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Adhesion development is the most common sequelae of intra-abdominal and pelvic surgery. Using a good surgical technique is advocated as a first step in preventing adhesions. However, the evidence for different surgical techniques to reduce adhesion formation needs confirmation. This review contributed to the growing knowledge pool by elucidating factors that potentially predispose to the development of adhesions. A literature search was performed using the PubMed database for all relevant English language articles and were reviewed with particular attention to predisposing factors to post-operative adhesion development. In addition, the reference lists of each article were reviewed to identify additional relevant articles. Various factors have been shown to directly increase the risk of post-operative adhesion development; namely, certain genetic polymorphisms in the interleukin-1 receptor antagonist, increased estrogen exposure, and endometriosis. There were 28 papers with 27 studies included for a systematic review. Of these, 17 studies were eligible for meta-analysis and 11 for qualitative assessment only. None of the techniques that were compared significantly reduced the incidence of adhesive small bowel obstruction. In a small low-quality trial, the pregnancy rate increased after subserous fixation of suture knots. However, the incidence of adhesions was lower after laparoscopic compared with open surgery (relative risk (RR): 0.14; 95% confidence interval (CI): 0.03-0.61) and when the peritoneum was not closed (RR: 0.36; 95% CI: 0.21-0.63). None of the specific techniques that were compared reduced the two main adhesion-related clinical outcomes, small bowel obstruction and infertility.

Background: Mifepristone and Dinoprostone are used in inducing labour in pregnancy by acting as cervical ripening drugs. A randomized case control study to evaluate the efficacy, safety and fetomaternal outcome of induction of labour with oral Mifepristone and intracervical Dinoprostone gel was done.Methods: About 300 patients were included after taking informed consent. 150 patients were placed in each group A and B. In group A patients received 200 mg oral Mifepristone tablet and in group B 0.5 mg Dinoprostone gel was given intracervically and 2nd dose was repeated after 6 hours later if adequate uterine contractions were not achieved. A detailed analysis was carried out in both groups regarding efficacy and safety of drugs in terms of necessity of augmentation of labour with oxytocin, induction to delivery interval, fetal outcome in terms of NICU admission.Results: 59.33% cases in Mifepristone group and 72% case in Dinoprostone group required augmentation with oxytocin. Mean induction delivery interval in Mifepristone group in primigravida was 17.998±1.128 hrs and mean induction delievery interval in multigravida was 11.648±1.112 hours. 88% cases in mifipristone group and 80% cases in Dinoprostone group delivered vaginally. NICU admission was 1.33% in Mifepristone group and 2.66% in PGE2 gel group.Conclusions: Mifepristone when compared with intracervical Dinoprostone gel, acts as a better cervical ripening agent and requires lesser need for Oxytocin augmentation. Though, mean induction delivery interval was more with Mifepistone, the incidence of successful vaginal delivery was higher as compared to Dinoprostone.

Background: Dysfunctional Uterine Bleeding (DUB) is the most common cause of abnormal uterine bleeding and is a major indication for referral to gynecological clinics. There are very few studies comparing the effect of ormeloxifene and progesterone in DUB. The objective of the study was to assess the efficacy and safety of Ormeloxifene in DUB and compare it with Norethisterone. Methods: Hundred women presenting with DUB were randomly allocated to 2 equal groups, Group-A, which received 60mg ormeloxifene twice a week for 12 weeks followed by 60mg once a week for next 12 weeks and Group-B, which received 5mg norethisterone twice daily for 21 days for 6 cycles. The primary outcomes were reduction in menstrual blood loss [measured by fall in PBAC (Pictorial Blood loss Assessment Chart) score and subjective assessment], rise in hemoglobin level and decrease in endometrial thickness. Results: The reduction in mean PBAC score with ormeloxifene (216 to 88) was significantly more than with norethisterone (262 to 162) at 3 months (p

Background: In India, many couples complete their families by the age of 25 to 30 years and opt for tubal sterilization as a method of family planning in spite of availability of other spacing methods. Due to unforeseen circumstances, 10 % of them regret their decision and about 1% want to restore their fertility due to various reasons like loss of only child, loss of male child, desire to have more children, loss of children in natural calamities, remarriage and other socioeconomic factors. The objective of the present study was to analyze various factors which are involved in pregnancy rate in tubal recanalization.Methods: 31 women undergoing microsurgical tubal recanalization by mini laparotomy in RRMCH, Bengaluru during a study period of 2 year from 2014 -2016 were followed up for a period of 2 years by telephonic conversation.Results: An overall 67.7 % pregnancy rate was achieved with microsurgery technique.Conclusions: The important factors determining the success of operation were age of the patient, method of previous ligation and the remaining length of tube after recanalization. The microsurgical technique should be available at specialized centres to improve the success of family planning services and also this could be the hope for hopeless.

Background: Objective of present study was to evaluate the efficacy and safety of intravenous bolus iron sucrose for iron deficiency anemia during pregnancy during second and third trimester women presenting at S.N. medical college, Agra.Methods: It was a prospective controlled trial and study was carried out in Department of Obstetrics and Gynecology, S.N. medical college, Agra in the year 2014-2016. 100Pregnant women with proved iron deficiency anemia having hemoglobin between 4-9gm/dl was included in this study. Total Iron deficit was calculated by standard formula. Target haemoglobin was 11gm/dl. Iron sucrose was administered by intravenous bolus and intravenous infusion techniques. Hemoglobin was repeated at 2 weeks, 4 weeks and 8 weeks after the last dose of intravenous iron sucroseResults: In Group A (bolus group n=50) 22 women had gestational age >24-28weeks and 20 women gestational age >18-24 weeks, with Mean gestational age of 24.36±3.78 weeks. In Group B (infusion group n=50) most of the patients 24 (48%) had gestational age >24-28 weeks, 18 (36%) had gestational age >18-24 weeks, with Mean gestational age of 24.94±3.51 weeks. Target hemoglobin was achieved in group A in all 50 (100%) cases and in group B in 49 (98%) cases. There were no allergic reactions.Conclusions: This study showed a significant improvement in the hemoglobin of the patients after receiving intravenous bolus and intravenous infusion of iron sucrose. Patients achieved the target hemoglobin of 11gm/dl. Both therapies are safe, effective and faster acting for the treatment of iron deficiency anaemia during pregnancy. The bolus push technique is more convenient to women and care provider, less time consuming as well as cost effective.

Background: Iron deficiency is the most common nutritional deficiency worldwide. Anemia is the most common treatable, direct/indirect cause of maternal and neonatal morbidity and mortality in developing countries like India. Methods: 100 cases with iron deficiency anemia in post-partum patient were selected from postpartum wards and assigned in two groups of 50 each. In group A iron carboxymaltose injection administered by intravenous infusion up to a maximum single dose of 20 ml of iron carboxymaltose injection (1000 mg of iron). In group B Iron sucrose was given as 200mg elemental iron (2 ampules of 5 ml) in 100ml of 0.9% normal saline infusion over 1 5 min alternate days up to 5 days. All patients were monitored for rise in hemoglobin level and any adverse effect at 2 weeks, 4 weeks, 8 weeks and 12 weeks of iron therapy. Results: In group A mean Hemoglobin level rise is 3.95 g/dl and in group B it is 3.32 g/dl at 4 weeks of initial therapy. In group A 100% cases achieved target hemoglobin at 12 weeks after therapy while in group B 98% cases achieved target hemoglobin at 12 weeks after therapy. In group A 12% cases have grade 1 adverse reaction while in group B 20% cases have adverse reaction. Conclusions: Administration of intravenous iron has a good clinical result, with minimum adverse reactions. Thus we can conclude that intravenous ferric carboxymaltose therapy is safe, convenient, more effective and faster acting than intravenous iron sucrose for treatment of severe iron deficiency anemia in postpartum patient.