Interlocked Twins: A Case Report.

Interlocking of twins is an exceedingly rare and potentially hazardous obstetric complication.we report a rare condition of an unbooked case of interlocked twins that attended labor room in advanced second stage of labour.

Transvaginal Sonography versus Histopathology in Postmenopausal Bleeding: A Prospective Study.

We compared Transvaginal Sonography (TVS) with histopathological results of the dilatation and curettage biopsies in 50 women with postmenopausal bleeding attending Gynaecology out-patient department of SMGS hospital, Jammu. These women underwent TVS followed by histopathological examination of endometrium. Endometrial lesions detected by histopathology in these women were: hormonal effects (proliferative and secretary endometrium) in 5 (10%), endometrial polyps in 4 (8%), endometritis in 2 (4%), endometrial hyperplasia in 9 (18%) and endometrial carcinoma in 5 (10%). A total of 21 (42%) showed atrophic endometrium and in 4 (8%) women, sample was insufficient. On TVS, 24 (48%) women had endometrial thickness (ET) < 5 mm and 26 (52%) women had ET > 5 mm. At a cut-off limit of > 5 mm for endometrial thickness indicating pathologic endometrium, the sensitivity and specificity of TVS was 100% and 80% respectively and a predictive value as a positive test, as a negative test and accuracy was 76.9%, 100% and 89% respectively. This study shows that TVS allows detection of endometrial pathology in vast majority of women and it is relatively easy, cheap, non-invasive and does not require anesthesia. It can be used as the first diagnostic step in the investigations of women with postmenopausal bleeding.

A Randomized Comparison Between Intravaginal Misoprostol and Intracervical Dinoprostone for Cervical Ripening and Labour Induction in Participants with Unfavourable Cervices.

To compare efficacy, safety and tolerance of intravaginal misoprostol with intracervical dinoprostone for cervical ripening and labour induction in women with unfavorable cervices.Two hundred women requiring induction of labour at or beyond term were randomized to receive one of the two methods: intravaginal misoprostol 25 ug every 4 hours up to a maximum of eight doses and intracervical diniprostone gel 0.5 mg every 6 hours up to a maximum of three doses. Induction delivery interval was significantly shorter (p< 0.01) in the study group 10.86 hours (651.470 minutes) versus 13.31 hours (798.625 minutes). The proportion of women delivering vaginally within 24 hours was 84% in misoprostol group and 69% in dinoprostone group. The rates of women who needed oxytocin (28% versus 48%) were higher in dinoprostone group. Cesarean section rate in the study group was lower than in control group but not significantly so (15% versus 24%; p=0.09). Foetal distress was more common in the study group than in the control group but not significantly so (23% versus 18%; p=0.38). Neonatal outcome was comparable in the two groups. There were no significant maternal complications in both the groups. Intravaginal misoprostol 25 ug every four hours was more effective for cervical ripening and labour induction than intracervical dinoprostone 0.5 mg every six hours.

Role of Fetal Kidney Length in Estimation of Gestational Age.

Fetal Kidney Length (FKL) is most accurate single parameter for estimating GA than other biometric indices in late 2nd and 3rd trimester and could be easily incorporated into the models for estimating GA. We evaluated role of FKL in estimation of gestational age (GA) in late 2nd & 3rd trimester. A total of 98 pregnant women with singleton pregnancy underwent serial biometric & FKL measurements ultrasonographically at 24, 28, 32, 36 and 38 weeks of gestation. These measurements were used to date the pregnancies relative to dating by last menstrual period. Linear regression models for estimation of GA were derived from the biometric indices and FKL. New models were constructed by combining different biometric indices and kidney length in various combinations. Comparison of accuracy in prediction of GA was made between individual parameters and these models to obtain best individual parameter and the best model in prediction of gestational age. Left FKL was slightly, but significantly longer than right FKL at each gestational period observed in the study. Standard error of prediction of GA was least for FKL (±8.56 days), closely followed by femur length (±8.9 days) and maximum for abdominal circumference (±11.72 days). The best model in estimating GA included all the five variables (femur length, FKL, biparietal diameter, head and abdominal circumference) with a standard error of ±7.41 days. FKL is the most accurate single parameter for estimating GA than other biometric indices in late 2nd and 3rd trimester and could be easily incorporated into the models for estimating GA.

Invasive Mole presenting as Acute Abdomen.

We present a rare case of invasive mole presenting as pain abdomen and bleeding per vaginum with subsequent hemoperitoneum. Emergency hysterectomy confirmed the presence of molar pregnancy perforating through the fundus.