Tuesday, October 13, 2009

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.

Wednesday, October 07, 2009

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.

Monday, October 05, 2009

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.

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