To study the outcome of previous one cesarean pregnancies in a rural tertiary center of Haryana, India

Background: Rising rates of caesarean section is a matter of great concern and TOLAC is an attractive alternative. Analysing outcome of previous one caesarean pregnancies will provide an insight for reducing the caesarean rates and formulating protocols and policies for TOLAC.Methods: A retrospective study of patients of previous one caesarean pregnancy was done from February 2015 to January 2016 and 3 groups were made, ERCS group, failed TOLAC group and successful TOLAC group. The rates of elective repeat caesarean, failed TOLAC, successful TOLAC, maternal complications, neonatal morbidity and mortality in all three groups were studied.Results: There were 5177 total deliveries with 488 (9.43%) previous one caesarean pregnancies. Out of 488 patients 161 (33%) underwent elective repeat caesarean and 327 (67%) underwent trial of labour. Out of 327 patients 234 (71.56%) had a successful TOLAC and 93 (28.44%) had failed TOLAC. Breech (23%) followed by foetal distress (20%) were the most common indications of previous caesarean. Commonest indication of elective repeat caesarean was short interval (33%) and that of failed TOLAC was foetal distress (38.7%) followed by failed induction (23.6%). There were 4 morbidly adherent placentas (0.82%), 1 scar rupture, 3 scar dehiscence, no maternal mortality and 10 neonatal deaths.Conclusions: Previous one caesarean section is not only a risk factor for repeat caesareans and complications like morbidly adherent placenta, uterine rupture but also a financial burden on health facilities. Encouraging the patients for trial of labour and emphasizing the usage of contraception is the need of the hour

Intracrine androgens enhance decidualization and modulate expression of human endometrial receptivity genes

The endometrium is a complex, steroid-dependent tissue that undergoes dynamic cyclical remodelling. Transformation of stromal fibroblasts (ESC) into specialised secretory cells (decidualization) is fundamental to the establishment of a receptive endometrial microenvironment which can support and maintain pregnancy. Androgen receptors (AR) are present in ESC; in other tissues local metabolism of ovarian and adrenal-derived androgens regulate AR-dependent gene expression. We hypothesised that altered expression/activity of androgen biosynthetic enzymes would regulate tissue availability of bioactive androgens and the process of decidualization. Primary human ESC were treated in vitro for 1–8 days with progesterone and cAMP (decidualized) in the presence or absence of the AR antagonist flutamide. Time and treatment-dependent changes in genes essential for a) intra-tissue biosynthesis of androgens (5α-reductase/SRD5A1, aldo-keto reductase family 1 member C3/AKR1C3), b) establishment of endometrial decidualization (IGFBP1, prolactin) and c) endometrial receptivity (SPP1, MAOA, EDNRB) were measured. Decidualization of ESC resulted in significant time-dependent changes in expression of AKR1C3 and SRD5A1 and secretion of T/DHT. Addition of flutamide significantly reduced secretion of IGFBP1 and prolactin and altered the expression of endometrial receptivity markers. Intracrine biosynthesis of endometrial androgens during decidualization may play a key role in endometrial receptivity and offer a novel target for fertility treatment

Meninges in cancer imaging

Primary malignant tumours arising from the meninges are distinctly uncommon, and when they occur, they are usually sarcomas. In contrast, metastatic meningeal involvement is increasingly seen as advances in cancer therapy have changed the natural history of malignant disease and prolonged the life span of cancer patients. The meninges can either be infiltrated by contiguous extension of primary tumours of the central nervous system, paranasal sinuses and skull base origin or can be diffusely infiltrated from haematogenous dissemination from distant primary malignancies. Imaging in these patients provides crucial information in planning management. This article reviews the pertinent anatomy that underlies imaging findings, discusses the mechanism of meningeal metastasis and highlights different imaging patterns of meningeal carcinomatosis and the pitfalls

Photographic appraisal of crystal lattice growth technique

Concept of creating mechanical retention for bonding through crystal growth has been successfully achieved in the present study. By using polyacrylic acid, sulphated with sulphuric acid as etchant, abundant crystal growth was demonstrated. Keeping in view the obvious benefits of crystal growth technique, the present SEM study was aimed to observe and compare the changes brought about by different etching agents (phosphoric acid, polyacrylic acid and polyacrylic acid sulphated) and to evaluate their advantages and disadvantages in an attempt to reduce iatrogenic trauma caused due to surface enamel alteration. Control and experimental groups were made of 24 and 30 premolars, respectively, for scanning electron microscopic appraisal of normal unetched and etched enamel surface and fracture site and finished surface evaluation. When compared with conventional phosphoric acid and weaker polyacrylic acid, investigations indicated that crystal growth treatment on enamel surface caused minimal iatrogenic trauma and surface alteration were restored to the original untreated condition to a large extent