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OPD procedures |
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OPD proceduresFollowing OPD procedures are routinely done in the department :
- Cervical cancer screening:
All the patients above 30 years of age or sexually active for more than 3 years are screened for cervical neoplasia by Pap smear collection. An Ayre’s spatula is used to scrape cells from ectocervix and then a thin smear is prepared on a glass slide. The smear is immediately fixed and sent for cytologic analysis.
- Colposcopy and colposcopy guided biopsy:
Colposcopy is the procedure by which cervix is visualized under magnification by using a colposcope. It is usually indicated once there are abnormal cells detected on Pap smear testing. It helps to identify the abnormal areas on the cervix and to direct the biopsy from those specific areas.
- LEEP biopsy:
LEEP utilizes a thin wire loop to remove the cervical transformation zone through electrocautery. It allows samples to be collected for additional tissue analysis and treats the condition in the same sitting.
It does not require any anesthesia. It is indicated in the treatment of cervical dysplasias.
- Cryocauterization:
This is a simple and safe procedure to treat cervical erosion and does not require any anesthesia. A cryoprobe is first cooled by nitrous oxide and then touched to the abnormal cervical area. This freezes and kills the cells, resulting in the sloughing of the abnormal tissue. Patient is sent home the same day.
- Ultrasound guided procedures:
In addition to the routine pelvic and obstetric scan, various ultrasound guided procedures are done on routine basis. This includes sonohysterography and sonosalpingography, where saline is instilled in the uterine cavity and the fluid helps in outlining the intracavitary uterine pathology and also to establish tubal patency in infertility patients.Ultrasound guided amniocentesis is done to procure a sample of amniotic fluid for metabolic and chromosomal analysis in patients who have bad obstetric history, previous affected babies or inherited disorders.
- Pipelle sampling:
Endometrial biopsy is taken by Pipelle device. It is a 2mm slender plastic curette. It is introduced in the uterine cavity and a strip of endometrium is obtained for histopathology. It is a painless and quick procedure which has replaced the conventional D& C. Endometrial biopsy is used in the assessment of abnormal uterine bleeding in perimenopausal patients, for the assessment of the endometrium during tamoxifen therapy and for the investigation of amenorrhoea or infertility. In women the combined use of pipelle sampling and ultrasound has a high detection rate for endometrial carcinoma.
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Obstetric services |
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Ours is a tertiary care center, well equipped for handling all types of high risk pregnancies and emergencies related to pregnancy and labor. We have the back up of a well equipped NICU with all advance life support systems. Besides the routine obstetric care for uncomplicated pregnancies specialized care is provided in high risk cases. This includes:
- Management of fetal abnormalities with close cooperation of departments of pediatric cardiology, pediatric surgery and neonatology. This includes fetuses with intrauterine growth restriction, those with salvageable structural anomalies such as congenital diaphragmatic hernia, PUJ obstruction, posturetheral valve, congenital cardiac defects, duodenal atresia, etc.
- Evaluation and Management of Recurrent miscarriages.
- Screening and management of Preterm labor and PROM.
- Management of Critically ill Obstetric cases – HELLP syndrome, APH , Ecclampsia, Obstetric Shock.
- Management of pregnancies complicated with maternal disorders like Hypertension, Diabetes, Cardiac diseases,Thyroid disorders, Collagen vascular disorders, Hematologic disorders, etc.
- Management of pregnancies associated with gynaecologic conditions such as fibroids, ovarian tumors, prolapse uterus etc.
Special services :
Special antenatal screeenig services:
- Prenatal diagnosis :Couples having previous mentally retarded or chromosomally abnormal babies or those with history of recurrent fetal or neonatal losses, are provided with detailed genetic counseling . They undergo antenatal screening procedures like chorion villus sampling or amniocentesis. Metabolic screen is provided for patient with history of inborn errors of metabolism.
- First trimester screening for chromosomal abnormalities by ultrasound and biochemical tests (Free beta HCG, PAPP- A and inhibin )
- Mid trimester – Level II ultrasound, fetal echocardigram and biochemical screen .
- Doppler velocimetry studies are available for evaluation for patients with PIH and those with intrauterine growth restriction.
Uterine artery embolization
Facilities for emergency embolization are available for uncontrolled postpartum hemorrhage. Our department has successfully managed -----cases of postpartum hemorrhage due to atonicity, pseudoaneurysm and secondary PPH.
Labor room facilities:
- Epidural Analgesia service available round the clock for painless labour .
Critically ill obstetrics patients treated in the Intensive care unit with close cooperation of the necessary superspecialities.
- 24 hour blood bank service with facility for blood component therapy.
- We are in the process of setting up two deluxe delivery suites. It will allow the patient to be with the family during labour.
Free services:
Patients belonging to BPL group are provided with free antenatal and intranatal care including Caesarean section. |
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Gynecologic surgeries |
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Our surgical team is performing all routine and complicated surgeries related to female genital tract.
Minimally invasive surgical procedures :
- Uterine surgeries – myomectomy , rudimentary horn excision, adenomyomectomy, total laparoscopic hysterectomy, laparoscopic assisted vaginal hysterectomy
- Tubal surgeries – adhesiolysis, tubal surgeries for ectopic gestation, salpingectomy
- Ovarian surgeries – follicular puncture, ovarian biopsy, cystectomy, adhesiolysis, ovariotomy.
- Hysteroscopic procedures – septum resection, myomectomy, polypectomy, tubal cannulation.
Special facilities
- Disorders like primary amenorrhoea, hirsutism, hyperprolactinemia , polycystic ovarian disease, premature menopause are dealt with by special coordination between the gynecologist and endocrinologist.
- Interventional radiological procedures such as Uterine artery embolization available for the treatment of uterine fibroids.
- Gynopsychiatric consultation : Psychologic support for patients with gynecological ailments such as chronic pelvic pain.
Rare procedures
- Our department is the first to perform laparoscopic ovarian transpositon in Kerala state. We have performed three laparoscopic ovarian transposition for ovarian conservation in young patients undergoing treatment for pelvic malignancies.
- One rare case of advanced first trimester rudimentary horn pregnancy was managed successfully by laparoscopy.
- Free tubal reconstructive surgeries were performed for 8 Tsunami victims, out of which two have conceived and delivered already.
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Infertility |
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| Couple is evaluated for various male and female factors. Male factor evaluation is done in conjunction with urologists. Female evaluation includes follicular monitoring, tubal evaluation, pelvic factor evaluation and endocrine assessment. Facilities for controlled ovarian stimulation with intrauterine insemination are currently available. Patients requiring further assisted reproductive techniques are referred to reputed IVF centers in the region. |
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Well women clinic |
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| Special health care package is available for women in the perimenopausal age group. They are screened for cervical and breast malignancies by Pap smear testing and mammogram. Transvaginal ultrasound is done for endometrium and ovarian screening. Dexa scan is done for women at risk for osteoporosis |
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Family planning services |
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| Counselling regarding family welfare, spacing and contraceptive methods is provided. Services include intrauterine device insertion, minilap and endoscopic tubal ligation. MTP facilities like first and second trimester medical and surgical methods are available. |
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Gynecologic oncology |
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| Comprehensive care is provided for all gynecologic malignancy cases by an organized team comprising of medical, surgical and radiation oncologists. Treatment planning is done after discussion in tumor board meetings which are organized once in every fortnight |
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