Improved diagnostic value of PCR in the diagnosis of female genital tuberculosis leading to infertility.

Histopathological and mycobacteriological examinations have limited utility in the diagnosis of genital tuberculosis. In this double-blind study, 61 samples, consisting of endometrial aspirates (EAs), endometrial biopsies (EBs) and fluid from the pouch of Douglas (POD), from 25 women suffering from infertility were investigated for the presence of the mpt64 gene of Mycobacterium tuberculosis by PCR and correlated with laparoscopic findings. PCR demonstrated M. tuberculosis DNA in 14 out of 25 patients (56.0 %), compared to one smear with acid-fast bacilli (1.6 %) and two culture-positive samples (3.2 %). The presence of M. tuberculosis DNA was observed in 53.3 % of EBs, 47.6 % of EAs and 16.0 % of POD fluid samples. All patients with laparoscopy suggestive of tuberculosis, 60 % of those with a probable diagnosis and 33 % of those with incidental findings were positive by PCR. However, one EA sample from an infertile patient with normal laparoscopy was also positive. Multiple sampling from different sites and amplification of the mpt64 gene segment by PCR offered increased sensitivity in determining tuberculous aetiology in female infertility.

Depot medroxy progesterone acetate: a poor preparatory agent for endometrial resection.

OBJECTIVE: To evaluate the efficacy of depot medroxy progesterone acetate (DMPA) as a preparatory agent for endometrial resection. STUDY DESIGN: Endometrial resection was performed on 50 women for excessive uterine bleeding. The patients were randomly divided into 2 equal groups, with the first group receiving DMPA and the second group not receiving any hormonal pre-medication. The resected tissue was sent for histopathology and all the patients were followed up regularly for a maximum period of 4 years. RESULTS: DMPA was found to increase the thickness of the endometrium, making it more fluffy and oedematous. The procedure in these patients was associated with a significantly greater fluid consumption and deficit. A power analysis showed the overall power of the study to be >90%. Forty-four percent of group 1 and 64% of group 2 patients achieved amenorrhoea or spotting. Three patients in all underwent a repeat procedure, and 1 a hysterectomy, following a dissatisfactory result. However, no statistically significant difference was found in the outcomes of the 2 groups. CONCLUSION: As a preparatory agent, DMPA, seems to have no added benefit. Larger studies are required to bring out differences in outcomes, if any.

Factors determining the occurrence of unwanted pregnancies.

BACKGROUND: We aimed to identify the factors involved in the occurrence of unwanted pregnancy in women seeking medical termination of pregnancy, and to describe their contraceptive practices. METHODS: A descriptive interview-based study of 402 women seeking abortion was done. Information was gathered regarding demographic variables, contraceptive practices and reasons for the unwanted pregnancy. RESULTS: All the women in our sample were married and multiparous. The husband's unwillingness for contraception and the improper use of condoms was responsible for one-third of all unwanted pregnancies. Lactation was believed to be a protection against pregnancy by 11.3% of women while 6.3% were unaware of any contraceptive method. CONCLUSION: We believe that focusing on these areas in public health programmes will help to decrease the number of unwanted pregnancies.

Broad ligament hematoma causing fetal death in a case of fracture pelvis.

Although motor ventricular accidents complicates 6-7% of all pregnancies, the experience of pelvic fractures in near term gravid patients is limited. We present a unique case of fetal death caused by bilateral broad ligament hematomas following maternal pelvic fracture which improved our understanding of management of such cases.

Ureteric calculi masquerading metastatic lymph nodes in a case of endometrial cancer.

Extensive pelvic lymph node metastasis in the absence of risk factors was noticed at surgical staging for endometrial cancer in a 55-year-old postmenopausal women. On exploration there was a dilemma as to the disappearing lymph nodes which subsequently proved to be asymptomatic ureteric calculi. The need to palpate the pelvic side walls at the time of surgery for endometrial cancer even in cases when no nodal enlargement is detected preoperatively is highlighted.

Ectopic hydronephrotic kidney masquerading as an ovarian cyst during pregnancy.

An ectopic iliopelvic kidney with hydronephrosis causing fetal malpresentation is a rare occurrence. We describe this case for its unusual presentation which was mistaken for an ovarian cyst. The difficulty in diagnosis and the need for a high index of suspicion is highlighted.

Gravid uterus in an incisional hernia.

A case of gravid uterus in an incisional hernia is reported. The pregnancy was further complicated by intrauterine growth restriction, oligohydramnios and pregnancy induced hypertension. The management of the case is discussed.

Influence of place of delivery on immediate perinatal outcomes: a study from Northern India.

One hundred and six women giving birth in a rural hospital in Northern India were compared with 100 women delivering in a tertiary care urban hospital located in an adjacent state. The women in the rural hospital were younger and more likely to be multiparous. Their antenatal course was characterized by fewer antenatal check-ups, significantly lower haemoglobin values, but equal weight gain during pregnancy. They were more likely to have a spontaneous vaginal delivery, and less likely to undergo caesarean section and episiotomy. Neonatal birth weights were lower in the rural group; other indices of neonatal well-being were comparable.

Hydatiform mole with coexisting live fetus in dichorionic twin gestation.

A case of dichorionic twin pregnancy was diagnosed in a 29-year-old, on routine ultrasound at 12 weeks. Subsequent ultrasounds for persistent vaginal bleeding at 16 weeks revealed molar placenta with viable fetus in both gestational sacs. The patient declined any invasive prenatal testing to confirm the karyotype of the fetus. The pregnancy was managed expectantly until 21 weeks, when she had a spontaneous abortion of twin fetuses and separate placentae with attached molar tissue. A final karyotype on cord blood samples confirmed 46XY and 46XX for both fetuses. Histopathology of molar tissue reported complete mole, with diploid chromosomal pattern on subsequent DNA flow cytometry. The clinical, ultrasound and chromosomal examination suggest that there has been a quadruplet pregnancy where two embryos developed into normal fetuses and other two degenerated to complete moles.

Aplastic anaemia during pregnancy: variable clinical course and outcome.

Aplastic anaemia occurring during pregnancy is a rare event and is associated with high maternal and fetal morbidity and mortality. Prognosis is poorer when aplastic anaemia develops during pregnancy and many such patients have an unsuccessful pregnancy outcome. We report two cases of aplastic anaemia associated with pregnancy. Both the patients had very different antenatal course and outcome. Their etiopathogenesis and management is discussed.

Port site metastasis subsequent to laparoscopy for chronic pelvic pain.

We present an interesting case of port site metastasis is a menopausal women subsequent to diagnostic laparoscopy undertaken for chronic pelvic pain, which later proved early ovarian malignancy as the source of primary. While cases of port site metastasis have mostly occurred after extensive disease the possbility of such complication should be in mind at laparoscopy of early cancer.

Indomethacin therapy in the treatment of polyhydramnios due to placental chorioangioma.

A 26-year-old primigravida presented with acute polyhydramnios at 30 weeks gestation. Ultrasonography revealed a large placental chorioangioma with severe hydramnios. No anomalies were detected in the fetus. Preterm labor started with respiratory distress and indomethacin, 25 mg was given every 6 hours. The patient showed a good response with improvement of the hydramnios and respiratory symptoms. A normal infant with no neonatal complications was delivered 3 weeks later.

Premenstrual dysphoric disorder--a study from India.

OBJECTIVE: To study the prevalence of Premenstrual Dysphoric Disorder (PMDD) in Indian women. METHODS: Prospective recording of symptoms of PMDD over two menstrual cycles using a structured proforma. SUBJECTS: Sixty-two volunteers who returned pro formas complete in all respects. RESULTS: Four women (6.4%) fulfilled the criteria of PMDD. CONCLUSIONS: The prevalence of PMDD detected in this first report on the condition from India is comparable to the prevalence reported in previous studies. The group of women selected by applying such rigorous criteria appears to be heterogeneous with regard to symptom profile over the cycle.

Vesicocervical fistula: an unusual presentation.

A rare case is presented of vesicocervical fistula that occurred in a woman who sought help for continuous dribbling of urine for nine years. The aetiological implications of her obstetric history are discussed in the context of previous reports in the literature. The management and outcome of this case is discussed.

Inversion of uterus during cesarean section.

Acute inversion of the uterus is a rare complication during cesarean section. We describe one such case in which diagnosis was made immediately and reversion was performed within few minutes. A high index of suspicion and prompt management can prevent further complications.

Hernia uterus inguinale in a 46,XX female. A case report.

BACKGROUND: Hernia uterus inguinale, a rare congenital anomaly, is usually found in hermophrodites. CASE: A case of lateral fusion defect associated with müllerian duct development in a young woman with primary amenorrhea and normal karyotype occurred. In our patient, bilateral müllerian duct systems were rudimentary and failed to fuse in the midline. The left horn of the uterus and ipsilateral ovary lay in the left inguinal canal. The right horn of the uterus, along with the tube and ovary, was intraabdominal. CONCLUSION: In the operative management of this rare anomaly, care must be taken to preserve and reposition the ovary in the abdominal cavity.