Endometriosis - A Crippling Illness: A Rare Case Of Bladder Endometrioma.

Endometriosis is a common gynaecological condition affecting 10-12% of general female population. It has variable clinical presentation commonly causing infertility, chronic pelvic pain, and dysmenorrhea. Rare presentation could be a tender cervical/rectal mass therefore should be considered in women of reproductive age group. A 30 years old woman with 1.5 years history of heavy menstrual bleeding with painful menstruation, painful coitus, urinary hesitancy and constipation reported after visiting multiple hospitals and failed medical treatment with pelvic scans showing fibroid uterus. MRI excluded fibroid uterus and laparoscopic exploration of pelvis and subsequent histopathology confirm the mass to be bladder endometrioma.

Efficacy of dinoprostone, intracervical foleys and misoprostol in labor induction.

OBJECTIVE: To compare the efficacy for Dinoprostone, intracervical foleys and misoprostol in labor trial regarding effects on cervical ripening, mode of delivery, induction to delivery interval and maternal complications i.e. tachysystole and postpartum haemorrhage. DESIGN: Randomized clinical trial. PLACE AND DURATION OF STUDY: Hamdard University Hospital and Patel Hospital between July 2004-June 2005. PATIENTS AND METHODS: Randomized trial was conducted such that group-A received Dinoprostone at 6 hourly intervals upto two doses. Group-B was induced with intracervical foley catheter. Group-C received 50 micro g oral misoprostol 4 hourly to a maximum of four doses. Cervical ripening, induction to delivery time interval, mode of delivery and maternal morbidity were main outcome measures. Test of proportions was used to compare the significance between the managements. RESULTS: In 226 cases, 219 (97%) were successfully induced while 7(3%) did not respond the labour induction. The rates of caesarean section in dinoprostone, intracervical foley and misoprostol were 14.7%, 14.1% and 12.3%, respectively, however, this difference was insignificant among three groups (p=0.911). Rate of earlier response (< or = 12 hours) to labor induction among three groups was insignificant (3.8% vs 4% and 13.7% respectively, p=0.125). Marginal significance of higher rate of complications was observed in those patients who were given misoprostol (p=0.08). CONCLUSION: In this series, all three agents were equally effective in terms of cervical ripening, induction-delivery interval, mode of delivery and maternal complications.