BackgroundThere is no universal screening method for discrimination between benign and malignant adnexal masses yet. Various authors have tried tumor markers, imaging studies, cytology but no one yet is a definite method for screening of cancer ovary, for which a combined diagnostic modality has come to practice in form of RMI. With this background we conducted our study “Evaluation of risk malignancy index and its diagnostic value in patients with adnexal masses”.MethodsThe aim of the study was to determine the effectiveness of risk of malignancy index (RMI-3) in preoperative discrimination between benign and malignant masses and also to reveal the most suitable cut off value. We have conducted a prospective study between November 2014 to October 2016. We included the parameters like menopausal status, ultrasound features, and serum levels of tumor marker like CA-125 for calculating RMI 3. Then RMI was compared with the histopathological report which was taken as gold standard.ResultsIn the present study malignant tumors constitute 54.76% (69/126) & benign tumors 45.24% (57/126). Bilaterality in adnexal masses and multilocularity is higher in malignant tumors than benign tumor, but a P –value >0.005 failed to be proved significant in our study. Solid area is seen in 24.69% (20/81) of benign and 75.30% (61/81) of malignant tumor. Similarly ascites was found in 38.09% (48/126) of cases. Out of which 18.75% (9/48) cases were found to be benign and malignancy was confirmed in 81.25% (39/48) patients. There is statistically significant number of malignant ovarian cancer patients where ascites and solid area is seen in USG findings (p = 0.000). Risk of Malignancy Index compared with individual parameters of Ultrasound score, CA-125 or menopausal score and a cut-off point of 236 shows a very high sensitivity (72.5%), specificity (98.2%), positive predictive value (98.1%), negative predictive value (74.7%) and diagnostic accuracy (84.13%) for discriminating malignant and benign pelvic masses.ConclusionSimplicity and applicability of the method in the primary evaluation of patients with pelvic masses makes it a good option in daily clinical practice in non-specialized gynecologic departments and also in developing countries where access to a gynaecologist oncologist is limited.

Background: Eclampsia continues to be a measure health issue in developing country. In order to get a comprehensive data on eclamptic patients we conduct a prospective observational study to address the maternal and fetal complication during pregnancy.Methods: It is a prospective observational study conducted in a tertiary care medical college between the periods September 2016 to February 2017. During the period all patients with eclampsia admitted to the labour room were taken. Any patients with known epilepsy were excluded from the study.Results: During the period 3780 women were admitted to the labour room, out of which 56 women had eclampsia with an incidence of 1.48%. Out this antenatal eclampsia was most common with an incidence of 91.08% followed by intra partum 4 (7.14%) and postpartum eclampsia 1 (1.78%). Majority of patients 54 (96.43%) were unbooked or inadequately supervised. Most of the patient had normalization of blood pressure after oral nifedipine 46 (82.14%), only 10 (17.86%) patient required additional injection labetalol for control of blood pressure. The maternal complications were placental abruption 8 (14.28%), HELLP 6 (10.71%), pulmonary edema 1 (1.78%), acute renal failure 1 (1.78%), DIC 1 (1.78%) and maternal death 2 (3.57%). Out of fifty six babies delivered 42 (75%) had live birth and 14 (25%) had still birth. A total of 17 (40.42%) had IUGR, 17 (40.47%) require SNCU admission post-delivery.Conclusions:Eclampsia still remains the major cause of maternal and fetal morbidity. In low resource countries improvement in health care facility, adequate antenatal supervision, and timely referral will reduce the maternal and fetal complication.

Introduction:We conducted a prospective trial to compare the maternal and fetal outcomes between the sickle cell disease (SCD) and sickle cell trait (SCT) pregnant patients. Materials and methods: From December 2015 to December 2016, a total of 59 patients were diagnosed with SCD and 119 patients with SCT. All the fetal and maternal parameters were compared between them. Results: A total of 17 (28.8%) SCD and 5 (4.2%) SCT patients presented with painful crisis. Acute chest syndrome developed in 9 (15.3%) of SCD and 1 (0.8%) of SCT cases. Hemolytic crisis was seen in 4 (6.8%) of SCD patients. The incidence of hypertension, preeclampsia, jaundice, blood transfusion during pregnancy, and IUGR among the SCD and SCT patients were 11 (18.6%) vs 5 (4.2%) (p = 0.000), 19 (32.2%) vs 7 (5.9%) (p = 0.000), 15 (25.4%) vs 0 (0%) (p = 0.000), 36 (61%) vs 8 (6.7%) (p = 0.000), and 33 (55.9%) vs 21 (17.6%) (p = 0.000), respectively. The mean periods of gestation of delivery were significantly lower, i.e., 36.5 ± 2.76 weeks for SCD patients compared to 38.2 ± 2.1 weeks for SCT patients (p = 0.000). Ten (16.9%) of SCD and one (0.8%) of SCT patients had intrauterine death. Average birth weights of babies delivered were 2142 ± 557.45 g and 2684 ± 551.23 g for SCD and SCT patients, respectively. Conclusion: Sickle cell anemia causes an increased risk to both mother and fetus. Sickle cell disease women are more prone to develop sickle cell crisis as well as increased obstetrical complication. A preconceptional counseling of all sickling women with a multidisciplinary approach can prevent many of the maternal and fetal complications during pregnancy.

In the modern era use of instrumental delivery is on a declining trend. Due to increase morbidity associated with forcep applications most women in developing countries preferred emergency caesarean section over instrumental delivery. But in country like India instrumental delivery is still preferable over caesarean section in many situations. We report a case that was referred from a peripheral hospital with simultaneous bladder and anal sphincter injury to our hospital. She was managed by a multidisciplinary team including urologist, surgeon and gynaecologist. Such type of case is very rare in modern era. To prevent such complications prerequisite for forcep application must be fulfilled. So that bladder injury, urinary fistula, anal incontinence and fetal complication can be avoided.