Background and objectives: To date, pregnancy-induced hypertension (PIH) and its sequelae remains dreaded complication of pregnancy. Several tests have been proposed for the prediction of PIH but none has been accepted widely due to the controversial results. This study hypothesized that elevated levels of maternal serum beta human chorionic gonadotropin (β-HCG) during the early second trimester (13–20 weeks) predict PIH. Materials and methods: The present 1-year prospective study was done in from January 2014 to December 2014 in the Department of Obstetrics and Gynecology, KLES Dr. Prabhakar Kore Hospital and Medical Research Centre, Belagavi. A total of 300 pregnant women in early second trimester (gestational age 13–20 weeks) were enrolled. All the women were evaluated for serum β-HCG and followed till delivery, for the development of PIH. Results: Maximum women (57%) were aged from 21 to 25 and the mean age was 23.42 ± 3.25 years. A total of 53.33% of the women were primigravida and most of the women had gestational age of 19 weeks (23.67%). The β-HCG levels of <30000 mIU/mL were noted in 46.33% of the women and mean β-HCG levels were 53338.50 ± 62109.39 mIU/mL and raised levels [rise of ≥2 multiple of median (MOM) β-HCG] was noted in 29% of the women. Out of 300 women, 25 (8.33%) women developed PIH of which 10 (40%) women had gestational hypertension, 9 (36%) developed mild preeclampsia, and 6 (24%) had severe preeclampsia. Significantly higher number of women with β-HCG MOM ≥2 were diagnosed with PIH (p = 0.003). The mean MOM of β-HCG was significantly high in women with PIH (2.41 ± 1.94 vs 1.62 ± 1.46; p = 0.012). Also significantly higher number of women with severe preeclampsia (83.33%), gestational hypertension (60%) had β-HCG levels of ≥2 MOM compared with women with mild preeclampsia (33.33%) (p = 0.002). There was significant rise in mean β-HCG MOM levels in women with mild preeclampsia, gestational hypertension, and severe preeclampsia compared with women who did not develop PIH (p = 0.002). The sensitivity of β-HCG considering a cut-off value of ≥2 MOM was 56% and specificity was 73.45%. Conclusion and interpretation: There is strong association between elevated serum β-HCG levels of >2 MOM and development of PIH but it is not a good predictor of PIH due to low sensitivity (56%) and moderate specificity (73.45%).

Background: Fetal heart rate (FHR) monitoring has caused a clinical dilemma due to widespread misinterpretation of the physiology influencing various FHR patterns and the development of cerebral palsy. This study aimed to correlate various category II FHR patterns with maternal risk factors and birth outcomes. Methods: This prospective observational study was conducted at SRM Medical College Hospital and Research Center, Kattankulathur, Chennai, from December 2020 to March 2022. A total of 150 parturients with category II cardiotocography (CTG) were studied, and all were followed up through delivery and in the neonatal period. Results: Of the pregnant mothers, 79.9% were aged between 21 and 29 years. Most patients were primigravida 113 (75.3%), and 97 (64.7%) were in the early term (37w–38w 6d). On studying the association between maternal risk factors and category II CTG, 68% had an associated risk factor. In our study, intrauterine resuscitation maneuvers did not help in improving the abnormal fetal heart pattern. Variable deceleration was the most commonly encountered CTG abnormality (50.7%). Common category II CTG abnormalities with risk factors were variable deceleration followed by tachycardia, minimal beat-to-beat variability, and bradycardia. The most common category II CTG abnormality associated with induced labor was tachycardia, and with spontaneous labor, it was variable deceleration with good beat-to-beat variability which was statistically significant. The difference in the mode of delivery between the different CTGs was statistically significant. The difference in the APGAR score and cord blood pH between CTG abnormalities was statistically significant. Conclusion: In our study, there was higher correlation seen between minimal beat-to-beat variability, tachycardia, and variable decelerations with adverse neonatal outcomes and when present should be carefully monitored and decision to be taken accordingly.

Aims and background: Menstrual hygiene is a critical aspect of women's health, and exploring the lived experience of menstrual cup usage, among nursing students, can light an insight into valuable output to educate and practice in adolescent groups. This qualitative study aims to explore the lived-in experiences, challenges, and implications of using menstrual cups among nursing students. Materials and methods: A qualitative approach with a phenomenology approach involving in-depth interviews with nursing students aged 18–23 from diverse backgrounds. A purposive sampling technique was used to select the participants from those who used menstrual cups for at least one menstrual cycle. A thematic content-based analysis with a framework was done to identify recurring patterns, themes, and insights related to the participants’ lived experiences. Results: The study revealed the multifaceted experiences of 12 nursing students using menstrual cups. Themes encompassed aspects of comfort, acceptability, challenges, and recommendations. Most of the participants were in favor of using the menstrual cup, and there were comments of difficulty in sterilizing the cup after usage. The background of the student played a significant role in shaping the attitude and experience of using the menstrual cup. Conclusions: This qualitative study provides an explored understanding of the lived-in experiences of nursing students using menstrual cups. The positive and negative experiences of initial and subsequent usage of menstrual cups are picturized in this study. Clinical significance: Nursing students are the medium of awareness to the public, and with the changing trends in menstrual practices. They can be the best reference to understand the experience in the use of menstrual cups. Further research areas suggested to explore in this study are the prevalence and long-term impact of menstrual cup usage among nursing students, including opinions from males.

Introduction: Antepartum hemorrhage (APH) is a life-threatening emergency and a leading cause of maternal and perinatal morbidity and mortality. Objective: To determine the prevalence, etiology, sociodemographic characteristics, associated risk factors, and maternal and fetal outcome in patients of antepartum hemorrhage (APH). Materials and methods: One-year retrospective study was done by the Department of Obstetrics and Gynecology, KGMU, Lucknow. All patients admitted with a diagnosis of APH were included. Data were retrieved from case sheets and hospital delivery registers. Results: Total deliveries were 9404, and 711 cases of APH were recorded. The institutional prevalence rate was 7.5%. Around 53.6% of cases were due to abnormal placental locations, 46% were due to abruptio placentae, and 0.4% were due to other causes. Around 69% of cases of abnormal placental location were of placenta previa and 31% were of low-lying placenta. Age difference in the two groups was statistically insignificant, while there was a significant difference in parity and booking status. Mean gestational age at the time of termination of pregnancy was 34.3 ± 2.3 weeks. Emergency primary LSCS was the commonest and statistically significant mode of delivery. Around 42% of patients had anemia and 17.3% had severe anemia. Around 4.3% of patients presented with hemorrhagic shock, 3.2% had DIC, and 2.7% were in ARF. Fetal complications like preterm birth, intrauterine growth restriction (IUGR), low birth weight (LBW), and neonatal unit (NNU) admissions were 65, 16, 46, and 12%, respectively. There were 40 morbidly adherent placenta and 40 cesarean hysterectomies for the same maternal mortality was 1.1%. Conclusion: Early diagnosis, advanced obstetrical care, and a multidisciplinary approach in cases of maternal hemorrhage can reduce maternal and perinatal mortality.

Aim and background: There is no reliable method to diagnose adenomyosis preoperatively. Recently, ultrasound has been suggested as a method to diagnose adenomyosis. The purpose of this study was to find out the accuracy of ultrasound in the diagnosis of adenomyosis. The objective of the study was to find the diagnostic accuracy of various features mentioned in morphological uterus sonographic assessment (MUSA) criteria by ultrasonography. Materials and methods: Patients undergoing hysterectomy for abnormal uterine bleeding over 12 months underwent the study. A transvaginal ultrasound was done preoperatively to diagnose adenomyosis using MUSA criteria. Postoperatively, histopathology was done to diagnose adenomyosis. All parameters mentioned in the MUSA criteria were analyzed to find the sensitivity and specificity of MUSA criteria in diagnosing adenomyosis. Results: Among the MUSA criteria, the highest sensitivity was for sunray appearance (80.85%) and asymmetrical thickening of the myometrium (80.85%). The highest specificity was for subendothelial lines (96.55%), translesional vascularity (93.10%), and hyperechoic islands (93.10%). Conclusion: Among the MUSA criteria, sunray appearance and asymmetrical thickening of myometrium are very sensitive markers of adenomyosis. Clinical significance: The MUSA criteria are a good marker for diagnosing adenomyosis preoperatively.

Background: Over-the-counter (OTC) medical termination of pregnancy (MTP) pill intake is on the rise across India. Clinical experience, and research, have documented several complications in such users. Adequate data from our district in this context is lacking. This study was conducted to examine the factors necessitating hospital admission in patients post-MTP pill administration and to characterize their clinical profile and sociodemographic factors. Materials and methods: This 1 year, hospital-based retrospective study was conducted in the Department of Obstetrics and Gynecology, Pramukhswami Medical College, Karamsad, Anand, Gujarat, India. Study population: Women hospitalized with a history of administration of MTP pills (self/health provider prescribed) between 1st January 2022 and 31st December 2022. A final sample size of 70 was obtained. Data source: Data abstraction from hospital records. Results: 92.85% of our study population had a self-prescribed OTC intake of MTP pills, and mainly comprised 3rd gravidas (41.42%), aged between 21 and 30 (67.14%) with pill intake at <12 weeks of gestation in 84.28%. About 87.14% presented with an incomplete abortion, complicated by severe anemia in 30% and shock in 52.85%, necessitating transfusion of blood products in 35.71%. Conclusion: Complications and treatment related expenditure far outweigh the ease of an OTC abortifacient for many. However, given the large number of those who rely on self-intake, pilot studies assessing the feasibility of the new WHO recommendations on abortion service delivery may be one step towards safeguarding both a reproductive right and their health. Clinical significance of our study: The establishment of OTC MTP pill intake as a preferred method of termination of pregnancy amongst our women, and the resultant adverse effects related to its use.

Background: Postpartum complications stand for significant challenges in maternal morbidity and mortality along with neonatal development. Antioxidants, a key contributor to preventing postpartum complications such as labor exhaustion, healing lacerations on external genital organs, restoring vigor and vitality, supporting the involution process, and helping in the preparation and secretion of breast milk by preventing oxidative damage, have emerged as potential therapeutic agents to alleviate these complications by neutralizing free radicals, reactive oxygen species (ROS) and reactive nitrogen species (RNS). The nourishment of blood (hematopoiesis) and high energy, the improvement of physique, and the holistic wellness of the mother are essential during the postpartum period. In Sri Lankan traditional medicine, a formula named “Kayam hodda” (KH) is the main and most important formula given at the onset of the delivery and during the entire postpartum period. The composition of the KH is different from the provincial vise in Sri Lanka. Aim: Therefore, the present study was carried out to evaluate the antioxidant capacity of ethanolic extracts of the different KH formulas related to nine provinces in Sri Lanka. Materials and methods: The antioxidant capacity of the KH formulas was estimated using a stable radical, 1, 1-diphenyl-2-picrylhydrazyl (DPPH) and 2,2’-azino-bis(3-ethylbenzothiazoline-6-sulfonic acid) (ABTS). Results: In the DPPH assay, the Western province formula of KH (WPF) extract exhibited the highest antioxidant capacity [44.38 ± 0.4% (44.38 mean; 0.70SD; 0.40SE)], while the Northern province formula (NPF) of KH recorded the lowest (7.43 ± 0.73%). In the ABTS assay, WPF possesses the highest [60.47 ± 1.39 (60.47 mean; 2.41SD; 1.39SE)]. DPPH IC50 of aqueous extract of WPF is 21.95. Conclusion and clinical significance: This study directs future research on the antioxidant activity of individual ingredients and the benefits of antioxidant activity as a therapeutic strategy to overcome postpartum complications associated with harming radicals to restore the health of the puerperal woman through the preclinical and clinical studies proving the efficacy and safety of KH supplementation during the postpartum period. Moreover, this could be develop as a user-friendly nutraceutical by analyzing and finalizing the required dose, and frequency adjuvants, aiming to restore health with better postpartum care.

Background: Optimum postoperative pain management is vital in enhancing recovery and maternal comfort following cesarean delivery. Transversus abdominis plane (TAP) block, a fascial plane block is an effective technique for managing postoperative pain after abdominal surgeries. Wound-site infiltration (WSI) is an established technique for analgesic management. Our research analyzes the pain-relieving effect of this fascial plane block vs WSI following cesarean delivery. Materials and methods: This trial, a double-blinded randomized study performed at AIMS Hospital, Karnataka over 3 months included 60 parturients posted for elective surgical delivery under subarachnoid block (SAB) who were randomly allocated into: TAP block group A (n = 30) receiving 20 mL of 0.25% of ropivacaine on either side and WSI group B (n = 30) receiving 20 mL of 0.25% ropivacaine infiltrated along the incision. Primary outcome was to note the time to first rescue analgesia demand. Secondary variables evaluated visual analog score (VAS), total first rescue analgesic needed, total number of parturient's needing second rescue pain management in 24 hours following surgery, also sequelae correlated to TAP block and infiltration method. Results: The average time for initial rescue analgesic in group A is 13.03 ± 1.24 hours, whereas in group B is 3.23 ± 1.072 hours (p = 0.001). The VAS scores at intervals 2, 4, 6, 12, and 24 hours were minimum in group A than in group B. In addition, group A had a considerably minimum analgesic demand in first 24 hours (p < 0.001). Conclusions: The TAP block with 0.25% ropivacaine provides superior postoperative analgesia compared with WSI in patients undergoing cesarean delivery under SAB. This approach should be used as part of a multimodal pain management for better postoperative recovery and patient comfort.

Aim: Various medical methods are available to manage intrauterine fetal death (IUFD). The current study aimed to evaluate the effectiveness of mifepristone as a termination method for IUFD. Methods: This prospective observational study included 128 patients with IUFD from the Department of Obstetrics and Gynecology, Chattogram Medical College Hospital (CMCH), Bangladesh, from January 2021 to June 2021. The primary induction method was Mifepristone 200 mg for 8 hours of six doses. Outcome measures included successful vaginal delivery within 72 hours of the onset of induction, maternal complications, and mifepristone's side effects. Results: More than half of the women (52.3%) were 20–29 years. Around 56.3% of the participants were multigravida, and 40.6% were gestational age 24–32 weeks. Ten women (7.8%) reported a previous history of uterine surgery. Mifepristone successfully induced labor as a primary method in 89 (69.5%) cases. In the other cases, secondary induction methods (misoprostol – 18.8%; oxytocin – 10.9%) were needed. Successful delivery within 72 hours was met in 61.7% of cases, and in 35.2% of cases, vaginal delivery occurred after 72 hours of induction. A psychological upset was the most frequent (21.9%) maternal complication, followed by fever (8.6%) and the need for blood transfusion (7.8%). Conclusion: Mifepristone is very effective and safe in the termination of IUFD. However, few cases need augmentation with oxytocin and/or misoprostol.

Aim and background: Dengue fever (DF) is a mosquito-borne febrile illness and has a varied clinical spectrum in pregnancy. This study aims to find out the feto-maternal outcome in pregnant women with DF from July 2019 to July 2022 at a tertiary care rural institute in northern India. Materials and methods: This cross-sectional observational study was carried out during the study period from July 2019 to July 2022. Pregnant women, irrespective of the gestational age; tested positive for dengue illness and were included in the study. Baseline socio-demographic data, obstetric data, and laboratory data were noted. Neonatal outcomes and details of any complications till the time of discharge from the hospital were noted. Statistical analysis was done using software SPSS version 22.0 (Statistical Package for Social Sciences). Results: During the study period, there were 317 pregnancies complicated with fever, a total of 32 pregnancies with dengue with a mean maternal age of 24.6 ± 3.4 years were included in the study. All women had presented with fever. Three patients presented with dengue hemorrhagic fever and one with dengue shock syndrome. Eight patients (25%) required admission to an intensive care unit for management. Platelet transfusion was required in 9 cases. Six patients had a preterm delivery; cesarean section rates were 34.4%. Around 9.4% of cases were complicated with ARDS, 15% were reported to have acute kidney injury (AKI), and 18.8% and 3.1% had a postpartum hemorrhage and hematoma formation, respectively. Around 12.5% mortality was observed among the study population. The mean birth weight of the neonates was 2375 ± 965 gms. A total of five stillbirths were reported during the study. Conclusion: With a high maternal mortality rate of 12.6%, dengue during pregnancy adversely impacts both maternal and fetal outcomes. Clinical significance: Early diagnosis, close materno-fetal monitoring, and timed interventions are essential to improve the feto-maternal outcomes.

Background: The relevance of postpartum women attending contraceptive clinics should be emphasized in efforts to increase postpartum contraception use. The impact of communication-balanced interventions using appointment cards and mobile telephony on increasing contraceptive acceptability among postpartum women was studied. Materials and methods: Two hundred postpartum women given routine appointment cards for contraceptive counseling were randomly allocated to two groups: control (no reminders) and interventional (appointment cards + text message reminders). These women were pursued to determine the percentage from the control and interventional groups who attended the contraceptive clinics. Their socio-demographic profile, contraceptive choices, and effectiveness of contraceptives were recorded. Results: Results showed that only 4% of those in the control group visited the contraceptive clinic, compared to 20% of those in the interventional group (those who received text messages). The women's top choices for contraception include the intrauterine device (IUD), progesterone-only pill (POPs), and deoxy-progesterone acetate. Contraceptive techniques were chosen by all the women who attended clinics, as opposed to just 44% of the women who did not. Conclusion: This study has identified the impact of communication interventions to increase the acceptability of contraceptive methods among postpartum women. Interventions delivered by mobile phone were effective as compared to routine appointment cards to motivate postpartum women to attend contraceptive clinics. Clinical significance: Communication-balanced interventions boosted contraceptive clinic attendance and acceptance among postpartum women. Therefore, efforts should be focused on educating postpartum women on the necessity of attending contraceptive clinics.

Objective: Comparing maternal and perinatal outcomes in emergency cesarean hysterectomies with elective cesarean hysterectomies. Materials and methods: “Prospective observational study” conducted at two centers in India from July 2018 to June 2022. Results: About 45 patients underwent cesarean hysterectomy. Out of this, 26.7% underwent elective CH and 73.3% underwent emergency CH. “Placenta accreta” was the most common and the only cause for elective CH (100%) whereas the most common cause for emergency CH was found to be atonic PPH (72.7%) which was followed by ruptured uterus (27.3%). The average duration of surgical procedure was much higher in the emergency CH compared with emergency CH group (177.73 ± 5.88 minutes vs 118.75 ± 4.33 minutes; p < 0.001). ICU care was required in 90.9% patients of emergency CH patients in comparison with 25% of patients who had elective CH (p-value of 0.002). Patients who underwent emergency CH required massive blood transfusions much more frequently (100%) than those who underwent elective CH (25%), (p < 0.001). Duration of stay in ICU in patients who underwent emergency CH was much more compared with elective CH (9.00 ± 3.40 days vs 3.40 ± 4.39 days), (p < 0.001). Severe maternal morbidities were more common in patients who underwent emergency CH (100 vs 25%; p < 0.001). Maternal death was more prevalent in emergency CH when compared with elective CH (18.2% vs zero; p-value of 0.113). Intraoperative bladder injury was seen in 50% of patients who underwent elective CH (p < 0.001). Stillbirth was more common in emergency CH (54.5% vs zero; p-value of 0.001). Babies born with poor APGAR score at 1 minute were much more in emergency CH (100% vs zero; p-value of 0.001). Conclusion: Elective CH has far less adverse maternal and neonatal outcomes. Whenever adverse outcomes are anticipated with cesarean, it is highly advisable to be prepared for an elective CH.

Aims and background: Currently, there is no consensus on the standardization of clinical phenotype data for endometriosis patients. The WERF-Endometriosis Phenome and Biobanking Harmonization Project initiated the development of standardization methods for collecting research samples of surgical phenotypes and clinical/biological data related to endometriosis research worldwide. Therefore, translation of the WERF-EPHect Clinical Questionnaire (Standard) (WERF EPQ-S) into Bahasa Indonesia and the validation of this questionnaire is required. To create a standard for taking clinical phenotype data for endometriosis patients by translating and validating WERF EPQ-S content. Materials and methods: This research was conducted using the transcultural adaptation method. This validation test WERF EPQ-S questionnaire was carried out through a process of forward–backward translation, harmonization by experts, cognitive debriefing to questionnaire targets, and proofreading and finalization by experts. Results: Translation and validation of the Indonesian version of the WERF EPQ-S questionnaire had 10 stages. There are cultural differences from the country of origin of the questionnaire, including medicines available, medical terms that are common in the country of origin but unfamiliar in Indonesia, and the presentation of racial tribes that do not describe variants of Indonesian ethnic tribes. The duration of finishing the questionnaire population was 79.3 minutes, and out of 116 questions, there were 21 that required to be guided. Conclusion: The WERF EPQ-S Indonesian version was obtained with contents according to users’ needs. Such a transcultural adaptation method is needed for this tool for the population. The WERF EPQ-S version in the Indonesian language is a valid questionnaire and is ready to be applied to endometriosis patients in Indonesia. Clinical significance: The translation and validation of the WERF-EPHect Clinical Questionnaire into Bahasa Indonesia represent a crucial step toward establishing a standardized and culturally relevant tool for collecting clinical phenotype data from endometriosis patients in Indonesia.

Postpartum hemorrhage (PPH) is a leading cause of maternal morbidity and mortality, with secondary PPH due to uterine artery pseudoaneurysm being a significant concern due to its rare and delayed presentation. Here we have discussed a case of secondary PPH presented at postoperative day 39 of an elective cesarean section. She was diagnosed with pseudoaneurysm of the uterine artery in a computed tomography (CT) angiography of the pelvis. After a multidisciplinary approach, the patient underwent uterine artery embolization under local anesthesia, where glue embolization using a 30% histoacryl and lipiodol mixture was done. The patient has recovered well and is still on regular follow up. This case highlights the need to recognize and manage uterine artery pseudoaneurysms in secondary PPH. Uterine artery embolization offers a highly effective, minimally invasive, and fertility-sparing alternative to more invasive surgical treatments. Early diagnosis and a multidisciplinary approach are essential for improving maternal outcomes.

Background: Toxic shock syndrome (TSS) is a lethal complication, which is rare. It is mediated by a toxin and can rapidly produce shock and multiorgan failure. It can lead to symmetrical peripheral gangrene (SPG), which is defined as ischemia or two or more limbs without obstruction of a large vessel or any vasculitis. Toxic shock syndrome can occur in some other clinical situations as well, like burns, nasal packing, and menstrual issues. The incidence of this syndrome is extremely low in gynecology, especially after intrauterine contraceptive device (IUCD) insertion. Case description: A 34-year-old female patient (Para 4 plus1), postpartum with lactational amenorrhea, was admitted as uterine perforation from the ER after IUCD insertion. The main complaints were abdominal pain, nausea, and vomiting. The patient's vital signs at admission were normal, but she developed shock within the next few hours. The patient was started on IV fluids, antibiotics, and analgesia and kept under observation. The patient became hemodynamically unstable. Official ultrasound revealed IUCD inside the uterus, marked fluid reaching up to Morrison's pouch, left ovarian cyst 2 × 2 cm, and pouch of Douglas contained free fluid. The patient underwent exploratory laparotomy. Mild to moderate hemoperitoneum was seen. Intrauterine contraceptive device was removed. She developed TSS, disseminated intravascular coagulation (DIC), multiple organ dysfunction syndrome, and SPG in the next few days. Multidisciplinary teams were involved in the management. The patient experienced discoloration of the hands, which worsened to dry gangrene. Conclusion: Symmetrical peripheral gangrene due to this syndrome is very rare in gynecology. The mortality rate due to TSS is high, and SPG may also follow it. Early diagnosis and aggressive treatment are important to save the patient. Clinical significance: Symmetrical peripheral gangrene caused by TSS following IUCD insertion is a rare and unsuspected occurrence. This fact should be kept in mind while managing gynecology patients.

Fetus papyraceus is a rare condition, where one fetus dies during the second trimester of gestation in a case of multiple gestation. The dead fetus is flattened, mummified, and compressed between the membranes of the surviving fetus and the endometrial wall. This is frequently associated with perinatal morbidity in another twin. Ultrasonography (USG) detection is not always possible due to the anatomical position of the fetus and technical obstacles. We delineate a case of fetus papyraceus in Obstetrics and Gynecology Department in M.K.C.G. Medical College and Hospital, Berhampur, Odisha, India. A 23-year-old woman gravida, three para, two living issue one, prior normal delivery, unbooked, and vaccinated at periphery health center was admitted with complaints of labor pains and underwent normal delivery, and on inspection of placenta found a fortuitous finding of fetus papyraceus which was inside a separate sac.

Fertility preservation is crucial to prevent the spread of cancer in younger adults, especially in women of reproductive age. A 30-year-old woman with breast cancer was referred for fertility preservation, despite having no family history of breast cancer. The couple was offered embryo cryopreservation before chemotherapy, and the procedure involved controlled ovarian stimulation (COS) with letrozole supplementation. The couple retrieved 13 oocytes, with 11 being metaphase 2 of which 9 fertilized. The oocytes were stimulated and monitored serially for blood estrogen levels. Fertility preservation is essential for improving the quality of life for cancer survivors and reducing concerns about increased estrogen levels in women with breast cancers. Multidisciplinary collaboration between oncologists and reproductive specialists is needed to improve awareness and availability. Early referral to a fertility specialist is essential for optimal results.

Background: Protein S (PS) deficiency is an inherited thrombophilia and is inherited as autosomal dominant form. When it occurs in pregnancy, there may be adverse outcomes for both the mother and the fetus. Mother can have recurrent thromboembolic episodes and recurrent pregnancy loss (RPL), while baby can have fatal condition like purpura fulminans (PF) when it occurs in homozygous state. Case description: We present to you a case of chronic deep vein thrombosis from the past 2 years which was diagnosed to be due to PS deficiency. While she was on oral anticoagulant thromboprophylaxis (Dabigatrin), she had conceived spontaneously. During her antenatal period, she was prescribed low molecular weight heparin thromboprophylaxis (Enoxaprin) throughout pregnancy. She underwent an emergency cesarean section and had a good pregnancy and fetal outcome. Clinical significance: Anticoagulation therapy plays a vital role in achieving a successful pregnancy outcome in cases of inherited thrombophilias.

Introduction: Gartner's duct cysts are remnants of the Wolffian duct system, which regresses in females but can occasionally persist. These cysts are relatively rare, found in about 1% of women with Gartner's duct remnants. A simple technique is described here for the complete excision of a giant Gartner cyst. Case description: A 37-year-old, Para 1, living 1, with a previous lower segment cesarean presented to the gynecological outpatient department of Dr RML Hospital with complaints of mass coming out per vaginum for 1 year. She was diagnosed to have a vaginal cyst, 11 years ago during her treatment for primary infertility for which a simple incision and drainage were done. The cyst recurred 7 years later. She had to manually reposit it. Investigations: Transvaginal ultrasound report showed a large, thick-walled cystic anechoic lesion of 11 × 6 cm lateral lo left ovary. Magnetic resonance imaging (MRI) pelvis showed a well-defined large cyst arising from the anterior wall of the vagina of 5.9 × 2.5 × 11.9 cm. The patient had complete Gartner duct excision under regional anesthesia, using methylene blue for delineation of the cyst wall. Conclusion: This is a simple technique for complete excision of the cyst vaginally. Methylene blue dye is a cheap and easily available alternative to fluorescein dye used in other studies.

Rowell syndrome is one of the peculiar diseases of the skin. It is characterized by its resemblance with systemic lupus erythematosus (SLE) and erythema-multiforme (EM)-like lesions. Criteria of its diagnosis as given by Rowell reflected similitude with that of SLE. Recently, two more diagnostic criteria were reanalyzed by Zeitouni and Torchia. Complications during pregnancy cause poor maternal and fetal outcomes. Mother suffers from exacerbation of the lupus, renal impairment, development of hypertension, or venous thromboembolism. Antepartum complications include prematurity, intrauterine growth restriction, fetal miscarriage, neonatal lupus syndrome. Neonatal lupus may also present in its severe form as congenital heart block in up to 2% of newborns in women who are Anti-RO positive.

Müllerian duct anomalies (MDAs) refer to defects arising during the embryological development of the female reproductive system. They are characterized by the failure of vertical fusion of the bilateral paramesonephric ducts with the urogenital sinus. Patients usually present with primary amenorrhea, infertility, recurrent miscarriages, and abdominal pain. Here, we discuss 9 patients who had presented to our tertiary care teaching institute with varying symptoms and were diagnosed with Müllerian anomalies and their management at our hospital.

These days, there is a noticeable rise in the number of pregnancies ending in scar surgery. This could be explained by the rise in the number of cesarean sections performed as well as advancements in diagnostic technologies like transvaginal ultrasonography (TVUS). In obstetrics, diagnosing and treating ectopic cesarean scar pregnancy (CSP) has become difficult. The study's objectives are to assess different diagnostic techniques (namely, ultrasonography) and examine successful CSP treatment strategies based on the patient's hemodynamic profile, factor, and current facility conditions. Considering all of the dangers and issues associated with a CSP, we must assess the patient and manage them accordingly, making the right decisions as soon as possible. In our study, we present four different cases where all patients presented in different ways and hence managed accordingly with good clinical outcome. As the patients came to us were referred from periphery centers in emergency after getting treated inadequately and we had less time for the evaluation in emergency and the diagnosis was blurred due to nonavailability of expertise during emergency hours. But if we rely on our clinical skills and do not delay the treatment, we can save the life of patient. We have managed the patients with exploration followed by obstetric hysterectomy in cases where patient had hemodynamically instability or going toward sepsis but also, we have given trial to conservative methods such as injectable methotrexate (MTX), uterine artery embolization (UAE) and USG-guided hysteroscopic dilatation and curettage, hence preserving the uterus. But sometimes, as in case no 1, we tried medical management along with UAE but eventually failed and had to go for obstetric hysterectomy.

Preterm birth as a result of cervical insufficiency is one of the most common causes for perinatal mortality and morbidity. Alongside the traditional approach of interventions like cervical cerclages and pharmacotherapy like progesterone, newer methods like Arabin pessary are burgeoning, thanks to their safer and more effective outcomes. Articles of Arabin pessary elucidating its mechanism of action, its outcomes and its comparison with other methods were collected, and an integrative review has been penned to shine a better understanding on its utilization.

This narrative review explores the characteristics and outcomes of facility-based quality improvement (QI) projects pertaining to maternal health, conducted over the last decade in low- and middle-income countries (LMICs). The literature on this topic was searched in PubMed, Medline, and Google Scholar, and 33 QI articles were identified. We used the quality standards proposed by the World Health Organization (WHO) quality of care framework for this review. The QI projects were analyzed based on several themes: the methodology adopted in the projects, interventions and outcomes, and common limitations of QI projects. In this review, we found that although LMICs have implemented several QI projects, there is still a deficiency in many key areas. The authors also synthesized 12 key steps that can be followed in future QI projects conducted in LMICs. This review highlights the importance of conducting QI projects in LMICs and encourages health administrators to focus on key areas identified by the authors.

Aims and background: Fetal growth restriction (FGR) poses a risk for neurodevelopmental impairment in the fetus. Hence, a literature review is essential to understand the correlation between cognitive, motoric, and linguistic impairments in term-born children who are appropriate for gestational age (AGA), particularly concerning FGR and small for gestational age (SGA) conditions. Materials and methods: Studies were reviewed through medical databases: PubMed, Science Direct, Google Scholar, and Research Gate. The keywords used were FGR and cognitive and motoric and language following Boolean operator rules. The written study was analyzed and synthesized through qualitative and quantitative approaches. The study quality was analyzed for presence of bias; non-randomized studies were evaluated and scored using the methodological index for non-randomized studies (MINORS). Results: There were 5 studies with a total sample of 550. Fetal growth restriction are significant influencing impairment in cognitive [MD –0.37 (–0.55, –0.18); 95% CI; z = 3.91; p < 0.0001], motoric [MD –3.53 (–4.63, –2.43); z = 6.29; p < 0.00001], linguistic [MD –8.02 (–14.77, –1.26); 95% CI; z = 2.32; p = 0.02] compared with AGA. Overall, the included non-randomized studies had an average MINORS score of 18–22. Conclusion: Children born at term with FGR exhibited significant impairments in cognitive, motoric, and linguistic development compared with children born with AGA. Clinical significance: Development impairment in cognitive, motoric and linguistic are found to be significant in children born at term.

In light of the COVID-19 pandemic and other emergencies, telehealth has become vital for improving women's health since it offers easy access to medical care. This strategy makes virtual consultations, remote monitoring, and access to expert treatment possible to address various health needs, such as mental health, chronic illness management, and reproductive health. Women are enabled via telehealth to take a more active role in their health decisions by removing obstacles associated with time and place. However, issues, including unequal access, digital literacy, and privacy concerns, must be resolved to realize its full potential. To grow these services, it will be crucial to maintain innovation and inclusivity, as this study examines the advantages, difficulties, and potential future directions of telehealth in women's health.

Human breast milk is of utmost importance in nurturing newborns as it furnishes them with vital nutrients and immune elements that are pivotal for their overall growth and maturation, majorly influencing the formation of infants’ gut microbiota. In situations where direct breastfeeding from the mother is unfeasible, pasteurized human donor breast milk sourced from human milk banks (HMBs) becomes an indispensable alternative for preterm and ill neonates. In this article, we delve into the bacterial makeup of pasteurized human milk found in HMBs. Our goals encompass exploring the range of microorganisms present, pinpointing potential sources of contamination throughout collection and processing, delving into the impact on healthcare, and evaluating the effectiveness of quality control steps. Recent breakthroughs in sequencing technologies have revealed an exciting discovery: Pasteurized human milk is teeming with a diverse array of bacteria. Among them are some friendly ones, such as bifidobacterium and lactobacillus, which have the potential to positively impact the gut health of newborns. While formerly believed to be sterile, human milk is today understood to be a dynamic ecosystem. The microbial diversity within pasteurized breast milk is influenced by maternal factors like diet and genetics. The risk of contamination arises during the collection, handling, and processing of milk. human milk banks follow strict quality control protocols, which mainly include donor screening, standardized collection, thorough pasteurization, and microbiological testing. The article raises questions about optimizing microbial diversity's benefits while mitigating risks, involving collaboration among clinicians, researchers, and HMBs. To ensure safety and quality, HMBs employ diverse strategies. Donor selection, sterile collection techniques, standardized pasteurization, and microbiological testing play critical roles. Proper storage and transportation practices are also essential. Staff training and quality assurance protocols further strengthen the safety and quality of pasteurized human milk, ultimately benefiting vulnerable neonates in need of nourishment and care.