Indian Journal of Obstetrics and Gynecology Research

5-8

Authors: CH Prasanna Kumari, A. Ashwini, K. Aparna, N. V. R. Murty.

Objectives: To identify the risk factors for meconium stained amniotic fluid (MSAF) and it’s impact on perinatal outcome. Materials and Methods: This prospective, observational study was conducted in labour room & operation theatre of St. Theresa’s Hospital from May 2015-May 2016. A total of 110 women who were found to have meconium on spontaneous or artificial rupture of membranes were monitored with fetal heart rate abnormalities,5 minute APGAR score and neonatal complications like meconium aspiration syndrome(MAS) as outcome variables. Results: The results of the study were analysed statistically using Windostat Version 9.2. The incidence of MSAF was 12.01%. Based on this study, it is evident that the incidence of MSAF was more in women with Oligohydramnios , Prolonged pregnancy , Diabetes complicating pregnancy , Hypertensive disorders in pregnancy, Fetal growth restriction and in women with induced labour. The Chi Square test was applied between Grades of Meconium and APGAR Score. p value< 0.05 which was statistically significant. Also, the study between Grades of Meconium and Cardiotocograph (CTG) pattern proved to be significant with p value < 0.05. Conclusion: MSAF alone is not associated with an adverse neonatal outcome, 78.18% of abies remained asymptomatic. Increasing grade of meconium is associated with increased adverse outcome. Association of MSAF with abnormal CTG is associated with poor outcome, increased caesarean section rate, increased neonatal complications. The presence of thick meconium is associated with increase in the perinatal morbidity and mortality and hence its presence should not be overlooked.

15-19

Authors: Deepika. N, Arun Kumar.

Objective: To study the efficacy of oral mifepristone in pre induction cervical ripening and induction of labour in term pregnancy. Materials and Methods: This is a single blind randomised control trial. 200 women with term pregnancy and bishop score < 6 were recruited and randomly allocated into two groups. Women who received tablet mifepristone 400 mg were assigned to study group (n=100) and who received placebo orally were assigned to control group (n=100). At the end of 48 hours, change in the bishop was assessed and accordingly induction/ augmentation of labour was done. Analysis regarding safety and efficacy of the drug was done with regards to maternal and perinatal outcome. Results: Among 200 women, 100 received mifepristone and 100 received placebo. In mifepristone group, 75% patients entered into labour within 48 hours of induction as compared to 48% in placebo group. The mean time interval between induction to start of labour pains was 28 hours 54 min in group A and 42 hours 18 min in group B. This difference was statistically significant. (p=0.000). In the study group 70% patients delivered within 48 hours of treatment as compared to 38% patients in control group. Mean induction delivery interval was 35 hours 38 min in study group and 49 hours 52 min in control group (p=0.000). There were fewer caesareans in the mifepristone treated group (10%) than placebo group (20%) particularly for failed induction (2 versus 6) and non progress of labour (2 versus 5). There was no statistically significant different in perinatal outcome between two groups. Conclusion: Mifepristone has modest affect on cervical repining when given 48 hour prior to labour induction and appears to reduce need for further induction compared to placebo. Mifepristone is a simple and effective method of inducing labour in women with term pregnancy and unripe cervix. The use of Mifepristone provides an interesting new alternative to classic uterotonic agents when induction of labour is necessary.

27-30

Authors: Hanumant V Nipanal, Susmitha Shivanna Reddy, Dilip Kumar Mauryya, Ravindra P. Nagendra.

Introduction: The present study is a retrospective analysis of vulval cancer patients who had been treated with surgery as primary mode. The cases studied were in tertiary care hospital south India of March 2008 to February 2013. Total number of patients was 11. Materials and Methods: The medical records of all patients studied retrospectively with reference to stage of the disease, surgery performed, prophylactic antibiotics, intra-operative and postoperative complications. Results: Among 11 patients 9 were postmenopausal. Ten patients histopathology showed stage 1b cancer for whom simple vulvectomy was performed, one patient had co-existing HGSIL( High Grade Squamous Intraepithelial Lesion) and positive right inguinal nodes, requiring TAH+ BSO+ right groin dissection and posterior colporrhaphy was done in one patient with rectocele. One patient presented with stage 2 disease for which radical vulvectomy with bilateral groin lymph node dissection was carried out. Postoperative radiotherapy was given for 8 patients with tumor positive margins. Conclusion: Even though many modifications in surgical methods of vulval cancer still morbidity is high. Particularly surgical complication of wound infection. This delay will further add up for delay in starting adjuvant treatment. Hence there is a need of further modifications of surgical treatments like minimally invasive approach. A team of oncology surgeons, medical oncologists, radiotherapists is needed to manage this rare cancer. With multidisciplinary approach Surgery for early stage vulval cancer has acceptable morbidity.

37-40

Authors: Jyoti Bindal, Sujata Bhargava, Anuradha Gupta.

Introduction: Mismanagement of postpartum haemorrhage (PPH) is the major reason for the maternal morbidity and mortality throughout the world, highest incidence is found in developing countries. Aims and objective: To study the various methods used to control PPH in all the deliveries that took place at the study place. Materials and Methods: Prospective study was performed on 402 PPH patients in the Department of Obstetrics and Gynecology, Kamla Raja Hospital, GR Medical College, Gwalior from Sept., 2014 to Aug., 2015. All the patients were divided in to atonic PPH and traumatic PPH. Patient’s detailed history including obstetric history, menstrual history and history of drug allergy were recorded in pre-approved excel format. Patients were managed either by catheterization and uterine massage, using uterotonic drugs, uterine packing and surgical intervention such as internal iliac ligation and/or hysterectomay. Results: Out of total 7977 deliveries, 62.09% were vaginal and 37.91% were caesarean section. Out of that 402 (5.03%) developed PPH. Mean age of study population was 23.3±1.37 years. Out of 402 PPH patients, 75% were having atonic PPH whereas 19.65% were having traumatic PPH. Most of the patients with atonic PPH were managed by uterotonic drugs (69%) followed by cathererization with uterine massage (25%). Most of the patients with traumatic PPH were found to be due to hematoma or tear and were managed by haematoma drainage (58%) followed by perineal with vaginal repair (33%). Conclusion: Uterotonic drugs were the most commonly used for the management of atonic PPH whereas haematoma drainage was mostly used in patients with traumatic PPH.

44-48

Authors: P. Thulasi, Balakrishnan R., Shanthi M..

Abnormal Uterine Bleeding (AUB) affects 50% of peri-menopausal women. It is common during the extremes of reproductive life, following pregnancy and also during lactation. About 10-15% of women experience AUB sometime during reproductive years of their lives.Irrespective of their age most of the women experience abnormal uterine bleeding at some or the other time. Objectives of the study: To ascertain the effectiveness of trans-vaginal ultrasound (TVS) to determine the endometrial thickness and its correlation with histopathology in abnormal uterine bleeding. Materials and Methods: This was a prospective study carried out in the department of Obstetrics and Gynecology with contribution from the department of Radiodiagnosis also, at P K Das Institute of Medical Sciences over a period of one year. The study included 75 women in the peri-menopausal and postmenopausal period who had presented with chief complaints of abnormal uterine bleeding. Patients were selected from OPD. Trans-vaginal sonography was done. Endometrial thickness was measured and was correlated with histopathology report after dilatation and curettage. Results: The age distribution of patients, clinical presentation, endometrial thickness by trans-vaginal ultrasound, endometrial hyperplasia as estimated by endometrial thickness and various histopathological patterns of endometrium on 75 patients were analyzed. Majority of the patients were between 40-45 years in the present study. Among 75 patients, menorrhagia was present in 30 cases [40 %]. Endometrial thickness between 8 to 10 mm was seen in 35 patients (46.66%), endometrial thickness between 10 to 15 mm was seen in 15 cases (20%), whereas, only 4 cases (5.33%) had endometrial thickness more than or equal to 15mm. Endometrial hyperplasia was seen in 30 patients (40%) followed by proliferative endometrium in 25 patients (33.33%). Among 30 patients of endometrial hyperplasia, only 2 patients (6.66%) had atypical hyperplasia. Majority 66.66% had simple hyperplasia. Conclusion: In peri-menopausal and postmenopausal AUB, trans-vaginalsonography should be the first investigation of choice. In peri-menopausal women, dilatation and curettage is recommended if endometrial thickness exceeds 10mm to rule out any hyperplastic process. Endometrial thickness of 5 mm should be taken as the upper limit for postmenopausal women.

54-58

Authors: Mirshad P.V, Mumtaz P, Jithesh T.K, Jaideep Mahendra, Prema Gurumurthy.

Introduction: Metabolic syndrome (MS) is a group of metabolic risk factors for cardiovascular diseases (CVD). Postmenopausal women may have an increased risk of MS and CVD. Vitamin-D (Vit-D) is believed to have an important role in the progression of CVD. Hence the study was conducted to assess the link between Vit-D and MS among postmenopausal Kerala population. Materials and Methods: A cross-sectional study was carried out in 298 postmenopausal women. Anthropometric measurements were measured using the standard procedure. Blood samples were collected and Vit-D levels of all participants were estimated. The study population was further grouped into three based on the Vit-D status as Vit-D deficient, Vit-D insufficient Vit-D normal group. Other parameters such as blood glucose, TC, TG, HDL, and LDL were measured and metabolic syndrome was identified. Result: There was a significant difference in the prevalence of MS between the groups. The one way ANOVA between the groups showed a significant difference (p≤0.05) for the components of MS such as waist circumference, BP, FBS, HDL-C. The Triglycerides levels did not show a significant difference between the groups. The Person correlation test indicated a negative correlation between Vit-D and the components of MS except for HDL-C. Conclusion: Vitamin-D deficiency was highly prevalent in Kerala menopausal women and serum Vit- D levels were significantly correlated with the prevalence of MS in postmenopausal women; this finding indicates that Vit-D could be an important factor for the development of MS and further CVD in Kerala postmenopausal woman.

64-67

Authors: Keshav Ram Benipal, Anita Pal, Manish Thakur, Anoop Sharma, Atul Sharma.

Introduction: The levonorgestrel- releasing intrauterine system (LNG-IUS) is the best tool for the non-surgical treatment for uterine bleeding and endometriosis. Materials and methods: Fifty-two women between the age 32 – 55 years were studied over a period of three years. Results: LNG-IUS caused 85% decrease in the amount of menstrual blood loss at 6 month and complete amenorrhea at two years. Conclusion: LNG-IUS was the best and effective to surgical management and other modes of medical treatment of abnormal uterine bleeding. The patient showed better compliance and satisfaction to the LNG-IUS.

72-76

Authors: Mohamed Abdelmoaty Elsamra.

Introduction: Pregnancy is a condition in which women undergo distinct physiological changes and stress. Also accompanied by unique physical and psychological demands, Yoga is thought to alter nervous system regulation and physiological system functioning (e.g. cardiovascular, gastrointestinal, endocrine and immune systems). It improves psychological wellbeing (e.g. frequency of positive mood states) and physical fitness (e.g. strength, flexibility). Patients and Methods: 250 primigravida females selected from the antenatal clinic of El-Shatby Maternity University Hospital, and allocated into two groups; group A: 125 females who will practice Yoga exercises and group B: 125 females who will not practice any kind of exercises. Results: Both groups are matched in age, height (p>0.05). Pulse, systolic, diastolic blood pressure and respiratory rate are matched in both groups (p>0.05). Incidence of edema, varicose vein, sleep disturbance, mood changes were significantly higher in group B (p<0.05). All women in group A had smooth course (p=0.000). Abnormal ultrasound findings, puerperium problems and mild postpartum hemorrhage were statistically significantly higher in group B (p<0.05). Conclusion: Prenatal Yoga is an excellent choice for any healthy woman to use in order to prepare herself physically and emotionally for child birth.

82-85

Authors: Alpana Bansal, Meena Saxena, Mukesh Bansal.

Introduction: Thyroid dysfunction is a common endocrine disorder in pregnancy. Thyroid hormones are necessary for development of fetal brain during pregnancy. Thyroid dysfunction during pregnancy has significant adverse effects such as preterm delivery, preeclampsia, miscarriage and low birth weight. In India one of the common health issues is hypothyroidism in pregnant patient. There is lack of data regarding prevalence of hypothyroidism in pregnancy while the problem is increasing day by day. Aim & Objective: 1. To study the prevalence of Hypothyroidism in rural population of Pilkhuwa, Hapur; 2. To study the age and trimester of pregnancy in relation to Hypothyroidism; 3. To Early diagnosis of disease so as to reduce morbidity & mortality; 4. To suggest corrective measures based upon the information gathered in the study. Materials and Methods: A study was conducted at Yashoda clinic Pilkhuwa Hapur. Patients attending antenatal clinic and checkup were included and TSH reports were collected. Observation: A total of 101cases were included in the study that came for antenatal check-up. Out of 101 cases, 59 are euthyroid. 16 cases had TSH between 2.5 -3.0. 26 cases had TSH from 3.0 -7.5. None of the patient had TSH equal to or above 10 units. Result: In first trimester 7 cases out of 81 which required treatment with eltroxin and needed follow up. 32 out of 81 cases required only follow up. In second trimester 3 cases out of 15 which required treatment with eltroxin and follow up. 7 cases out of 15 required follow up. In third trimester none of the cases in third trimester required treatment or follow up. Conclusion: Hypothyroidism is an important health issue among pregnant women which can cause several complications in ongoing and future pregnancies like recurrent abortions, infertility, PIH, preterm labour APH, PPH. All pregnant women and ladies who are planning pregnancies should be screened for thyroid disease.

89-92

Authors: Sapna B. Jain, Nishi Mitra, N. Singh, Sangam Jha

Introduction: Prior to medical advances in yester years VH was limited to uterine prolapse but in present techno-medical era the techniques and indications of vaginal hysterectomy have changed to give an excellent health care to women cosmetically at a reasonable cost with minimum invasion and maximum safety and satisfaction. Aims and objective: The aim of the study was to find out the answer of the question, IS REALLY TLH LESS INVASIVE THEN NDVH? By analyzing these two commonly performed procedures to find out the differences to decide whether NDVH is a simpler, less invasive, quicker, cost effective, environment friendly technique then TLH in the similar gynecological indications. Materials and Methods: A retrospective study was done on 120 randomly selected patient of Hysterectomy for various reasons between March 2016 till September 2017 in Dept. of Ob/Gyn LNMC JKH, Bhopal. Patients' original files and surgery reports of the TLH and VH were analyzed and compared retrospectively for the indication of surgery, patients' age, weight, parity, uterus size, time taken for surgery, blood loss, post-operative analgesia, hospital stay, Intra and post op complications. A stastical analysis of the data was performed using independent t test and p value of less than 0.01 was considered statically significant. Results: The mean time taken to perform TLH was significantly longer i.e. 184.83 minutes compared with NDVH, i.e. 83.5.minutes (p<0.004). Rate of conversion to AH was more with TLH due to haemorrhage in 3 and bladder injury in one of our cases, in comparison two cases in NDVH due to rectal and bladder injury. Blood loss in both the surgery was comparable as mean post op Hb in both group were 9.5 & 9.8 with no significant p value. Mean Pain score measured by VAS after 24 hours of surgery in TLH was 5.4+-2.02 and in NDVH was 3.57 +-1.3 after test of significance the p value was significant[<0.001] Proves that pain was less in NDVH than TLH. Duration of stay in the hospital was almost the same for both groups. Cost of surgery was more with TLH in comparison to NDVH. Conclusion: NDVH was as less invasive as TLH with the advantages of no visible scar on the abdomen, done under regional anaesthesia with routine instruments, less pain, less medication, less operative time, thus faster recovery so should be the first option whenever minimally invasive scar less hysterectomies is desired for similar indications.

98-103

Authors: Shashikala Karanth, Shruthi K., Sheela C. N., Cecil Ross.

Introduction: Thrombocytopenia can result from a wide range of conditions with several of them being pregnancy related. Obstetricians manage most cases of pregnancy-associated thrombocytopenia. Thus, a working knowledge of the clinical features and management of thrombocytopenia in pregnant women is important. The objective of the study was to evaluate the causes of thrombocytopenia and its effect on maternal and neonatal outcome in parturient women and also evaluate the obstetric risk factors, complications, and outcome of pregnancies complicated by thrombocytopenia. Materials and Methods: A prospective study of 100 antenatal women with thrombocytopenia who delivered at St John’s Medical College Hospital during a one and a half year period. The blood samples of pregnant women in labor room were collected at the time of admission. These women were followed up till they deliver. Results: The main causes of thrombocytopenia were hypertensive disorders: preeclampsia (15%), Hemolysis, elevated liver enzymes, and low platelets (24%) and eclampsia (4%); idiopathic thrombocytopenic purpura (16%), gestational thrombocytopenia (11%). Women with hypertensive disorders had higher rates of cesarean delivery (65%), intrauterine growth restriction (30%) and preterm deliveries (31%). Hemorrhagic complications are common in rarer causes of thrombocytopenia. Conclusion: The adverse outcome is specifically attributed to preeclampsia, HELLP syndrome and rare causes. While the perinatal outcome of GT and ITP is basically favorable. Careful surveillance is required for these women in high-risk units for early detection and treatment of possible complications, in order to reduce adverse maternal and neonatal outcomes.

109-111

Authors: Uma Pandey.

Introduction: Autoimmune congenital heart block (CHB) of the fetus is the severest manifestation of neonatal lupus, and it is damage of AV node of the fetus that is the root cause problem. Congenital heart block is mainly associated with maternal Systemic Lupus Erythematous (SLE) and anti-Ro and anti-La positive maternal status. This observational study was done to know the incidence of congenital heart block in patients of Systemic Lupus Erythematous who had ANA, anti-Ro/SSA and anti-La/ SSB levels positive. Materials and Methods: A prospective observational study was done in a University teaching hospital of North India (Banaras Hindu University). The study duration was between January 2014 to December 2016 and 9 cases of SLE were identified and diagnosed. All these patients were tested for ANA, anti-Ro/SSA and anti- La/SSB antibodies, were found to be positive. Three fetuses had confirmed fetal heart rate abnormalities/congenital heart block. Our neonatologist treated fetuses with heart block as per their protocols. Mothers were counseled regarding recurrence of congenital heart block in the next pregnancy. Results: All patients of SLE were positive for ANA, and had anti-Ro/ SSA- and anti-La/SSB-positive status. Three fetuses/neonate had congenital heart block, and one fetus required pacemaker after delivery. Conclusions: Delivery should be organized in tertiary referral center and with multidisciplinary care. Treatment with pacemaker insertion is life saving. These fetuses can be salvaged if they are given proper care although couple should be explained the prognosis.

118-123

Authors: C. S. Madkar, Garima Sinha, Shankar Burute, Mangal S. Puri, Pankaj Salvi.

Introduction: A variety of neurological disorders may be encountered during pregnancy and puerperium. These disorders may be unrelated to the pregnant state (e.g., tuberculous meningitis) or peculiar to or more prevalent during pregnancy which are still a cause of significant maternal morbidity and mortality in rural India (e.g., eclampsia and cortical venous thrombosis). Aim: To study the clinical profile of patients presenting with primary and secondary neurological disorders during pregnancy and puerperium and their outcome. Materials and Methods: This study was carried out at the Mamata Medical College between january 2009 and december 2013. All antenatal patients, postabortal or postpartum period requiring neurological consultation were included in this study. Women with eclampsia were excluded. Results: There were 75 women included in this study, with 45 cases of primary and 30 of secondary neurological disorders. The former included epilepsy,21 CNS infections,12 cerebrovascular disorders,9 intra cranial tumour,1 post traumatic paresis1 and encephalomyelitis.1 The latter included hepatic encephalopathy,28 enteric encephalopathy1 and polyneuropathy.1 In patients of epilepsy, the seizures had an equal distribution in all the trimesters and post-partum period, they were mainly of generalized type (77.27%) and were controlled in the majority (90.9%). No fetal congenital malformations were seen. Tubercular meningitis,8 pyogenic meningitis3 and viral encephalitis1 were the CNS infections encountered and pregnancy outcome was good in most cases. All cases of CVT presented in the postpartum period with fever and neurological signs following delivery. Among them 2 patients recovered completely, one patient had residual deficits, another had persistent seizures. We had one maternal death. HE affected patients mainly during the latter half of pregnancy or the post-partum period and was associated with 64.3% mortality. Conclusion: The incidence of neurological disorders in pregnancy and puerperium was very high especially in our hospital since it is a tertiary care referral centre. Epilepsy and hepatic encephalopathy were the commonest primary and secondary neurological disorders respectively found in our study.

129-130

Authors: G. Sravani, M. Jyothsna.

Introduction: Pregnancy luteomas are non-neoplastic tumor like masses found in the ovary. These pregnancy luteomas spontaneously regress after delivery. Luteomas are usually asymptomatic and found incidentally during cesarean section or radiological imaging. Materials and Methods: A two year prospective study was done on 450 pregnant women while undergoing cesarean section. While doing cesarean section surgeons found ovarian masses of varying size in a few patients, these masses we suspected to be an ovarian neoplasm. salpingo-oophorectomy was performed in these pregnant women. Post operatively the excised ovaries with fallopian tube were sent for histopathological examination. Results: Out of 450 cesarean section, ovarian mass were found incidentally in 16 (3.5%) cases out of which 3 (0.6%) were luteomas. Conclusion: Recognition of these luteomas is important during cesarean section, so that unnecessary oophorectomy is avoided which is risky and can prevent unnecessary complication for both the mother and the fetus.

136-138

Authors: Manish Raj Kulshrestha, Rupita Kulshrestha.

Vitamin D is a steroid hormone which is fat soluble and activated in kidneys. It plays multiple roles including regulation of cellular growth and differentiation, metabolic modifications, immunity, insulin resistance, cardiovascular disease, malignancies and also various reproduction related states like preeclampsia, preterm birth and gestational diabetes, along with calcium and phosphorous regulation in the body. In present study, we analyzed serum vitamin D levels in 100 women of reproductive age group (15-45 years). Surprisingly, only 7% of the women were found to have sufficient vitamin D level while 19% had insufficient level and 74 % were deficient. Such alarming community wide deficiency raises concern. Especially in this reproductive age group the women are liable to have rickets, osteoporosis, osteomalacia, low fertility and increased risk for adverse pregnancy outcomes. Pre-conception vitamin D supplementation is simple, easy, and inexpensive method which can prevent such grave outcomes.

143-147

Authors: Shivani Singh, Hemprabha Gupta, Kumkum Shrivastava, Vasudha Rathi, Uma Gupta.

Objective: To determine the efficacy and safety of misoprostol administered sublingually and vaginally for induction of labour. Material and Method: A randomized control trial was conducted on antenatal women for 18 month period from 1st Jan 2015 - 30th June 2016 admitted to Obstetrics & Gynaecology department of Era’s Lucknow Medical College and Hospital Lucknow. Total 120 antenatal women of 37 weeks or more gestational age fulfilling the inclusion criteria were enrolled in the study and they were randomly divided in to two groups (60 women in each group) sublingual group where they received 25 microgram misoprostol sub lingual and vaginal group where25 microgram of misoprostol was administered per vaginally .Same dose was repeated every four hour until 3 or more uterine contraction of 40sec duration occur over 10 minutes, or when a maximum of six doses i,e 150 microgram was reached and labour outcome was noted. Result: In our study the mean induction –delivery interval in sub lingual group was 13.28 hour and12.96 hour in vaginal group. The rate of caesarean section in the sublingual group was31.7% and invaginal group it was found to be 20%. However, it was not statistically significant. No significant side effect of misoprostol was seen during the study. Conclusion: Sublingual route of misoprostol administration is as efficacious and safe as vaginal route for induction of labour.

154-156

Authors: Humaeel Ali, M. B. Swami

Ovarian fibroma comprises 3% of all ovarian neoplasms and their malignant counterpart is very rare. Till today only 100 cases have been reported in the literature.1 Woman aged 60 years, postmenopausal, reported with pain in abdomen from 3 years. A 10 x 6 cm mobile, firm ovarian mass was felt through left fornix with no other significant findings was noted in general and systemic examination. All tumor markers were within normal limit. USG detected left ovarian mass. Laparotomy showed white, firm, solid mass arising from left ovary of 10x7cm size. No evidence of metastases. Histopathology examination revealed ovarian fibrosarcoma.

161-162

Authors: Jaydeep Pol, Yash Kale, Madhura Phadake, Girish Kadkol.

Uterus – like ovarian mass is a rare entity of uncertain histogenesis. A 30 year old female had a Left ovarian mass. Her preoperative serum CA 125 was 700U/ml. So a clinical diagnosis of Carcinoma ovary was made. We received left salpingo-opherectomy specimen for intraoperative frozen consultation. On gross examination, left ovarian mass measured 10x8x6.5cm. External surface was smooth and showed congested blood vessels. On cutting, mass was partly solid and partly cystic showing small cystic cavities filled with blood mixed fluid. The cyst wall surrounding the cavities was remarkably thickened. Microscopic examination of frozen section revealed a lesion predominantly composed of benign spindle cells. So we gave a diagnosis of benign cystic non neoplastic lesion on frozen section. Formalin fixed paraffin embedded sections followed. Microscopic examination of formalin fixed paraffin embedded sections revealed a cystic mass lined by endometrial type of lining and stroma surrounded by remarkable smooth muscle hyperplasia. In areas, haemorrhage, infiltration by hemosiderophages and hemorrhagic corpus luteum were also seen. So we gave a final diagnosis of uterus like ovarian mass. To the best of our knowledge, only 15 cases of extrauterine uterus like masses have been reported in the literature. Of these, 5 cases were of ovarian origin. This report documents a sixth case of uterus-like ovarian mass.

167-171

Authors: Kalpana Khandheria, Manish R. Pandya.

Introduction: Palliative care is an approach that improves the quality of life of patients and their families facing the problems associated with life-threatening illness, through prevention and relief of suffering by means of early identification, assessment and treatment of pain, and other problems – physical, psychosocial, and spiritual. Objective: The goal of Moments of Life: Made Possible by Hospice “SAMVEDANA” is to make aware the public about the choices we all have when facing a life-limiting illness and start having benefit of it to reduce their agony. The Aim is “To put life into their days and not just days into their life” - The idea is to help the person have a meaningful life, not just to live somehow till deaths concerned with quality of life. Materials and Methods: This was achieved with a study of 21 patients attended day care hospice during three- month study period. McGill quality of life questionnaire, and a new measure of patient satisfaction with hospice care were used. Result: All patients were getting appropriate psychosocial and spiritual support in addition to the medical / nursing interventions. Palliative care at Hospice Samvedana Affirms: 1. Life and regards dying as a normal process. 2. Neither hastens nor postpones death. 3. Provides relief from pain and other distressing symptoms. 4. Is a team approach. 5. Is individual specific – depends on assessment of patient and family needs. 6. Shifts emphasis from technology to people – “high touch-low tech”. 7. Is a partnership between the patient & the team. Conclusion: It can be concluded that satisfaction with hospice care was associated with quality of life more than symptoms. Patients can assess their care and can provide valuable information for improving palliative care. Training of medical officers and health care professionals, and sensitization of the public through awareness campaigns are vital to improve the scope and coverage of palliative care. Process of translating palliative care plan into action requires strong leadership, competent management, political support and integration across all levels of care.