Answering Clinical Questions Improves Patient Safety

  • What are the causes of excessive bleeding during menstrual cycle?

    • Fibroid uterus
    • Polyps
    • Dysfunctional uterine bleeding
    • Foreign body in uterine cavity
    • Genital cancers of as uterus & cervix

  • How to diagnose these problems?

    Pelvic examination
    • Ultrasonography
    • Hysteroscopy
    • D&C Biopsy
    • Colposcopy & Cervical biopsy
    • MRI
    • Laboratory Investigations

  • How to treat?

    How to treat?

    Medical –Only for benign conditions ( Non cancerous)
    • Surgical:
    I) D&C
    II) TABC – Thermal Balloon Ablation of Endometrium.
    III) TCRE – Trans cervical Resection of Endometrium.
    IV) HYSTERECTOMY
    V) Radical Hysterectomy malignant (Malignant or Causes)

  • What is Hysterectomy?

    What is Hysterectomy?

    Removal of uterus (womb)

  • What are various types of Hysterectomy?

    What are various types of Hysterectomy?

    1. Laparoscopic removal of uterus (Laparoscopic Hysterectomy)
    a) Total Laparoscopic Hysterectomy (TLH)
    b) Laparoscopic Assisted Vaginal Hysterectomy (LAVH)
    2. Total Abdominal Hysterectomy
    3. NDVH-Non descent Vaginal Hysterectomy
    4. Vaginal Hysterectomy

  • What are the indications of hysterectomy?

    What are the indications of hysterectomy?

    1. Fibroids.
    2. Prolapse
    3. Heavy uterus bleeding.
    4. Cancers of uterus and cervix.

  • What is laparoscopic Hysterectomy and its benefits?

    What is laparoscopic Hysterectomy and its benefits?

    The separation of uterus through multiple ports (key holes) in the abdominal wall & removal of uterus through the birth canal (normal passage)
    Benefits
    i) Quick recovery time.
    ii) Less painful – Post surgery.
    iii) Cosmetically better.
    iv) Less blood loss during surgery.

  • What are the other procedures which can be done laparoscopically?

    What are the other procedures which can be done laparoscopically?

    i) Ovarian cysts.
    ii) Ectopic pregnancy – Pregnancy in tubes or outside uterus.
    iii) Infertility
    a) Ovarian drilling
    b) Tubal cannulation
    iv) Myomectomy

  • Is this operation painful and Does it require hospitalization?

    Is this operation painful and Does it require hospitalization?

    No, as a comfortable anaesthesia is given to do the Operation. Preferably, it is done under general anaesthesia.

    Does it require hospitalization?

    It depends on the type of surgery. Some surgeries may be require an overnight stay.

  • When can I go back to normal work & How much pain, does one feel post-surgery?

    When can I go back to normal work & How much pain, does one feel post-surgery?

    Varying on the type of surgery & condition of the patient. Doctor will advice you on how soon you can return to work.

    How much pain, does one feel post-surgery?

    It depends on a patient’s tolerance level. In pain medications are prescribed for the post-surgery patients.

    When can I get back to routine exercises?

    This again depends on the type of surgery performed. All patients are suggested to start a slow walking routine on the second day of post-surgery day. She keeps on increasing the exercises depending on her convalescence.

  • Is it must to get treatment of fibroid uterus?

    Is it must to get treatment of fibroid uterus?

    No, all patients diagnosed to be having fibroid uterus need not be treated. A symptom less patient whose fibroid is a coincidental finding while investigating for something else should be left untouched. Only fibroids causing symptoms like:

    a) excessive bleeding
    b) Infertility
    c) Pressure symptoms
    d) Sudden enlargement
    e) Appearance of degenerative changes
    f) It becomes painful
    g) Cancerous changes which are mostly sarcomatous.
    h) Very big fibroids causing abdominal distension need to be treated surgically.

    What is the treatment of fibroid uterus?

    There is no permanent medical treatment of fibroids.
    Surgical treatment is HYSTERECTOMY i.e. removal of uterus and MYOMECTOMY i.e. removal of fibroids only.

INFERTILITY
  • When should I contact a doctor for not able to conceive after marriage?

    When should I contact a doctor for not able to conceive after marriage?

    When after one year of cohabitation i.e. living together after marriage if a couple doesn’t conceive should report to a doctor for investigation or report earlier if the female partner has irregular menstrual cycle.

  • What is infertility?

    What is infertility?

    Infertility is not able to conceive which may be because of many factors.
    • Male Factors
    • Female Factors
    • Factors from both partners

    Male Factors:

    Azoospermia
    Oligospermia
    Asthenospermia
    pyospermia
    Blockage in the ducts that carry sperm
    Physical problems with the testicles
    Hormonal problems
    Genetic disorder
    Lifestyle or environmental factor
    a) Addiction of smoking
    b) Excessive drinking
    c) More stress
    d) Working in hot places
    e) Wearing tight clothes

    Female Factors:

    Uterine
    a) Congenital Abnormality
    I. Small Uterus ( Hypo-plastic Uterus )
    II. Septum of Uterus
    III. Double Uterus
    b) Synechiae Uterus
    c) Polyp of Endometrial Cavity
    d) Fibroid Uterus
    e) Tuberculous Endometritis
    f) Foreign body

    Tubal

    a) Hydrosalpinx
    b) Pyosalpinx
    c) Blocked Tubes

    Ovarian

    a) Hyoovalation
    b) Anovulation
    c) PCOD
    d) Ovarian Cysts

    Harmonal Factors

    a) Thyroid Diseases
    I. Hypothyroidism
    II. Hyperthyroidism
    b) Ovarian Hormonal imbalance
    c) Hypothalamic Factors
    d) Hyperprolactinaemia

    Others

    a) Endometriosis
    b) Adhesions in ‘Pouch of Douglas’ (POD)
    c) Previous abdominal surgery

  • What all tests / investigations are required for infertile couple?

    What all tests / investigations are required for infertile couple?

    A) Investigations for the male partner
    a) Semen examinations
    b) Testicular biopsy if azoospermic (FNAC OR INCISION BIOPSY)
    c) Male hormonal study
    d) Routine blood investigations.

    B) Investigation for the female partner
    a) Routine blood investigations
    b) Female hormonal study
    c) Follicular study
    d) HSG/ SSG
    e) PCR for tuberculous endometritis.

    Is a female partner alone getting investigated is enough?

    No as already mentioned infertility can be from both partners. So investigation for both the partners is mandatory.

  • What is HSG & SSG?

    What is HSG & SSG?

    HSG stands for HYSTEROSALPINGOGRAPHY. It is a test to know the patency of the fallopian tubes. It is done by injecting a dye in the uterus through cervix by inserting a cannula under screening and taking X-RAYS. In normal patent tubes the dye should freely move from uterus to fallopian tubes and should be seen in the peritoneal cavity i.e. abdomen. If we don’t see the dye in the tubes then it shows that tubes are blocked.

    What is SSG?

    SSG stands for SONOSALPINGOGRAPHY, which is done by putting a dye/saline through the cervix and the movement of the dye through the tube is visualised under ultrasound.

  • What is ectopic pregnancy?

    What is ectopic pregnancy?

    Pregnancy which is outside uterus is ectopic pregnancy. The various common sites are:

    A) Fallopian tubes
    B) Ovaries
    C) Broad ligament
    D) In the abdomen