The standard of care for women with advanced stage epithelial ovarian cancer (EOC) involves surgery followed by adjuvant platinum-based combination chemotherapy. One of the goals of surgery is to resect all macroscopic disease. In this review we will discuss the justification for an aggressive surgical approach, including a discussion of factors limiting its implementation and suggestions for providing appropriate surgical intervention for all women with EOC.
Objectives: To study the effect on perinatal mortality of introduction of daily fetal movement count (DFMC) chart in the last month of pregnancy in all low risk and high-risk pregnancies.
Methods: A prospective study was carried out on 300 booked cases after introducing DFMC chart in the 9th month of pregnancy. Prior ultrasound (USG) was done to rule out any risk factor
e.g. intrauterine growth restriction (IUGR), oligohydramnios etc. DFMC chart was used to record number of fetal movements perceived by patient for one hour after food (breakfast, lunch, dinner). The patient was made to lie down in left lateral side and put the hand over her abdomen and count fetal movements for one hour. Fetal movements were considered satisfactory if the fetal count was three or more on each occasion.
Results: No fetus was lost after introduction of DFMC chart in the 150 cases that were given DFMC chart (study group) and delivered in our hospital. This was compared with 150 booked cases (control group) that were not given DFMC chart but had normal ultrasound done after the completion of 8 months of pregnancy and were followed up. Four intrauterine deaths occurred in the 9th month in the control group (perinatal mortality 4/150; 2.66%). In the study group, nine women were admitted with loss of fetal movement. Out of these seven were discharged after monitoring for 3 days to confirm satisfactory fetal movements and two who continued to have reduced fetal movement were delivered vaginally.
Conclusion: DFMC chart in the 9th month of pregnancy helps in reducing perinatal mortality in the absence of any other adverse factors necessitating early delivery.
Objectives: The main aim for undertaking this study was to determine the relationship between the closure of parietal peritoneum and subsequent adhesion formation. Our aim was also to find out the type of adhesions between parietal peritoneal closure and non closure.
Methods: A retrospective study from the records of women who came for their repeat cesarean section was done for a period of five years from 1999 to 2003.
Results: There were 402 women who met the inclusion criteria in the study. All the cases included in our study had Pfannenstiel incision during their primary cesarean section (CS). No muscle cutting incision was used in any case. Of the 402 cases 223 (55.47%) had peritoneal closure and 179 (44.52%) cases did not have peritoneal closure. Looking through the data we found that in peritoneal closure of 223 cases, 40 (17.9%) had adhesions, while 183 cases (82.06%) had no adhesions. In the non peritoneal closure group, out of 179 cases, 121 (67.59%) had adhesions, while 58 (32.40%) did not have adhesions. In the peritoneal closure group, out of 40 cases 13 (32.50%) had dense adhesions, while 27 (67.50%) had flimsy adhesions. In the peritoneal non closure of 121 cases, 82 (67.76%) had dense adhesions, while 39 (32.23%) had flimsy adhesions. Using statistical significance, Pearson chi square value =101.992, P<0.001 and odds ratio, we found a 9.5 fold increase in adhesions in the peritoneal non closure group and even dense adhesions were found to be increased by 3.6 fold (X2=10.69, P=0.001 OR = (1:6;7.7) in the peritoneal closure group.
Conclusion: As the adhesion formation is less in the peritoneal closure group, it is advisable to close the parietal peritoneum during primary cesarean section. The uterus was sutured in two layers with No.1 NW 2347 vicryl and peritoneum with No. 0 chromic NW 4242 with atraumatic needle.
Objectives : To assess immunogenicity and safety of tetanus toxoid in pregnant Indian women. Methods : A post marketing surveillance study was conducted in 300 pregnant women of 28-36 weeks of gestation, who were administered 2 doses of 0.5 ml of tetanus toxoid one month apart as per WHO recommendations. Immunogenicity was assessed by determining serum and tetanus IgG antibody titre, pre and post-vaccination and safety was assessed by monitoring adverse events actively following each dose. Results : Irrespective of the prevaccination serostatus, all 300 pregnant women (100%) became seroprotected, 6- 8 weeks postvaccination. A fourfold increase was observed in anti tetanus IgG antibody titres post vaccination (p<0.0001) in all women. Local and systemic adverse events were mild, and comparable to earlier studies. No serious adverse event was observed. Conclusion : Tetanus toxoid is safe and immunogenic in pregnant women and additionally confers protection in neonates due to transplacental transfer of maternal antibodies.
Objectives: The present study was conducted with the aim to assess and comparatively evaluate the safety and efficacy of oral misoprostol 400 µg and I/V methylergometrine 0.2mg in the active management of third stage of labor.
Methods: The study was conducted in the department of Obstetrics & Gynaecology Pt. J.N.M. Medical College, Raipur (C.G.) and associated Dr.
B.R.A.M. Hospital from January 2006 to July 2006. The 200 cases selected for the study were divided in two groups of 100 cases each. In the study group misoprostol 400 µg was given orally and in the control group 0.2mg methylergometrine was given intravenously at the time of the delivery of anterior shoulder of the fetus. The duration of the third stage, amount of blood loss, side effect and complications if any were noted down. The results were analyzed.
Results: The mean duration of the third stage of labor in the study group was 10.17±6.87 minutes as compared to 5.68±1.91 minutes in the control group (P=<0.001).The mean blood loss in the study group was 117.28±99.77 ml as against 124.58±64.19 ml in the control group (P=>0.05). The side effects observed in the misoprostol group were shivering, fever and in methylergometrine group were nausea, vomiting & headache.
Conclusions: Oral misoprostol is an effective alternative to conventional uterotonics for the active management of third stage of labor.
Objectives: To find out the changes in homocysteine levels that occur during normal pregnancy with PET and also to find out correlation between homocysteine concentration and PET.
Methods: The study was conducted on 90 women, of whom 30 were controls which included normotensive non-pregnant women. Study group I consisted 30 pregnant normotensive women; study group II consisted 30 pregnant women with PET. Serum homocysteine was measured in all subjects using fluorescence polarization immunoassay.
Results: Control group had the highest mean homocysteine levels, while the study group I had least mean homocysteine levels (p<0.001). Levels were significantly higher in subjects with BP >146/100 mm of Hg as compared to those with BP >140/90 and <146/100 (p=0.017). There was significant difference between the study groups I and II at same gestational age.
Conclusions: Hyperhomocysteinemia was observed in pre-eclamptic females; it was also found that homocysteine levels were directly correlated with severity of preeclampsia.
Homocysteine, hyperhomocysteinemia, preeclampsiaObjectives: To evaluate the effectiveness and safety of the recently described Sheth’s pnuemo-surgical pack when used for a variety of gynecological surgeries.
Methods: The pack available in three sizes (3, 6 and 12 inches) was utilized by 11 gynecological surgeons in 62 cases of abdominal, vaginal and laparoscopic surgeries over 12 months.
Results: The pneumo- surgical pack was effective in maintaining a clear surgical field and was safe and easy to use. It was assessed by the surgeons and reported as being very useful in 35 cases, useful in 22 cases and of no particular advantage in 5 cases.
Conclusion: The pneumo-surgical pack is a potentially useful adjunct to a variety of gynecological surgeries. It has the benefit for being easy to use and atraumatic, while reducing the risk and complications associated with conventional techniques.
Objectives : To evaluate the status of antioxidant enzymes and lipid peroxidation in women with genital cancer at stage I.Methods : Erythrocyte malondialdehyde and antioxidant enzymes levels were estimated in the blood of women with stage Igenital cancer (n=94) and the results were compared with the levels in age and socioeconomic status matched healthy women(n=50). Results : There was significant increase in erythrocyte malondialdehyde level (p<0.001) and decrease in antioxidantenzymes (p<0.001) in women with genital cancer. Conclusion : Female genital cancer at stage I is associated with disturbedlevels of antioxidant enzymes and lipid peroxide. This could be demonstrating oxidative damage /injury.
