Free communication (oral) presentations / International Journal of Gynecology & Obstetrics 119S3 (2012) S261–S530 S487

sac to sample the decidua basalis. The biopsies were immediately

fixed and processed for light, transmission and scanning electron

microscopy.

Results: Morphological and immunohistochemical studies con-

firmed the accuracy and adequacy of the samples, with a high (40%)

myometrial spiral artery presence, and the presence of trophoblast

in DB and its absence in DP. Ultrastructural morphological

differences between the two types of decidua were described with

prominent changes such as 1) increase in collagen fiiberdiameters

and 2) altered lengths and distribution of collagen fibers around

spiral vessels in the placental bed in response to the breakdown

of the extracellular matrix of decidua basalis brought about by the

trophoblast invasion.

Conclusions: We describe a simple and accurate novel technique of

decidual biopsy under direct hysteroscopic vision and the various

ultrastructural changes in the extracellular matrix surrounding the

spiral arteries of the placental bed. Our findings have implications

for progress in research on the early events of human placentation

such as spiral artery remodelling.

Figure: Hysteroscopic biopsy of decidua.

O642

HYDATIDIFORM MOLE: A CLINICAL STUDY

N. Singh N1, T. Meetei1, I. Devi1, Y.A. Kumar1, R. Bala1. 1Obstetrics

and Gynecology, Regional Institute of Medical Sciences, Imphal,

Manipur, India

Objectives: Post molar gestational disease still remains a nagging

problem to pregnant mothers and continues to perplex medical

scientists. Keeping this in view the aim of the present study is set

to evaluate the incidence rate, clinical profile and role of follow up

to identify the risk factors for post molar gestational trophoblastic

disease (GTD).

Materials: A hospital based study of molar pregnancy conducted

between August 2009 to December 2011 in the department of

Obstetrics and Gynecology, RIMS, Imphal, Manipur, India. A total of

42 cases of molar pregnancy were evaluated.

Methods: After clinical evaluation and investigations, FIGO scoring

was done to categorize low and high risk groups. Treatment with

suction evacuation or total abdominal hysterectomy was done and

followed up weekly and monthly with clinical evaluation, beta

hCG and USG. Chemotherapy with methotrexate with leucovorin

or EMACO was given for persistent cases.

Results: The incidence of molar pregnancy was 1.1/1000

pregnancies. For analysis of patients with molar pregnancy. c2 test

was used with P-value less than 0.05 as cut off value of significant.

Patients younger than 30 years constituted 76.2%. Nulliparous

constituted 57.1%. Bleeding per vaginum was seen in 83.3%. b-hCG>1,00,000 mIU/ml were seen in 66.7%. b-hCG return to normal by

12 weeks in 71.8%. Chemotherapy was used in 30.8%.

Conclusions: The incidence rate of molar pregnancy is 1.1./1000

pregnancies. It is more common in nulliparas and also in the

extremes of age (above 4o years and below 20 years). Presence

of theca lutein cyst, fundal height more than period of gestation

and b-hCG more than 1,00,000 mIU/ml are high risk factors for

development of post molar GTD. Follow up with beta hCG is still

the key to identify the post molar GTD. Proper follow up and

management with methotrexate with leucovorin or EMACO can

reduced the morbidity and mortality dramatically.

O643

DIFFERENTIAL MATERNAL MORTALITY: A HOSPITAL BASED

STUDY IN THIRTY NINE YEARS

K.P. Devi1, M.R. Singh1, S.R. Devi1, L.R. Singh1, N.N. Singh1,

Ch.M. Singh1. 1Gynaeology & Obstetrics, Regional Institute of Medical

Sciences, Imphal, Manipur, India

Objectives: The study was aimed at evaluating the spectrum of

causes of maternal deaths and to seek its remedy. Also to bring

effective changes in the medical curriculum and reorganize the

health care in Reproductive and Child Health services.

Material: The present study was based on a primary data of 2, 38,

225 live births occurred during January 1972 to December 2010 at

Regional Institute of Medical Sciences Hospital, Imphal, Manipur.

Methodology: The data was analyzed through SPSS package using

X2 test and p-value of 0.05 was taken as significant level.

Results: The overall MMR was found to be 148.12 per 100000

live births. Out of the complications: hemorrhage (46.18%), sepsis

(20.40%) and toxemias (10.48%) were the major killers. In case of

socio-demographic factors: age, parity and education were found

to play a significant role toward maternal death (p < 0.001). MMR

was lowest in the 21–30 years age group (121.8) and increases with

age. MMR increases with increasing parity except in P1 which was

significant. MMR was higher in illiterate mothers, unbooked and

women residing in rural areas compared to literate, booked and

urban areas (p value <0.001). Majority of the deaths occurred in

the first 24 hours of admission and in the postpartum period.

Conclusion: The MMR of Manipuri women were varied over during

the last 39 years. Improving female literacy, access to effective

contraceptives, good quality health care as well as good transport

facilities may reduce maternal deaths.

O644

CHEMOTHERAPY FOLLOWED BY RADIOTHERAPY VERSUS

RADIOTHERAPY ALONE IN LOCALLY ADVANCED CERVICAL

CANCER

R. Singh1, A. Oumachigui2, K.S. Reddy2, R. Reddy2, K. Majumder3,

V. Celine2, R. Sethi2. 1Palmerston North Hospital, Palmerston North,

New Zealand; 2JIPMER University Hospital, Pondicherry, India; 3Oxford

University Hospital, Oxford, United Kingdom

Objectives: 1. To assess the response of chemotherapy and

chemoadjuvant radiotherapy in patients with locally advanced

cervical cancer. 2. To analyze side effect profiles of chemotherapy &

chemoadjuvant radiotherapy. 3. observe the contribution of

chemotherapy in increasing locoregional and systemic control of

the disease. 4. evaluate a new mathematical model to help compare

results of various clinical studies.

Materials: Prospective, randomized study in a tertiary care

University hospital in South India. One of the largest randomised

studies of its type, 120 patients with locally advanced cervical

cancer (40 stage IIB, 80 stage IIIB) were randomised to receive

2 cycles of Cisplatin, Vincristine and 5-Fluorouracil followed

by radiotherapy or radiotherapy alone and the responses were

assessed.

Methods: Prospective randomized study. Standard statistical

analysis including regression analysis used.

Results: Patients with good clinical responses to chemotherapy

responded to subsequent radiotherapy. Clinical stage, tumour size &

burden had an inverse relationship to clinical response. Nausea/

vomiting and alopecia were the major side effects of chemotherapy.

Diarrhoea, local skin reaction and alopecia were the major side

effects of radiotherapy. Our modified score was a better indicator

of response compared to previous ones.