BOHR Journal of Obstetrics and Gynaecology

Complications and difficulties faced during laparoscopic tubal ligation using single-puncture technique in scarred abdomen

Sumant R. Shah — 2024-01-31

This study was carried out in Dr. MK Shah Medical College and SMS Multispeciality Hospital, a tertiary care medical center, catering to Lower middle class and middle-class communities.
Objective: To evaluate the difficulties faced during laparoscopic tubal ligation and complications that occurred during or after laparoscopic tubal ligation in the scarred abdomen using the single-puncture technique and its outcome.
Methodology: A prospective study was carried out in tertiary care medical center in the periphery of the metropolitan area from 1st January 2022 to 30th September 2023. Consent of the ethical committee of the hospital and written consent of the patient were taken. All patients with a history of previous pelvic/abdominal surgery undergoing laparoscopic tubal ligation with a fallopian ring were included in the study and any difficulties faced or complications that occurred were noted. Patients undergoing the concomitant procedure (MTP/D&E/Check curette) with Lap TL were also included.
Results: A total of 41 patients were included in the study. 46.3% patients were in the age group of 25−30 years. There was only a marginal difference of around 3% between the age group of >30 years. The majority of patients were up to G3 (85.4%). Patients accepted laparoscopic tubal ligation if they had more than 2 children. Preoperative assessment should be done thoroughly by senior faculty. Fixed mobility is an ominous sign to take patients for Lap TL. Normally these findings are the same in patients with 3 scars on the abdomen and having a history of closure
of the abdomen in single layer. 80% of patients undergoing Lap TL had a history of previous 2 CS. 12.5% of patients had a history of previous 3 Lower Segment Cesarean Section (LSCS). 1 out of 41 pt had operative h/o 2 LSCS + open appendicectomy. 1 pt had operative h/o 2 LSCS + 3 Lap surgeries for surgical pathology. 1 pt had an exclusive history of open appendicectomy. The majority of patients, 78.1%, had interval Lap TL. 17.1% had concurrent Lap TL with suction & evacuation. 4.8% had Lap TL following the 2nd trimester MTP. In 75.6% of patients, there was no difficulty in applying fallopian ring. 19.5% of patients who had peritubal adhesions were
taken care of while doing single-puncture Lap TL. Complications were comparable with those of non-scarred abdomen undergoing Lap TL.
Conclusion: Lap TL in a patient with a scar on the abdomen is a preferable method rather than Laparotomy. Junior gynecologists should take the help of senior gynecologists conversant with doing Lap TL in patients with scarred abdomen. Complications are comparable with those of Lap TL in non-scarred abdomen. The abdomen should be closed in layers. It should be standard protocol for all gynecologist practicing universally. Scar/scars on the abdomen is not a contraindication of Lap TL.

Large anechogenic “Holes” in the uterus: The utility of contextual combination of ultrasound and hysteroscopy

Paola Algeri — 2024-01-08

Cystic adenomyosis is a rare occurrence, especially in young patients. We report a challenging case of a 44- year-old African patient, in which the ultrasound described a large bilobate anechogenic cyst in the myometrium. The combination of ultrasound, contextual hysteroscopy, and subsequent magnetic resonance imaging helped to clarify the case, reducing the risk of complications for the patient, potentially due to misdiagnosis.

A first trimester scan may reveal the presence of placenta accreta. Absence of the anterior uterine wall during caesarean section: An unexpected placenta accreta that was treated conservatively

Paola Algeri — 2024-01-29

Objective: Placenta accreta spectrum (PAS) is a rare condition, but it is a potential life threating obstetric event.
Case report: A second-time mother, 32◦years old, has had a caesarean section before. At 11◦weeks, a doubt about scar pregnancy was posed but not confirmed at subsequent serial ultrasound evaluations. A caesarean section was performed at 38.4◦weeks for breech presentation. A placenta accreta, diagnosed during surgery and confirmed by histological evaluations, was visible at uterine examination with a lacuna in the anterior uterine wall. After fetal extraction, the surgeons opted for conservative management. Subsequent clinical and ultrasound followup described a patient in a good state of health with a progressively reduced intrauterine placenta residual.
Conclusion: (1) Even in the absence of typical second- or third-trimester ultrasound signs, first trimester ultrasound played a role in posing the suspect of PAS. (2) Conservative management could be a safe option in cases of undiagnosed PAS, even if reported in the literature as a correlation with possible subsequent complications, which must be explained to the patient with adequate counseling

Pre-eclampsia risk monitoring and alert system using machine learning and IoT

K. Shanmugam — 2024-01-25

After 20◦weeks of gestation, pre-eclampsia is characterized by newly developing hypertension. Preventative interventions only moderately lower a woman’s risk of pre-eclampsia due to its prevalence, the risk variables that have been found to be accurate in predicting its beginning, and the occurrence of pre-eclampsia. The signs and symptoms typically become visible toward the end of pregnancy (late second to early third trimester). Some of these tests are straightforward, while others are invasive; some have undergone significant research, while others are still being investigated in clinical settings. Pre-eclampsia has been linked, in particular, to cardiovascular sequelae in the fetus, such as hypertension and impaired vascular function. In our project, a system and an algorithm for evaluating the health status of pregnant women are proposed. Pre-eclampsia can cause major diseases and issues during pregnancy; thus, the system’s goal is to diagnose the condition early and monitor its risk. Our research examines the diagnostic options for early risk assessment to identify pregnant women at high risk for pre-eclampsia and the possible advantages for the women, the unborn child, and health-care systems. A system like this will be widely used in clinical obstetric practice. It is designed to be implemented to monitor pregnant women’s status updates through the Internet of Things based on machine learning.