European Journal of Molecular & Clinical Medicine

Hysterectomy is the surgical procedure of removing the uterus. It is one of the most common gynaecological operations and second most common after caesarean section. It can be performed by abdominal route, vaginal route, by applying minimally invasive techniques, or by a combination of the later two. The route chosen depends on the pathology and size of the uterus, presence or absence of adnexalpathology, surgeon's preference and expertise, patient's body habitus and medical co-morbidities, and hospital infrastructure.
Methods
The study was a hospital-based time bound prospective and observational study conducted in the Department of Obstetrics and Gynaecology at Gauhati Medical College and Hospital, Guwahati, Assam. 150 patients in the age group from 35-85 years with symptomatic benign uterine pathology excluding uterine descent and uterine size less than 16weeks were selected randomly. All the three routes of hysterectomy: Abdominal, Laparoscopic and Non Descent Vaginal Hysterectomy were assigned 50 cases each.
Outcomes measured were operating time, intraoperative complications, requirement of blood transfusions, post-operative VAS score, post-operative mobility, post-operative complications (febrile morbidity, bowel distension, urinary retention, wound infection) and duration of hospital stay.
Result
The most common age group undergoing hysterectomy was 40-49yrs with AUB-L being the most common indication. The mean operating time in NDVH (82.8±22.29) minutes was significantly less than TAH and TLH. Post operative VAS score was significantly lower in NDVH. All the post-operative complications were significantly higher in the TAH group. Mean duration of hospital stay was least in NDVH(3.28±0.70) days.
Conclusion
 From this study we have concluded that vaginal approach should be the procedure of choice for benign causes unless contraindicated, but at the end, route of hysterectomy is dependant  on multiple factors and should be individualized.

Uterine fibroids are the most common benign tumours of the female reproductive tract and have impact on quality of life in women with multiple & severe symptoms and affect the daily activities. Woman with abnormal uterine bleeding related to fibroids can persist during the perimenopausal age and after the menopause. It has been estimated that about half of all hysterectomies in industrialized countries today are for the treatment of symptomatic fibroids. Methods: This was a prospective hospital based observational study. Inclusion criteria: 1. Women beyond 45 years of age.2.Symptomatic women with uterine fibroids. Exclusion criteria: 1.Women with medical problems such as Diabetes, hypertension, thyroid dysfunction, heart disease2.Women with genital tract malignancy.3.Coagulative disorders. The main outcome measures were socio-demographic data, clinical features, histopathological findings, type of hysterectomy and postoperative follow up. Results: In the present study Out of 200 women with fibroid uterus presenting to gynaecology department 155(77.5 %) were multiparous. The mean age was 46 years. Themost common presenting complaint was heavy menstrual bleeding in 128(64%), abdominal mass 72 (36%) pain abdomen 67(33.5%) women followed by frequent cycles 36(18%).Abdominal hysterectomy constitutes about 67%.Majority of the fibroids were intramural and submucosal fibroids. Conclusion: Women with fibroid uterus with severe symptoms like heavy menstrual bleeding, mass per abdomen with pressure symptoms require treatment, majority were presented to hospital late so they need surgical intervention like hysterectomy. Early screening, identification appropriate and relevant treatment with medical and minimal invasive surgeries will reduce morbidity and improve quality of life

Background: Hysterectomy is a common surgical procedure most commonly performed in the practice of gynaecology. Non-descent vaginal hysterectomy (NDVH), which is an art of gynaecological surgeons, has established its place in the gynaecological surgeries. Total laparoscopic hysterectomy (TLH) has a steep learning curve, requires modernized OT set-up including special endoscopic instruments and may not be available in all centres. Non-decent vaginal hysterectomy is a viable alternative in such a scenario. Hence these two surgeries have been compared in this study.
Methods: A total 50 patients undergoing hysterectomy for various benign indications, were included in this study. They were divided into two groups of 25 each. One group underwent TLH and the other NDVH. Demographic profile and other peri-operative events were compared and statistically analysed.
Results: NDVH group experienced more pain and required a greater number of analgesic doses. The intra-operative blood loss was more in NDVH group and duration of surgery was significantly higher in NDVH group. Two most common complications in the post operative period were fever and hematuria.

Background: Spinal anaesthesia is preferred technique for conducting abdominal hysterectomy, but it is insufficient to provide post-operative analgesia adequately. The addition of local anaesthetic adjuvants increases subarachnoid block efficacy and prolongs postoperative analgesia. Due to its fast onset with a limited time of action with minimal cephalic spread, Fentanyl is preferred as an adjuvant in spinal anaesthesia. Adding Fentanyl to a low dose, Bupivacaine offers improved surgical anaesthesia and increased block reliability. Ketamine has several clinically useful properties, including analgesia and less cardiorespiratory depressant effects than other anaesthetic agents, in fact it causes some stimulation of the cardiovascular system.
Objectives: To compare the Duration of the postoperative analgesia (Time of 1st rescue Analgesic) between intrathecal administration of Ketamine and fentanyl with bupivacaine. To compare the duration and onset of sensory and motor block (modified bromage scale), the effect on hemodynamic parameter, Degree of sedation and side –effects (post-operative nausea and vomiting, pruritus, shivering, urinary retention and any other).
Methodology: Two group were included in this study i.e. Group A & Group B. Both group had 18 cases for total abdominal hysterectomy Group A(n=10)- received 15mg of Bupivacaine 0.5% along with Fentanyl 25 mcg intrathecally and Group B (n=10)-received 15mg of Bupivacaine 0.5% along with Ketamine 25 mgintrathecally. The onset of sensory and motor block, duration of block, hemodynamic parameter, sedation score, total postoperative analgesia time, and side effects if any will be recorded.
Results: Demographic variables were compared between both groups A and B. Group A is A significant faster onset of sensory block was found in ketamine group in comparison to fentanyl group. (p-value<0.001). While the time to achieve the highest level of sensory block was found to be almost similar in both the groups.
Conclusion: ketamine or fentanyl to spinal bupivacaine were equally effective in pain control after abdominal hysterectomy

Background: Hysterectomyare mostlycommon performed in the gynecological procedure for clinical problem in its treatments includes fibroids, prolapse, adenomyosis, endometriosos. Hysterectomy is performed worldwide in women at 30- 55 years of age. Aim and objectives to indicate the diagnosis to performed hysterectomy in patients and complications associated undergoing hysterectomy.
Methods: Total 255 patients undergone hysterectomy in the hospital was studied and analysed it clinical indications of surgery and complication of it, surgical specimens were sent for histopathology and report.
Results: The study shows thathysterectomy was performed in the major diagnosis of uterine prolapse (33.50%), leiomyoma (45.50%), adenomyosis (12.50%) while the report specimens also showed it. The diagnosis before the hysterectomy was confirmed by histopathology. There was no major complications were observed in the patients undergoing hysterectomy as this procedure is widely used for gynecological problems.
Conclusions: The study shows the data of patients’ trends of the hysterectomy and diagnosis that leads to perform hysterectomy was analyzed by histopathological finding in the patients. Complications were negligible in the hysterectomy and safe procedure

Background: Leiomyoma (fibroid) is the commonest neoplasm accounting for 75% of benign tumours affecting women in reproductive age group. They are dependent upon the steroid hormones for their growth and maintenance. As the endometrium and leiomyoma (fibroid), are both steroid hormone dependent, we studied the corresponding histological changes in endometrium in cases of uterine leiomyoma.
Materials and Methods: The study included 100 hysterectomy cases where leiomyoma/leiomyomas were present. Brief clinical history regarding age, clinical presentation, parity was obtained. The specimens were fixed in 10% formalin; tissue bits from representative areas were taken and stained with Haematoxylin and Eosin.
Results: The commonest age group was 4^th decade (54%). The commonest clinical presentation or chief complaint in current study is menorrhagia (46% cases). Majority of the women in the study were multiparous (89%) and the most common type of leiomyoma encountered in the study, based on location, was intramural type (62% cases). Proliferative pattern of endometrium (62%) is the most common pattern associated with leiomyomatous uteri in this study.
Conclusion: Uterine fibroids (leiomyomas) are the most common benign gynecological tumors in women of reproductive age globally. Endometrium and leiomyoma (fibroid), are both dependent on steroid hormones for the growth and maintenance. Histopathological diagnosis is the mainstay to identify the uterine leiomyoma, though some amount of clue may be obtained from the endometrial curettings.

Aim: To study the histo-morphological diversity of various lesions of the uterus, cervix and adnexa.
Materials and Methods: A Retrospective Histopathological study of 609 cases of nonneoplastic and neoplastic lesions of hysterectomy specimens was conducted in Department of Pathology, over the period from June 2015- May 2017. Hysterectomy specimen with or without unilateral or bilateral adnexa received in the department. The specimens were analyzed in detail macroscopically for various parameters like size, external surface, and consistency and cut sections.
Results: Atrophic changes were seen in 13.46% cases. Endometrial hyperplasia was seen in 26 cases. Among the neoplastic lesions 2.46% cases were endometrial polyps with only 3 cases of malignancy forming 0.49%. Among the histologic types of lesions of myometrium, majority were Leiomyoma (27.59%). Leiomyoma and Adenomyosis were seen in 55 cases (9.04%). Adenomyosis was seen in 22.00%. Chronic cervicitis was seen in 36.07% cases and chronic cystic cervicitis in 6.21% of cases. Nabothian cyst were seen in 124 cases (20.80%). 19.80% cases showed Squamous metaplasia. Out of 188 Ovarian lesions, 167 (88.83%) were non-neoplastic lesions and 21 (11.17%) were neoplastic lesions. Fallopian tube pathology included chronic salpingitis in 2 cases, paratubal cyst in 07 cases. 69.4% of cases show unremarkable fallopian tubes.
Conclusion: The present study provides awareness into the wide range of histopathological patterns of lesions in uterus and cervix in hysterectomy specimens. It aids to appropriate management in the postoperative period.

Background: Abnormal uterine bleeding (AUB) is the most common clinical presentation in premenopausal and postmenopausal period which could be due to either endometrial or cervical lesions. Early detection of precursor lesions and exclusion of malignancy is a diagnostic challenge for pathologists. Many studies were done on either endometrium or cervix alone, hence we took this study to evaluate both simultaneously before the hysterectomy. Objectives: To profile the histomorphological spectrum of endometrium and cervical lesions on curettage and biopsy concurrently before hysterectomy and correlation with hysterectomy specimens wherever available.
Materials and Methods: The present study was conducted on 153 cases of endometrial curetting’s and cervical biopsies received from Department of Gynaecology to Department of Pathology, RIMS, Raichur during a period of February 2020 to January 2022. Histopathology slides were retrieved from the archives of Department of Pathology. New slides were made from Paraffin embedded blocks wherever necessary and stained with Haematoxylin and Eosin. Histopathological examination of the hysterectomy specimens was conducted wherever available.
Results: Majority of the patients were in third decade of life with mean age of 41.3 years (P<0.0001) and the commonest clinical indication was AUB ((P<0.0001). Majority of the endometrium showed cyclical changes in both endometrial curettage and in hysterectomy specimens which showed a perfect positive coefficient correlation of 0.92 (P value = 0.028). Similarly, the cervical biopsy and cervix findings in hysterectomy specimen showed a highly significant P < 0.0001. The commonest histomorphological lesion in cervix was non-specific chronic cervicitis (NSCC).
Conclusion: Abnormal uterine bleeding is a major gynaecological problem in perimenopausal and post-menopausal women. It could be due to either endometrial / cervical lesions hence if it is evaluated simultaneously with a minimally invasive procedure as our study so that unnecessary radical surgeries can be avoided and medical/ conservative treatment could be offered.

Aim: The aim of the study was to evaluate the incidence, predisposing factors & associated complications and outcome of emergency peripartum hysterectomy.
Methods: This prospective observational study was carried out in the Department of Obstetrics and Gynecology. Age, parity, traumatic or atonic PPH, risk factors, complications were all studied in detail and analysed.
Results: 50 underwent emergency peripartum hysterectomy, yielding to an incidence of 0.12%. 14 (28%) patients underwent emergency peripartum hysterectomy following vaginal delivery, among whom 3 (6%)patients had instrumental delivery and 33(66%) following caesarean section. The most common indications out of the incidence was atonic PPH, noted in 24 patients (48%), following vaginal delivery were 9 (18%), following caesarean section were 15 (30%). Indication for rupture uterus were 24 (48%), 12 (24%) following rupture of an unscarred uterus. 12 (24%) following rupture of scarred uterus. Due to secondary post- partum haemorrhage were 6(12%). Acute inversion of uterus was 1(2%).  Out of 50 patients, 16(32%) patients experienced intra-operative hypotension,  8(16%) developed febrile illness, 31(62%) required ICU care. The mean hospital stay of the patients <10days were 18 (36%), >10days were 26(52%) patients. None of the 50 patients required re-laparotomy, 19(38%) patients went into DIC, 5(10%) experienced bladder injury due to involvement of bladder along the rupture of uterus ,repair done simultaneously during hysterectomy, 3(6%) patient developed vesicovaginal fistula post-operatively. 6(12%) patients who underwent emergency peripartum hysterectomy died during post-operative period. Maternal mortality was 12% in the study.
Conclusions: Hysterectomy is a lifesaving procedure to control postpartum hemorrhage, but is associated with significant maternal morbidity and mortality. Uterine atony, uterine ruptures, also due to prior caesarean delivery, placenta previa were identified as risk factors.

Aim: to study the incidence and indication for hysterectomy in the study population.
Materials and Methods: A Retrospective study was conducted in Department of Pathology, over the period from June 2015-May 2017. Hysterectomy specimen with or without unilateral or bilateral adnexa received in the department. The specimens were analyzed in detail macroscopically for various parameters like size, external surface, and consistency and cut sections.
Results: Out of total 10230 histopathological specimens received at department of Pathology from June 2015 to May 2017, hysterectomy specimens were 609 accounting for of total specimen received. Hysterectomy specimens were received from a wide range of age groups varying from 15 years to 81 years. The average age for undergoing hysterectomy was 43.05 years. Majority of cases (44.01%) were from the 5th decade followed by 4th decade (36.95%). Among the 609 cases, the major clinical diagnosis for which hysterectomy was performed included DUB (32.35%), Fibroid (29.39%) and Prolapse (16.09%). 6 Hysterectomies were performed for malignant lesions (Carcinoma of cervix, Endometrial carcinoma and Ovarian malignancy) and 24 Obstetrics Hysterectomies were done.
Conclusion: Maximum numbers of patients were from the 5th decade followed by 4th decade. DUB, Fibroid and Uterine Prolapse were the major clinical diagnosis before Hysterectomy was done.

INTRODUCTION-uterine fibroids are common tumor of uterus, seen in reproductive age group. Fibroids during pregnancy produce special challenges during labour. Small fibroids with minimal symptoms treated with medical management, while large, multiple fibroids with pressure symptoms require surgical management. Fibroids during pregnancy produces special challenges during labour.
AIMS & OBJECTIVES –To study and analyse the Risk factors associated withfibroids, Clinical features according to different type offibroid, Different types of management of fibroid.
METHODOLOGY- fibroid cases were diagnosed clinically and with ultrasonography. Details of clinical examination findings, investigations and treatment modalities used were noted. Difficulties during surgery and methods to overcome were studied.
Histopathology details of specimen and other associated findings were studied.
RESULTS- Fibroids are Commonly seen in reproductive age group showing 45.5% cases. Majority cases are multipara seen in 79.35% cases and 5.14% cases are pregnant patients with fibroid. Intramural fibroid was seen in 60% and presented with menorrhagia (73%) and dysmenorrhea (50.5%). Fibroids presented with menstrual symptoms were seen in 96.15% cases. 61.7% cases underwent surgical management in that Total Abdominal Hysterectomy alone constitute 76.19%. neglected fibroids were common in rural areas making surgical management more common.
CONCLUSIONS- Pre-operative adequate preparations with general build-up for anesthesia and surgery, imaging studies, ureteric stenting where-ever required, use of GNRH analogues and following the principles of Fibroid surgery, made successful surgeries with no surgical morbidity and mortality. Caesarean section is common mode of delivery in fibroids in pregnancy with no complications.

Context: Hysterectomy is the surgical removal of the uterus and is the most common major
gynaecological surgical procedure performed worldwide.
Aims: To study the incidence and distribution of various types of pathologies in the
hysterectomy specimens in the population studied.
Methods and Material: A total of 500 cases were studied. The study material was obtained
from patients’ hospitals that underwent hysterectomy and also specimens sent from nearby
private or government
Results: Among various significant pathologies, benign accounted for 95.7% of lesions while
malignant for 4.3% of lesions. Among benign lesions, adenomyosis was commonest with 203
(136 isolated + 67 with leiomyoma) cases and it was most common in 41-50 years age group.
Leiomyoma was next common with 183 (116 isolated + 67 with adenomyosis) cases and it
was also most common in 41-50 years age group. 67 (13.4%) cases had both leiomyoma and
adenomyosis. CIN1 or LSIL accounted for 15 cases, serous cystadenoma of ovary for 12
cases, endometrial polyp for 12 cases, mature cystic teratoma of ovary for 8 cases,
endocervical polyp for 9 cases, cervical leiomyoma for 6 cases, mucinous cystadenoma for 3
cases, placenta accreta for 3 cases, simple endometrial hyperplasia without atypia for 2 cases,
infected decidua for 2 cases, CIN2/CIN3 or HSIL for 2 cases, adult granulosa cell tumour for
2 cases, endometriosis of ovary for 2 cases, broad ligament leiomyoma for 2 cases, acute
salpingitis for 1 case, endometriosis of fallopian tube for 1 case, complete hydatidiform mole
for 1 case, invasive hydatidiform mole for 1 case and adenomatoid tumour of myometrium
for 1 case. Among malignant lesions, carcinoma of cervix was commonest with 11 cases,
followed by carcinoma of ovary with 7 cases and carcinoma of endometrium with 3 cases.

Background: Bipolar vessel sealing systems (BVSS) are accepted to be safe and efficacious
with possible advantages over conventional methods, namely fewer requirement of postoperative
analgesics, less blood loss, shorter operative time and minimum hospital stay.
Objectives: To compare the efficacy and safety between use of BiClamp (Bipolar
Coagulation Forceps) in Vaginal Hysterectomy and Conventional Vaginal Hysterectomy.
Materials and Methods: This prospective study was done among 80 cases indicating
hysterectomy for benign diseases admitted in OBGY unit were selected randomly out of
which 40 cases underwent Conventional Vaginal Hysterectomy and 40 cases underwent
BiClamp Vaginal Hysterectomy at department of obstetrics & Gynecology in Government
medical college and hospital, Latur during November 2012 to September 2014.
Results: Mean duration of hospital stay required for participants of cases and control group
was 2.6 days and 4.2 days respectively (p<0.05). Mean duration of operation of cases and
control group participants was 70.9 min and 75.5 min respectively (p<0.05). Mean blood loss
during operation noted among the cases and control group participants was 90.1 ml and 115.9
ml respectively (p<0.05). During operation, three suture material required in in 0.0%
participants of cases group and 82.5% of control group respectively (p<0.05). Post- op
complications like fever, bladder injury, bowel injury & hemorrhage noted only in
participants of control group.
Conclusion: BiClamp Vaginal Hysterectomy post-operative pain was less, intraoperative
blood loss was less, operative time was significantly shorter, duration of hospital stay was
less and BiClamp Vaginal Hysterectomy was more Cost effective than the Conventional
Vaginal Hysterectomy

One of the most pressing problems in modern gynecology is the problem of chronic inflammation of the appendages. Every obstetrician-gynecologist has to deal with a complaint of pain in the lower abdomen in women every day. About 39% of women experience pelvic pain caused by inflammation of the uterine appendages periodically, while 12% of patients experience pain for at least 5 days every month, and another 12% suffer from persistent pelvic pain [2]. Chronic pelvic pain occupies a special place among the variety of clinical manifestations of gynecological diseases and is considered by most researchers as one of the leading symptoms of inflammatory diseases of the pelvic organs: chronic salpingitis and oophoritis, pelvic peritoneal adhesions, chronic endometritis. However, the presence of a "routine" gynecological pathology cannot always explain the development of pain in the lower pelvis. Pelvic pain is an indication in 12% of all hysterectomies. For this reason, the aim of our study was to optimize the treatment of chronic inflammatory diseases of the uterine appendages to improve the quality of life and prevention of pelvic pain. The object of the study was 100 women with chronic salpingoophoritis complicated by pelvic pain, who were divided into three groups according to the method of treatment. During the study, we used, along with general clinical research methods and examination for sexually transmitted infections, special research methods, such as: studying the intensity of pain on the VAS scale, bacterioscopic and bacteriological examination of vaginal contents, ultrasound scanning and Doppler studies, estradiol, progesterone, testosterone, FSH, LH, DHEAS-S, TSH, prolactin and cortisol in the blood serum, the content of prostaglandins F2α, E2 and growth factors in the serum. In addition, the level of immunoglobulin A (IgA), the concentration of the main cytokines (IL 1β, IL6) in the blood serum were determined. The resulting material was subjected to automated statistical processing. After the examination, the patients received the necessary treatment, which included antibiotic-anti-inflammatory therapy (ceftriaxone, doxycycline, metronidazole), 20 procedures of pharmaco-physiotherapeutic intravaginal electrotherapy with the drug Glutoxim in an amount of 1 ml of 1% solution, intravaginal ultrasound therapy, synbiotic Bifiten. Based on the results of the data, the effectiveness of the use of the developed pharmaco-physiotherapeutic method (91%) was proved in comparison with intravaginal ultrasound therapy (74%) and, especially, drug therapy (40%).