Blood loss assessment in abdominal hysterectomy: how accurate?

Background: Precise estimation of blood loss is the key to optimal transfusion practice in surgery. Many studies done in various fields of surgery infer that clinical assessment of blood loss by the surgeon or anesthesiologist is inaccurate. The purpose of this study is to see if there is any difference in visual estimation of blood loss and actual blood loss calculated using modification of gross formula in abdominal hysterectomy.Methods: Fifty four patients undergoing total abdominal hysterectomy for various indications at JSS Hospital, Mysore were included in the study. Baseline characteristics, pre-operative haematocrit, clinically estimated blood loss (EBL) and post-operative haematocrit were noted. Actual blood loss (ABL) was calculated from a modification of the Gross formula. The number of cases where the blood loss was clinically underestimated and overestimated; and the relationship between the difference in actual and estimated blood loss and accuracy of clinical assessment of blood loss was determined. The data obtained was analysed using descriptive statistics and Crammer’s V test.Results: In the 54 cases of abdominal hysterectomy which we studied, there was overestimation of blood loss in 28 (51.9%) cases and underestimation of blood loss in 26 (48.1%) cases. The more the inaccuracy in clinical assessment of blood loss, more was the possibility of clinicians underestimating the blood loss.Conclusions: Clinical estimation of blood loss is an inaccurate method of assessing blood loss in abdominal hysterectomy

Total laparoscopic hysterectomy versus vaginal hysterectomy: a retrospective study

Background: Total laparoscopic hysterectomy (TLH) is now emerging as a safe procedure even in patients suitable for vaginal hysterectomy (VH) due to its advantages like better visualisation, less post-operative pain and shorter hospital stay. This study was done to compare the duration of surgery, intra-operative and postoperative complications, hospital stay and post-operative analgesia requirement in TLH and VH.Methods: A retrospective study of women undergoing TLH and VH between June 2013 and September 2014 in JSS Hospital, Mysore was done. Patients with suspected genital malignancy and uterine prolapse were excluded. Baseline characteristics like age, BMI, parity, indication for hysterectomy, uterine size and previous pelvic surgeries were noted. Intra-operative and post-operative parameters like duration of surgery, complications, post-operative analgesic dosage and hospital stay were compared between the two surgeries and the results were analysed using Chi square test and independent t test.Results: The mean time taken to perform TLH was significantly longer, i.e. 113.46 minutes compared with VH, i.e. 61.18 minutes ( p <0.0001). But the duration of stay in the hospital was shorter for the women undergoing TLH, mean duration being 3.74 days as opposed to 5.85 days in women undergoing VH  (p<0.0001). Also, women undergoing VH required more analgesic doses (mean 1.79) than those undergoing TLH (mean 1.36). When we studied the rate of complications in both the groups, we found no statistically significant difference.Conclusions: TLH was as safe as VH and had advantages like shorter hospital stay and reduced analgesia dose.

Efficacy of metformin and insulin in the management of gestational diabetes mellitus: A comparative study

Background: In Gestational Diabetes Mellitus (GDM), the insulin secretion is not adequate enough to compensate for the severity of hyperglycaemia and pregnancy is also a state of high insulin resistance which leads to ineffective glycaemic control. Aim and Objectives: To compare the efficacy of metformin and insulin in management of GDM; and to assess neonatal and maternal outcomes in the study group. Material and Methods: One hundred pregnant women visiting the Outpatient Department of Obstetrics and Gynecology, JSS Hospital, Mysuru were screened for GDM at first antenatal visit. If the first test results were negative, then second test was done at 24 - 28 weeks of gestation. One hundred pregnant women diagnosed as GDM after 20 weeks of gestation by Diabetes in Pregnancy Study Group of India (DIPSI) method were included for the study. They were randomly assigned into two groups with 50 patients each and were subjected to pharmacological treatment with either insulin or metformin. Optimum glycemic control between the two groups was studied along with the maternal and fetal outcome. Results: Our study showed no significant difference in GDM with the use of metformin or insulin. All patients (100%) from the insulin group achieved good glycemic control whereas in the metformin group, 98% achieved good glycemic control. Maternal and fetal outcomes were also not significant between the two groups. Conclusion: Our study showed no significant difference in the use of metformin or insulin and suggests that metformin is effective in controlling GDM without associated higher risk of maternal or neonatal complications compared with insulin