Aims and objectives: The objective of this study was to determine the less post operative morbidities and better compliance of the patient following vaginal hysterectomy in case of non descent uterus.Materials and Methods: This is a cross sectional descriptive study of patients admitted in Chittagong medical college Hospital and different private clinics between May 2010 and April 2013. Total 126 patients requiring hysterectomy recruited for the study. Indications of Non-descent vaginal hysterectomy (NDVH) were dysfunctional uterine bleeding ( DUB), fibroid uterus, adenomyosis, chronic cervicitis, CIN- II and III, endomertrial hyperplasia, PID and invasive mole. NDVH were performed in cases with mobile uterus, size not exceding 14 weeks of gestation, and with adequate vaginal access. Morcellation techniques like bisection, myomectomy, wedge debulking or combination of these were employed in bigger and firmer uteri.Results: Age ranged from 35 -60 years with majority (68.25%) between 45 and 50 years and 8.70% above 50 years. Seventy nine (62.698%) women were of 3 or more parity, 38 cases (30.15%) had two and 9 cases (7.14%) had one. Preoperative uterine size varied from eight weeks size 98 (77.77%), 12 weeks size 21 cases (16.66%) and more than 12 weeks size7 cases (5.55%). Table 1 depicts the indications for NDVH. One hundred nineteen patients had hysterectomy and remaining 7 had hysterectomy with salpingo-oophorectomy. Eighty four (66.66%) operations were complete within 90 minutes and remainder needed 90 minutes to 3 hours. Average blood loss was up to 200 ml in 91 (72.20%) cases and in other cases it was more than 200 ml. Average hospital stay was 2 days in the majority (76.20%) while 3-5 days in others. Bladder injury occurred in 6 cases (4.76%) and rectum injury in 1case (0.79%) during operation. Postoperatively 12 (9.52%) patient were suffering from secondary haemorrhage and 15 (11.11%) patient from vault granuloma. Analgesic requirement was at minimum during post operative period. Cost was reduced with the compared to the other route of hysterectomy.Conclusion: NDVH is a less invasive technique with benefits,which includes shorter hospital stay and faster convalescence and avoid abdominal wound complications. It should be a primary methods for removal of large uterus provided one is familiar with morcellation technique.DOI: http://dx.doi.org/10.3329/cmoshmcj.v13i1.19411

Hepatitis C virus is a significant healthcare problem, affecting more than 170 million people worldwide and as many as 4 million new infections occur annually. Incidence rates across the world fluctuate and are difficult to calculate given the asymptomatic, often latent nature of the disease prior to clinical presentation. Of those exposed to HCV, 80% become chronically infected, and at least 30% of carriers develop chronic liver disease, including cirrhosis and hepatocellular carcinoma. HCV infection also increases the number of complications in persons who are co-infected with HIV. This article reviews an overview of the prevalence, genotype data, transmission risk and prevention. DOI:10.3329/jbcps.v27i3.4294 J Bangladesh Coll Phys Surg 2009; 27: 160-165

Cervical ectopic pregnancy is the implantation of the conceptus within the cervix below the level of internal os 1 . Such pregnancy typically aborts within the first trimester, if it is implanted closer to the uterine cavity called cervico isthmic pregnancy it may continue longer 2 . Cervical pregnancy accounts for less than 1% of all ectopic pregnancies, with an estimated incidence of 1 in 2500 to 1 in 18000. Though the pregnancy in this area is uncommon but possibly life threatening condition due to risk of severe hemorrhage and may need hysterectomy 2,3 . Early detection and conservative approach of treatment limit the morbidity and preserve fertility. A 37 year old lady para 4+0 diagnosed as a case of cervical ectopic pregnancy with intractable bleeding and save the patient by emergency hysterectomy to control hemorrhage. The case is reported here for its relative rarity.

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