To compare the efficacy and side effects of 0.2 mg methyl-ergometrine IM, 400 μg misoprostol sublingual and 125 μg 15 methyl PGF2α IM in active management of third stage of labor.

Background: Granulosa cell tumours account for less than 5 percent of all ovarian malignancies. Limited data is available from India. Methods: 27 patients with diagnosis of granulosa cell tumour of the ovary were treated between 1991 and 2003 at our Institute. The surgical records were reviewed and the patients were staged according to the FI6O system. The clinical and histological findings are correlated with prognosis and survival. Results: Mean age at diagnosis was 46.2 (2-64) years. The numberof patients in various stages was 1-19; II-l; III-5 and IV-2. Menstrual irregularity was diagnosed in 22 percent, and postmenopausal bleeding in 7.4 percent of women. Twenty-five patients were treated with primary surgery, 9 patients received adjuvant chemotherapy (CT) and only one patient received chemotherapy as primary treatment. Overall survival was 82 percent at 5 years. Overall survival for stage I was 100 percent after 5 and 10 years and in stage II-IV, was 56.4 percent after 5 and 10 years. Meantumour size was 18cm (range 3-30 cm). Women with larger tumour diameter (greater than 15cm) had significantly worse outcome than those with tumours of smaller diameter (P less than 0.05). The frequency of observed mitosis influenced the survival rate; with 0-3/10, HPF the survival was 100 percent in 5 years and with 4/10, HPF the survival was 2.6 years. Conclusion: The tumour size, mitotic rate and stage of disease are well-defined variables and influence the survival significantly and should be considered as important prognostic factors for treatment planning.

Background. Malignant degeneration of benign cystic teratoma of the ovary is rare. Occurrence of melanoma in an ovarian cystic primary teratoma in the absence of a demonstrable extraovarian primary is even rarer. We describe here one such case.Case. A 42-year-old nulliparous woman underwent laparotomy for a cyst in the right ovary. Histopathological examination of the specimen revealed malignant cystic teratoma with the presence of a melanoma component. There was no evidence of extraovarian primary melanoma on clinical examination. Two years later, she presented with lung metastasis and underwent left pneumonectomy. Histopathology confirmed metastatic melanoma. Postoperatively, she received combination chemotherapy using cisplatin and dacarbazine. She is on regular follow-up and continues to be disease-free, 18 months after treatment.Conclusion. Primary malignant melanoma in cystic teratoma of the ovary is extremely rare. We could find only 19 such cases on review of the literature. Clinical presentation is similar to that of primary epithelial ovarian cancer. Surgery remains the mainstay of treatment. Use of cisplatin and dacarbazine may be considered in a patient with metastatic disease. (C) 2001 Academic Press.