Vaginal leiomyomas are rare. They usually arise from the anterior vaginal wall. We report a case of a vaginal leiomyoma arising from the right lateral wall that presented as a gluteal swelling with pus discharging per vagina, creating a clinical dilemma in diagnosis. Preoperative imaging and biopsy may help to rule out malignancy. The size of the tumor necessitated abdominoperineal approach and hysterectomy for better surgical access. To the best of our knowledge such a clinical presentation of a vaginal leiomyoma has not been reported in the literature.

Case reportIntrapartum transcervical amnioinfusion is an accepted therapeutic measure in the presence of variable decelerations with or without meconium-stained amniotic fluid. 1 Widely varying protocols are being used and have been thought to be safe.2 Amniotic fluid embolism and or pulmonary oedema in patients undergoing amnioinfusion have been described in six cases reports although no causal link has been established. We report two fatal cases of probable amniotic fluid embolism after saline amnioinfusion. Case 1A 23-year-old nulliparous woman presented to our hospital at 41 þ2 weeks of gestation with vaginal leakage of clear fluid for 5 hours. She was previously well and her pregnancy had been uncomplicated. On examination she was not anaemic, there was no tachycardia or fever and her blood pressure was 110/70 mmHg. Examination of her abdomen revealed a single term fetus in a cephalic presentation with reduced amniotic fluid. The uterus was soft with the vertex was at the pelvic brim and there were normal fetal heartbeats on auscultation. A vaginal examination confirmed ruptured membranes and revealed a soft, partly effaced cervix with a closed os.Prostaglandin E 2 gel (0.5 mg) was administered intracervically for cervical ripening with a second dose of 0.5 mg given 6 hours later. Five hours after the second dose, the uterus was contracting regularly and intermittent auscultation of the fetal heartbeat revealed no abnormality. Vaginal examination revealed that the cervix was fully effaced and 3 cm dilated. The membranes were absent and thick meconium-stained amniotic fluid was draining. An amnioinfusion with normal saline infused under gravity was administered through a transcervical sterile rubber catheter and labour was augmented with an infusion of 2.5 mU/ minute oxytocin. The infusion rate was not changed through labour. A total of 1000 mL of saline was infused into the amniotic cavity over 1 hour 40 minutes. Within 3 hours of starting the amnioinfusion, the patient was found to be in second stage and had a spontaneous vaginal delivery of a 2.7-kg fetus in good condition. No additional oxytocics were administered at delivery. Immediately after delivery of the placenta, the patient had acute dyspnoea, hypotension, tachycardia, cyanosis and frothing at the mouth, which quickly evolved into a full cardiac arrest. The patient was intubated and cardiopulmonary resuscitation initiated promptly but she could not be revived. There had been no postpartum haemorrhage or trauma to the genital tract. The relatives did not give permission for a postmortem examination. Case 2A 23-year-old woman with two living children (G3P2) presented at 40 weeks of pregnancy with vaginal leakage of fluid and labour pains. She had been previously well and her pregnancy had been uneventful. On examination she was not anaemic or pyrexial, and her blood pressure was 100/60 mmHg. Abdominal examination revealed a single term fetus in a cephalic presentation, with reduced amniotic fluid and mild uterine contractions every 5 minutes. On au...

As there are no specific non-invasive markers for the diagnosis of tubal ectopic pregnancy, our objective in the present study was to explore the role of inflammatory cytokines IL-6 and IL-8 in the diagnosis of ruptured tubal ectopic pregnancy. Twenty-eight women with tubal ectopic pregnancy, 31 patients with intrauterine abortion and 29 gestational age matched women having normal intrauterine pregnancy were included in the study. Five millilitre of blood was collected at the time of admission, serum was separated and stored at -70 °C for subsequent analysis of β hCG, IL-6 and IL-8 levels. The level of IL-6 was a significant increase in the women with tubal ectopic pregnancy compared to intrauterine abortion and normal pregnancy. IL-8 levels decrease significantly in the tubal ectopic pregnancy and in intrauterine abortion patients when compared with the normal pregnancy group. At the cutoff of 26.48 pg/ml IL-6 level predicted the tubal ectopic pregnancy with moderate accuracy. Therefore, it can be concluded that measurement of IL-6 may have relevance in the diagnosis of ectopic pregnancy as a novel inflammatory serum biomarkers.

Twenty-seven cases of endometriosis in abdominal scars seen over a 10-year period have been reviewed. Multiparous women within the age group of 25-35 years were affected more frequently. Hysterotomy for termination of midterm pregnancy was the most common surgical procedure done prior to the occurrence of scar endometriosis. Associated pelvic endometriosis was present in 25.9% of the cases. Treatment of choice is complete surgical excision. Progestogen therapy appears to be less effective. Good technique and proper care during surgery may help in preventing this complication.

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