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Background: Fetal well-being has traditionally been evaluated on the basis of fetal activity fetal heart and presence of meconium in liquor amnii in vertex presentation. The significance of meconium claimed to vary between its entirely being physiological to a sign of fetal distress. Passage of meconium is considered physiological exhibiting sign of fetal maturity on one hand & a sign of fetal distress and response to hypoxic insult on the other hand. Methods: The present study is a case-control study of meconium stained amniotic fluid, its significance and early maternal and neonatal outcome and was carried out in the department of Obstetrics & Gynecology, Dhiraj General Hospital, Pipariya during April 2011 to March 2012. Results: The incidence of passage of meconium was relatively higher in patients with pregnancy induced hypertension (20%) and pregnancy beyond 40 weeks (14.66%). Amongst the cases 28.66% patients had an abnormal fetal heart pattern and 12% had a variable fetal heart pattern whereas in controls the values were 8% and 3.33% respectively. The total number of patients with meconium aspiration was 18% whereas those with meconium aspiration syndrome were 6%. Conclusions: Meconium passage still remains an enigma to the obstetrician. However, as shown in the study, thick meconium or thin are indicative of fetal distress. If modern management is based on the understanding of underlying pathophysiology of meconium passage than the harmful effect of meconium can certainly be lessened. [Int J Reprod Contracept Obstet Gynecol 2013; 2(2.000): 190-193

mechanisms. Although we basically agree, we argue that the underlying mechanism(s) motivating the use of vasopressor(s) must be kept in mind. Increasing BP by a pressor combination increasing the vascular tone via different mechanisms might be correct. This approach will work well if hypotension results mainly from the loss of vascular tone. In this case, the proposed approach fits well with the physiological acute cardiovascular response. Sympathetic stimulation, vasopressin release, and angiotensin level increase interact synergistically to increase the vascular tone. However, the decrease in BP in critically ill patients results from more complex interactive mechanisms (eg, heart failure, hypovolemia, abnormal ventriculo-arterial coupling), for which the pure vascular tone control might be insufficient or dangerous. We do not share the "no sense of a norepinephrine association with epinephrine." Epinephrine is the emergency hormone, which links vascular tone, heart function, and metabolic effects to "escape" the life-threatening situation. Its combination with norepinephrine can be then logical for some patients.The second concept ("catecholamine vasopressor support-sparing strategies") proposes the use of "adjunctive" therapies to reduce pressor support. Although theoretically appealing, such adjunctive therapies are not easy to use in practice.The last concept ("microcirculatory protection") is the oldest but the most recently investigated in critical care. Until now, it seemed obvious that the microcirculation changes might be corrected by therapeutic actions focused on macrocirculation, suggesting that microcirculation is passively impaired. This is very different when microcirculation is impaired by a combination of abnormal systemic circulation associated with pure inflammatory mechanisms at the microcirculation level (activated adhering white cells with microthrombosis). This situation frequently occurs in critically ill patients and could be improved by a combination of cardiovascular hemodynamic supports with modulation of the inflammation-induced interaction between endothelial cells and circulating immune cells.

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Granulosa cell tumor is a sex cord-stromal tumor of the ovary derived from non-germ elements. These lesions occur most frequently in menopausal or postmenopausal women and its association with endometrial carcinoma is seen only in less than 5% of these cases. We herein report a rare case of adult type granulosa cell tumor of the ovary with coexistent endometrial adenocarcinoma in a 35 year old, married Indian female