Objective: Vaginal reconstruction in Müllerian agenesis through nonsurgical method, using serial vaginal dilators which were worn by the patients with the help of a T-shaped peri neal bandage. Materials and methods:Seven patients with Müllerian agenesis had attended the outpatient clinic between 2008 and 2013. The age of women ranged from 18 to 30 years. This clinical report describes the use of prosthesis, fabricated by a maxillofacial prosthodontist that enabled the patients to have custom made personalized vaginal dilators of increasing dimen sions which they could wear with comfort with a tight perineal T-bandage.Results: Seven women with Müllerian agenesis had consented for nonsurgical mode of vaginal reconstruction. Vagina was serially dilated with tailor made prosthesis worn using tight perineal T-bandage for a period of 3 to 4 months. Post dilatation average vaginal length was 11 to 13 cm which allowed intro duction of Sims speculum with ease. Conclusion:Nonsurgical vaginal dilatation using prosthetic vaginal dilators kept in place with tight perineal T-bandage is a well-accepted custom made and a successful technique in the creation of neovagina.

Objective: To study the efficacy of mifepristone in preinduction cervical ripening in term pregnancy. Study design: This is a prospective observational study, done in a tertiary care hospital. Fifty pregnant women in the study group were given oral mifepristone 200 mg for preinduction cervical ripening (second dose after 24 hours if applicable) and another 50 pregnant women who underwent expectant management were included in the expectant group. The primary objective was to assess the effect of mifepristone on the change in Bishop score. The secondary objective was to assess the induction-delivery interval and the mode of delivery. Results: In this study, the mean modified Bishop score 24 hours after oral mifepristone (single dose) was (7.34 ± 1.533) which was statistically significant compared to the expectant group's Bishop score (4.28 ± 1.179) p <0.001. Similarly, the mean modified Bishop score 48 hours after oral mifepristone (two doses) was 7.50 ± 0.57 which was statistically significant when compared to the expectant group (4.28 ± 1.155) p <0.001. The requirement for further inducing agents has also been significantly less in the study group compared to the expectant group (p <0.001). Twenty-four percent went into spontaneous labor within 24 hours of the first dose of oral mifepristone without the requirement of a prostaglandin E2 (PGE2) gel. Augmentation with oxytocin was required in 60% of the study group and 86% of the expectant group in active labor. The mean duration between the initiation of PGE2 gel induction and delivery was 13.45 ± 4.536 hours in the study group and 20.41 ± 3.896 hours (p <0.001). Spontaneous vaginal delivery was 82% in the study group and 80% in the expectant management group. Conclusion: Oral mifepristone given for preinduction cervical ripening was found to be effective and safe with a reduction in the need for additional prostaglandins and oxytocin and also shorter induction-to-delivery interval with no serious maternal or fetal adverse effects.

There are several numbers of benign and malignant lesions occurring within the ovaries and Benign ovarian cysts being the most common among adolescents and child bearing age and constitute about 90% of ovarian tumours. Aim & Objectives: A Prospective observational study, to assess the clinical manifestations along with its tumor markers and histopathological pattern of ovarian masses in adolescents in Sri Ramachandra Institute of higher education and Research between September 2016 and September 2018. Methods: The study included adolescent age group between 11-19 years.Patients were explained about the study in detail following which detailed clinical history and physical examination were recorded. Routine laboratory parameters along with tumour markers were sent and postoperatively the excised specimen was sent for histopathology. Then the results were analysed. Results: Among 101 patients, the common age of presentation in our study was among 17 to 19 years (54.4%) and common presenting complain was pain abdomen (70.2%). In our study, Benign ovarian masses were more common in adolescent age group. Simple serous cyst (34.7%) was the most common pathology among the benign ovarian masses. CA 125 was observed to be elevated in benign ovarian tumors -simple serous cyst (19.8%) and serous (5%) and mucinous cystdenoma (2%). AFP, LDH, and β-hCG were found to have high positive rate for germ cell tumors. CA 19-9 was observed to be elevated in dermoid cyst (5%) and Mucinous Cystadenoma (2%), and CEA was found to be elevated in Dermoid cyst (2%). Conclusion:One should aim for an accurate diagnosis and timely intervention. While surgical intervention should target to preserve fertility, adhesion prevention measures should be employed in benign ovarian masses. Tumor markers are helpful tool for diagnosis but not reliable when used in isolation and has a limited value in differentiating benign from malignant pelvic masses.

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A heterotopic pregnancy is defined as the presence of a combined intrauterine and ectopic pregnancy. Its estimated incidence is as between 1/7000 and 1/30,000 pregnancies. It is also reported to be as high as 1% after the use of assisted reproductive technology. Heterotopic pregnancies are diagnostic and therapeutic challenges for obstetricians. If they continue without diagnosis, a life-threatening situation may occur even when timely surgical intervention with laparotomy is performed. Here, we report a case series of three patients having three different scenarios, who were diagnosed with heterotopic pregnancies in the first trimester and managed successfully.