Trends in Gynaecology

Dr Seema Wadhwa
Is it surprising to hear of Advancement in  Technology in a field like Gynaecology? Technology boost & boom spreading across and hitting an arena where since time immemorial the world revolved around D&Cs, Normal Deliveries and at the most Hysterectomies.
Need to the hour
Even today  ladies walk in our Clinics claiming ‘ No tests were  done when I was expecting, not even a single scan, and all went well…I delivered normally!’
But if we analyse, those were the  times when Congenitally malformed babies were not diagnosed. A couple would have multiple pregnancies and deliveries, not realising maybe one child is a Down’s Syndrome baby, another one with Cerebral Palsy or a couple of Neonatal… even Maternal deaths ! What was important was they were all Normal Deliveries absolutely unsupervised medically!
India’s main MDG5 ( Millennium Development Goal) Target is to reduce MMR (Maternal Mortality Rate) by three quarters between 1990  & 2015 i.e. from 437 maternal deaths per 100 000 live births to 109, while it has also committed to improve the proportion of skilled health personnel. This I guess is self explanatory & hence the battery of tests & visits to us.
Speaking of chronic problem in women, Menstrual irregularity has been  definitely the most common reason why a lady visits a tertiary care hospital. ‘We got D&C done 2 to 3 times but still not cured ‘…is a regular remark made by patients…not realising that ‘ Blind D&C’ whether Diagnostic or Therapeutic has a chance of missing the real findings and even Polyps & Cancers to the tune of 50%.
What is recommended is a procedure that can visualise the uterus lining from inside known in medical terms as Hysteroscopy and is not a Blind procedure. A fine Medical Telescope is introduced into the uterus without a cut or any stitches, the endometrium (lining of uterus) visualised and lesions biopsied. Hence need of the hour is to say goodbye to Blind D&Cs when we can visualise and say for sure.
Invariably the scans show Ovarian cysts, Fibroids and Endometrial Hyperplasia. Advanced Laparoscopy enables us to perform procedures as removal of these lesions as well as treat Endometriomas, do Tubal Patency tests, Infertility workup and even remove the uterus if the disease demands, through a keyhole surgery done now in a DayCare setting… hence saying goodbye to prolonged hospital stay, large debilitating open wounds on the abdomen, disfigurement, being bedridden & off work for weeks after a surgery and definitely no chances of future wound Hernias & Adhesion formation.
Thanks to Advancement in Technology!
(The author is Senior Consultant Obstetrician, Gynaecologist & Endoscopy Specialist Max Superspeciality nhospital Mohali)