Abstract

This is a review on the transition from our empirical approach to treat ovarian cancer to a specific treatment based on molecular signature. We have reviewed not only the evidence-based medicine focused on the origin and tumor morphology of ovarian cancer but also the molecular signature era based on molecular phenotyping of the tumor and its microenvironment, which influences the direct targeted therapy. Evidence-based medicine has shown that the targeted therapy studies are mainly biomarker driven, more focused, and hence treat only those patients who have the underlying molecular abnormality. This molecular abnormality is the target of the drug, leading to higher rates of response. These findings will carry important implications for screening, detection, and treatment of ovarian cancer in the future.

Abstract

Objective: Placental growth factor (PlGF) is an angiogenetic factor and inducts the development of preeclampsia in a hypoxic environment. In this study, we examined maternal blood PlGF levels in a pregnant population between 16 and 19 weeks of gestation for determining the prospective value for early diagnosis of preeclampsia as a screening test.

Materials and Method: In this prospective cross-sectional study, 114 nulliparous normotensive pregnant women were selected for the control group and 34 patients who have chronic hypertension or had a medical history of hypertensive disorders in previous pregnancies were selected for the study group.

Result: In the study group, the risk of preeclampsia increased 3.2 times when compared with the control with a confidence interval of 95 %. The cut-off value for PlGF for discriminating preeclamptic and non-preeclamptic patients was found to be 62.5 pg/ml.

Conclusion: Patients with a medical history of hypertensive disorders and low PIGF levels in early second trimester have an increased risk for preeclampsia.

Abstract

Objective: The aim of this study was to investigate perinatal outcome and the rate of cesarean section (CS) following intrapartum amnioinfusion in women with meconium-stained amniotic fluid (MSAF).

Method: A total of 100 women at term in labor with meconium were randomized to infuse transcervical intrapartum amnioinfusion with saline (50) and routine obstetrical care (50). Perinatal outcome and obstetric outcome were recorded and analyzed in both groups by means of Chi-square test.

Result: The CS rate due to fetal distress was 40.0 % in the control group and 20.0 % in the study group. The difference was statistically significant (P\0.01). Respiratory distress of the neonate was significantly less common in the study group than in the control group (4.0 % vs. 12 %; P = 0.0349).

Conclusion: Amnioinfusion in cases of meconium-stained liquor significantly improved neonatal outcome and CS rate without increasing any maternal and fetal complications.

Abstract

Objectives: To study the efficacy of fetal Doppler and non-stress test (NST) in predicting fetal compromise in preeclampsia and growth-restricted fetuses.

Method: ln a prospective study, 189 pregnant women beyond 32 weeks of gestation with preeclampsia or growth-restricted fetuses confirmed by ultrasound were evaluated by Doppler velocimetry (umbilical and middle cerebral artery) and non-stress testing. The outcome of pregnancy was recorded according to Group I (n = 109, Doppler and NST normal), Group II (n = 48, Doppler abnormal and NST normal), Group III (n = 14, Doppler normal and NST abnormal), and Group IV (n = 18, Doppler and NST both abnormal). The evaluation was done by Chi square testing.

Results: Both Doppler and NST had a better specificity and negative predictive value, indicating that these tests were more predictive of a healthy fetus. The fetal compromise in terms of APGAR scores, NICU admissions, birth weight, etc., was greater when both Doppler and NST were abnormal. Doppler detected changes earlier in the disease cascade than NST as evidenced by the lead time of 5.86 days.

Conclusion: The use of both the tests is necessary as it helps in detecting a spectrum of fetuses compromised at various stages of disease affection.

Abstract

Purpose: To evaluate various laparoscopic methods for management of tubal ectopic pregnancy and study the incidence of ectopic pregnancy including the incidence of cornual ectopic pregnancy and conversion to laparotomy during laparoscopic procedure.

Methods: A retrospective study was conducted in North Point Hospital, Delhi, on all laparoscopies conducted in 4 years, i.e., from January 2008 to December 2011.

Results: Incidence of ectopic pregnancy was 4.62 % (out of all laparoscopic surgeries over 4 years) and that for cornual pregnancy was 4.65 % (out of all ectopic pregnancies); no laparotomy was done for the management of ectopic pregnancy. The site of ectopic pregnancy in the tubal pregnancy varied, with 76.75 % in the ampullary region, 16.27 % isthumic, 2.33 % fimbrial, and 4.65 % in the cornual region. Salpingectomy was done in 53.5 % cases and 46.5 % of patients underwent a conservative approach in the form of salpingostomy.

Conclusion: The laparoscopic management of ectopic pregnancy is a safe and effective option with greatly reduced morbidity.

Abstract

Objectives: The objective of the current study is to compare outcomes of twin pregnancies with attempted labor and active second-stage management with twin pregnancies delivered by planned cesarean delivery.

Material and Method: Two hundred and eighty-three patients with twin pregnancy meeting the inclusion criteria were reviewed. They were followed for success of ECV and/or IPV in planned vaginal group and abdominal mode of delivery. Fetal outcome was assessed by APGAR score of both twins as well as NICU admission, if needed.

Results: Out of 283 patients, 116 patients (40.9 %) had planned cesarean section, and 167 patients (59.01 %) had planned vaginal delivery. Out of 167 patients, 148 patients (88.6 %) had a vaginal delivery of both twins. ECV was successful in 36 patients (25.3 %), and IPV was successful in 102 (95.3 %). IPV failed in five patients (4.6 %), and hence resorted to emergency cesarean section. There was no significant difference in the rates of twin B having a 5-min Apgar score lower than 7 or an arterial cord pH below 7.20 in both the groups. Among the patients in the planned vaginal delivery group, the cesarean delivery rate was 8.3 %, out of which combined vaginal—cesarean delivery rate was 4.6 %.

Conclusion: Active second-stage management is associated with neonatal outcomes similar to those with planned cesarean delivery and a low risk of combined vaginal cesarean delivery.

Abstract

Purpose: To assess correlation between lactate levels in vaginal fluid and onset of labor in suspected PROM.

Method: A prospective observational study conducted at the Dept. of Obstetrics and Gynecology and Pathology from 2008 to 2009. 118 women with complaints of leaking per vaginum underwent a sterile speculum examination and vaginal fluid was taken to estimate lactate level. Then, women were followed till the spontaneous onset of labor. The association was presented as Odds ratio with 95 %CI.

Result: The median time of onset of spontaneous labor and examination was 12 h in patients with lactate levels[5.0 mmol/L and 76 h in patients with lactate levels\5.0 mmol/L. Among 62 women with lactate levels[5.0 mmol/L, 67.7 % of women (n = 42) had spontaneous onset of labor within 24 h and 83.87 % women of (n = 52) within 48 h.

Conclusion: A lactate level[5.0 mmol/L is significantly associated with the spontaneous onset of labor within 24 and 48 h in suspected cases of PROM.

Abstract

Aim: The aim of the present study was to prove the efficiency of Color Doppler and Spectral Doppler in evaluation and characterization of the ovarian neoplasm.

Materials and Method: In total, 104 patients with adnexal masses were examined sonographically to evaluate for morphologic characteristics, as well as pulsatility indices (PI), and resistance indices (RI) over a period of 2 years, of which 20 were excluded as the masses were not finally proven to be adnexal, and thus 84 patients with ovarian neoplasm were retained as the study subjects. The final diagnosis was based on histopathologic confirmation.

Result: Out of 84 cases, 44 were benign and 40 were malignant. Color Doppler showed vascularity in 97.5 % of malignant tumors in contrast to only 68.1 % of benign tumors. The present study showed that, 87.5 % of malignant tumors had PI less than 0.8 in contrast to only 4.54 % of benign tumors. Similarly, 82.5 % of malignant tumors had RI less than 0.6 in contrast to only 6.81 % of benign tumors.

Conclusion: Multiparameter analysis utilizing B-mode USG along with Color Doppler and Spectral Doppler is the mainstay in diagnosis of patients with ovarian tumors. A good specificity (84.1 %) and sensitivity (97.5 %) with PI and RI values of\1.0 and\0.6, respectively, was achieved with the present study which is highly significant in differentiating between malignant and benign ovarian tumours.

Abstract

Contex: Any deviation of the normal prenatal development right from gametogenesis may give rise to condition now known as disorders of sex development. XY gonadal dysgenesis is characterized by 46,XY chromosome complement with female phenotype and streak gonads. This study reports incidental finding of eight such cases.

Aim: To find out correlation between clinical findings and chromosome complement in cases presenting with menstrual dysfunction.

Settings and Design: Prospective, cross-sectional study conducted in a tertiary healthcare center.

Materials and Methods: Chromosomes were studied after planting and harvesting through conventional short-term culture method. Attempt was made to correlate the cytogenetic findings with other clinical findings of cases.

Statistical Analysis: Nil.

Results: Hundred cases of menstrual dysfunction referred from other clinical departments were studied. Abnormal chromosomes were obtained in total ten cases where 46XY disorder of sex development was observed in eight cases and two- cases had Turner syndrome. It was observed that these cases belonged to primary and secondary amenorrhea only. There were six cases where the chromosomal complement was 46,XY and two cases with mosaicism of 46,XY/45,X. Patients with hypomenorrhea and oligomenorrhea had normal chromosomal findings.

Conclusions: It is possible to have normal looking females with normal development of secondary sex characters to have abnormal chromosome complement. Cytogenetic testing becomes inevitable in such cases. If possible, molecular diagnostic methods also can be employed for detailed description of derangement.

Abstract

Objective(s): The objective of this study was to compare the efficacy and safety of CEE, tibolone, and DHEA for prevention of menopausal symptoms.

Method(s): One hundred patients with surgical menopause were included in this study: 25 of whom were not treated with any HRT, 25 were treated with 0.625 mg of CEE, 25 were treated with 2.5 mg of tibolone, and 25 were treated with 25 mg of DHEA for 1 year, and the results were statistically analyzed regarding drug efficacy and side effects at follow-up periods of 1, 6 and 12 months.

Result(s): Frequency of menopausal symptoms was significantly less in cases received with CEE, tibolone, DHEA with p values 0.001, 0.004 and 0.004, respectively. Percentage gain in BMD was 2.8 % with CEE at lumbar spine, which was greater than that caused by DHEA and tibolone, but this difference was not statistically significant. CEE caused side effects like headache (40 %) and nausea (28 %).

Conclusion(s): CEE, Tibolone, and DHEA are very effective in alleviating climacteric symptoms. CEE has beneficial effects on lipid and bone and is a low-cost drug but frequently causes side effects. Tibolone offers beneficial androgenic effects on mood and libido with fewer side effects but is a costly drug. DHEA shows positive effects on psychological symptoms. However, its cost and androgenic side effects limit its use as long-term HRT.

Abstract

Purpose: The primary aim of this study is to determine the awareness regarding menopause and its treatment options among women in Mumbai, India and correlate the same with the social class of the subject. In addition, this study also attempts to identify the attitude of Indian women toward menopause.

Methods: A cross-sectional study was conducted using a self-constructed semi structured questionnaire given to women between the ages of 35 and 55 years, currently residing in Mumbai. The 192 women interviewed were then divided into 6 groups as per Prasad’s Socioeconomic Classification (based on per capita monthly income) with 53 % falling in class I and II and 47 % in class III, IV and V. Although the study was conducted primarily at a charitable hospital, no subject was found who fulfilled the Class VI criteria.

Result: The study shows that two-thirds of class I, four-fifths of class II, less than half of class III, and one third of class IV andVare aware about treatment options formenopausewhich is a significant variation (v2 value = 20.127, df = 1, P\0.0001). We also found that once counseled, more than half the subjects of classes I to V were willing to accept treatment, which thus is not a significant variation (P = 0.4659). Of the total subjects, more than half were relieved, one fourth frightened, and less than one fifth were uncertain about their feelings toward menopause.

Conclusion: We thus conclude that there is a significant relationship between socioeconomic status and awareness about menopause treatment options while there is no relationship between socioeconomic status and acceptance of treatment for the same. A majority of the Indian women are relieved by the onset of menopause.