Long anovulatory periods with unopposed estrogen stimulation may result in endometrial hyperplasia, thus increasing the risk of endometrial cancers. Therefore,

Background: Hypertensive disorders of pregnancy are a leading cause of maternal and perinatal mortality and morbidity worldwide. In India, they account for the third most important cause of maternal mortality. The objectives of this study were to evaluate maternal and perinatal outcome and complications in cases with severe preeclampsia and eclampsia. Methods: A retrospective study was carried out on 110 women with severe preeclampsia and eclampsia in a tertiary care referral centre over a period of 15 months. Only those cases with initial B.P reading of ≥160/110 mm Hg or presenting with eclampsia were included in the study. Investigations and management were carried out as per standardized department protocol and maternal and fetal outcomes were analyzed. Results: 42% of the cases were in the age group of 26-30 years, nearly 61% were primigravidae and the majority (64) were referred from peripheral hospitals. Liver function tests were deranged in 19% of the patients and 17% had abnormal renal function. Nifedipine was the most commonly used antihypertensive and magnesium sulphate was the anticonvulsant used in all the cases. Lower segment caesarean section was the mode of delivery in 64.5% of the cases. Commonest maternal complication was atonic PPH. There was no maternal mortality but there were 3 maternal near-miss cases due to DIC. 65% of the cases had a preterm delivery and 39% of the babies needed NICU admission. There were 10 neonatal deaths. Conclusions: Accessible health care and health education and awareness regarding antenatal check-ups for all women will lead to early detection of severe preeclampsia. Prompt treatment and management of its complications will certainly improve the maternal and fetal outcome.

Background: High-risk pregnancy is one in which the mother, foetus or the newborn has an elevated risk of experiencing an adverse outcome. These high-risk women form a special vulnerable cohort that can be identified in the antenatal period using a simple, easy to use, cost-effective tool- a maternal risk scoring system. Early identification of these high-risk mothers will facilitate effective intervention strategies to deal with the complications.Methods: This study was carried out on 300 pregnant women with gestational age more than 28 weeks. Detailed history, examination and necessary investigations were done and then using the Modified Coopland scoring system, each pregnant woman was assigned a risk score and stratified into 3 risk groups- low risk (0-3), moderate risk (4-6) and high risk (≥7) and followed up till delivery and 7 days postpartum. Subsequently, the maternal and perinatal outcomes were compared with their respective scores.Results: In this study, 14.66% patients belonged to the high-risk category. Statistically, a significant difference was noted in the number of low-birth-weight babies, in 5 minutes APGAR score <7 and in NICU admissions in the high-risk group compared to the low-risk group. Overall perinatal mortality was 13.33/1000 live births. In the high-risk group, a significant difference was seen in the occurrence of PPH and the need for operative delivery.Conclusions: Significant association between high-risk pregnancy and the poor maternal and perinatal outcome was noted. Therefore, a simple, cost-effective high-risk pregnancy scoring system such as the one proposed in this study can be used to identify potential high-risk pregnancies, provide them with tertiary care facilities and also corrective measures can be undertaken to prevent or minimize the complicating factors.

Background: Pelvic mass lesions are a commonly encountered entity in gynecological practice. These masses may be uterine or adnexal, benign or malignant. Clinicians have to be aware of their differential diagnosis to triage the patients and ensure optimum therapeutic approach. The objectives of this study were to study the diverse clinical spectrum of gynecological pelvic masses and to correlate the preoperative diagnosis based on clinical examination and ultrasonography with intraoperative surgical findings and histopathological examination.Methods: This was a cross sectional observational study on 114 patients with a diagnosis of pelvic mass who underwent laparotomy. All the patients were evaluated by a complete history, general abdominal and pelvic examination, followed by ultrasonography. These preoperative findings were then correlated with surgical findings and histopathological diagnosis.Results: 48% 0f the patients were in the age group of 41-50 years. The most common presenting complaint was lower abdominal/ pelvic pain seen in 78% of the patients. Uterine masses mostly presented as abdominal pain, abdominopelvic mass, menstrual complaints whereas ovarian masses presented with vague G. I symptoms or were asymptomatic. 37% of all masses were leiomyomas. There were 16 uterine malignancies and 14 ovarian cancer cases. Preoperative USG correlated well with histopathological diagnosis.Conclusions: A methodical approach consisting of a proper history, clinical examination, imaging studies and correct interpretation of diagnostic procedures is necessary for the triage and optimum management of gynecologic pelvic masses.

Background: Abnormal uterine bleeding (AUB) is defined as bleeding pattern that differs in frequency, duration and amount from the normal cyclical flow. Endometrium in AUB vary depending on etiology and age. The present study attempts to categorize the histopathology of endometrium in abnormal uterine bleeding in women of various age groups.Methods: A hospital based prospective study was carried out in 220 cases of abnormal uterine bleeding. Paraffin processed endometrial biopsies analyzed correlating the clinico-radiological data. Endometrial samples of infertility and pregnancy related bleeding were excluded.Results: 220 cases of AUB from 25 years to 78 years of age were evaluated under three groups, reproductive (23%), perimenopausal (52%) and postmenopausal (25%). AUB was most common in the perimenopausal group. The predominant pattern seen was physiological cyclical endometrium (67.2%). Disordered proliferative endometrium (18.63%) was the predominant abnormal pattern. Malignant lesions were (99.5%) in postmenopausal age and disordered proliferative endometrium seen predominantly (65.85%) in perimenopausal age group. As per PALM-COEIN classification, uterine structural abnormalities (PALM) were found in 70 (31.9%), non-structural causes (COEIN) in 150 (68.1%). Endometrial thickness >16 mm on radiology were seen in endometrial carcinoma.Conclusions: Endometrial morphology vary with ovulatory abnormalities, anovulation and uterine abnormalities. Acronym PALM-COEIN is useful in categorizing AUB. The incidence of disordered proliferation, hyperplasia and malignancy seen in extremes of age, reiterates that early clinic-radiological workup and endometrial study are the mainstay in early detection of lesions.

Endometrial Stromal Sarcoma (ESS) is a rare slow growing tumour of mesodermal origin arising from the stroma of the endometrium and accounting for less than 1% of all uterine cancers. It is characterized by late recurrences and distant metastases. This report presents a case of ESS in a 40 year old nulliparous woman who had a myomectomy for a clinically suspected Leiomyoma uterus in a local hospital. The histopathological examination of the specimen revealed ESS and the patient was referred to our tertiary institute. Here after investigations including a CT scan which also revealed pulmonary metastases, patient underwent Modified Radical Hysterectomy with Bilateral Salpingooophorectomy with pelvic lymph node sampling. Histopathological Examination of the uterine specimen confirmed the diagnosis. The patient was given the option of referral to a thoracic surgeon for resection of the isolated lung metastasis, but she refused this and opted instead for hormone therapy which she is presently undergoing. ESS is a very rare tumour often presenting with clinical and examination findings suggestive of leiomyoma of the uterus and hence misdiagnosed. In cases of rapidly growing tumours and suspicious radiological features, suspect sarcoma and initiate timely diagnosis and proper treatment. Recommended long-term follow up in view of late recurrences.