Indian Journal of Obstetrics and Gynecology

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Objective: To compare the efficacy of 2.5mg versus 5mg ulipristal acetate in reducing symptoms (menstrual blood loss and pelvic pain) and volume of uterine fibroids. Design: Randomized controlled trial, conducted at All India Institute of Medical Sciences, New Delhi. Recruitment was terminated after 40 patients in June 2018, after MHRA advisory. Methods: Women with symptomatic uterine fibroids, with PBAC score >100 with or without pelvic pain and at least one fibroid >3cm diameter, were recruited and randomized into two groups: group 1 (n=20) received 2.5mg ulipristal acetate and group 2 (n=20) received 5mg ulipristal acetate once daily for 13 weeks. Assessment of PBAC scores and fibroid volume by ultrasound were done at baseline, after 3 months of therapy and then 3 months after discontinuation of therapy i.e. at 6 month follow-up. Liver functions were evaluated at 3 and 6 months follow-up. Results: Significant reductions in PBAC scores occurred in both groups. Median (interquartile range) of PBAC scores reduced from 282 (124–1384) to 34 (0-385), in the 2.5mg group and 362 (128–940) to 0 (0- 284) in the 5mg group showing .87.5% and 100% reduction respectively. Further reduction after 3 months on treatment was as 0 ((0- 185) and 0 (0-322), p=0.001 in group1 and 2 respectively(p=0.001), 3 months after stopping treatment, score increased to 122(0-1312) & 165(0-560) however reduction from baseline in both groups 56.7 & 54.4% respectively. Amenorrhoea occurred in 6(30%) and 13(65%), 15(75%) & 16(80%) after1mth, 3mths on therapy and 4(20%) & 1(5%) 3months after treatment in 2.5 and 5mg group respectively. Normal periods achieved in 8(40%), 3(15%) at 1 month, 2(10%) & 1(5%) at 3mths and 4(20%) & 6(30%) cases in gp1 & 2 respectively. VAS remained significantly reduced in both groups even after stopping drug Median fibroid volumes reduced significantly in the 2.5mg group [(79.63cm3 (27.35- 148.04) to 51.3cm3 (2.52-82.86), 35.58%, p=0.002] but less in the 5mg group baseline 83.31cm3 (33.99- 309.8)] to 74.61cm3 (18.-283.64), 10.44%, p=0.526] Monitoring of liver functions showed increased SGOT and SGPT up to 222 and 399 in group 2 at 3 months follow-up which became normal in 3 months’ time. Monitoring of liver functions tests in both groups did not reveal any abnormalities. Neither dose of ulipristal suppressed estradiol. Conclusions: Treatment with 2.5mg Ulipristal acetate for 3 months is a feasible option in terms of symptoms control when compared to 5 mg dose. Rebound phenomenon is more with higher dose. With concerns of side effects with 5 mg dose, chief aauthor suggests to give 2.5 mg dose as it can be safer option. Further larger well powered studies may be conducted with lower doses of ulipristal for fibroid management.

Unintended pregnancies represent a significant public health challenge on a global scale. While there exists a diverse array of contraceptive methods available for women, the options for men remain largely restricted to condoms and vasectomy. The efficacy of condoms is often compromised by high failure rates, and vasectomy, being a surgical procedure, lacks reversibility. Consequently, there is a pressing need and a widespread interest in the development of male contraceptive methods across the world.

Introduction: Amoebic liver abscesses, primarily due to Entamoeba histolytica, are prevalent in tropical regions. Undetected, they can reach huge sizes causing febrile illness with features of acute abdomen. Early diagnosis and timely intervention are more crucial in pregnancy to prevent complications not only to mother (like rupture, sepsis and septic shock), but also to fetus. This case discusses the diagnostic and management problems in one such gravid woman with a gigantic Liver abscess presenting with sepsis. Case Presentation: We present a case of a 39 years, Primigravida at 33 weeks of gestation who presented to emergency with high grade fever, severe pain abdomen, abdominal distension, nausea-vomitting and constipation. She had a qSOFA score of 10 and was admitted in the ICU with Sepsis and Acute abdomen. Investigations revealed a Liver abscess of 1000cc in the left lobe. ICU management was done followed by percutaneous drainage of the abscess was done and patient was started on parenteral meropenem and metronidazole along with close feto-maternal monitoring. Serological tests confirmed Entamoeba histolytica. She was discharged with a healthy fetus after 9 days and sent home on Tab metronidazole. Discussion: This case highlights the importance of considering amoebic liver abscess in patients from endemic areas presenting with fever and right upper quadrant pain. Diagnostic imaging, combined with serology, plays a pivotal role in prompt diagnosis. Antiparasitic therapy remains the cornerstone of treatment, drainage can be considered to hasten the response specially in cases with large collection while other surgical interventions are kept for complicated cases. Acute

A 46-year-old postmenopausal woman presented with abdominal lump, weight loss, anorexia, and dyspepsia. Imaging revealed bilateral ovarian masses, and she underwent total abdominal hysterectomy with bilateral salpingo-oophorectomy. Histopathological examination revealed a rare case of bilateral primary ovarian cancer with two distinct histopathologies: high-grade serous carcinoma in the left ovary and endometrioid carcinoma in the right ovary. The patient had a history of breast cancer and was suspected to have a genetic predisposition, but genetic screening was declined due to economic constraints. The case highlights the rarity of synchronous bilateral primary ovarian cancers and the importance of meticulous histopathological evaluation and multidisciplinary collaboration in management. The patient was referred for adjuvant treatment, and the case underscores the need for further research and personalized treatment approaches for such complex ovarian malignancies.