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How to decrease hysterectomy in  rate in india,dr. sharda jain lecture 1
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  • WHY SHOULD’NT A HYSTERECTOMY BE AVOIDED IF THE BENEFIT CAN BE PROVIDED TO A GOOD NO, OF PATIENTS BY A SAFER ALTERNATIVE TT MODALITY COZ HYSTERECTOMY DOES CARRY RISKS OF ANAESTHESIA ETC <br />
  • As u can see from thslide that 20 % of all hystrec are done for dub alone so if we take that chunk out of the pie and treat a lot of these patients with newer modalities you can understand the impact IT WOULD HAVE on the morbidity and financial implications. <br />
  • The rcog issued evidence based clinical guidelines in 1998 on initial management of menorrhagia and were subsequently updated. <br />
  • THERE HAVE BEEN SEVERAL STUDIES PUBLISHED IN VARIOUS JOURNALS QUESTIONING THE APPROPRIATENESS OF HYSTERECTOMY <br />
  • Why would hysterectomies be performed inappropriately BECAUSE OF <br />
  • WHY SHOULD’NT A HYSTERECTOMY BE AVOIDED IF THE BENEFIT CAN BE PROVIDED TO A GOOD NO, OF PATIENTS BY A SAFER ALTERNATIVE TT MODALITY COZ HYSTERECTOMY DOES CARRY RISKS OF ANAESTHESIA ETC <br />
  • THE SECOND SESSION WILL HAVE A DETAILED PRESENTATION BY DR SHARDA JAIN AS WELL AS THE PATIENTS OWN EXPEREINCES REGARDING THE UTERINE BALLOON THERAPY <br />

How to decrease hysterectomy in  rate in india,dr. sharda jain lecture 1 How to decrease hysterectomy in rate in india,dr. sharda jain lecture 1 Presentation Transcript

  • Lecture 1 How to decrease Hysterectomy Rate in India? Dr. Sharda Jain “Save Uterus Campaign” Lecture Series (1 to 4 )
  • How to decrease Hysterectomy Rate in India? Dr. Sharda Jain Dr. Jyoti Agarwal Dr. Jyoti Bhaskar
  • Save PARTNERS •Delhi Gynae Forum •Faridabad obs/Gynae Society •Gurgaon obs/Gynae Society •Gaziabad obs/Gynae Societ •Noida obs/Gynae Society •Muradabad obs/Gynae Society Uterus Campaign CROSSING All Boundaries in GYNAECOLOGICAL Care to SAVE UTERUS THEMES • How to decrease Hysterectomy rate In India • Global Endometrial ablation • Uterine Balloon Therapy • Mirena • Minimizing Complications in Hysteroscopic Surgeries •Simplifying Medical Treatment of DUB
  • TOI Sept. 2010 Landmark article 80% of Andhra Village women are minus their uterus
  • Uterus chopping States Andhara Pradesh , Madhya Pradesh,Punjab Bihar, Delhi Modus Operandi Same as Female Foeticide
  • 22 Sept.2012 appealed to Gynaecologists To be kind to uterus
  • Why Did he say so about Hysterectomy ? • Second most frequent surgical procedure in women of reproductive age group • 90% for benign reasons • Promptly offered following a diagnosis. • Hysterectomy should not be taken up lightly.
  • BIG FACT !! Women AGE early even if ovaries are retained At Hysterectomy All Elders endorse this fact
  • Hysterectomy is Not 100% safe Disadvantages • Performed under general or regional anesthesia • Long hospitalization and recovery time • Mortality 0.6-1/1,000 • Major complications 3% • Morbidity 24-43% • Psychological 25-35% • Long period of convalescence KJ Carlson, NEJM 328:856, 1993
  • Do You want to guess the Number of HYSTERECTOMY done in India ?
  • Numbers of Hysterectomies Per year USA 5.9 lac UK 1.3 lac Russia 3.12 lac India 23.2 lac CDC
  • 1990-2000 Life time risk Of Uterus Removal
  • U.K. 1:5 Women before 60 years had Hysterectomy
  • USA 1:3 Women before 60 years had Hysterectomy
  • Indications of Hysterectomy Indications of Hysterectomy In USA In USA Prolapse 15% (Pre) cancer 10% Chronic pelvic pain 10% Fibroids 30% Endometriosis/ Adenomyosis 20% DUB 20% 1990 - 2000
  • Hysterectomy Rate ↓↓ th To 1/10 (20 years) In western world
  • Causes of Hysterectomy in USA now 5 per 1000 % • • • • • • Uterine leiomyoma Endometriosis Uterine Prolapse Cancer Endometrium hyperplasia Misc. (Includes CERVICAL DYSPHASIA) Obstat Gvnecol 2008;34.e1-e7 40.7 17.7 14.5 9.2 2.7 15.2
  • Bilateral Salpingo- Oopherectpomy Rate 65% ↓↓↓ 45% Uterus Retained (Bad PID)
  • Average AGE of Hysterectomy in USA 46 yrs (40 – 50 yrs) Uterus Removal In India 10 to15 yrs. earlier
  • Menace of Uterus Removal is on
  • GOVT enquiry in Many states
  • Who has Caused this Menace in India ? Gynaecologists & Surgeons
  • Big Question How western world has ↓↓↓ Hysterectomy Rate? ACOG / Royal College
  • February, 2000, Vol 95, No. 2, Pages 199-205 The Appropriateness of Recommendations for Hysterectomy Michael S. Broder, MD, David E. Kanouse, PhD, Brian S. Mittman, PhD, and Steven J. Bernstein, MD, MPH
  • The Appropriateness of Recommendations for Hysterectomy* Michael S. Broder, MD, David E. Kanouse, PhD, Brian S. Mittman, PhD, and Steven J. Bernstein MD, MPH 76% of the patients who were taken up for hysterectomy did not meet ACOG criteria for hysterectomy *Obstet Gynecol 2000;95:199-205
  • “The most common reasons for which hysterectomies were considered inappropriate were • lack of adequate diagnostic evaluation • failure to try alternative treatments before hysterectomy.” *Obstet Gynecol 2000;95:199-205
  • HYSTERECTOMY as Treatment Should be last resort KJ Carlson, NEJM 328:856, 1993
  • Risk of Endometrial Carcinoma • 20-40 yrs – 10 / lac • 40-50 yrs - 36 / lac
  • More than 1 in 5 30s & 40s suffer from HEAVY PERIODS (Unmanageable)
  • FIGO PALM - COEIN
  • TVS Gold Standard
  • Office Hysteroscopy Gold standard for HMB but not cost effective as first line diagnostic tool.
  • Office EB - Diag. Procedure Gold Standard • Has replaced conventional D & C under GA • No therapeutic value
  • Treatment
  • THE IDEAL TREATMENT FOR HMB Is Not Hysterectomy
  • Current Treatment Recommended for HMB Drug therapy 20%-30% after 35 years Global Endo. Ablation/ Mirena Hysterectomy
  • Medical management of DUB Effectiveness Side effects Costs Contraceptive Pill 50% + Progestagens 20% ++ Danazol 100% (dose!) GnRH`agonist + ++ 100% ++ ++ NSAID 30% + Antifibronilytic agents 50% + ++ IUD with Progesteron 65%-97% + ++ 20-30% success after 35 years
  • Mirena (LNG IUS) (5 yrs) is a Magic Stick
  • Conclusions about Mirena • Mirena provides most effective medical treatment with least side effects • It can replace in about 50 % cases the need for endometrial ablation or hysterectomy • Especially useful when presently contraception is required but future fertility is desired
  • We have largest Number of cases of MIRENA in Delhi & NCR (2013 upto 30th June)
  • GLOBAL ENDO. ABLATION TECHNIQUES (10-15 years) • Success is 80 to 90% •Repeat procedure / Hysterectomy – 10 to 20% Amenorrhea, ↓↓ bleeding in over 90%
  • Uterine Balloon Therapy (Many Types) For Treatment of DUB
  • Very Effective 10 minute Solution for ‘Heavy Periods’
  • We Have Largest No. of Cases of UBT in India Our cases : till March 2013 N - ↑ 1300 (24 months F/U completed – Over 1000 cases)
  • UBT’s Biggest Use Is In Bad Surgical Risk cases
  • Let us come forward to stop this menace of uterus removal. ° Think rationally yourself. ° Vow yourself & ° Join the Movement for motivating 10 other gynaecologists to do the same
  • No way should SURGEONS be allowed to do hysterectomy in India …… Such practices should become history !!
  • Thanks