Intrauterine polyp

This is an interesting 29yr old patient who presented with increased and prolonged menstrual bleeding. On TVS we thought that there was an intrauterine polyp. Diagnostic hysteroscopy revealed this finding.

Abortion pill should always be preceded by Transvaginal Sonography

I had an interesting case recently who gave me a clear cut history of having taken mifepristone and misoprostol from another doctor on the 20th of August 2009 after having missed her periods on the 15th of August ( her LMP was 15th July2009). Following which she had bleeding for 11 days.

She came to me on 4th September 2009 with the complaint of severe vomiting. I went for a whole abdomen scan. We discovered that she had an ectopic pregnany in her left tube. I got her ßHCG done it was 36454units and repeat ßHCG was 42756 units. 

On 10th September we did a laparoscopic removal of the tube with the ectopic pregnancy.
This case shows clearly the need to identify an intrauterine pregnancy with the help of ultrasound before, using the abortion pill. The need for this post arose with one NGO propagating over-the-counter sale of abortion pills indiscriminately.

How to remove an IUCD with missing threads

I had a patient with irregular bleeding and echogenic endometrial lining. At first look it looked like that there was an IUCD inside, but as the patient did not give any history of having an IUCD inside I looked for other pathological reasons, without success. In any case I decided to do a diagnostic hysterscopy.

The Hysteroscopic view (pardon the poor video quality due to technical reasons)

This is the IUCD which I had removed with the help of curved artery forceps after doing the hysteroscopy.

A few days back I again removed an IUCD whose threads were not seen from below but we could see the IUCD on USG. This time the hysteroscopic view showed just a part of the IUCD and I was not able to negotiate the hysteroscope inside the cervix, beyond the internal os.

In both cases the IUCD was felt stuck on the anterior wall. This time I could not take it out with the curved artery forceps, But instead due to the ingenuous staff nurse, I could take it out with the help of a Desjardin Gall stone forceps.

My suggestion for all gynaecs stuck with an IUCD with missing threads, but visible on USG, who do not have the facility of hysteroscopy, is to try to remove it from the anterior wall of uterus with the help of a Desjardin's forceps.
Advantages of this forceps:-

• The forceps is useful because it is slender, advantage over a sponge holding forceps.
• It has a good grip, advantage over ovum forceps, that is if you have a slender enough ovum forceps.
• An advantage over both the above forceps is its curve. The second patient was a previous caesarean patient whose uterus was badly stuck up anteriorly and there was hardly any mobility, I needed an instrument with which I could reach up anteriorly.
  

Cyclebeads - A natural method of contraception

CycleBeads are available from Cycle Technologies under license from Georgetown University, Institute for Reproductive Health. As part of Georgetown University's School of Medicine, the Institute is working to advance the base of scientific knowledge on reproductive physiology

To use CycleBeads a woman simply moves a ring over the
series of color-coded beads that represent the days of her cycle. The color of the beads lets her know whether she is on a day when she is likely to be fertile or not. The one medical criterion for using CycleBeads to prevent pregnancy is that a woman should have cycles between 26 and 32 days long.

It is actually an old method, but is innovatively packaged as new.It is a modification of the Natural method. This method is to be used by women.
1.having regular cycles
2.Wish to avoid hormonal and other existing methods of contraception in popular use.
3.Co-operative partner.



The day a woman starts her period she puts the rubber ring on the red bead. Each day she moves the ring one bead, always in the direction of the arrow. When the ring is on the red bead or a dark bead, there is very low likelihood of pregnancy, so she can have intercourse on these days without getting pregnant. When the ring is on a white bead - Days 8 through 19 - there is a high likelihood of getting pregnant if a woman has unprotected intercourse

Gardasil or Cervarix- ideal vaccine for cancer cervix

Glaxosmithkline has launched it's bivalent vaccine, Cervarix against Cervical cancer last month in India. Merck launched its vaccine Gardasil, a quadrivalent vaccine in India a few months back. The question now arises which vaccine to be the vaccine of choice.

1. On the face of it a quadrivalent vaccine seems to be the better choice. In reality that is not so. The vaccine protects against the HPV viruses 16,18, 6, 11, of which only the first two are responsible for cervical cancer, while the other two are responsible for genital warts.
2. On the other hand Cervarix gives protection against 16 and 18. It is better because, there is cross-reactive protection against the virus strains 45 and 31, two other viruses causing cervical cancer.
3. Cervarix is formulated with AS04, a propriety adjuvant that boosts the immune system response for a longer period of time.
4. Both vaccines are against the human papilloma virus but Cervarix seems to be more effective against cancer cervix.
   
5. Cervarix can be given to females between 10 to 45 yrs old, whereas Gardasil can be given to females between 16 to 26yrs only.
6. Both the vaccines are given in the schedule of 0,1,6 months. Cervarix is the costlier one being priced at Rs.3200 per dose.
   

Cervarix seems to win against Gardasil because of its stronger immune response and broader protection

Septate uterus

Hysteroscopic and laparoscopic appearance of septate uterus

Hysteroscopy showing a large intrauterine polyp

Diagnostic hysteroscpy and Laparoscopy

Converting my colposcope into a digital colposcope

I own a colposcope for the last 10yrs. A few days back I was able to convert it into a digital colposcpe with the help of a small attachment which I attach to my Sony digital camera and then connect the camera to a video capturing device on my laptop. I am able to get good photograghs from it