl) x FPI (IU/ml) FG (mmol/l) x FPI (IU/ml)------------------------------------ OR -----------------------------------                                             405 22.5Where 1 mmol/l = 18mg/dl, A value of > 4.5 being diagnostic of insulin resistance.Results: 150 patients were enrolled in this study among which 75 were selected as cases and 75 as controls after fulfilling inclusion and exclusion criteria with mean age cases group was28.4+2.37 years and 29.1+2.70 years in control group mean miscarriage rate in study group was 3.17+83 and control group with 0.35+0.48 with statistically significant difference. Mean fasting glucose (96.5+ 7.86) mg/dl, Fasting Insulin (14.1±5.91) IU/ml. Mean Glucose Insulin ratio (8.1±3.39), HOMA-IR (3.4 ±1.51) in the study group and in control group mean fasting glucose was (87.1+11.49) mg/dl, Fasting Insulin (6.9 ± 4.99) IU/ml. Mean Glucose Insulin ratio (17.8 ±11.44), HOMA-IR (1.5 ±1.27) respectively with statistically significant difference.Conclusions: In women with recurrent pregnancy loss fasting insulin and insulin resistance are higher than those in women without spontaneous abortion. The most sensitive parameter for calculating insulin resistance was found to be fasting insulin followed by HOMA – IR and followed by fasting glucose/fasting insulin ratio. It is therefore important to recommend a fasting insulin and fasting glucose level while evaluating a case of recurrent pregnancy loss to assess for insulin resistance.

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Background: Uterine leiomyoma (i.e. fibroid or myoma) are benign clonal tumours arising from the muscle cell of the uterus .Uterine myomas are the commonest tumour over the age of 30 years and seen in 2% pregnant women. The impact of uterine myomas on pregnancy depends on the size, number and location of myoma. Myomectomy is a surgery to remove one or more fibroids. Recently, it has been suggested that caesarean myomectomy is a safe surgical modality if is performed in carefully selected patients. The aim of the study was to assess the safety and feasibility of performing myomectomy during caesarean section.Methods: This prospective observational study was conducted in the Postgraduate Department of Gynaecology and Obstetrics for a period of one and a half year in Government Lalla Ded Hospital – an associated hospital of Government Medical College, Srinagar which is the sole tertiary care referral centre in the valley.Results: A total of 54 patients were taken for caesarean myomectomy. Majority of the patients were in the age group of 26-30years and were of para-1 or 2. Mean blood loss was ≤500 ml during surgery. Most common intraoperative complication was haemorrhage and post-operative complication was fever.Conclusions: From the present study, it is concluded that with the advent of better anaesthesia and availability of blood, caesarean myomectomy is no longer a dreaded job in the hands of an experienced surgeon and in a well-equipped tertiary institution.