Lakshmi Seshadri

A predictive model for cesarean section in low risk pregnancies

A small number of women with low risk pregnancies undergo cesarean section. A model that can predict this risk and therefore identify these women will be of help in several hospitals where personnel and resources are limited.

Tamoxifen-induced endometrial changes in postmenopausal women with breast carcinoma

Objectives: To assess the effects of tamoxifen (TAM) on the endometrium in postmenopausal women. Methods: A case control study of postmenopausal women with breast carcinoma, who were undergoing treatment in the Department of Radiotherapy and Surgery at the Christian Medical College Hospital, Vellore, India was done. Thirty‐five women who were on tamoxifen (20 mg/day) for a period of at least 6 months formed the study group. Thirty‐three women who were not receiving tamoxifen, formed the control group. Subjects in both groups had a pelvic examination and transvaginal sonogram followed by endometrial biopsy. Results: There was a statistically significant difference in the mean endometrial thickness between the study group and control group (7.8±6.4 mm vs. 4.0±2.0 mm, respectively) More women in the tamoxifen group had an endometrial thickness of >5 mm but the number of women with polyps or hyperplasia of the endometrium did not differ significantly between the two groups. There were no women with endometrial carcinoma in either group. Conclusion: All patients on tamoxifen need to be evaluated by clinical examination annually. A transvaginal sonogram and endometrial biopsy/hysteroscopy may be performed on patients with abnormal vaginal bleeding, bloody discharge, staining or spotting.

Massive ascites associated with endometriosis.

Laparoscopy in patients with cardiac disease is a relative contraindication. The risk of laparoscopy is due to the anesthesia required, as wel1 as the procedure itself. Cardiac patients have a fíxed output state, cardiac failure can be precipitated by tachycardia and tachyarrhythmias due to drugs and stress of surgery. Acute LVF can be a complication of hypoventilation leading to hypoxia [ 1,2]. The Trendelenburg position and pneumoperitonium which are prerequisites for laproscopy can lead to respiratory difficulties and cardiac arrest and failure because of increased intraabdominal pressure and relative fixation of the diaphragm. In our study the two main risk factors for laparoscopy in the Trendelenburg position and pneumoperitonium were were within the normal limits. The tubes were occluded silastically. The operation time varied between 2 and 5 min and the

Cervical Ripening Induces Labour Through Interleukin 1β

Summary: In order to study the Interleukin 1β (IL‐1β) levels in mechanical cervical ripening with Foley catheter, IL‐1β levels in amniotic fluid of 12 women before and after cervical ripening were compared with those in 23 women in spontaneous active labour. IL‐1β was present in 81.8% of patients after cervical ripening and in none prior to it. In women with spontaneous labour 69.6% had immunodetectable IL‐1β. Women with spontaneous labour and those sampled after cervical ripening had similar IL‐1β levels in the amniotic fluid. Cervical ripening with Foley catheter is associated with high levels of IL‐1β and this probably induces labour.

Spontaneous Rupture of the Urinary Bladder in the Puerperium

EDITORIAL COMMENT: We accepted this paper for publication because it is important for obstetricians to know that spontaneous rupture of the bladder can occur in the puerperium even when there is no predisposing cause such as obstructed labour or previous injury.

Teratoma of the placenta

Primary non‐trophoblastic tumours of the placenta reported to date are chorioangioma and teratoma, both of which are extremely rare. A case of teratoma in a term placenta is reported.

Transvaginal Sonography of the Endometrium in South Indian Postmenopausal Women

EDITORIAL COMMENT: We accepted this paper because it has a simple important message, namely that postmenopausal women with an endometrial thickness ≤4 mm will not have an endometrial cancer; they are likely to have endometrial atrophy. A vaginal ultrasound examination to measure endometrial thickness is a noninvasive investigation. There are about 100 papers on this subject in the world literature at present, and it appears that this investigation will adequately exclude endometrial malignancy in postmenopausal women. This is especially useful in older, unfit or frail women. However, if bleeding is heavy or persists it would still be recommended that hysteroscopy and/or curettage be performed.

THE GRIESS TEST : AN INEXPENSIVE SCREENING TEST FOR ASYMPTOMATIC BACTERIURIA IN PREGNANCY

EDITORIAL COMMENT: We accepted this paper for publication, even though the test it describes is not new (A), to remind practitioners that this is a method for screening women for asymptomatic bacteriuria in pregnancy without the expense of culturing a mid‐stream specimen of urine. The Griess test will be more familiar to most readers as the detection of urinary nitrates, which is possible using commercially available dipsticks without the necessity for the preparation of the Griess reagent. These dipsticks often also incorporate a test for leucocyte esterase activity. Whilst the individual specificities of the urinary nitrites and leucocyte esterase activity are probably too low to be used as sole screening tests for asymptomatic bacteriuria in pregnancy, the combination of the tests (either test abnormal) has a sensitivity of 92% and a specificity of 95% when compared with formal urine culture (B). The dipstick test is approximately 1/100th the cost of urine culture, so those practitioners who do not perform a urine culture at the booking visit because of cost may wish to consider testing urine for the presence of nitrites and leucocyte esterase activity, and reserving urine culture for those positive for one of the screening tests. Treatment of asymptomatic bacteriuria in pregnancy is associated with a clear and significant decrease in the risk of preterm delivery (C).

Routine cystoscopy in staging cancer of the cervix: Is it a must?

Objectives: The aim of the study was to evaluate the usefulness of cystoscopy in staging of cervical cancer. Study Methods: Charts of 669 women with cervical cancer were reviewed. Data regarding the clinical staging histology and cystoscopy findings were reviewed. Statistical analysis was carried out using SPSS/PC + statistical package for IBM PC. Results: Overall 36 patients had positive cystoscopy findings. In stage I and IIa none of our patients had positive findings on cystoscopy. Bladder involvement was seen in 0.41% in stage IIb, 15.38% in stage IIIa, 7.19% in stage IIIb, 75% in stage IVa, 6.6% in stage IVb. Conclusion: was not found to be useful as a staging procedure in early cervical cancer (stage I & IIa). It can be used selectively in patients with advanced local disease (stage IIIb and above) or in patients who have other indications for cystoscopy. However, prospective study would be necessary to define the role of cystoscopy in staging cervical cancer.

Endometrial carcinoma in a tamoxifen-treated breast cancer patient.

The reports of endometrial carcinoma occurring after adjunctive treatment of breast cancer with tamoxifen have aroused alarm (1,2). There is clear evidence of a favourable effect on the primary breast tumour. However, the induction of malignancy in the uterus must be recognized and a strategy arrived at for the prevention of such a sequel. The antioestrogenic property of tamoxifen is related to its capacity to occupy the oestradiol receptor in endometrial target cells. However in postmenopausal women, with little oestradiol available, tamoxifen can readily act oestrogenically by the same receptor action (3.4). Stimulation of endometrial cancer cells in culture by tamoxifen has also been reported (5).