Lilly Varghese

HIV and obstetric complications and fetal outcomes in Vellore, India.

Antenatal prevalence is more than 1% in parts of India, yet little is known about the complications and fetal outcomes in this region. We reviewed the records of 23,386 women who delivered at the Christian Medical College Hospital in Vellore, India from 2000 through 2002. HIV-infected women were more likely than HIV-uninfected women to have pregnancy-induced hypertension, anaemia, breech presentations, stillborn babies and fetal deaths. HIV-infected women who did not receive mother-to-child transmission prophylaxis or had breech fetal presentation were more likely to have fetal deaths (P = 0.001). HIV prophylaxis and optimal prenatal care should be a priority for HIV-infected pregnant women in resource-limited countries.

Bowel vaginoplasty in children and young women: an institutional experience with 55 patients

Introduction and hypothesisAbsence of a vagina owing to congenital Mullerian defects or other acquired causes requires reconstruction of the female genital passage. We present our experience using various bowel segments.MethodsBowel vaginoplasty was performed in 55 patients from January 2004 through May 2014 for cervicovaginal atresia (20), Mayer–Rokitansky–Küster–Hauser (MRKH) syndrome (20), distal vaginal atresia (8), cloaca (2), cervical atresia (1), complex urogenital sinus (1), transverse vaginal septum (1), rhabdomyosarcoma of the vagina (1), and traumatic stricture of the vagina (1). The bowel segments used were sigmoid (50), ileum (2), anorectovestibular fistula ( 2), and loop rectovaginoplasty (1).ResultsThirty-nine patients who had the proximal vagina or uterus anastomosed to the bowel segment reported regular menstrual flows. Three patients are sexually active with satisfactory coital function. None of our patients developed pyometra. Five patients had neovaginal mucosal prolapse. Two patients had severe stenosis requiring excision of the neovagina. Seven patients had mild stenosis requiring dilatations in 6 patients and V-Y meatoplasty for 1 patient. One patient had a descending colon anastomotic leak requiring a diversion ileostomy.ConclusionsGenital reconstruction with bowel vaginoplasty is a highly skilled operation that provides a durable and lubricated replacement of the vagina with good outcomes. Utero-coloneovaginoplasty is a safe procedure preserving the menstrual flow in patients with a functional uterine fundus.

Cervicovaginal atresia with hematometra: restoring menstrual and sexual function by utero-coloneovaginoplasty

BackgroundCervicovaginal atresia is a rare Mullerian anomaly. The management of cervicovaginal atresia has evolved from historical recommendations of hysterectomy to various reconstructive procedures more recently. The latter carries a risk of significant morbidity and unknown fertility. We present our experience in the management of this complex anomaly.MethodsTwenty patients with cervicovaginal atresia were operated in our hospital from January 2004 through December 2013. The details of their anatomical variations and functional outcomes were analyzed.ResultsEighteen out of twenty patients had cervical agenesis. Two patients had cervical hypoplasia. All patients underwent utero-coloneovaginoplasty. Post operatively, all patients have regular menstrual cycles. One patient is married, sexually active and has satisfactory coital function. One patient had a bowel anastomotic leak that required a diversion ileostomy. Two patients developed mild stenosis. One patient has mild neovaginal mucosal prolapse. No patient has developed pyometra.ConclusionPatients with cervicovaginal atresia need to be counselled about the various reconstructive options available and the potential risks. Social and economic factor play a significant role in determining the plan of management. For patients from conservative societies, utero-coloneovaginoplasty provides a safe conduit for the passage of menstrual flow and coitus, at the cost of permanent infertility.

Rectovestibular fistula with vaginal atresia: our experience and a proposed course of management

AbstractBackground Rectovestibular fistula with coexisting vaginal atresia poses a surgical dilemma with regard to the timing and type of reconstruction. We present our experience and suggest an appropriate course of management.MethodsSeven patients with rectovestibular fistula and coexisting vestibular atresia were operated in our hospital during January 2004 through December 2013. The details of their bowel, menstrual and sexual functions were recorded.ResultsFive of the seven patients who underwent anoplasty in childhood presented to us in their teens with primary amenorrhea and cyclical abdominal pain. All five had sigmoid colon neovaginoplasty. Four of these had the uterus or its remnants anastomosed to the neovagina. All four have regular menstrual cycles. One patient is sexually active and has satisfactory sexual function. The bowel function in all the five patients is good. The remaining two patients presented in their infancy and had the anorectovestibular fistula left as the neovagina. The recto-sigmoid was pulled down to form the neoanus. Both these patients have bowel incontinence.ConclusionWe recommend the rectovestibular fistula be used as the neoanus and not as the neovagina. Delayed bowel vaginal replacement has excellent results and allows for optimal assessment of functioning uterine body or remnants.

Vitamin D deficiency in postmenopausal women with pelvic floor disorders.

Introduction: The aim of this study is to evaluate the association of vitamin D deficiency and pelvic floor disorders (PFD) including pelvic organ prolapse (POP) and stress urinary incontinence in postmenopausal women. Materials and Methods: This is a prospective case control study on 120 women with or without symptoms of PFD. Relevant history and clinical examination were conducted. Serum 25-hydroxy vitamin D levels were measured in all women. Chi square and student t test were used to test significance of association. Logistic regression was used to adjust for age. Odds ratios and 95% confidence intervals were calculated. Results: Of the 120 postmenopausal women included, 51 had PFD on clinical examination. Of the 51 cases, 28 women had POP and 14 women had stress incontinence (SUI) while nine women had both POP and SUI. The study showed that vitamin D levels were significantly lower in women with PFD than those without PFD. Menopausal status of more than 5 years was also significantly associated with PFD. Conclusion: Findings suggest association of vitamin D deficiency and PFD in postmenopausal women. In addition, postmenopausal women have a high prevalence of vitamin D deficiency indicating a need to evaluate vitamin D levels in these women.

Symptoms, prevalence, and risk factors of overactive bladder in women in south India

[1] Kitagawa R, Kim D, Reid N, Kline D. Surgical management of obturator nerve lesions. Neurosurgery 2009;65(4 Suppl.):A24–8. [2] Vasilev SA. Obturator nerve injury: a review of management options. Gynecol Oncol 1994;53(2):152–5. [3] Song MJ, Lee CW, Yoon JH, Hur SY. Transection of the obturator nerve by an electrosurgical instrument and its immediate repair during laparoscopic pelvic lymphadenectomy: a case report. Eur J Gynaecol Oncol 2014;35(2):167–9. [4] Göçmen A, Sanlıkan F. Immediate repair of an incompletely transected obturator nerve during robotic-assisted pelvic lymphadenectomy. J Minim Invasive Gynecol 2015;22(2):302–4. [5] Spaliviero M, Steinberg AP, Kaouk JH, Desai MM, Hammert WC, Gill IS. Laparoscopic injury and repair of obturator nerve during radical prostatectomy. Urology 2004; 64(5):1030.

Prevalence of voiding and defecatory dysfunction in postmenopausal women with pelvic organ prolapse: a prospective observational study

Pelvic organ prolapse (POP), is defined by the international continence society as the the symptomatic descent of the anterior vaginal wall, the posterior vaginal wall, the apex of the vagina or the vaginal vault. Women with POP may presents with symptoms of urinary incontinence, fecal incontinence, voiding dysfunction, and defecatory dysfunction, this interrelated group of conditions collectively describe as “Disorders of the Pelvic Floor”. This study aims to understand the prevalence and relationship between pelvic organ prolapse and voiding dysfunction and defecatory dysfunction. The available outcome of these measures can be used by clinicians and researchers to assess the functional outcomes of prolapse and its treatment on patients with an emphasis on symptom and quality-of-life assessment. ABSTRACT

Transobturator tapes are preferable over transvaginal tapes for the management of female stress urinary incontinence: For

Tension-free midurethral slings have proven to have low morbidity and high success rates in the management of female stress urinary incontinence. Among midurethal slings, the transobtuator tapes has comparable success and satisfaction rates as the transvaginal tapes but with reduced risk of intra-operative bladder injury, shorter operating time and quicker return to activities. Thus, the transobturator tapes may be recommended as the primary choice for the treatment of female stress urinary incontinence.