Germ Cell Tumors and their Association with Pregnancy

Ovarian germ cell tumors (OGCTs) comprise 20–25% of all ovarian cancers arising from germ cells of ovary. Mature teratoma (dermoid) is the only benign and commonest germ cell tumor. Only 3–5% germ cell tumors are malignant, dysgerminomas being the most common. These tumors occur in adolescents and reproductive age group. Hence, its association with pregnancy is not uncommon. They can be reliably diagnosed with ultrasound imaging. Raised levels of tumor markers in pregnancy should be interpreted with caution. Cystectomy can be done for benign germ cell tumors. However, fertility sparing surgery with surgical staging with or without adjunctive therapy is recommended for malignant germ cell tumors (MOGTs). Surgery is safe in the second trimester of pregnancy. MOGTs are quite sensitive to chemo and radiotherapy. Three to four courses of chemotherapy with bleomycin, etoposide, and platinum is recommended. Prognosis of these germ cell tumors is excellent

Gossypiboma versus Gossip-Boma

Gossypiboma, or a retained surgical sponge, is a rare condition, and it can occur after any surgical intervention that requires use of internal swabs. A case of an eight-year-old girl is presented, who had right minithoracotomy for ASD closure. She was finally diagnosed to have a retained surgical sponge in the right pleural cavity

Knowledge, attitude, beliefs and use of over the counter drug products among medical undergraduates

Background: Over the counter (OTC) drug products are available without prescription and considered safe, effective, affordable and easily accessible. Among medical students use of OTCs and even prescription drugs available as OTCs is increasing day by day. The objective of the study was carried out to assess the knowledge, attitude and beliefs about OTCs, their use, safety and regulatory issues of OTCs among medical undergraduates.Methods: A questionnaire-based study was conducted and 151 medical students participated in this study. A preformed and validated questionnaire consisting of 2 parts was used. Part 1 consisted of general information regarding OTCs and Part 2 consisted information about knowledge, attitude, beliefs and use of OTCs. Data were analyzed and the results were expressed as percentages.Results: 100% participating students were aware about OTCs. 70% used them a lot because of availability and belief on safety. Chemist was a good source of advice over minor medical problems according to 38% of students. Information to be read on drug label was known to 62.5% of them. Affordability and accessibility (84%) was the main reason for OTCs use. Common medications bought without prescription were antibiotics, antihistaminics (100%) and cough syrups (90%). Headache and fever (100%), acidity (91%) were common indications for OTC use. Common OTCs stored at home were painkiller, antacids and skin care products.Conclusions: All students though were aware of OTCs but had little knowledge of regulation and usage. Many prescription drugs were also available as OTCs. Medical students need to be educated and trained about OTCs and the related issues.

Predictive value of admission and intrapartum cardiotocography in normal and high risk antenatal women

Background: Cardiotocography is the most common method for assessing fetal health and reveals brain oxygenation. This study is done for admission and intrapartum cardiotocography in high- and low-risk pregnancies and its correlation with neonatal outcome. Methods: All high-risk and normal antenatal women with more than 34 weeks of pregnancy and vertex presentation who came to the labor room were included in the study. 200 cases were taken, 100 were in the "high risk group," and the remaining 100 were in the "low risk group." On admission CTG and intrapartum CTG tracing were taken after written and informed consent, neonatal outcomes were observed, and adverse neonatal outcomes were noted. Results: Admission CTG results were unsatisfactory for 9% of women in the high-risk group and none in the low-risk group. Intrapartum NST was non reassuring in 51% of high-risk women and 6% of the low-risk group. Of the total number of neonates admitted to the NICU, 14 were from the low-risk group, while 50 were from the high-risk group. Conclusions: On admission NST in both low and high-risk women, the absence of category III NST predicted the absence of an adverse neonatal outcome most accurately. Even during labor in both high-risk and low-risk women, the absence of category III reassured the fetal well-being most precisely

Decidual cast

Decidual cast describes the spontaneous sloughing of endometrium as an entire piece while retaining the shape of endometrial cavity. 15 year old girl presented to the outpatient Department of Obstetrics and Gynaecology, Subharti medical college in September 2015 with complaints of heavy menstrual bleeding since the onset of menstruation. On examination her vitals were stable and there was mild pallor. Systemic examination was found to be normal. All her investigations were within normal limits. She was give iron supplementation and was started on low dose combined oral contraceptive pills. Every woman should obtain detailed information about the possible side effects of hormonal therapies including endometrial cast discharge

Kimura’s disease: a diagnostic and therapeutic enigma

Kimura’s disease is a rare chronic inflammatory disorder present in 2nd and 3rd decade. It has a predilection for head and neck region presenting as a slowly growing painless swelling. It is usually accompanied by peripheral eosinophilia and elevated serum IgE and hence it was initially thought to be of allergic origin. Histologically the lesions are characterized by reactive hyperplasia of lymph nodes, eosinophilic infiltration and increase in postcapillary venules. Authors have reported a male patient with a slowly growing right sided neck swelling which is recurring even after course of steroids and excision done twice at an interval of 6 months. Kimura’s disease although a benign Lymphoid disorder but the incidence of recurrence despite taking treatment is a cause of much concern for the patient

Over the counter sale of abortion pills - time to act now

Background: Government of India has approved abortion pill for termination of early pregnancy. But over the counter availability of this drug instead has earned a bad name for this miracle drug. The aim of this study was to find out the incidence of over the counter availability of abortion pills, the outcome associated with this practice and what cost society has ultimately to pay for this unethical practice.Methods: This is a retrospective observational study. Among 200 patients who reported to Gynecology emergency with signs and symptoms suggestive of abortion process, those with history of abortion pill intake without prescription were included in the study group and their records were evaluated.Results: 70 patients who bought abortion pills over the counter were included in the study group. 90% (63/70) patients were not using any kind of contraceptive method. Only 55.71% (39/70) patients took the abortion pills as per the recommended standard protocol. Gestational age was < 8 weeks in 45.71% (32/70) patients only. Most common presenting complaint was varying amount of bleeding per vaginum followed by abdominal pain met in 97.14% (68/70) and 30% (21/70) patients respectively. 7.14% (5/70) patients presented to emergency in shock. Final diagnosis was complete abortion in 21.42% (15/70) patients, incomplete abortion in 47.14% (33/70), missed abortion in 11.42% ( 8/70), septic abortion in 7.14% ( 5/70) , threatened abortion in 5.71% ( 4/70), ectopic pregnancy in 5.71% ( 4/70) and molar pregnancy in 1.42% ( 1/70) patients and they were managed accordingly as per standard guidelines.Conclusion: The women in India should be aware of their legal right to safe abortion. They should stop buying the drug without prescription as medical abortion facilities are being made easily available, accessible and affordable to all. However strict ban on over the counter availability of abortion pills can make the situation worse

Post-partum intrauterine contraceptive device: acceptability and safety

Background: Antenatal period is the ideal time for counselling regarding contraception. PPIUCD is a long term reversible method for unmet need of contraception in women of reproductive age. The objectives of this study were to determine proportion of women accepting PPIUCD insertion, their socio-demographic, obstetrics characteristics, reason for acceptance, denial, rates of expulsion, complications and continuation rate till 10 weeks after insertion.Methods: A prospective descriptive study on 300 consented women was done in 2012-2013. A structured questionnaire and performa were used to obtain data. PPIUCD (CuT380A) was inserted in these women and were followed up till 10 weeks post insertion.Results: Out of 300 women counselled, only 85 accepted PPIUCD giving an acceptance rate of 28.33%. Women who had short inter-conceptional period or those who had previously used interval IUCD were significantly associated with greater acceptance. Fear of pain, heavy bleeding and infertility when planning next pregnancy were the most common reasons for denial. Continuation rate was 86.89% at 10th week after insertion. No major complication was observed i.e. perforation, infection and pregnancy.Conclusions: PPIUCD is quite safe method of contraception. Adequate counselling and clarification of myths associated with PPIUCD use can help acceptance and meet the unmet needs of contraception in post-partum period and even later in reproductive age women

Missing IUCD strings: an analysis

Background: Missing IUCD strings, i.e.  IUCD strings that are not visible at the external cervical os, are a commonly encountered problem and needs to be analysed.Methods: IUCD users coming for routine checkup (follow-up / renewal / removal) or with any complaints related to IUCD or gynecological complaints or referred from other health center and found to be having missing threads were included in the study. Complaints by woman, obstetric history, details of IUCD insertion, USG imaging reports were recorded. Removal of IUCD was done if indicated or if the woman desired so, by simple OPD procedure and if required in operation theatre.Results: Out of 324 IUCD users who were examined in OPD, missing IUCD threads were found in 69.  About half of them were asymptomatic. AUB was the commonest symptom. 82.6% women had IUCD in situ on USG. Displacement was seen in 10.14%, embedment in 4.35%. Expulsion was seen in 4.35% women. Removal was done in only 29 women. Removal was done by simple OPD procedure in 24 women, as minor OT procedure in 3. Only 1 required hysteroscopic removal. Commonest cause of missing threads was found to be broken, detached or severed strings.Conclusions: As most of these women with missed IUCD strings, IUCD was found to be in situ on ultrasound imaging; hence, these women need counselling regarding continuation of using IUCD.  If required, removal can be done as an OPD procedure

Pregnancy outcome in pre-gestational and gestational diabetic women: a prospective observational study

Background: India is considered the world capital of diabetes, proper care and management of the same is the demand of society. The present study is carried out to identify the disease burden of GDM/ overt DM among antenatal cases. The main objective was to study the maternal and fetal outcome of diabetes complicating pregnancy.Methods: The present study was conducted at Dr. Rajendra Prasad Government Medical College at Tanda, District KangraHP from October 2015 to September 2016. All antenatal cases were screened for diabetes by OGTT 75 gm, 2-hour blood glucose level as per DIPSI guidelines and labelled as GDM/ overt DM. Those who fulfilled selection criteria were enrolled in the study. A total of 6452 cases who attended antenatal clinic during the study duration and were screened were selected for the study. 116 cases were found to have GDM / overt DM. Seventy-nine had GDM with OGTT>140 mg/dl (DIPSI guidelines) and 37 had overt DM with 2 hours PP >200 mg/dl (WHO criteria). Total 100 cases comprised of study group were followed till delivery to study maternal and fetal outcome.Results: The prevalence of diabetes in pregnancy was found to be low 1.79%. GDM was found to be more prevalent than overt diabetes in pregnant women (66% versus 34%). Among the antenatal maternal complications observed missed abortion (11.8% versus 1.55; p=0.026), polyhydraminos (26.4% versus 10.6%; p=0.04) and preterm labour (17.6% versus 4.5%; p=0.003) were significantly more common in overt diabetics than GDM cases. IUFD (8.8% versus 0; p=0.014) was also significantly more common in overt diabetics than GDM case. RDS was found significantly higher in neonates of overt diabetics as compared to GDM mothers (14.7 % versus 1.5%; p=0.009).Conclusions: Early detection and good glycemia control by MNT and insulin, regular antenatal check-ups, patient counselling and compliance, intrapartum fetal monitoring and early neonatal care are keys to improved outcome.