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Background: Most ovarian cancers are diagnosed in advanced stages because these tumours may not cause any specific symptoms, particularly in its early stages. Though specific risk actors have been identified there are no reliable screening tests for ovarian cancer. However, improvements in identification of women at high risk for ovarian cancer, as well as improved imaging techniques like the USG and color Doppler along with CT Scan and MRI has increased the likelihood of early detection. Methods:The aim of the study was to evaluate the efficacy of color and spectral Doppler in diagnosing the ovarian malignancy. A Prospective randomised study was conducted at a tertiary care centre where 50 patients with ovarian masses were selected. The study design included thorough history taking and clinical examination followed by evaluation of tumour markers. USG along with color Doppler evaluation was done followed by surgery and then corelated with histopathology. The color Doppler parameters such as vascularity, distribution of vascularity, pulsatility and resistive index were also evaluated and statistical significance assessed. Results: Color Doppler showed increased vascularity in 100% of malignant tumors in contrast to only 54.24% of benign tumors. Absent blood flow in a solid tumor almost always ruled out the possibility of malignancy. Spectral Doppler helped to assess the nature of the blood vessels picked up on color Doppler. All the patients in the malignant group and 4 patients in the borderline group had PI<1.0. Remaining 6 tumors with P1 <1.0 belonged to the benign group. Out of 15 patients with PI >1.0, 13 were benign and 2 patients had borderline tumours. RI of <0.4 was seen in 8 Patients with malignancy and RI of >0.4 was seen in 26 patients with benign lesions. Conclusions: Color Doppler is a good non-invasive modality to differentiate benign from malignant lesions. Vascularity is most sensitive and RI is most specific. Thus, color Doppler and spectral Doppler tremendously increased the reliability in diagnosing a malignant ovarian tumor. Color Doppler served as an important tool to rule out malignancy in solid tumors if they failed to show any intra-tumoral vascularity. B-Mode USG in combination with color Doppler and spectral Doppler is proposed as the first and foremost diagnostic modality in patients with ovarian tumor, so as to establish the definite diagnosis of malignancy early in the course of the disease.

Background:Although rare in modern obstetrics, emergency peripartum hysterectomy (EPH) remains a life-saving procedure, in the event of uncontrollable postpartum hemorrhage. Observations regarding the causes and outcomes of EPH provide valuable insights relevant to the current management perspectives in obstetrics. This study is intended to assess the contemporary prevalence, indications, and outcomes of EPH, at a Tertiary care referral institute. Methods: A descriptive observational study was conducted as a retrospective analysis of patient-records, over a span of 3 years January 2011-December 2013, in the department of obstetrics and gynecology, at the KEM hospital, in Mumbai. Cases of EPH were analyzed for information, maternal age, parity, gestational age, type of delivery, indications for EPH and outcomes of the procedure. Results: The average annual incidence rate was1 per 1000 deliveries. 44% of the cases had an indication of abnormal placentation. 60% of the cases had caesarean section deliveries. Multiparity, previous LSCS, and gestation period of <37 weeks, were the commonly observed associations. 52% of cases required ICU admission. Maternal mortality rate was 8%. 20% of the cases had intrauterine fetal death. Conclusions: Abnormal placentation was evident as the leading cause of uncontrollable hemorrhage. This is possibly in view of a continual improvement in the management of uterine atony, reduced incidence of uterine rupture, and importantly, a rising trend of caesarean section delivery. This calls for more thoughtful considerations, regarding decisions for caesarean section delivery, in obstetrics practice.

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B Lynch is a conservative surgical procedure for Atonic PPH not responding to medical line of treatment very few complications of this procedure have been reported. We describe B-Lynch suture erosion through the uterine wall identified on 16 day postpartum. A 24 year old primigravida underwent a primary low transverse cesarean section at term indication being primigravida with breach presentation intra-operatively there was torrential blood loss and uterus remained flabby despite treatment with uterotonics drugs delayed absorbable suture was used to place B-Lynch suture for control of the hemorrhage and had sepsis for which she had to undergo obstetric hysterectomy.