Mettler L, Abdusattarova K. Tissue Extraction and Morcellation: The Menace of Unexpected Malignancy. Int J Gynecol Endsc 2017;1(1):1-4.

A total of 100 women underwent combined diagnostic laparoscopy and simultaneous diagnostic hysteroscopy during the period from January 2015 to December 2015 in the Obstetrics and Gynecology Department, Umaid Hospital, Dr. Sampurnanand Medical College, Jodhpur, Rajasthan, India.

Age ranged from 21 to 38 years, and mean age was 25.98 years. Abnormal laparoscopic findings were noted in 41% cases, abnormal hysteroscopy seen in 24% cases, and 17% cases showed abnormality in both. Bilateral tubal patency was demonstrated in 81% cases. Tubal blockage was bilateral in 5% and unilateral in 9% cases. In 2% cases, bilateral block with beaded appearance found suggestive of tuberculosis. Of total 100 cases, 12% cases were found to have endometriosis, 8% had polycystic ovarian syndrome (PCOS), chocolate cyst was found in 5% cases, and 7% had functional cyst of ovary. Pelvic adhesions were found in 15% patients. Myomas were found in 8% cases. Endometrial polyps were revealed in 5% and Asherman’s syndrome in 6% patients. Combined laparoscopy and hysteroscopy was diagnostic in 17% of cases, 41% were diagnosed through laparoscopy alone, 24% through hysteroscopy alone, while in 18% cases findings were normal. In our study, tuboperitoneal factors were responsible for infertility in 40% cases, ovarian factors in 26% cases, and PCOS in 8% cases.

In our study, 74% of the cases had some form of tubo-ovarian pathology, which makes laparoscopy an essential tool of infertility workup. Although hysteroscopy alone was diagnostic in 30% of cases, its simultaneous use with laparoscopy provides cost-effective, comprehensive, and single setup diagnostic aid in these kinds of patients.

Jodha BS, Chawla P. Study of Combined Laparoscopic and Hysteroscopic Findings in 100 Cases of Infertility. Int J Gynecol Endsc 2017;1(1):5-10.

Success of induction depends largely on cervical ripening and increases the likelihood of vaginal delivery. This study compared the outcomes for induction of labor using extra-amniotic saline infusion (EASI) vs intracervical dinoprostone gel.

Primary: To compare improvement between pre- and post-induction Bishop’s scores in both the groups.

Secondary: To compare induction to delivery interval, mode of delivery, and neonatal outcome in both the groups.

A randomized controlled trial of 1 year was conducted in the Department of Obstetrics and Gynaecology, Karnataka Lingayat Education University Dr Prabhakar Kore Hospital and Medical Research Centre, Belagavi, Karnataka, India, on 82 pregnant women from January 2014 to December 2014. The selected women were divided into two groups of 41 each as group I (induced with dinoprostone) and group II (induced with EASI using Foley’s catheter).

Significantly higher number of women had postinduction Bishop’s scores between 9 and 12 in the dinoprostone group (70.73%; p < 0.001). The mean Bishop’s scores were significantly high in the dinoprostone gel (9.27 ± 3.07) vs EASI (8.22 ± 2.34; p = 0.086). Cervical ripening based on cut-off score of ≥6 was noted in a significantly higher number of women (92.68%) in EASI (p = 0.241). The mean time for cervical ripening was significantly high in dinoprostone gel group compared with EASI (15.44 ± 8.41 vs 3.88 ± 3.67; p < 0.001), but mean induction to delivery time was comparable (p = 0.086). Significantly higher numbers of vaginal deliveries were noted in dinoprostone group (91.43%; p = 0.001). The neonatal outcomes, i.e., birth weight, mean birth weight, appearance, pulse, grimace, activity, and respiration score at 1 and 5 minutes, and neonatal intensive care unit admission, were comparable (p = 0.570).

Dinoprostone gel and EASI using Foley’s catheter appear to be effective methods for cervical ripening and labor induction, but dinoprostone gel yielded significantly higher rate of vaginal delivery.

Rodrigues SV, Swamy MK, Jadhav N. A Randomized Controlled Trial of Extra-amniotic Saline Infusion vs Intracervical Dinoprostone Gel for Induction of Labor. Int J Gynecol Endsc 2017;1(1):11-17

Large ovarian cysts are conventionally managed by laparotomy. This study was undertaken to assess the feasibility and outcome of laparoscopic surgery for the management of large ovarian cysts.

Rural teaching hospital – prospective study.

Thirty-eight patients from January 2014 to December 2016 presumed to be with large ovarian cyst were managed laparoscopically. Preliminary evaluation suggestive to be of benign ovarian cyst by history, clinical examination, sonographic imaging, and basic serum marker were only included in this study. The cysts were aspirated initially, followed by cystectomy, oophorectomy, or total hysterectomy depending on age, parity, coexisting pathology, and desire for future fertility.

Out of 38 cases, 6 were nonovarian adnexal masses. Eight of the 32 cases who presented with pain due to torsion were managed on emergency basis; rest of the cases were operated electively. Mean operating time was 90 minutes. Mean size of the cyst was 16 cm. One case of borderline malignancy was detected and the rest showed benign pathology. Six of the cases required minilaparotomy for specimen removal. Most women were successfully treated laparoscopically without any complications, and conversion to laparotomy was required in three cases.

With proper patient selection and exclusion of malignancy, laparoscopic management of large ovarian cyst by gynecologist is feasible.

Beeresh CS, Doopadapalli D, Vimala KR, Lingegowda K. Laparoscopic Management of Large Ovarian Cysts. Int J Gynecol Endsc 2017;1(1):18-21.

To assess the feasibility and outcome of laparoscopic myomectomy and multiple-layer closure of myoma bed for management of myomas at a tertiary care hospital.

Five hundred and ten patients from January 2011 to January 2017 with large and moderate size myomas were managed by laparoscopic myomectomy. Indications were subfertility, menorrhagia, and abdominal mass. Preoperative evaluation included history, clinical examination, and sonographic mapping. Myomas were enucleated and retrieved laparoscopically. Myoma beds were sutured in multiple layers by endoscopic intracorporeal suturing. Fluid as adhesion barrier was used.

Three hundred and eighty two patients presented with subfertility, 69 with menorrhagia, and 59 with abdominal mass. The average maximum diameter of myoma was 9.1 cm. The mean duration of surgery was 90 minutes. The mean postoperative stay was 24 hours. No intraoperative complication occurred and the hospital course was uncomplicated. In seven cases, minilap incision was given for retrieval of myoma and suturing of the bed. Two patients had minor delayed wound healing of the morcellator port site. The patients did not report any complaints during follow-up except one patient who developed omental hernia at morcellator port site. There was no rupture of scar and very low adhesion scores in subsequent cesarean sections or second look scopies.

With proper multilayer closure of the myoma bed, laparoscopic myomectomy is feasible for moderate and even large myomas and has good outcomes in terms of fertility and alleviation of symptoms.

Jain N, Singh S. Multiple-layer Closure of Myoma Bed in Laparoscopic Myomectomy. Int J Gynecol Endsc 2017;1(1):22-27.

Agarwal M, Kashyap M, Meshram S. A Case of Laparoscopically Managed Myometrial Scar Ectopic Pregnancy. Int J Gynecol Endsc 2017;1(1):28-31.

Jain N, Singh S. Bartholin Gland Endometriosis. Int J Gynecol Endsc 2017;1(1):32-34.

Spontaneous abortion has been reported in 15 to 20% of all diagnosed pregnancies. The most common cause of spontaneous abortion is chromosomal abnormalities of the embryo. Robertsonian translocation is one of the major chromosomal rearrangements with a prevalence rate of 0.1% of the general population and 1% of the infertile population. Robertsonian translocation carriers especially 21,14 are the most common balanced rearrangements among the carrier couples with a history of spontaneous abortion.

Cytogenetic evaluation of both the partners and the child revealed that the child had translocated Down’s syndrome and the mother was carrier of balanced Robertsonian translocation of 14q;21q. Amniocentesis of the next pregnancy and detection of chromosomal abnormality in the fetus were done by fluorescence in situ hybridization (FISH) analysis of the amniotic cells with 13,18,21,X,Y probe mix.

The present case study shows that genetic counseling, cytogenetic evaluation, prenatal diagnosis by amniocentesis, and FISH together help couples with nonhomologous RT and history with syndromic child and repeated abortions to get normal offspring.

De P, Chakravarty S, Chakravarty A. Invasive Pre- and Postnatal Genetic Evaluation reduces the Reproductive Risk in the Era of Noninvasive or Minimally Invasive Prenatal Screening Method. Int J Gynecol Endsc 2017;1(1):35-39.

Jain N, Varshney S. Ectopic Pregnancy in Isthmocele: A Report of Unrecognized Case. Int J Gynecol Endsc 2017;1(1):40-43.

Raikwar P, Jain V, Raikwar R. Ruptured Ovarian Ectopic Pregnancy after Interval of Tubal Ligation. Int J Gynecol Endsc 2017;1(1):44-45.

Jain N, Hakim M. Cystic Degeneration of Fibroid following Mifepristone. Int J Gynecol Endsc 2017;1(1):46-49.

Agarwal M, Hegde S, Sawapure N. Leiomyosarcoma in a Posthysterectomy Patient. Int J Gynecol Endsc 2017;1(1):50-52.

Kotdawala S, Patel U, Tanna B, Kotdawala P. Ovary in Inguinal Hernia. Int J Gynecol Endsc 2017;1(1):53-55.