Depot medroxyprogesterone: the way forward

India has a high rate of unintended pregnancies and abortions contribute to 8% of maternal mortality. The addition of injection depot medroxyprogesterone (DMPA) to the basket of contraceptives has allowed women to use a long-term contraceptive which does not require any user action to maintain efficacy and whose effect is easily reversible. Injectable progestins are now estimated to be used by 6% women globally.

Misplaced intra uterine devices: a rare case of vaginal entrapment

Intra uterine devices (IUD) are the second most common accepted methods of contraception worldwide after sterilization. It is a long acting reversible contraceptive (LARC) which is now being promoted as a simpler, safer and effective method of contraception for those women who do not want a permanent method of contraception. Missing thread is the most common complaint seen within 6 weeks of insertion and may be the only presentation of misplaced IUD. Most women who spontaneously expel the IUD are unaware of the situation. We are presenting a case of misplaced IUD which was partially expelled and got embedded in the vagina which is a rare site of misplaced IUD.

The Effect of Conventional Hormone Therapy and Tibolone on Tear Composition and Function in Postmenopausal Women.

Objective: To compare the effects of conventional hormonal therapy (HT) and tibolone on tear composition and tear function. Material and methods: Prospective randomized study in 60 postmenopausal women who received conventional HT versus tibolone for postmenopausal symptoms. Response assessed on Kupperman index, eye symptoms and qualitative and quantitative tests for tears at six months follow-up. Quantitative data analyzed using Student’s t-test, ANOVA test, Fisher’s exact test and qualitative data by using McNemar-Bowker test with Bonferroni correlation and Kappa test. Results: There was a significant improvement in the mean Kupperman scores with conventional HT and tibolone (p < 0.01). Tibolone effectively reduced foreign body sensation but there was no appreciable change in other eye symptoms with both therapies. P value did not show any significant change in quantitative tests (Schirmer’s I and II) and qualitative tests (break-up time) for tear secretion. Tear immunoglobulin A level was significantly elevated with both therapies. Conclusion: Conventional HT or tibolone did not have any significant beneficial effect on tear composition and tear function. A larger study can be undertaken using systemic or topical estrogen or androgen containing preparation for further evaluation for dry eye symptoms.

Behcet’s disease in pregnancy – A rare phenomenon.

Behcet’s disease is a multisystem relapsing disorder that affects the mucocutaneous surfaces. Though it is rare in pregnancy, suspicion should be kept in mind when any pregnant woman presents with multiple oral and genital ulcers. We wish to share our experience of managing a woman who was diagnosed as having Behcet’s disease first time during pregnancy.

Massive Retroperitoneal Tumour Complicating Advanced Pregnancy: A Surgical Challenge.

Leiomyomas or fibroids are most common uterine tumours and are often associated with pregnancy. There is a common belief that uterine growths increase in size during pregnancy.Giant uterine leiomyoma going retroperitoneally concomitant with pregnancy, is a rare clinical entity, a diagnostic dilemma and a great surgical challenge.We hereby, describe a case of giant retroperitonial tumour complicating the pregnancy. A massive tumor of approximately 40cm x 35 cm, unencapsulated, fleshy and 'sarcomatoid' in consistency with increased vascularity occupying entire retroperitoneum was seen.Retroperitoneally tumour was dissected from bilateral ureters, inferior vena cava, aorta and bilateral iliac vessels. Uterus, both ovaries and cervix along with tumour mass was removed.The tumour mass weighed 8 kg and on histopathology a degenerated leiomyoma was diagnosed. I