BACKGROUND Vaginal hysterectomy is often performed to correct uterovaginal prolapse. The effect of surgery is seldom addressed. Long term results and QOL data are sparse. The objectives of the study were to determine the short-term complications and to assess the post-operative wellbeing of the patients following Ward Mayo surgery at Department of Obstetrics and Gynaecology, Calicut Medical College. To determine the incidence of vault-prolapse one year after surgery. MATERIALS AND METHODS Hospital based prospective cohort study. All post-menopausal patients in the age group 50-70 years with third degree uterovaginal prolapse POP Q stage III and IV, who underwent Ward Mayo procedure from IMCH Calicut are followed up for a period of 1 year. Patients were reviewed 6 weeks after surgery and at the end of 1 year. RESULTS Regarding short term complications, 12% had anaemia requiring blood transfusion, 3% had urinary bladder injury, 8% had post-operative fever, 3% had vaginal infection. Presence of COPD and a BMI of more than 25 are significant risk factors for the short-term complications. In long term, 26% developed de-novo urinary symptoms. 90% patients had satisfactory relief from pre-surgery symptoms. Emotional stress of hysterectomy was experienced by 7%. Incidence of vault prolapse was nil. The proportion of Ward Mayo surgeries at IMCH in 2016 is 11.4%. CONCLUSION Vaginal hysterectomy is an efficient treatment for uterovaginal prolapse. However, 15% of the operated patients developed de novo urinary stress incontinence. Therefore, efforts to identify latent stress incontinence should be undertaken preoperatively and it should be properly corrected during the surgery.

BACKGROUND Acute uterine inversion is a collapse of the uterine fundus into the cavity during the third stage of labour or immediately after delivery. It is a rare complication with an incidence of 1 in 2000 to 1 in 20000 deliveries. Shock is out of proportion to blood loss. WHO recommends hydrostatic correction if immediate manual repositioning fails. Hydrostatic method for reducing acute uterine inversion is a simple method with excellent outcome if advocated properly. The key to success of the hydrostatic correction is developing a good enough water seal to allow generation of adequate hydrostatic pressures for uterine replacement. A modification of hydrostatic method by using a condom catheter ensures an excellent water seal and helps to reduce failures during the procedure. The aim of this study was to use a condom catheter as a modification of hydrostatic method to correct cases of acute puerperal inversion so as to reduce failures during the procedure. MATERIALS AND METHODS This study was conducted as a prospective case series at Govt. Medical College, Kozhikode over a 10-year period from 01/01/2008 to 31/12/2017. All cases of acute uterine inversion managed at the hospital during this period were included. Cases of chronic inversion of uterus were excluded from the study. RESULTS There were 8 cases of acute inversion of uterus out of a total 1,59,102 births. All of them were multiparas and 6 cases were referred. 5 of them belonged to 26-30 years age group. 6 patients were having third degree inversion and 2 had fourth degree inversion. 6 patients were stable at the time of diagnosis, but 2 of them were in shock at the time of presentation. A total of 4 patients received blood transfusion. 2 patients were diagnosed with acute uterine inversion within 30 minutes of delivery. The remaining 6 cases reached our hospital at 1.5 to 2 hours after delivery. Two patients underwent immediate manual repositioning and six had hydrostatic correction using a condom catheter which was filled from a urobag filled with 2-2.5 litres of normal saline. All six cases were successfully corrected but two patients underwent emergency obstetric hysterectomy for PPH. CONCLUSION This modification of hydrostatic correction with condom catheter and urosac filled with normal saline is simple and effective and will definitely reduce maternal morbidity and mortality in cases of acute uterine inversion.

A 62-year-old female with III degree uterovaginal prolapse was scheduled for elective vaginal hysterectomy. She was diagnosed to have hypertension since 14-years and was on treatment with Amlodipine 5 mg OD, Perindopril 4 mg OD and Aspirin 150 mg OD. She has two brothers and both of them were hypertensive on treatment since 10-years.On examination, heart rate was 82/min regular, systemic blood pressure of 138/80mmhg in supine position. Systemic examination was unremarkable. Airway was graded as mallampatti classification class two with normal neck movements and without any spinal abnormality.Preoperative investigation showed haemoglobin (Hb) of 11.9 gm% and normal blood cell counts. Biochemical profile showed blood urea of 41mg/dl, Serum creatinine 1.2mg/dl, Na + 130meq/l, k + -4.1 meq/ l, ca ++ -7.9 meq/ l, acid phosphatase 1.2 U and 24 hrs urine protein -76 mg/dl. Liver function tests and coagulation profile were within normal limits. ECG showed sinus rhythm with left axis deviation and echo showed left ventricular hypertrophy (LVH) with ejection fraction of 58%. Chest X-ray showed normal lung fields and abdominal sonography revealed bilateral polycystic kidney. Magnetic resonance imaging of brain was found to be normal. A nephrology and cardiology opinion was taken and was advised to avoid nephrotoxic drugs, and intraoperative hypotension.On the night prior to surgery, patient was counselled and informed consent was obtained. She was given tablet diazepam 10 mg, advised nil perorally and to continue antihypertensives on the morning of the surgery. On the day of surgery, she was wheeled into operation theatre. Monitoring included pulse oximeter, noninvasive blood pressure (NIBP), five lead electrocardiography (ECG), central venous pressure (CVP) and urine output measurement. Combined spinal epidural (CSE) technique in different interspaces was planned. She was preloaded with 500 ml of ringer lactate solution through central venous line. Under aseptic precautions, 18 guage epidural catheter was inserted at L1-L2 space and spinal anaesthesia was given at L3-4 space through 25 gauge spinal needle, using 3 ml of 0.5% heavy bupivacaine with buprenorphine 2 mcg/kg. Anaesthesia and level of blockade were adequate. Throughout the surgery blood pressure was maintained in the range of 110-120 mmhg of systolic and 68-80 mmhg of diastolic and there was no episode of bradycardia during the surgery. Postoperative analgesia was achieved by 8 ml of 0.125% bupivacaine with buprenorphine two mcg/kg epidurally every 8 th hourly. Her vitals were stable and she was shifted to the postanaesthesia care unit. Patient had an uneventful postoperative period and she was discharged from hospital on 8 th postoperative day. DisCussionThe polycystic kidney diseases are among the most common life threatening inherited diseases worldwide [1]. Hypertension is an early symptom, occurring in approximately 60% of patients secondary to stretching of arterioles across expanding cysts leading to increased secretion of rennin and angiotensin [2].Decr...