ABSTRACT:The incidence of cervical fibroids is 0.5-1%. It is usually single; they are usually confined to supravaginal portion of the cervix. Rarely it becomes submucous and polypoidal. So it is usually subserous or interstitial. It can be anterior, posterior or central in position. We had different types of cervical fibroids of which we will describe a few. Usually cervical fibroids cause infertility, difficulty in labor, infections, metrorrhagia, menorrhagia, constipation, retention of urine and dyspareunia. The cervical fibroid distorts the shape of cervix and grows bigger. It pushes the uterus upward giving the appearance of lantern of Saint Paul's dome in a case of a central cervical fibroid. Most of the patients in the reproductive age get admitted for menorrhagia due to fibroid. Its growth is dependent on estrogen. It does not grow after menopause. KEYWORDS: Cervical fibroid, fibroid polyp, hysterectomy. CASE 1:A 52 year old housewife, completed the family, who had previous two LSCS section and sterilization done 20 years ago, got admitted with retention of urine for the past 12 hours. She gave history of burning micturition and frequent retention of urine for which catheterization was done a number of times outside.She had lower abdominal pain and post coital bleeding. She had irregular menstrual history. Foley's catheter was introduced. Bimanual examination showed cervix was replaced by huge mass 8×11 cm occupying the whole cervix and vagina. This was a central cervical fibroid wherein the uterus was found sitting on top of it.The uterus was palpable per abdomen as a soft globular mass2×3 cm suggestive of a fundal fibroid. Patient was anemic and 2 units of blood transfusion were given. Routine investigations were normal. Ultrasound(USG) report showed a small fundal fibroid 2×2 cm and a huge central cervical fibroid of size 8.3×11.3 cm (figure1). Patient was explained and consent for laparotomy was obtained.Laparotomy showed plenty of adhesions due to previous surgeries which were released .The bladder was found plastered with the mass. So a transverse incision was made at the level of the UV fold to push the bladder up. Uterine vessels supplying the fibroid were engorged and tortuous were carefully cut and ligated (figure 2).The uterus along with the central cervical fibroid shelled out without injuring the bladder, ureter and rectum. Pre-operative ureteric stenting could have helped in the surgery of shelling the cervical fibroid. Vault and abdomen closed after perfect hemostasis. The cut section of the specimen showed the uterus sitting on top of the cervical fibroid and had a small fundal fibroid of size 3×3cm.The specimen was sent for histopathology, because of the increased cellularity and mitosis, leiomyosarcoma was thought of initially by the pathologist. Later on, they confirmed it as a feature of highly cellular leiomyoma with hyaline and cystic degeneration (figure 2) Post-operative period was uneventful. Patient passed urine freely. She came for follow up. She had no complaints.

The incidence of hypothyroidism in pregnancy is 2-3%, subclinical hypothyroidism is 2-2.5% and overt hypothyroidism is 0.3-0.5%. Hypothyroidism may cause abortion, placental abruptions, pre-eclampsia, intrauterine growth restriction (IUGR), preterm delivery and mental retardation of the baby .Treating clinical and subclinical hypothyroidism may reduce adverse obstetric outcomes. Universal screening is currently not recommended. Thyroid dysfunction and thyroid autoimmunity are prevalent among women of reproductive age. Preconception or early pregnancy screening for thyroid dysfunction has been proposed but is not widely accepted. A 21year old primi with nine months of amenorrhoea with oligohydramnios with hypothyroidism was referred from outside for safe confinement. She had hoarseness of voice, nonpitting edema, puffiness of face and had high blood pressure (preeclampsia). Cesarean section was done and an alive male 2 kg baby was delivered and had feature of IUGR. Patient had atonic postpartum haemorrhage (PPH). She was resuscitated with blood and prostodin. She was advised to continue thyroid drugs. Preconception or early pregnancy screening for thyroid dysfunction is essential just like diabetics screening hence there is a need for increased awareness. The early diagnosis and treatment will solve the problems of hypothyroidism in pregnancy.

BACKGROUND – Ovulation Induction refers to the therapeutic restoration of the release of eggs per cycle in women.The aim of the study is to compare the effectiveness of Tamoxifen citrate and Clomifene citrate in ovulation induction and to compare the age wise efficacy of the drug. METHODS:A total of 90 infertility patients were included in the study, and 45 were allocated to group A and 45 in group B.Group A was given Clomifene citrate 50 mg and group B was given Tamoxifine 40 mg from day 5 to 9.RESULTS: The number of patients who ovulated in first cycle is 26.6%, second cycle 40% and third cycle is 26.6% in group A. In group B the number of patients who ovulated in first cycle is 24.4%. second cycle 48.8%, third cycle 20% respectively.The mean pregnancy rate in clomifene group is 22.22% ans tamoxifen is 24.4% with P value of >0.05 showed no significant difference in both group.CONCLUSION:Tamoxifen was better drug for ovulation induction when compared with clomifene citrate which is standard drug usually used for ovulation induction. This is because of the endometrial thickness which is needed for implantation is better with tamoxifen..