JOURNAL BEST PAPER PRIZE FOR THE YEAR 2017 - FOGSI

GUIDANCE NOTE ON SUPREME COURT JUDGEMENT - 2 FINGER TEST-GUIDELINES NMC RMP Regulations, 2023 A Guide Book for Master Trainers: Preventing Cervical Cancer through HPV vacciation in India Dear FOGSIans, Verify your details by 31st March to continue enjoying membership benefits. Update your address, email ID, or mobile number at member.fogsi.org. Email on membership@fogsi.org for further assistance. FOGSI demands zero tolerance against violence and abuse against Doctors in any form

GUIDANCE NOTE ON SUPREME COURT JUDGEMENT - 2 FINGER TEST-GUIDELINES NMC RMP Regulations, 2023 A Guide Book for Master Trainers: Preventing Cervical Cancer through HPV vacciation in India Dear FOGSIans, Verify your details by 31st March to continue enjoying membership benefits. Update your address, email ID, or mobile number at member.fogsi.org. Email on membership@fogsi.org for further assistance. FOGSI demands zero tolerance against violence and abuse against Doctors in any form

	OPEN CATEGORY
Dr. PikeeSaxena (First Prize)	Comparison of Diagnostic Accuracy of Non-fasting DIPSI and HbA1c with Fasting WHO Criteria for Diagnosis of Gestational Diabetes Mellitus Abstract Background To compare diagnostic accuracy of non-fasting DIPSI and HbA1c with fasting WHO 1999 as gold standard for diagnosis of gestational diabetes mellitus (GDM). Methods Pregnant women attending antenatal clinic underwent a 2-h 75-gm GCT in non-fasting state (DIPSI). HbA1c was also determined at the same sitting. A 2-h 75-gm GCT was repeated for all women after 72 h in a fasting state (WHO criteria). GDM was diagnosed if plasma glucose was ≥140 mg/dl by either test or if HbA1C ≥6%. Results Of the 800 women evaluated, 51 were diagnosed as GDM by WHO criteria, 63 by DIPSI, and 40 by HbA1c. The sensitivity of DIPSI test with respect to WHO 1999 was 98.04% and specificity 98.26%. The diagnostic accuracy was 98.25%. The area under the ROC curve for DIPSI was 0.988 (p < 0.001) (95% confidence interval: 0.960–1.000). The sensitivity of HbA1c with respect to WHO GTT was 47.06%, specificity 97.86%, and diagnostic accuracy 94.63%. The ROC curve between WHO GTT and HbA1c covered an area of 0.805 (p < 0.01) (95% confidence interval: 0.731–0.879). Conclusions Non-fasting DIPSI criteria had high diagnostic accuracy compared to gold-standard WHO GTT and can be an effective and practical alternative to the latter. HbA1c had a low sensitivity although the specificity was good and therefore is not a suitable test for screening GDM.
Dr. H. K. Chaudhari (Second Prize)	Morbidly Adherent Placenta: Its Management and Maternal and Perinatal Outcome Abstract Objectives The aim of the study was to identify the risk factors predisposing to morbidly adherent placenta and to study the different modes of management and the obstetric and neonatal outcome of these patients. Methods This was a retrospective cum prospective observational study conducted in the Department of Obstetrics and Gynaecology in a tertiary care referral hospital in Mumbai from January 2012 to November 2014. Results The incidence of morbidly adherent placenta was 1.32 per 1000 pregnancies with patient profile comprising second gravida in the age group 26–28 years; 90 % of the patients in this study had previous Caesarean section and co-existing placenta praevia was diagnosed in 63 %. Fifty-three per cent of the women delivered between 35 and 38 weeks and 40 % had elective deliveries. Caesarean section was the mode of delivery in 90 % of the patients. Prophylactic balloon placement in the internal iliac artery followed by classical Caesarean section, uterine artery embolization and post-operative methotrexate was done in 27 % which preserved the uterus and was associated the blood loss of 1000–2000 mL. Conclusion Antenatal diagnosis of morbidly adherent placenta allows for multidisciplinary planning in an attempt to minimize potential maternal or neonatal morbidity and mortality.
Dr. TusharKar (Third Prize)	Serous Tubal Carcinogenesis: The Recent Concept of Origin of Ovarian, Primary Peritoneal and Fallopian Tube High-Grade Serous Carcinoma Abstract Background Pelvic (non-uterine) high-grade serous carcinomas (PHGSC) including ovarian, tubal and primary peritoneal serous carcinomas have increased death: incidence ratio due to presentation at advanced stage, rapid progression, poor prognosis and high morbidity. Ambiguity regarding their pathogenesis and lack of a proper screening method is the cause of their late detection and high fatality rate. This study was undertaken to assess the fallopian tube for the presence of precursor lesions in pelvic serous carcinoma. Methods This was a prospective case–control study carried out in a tertiary care center. Consecutive specimens of 55 cases of pelvic high-grade serous carcinoma and 41 controls inclusive of 21 low-grade serous carcinoma, 10 benign adnexal masses and 10 normal adnexa were included in the study. Both side fallopian tubes in each case were subjected to histopathological examination and p53, Ki67 immunohistochemistry. Results There were 55 cases of PHGSC comprising of 50 cases of ovarian HGSC, two cases of primary peritoneal carcinoma (PPC) and three cases of tubal carcinoma. Serous tubal intraepithelial carcinoma (STIC) was detected in 14 cases (28%), p53 signature in 13 cases (26%) and tubal intraepithelial lesion in transition in 10 cases (20%) of ovarian HGSC. One case (50%) of PPC and one (33%) case of tubal carcinoma revealed the presence of STIC. None of the controls exhibited any precursor lesion except ovarian low-grade serous carcinoma where p53 was detected in 20% of cases. Conclusion This revelation concludes that fallopian tubes are the sites of precursors of PHGSC to a large extent. In the absence of a proper screening method of HGSC, prophylactic bilateral salpingectomy at hysterectomy for benign diseases can achieve ultimate goal of reduction in incidence of PHGSC.
	JUNIOR CATEGORY
Dr. Leena Rose Johnson (First Prize)	Adenoid Cystic Carcinoma of Vulva – 11 Years’ Single-Institution Experience Abstract Introduction Adenoid cystic carcinoma of vulva (ACC-vulva) is an extremely rare entity with <100 cases reported in the literature so far. Objective To study the clinical profile and outcome of ACC-vulva treated at a tertiary cancer care centre in South India. Methods This is a retrospective, record-based study of histopathologically confirmed cases of ACC-vulva treated at our centre from January 2005 to March 2016. Results Only four patients were diagnosed with ACC-vulva during the 11-year period under study. The longest duration of follow-up was 129 months. The age at diagnosis ranged from 32 to 43 years, with a median of 40 years. All patients were married, parous and premenopausal and presented with a painless unilateral vulval swelling. All patients had involvement of the Bartholin’s gland site with normal overlying skin. In all patients, wide excision was performed. Unilateral inguinal node dissection was done in one case. Perineural infiltration was documented in two cases, while positive excision margins were present in three cases. None of the patients had any lymph node involvement at diagnosis or during follow-up. Two patients had recurrence of disease. The disease-free interval was 23 months for one patient and 118 months for the other. In both, local (vulval) and distant (multiple lung) metastases were detected simultaneously. Conclusion Adenoid cystic carcinoma of vulva is an extremely rare, slowly progressing neoplasm mostly involving the Bartholin’s gland. The usual treatment includes wide excision and adjuvant radiotherapy (if required). There may be late local and distant recurrence.
Dr. Punit Hans (Second Prize)	Proposing a Hybrid Model Based on Robson’s Classification for Better Impact on Trends of Cesarean Deliveries Abstract Aim and Objectives To construct a hybrid model classification for cesarean section (CS) deliveries based on the woman-characteristics (Robson’s classification with additional layers of indications for CS, keeping in view low-resource settings available in India). Methods This is a cross-sectional study conducted at Nalanda Medical College, Patna. All the women delivered from January 2016 to May 2016 in the labor ward were included. Results obtained were compared with the values obtained for India, from secondary analysis of WHO multi-country survey (2010–2011) by Joshua Vogel and colleagues’ study published in “The Lancet Global Health.” The three classifications (indication-based, Robson’s and hybrid model) applied for categorization of the cesarean deliveries from the same sample of data and a semiqualitative evaluations done, considering the main characteristics, strengths and weaknesses of each classification system. Results The total number of women delivered during study period was 1462, out of which CS deliveries were 471. Overall, CS rate calculated for NMCH, hospital in this specified period, was 32.21% (p = 0.001). Hybrid model scored 23/23, and scores of Robson classification and indication-based classification were 21/23 and 10/23, respectively. Limitations of the Study Single-study centre and referral bias are the limitations of the study. Conclusion Given the flexibility of the classifications, we constructed a hybrid model based on the woman-characteristics system with additional layers of other classification. Indication-based classification answers why, Robson classification answers on whom, while through our hybrid model we get to know why and on whom cesarean deliveries are being performed.
Dr. Nupur Shah (Third Prize)	Role of Ultrasound-Based Prenatal Prediction of Pulmonary Function in Congenital Diaphragmatic Hernia: Does It Have Prognostic Significance Postnatally? Abstract Background and Objectives The incidence of congenital diaphragmatic hernia (CDH) in India is 1 in 1000. About 60 % of these are isolated, and the survival prognosis in them depends upon the quantum of contralateral functional lung. Out of the various pulmonary and extrapulmonarysonological predictors, observed to expected lung–head ratio (O/E LHR) is an efficient gestation-independent predictor of pulmonary function. This study was carried out to see the correlation of this prenatal predictor with the postnatal outcome depending on the pulmonary function. Methodology This study was carried out at Apollo Center of Fetal Medicine, New Delhi, from January 2009 to December 2015. A total of 14 fetuses with isolated left-sided CDH were included. The contralateral lung area was measured in 2D transverse view of the thorax at the level of four-chamber view of the heart by tracing method. The obtained value (square mm) was then divided by the expected mean lung area at that gestation and multiplied with 100 to express O/E LHR as percentage. These were then classified as severe (O/E LHR <25 %), moderate (25–45 %) or mild (>45 %) varieties of CDH. The parents to be were counselled for termination or continuation of pregnancy based on severity of CDH and total lung area. The patients were followed up for obstetrical and neonatal outcome till the time of first postoperative visit (diaphragmatic repair). Results The survival correlation in mild cases was 100 % (n = 5 out of 5) and 50 % in moderate cases (n = 2 out of 4), and both severe cases were terminated. There was a significant difference (p < 0.01) in the survival rate in the mild versus severe cases. Conclusions The prenatal predictor for postnatal pulmonary function correlates well with the neonatal outcome and hence is an important tool in prenatal counseling and triaging those who require termination of pregnancy versus expectant management. An obstetrician who is a first point of contact to the pregnant women can understand this and use it for counseling and differentiating the patients who need termination with regard to CDH.