tips and tricks in rural gynecology & obstetrics 97 2003
TRANSCRIPT
DR.SHANTANU ABHYANKAR
Dr. Shantanu Abhyankar
• A qualified Homeopath who does not believe in homeopathy.
• Later on passed MBBS and MD (Ob & Gy) from BJ Medical College.
• Practicing in Wai since 1997
DR.SHANTANU ABHYANKAR
Dr. Shantanu Abhyankar
• Member Rural Member Rural Obstetrics committee Obstetrics committee and Safe Motherhood and Safe Motherhood Committee; FOGSICommittee; FOGSI
• A well known speaker A well known speaker • Contributed chapters Contributed chapters
to books on rural to books on rural obstetrics and medical obstetrics and medical disorders in pregnancydisorders in pregnancy
DR.SHANTANU ABHYANKAR
Dr. Shantanu Abhyankar
• On the editorial board of the IMA journal.
• Edited the souvenir for MASTACON 2005
• Freelancing on issues related to public health
DR.SHANTANU ABHYANKAR
Dr. Shantanu AbhyankarDr. Shantanu Abhyankar
• Known for innovations like – A bangle breaker
– An obstetric petticoat
– Tubectomy using a Laryngoscope and Band Applicator
– A Urethral Hoist for Stress Incontinance etc
DR.SHANTANU ABHYANKAR
Dr. Shantanu Abhyankar
• The last two presented
at FIGO 2006,
Kuala Lumpur
Malaysia.
DR.SHANTANU ABHYANKAR
Dr. Shantanu Abhyankar
WAS AWARDED THE
DR.ANANDIBAI JOSHI GAURAV PURASKAR
FOR CONTRIBUTION TO
WOMEN’S HEALTH
BY THE
GOVERNMENT OF MAHARASHTRA
TIPS AND TRICKS IN RURAL GYNECOLOGY & OBSTETRICS
DR.SHANTANU ABHYANKAR
M.D.
DR.SHANTANU ABHYANKAR
DR.SHANTANU ABHYANKAR
RATIONAL MEDICINE
• ILLITERACY• POVERTY• TRADITIONAL
PRACTICES• LOW SOCIAL STATUS
OF WOMEN• POLITICS• CASTE• DEARTH OF MEDICAL
INFRASTRUCTURE• AWARENESS OF CPA
DR.SHANTANU ABHYANKAR
ANTE-NATAL CLASSESFOR PATIENTS.
(ANKUR INITIATIVE.)A BOON IN RURAL PRACTICE,
A ROAD LESS TAKEN, A PATH UNTRODDEN.
DR.SHANTANU ABHYANKAR
HOW DOES ONE FACE THIS CHALLENGE?
• BUILDS CONFIDENCE• IMPROOVES
COMPLIANCE• WORKS AS
EXCELLENT, CLEAN PUBLICITY STRATEGY
• THE PLACE IS ALL SPRUCED UP
• EDUCATIONAL MATERIAL
• PATIENTS POSE FRANK QUESTIONS
DR.SHANTANU ABHYANKAR
HOW DOES ONE GO ABOUT THE TASK?
• INVITATIONS BY POST• COVERED TERRACE IS THE VENUE• LECTURES, DEMOS, SLIDES, VIDEOS• WIDENING AUDIENCE; MALE
PARTICIPATION IS VERY IMPORTANT.
DR.SHANTANU ABHYANKAR
COURSE CONTENT
• ANATOMY & PHYSIOLOGY
• MINOR AILMENTS OF PREGNANCY
• DIET EXHIBITION, EXERSICE, TRAVEL TIPS, REST, SEX.
DR.SHANTANU ABHYANKAR
COURSE CONTENT
• LAB & OTHER TESTS
• ‘LESS-PAIN’ LABOUR.
DR.SHANTANU ABHYANKAR
COURSE CONTENT
• BFHI, NEONATAL CARE.
• SPACING METHODS, ‘MORNING-AFTER’ PILLS,
• ‘DO-IT-YOURSELF’ ABORTION PILLS
• FA & RUBELLA PROPHYLAXIS FOR THE NEXT KID IN LINE
DR.SHANTANU ABHYANKAR
LET PARAMEDICS SPEAK…
• MORE INFORMAL
• MORE NATIVE TONGUE
• ‘DOCTOR’S TRUSTED AIDS’
• THEY TRY AND UPDATE
• COMMITTING A CERTAIN LEVEL OF CARE
DR.SHANTANU ABHYANKAR
BENEFITS FOR THE DOCTOR
• DOES AWAY WITH THOSE ‘SAME OLD ADVICE’ SESSIONS
• TIME TO CONCENTRATE ON CLINICAL ASPECTS
• SPEEDS UP OPD• PATIENTS BECOME
WISER, MINOR COMPLAINTS ARE NOT TOLD.
DR.SHANTANU ABHYANKAR
BENEFITS FOR THE DOCTOR
• EXPLAINATION OF UNTOWARD OUTCOME IS EASIER
• EASIER TO SEEK A ‘TRULY’ INFORMED CONSENT
DR.SHANTANU ABHYANKAR
ONE WORD THAT COUNTS…RAPPORT
DR.SHANTANU ABHYANKAR
MERE HATHON ME NAU NAU CHUDIYAN HAI
DR.SHANTANU ABHYANKAR
Bangles to keep track of DFMC
10 loose fitting plastic bangles.… to be moved from one wrist to another.… to report if she fails to transfer all by the end of the day.
Because bed rest is impracticalBecause bangles are culturally loaded with
good omen
DR.SHANTANU ABHYANKAR
MERE HATHON ME NAU NAU CHUDIYAN HAI
DR.SHANTANU ABHYANKAR
IDEAL METHOD….
• BANGLES CAN BECOME A CAUSE OF DEATH
• SAFE AND ATRAUMATIC FOR THE PATIENT AND THE HEALTH CARE PROVIDER.
DR.SHANTANU ABHYANKAR
ALL THAT IT NEEDS IS…
• RINGS USED FOR HAND EMBROIDERY
• THICK SEE THROUGH PLASTIC BAG
• SIX INCH METAL SCALE
• WOODEN ROD (ROLLING PIN!!)
DR.SHANTANU ABHYANKAR
DO IT YOURSELF…
DR.SHANTANU ABHYANKAR
THIS IS THE WAY TO USE IT
DR.SHANTANU ABHYANKAR
OBSTESTRICS IS BLOODY BUSINESS
• SOILING OF TABLE AND FLOOR IS COMMON
• SPILLS AND SPURTS OF HIGH RISK BODY FLUIDS IS COMMON
• USE OF UNIVERSAL PRECAUTIONS IS PRACTICALLY UNKNOWN
DR.SHANTANU ABHYANKAR
PROBLEMS IN CURRENT PRACTICE…
• IMPERMIABLE COVERINGS ON THE TABLE PROTECT THE TABLE BUT CAUSE BLOOD TO SPILL FROM ALL THE FOUR SIDES.
• HEADLOW LEADS TO SOILING OF PATIENTS’S BLOUSE AND HAIR
• PATIENTS KEEP WRITHING DUE TO PAIN AND DISCHARGES DON’T DROP IN THE BUCKET UNDER THE LITHOTOMY SECTION
DR.SHANTANU ABHYANKAR
THE NEW PETTICOAT…• THE LONG
DISCHARGE DIRECTOR CARRIES EVERYTHING STRAIGHT INTO THE DRUM.
• FLOW IS ALONG THE DISCHARGE DIRECTOR AND NOTHING DROPS AND SPLASHES FROM A HEIGHT.
DR.SHANTANU ABHYANKAR
THE NEW PETTICOAT
• NOTHING GOES BEYOND THE WAIST BECAUSE OF THE STRAP
• IS STRAPPED TO THE PATIENT.SO MOVES WITH THE PATIENT.
DR.SHANTANU ABHYANKAR
TUCK IN A SEE THROUGH PLASIC SHEET AND
WORK WITH YOUR HANDS UNDER IT
OBSTESTRICS IS BLOODY BUSINESS
DR.SHANTANU ABHYANKAR
• THERE ISN’T ANY!!!
BLOOD; I MEAN.
AVAILABILITY IS THE PRIME PROBLEM.
DR.SHANTANU ABHYANKAR
THE ANSWER IS STORAGE UNITS.
• IDEAL FOR REMOTE AND RURAL AREAS.• CAN CERTAINLY BE SET UP.
ST O RAGE C ENT ER ST O RAGE C ENT ER
BLO O D BANK
ST O RAGE C ENT ER ST O RAGE C ENT ER
BLO O D BANK
RBT C
DR.SHANTANU ABHYANKAR
PROBLEM(S) VIS A VISBLOOD TRANSFUSION IN
RURAL SET-UP
DR.SHANTANU ABHYANKAR
• IN MAHARASHTRA
– 419 TALUKAS
• 274 BLOOD BANKS
– ONLY 17 BLOOD BANKS AT TALUKA PLACES
– 257 IN CITIES!!
DR.SHANTANU ABHYANKAR
THE ANSWER IS APPROPRIATE USE OF BLOOD.
• ‘SAFE BLOOD STARTS WITH ME’
• EARLY DIAGNOSIS & TREATMENT OF ANEMIA– Hb @ FIRST VISIT &
NEAR TERM– ANTIHELEMENTHICS
FOR ALL.– CHEMOPROPHYLAXIS
FOR MALARIA.– INJ.Fe
DR.SHANTANU ABHYANKAR
BATTLING BLOOD LOSS SANS BLOOD.BATTLING BLOOD LOSS SANS BLOOD.
• STOP ANTI COAGULANTS BEFORE SURGERY.STOP ANTI COAGULANTS BEFORE SURGERY.
• CONSIDER OTHER REPLACEMENT FLUIDS CONSIDER OTHER REPLACEMENT FLUIDS FOR ACUTE LOSS. THEY MAY BE AS FOR ACUTE LOSS. THEY MAY BE AS EFFECTIVE, SAFER & CHEAPER.EFFECTIVE, SAFER & CHEAPER.
• GOOD ANAESTHESIA.GOOD ANAESTHESIA.
• GOOD SURGICAL TECHNIQUE.GOOD SURGICAL TECHNIQUE.
DR.SHANTANU ABHYANKAR
BATTLING BLOOD LOSS SANS BLOOD.
• RESTORE AND MAINTAIN ADEQUATE BLOOD RESTORE AND MAINTAIN ADEQUATE BLOOD VOLUME. STARCH SOLUTIONS PREFFERED.VOLUME. STARCH SOLUTIONS PREFFERED.
• MAINTAIN SUFFICIENT OXYGEN CARRYING MAINTAIN SUFFICIENT OXYGEN CARRYING CAPACITY. KEEP HER INTUBATED, IF NEED BE, CAPACITY. KEEP HER INTUBATED, IF NEED BE, TILL BLOOD IS AVAILABLE.TILL BLOOD IS AVAILABLE.
• SECURE HEAMOSTASIS. AT TIMES OPERATING SECURE HEAMOSTASIS. AT TIMES OPERATING WITHOUT BLOOD IS SAFER THAN AWAITING WITHOUT BLOOD IS SAFER THAN AWAITING BLOOD.BLOOD.
DR.SHANTANU ABHYANKAR
SOME PRACTICAL TIPS• CUT A BOTTLE OF NS AT IT’S BASE & KEEP JUST CUT A BOTTLE OF NS AT IT’S BASE & KEEP JUST
100ml OF NS100ml OF NS
• ADD 1000iu INJ HEPARINADD 1000iu INJ HEPARIN
• POUR SALVAGED BLOOD THROUGH 6 LAYERED POUR SALVAGED BLOOD THROUGH 6 LAYERED GAUZEGAUZE
• MIX WELLMIX WELL
• INFUSEINFUSE
DR.SHANTANU ABHYANKAR
THINK OF AUTOLOUGUS DONATION/TRANSFUSION
• FORESEEABLE NEED OF TRANSFUSION.
• FORESEEABLE SCARCITY.
• RARE BLOOD GROUPS.• IRREGULAR
ANTIBODIES.• MULTIPLE PREVIOUS
TRANSFUSIONS.
DR.SHANTANU ABHYANKAR
THINK OF AUTOLOUGUS DONATION / TRANSFUSION
• ANY WOMEN WITH NO OTHER ANY WOMEN WITH NO OTHER CONTRAINDICATION FOR CONTRAINDICATION FOR DONATION & Hb OF 10+ & PCV DONATION & Hb OF 10+ & PCV 35%+ MAY DONATE BLOOD35%+ MAY DONATE BLOOD
DR.SHANTANU ABHYANKAR
THINK OF AUTOLOUGUS DONATION / TRANSFUSION
• ADVANTAGES– NO MISMATCH
– NO TTD
– NO GRAFT V/S HOST REACTION
– MEDICO LEGAL SAFETY
• RISKS– CLERICAL ERRORS
– SENSITIVITY TO STABILISERS
– CONTAMINATION
DR.SHANTANU ABHYANKAR
USE THE LEAP FROG TECHNIQUE• DRAW A BAG
• 7 DAYS LATER…TRANSFUSE THE STORED BAG AND DRAW TWO
• 7 DAYS LATER TRANSFUSE ONE OF THE STORED BAG AND DRAW TWO, LEAVING THREE IN STORE.
DR.SHANTANU ABHYANKAR
REDEFINING HIGH RISK
• DISTANCE FROM THE BLOOD BANK,
• DISTANCE FROM THE ANAESTHETIST,
• DISTANCE FROM OTHER EXPERT HELP,
(IN TERMS OF DURATION OF TRAVEL)
DR.SHANTANU ABHYANKAR
IF ALL THESE ARE FARTHER THAN AN HOURS TRAVEL…
NOT JUST A FEW
CASES BUT YOUR
PRACTICE ITSELF IS
HIGH RISK.
DR.SHANTANU ABHYANKAR
RCOG GUIDELINES• USE STARCH SOLUTIONS TO PRE-LOAD
THE PATIENT PRIOR TO SPINAL ANAESTHESIA.
• ADMINISTER O2 ON MASK THROUGHOUT THE SURGERY, SINCE THE SpO2
INVARIABLY DROPS WITH SEDATION (PENTAZOCINE).
• A CONTINUOUS TRICKLE CAN KILL THE PATIENT.
• NEVER FORGET THE FOURTH STAGE OF LABOUR.
DR.SHANTANU ABHYANKAR
ON ADMISSION…
INSIST ON THE PRESENCE OF A RESPONSIBLE MALE RELATIVE.
ALWAYS LOOK FOR ICTERUS.
DRAW BLOOD THROUGH A WIDE BORE SCALP/CANULA. KEEP IT IN SITU FOR I/V ACCESS.
KEEP 5cc IN A LABELED PLAIN BULB. THIS WILL BE USEFUL FOR A CROSS MATCH IF NEEDED. WATCH THIS FOR CLOTTING.
GET Hb DONE REGARDLESS OF PREVIOUS VALUE
RCOG GUIDELINES FOR ALL PTNs IN LABOUR
DR.SHANTANU ABHYANKAR
INSIST ON A BT, CT, PC, AND PT(IF POSSIBLE EVEN APTT).
OBSERVE THE CLOT VERY KEENLY AND FREQUENTLY.
IF IT FORMS AND DISSOLVES, WARN OF MORTALITY,
EVACUATE FIRST THE UTERUS AND
THEN THE PATIENT.
RCOG GUIDELINES
IN HIGH RISK PATIENTS…
DR.SHANTANU ABHYANKAR
RCOG Protocol for CS for placenta previa
DR.SHANTANU ABHYANKAR
INTRA–OP
• EXTERIORISE THE UTERUS
• AORTIC PRESSURE
DR.SHANTANU ABHYANKAR
INTRA–OP
• POSTERIOR PLACENTA– BLEEDING BED
• HOT MOPS & FIGURE OF EIGHT SUTURES
DR.SHANTANU ABHYANKAR
INTRA–OP
• ANTERIOR PLACENTA – BLEEDING ‘ROOF’
• CIRCUMFERNTIAL SUTURES ALONG THE EDGES
• IF NOT CONTROLLED…
DR.SHANTANU ABHYANKAR
INTRA–OP
• PROGRESSIVE DEVASCULARISATION– OVARIAN VESSELS
– UTERINES• CHECK BLEEDING…SOS
FROG LEG POSITION
– INTERNAL ILIAC LIGATION
• CHECK BLEEDING
DR.SHANTANU ABHYANKAR
INTRA–OP
• IF BLEEDING CONTINUES…
• OBSTETRIC HYSTERECTOMY– SUBTOTAL MAY NOT SUFFICE– REMAIN INSIDE THE UTERINES
• IF ONLY PARTIAL CONTROL…
DR.SHANTANU ABHYANKAR
INTRA–OP
• PACKING– UTERUS– PELVIS; POST HYSTERECTOMY
• BALLOON – S.B. TUBE– RUSCH– CONDOM
DR.SHANTANU ABHYANKAR
INTRA–OP
• B-LYNCH SUTURE
• HAYMAN SUTURE– VERTICAL AND
HORIZONTAL CERVICO-ISTHUMIC SUTURES
• CHO MULTIPLE SQUARE SUTURES– HAVE DIAGRAMS IN
PPH KITS
DR.SHANTANU ABHYANKAR
INTRA–OP
• B-LYNCH SUTURE
• HAYMAN SUTURE– VERTICAL AND
HORIZONTAL CERVICO-ISTHUMIC SUTURES
• CHO MULTIPLE SQUARE SUTURES– HAVE DIAGRAMS IN
PPH KITS
DR.SHANTANU ABHYANKAR
• YOUR INSTRUMENT SET FOR CAESARIAN MUST CONTAIN AN EXTRA GOWN, KOCHER’S CLAMPS AND MIXTERS.
RCOG GUIDELINES BE TUNED TO IIL/OBST. HYST.
DR.SHANTANU ABHYANKAR
Tight rope walk
• Poor paramedical support Poor paramedical support
• No health insuranceNo health insurance
• Shoestring budgets and packagesShoestring budgets and packages
• Monsoon economyMonsoon economy
– Farmer suicidesFarmer suicides
DR.SHANTANU ABHYANKAR
Fundal pressure
• Ventouse and Forceps… only after you have tried Biceps and Triceps
• WHO says…– Level C recommendation– Proper pressure, direction and timing
DR.SHANTANU ABHYANKAR
NT, sos biochemical markers
• Consider maternal age (30%)
• Do an NT scan at 11 to 13+6 weeks ( 75%)
• If more than 3mm consider – Nasal bone (90%)– Biochemical markers (95%)
DR.SHANTANU ABHYANKAR
RCOG guidelines for Thal screening
• High RBC count
• Low indices• RBC > 4.5
• MCV < 72
• MCH < 22
DR.SHANTANU ABHYANKAR
Necessity is the mother of invention
• Economy
• Unavailability
• Mosquitonet as mesh– Dr. Tongaonkar– Dr. Bramha Reddy
• Reusing disposables• Water for glycine• Air for CO2
• Kangaroo care
• Surgeons as anaesthetists• Vg hyst under local!!!• UBDBT
DR.SHANTANU ABHYANKAR
DR.SHANTANU ABHYANKAR
TO ERR IS HUMAN
TO FORGIVE IS
ABHYANKAR’S URETHRAL HOIST
USE OF VAGINAL BALL BEARING:
AN EFFECTIVE AND COST-EFFECTIVE METHOD TO TREAT POST PARTUM SUI AND
EVEN THAT EMBARRASING PASSAGE OF GAS PER VAGINUM.
DR.SHANTANU ABHYANKAR
Introduction
• SUI, A COMMON CLINICAL PROBLEM.
• AN EPIDEMIC WAITING TO HAPPEN.
• DOCTORS ARE RELLUCTANT TO OFFER TREATMENT
• PATIENTS HARDLY SEEK TREATMENT..
GRANDGRAND
DR.SHANTANU ABHYANKAR
Plevnik’s vaginal cones• 20, 32.5, 45, 60 and 75gm.
DR.SHANTANU ABHYANKAR
NECESSITY IS THE MOTHER OF INVENTION
• ON THE NET– EXORBITANT COST
• SO BALL BEARINGS– THOSE USED FOR TRUCKS AND TRACTORS.
– CHEAP
– 20 gm TO 100 gm WEIGHT.
– READILY STERILISED.
– THEY DISCOURAGE ‘VALSALVA’ & ENCOURAGE ‘KEGEL’
– BUT
– TOO SMALL AND TOO LARGE
DR.SHANTANU ABHYANKAR
HOW TO GO ABOUT IT…
• CONFIRM SUI, ETC:• BE SURE THAT VAGINAL
WEIGHTS WILL HELP.• GIVE DETAILED
EXPLANATION.• START WITH THE ‘PASSIVE
WEIGHT’.• ENDOWS CONFIDENCE.
DR.SHANTANU ABHYANKAR
FINER POINTS
• 20 gm INCREMENT / DAY.• 15 TO 20 min OF WALKING
WITH WEIGHTS IN SITU. • NO SQUATTING OR SITTING
TO BEGIN WITH.• LATER PERMIT SITTING
AND EVEN SQUATTING.• THERAPY AT HOME GOOD
ENOUGH.
DR.SHANTANU ABHYANKAR
Vaginal dumbbells• 80, 100, 120, 140 & 160gm• Some how found to be
better and faster than ball bearings.
• Thread adds to the security.• May be the
bulbocavernosus too is brought into play.
• Many reported better sexual pleasure following dumbbell use.
DR.SHANTANU ABHYANKAR
• VAGINAL WEIGHTS IS A CHEAP, EFFECTIVE, SAFE, VAGINAL WEIGHTS IS A CHEAP, EFFECTIVE, SAFE, NON-INVASIVE THERAPY AIDING PELVIC FLOOR NON-INVASIVE THERAPY AIDING PELVIC FLOOR REHABILITATION.REHABILITATION.
• THE ‘FLICKS’ HAVE TO BE PRACTICED THE ‘FLICKS’ HAVE TO BE PRACTICED SEPARATELYSEPARATELY
• BETTER COMPLIANCE IF YOU MENTION THAT BETTER COMPLIANCE IF YOU MENTION THAT THIS ENHANCES SEXUAL PLEASURE!!THIS ENHANCES SEXUAL PLEASURE!!
DR.SHANTANU ABHYANKAR
PLEASE, PLEASE,
PLEASE, PLEASEn
TALK SEX!!!
DR.SHANTANU ABHYANKAR
• ALL PEOPLE HAVE SOME ALL PEOPLE HAVE SOME QUESTION OR THE OTHER QUESTION OR THE OTHER ABOUT SEX, SOME TIME OR THE ABOUT SEX, SOME TIME OR THE OTHER IN THEIR LIFE!!OTHER IN THEIR LIFE!!
• SO THE POTENTIAL CLIENTALE SO THE POTENTIAL CLIENTALE IS 100% OF THE POPULATION. IS 100% OF THE POPULATION.
• SEXOLOGY PRACTICE IS VERY SEXOLOGY PRACTICE IS VERY REWARDING, EVEN REWARDING, EVEN ECONOMICALLY.ECONOMICALLY.
DR.SHANTANU ABHYANKAR
FOOLS STEP IN WHERE ANGLES
FEAR TO TREAD.
DR.SHANTANU ABHYANKAR
• A GYNECOLOGIST’S CONSULTING ROOM IS PERHAPS THE BEST PLACE TO START.
DR.SHANTANU ABHYANKAR
LET YOUR ABILITIES BE KNOWN.
‘A FRANK TALK ABOUT YOUR SEXUAL PROBLEMS IS WELCOME!
MAY BE THE DOCTOR CAN HELP.’
DR.SHANTANU ABHYANKAR
HAVE SOME BOOKS FOR SALE…• HELP DEFINE THE
BASICS, SAVE A LOT OF TIME.
• YOU CAN SAFELY ASSUME SOME BACKGROUND KNOWLEDGE.
• REDUCE EMBARRASSMENT TO A GREAT EXTENT FOR BOTH THE PARTIES.
• PROVIDES ‘STANDARD’ VOCABULARY
DR.SHANTANU ABHYANKAR
COUPLES ARE EXPECTED TO PROOVE THEIR FERTILITY WITHIN A YEAR OF
MARRIAGE.
WOMEN WILL NEED SPECIAL PERMISSION FOR REGULAR
FOLLICULOGRAPHY.
BBT; A FORGOTTEN METHOD THAT NEEDS TO BE REVIVED
DR.SHANTANU ABHYANKAR
DR.SHANTANU ABHYANKAR
DR.SHANTANU ABHYANKAR
DR.SHANTANU ABHYANKAR
DR.SHANTANU ABHYANKAR
SEMEN ANALYSIS• MEN WILL NOT VISIT• WILL NOT SUBMIT TO ANY
EXAMINATION• MAY NOT AGREE TO SEMEN CHECK• MAY FALL PREY TO DEMAND
IMPOTENCE• NO PROPER SEMEN COLLECTION
ROOMS• USE TADALIS
TUBECTOMY USING LARYNGOSCOPE AS AN ILLUMINATOR
(TULI) &
THE ABHYANKAR’S BAND APPLICATOR
(ABA)
(TULI-ABA)
DR.SHANTANU ABHYANKAR
DR.SHANTANU ABHYANKAR
TUBECTOMY…
• FORMS THE MAINSTAY OF CONTRACEPTIVE SERVICES IN INDIA.
• IT IS PREFFERED OVER VASECTOMY FOR SOCIO-POLITICAL REASONS
DR.SHANTANU ABHYANKAR
GOVERNMENT RUN PRIMARY HEALTH CENTERS…
• SHOULDER A MAJOR BULK OF ALL TUBECTOMIES DONE
• PERFORMANCE OF THE MEDICAL AS WELL AS THE PARAMEDIC STAFF IS JUDGED ALMOST EXCLUSIVELY DEPENDING ON THEIR ACHIEVING PRESET TARGETS
DR.SHANTANU ABHYANKAR
DR.SHANTANU ABHYANKAR
GOVERNMENT RUN PRIMARY HEALTH CENTERS…
• SHOULDER A MAJOR BULK OF ALL TUBECTOMIES DONE
• PERFORMANCE OF THE MEDICAL AS WELL AS THE PARAMEDIC STAFF IS JUDGED ALMOST EXCLUSIVELY DEPENDING ON THEIR ACHIEVING PRESET TARGETS
DR.SHANTANU ABHYANKAR
DR.SHANTANU ABHYANKAR
TECHNICAL PROBLEMS…
• NO SHADOWLESS LAMPS.
• FREQUENT POWER FAILURES
• TABLES OFTEN PROPPED UP WITH BRICKS TO ACHIEVE HEAD LOW POSITION.
DR.SHANTANU ABHYANKAR
DR.SHANTANU ABHYANKAR
TECHNICAL PROBLEMS…
• NO SHADOWLESS LAMPS.
• FREQUENT POWER FAILURES
• TABLES OFTEN PROPPED UP WITH BRICKS TO ACHIEVE HEAD LOW POSITION.
DR.SHANTANU ABHYANKAR
DR.SHANTANU ABHYANKAR
PROBLEMS GALORE…
• NO GA (RELAXATION)
• THE PROCEDURE BETTER BE QUICK
• ASSISTANTS OFTEN ARE ILL-TRAINED.
• FOR 78% DOCTORS TUBECTOMY IS THE ONLY ABDOMINAL SURGERY THAT THEY KNOW OF.
DR.SHANTANU ABHYANKAR
DR.SHANTANU ABHYANKAR
DR.SHANTANU ABHYANKAR
PROBLEMS GALORE…
• NO GA (RELAXATION)
• THE PROCEDURE BETTER BE QUICK
• ASSISTANTS OFTEN ARE ILL-TRAINED.
• FOR 78% DOCTORS TUBECTOMY IS THE ONLY ABDOMINAL SURGERY THAT THEY KNOW OF.
DR.SHANTANU ABHYANKAR
DR.SHANTANU ABHYANKAR
PROBLEMS GALORE…
• NO GA (RELAXATION)
• THE PROCEDURE BETTER BE QUICK
• ASSISTANTS OFTEN ARE ILL-TRAINED.
• FOR 78% DOCTORS TUBECTOMY IS THE ONLY ABDOMINAL SURGERY THAT THEY KNOW OF.
DR.SHANTANU ABHYANKAR
DR.SHANTANU ABHYANKAR
COMPLICATIONS…• ACCIDENTAL OPENING OF THE BLADDER
• AVULSION OF THE TUBE
• RARELY– INFECTION
– BOWEL INJURY
DR.SHANTANU ABHYANKAR
ESPECIALY AT THE PHC LEVEL…
• MORE & MORE COUPLES ARE ACCEPTING THE TWO CHILD NORM.
• REVERSIBILITY IS AN ISSUE WORTH A THOUGHT.
DR.SHANTANU ABHYANKAR
THE SOLUTION…
• TUBECTOMY USING LARYNGOSCOPE AS AN ILLUMINATOR &
DR.SHANTANU ABHYANKAR
‘OPEN BAND APPLICATION INSTEAD OF MPM’
• A MINI VERSION OF THE LAPAROSCOPIC BAND APPLICATOR FOR BANDING THE TUBES.
DR.SHANTANU ABHYANKAR
DR.SHANTANU ABHYANKAR
ADVANTAGES
• THE LARYNGOSCOPE PROVIDES RETRACTION, ILLUMINATION AND GOOD PNEUMOPERITONIUM.
• TUBES NEED NOT BE HOOKED OUT OF THE ABDOMEN. NO FEAR OF AVULSION.
• LESS PAINFUL.
DR.SHANTANU ABHYANKAR
ADVANTAGES
• QUICK.
• MORE REVERSIBLE.
• BAND APPLICATION AT THE ISTHMUS IS EASIER THAN WITH MPM.
• IT KEEPS THE LARYNGOSCOPE IN GOOD WORKING CONDITION.
DR.SHANTANU ABHYANKAR
Promote Vasectomy
• FAMILY PLANNING = TUBECTOMYFAMILY PLANNING = TUBECTOMY• BUT VASECTOMY SCORES ON EVERY BUT VASECTOMY SCORES ON EVERY
COUNT.COUNT.• VASECTOMY IS OUT OF FAVOUR, VASECTOMY IS OUT OF FAVOUR,
MORE FOR SOCIO POLITICAL MORE FOR SOCIO POLITICAL REASONS THAN FOR SCIENTIFIC REASONS THAN FOR SCIENTIFIC REASONS.REASONS.
• TALK OF THE IDEA….TALK OF THE IDEA….
DR.SHANTANU ABHYANKAR
India is a land of festivals…
• Menarch
• Engagement
• Marriage
• Honeymoon
• Pregnancy
• Childbirth
• Naming ceremony
DR.SHANTANU ABHYANKAR
But…..
• Termination of fertility…..
DR.SHANTANU ABHYANKAR
Rural practice is a subspeciality in itself…
• Low cost high risk practice.• One wo/man show.• You are forced to be alert, to be innovative,
to be an electrician, a plumber, a nurse and a doctor all rolled into one
• Diploma in rural medical practice• Dip. M.P.R.P.S.
DR.SHANTANU ABHYANKAR
DR.SHANTANU ABHYANKAR
DR.SHANTANU ABHYANKAR
DR.SHANTANU ABHYANKAR
THINK OF ME….
DR.SHANTANU ABHYANKAR
DR.SHANTANU ABHYANKAR
DR.SHANTANU ABHYANKAR
DR.SHANTANU ABHYANKAR
DR.SHANTANU ABHYANKAR
SPECIAL THANKS TO…
• DR.VIDYADHAR GHOTAWDEKAR• DR MRS.LATA PATIL• DR VILAS PARAMANE• DR.VINAY JOGALEKAR• DR. R. L. MARATHE• DR. SANJAY SHIWADE• AND MANY MORE WHO HAVE DARED TO
SERVE THE RURAL MASSES RISKING SO MUCH FOR SO LITTLE…