Blue dye single labelling for colorimetric sentinel lymph node mapping in early endometrial cancer: A feasibility study.

Background: Surgical staging in endometrial cancer includes a systematic lymphadenectomy with significant morbidity, although its therapeutic role is unclear. Sentinel lymph node (SLN) study is a less morbid alternative to identify nodes most likely to be metastatic, permitting selective removal and thus reducing morbidity without compromising oncological safety. This study was done using blue dye single labelling to study the feasibility and utility in identifying SLN in early disease. Methods: Twenty-two patients of early-stage low-risk disease during surgical staging underwent cervical injection of methylene blue, SLN mapping, and sampling as per the standard algorithm, followed by a systematic lymphadenectomy in all cases. SLN were submitted separately for ultrastaging (US). Results: Twenty patients underwent the procedure, and SLN could be identified in 18 patients with an overall mapping rate of 90% with a bilateral mapping rate of 70%, and a negative mapping rate of 10%. 57 SLN were identified along with two suspicious non-sentinel nodes and 11 were metastatic on US with a sensitivity of 66.7% and NPV of 87.5%. All patients with metastatic nodes, however, could be identified by applying the standard SLN algorithm for sampling. Conclusion: SLN mapping algorithm with blue dye single labelling in early endometrial cancer, by identifying LN most likely to be metastatic enabling their selective removal may help avoid routine lymphadenectomies without compromising oncological safety. The procedure is simple and can be practiced at all centres and can also aid pathologists by pinpointing the likely metastatic nodes after a selective or complete lymphadenectomy.

First trimester obstetric outcome of frozen thawed embryo transfer: does the stage of embryo make any difference?

BACKGROUND: The direction of management and outcome of frozen thawed embryo transfer (FET) is becoming different day by day with the invention of newer technologies and application of it as a treatment modality in modern medicine. It also contributes to around 25% of births because of Assisted Reproductive Technology (ART) procedures worldwide today. METHODS: A prospective longitudinal study was conducted at ART Center of tertiary care hospital. Couples with infertility planned to undergo FET were included in the study. Following FET, all positive cases were followed up till 14 weeks period of gestation. Data were collected and analyzed with appropriate statistical test using Epitable, 6.04 version, and SPSS, version 18, software. RESULTS: During the study period, a total of 470 FET cycles were carried out, and 1108 cryopreserved embryos were subjected to thawing procedure. Overall survival rate of 93.86% was noted. Among various stages of embryos thawed, the lowest survival rate (64.62%) was found in blastocyst group. Biochemical pregnancy rate, clinical pregnancy rate, and ongoing pregnancy rate were also analyzed in different subgroup of transferred embryos. The blastocyst group showed best implantation and clinical pregnancy rate but lowest survival rate among all subgroup of embryos. CONCLUSION: The blastocyst transfer during FET cycle showed best clinical and ongoing pregnancy rate. So if clinical situations were favorable for blastocyst stage transfer, the same should be preferred for FET cycle.

Why do obstetric patients go to the ICU? A 3-year-study.

BACKGROUND: Pregnant women are at risk to develop complications due to illness related to pregnancy or due to aggravation of pre-existing disease. These patients also require critical care and ICU admissions in some cases. To determine the current spectrum of diseases in an obstetric population resulting in admission to the intensive care unit (ICU) at a tertiary care hospital. METHODS: A retrospective case series study and analysis of data from obstetric patients admitted for critical care management. RESULTS: 0.26% of the total obstetric patients admitted to the hospital required ICU admissions. 46% of patients were admitted to ICU for ventilator support. Pre-eclampsia and obstetrical hemorrhage were the common diagnosis for these patients. CONCLUSION: Critically ill obstetric patients require a team approach of the obstetrician, anesthesiologist and intensive care specialist for the optimal care of these patients.

Generation and characterization of human iPSC line from CD34+ cells isolated from umbilical cord blood belonging to Indian origin.

We describe here the reprogramming of CD34+ cells isolated from umbilical cord blood obtained after full term delivery of a healthy female child of Indian origin. The cells were nucleofected by episomal vectors expressing Oct4, Sox2, L-Myc, Klf4, Lin28 and p53DD (negative mutation in p53). Colonies were identified by alkaline phosphatase staining and characterized for expression of pluripotency markers at protein level by immunofluorescence, flow cytometry and at transcript level by PCR. Genomic stability of the cell line was checked by G-banded karyotype. The ability to differentiate to endoderm, mesoderm and ectoderm in vitro was confirmed by immunofluorescence staining.

HELLP or Help: A Real Challenge.

OBJECTIVES: To ascertain the prevalence, presentation, diagnosis, severity, and complications of HELLP syndrome. MATERIALS AND METHODS: This is a prospective observational study analyzing the conditions and the data of 24 cases of HELLP syndrome in a tertiary care hospital. The analysis was done for the demographic characteristics, presentation of these patients, complications associated, and the perinatal outcome. RESULTS: 0.45 % of the patients admitted for delivery developed HELLP syndrome. Majority of the patients developed the condition in 30-36 weeks period of gestation, while five patients developed it in the postpartum period. The condition led to 12.5 % of maternal and 45.8 % of perinatal mortality. CONCLUSION: HELLP syndrome is an important cause for maternal and perinatal morbidity and mortality.

Study of the Risk Factors for Cesarean Delivery in Induced Labors at Term.

BACKGROUND: Induction of labor has become one of the most common interventions in obstetrics. Induction is indicated when the benefits to either mother or fetus outweigh those of continuing the pregnancy. Maternal complication rates that are increased in association with labor induction include cesarean delivery, chorioamnionitis, abruptio placentae, and uterine atony. So identifying those pregnancies that can be induced with low risk of cesarean delivery is important. The aim of this study was to identify those factors which influence the risk of emergency cesarean delivery in induced labors at term. METHODS: It is a case-control study conducted at Tertiary care center and affiliated hospitals. In this study, odds ratio with 95 % confidence interval is taken as a measure of relative risk. Patients were evaluated for risk factors for cesarean section using logistic regression. Cases include all women who were induced at term and delivered by emergency cesarean section. Controls include all women who were induced at term and delivered vaginally. RESULTS: The risk factors for cesarean delivery are advanced maternal age at delivery (≥35 years), high early pregnancy body mass index (≥30 kg/m(2)), nulliparity, low preinduction Bishops score (<5), gestational diabetes mellitus, and intrauterine growth restriction. CONCLUSION: Women with multiple risk factors for cesarean can be taken up for elective cesarean section rather than inducing them at term.