Ectopic pregnancy--an analysis of 180 cases.

Ectopic pregnancy is the most life threatening emergency in pregnancy. Increase in incidence and impairment in fertility are now the real concerns. The aim of this study was to estimate the epidemiological, diagnostic and therapeutic aspects of ectopic pregnancy with a view to suggest action to improve the prognosis. This was a prospective study carried out at NRS Medical College, Kolkata, among consecutive 180 patients of ectopic pregnancy admitted from January, 2002 to December, 2004. During this period the incidence of ectopic pregnancy was 1 in 161(0.6%). The peak age of incidence was 26-30 years; primi were the most sufferers. There were 65.0% patients was had identifiable risk factors. Tubectomy (14.4%), history of abortion (26.1%), infertility (12.2%), pelvic inflammatory diseases (12.8%) and history of previous surgery (11.1%) were the important risk factors. Amenorrhoea (76.1%), abdominal pain (86.1%) and vaginal bleeding (42.2%) were the frequent presenting complaints. There were 87.8% patients was had pallor, 9.4% were admitted with features of shock. Cervical motion tenderness (82.2%) was the most frequent sign. Urinary beta-hCG was positive in 96.1% cases. Ultrasonography revealed diagnosis in 2/3rds cases among 129 patients. Culdocentesis evoked the diagnosis in 73.3% cases out of 135 patients. In 95.0% cases it was of tubal variety, 70.2% ruptured, 19.9% tubal abortion and 9.9% unruptured. Surgery by open method in the form of salpingectomy (81.9%), salpingo-oophorectomy (9.3%) and salpingostomy (5.3%) were the mainstay of management. Expectant management and medical therapy can be offered only in 1.2% and 1.75% respectively. There was no case fatality. By reducing and identifying the risk factors and 'catching' the patients at the earliest it is possible to improve the prognosis so far as morbidity, mortality and fertility are concerned.

Ovarian neoplasms in adolescence and childhood--an analysis of twenty cases.

Between January, 1999 and June, 2001 consecutive twenty cases of ovarian tumours in girls below 20 years of age admitted in Burdwan Medical College, Burdwan, West Bengal were analysed. Commonest presentation was lump abdomen (80%), 15% presented with acute abdomen, one patient presented with virilisation and another with precocious puberty and 85% had single ovarian involvement. Among 5 cases of torsion of ovarian tumours, one along with the twisted uterus was detected. Conservative surgery in the form of cystectomy or unilateral oophorectomy with or without salpingectomy was possible in 85% cases. Germ cell tumours (60%) took the leading place followed by epithelial (3 0%) and sex-cord stromal tumour (10%). Fifty percent neoplasms were malignant with majority (80%) being instage I. Combination chemotherapy was considered for 7 out of 10 cases. Conservative surgery in one hand and the fear of malignancy on the other are the real problems in these cases. Early detection, optimal therapy and intense follow-up are the key points of the management.