AIM: To compare the coagulation parameters in patients with preeclampsia and eclampsia with normotensive pregnant patients in Nainital district of Uttarakhand state. MATERIAL AND METHODS: From January 2012 to June 2013, coagulation indices including platelet count, prothrombin time (PT), activated partial thromboplastin time (aPTT), bleeding time (BT) and clotting time (CT) were measured in 100 patients with preeclampsia and eclampsia and compared with 100 normotensive pregnant women. The patients with coagulopathies were excluded. RESULT: In preeclampsia and eclampsia, decrease in platelet count (157.18±56.66 lacs/cumm) was highly significant (p<0.001). PT, aPTT and CT were normal but BT (322.46±171.39 sec) was significantly prolonged (p<0.001) in pre eclampsia and eclampsia patients. CONCLUSION: The abnormalities pertaining to coagulation parameters in hypertensive disorders of pregnancy indicate the intravascular coagulation.

Although our study was small, it indicates that in case of twin pregnancy with single fetal death with good surveillance, the live fetus can be salvaged.

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BackgroundObliterated posterior cul-de-sac has been a real surgical challenge during vaginal hysterectomy. The present study demonstrates an anteroposterior approach to accomplish the vaginal hysterectomy in cases faced with an obliterated posterior cul-de-sac.MethodsIn a retrospective study in private setup, 51 consecutive cases with obliterated posterior cul-de-sac during vaginal hysterectomy due to severe benign pelvic adhesions were studied to know the feasibility of the anteroposterior approach. The upper limit of uterus size was that of 16 weeks of gestation.ResultsVaginal hysterectomy was completed in 49 (96.08%) cases with obliterated posterior cul-de-sac due to severe benign pelvic adhesions. Two (3.92%) cases needed laparoscopic assistance to complete vaginal hysterectomy. Mean operation time was 109.92±40.13 (45–217) minutes due to the need for careful separation of adhesions from the uterus and indicated additional procedures. Mean weight of specimen uterus was 162±106.51 (40–460) grams. There was no major intra- or postoperative morbidity.ConclusionCompletion of vaginal hysterectomy was feasible using the anteroposterior approach in most of the cases with obliterated posterior cul-de-sac due to severe benign pelvic adhesions.

BackgroundLaparoscopic hysterectomy for benign indications in cases with ventrofixed uterus following previous cesarean section (CS) increases the surgeon’s concern of bladder injury. The present study describes a laparovaginal strategy to avoid bladder injury during laparoscopic-assisted vaginal hysterectomy (LAVH) in cases with ventrofixed uterus following previous CS.MethodsIn a retrospective study conducted in our private general hospital, we included consecutive cases of laparoscopically confirmed ventrofixed uterus associated with previous CS. These were from the cases who underwent LAVH for benign indications. Cases with uterus size >16 weeks of gestation were excluded. Patients’ clinical, intraoperative and postoperative characteristics were studied to evaluate the feasibility of the described laparovaginal strategy to prevent bladder injury during LAVH in cases with ventrofixed uterus.ResultsA total of 35 cases with ventrofixed uterus underwent LAVH during the study. Six (17.14%) cases had a history of one CS, while 29 (82.86%) cases had a history of previous two or more CSs. A supravesical loose fatty tissue plane (supravesical space) indicating reach to the bladder wall during laparoscopic lysis of the uterus from the anterior abdominal wall was successfully demonstrated in all the cases. The bladder flap preparation was avoided. Uterovesical adhesions were dissected by posteroanterior approach during vaginal phase of LAVH in all the cases. LAVH was successfully performed in all the cases. None of the cases had bladder injury, laparotomic conversion or other major complications. Mean operating time for LAVH was 149.71±38.36 minutes (70–200 minutes). Mean uterine specimen weight was 162.85±92.57 g (60–500 g). Mean postoperative hospital stay was 2.42±0.73 days (2–5 days).ConclusionIn spite of severe adhesions in cases with a ventrofixed uterus following previous CS, bladder injury can be avoided during LAVH by the described laparovaginal approach in the present study.Short synopsisThe described laparovaginal approach may avoid bladder injury during laparoscopic-assisted vaginal hysterectomy in cases with a ventrofixed uterus following previous cesarean section.