Prophylactic Intramuscular PGF2  Versus Intravenous Methylergometrine For Prevention Of Atonic PPH In High Risk Pregnant Women.

To assess, evaluate and compare the safety and efficacy of i/m PGF2  125 mcg and i/v methylergometrine 0.2 mg during active management of third stage of labor in high risk pregnant women who are prone to develop atonic postpartum hemorrhage. The study was conducted on two hundred women prone to develop PPH with vertex presentation and spontaneous onset of labor at term. Slected cases were divided into two groups: Group I – Comprised of 100 women who were given 125 microgram of intramuscular 15 methyl PGF2  (Carboprost) at the time of delivery of anterior shoulder prophylactically. Group II – Comprised of 100 women who were given 0.2 milligrams of intravenous methylergometrine, at the time of delivery of anterior shoulder prophylactic ally. Tools of statistical analysis used were paired ‘t’ test , ‘Z’ test and mean ± SD. The mean duration of the third stage of labor after giving uterotonic drug was significantly shorter in Group I (3.50 ± 1.10 mins) as compared to Group II (5.15 ± 1.30 min) (p<0.001).The mean blood loss was significantly less in Group I (85 ± 30 ml) versus Group II (185 ± 40 ml) (p<0.0001).There was no statistical difference in mean haemoglobin concentration observed before and 48 hrs after delivery. The only significant side effect was diarrhoea in Group I. Prophylactic intramuscular PGF2  125 mcg is a better alternative to prophylactic intravenous methylergometrine 0.2 mg in high risk pregnant women who are prone to develop atonic PPH.

Evaluation of cervical smear in high risk women.

Background: Objectives of current study were (i) To find out the pattern of cervical smear in females having risk factors. (ii) To observe the relationship between abnormal cervical smear with high risk factors. Methods: A cross-sectional descriptive study was carried out in the department of obstetrics and gynecology, Guwahati medical college & hospital from July 2009 to August 2010 with the help of Pathology department. 200 women attending gynecological OPD with associated risk factors were selected at random. Detailed history, demographic information, contraceptive history and coital history were taken. Smear was taken from endocervix with the help of Ayer’s spatula or cytobrush. Results: Out of 200 cases, in 110 (55%) the smear was reported negative for malignancy. 73(36.5%) had an inflammatory smear, 11 (5.5%) had CIN, 1(0.5%) had malignancy and 5(2.5%) the smear was inadequate for cytological examination. In the study mean age of Cervical Intraepithelial Neoplasia (CIN) was 42.64 ± 6.34 years. Low socio-economic status, high parity & the use of oral contraceptive pills were major risk factors. Conclusion: Cervical smear should be routinely used as a reliable diagnostic aid for early detection carcinoma cervix especially in high risk cases. The need of the hour is to create awareness and easy accessibility to proper screening.

Ressonância magnética no rastreamento de mulheres com alto risco para câncer de mama / Magnetic ressonance in the screening of women at high risk for cancer breast

A técnica de ressonância magnética (RM) tem alta sensibilidade, mas especificidade limitada, podendo ser utilizada em indicações específicas como adjuvante à mamografia e à ultra-sonografia. As limitações da mamografia no rastreamento de mulheres de alto risco para câncer de mama estimulou o desenvolvimento de ensaios clínicos para avaliar a ressonância magnética como adjuvante à mamografia. Em mulheres de alto risco familiar para câncer de mama e nas portadoras de mutações conhecidas para BRCA1 e BRCA2, o câncer ocorre mais precocemente e o rastreamento deve começar em pacientes mais jovens cujas mamas são mais densas e a mamografia sofre importante queda na sensibilidade. Com base no resultado desses ensaios clínicos, houve um aumento no interesse em oferecer a RM a mulheres de alto risco após discussão dos potenciais riscos e benefícios. Este artigo revê a experiência do rastreamento do câncer de mama por RM em populações de alto risco.

The technique of magnetic resonance (MR) has high sensitivity, but a relatively limited specificity. It may only be used for specific indications for adjunct to mammography and ultrasound. The limitations of mammography in screening women at high risk for breast cancer stimulated clinical trials to evaluate magnetic resonance imaging as an adjunct to mammography. In women with high familial risk for breast cancer and in the carriers of mutations known for BRCA1 and BRCA2, the cancer occurs more precociously and the screening must start in younger patients in whon the breasts are denser and the mammography suffers important fall in sensibility. Based on the results of these trials, there is increased interest in offering screening MR to high-risk women after discussion the potential benefits and risks. This article reviews the experience of screening breast MR high-risk population.