Parulekar SV

This issue of the Journal of Postgraduate Gynecology  Obstetrics is a fine mix of articles from different areas of the subject. Usually very large ovarian tumors do not undergo torsion, because there is just not enough space left in the abdominal cavity for a torsion to take place. Here is a case in which a tumor weighing 3.75 kg underwent torsion. Another area of concern in Gynecological surgery is development of postoperative adhesions. These adhesions are more intense after operations that produce scars on peritoneal surface of the uterus, as in myomectomy. Adhesions of the uterus with the back of the anterior abdominal wall are not common even after myomectomy, because the uterus is nearly normal-sized at the end of the surgery and does not come in contact with the abdominal wall during the process of healing. They are less common after cesarean sections, because the uterine scar is extraperitoneal, and the large puerperal uterus with an intact serosa does not permit development of such adhesions. But we have seen a few cases where the uterus was totally adherent to the anterior abdominal wall, and a repeat cesarean section in those cases was virtually extraperitoneal. Here we present a case of such adhesions encountered during an abdominal hysterectomy and a novel way of handling such adhesions. Tuberculosis continues to be a menace in some Asian countries, especially the multi-drug resistant type. It also continues to be an important cause of maternal mortality. We present a case which was managed very well and survived the serious disease. Congenital heart disease should be treated in childhood, and no girl child should reach adulthood and get pregnant with an uncorrected heart disease. Unfortunately healthcare is too expensive or inaccessible in some parts of the country and such cases do turn up. Here we present a case whose management was quite taxing, but the results were equally rewarding. In the area of assisted reproduction, ovarian hyperstimulation is the norm. Unfortunately, sometimes it is done by persons not adequately trained to do so, and the patient develops ovarian hyperstimulation syndrome. Here is a case of that type, which was successfully managed. Postmenopausal bleeding from the uterus can have varied etiology. Forgotten intrauterine device can be one of them, though the question that remains unanswered is how a woman could forget the intrauterine device she had got inserted. Here is a case in which the diagnosis was missed even on ultrasonography, and was made during a fractional curettage. Vulvar angiomyofibroblastoma is a rare but interesting tumor. The diagnosis is critical, because unlike others that it can be mistaken for, it has a very good prognosis after its removal. Such a case is presented here. The previous issues of the journal have carried articles on hemoperitoneum in women on anticoagulation. A case of spontaneous hemoperitoneum in such a woman is presented in this issue. I hope articles on such varied aspects of Gynecology and Obstetrics will interest our readers.