Introduction: Induction of labor is carried out in 20% of pregnancies in some countries. The success of induction of labor depends mainly upon the cervical ripening score. The most popularly used prostaglandins, misoprostol and dinoprostone, are effective in cervical ripening but have side effects of uterine hyperstimulation and fetal hypoxia, which may increase operative intervention and admissions to neonatal intensive care units. Mechanical dilatation is an age-old method that is safe and effective but lost its popularity with fear of chorioamnionitis. Aims and objectives: To study the efficacy and safety of Foley's catheter balloon as cervical ripening method when compared with misoprostol administered vaginally. Materials and methods: In this experimental study, 50 full-term patients with poor cervical score were included. They were divided into group I—those who received intracervical Foley and group II—those who received vaginal misoprostol. The cervical score was reassessed 24 hours later. Other variables like mode of delivery, fetal heart variability, and uterine hyperstimulation were also studied. Results: Both groups I and II showed improvement in cervical score. The occurrence of uterine hyperstimulation and fetal heart variabilities was less in group I. Conclusion: Mechanical cervical ripening with Foley's balloon catheter is as effective and safer compared with msoprostol when used for preinduction cervical ripening in full-term patients.

Aim: Abnormal uterine bleeding (AUB) is a common cause for gynecological referrals. Serum correlation of hormone levels along with study of expression of estrogen receptor (ER) and progesterone receptor (PR) in the endometrium of patients with AUB may be helpful in deciding treatment. Materials and methods: Forty AUB-endometrium (AUB-E) cases classified as per PALM-COEIN (polyp, adenomyosis, leiomyoma, malignancy and hyperplasia, coagulopathy, ovulatory disorders, endometrium, iatrogenic, and not classified) classification were assessed. Endometrial biopsies were stained with hematoxylin and eosin (H&E) for histomorphological details and immunohistochemistry (IHC) for quantification of ERá and PR expression in AUB-E cases. Serum samples were obtained on the day of biopsy and examined for serum estrogen and serum progesterone levels. Unpaired Student's t-test was used for statistical calculation and p = 0.05 value was taken as critical level of significance. Results: Serum estradiol was decreased in 10%, normal in 65%, and increased in 25% cases. Serum progesterone levels were decreased in 52.5%, normal in 30%, and increased in 17.5%. Correlation of ERá with serum estradiol levels showed an inverse relationship. The difference was statistically significant (p = 0.04). Conclusion: In AUB-E cases, a hyperestrogenic state may be due to true/relative increase in serum estradiol levels. Decreased serum estradiol levels present with changes of hyperestrogenism may be due to overexpression of ERá receptors. Both expressions of receptors in endometrium and serum hormone levels play a role in the final outcome of hyperestrogenic state. Therefore, patients with normal or decreased serum estradiol levels may be investigated for expression of ERá in endometrium for deciding the final treatment. Clinical significance: Patients with AUB-E with normal or decreased hormonal levels should be investigated for ERá in endometrial biopsy to decide optimal hormonal therapy.

Aim: Studies have shown that intrauterine injection of human chorionic gonadotropin (hCG) prior to embryo transfer causes success in pregnancy. This study has been done to determine the effect of 1,000-unit intrauterine injection of hCG prior to in vitro fertilization (IVF) on success rate of implantation in infertile women. Materials and methods: This double-blind clinical trial study has been done on two intervention groups (n = 40) and control group (n = 40), who were randomly selected. For the intervention group cases, soft catheter penetrated the uterus and 0.3 cc of liquid fetus culture media with 0.2 cc (1000 unit) of hCG was injected into the uterus. After 7 minutes, the fetus was transferred into the uterus with a soft catheter. In the control group, 0.5 cc of liquid fetus culture media was injected into the uterus and after 7 minutes embryo was transferred into the uterus with another soft catheter. In both groups, the speculum was removed after 3 minutes. Results: The results of this study showed that pregnancy success was the same in both intervention and control groups and it was in eight cases (20%). In this study, 38 cases (95%) of the agonistic cycle type were in the intervention group and 33 (82.5%) cases were in the control group (p > 0.05). On assessment of the situation of pregnancy of each person according to the ultrasound results, the size of right and left ovary in two groups showed no significant differences (p > 0.05). Conclusion: The pregnancy success during the IVF process is related to the quality of the blastocyst in the secretion of many cytokines and hormones in the early days of egg cell implantation, such as interleukin 1 and hCG, and increased level of these hormones and mediators causes disruption of the process of making proteins needed for implantation at the start of the initial development.

Aim: To observe fetomaternal outcomes of both pulmonary and extrapulmonary tuberculosis (TB) in pregnancy as well as effects of pregnancy on TB. Materials and methods: Antenatal patients with history of chronic cough, expectoration, and weight loss were enrolled and included from antenatal, chest medicine, medicine outpatients as well as from obstetric emergency and labor wards. Detailed history, examination, sputum for acid-fast bacilli (AFB), and culture were used to diagnose, and additional investigations, such as cassette-based nucleic acid amplification test (CBNAAT), Mantoux, chest X-ray, and computed tomography (CT)/magnetic resonance imaging (MRI) according to indications were used. Affected patients received antitubercular treatment (ATT) according to Revised National Tuberculosis Control Program (RNTCP) guidelines. Maternal weight gain in pregnancy, time and mode of delivery, fetal prematurity, growth restriction, and medical complications in pregnancy were chief parameters observed. Results: A total of 14 patients were diagnosed with TB in pregnancy over 18 months from August 2015 to January 2017. Women who booked early in pregnancy had better weight gain, later gestation of delivery (38 vs 35 weeks), higher fetal birth weights (2,745 vs 1,835 gm) at delivery than those who booked late. Among the patients who booked late, one developed TB pericarditis, one had central nervous system (CNS) tuberculoma, and another lady died due to fatal pulmonary embolism from deep vein thrombosis (DVT) due to immobility. One of the preterm babies had congenital TB. Conclusion: Tuberculosis, particularly extrapulmonary and presenting in advanced pregnancy, can be confused and missed, leading sometimes to catastrophic consequences. Clinical significance: Pulmonary TB detected early and treated has an uneventful course in pregnancy. Any duration of TB treatment in pregnancy and postnatally should be accompanied with thromboprophylaxis, if immobility is present.

Objectives: The purpose of this study was to test the association between elective induction of labor and cesarean delivery and to determine maternal and neonatal outcomes in elective induction of labor. Materials and methods: We conducted a retrospective matched cohort study in a tertiary care hospital from January 2014 to December 2015, among 182 nulliparous women at gestational age of 39^0/7 weeks or more who had single live pregnancy with known cervical status of ≥5 at 38^0/7 to 38^6/7 weeks and were managed either by elective induction or expectant management. Data were compared using χ² and Student's t-test, and p < 0.05 was considered significant. Results: The cesarean delivery rate was 51% in expectant and 46.8% in elective induction group, which was not much different. Women who were electively induced spent more time in labor delivery unit (14 hours, 21 minutes vs 12 hours, 45 minutes, p < 0.01), had labor longer than 12 hours (50 vs 36.5%, p = 0.05), received more frequently oxytocin (63.5 vs 47.9%, p = 0.03), and were more likely to deliver during daytime between 6.00 am and 6.00 pm (64.5 vs 52%, p = 0.07) compared with expectant group. There were no difference with regard to obstetric events and maternal neonatal outcomes. Conclusion: Elective induction did not result in increased risk of cesarean delivery in nulliparous women with unfavorable cervix. It is relatively safe as we had observed no evidence of any other increased adverse maternal or neonatal outcomes with elective induction.

Introduction: Medical management is a keystone in managing symptomatic fibroids. Availability of an effective, safe, and costeffective medical treatment should always be considered as an alternative to reduce the cost, morbidity, and impact of avoidable major surgeries. Objective: To study the effect of 10 mg Mifepristone on symptomatic fibroids. Materials and methods: This prospective study was conducted at a tertiary care center in Raipur. Fifty women of the reproductive age group with symptomatic uterine fibroids with normal liver and kidney function tests were recruited. A total of 10 mg of oral Mifepristone was administered daily for 3 months. Monthly symptomatic assessment, ultrasonography, and biochemical parameters were done to assess changes. Results: There was significant reduction in menstrual blood loss (MBL) and associated symptoms. Amenorrhea occurred in 100% of women after 3 months of treatment. The fibroid volume and mean uterine size reduced by 26.2 and 26.99% respectively. Mean hemoglobin levels increased by 1.93 gm/dL. Observed side effects were few and tolerable. Conclusion: Mifepristone is an effective and safe alternative for the management of leiomyoma.

Objective: The study aims at testing the hypothesis that women with high serum beta-human chorionic gonadotropin (β-hCG) and serum lipid profile levels in early second trimester have risk of developing pregnancy-induced hypertension and poor maternal and neonatal outcome. Materials and methods: Serum β-hCG and lipid profile was done in 400 antenatal women between 12 and 24 weeks of gestation and were followed up till delivery. Assessment of serum β-hCG and serum lipids and their predictability for development of pregnancy-induced hypertension and its effect on maternal and fetal outcome were noted. Results: Women with high serum β-hCG levels at 12 to 24 weeks of gestation have 1.67 times more risk of developing pregnancy-induced hypertension (p = 0.035), and poor maternal and perinatal outcome. Raised total cholesterol (TC), triglycerides (TGs), low-density lipoprotein (LDL), very lowdensity lipoprotein (VLDL), TC/high-density lipoprotein (HDL) and LDL/HDL are important risk factors for development of pregnancy-induced hypertension. The mean TC level in women with pregnancy-induced hypertension was 210.1304 ± 50.7392 as compared with 178.0908 ± 47.0994 in normotensive women. The difference in levels of TC (p <0.001), TG (p = 0.0037), LDL (p <0.001), VLDL (p = 0.0193), TC/HDL (p <0.001), and LDL/HDL (p <0.001) in both the groups was statistically highly significant. Conclusion: Maternal dyslipidemia and elevated maternal serum β-hCG at early second trimester are very good noninvasive predictors of pregnancy-induced hypertension. The maternal and perinatal outcome was directly proportional to levels of serum β-hCG and lipid profile.

Introduction: Angular ectopic pregnancies implant in the intrauterine portion of the fallopian tube. Delay in diagnosis due to rarity of the condition causes high morbidity. Transvaginal two/ three-dimensional (2D/3D) ultrasound (USG) in combination with serial â-human chorionic gonadotropin (hCG) or laparoscopy confirms the diagnosis. Materials and methods: This is a retrospective case series of all angular ectopic pregnancies seen in a 40-month period (Jan 2014–April 2017) in the Obstetrics and Gynecology Department of a tertiary referral center. Of a total 245 ectopic pregnancies, 13 cases were angular pregnancy. Data pertaining to diagnosis, USG findings, treatment, and outcomes were analyzed. Results: Among 13 angular pregnancies, one underwent immediate surgery for rupture. All the other 12 were diagnosed at initial scan. The 2D USG followed by 3D USG was used for confirmation of diagnosis in all cases. Additional magnetic resonance imaging (MRI) was required to confirm diagnosis in 2 of the 13 patients. Methotrexate was successful in 6 of 12 cases. Four underwent single-dose regime (mean â-hCG = 1,688 mIU/mL; range: 1,105–2,401 mIU/mL) and two required multiple doses (â-hCG: 87,590 and 36,590 mIU/mL). Surgical management included suction and evacuation under USG guidance in three, laparoscopic cornuostomy in two, and one laparoscopic bilateral cornuostomy with unilateral salpingostomy. Conclusion: The 3D USG aids in the diagnosis of suspected angular pregnancy. Early recognition reduces morbidity, enabling fertility preservation. Medical and skilled surgical therapies are required for optimal outcome.

Aim: Study of systemic lupus erythematosus (SLE) with pregnancy to manage them in a multidisciplinary approach for better pregnancy outcomes. Materials and methods: This study was a prospective cohort study. A total of 100 pregnant women with diagnosed SLE were included in the study and another 100 age-matched normal pregnant women without any obvious complications were recruited as controls. Results: Maternal organ involvement—five patients of renal involvement and seven patients of cardiac and pulmonary involvement in SLE group—was found. Antinuclear antibody (ANA) was positive in all cases and 87 were positive for antidouble- stranded deoxyribonucleic acid (anti-dsDNA) antibody. The disease flare was found only in a single case of planned pregnancy and total nine cases of unplanned pregnancy. Most of the women, 41 (53.25%), in the SLE group were delivered by cesarean section, but only 24 (25%) in the control group underwent cesarean section. Conclusion: The SLE with pregnancy is a high-risk condition where prepregnancy disease-free interval is the most important criteria to minimize complications. Hydroxychloroquine can be used safely throughout the pregnancy. Multidisciplinary approach plays a crucial part in management. Clinical significance: Management of lupus flares and preeclampsia during SLE pregnancy is being treated with difficulties with overlapping clinical features. Presence of antiphospholipid antibodies (APLA) is a major unresolved issue. Adverse events to maternal and fetal well-being with use of appropriate medications are required for optimum outcomes.

Aims and objectives: The objectives are to study the effect of vaginal bleeding during first trimester of an intrauterine pregnancy on maternal and perinatal outcomes. Materials and methods: A prospective cohort study was conducted over a duration of 2 years of 430 pregnant women. Data of 210 and 176 women in the study and control group were studied respectively. Study group comprised of women with first-trimester vaginal bleeding and control group comprised of women with no vaginal bleeding, after ultrasonography (USG) confirmation of intrauterine pregnancy done routinely in all women. Maternal and perinatal outcomes were studied in both groups. Results: The two groups were matched in terms of age, parity, socioeconomic status, and body mass index (BMI), and no statistically significant difference was detected in these parameters. A total of 104 women (49.5%) had bleeding during 7 to 8 weeks of gestation. Miscarriage occurred in 96 women (45.7%) with first-trimester vaginal bleeding in study group compared with 20 women (10.2%) among control group; 54.3% women in the study group and 89.8% of women in control group had continuation of pregnancy. The most common type of miscarriage was missed miscarriage (40; 19%) in the study group. Maternal complications occurred more in the study group (74; 64.9%) as compared with 28 (15.9%) in the control group during the course of pregnancy. The incidence of preterm deliveries was higher in the study group (17.5%) than in the control group (2.3%). Most of the women in both the groups delivered by vaginal route. Overall, neonatal complications were higher in the study group (49.1%). The mean birth weight was significantly lower in the study group as compared with control group. Conclusion: Women with first-trimester vaginal bleeding are at increased risk of adverse pregnancy outcomes, such as spontaneous miscarriage, preterm premature rupture of membranes (PPROM), premature rupture of membranes (PROM), intrauterine growth retardation (IUGR), oligohydramnios, low birth weight (LBW), preterm delivery, and increased perinatal morbidity.

Diabetes mellitus is a chronic illness that requires continuing medical care and ongoing patient self-management education and support to prevent acute complications and to reduce the long-term complications. Moderate-to-severe maternal hyperglycemia in pregnancy has unique diabetes-related risks to mother and her unborn baby. So, gestational diabetes mellitus (GDM) is a carbohydrate intolerance that has been diagnosed for the first time during pregnancy. Approximately, 7% of pregnancies are affected by GDM. Patients with GDM are at higher risk for excessive weight gain, preeclampsia, and cesarean sections. Infants born to mothers with GDM are at higher risk for macrosomia, birth trauma, and shoulder dystocia. After delivery, these infants have a higher risk of developing hypoglycemia, hypocalcemia, hyperbilirubinemia, respiratory distress syndrome, polycythemia and subsequent obesity, and type II diabetes. The management of GDM is very important, and its management remains a challenge for obstetricians and endocrinologists. Medical nutritional therapy (MNT) is the initial and most common therapy that suffices for GDM. Pharmacological therapy becomes necessary, and the treatment of choice is human insulin. Oral hypoglycemic agents have also reached the high tables in the management of GDM. Glyburide and metformin have been found to be safe, effective, and economical for the treatment of gestational diabetes.

Occurrence of epithelial ovarian carcinoma in young women is rare. Fertility-sparing surgery is a viable option for such women. We are reporting a case of a 24-year-old nulligravida woman, diagnosed with an ovarian lesion suspicious of malignancy, in whom unilateral salpingo-oophorectomy along with omentectomy and peritoneal biopsy was done. Histopathological report showed well-differentiated epithelial ovarian carcinoma [International Federation of Gynecology and Obstetrics (FIGO) stage IA, grade I], and after 1½ years of surgery, she conceived and delivered a healthy baby at term.

Background: Placental abruption usually presents as an acute event needing emergent measures, but may even present with diverse clinical features. Aim: We report a case of chronic abruption oligohydramnios sequence, a rare entity in itself. Case report: We report an atypical case of a 20-year-old primigravida at 16 weeks of gestation who had complaints of mild pain in the lower abdomen for 1 month and minimal bleeding per vaginum for a day. Her vitals were stable but she was severely pale. On per abdominal examination, uterus was felt corresponding to 20 to 22 weeks gestation and basal tone of uterus was raised. Ultrasound findings revealed a dead fetus of 16 weeks gestation and a large retroplacental clot of 12.5 × 7 cm. The patient was given three units of packed cell volume after which she started having uterine contractions and delivered uneventfully 23 hours after admission. Conclusion: In our case, favorable maternal outcome was because of early diagnosis and treatment of chronic abruption as discussed. Clinical significance: Chronic abruption should be an important differential diagnosis in patients presenting with pain in the abdomen in early pregnancy.

Fecoliths cause many complications in pregnancy, such as dystocia, rupture uterus, and malpresentation. Obstructed labor due to a fecolith in the rectum and colon is very rare. We are presenting a case of obstructed labor and malpresentation caused by a large fecolith.

Spontaneous rupture of urinary bladder following vaginal delivery is a surgical emergency. We present a case of primipara who presented on 6th day following instrumental vaginal delivery with distention of abdomen, massive urinary ascites, and anuria due to intraperitoneal rupture of urinary bladder. Computed tomography (CT) retrograde cystogram showed rupture at the dome of bladder for which exploratory laparotomy was done. Diagnosis of intraperitoneal bladder rupture was confirmed and the rent was repaired in two layers. Prolonged drainage of bladder was carried out. The patient on follow-up after 8 weeks did not show any voiding abnormalities.

Acrochordon commonly known as skin tag is a benign mesenchymal lesion which appears on keratinized surface of skin folds. Most of them are 2 to 5 mm in dimension. Females have a greater predilection for the vulvovaginal region as compared with the cervix. The diagnosis may be misunderstood as being malignant due to its clinical picture and hence, histopathology report may be necessary for confirmation. This case reports the rarest of its kind with regard to its size measuring 55 × 10 × 20 cm. Thus, it becomes the largest acrochordon reported till date.

Objective: This prospective study was undertaken to increase postpartum family planning (PPFP) acceptance among urban slum dwellers in Agra city by initiating postpartum (PP) women tracking through free phone calls and effective counseling by counselor, wherein the potential clients can be followed up and called back to the health facility for postnatal care (PNC) checkups and immunization of the newborn and helped in making an informed choice of the PPFP method best suitable to them. Materials and methods: A thorough analysis of PPFP methods at the PP center at S.N. Medical College, Agra, India, showed that the acceptance of PPFP methods was low. To boost up the PPFP program, an innovation of mobile tracking of PP women was done by a counselor. Every day the experienced counselor counseled all women in early labor in clean labour room (CLR) and recently delivered clients in PNC ward and postoperative ward on PPFP methods and services. Some of them adopted immediate PP intrauterine contraceptive device (PPIUCD) or ligation, while others were tracked by the counselor through their mobile numbers for the next 2 months. The counselor makes the following free phone calls to the potential clients: First call within 3 to 7 days of delivery Second call in 20 to 42 days of delivery Third call in 42 to 60 days of delivery This tracking was started in 2013 and completed in 2016. The results of acceptability and acceptance have been compiled. Results: • This pilot study has shown very promising results. Hence, according to this study, the effective PPFP has increased to 29.7%, which was initially 4.9%. • Also, PPFP acceptance has increased from 6% in 2012 to 73% in 2015, including all methods [condom and oral contraceptive pill (OCP)/progestin-only pill (POP) also]. The PP women who did not accept any method were referred to their respective nongovernmental organization (NGO) and they were then counseled by them and the acceptance further increased by another 5%. Conclusion: The tracking of PP women through mobile communication by the counselor in Agra city since last 48 months of implementation seems to be successful. It is going in the right direction. Linking up the recently delivered clients by the respective NGO to the nearby health facility for PPFP methods and services is playing an important role and will definitely improve with time and intensive efforts.