Giant cystadenocarcinomas of the ovary are rarely described. Huge ovarian masses are mostly benign, but malignancy should be ruled out by investigations and clinical assessment. Giant cysts require resection because of compressive symptoms or risk of malignancy and their management invariably requires laparotomy to prevent perforation and spillage of the cyst fluid into peritoneal cavity. Here, we present a case of a 42-year-old female with severe and rapidly growing abdominal distension operated for exploratory laparotomy for cystic mass excision. On histology, mass was found to be metastatic mucinous cystadenocarcinoma with omental metastasis. The diagnostic and management challenges posed by this unexpected and unusual presentation of an ovarian cystadenocarcinoma are discussed. The main aim of this report is to draw attention to huge ovarian epithelial cysts with unsuspected presentation contributing to a decrease in any underdiagnosis, misdiagnosis, and mismanagement that might occur.

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Background: Abnormal Uterine Bleeding (AUB) refers to bleeding that is excessive or occurs outside of normal cyclic menstruation. It accounts for two-thirds of all hysterectomies worldwide. Evaluation of the endometrium as a cause of AUB is done mainly in three modes i.e. by Imaging of endometrium by transvaginal/transabdominal ultrasound, visual assessment by hysteroscopy and cellular assessment by microscopic evaluation of endometrial samples. Methods: Ours is a retrospective observational study of all diagnostic hysteroscopies performed for AUB in 40-45 year age group at Cama and Albless hospital, Mumbai between April 2012 and January 2015. We studied 66 cases of conventional diagnostic hysteroscopy at our institute to establish correlation of hysteroscopy findings with other diagnostic tools i.e. ultrasound and histopathological findings. Results: On ultrasound 65.2% of the endometrial pathologies leading to AUB were due to endometrial hyperplasia with polyp accounting for 4.5%. 43.9% of the total patients were having fibroid as associated pathology on ultrasound. On hysteroscopy more number of cases of polyp were diagnosed (21.2%) as compared to ultrasound (4.5%). On histopathological appearance we found simple hyperplasia in 4.5% of cases and simple hyperplasia with atypia in 1.5% all of cases i.e. 6% total cases of hyperplasia. These are potentially carcinogenic patients. 47% of cases had endometrium in proliferative phase which is the commonest pathological finding on histopathological examination. Conclusions: The relatively poor sensitivity of both endometrial biopsy and ultrasound in the detection of intrauterine focal pathology encourage us to propose that Hysteroscopy be utilized as a first line investigation in AUB.

Background: Caesarean section has become a relatively safer and so common procedure in the practice of modern obstetrics. Audit plays an important role in the analysis of changing trends in caesarean delivery. The present retrospective analytical study attempts to critically analyze 474 cases of caesarean deliveries performed in tertiary hospital over a span of six months with an aim to identify the indications and risk factors involved in early peri-natal morbidity and mortality. Methods: The Cama and Albless hospital is a tertiary care center located in South Mumbai, which cares for over 3000 deliveries per year. In the present retrospective analytical study, all cases of caesarean delivery from August 2013 to January 2014 were analyzed regarding the indication, associated risks factors, and all NICU admissions were studied. The decision to perform a caesarean section in each of these patients was made by a consultant on duty in consultation with the unit head telephonically. The primary objective of the study was to do LSCS audit with the secondary objective to analyse relationship of early peri-natal morbidity with indication of LSCS and risk factors associated. Results: In the present study we found that the overall incidence of LSCS is 25.7%, incidence of primary LSCS is 23.1 %, incidence of LSCS in Referred cases is 61.7 %. So overall high incidence of LSCS is justified as our's is a tertiary care referral unit. 3.5% of total LSCS cases were elderly gravidas and teenage pregnancies each. In our study, 11.8% and 3.5% patients were less than 37 weeks and 34 weeks respectively. However 30.6 % of NICU admissions were due to low birth weight. So IUGR in near term patients is an important morbid factor. Previous LSCS was the leading indication in 35.2% of cases followed by foetal distress in 14.9% of cases and Previous 2 LSCS 10.5%. Two important relative indications we found were Previous 1 LSCS and PIH contributing for nearly half of the total cases. Average duration of surgery was 86 minutes in our study and average stay in hospital was 9 days. In our study early perinatal mortality was 1.6% and morbidity in the form of NICU admissions was 20.8%. Most common cause for NICU admission was LBW followed by Respiratory distress. After comparing high risks factors and indications with NICU admissions we found highest morbidity in neonates who underwent LSCS for fetal distress, multiple pregnancy and premature rupture of membranes. Conclusions: Individualization of the indication and careful evaluation can help us limiting early peri-natal morbidity and mortality. Obstetric audits in the institution, following standardized guidelines and practice of evidenced-based medicine will help us a lot in reducing the peri-natal morbidity and mortality.

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