Nidhi Sharma

By Nidhi Sharma and Vanusha Selvin

The applications of minimally invasive pelvic surgery continue to grow. This chapter focuses primarily on the preoperative evaluation, surgical technique and post-operative care of total laparoscopic hysterectomy. Since laparoscopic assisted vaginal hysterectomy is a slight modification of the procedure it is not being discussed separately. The major physiologic obstacles to safe laparoscopy include pregnancy, increased intra cranial pressure, abnormalities of cardiac output and gaseous exchange in the lung, chronic liver diseases and coagulation disorders. In a redo surgery there may be problems of laparoscopic port entry.

Part of the book: New Horizons in Laparoscopic Surgery

By Nidhi Sharma and Sudakshina Chakrabarti

The treatment of recurrent pelvic organ prolapse is challenging. The pelvic floor symptom needs to be treated, a high quality of life has to be ensured and complications have to be minimized. There is a wide range of surgical options that may be used. The surgeon should be able to discuss and offer native tissue procedures for prolapse. In addition, for the clinically challenging situations of recurrent prolapse, mesh augmented procedures may need to be discussed with the patient. A thorough knowledge of mesh and graft options, as well as knowledge of prolapse recurrence and adverse events rate, can help guide clinicians in counseling their patients effectively. Ultimately, this will allow surgeons to choose a personalized treatment option that best align with a woman’s lifestyle and treatment goals. In this chapter the anatomical concepts of supports of vagina are elaborated. The pelvic diaphragm, lateral attachment of vagina to arcus tendineus fascia pelvis, intrinsic and extrinsic sphincter control mechanisms are elaborated. The surgical techniques of suspending the vaginal vault with autologous tissue and synthetic mesh are discussed. Finally, the role of minimally invasive surgery of pelvic floor is discussed as an integral part of management of recurrent vaginal prolapse.

Part of the book: Pelvic Floor Disorders

By Sudakshina Chakrabarti and Nidhi Sharma

The genetic code information programs the embryogenesis. In this chapter the three phases of prenatal development the pre-embryonic, the embryonic and the fetal are elaborated. The role played by transforming growth factor beta related genes in the growth and differentiation of early embryo will be described. The implications of Fibroblast growth factor gene in binding heparin its effect on cell survival and mitogenic pathways is discussed. The orchestrated symphony of Sonic Hedgehog genes in early human embryo development is elaborated. The Homeobox genes (Hox gene) and their role in early human embryogenesis are described. The different tests available for prenatal genetic testing are briefly described. Preimplantation genetic diagnostic procedures are indispensable in clinical embryology. The microsurgical techniques of the Polar body biopsy, Blastomere biopsy and Blastocyst biopsy are discussed at the end of the chapter. A diagrammatic representation of individuals and relationships in clinical genetics is described. A brief description of procedures of invasive fetal tests for collecting the fetal tissue is also discussed.

Part of the book: Genetic Diversity and Disease Susceptibility

By Nidhi Sharma

Part of the book: Prediction of Maternal and Fetal Syndrome of Preeclampsia

By Nidhi Sharma and Sudakshina Chakrabarti

The human ovary is a complex structure that is controlled by endocrine, paracrine, and autocrine mechanisms. The number of eggs retrieved after controlled ovarian stimulation in in vitro fertilization depends on the physiological follicular reserve pool of ovaries. Ovarian reserve is decided genetically and decreases with advancing age and gets affected by ovarian surgery, chemotherapy, radiotherapy, and autoimmune disorders. Environmental influences like chronic smoking, hyperglycemia, and conditions interfering ovarian vascularity also reduce the ovarian reserve. This chapter summarizes the methods to assess the ovarian reserve. This helps in deciding the initiating dose of gonadotropins for controlled ovarian hyper stimulation for optimal follicular response.

Part of the book: Innovations In Assisted Reproduction Technology