Neerja Goel

Oral micronized progesterone for prevention of preterm birth

To evaluate oral micronized progesterone (OMP) to prevent preterm birth (PTB).

Drotaverine hydrochloride for augmentation of labor

Objectives: To study the use of drotaverine hydrochloride for acceleration of labor and relief of labor pains. Methods: In this double‐blind placebo‐controlled randomized study, 100 primigravidas in uncomplicated spontaneous labor at term were given drotaverine hydrochloride or placebo (distilled water) intramuscularly. Labor events, including pain (assessed by a visual analog scale and a verbal rating scale), neonatal outcome, and side effects of the drug were recorded. Students t‐test was used for analysis. Results: Forty‐four patients in the drug group and 40 in the placebo group had complete data for analysis after decoding. In drotaverine group, there was a mean 15% reduction in the duration of the first stage of labor and a mean 19% reduction in the second stage. The maximum shortening of the first stage (28%) was observed when drotaverine was administered when cervical dilatation was 4 cm (P=0.044). There were no adverse fetal effects, but atonic postpartum hemorrhage was more common in the drotaverine group. There was no relief of pain with the drug except in the fourth stage of labor. Conclusions: Drotaverine hydrochloride is safe and effective in accelerating labor, but not effective in lessening labor pain.

Awareness about Human Papilloma Virus and its Vaccine Among Medical Students.

Background: Cancer of the uterine cervix is the most common malignancy amongst women in India. Identification of its pre-cancerous lesions and prevention by HPV vaccine may go a long way in decreasing the incidence. Aim: The aim was to study the awareness about the various aspects of the HPV infection and vaccine among medical students. Settings and Design: It was a cross-sectional study conducted in a tertiary care hospital of Delhi. Materials and Methods: 150 medical students aged between 18-25 years were requested to complete a 35 point questionnaire regarding cervical malignancy, HPV infection, HPV vaccine and the answers were then analyzed. Results: None of the students knew the correct incidence of cervical cancer in India and 18% of them did not know that the HPV vaccination prevents cervical cancer and 50% thought that vaccination induces false sense of security. Fifty percent were unaware of HPV infection and its association with other STDs and cervical cancer. The information regarding the mechanism of action, dosage, schedule and cost of the HPV vaccine was lacking in majority of them. The limitation of this study is that it does not reflect the knowledge or awareness of a layman or full-fledged medical doctor. Conclusions: To conclude gaps in knowledge regarding HPV infection and vaccination existed amongst the medical students and a more integrated teaching regarding HPV carcinogenesis, vaccination and cervical cancer needs to be introduced.

‘Quick Course’ Neoadjuvant Chemotherapy with Cisplatin, Bleomycin and Vincristine in Advanced Cervical Cancer

To evaluate the response and safety of ‘quick course’ neoadjuvant chemotherapy, 30 patients with advanced squamous cell carcinoma of cervix were given cisplatin, bleomycin, and vincristine weekly for 3 courses. The response was evaluated by subjective parameters and by standard response criteria. In addition to the marked improvement in symptoms, the overall objective response was 60% with a complete pathological response of 6.6%. Tumor volume decreased significantly (p = 0.002) after chemotherapy. Patients with stage IB and 27% (3 of 11) of patients with stage II disease who became technically stage IB (stage reduction) after chemotherapy underwent surgery. Radiotherapy was given to the remaining patients. All patients tolerated the chemotherapy.

Postmenopausal bleeding: squamous cell carcinoma of cervix with coexisting endometrial tuberculosis.

Case reportA case of squamous cell carcinoma of cervix co-existent with endometrial tuberculosis presenting as postmenopausal bleeding is being reported for its rarity. The atrophic postmenopausal endometrium is thought to be poorly supportive of tubercle bacilli. Following a radical Wertheim’s hysterectomy patient had a hectic postoperative period, which responded to antitubercular treatment. Diagnosis of tuberculosis in this case was made on histopathology postoperatively and confirmed by polymerase chain reaction (PCR) on scrapes from the granulomas obtained by microdissection.ConclusionTuberculosis complicating malignant disease may occur in regions with a high prevalence of disease; with a resurgence of tuberculosis worldwide this association may not be uncommon. The diagnosis and treatment of tuberculosis in a patient with cancer assumes importance as a high mortality has been seen in patients with co-existent disease.

First trimester abortion with mifepristone and three doses of sublingual misoprostol: a pilot study

Objective:  To evaluate the efficacy and safety of a medical abortion regimen with multiple doses of sublingual misoprostol 24 h after mifepristone.

Medical termination of pregnancy in acute intermittent porphyria.

Acute intermittent porphyria is a rare autosomal dominant disease characterized by acute attacks of neuropsychiatric and neurovisceral dysfunction. In pregnancy, exacerbation of attacks in the form of seizures and acute abdomen occur due to hormonal changes. We report the case of a young woman presenting at 8 weeks of gestation requesting pregnancy termination. The patient suffered several episodes of acute abdomen and seizures in a prior pregnancy before the diagnosis was clinched. This case is reported because of its rarity and the limited obstetric experience of this disorder. Proper management depends on avoidance of precipitating factors. Anaesthetic drug safety in porphyria is reviewed and the choice of regional anaesthesia discussed

Conventional cytology, visual tests and evaluation of P16INK4A as a biomarker in cervical intraepithelial neoplasia

OBJECTIVES (1) To detect cervical intraepithelial neoplasia (CIN) using Papanicolaou test (PAP test), visual tests (visual inspection after the application of acetic acid [VIA], visual inspection after the application of Lugols iodine [VILI]), colposcopy, and biopsy. (2) To study the biomarker p16(INK4A) expression by immunostaining. MATERIALS AND METHODS Experimental study was conducted from November 2009 to April 2011. 1500 women were screened for cancer cervix using conventional PAP test, VIA, and VILI. Sensitivity, specificity, positive, and negative predictive values of these tests were calculated individually, sequentially, and in parallel. Women having positive results underwent colposcopy and biopsy if required. p16(INK4A) expression in biopsy samples was studied using immunohistochemistry. RESULTS All test positive cases (n = 235) underwent colposcopy. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of PAP with atypical squamous cells of undetermined significance (ASCUS) as cut-off was 40%, 99.25%, 35.25%, and 99.39%; VIA was 60%, 93.06%, 8.03%, and 99.56% and VILI was 80%, 86.06%, 5.4%, and 99.76%, respectively. When PAP, VIA, and VILI were used in parallel sensitivity, specificity, PPV, and NPV improved to 100%, 85.18%, 6.38%, and 100%, respectively. Colposcopic abnormalities were detected in 83 and biopsy proven CIN in 15. p(16INK4A) expression was seen in eight of 15 CIN cases. CONCLUSIONS (1) PAP test and visual techniques are complementary. (2) p(16INK4A) expression was seen in majority of CIN 2 lesions suggesting a higher grade lesion.

Awareness and practice patterns of family planning methods among antenatal women in Indian community: Are we hitting the bull's eye?

A questionnaire-based cross-sectional survey was undertaken to assess the awareness and practice patterns of family planning among the antenatal women in North India. The study included 400 respondents. Three-fourths of the respondents (74.2%, n = 297) were aware of family planning methods. Condoms were the most commonly used family planning method (78.2%), while intrauterine devices and oral contraceptive pills were used by 25.5% and 16.7% respondents, respectively. The main reasons cited for not using contraception were inadequate knowledge and fear of side-effects. Post counseling, 90.5% (n = 362) of the respondents clearly conveyed their desire to use one of the family planning methods in the postpartum period. Awareness and acceptance of family planning methods in the Indian community needs strengthening. Family planning counseling during antenatal check-up is likely to increase the acceptance of family planning methods in the postpartum period.

Pregnancy with Metastatic Gastrointestinal Stromal Tumor (GIST) on Imatinib Chemotherapy: an Oncologist’s Nightmare and Obstetrician’s Dilemma

IntroductionGastrointestinal stromal tumors (GISTs) are among the few cancers amenable to successful treatment by targeted molecular therapy with KIT receptor inhibitors like imatinib mesylate. Increasing incidence of this tumor and its successful treatment has given rise to issues of fertility and child bearing in patients affected at young age. Although contraception advice and termination of early pregnancy have been the standard practice in patients on such therapy, an occasional patient who desires pregnancy can leave both obstetrician and oncologist perplexed.Clinical PresentationWe report our experience in a rare patient of metastatic GIST who had a successful normal pregnancy while on imatinib therapy. We further attempt to evaluate similar evidence in literature.