Bhaswati Ghosh - Academia.edu (original) (raw)

Papers by Bhaswati Ghosh

Research paper thumbnail of Comparison of oral naproxen and intrauterine lignocaine instillation for pain relief during hysterosalpingography

International Journal of Gynaecology and Obstetrics the Official Organ of the International Federation of Gynaecology and Obstetrics, Aug 1, 2008

Objectives: To compare the efficacy of oral naproxen with intrauterine instillation of 1% lignoca... more Objectives: To compare the efficacy of oral naproxen with intrauterine instillation of 1% lignocaine for pain relief in women undergoing hysterosalpingography (HSG) as an infertility investigation. Methods: One hundred women undergoing HSG were randomly allocated into 2 groups. Group A (n = 50) underwent intrauterine instillation of 5 mL of 1% lignocaine 2 minutes prior to the procedure, while the women in group B (n = 50) were instructed to self-administer a single oral dose of 375 mg of naproxen 1 hour prior to HSG. Pain scores immediately after the procedure (0 minutes) and delayed pain scores (30 minutes) were recorded and compared. Results: Women in both groups were comparable in age and parity. The mean ± SD pain scores in group A and group B at 0 minutes and 30 minutes were not significantly different (P = 0.12 and P = 0.07). Conclusion: Intrauterine lignocaine was no more effective than oral naproxen for pain relief during HSG.

Research paper thumbnail of Successful management of live ectopic pregnancy with high β-hCG titres by ultrasound-guided potassium chloride injection and systemic methotrexate

Archives of Gynecology and Obstetrics, Feb 20, 2009

Background Methotrexate (Mtx) is accepted modality for conservative treatment of ectopic pregnanc... more Background Methotrexate (Mtx) is accepted modality for conservative treatment of ectopic pregnancy. However, there is no consensus regarding its use in live ectopic pregnancy and high serum beta-human chorionic gonadotrophin ( -hCG) titres. Case report We report a successful management of live ectopic pregnancy in a 27-year-old nulliparous woman, with very high -hCG titres (89,200 mIU/mL), using ultrasound-guided intra-sac potassium chloride (KCl) injection and systemic Mtx. Successful resolution of the ectopic pregnancy, with negative serum -hCG (<1 mIU/mL) was achieved after three doses of Mtx, and a prolonged followup of 71 days. No treatment related complications were encountered. Conclusion Concurrent use of intra-sac hypertonic KCl, to produce cardiac asystole, with systemic Mtx could potentially improve outcome in live ectopic gestations with very high serum -hCG titres. However, individualised treatment, with a stringent follow-up regime is mandatory in such cases.

Research paper thumbnail of Oxidized Cellulose for Epithelialization of Neovagina in Vaginal Agenesis

Journal of Gynecologic Surgery, 2010

... Deepika Deka, MD, and. Suneeta Mittal, MD, FRCOG. Department of Obstetrics & Gynecology, ... more ... Deepika Deka, MD, and. Suneeta Mittal, MD, FRCOG. Department of Obstetrics & Gynecology, All India Institute of Medical ... Immunohistochemical Profile of Tamoxifen-Related Uterine Adenosarcomas. Greg Berman, Kelly J. Manahan, John P. Geisler Journal of Gynecologic ...

Research paper thumbnail of Comparison of Lignocaine Gel–Soaked Falope Rings vs Rectal Diclofenac Suppository for Pain Relief in Laparoscopic Sterilization

Journal of Minimally Invasive Gynecology, 2011

To compare the analgesic efficacy of lignocaine gel-soaked Silastic bands compared with rectal di... more To compare the analgesic efficacy of lignocaine gel-soaked Silastic bands compared with rectal diclofenac suppositories in patients undergoing interval laparoscopic sterilization under conscious sedation. Prospective, randomized, controlled, single-blinded, clinical trial. Day-case center in a tertiary care hospital in India. Ninety-six women undergoing interval laparoscopic sterilization using Silastic bands (Yoon rings) randomly allocated by computer-generated random numbers into 3 groups. All women received intravenous sedation with injection diazepam and pentazocine along with local infiltration lignocaine injected at the site of the incision meant for insertion of the single site laparocator. In group 1 (n = 32), the Silastic bands (Falope rings) were presoaked in 2% sterile lignocaine gel; in group 2 (n = 32), women received a 100-mg rectal diclofenac suppository while on the operating table; and women in group 3 received only conventional analgesic. Pain perception was assessed using an 11-point visual analog score just after the procedure while still on the table (zero minutes), at 30 minutes and 1 hour after the procedure, and at discharge. The women in all 3 groups were comparable insofar as age and parity. At zero minutes (while on the operating table), the pain score in all 3 groups was similar. However, the pain scores at 30 and 60 minutes, and at discharge were significantly lower in groups 1 and group 2 compared with group 3. However, 2 women (6.25%) in group 2 and 6 (18.75%) in group 3 required supplemental analgesia within 1 hour, and were administered a 500-mg oral dose of mefenamic acid. The need for further analgesia was significantly lower in groups 1 and 2 compared with group 3 (p = .02). Comparison of groups 1 and 3 revealed that in group 1, the pain scores were significantly lower at 30 minutes (p = .02), 1 hour (p = .005), and at discharge (p = .004). No patients in group 1 requested analgesia, whereas 6 women in group 3 asked for further analgesia within an hour postoperatively (p = .01). Similarly in groups 2 and 3, women who received diclofenac suppositories had significantly lower pain scores at the specified intervals (p = 0.02, 0.002, and 0.02, respectively). Application of lignocaine gel to Falope rings and preoperative insertion of a rectal diclofenac suppository are simple and effective measures for pain control in the early postoperative period in patients undergoing day-case laparoscopic sterilization under conscious sedation. Either method could be incorporated into routine practice, depending on patient and physician choice.

Research paper thumbnail of A Case of Colouterine Fistula Managed Laparoscopically

Journal of Minimally Invasive Gynecology, 2008

Fistulas between the uterus and bowel are rarely reported. We report successful laparoscopic mana... more Fistulas between the uterus and bowel are rarely reported. We report successful laparoscopic management of a colouterine fistula caused by a foreign body in the uterus. Fistulas between the gastrointestinal tract and the female genital tract are usually found between the vagina and rectum as a result of complications of childbirth or iatrogenic trauma. Communication between the uterus and bowel is rarely reported. We report successful laparoscopic management of an unusual case of colouterine fistula caused by a foreign body in the uterus.

Research paper thumbnail of Comparison of oral naproxen and intrauterine lignocaine instillation for pain relief during hysterosalpingography

International Journal of Gynecology & Obstetrics, 2008

Objectives: To compare the efficacy of oral naproxen with intrauterine instillation of 1% lignoca... more Objectives: To compare the efficacy of oral naproxen with intrauterine instillation of 1% lignocaine for pain relief in women undergoing hysterosalpingography (HSG) as an infertility investigation. Methods: One hundred women undergoing HSG were randomly allocated into 2 groups. Group A (n = 50) underwent intrauterine instillation of 5 mL of 1% lignocaine 2 minutes prior to the procedure, while the women in group B (n = 50) were instructed to self-administer a single oral dose of 375 mg of naproxen 1 hour prior to HSG. Pain scores immediately after the procedure (0 minutes) and delayed pain scores (30 minutes) were recorded and compared. Results: Women in both groups were comparable in age and parity. The mean ± SD pain scores in group A and group B at 0 minutes and 30 minutes were not significantly different (P = 0.12 and P = 0.07). Conclusion: Intrauterine lignocaine was no more effective than oral naproxen for pain relief during HSG.

Research paper thumbnail of Uterine artery embolization versus laparoscopic occlusion of uterine vessels for management of symptomatic uterine fibroids

International Journal of Gynecology & Obstetrics, 2009

Objective: To evaluate the efficacy and complications of uterine artery embolization (UAE) versus... more Objective: To evaluate the efficacy and complications of uterine artery embolization (UAE) versus laparoscopic occlusion of uterine vessels (LOUV) in the management of symptomatic fibroids. Methods: A pilot randomized clinical trial in which 20 patients with symptomatic fibroids were randomly allocated into two groups. Ten women underwent UAE, and 10 women underwent LOUV. Symptomatic improvement in menorrhagia and reduction in the volumes of the uterus and the fibroid were assessed at 3 and 6 months. Results: The patients were comparable with regard to age and parity. At 6 months, there was no significant difference in the mean reduction in menstrual blood loss, uterine volume, and volume of the dominant fibroid between the two groups (P = 0.436, P = 0.796, P = 1.00, respectively). However, higher pain scores were recorded on day 1 in the UAE group compared with the LOUV group (P = 0.0002). Conclusions: The effects of UAE and LOUV in the management of symptomatic fibroids are comparable. The main advantage of LOUV is less postoperative pain compared with UAE.

Research paper thumbnail of O872 Unsuspected intrauterine pathology diagnosed on hysteroscopic evaluation of infertile women at a tertiary care hospital in India

International Journal of Gynecology & Obstetrics, 2009

Research paper thumbnail of Prediction of perinatal asphyxia with nucleated red blood cells in cord blood of newborns

International Journal of Gynecology & Obstetrics, 2003

To determine normal level of nucleated red blood cells (NRBC) per 100 white blood cells (WBC) in ... more To determine normal level of nucleated red blood cells (NRBC) per 100 white blood cells (WBC) in cord blood of term non-asphyxiated newborns and to investigate variations in NRBC counts in perinatal asphyxia. Methods: A total of 75 cases were studied. Levels of NRBC per 100 WBC in umbilical venous blood were compared between 26 asphyxiated newborns (group I) and 49 non-asphyxiated newborns (group II). Correlation with neonatal outcome was also evaluated. Results: The mean ("S.D.) NRBC per 100 WBC level in umbilical blood of newborns in group I was 16.5"6.4, range 3-25; whereas that in group II was 8.6"7.01, range 1-26. This difference was statistically significant (P-0.001). A statistically significant negative correlation existed between NRBC level and markers of acute intrapartum asphyxia, Apgar score and umbilical arterial pH (rsy0.50, P-0.001 and rsy0.48, P-0.001, respectively). Positive correlation was demonstrated with evidence of chronic antepartum asphyxia, presence of pregnancy induced hypertension and intrauterine growth restriction (rs2.66, Ps0.02). A high NRBC count in umbilical blood correlated with poor early neonatal outcome. Conclusions: The level of NRBC per 100 WBC correlates both with acute as well as chronic antepartum asphyxia. Further, it can be used as a reliable index of early neonatal outcome.

Research paper thumbnail of Recurrent ovarian haemorrhage in a girl with congenital factor X deficiency

Research paper thumbnail of Ectopic pregnancy following levonorgestrel emergency contraception

Contraception, 2009

ABSTRACT There are little or no data on the risk of ectopic pregnancy following levonorgestrel tr... more ABSTRACT There are little or no data on the risk of ectopic pregnancy following levonorgestrel treatment as an emergency contraception. We encountered three cases of ectopic pregnancy following the use of levonorgestrel administered peri- or postovulation. Here we report these cases and discuss the clinical and epidemiologic implications of this association. Health providers should be alert to the possibility of an ectopic pregnancy in women who become pregnant or complain of lower abdominal pain after taking levonorgestrel.

Research paper thumbnail of Successful management of live ectopic pregnancy with high β-hCG titres by ultrasound-guided potassium chloride injection and systemic methotrexate

Archives of Gynecology and Obstetrics, 2009

Background Methotrexate (Mtx) is accepted modality for conservative treatment of ectopic pregnanc... more Background Methotrexate (Mtx) is accepted modality for conservative treatment of ectopic pregnancy. However, there is no consensus regarding its use in live ectopic pregnancy and high serum beta-human chorionic gonadotrophin ( -hCG) titres. Case report We report a successful management of live ectopic pregnancy in a 27-year-old nulliparous woman, with very high -hCG titres (89,200 mIU/mL), using ultrasound-guided intra-sac potassium chloride (KCl) injection and systemic Mtx. Successful resolution of the ectopic pregnancy, with negative serum -hCG (<1 mIU/mL) was achieved after three doses of Mtx, and a prolonged followup of 71 days. No treatment related complications were encountered. Conclusion Concurrent use of intra-sac hypertonic KCl, to produce cardiac asystole, with systemic Mtx could potentially improve outcome in live ectopic gestations with very high serum -hCG titres. However, individualised treatment, with a stringent follow-up regime is mandatory in such cases.

Research paper thumbnail of Vaginal misoprostol for cervical priming prior to diagnostic hysteroscopy––efficacy, safety and patient satisfaction: a randomized controlled trial

Archives of Gynecology and Obstetrics, 2009

Objective To evaluate the eVectiveness and safety of vaginal misoprostol for cervical priming pri... more Objective To evaluate the eVectiveness and safety of vaginal misoprostol for cervical priming prior to diagnostic hysteroscopy and to assess impact on pain scores and patient satisfaction. Methods One hundred women undergoing hysteroscopy were randomly allocated into two groups. The study group (n = 50) received 400 g of misoprostol vaginally (self administered) 4-6 h prior to hysteroscopy while the control group (n = 50) did not receive any cervical priming. Primary outcome measured was need for cervical dilatation, analgesia or sedation. Secondary outcomes were pain scores, patient satisfaction and side eVects. Results There was no signiWcant diVerence in the need for cervical dilatation, analgesia or sedation in the two groups (P = 0.25, 0.64 and 0.5, respectively). In addition, there was no diVerence in subjective patient satisfaction (P = 0.70). However, those in the control group recorded a higher pain score (median § SD = 5 § 1.8) when compared to those who received misoprostol (median § SD = 4.5 § 2, P = 0.03). Only two women (4%) had bleeding per vaginum and one (2%) had a slight fever attributable to misoprostol. Conclusion Vaginal misoprostol prior to diagnostic hysteroscopy did not facilitate cervical dilatation. It did eVect a reduction in pain scores, but there was no diVerence in patient satisfaction, need for analgesia or sedation. No signiWcant side eVects were reported.

Research paper thumbnail of Comparison of oral naproxen and intrauterine lignocaine instillation for pain relief during hysterosalpingography

International Journal of Gynaecology and Obstetrics the Official Organ of the International Federation of Gynaecology and Obstetrics, Aug 1, 2008

Objectives: To compare the efficacy of oral naproxen with intrauterine instillation of 1% lignoca... more Objectives: To compare the efficacy of oral naproxen with intrauterine instillation of 1% lignocaine for pain relief in women undergoing hysterosalpingography (HSG) as an infertility investigation. Methods: One hundred women undergoing HSG were randomly allocated into 2 groups. Group A (n = 50) underwent intrauterine instillation of 5 mL of 1% lignocaine 2 minutes prior to the procedure, while the women in group B (n = 50) were instructed to self-administer a single oral dose of 375 mg of naproxen 1 hour prior to HSG. Pain scores immediately after the procedure (0 minutes) and delayed pain scores (30 minutes) were recorded and compared. Results: Women in both groups were comparable in age and parity. The mean ± SD pain scores in group A and group B at 0 minutes and 30 minutes were not significantly different (P = 0.12 and P = 0.07). Conclusion: Intrauterine lignocaine was no more effective than oral naproxen for pain relief during HSG.

Research paper thumbnail of Successful management of live ectopic pregnancy with high β-hCG titres by ultrasound-guided potassium chloride injection and systemic methotrexate

Archives of Gynecology and Obstetrics, Feb 20, 2009

Background Methotrexate (Mtx) is accepted modality for conservative treatment of ectopic pregnanc... more Background Methotrexate (Mtx) is accepted modality for conservative treatment of ectopic pregnancy. However, there is no consensus regarding its use in live ectopic pregnancy and high serum beta-human chorionic gonadotrophin ( -hCG) titres. Case report We report a successful management of live ectopic pregnancy in a 27-year-old nulliparous woman, with very high -hCG titres (89,200 mIU/mL), using ultrasound-guided intra-sac potassium chloride (KCl) injection and systemic Mtx. Successful resolution of the ectopic pregnancy, with negative serum -hCG (<1 mIU/mL) was achieved after three doses of Mtx, and a prolonged followup of 71 days. No treatment related complications were encountered. Conclusion Concurrent use of intra-sac hypertonic KCl, to produce cardiac asystole, with systemic Mtx could potentially improve outcome in live ectopic gestations with very high serum -hCG titres. However, individualised treatment, with a stringent follow-up regime is mandatory in such cases.

Research paper thumbnail of Oxidized Cellulose for Epithelialization of Neovagina in Vaginal Agenesis

Journal of Gynecologic Surgery, 2010

... Deepika Deka, MD, and. Suneeta Mittal, MD, FRCOG. Department of Obstetrics & Gynecology, ... more ... Deepika Deka, MD, and. Suneeta Mittal, MD, FRCOG. Department of Obstetrics & Gynecology, All India Institute of Medical ... Immunohistochemical Profile of Tamoxifen-Related Uterine Adenosarcomas. Greg Berman, Kelly J. Manahan, John P. Geisler Journal of Gynecologic ...

Research paper thumbnail of Comparison of Lignocaine Gel–Soaked Falope Rings vs Rectal Diclofenac Suppository for Pain Relief in Laparoscopic Sterilization

Journal of Minimally Invasive Gynecology, 2011

To compare the analgesic efficacy of lignocaine gel-soaked Silastic bands compared with rectal di... more To compare the analgesic efficacy of lignocaine gel-soaked Silastic bands compared with rectal diclofenac suppositories in patients undergoing interval laparoscopic sterilization under conscious sedation. Prospective, randomized, controlled, single-blinded, clinical trial. Day-case center in a tertiary care hospital in India. Ninety-six women undergoing interval laparoscopic sterilization using Silastic bands (Yoon rings) randomly allocated by computer-generated random numbers into 3 groups. All women received intravenous sedation with injection diazepam and pentazocine along with local infiltration lignocaine injected at the site of the incision meant for insertion of the single site laparocator. In group 1 (n = 32), the Silastic bands (Falope rings) were presoaked in 2% sterile lignocaine gel; in group 2 (n = 32), women received a 100-mg rectal diclofenac suppository while on the operating table; and women in group 3 received only conventional analgesic. Pain perception was assessed using an 11-point visual analog score just after the procedure while still on the table (zero minutes), at 30 minutes and 1 hour after the procedure, and at discharge. The women in all 3 groups were comparable insofar as age and parity. At zero minutes (while on the operating table), the pain score in all 3 groups was similar. However, the pain scores at 30 and 60 minutes, and at discharge were significantly lower in groups 1 and group 2 compared with group 3. However, 2 women (6.25%) in group 2 and 6 (18.75%) in group 3 required supplemental analgesia within 1 hour, and were administered a 500-mg oral dose of mefenamic acid. The need for further analgesia was significantly lower in groups 1 and 2 compared with group 3 (p = .02). Comparison of groups 1 and 3 revealed that in group 1, the pain scores were significantly lower at 30 minutes (p = .02), 1 hour (p = .005), and at discharge (p = .004). No patients in group 1 requested analgesia, whereas 6 women in group 3 asked for further analgesia within an hour postoperatively (p = .01). Similarly in groups 2 and 3, women who received diclofenac suppositories had significantly lower pain scores at the specified intervals (p = 0.02, 0.002, and 0.02, respectively). Application of lignocaine gel to Falope rings and preoperative insertion of a rectal diclofenac suppository are simple and effective measures for pain control in the early postoperative period in patients undergoing day-case laparoscopic sterilization under conscious sedation. Either method could be incorporated into routine practice, depending on patient and physician choice.

Research paper thumbnail of A Case of Colouterine Fistula Managed Laparoscopically

Journal of Minimally Invasive Gynecology, 2008

Fistulas between the uterus and bowel are rarely reported. We report successful laparoscopic mana... more Fistulas between the uterus and bowel are rarely reported. We report successful laparoscopic management of a colouterine fistula caused by a foreign body in the uterus. Fistulas between the gastrointestinal tract and the female genital tract are usually found between the vagina and rectum as a result of complications of childbirth or iatrogenic trauma. Communication between the uterus and bowel is rarely reported. We report successful laparoscopic management of an unusual case of colouterine fistula caused by a foreign body in the uterus.

Research paper thumbnail of Comparison of oral naproxen and intrauterine lignocaine instillation for pain relief during hysterosalpingography

International Journal of Gynecology & Obstetrics, 2008

Objectives: To compare the efficacy of oral naproxen with intrauterine instillation of 1% lignoca... more Objectives: To compare the efficacy of oral naproxen with intrauterine instillation of 1% lignocaine for pain relief in women undergoing hysterosalpingography (HSG) as an infertility investigation. Methods: One hundred women undergoing HSG were randomly allocated into 2 groups. Group A (n = 50) underwent intrauterine instillation of 5 mL of 1% lignocaine 2 minutes prior to the procedure, while the women in group B (n = 50) were instructed to self-administer a single oral dose of 375 mg of naproxen 1 hour prior to HSG. Pain scores immediately after the procedure (0 minutes) and delayed pain scores (30 minutes) were recorded and compared. Results: Women in both groups were comparable in age and parity. The mean ± SD pain scores in group A and group B at 0 minutes and 30 minutes were not significantly different (P = 0.12 and P = 0.07). Conclusion: Intrauterine lignocaine was no more effective than oral naproxen for pain relief during HSG.

Research paper thumbnail of Uterine artery embolization versus laparoscopic occlusion of uterine vessels for management of symptomatic uterine fibroids

International Journal of Gynecology & Obstetrics, 2009

Objective: To evaluate the efficacy and complications of uterine artery embolization (UAE) versus... more Objective: To evaluate the efficacy and complications of uterine artery embolization (UAE) versus laparoscopic occlusion of uterine vessels (LOUV) in the management of symptomatic fibroids. Methods: A pilot randomized clinical trial in which 20 patients with symptomatic fibroids were randomly allocated into two groups. Ten women underwent UAE, and 10 women underwent LOUV. Symptomatic improvement in menorrhagia and reduction in the volumes of the uterus and the fibroid were assessed at 3 and 6 months. Results: The patients were comparable with regard to age and parity. At 6 months, there was no significant difference in the mean reduction in menstrual blood loss, uterine volume, and volume of the dominant fibroid between the two groups (P = 0.436, P = 0.796, P = 1.00, respectively). However, higher pain scores were recorded on day 1 in the UAE group compared with the LOUV group (P = 0.0002). Conclusions: The effects of UAE and LOUV in the management of symptomatic fibroids are comparable. The main advantage of LOUV is less postoperative pain compared with UAE.

Research paper thumbnail of O872 Unsuspected intrauterine pathology diagnosed on hysteroscopic evaluation of infertile women at a tertiary care hospital in India

International Journal of Gynecology & Obstetrics, 2009

Research paper thumbnail of Prediction of perinatal asphyxia with nucleated red blood cells in cord blood of newborns

International Journal of Gynecology & Obstetrics, 2003

To determine normal level of nucleated red blood cells (NRBC) per 100 white blood cells (WBC) in ... more To determine normal level of nucleated red blood cells (NRBC) per 100 white blood cells (WBC) in cord blood of term non-asphyxiated newborns and to investigate variations in NRBC counts in perinatal asphyxia. Methods: A total of 75 cases were studied. Levels of NRBC per 100 WBC in umbilical venous blood were compared between 26 asphyxiated newborns (group I) and 49 non-asphyxiated newborns (group II). Correlation with neonatal outcome was also evaluated. Results: The mean ("S.D.) NRBC per 100 WBC level in umbilical blood of newborns in group I was 16.5"6.4, range 3-25; whereas that in group II was 8.6"7.01, range 1-26. This difference was statistically significant (P-0.001). A statistically significant negative correlation existed between NRBC level and markers of acute intrapartum asphyxia, Apgar score and umbilical arterial pH (rsy0.50, P-0.001 and rsy0.48, P-0.001, respectively). Positive correlation was demonstrated with evidence of chronic antepartum asphyxia, presence of pregnancy induced hypertension and intrauterine growth restriction (rs2.66, Ps0.02). A high NRBC count in umbilical blood correlated with poor early neonatal outcome. Conclusions: The level of NRBC per 100 WBC correlates both with acute as well as chronic antepartum asphyxia. Further, it can be used as a reliable index of early neonatal outcome.

Research paper thumbnail of Recurrent ovarian haemorrhage in a girl with congenital factor X deficiency

Research paper thumbnail of Ectopic pregnancy following levonorgestrel emergency contraception

Contraception, 2009

ABSTRACT There are little or no data on the risk of ectopic pregnancy following levonorgestrel tr... more ABSTRACT There are little or no data on the risk of ectopic pregnancy following levonorgestrel treatment as an emergency contraception. We encountered three cases of ectopic pregnancy following the use of levonorgestrel administered peri- or postovulation. Here we report these cases and discuss the clinical and epidemiologic implications of this association. Health providers should be alert to the possibility of an ectopic pregnancy in women who become pregnant or complain of lower abdominal pain after taking levonorgestrel.

Research paper thumbnail of Successful management of live ectopic pregnancy with high β-hCG titres by ultrasound-guided potassium chloride injection and systemic methotrexate

Archives of Gynecology and Obstetrics, 2009

Background Methotrexate (Mtx) is accepted modality for conservative treatment of ectopic pregnanc... more Background Methotrexate (Mtx) is accepted modality for conservative treatment of ectopic pregnancy. However, there is no consensus regarding its use in live ectopic pregnancy and high serum beta-human chorionic gonadotrophin ( -hCG) titres. Case report We report a successful management of live ectopic pregnancy in a 27-year-old nulliparous woman, with very high -hCG titres (89,200 mIU/mL), using ultrasound-guided intra-sac potassium chloride (KCl) injection and systemic Mtx. Successful resolution of the ectopic pregnancy, with negative serum -hCG (<1 mIU/mL) was achieved after three doses of Mtx, and a prolonged followup of 71 days. No treatment related complications were encountered. Conclusion Concurrent use of intra-sac hypertonic KCl, to produce cardiac asystole, with systemic Mtx could potentially improve outcome in live ectopic gestations with very high serum -hCG titres. However, individualised treatment, with a stringent follow-up regime is mandatory in such cases.

Research paper thumbnail of Vaginal misoprostol for cervical priming prior to diagnostic hysteroscopy––efficacy, safety and patient satisfaction: a randomized controlled trial

Archives of Gynecology and Obstetrics, 2009

Objective To evaluate the eVectiveness and safety of vaginal misoprostol for cervical priming pri... more Objective To evaluate the eVectiveness and safety of vaginal misoprostol for cervical priming prior to diagnostic hysteroscopy and to assess impact on pain scores and patient satisfaction. Methods One hundred women undergoing hysteroscopy were randomly allocated into two groups. The study group (n = 50) received 400 g of misoprostol vaginally (self administered) 4-6 h prior to hysteroscopy while the control group (n = 50) did not receive any cervical priming. Primary outcome measured was need for cervical dilatation, analgesia or sedation. Secondary outcomes were pain scores, patient satisfaction and side eVects. Results There was no signiWcant diVerence in the need for cervical dilatation, analgesia or sedation in the two groups (P = 0.25, 0.64 and 0.5, respectively). In addition, there was no diVerence in subjective patient satisfaction (P = 0.70). However, those in the control group recorded a higher pain score (median § SD = 5 § 1.8) when compared to those who received misoprostol (median § SD = 4.5 § 2, P = 0.03). Only two women (4%) had bleeding per vaginum and one (2%) had a slight fever attributable to misoprostol. Conclusion Vaginal misoprostol prior to diagnostic hysteroscopy did not facilitate cervical dilatation. It did eVect a reduction in pain scores, but there was no diVerence in patient satisfaction, need for analgesia or sedation. No signiWcant side eVects were reported.