Ovarian Endometrioid Adenocarcinoma Arising in Endometriosis: A Case Report.

Malignant transformation of ovarian endometriosis was first described in 1925 by Sampson; later on it has been described in extragonadal regions by few authors also. Ovarian endometrioid and clear cell carcinoma are highly associated with endometriosis. Here we present a case of malignant transformation of ovarian endometrioma into endometrioid adenocarcinoma and review the clinical and pathological features of these tumors. A 45-years old infertile woman diagnosed as a case of bilateral chocolate cyst with pelvic endometriosis underwent total hysterectomy with bilateral salpingo-oophorectomy. A solid portion was also identified in the right sided cyst, histology of which revealed a well-differentiated endometrioid adenocarcinoma grade-II with foci of squamous morules and keratin pearls. Her pre-operative CA-125 level was within normal range. Women with endometriosis should be considered at an increased risk for the development of ovarian cancer even with normal CA-125 level.

Overt and subclinical hypothyroidism among Bangladeshi pregnant women and its effect on fetomaternal outcome.

OBJECTIVES: Thyroid disorders are among the common endocrine problems in pregnant women. It is now well established that not only overt but subclinical thyroid dysfunction also has adverse effects on maternal and fetal outcome. There are few data from Bangladesh about the prevalence of thyroid dysfunction in pregnancy. With this background, this study aims to find out thyroid dysfunction (both overt and subclinical hypothyroidism) in pregnancy and its impact on obstetrical outcome. METHODS: We studied the evaluation of 50 admitted pregnancies corresponding to 29 women with subclinical hypothyroidism and rest 21 was overt hypothyroidism. Detailed history and examination were performed. Apart from routine obstetrical investigations, Thyroid Stimulating Hormone (TSH) estimation was done. Their obstetrical and perinatal outcomes were noted. RESULTS: Overt hypothyroidism was significantly (p < 0.05) higher in 25 to 44 years age group. However two and three abortions were significantly (p < 0.05) higher in overt hypothyroidism patients. In sub clinical hypothyroidism 86.2% conceived firstly within 2 years and 66.7% in overt hypothyroidism patients conceived firstly in between 3 to 5 years after marriage. Overt hypothyroids were prone to have pregnancy-induced hypertension 42.9%, intrauterine growth restriction (P = 0.001) and gestational diabetes (38.1%) as compared to subclinical cases. Neonatal complications were significantly more in overt hypothyroidism group. Mean TSH level was significantly (p < 0.05) higher in overt hypothyroidism patients but mean FT4 level was almost similar in both groups. Majority of the patient underwent caesarean section in both groups due to associated medical and obstetrical complications. None of the babies showed hypothyroidism by cord blood tests. In this analysis our results showed that overt hypothyroidism among Bangladeshi pregnant women are associated with more maternal complication & adverse parental outcome than subclinical hypothyroidism. The adequate treatment of hypothyroidism during gestation minimizes risks and generally, makes it possible for pregnancies to be carried to term without complications. Significant adverse effects on maternal and fetal outcome were seen emphasizing the importance of routine antenatal thyroid screening.

The tocolytic role of nifedipine in preventing preterm labour pain.

This study was undertaken to evaluate the efficacy of oral nifedipine to reduce labour pain in patient with preterm labour, to complete the doses of steroids in lung maturity and in utero transfer to the Neonatal Intensive Care Unit (NICU) and to evaluate the maternal adverse effects and neonatal outcome. Diagnosed cases of preterm labour (between 24 to 34 weeks gestation) were randomly selected. Among them 50 patients were given oral nifedipine (n=50) and 50 patients were observed with no treatment (n=50). There were no statistically significant differences in age, race, parity, preterm delivery risk factor between the groups. At first the labour pain were observed through Continuous CTG in first hour, then intermittent CTG. The patient in the Nifedipine group can prolong the pregnancy time 36.0±3.2 wks than 30.6±3.1 wks in the control group (p<0.05) with reduced neonatal complications and admission to NICU. Oral nifedipine in patients with preterm labour pain as Tocolytic therapy has significantly prolonged pregnancy with lesser neonatal problems and fewer maternal adverse effects.