Introduction: Endometriosis is an important cause for abdominal and pelvic pain in young women. It occurs due to the presence of functional endometrial tissue outside the uterine cavity. Ultrasonography and magnetic resonance imaging (MRI) are noninvasive and accurate diagnostic modalities for evaluation of ovarian and deep endometriosis. Aim: To compare and assess the diagnostic accuracy of ultrasonography and MRI for evaluation of endometriosis. Materials and methods: A prospective study was done on 40 patients sent to the radiology department in our tertiary-care hospital over a period of 2 years with clinical suspicion of endometriosis. These patients were evaluated on ultrasonography, followed by MRI scan for the location and extent of disease. The sensitivity and specificity of diagnostic modalities were calculated. Results: The sensitivity and specificity of ultrasound for diagnosing ovarian endometriosis (endometriomas) were 90.62 and 75.00%, respectively, and that of MRI were 93.94 and 85.71%, respectively. The sensitivity and specificity of ultrasound for diagnosing deep endometriosis (involving uterosacral ligament) were 25 and 97.30%, respectively, and that of MRI were 75.0 and 100%, respectively. The sensitivity and specificity of ultrasound for diagnosing scar endometriosis were 66.67 and 97.30%, respectively, and that of MRI were each 100%, respectively. The sensitivity and specificity of ultrasound for diagnosing tubal endometriosis were 50.00 and 97.37%, respectively, and that of MRI were each 100%, respectively. The findings of ultrasonography and MRI for evaluation of endometriosis were also correlated with histopathology. Conclusion: Both ultrasonography and MRI are comparable modalities for evaluation of ovarian, scar site, and tubal endometriosis; however, MRI is the most useful and better imaging modality for evaluation of indeterminate cases and deep endometriosis.

Aim: Cervical cancer caused by human papillomavirus (HPV) is heterogenic in nature with a regional variation in its distribution. It is crucial to detect high-risk HPV, and thus, the present study aims to find the distribution and prevalence of HPV genotypes by DNA testing and its correlation with cervical cytology. The results of this study would be helpful in the development of newer and efficacious HPV vaccine to make it regionally more specific. Materials and methods: A cross-sectional study was conducted in a tertiary-care hospital. A total of 217 women presented at the outpatient Department of Obstetrics and Gynaecology with different clinical conditions. Women with history of malignancy and pregnancy were excluded from the study. Detailed history was taken on a preformed pro forma, and cervical samples were detected for abnormal cytology by Pap smear and genotyping by HPV DNA testing by polymerase chain reaction. Results: The overall prevalence of HPV was 5.5% (12/217), and HPV types 59, 56, 51, 33 and 18 were found prevalent in this study. The higher number of HPV DNA positivity found was in low-grade squamous intraepithelial lesion constituting (66.6%), followed by inflammatory smear (20.6%) and normal cytology with (1.1%). Conclusion: It has been observed that there is a high prevalence of HPV genotypes 59, 56, 51, 33, and 18. Our study highlights the importance of considering other high-risk genotypes which are not covered by the vaccines currently available in India; therefore, it is necessary to redesign the vaccine by including these genotypes to reduce the incidence of carcinoma cervix.

Introduction: Uterine smooth muscle tumors are the most common tumors of female genital tract and among these leiomyomas predominate. Leiomyomas most commonly occur during the reproductive years in women with manifestation of abnormal uterine bleeding and abdominal pain. These exhibit wide range of morphological variants and secondary changes. Here, we present a study of 70 cases, which includes rare variants and degenerative changes in leiomyomas. Materials and methods: A retrospective study conducted in a department of pathology for a period of 1 year from January 2019 to December 2019 at a tertiary care hospital. Seventy patients were diagnosed as leiomyoma on histopathological examination of 124 hysterectomy specimens and one myomectomy specimen and included in the study. Detailed microanatomic features were studied and recorded. Result: Uterine leiomyoma was most common among the age-group of 41–50 years of age (64.21%). Most common location was intramural (54.29%). Secondary changes were observed in 48 cases (68.57%). Most common secondary change was hyaline degeneration noted in 38 cases (79.17%). Classical variant of leiomyoma was seen in 66 cases (94.28%) followed by one case (1.43%) each of symplastic, neurilemmoma-like, lymphocyte-rich, and cellular leiomyoma and leiomyomas with rare secondary changes like osseous and chondroid metaplasia. Conclusion: Uterine smooth muscle tumors are commonly seen in perimenopausal females. Leiomyoma is associated with various pathologies comprising of degenerative changes and rare variants which sometimes can be misdiagnosed as malignancy. Hence, a vigilant histopathological examination is necessary to identify the various spectrum of uterine leiomyomas and associated pathologies.

Introduction: Ectopic pregnancy (EP) is a pregnancy complication where the fertilized egg is implanted in an area other than the uterus. In 98% of EP cases, the implantation of the egg occurs within the fallopian tube. It can happen due to many factors related to the patient's history and sexual and reproductive history. This research is aimed to study the association between EP and Chlamydia trachomatis infection and also other risk factors. Methodology: The study was conducted in the Department of Obstetrics and Gynecology, Chattogram Medical College Hospital, Bangladesh. Women with ruptured EP were selected as cases; women undergoing tubal ligation were taken as control. The biological test was conducted using PCR to detect the presence of the Chlamydia bacteria in the specimens collected from both the cases and controls. The collected data were analyzed using IBM SPSS version 20.0. Results: The average age of the cases was 27.55 ± 5.32 years, and the average age of the control was 31.61 ± 6.89 years; the age difference was not statistically significant (p >0.1). Medical history of individuals with sexual–reproductive health issues, such as parity, PID, abdominal pain, and vaginal bleeding, showed a significant connection (p = 0.1) with EP. In women, infection with C. trachomatis was strongly linked to tubal EP (15 positive cases out of 22). The presence of C. trachomatis infection, parity, abdominal discomfort, vaginal bleeding, and PID results was significant at a 90% confidence interval (p <0.1) using binary logistic regression for all variables to predict which factors affect the dependent variable. Tubal EP is 5.7 times more common in women infected with C. trachomatis. Conclusion: This study proved a strong association between the presence of C. trachomatis infection and EP. For future studies, using a greater sample size and investigating other microbes are suggested for better results.

Purpose: Pregnancy, with its associated hormonal changes, leads to an increased risk of mental health problems. These are likely to be worsened by the socioeconomic effects of the coronavirus disease-2019 (COVID-19) pandemic. This study aims to find out the proportion of anxiety and depression in perinatal women and the associated risk factors during the pandemic in India, where mental health is a neglected domain. Methods: In a cross-sectional study spanning from March 2020 to July 2021, 124 patients who were pregnant or had delivered within 1 year were selected. The survey collected sociodemographic information and assessed the severity of anxiety and depression using the pretested and validated generalized anxiety disorder 7 and patient health questionnaire-9 (PHQ-9), respectively. The results were analyzed by suitable statistical tools and techniques. Results: Elevated anxiety and depression symptoms compared to similar pre-pandemic perinatal cohorts were observed. Anxiety (GAD), depression and both anxiety and depression were diagnosed in 31 (25%), 36 (29.03%), and 21 (16.94%) participants, respectively. Higher symptoms of anxiety and depression were associated with more concern about threats of COVID-19 to the life of mother and baby, concerns about not getting necessary medical and obstetric care during the lockdown, social isolation, and unemployment during a pandemic. Support and compassionate behavior of treating doctor was associated with lower psychological symptoms. Conclusion: COVID pandemic has had a definite impact on the mental health of perinatal mothers with elevated levels of anxiety and depression. So clinicians need to be more vigilant in this vulnerable group to facilitate early detection and management of anxiety and depression to prevent further morbidities in mother and her offspring.

Background: Abruptio placentae is one of the obstetric emergencies for both mother and fetus. Obstetrical hemorrhage is one of the main causes of maternal and perinatal morbidity and mortality. Hence, this study was conducted to find out the prevalence of abruptio placentae and potential determinants of maternal and fetal adverse outcomes at St John's Medical College and Hospital, Bengaluru, India. Methods: This is a retrospective study of 5 years (2014–2019) at St John's Medical College and Hospital. Totally, 16,082 charts were reviewed to find 140 cases with abruption. Data were collected using a structured validated questionnaire which included four parts, namely, sociodemographic details, risk factors, maternal outcomes, and perinatal outcomes. Statistical analysis was performed using IBM SPSS statistics 23.0. Results: A total of 16,082 deliveries occurred during study period, and 140 of them had abruptio placentae with prevalence of 8.7 in 1,000 deliveries. Most of the women belonged to 20–35 years of age (91.4%) and 76 (54.3%) were between 28 and 34 weeks of gestation. One-hundred and thirty-seven (97.9%) had singleton pregnancy and 77 (80%) were multigravida. Seventy-nine (54.5%) had preeclampsia. Postpartum hemorrhage was most frequently observed in maternal complication (30%). Other complications were disseminated intravascular coagulation (5%), intensive care unit (ICU) admission of mother (1.5%), and acute renal failure (9.3%). Interval between diagnosis to delivery and mode of delivery and parity index were analyzed as predictors for maternal and perinatal course, but they were not significant statistically. Significance was found for multipara and ICU admission of mother (p = 0.023). Conclusion: There is high association between antenatal complications like preeclampsia and abruptio placentae. Interval between diagnosis to delivery should not be prolonged (<24 hours). High parity index women need more attention during their antenatal period. Key messages: Newer approach of treatment with better pregnancy outcomes in mothers with abruption with risk determination in an Indian population.

Aim: The study aims to compare postoperative pain and recovery with a tailored multimodal Enhanced Recovery after Cesarean Delivery (mERCD) protocol and conventional postoperative management protocol after elective cesarean delivery. Materials and methods: This prospective cohort study involved women undergoing elective cesarean delivery. One group of women received the new multimodal ERCD (mERCD) protocol, and the other group, conventional management. The mERCD group had transversus abdominis plane (TAP) block, gum chewing, early oral initiation, and urinary catheter removal. The conventional group received standard analgesia, started on orals, and had catheter removal at 24 hours. We compared postoperative pain and recovery between the groups at 6 and 24 hours using a visual analog scale (VAS) and predefined variables assessing recovery. Results: Pain scores at rest in mERCD group and the conventional group were 4.20 and 6.19 at 6 hours (p = 0.005) and 3.71 and 4.1 at 24 hours (p = 0.018). Respective pain scores with the movement were 4.84 and 6.35 (p = 0.005) at 6 hours and 3.74 and 4.91 at 24 hours (p = 0.005). Return of bowel sounds at 6 hours was 100% and 123 (82%) in mERCD and conventional groups, respectively (p = 0.005). In mERCD group, 49 (70%) passed flatus at or before 24 hours, whereas in the conventional protocol group, the same it happened before 24 hours in 84 (56%) (p = 0.04). There was no significant difference in the time taken to pass urine after catheter removal; the mERCD group had higher satisfaction scores 7.02 SD 1.16 than 4.05 SD 1.06 in the conventional group (p = 0.005). Conclusion: Multimodal Enhanced Recovery after Cesarean Delivery protocol effectively improved women's postoperative experience by providing good analgesia and enhancing early recovery. Clinical significance: Hospitals must adopt a tailored multimodal early recovery after surgery (ERAS) approach to enhance postoperative recovery after cesarean delivery.

Background: Labor induction is the most commonly performed intervention in obstetrics and is usually carried out for maternal, fetal, and placental conditions when the benefits to either mother or fetus outweigh those of continuing the pregnancy. Labor induction process in itself is not without complications and is associated with a higher risk of maternal and fetal complications. However, in carefully selected high-risk pregnant women, labor induction is associated with higher chance of vaginal delivery with least maternal and fetal complications. The present study was conducted to identify the factors which determine the risk of failed induction and to compare the maternal and fetal outcome between spontaneous and induced labor pregnant women. Materials and methods: This retrospective study was done in a teaching institute of Chennai for a period of 6 months. The required medical and obstetrical details were obtained from case records. Chi-square test was used to compare the proportions of various clinical parameters between cesarean and vaginal deliveries. Binary logistic regression method was applied for estimating factors that were associated with higher chances of cesarean delivery. Results: Among 292 deliveries, 35.95% women required labor induction and 27.73% women had spontaneous labor; 50% of labor-induced women had successful vaginal delivery compared to 79% of women who had spontaneous labor with insignificant maternal and neonatal complications. Women with unfavorable preinduction Bishop score were at higher risk for cesarean delivery in labor-induced women. The risk factors such as advanced age, nulliparity, neonatal birth weight >3.5 kg, and labor induction for oligohydramnios, glucose intolerance, hypertension, premature rupture of membranes, and low-risk pregnancy at 40 weeks were not associated with higher chance of cesarean delivery. Conclusion: To curtail the increase in cesarean delivery rate, there is definite need for labor induction. Labor induction should be considered in pregnant women with medical and obstetric complications after assessing the clinical condition. Mechanical methods and sweeping of membranes may be attempted in women with unfavorable Bishop score prior to pharmacological methods of cervical ripening.

Background: Sexually transmitted infections (STIs) are one of the major health problems encountered during pregnancy having impact on both mother and child health. Objective: To know the prevalence of STIs in pregnant females in our tertiary care center. Methods: A retrospective observational study in which data of all the pregnant females diagnosed with STI over a period of 6 years (2016–2021) were studied. Results: There were 508 females with pregnancy having sexually transmitted infections, which is 5.43% of total females with STIs with a mean age of 23 years. Majority of cases were from rural area (62.79%), illiterate (32.48%), diagnosed in first trimester (76.4%), and primigravida (65.7%) with heterosexual (100%) mode of sexual contact. Viral infections were the most common STIs in groups, but syphilis was the most common form of STI caused by a single organism encountered in females with pregnancy, 157 cases (30.9%), followed by condyloma acuminata, 94 cases (18.5%). Syphilis was the commonest STI seen with adverse fetal outcome (86.7%) among all causes of adverse fetal outcome. Conclusion: Present study reported a low prevalence of sexually transmitted infections in pregnancy, and syphilis was the single most common cause of STIs in pregnancy. Clinical significance: Sexually transmitted infections are quite common in pregnancy, which increases morbidity and mortality of both mother and child. Thus, antenatal clinic visits and checkup for STIs in pregnant female are advised.

Background: Hemolysis, elevated liver enzymes, and low platelet (HELLP) syndrome is a serious obstetric complication with high risk of adverse maternal and perinatal outcomes. The aim of the study was to find the prevalence of HELLP syndrome and to analyze the maternal and perinatal outcomes. Methods: This was a descriptive cross-sectional study conducted in a tertiary care center from April 13, 2016, to April 12, 2020, after obtaining ethical clearance from the Institutional Review Committee. All the women with HELLP syndrome who delivered in the hospital during the study period were enrolled. A convenience sampling technique was used. Data were analyzed using the Statistical Package for the Social Sciences version 24 software. Descriptive analysis was done and frequency and proportion were calculated for binary data. Results: Prevalence of HELLP syndrome was 0.23%. The majority of the cases were in the 25–29 years age-group and the mean maternal age was 28.05 years. Twenty-seven (61.36%) were primigravida. Of 44, 27 (61.36%) delivered through lower segment cesarean section. Nineteen (43.18%) women were admitted to the high dependency unit. There were four (9.1%) maternal deaths. Most (68.18%) of the babies were preterm and 62.5% of the live-born babies were admitted to the neonatal intensive care unit. There were 20 perinatal deaths with a perinatal mortality of 45.45%. Conclusion: Hemolysis, elevated liver enzymes, and low platelet syndrome is a dreadful complication with high morbidity and mortality. Timely termination of pregnancy is warranted to arrest further progress of pathophysiology. Clinical significance: Outcomes in HELLP syndrome can be improved with early diagnosis and timely intervention.

Aim: We have witnessed diverse presentations of coronavirus disease-2019 (COVID-19) in pregnant females during first and second waves. The aim of this study was to evaluate the usefulness of chest X-ray and its correlation of severity scoring with clinical, laboratory parameters and maternal-fetal outcome during management of COVID-19 pregnant women in low resource settings. Methodology: This was a retrospective observational study conducted at the Government Institute of Medical Sciences, Greater Noida, from May 2020 to May 2021. The study included 185 pregnant women in second and third trimesters with reverse transcription-polymerase chain reaction (RT-PCR)-confirmed COVID-19 disease. The chest radiographs of all patients were analyzed and severity scoring was done using modified radiographic assessment of lung edema (RALE) criteria. The correlation of severity index with clinical and biochemical profile of patients with normal and abnormal X-ray findings was compared. Two-tailed p-value of <0.05 was considered significant in our study. Results: Out of 185 patients, 38 had abnormal X-ray findings, whereas 147 had normal X-ray. A significant difference was observed in mean values of lactate dehydrogenase (LDH), ferritin, C-reactive protein (CRP), D-dimer, total leukocyte count (TLC), and interleukin 6 (IL-6) levels across both X-ray groups. The proportion of pregnant mothers with live birth, high-risk pregnancy, steroid treatment, oxygen supplementation, invasive ventilation, and number of presenting symptoms varied statistically across both the X-ray groups (p-value <0.05). Receiver-operating characteristic (ROC) analysis revealed that an X-ray score of “5.5” has the best prognostic significance of maternal death with sensitivity of 87.5 and 96.6% specificity. Conclusion: Chest radiography for the assessment of disease status in COVID-19 pregnancies is an effective and affordable alternative to CT scan in low resource settings.

Aims and objectives: To determine the tests of antepartum fetal surveillance such as Doppler ultrasound, modified biophysical profile (MBP) alone, and in combination for assessing adverse neonatal outcome in term low-risk pregnancy. Materials and methods: Prospective observational study was done in a rural tertiary care center for 1 year duration. A total of 169 term low-risk pregnant women were included in the study and fetal surveillance tests such as MBP and Doppler ultrasound were done. The sensitivity of MBP and Doppler analysis in predicting the neonatal outcome using parameters such as birth asphyxia, meconium-stained amniotic fluid (MSAF), neonatal intensive care unit (NICU) admission, and Appearance, Pulse, Grimace, Activity, and Respiration (APGAR) score were assessed. Results: Among 169 pregnant women, MBP was normal in 66% and abnormal in 34% cases. 150 (89%) showed normal Doppler indices and 19 (11%) were found abnormal. Those with normal MBP and with normal Doppler were found to have better neonatal outcome and this was statistically meaningful (p <0.00). Doppler sensitivity was 37.5% and MBP was 62.5%. The results of combination of MBP and Doppler showed higher sensitivity of 73.5%. Conclusion: Modified biophysical profile was found to be a more significant than Doppler analysis in determining fetal well-being and in presage of fetal distress. Together MBP and Doppler analysis has yielded a higher sensitivity to detect adverse neonatal outcome. Clinical significance: Even if Doppler ultrasound is unavailable for surveillance, MBP alone can be the best modality to determine reassuring status in low-risk pregnancy.

Aim: Antenatal corticosteroids (ACS) are recommended for use in antenatal mothers at risk of preterm delivery before 34 weeks. One common side effect is the propensity to cause hyperglycemia. Our study aimed at characterizing glycemic response to betamethasone in preterm women and compared this response in patients with gestational diabetes mellitus (GDM) and those without GDM. Materials and methods: After ethical clearance, 160 preterm antenatal patients who required ACS were included between 28- and 34-week periods of gestation. They were allotted into two groups: those with GDM and those without GDM. Fasting blood sugar (FBS) and postprandial blood sugar (PPBS) were followed for 4 days after betamethasone administration. Results: A total of 54.65% showed an elevated FBS in the normal group on D2 and this reduced to 29.53% on D4 and 19.76% on D5. Similarly, PPBS was elevated in 54.65% on D2 and reduced to 26.7% on D4 and 13.95% on D5, whereas in the GDM group, FBS remained elevated on D2–D4 in 77.02, 81.08, and 71.62%, respectively, and started showing a downward trend with 45.94% on D5. Similarly, PPBS was elevated in 78.38, 77.03, and 67.57% on D2–D4, respectively, and reduced slightly to 56.76% on D5. Conclusion: Our findings highlight the need for monitoring the glycemic levels even up to 5 days after ACS administration. Clinical significance: With the increasing prevalence of GDM in antenatal mothers in India, this study highlights the need for more stringent glucose monitoring after steroid administration and also the need for protocols on the frequency of monitoring and dosage of insulin regimen.

Aim: The aim of the study was to describe how medical and administrative barriers in implementing a labor companionship program were overcome and to identify similar barriers adversely affecting the sustenance of the program. Materials and methods: Medical and administrative barriers encountered when implementing a labor companionship program at the Academic Unit (AU) of Teaching Hospital, Mahamodara, Galle (THMG), in 2012 and how these barriers were overcome are described. From March to April 2016, a cross-sectional study was carried out using an interviewer-facilitated self-administered questionnaire, on specialist obstetricians and gynecologists, house officers, staff nurses, and midwives of AU of THMG, to identify possible reasons for the failure to sustain the labor companionship program. Data regarding demographic characteristics, knowledge and attitudes regarding women having a labor companion (LC), and counseling pregnant women to have an LC were collected. Results: Four out of five specialists, all 13 house officers, 23 out of 30 staff nurses, and 12 out of 16 midwives participated in the study. All the specialists and nurses, 85% of house officers, and 58% of midwives were aware that the presence of an LC was beneficial for women in labor. However, only 24% of doctors and 17% of staff nurses and midwives had counseled pregnant women routinely regarding an LC and only 53% of doctors and 20% of nurses and midwives had counseled more than 10 pregnant women regarding LC, during the week immediately preceding the data collection. Conclusion: Medical and administrative barriers are encountered when establishing a labor companionship program, but they can be overcome. Midwives must be educated regarding the beneficial effects of an LC. Doctors and nurses must be motivated to increase counseling of women and their partners regarding the beneficial effects of an LC in order to sustain a labor companionship program.

Background: Preeclampsia is a leading cause of preterm birth, accompanied by compelling maternal and neonatal morbidities. This study aims to investigate preterm neonate outcomes in pregnancy with preeclampsia. Materials and methods: A retrospective observational study was conducted in Indonesia's national referral hospital. Infants born <37 weeks from January 2015 to December 2018 were recruited, both from preeclamptic and non-preeclamptic mothers. The measured outcomes were necrotizing enterocolitis (NEC), hypoxic–ischemic encephalopathy (HIE), respiratory distress syndrome (RDS), as well as bronchopulmonary dysplasia (BPD). Results: There were 2,750 preterm neonates enrolled in this study, with 455 neonates born from mothers with preeclampsia. Neonates in the preeclampsia group had a higher incidence of NEC (OR [odds ratio] 2.22; 95% CI [confidence interval] 1.5–3.17), HIE (OR 3.84; 95% CI 1.61–9.17), RDS (OR 5.51; 95% CI 4.35–6.98), and BPD (OR 1.87; 95% CI 1.03–3.42). Conclusion: Neonatal morbidities, such as NEC, HIE, RDS, and BPD, were found higher in preterm neonates born from preeclamptic mothers compared to uncomplicated pregnant women.

Background: The global coronavirus disease-2019 (COVID-19) pandemic has infected a large subset of women in the reproductive age-group, but the effect of COVID-19 infection on menstruation is still unclear. This study outlines the influence of COVID-19 infection on the menstrual cycle. Methods: Women in the reproductive age-group, admitted with COVID-19 infection were followed up with a structured telephonic interview. Women with previously regular menstrual cycles were included in the study. The questions included severity of COVID-19 infection, details of menstrual cycle before and after the infection, and COVID-related stress recorded by Perceived Stress Scale-10. Results: Data from 350 women with COVID-19 infection were presented. Moreover, 59.1% (n = 207) of women reported a change in their menstrual cycles. About 43.7% (n = 153) noted changes in the volume of flow with 78.4% (n = 120/153) experiencing less flow. Irregular menstrual cycles were reported by 37.1% (n = 130) women, 50.8% (n = 66/130), experienced infrequent menstruation, with delay varying from 45 to 90 days, and 13.8% (n = 18/130) of these women also experienced intermenstrual spotting. Most of these women recovered, and only 17.1% continue to have irregular menstrual cycles even after 1 year of COVID infection. Moreover, 34.28% (n = 120) reported worsening of premenstrual symptoms, and 22.44% (n = 55) reported worsening of dysmenorrhea after the COVID-19 infection. The stress score was not significantly associated with the severity of COVID-19 infection (p >0.05). Social factors like concern about health of other family members, quarantine, and isolation were the biggest contributors to stress. Conclusion: COVID-19 infection and associated stress can influence normal menstruation. Clinical significance: The findings of this study outline the short- and long-term effects of COVID-19 infection on menstruation. This information can be used to reassure the patients and will be helpful in counseling to allay their fears related to altered menstrual cycles after the COVID-19 infection.

Background: Cesarean scar pregnancy (CSP) is a rare but catastrophic event. The incidence of cesarean section (CS) is on an increasing trend and hence is the incidence of CSP. Failure to diagnose and initiate prompt management of CSP may lead to uterine rupture, massive hemorrhage, and even maternal death. Methods: This study was conducted as a retrospective cohort study in women presenting to the Department of Obstetrics and Gynecology, MLN Medical College and Saket Maternity Nursing Home, Prayagraj, Uttar Pradesh, between January 2017 and February 2021, in which a final diagnosis of cesarean scar pregnancy was made. Comprehensive clinical, laboratory, and radiological data were collected from medical records of nine CSP cases. An analysis of demographic and clinical features with treatment modalities was done including age, gravidity, parity, number of previous CS, history of dilation and evacuation (D&E), history of abortifacient intake, presenting complaints, serum beta-hCG levels, sonographic features, and requirement for blood transfusion. Results: The mean age of patients with a final diagnosis of CSP was 30 ± 4.5 years. The previous history of D&E in this study was seen in 22% of patients. The majority (67%) of cases had one previous CS. The median duration from the last CS was 2 years. Approximately 55% of the patients had their last CS done without going into labor. History of abortifacient intake in present pregnancy was notably present in 67% of the patients. The mean gestational sac diameter in patients was 15.4 ± 4.0 mm. Mean myometrial thickness between the bladder and gestational sac was 2.2 ± 1.18 mm. Vascularity was mild in three and severe in five cases. The mean serum beta-hCG level at presentation was 39891.6 ± 36,305 mIU/mL. The majority, i.e., five out of nine patients were managed surgically by laparotomy with a wedge excision of the scar and trophoblastic tissue followed by uterine repair. Conclusion: High index of suspicion for the prompt and accurate diagnosis of CSP by both the gynecologist and sonologist is the need of the hour.

Background: Placenta accreta spectrum (PAS) is characterized by abnormal trophoblast invasion of part or entire placenta into the myometrium due to defects in the endometrial–myometrial interface following surgeries involving the uterine cavity, uterine curettage, or uterine infection. Cesarean section is an important risk factor for PAS. A global increase in Cesarean section has resulted in an exponential increase in the PAS. Objective: To examine the prevailing practices for the management of PAS in India and to formulate readily translatable practical management algorithms for low-resource settings. Materials and methods: This cross-sectional study was conducted from April 2019 to March 2020 across nine tertiary care centers in India. Ethics clearance was obtained for the study. Patient details were noted in predesigned pro forma. Risk factors, investigations for antenatal diagnosis and treatment options, and outcomes were recorded. Analysis data were analyzed using the statistical software Statistical Package for the Social Sciences (SPSS) version 16 (IBM, Armonk, New York, USA). The qualitative variables were reported as numbers and percentages. The association of surgery type (elective/emergency) and technique with qualitative variables and risk factors was analyzed using Chi-square/Fisher's exact test. The quantitative variables are reported as the median and interquartile range and were tested with the Mann–Whitney U-test between the two groups. The Kruskal–Wallis test was applied to compare the quantitative variables among the three groups. A p-value less than 0.05 was considered significant. Result: The prevalence of PAS was 0.12%, and previous Cesarean scarring was the most important risk factor. There were almost 43% of women unbooked at the tertiary centers though they were being supervised by lower healthcare facilities during the antenatal period. Ultrasound (USG) diagnosis of PAS was established in 51.3% of cases only. Cesarean-hysterectomy and interval hysterectomy were undertaken in 84% and 8% women respectively. Intraoperative hemorrhage and urological injury were the most common complications. Based on the findings of the study, a simple, user-friendly algorithm for clinical practice and management was formulated. Conclusion: Identification of antenatal clinical factors for PAS risk stratification in low-resource settings is important to enable timely referral to tertiary care. The availability of USG and the necessary skills for detection of PAS are important factors for the diagnosis and management of PAS. Therefore, both radiologists and obstetricians should be adequately trained for the condition to prevent maternal morbidity and mortality. PAS-complicated Cesarean is best carried out at tertiary facilities with multidisciplinary planning and preparation.

Background: Most common severe congenital anomalies are birth defects, neural tube defects, and Down syndrome. Congenital anomalies of the kidney and urinary tract anatomy (CAKUT) are common in children and represent approximately 30% of all prenatally diagnosed malformations. The spectrum includes more common anomalies such as vesicoureteral reflux and, rarely, more severe malformations such as bilateral renal agenesis. Materials and methods: The present study was an observational prospective study, conducted in tertiary maternity hospital affiliated to a medical college in a metropolitan city. The study subjects were recruited in the study at the time of delivery or at the time of termination of pregnancy through universal sampling of all patients who register at Maternity Hospital. Study period was of 18 months, i.e., from February 2017 to August 2018. Results: The antenatal diagnosis of urological anomalies was made in second trimester in 50%. 57.4% were male fetuses and 42.6% were female. Six fetuses underwent medical termination of pregnancy. Of the 54 cases born, 3 babies were stillborn, 3 babies died, and 84% survived till the 28th day of life. Most common anomaly diagnosed was hydronephrosis (51%), followed by renal agenesis (12.7%) and polycystic kidney (12.7%). Conclusion: It can be said that antenatal and postnatal USG are good diagnostic tools when it comes to diagnosing congenital urological anomalies. Any suspected case of congenital urological anomaly should be referred to a tertiary care setup where NICU facilities are available.

Objective: To study the efficacy of mifepristone in preinduction cervical ripening in term pregnancy. Study design: This is a prospective observational study, done in a tertiary care hospital. Fifty pregnant women in the study group were given oral mifepristone 200 mg for preinduction cervical ripening (second dose after 24 hours if applicable) and another 50 pregnant women who underwent expectant management were included in the expectant group. The primary objective was to assess the effect of mifepristone on the change in Bishop score. The secondary objective was to assess the induction–delivery interval and the mode of delivery. Results: In this study, the mean modified Bishop score 24 hours after oral mifepristone (single dose) was (7.34 ± 1.533) which was statistically significant compared to the expectant group's Bishop score (4.28 ± 1.179) p <0.001. Similarly, the mean modified Bishop score 48 hours after oral mifepristone (two doses) was 7.50 ± 0.57 which was statistically significant when compared to the expectant group (4.28 ± 1.155) p <0.001. The requirement for further inducing agents has also been significantly less in the study group compared to the expectant group (p <0.001). Twenty-four percent went into spontaneous labor within 24 hours of the first dose of oral mifepristone without the requirement of a prostaglandin E2 (PGE2) gel. Augmentation with oxytocin was required in 60% of the study group and 86% of the expectant group in active labor. The mean duration between the initiation of PGE2 gel induction and delivery was 13.45 ± 4.536 hours in the study group and 20.41 ± 3.896 hours (p <0.001). Spontaneous vaginal delivery was 82% in the study group and 80% in the expectant management group. Conclusion: Oral mifepristone given for preinduction cervical ripening was found to be effective and safe with a reduction in the need for additional prostaglandins and oxytocin and also shorter induction-to-delivery interval with no serious maternal or fetal adverse effects.

Condom uterine balloon tamponade (UBT) has the advantage of being cheap and easily available for the control of postpartum hemorrhage (PPH) in cases where preliminary methods to control PPH fail. This study was conducted to study the efficacy of condom (Chhattisgarh balloon/CJ balloon) and its indications in a tertiary care center for the management of massive obstetric hemorrhage. Materials and methods: Women who were refractory to first-line management with uterine massage and uterotonics in cases of atonic uterus or failed attempt at surgical repair in lower genital tract tears were introduced indigenous made condom catheter as balloon tamponade because Bakri balloon, etc., are not a cost-effective option in developing countries. Results: Condom balloon tamponade is highly effective in managing postpartum hemorrhage. The mean volume of fluid used to create tamponade and stop bleeding was about 381.06 mL. The mean time taken to arrest bleeding after the application of balloon tamponade was 6.66 minutes. Only one patient needed hysterectomy. Conclusion: Modified condom UBT is a minimally invasive, easy to perform, cheap, and fertility-sparing treatment option and it has shown an excellent hemostatic effect even in the setting of DIC.

Backround: Uterus didelphys with obliterated half-vagina and absent kidney on the same side is a syndrome with very low incidence known as Herlyn-Werner-Wunderlich syndrome (HWW) and also known as obstructed half-vagina and ipsilateral renal anomaly (OHVIRA).^1,2 Case report: Sixteen-year-old female presented with cyclical pain in abdomen mostly from Day 1 on her periods since menarche since 1–2 years. She had regular menstrual cycle with dysmenorrhea. Clinical examination was done, and on ultrasound, we diagnosed it as HWW syndrome. Intraoperatively, a bulge was arising from right vaginal wall, and on left side, cervix was felt with normal size uterus. Incision was taken on the bulge, about 60cc of mucous discharge was drained. We confirmed uterine didelphys. Later suturing was done on the opening of the right vagina, to keep it patent. Conclusion: We should think of HWW syndrome in patients who have cyclic pain in abdomen and also in newborn cases with any renal abnormalities. Early and prompt surgical therapy prevents further complications. Clinical significance: Early diagnosis and treatment prevents complications such as endometriosis and infertility.

Aim: The aim of the article was to emphasize the need for a fetal medicine unit at tertiary care hospitals. Background: The incidence of Rh-negative in India is 5–10%. The issue of Rh incompatibility arises when the mother is Rh-negative and the fetus is Rh-positive. Rh alloimmunization can lead to fetal anemia, hydrops fetalis, and even intrauterine death. It leads to perinatal loss of 1–2.5%. Fetal anemia is a serious complication in pregnancy and is associated with perinatal morbidity and mortality. Intrauterine transfusion (IUT) is a good treatment option for fetal anemia due to Rh incompatibility. Intravascular transfusion offers the best chance of survival to fetuses severely affected with Rh isoimmunization, overall survival exceeding 80%. In the cases with detectable antibodies, prenatal monitoring of maternal antibody titers and fetal middle cerebral arterial-peak systolic velocity (MCA-PSV) Doppler ultrasound assessment helps to plan fetal blood sampling and IUT procedures. Thus, the establishment of fetal medicine unit at tertiary care centers in India is need of the hour. Case description: We report a case of 32-year-old G4P3L1END1IUD1 with Rh-negative sensitized pregnancy with fetal anemia, managed successfully with IUT. Clinical significance: Early diagnosis of fetal anemia by serial MCA-PSV measurements and referral to fetal medicine unit are important for improving the outcome in Rh-negative sensitized pregnancies. Conclusion: Establishment of fetal medicine unit at tertiary care centers is the need of the hour to improve the fetal outcome in high-risk pregnancies like Rh-negative pregnancy.

Background: Acephalus is a rare complication of multiple gestations with an incidence of 1 in 35,000 pregnancies and 1% of monochorionic twins. Case description: A 21-year-old primigravida with a twin pregnancy with one acardiac acephalus, with ultrasonography (USG) s/o twin gestation approximately 25.3 weeks along with the presence of hydropic acardiac twin corresponding to 23 weeks and the presence of rudimentary spinal elements with no skull and upper extremities was managed conservatively at a tertiary care center with routine fetal monitoring using USG and Doppler ultrasonography. Conclusion: Early and accurate antenatal diagnosis is very important in order to prevent the pump twin from developing its usual complications. Both conservative and interventional management approaches are available which varies from patient to patient depending on various factors.

Aim: To report a case of a pregnant patient with unconsciousness who was presented with features of obstetric hemorrhage but was diagnosed with diabetes ketoacidosis. Background: Gestational diabetes mellitus can cause many complications. Of these, diabetic ketoacidosis (DKA) is one. The clinical features of DKA include nausea, vomiting, mild abdominal discomfort, tachycardia, elevated random blood sugars, despite a normal or near normal HbA₁c, and presence of urinary ketones. Case description: G2P1L1 with 28 weeks period of gestation who presented clinically similar to abruptio placenta, underwent cesarean section, but had coexisting DKA. Conclusion: When a patient presents with unconsciousness, the tendency of an obstetrician is to consider an obstetric diagnosis, whereas a coexisting metabolic condition which should not be neglected.

Abdominal wall endometrioma (AWE) being an unusual phenomenon is a benign tumor defined as ectopic functional, endometrial tissue located in the abdominal wall. Abdominal wall endometrioma is a rare sequela to gynecologic surgeries such as cesarean section, tubal ligation, and hysterectomies. The incidence varies from 1 to 2%. It presents as intense pain and discomfort to the patient with a seemingly non discernible cause. Awareness of this entity can help the surgeon to make an early diagnosis and deliver prompt treatment, usually surgical. We present a case of AWE, along with a brief review of literature.

Background: Endometrial stromal tumors (ESTs) are rare tumors arising from the uterus. The incidence of EST is 2 per million women. Endometrial stromal nodules (ESNs) are rare subtype of ESTs and they are benign tumors. We describe a case of ESN since it is a rare tumor and the clinical presentation was different. Case description: A 54-year-old perimenopausal woman, para 2, live 2 presented with complaints of lower abdomen pain for 2 months. Clinical features, ultrasound, and contrast-enhanced computed tomography (CECT) abdomen report were suggestive of malignant ovarian tumor. Tumor markers were within normal limits. Staging laparotomy was done. Solid mass of 9 × 6 × 6 cm arising from uterine fundus above which large cystic lesion measuring 21 × 18 × 13 cm was seen. Both side fallopian tubes and ovaries were normal. The morphological, microscopic, and immunohistochemical features of that solid with cystic mass were consistent with ESN. Preoperatively suspected malignant ovarian tumor case later turned out to be ESN. Conclusion: There is no definitive test available to confirm ESN before surgery. Usually, it is diagnosed postoperatively and the clinical presentation could be variable like in our case. Clinical significance: High-grade endometrial stromal sarcoma (HGESS) can be differentiated from low-grade endometrial stromal sarcoma (LGESS) by gross appearance, microscopic features, mitotic state, and immunohistochemistry.

Aim: To understand an algorithmic approach toward a nonhealing surgical site infection (SSI) and broaden our diagnostic outlook toward its uncommon infective etiologies. Background: Nonhealing wound causes significant morbidity and mortality of patients. One of the rare causes behind nonhealing wound infection is Mycobacterium tuberculosis which often remains undiagnosed and increases financial, psychological, and physical burden of the patient and hospital. Case description: Twenty-five-year-old female with a refractory nonhealing lower segment cesarean section wound infection which did not respond to higher antibiotics was later found to be of tubercular and fungal etiology. Conclusion: Optimal involvement of a multidisciplinary team and a precise diagnostic algorithmic approach to treat a refractory SSI with a high degree of suspicion for unusual causes of refractory SSI. Clinical significance: This case report recommends having high degree of clinical suspicion of wound tuberculosis and concomitant infections and sending wound biopsies in all the patients with delayed/nonhealing at earliest.

Introduction: Up to 85% of pregnant women experience nausea and vomiting (NV), which has a number of negative repercussions for the pregnancy's prognosis. The real cause of nausea and vomiting during pregnancy (NVP) remains unknown. Ginger is being used to treat NVP, despite the possibility of pharmaceutical drugs being teratogenic to the fetus. Ginger has been shown in certain trials to mitigate the intensity of NV when compared to vitamin B6, while the results are inconsistent. As a result, the purpose of this meta-analysis is to compare ginger with vitamin B6 for treating nausea and vomiting during pregnancy. Methods: Through November 2021, studies were obtained by doing a systematic search of the electronic databases PubMed, Embase, SCOPUS, and gray literature. Meta-analysis was carried out using Review Manager (Version 5.3) software. In addition, leave-one-out analysis was used to investigate the source of heterogeneity, and Funnel plots were used to examine publication bias; significance level was set at p ≤0.05. Results: This meta-analysis comprised seven trials with a total of 819 participants. The results established that ginger has no discernible influence on the intensity of nausea scores (SMD −0.15, 95% CI −0.35, 0.05; I² 50.0%; p = 0.14), decreasing vomiting scores (SMD 0.05, 95% CI: −0.11, 0.21; I² 0%; p = 0.57) compared with vitamin B6. But, when compared to ginger, vitamin B6 intervention had a substantial influence on improving total NVP results [SMD 0.36, 95% CI (0.06, 0.65), I² 17%, p = 0.02]. Conclusions: Women who are experiencing nausea and vomiting during pregnancy can utilize ginger to alleviate their symptoms to the same amount as vitamin B6. Additionally, thorough RCTs with more number of participants are necessary to validate the effect of ginger supplement against vitamin B6 supplement for NVP therapy.

Introduction: Thalassemia and other structural variants of hemoglobin are among the commonest hereditary disorders in India. They pose a great burden on the existing health resources with an estimated 300,000–400,000 babies born every year with a major hemoglobin disorder. The best strategy for reducing the burden of thalassemia is prenatal screening. However, there are no existing universal guidelines for thalassemia screening in pregnancy. This study was planned to evaluate the extent of published work on the subject in the state of Uttar Pradesh (UP), in order to suggest recommendations for the same. The aim of this study is to examine the data on prevalence of thalassemia in the state of UP, find out the cost burden of treating patients with thalassemia major, and to assess data on knowledge, attitude, and practices (KAP) among healthcare professionals dealing with antenatal women with regard to thalassemia screening. Methodology: The study was planned as a systematic review with literature search done using relevant MeSH terms as well as Free-text terms to run a search. The papers were assessed for relevant questions on prevalence, cost analysis, and KAP, from the state of UP. Results: Studies were limited in the designated research period with varying prevalence. Much of the data has the bias of being hospital based which precludes to the assessment of actual prevalence in the state. There are no studies on knowledge, attitude, and practices of healthcare professionals involved in antenatal care with respect to thalassemia. Only one study has looked into the detailed aspects of socio-economic burden imposed on the family due to a member affected by thalassemia major. Conclusion: There is significant economic impact caused by having a thalassemia sufferer in the family. However, the approximate financial burden is difficult to estimate because we have lack of sufficient studies on the subject. There are no studies on knowledge, attitudes, and practices of healthcare practitioners dealing with antenatal women with regard to thalassemia screening and management.