Study of changes in levels of salivary estriol and progesterone in preterm labor in comparison to normal pregnancy

Background: This prospective research was designed to evaluate changes in levels of salivary Estriol and Progesterone in preterm labor in comparison to normal pregnancy. Spontaneous onset of labor at term is produced by definite increase in estriol and fall in progesterone. This rise in free estrogen should precede the onset of labor according with the known effect of estrogen and progesterone on myometrial activity. Concentration of steroid in saliva reflect unbound unconjugated and biologically active fraction.Methods: The present study was carried for duration of one year enrolling 115 antenatal women between 28 and < 37 weeks of gestation with or without labour pains attending the antenatal clinic in KGMU, Lucknow and those admitted in Queen Mary’s Hospital Lucknow. 5 ml of saliva was collected in cryovials from each patient to estimate estriol and progesterone. The estimation of saliva progesterone and estriol was done by immunoenzymatic colorimetric method of the supernatant of sample.Results: In our study mean value of saliva progesterone levels of pregnant women with preterm delivery (study group IIA) was lower than the control group (Group l) but the difference was not significant (3814.46±751.14 pg/ml versus 3945.16±577.11 pg/ml, p = 0.351). Mean value of estriol study group who delivered preterm (3512.85±586.16 pg/ml) was higher as compared to the mean value of control group (2691.72±681.08 pg/ml) and difference was significant (p value < 0.001).Conclusions: Thus, there is significant rise in level of saliva estriol, it can be used as a predictor for detecting symptomatic and asymptomatic women at risk for preterm birth.

Importance of examination under anaesthesia in adolescent age group for effective diagnosis and treatment in diagnostic dilemma: case series

Problems of the adolescent girls like discharge and bleeding per vaginum (BPV) are usually underestimated and under diagnosed and are considered as physiological. Often diagnosis not settled due to incomplete or absent examination. In such situations Examination under anaesthesia (EUA) is an invaluable method in the lower genital tract assessment of adolescent females. The aim of this study was to discuss Importance of EUA in adolescent age group with persistent complain of discharge and bleeding for aiding the diagnosis. Present case series discusses three cases of girls of adolescent age group who presented to tertiary care centre of Northern India over a period of six month with complain of discharge per vaginum and on and off bleeding p/v which was refractory to medical management. After initial examination and investigations they were planned for Examination under Anaesthesia. Gynecological complaints such as vaginal discharge, irregular BPV are common complains in adolescent age group. Many complaints can be dealt with by reassurance, whereas most others respond to medical therapy. To facilitate diagnosis in recurrent or unresponsive patients EUA is recommended. In diagnostic dilemma and in unusual presentation in young age EUA is invaluable.

Recurrent vaginal discharge: an unusual presentation of embryonal rhabdomyosarcoma of uterine cervix in an adolescent girl

Embryonal rhabdomyosarcoma (ERMS) is a rare tumor of the female genital tract. It tends to occur during childhood in the vagina and rarely it can arise in the uterine cervix, with a peak incidence in the second decade. We report a case of 15 year old adolescent girl who presented with recurrent vaginal discharge not responding to medical treatment. Examination under anesthesia showed friable growth arising from the cervix. Histopathological examination revealed embryonal rhabdomyosarcoma (botyroid variant) of the cervix. Patient underwent local excision of growth followed by IRS-4 protocol based chemotherapy and now patient is under follow up at our side and pediatric oncology and doing well. Young girls presenting with recurrent vaginal discharge not responding to medical treatment must undergo proper clinical examination and EUA and any suspicious lesions should be examined so as to avoid missing rare but aggressive etiology like rhabdomyosarcoma. Due to the young age of affected patients, embryonal rhabdomyosarcoma (sarcoma botyroides) poses a management challenge as the preservation of hormonal, sexual and reproductive function is essential. Awareness of such as uncommon lesion and its clinical implications is important for the counseling and management of the patient.

Term pregnancy with large anterior wall intramural fibroid: an intra-operative challenge

Leiomyomas are the most common benign smooth muscle tumors of the uterus. The incidence during pregnancy ranges between 1.6 to 10%. The management of fibroids encountered during caesarean section poses a therapeutic dilemma. We present a case of giant anterior wall lower segment leiomyoma complicating term pregnancy which posed a great surgical challenge. Myomectomy was performed before delivering the baby by lower segment caesarean section by locating the tumor free area using preoperative ultrasound. The tumor mass weighed 3kg. This case highlights the preoperative use of ultrasound in emergency caesarean section to avoid classical caesarean section and to prevent fetal mortality and morbidity by avoiding time consuming caesarean myomectomy before the delivery of the baby.

A study of changes in homocysteine levels during normal pregnancy and pre-eclampsia.

To find out changes in homocysteine levels that occur during normal pregnancy and pregnancy with pre-eclamptic toxaemia and also to find out correlation between homocysteine concentration and preeclamptic toxaemia a study was carried out among 90 women of which 30 were control which included normotensive non-pregnant women and the study group I comprised 30 pregnant normotensive women and the study group II comprised 30 pregnant women with pre-eclamptic toxaemia. Serum homocysteine was measured in all subjects using fluorescence polarisation immuno-assay. Control group had highest mean homocysteine levels while the study group I had least mean homocysteine levels (p < 0.001). Levels were significantly higher in subjects with BP > 146/100 mm Hg as compared to subjects with BP >140/90 and <146/100 mm Hg (p=0.017). There was significant difference between study group I and II at same gestational age. Hyperhomocysteinaemia was observed in pre-eclamptic females, also it was found that homocysteine levels were directly correlated with severity of pre-eclampsia.

Laevonorgestrel intra-uterine system--a revolutionary intra-uterine device.

Laevonorgestrel intra-uterine system is a new hormone releasing long acting intra-uterine device. Besides being used as long acting contraceptive, it has multiple non-contraceptive benefits. It is the best choice for young women suffering from menorrhagia who want contraception along with preservation of fertility and for premenopausal women who want to avoid surgery. Moreover, it has been reported to be useful in patients with dysmenorrhoea, fibroids, endometriosis and adenomyosis and endometrial hyperplasia.