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Objectives: To report the authors' experience in suction and evacuation with cannula followed by maintenance of negative pressure in the uterine cavity by keeping the cannula inside for 20-30 minutes, which was performed for controlling intractable postpartum hemorrhage (PPH) in a tertiary care hospital. Materials and Methods: This is a retrospective observational study carried out from July 2011 to December 2012 at Batra Hospital and Medical Research Centre, New Delhi, India. Nine patients who delivered either vaginally or via caesarian section and developed primary PPH refractory to conventional medical treatment, were included in the study. Suction and evacuation of the uterine cavity was done and then the cannula was kept inside the uterine cavity for 20-30 minutes thereby maintaining negative pressure (400-600 mmHg) in the cavity. Data were retrieved from patients' hospital records. Results: Intractable primary hemorrhage was encountered in 9 patients of whom 6 had bleeding after caesarian section and 3 after vaginal deliveries. Uterine atony due to prolonged labour was the commonest cause. Hemorrhage was effectively controlled in 8 out of 9 cases (88.9%) and hysterectomy was avoided. In one patient (11.1%) the procedure failed and life saving hysterectomy was done to control the bleeding. This approach not only controls PPH but also preserves the woman's reproductive functions and avoids hysterectomy and its related complications and consequences. Conclusion: This is a simple conservative surgical method to treat PPH in low resource settings. It requires minimal training, conserves the uterus, and is technically less challenging and associated with less blood loss than hysterectomy.

Background: Induction of labour is the intentional initiation of labour before spontaneous onset for the purpose of delivery of fetoplacental unit. Failure of induction is responsible for increased incidence of caesarean delivery. This study performed to assess and compare the clinical effects of sustained release vaginal insert versus intracervical gel in primiparous women with term pregnancy in terms of improvement of Bishop's score, Induction delivery interval, incidence of hyperstimulation, maternal and neonatal outcomes. Methods: A total 100 consecutive term pregnant women who underwent labor induction for fetal or maternal indications were divided randomly into two groups. Group A -sustained release Vaginal insert and Group B -Intracervical gel. Informed consent was taken from each patient. Results: Statistically significant increase in final Bishop's score (p=0.008) and hyperstimulation (p=0.04) was seen in Vaginal insert group as compared to Intracervical gel group, while there were no statistically significant differences in maternal outcomes, neonatal outcomes and need for oxytocin augmentation in both groups. Conclusions: In this study we found that insert did not improve the induction delivery interval or rate of successful induction, nor did it have any advantage in terms of neonatal outcome although it did improve the Bishops score -Its advantage was in terms of single application, few prevaginal examinations, longer duration of action and immediate retrieval in case of hyperstimulation. Its main drawback remained the maintenance of cold chain without which its efficacy decreases. Another significant observation was the dropout rate of insert (16%).

IntroductionBorderline ovarian tumors (BOT) constitute 15% of all epithelial ovarian cancers. As the term borderline implies they clinically behave intermediate between benign and malignant tumors. Synonyms of BOT include tumors of borderline malignancy, tumors of low malignant potential, and atypical proliferative tumors (1). Histologically, the borderline tumors are defined by the presence of nuclear atypia, epithelial stratification, mitotic activity, and absence of stromal invasion (2,3). Lack of invasion of the ovarian stroma by neoplastic cells is the cardinal feature that separates BOT from invasive ovarian carcinomas (IOC). According to the World Health Organization classification schemata, 2003 (4), BOT are classified on the basis of histopathology and histogenesis into serous, mucinous, endometrioid, clear cell, and transitional (Brenner) subtypes. Serous and mucinous neoplasms constitute the majority of BOT and occur mostly in women of reproductive age. The mean age of presentation of BOT is approximately 20 years earlier than that of IOC (5). It is most frequently seen between the ages 30 and 50 years. Because BOT behaves in a much less aggressive way, in most women the condition has not spread beyond the ovary when it is diagnosed (stage 1 disease). Despite some of the histologic features suggestive of malignancy, the clinical prognosis of these tumors is excellent compared with that of invasive ovarian carcinoma. Although patients have an excellent prognosis, risk of recurrence remains in some cases (6). We present an interesting case series of BOTs and discuss the management dilemmas associated. Materials and MethodsFor literature review we performed a literature search of relevant articles that were based on management dilemmas. We searched Medline/Pubmed electronic database and "Google Scholar" search engine in the internet for articles on this topic since 1995. Additionally, the data of 4 patients with BOT, who were treated in our Institute, are reported and reviewed by medical data information and patient interview, to establishing a database for a better understanding of the management dilemmas of BOT. Case 1A 19-years-old unmarried girl presented at our hospital with the complaint of lower abdominal pain for 6 years. Menstrual cycles were irregular with excessive bleeding and pain during cycles since 4-5 years. Ultrasound (USG) examination showed right ovarian cyst measuring 10×10 cm with multiple septations and no solid area, suggestive AbstractObjective: Borderline ovarian tumors (BOT) constitute 15% of all epithelial ovarian cancers. The aim of this study is to analyze and discuss the management dilemmas associated with BOT.

Introduction: Perinatal asphyxia is one of the major causes of neonatal morbidity and mortality. Fetal Cardiotocography (CTG) has been used for long to predict fetal asphyxia. Despite its popularity, it has not been proved to be an ideal tool for monitoring as, although a normal trace is indicative of a normal acid-base status at birth, in about 98% of cases, an abnormal trace has a low positive predictive value in term of fetal acidosis (pH less than 7.25) .An undisputed evidence of perinatal asphyxia is metabolic acidosis on arterial cord blood or very early neonatal samples: pH< 7 and base deficit >12 mmol/L Aim: To see the correlation between suspicious/pathological CTG and umbilical cord blood pH at birth in term pregnancies.Material and methods: This was a hospital based prospective randomized observational study over a period of 1 year. It was conducted on 165 pregnant women with singleton term pregnancy admitted to labour ward for delivery and having suspicious / pathological CTG trace or meconium stained liquor with normal CTG trace. Immediately after the birth of the neonate, umbilical cord was clamped, cut and umbilical artery cord blood was collected in a pre -heparinized syringe and sent for pH analysis. Cord blood pH of less than 7.2 was interpreted as acidosis.Results: The number of acidotic cases (as determined by cord blood pH less than 7.2) was 2(5.6%) in normal traces whereas 34 cases (94.4%) of normal traces were non acidotic. In the suspicious traces, 2 cases (3.2%) were acidotic and 59 cases (96.8%) were non acidotic. In the pathological category, 13 cases (19.1%) were acidotic and 55 cases (80.9%) were non acidotic. There was no significant association of CTG category with cord blood pH, acidosis, pO2 or pCo2 values but that with presence of MSL and grade of MSL was statistically significant.Conclusion: Abnormal CTG while being a good predictor of the presence of MSL and also the grade of MSL, is a poor predictor of the presence of fetal acidosis and neonatal status after birth. Fetal monitoring using cardiotocography was associated with considerable false positive results. Thus, using fetal heart rate abnormalities alone as a measure of diagnosis of fetal distress during labour is a contributing factor of increasing rate of cesarean sections.