Role of transvaginal ultrasonographic cervical assessment in predicting the outcome of induction of labor

Background: Induction of labor is the most common intervention in modern obstetrics. The pre-induction ‘favourability’ of the cervix as assessed by the bishop score is very subjective. Transvaginal sonography appears to be a feasible alternative to the traditional bishop’s score. Aim of this study, was to compare cervical assessment by transvaginal sonography and digital examination in prediction of outcome of labor induction.Methods: Three hundred women at term with maternal and foetal indications for labor induction were included in the study. Modified Bishop score was assessed by digital examination and the cervical length was measured by Transvaginal sonography (TVS). Successful labor induction was taken as a vaginal delivery within 24 hours from the start of induction. Data were analyzed using SPSS for Windows 15.0.Results: Labour induction was successful in 81.33% of patients. Mean cervical length by digital examination was 2.6 cm, whereas the mean sonographic cervical length was 3.4cm. There was a significant difference of 0.8cm in mean cervical length measured by two methods (P=0.01). The best cut off point for predicting successful induction of labor was ≤3.4cm for sonographic cervical length (sensitivity 0.82, specificity 0.87, positive predictive value 0.77 and negative predictive value 0.25). The best cut off point for Modified Bishop score was 2 (sensitivity 0.95, specificity 0.93). The ROC curve showed that compared to TVS cervical length, Modified Bishop score was the best parameter for predicting successful induction of labor.Conclusions: Transvaginal sonographic cervical length measurement can be used as an adjunct tool to the traditional Bishop score for predicting successful labor induction in high risk pregnancies.

Chromohysteroscopy Role In Evaluation Of Intrauterine Cavity Lesions In Perimenopausal Women Of Aub

Aim: To evaluate the role of chromohysteroscopy in detection of intracavitary lesions in perimenopausal women with abnormal uterine bleeding. Methods: This was a prospective study conducted in 100 perimenopausal women with AUB who underwent transvaginal sonography, conventional hysteroscopy and chromohysteroscopy. Atotal of 34 cases in our study group underwent hysterectomy and specimens were sent for histopathology. Histopathological examination was carried out by a clinical pathologist who was blinded regarding hysteroscopic findings. Diagnostic accuracy of hysteroscopy and chromohysteroscopy in detection of intracavitary lesions was then studied keeping histopathology as the gold standard.Results: 2Mean age of the study group was 43.49 ± 3.42yrs, average parity was 3 and mean BMI was 25.41± 3.41 Kg/m. 40% cases presented with menorrhagia, 38% with polymenorhagia, 9% with metrorrhagia and 4% with postmenopausal bleeding. Hysteroscopy revealed normal cavity in 59 cases, intracavitary lesions were detected in 26 cases (submucous fibroids in 14, endometrial polyps in 11, and growth with areas of necrosis in one case), synechiae in 2 cases and diffuse endometrial disease was suspected in 17 cases (hyperplastic in 13 cases and polypoidal in 4 cases. On chromohysteroscopy, most of the intracavitary lesions (72%) either did not stain or the uptake was very minimal giving an unstained appearance in comparison to the surrounding endometrium. The lesions thus got demarcated and separated from the surrounding endometrium. The conventional hysteroscopic, chromohysteroscopic and histopathologic findings were then compared with each other. The diagnostic accuracy of conventional hysteroscopy in detecting polyps was found to be high (Sensitivity-85.71 %, specificity- 92.59%, positive predictive value- 75.0%, negative predictive value- 96.15% ; P<0.001). Its diagnostic accuracy in detecting submucous fibroids was also high (Sensitivity-92.31 %, specificity- 90.47%, positive predictive value 85.71%, negative predictive value- 95.00 %;(P<0.001). The diagnostic accuracy of chromohysteroscopy in detecting intracavitary lesions as unstained areas was also found to be significantly high (Sensitivity-80.0 %, specificity- 78.57%, positive predictive value- 84.2%, negative predictive value- 73.34% ; (P<0.01).Conclusion:The diagnostic accuracy of both hysteroscopy and chromohysteroscopy in detecting intracavitary lesions is high. However, differential staining on chromohysteroscopy made these lesions look more prominent and easily identifiable to the observer.

Recommendations on Recognition and Response to Child Abuse and Neglect in the Indian Setting.

Justification: Pediatricians are usually the first point of contact of children with the health system. Studies worldwide have shown that there is insufficient knowledge about child abuse recognition and management among health workers. Presently no uniform guidelines exist in India for pediatricians regarding the appropriate response to child abuse. Process: As part of the Child Rights and Protection Programme (CRPP) under IAP VISION 2007 of Indian Academy of Pediatrics, a ‘Training of Trainers (TOT) Workshop on Child Rights and Protection’ was held in Mumbai in January 2007. It was attended by participants from all over the country. The workshop recommended ‘developing country-specific teaching and training material’. A Task force of IAP CRPP was formed and it developed a module for ‘Training of Trainers Workshops for Pediatricians’. A National Consultative Meet was held in October, 2007 at New Delhi, where the program was discussed and ratified. Objectives: To train pediatricians to: recognize and respond to child abuse; engage in a multi-disciplinary networking mode to deal with child abuse; and, document, record and report instances of child abuse. Recommendations: Guidelines for recognition and management of child abuse are presented. All pediatricians should assess suspected harm with the same thoroughness and attention as they would do with a life threatening condition. Poor management after disclosure can increase psychological damage. Pediatrician should believe, support, reassure, treat and ensure rehabilitation of victims of child abuse, keeping the best interest of the child as the primary goal.

Botryoid rhabdomyosarcoma of common bile duct.

Common bile duct is an unusual site for occurrence of botryoid rhabdomyosarcoma. Clinically it is often misdiagnosed as infectious hepatitis. Early diagnosis and treatment has greatly improved the prognosis of this aggressive neoplasm. Here the authors present a case report of Bortroyid Rhabdomyosarcoma of CBD in a two and half year old child masquerading as obstructive jaundice.

Solitary intramuscular nasal Juvenile Xanthogranuloma: a case report with review of literature.

Juvenile Xanthogranuloma is a non-langerhans cell histiocytosis characterized by yellowish cutaneous nodules that usually appear in early infancy and childhood. Intramuscular variant is a rare form, with only eight reported cases, and none reported in ala of nose. Sheets of histiocytes, few touton giant cells and infiltrative borders makes it susceptible to misdiagnosis as childhood sarcomas or lymphoproliferative disorders. Awareness of the lesion aided by immunohistochemistry helps in reaching the proper diagnosis.