Comparing difference in mean total protein, albumin and globulin based on severity of rhesus isoimmunization: a prospective study

Background: Maternal RBC alloimmunization results from exposure and response to a foreign RBC antigen. Transplacental fetal to maternal hemorrhage is the most common cause of alloimmunization. Rh incompatibility can lead to either fetuses with hydropic features or non-hydropic. The precise mechanism leading to the development of hydrops is uncertain. Biochemical markers have the potential to be used to assess the severity of problem. But of the mechanisms proposed none have been able to totally explain the phenomenon or predict the prognosis. Objective of this study wads to compare the difference in mean total protein, albumin and globulin bases on severity of isoimmunization and comparing it with normal controls.Methods: A Total of 40 pregnant patients were enrolled which included 10 hydropic fetuses of Rh isoimmunised mothers, 10 non hydropic fetuses of Rh isoimmunized mothers. Control group included 18 Rh positive women without any fetal complication and 2 fetuses in women undergoing cordocentesis. Blood sampling was done at time of intrauterine transfusion and sent for estimation of total proteins, albumin, globulin in fetal blood. Pregnancies were followed up till delivery and fetal outcome noted.Results: Mean total protein, albumin and globulin between hydropic, non hydropic group and control group (3.25, 2.17 and 1.18 g/dl) in hydropic, (4.14, 2.70 and 1.44 g/dl) in non hydropic and (4.42, 2.95 and 1.47 g/dl) in control group respectively. Mean total protein, albumin and globulin between mild hydropic (3.43, 2.30 and 2.10 g/dl) and severe hydropic group (2.59, 1.6 and 1.3 g/dl) respectively.Conclusions: There was significantly lower levels of serum total proteins, albumin and globulin in hydropic fetuses as compared to non hydropic fetuses. Thus, hypoproteinemia can be considered a strong marker for development of hydrops in Rh isoimmunized fetuses.

Locally advanced cervical cancer – neoadjuvant chemotherapy followed by concurrent chemoradiation and targeted therapy as maintenance: A phase II study

Aim: The survival in locally advanced cervical cancer remains low. We evaluated the role of neoadjuvant chemotherapy (NACT), chemoradiotherapy (CRT), followed by gefitinib maintenance in locally advanced cervical cancer. Materials and Methods: Twenty-five patients with locally advanced carcinoma cervix were enrolled between July 2012 and May 2013. Patients received 6 weekly doses of NACT Paclitaxel (60 mg/m2) and carboplatin (AUC 2), followed by CRT and brachytherapy. The analysis of epidermal growth factor receptor (EGFR) expression was carried out by immunohistochemistry. Gefitinib (250 mg daily) was given as maintenance therapy for 1 year after completion of chemoradiation. Comparison of EGFR expression and survival outcomes was done. Results: Twenty-four of 25 patients completed the neoadjuvant chemotherapy and concurrent chemoradiotherapy. Post-CRT, all patients were started on gefitinib maintenance, and twenty patients completed the intended 1 year of gefitinib maintenance. Nineteen (76%) patients had a radiological complete response to NACT. EGFR was moderately or strongly expressed in 86.3% of the patients. The 3-year overall survival was 69.8%, and 3-year progression-free survival was 51.4%. Expression of EGFR was not found to be a significant factor affecting overall survival or progression-free survival. Conclusions: Weekly neoadjuvant chemotherapy is associated with a good response rate in locally advanced cervical cancer. Neoadjuvant chemotherapy, chemoradiation, followed by gefitinib maintenance gives good survival outcome in patients with locally advanced cervical cancer.

Supernumerary Marker Chromosome And Global Developmental Delay: Role Of Microarray - Case Report And Review Of Literature

Small supernumerary marker chromosomes (sSMCs) are defined as structurally abnormal chromosomes that cannot be identified or characterized by conventional karyotype analysis and are generally equal in size or smaller than chromosome 20. Here, we present the molecular characterization of an sSMCs derived from chromosome 15 in prenatal diagnosis in a 38-years-old female

Assessment of the customized birth weight formula in a low risk Indian population

Background: Birth weight is probably the single most important factor that affects neonatal mortality, infant and childhood morbidity in both developed and developing countries. Objective of the study was to formulate a model for prediction of fetal weight at term based on individualized fetal growth parameters.Methods: 131 participant low risk gravidas were enrolled into the study. The participants underwent an ultrasound 7 days prior to delivery. All fetal variables of growth of a random 100 participants were incorporated in an equation derived using multiple regressions to predict birth weight at term. The new equation was then prospectively applied to another 31 pregnant women for validation. The diagnostic performance of the new regression formula was then compared to the Hadlock formula.Results: The customised birth weight formula predicted a higher accuracy with MPE±SD of 0.790±9. compared to the Hadlock formula with MPE±SD - 4.42±8.73. The new formula also explained a greater variance in birth weight of 56% compared to the Hadlock formula of 49%.Conclusions: The new model based on individualized fetal growth parameters recognizes the capacity to modulate an accurate final birth weight, thus emphasizing the need for customized population specific birth weight formulas.

Congenital Absence of the Cervix - Its Place in the Present Classification of Female Genital Tract Malformations

Aims and Objective: To outline and group cases of cervical agenesis / dysgenesis according to the associated uterine and vaginal abnormalities, as per the proposed ESHRE/ESGE CONUTA classification. Methods: The study was conducted in a tertiary care hospital and involved a total of 93 young girls diagnosed as having an absent cervix. Patients with utero-vaginal anomalies alone, with a patent cervix - such as uterine septae, uterus didelphys, bicornuate uterus; or transverse vaginal septae, imperforate hymen and complete or partial vaginal atresia, were excluded. All cases were subjected to specific clinical and local examination. Detailed 2 D Ultrasound was done to study the uterus. Identification of the cervix, its presence or absence, length of the cervical canal, hemato-cervix or hematocolpos was done by trans-abdominal route. All the cases were operated by the same team of surgeons, with the first author as the chief surgeon, to confirm and make a final diagnosis. They were then tabulated as per the CONUTA classification. Result: There was absence of the cervix (aplasia / dysplasia) in 93 cases as per the clinical examination, ultrasound, MRI and operative findings. There was complete or partial vaginal atresia (aplasia) in 69 (74.19%) cases and a normal vagina in 22(23.65%) cases. There were 33 cases (35.4%) with a normal uterus, with no cases of T-shaped uterus. There were 29/33 cases (87.89%) without vagina. There was one case with septate uterus and complete cervical and vaginal aplasia. Cases with two Bicornuate uteri with a common aplastic/dysgenetic cervix was seen in 4 cases. In 3 cases the cervix was partially patent in the upper side and obstruction was present only in the lower 4-5mm, causing ‘hemato-cervix’. There were 14 cases (15.1%) with unilaterally formed uterine horn, with the non-communicating rudimentary horn. There were 13 cases (13.9%) of cervical aplasia of the unilateral formed uterine horn. In 11 out of 93 cases (11.8%) of cervical aplasia, uterine aplasia / dysplasia and rudimentary horns with cavity were present. Conclusion: Our findings underscore the fact the patients with congenital absence of the cervix present a diagnostic challenge and that this entity should be thoroughly evaluated. The new ESHRE/ESGE classification system has the potential to overcome the limitations of the previous classification systems as it provides an effective and comprehensive categorization of almost all the currently known anomalies of the female genital tract.

Uterine Artery Pseudoaneurysm with AV Malformation: A Rare Cause of Secondary Post Partum Hemorrhage.

Vascular malformations of uterus are a rare cause of delayed post partum hemorrhage (PPH).We discuss a case of a combined pseudoaneurysm with arteriovenous malformation as a cause of secondary PPH, which was diagnosed on doppler sonography and confirmed on angiography. It was successfully managed with uterine artery embolization.

Symptomatic Postoperative Rectus Sheath Haematomas

We retrospectively reviewed six cases of post-operative rectus sheath haematoma (RSH) managed at our institute during last six years. Out of 6 patients (mean age 27 years) who presented with RSH, four preceded caesarean section and two abdominal hysterectomy. They presented clinically as pain abdomen (n-6), shock (n-3), DIC (n-2) and fever (n-1). Haemoperitoneum was observed in 3 patients with shock and the diagnosis was confirmed at surgery. Three clinically stable patients with an infraumbilical abdominal mass were managed conservatively. One required US guided aspiration of the infected haematoma. Massive RSH is an unusual potentially life threatening condition. The diagnosis should be considered in all patients with acute post-operative pain and free fluid in the abdomen.

Expectant Management of Ectopic Pregnancy : Analysis of Four Cases

Expectant management of ectopic pregnancy is infrequently used. Used in a select group of patients, the result in terms of success of treatment, tubal patency , later intrauterine pregnancy are comparable to medical and surgical management.We report 4 cases of ectopic pregnancy managed expectantly in one year period and present a review of literature.

Uterine Volume and Blood Flow Changes in the Uterus Induced by GnRH Analogues in Cases of Fibroids

This prospective study was conducted to study the effect of gonadotropin releasing hormone ( GnRH) agonist on uterine and fibriod volume and the changes in blood flow in the uterine vessels. Nine patients with symptomatic fibriods, not willing for surgery, were enrolled. All patients recieved minimum 3 injections of GnRH agonist at 4 weeks interval. Uterine and fibroid volume and blood flow in the utrine vessels was measured before and three months after treatment. There was decrease in the fibriod volume and increase in resistance index in uterine arteries. There was no significant decrease in uterine volume. Out of four perimenopausal women two achieved menopause. GnRH agonist may have a role in perimenopausal women with symptomatic fibroid.

Primary Ovarian Abscess in Pregnancy

Primary ovarian abscess is a rare entity, occurrence of ovarian abscess during pregnancy is even rarer. The clinical presentation is variable ranging from asymptomatic abscess to diffuse peritonitis. A delay in diagnosis may be detrimental to both mother and the fetus. We report a case of asymptomatic primary ovarian abscess associated with a term pregnancy.

Vaginal Birth after Cesarean Delivery: Variables affecting Outcome

In this retrospective study, case records of 156 women with previous one cesarean who underwent trial of labom were analysed. Use of oxytocin, previous vaginal delivery and indication of previous cesarean were studied as predictive factors for success. One hundred out of 156 (64.1 %) women with previous cesarean section delivered vaginally. 2.56% of women experienced uterine rupture. The only variable that predicted successful outcome was previous vaginal delivery. Use of oxytocin and indication of previous cesarean did not affect the success rate of vaginal birth after cesarean.

Squamous cell carcinoma in situ arising in mature cystic teratoma.

Mature cystic teratomas of ovary are common tumors. A few may exhibit malignant degeneration, most of these being invasive squamous cell carcinoma. We report a rare case of pure squamous cell carcinoma in situ in benign cystic teratoma.