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1.  A rare case of Endometriosis in vaginal hysterectomy scar 
Presented hereunder is probably the first reported case of endometriosis at the vaginal apex following vaginal hysterectomy. No other similar case could be traced in the review of the literature.
doi:10.1186/1750-1164-7-6
PMCID: PMC3707828  PMID: 23816336
Endometriosis; Vaginal Hysterectomy; Vault
2.  A Rare Case of Retroperitoneal Leiomyoma 
Case Reports in Surgery  2012;2012:425280.
Introduction. Leiomyoma uteri is one of the most common benign conditions for which women undergo hysterectomy every year. Fibroids found retroperitoneally are a rare entity, especially, primary retroperitoneal fibroid. Case Presentation. We report a case of 42-year-old para 1 who presented to our hospital with recurring retention of urine, lower abdominal and pelvic pain, and dyspareunia . Provisional diagnosis on the basis of examination and imaging was large subserosal fibroid with mild right-sided hydroureteronephrosis, due to pressure effect of the fibroid. Abdominal hysterectomy was done for the patient, and intraoperatively, a bulky uterus was found with multiple small fibroids on anterior and posterior walls, and a large fibroid approx. 10 × 8 cm was found arising from the posterior surface at the level of internal os retroperitoneally, which was confirmed by histopathology as leiomyoma. Conclusion. Retroperitoneal fibroids are rare neoplasms and treatment is surgical removal. Preoperative imaging can only give provisional diagnosis and can be misguiding. Final diagnosis of retroperitoneal fibroid can be made only intraoperatively.
doi:10.1155/2012/425280
PMCID: PMC3415088  PMID: 22900220
3.  At times, myomectomy is mandatory to effect delivery 
Background
Excision of a leiomyoma has never been a choice during caesarean section.
Method
Myomectomy of a massive fibroid was necessitated prior to delivering the baby.
Results
Delivery of a healthy was effected by Classical caesarean section.
Conclusion
Leiomyoma in pregnancy is not an unknown entity and is a cause of concern for being a source of excruciating pain, at times, during the ongoing gestation.
Although performed rarely, it is sometimes necessary to remove a large myoma to effect delivery of the baby during Cesarean section as is depicted in the case being presented hereunder.
doi:10.1186/1750-1164-5-9
PMCID: PMC3217843  PMID: 22035449
pregnancy; leiomyoma; myomectomy
4.  Shortening the induction delivery interval with prostaglandins: a randomized controlled trial of solo or in combination 
Objective
To compare the efficacy and safety of misoprostol alone with dinoprostone followed by misoprostol, all inserted intravaginally in induction of labor at term and the obstetrical outcome.
Material and Methods
A pilot study comprising 111 primigravidae, >37 gestational weeks with singleton pregnancy in cephalic presentation having an unfavorable Bishop score admitted for labor induction, were considered and randomly allocated into two groups. In group I (n=55) with intravaginal 25mcg misoprostol 4 hourly (six doses at the most) and and group II (n=56), with dinoprostone 0.5mg followed eight hours later by 25mcg misoprostol induction to vaginal delivery time was found to be significantly different, being 14.8 h in group-I and shorter in group-II with a mean of 11.6 h. Vaginal delivery rates within 12 h (groups-I and −II: 47.2%, as compared to 60.7%, respectively) were found to be higher with dinoprostone-misoprostol induction, as well as vaginal delivery rates in 24 h, 80.0% and 91.1%. The need for oxytocin augmentation was more frequent in the misoprostol than in the dinoprostone-misoprostol group, (61.8%, and 39.3%), and all these observations were statistically significant. Abnormal foetal heart rate pattern occurred more frequently (18.2%) in group-I in contrast to 5.3% in group-II, as was the incidence rate of (18.2%) who had passage of meconium in group-I, this rate being significantly different from group-II having meconium passage in 3 cases, a rate of 5.3%.
Conclusion
Using dinoprostone followed by vaginal misoprostol is safe and effective for induction of labor with less need for oxytocin augmentation and shorter induction delivery interval.
doi:10.5152/jtgga.2011.20
PMCID: PMC3939111  PMID: 24591967
Labor induction; prostaglandin; intravaginal
5.  An effective and safe innovation for the management of vault prolapse 
Objective
Considering the great variety of techniques and disagreement about the ideal route, there is a need for a simple, safe and effective method for the management of vault prolapse.
Study Design
51 cases of post- hysterectomy vault prolapse: 45 following vaginal and 6 after total abdominal hysterectomy were treated surgically by anterior abdominal wall colpopexy with autogenous rectus fascia strips.
Results
Except for minor complaints like vomiting, fever and urinary retention in 3.92% cases each (n = 2 each), no major complications were encountered. Moreover, no recurrence, thus far, on follow-up.
Conclusion
Using autogenous rectus fascia strips in anterior abdominal wall colpopexy is not only simple, cheap and effective method of treating apical prolapse but is also devoid of any serious complications as described with other techniques.
doi:10.1186/1750-1164-4-6
PMCID: PMC2967552  PMID: 20958980
6.  Is uterine prolapse a cause of primary infertility? 
Presented in this report is apparently the first case of its kind in the medical literature where a woman with 11 years of primary infertility not only conceived following conservative surgery for uterine prolapse but also had a successful obstetrical outcome.
doi:10.5152/jtgga.2010.25
PMCID: PMC3939225  PMID: 24591924
Uterine prolapse; primary infertility; cervicopexy
7.  Rectus fascia colpopexy for post-hysterectomy vault prolapse: a valid option 
Objective
Considering the great variety of techniques and disagreement about the ideal route, there is a need for a safe, simple and effective method for the management of apical prolapse.
Material and Methods
Twenty seven cases of post- hysterectomy vault prolapse (twenty four following vaginal and three after total abdominal hysterectomy) were treated surgically by anterior abdominal wall colpopexy with autogenous rectus fascia strips.
Result
Except for minor complaints like- vomiting, fever and urinary retention in 3.7% cases each (n=1), no major complications were encountered. Moreover, no recurrence, on follow-up thus far.
Conclusion
Using autogenous rectus fascia strips in anterior abdominal wall colpopexy is not only a simple, cheap and effective method of treating vault prolapse but is also devoid of any serious complications such as described with other techniques.
doi:10.5152/jtgga.2010.01
PMCID: PMC3939092  PMID: 24591901
Vault Prolapse; rectus fascia; enterocoele
8.  Shortening the second stage of labor? 
Objective
To evaluate the benefits and risks of using uterine fundal pressure in shortening the second stage of labor and on the obstetrical outcome.
Material and Methods
A pilot study comprising 209 primigravidae between 37 and 40 gestational weeks with singleton fetus in cephalic presentation admitted to the delivery suite were considered and were randomly allocated into two groups: I (n=101) and II (n=108), with or without manual fundal pressure, respectively, during the second stage of labor. Main observation measures considered were: duration of the second stage of labor was the primary outcome measure and the secondary outcome measures were severe maternal morbidity/mortality, neonatal trauma, admission to neonatal intensive care unit, and neonatal death.
Results
There were no significant differences in the mean duration of the second stage of labor and secondary outcome measures. Significant adverse findings having no mention in the earlier literature, were noticed which were: one case each of retained placenta and uterine prolapse besides increased evidence of maternal exhaustion and perineal injuries (including one case of complete perineal tear) in the group where fundal pressure was exercised.
Conclusion
Application of uterine fundal pressure in a delivering woman was not only ineffective in shortening the second stage of labor but added to the risks during parturition.
doi:10.5152/jtgga.2010.07
PMCID: PMC3939098  PMID: 24591907
Fundal pressure; second stage; perineal injuries
9.  Preservation of fertility following abnormally adherent placenta treated conservatively: a case report 
Cases Journal  2009;2:9349.
Introduction
One of the ensuing complications of placenta accreta includes loss of fertility.
Case presentation
An Asian origin Indian national patient with history of placenta accreta at the time of previous delivery and had conservative management with injection methotrexate after the failure of surgical intervention, conceives again and has uneventful antenatal period and parturition.
Conclusion
Conservative strategy of leaving the excessively adherent placenta in-situ alongwith adjuvant therapy in the form of injection methotrexate, not only prevents dreadful complications but also retains fertility in haemodynamically stable patients desirous of future pregnancy.
doi:10.1186/1757-1626-2-9349
PMCID: PMC2804001  PMID: 20062601
10.  Hysterectomy through minilaparotomy for benign gynaecological conditions: a valid option 
Objective
Efforts are continuously being made for surgery to be less invasive with a minimal access approach. This article reports our experience with minilaparotomy hysterectomy in patients with benign gynecological disease or preinvasive pathology.
Material and Methods
A prospective study to analyse the outcome and per-operative and post-operative complications was conducted in 69 patients undergoing hysterectomy by the minilaparotomy approach through 4–5cm Pfannenstiel incision.
Results
The mean operating time and postoperative hospital stay were 41.3 min and 3.1 days, respectively. Composite morbidity was encountered in 12 women (17.4%) with no major complications or mortality. None of the patients had an estimated blood loss over 500ml.
Conclusion
Minilaparotomy hysterectomy in benign gynecological disease provides an appealing, effective, expeditious, minimal access and cost-effective option/alternative to the traditional abdominal hysterectomy. It obviates the need for any additional expensive equipment and above all improves upon the per-operative and post-operative outcomes without compromising, whatsoever, the quality of surgery.
PMCID: PMC3939167  PMID: 24591874
Hysterectomy; minilaparotomy; Pfannenstiel incision

Results 1-10 (10)