Cervical length by ultrasound as a predictor of preterm labour

Background: Objective of current study was to evaluate cervical length by transabdominal and transvaginal ultrasonography at 14-24 weeks of gestation in asymptomatic women for predicting women at risk of preterm delivery and to find out the one method which is more accurate of the two.  Methods: Fifty one women were enrolled in this prospective study. Women with cervical incompetence, multiple gestation, maternal medical diseases, previous cervical surgery were excluded. Each woman underwent a transabdominal and transvaginal ultrasonographic cervical length measurement. The period of gestation at delivery in these women was then correlated with sonographic findings. Statistical comparisons were made between the two ultrasonographic methods.  Results: Preterm delivery occurred in 37.2% of the women. By transabdominal sonography it was seen that with cervical length of less than 3cm at 14-24 weeks, majority (63.15%) delivered preterm. The mean cervical length of cases who delivered preterm was 3.3 ± 0.9 cm. Whereas the mean cervical length of cases that had term delivery was 3.5 ± 0.6, and majority (86.2%) had cervical length of more than 3 cm, similar trend was also seen with transvaginal sonography, majority (78.9%) of cases with cervical length of less than 3 cm delivered preterm. The mean cervical length of cases who delivered at term was 3.1 ± 0.4 and the mean cervical length of cases who delivered preterm was 2.85 ± 0.5 cm. There was definitive positive correlation between cervical length at 14-24 weeks and period of gestation at delivery. On analysis, prediction of risk of preterm delivery by cervical length cut off value on the basis of the median at earlier weeks, 35 mm for transabdominal and 30 mm for transvaginal sonography, it was observed that transabdominal sonography with a sensitivity of 63.15% and specificity of 71.8%, predicted relative risk of 2.47 which was not significant (P <0.1) but transvaginal sonography with sensitivity of 78.9% and specificity of 81.2 predicted relative risk of 5.35 which was significant (P <0.001).Conclusions: Transvaginal ultrasonography seems to be the optimal method for assessment of cervical length in the second trimester and for screening for spontaneous preterm delivery

Tuboenterocutaneous fistula following caesarean section

Fistulous communication between fallopian tube, sigmoid colon and the skin after caesarean section is an unreported entity so far. Here we report a case of tuboenterocutaneous fistula which developed after wound complication following lower segment caesarean section (LSCS). Computed tomography (CT) was used to diagnose the case and laparotomy was done as definitive surgery

Sublingual versus vaginal misoprostol for medical termination of pregnancy: a comparative study

Background: Medical  abortion  with  a  combination  of  mifepristone  and  a  prostaglandin  analogue, as  an  alternative  to  surgical  abortion  in  early  pregnancy.Methods: This randomized comparative study was conducted for 60 women with pregnancy up to 20 weeks period of gestation after getting approval from the institutional ethics committee and informed consent from the patient. Patients were divided into 2 groups based on computer generated random number. Patients in one group had received 200mg mifepristone orally and after 24 hours 400 mcg of misoprostol sublingually after admission in to labour ward. Dose was repeated every 6 hours up to maximum of 5 doses. Patients in other group had received 200mg mifepristone orally and after 24 hours 400 mcg of misoprostol vaginally after admission in to labour ward. Dose was repeated every 6 hours up to maximum of 5 doses.Results: The maternal age distribution, parity and gestational age in the two groups were found to be comparable. Requirement of mean dose of misoprostol in sublingual and vaginal were 1300 mcg, 1253 mcg respectively. The mean induction and abortion interval was 15.31±7.9 and 15.41±7.8 hours in sublingual and vaginal respectively. The complete abortion rate was 80% and 83.3% in sublingual and vaginal groups. The rates of side effects were similar in both groups respectively.Conclusions: There is no significant difference in efficacy and side effects between sublingual and vaginal route of misoprostol for termination of pregnancy

Controversies in the management of early endometrial carcinoma: an update

Endometrial carcinoma (EC) is the commonest genital tract malignancy in developing countries and is usually confined to the uterus at the time of diagnosis with excellent prognosis and high cure rates. But the management is associated with lot of controversies like in staging, best surgical approach, extent of lymphadenectomy, adjuvant therapy, fertility sparing surgery in young women etc. A thorough surgical staging is important to determine uterine and extrauterine spread and also understanding of the pathophysiology and management strategies to identify women who are at high risk and tailoring the adjuvant treatment if necessary without increasing the morbidity. This evidence based narrative review conducted by searching Medline (1994- 2015) and other online articles from Pubmed, Google scholar. Articles were selected based on their currency and relevance to the discussion they summarize the current literature to provide an approach to best practice management of early endometrial carcinoma

Lipoleiomyoma in a postmenopausal woman: an incidental finding

Lipoleiomyomas are rare variants of uterine leiomyoma, in spite of relatively common occurrence of leiomyomas of uterus. Their reported incidence varies from 0.03 to 0.2%. These tumors generally occur in asymptomatic obese perimenopausal or menopausal women. The presence of fatty tissue in the myometrium is interpreted as lipomatous degeneration, smooth muscle metaplasia or as a benign tumour called as lipoleiomyoma. Imaging can play an important role in determining the intrauterine location and fatty nature of lipoleiomyomas but most of these are detected incidentally in histopathological findings postoperatively. We report a case of lipoleiomyoma in fundus of uterus in 61 years old postmenopausal female, who presented with on and off abdominal pain

Combined hysterolaparoscopy as an early option for initial evaluation of female infertility: a retrospective study of 135 patients

Background: The aim of this study was to find out different causes of female infertility with diagnostic approach using laparoscopy and hysteroscopy.Methods: This retrospective study was done in the Department of Obstetrics and Gynecology of MGMCRI, Puducherry. 135 infertile women aged 19-40 years were enrolled retrospectively for combined laparoscopy and hysteroscopy. These infertile women were confirmed to have normal ovulatory cycles, hormonal assays and seminogram report. Patient with active genital tract infection and any contraindication to hysterolaparoscopy procedure were excluded. Dye studies as well as inspection for abnormal pelvic and intrauterine pathology and necessary therapeutic interventions were done during the procedure. Abnormal pelvic and intrauterine pathology by hysterolaparoscopy were categorized. Data was statistically analyzed using SPSS software version 15; a result of P <0.05 was considered as significant.Results: Out of 135 cases, 65% patients had primary and 34.8% patients had secondary infertility. As a whole pelvic pathology were confirmed in 54.5% and intrauterine pathology in 20.7% patients by hysterolaparoscopy. The most common laparoscopic abnormality detected was tubal pathology 40%, followed by pelvic inflammatory disease 18.5%, ovarian pathology 8.1% pelvic endometriosis 4.4%, and uterine pathology 4.4% in infertile patients. In hysteroscopy, the incidence of uterine anomaly was 9.6% and intrauterine septum is the most common anomaly with a mean incidence of approximately 84% in both the group of infertile patients.Conclusions: Hysterolaparoscopy is an effective diagnostic tool for evaluation of certain significant and correctable abnormalities in pelvis, tubes and the uterus which are usually missed by other imaging modalities.

Maternal and neonatal outcome in newborns with nuchal cord loop: a comparative study

Background: To compare the maternal and neonatal outcome between the new-born with and without nuchal cord loop at the time of delivery.Methods: It is a prospective comparative study, conducted in Mahatma Gandhi Medical College and Research Institute, Pondicherry from August 2013 to May 2014. All the pregnant women, who fulfill the inclusion and exclusion criteria, were taken into account and allowed to have the normal course of labour. At the time of delivery all neonates born with nuchal cord loop were taken as the study group and without nuchal cord loop were included in the control group. Cord blood gas analysis was done using blood gas analyzer (Radiometer ABL5) for neonates with Apgar score <7 at 1 minutes. Outcomes measured were requirement of induction of labour, requirement of augmentation with oxytocin following spontaneous onset of labour, duration of labour, mode of delivery , amniotic fluid index, foetal heart rate irregularities, birth weight, meconium stained liquor, Apgar score, cord blood gas analysis like pH, PO2, PCO2 (neonatal parameters) in new-born with nuchal cord loop.Results: There were no statistically significant differences between the two groups in relation to  maternal outcome .As far as neonatal outcome concerned, although meconium stained liquor (15.3% vs. 10.6% ), foetal heart irregularities (20.9% vs. 11.5 %) and 1st minutes Apgar score <7 (13.2% vs. 7.2%, p=0.033)  are more  in the study group , the   difference is not significant.Conclusions: The study concluded that the presence of nuchal cord loop does not adversely affect the maternal outcome. Although it increases the meconium stained liquor, affect FHR irregularities and low 1st minute Apgar score, it does not increase the operative interference in mother.

Complete molar pregnancy in postmenopausal women

Gestational trophoblastic disease (GTD) is an abnormal proliferation of trophoblastic tissue during pregnancy. It is a disease of reproductive age, and a few cases have also been seen in women with advanced age, although it is extremely rare in postmenopausal women. Here, we describe an uncommon case of complete hydatidiform mole (CHM) in a postmenopausal woman, who has presented to us with complaints of bleeding per vagina, vomiting with 22 weeks size gravid uterus. Ultrasound finding along with raised serum beta-human chorionic gonadotropin (α -HCG) 400,000 mIU/ml suggested the diagnosis of CHM. In view of postmenopausal status and future risk of postmolar gestational trophoblastic neoplasia, we performed a total abdominal hysterectomy . Uterus was 20 cm × 15 cm × 15 cm filled with cystic, grapes such as vesicles. Microscopic examination demonstrated generalized trophoblastic proliferation with hydropic degenerated villi suggested of benign CHM. Follow-up showed steady fall in serum α -HCG level and no evidence of any residual disease. A suspicion of GTD should be kept in mind while evaluating a patient with peri- or post-menopausal bleeding so that it will prevent a delay in diagnosis and treatment

Vaginal Fluid Urea and Creatinine in the Diagnosis of Premature Rupture of Membranes in Resource Limited Community Settings

Objective: Diagnosis of premature rupture of membranes (PROM) is difficult in equivocal cases with traditional methods. This study aimed to evaluate the reliability of vaginal washing fluid urea and creatinine for diagnosis of PROM and to determine the cut off value. Materials and methods: The current study was a prospective case control. Women having gestational age of 28 to 42 weeks were divided into two equal groups: Fifty with history of leaking per vagina (study group) and an equal number with gestation matched none leaking (control group) were recruited. Data analysis was done by Student’s t-test, receiver operator curve and chi square test. Results: The demographic data of both groups were comparable at the time of sampling (p > 0.05).Vaginal fluid urea and creatinine was significantly higher in study group (p 6mg/dl and creatinine with a cut off value of > 0.3 mg/dl to diagnose PROM were all more than 90%. The sensitivity, specificity, PPV, NPV and accuracy of amniotic fluid index (AFI) to diagnose PROM were 30%, 91.8%, 83.33%, 57.32% and 62 % respectively, with a cut-off value of ≤ 7 cm. The areas under the curves are 0.952 for creatinine, 0.999 for urea and 0.635 for AFI. Conclusion: Detection of vaginal fluid urea and creatinine to diagnose PROM is a simple, reliable and rapid test. Introduction of this method into routine use even in low resource community setting is feasible, practical and cost effective