Thin endometrium is frequently encountered during the treatment of female infertility. It is associated with lower implantation and pregnancy rates. Adequate growth is an integral step in endometrial receptivity and embryo implantation. Several modalities have been studied and include extended estrogen, pentoxifylline, tocopherol, low-dose aspirin, acupuncture, neuromuscular stimulation, L-arginine, vaginal sildenafil, granulocyte colonystimulating factor (G-CSF), and stem cell therapy. Studies show that vaginal sildenafil appears to be the first-line therapy option, G-CSF appears to be a potential second option, while stem cell therapy appears a new promising treatment modality.

Aim: To study the effects of cluster of differentiation 4 (CD4) level on abnormal cervical cytology in human immunodeficiency virus (HIV)-infected women who have not received highly active antiretroviral therapy (HAART). Materials and methods: Retrospective cross-sectional study was carried at Hatyai Hospital from October 1, 2010 to June 30, 2016. Medical records of 270 HIV-infected women who have not received HAART and have been screened for cervical cancer with Pap smear were reviewed. The CD4 level has been evaluated in all patients. Participants were divided into two groups: 135 patients with CD4 < 200 cells/ìL (low CD4 group) and 135 patients with CD4 at least 200 cells/ìL (high CD4 group). Statistical analysis was performed. Results: The prevalence of abnormal cervical cytology in HIVinfected women who have not received HAART was 25.9%. There was difference in prevalence of abnormal cervical cytology between low and high CD4 groups (37.8 vs 17.0%) with statistical significance (p = 0.001). Odds ratio was 2.60 (95% confidence interval: 1.47–4.61). Conclusion: The low CD4 level (CD4 < 200 cells/ìL) in HIVinfected women who did not receive HAART increased risk of abnormal cytology of 2.6 folds, compared with high CD4 level (CD4 at least 200 cells/ìL). The prevalence of abnormal cervical cytology in HIV-infected women who have not received HAART was 25.9%. Clinical significance: Human immunodeficiency virus infection is the significant risk factor of cervical cancer. The authors evaluated the effects of CD4 level on abnormal cervical cytology in women who have not received HAART.

Aim: The study aims to assess the utility of visual inspection methods—visual inspection with acetic acid (VIA) and visual inspection with Lugol's iodine (VILI)—for detecting premalignant lesions of the cervix in low-resource settings. Materials and methods: The duration of the study was 1 year from May 1, 2014 to April 31, 2015 and was conducted at Medical College, Kolkata. A total of 2,278 apparently healthy, sexually active women aged 21 to 45 years were selected for the study. A Pap smear, VIA, and VILI were performed on all patients. Colposcopy-guided biopsy (considered as gold standard investigation) was performed on patients who tested positive for any of the above screening tests. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the various screening tests were compared. Results: A total of 2,278 women were screened, of which 382 were lost to follow-up. Of the remaining 1,896 women, positive screening test was reported with Pap smear for 162 (8.5%), VIA for 306 (16.08%), and VILI for 338 (17.83%). In the present study, the sensitivity, specificity, PPV, and NPV of Pap smear were 81.36, 93.79, 29.63 and 99.37% respectively. For VIA, sensitivity, specificity, PPV, and NPV were 86.75, 86.06, 16.34, and 99.43%, whereas for VILI were 86.44, 84.38, 15.09, and 99.49% respectively. Although the specificity and PPV of Pap smear were slightly higher than the visual inspection methods, there was no significant difference in the sensitivities and the NPV. Conclusion: The sensitivity and specificity of VIA and VILI are comparable to cytology and do not require any cost-intensive paraphernalia. They can be easily done and interpreted by trained health workers, reducing the burden on tertiary care hospitals. Visual inspection methods like VIA and VILI are the most legitimate alternatives to cytology for screening cervical cancer, especially in low-resource settings.

Leiomyomas are benign smooth muscle tumors of the uterus found in 20 to 50% of women of reproductive age. The objective of this study was to evaluate the fetomaternal outcome in women having pregnancy with uterine leiomyomas. We compared the clinical, obstetric data, perinatal outcomes of 28 patients from a retrospective study of 5 years in our hospital. Twenty-eight pregnant women with fibroid >5 cm were included in our study. Major proportion of patients with fibroids were in younger age group of 20 to 25 and 25 to 30 years when compared with older age group of 31 to 35 years. Fibroids were more frequent in primigravida compared with multigravida. The complications were acute abdomen, cephalopelvic disproportion, antepartum hemorrhage (APH), preterm labor, malpresentation, postpartum hemorrhage (PPH), dysfunctional labor, intrauterine growth restriction (IUGR), and retained products of placenta. Cesarean section was done in 100% of women who attained term pregnancy and one patient had technical difficulty during cesarean section with intramural fibroid extending to lower segment of size 15 × 11 cm. Because of these complications, the pregnancy with fibroids should be considered as high-risk pregnancy.

Aim: To study the diagnostic efficacy of serum anti-Müllerian hormone (AMH) in polycystic ovarian syndrome (PCOS) and its comparison with ultrasonography (USG). Study design: Prospective observational study. Materials and methods: In the study group, a total of 80 women in the age group of 20 to 35 years with diagnosis of PCOS by Rotterdam's criteria were recruited at B.R.D. Medical College, Gorakhpur, India, during the period from January 2015 to December 2016. Women without PCOS, having regular cycles which were selected randomly comprised the control group (n = 80). Serum levels of luteinizing hormone (LH), folliclestimulating hormone (FSH), testosterone, androstenedione, estradiol, fasting insulin, and AMH were measured on days 2 to 3 of natural cycle or progesterone-induced withdrawal bleeding together with transvaginal sonography (TVS) for detection of the number of small follicles (<10 mm) and measurement of ovarian volume (OV). The AMH levels above 5 ng/mL were taken as diagnostic cut-off for diagnosing PCOS. Results: Anti-Müllerian hormone was positively correlated to LH, estradiol, testosterone, number of follicles (<10 mm), and OV; and negatively correlated to FSH. No correlation was found between AMH and age, body mass index (BMI), waist–hip ratio (WHR), and fasting insulin. The AMH-based diagnosis of PCOS showed sensitivity of 91.25% and a specificity of 95%. Conclusion: Serum AMH level is a promising marker for diagnosis of PCOS, especially in cases where reliable USG data are not available or when there are no typical clinical and laboratory findings.

Objective: The study aims at testing the hypothesis that women with high serum beta human chorionic gonadotropin (β-hCG) in early second trimester have risk of developing pregnancy-induced hypertension and poor maternal and neonatal outcome. Early identification of at-risk women may help in taking timely preventive and curative management to prevent or delay complications associated with pregnancy-induced hypertension. Materials and methods: Serum β-hCG was done in 400 antenatal women between 12 and 24 weeks of gestation and they were followed up till delivery and postpartum for 7 days. Assessment of serum β-hCG and its predictability for development of pregnancy-induced hypertension and its effect on maternal and fetal outcome were done. 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. Conclusion: Elevated maternal serum β-hCG at early second trimester is a good noninvasive predictor of pregnancy-induced hypertension. The maternal and perinatal outcome was directly proportional to levels of serum β-hCG.

Background: Demographic, socioeconomic, and cultural factors account for variation in global incidence trends of ovarian malignancy. Indian cancer registry statistics revealed equally wide interstate variations and prompted us to rethink on variations in screening techniques between different population groups. The present study was undertaken to verify the feasibility and effectiveness of Risk of Malignancy Index (RMI) and cancer antigen (CA) 125 in women residing in North India and place their screening results in the context of literature relevant to geographic and ethnic variations. Materials and methods: The study is a retrospective review of patients attending a tertiary hospital in New Delhi between January 2009 and July 2011 with adnexal masses subsequently undergoing laparotomy. Information on demographic characteristics, ultrasound findings, menopausal status, CA-125, and histopathology was collected. The RMI scores were calculated and correlated with histopathological findings. Results: Mean age of participants (n = 78) was 33.8 years with an average delay of 16 months before the presentation. Seventy-three tumors turned out to be ovarian in origin. Of these, 63 were benign and 16 malignant. The CA-125 (>35 IU) was used to predict the malignant nature of tumor, with sensitivity of 75%, specificity of 76.2%, positive predictive value of 47.4%, and negative predictive value of 91.4%. In contrast, RMI (>200) had improved sensitivity of 87.5%, specificity of 91.3%, positive predictive value of 73.6%, and negative predictive value of 96.5%. Conclusion: The study demonstrated that CA-125 and RMI are feasible tools for distinguishing between benign and malignant ovarian masses for women residing in North India. Literature review revealed wide variation in performance of RMI in women living in the same geographic area and no correlations could be drawn due to paucity of data from different parts of the world. However, the ideology of individualized cut-offs for distinct ethnic and geographic groups needs additional research in future.

Aims and objectives: • To determine the proportion of women accepting immediate PPIUCD insertion. • To determine the rates of expulsion, pelvic infection, lost strings, and displacement following PPIUCD insertion among the acceptors by 6 weeks. Materials and methods: The material used in this study was copper T 380A.The modified kelly's forceps was used for the post placental insertion of copper T into the uterine cavity under aseptic precautions. Results: The acceptance rate of copper T in this study was 26.44. • The expulsion rate of copper T at the end of 6 weeks was 2.22% • There were no cases of pelvic infection or displacement of copper T in this study. Conclusion: The acceptance rate of copper T was poor which was mainly attributable to the lack of sufficient knowledge about copper T and the false beliefs regarding the impact the copper T has on the health of the individual. However in those women who accepted for copper T insertion were satisfied with the copper T as a temporary method of contraception.

Introduction: Preeclampsia becomes the main cause of both maternal and perinatal morbidity and mortality. Growth stimulation gene-2 (ST2) is a protein as sign of vascular inflammation, especially soluble ST2 (sST2). This study aims to determine the sST2 concentration on preeclampsia patients without and with complication. Materials and methods: This analytical observational study using cross-sectional design was conducted at the Polyclinic and Emergency Installation, Department of Obstetrics and Gynecology, Dr. Cipto Mangunkusumo Hospital/Faculty of Medicine, Universitas Indonesia, and Budi Kemuliaan Hospital from August to December 2015. We recruited all pregnant women with normal blood pressure and severe preeclampsia to know the difference between maternal blood sST2 on normal blood pressure, severe preeclampsia without and with complication patients. All statistical analysis was done by Statistical Package for the Social Sciences (SPSS) version 19.0. Results: There were 63 subjects consisting of 23 normal blood pressure pregnant women, 19 preeclampsia without complication, and the other 21 preeclampsia with complication. Kruskal–Wallis test pointed out that there was statistical significance among groups (p < 0.001) and significant result between groups (p < 0.001) in Mann–Whitney test. Post hoc analysis indicated that there were significant differences of sST2 level among three groups. The area under the curve (AUC) of sST2 was 96.1% [p < 0.001; 95% confidence interval (CI) 91.8–100%]. The cut-off of sST2 level in this study was 96 ng/mL with 82% sensitivity and 78% specificity. Conclusion: There is significant difference of blood plasma sST2 level among normal blood pressure and preeclampsia without and with complication group.

Aim: To study the association between antenatal umbilical cord coiling index (aUCI) and perinatal outcome. Materials and methods: This prospective study was conducted on 100 patients. The aUCI between gestational age 28 and 42 weeks was calculated by color Doppler as the reciprocal of the distance between a pair of coils. It was then correlated with the following pregnancy outcomes: mode of delivery, preterm delivery, birth weight, meconium staining, Apgar score at 1 and 5 minutes, and neonatal intensive care unit (NICU) admissions. Hypocoiled cords were those having umbilical cord coiling index (UCI) less than 10th percentile and hypercoiled cords were those having UCI >90th percentile. The results were statistically analyzed by chi-square test. Results: The mean UCI was 0.61 ± 0.16. The hypocoiled umbilical cords (UCI < 10th percentile) were significantly associated with low birth weight, meconium staining, low Apgar score at 1 minute, and increased NICU admissions with a p-value < 0.05. Conclusion: Hypocoilled cords are significantly associated with adverse perinatal outcome.

Despite considerable advances in the field of in vitro fertilization (IVF), embryo implantation and pregnancy rates have plateaued globally. Thus, much of current research focus is on embryo and endometrial assessment. Day 3 embryo transfers (ETs) have been the standard of practice for long. However, development of blastocyst culture media has led to recent switch toward blastocyst transfers, although this is associated with greater technical skill and know-how in order to optimize the culture process. We analyzed our blastocyst transfer results to see whether this strategy appeared to be a viable intervention in terms of acceptable pregnancy outcome. Our study found a pregnancy rate of 37.5% with blastocyst transfers, with the complete absence of any multiple pregnancies. Thus, we feel blastocyst transfers represent a viable intervention in an IVF program to ensure acceptable pregnancy rates and simultaneously reduce the incidence of multiple births.

Background: Conception is a rare event in women with cirrhosis with portal hypertension due to altered metabolism of sex steroids and malnutrition, provided the liver disease is well compensated. Maternal prognosis is better with extrahepatic portal venous obstruction (EHPVO) and noncirrhotic portal fibrosis (NCPF) and poor with cirrhosis of the liver. Maternal mortality ranges between 2 and 18%, being maximum with cirrhosis, whereas women with NCPF fare better with mortality rates between 2 and 6%. Perinatal mortality ranges between 11 and 18%, owing to preterm delivery or intrauterine growth restriction (IUGR). Nephrotic syndrome occurs in 0.012 to 0.025% of all pregnancies that add further insult to the uteroplacental insufficiency. Aim: In the light of advancement of modern obstetrics, the rising incidence of pregnancy with cirrhosis and portal hypertension is of common occurrence with today's obstetricians who should be well equipped to deal with the various adverse maternal and fetal outcomes associated with this condition in coordination with other specialty branches for holistic management of the case. Case report: A 35-year-old G3P1L1A1 known case of cirrhotic portal hypertension postsplenectomy 6 years earlier due to massive splenomegaly, severe anemia (pancytopenia) with immunoglobulin M (IgM) nephropathy, with previous baby having Down's syndrome presented at 20 weeks of gestation for further evaluation. Level II scan done was normal. Karyotyping of the fetus showed normal chromosomes. Upper gastroesophageal endoscopy done 2 years prior showed grade I esophageal varices. Ultrasonography abdomen showed heterogeneous echo texture of liver with cavernomatous transformation of the portal vein with extensive collaterals. The prognosis of this pregnancy was explained and continued with close monitoring with development of superimposed preeclampsia at 24 weeks of gestation. Urine routine and microscopy which showed albumin 3+, 80 to 100 pus cells, and 50 to 60 red blood cells with casts, with serum albumin in liver function test (LFT) being 1.5 at 34 weeks of gestation. She was taken up for elective lower segment cesarean section (LSCS) at 35 weeks of gestation in view of superimposed preeclampsia with IUGR and a live male baby of 1.97 kg was delivered. Conclusion: Patient had good pregnancy outcome despite having cirrhosis with portal hypertension and good renal function was achieved without steroids. Clinical significance: A multidisciplinary team approach in tertiary care center with availability of intensive care units is likely to yield best pregnancy outcome in pregnant women with cirrhosis and portal hypertension despite various associated complications.

Aim: Thrombotic complications like thrombotic thrombocytopenic purpura (TTP), hemolytic uremic syndrome (HUS), and posterior reversible encephalopathy syndrome (PRES) in pregnancy are due to the deposits of platelet and fibrin in the microvasculature damaging and destroying the passing red blood cells (RBCs) and platelets so as to cause hemolysis, thrombocytopenia, and anemia. They are relatively rare fulminant life-threatening conditions, which can lead to significant perinatal and maternal morbidity and/or mortality. Pregnancy itself is thrombus prone and conditions like preeclamptic toxemia (PET), eclampsia, and hemolysis, elevated liver enzymes, and low platelet count (HELLP) are not only occasionally associated, but can add to the gravity of the seriousness. Case report: Three cases each of TTP, HUS, and PRES are being presented with their case history treatment and outcome to show the similarity in their presentation along with diagnostic dilemma, clinching diagnostic tests, and overall management with specific treatment in individual cases. Conclusion: The TTP, HUS, and PRES are life-threatening complications in pregnancy without any signs of early recognition. Awareness of the condition and prompt action is the need to avoid perinatal and maternal mortality and morbidity associated with these syndromes.

Introduction: Intimate partner violence (IPV) is a significant, yet preventable public health problem that affects millions of women regardless of age, economic status, race, religion, ethnicity, sexual orientation, or educational background. The IPV has been associated with poor pregnancy outcomes, such as anemia, still birth, abruption, fetal injury, preterm delivery, and low birth weight. With this background, we did a screening study to assess prevalence, demographic features, and maternal and neonatal outcomes. Materials and methods: This is a prospective observational study done at the Modern Government Maternity Hospital, Osmania Medical College, Hyderabad, India. About 300 pregnant women admitted for various obstetric reasons during January 2013 and December 2013 and delivered were considered for the study. History and various aspects of domestic violence were obtained with a detailed written pro forma. Descriptive analysis was carried out to summarize relevant variables. Primary outcomes included incidence, risk factors, maternal morbidity, and fetal and neonatal outcome. Results: About 114 women (38%) revealed domestic violence, which is very high compared with 0.8% when there was no screening for domestic violence. A total of 186 women showed no history of violence. Demographic features and obstetric outcomes were compared. About 90% women in both groups were economically dependent. About 50% women did not have a right over their reproductive choices. About 33 women faced violence at the time of pregnancy (28.9%). Very strong association between antenatal care booking and partner abuse was observed. About 50% had less than three visits and 64.4% of abusive partners are alcoholic. Gender bias, male child preference, unemployment, and dowry were the other common causes for abuse. Abruption was seen in 6.14% in the abuse group vs 1.79% in the control group. Preterm labor was 6.14 vs 2.15%. Four women with severe acute maternal morbidity due to IPV and one case of severe sexual violence have been highlighted. Conclusion: Domestic violence and IPV are widely prevalent, and what is visible is only the tip of the iceberg. It contributes to a spectrum of maternal and fetal complications. The obstetrician–gynecologist has the unique opportunity to screen for domestic violence, and screening for domestic violence has to be made part of antenatal care. Linking up medical, legal, police, welfare homes, and counseling can go a long way. Millennium development goal (MDG) 3, i.e., gender parity, should be the route to achieve MDG 4 and 5.

Introduction: To identify determinants of maternal death, which consisted of close determinants (obstetric complications), intermediary determinants (maternal age, parity, gestational distance, nutritional status, three of delays), and remote determinants (education, employment, and income) in Boyolali district. Materials and methods: This was an observational analysis with case–control study with 21 cases and 42 controls with simple random sampling technique. Data analysis was done with univariate, bivariate with chi-square test, and multivariate with multiple logistic regression. Results: Results showed a significant association between pregnancy complications (p < 0.001), maternal complications (p < 0.001), puerperal complications (p < 0.001), maternal age (p = 0.011), and gestational range (p = 0.035). There was no significant correlation between parity (p = 0858), nutritional status (p = 0.593), delay in decision-making (p = 0.848), and delay of place of reference (p = 0.530) to maternal deaths. There was no significant correlation between parity (p = 0.858), maternal education (p = 0.363), maternal employment (p = 0.814), and family income (p = 0.373) to maternal deaths. The probability of a maternal death by having the above-mentioned risk factor is 85.5%. Conclusion: Pregnancy complication, labor complication, and parturition complication are related to an increase of maternal deaths, while maternal age and range of pregnancy are only slightly related to maternal deaths. Clinical significance: We hope that this study may improve awareness and service of health practitioners toward pregnant mothers so that we can reduce the number of maternal deaths in Indonesia.