Pregnancy and Birth

Even though the anterior repair is the most commonly utilized operation for correction of a cystocele, it is probably not the most effective, nor is it the correct operation for restoring a woman's anatomy and maintaining vaginal length and function. The problem with using this operation in young healthy sexually active woman with a paravaginal defect (cystocele) is the surgeon does not really surgically support the bladder, but instead reduces the bulge by "scrunching " the fascia under the bladder together.

Hysterectomy is the most frequently performed operation in women, with a life time risk varying from country to country from less than 20% to more than 40%. Overall these differences reflect more medical practice than differences in pathology between countries.

Whenever the surgery that is considered can be performed equally well and equally safely by either laparoscopy or laparotomy, the decision as to the type of incision to be used can (and in my opinion really should) include the patient.

Chronic pelvic pain and/or associated intestinal disturbance are a major cause of misery for thousands of patients. Often in constant pain, the patient experiences loneliness, hopelessness, frustration and desperation with thoughts of suicide. Family and work relationships are strained to the limit. Although ADHESIONS are often (but not always) the cause of this pain, treatment for adhesions is not performed either because the surgeon does not believe that adhesions can cause the problem, or because lysis of adhesions is considered too difficult or futile.

FAQs on Infertility from Malpani Infertility Clinic

I had an interesting email come in the a few weeks ago from a woman looking for advice on finding a doctor:

Fibroids are the most common benign tumors of the uterus. These noncancerous growths are present in 20-40% of women over the age of 35. In some women, the fibroids can become enlarged and cause symptoms of excessive bleeding and pain. While the classic treatment of symptomatic fibroids has been surgical removal of the fibroids (myomectomy) or the uterus (hysterectomy) recent advances now afford a nonsurgical treatment.

Ovarian cysts are enlargements of the ovary that appear to be filled with fluid. They can be a simple fluid filled bleb or contain complex internal structures. The term cyst is used to differentiate them from solid enlargements. Simple cysts have no internal structures and are less worrisome than those with complex structures or solid components. A sonogram or ultrasound test can determine if a cyst is simple or complex.

Cystitis is defined as an inflammation of the bladder, and may be caused by such things as bruising, as in the case of ‘Honeymoon Cystitis’, sexually transmitted diseases, or even a reaction to ‘personal care’ products.

Around 153 million women around the world have chosen to be sterilized for contraceptive purposes, of these 138 million are in the developing countries. 1 Approximately fifty percent of all female sterilization is performed during the puerperal period or a cesarean section, and the other fifty percent is called “interval sterilization” when there has been no pregnancy for the previous six weeks.

Uterine fibroid is a slowly growing benign smooth muscle tumor. Approximately 25% of women after the age of 35 years harbor uterine fibroid. Most of these women are asymptomatic and in general, they do not need any treatment

Because endometriosis is a common disease entity among infertile patients with a prevalence of up to 50%, one could argue that without laparoscopy clinical work-ups can not completely rule out all of the causes of infertility. The decision to perform laparoscopy on patients with infertility is very complex owing to a number of factors, such as maternal age, semen parameters, tubal patency, pelvic symptoms, insurance coverage, surgical risks, and availability of surgical expertise.

Endometriosis is one of the most common gynecologic disorders and is significantly more prevalent in the setting of infertility. The prevalence of endometriosis in infertile women ranges from 25% to 50% compared to 5% in fertile women. Successful laparoscopic management of all stages of endometriosis was reported as early as 1986. This has revolutionized the management of endometriosis. The benefits of surgical therapy for infertility associated with endometriosis have been well documented.

The most important requirement for successful hysteroscopy is satisfactory distension of the uterus. While many different media have been used, recent advances in equipment have greatly simplified the use of saline for diagnostic and simple operative hysteroscopy that does not require the use of electrosurgical instruments.

A new committee opinion from the American College of Obstetricians and Gynecologists has concluded that the popular antibiotics used to treat UTIs - sulfonamides and nitrofurans - may be given during the first trimester in the absence of an alternative treatment and may be used as first-line agents during the second and third trimesters. Do you prescribe antibiotics to pregnant patients?

It is usually quite simple to find the cause of abnormal menstrual bleeding, although occasionally the cause may not be found. Since abnormal uterine bleeding can be caused by disorders of the uterus, hormone imbalance (usually not ovulating), and pregnancy, it is helpful to look at each area separately. When I see someone for abnormal bleeding, I ask the following questions.

Currently there are two ways to treat endometriosis – hormonal therapy and surgery. Depending on the patient’s expectations and the extent of the disease, we may prescribe hormonal therapy, surgery, a combination of surgery and hormonal therapy, or occasionally a just “wait and see” approach.

Approximately 750,000 hysterectomies are performed annually in the United States, with a mortality rate of about 12 per 10,000 operations.1 Costs to consumers and insurers have been estimated at approximately $1.7 billion per year.2 Thus, alternative procedures that are safer and less invasive, preserve the uterus, and cost less are increasingly in demand. In recent years, several such techniques have been introduced.

Laparoscopic myomectomy (LM) is a minimally invasive surgical procedure for the removal of uterine myomas. It was first described in the late 1970s by Semm. Subsequently, equipment has been developed to enhance the procedure. LM requires advanced laparoscopic skill and expertise in suturing and tissue removal. Laparoscopic assisted myomectomy (LAM), a procedure that combines operative laparoscopy and minilaparotomy, was described by Nezhat et al in 1994.

Isolated unilateral torsion of a fallopian tube is an infrequent but significant cause of acute lower abdominal pain in a female of reproductive age. We present a literature review and a case of a 41 yrs old lady who presented with sudden onset right sided lower abdominal pain radiating to right thigh. Clinical examination revealed tenderness in right lower abdomen and tender right adnexal mass was noted on vaginal examination.

A rare case of the inguinal endometriosis was reported with immunohistochemical analysis. A 28-year-old woman had a thumb-sized tumor in the right groin for two years with a gradual increase in size and pain. An operation revealed an elastic hard tumor with an unclear margin and adhesion to the uterine round ligament. The histology showed irregular proliferation of the endometrial glands and stroma.

Intracytoplasmic sperm injection (ICSI) is a component of infertility treatment often employed when conventional in vitro fertilization is unlikely to be successful. Despite good clinical results with ICSI, the procedure is typically associated with degeneration of a significant percentage (approximately 10%) of the treated oocytes. The cause of this degeneration remains unclear. Speculation that damage caused by oocyte compression during the injection procedure may be responsible has led to the development of a novel technique known as laser-assisted ICSI.

Comparison of Human Uterine Cervical Electrical Impedance Measurements Derived Using Two Tetrapolar Probes of Different Sizes

It is usually quite simple to find the cause of abnormal menstrual bleeding, although occasionally the cause may not be found. Since abnormal uterine bleeding can be caused by disorders of the uterus, hormone imbalance (usually not ovulating), and pregnancy, it is helpful to look at each area separately.

Myomectomy is the only surgical treatment of myomas that preserves fertility. The safety of pregnancy after uterine artery embolization has not been established, and pregnancy is impossible after hysterectomy. The average reduction in volume of fibroids after a UAE is 50%, where fibroids that have removed are completely gone.

Uterine fibroid embolization represents a fundamentally new approach to the treatment of fibroids. Embolization is a minimally invasive means of blocking the arteries that supply blood to the fibroids. It is a procedure that uses angiographic techniques (similar to those used in heart catheterization) to place a catheter into the uterine arteries. Small particles are injected into the arteries, which results in the blockage of the arteries feeding the fibroids. This technique is essentially the same as that used to control bleeding that occurs after birth or pelvic fracture, or bleeding caused by malignant tumors.

The most important question to ask is whether or not the fibroids need to be treated at all. The vast majority of fibroids grow as a woman gets older, and tend to shrink after menopause. Obviously, fibroids that are causing significant symptoms need treatment. While it is often easier to treat smaller fibroids than larger ones, many of the small fibroids never will need to be treated. So just because we can treat fibroids while they are small, it doesn't follow that we should treat them. The location of the fibroids plays a strong influence on how to approach them. A gynecologist experienced in the treatment of fibroids can help you determine if they need to be treated.

Menopause is the time in a woman's life when the ovaries stop producing estrogen. Menopause is usually recognized by the cessation of menstrual periods. Other symptoms of menopause include flashes, mood changes, difficulty sleeping, and vaginal dryness. If a woman is not menstruating because she has had a hysterectomy or endometrial ablation, other symptoms of menopause often alert her that menopause is starting.

Fibroids are non-cancerous (benign) growths of the muscle wall of the uterus. They are probably responsible for more unnecessary gynecologic surgery than any other condition. It is a staggering number, but about 600,000 American women have a hysterectomy every year. And about 30% of those hysterectomies, 180,000 in all, are performed because of fibroids. For many years these growths have been surgically removed, often because of fear of the problems they might cause in the future. And, those problems are often overstated. While approximately 30% of all women will have fibroids during their lifetimes, the vast majority of these women will never have symptoms and will never require treatment. And, for the rare patient that does have problems, there are a number of sound and effective options available. Hysterectomy should be the solution of last resort.

Pelvic pain that lasts 6 or more months, and is not associated with the menstrual period, is called chronic pelvic pain (menstrual pain is discussed in chapter 3). Chronic pelvic pain is a fairly common problem. It is estimated that about 20% of the visits to gynecologists are for pelvic pain, and one out of every seven hysterectomies are performed for this reason. Chronic pelvic pain can lead to significant distress and even disability. In recent years, a great deal of effort and research has been focused on helping women with chronic pelvic pain and people suffering from all types of chronic pain. Because of this, we are able to help people diminish the effects of pain.