Breast stimulation in low-risk primigravidas at term: does it aid in spontaneous onset of labour and vaginal delivery? A pilot study.

AIMS: The aim of the study was to elicit the safety and efficacy of breast stimulation as an intervention to prevent postdatism and as an aid in spontaneous onset of labour. METHODS: Primigravidas with cephalic presentation, without any high-risk factor, were recruited between 36 to 38 weeks of gestation. 200 patients were recruited and randomized into two groups (n = 100). Breast stimulation was advised to one group but not to the other group. Bishop's scoring was done at 38 weeks and repeated at 39 weeks of gestation. Maternal and fetal outcomes were compared in two groups. RESULT: Bishop's score changed from 3.12 (±1.01) to 3.9 (±1.08) in control group and from 3.02 (±0.82) to 6.08 (±1.29) in breast stimulation group after one week (P value < 0.0001). The period of gestation at delivery was 39.5 (±2.3) weeks in control group and 39.2 (±2.8) weeks in intervention group (P value: 0.044). There were increased chances of vaginal delivery in intervention group (P value: 0.046). Duration of labor, hyperstimulation, presence of meconium stained liquor, postpartum hemorrhage, and neonatal outcomes were similar in both groups. CONCLUSION: Breast stimulation in low-risk primigravidas helps in cervical ripening and increases chances of vaginal delivery.

Can preterm labour be predicted in low risk pregnancies? Role of clinical, sonographic, and biochemical markers.

BACKGROUND AND OBJECTIVES: This is a prospective nested cohort study conducted over a period of 3 years. 2644 women were recruited, out of which final analysis was done for 1884 women. METHODS: Cervicovaginal and blood samples were collected for all recruited women. Out of these, 137 women who delivered before 35 weeks were treated as cases and equal number of matched controls were chosen. Analysis of samples for serum G-CSF, AFP, ferritin, and cervicovaginal interleukin-6 and IGFBP-1 was done. RESULTS: Poor orodental hygiene, which can be a social marker, was significantly more common in women who delivered preterm (P = 0.008). Serum alkaline phosphatase and serum ferritin were found to be significantly associated with preterm deliveries. The 90th percentile value of these parameters was considered as cut-off as there is no specific cut-off. CONCLUSIONS: Our study did not prove usefulness of any predictive marker. Serum ferritin and alkaline phosphatase were found to have correlation but their values are affected in many conditions and need to be elucidated with caution. Larger studies are needed for predicting preterm labour in asymptomatic women.

Xanthomatous oophoritis following uterine artery embolisation: successful conservative surgical management with favourable outcome.

Xanthomatous oophoritis is a rare inflammatory condition of the ovaries. We are reporting a case of a 28-year-old woman, who had undergone uterine artery embolisation 4 years ago due to symptomatic focal adenomyosis. After 3 years of embolisation, the patient started having chronic pelvic pain, dysmenorrhoea and polymenorrhagia along with inability to conceive. Abdominal examination showed 16 weeks size mass arising from the pelvis. Ultrasound findings were suggestive of focal adenomyosis and bilateral tubo-ovarian masses. A CT scan report showed cystic enlargement of ovaries showing high-density fluid contents. MRI showed two well-defined, thick-walled, septated, cystic lesions appearing hyperintense on both T1-weighted (T1w) and T2w images with peripheral and septal enhancement. Bilateral abscess walls were excised and the healthy ovarian tissue was left behind during surgery. Histopathology of the cyst wall showed xanthomatous oophoritis. After the conservative surgery, she received three doses of goserelin. She conceived spontaneously thereafter and delivered a healthy term baby.

Primary malignant melanoma of uterine cervix with probable origin from benign cervical melanosis.

We report a case of primary malignant melanoma of cervix which is a rare malignancy with only around 60 cases being reported. This patient presented with bleeding per vaginum. A large exophytic growth from cervix with black discolouration was seen. International Federation of Gynaecology and Obsterics (FIGO) staging was stage IIa. Histoimmunocytology confirmed the diagnosis of malignant melanoma of cervix. S-100 and HMB-45 are reliable markers for cervical melanomas. We attempted Wertheim's hysterectomy; but, due to extensive disease, paravescical and pararectal fossae could not be dissected and we had to perform type I hysterectomy. The patient was started on adjuvant chemotherapy with dacarbazine. Despite counselling, she refused a complete course of chemotherapy and died after 6 months. Radical surgery, chemotherapy and immunotherapy are the therapeutic modalities used. In bulky disease, neoadjuvant chemotherapy should be considered to reduce the tumour bulk and facilitate required surgery. Prognosis is poor and unpredictable.

Large functional benign endometroid cystadenofibroma of the ovary leading to endometrial cystic glandular hyperplasia and postmenopausal bleeding.

Benign endometroid cystadenofibroma of the ovary is a rare tumour with few reported cases. The association of endometroid cystadenofibroma with endometrial cystic glandular hyperplasia has not been previously reported to authors' knowledge. We are reporting a 75-year-old postmenopausal woman who presented with a large abdominopelvic mass corresponding to 30 weeks size gravid uterus and postmenopausal bleeding. She has a well-oestrogenised vagina. Ultrasound pelvis revealed a large cystic mass extending from pelvis to epigastrium with no solid component and few incomplete septations and no internal echoes. MRI findings showed mainly cystic component with few moderately enhancing, fine, incomplete septa. Endometrial aspiration reported histopathology of cystic glandular hyperplasia without atypia. Serum oestrogen level reported to be high (210 pg/mL). Hysterectomy with bilateral salpingo-oophorectomy was performed. Histopathology of the specimen revealed benign endometroid cystadenofibroma. She remained asymptomatic and disease free during her 6-month follow-up.

Primary amenorrhoea due to a rare cause: epidermolysis bullosa causing haematometra.

A 27-year-old woman with junctional epidermolysis bullosa (EB) presented with primary amenorrhoea and massive haematometra. Considering her severe physical handicap and anticipated problems in optimising menstrual hygiene, the patient and her parents opted for hysterectomy which was performed uneventfully. The patient was recovering well postoperatively until the eighth postoperative day when she developed acute dilation of stomach and unfortunately died on day 17.

Screening for gestational diabetes mellitus: a prospective study in a tertiary care institution of North India.

AIM: The aim of this study was to determine the relevance of universal screening for gestational diabetes mellitus (GDM) in the patients attending the antenatal clinic of a tertiary institute of North India. MATERIAL AND METHODS: This was a prospective study conducted on 700 pregnant women attending the antenatal clinic of Lok Nayak Hospital, New Delhi at or before 24 weeks of gestation. All patients underwent screening with a 50-g 1-h glucose challenge test at 24-28 weeks of gestation. The women with an abnormal glucose challenge test subsequently underwent a diagnostic 3-h oral glucose tolerance test. All the patients were followed up till delivery. RESULTS: Out of 700, thirteen patients were lost to follow up and hence the final outcomes were measured on 687 patients. Out of 687, 613 patients (89.2%) had a normal glucose challenge test value, that is, <140 mg%, and 74 (10.8%) had a glucose challenge test value ≥140 mg%. On the subsequent oral glucose tolerance test, 64 (9.3%) had normal values and only 10 (1.5%) had an abnormal oral glucose tolerance test, that is, GDM. CONCLUSION: With such a low prevalence rate it appears to be unjustified to recommend universal screening for GDM. These findings may be considered as a basis for conducting larger, multicentric studies to establish the prevalence rate of GDM before deciding on a policy for screening.

Coexisting genital tuberculosis and endometriosis presenting as abdominal mass in an infertile woman: a report of a rare case.

OBJECTIVE: To document a rare case of coexisting endometriosis and genital tuberculosis. DESIGN: Case Report. SETTING: Tertiary-care center. PATIENT(S): A 24-year-old infertile woman presented with atypical clinical and radiological features that were suggestive of an ovarian malignancy. INTERVENTION(S): Exploratory laparotomy with left-sided salpingo-oophorectomy and right-sided ovarian cystectomy. Coexisting endometriosis and tuberculosis were diagnosed postoperatively on the basis of histopathology with positive polymerase chain reaction and culture for Mycobacterium tuberculosis. The patient was treated with antitubercular drugs and GnRH agonist for 6 months postoperatively. MAIN OUTCOME MEASURE(S): Impact of dual pathology of genital tuberculosis and endometriosis of fertility. RESULT(S): The patient improved symptomatically but declined infertility treatment because of financial crisis. The patient did not conceive spontaneously and is currently disease free, 1 year postoperatively. CONCLUSION(S): Coexisting endometriosis and tuberculosis simultaneously affecting tubes and ovaries is rare. Such combined pathology has a greater impact on fertility and may lead to a dilemma in diagnosis and management because of the unusual clinical picture. Early diagnosis by surgical exploration, as well as adequate treatment, may improve fertility.