Background: Avoiding maternal deaths is possible even in resource-limited countries, but r correct information on which to base maternal health programmes is required. Knowing the level of maternal mortality is not enough to prevent further deaths; there is need to understand the underlying factors that led to the deaths. Maternal death review is one of the oldest and the most documented methods that can be effective in improving emergency obstetric care and maternal outcomes. Objectives: To study the maternal deaths in a District level tertiary health care unit so as to find the determinants of maternal mortality and suggest local solutions. Methods: Maternal deaths occurring in a tertiary care district hospital were analysed using maternal death review form. Socio demographic profile, antenatal care, labour and delivery parameters and cause of death was studied. Analysis was done using computer software stata. Results: In the present study there were 12 maternal deaths among 4953 deliveries giving a Maternal Mortality ratio of 242.27 per 1,00,000 live births. Pulmonary embolism was the leading cause of death complicating obstetric disorders of pregnancy induced hypertension and eclampsia. Most of the women died in the postpartum period. The affected population was rural, illiterate and belonged to the 19-29 years age group. Conclusions: Maternal death review is an important tool for delineating the causes of maternal deaths and finding cause specific and need based local solutions for curtailing maternal mortality.
Introduction: Ovarian tumors pose a diagnostic predicament as it is difficult to differentiate benign from malignant without a histopathology report. Appropriate tumor markers may serve as diagnostic aid to better decision making in the management of these cases. We attempted to determine the relationship between age, serum markers, and histopathological sub types of ovarian tumors to help distinguish benign from malignant tumors.Methods: A retrospective cross sectional study of all cases with ovarian tumors that had available histopathology reports and tumor marker levels was done at a single centre. Variables examined were age, histopathology report and serum tumor markers CA-125, CEA, CA19-9, LDH, and βHCG. Results: Histopathological analysis revealed 26% teratomas, 28% cystadenomas, 14% corpus luteal cysts, 26% carcinomas and 6% endometriomas. CA-125 was the only marker that was significantly raised in malignant versus benign tumors (p=0.008) and increased with increasing age. All women with raised CEA reports had teratomas, and none with cancers had a raised CEA. CA19-9, LDH and βHCG were not significantly different in benign versus malignant tumors.Conclusions: CA-125 may be used as an adjuvant diagnostic tool for ovarian cancer in older women. The role of CEA as a marker for teratomas needs further evaluation.
Cervical cancer is a leading cause of cancer-related morbidity and mortality. It usually spreads via direct invasion and lymphatics. Few cases with superficial spread to the uterine endometrium, fallopian tubes, and ovaries have been observed. The staging of these cases, as well as management, is not yet clear due to limited data. The Federation of Gynecology and Obstetrics (FIGO) staging disregards uterine spread to upstage the disease, and it also fails to provide clear guidelines regarding the superficial extension to the ovaries and tubes which is not uncommon in these cases. A 63-year-old female with postmenopausal bleeding was diagnosed with squamous cell carcinoma on a pap smear. Ultrasound and magnetic resonance imaging revealed a predominant endometrial lesion. Histopathology after Wertheim's hysterectomy revealed a squamous cell carcinoma of the endocervix, stage 1B2, that had spread superficially to the endometrium. A total of 48 cases of cervical cancer with superficial spread were identified. The commonest complaint was postmenopausal bleed in 39.39%. In 50% of the cases, the disease was carcinoma in situ, and 70.45% of the women had disease of stage 1B or less. In many cases, the disease had reached the tubes, 36.66%, and ovaries 23.33%. All women with stage 2A or lesser disease except for one were alive at 6 months after surgery. Superficial spread of cervical cancer is a distinct entity. Endometrial pathology must be ruled out before planning management in these women, especially when managing early-stage disease with conservative therapy.
Primary fallopian tube cancer is a rare malignancy. It is commonly confused clinically with ovarian mass. The commonest clinical features are clear or blood stained discharge per vaginum and abdominal pain. As the fallopian tube distends with the mass the patient has severe abdominal pain and thus presents earlier to the clinician. However thorough clinical examination may still not enable a preoperative diagnosis and thus intraoperative inspection becomes very important to label it as primary tubal origin. The management is similar to epithelial ovarian cancer. It carries a better prognosis than ovarian tumors as it tends to be diagnosed early and has a better five year survival rate.
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