Editorial

The best method of abdominal entry is a debated subject in laparoscopy. Despite Veress needle being highly popular, the evidence indicates that it carries a significantly increased risk of minor complications, likelihood of multiple insertions and failed entry. In this review, we have evaluated the available evidences regarding the two laparoscopic entry techniques i.e. direct trocar insertion viz-a-viz veress needle (VN) followed by primary trocar insertion.

Synchronous primary tumors of the uterus and ovary are rare and should be distinguished from the metastatic tumors as the management and the prognosis differs in both the entities. Management of postmenopausal female presenting with the complaints of vaginal bleeding who was diagnosed to have a primary synchronous tumor of the uterus and the bilateral ovaries is discussed.

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Peripartum is the time when a female is most vulnerable to develop mental illness. Postpartum depression (PPD) is the most common psychiatric morbidity seen during this period. Prevalence of PPD is higher in developing countries as compared to developed countries. PPD often goes undetected as there is lack of awareness regarding maternal mental health issues especially in a country like India. Various studies in the past have shown adverse effects of PPD not only on mother but also on the child. Thus it becomes important to increase awareness regarding PPD and to identify and address risk factors associated with it. It is also equally important to make timely diagnosis and management of PPD to prevent long term consequences.

Background: Proteinuria is a significant marker of preeclampsia. Urinary protein in a 24-hour urine collection is conventionally considered as the standard for detection of proteinuria. However, it is tedious and is associated with collection errors. The role of urine protein/ creatinine ratio (UPCR) in a random urine sample is being proposed as an alternative. Aims: To compare accuracy of dipstick and random UPCR vis-a-vis 24-hour urine protein for prediction of significant proteinuria in preeclampsia. Methods/Materials: Two hundred pregnant women with gestational age more than 20 weeks of pregnancy with blood pressure = 140/90 mm Hg were recruited in the study. For each patient, the proteinuria was estimated by dipstick, random UPCR and 24-hour urine protein. Considering the 24-hour urinary protein analysis to be gold standard, the results of the other two methods were compared for their diagnostic accuracy. Data was compared by using Pearson’s correlation coefficient (r). Receiver operating characteristic (ROC) curve was plotted for spot UPCR value for detecting significant proteinuria (= 300 mg/day).

Luteal phase support (LPS) is a known intervention for preventing the pregnancy loss. It is most commonly used in the artificial reproduction cycles. Most common agent used for the LPS is progesterone. Current review discusses the reasons of LPD in stimulated and unstimulated cycles and also analyses the utility of various drugs in the treatment of the same.

Posterior reversible encephalopathy syndrome (PRES) is a novel clinic-radiological entity characterized by headache, visual disturbances, encephalopathy and seizures. Radiological features typically include bilateral symmetrical edema of posterior cerebral region especially of parieto-occipital lobe. Various conditions have been associated with PRES but toxemia of pregnancy, organ transplantation, immunosuppressive treatment, and hypertension are most commonly described. The pathophysiology of PRES is still debatable. Basically, it represents vasogenic edema resulting from the breakdown of cerebral autoregulation which if not managed promptly may lead to cytotoxic edema. Treatment of severe hypertension, seizure control, withdrawal of the causative agent and antiedema drugs are the hallmark of specific therapy in PRES. Delay in diagnosis and treatment may lead to permanent neurological impairment. Therefore, awareness of PRES is important for both obstetrician and radiologist. This article reports three cases of PRES which illustrate clinical features, diagnosis and management with the aim to draw attention of clinicians and radiologist to the existence of this clinic-radiologic entity associated with preeclampsia-eclampsia.

Genital tuberculosis in females (FGTB) is a significant cause of morbidity. Mycobacterium tuberculosis is a causative agent for tuberculosis (TB). In majority of cases tubes are involved in almost 90-100% of cases. Endometrium is the next commonly involved organ (50-80%), ovarian involvement is seen in 20-30% of cases followed by cervical involvement (5-15%). Vulva and vagina are rarely involved (1-2%). Diagnosis of FGTB is traditionally made by the presence of tubercular bacilli on microscopic examination or culture of endometrial biopsy specimen or granuloma in histopathological examination. Polymerase chain reaction have false positive results and as an isolated test it is not enough to detect the condition. Gold standard investigation for the diagnosis of FGTB is hysteroscopy and laparoscopy Genital tuberculosis falls under category 1 of Directly Observed Treatment Short Course (DOTS) treatment and antitubercular treatment is given for 6 months. Therapy consist of initial 2 months of rifampicin, isoniazid, pyrazinamide and ethambutol and 4 months treatment with two drugs i.e. rifampicin and isoniazid. Surgical treatment has a very limited role, particularly for the drainage of residual tubercular abscess.

Acardiac twin is an anomaly, which rarely occurs in monochorionic twin pregnancies. The normal twin is also called as pump twin as it pumps blood to the acardiac twin. Acardiac twin lives like a parasite with normal twin. In acardiac twin, heart does not develop properly or presents with rudimentary heart, due to which other upper structures of the body do not develop. This often results from placental vascular nastomoses. As heart does not develop, survival of acardiac twin is impossible. A 26-year-old woman referred as a case of uterine inversion after delivery of stillborn female fetus at home and placenta at some local hospital. The mass coming out of vagina turned out to be a acardiac twin with poorly developed head with few hairs, unformed trunk, poorly developed both lower limbs and centrally attached umbilical cord. As woman was unbooked and uninvestigated, the diagnosis of acardiac twin was made after delivery of the fetus.

The major aim of prenatal diagnosis is prevention of mental and physical handicap. This involves both low risk women without any family history and high risk women who have a family history of a child with malformations, child with intellectual disability or autism. In low risk women fetal disorder is suspected on the basis of abnormal biochemical screen, abnormal ultrasound etc. Fetal diagnosis is mainly done by chorionic villus sampling (CVS) amniocentesis and genetic testing is ordered based upon clinical indication