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The most common benign neoplastic uterine tumors that grow monoclonally from the smooth muscle cells of the uterus are uterine fibroids or leiomyomas, which may occur as a single lesion or as multiple lesions with variation in size from microscopic to large macroscopic extent. The majority are diagnosed in the preclinical routine reliably, despite challenges due to the possibility of multiple differential diagnoses. Hence, this report highlights a case of a postmenopausal female of 53-year-old working as a staff nurse at the same hospital and who visited the outpatient department of obstetrics and gynecology with chief complaints of pain in the right side of the abdomen for four hours (presentation similar to that of appendicitis). Per abdomen examination resulted in a non-tender mass with flank fullness and firmness with a smooth surface and approachable lower border. It clinically appeared as a large uterine fibroid. The built of the patient was obese due to which neither the patient nor relatives were ever able to make out any evident symptoms. The diagnostic investigation involved a magnetic resonance imaging (MRI) that confirmed the diagnosis of two parity with both living, and two were aborted (P2L2A2) with uterine fibroid. The management of the fibroid consisted of exploratory laparotomy along with a hysterectomy and bilateral salpingo-oophorectomy. The intraoperative findings and frozen section report confirmed the presence of benign uterine leiomyoma. Therefore, the utilization of physical examinations and diagnostic tests may assist in preventing a delay in the detection and management of curable conditions such as fibroids, which can be treated without complications with surgery.

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Peritoneal tuberculosis (TB) is one of the types of extrapulmonary TB that predominantly involves the omentum, liver, intestinal tract, spleen, or female genital tract. It can occasionally result in gynecological-related oncology diagnoses such as advanced ovarian cancer due to its non-specific signs and symptoms, making it very difficult to detect. This report presents a case of a 22-year-old female who presented with the chief complaints of pain and distension of the abdomen for one month with dysuria. Ultrasonography and magnetic resonance imaging was performed that reported a large uni-loculated cystic pelvic abdominal lesion likely to be of ovarian origin and suggestive of neoplastic etiology with bilateral hydroureteronephrosis. To confirm the diagnosis, an exploratory laparotomy was performed which revealed extrapulmonary abdominal TB, and was registered for Directly Observed Treatment Shortcourse (DOTS) following which anti-tubercular drugs were given. In conclusion, this case report highlighted the masquerading behavior of encysted peritoneal TB as an ovarian tumor, and the fact that it should, therefore, should be considered in the differential diagnosis in regions where TB remains endemic, such as in developing countries. Hence, an appropriate diagnosis can prevent the need for unnecessary surgical operations and adequate therapy can save the patient's life.

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Invasive mole (IM) is a very uncommon subtype of gestational trophoblastic disease (GTD), which is the invasion of molar tissue into the uterine or myometrial vasculature. However, this report presents a rare case of a 41-year-old female multiparous P7 with five full-term normal vaginal deliveries and two preterm normal vaginal deliveries. As the patient was not using contraception, her urine pregnancy test (UPT) was done, which demonstrated positive results. A speculum examination revealed a healthy cervix with just mild bleeding, whereas a vaginal examination revealed a firm cervix and an anteverted and mobile eight-week-old uterus along with a free fornix. Pelvic ultrasound and magnetic resonance imaging (MRI) demonstrated the diagnosis of GTD, for which consultation from an oncology physician was taken and the treatment proceeded with a total abdominal hysterectomy. Histological examination of the uterus showed a circumscribed nodule showing a large area of hemorrhage with few chorionic villi lined with trophoblastic cells and occasional villi invading the myometrium and endometrial cavity suggesting hydatidiform mole showing early invasion that confirmed the diagnosis of IM. In conclusion, reproductive-age women who experience abnormal uterine bleeding (AUB) should suspect pregnancy with several possible complications, for which a pregnancy test should be done to rule out complications.

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Introduction: Approximately one-third of a woman's life is spent in the menopausal phase. The unpleasant menopausal symptoms are unacceptable as a part of routine life. Indications of menopausal hormone therapy (MHT) are for alleviation of vasomotor symptoms, prevention of osteoporosis, and genitourinary symptoms associated with menopause. MHT is associated with an increased risk of breast cancer, cerebrovascular accidents, and coronary heart disease. Soy isoflavones have been extensively used as an alternative treatment in patients who cannot take MHT. The evidence of the efficacy of isoflavones in the literature is equivocal. Aim: The aim of the study was to evaluate the efficacy of soy isoflavone supplementation on menopausal symptoms in perimenopausal and postmenopausal women and to evaluate the effect on blood pressure (BP) and body mass index (BMI). Materials and Methods: A questionnaire-based prospective observational study was undertaken involving 39 perimenopausal and 61 postmenopausal women, who were prescribed 40 mg soy isoflavone supplements twice daily for 12 weeks. Menopause Rating Scale questionnaire was given to the patients before starting soy isoflavone therapy and at the end of the treatment; BP and BMI were also noted. Results: The total score of both the groups was comparable at baseline. Among perimenopausal and postmenopausal women, the highest score was noted in symptoms of somatic domain. At the completion of our study, the total scores improved significantly by 38.6% and 33.3% in perimenopausal and postmenopausal women, respectively. The greatest improvement was seen in somatic subscale (42.5%) and psychological subscale (42.5%) and the least in urogenital subscale (16.1%) for perimenopausal women. For postmenopausal women, the greatest improvement was seen in psychological subscale (40.0%) and the least in urogenital subscale (14.2%). Conclusion: Soy isoflavone supplementation is beneficial in both perimenopausal and postmenopausal women, more so in perimenopausal women. There is no beneficial effect of soy isoflavone supplementation on lowering systolic BP and BMI.

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BACKGROUND: Prophylactic salpingo-oophorectomy refers to the removal of clinically normal ovaries at the time of hysterectomy for benign lesions, to reduce the risk of ovarian and breast cancer in future. This risk reduction holds true for high-risk women, i.e., those with strong family history of breast or/and ovarian cancer and those who carry germline mutations (BRCA-1 and BRCA-2). However, it is still one of the commonly performed surgeries in low-risk women and has fallen into controversy. It is said that the number needed to treat is 300. AIMS AND OBJECTIVES: The aim of the study was to analyze and understand the reasons behind women opting for prophylactic oophorectomy in spite of the available evidence. We also aimed to study the histopathology reports of the ovaries and tubes removed prophylactically. MATERIAL AND METHODS: This was a prospective study carried out at a tertiary care center which serves both rural and urban population. Of the 252 patients counseled, 86 patients who opted for prophylactic salpingo-oophorectomy were included in the study. A detailed history, clinical examination, relevant investigations (ultrasonography and CA 125 levels), indications for hysterectomy, reasons for prophylactic oophorectomy, intraoperative findings, and the histopathology findings were noted. RESULTS: Main reasons for opting for prophylactic oophorectomy were lack of understanding and thus dependent on their treating doctor for the decision-making, fear of ovarian malignancy in future, inability to follow-up, and previous one or more abdominal surgeries. CONCLUSION: We as gynecologists need to reconsider the age at which we recommend prophylactic oophorectomy. Too much negative counseling should be deferred.

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Anaphylactic-like reaction or anaphylactoid reaction resembles generalized anaphylaxis but is not caused by immunoglobulin E-mediated allergic reaction. This reaction is caused by a non-immunologic mechanism even after first exposure to antigen. Prostaglandin E2 (dinoprostone) gel is commonly used for pre-induction cervical ripening. We report a case of anaphylactiod reaction after insertion of prostaglandin E2 gel for induction of labor. Hyperstimulation with dinoprostone gel is reported in the literature. An isolated report of three cases of anaphylactiod reaction after intracervical dinoprostone gel was found during a literature search. We are reporting this case for its rarity. As a potentially life-threatening condition, every obstetrician should be aware of this rare complication of dinoprostone gel.

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The Accreditation Council for Graduate Medical Education requires that training programs comprehensively evaluate residents in the six core Accreditation Council for Graduate Medical Education competencies. One of the ways we do this in our residency is by administering a nine-station Objective Structured Clinical Examination (OSCE) at the end of each year, which evaluates tasks such as history taking, focused physical examination, communication, professionalism, procedural skills, management, prescription writing, and understanding systems-based practice. We have classified our OSCE stations into what we consider key areas in our field and assessed these on a rotating basis over 3 yrs. This results in the assessment of 27 areas over the 3 yrs of residency. Structuring the OSCE as a series of stations over 3 yrs is an efficient method to evaluate residents' competencies that are required by the Accreditation Council for Graduate Medical Education and certifying boards. An analysis of OSCE scores when compared with American Board of Physical Medicine & Rehabilitation parts 1 and 2 scores and final summative resident evaluation scores reveals that OSCE results correlate with part 1 scores and final evaluation scores but do not show the same strong correlations with part 2 scores. We discuss the way the OSCE can complete other assessment techniques and ways to improve cases in the future.

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Pregnancy in the rudimentary horn is a very rare condition. In these cases, rupture of the rudimentary horn in the second trimester with fetal death and catastrophic intraperitoneal hemorrhage is the commonly reported outcome. Silent rupture of the rudimentary horn and continuation of pregnancy as a secondary abdominal pregnancy is the most unusual outcome of this rare condition. We report such a case with a good maternal and neonatal outcome. The case is being reported for its rarity.

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