Arun Nayak

Advances in the SUI Surgeries

Stress urinary incontinence is a condition associated with advancing age and high parity. Millions of women all over the world have suffered, in silence, embarrassment and social isolation due to this condition. Over the years, several operative procedures have evolved for correction of urinary incontinence with many of them having poor success or high recurrence rates over long-term period. This mini review covers various surgical procedures evolved over the last couple of years and recent advances in the management of urinary incontinence.

A Study of Maternal Outcome in Uterine Rupture in Pregnancy at a Tertiary Care Institute

Aim and Objective: The present research was carried out with an objective to determine the incidence, etiology, trend, and management, maternal and fetal outcome of ruptured uterus and to identify the preventive measures. Material and Methods: A prospective observational study was conducted over a period of 2 years from Nov 2012 – Nov 2014 in a tertiary care hospital of Mumbai, India. A total of 40 patients who came with rupture of uterus in pregnancy were studied. These cases were analyzed based on clinical features, etiology and risk factors of rupture uterus, the mode of management and the foetal and maternal outcome. Results: There were 40 cases of uterine rupture out of 32,200 deliveries giving an incidence of 1 in 805 i.e. 0.12%. Most common clinical features were those of classical signs of rupture with ill defined uterine contour, superficially felt foetal parts and absent foetal heart sounds. The commonest cause of rupture was due to separation of previous cesarean scar rupture (72.5%). The lower uterine segment was the commonest site of rupture.xa0 Rent repair was the commonest procedure done in the cases of ruptured uterus. Perinatal mortality of 77.5% and maternal mortality of 10% was observed in this study. Conclusion: Skilled attendance with accessible emergency obstetric care and focused antenatal care are key elements for the prevention and management of uterine rupture.

Successful Conservative Management of an Unruptured Cesarean Scar Ectopic Pregnancy.

Dr. Arun Nayak, MBBS, MD Obstetrics & Gynaecology, DGO, FICOG is Professor & Head of Unit in Department of Obstetrics & Gynecology at Lokmanya Tilak Municipal General Hospital, Mumbai, India; Dr. Meenal Sarmalkar, MBBS, MD Obstetrics & Gynaecology, DGO is Additional Associate Professor in Department of Obstetrics & Gynecology, Lokmanya Tilak Municipal General Hospital, Sion, Mumbai, Maharashtra, India; Dr. Madhuri Mehendale, MBBS, DGO, DNB Obstetrics & Gynaecology, FCPS is Assistant Professor in Department of Obstetrics & Gynecology, Lokmanya Tilak Municipal General Hospital, Sion, Mumbai, Maharashtra, India; Dr. Neha Singh, MBBS, MD Obstetrics & Gynaecology is Senior Resident in Department of Obstetrics & Gynecology, Lokmanya Tilak Municipal General Hospital, Sion, Mumbai, Maharashtra, India; Dr. Pratibha Dixit, MBBS, Post Graduate student MD is Obstetrics & Gynaecology in Department of Obstetrics & Gynecology, Lokmanya Tilak Municipal General Hospital, Sion, Mumbai, Maharashtra, India; Dr. Shamlee Mistry, MBBS, MD is Obstetrics & Gynaecology, ExRegistrar in Department of Obstetrics & Gynecology, Lokmanya Tilak Municipal General Hospital, Sion, Mumbai, Maharashtra, India. & Arun Nayak drarunhnayak@hotmail.com

Postpartum IUCD: Rediscovering a Languishing Innovation

The National Family Planning Programme of India, since its inception in 1951, has been able to successfully achieve significant reductions in maternal mortality and fertility. Over the past decade, the need for contraception has changed dramatically in India. Couples no longer desire sterilization, but prefer modern reversible long-term methods of contraception. The ideal time to discuss contraception is in the antenatal period when there is a good rapport between the doctor and the patient. The window period when the patient is admitted in the hospital during delivery can be used effectively to offer postpartum contraception. It has been found that the highest chance of unwanted pregnancy is in the first year after delivery, when women do not report to the doctor if this window period is missed. Postpartum intrauterine contraceptive devices are ideal for a country like India and it can be used to cover the unmet need of contraception if inserted immediately after delivery. There are two types of insertion: post placental, within 10xa0min of delivery of placenta and postpartum, within 48xa0h of delivery. Although there is a greater chance of expulsion in the postpartum insertions, it can be significantly reduced with proper training and user experience. Postpartum IUCD should be routinely offered to all patients delivering in institutions to provide complete care to a parturient and to achieve safe motherhood.

Spontaneous nontraumatic epidermoid cyst of the clitoris: a rare case report

Epidermoid cysts are slow growing, intradermal or subcutaneous tumors with a wall composed of true epidermis. They are rarely seen in the clitoral region but when found; they are commonly seen following female genital mutilation. Spontaneous onset clitoral epidermoid cysts have been scarcely reported .We report a rare case of a large spontaneous nontraumatic epidermoid cyst of clitoris in a 22 year old nulliparous female. This presentation mimicked clitoromegaly but was diagnosed to be a large epidermoid cyst after excision.