Aims: To identify and share the experience of clinical presentation and management of ectopic pregnancy (EP) in women who presented with unsupervised use of Medical abortion (MA) pills.Methods: A prospective study was conducted in department of Obstetrics and Gynaecology of Civil Service Hospital over one year (March 2015- February 2016). Women with a history of unsupervised use of MA pills were taken into study group as there has been a trend of taking theses pills without consultation in recent days. Detail clinical, menstrual, obstetrics and MA history were taken. Relevant investigations and Ultrasonography were done. Women diagnosed to have ectopic pregnancy were followed and their operative findings were recorded. Results: Ninety-six women presented with unsupervised use of MA, among which 8 (8.33%) diagnosed to have EP. Most women were 20-30 years of age and 37.5% were unmarried.  They gave history of taking MA from pharmacy. Among eight women, 37.5 % had taken MA at the period of gestation <5 weeks, 37.5% between 5-7 weeks and 25% >7-9 weeks. Fifty percent attended hospital after seventy- two hours of MA. Majority (50%) presented with lower abdominal pain and ruptured EP with hemoperitoneum (>one litre) requiring blood transfusion. History of easy availability and social reasons for MA intake were given by 37.5% each.Conclusions: Even though medical abortion is easily accessible, affordable and available, it should also be safer. It is of utmost importance to take it from health facility or a registered medical practitioner following World Health Organization (WHO) guidelines, one of which is excluding extra-uterine pregnancy.

Background: Dermoid cyst, a common benign neoplasm of ovary in women, needs treatment because of the risk of torsion, rupture, and malignant change. Laparoscopic surgery nowadays is the preferred treatment modality, but the only issue is its safety in case of rupture and spillage of its contents with the risk of chemical peritonitis and malignant dissemination. Aim of the study was to find out the safety of laparoscopic surgery for dermoid cyst of ovary.Methods: It was a retrospective study done from January 2017 to December 2019. All the women with diagnosis of dermoid cyst of ovary managed laparoscopically either salpingoophorectomy or cystectomy were taken into study. Analysis of size of the cyst operated, the time taken, spillage rate, duration of hospital stay, and post-operative complications especially chemical peritonitis was done.Results: There were 61 women who had undergone laparoscopic surgery. Laparoscopic cystectomy was done in 68.9% (n=42), laparoscopic salpingoophorectomy in 29.5% (n=18). Mean age of the patient was 31.74±8.38 years. Mean size was 6.21±1.99 cm. Rupture and spillage were observed in 21.3% (n=13) that were > 5cm in diameter (X2= 3.62, p=0.05). Larger the size of the cyst, more the surgical time was noted (X2=6.26, p=0.04). Significant difference in mean operating time in case of cyst rupture and spillage (p=0.004) was observed. Mean hospital stay was 53.5±1.3 hours. No case of chemical peritonitis was observed with spillage. All cases had histopathology of mature cystic teratoma.Conclusions: Laparoscopic surgery is safe for dermoid cyst of ovary even with rupture and spillage of its contents.Keywords: Dermoid cyst; laparoscopy; spillage

Mature cystic teratomas account for about 30-45% of all ovarian tumors. Malignant transformation in these tumors is a rare event, occurring in only 0.17-2% of cases, with squamous cell carcinoma being the most common type. As there are no specific signs and symptoms to suggest malignancy in dermoid cyst, it is difficult to predict, and most cases are diagnosed postoperatively. We report a 55-year-old postmenopausal lady who presented with the complaint of pain in abdomen and abdominal distension for four months and a large complex abdomino-pelvic mass evident clinically and radiologically. Final histopathology was reported as malignant transformation in mature cystic teratoma. The patient was assigned to squamous cell carcinoma of the ovary arising in a mature cystic teratoma, surgical stage IIC. In view of the poor prognosis, adjuvant chemotherapy was given.

Background: Immune thrombocytopenic Purpura (ITP) is the second most common cause of an isolated low platelet count during pregnancy. It account for about 3% of thrombocytopenic cases during delivery. Treatment is indicated, if there is an evidence of bleeding or platelet count is less than 30,000/µl. Herein, we presented a medical record of twenty-four pregnant women, who were diagnosed with ITP during pregnancy. Method: A total number of twenty four pregnant women diagnosed with primary ITP and having platelet count of less than 30000/µl were enrolled in the study. Oral prednisolone (1mg/kg) was started in all patients with an aim to keep the platelet count above 50000/µl during delivery. Steroid was continued for 21 consecutive days and were tapered (10 mg) every week, if platelet counts were above 30000/µl. Data pertaining to the ITP during pregnancy was recorded for age, platelet count, mode of delivery and complications related to steroid therapy and were analyzed by simple statistical analysis. Result: ITP was observed in about 58%, 25% and 17% of the cases during first, second and third trimester respectively. About, 63% of patients presented with purpuric rash, 18% presented with mucosal bleed, one present presented with hematuria and others were asymptomatic. More than two third of cases responded to the steroid and in those cases platelet counts were above 50,000/µl at the time of delivery. All subjects delivered a healthy child. There was no maternal mortality and post-partum hemorrhage was absent in all patients. Conclusion: Steroid is the treatment of choice for all cases of ITP. ITP is no longer a contraindication to the continuation of pregnancy, the tradition and tendency to advice for abortion in these pregnant mothers, may not be justifiable.

Involvement of the ovary by malignant lymphoma is a well-known manifestation of disseminated nodal disease. But, lymphoma as primary manifestation is extremely rare. Here, we report a case of malignant lymphoma which presented as ovarian cancer and managed with surgery and subsequent chemotherapy. A lady of thirty two years presented with features of malignant ovarian tumor. The diagnosis of malignant ovarian lymphoma was made after surgery and histological and immunohistochemical study of the excised tumor. The tumor was classified as diffuse large B-cell lymphoma. The patient was put on chemotherapy and she is on follow-up in disease free-state for last two years.