Dr. Kuharaj Maternity and Gynaecology

12/05/2024

08/03/2024

21/02/2024

Fun with the new 5D machine 😊

08/02/2024

Previous multiple Caesarean sections can result in uterine dehiscence and even uterine rupture without the patient being in labour or having contractions …not all uterine ruptures are catastrophic events with massive blood loss (as per the description in the text books) ….A high index of suspicion (especially in patients with risk factors for uterine rupture) and sometimes ultrasound findings can prevent a catastrophic event …in both these cases the patients were informed of their high risk for uterine rupture and advised for an early delivery via Caesarean section …..
Uterine scar rupture by definition is when all the 3 layers of the uterus give way (endometrium, myometrium and the serosal layer of the uterus)
Uterine scar dehiscence is when the endometrium and myometrium have opened up but the thin serosal layer remains intact
The picture on the left shows a small uterine dehiscence with the fetal ear visible on entry into the abdominal cavity
The picture on the left shows a complete rupture of the uterus with the amniotic membranes bulging out (note that there is significant scar dehiscence right next to the area that has ruptured-the serosal layer is intact there)
Fortunately in both these cases the patients were identified on time and early delivery via Caesarean section was carried out ….

25/11/2023

New toy always fun to play with …. ☺️

05/09/2023

43 year old lady was referred by a GP for ascites. A CT scan of the thorax, abdomen and pelvis revealed ascites and a right sided pleural effusion with no other discernible pathology. Peritoneal and pleural tapping only revealed lymphocytic effusion. The patient was informed regarding the clinical suspicion of peritoneal tuberculosis and was offered a diagnostic laparascopy and peritoneal biopsy. A diagnostic laparascopy was performed and the peritoneal biopsies taken confirmed peritoneal tuberculosis.

03/01/2023

24 year old lady presented with lower abdominal pain and was noted to have a palpable mass up to 20 weeks size on abdominal examination. A huge right sided ovarian cyst was noted on ultrasound measuring 12x12x10.4 cm.
The patient underwent a Laparascopic Ovarian cystectomy for a huge leaking multi-lobulated endometrioma.
The adhesions of the o***y and due to endometriosis was released and endometriosis over the left o***y was ablated with diathermy.
Abdominal lavage was done with normal saline and an abdominal drain was inserted.

01/06/2022

Total Laparoscopic Hysterectomy with Ligasure.

Patient presented with menorrhagia with anaemia that was not responding to medical therapy. Patient opted for a laparascopic Hysterectomy as she had completed her family and had no desire to retain her uterus.

The entire procedure was carried out with only two working ports and the vault was sutured with interrupted Vicryl suture (sliding knot technique).

23/05/2021

Recently in my practice I have come across many ladies who regularly take emergency contraceptive pills instead of some form of regular contraception. This is NOT a practice that is safe as emergency contraceptive pills are meant to be used in cases of emergency only, for example when conventional contraceptive methods have failed ..like the proverbial broken condom. These emergency contraceptive pills are purchased over the counter and although they are consumed within the recommended time of 72 hours from the time of in*******se, significant problems such as the following can occur:
1) Failure of emergency contraception-resulting in pregnancy within the uterus
2) Menstrual irregularity -missed, heavy or painful periods on the next cycle
3) Side effects of the emergency contraception like bloating, headache and lower abdominal discomfort
4) ECTOPIC PREGNANCY-this is the most serious complication due to the use of emergency contraceptive pills. Despite the individual taking the emergency contraception within the recommended time (72hours) she gets pregnant and the pregnancy is OUTSIDE the uterus-usually in the fallopian tube (>90% of cases). This is a life threatening condition as it results in bleeding within the abdominal cavity and if the bleeding is excessive or undetected this can results in death.
There is some evidence to suggest that the use of emergency contraceptive pills may increase the risk of ectopic pregnancy (as the one of the modes of action of the emergency contraceptive pill is to slow down the passage of the egg through the fallopian tubes). I have unfortunately already seen 5 cases of ectopic pregnancy AFTER the use of emergency contraceptive pills in my practice. Below are videos of the surgery of two such cases of ectopic pregnancy after emergency contraceptive pill use.
It is recommended that emergency contraceptive pills be used only as an EMERGENCY and not as a substitute to regular forms of contraception like Condoms, combined contraceptive pills, depot injections, intra-uterine contraceptive devices (IUCD) or implants. Stay safe ...