Labour Induction Methods: An Overview

Overall the rate of induced labours has increased and almost 25% of women undergo labour induction worldwide. Cervical ripening and cervical preparedness is necessary before labour can be induced. The status of the cervix is traditionally assessed with help of Bishop’s score. Labour induction becomes necessary when the cervix is not favourable as noted on the cervical scoring system. Mechanical or surgical methods or a combination of both can be sued for labour induction. These include Foley’s catheter induction, sweeping of membranes, amniotomy etc. Pharmacological agents like oxytocin, prostaglandins PGE1 & PGE2 and newer agents like mifepristone can be used. Mechanical methods like Foley’s catheter induction are associated with lesser FHR variability and decreased rates of caesarean section as compared with oxytocin infusion or prostaglandins used locally. Oxytocin is the most widely used pharmacological method used for induction of labour. Proper titration of oxytocin can result in contractions that mimic normal labour. Oxytocin is often combined with amniotomy. Prostaglandins PGE1 & PGE2 are safe and effective options for labour induction. Prostaglandin PGE1 or misoprostol is used in the dose of 25 microgram mcg given orally or vaginally or via the sub-lingual route. Prostaglandin PGE2 or dinoprostone is used intra-cervically or vaginally in the posterior fornix. The newer drug mifepristone is being studied as cervical ripening agents because of its anti-progesterone effect.

Cure of Interstitial Cystitis and Non-Ulcerating Hunner’s Ulcer by Cardinal/Uterosacral Ligament Repair

A serendipitous cure in a 73-year-old woman of Hunner’s ulcer, urge, nocturia, apical prolapse by a tissue fixation system tensioned minisling (TFS) which reinforced the cardinal, and uterosacral ligaments (USLs) led us to analyse the relationship between Hunner’s ulcer and known pain conditions associated with USL laxity. The original intention was to cure the “posterior fornix syndrome” (PFS), uterine prolapse, and associated pain and bladder symptoms by USL repair. A speculum inserted preoperatively into the posterior fornix alleviated pain and urge symptoms, by mechanically supporting USLs. Hunner’s ulcer, along with pain and other PFS symptoms were cured by USL repair. The concept of USL laxity causing chronic pelvic pain and bladder problems is not new. It was published in the German literature by Heinrich Martius in 1938 and by Petros in the English literature in 1993. These findings raise important questions. As PFS symptoms are identical with those of interstitial cystitis (IC), are PFS and IC similar conditions? If so, then patients with IC who have a positive speculum test are at least theoretically, potentially curable by USL repair. These questions need to be explored.

Benign papillary cystadenofibroma of fallopian tube presenting as posterior fornix cyst: case report

Benign papillary cystadenofibroma of fallopian tube is very rare tumor of female genital tract. Usually asymptomatic and incidental finding. Worldwide literature only 18 cases were found. On account of its rarity and best of our knowledge, is the first case of benign papillary cystadenofiboma presented as posterior fornix cyst, so we are presenting this case. We report a rare case of benign papillary cystadenofibroma of fallopian tube in a 30-years old female P3L3 presenting with abdominal pain. On examination abdomen was soft, per vaginally mobile non-tender cystic mass of 5×4 cm was noted. Laparotomy was planned. Intraoperatively 5x4 cm cyst arising from serosal surface of left fallopian tube near fimbrial end noted with bilateral ovaries normal. Left fimbrial cystectomy with salpingectomy was done with sparing both ovaries. Histopathology suggestive of benign papillary cystadenofibroma of fallopian tube. Patient had uneventful recovery in follow up period. Benign papillary cystadenofibroma of fallopian tube is rare tumor found incidentally. Tumor seems to have benign course only cystectomy is required for treatment.

Sleeve leucorrhoea treatment

Rsch (Mnch, med ....) recommends for this purpose to inject into the posterior fornix, through qi (....) boric acid powder in an amount of 0.5: this is introduced first daily, then every 2-3 days. If after 2-3 weeks. pain with such treatment will not go away, which means that they are not of sleeve origin.

Colpotomia post. or keliotomia vaginalis post., as a method of treatment of uterine appendages and their neoplasms.

In 1857 W. Atlee for the first time made an attempt to use the incision of the vagina, in the posterior fornix, to remove the degenerated ovary. This operation is colpotomia post. later it was repeated by some of the gynecologists (G. Thomas, Davis, R. Battey) and, according to Mignon's statistics, before 1878, there were already up to 113 colpotomy in the literature. However, this method was soon completely abandoned. There were several reasons for this; The main thing can be considered the fact that at this time, that is, in 70-80 years, thanks to the beginning of the adoption of the basis of antiseptics in surgery, gynecology entered a new era of development of its therapy and the womb was broken by the operation, on which sympathies and attention of all gynecologists. The enthusiasm for this method of treatment, which among some of the operators reached the pruritus secandi, brought enormous services to the development of our science. Tubes and ovaries removed during the womb - these trophies of unreasonably "useless uvuchіy", have enriched the pathology rooms with extremely valuable material for a detailed study of the pathology and physiology of female reproductive development of organs.

Another case of detachment of the posterior fornix sub coitu

In view of the small number of cases of damage to the female, genital organs, occurring sub coitu, and in view of the lack of clarification of the etiology of damage to the posterior fornix at the same time, I allow myself to describe the following case, which was under my supervision.

Posterior colpotomy (colpotomia posterior) with inflammation of the uterine appendages and neoplasms in them

In 1892, in The Doctor, I published my first article the removal of the uterine appendages and their neoplasms through the vagina. In this article, on the basis of my clinical observations, I recommended for some cases a new surgical method for removing large appendages of the uterus and their neoplasms through the posterior fornix. This article of mine caused only one critical note by Dr. Tipyakov in the same "Doctor" in which he spoke out against this operation. I replied to this article with a second article, also in Physician for the same 1892, in which I proved with new clinical observations the relevance and superiority of this operation before gluttony in certain cases. Then, until 1895, no attention was paid to my proposal, and only from that time, when the question of vaginae fixatio uteri began to be developed in German literature, and then when prof. Dhrssen's proposal to remove uterine appendages and some neoplasms of the uterus using colpotomiae anterior, since that time the question of the significance of colpotomiae anterior et posterior for removing diseased uterine appendages and their neoplasms has become fashionable on the pages of the special medical press. At the present time, the literature on this issue is quite large and I will not expound it here, since this issue will be examined in detail in a special work of my friend Dr. P. Ya. Teplov, which will soon appear in print. I currently wish only to summarize my clinical data on posterior colpotomia.

MODE OF ACTION OF STHANIK CHIKITSA IN COMMONLY USED IN STREE ROGA

Yoni Roga do not occur without vitiation of Apana Vata, thus first of all Vata should be normalized then treatment of other Doshas should be done. Sthanika Chikitsa (local therapies) prescribed by ancient Acharyas as Yoni Prakshalana (cleansing of vagina), Yoni Pichu (medication soaked tampon place in the vagina), Yoni Purana (vaginal packing), Yoni Lepa (semisolid drug applied in vaginal wall), Yoni Varti (vaginal suppository), Yoni Dhoopana (vaginal fumigation) & Uttarbasti (medicated oil/Ghrita pushed in the uterine cavity). For better result of this therapy the appropriate knowledge of mode of action of drug ought to be important. Our Acharyas very well know the mode of action of this Sthanika Chikitsa and describe the specific Sthanika Chikista according to different Yoni- Vyapada or vitiated Doshas. The reason behind for chosen the vaginal route because of the rugae of the vaginal epithelium create a invoulted surface and results in a large surface area provide, this large surface area allows the trans-epithelial absorption of medications via the vaginal route & the posterior fornix have rich blood supply so actively absorption of drug. The main objective of this literature to find out the probable mode of action of special drug in specific Sthanik Chikitsa.

Quenu. Hystérectomie vaginale dans les lésions des annexes. (Société de Chirurgie Séance 27 Avril. Semaine Medicale № 23, 1892). Vaginal uterine dissection with lesions of the appendages.

The author demonstrated the uterus removed from a very weak woman, 29 years old, due to pisalpingitis. Removal was performed through the vagina according to Pean's method, according to the method described by Muller for extirpation of the uterus in cancer. Mller is known to make a midline incision of the uterus to facilitate ligation of the wide ligaments. The author acted in the following way: having opened the posterior fornix, he pulls the uterus down and along the way of her lowering, he cuts it open and thus reaches the bottom of the uterus, after which he opens the lateral accumulations of pus; In his case, there was up to one and a half liters of pus. The patient did not lose a drop of blood and recovered.