4. 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
9. 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.
10. BIG FACT !!
Women AGE early even if
ovaries
are retained
At
Hysterectomy
All Elders endorse this fact
11. 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
12. Do You want to guess
the
Number
of
HYSTERECTOMY
done in India ?
17. 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
27. 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
28. 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
29. “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
42. 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
43. We have largest Number of
cases
of MIRENA
in Delhi & NCR
(2013 upto 30th June)
49. 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
50. No way should
SURGEONS be
allowed to do
hysterectomy in
India ……
Such practices
should become
history !!
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
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.
The rcog issued evidence based clinical guidelines in 1998 on initial management of menorrhagia and were subsequently updated.
THERE HAVE BEEN SEVERAL STUDIES PUBLISHED IN VARIOUS JOURNALS QUESTIONING THE APPROPRIATENESS OF HYSTERECTOMY
Why would hysterectomies be performed inappropriately BECAUSE OF
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
THE SECOND SESSION WILL HAVE A DETAILED PRESENTATION BY DR SHARDA JAIN AS WELL AS THE PATIENTS OWN EXPEREINCES REGARDING THE UTERINE BALLOON THERAPY
