A 20-year-old nulliparous woman, married since one year, presented to the outpatient department with complaints of three months of amenorrhea followed by increased bleeding per vagina, hyperemesis and abdominal pain of one week duration. She also complained of tremors and palpitation. There was no history of abdominal distension or diarrhoea. There was no history of menstrual irregularity prior to the current episode.On examination, her pulse rate was 110 beats per minute and regular in rhythm, blood pressure was 120/78 mmHg, respiratory rate was 16 breaths per minute and oxygen saturation was 99% at room air. She was found to have conjunctival pallor and diffuse non tender enlargement of the thyroid gland. On abdominal examination, there was no palpable mass present. On per vaginal examination, the uterus was found to be bulky (about 10 weeks of gestational size), anteverted, with mild cervical motion tenderness present. Bilateral fornices were free and non tender. Urine pregnancy test was found to be positive. Transvaginal ultrasound of pelvis revealed uterus which measured 10.6x7 cm, with intrauterine gestational sac measuring 4.3 cm and presence of anechoic areas likely to be cystic, suggestive of molar pregnancy. Bilateral ovaries on ultrasound showed theca lutein cysts with the largest measuring 18 mm. Laboratory data showed β-hCG levels of 8,04,578 mIU/ ml, haemoglobin of 8.4 g/dl, peripheral smear showed microcytic hypochromic picture, TSH levels of 0.015 mIU/ml, T3 of 3.07 ng/ ml and T4 of 24.86 μg/dl. Thyroid profile was done after seeking consultation with physician for tremors and palpitation. Ultrasound of the thyroid gland showed diffuse enlargement of the gland without nodularity and Technetium-99m scan of thyroid was done which was found to be normal. Electrocardiogram showed sinus tachycardia and 2D-ECHO was normal.She was subsequently admitted and transfused 2 units of packed red blood cells and was started on propranolol (60 mg/day). An ultrasound guided suction evacuation of products of conception was done under general anaesthesia three days following admission. Histopathology report of specimen confirmed diagnosis of hydatidiform mole [Table/ Fig-1]. A repeat ultrasound scan done following evacuation showed retained products of conception and laboratory data showed β-hCG of 89,677 mIU/ml, TSH of 0. AbSTRACTMolar pregnancy is one of the components of a broader spectrum of diseases known as Gestational Trophoblastic Disease (GTD), presenting with amenorrhoea and irregular bleeding which may be rarely associated with passage of vesicles per vagina. However, it can rarely be associated with hyperthyroidism, which may be associated with clinical features of hyperthyroidism. The following is a report of a 20-year-old woman who presented with amenorrhea followed by irregular bleeding per vagina, thyromegaly and abnormal levels of thyroid hormones. Transvaginal ultrasound revealed features consistent with molar pregnancy. A suction evacuation was done following which serum levels of β-hCG reduced ...

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Purpose Uterine cancer is the second most prevalent cancer of the female genital tract, with 90% of it being of endometrial origin. The aim of this research was to create and validate a risk-scoring model using patients’ clinical variables in predicting premalignant and malignant lesions of the uterine endometrium among premenopausal women with abnormal uterine bleeding (AUB). Methods This is a retrospective cohort study conducted at a tertiary hospital of Southern India for a period of 5 years from July 2014 to August 2019, including women aged ≤55 years who had AUB and underwent endometrial biopsy. The incidence of atypical endometrial hyperplasia (AEH) and endometrial cancer (EC) was determined, and clinical and demographic variables were compared among cases (AEH/EC) and controls (no AEH/EC) using simple logistic regression. A risk-scoring model was derived and validated with a split-sample internal validation method. Results A total of 472 premenopausal women presenting with AUB were included in the study. There were 20 women (4.2%) with AEH and eight (1.7%) with EC. We found a statistically significant positive correlation of an anovulatory pattern of bleeding (odds ratio [OR]=3.4; p =0.009), age ≥45 years (OR=1.12; p =0.01), body mass index (BMI) ≥30 kg/m 2 (OR=2.46; p =0.04) and diabetes mellitus (OR=3.00; p =0.02) with a higher risk of AEH/EC diagnosis upon histopathological examination of endometrial biopsy specimens of the study population. A risk-scoring model (PAD30) was created using these variables to predict premalignant and malignant endometrial lesions. The best cutoff score derived by the receiver operating characteristics (ROC) curve, of ≥5, had a sensitivity of 85.7% and specificity of 87.6% with an area under the curve (AUC) of 0.84 (95% CI 0.75–0.93; p =0.04). With a positive likelihood ratio of 6.91, our prediction model increases the post-test probability of AEH/EC to 30.6% from 6% of the pre-test probability. Conclusion The proposed model demonstrated a moderate diagnostic accuracy in predicting premalignant and malignant lesions of the uterine endometrium among symptomatic premenopausal women.

Background: Prediction of the mode of delivery is crucial for better labour outcome. Recent studies suggest that the angle of progression (AOP), measured using transperineal ultrasound, can substantially aid the assessment of fetal head descent during labor, thereby predicting the mode of delivery. Objective: To assess the ability of the AOP measured by transperineal ultrasound to predict the mode of delivery in nulliparous women before the onset of labor. Methods: A prospective observational study was conducted at our hospital, of nulliparous women who had presented to the antenatal clinic at ≥ 38 weeks of gestation but not in labor. AOP was measured using transperineal ultrasonography and compared among the women having Caesarean section (CS) due to labor dystocia and vaginal delivery (VD). Various other confounding factors which increase the risk of caesarean section were analyzed. Results: Among total 120 nulliparous women, the mean AOP was narrower in patients undergoing CS (n = 28) compared to those with VD (n = 92) (91.6 ± 6.1° vs. 100.7 ± 6.9°; P < 0.01). Multivariable logistic regression analysis revealed that narrow AOP values (OR 3.66; P < 0.001; 95% CI 1.7- 14.5) and occiput-posterior fetal position (OR 1.63; P = 0.04; 95% CI 1.0-7.5) were the independent risk factors for CS. An AOP ≥ 96° (calculated from the ROC curve) was associated with VD in 95% (76/80) of women and an AOP < 96° was observed among 60% (24/40) of women who underwent CS. Conclusion: Narrow AOP (< 96°) and occiput-posterior fetal position are at higher risk for CS due to labor dystocia. AOP measured at the antenatal period could accurately predict the mode of delivery, thereby modifying labor outcome.