Meconium stained liquor in labour and mode of delivery: a time for reappraisal

Background: The objective of this study was to determine the significance of meconium staining of the amniotic fluid and find out an appropriate mode of delivery in women with MSL.Methods: A retrospective study was carried out in Lady Hardinge Medical College and Smt Sucheta Kriplani Hospital, a tertiary government hospital, New Delhi over a time period of 1 year between 2009 to 2010 on 1425 consecutive women of which 142 women were diagnosed as having meconium staining of the amniotic fluid during labour.  All cases were critically analysed and maternal and fetal outcomes were studied in these women.Results: The incidence of MSL was 10% (142/1425), 45% had thin MSL and 55% had thick MSL. In women with thick MSL, 85% had early thick MSL and 15% had late thick MSL. In women who had early thick MSL (n=66), 55 (83.3%) delivered by LSCS and 11 (16.7%) delivered vaginally. On correlating the perinatal outcome with mode of delivery irrespective of fetal heart rate abnormality in early thick MSL, it was seen that the perinatal outcome was significantly affected by mode of delivery. The rates of respiratory distress and MAS was significantly higher in babies who delivered vaginally compared to those by LSCS (18% & 100% vs 9% & 40%, p=0.012, RR- 5.2 [95% CI: 1.8-3.42]. There were no perinatal mortality in early thick MSL.Conclusions: In distinguishing between thick and thin meconium, it was noted that finding of thick meconium in the latent phase of labour (i.e. early thick MSL) is ominous and demands an urgent caesarean delivery.

Torsion of para-ovarian cyst: a cause of acute abdomen.

Torsion of uterine adnexa is an important cause of acute abdominal pain. Torsion of ovarian masses is quite common and isolated torsion of fallopian tube has also been reported in literature. However, torsion of para ovarian cyst is a very rare. We report a rare case of twisted para ovarian cyst resulting in secondary torsion of the fallopian tube. Torsion of fallopian tube and para ovarian cyst are usually seen in the reproductive age group. Physicians need to maintain a high index of suspicion for this uncommon and often difficult to diagnose cause of abdominal pain.

Comparison of direct immunofluorescence and ELISA for the detection of Chlamydia trachomatis antigen in the patients of pelvic inflammatory disease.

Fifty female patients clinically diagnosed as pelvic inflammatory disease (PID) attending Gynaecology OPD of Smt. Sucheta Kriplani Hospital were studied for the presence of Chlamydial antigen by direct immunofluorescence (DFA) and Enzyme linked immunosorbant assay (ELISA) test. Out of fifty PID patients Chlamydia tracchomatis lipopolysaccharide antigen could be detected in 28% of cases by ELISA and Chlamydial outer membrane protein antigen could be detected in 32% of cases by DFA. Although in the present study DFA and ELISA compare well with each other, but DFA has been found to be more specific test as it detects outer membrane protein antigen of Chlamydia trachomatis.