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Wali AA, Taher A, Abd-El-Fatah SM. Awareness, Knowledge, and Attitude of Egyptian Women toward Cesarean Delivery: A Cross-sectional Survey. J South Asian Feder Obs Gynae 2020; 12 (4):203-208.
Background: Cesarean section (CS) rates have almost doubled globally from 2000 to 2015, with Egypt having one of the highest rates worldwide. This survey was carried out to highlight the role of poor knowledge in increasing unindicated cesarean deliveries (CDs). Aim and objective: To assess the awareness of Egyptian women about the indication of their first CD, their knowledge about different modes of delivery, and their attitude toward CD. Materials and methods: A cross-sectional survey of 2,379 multiparous ladies, with history of at least one CS, was conducted at a tertiary university hospital, from April 2018 to August 2018. A semistructured questionnaire was used which covered sociodemographic aspects, information about previous deliveries, and 13 closed-ended questions assessing awareness, knowledge, and attitude toward CD. Results: We found that 72.8% of the women had their CS in their first delivery. The private sector is responsible for 48.5% of the primary CD. Nineteen percent of the participants did not know or were not told of their indication for CD, and nine percent had a CS upon demand. Answers showed that 54.6% of women saw CS is safer for the mother, and 63.7% that it is safer for the baby. Participants thought that CS compared to vaginal delivery is less painful (63.4%), associated with less bleeding (69.8%); does not affect emotional bonding (54.1%); protects against prolapse, urinary, and sexual problems (48.7%); and does not affect future fertility (75.8%). In addition, 44% did not know that vaginal birth is possible after a CS, 28% would opt for a CS to avoid the lithotomy position, and 72.5% did not regret delivering by CS. Conclusion: Egyptian women\'s awareness about their indication for CD is defective, and their knowledge regarding pros and cons of different modes of delivery is inadequate and incorrect.
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Armo M, Sainik S. Assessment of Menopausal Symptom Using Modified Menopause Rating Scale among Rural Women of Rajnandgaon in Chhattisgarh, a Central India Region. J South Asian Feder Obs Gynae 2020; 12 (4):209-214.
Background: Menopause is a natural process that results in atresia of almost all oocytes in ovaries, causing an increase in follicle-stimulating hormone and luteinizing hormone levels and a decrease in estrogen levels. Menopausal symptoms impact physical, psychological, vasomotor, and sexual health-related quality of life among women. Aim and objective: The study was planned with the aim to assess the commonly reported menopausal symptoms among rural women of Central India, Rajnandgaon, Chhattisgarh, using the menopause rating scale (MRS). Materials and methods: An observational cross-sectional study was carried out in the Department of Obstetrics and Gynecology, Atal Bihari Vajpayee Memorial Medical College Rajnandgaon, Chhattisgarh, for a period of 6 months. In all, 199 patients who had attained menopause were analyzed. Menopausal symptoms were assessed using modified MRS). Quantitative data were presented as frequencies and percentages by using SPSS version 21. Results: Two hundred Questionnaires were distributed among the females who attended gynecology OPD and IPD and 199 gave consent to participate in the study; the response rate was 99.5%. The mean age at menopause was 45.35 ± 4.42 years. In all, 100% of women reported having experience of more than five menopausal symptoms. The prevalence of symptoms in urogenital—sexual was 76.88%, somatic 75.62%, and psychological 73.33%. Conclusion: Menopause-related symptoms are highly prevalent among middle-aged women in rural areas of Rajnandgaon, Chhattisgarh; this signifies the urgent need for community-based screening for such condition. Physical symptoms (joint and muscle problems) are the most commonly reported one. Healthcare providers have to be sensitized to special health needs of these rural middle-aged menopausal women.
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Patil H, Kataria A, Teli A, Tamagond B, Dalal A. Analysis of Pulmonary Function and Serum Progesterone Level during Pregnancy: A Cross-sectional Study. J South Asian Feder Obs Gynae 2020; 12 (4):215-219.
Aim and objective: Pregnancy is often accompanied by physiological variations, especially variations in the respiratory function. However, there is insufficient information regarding the association of hormonal changes and pulmonary function tests in different trimesters of pregnancy. Hence This was aimed to assess the effects of progesterone levels on the lung function of pregnant women. Materials and methods: A total of 150 pregnant women comprising 50 women in each of the 3 trimesters of pregnancy were recruited for this study to compare the lung function variations across the trimesters. Both dynamic and static pulmonary function tests were measured. Serum progesterone and blood hemoglobin levels were also estimated. Data was analyzed using ANOVA and Kruskal–Wallis test. Tukey\'s HSD and Dunn\'s test were used as post hoc tests. p < 0.05 was considered as statistically significant. Results: Variations in the lung functions were observed across all the trimesters of pregnancy. Among the dynamic lung function tests, peak expiratory flow rate (PEFR, p = 0.0043) and forced expiratory flow (FEF, p = 0.0151) were significant in the first trimester. PEFR (p = 0.0047) and FEF (p = 0.016) were significant in the second trimester. Among the static lung function tests, maximum voluntary ventilation (p = 0.0003) was a significant variable in the second trimester. Progesterone levels were significant in all the 3 trimesters of pregnancy (p < 0.0001) and were associated with increased gestational age. In contrast, hemoglobin levels were insignificant throughout pregnancy (p = 0.8548). Conclusion: The progesterone levels did not have any significant association with the pulmonary function test during gestation. Clinical significance: The chronic respiratory diseases ranked third most cause and in order to evaluate any respiratory ailment during pregnancy, an accurate knowledge of the physiological changes in pulmonary functions during normal pregnancy is necessary.
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Sreenivas G, Sujatha M. Relationship between Ultrasound Measurements of Fetal Adipose Subcutaneous Tissue and Polyhydramnios with Gestational Diabetes Mellitus. J South Asian Feder Obs Gynae 2020; 12 (4):220-223.
Background: Gestational diabetes mellitus (GDM) typically diagnosed by the oral glucose tolerance test (OGTT) between 24 weeks and 28 weeks may miss diagnosis of GDM. Hence, alternative predicators have to be found to classify women as high risk for GDM and keep them under regular follow-up. Aim and objective: To assess the relationship between ultrasound measurements of fetal adipose subcutaneous tissue (ASCT) and polyhydramnios with GDM in a high-risk population attending a teaching hospital of South India. Materials and methods: This cross-sectional study with prospective data collection was performed among 120 women with singleton pregnancies after 23 weeks with at least one risk factor for GDM. Fetal ASCT and polyhydramnios on ultrasound were measured and correlated with GDM, which was diagnosed by Diabetes In Pregnancy Study Group India (DIPSI) criteria. Results: Total 11 (9.2%) of 120 study participants were diagnosed to have GDM. About 65.91% of GDM women had increased ASCT (p < 0.0001) and 56.82% had polyhydramnios (p < 0.0001). The ASCT was significantly higher in GDM (p < 0.0001). Univariate logistic regression showed thickened ASCT and polyhydramnios to be highly significant predictor of GDM (p < 0.0001). Conclusion: There is a strong correlation between thickened ASCT and polyhydramnios with GDM and can be incorporated into regular ultrasound scan after 24 weeks, thereby ensuring that no pregnant woman with GDM is missed. Further studies are recommended to explore other USG parameters with GDM.
Kamal P Patil,
Mrityunjay C Metgud,
Mallayya Kenchaveeraiah Swamy
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Kiran P, Patil KP, Metgud MC, Swamy MK. Prediction of Vaginal Birth after Cesarean Section Using Scoring System at the Time of Admission for Trial of Labor: A One-year Prospective Cohort Study. J South Asian Feder Obs Gynae 2020; 12 (4):224-229.
Aims and objectives: To assess the prediction of a successful trial of labor after cesarean section (TOLAC) using a predictive scoring system at the time of labor. Materials and methods: The present study was a prospective cohort study. Women with one previous lower segment cesarean section (LSCS) in labor admitted to the labor room, willing for a vaginal birth after cesarean section (VBAC) were included in the study and explained about the option of TOLAC with the predictive score (integer score) and its success. The predictive validity of the VBAC score was assessed by the receiver operating curve (ROC) analysis. Results: A total of 194 women were included in the study. The proportion of successful VBAC was 43.30% in the current study. The most common indication for previous LSCS in the patients who underwent repeat LSCS was nonprogress of labor (17.53%) followed by fetal distress in 12.89%. The VBAC score had good predictive validity in predicting successful VBAC, as indicated by the area under the curve of 0.853 (95% CI 0.798 to 0.908, p value < 0.001). The sensitivity of a VBAC score of 13.5 or more in predicting successful VBAC was 83.3% (95 CI 75.36% to 91.3%) and specificity was 78.2% (95 CI 70.46% to 85.9%). Positive predictive value was 74.5% (95 CI 65.65% to 83.3%), negative predictive value was 86% (95 CI 79.2% to 92.8%), and the total diagnostic accuracy was 80.4% (95 CI 74.83% to 86%). After controlling the effect of other values in the equation, the history of previous vaginal birth and high modified Bishop score were the factors that were significantly associated with successful VBAC. The symptomatic uterine rupture occurred in 0.1% of women who underwent TOLAC. No perinatal morbidity or mortality is seen. Conclusion: Vaginal birth after cesarean section score has demonstrated as a good predictive validity in predicting successful VBAC. TOLAC should be encouraged in most of the women who are willing to attempt it, provided no obstetric contraindication exists.
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Budi GK, Chalid SM, Tiro E. Comparison between Blood Electrolyte and Ketonuria Pre- and Post- 5% Dextrose—Ringer's Lactate Rehydration Compared with Ringer's Lactate on Grade II Hyperemesis Gravidarum. J South Asian Feder Obs Gynae 2020; 12 (4):230-234.
Aim and objective: To compare 5% dextrose–Ringer\'s lactate against Ringer\'s lactate solution in the intravenous rehydration of grade II hyperemesis gravidarum. Materials and methods: The research was conducted in Wahidin Sudirohusodo Hospital and the network education hospitals, using the prospective cohort method. The total samples were 66 subjects meeting the criteria and randomly assigned to receive either the 5% dextrose–Ringer\'s lactate or Ringer\'s lactate group by intravenous infusion at a rate of 125 mL/hour over 24 hours in a randomized clinical trial. All participants received neurotropic and antiemetics intravenously as well. Oral intake was not allowed. Primary outcomes were resolution of blood electrolytes and ketonuria after 24 hours. Results: There was a significant increase of the levels of blood electrolyte (hyponatremia, hypokalemia, and hypochloremia) and resolution of ketonuria after the first 24 hours of both groups. Yet, the mean increase of the levels of the blood electrolyte and resolution of ketonuria was insignificant for both groups; however, the increase of the blood electrolyte potassium level was greater in the group treated with 5% dextrose–Ringer\'s lactate. At the value of 95% CI, the mean increase of the blood potassium levels in the 5% dextrose–Ringer\'s lactate group and Ringer\'s lactate was 0.31 and 0.20 mmol/L, respectively (p 0.044). Conclusion: Intravenous rehydration with 5% dextrose–Ringer\'s lactate or Ringer\'s lactate solution in women hospitalized for grade II hyperemesis gravidarum produced similar outcomes, other than that for the greater value of potassium electrolyte in 5% dextrose–Ringer\'s lactate group.
Kumkum R Srivastava
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Sinha P, Gupta M, Sharma R, Srivastava KR. Comparison of Estimation of Gestational Age by Transverse Cerebellar Diameter with Biparietal Diameter in Third Trimester of Pregnancy. J South Asian Feder Obs Gynae 2020; 12 (4):235-238.
Aims and objectives: To determine the accuracy of transverse cerebellar diameter for assessment of gestational age in comparison with biparietal diameter (BPD) in third trimester of pregnancy using the 1st day of the last menstrual period (LMP) for calculation of the actual period of gestation. Materials and methods: The study was a prospective observational study conducted on 150 antenatal patients between gestational ages 28 weeks and 40 weeks visiting the outpatient department and emergency of Department of Obstetrics and Gynecology, Era\'s Lucknow Medical College and Hospital, Lucknow. After obtaining detailed history and doing thorough clinical examination, ultrasound of all selected cases was performed; transcerebellar diameter (TCD) and BPD were measured and compared with LMP. Results: Difference between actual gestational age and gestational age assessed by BPD ranged from −5 to 9 days and by TCD ranged from −6 to 7 days irrespective of gestational age. With respect to mean difference between estimated gestational age by TCD and actual gestational age, it was higher for 28 weeks (1.89 ± 1.32 days) and 34 weeks (1.94 ± 1.53 days) as compared to that at 36 weeks (0.82 ± 0.71 days). Statistically, this difference was significant (p < 0.001). For overall assessment as well as assessment at different gestational ages, mean error was higher for BPD as compared to TCD (p < 0.001). Conclusion: In the given scenario, both TCD and BPD were quite useful as observed in the present study; however, in statistical terms, TCD was definitely better as compared to BPD. The applicability and validity of these results in a relaxed sampling frame needs to be validated in further studies.
Laxmi S Sangolli,
Sangamesh S Mathapathi,
Shreedevi S Kori,
Neelamma G Patil,
Rajasri G Yaliwal,
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Sangolli LS, Biradar A, Mathapathi SS, Kori SS, Gowda S, Patil NG, Yaliwal RG, Gamini B. Determinants in Outcome of Tubal Recanalization: A Prospective Cohort Study. J South Asian Feder Obs Gynae 2020; 12 (4):239-242.
Introduction: Tubal sterilization is the most prevalent family planning method practiced in our country. According to National Family Health Survey (NFHS 4) (2015–2016), a total of 51.8% of married women use any method of family planning, of which female sterilization accounts for majority with 48.6%, use of intrauterine device (IUD) by just 0.8% of women, pills by 0.4% of women, and condom by 1.3% women.1 More than 45.5% women undergoing sterilization belong to young reproductive-age group of 20–25 years.2 The gold standard for recanalization has been microsurgical tubal recanalization through laparotomy. Laparoscopy can be used as an alternative route but requires high expertise.3 Although an option of in vitro fertilization is widely available, due to economic constraints people go for microsurgical tubal recanalization as a first option.2Material and methods: The study involves all women coming to the Department of Obstetrics and Gynecology, Bangalore Medical Collage and Research Institute, Bengaluru, for reversal of sterilization between August 2010 and September 2012. Results: A total of 40 prospective cases were studied and followed up for at least 1 year of which intrauterine pregnancy was noted in 21 (52.5%) cases, 1 (4.7%) patient had ectopic pregnancy, and 2 (9.5%) had abortions. Conclusion: The study concluded that factors favoring successful tubal recanalization are age of the patient less than 30 years, interval between sterilization and its reversal less than 4 years, site of anastomosis being isthmo-isthmic, remaining tubal length being more than 6 cm, and when type of previous sterilization was by laparoscopic method.
Background: The coronavirus disease-2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is a global public health emergency. Physiological and mechanical changes in pregnancy increase susceptibility to infections in general, particularly when the cardiorespiratory system is affected, and encourage rapid progression to respiratory and heart failure in the gravida. Case description: We present a case report of 30-year-old primigravidae with 36.5 weeks by date and 37 week by scan with diagnosed preeclampsia 2 weeks back on medication with 11 × 10.4 × 10.9 cm single intramural anterior wall fibroid with breech presentation. COVID nasopharyngeal sample reported as SARS-CoV-2 real-time PCR positive. The patient was started on medication defining the Stage 1 Group A Asymptomatic Category. Chest X-ray showed mild bilateral pulmonary infiltrates. On Day 6 of admission, the patient went in labor, and hence was taken for emergency LSCS in view of primigravidae with breech with preeclampsia with fibroid with PROM under spinal anesthesia with all precautions. Intraoperatively, the LSCS was uneventful. Postoperatively 6 hours postpartum, the patient developed sudden onset breathlessness NYHA Grade 4, with saturation of 56%, and patient was intubated and shifted to ICU. Chest X-ray revealed viral pneumonia, and further 2D ECHO was suggestive of cardiomyopathy. Conclusion: We suggest an echocardiogram in pregnant women with coronavirus disease 2019 pneumonia, in particular those necessitating oxygen or those who are critically ill. Clinical significance: Viral myocarditis and cardiomyopathy have been reported in nonpregnant COVID-19 patients. Information on COVID-19 in pregnancy is currently limited. No specific literature is available of viral cardiomyopathy reported in pregnant women with COVID-19 infection.
The placenta plays a vital role in the fetal growth and development; and it is an important link between the mother and fetus. The placental pathology may result in hypoperfusion and fetal growth restrictions. Here we present three cases with varied placental pathologies and the effect on fetal outcome. First case is a primigravida patient with placental teratoma; in second case, a multigravida patient presented with placental chorangiosis. Third case came at 19 weeks of gestation with ultrasonography showing features of cystic changes in the placenta. The patient was followed up throughout pregnancy with serial ultrasound monitoring and terminated at 37 weeks in view of fetal growth restriction. All the three placental conditions were associated with fetal morbidities. We emphasize the need for careful sonographic examination of the placenta in the antenatal period and gross examination and histopathology of the placenta postdelivery.
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Mohammad S, Bhute A, Acharya N, Acharya S. Moschcowitz Syndrome or Thrombotic Thrombocytopenic Purpura and Antiphospholipid Antibody Syndrome as a Rare Cause of Thrombocytopenia in Pregnancy Mimicking Hemolysis, Elevated Liver Enzymes, and Low Platelets Syndrome in a Patient with Bad Obstetric History: A Diagnostic Dilemma. J South Asian Feder Obs Gynae 2020; 12 (4):250-253.
Thrombotic microangiopathy (TMA) is a group of disorders characterized by microangiopathic hemolytic anemia, moderate to severe thrombocytopenia, and end-organ damage. In pregnancy, TMA is most commonly due to preeclampsia and hemolysis, elevated liver enzymes, low platelets (HELLP) syndrome. Very rarely it occurs due to Moschowitz syndrome also known as thrombotic thrombocytopenic purpura (TTP), antiphospholipid antibody (APLA) syndrome, or atypical hemolytic uremic syndrome (aHUS). All of these share common clinical features; yet their etiologies are different. Although both HELLP and TTP share common features of endothelial injury and microvascular thrombi, yet, they have different courses and line of management. In term pregnancy, differentiating between these two pathologies can be extremely difficult due to the extreme overlap in clinical and laboratory manifestations, and this becomes possible only with the use of specific markers as ADAMTS-13, whenever available. Unfortunately, delay in timely diagnosis and treatment can be life-threatening. We describe case of 25-year-old pregnant woman who came with HELLP syndrome which did not resolve postpartum only to improve after plasmapheresis.
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Anant M, Gupta S. Cervical Reconstruction after Cervical Myomectomy or Hysterectomy: Operative Challenges in Huge Cervical Fibroids. J South Asian Feder Obs Gynae 2020; 12 (4):254-257.
Fibroids are an extremely common benign neoplasm of uterine smooth muscle but fibroids originating in cervix are uncommon (1% of all fibroids). Huge cervical fibroids pose operative challenge in both hysterectomy and myomectomy. We report two cases with a 24-week-sized central cervical fibroid with uterus sitting atop, i.e., lantern on the St. Paul\'s Cathedral appearance. The younger patient desirous of future childbearing underwent open cervical myomectomy followed by uterine cervix reconstruction and the postmenopausal women underwent hysterectomy.
Mohammad Abdus Sattar
Background: Coronavirus disease-2019 (COVID-19) has spread across the globe and has been declared pandemic by the World Health Organization (WHO). People of all age groups are at risk of getting the disease. Pregnant women are at an increased risk of acquiring the infection and developing moderate-to-severe pneumonia resulting in adverse outcome. Case Descriptions: Published case series have shown that high-risk pregnancies have been associated with higher morbidity and mortality. Pregnancy-induced immune response might have an impact on maternal cardiovascular system and exaggerate the course of COVID-19 disease. Here, we report two cases of late pregnancy with COVID-19 one of which ended with complete recovery and another with adverse outcome. Conclusion: These two case scenarios might add to the emerging evidence of pregnancy outcome in COVID-19.
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Mendoza MC. Successful Birth in a Case of Cervical Cancer Following Total Laparoscopic Nerve Sparing Radical Trachelectomy with Sentinel Node Dissection and Preventive Cerclage. J South Asian Feder Obs Gynae 2020; 12 (4):261-264.
Aim and objective: The aim of this case report is to show the feasibility of a fertility-sparing and nerve-sparing procedure for early-stage cervical cancer to preserve the patient\'s reproductive ability and minimize the surgical complications associated with the radical surgery while providing adequate treatment to ensure good oncologic outcome. Background: The standard management for early-stage cervical cancer is radical hysterectomy with pelvic lymphadenectomy or concurrent chemoradiation. Both are associated with good survival, but neither form of therapy allows the preservation of a functional utero-ovarian system for future fertility. Case description: We present a young woman with cervical adenocarcinoma stage IB1 who underwent laparoscopic nerve-sparing radical trachelectomy with sentinel node dissection and preventive cerclage. There were no intraoperative or postoperative complications. The patient had a successful pregnancy 2 years after the operation and no evidence of disease for more than 5 years. Conclusion: With laparoscopic nerve-sparing radical trachelectomy, a woman\'s reproductive ability is maintained while ensuring good oncologic survival. It is also associated with less surgical and postoperative morbidity, such as urinary and sexual dysfunction, which are common in the traditional technique of radical trachelectomy. Clinical significance: This technique of radical trachelectomy provides the chance to retain future fertility for possible conception while minimizing patient morbidity and ensuring good prognosis.
Background: Choriocarcinoma is a gestational trophoblastic tumor commonly seen in the reproductive-age group. It is an aggressive tumor with high malignant potential and responds well to chemotherapy. Lungs and vagina are the most common sites for metastasis, and brain involvement is seen in 20–25% of cases. It usually presents within 6 months to 1 year following a molar or normal pregnancy. Case descriptions: We are presenting two interesting cases of choriocarcinoma who reported with atypical symptoms. Case 1: A 47-year-old P3L3 reported with abnormal uterine bleeding and cough with expectoration. Suction and evacuation suggested choriocarcinoma, and she was started on EMACO regimen of chemotherapy in view of lung metastasis. Case 2: A 23-year-old P1L1 presented with irregular vaginal bleeding for 15 days, 2 months following delivery. She developed left-sided hemiparesis, diagnosed as choriocarcinoma with brain metastasis and started on chemotherapy with etoposide, methotrexate, actinomycin D, cyclosphosphamide, and vincristine (oncovin) (EMACO) regimen. Both the cases had a prior history of molar pregnancy but failed to follow-up after the evacuation. Conclusion: Women with prior history of molar pregnancy need to be counseled to follow-up with serum beta-human chorionic gonadotropin (β-hCG) following evacuation. Choriocarcinoma is an aggressive tumor that can present with atypical symptoms such as abnormal uterine bleeding in postpartum period or perimenopausal age. Early diagnosis and treatment with or without metastasis have excellent prognosis. Clinical significance: Choriocarcinoma can present with atypical symptoms, especially in postpartum period and perimenopausal age. Clinicians need to have an index of suspicion of choriocarcinoma in treating women with atypical features.
Aim and objective: To understand and be efficient enough to deal with rare maternal and fetal complications of obstetric analgesia. Background: Epidural analgesia is the most effective method for pain relief during labor. Although complications related to this procedure are rare nowadays due to the expertise achieved, but a potential life-threatening complication of unexpected high block cannot be neglected. Case descriptions: We have encountered two normal parturients who developed sudden cardiorespiratory disturbance within few minutes of administration of epidural analgesia. On a background of worsening maternal clinical status, an emergency cesarean section was performed for severe persistent fetal bradycardia. While one patient recovered completely with no intraoperative complications, the other patient required intubation and intensive care. Postoperatively, echocardiography revealed decreased left ventricular ejection fraction with generalized left ventricular hypokinesia which improved subsequently on medical management. Working hypothesis for cardiomyopathy (Takotsubo) was considered in this case. Conclusion: We should not underestimate the complications that can arise with epidural analgesia, and hence it should always be provided by expert anesthetists in an appropriate set up with resuscitation equipment and drugs. An awareness of such rare complications can prepare obstetricians and nursing staff along with anesthetists to tackle them. Clinical significance: Along with the anesthetists, the obstetrics team should also be able to anticipate such rare entities and take appropriate steps for favorable maternal and fetal outcome.