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This is presentation of woman on unmonitored anticoagulants with life threatening haemoperitoneum.

Background: To differentiate ovarian mass as benign or malignant could change clinical approach. Finding a screening and diagnostic method for ovarian cancer is challenging due to high mortality and insidious symptoms. Risk malignancy index (RMI) has the advantage of rapid and exact triage of patients with ovarian mass.Methods: Prospective study carried for 2 years at NRI Medical College and General Hospital, Chinakakani, Mangalagiri, Andhra Pradesh, India. 79 patients with ovarian mass were investigated and risk malignancy index (RMI-3 and RMI-4) calculated. Final confirmation was done based on histopathological report. Sensitivity, specificity, positive predictive value and negative predictive value were calculated for RMI 3 and RMI 4 taking histopathology as control and comparison was done.Results: (n=79); 50 (63.29%) cases were benign and 29 (36.70%) were malignant based on histopathology. RMI 4 is more sensitive (68.96%) than RMI 3 (62.06%), but RMI 3 is more specific (94%) than RMI 4 (92%).The positive predictive value of RMI-3 and RMI-4 were 85.71%  and 83.33% respectively. The negative predictive value for RMI-4 and RMI-3 were 83.63% and 81.03% respectively.Conclusions: With increasing age, chance of malignancy increases. RMI 4 was more sensitive than RMI-3, however less specific than RMI 3 in differentiating benign and malignant tumors. The positive predictive value is slightly more for RMI 3, than RMI 4. Negative predictive value is slightly more for RMI 4, than RMI 3.

Psoas Abscess is a rare association with pregnancy. A 24 years old primi gravida with term pregnancy presented with PROM, oligo hydramnios, fever, tachycardia and inability to move both lower limbs. On examination, membranes were intact, there was bleeding PV with excess vaginal discharge. There was foetal tachycardia (180/min). To exclude abruptio ultrasound was done. Intra Uterine Death was diagnosed. That time patient was in early labour which was accelerated with syntocinon. Suddenly she became hypoxic and was ventilated. She delivered a stillborn baby. In the puerperial period patient suffered fever for more than a month. As fever was not controlled for long period (one month) CT was done which showed hypodense areas in right psoas muscle. CT guided Percutenous drainage was failed. By MRI investigation, it was diagnosed as multiple abscesses with sacro illitis and was drained extra peritoneally. As fever is not controlled with broad spectrum antibiotics, montox skin was done which was strongly positive. Hence treatment with anti tuberculosis drugs was planned. Finally fever was controlled by antituberculosis drugs ISONIAZID 300 mg/day, REFAMYCIN 600 mg/day, ETHAMBUTOL 800mg/day, Inj. STREPTOMYCIN 1 gm/day as a thereuptic trail.