Uterine Transplantation: An Option beyond Surrogacy.

Over the years, a lot has developed in the field of infertility and artificial reproductive techniques worldwide, but the uterine factor infertility still remains an unresolved issue in reproductive medicine. Absolute uterine factor infertility is synonymous with congenital absence of uterus or a physiologically nonfunctioning uterus. Very few options including surrogacy and adoption are available for these patients. Both surrogacy and adoption are associated with legal, ethical, financial, religious, and psychological issues. For some of these patients, uterine transplant could be a viable option in future. However, the ability of uterus to carry the pregnancy to the period of viability and the effect of immunosuppressant on the fetus make the uterine transplant a more complex operation than any other transplants. From the earliest uterine transplant tried in 1931 in Germany to the first successful child birth following transplant in Sweden in 2014, uterine transplantation has come a long way. Among the countries that have tried this till now, Sweden has reported five cases of successful births posttransplant. Behind these successful cases, there is dedication and perseverance of few individuals who continued their efforts in spite of repeated failures. At the moment, the uterine transplant can be considered experimental at the best. However, considering the large number of hysterectomies done all over the world and uteruses available for transplantation, uterine transplant has potential to surpass, in numbers, the other transplant in near future.

High CA 125 in a Case of Abdominal Tuberculosis mimicking Ovarian Malignancy.

A 45-year-old patient was admitted with history of abdominal pain and distension. Clinically diagnosis was pointing toward a case of right-sided ovarian mass with ascites. Computed tomography (CT) scan of the abdomen was suggestive of mucinous cystadenoma of right ovary with moderate ascites. Ascitic fluid tap was exudative in nature and negative for malignant cells. Blood investigations were within normal limits except for raised CA 125 (more than 1000 mIU/L) and raised erythrocyte sedimentation rate (ESR) (112 mm/h). Our provisional diagnosis was serous cystadenocarcinoma right ovary or pelvic tuberculosis (TB) involving right adnexa and pelvic peritoneum. Ascitic fluid findings were more in favor of pelvic TB, therefore the patient was started on antitubercular treatment (ATT) on trial basis. The patient responded considerably well to ATT.

Rising Maternal Mortality in Mumbai Metropolitan Region: Need for Action.

Data from the past suggest that maternal deaths mostly occurred due to obstetric complications, like postpartum hemorrhage, sepsis or maternal morbidities, like eclampsia and cardiac diseases. This trend, however, has changed over a period of time in developing countries, like India where increasing number of maternal deaths have been attributed in recent years to preventable infectious causes, such as hepatitis, tuberculosis and malaria. Rising maternal mortality ratio (MMR) due to infections indicates there are several loop holes in the basic healthcare system at various levels in their prevention and control. Although maternal mortality worldwide is decreasing progressively, curbing maternal deaths in certain developing regions of the World including few parts of India and Mumbai Metropolitan Region at a faster rate is essential in order to achieve the United Nations Fifth Millennium Development Goal of 2015.