Aim:To compare the effect of clomiphene citrate (CC) + human menopausal gonadotropin (hMG) with letrozole + hMG on size, number of follicles, endometrial thickness, serum levels of oestradiol and progesterone and pregnancy rate.Settings and Design:Non-randomised interventional study.Patients and Methods:A total number of 60 patients in the age group of 20–35 years with unexplained infertility were divided into two groups, 30 in each. Group A received CC + hMG and group B received letrozole + hMG. In both the groups, ovulation was triggered by hCG followed by intrauterine insemination.Results:The number of follicles on day 8 were significantly higher in the CC + hMG group than that in the letrozole + hMG group. Serum oestradiol level was significantly higher in the CC + hMG group on day 10 and on the day of hCG administration. Pregnancy rate in the CC + hMG group was 23.3% and 13.3% in the letrozole + hMG group.Conclusion:The sequential protocol was cost-effective. CC + hMG could be a preferred ovarian stimulation protocol in couples with unexplained infertility with the added advantage of having no significant complications in properly monitored cycles.
Aim: To study the clinical characteristics of adnexal masses in children and adolescents who were treated in our hospital from 2009-2013. Materials and methods:We performed a retrospective analysis of adnexal masses in girls less than 20 years of age. Medical records were reviewed for symptoms, tumour markers, origin /size of the masses, treatment, histopathology and outcome. Data management and descriptive analysis were performed using SPSS 16.0.Results: A total of 58 patients were included in the study. 87% of girls were postmenarchal, (7%) were hypothyroid and 57 were elective admissions. The most frequent symptoms were abdominal pain (82%), swelling (16%) and menstrual disorders (2%).Tumour markers -either LDH, CA -125 , CEA or βhCG were abnormal in 12%. Size of tumour varied from 5-35 cm. The origin of adnexal mass was ovarian in 92% and paraovarian in 8%. The operations included laparoscopy in 13 cases and laparotomy in 45 cases. The type of surgery performed was ovarian cystectomy (15%), paraovarian cystectomy (8%), oophorectomy (35%) and salpingoopherectomy (38%). 2 girls had bilateral masses -frozen section showed immature teratoma, one underwent TAH+BSO and other girl had bilateral ovariotomy done. Ovarian torsion was seen in 25% of cases. Histopathological examination revealed 23 functional lesions, 33 benign and 2 malignant masses. One girl was diagnosed with hydatid cyst intraoperatively and was started on Albendazole. Postoperative course was uneventful in all cases. Conclusion:Adnexal masses are relatively uncommon in children and adolescents. Minimal invasive surgery targeting fertility preservation is recommended in managing these adnexal masses.
Ovarian tumor is the most common diagnosis in postmenopausal women, presenting with a pelvic mass, though other surgical causes can still be a remote possibility. We report an extremely rare case of a woman, post hysterectomy, presenting with a pelvic mass where both clinical and radiological evaluations were suggestive of an ovarian tumor. The patient underwent laparotomy and a pre-sacral cystic mass was found and excised. Histopathology revealed a schwannoma as the final diagnosis. Hence, it mandates a high index of suspicion to consider other surgical possibilities, vigilant management in the form of advanced radiological evaluation, especially when dealing with doubtful cases of adnexal tumors prior to surgery.
Objective To assess associated risk factors, maternal and neonatal outcome of pregnancies complicated by umbilical cord prolapse in South Indian population. Study design It was a descriptive study. Risk factors, maternal and neonatal outcome were noted down retrospectively from case records of mothers affected by umbilical cord prolapse from April 2014 to March 2016. Results There were 39 cases of umbilical cord prolapse in 2 years. The incidence of umbilical cord prolapse in our hospital was 0.1%. Most of the women were ≤ 25 years of age (72%). Primis were 56%. Most common presentation in umbilical cord prolapse was cephalic presentation (64%). Among the affected individuals, 82% had term gestation, 79% had higher presenting part, and 87% had spontaneous rupture of membranes. Babies were delivered by lower segment cesarean section (LSCS) in 95% and birth weight was ≥2.5 kg in 67% of cases with umbilical cord prolapse. Decision to delivery interval (DDI) was ≤30 minutes in 84% of cases. APGAR score was ≥7 at 1 minute in 65% and ≥7 at 5 minutes in 83% of cases. There were 15 neonatal intensive care unit (NICU) admissions and 2 stillbirths. Most common gender was male (75%). Conclusion In our study, maternal risk factors were different from traditional risk factors in relation to age, parity, period of gestation, presentation, and birth weight. But, station of presenting part, early dilatation of cervix at diagnosis, and male gender predominance were similar to traditional risk factors. Neonatal outcome was good in our study with no birth injuries. All cases should be monitored properly to reduce the occurrence of umbilical cord prolapse even in low-risk population. Early detection and intervention is required for good neonatal outcome. Umbilical cord prolapse should be managed by an expert obstetrician. How to cite this article Hembram M, Sagili H. Risk Factors, Maternal and Neonatal Outcome in Umbilical Cord Prolapse in South Indian Population. J South Asian Feder Obst Gynae 2017;9(4):323-326.
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