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How to decrease
Hysterectomy Rate
in India?
Dr. Sharda Jain
Director :-
Founder Chairman PCH OBST/ Gynae Dpt.
Sec General ...
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% ...
BIG FACT !!
Women AGE early even if
ovaries
are retained
At
Hysterectomy
All Elders endorse this fact
KJ Carlson, NEJM 328:856,
1993
DisadvantagesDisadvantages
• Performed under general or regional
anesthesia
• Long hospital...
Do You want to guess
the
Number
of
HYSTERECTOMY
done in India ?
USA 5.9 lac
UK 1.3 lac
Russia 3.12 lac
India 23.2 lac
CDC
Numbers of
Hysterectomies Per year
1990-2000
Life time risk
Of
Uterus Removal
1:5
Women before 60 years
had Hysterectomy
U.K.
1:3
Women before 60 years
had Hysterectomy
USA
DUB 20%DUB 20%
FibroidsFibroids 30%30%
Endometriosis/Endometriosis/
Adenomyosis 20%Adenomyosis 20%
(Pre) cancer(Pre) cance...
Hysterectomy Rate
↓↓
To 1/10th
(20 years)
In western world
Causes of Hysterectomy
in USA now
5 per 1000
%
• Uterine leiomyoma 40.7
• Endometriosis 17.7
• Uterine Prolapse 14.5
• Can...
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
How western world has
↓↓↓ Hysterectomy Rate?
Big Question
ACOG / Royal College
February, 2000, Vol 95,February, 2000, Vol 95,
No. 2, Pages 199-205No. 2, Pages 199-205
The Appropriateness of Recommendat...
76%76% of the patients who were takenof the patients who were taken
up for hysterectomyup for hysterectomy did not meetdid...
““The most common reasons for whichThe most common reasons for which
hysterectomies were consideredhysterectomies were con...
KJ Carlson, NEJM 328:856,
1993
HYSTERECTOMY
as Treatment
Should be last resort
•20-40 yrs – 10 / lac
•40-50 yrs - 36 / lac
Risk of Endometrial Carcinoma
More than 1 in 5
30s & 40s suffer from
HEAVY PERIODS
(Unmanageable)
PALM - COEIN
FIGO
TVS
Gold Standard
Gold standard for HMB but not cost effective
as first line diagnostic tool.
Office Hysteroscopy
• Has replaced conventional
D & C under GA
• No therapeutic value
Office EB - Diag. Procedure
Gold Standard
Treatment
IsIs Not HysterectomyNot Hysterectomy
THE IDEAL TREATMENTTHE IDEAL TREATMENT
FOR HMBFOR HMB
Current TreatmentCurrent Treatment
Recommended for HMBRecommended for HMB
Drug therapyDrug therapy
HysterectomyHysterectom...
Medical management of DUBMedical management of DUB
EffectivenessEffectiveness Side effectsSide effects CostsCosts
Contrace...
Mirena (LNG IUS)
(5 yrs)
is a
Magic Stick
• Mirena provides most effective medical
treatment with least side effects
• It can replace in about 50 % cases the need f...
We have largest Number of
cases
of MIRENA
in Delhi & NCR
(2013 upto 30th
June)
•
SuccessSuccess isis 8080 toto 90%90%
•Repeat procedure / HysterectomyRepeat procedure / Hysterectomy ––
10 to 20%10 to 2...
Pooled Results
UBT
Pooled Results
UBT
Amenorrhea/ spotting
36%
Eumenorrhea
22%
Minimal or no
Reduction in
Menses 4.0%
Hypo...
For Treatment of DUB
Uterine Balloon Therapy
(Many Types)
GYNECARE*
THERMACHOICE*
Performance
> OVER 20,00,000
procedures worldwide
10 minute
Solution
for
‘Heavy
Periods’
Very Effective
We Have Largest No. of Cases
of UBT in India
Our cases : till March 2013
N - ↑ 1300
(24 months F/U completed – Over 1000
c...
UBT’s
Biggest Use
Is In
Bad Surgical
Risk cases
° Think rationally yourself.
° Vow yourself &
° Join the Movement for
motivating 10 other
gynaecologists to do the
same
Le...
No way should
SURGEONS be
allowed to do
hysterectomy in
India ……
Such practices
should become
history !!
Thanks
How to Decrease Hysterectomy Rate In India
How to Decrease Hysterectomy Rate In India
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How to Decrease Hysterectomy Rate In India

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How to Decrease Hysterectomy Rate In India

  1. 1. How to decrease Hysterectomy Rate in India? Dr. Sharda Jain Director :- Founder Chairman PCH OBST/ Gynae Dpt. Sec General : Delhi Gynaecology Forum
  2. 2. TOI Sept. 2010 Landmark article 80% of Andhra Village women are minus their uterus
  3. 3. Uterus chopping States Andhara Pradesh , Madhya Pradesh,Punjab Bihar, Delhi Modus Operandi Same as Female Foeticide
  4. 4. 22 Sept.2012 appealed to Gynaecologists To be kind to uterus
  5. 5. 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.
  6. 6. BIG FACT !! Women AGE early even if ovaries are retained At Hysterectomy All Elders endorse this fact
  7. 7. KJ Carlson, NEJM 328:856, 1993 DisadvantagesDisadvantages • 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 Hysterectomy is Not 100% safe
  8. 8. Do You want to guess the Number of HYSTERECTOMY done in India ?
  9. 9. USA 5.9 lac UK 1.3 lac Russia 3.12 lac India 23.2 lac CDC Numbers of Hysterectomies Per year
  10. 10. 1990-2000 Life time risk Of Uterus Removal
  11. 11. 1:5 Women before 60 years had Hysterectomy U.K.
  12. 12. 1:3 Women before 60 years had Hysterectomy USA
  13. 13. DUB 20%DUB 20% FibroidsFibroids 30%30% Endometriosis/Endometriosis/ Adenomyosis 20%Adenomyosis 20% (Pre) cancer(Pre) cancer 10%10% Chronic pelvic pain 10%Chronic pelvic pain 10%ProlapseProlapse 15%15% Indications of HysterectomyIndications of Hysterectomy In USAIn USA Indications of HysterectomyIndications of Hysterectomy In USAIn USA 1990 - 2000
  14. 14. Hysterectomy Rate ↓↓ To 1/10th (20 years) In western world
  15. 15. Causes of Hysterectomy in USA now 5 per 1000 % • Uterine leiomyoma 40.7 • Endometriosis 17.7 • Uterine Prolapse 14.5 • Cancer 9.2 • Endometrium hyperplasia 2.7 • Misc. 15.2 (Includes CERVICAL DYSPHASIA) Obstat Gvnecol 2008;34.e1-e7
  16. 16. Bilateral Salpingo- Oopherectpomy Rate 65% ↓↓↓ 45% Uterus Retained (Bad PID)
  17. 17. Average AGE of Hysterectomy in USA 46 yrs (40 – 50 yrs) Uterus Removal In India 10 to15 yrs. earlier
  18. 18. Menace of Uterus Removal is on
  19. 19. GOVT enquiry in Many states
  20. 20. Who has Caused this Menace in India ? Gynaecologists & Surgeons
  21. 21. How western world has ↓↓↓ Hysterectomy Rate? Big Question ACOG / Royal College
  22. 22. February, 2000, Vol 95,February, 2000, Vol 95, No. 2, Pages 199-205No. 2, Pages 199-205 The Appropriateness of RecommendationsThe Appropriateness of Recommendations for Hysterectomyfor Hysterectomy Michael S. Broder, MD, David E. Kanouse, PhD,Michael S. Broder, MD, David E. Kanouse, PhD, Brian S. Mittman, PhD, and Steven J. Bernstein, MD, MPHBrian S. Mittman, PhD, and Steven J. Bernstein, MD, MPH
  23. 23. 76%76% of the patients who were takenof the patients who were taken up for hysterectomyup for hysterectomy did not meetdid not meet ACOGACOG criteria for hysterectomycriteria for hysterectomy *Obstet Gynecol 2000;95:199-205*Obstet Gynecol 2000;95:199-205 The Appropriateness of Recommendations for Hysterectomy* Michael S. Broder, MD, David E. Kanouse, PhD, Brian S. Mittman, PhD, and Steven J. Bernstein MD, MPH
  24. 24. ““The most common reasons for whichThe most common reasons for which hysterectomies were consideredhysterectomies were considered inappropriate wereinappropriate were • lack of adequate diagnostic evaluationlack of adequate diagnostic evaluation • failure to try alternative treatmentsfailure to try alternative treatments before hysterectomy.”before hysterectomy.” *Obstet Gynecol 2000;95:199-205*Obstet Gynecol 2000;95:199-205
  25. 25. KJ Carlson, NEJM 328:856, 1993 HYSTERECTOMY as Treatment Should be last resort
  26. 26. •20-40 yrs – 10 / lac •40-50 yrs - 36 / lac Risk of Endometrial Carcinoma
  27. 27. More than 1 in 5 30s & 40s suffer from HEAVY PERIODS (Unmanageable)
  28. 28. PALM - COEIN FIGO
  29. 29. TVS Gold Standard
  30. 30. Gold standard for HMB but not cost effective as first line diagnostic tool. Office Hysteroscopy
  31. 31. • Has replaced conventional D & C under GA • No therapeutic value Office EB - Diag. Procedure Gold Standard
  32. 32. Treatment
  33. 33. IsIs Not HysterectomyNot Hysterectomy THE IDEAL TREATMENTTHE IDEAL TREATMENT FOR HMBFOR HMB
  34. 34. Current TreatmentCurrent Treatment Recommended for HMBRecommended for HMB Drug therapyDrug therapy HysterectomyHysterectomy 20%-30% after 35 years Global Endo. Ablation/ Mirena
  35. 35. Medical management of DUBMedical management of DUB EffectivenessEffectiveness Side effectsSide effects CostsCosts Contraceptive PillContraceptive Pill 50%50% ++ ProgestagensProgestagens 20%20% + ++ + DanazolDanazol 100% (100% (dose!)dose!) + +++ ++ GnRH`agonistGnRH`agonist 100%100% + + +++ + ++ NSAIDNSAID 30% +30% + Antifibronilytic agentsAntifibronilytic agents 50% + ++50% + ++ IUD with Progesteron 65%-97%IUD with Progesteron 65%-97% + +++ ++ 20-30% success after 35 years
  36. 36. Mirena (LNG IUS) (5 yrs) is a Magic Stick
  37. 37. • 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 Conclusions about Mirena
  38. 38. We have largest Number of cases of MIRENA in Delhi & NCR (2013 upto 30th June)
  39. 39. • SuccessSuccess isis 8080 toto 90%90% •Repeat procedure / HysterectomyRepeat procedure / Hysterectomy –– 10 to 20%10 to 20% Amenorrhea, ↓↓ bleeding in overAmenorrhea, ↓↓ bleeding in over 90%90% GLOBAL ENDO.GLOBAL ENDO. ABLATIONABLATION TECHNIQUESTECHNIQUES (10-15 years)(10-15 years)
  40. 40. Pooled Results UBT Pooled Results UBT Amenorrhea/ spotting 36% Eumenorrhea 22% Minimal or no Reduction in Menses 4.0% Hypomenorrhea
  41. 41. For Treatment of DUB Uterine Balloon Therapy (Many Types)
  42. 42. GYNECARE* THERMACHOICE* Performance > OVER 20,00,000 procedures worldwide
  43. 43. 10 minute Solution for ‘Heavy Periods’ Very Effective
  44. 44. 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)
  45. 45. UBT’s Biggest Use Is In Bad Surgical Risk cases
  46. 46. ° Think rationally yourself. ° Vow yourself & ° Join the Movement for motivating 10 other gynaecologists to do the same Let us come forward to stop this menace of uterus removal.
  47. 47. No way should SURGEONS be allowed to do hysterectomy in India …… Such practices should become history !!
  48. 48. Thanks

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