Background Interstitial and cornual ectopic pregnancy is rare, accounting for 2-4% of ectopic pregnancies and remains the most difficult type of ectopic pregnancy to diagnose due to low sensitivity and specificity of symptoms and imaging. The classic triad of ectopic pregnancy-abdominal pain, amenorrhea and vaginal bleeding-occurs in less than 40% of patients. The site of implantation in the intrauterine portion of fallopian tube and invasion through the uterine wall make this pregnancy difficult to differentiate from an intrauterine pregnancy on ultrasound. The high mortality in this type of pregnancy is partially due to delay in diagnosis as well as the speed of hemorrhage. Methods Three cases of interstitial pregnancy were retrospectively analyzed. Result Successful laparoscopic cornuostomy and removal of products of conception were performed in two cases, while one case was successfully managed by local injection with KCL and methotrexate followed by systemic methotrexate. Conclusion Early diagnosis and timely management are key to the management of interstitial and cornual ectopic pregnancy. With expertise in ultrasound imaging and advances in laparoscopic skills progressively, conservative

Objectives: Quick and effective hemostasis is essential for a successful laparoscopic surgery. Hence, it is of utmost importance for laparoscopic surgeons to understand the various available and emerging energy sources to tailor their use according to their properties and surgical requirement. The aim of this study was to compare LigaSure, an advanced bipolar versus conventional bipolar in total laparoscopic hysterectomy, with respect to operating time, mean blood loss, mean reduction in hemoglobin, intraoperative, and postoperative complications, and duration of prospective hospital stay. Materials and Methods: It was a randomized controlled study. One hundred and twenty patients scheduled for elective hysterectomy for any benign indication were randomly allocated to two groups namely, conventional bipolar group and LigaSure group. Patients with a history of ≥3 laparotomies, uterine size >20 weeks were excluded. Total laparoscopic hysterectomy with bilateral salpingectomy/salpingo oophorectomy was done in all the patients and endpoints were evaluated. Results: All the recruited participants ( n = 120) achieved study endpoints. There was statistically significant difference in the meantime to dissect adnexal ligaments, primary and total operating time (for adnexal ligaments: Conventional bipolar-9.44 min vs. LigaSure-7.05 min; P = 0.000) (Primary: Conventional bipolar-97.03 min vs. LigaSure 74.39 min; P = 0.000) (Total: 142.5 min vs. 136.37 min P = 0.002). Mean blood loss (145 ml vs. 141.67 ml; P = 0.846), mean reduction in hemoglobin (0.802 versus 0.752; P = 0.484) and duration of postoperative stay (2.54 days vs. 2.32 days; P = 0.128) were comparable ( P > 0.05). None of the participants suffered from any major complication during the surgery or in the postoperative recovery period. Conclusion: With an ability to effectively reduce operating time, LigaSure is a safe and efficient instrument for laparoscopic hysterectomy.

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Introduction: Induction of labour is the artificial initiation of labour before its spontaneous onset for the purpose of delivery of the foetoplacental unit.The purpose of this study was to determine whether the current practice of elective labour induction was associated with differences in mode of delivery,demand for pain relief and foetal outcomes when compared with labour of spontaneous onset. Methods And Materials: This cross-sectional study carried out on 100 pregnant women with singleton pregnancy between 37 and 41 weeks of gestation with cephalic presentation delivering in labour room. This study included two groups:Electively induced (50) and spontaneous group (50). Results: In electively induced group 44% had normal vaginal delivery and 6% had instrumental delivery. With spontaneous labour,78% had normal vaginal delivery and 4% had instrumental delivery.Postpartum hemorrhage (PPH) was 20% in electively induced group and 6% in the spontaneous group (p-0.038).Apgar scores,mean birth weights were comparable. Analgesia demand was 22% in the electively induced group when compared to 6% in the spontaneous group. Conclusion:The present study emphasizes that elective induction of labour in nulliparous women with a single cephalic presentation is associated with increased risk of caesarean section, which is predominantly related to an unfavorable cervix. Hence, elective induction is safe and efficacious. Caesarean delivery rate was more due to nulliparity or unfavorable cervix not due to elective induction itself.

Introduction: Female adnexal tumour of probable wolffian origin (FATWO), is a rare neoplasm arising within the leaves of a broad ligament or hanging from it or a fallopian tube. It is considered a tumour of low malignant potential which shares similar histological and immunochemical features with mesonephric remnants. Case: Here we present a case repot of a 40 years old, nulliparous female who presented with acute pain abdomen and fever since 2 days. Her LMP was 30.09.2015 and her past menstrual cycles were irregular. She was nulliparous with history of infertility. In past medical history revealed her to be a known diabetic for 5 years, with uncontrolled blood sugars. Patient was hemodynamically stable. On per abdominal examination there was generalized tenderness all over the abdomen with guarding and rigidity. On per speculum examination vaginal discharge was noted with unhealthy cervix. Per vaginal examination revealed a tender mass of approximately 8 x 6 cm was felt on left fornix. All her base line investigations were normal. The salient investigations like CA-125 35.60 IU/L, CEA 3.46, Beta-HCG 2.29 were normal. On imaging, MRI showed a well defined solid cum cystic space occupying lesion of 9 x 8 cm arising from left adnexa with evidence of right hemorrhagic adnexal cyst 6 x 7 cm and hydro/hematosalpinx noted. There was well defined space occupying lesion in the pelvis on the left of the uterus which is likely a broad ligament leiomyoma. Diagnosis of acute abdomen was made with adnexal mass probably infectious in origin. Injectable antibiotics were started. In view of acute pain abdomen decision for surgical intervention was taken. Laparoscopic findings revealed bilateral ovarian abscess with left sided broad ligament mass (solid consistency) probably leiomyoma. Right tube and ovary were normal. Drainage of tuboovarian abscess with left salpingo-oophorectomy with right salpingectomy with adhesiolysis was done and sent for histopathology. HPE reported Female adnexal tumour of probable wolffian origin (FATWO) which was positive for vimentin and CD10, possibly arising from left sided broad ligament. Patient underwent radical hysterectomy with omentectomy with appendicectomy was done in view of FATWO. Conclusion: Female adnexal tumour of probable wolffian origin (FATWO), is a rare neoplasm which is usually considered as benign, although in some cases metastasis on recurrences have been reported even after a long interval following the initial diagnosis. Pre-operative diagnosis of FATWO is very difficult because of the rarity of the disease and paucity of the literature available.