Dr. P Sreenivasa Rao

Background: Episiotomy is the surgical enlargement of the vaginal orifice by an incision on the perineum during the last part of the second stage of labour or delivery. Episiotomy, incision of the perineum at the time of vaginal childbirth, is a common surgical procedure experienced by women. This study is done to compare use of restrictive episiotomy and routine episiotomy in primigravidae undergoing vaginal birth.Methods: This is a prospective cohort study designed to analyse the outcome of the restrictive use of episiotomy in comparison to routine use of episiotomy. Total 100 primigravidae women reporting to labour room in spontaneous labour/induction of labour were included and two cohorts were formed. Both the cohorts were evaluated during labour, immediate postpartum period and first postnatal day and data was tabulated and analysed.Results: Vaginal and paraurethral tears were noted in 14% primigravidae in the routine episiotomy group and 22.22% in the restrictive episiotomy group with no statistically significant association. Number of cases sustaining perineal tear in restrictive group was 15.55% and extension of episiotomy in the routine group was 26% with no statistically significant association. Requirement of suturing was far less in restrictive group (20%) as compared to routine group (100%), as 64.45% of the patients in restrictive group delivered with an intact perineum. The restrictive use of episiotomy does not prolong the second stage of labour and has requirement of significantly less pain relief compared to the routine group. Complication rate was higher in the routine group and perineal laceration and pain severity, was less in restrictive episiotomy group. However, neonatal complications were similar in the two groups.Conclusions: This study identified fair to good evidence suggesting that immediate outcomes following routine use of episiotomy are no better than those of restrictive use. Indeed, routine use is harmful to the degree that some proportion of women who would have had lesser injury instead had a surgical incision.

Background: In the last decade, male factor infertility has been recognized as a significant global problem, which is on an increase. Till date, very few options are available for ameliorating male factor infertility. Development of intracytoplasmic sperm injection has revolutionized the treatment of males with very low sperm counts or with poor quality sperm. However, patients with a diagnosis of azoospermia had no option but to resort to adoption or use of donor sperm. The clinical management of men with azoospermia seeking fertility has been a challenge for andrologists, urologists, and reproductive medicine specialists alike. The older approaches denied such couple the possibility of having own genetic children. Surgical sperm retrieval and intracytoplasmic sperm injection have successfully transformed the treatment of male infertility so that now most of the men can father their own children. The aim of this study is to present the outcome of IVF with surgically retrieved sperm from azoospermic men.Methods: This study was a retrospective analysis of 100 cycles using surgically retrieved sperm. Outcome measures were fertilization rate (FR) and implantation rate (IR) per transfer.Results: Sperm retrieval rate in our study was 76% when Per cutaneous epididymal sperm aspiration (PESA) and Testicular sperm extraction (TESE) are combined. Our data demonstrated similar outcome between the use of epididymal or testicular sperm in men with azoospermic. There was no statistical difference concerning fertilization rate, embryo quality and pregnancy rate between ICSI with surgically retrieved sperm and ejaculated sperms.Conclusions: Surgical sperm retrieval is a feasible and successful procedure. Spermatozoa can be retrieved from the testis in up to 76% of patients, even in cases with severe disorders of spermatogenesis and deranged hormonal profile. Comprehensive genetic counseling is important for infertile couples deciding for surgical sperm retrieval, since genetic disorders, as yet undetected, may be passed on to the following generation with multiplying variety.