Inferior Vena Cava Ligation for Intractable Pelvic Haemorrhage

Inferior vena cava ligation was performed as the last resort in a case of iatrogenic injury to the common iliac veins during pelvic surgery. The post-operative recovery was satisfactory.     

Follicular Ring Sign

The follicular ring sign is a novel, easily identifiable sonographic finding of ovarian torsion consisting of hyperechoic rings around the antral follicles. In a retrospective analysis of 15 consecutive patients with torsion undergoing surgery, the follicular ring sign was frequently present, starting early in the disease course. This sign could be valuable for accurate and early diagnosis of torsion in the absence of specific conventional sonographic features.     

Labour Induction with Intracervical Prostaglandin E2 Gel and Intravenous Oxytocin in Women with a Very Unfavourable Cervix

Summary: Two hundred and sixty-three gravid women having a very unfavourable cervix and requiring labour induction were studied; 80 primigravidas and 56 multigravidas were administered a single dose of intracervical prostaglandin E₂ gel (PGE₂) and 72 primigravidas and 55 multigravidas had labour induced with an escalating oxytocin infusion. After 24 hours 73.8% of the primigravidas induced with PGE₂ had delivered vaginally compared with only 52.8% of those induced with oxytocin. The incidence of Caesarean sections was very high (47.2%) in the primigravidas receiving an oxytocin infusion. In the multigravidas, there was no significant difference in the proportion of women who had delivered vaginally within 24 hours and in the percentage of Caesarean sections in the 2 induction groups. After 12 hours, a significant increase in the cervical score was seen in all women receiving PGE₂ intracervically. The fetal outcome and perinatal mortality were not affected by the mode of induction. Intracervical PGE₂ appears to be more effective than oxytocin in inducing labour in primigravidas having an unfavourable cervix, whereas in multigravidas, both methods appears to be equally effective.     

Why Deliver in the Supine Position?

This study was conducted at the Lokmanya Tilak Municipal General Hospital, Bombay, India during the year 1990. The aim was to compare the routinely used supine position versus ambulation in the first stage and squatting position during the second stage of labour. Our study was comprised of 200 patients both primigravidas and multigravidas; 100 were kept in the supine position throughout labour and 100 were kept ambulatory in the first stage and adopted the squatting position during the second stage. The study showed a shortening of both stages of labour in the squatting group but the incidence of complications was less in the control group. It was concluded that without proper birthing chairs which can give excellent perineal support, the usual supine position is preferable in our setup.     

The Sion Test

Endosonography as a tool for checking the patency of Fallopian tubes was an expected development in the progress the field of gynaecology was taking. We at Sion Hospital have used transvaginal sonography in evaluating the patency of Fallopian tubes with a technique which encompasses a thorough pelvic scan as well. We offer The Sion Test not as a substitute for hysterosalpingography, laparoscopy or hysteroscopy but as a screening technique in infertility investigation. The Sion Test can be performed in the gynaecologists' office at the same time as the pelvic examination. A series of 50 infertile patients had a diagnostic laparoscopy and hysterosalpingography after our test was done. We have compared the accuracy of the 3 methods of evaluating tubal patency and have found our test an excellent screening technique for investigations in infertility.