Study of ovarian cancer at a tertiary care centre

Background: Despite major advances in case management, ovarian cancer continues to have the highest case fatality rate of all gynaecologic malignancies. There is paucity of meaningful screening and diagnostic protocols. Present study was planned with the objective of assessment of the prevalence of ovarian cancer and the associated risk factors at a tertiary care centre.Methods: The present prevalence study was conducted at a tertiary care government hospital and entailed analysis of data of 73 patients of ovarian cancer. All the participants were subjected to comprehensive history taking, followed by general, systemic, per-speculum and per-vaginal examination. Serum tumour markers of the patients were assessed. Imaging studies including ultrasound, CT or MRI abdomen/pelvis were done as per need. Final diagnosis was confirmed on histopathology and the cases were classified according to histological classification of World Health Organization.Results: Majority (41, 56.2%) were aged more than 45 years and above, most of them with one to two previous issues (64.3%). The disease was observed to be more common in postmenopausal women (65, 89%). Three fourth participants had negative family history of ovarian or breast cancer. Out of 73 patients, 31 had value of CA 125 between 150-400 U/mL and 42 had values >400 U/mL. Epithelial ovarian cancer (serous- 33, 45.2%, mucinous- 18, 24.7%) was observed to be the commonest histological type.Conclusions: To diagnose ovarian tumours early using multipronged approach with focussed risk factor identification and screening with CA-125 is very important and is strongly recommended

Clinical study of gestational trophoblastic disease in a tertiary care hospital

Background: Gestational trophoblastic diseases (GTDs) had been associated with significant morbidity and mortality till recently. Wide variation in incidences have been reported worldwide. The present study was planned with the objective of determination of incidence, assessment of risk factors, clinical presentation, management protocols and outcomes in GTD cases in Indian population at a tertiary care centre.Methods: All the diagnosed cases of GTD reporting to study centre during study period of 1.5 years were included. Detailed history taking, examination and relevant investigations (Hb%, blood grouping, thyroid functions, serum ß-hCG, USG and chest X-ray) were undertaken. Suction and evacuation were done for all patients as primary mode of management and samples were sent for histopathological examination. Comprehensive follow ups were done, including weekly ß-hCG until normal for 3 consecutive weeks followed by monthly determination until the levels were normal for 6 consecutive months.Results: Total 22 cases out of 19500 deliveries were diagnosed as GTD (incidence rate-1.13/1000 deliveries). Mean age was 23.64±3.89 years with 50% participants being primigravida. The commonest symptom after amenorrhea 22 (100%) was bleeding per-vaginum 15 (68.2%). Maximum cases were of complete hydatidiform mole histopathology 16 (72.73%), USG 19 (86.4%). Clinical characteristics were statistically comparable between patients of complete mole and partial mole. Out of 22 cases, 1 (4.5%) was diagnosed as GTN.Conclusions: Early diagnosis and treatment along with regular follow up is the key in GTD. There is need to establish a centralized disease specific registry in future

Emergency obstetric hysterectomy: experience at a tertiary care centre in Central India

Background: Obstetric hysterectomy is an important procedure in modern obstetrics and its proper indications, risks and complications need to be studied for judicious usage and improvement in outcome.Methods: A retrospective, record-based study was carried out over one and a half years at a tertiary care government hospital. All the patients who underwent emergency obstetric hysterectomy at the study centre during study period were studied. Labour room register, operation room register for emergency and elective cases, case records, referral slips and mortality register data were reviewed for the same and outcomes analysed.Results: Total 33 patients underwent emergency obstetric hysterectomy, with the incidence observed at 0.21%. The most common indications were atonic post-partum hemorrhage (42.4%), uterine rupture (33.3%) and morbidly adherent placenta (18.1%). Prior cesarean section (36.4%) and placenta previa (15.1%) were the commonest predisposing factors associated with PPH and uterine rupture. Subtotal hysterectomy (66.7%) was observed to be the preferred type of surgery. Out of total 7 maternal deaths that occurred, 4 (57%) were because of disseminated intravascular coagulation.Conclusions: There is increasing trend in the rate of obstetric hysterectomy along with rise in rate of previous LSCS, emphasizing the importance of the mode of delivery. Measures to reduce the rate of primary cesarean section are advisable

Foley catheterisation versus oral misoprostol for induction of labour in hypertensive women in India (INFORM): a multicentre, open-label, randomised controlled trial

Background Between 62 000 and 77 000 women die annually from pre-eclampsia and eclampsia. Prompt delivery, preferably by the vaginal route, is vital for good maternal and neonatal outcomes. Two low-cost interventions—low-dose oral misoprostol tablets and transcervical Foley catheterisation—are already used in low-resource settings. We aimed to compare the relative risks and benefits of these interventions. Methods We undertook this multicentre, open-label, randomised controlled trial in two public hospitals in Nagpur, India. Women (aged ≥18 years) who were at 20 weeks' gestation or later with a live fetus and required delivery as a result of pre-eclampsia or hypertension were randomly assigned (1:1), via computer-generated block randomisation (block sizes of four, six, and eight) with concealment by use of opaque, sequentially numbered, sealed envelopes, to receive labour induction with either oral misoprostol 25 μg every 2 h (maximum of 12 doses) or a transcervical Foley catheter (silicone, size 18 F with 30 mL balloon). Randomisation was stratified by study centre. The catheter remained in place until active labour started, the catheter fell out, or 12 h had elapsed. If the catheter did not fall out within 12 h, induction continued with artificial membrane rupture and oxytocin, administered through a micro-drip gravity infusion set. Fetal monitoring was by intermittent auscultation. The primary outcome was vaginal birth within 24 h. Due to the nature of the interventions, masking of participants, study investigators, and care providers to group allocation was not possible. We analysed by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT01801410. Findings Between Dec 20, 2013, and June 29, 2015, we randomly assigned 602 women to induction with misoprostol (n=302) or the Foley catheter (n=300; intention-to-treat population). Vaginal birth within 24 h was more common in women in the misoprostol group than in the Foley catheter group (172 [57·0%] vs 141 [47·0%] women; absolute risk difference 10·0%, 95% CI 2·0–17·9; p=0·0136). Rates of uterine hyperstimulation were low in both the misoprostol and Foley catheter groups (two [0·7%] vs one [0·3%] cases; absolute risk difference 0·3%, 95% CI −0·8 to 1·5; p=0·566) and neonatal deaths did not differ significantly between groups (six [2·0%] vs three [1·0%] neonatal deaths; 1·0, −1·04 to 2·97; p=0·322). 17 serious adverse events (3%) were reported during the study: one case of intrapartum convulsion and one case of disseminated intravascular coagulation (both in the Foley group); ten perinatal deaths, including two stillbirths (both in the Foley catheter group) and eight neonatal deaths (n=5 in the misoprostol group and n=3 in the Foley catheter group); and five of neonatal morbidity, comprising birth asphyxia (n=3), septicaemia (n=1), and neonatal convulsion (n=1). Interpretation Oral misoprostol was more effective than transcervical Foley catheterisation for induction of labour in women with pre-eclampsia or hypertension. Future studies are required to assess whether oxytocin augmentation following misoprostol can be replaced by regular doses of oral misoprostol tablets

The Induction with Foley OR Misoprostol (INFORM) Study dataset. A dataset of 602 women with hypertensive disease in pregnancy, in India, randomised to either Foley catheter or oral misoprostol for induction of labour

Objectives: Induction of labour (IOL), or starting labour artificially, can be a lifesaving intervention for pregnant women and their babies, and rates are rising significantly globally. As rates increase, it becomes increasingly important to fully evaluate all available data, especially that from low income settings where the potential benefits and harms are greater. The goal of this paper is to describe the datasets collected as part of the Induction with Foley OR Misoprostol (INFORM) Study, a randomised trial comparing two of the recommended methods of cervical ripening for labour induction, oral misoprostol and Foley catheter, in women being induced for hypertension in pregnancy, at two sites in India during 2013-15. Data description: This dataset includes comprehensive data on 602 women who underwent IOL for hypertensive disorders in pregnancy. Women were randomly assigned to cervical ripening with oral misoprostol or a transcervical Foley catheter in two government hospitals in India. The main dataset has 367 variables including monitoring during the induction of labour, medications administered, timing and mode of delivery, measures of neonatal morbidity and mortality, maternal mortality and morbidity, maternal satisfaction and health economic data. The dataset is anonymised and available on ReShare