Search

Trends in patient profile, clinical presentation, diagnosis, management options and outcome of abnormally invasive placenta (AIP) were retrospectively evaluated at a tertiary care centre from 2001 to 2010. AIP was diagnosed when confirmed by ultrasound or MRI, when complete manual removal of placenta was not possible or when histological confirmation was achieved in a hysterectomy specimen. The first and second halves of the time period were compared. The total number of cases was 56 and the incidence increased significantly in the second half. Main risk factors were placenta previa and previous cesarean section. Antenatal diagnosis by ultrasound was made in 72% in the second half, compared with 35% in the first half (p = 0.009). Maternal mortality was 29% in the first half and 21% in the second half. Hysterectomy was the mainstay in management; elective procedures being significantly higher in the second half.

Primary umbilical endometriosis accounts for 0.5–1% of extragenital endometriosis. Clinical presentation is typical and treatment involves complete excision. It is important to consider it in differential diagnosis of an umbilical nodule.

Uterine rupture is a potential obstetric catastrophe. We report a case of a gravida 2 para 1 with intrapartum unscarred uterine fundal rupture. Immediate resuscitation, laparotomy and hysterectomy, was done with maternal survival. History of passive cocaine smoke exposure elicited postoperatively was the possible etiology leading to complete fundal rupture. This case is an eye opener as regards to ill effects of drug abuse even though passive. A careful history of drug abuse must be elicited when the common causes of uterine rupture have been excluded or the rupture site is unusual.

The vibrational anharmonicity and Gruneisen parameters of hexahelometallate A 2 MX 6 single crystals have been determined theoretically by making use of phonon lattice theory. The potential model employed to calculate these properties consists of long range coulomb, three body interactions, short range overlap repulsion effective upto the nearest neighbour ions and phonon-lattice interactions. These antifluorite structure compounds contain large MX 2− 6 - ions and as the interionic spacings are much greater than those of the alkaline-earth fluorite structure halides, their elastic constants are correspondingly smaller. The hydrostatic pressure derivatives of the second order elastic constants (SOEC) calculated for K 2 SnCl 6 , K 2 ReCl 6 , (NH 4 ) 2 SnCl 6 , (NH 4 ) 2 TeCl 6 , (NH 4 ) 2 SnBr 6 , and (NH 4 ) 2 TeBr 6 , are found to be positive and close to the experimental values. The vibrational anharmonicities of the long-wavelength modes are explained in terms of the acoustic mode Gruneisen parameters.

Fetal warfarin syndrome (warfarin embryopathy) is a consequence of maternal ingestion of warfarin during pregnancy. Warfarin fetotoxicity comprises wide range of manifestations including dysmorphology in neonate with characteristic classical features of nasal hypoplasia and stippling of epiphyses.Here we present a case of a neonate whose mother was on unsupervised warfarin prophylaxis throughout pregnancy. A brief review of literature with suitable options for anticoagulation during pregnancy is discussed.The final consensus over LMWH and warfarin in the first trimester is yet to be finalised. The treatment of warfarin embryopathy is symptomatic. Long term sequels in survivors are still not known.

A 13-year-old unmarried virgin reported to our gynaecological out patient department with continuous right-sided lower abdominal pain of one-month duration, with increasing severity since last 24 h. It was not associated with fever, but with mild nausea and vomiting. She attained menarche at 11 years of age, had regular menstruation and her last menstrual period occurred 10 days previously. On examination, vitals were stable with a tender suprapubic cystic mass corresponding to 14–16 weeks size of gravid uterus with restricted mobility. Bowel sounds were normal. On rectal examination, a right-sided tender mass was felt measuring approximately 5 £ 6 cm, which was conWrmed by ultrasound. She had undergone ultrasound (USG) guided cyst aspiration for the same mass 3 months back at our institute. Two hundred ml of straw colored Xuid was drained and cytology revealed only blood cells and occasional histiocytes. Tumor markers were within normal limits. Repeat USG scan a month later due to a similar episode of acute pain abdomen showed recurrence of the cyst, measuring 5.6 £ 4.8 cm with no solid areas and normal doppler Wndings. USG done at this visit showed a right ovarian unilocular cyst measuring 11.2 £ 8.2 £ 6.1 cm, with no septae or suspicious areas. Her haemoglobin value was 10.6 g/dl and white blood cell count was 9,800 mm. Her symptoms did not resolve on conservative management. A diagnostic laparoscopy was performed which showed a right sided elongated hydrosalpinx measuring 8 £ 8 cm, twisted twice on its pedicle with moderate congestion (Fig. 1). The left fallopian tube, ovaries, uterus and appendix all looked grossly normal; there were no adhesions in pelvis. Right salpingectomy was performed after taking informed consent from the relatives. The patient recovered well postoperatively and was discharged on postoperative day 2. Cytology of the Xuid drained from hydrosalpinx showed sheets of mesothelial cells in a haemorrhagic background; polymerase chain reaction (PCR) and acid fast bacillus (AFB) stain for mycobacterium tuberculosis was negative. Histopathological sections examined conWrmed our diagnosis of fallopian tube torsion with a hydrosalpinx.

Objective To compare the acceptability, efficacy, adverse effects, and user satisfaction of a levonorgestrel intrauterine system (LNG-IUS) and transcervical resection of the endometrium (TCRE) for the treatment of dysfunctional uterine bleeding. Method Of 50 women with a pictoral blood loss assessment chart (PBAC) score of 100 or greater, 25 had a LNG-IUS inserted (Mirena; Schering, Berlin, Germany) and 25 underwent TCRE. Procedure-related complications, PBAC score, hemoglobin levels, adverse effects, and rates of acceptability and satisfaction were recorded at 3-month intervals for a period of 12 months. Results At the end of 1 year there were a 97% and a 94% reduction in menstrual blood loss in the LNG-IUS and TCRE groups, respectively, and hemoglobin concentration had increased by 5.5% in the LNG-IUS group and 5.2% in the TCRE group. Adverse effects were similar in both groups except for systemic effects, which were seen only in the LNG-IUS group. Satisfaction rates were about 80% in the 2 groups. Conclusion Both treatments were found to be equally effective but LNG-IUS placement requires less operator skill and entails no operative hazards, and the device provides effective contraception.

We thank Prof. Gursoy et al. [1] for going through our study [2] in depth and we welcome their comments. However, here we could like to correct them regarding comment, ‘‘pathological range pH and lactate in non nuchal group in our study’’. In our study, Nuchal cord group had slightly lower pH as compared to non-nuchal cord group; however, neonate in neither of the group had pathological range pH suggesting that presence of NC interrupt umbilical blood flow to some extent causing some biochemical derangement, however, most with adequately functioning placenta are able to compensate quickly, this may lead to slight fall in pH but rarely pathological range acidosis in those who are able to sustain vaginal delivery. However, among NC group who were not able to compensate for the reduced blood flow must have had fetal distress and undergone secondary cesarean section. Since we have not included cases of cesarean section in our study, at moment we are not able to comment on this aspect. Regarding excluding nuchal cord cases delivered by cesarean section. At the start of our study, we purely wanted to evaluate the effect of NC on outcome parameters of vaginal delivery. Second to avoid bias, as the most common indication for emergency caesarean sections are fetal distress which could be due to meconium staining, non-progress of labour, uterine inertia, second stage arrest, cephalopelvic disproportion, if associated with presence of NC, then NC could be labelled as cause of fetal distress and as indication of caesarean section. NC could be the reason for secondary cesarean section in some cases. Since we only followed vaginal delivery we do not have data on cesarean section due to NC. Further research is underway in our department, after which we can comment on this aspect in a better way.

Background. Anterior colporrhaphy has been the traditional standard surgical treatment for anterior vaginal prolapse. However, since it is associated with a 40% recurrence rate, an attempt has been made to resolve the problem of recurrence by means of artificial mesh. Objective. To compare traditional colporrhaphy with self-tailored mesh in anterior colporrhaphy. Methods. One hundred and six women were enrolled in a prospective randomised controlled trial and divided into two groups: traditional anterior colporrhaphy ( n =54) and anterior self-tailored mesh repair ( n =52). The standard pelvic organ prolapse quantification (POPQ) system was used. Women with symptomatic anterior vaginal prolapse ≥POPQ stage II were included. Those with concomitant stress urinary incontinence, dominant posterior vaginal prolapse, active vaginal infections and suspected malignancy were excluded. Outcomes at the end of the procedure, intraoperative and postoperative complications, and follow-up (4 weeks, 6 months,1 year) were noted. Patients were assessed for recurrence (≥POPQ stage II), complications, satisfaction and acceptability. Results. Postoperative outcome was significantly better than preoperative staging, but no significant difference was seen in the two groups. On follow-up, the primary endpoints (Aa, Ba, tVL) did not differ significantly between the two groups. There were more complications in the mesh group. Satisfaction and acceptability were similar in the two groups. Conclusion. Although the outcomes in the two groups were similar, duration of surgery and blood loss were significantly greater in the mesh group. The use of mesh in anterior prolapse repair needs to be evaluated further.

Dysuria is a very common symptom, which is taken lightly. It can lead to a diagnosis of disseminated Koch's, which if identified early can prevent permanent sequelae.

Genital tract tuberculosis is usually secondary to extragenital tuberculosis. The upper genital tract is usually involved; involvement of cervix and vulva is very uncommon. We present two such rare cases of vulval and cervical tuberculosis diagnosed on histopathology and treated with antitubercular chemotherapy.

Vulvar cancer is an uncommon malignancy and accounts for around 5% of all gynecologic cancers. Incidence rates have increased for young adults and may be linked to increasing HPV prevalence. Treatment of vulvar cancer has evolved from 'en-bloc' surgery with high morbidity to more conservative approaches without compromising oncological safety. In recent years sentinel node evaluation has been advocated in early stage cancers to reduce complications of inguino-femoral lymphadenectomy. Minimising extent of radical excision for the vulvar growth and separate incisions for groin dissection have reduced the number of wound breakdowns, infection, lymphocoele and chronic lymphedema but complication rate is still as high as 60%. Incorporating sentinel node evaluation into clinical practice has brought down complications to less than 10% for both lymphedema and wound infection. Role of imaging is increasing in vulvar cancer, especially for locally advanced disease as a result of transition from exenterative and extensive surgery to use of neoadjuvant chemoradiation and a less moribund approach to management. Locally advanced vulvar cancer includes large primary tumors or locally advanced disease i.e. FIGO stages III and IV. Treatment decision here is still a challenge as there is no standard recommended treatment strategy. Neoadjuvant chemoradiation is an effective modality for locally advanced vulvar cancer, as it reduces tumor size and renders the lesion operable. Primary chemoradiation without post treatment surgery has been used as an alternative treatment to avoid extensive radical surgery and complex reconstructive procedures.