External Aortic Compression

Odon Device a possible alternative to Obstetric Forceps & Ventouse

Pelvic Organ Prolapse Operations (playlist)

Practical Obstetrics (playlist)

Manchester Operation showing Fothergill's points and stitch and Sturdorm...

Fothergill's Operation Video

Burch Colposuspension

Burch Colposuspension Video

Virkud Compsite Sling Operation, abridged version with audio

My Composite Sling Operation Video

Pudendal Nerve Block

Recent changes in diagnosis, management of preeclampsia by ACOG

Recently ACOG has made the following observations as regards diagnosis, management of preeclampsia

• First and foremost observation made by ACOG is that proteinuria should no longer be considered the signature criterion in diagnosing preeclampsia. How things have changed over the years. When we were students preeclampsia was considered a TRIAD of three signs: Hypertension, Edema and Proteinuria. Later Edena as a criteria for diagnosis was dropped as it came to be realised that edema is an incidental finding in preeclamsia and has no bearing on severity or prognosis. And now in 2014, ACOG says: “Proteinuria, in addition to being downgraded as the signature diagnostic finding in preeclampsia, should no longer be considered as useful in classifying preeclampsia as severe or in deciding whether to induce, the guidelines say, because the amount of protein in the urine has not been shown to predict either maternal or fetal outcomes.”
• ACOG says that equal weight should be given to reduced platelet counts, renal insufficiency, severe headache, heart-lung compromise, and impaired liver function. Any one of these concurrent with new-onset hypertension at 20 weeks of pregnancy or beyond is enough to establish preeclampsia, even in the absence of proteinuria. I feel vindicated about this because I have already said in II edition of my textbook, Modern Obstetrics, that significant hypertension with any organ damage such as kidneys, liver, lung, heart, brain etc. should be called preeclampsia. As I have said in my book “nonproteinuric preeclampsia is now a diagnostic entity”
• Another important change is that preeclamsia is no longer considered as Mild and Severe. Now ACOG guidelines distinguish extensively between preeclampsia with and without severe features, but discourage the use of the phrase "mild preeclampsia," considering it misleading. "Preeclampsia in any form should never be minimized as ‘mild.’
• Fetal growth restriction (FGR), once considered a major criterion to make the diagnosis of severe preeclampsia, is now to be used not for diagnosis of preeclampsia, but for indicated delivery in a patient with preeclampsia who also has an extremely small fetus (< 5th centile) that is associated with abnormal blood flow findings in the umbilical cord connecting the fetus to the placenta.
• The guidelines emphasize that preeclampsia can appear for the first time following delivery, or worsen rather than improve during in the postnatal period.
• As regards prevention, ACOG has this to say: The use of vitamins C and E is not advised in preventing preeclampsia. Low-dose aspirin, however, is recommended starting late in the first trimester for patients who experience preterm severe preeclampsia.
• Delivery at 37 weeks is advised for women with preeclampsia without severe features.

NACO Kits for Treatment of Sexually Transmitted Infections

The other day my DNB students were asking me about various color kits that are available for syndromic management of vaginal discharge. I said I will tell you provided you answer one question. They said shoot! 

My question: 

Q.: What is the difference, if any, between sexually transmitted disease (STD) and venereal disease (VD)?

Needless to say, nobody could give the correct answer.

Answer: Venereal diseases are those sexually transmitted diseases that have lesions on the genital tract whereas other diseases that transmitted sexually but do not have pathological manifestations on the female genital tract should be called only sexually transmitted diseases. Thus all venereal diseases are sexually transmitted diseases but all sexually transmitted diseases are not venereal diseases. Examples: gonorrhea, syphilis, chancroid, lymphogranuloma venereum, and granuloma inguinale are venereal diseases; on the other hand HIV and hepatitis B are sexually transmitted infections but they are not venereal diseases.

Reference: Modern Gynecology, II edition, Ch. 06, Page 57, Ajit Virkud, APC Publishers.

Now back to syndromic management of vaginal discharge using different NACO kits.

In low resource settings e.g. developing countries like India, WHO advocates prescribing a single day course of multiple drugs for syndromic management of vaginal discharge. To avoid costs, no diagnostic tests are done before starting treatment. The treatment should be given to both the partners. National Aids Control Organization (NACO) of India has also adopted these guidelines and added a few extra measures to simultaneously control HIV in this high risk group. With this aim, they have developed different colour kits for syndromic management of symptomatic patients are shown in the table below.

NACO KITS

For more information on this topic refer to my textbook: Modern Gynecology, II Edition, APC Publishers