Jaideep Malhotra

Vaginal agenesis associated with renal ectopia

Abstract Two rare cases of congenital absence of the vagina due to Mayer-Rokitansky-Kuster-Hauser syndrome, the first associated with a crossed pelvic kidney and the second with a solitary pelvic kidney, are presented. Diagnosis was based on the history, gynecological examination, pelvic sonogram, intravenous pyelogram, and laparoscopy. Vaginoplasty was successfully applied in both cases to facilitate sexual intercourse.

Principles and Practice of Obstetrics and Gynecology for Postgraduates

In civilized society, citizen is governed by number of laws of the land. Numbers of laws are directly proportional to the state of civilization. India is not an exception. Acts which are applicable mainly to the obstetrician and gynecologist, such as Preconception and Prenatal Diagnostic Techniques (PCPNDT) Act, Consumer Protection Act (CPA), criminal laws and Biomedical Waste (BMW), are discussed. Labor laws are just mentioned. The application of certain Acts may vary from state to state as few Acts are central and few are state Acts. Certain rules under the Act may be different in some states.

Assisted reproduction in polycystic ovarian disease: A multicentric trial in India

AIM: The aim of this study is to compare ovarian response, oocyte, embryo quality, ovarian hyperstimulation syndrome incidence, and pregnancy rates in polycystic ovary syndrome (PCOS) and non-PCOS group. MATERIALS AND METHODS: This was a prospective observational study on PCOS carried out in seven assisted reproduction centers in India between August 2008 and July 2010, as part of trial under the Indian Society of Assisted Reproduction. A total of 192 women (77 in the PCOS group and 115 in the non- PCOS group) undergoing in vitro fertilization/intracytoplasmic sperm injection were included. All women had long protocol and recombinant follicle-stimulating hormone stimulation. ANALYSIS: The mean number of follicles and oocytes was higher in PCOS group compared with non-PCOS, being 27.2 (±8.8) and 13.6 (±5.3); 15.9 (±6.3) and 10.9 (±6.2), respectively. The recovery rates of oocytes and mature oocytes per follicle were less in the PCOS group which was 64% and 61.1%, respectively as opposed to 80.3% and 74.5%, respectively in non-PCOS group. The total numbers of top-quality embryos were less in the PCOS group. CONCLUSION: In PCOS women though the number of follicles was more, recovery of mature oocytes, top-quality embryos was less. Pregnancy rates were comparable in both groups.

Prevention of Adhesion Reformation After Hysteroscopic Surgery

Uterine adhesions are significant fertility complications. Intrauterine adhesions are fairly a common finding in cases of oligomenorrhea and amenorrhea, especially in developing countries following various infections and tuberculosis. All efforts for adhesion prevention should be done to have better outcome.

Classification of Cesarean Sections in Small Private Maternity Hospitals as assessed by the Modified Robson Criteria (Canada)

We read with interest the article titled “Classification of Cesarean Sections in Small Private Maternity Hospitals as assessed by the Modified Robson Criteria (Canada)” by Dr Atnurkar and Dr Mahale.1 We are impressed by two revelations: That some visiting surgeon is keeping a record of a very common (and, therefore, seemingly unimportant) surgical procedure for over 15 years (an example of great perseverance), and that the data relate to “Small Sole Proprietorship Type Hospitals.” The publications from such hospitals are usually limited to case reports and some rare surgical procedures. Rising rates of cesarean sections have become a matter of social criticism. Michael Robson’s method of classifying cesarean sections definitely helps in indentifying a group, which, if addressed, because of its hugeness, might change the cesarean section rates. However, this classification is just the first step for those who wish to control the rising rate of cesarean section; hereafter, the problem is complex and solutions appear very difficult, if not impossible. Increasing safety of cesarean procedure, its widespread availability, and financial affordability of the family have also contributed to its rising rate. However, morbidity associated with it will always encourage practitioners to focus on its avoidance. We have certain issues with this article. Were the authors only visiting surgeons at these hospitals? Does the number 7,342 include all cesarean sections from these hospitals, or are those done by other visiting surgeons not JSAFOG

Hollow Cervical Stent: Management of Transverse Vaginal Septum

This clinical report deals with the management of obstructive vaginal transverse septum at an early stage and conservative management of the same with canalization along with the help of hollow cervical stent.

Internal Iliac Artery Ligation: A Retrospective Analysis of Two Different Approaches

Techniques: Internal iliac artery ligation can be done by approaching the artery by opening the retroperitoneal space, either by dividing the round ligament or by opening the pouch of Douglas. The internal iliac artery is identified by locating the bifurcation of the common iliac artery with the ureter crossing it. The external iliac artery is the lateral branch of the common iliac artery and it runs a straight course to continue as the femoral artery in the lower limb. The ureter is identified by peristalsis, and the internal iliac artery is the short medial branch of the common iliac which runs a short course and immediately divides into an anterior and a posterior division, which in turn divide into a number of branches. The uterine artery is the branch of anterior division of the internal iliac artery. The internal iliac artery is ligated by passing a stout suture material under it with the help of a right-angled forceps, or it can be directly occluded with clips, applied using a clip applicator.

Role of Magnetic Resonance Imaging in the Diagnosis and Management of Pelvic Floor Dysfunction

Materials and methods: Patients with pelvic floor dysfunction are subjected to clinical examination and magnetic resonance imaging (MRI). The changes in anatomy are analyzed in terms of levator hiatus dimension and descent of the pelvic organs. Substratified analysis is done and mean diameters in each degree of prolapse are identified (Chi-square tests using cross tables). Patients with cystocele, rectocele, or enterocele are also compared in both clinical examination and MRI and the degree of correlation is measured (inter-rater kappa). The changes in pelvic floor anatomy in terms of H line, M line, and levator plate angle with respect to age and parity are studied. In patients with lower degrees of prolapse, the changes in anatomy in terms of H line, M line, and levator plate angle are studied after a course of pelvic floor exercises (post hoc tests and paired t-tests). The area under curve of receiver-operating curve in each degree of prolapse is seen and the critical cut-off value of the various anatomical parameters above which a patient develops a prolapse is calculated.

Comparison of Two Protocols for Management of Placenta Accreta at a Tertiary Care Center in Pakistan

Materials and methods: All women with placenta accreta coming to Abbasi Shaheed Hospital were included and divided in two groups. Group I included all women with accreta who were managed by lower segment transverse incision in the year 2013. Group II included all women whose accreta was dealt with classical incision in the year 2014. Morbidity from placenta accreta in all these cases was assessed.

Low-dose Magnesium Sulfate Regime for Eclampsia in India

Introduction: Eclampsia is one of the leading causes of maternal mortality. Magnesium sulfate (MgSO4) can be a drug for its management. Objectives: To study the safety and efficacy of low-dose MgSO4 for control of convulsions in case of eclampsia and to compare it with Pritchard regimen in terms of its effects and perinatal outcome. Materials and methods: This study was conducted in Department of Obstetrics and Gynecology. It was a prospective study and included 78 cases of eclampsia. Thirty-nine cases were given low-dose regime and remaining 39 were given Pritchard regimen. Low-dose regime for eclampsia: Loading dose 4 gm MgSO4 IV diluted in 20 cc of 5% dextrose, slowly over 5 to 8 minutes. Maintenance dose 2 gm IV similarly diluted was given 3 hourly till 24 hours after delivery or after convulsion which ever was later. If recurrence of convulsions occurs, then additional dose 2 gm IV was given and previous dose schedule continued as such. Results: Eclamptic convulsions were controlled in 94.87% of cases with low-dose regime, and in the remaining cases were controlled with additional 2 gm IV dose MgSO4 compared to 37.14% with Pritchard regimen. Conclusion: Low-dose magnesium regime is highly suitable for women in our setup, and it is as effective as Pritchard regimen for controlling convulsions in eclampsia along with better perinatal outcome and with less MgSO4 toxicity.