Background: Pregnant women are particularly susceptible to iron deficiency anemia (IDA), a global health problem. Having an IDA is associated with poor outcomes for both the mother and the child. Due to the variety of laboratory tests available, the most commonly used are hemoglobin (Hb) and serum ferritin (SF). The standard treatment for IDA is intravenous (IV) iron. Aim and objective: Iron isomaltoside (IIM) 1000 (Rapifer IV) treatment in pregnant and gynecological patients was evaluated in this study. Materials and methods: Fifty pregnant women who were followed from the start of the second trimester until a few days before delivery were studied for IDA. For a minimum of 15 minutes, all women received the same dose of IIM 1000 mg (Rapifer IV). To determine the efficacy of the treatment plan, several tests were conducted, including estimations of Hb, red blood cell (RBC) count, white blood cell (WBC) count, platelet count, polymorphs, lymphocytes, eosinophils, monocytes, packed-cell volume (PCV), and mean corpuscular volume (MCV). When the ferritin level is 30 gm/L, severe iron deficiency (ID) is defined, while a mild-moderate ID is determined when the ferritin level is between 100 and 30 gm/L. Results: Mean age of women with IDA was 35.14 ± 7.183 which ranged from 22 to 53 years. Significant improvement in mean Hb (8.64 ± 0.85 vs 12.86 ± 0.97, p <0.001), platelet count (115.11 ± 161.22 vs 3.13 ± 0.68, p < 0.001), polymorphs (70.9 ± 34.36 vs 50.62 ± 6.39, p = 0.0001), lymphocytes (32.24 ± 9.70 vs 39.68 ± 7.64, p = 0.0001), PCV (31.40 ± 4.46 vs 39.72 ± 2.56, p = 0.023), MCV (74.51 ± 8.23 vs 87.14 ± 3.05, p = 0.021), mean corpuscular hemoglobin (MCH) (23.71 ± 3.77 vs 31.62 ± 2.10, p = 0.012), mean corpuscular hemoglobin concentration (MCHC) (27.56 ± 2.81 vs 34.90 ± 2.30, p = 0.001), red cell distribution width (RDW) (18.48 ± 3.02 vs 13.94 ± 1.62, p = 0.004), total iron binding capacity (TIBS) (397.1 ± 74.53 vs 273.86 ± 31.55, p = 0.024), SF (32.19 ± 78.18 vs 85.96 ± 21.74, p <0.001), serum iron (46.40 ± 14.89 vs 108.32 ± 21.38, p <0.001), and reticulocytes (1.84 ± 0.79 vs 1.07 ± 0.29, p <0.001) after 27th day treatment with IIM 1000 compared to baseline. A significant improvement in Hb was observed in obstetrics and gynecological (12.68 from 8.24; p <0.001) and postoperative women (13.22 from 8.62; p <0.001). IIM 1000 was also able to improve severe ferritin level to mild-moderate ferritin level in a span of 27 days. Conclusion: IIM 1000 (Rapifer IV) is efficacious in obstetrics and gynecological and postoperative women. A significant improvement was observed on the classical parameters of IDA.

Aim: The purpose of the study is to discuss about the presentation and management of adolescent adnexal torsion at ESIC Medical College and PGIMSR. Materials and methods: This is a case series study of adolescents with adnexal torsion, from December 2019 to March 2022 at ESIC Medical College and PGIMSR, Chennai, Tamil Nadu, India. Detailed history and clinical examination followed by ultrasonography with Doppler pelvis were done. The type of surgery and the histopathological findings were studied. Written informed consent was taken from all the subjects for publishing the data and images. Results: All patients presented with acute onset of abdominal pain. Eight patients had vomiting. Six patients had right-sided torsion and four patients had left-sided torsion. Laparotomy was done for nine cases. A laparoscopy was done for one case. Only two patients underwent salpingo–oophorectomy due to necrotic changes. The ovary was preserved in eight patients. Two patients had oophoropexy done. One was for recurrent torsion and the other case had undue long ovarian ligament and fallopian tube. Conclusion: Adnexal torsion is a gynecological emergency and requires early surgical intervention. Adnexal torsion in adolescents is usually due to benign functional ovarian cysts and benign teratoma. Malignant ovarian tumors are rare in the adolescent age-group. The goals of surgery are detorsion and preservation of the ovary regardless of its appearance at the time of surgery. Oophorectomy is required only when the ovary is severely necrotic and falls apart. Clinical Significance: Minimally invasive surgical approach with detorsion of adnexa and avoiding oophorectomy will lead to preservation of adnexal structures and their function.

Aim: Several neurological disorders occur in women of the childbearing age group and are an important cause of maternal morbidity and mortality. The diagnosis and management of neurological disorders in pregnancy is always a challenging task due to varied symptomatology and risks to the fetus. A rare neurological disorder in pregnancy can be pregnancy related or can be caused by exacerbation of a pre-existing neurological condition or sometimes can be detected for the first time during pregnancy which might be an incidental finding. Treating these patients remain a challenge. Thus, our study aimed to determine the challenges in managing pregnant mothers with rare neurological complications in a tertiary health care hospital. Methods: All pregnant women with rare neurological conditions admitted to the Department of Obstetrics & Gynaecology, St. Johns Medical College and Hospital, Bengaluru, Karnataka, India during our 1-year study period (from January 2020 to December 2020) were analyzed retrospectively. Our experience may help to take proper decisions when a similar condition is encountered elsewhere. Results: In a study period of 1 year, the total incidence of neurological disorders with pregnancy was 0.89%, which included eclampsia (0.4%) and epilepsy (0.25%). We had nine cases with a rare neurological disorder. Three of them were primigravida (33.5%). Four were diagnosed with the neurological disorder before the pregnancy. Five cases were diagnosed for the first time during pregnancy. We had two cases with Wernicke's encephalopathy (WE), one case of the acute motor sensory axonal neuropathy (AMSAN) variant of Guillain–Barré syndrome (GBS), and one case with GBS. One case with right cerebellopontine angle tumor which got diagnosed during her first trimester of pregnancy. Four cases with pre-existing neurological disorder included status epilepticus, limb–girdle muscular dystrophy, middle cerebral artery (MCA) aneurysm/internal carotid artery (ICA) supraclinoid occlusion and situs inversus totalis with neuromyelitis optica. The mean maternal age was 27.77 years. Gestational age varied from case to case at the time of their presentation and five cases had associated obstetric complications. Six mothers recovered well, one mother went against medical advice, two mothers lost to follow-up and we had one maternal mortality. Conclusion: Even though knowledge about rare neurological diseases in pregnancy is finite, these cases require tertiary care referral and patients should be promptly managed through a multidisciplinary approach. Strict antepartum vigilance is essential for the treatment and good neonatal outcomes. Holistic and vigilant care toward these patients reduces mortality and improves maternal and neonatal outcomes.

Background: Postpartum hemorrhage (PPH), is one of the most common causes of maternal mortality as well as morbidity worldwide. Around 88% of maternal deaths occur in the first 4 hours of delivery. So, the majority is the consequence of events in the third stage of labor. Most cases of primary PPH are caused by atonic uterus often due to prolonged labor, pre-eclampsia, or past history of PPH. Management of PPH involves a stepwise approach from medical to surgical management like laparotomy for systemic devascularization, uterine compression sutures, or peripartum hysterectomy. In 1983, Goldrath published that uterine tamponade can be possible by insufflating a Foley catheter in the uterus. Commercially available catheters such as Sengstaken Blackmore tube, Rusch urological catheter, and Bakri balloon are commonly used; however, their cost is the limiting factor for the regions of less privilege. Hence, this study is planned to evaluate the efficacy of 24-French Foley catheter tamponade in atonic PPH, after the failure of medical management, which is easily available, economical, and also quantifies blood loss. Methods: It is a prospective study. The subjects were PPH patients who failed to respond to medical management and were hemodynamically stable. Intrauterine 24-French Foley catheter was applied. The vital parameters were monitored. Monitoring for vaginal bleeding was done. The Foley catheter was kept for 24 hours. Results: Atonic PPH was there in 961 subjects. Intrauterine balloon tamponade by 24-French Foley catheter was applied to 800 patients. The duration of the study was June 2014 to May 2020 in Gadag Institute of Medical Sciences, Gadag, Karnataka. It was effective in 766 (95.75%) subjects. Around 34 subjects were in need of surgical management. Hence this alternative simple intervention method decreased many surgical interventions and respective morbidity. Conclusions: The intrauterine balloon tamponade by 24-French Foley catheter is the most effective, quite simple economical technique for preventing blood loss in atonic PPH.

Introduction: Cervical cancer is the second most common cancer and the leading cause of death in women in developing countries such as India. Papanicolaou (Pap) smear is the most effective and successful screening to identify cervical non-neoplastic lesions as well as lesions with significant epithelial cell abnormalities. Aim: To evaluate the use of Pap smear for detecting premalignant and malignant lesions of the cervix and their incidence with respect to age, parity, age at marriage, and contraception in order to prevent mortality from cervical cancer. Materials and methods: This is a prospective study conducted from October 2021 to June 2022. In this study, Pap smears were collected from 620 women and processed by routine Pap staining techniques and reported on the basis of the revised Bethesda system (2014). Results: In our study, out of 620 smears, 27 smears were inadequate. Maximum smears were found in the age range of 41–50 years, in multiparous women who married at age of 22–27 years, and the ones who did not use any contraception. Inflammatory smears formed the majority with 365 (58.89%) smears. Other following epithelial cell abnormalities were also found: Premalignant lesions such as atypical squamous cells of undetermined significance (ASCUS) (1.9%), atypical squamous cells, HSIL cannot be excluded (ASCH) (0.6%), low-grade squamous intraepithelial lesion (LSIL) (1.3%), high-grade squamous intraepithelial lesion (HSIL) (0.59%), and malignant lesions such as cervical squamous cell cancer (0.33%) and atypical glandular cells (AGC) (0.09%). Conclusion: Our findings suggest that the incidence of cervical carcinoma can be greatly reduced by using Pap smear examination extensively as it helps not only to analyze the spectrum of cervical lesions but also helps in the early detection of premalignant and malignant lesions of the cervix, thereby reducing the mortality in such patients.

Introduction: Gynecological emergencies can threaten the life of the female and cause loss of fertility and organ. Ruptured ectopic pregnancy is the most prevalent of the gynecological potentially life-threatening emergencies (G-PLEs). Diagnostic tools are medical history, clinical examination, imaging, and lab investigations, mainly human chorionic gonadotropin (β-HCG) and hemoglobin. Surgery is the mainstay of treatment and the approach can be laparotomy and laparoscopy. Objective: The objective of this study is to assess the time taken from arrival in the emergency department (ED) to arrival to diagnosis and to assess the time taken from arrival to ED to arrival to operation theater (OT) and correlate the time taken with patient morbidity. Methods: The study was done between April 1, 2021 and September 30, 2021. All patients with suspected gynecological emergencies requiring emergency laparotomy/laparoscopy arriving at the ED were included in the study. Data collection was from medical records – six time intervals were collected. Results: There were 16 ruptured ectopic pregnancies during the study period. ED to OB consultation was in <60 min in 12 (75%) cases. ED to ultrasound (USG) and diagnosis were in <60 min in 11 (73%) cases. Diagnosis to OT was in <60 min in only 8 (50%) cases. Delay after diagnosis was due to delay in admission in four (delay in the decision by attendees mostly due to financial constraints), delay in the decision for surgical intervention in three, and nonavailability of blood in one patient. All 5 (100%) patients with grades III and IV of shock had hemoperitoneum >1.5 L and 3 (60%) required postoperative intensive care unit (ICU). Conclusion: Higher morbidity was seen in a higher grade of shock. It is essential to recognize the degree of physiological deterioration with the help of an early warning scoring system. Timely surgical intervention with simultaneous efforts for resuscitation reduces morbidity and mortality.

Introduction: Multiple pregnancies are considered high-risk pregnancy. The commonest being twin pregnancy. It can lead to many maternal and perinatal complications. The global twinning rate has increased by a third, due to the dramatic increase in use of ovulation-induction drugs, IVF, and delayed marriages. To minimize the risks, patients with multiple pregnancies require close monitoring and frequent follow-up. Aim: To evaluate maternal and perinatal complications and pregnancy outcomes in women with twin pregnancies. Materials and methods: This is a retrospective observational study conducted in Municipal General Hospital and Medical College, Ahmedabad. During this study period of 2 years, there were a total of 10,682 deliveries, which include 142 women with twin pregnancies. We studied maternal factors like age, parity, complications, mode of delivery, and perinatal morbidity and mortality. Results: The incidence of twins in this study was found to be 1.32%. The most common maternal age was 20–25 years (mean age – 23.7) and higher incidence in multiparous women. Women with spontaneous conception – 96.4%. The most common fetal presentation was cephalic–cephalic presentation (59.5%). The commonest maternal complications were preterm (83.8%) and anemia (41.5%). Mode of delivery in our study 44.5% being vaginal birth and 55.6% women underwent lower segment cesarean section (LSCS). Neonates with birth weight less than 2.5 kg were 91.9%. Perinatal mortality was 11%. Conclusion: Twin gestation necessitates special attention as they contribute to maternal and fetal morbidity and mortality. Regular antenatal visits, adequate rest, administration of steroids, good nutrition, intensive neonatal care, and good health services can give fruitful outcomes.

Aim and objective: To estimate the outcomes of enhanced recovery after surgery (ERAS) protocol implementation in perioperative elective cesarean patients. Study design: Cross-sectional study was conducted from January 2020 to December 2021 at a tertiary healthcare center. During the study period, ERAS protocol was implemented on elective cesarean deliveries at the study institution to find out the time to first ambulate, incidence of urinary retention, total intravenous (IV) fluids in the postoperative period, tolerability of early oral intake, hospital stay, readmissions for maternal cause, and the complications up to 30 days postpartum. Results: In total, 150 cases were enrolled in the study. Six hours 23 minutes was the mean ambulation time, and all patients started ambulation within 10 hours of surgery. There were no cases of urinary retention. About 132 patients needed 1500 mL of IV fluids in the postopertive period. About 146 postoperative patients tolerated a 2-hour liquid diet. The postoperative length of stay was 3 days 3 hours with 11 cases of postoperative complications with 3 cases requiring readmission. Conclusion: The implementation of ERAS protocols in elective cesarean delivery has shown favorable outcomes with minimal complications and readmission. Early resumption of oral feed was well-tolerated and led to a reduced need for IV fluids. Early removal of the catheter aided in early ambulation and without undue retention of urine. Early discharge is beneficial for the patient to reduce hospital-acquired infections and bed turnover in limited-bedded hospitals. Enhanced recovery after surgery protocol can be implemented in low-risk elective cases posted for cesarean delivery in Government hospitals.

Aim: To determine the efficacy of Foley catheter compared to dinoprostone insert for preinduction cervical ripening in women with a previous cesarean delivery. Background: Labor induction is a common intervention in obstetric practice. Both intracervical Foley catheter and dinoprostone insert have been used for the ripening of the cervix and labor induction. Foley catheter has been used for cervical ripening and labor induction in women with previous cesarean section. Recently dinoprostone insert has been approved for preinduction cervical ripening in women having unfavorable cervix. Method: A prospective clinical observational study was conducted in Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh from October 2019 to December 2021. Results: Group I included women who were induced with dinoprostone insert while group II had women induced with transcervical Foley catheter. Most of the women in both groups were induced for hypertensive disorders and gestational age >40 weeks. Successful vaginal birth was significantly higher in the Foley catheter group as compared to the dinoprostone group. Significant uterine hyperstimulation was seen in women induced with dinoprostone while there was negligible maternal and neonatal complications in group II. Conclusion: Our study showed that transcervical Foley catheter was more effective, safe, and acceptable method for labor induction in women with previous cesarean sections without increasing maternal and neonatal morbidity. There was an increased rate of uterine hyperstimulation and scar tenderness in women who were induced with dinoprostone insert. Clinical significance: Intracervical Foley catheter is a better preinduction cervical ripening agent in women with previous cesarean section.

Background: Pre-eclampsia is a multisystem disorder with two-stage disease pathology where abnormal placentation precedes the endothelial dysfunction which ultimately leads to the systemic inflammatory response. Endothelial dysfunction is one of the hallmark pathologies of pre-eclampsia, microalbuminuria is the measure of the same and could be used as a marker for predicting pre-eclampsia in early gestation. This study has been carried out to predict pre-eclampsia among low-risk pregnant women with the use of spot urine albumin–creatinine ratio (ACR) and to derive at a definite cut-off value of spot urine ACR. Materials and methods: This prospective study was done in ESIC Medical College & PGIMSR, Chennai, Tamil Nadu, India, for a period of 12 months. Low-risk singleton pregnant women between 16 and 20 weeks of gestational age who satisfied the inclusion criteria were considered. Participants who tested negative for urine albumin by urine dipstick method were subjected to a spot urine ACR test. Urine albumin was measured by the immunoturbidimetric method and urine creatinine by Jaffe's kinetic method. Urine albumin is expressed as mg/dL, urine creatinine as gm/dL, and ACR as mg/gm. All the participants were followed up to delivery. The primary outcome measure was pre-eclampsia, secondary outcome measures were gestational hypertension (GHTN), gestational diabetes mellitus (GDM), intrauterine growth restriction (IUGR), and a cut-off value of urine spot ACR in the prediction of pre-eclampsia was calculated by receiver operative curve (ROC) analysis. Results: Among 164 participants, the proportion of pregnant women affected with pre-eclampsia was 3.04%. The optimum value of ACR in predicting pre-eclampsia obtained was 25.89 mg/gm by applying the ROC curve. It also derived 80% sensitivity and 87% specificity with a positive predictive value (PPV) of 16% and a negative predictive value (NPV) of 99%. Conclusion: The ACR test is widely available with easy interpretation and also convenient for pregnant women. Spot urine ACR value of more than 25.89 mg/gm in asymptomatic pregnant women when measured between 16 and 20 weeks of gestation can predict the development of pre-eclampsia with the sensitivity and specificity of 80 and 87%, respectively. The higher NPV value of 99% of spot urine ACR ratio may help in accurately diagnosing true negatives. However, additional prospective studies with higher sample size and cost–benefit analysis of the test are recommended to confirm these findings before routinely using urine spot ACR as a predictive marker.

Aim: The aim was to study the distribution of causes in nongravid women of reproductive age-group having abnormal uterine bleeding (AUB) as per the new International Federation of Gynecology and Obstetrics (FIGO) polyp; adenomyosis; leiomyoma; malignancy and hyperplasia; coagulopathy; ovulatory dysfunction; endometrial; iatrogenic; and not yet classified—(PALM-COEIN) classification system and to evaluate the practical applicability of this classification system in the clinical scenario. Materials and methods: A prospective cross-sectional study was conducted among 300 women with AUB attending the outpatient department of gynecology, selected by the kth random sampling technique. The etiological diagnosis was made in the PALM-COEIN spectrum. The practical applicability of the AUB-FIGO classification system was assessed by the survey of clinicians with help of a scoring system. Results: The majority of the study subjects were from 40 to 55 years age group with the median age of the study subjects being 42 years. Fifty-two subjects had two attributable causes from PALM-COEIN for AUB. In our study, 45% of subjects had leiomyoma, which turned out to be the most common etiology for AUB, and hypothyroidism was the most common endocrinopathy associated with 10% of AUB cases. Hysteroscopy was required to diagnose one case of amenorrhea. The clinician survey emphasized the high practical applicability of PALM-COEIN classification. Conclusion: The data generated from the clinical settings with this classification could be more comparable due to homogeneity and consistency in nomenclature. Clinical significance: The International Federation of Gynecology and Obstetrics classification for AUB is a clinician-friendly modality providing an easy algorithm for accurate diagnosis and definitive treatment of AUB.

Aim: To assess the effect of high maternal body mass index (BMI) on complications during pregnancy, mode of delivery, complications of labor and delivery, and postnatal outcomes. Materials and methods: A prospective and comparative observational study was carried out in 350 antenatal women with singleton pregnancy in the first trimester, divided into two groups of 175 each based on BMI, after taking inclusion and exclusion criteria in the OBGY Department of Fortis Escorts Hospital, Faridabad. Patients were divided into two groups: group I – (Control group) BMI less than 25 and group II – (Study group) BMI equal to or more than 25. Maternal and fetal outcomes were studied during pregnancy, at the time of labor, during delivery, and postnatal stay. Results: In comparison with women of BMI less than 25 kg/m², women with BMI more than 25 kg/m² faced more risk of gestational hypertension (13.71% in group I and 33.71% in group II), gestational diabetes (8.57% in group I and 26.86% in group II), intrauterine growth restriction (IUGR) (5.71% in group I and 12% in group II), induction of labor (10.06% in group I and 24.42% in group II), nonprogress of labor (NPOL) (4.69% in group I and 17.55% in group II), and cesarean section (24% in group I and 48.57% in group II) with statistically significant increased incidence. In this study, we also found that high maternal BMI along with excessive gestational weight gain (above recommended value) has a statistically significant association with gestational hypertension and gestational diabetes (p-value <0.0001). Conclusion: We concluded that there is high prevalence of complications to the mother when the BMI of the mother is more or equal to 25. Clinical significance: The results of this study add to the emerging body of literature on the consequences of mothers being overweight and obese during pregnancy and childbirth.

Aim: The aim of this study is to assess the prevalence, indications, and maternal outcome of emergency obstetrics hysterectomy and to determine the change in trend in indications of emergency obstetrics hysterectomy in a tertiary care center in Pakistan. Materials and methods: This retrospective, observational analytical study was conducted in the Department of Obstetrics and Gynecology – Unit-III of Dr Ruth KM Pfau Civil Hospital, Karachi, Pakistan from 2016 to 2019. All patients who had undergone emergency obstetrical hysterectomy from January 2016 to December 2019 were enrolled in the study. Data were collected from files and registers. The rate for emergency obstetric hysterectomy (EOH) was calculated. The indications for hysterectomy were also noted. Maternal outcomes including injury to organs, transfusions of blood and its products, intensive care unit (ICU) admissions, and maternal death were secondary outcome measures. Results: Over a 4-year period between January 2016 to December 2019, 15,040 women were delivered, and out of these, 202 underwent EOH. The prevalence of EOH was 13.42 per 1,000 deliveries. The rate was 0.37% in 2016, 0.58% in 2017, 1.76% in 2018, and 2.48% in 2019. Overall, the most common indication for hysterectomy was morbidly adherent placenta (MAP) 64 (31.7%) followed by postpartum hemorrhage 60 (29.7%). There was a gradual change in indications for EOH; in 2016 only one EOH was due to MAP, whereas in 2019, 34 (33%) EOHs were due to MAP. Out of these 202 women, 29 (14.4%) succumbed to death. Conclusion: There was a sharp increase in the rate of EOH from 2016 (0.37%) to 2019 (2.48%). Morbidly adherent placenta has become the leading indication for EOH. Policymakers need to take necessary action to reduce the cesarean section rate.

Introduction: Increased reporting of menstrual disturbances post-vaccination and inadequate inclusion of questions about menstruation in vaccine trials and disease progression studies have been the baseline for conducting this study. We aim to assess the influence of vaccines and COVID-19 infection on menstruation and identify patterns, if any, in cycles post-disease/vaccination. Methods: A multicenter observational study was performed using a questionnaire-based survey via an online link. The participants who filled the survey were predominantly in the age group of 21–25 years (80%). Participants with prior menstrual irregularities were eliminated from the study. Results: The prevalence of unusual menstrual cycles post-infection/vaccination was 21.7%. A total of 17.11% experienced changes post-vaccination and 22.8% of the infected individuals reported abnormalities post-COVID-19 disease. A substantial increase in dysmenorrhea was reported (p <0.001) post-infection/vaccination. An increase in menstrual flow was observed in 14.9% post-vaccination and 23.9% post-infection. Conclusion: Menstrual changes post-vaccination were insignificant; however, significant differences in menstruation were reported post-infection. The study strengthens the association between COVID-19 and menstruation and urges the inclusion of menstrual health in disease intervention studies.

Aim: To study the outcome of intravaginal dinoprostone insert for induction of labor with and without a saline vaginal wash. Materials and methods: A randomized controlled trial was conducted from October 2019 to June 2021 in the Department of Obstetrics and Gynaecology of a tertiary care center located in Puducherry, India. The total study population was 164. Participants were allocated into group I (n = 82) and group II (n = 82) based on computer-generated random numbers. A 20 mL of 0.9% NaCl wash was given intravaginally prior to insertion of dinoprostone for group I and no wash was given for group II. Duration of dinoprostone kept intravaginally, time from insertion to active stage, and full cervical dilatation was noted. The software used was statistical package for social sciences (SPSS) software, version 17. Results: Group I patients were found to attain the active stage of labor in 10 hours compared to group II patients who attained the active stage of labor in 14 hours. The difference between the mean duration of dinoprostone kept intravaginally, insertion to the active stage and full cervical dilatation were statistically significant. Conclusion: Thus, the labor duration for patients who underwent vaginal wash was less when compared to those who did not undergo vaginal washing. Vaginal pH has been shown to alter with vaginal washing. Vaginal washing before intravaginal dinoprostone insertion may increase the vaginal pH, and change the prostaglandin E₂ (PGE₂) vaginal insert bioavailability leading to shorter labor duration. Clinical significance: For pregnant women with planned labor induction, vaginal douching can be easily performed before intravaginal dinoprostone insertion and can provide safe and rapid labor.

Background: The triple burden of malnutrition (TBM) presents a significant threat to the health of mothers and their future generations, particularly in low- and middle-income countries. Though having adequate macro- and micronutrients and maintaining a healthy weight are essential for all, pregnant women require special attention. However, their nutrition status and dietary requirements are not focused upon during their clinical visits. Methods: International Federation of Gynecology and Obstetrics (FIGO) nutrition checklist was administered to 714 women for the first time in selected private healthcare facilities in 3 states of India. A descriptive analysis of data was done to assess their nutrition status and dietary pattern. Logistic regression was done to evaluate any significant association of their dietary and supplementary intake with the hemoglobin (Hb) levels. The feedback on FIGO checklist administration from 50 healthcare providers (HCPs) was also collected using a survey questionnaire. Result: The analysis of FIGO checklist data has shown that a significant proportion (48%) of women are overweight or obese and 33% are with low Hb. The increased Hb levels were significantly associated with supplement intake. However, the associations observed between any other dietary intake and Hb levels were insignificant. Healthcare providers considered the checklist as an important tool to encourage nutrition-related dialogues with women and recommended its use during clinical visits. Conclusion: The FIGO checklist holds promising potential as a nutrition intervention to curb the increasing burden of malnutrition by keeping health, nutrition status, and weight management in check. However, the challenges associated with its administration should be addressed to have a greater impact.

Objective: To compare the effectiveness of oral misoprostol versus intravenous oxytocin for induction of labor. Methodology: This was a single-center, prospective comparative study done at a tertiary care academic health center from January 2018 to June 2019, where a total of 266 term pregnant women who were candidates for induction of labor were assessed and selected to enter the study. The women were assigned to one of the two groups according to the mode of induction, oral misoprostol, or intravenous oxytocin. The misoprostol group received 25 μg of oral misoprostol solution every 2 hours for a maximum of six doses, and the oxytocin group received an infusion drip starting from 6 mIU/minute, which gradually increased every 30 minutes up to a maximum of 37 mIU/minute. Women who went into active labor within 24 hours of the first dose in the misoprostol group and 12 hours in the oxytocin group were considered successful induction. Results: The successful induction rate was more with oral misoprostol than with oxytocin (64.3% vs 58.8%). More women delivered vaginally with oral misoprostol as compared to oxytocin (59.1% vs 50.4%). Induction to active labor time and induction to delivery time was significantly shorter for the oxytocin group than the misoprostol group (5.96 ± 2.59 and 7.75 ± 2.90 vs 10.15 ± 5.66 and 12.53 ± 6.33 hours; p-value <0.001). Conclusion: Oral misoprostol is a safe and effective drug with low complications for induction of labor in women with an unfavorable cervix compared to oxytocin.

Aim: The aim was to determine the prevalence of chronic endometritis (CE) and luteal phase defect (LPD) in women with recurrent pregnancy loss (RPL). Materials and methods: It was an observational study done over 18 months in the tertiary care center in India. Women with two or more than two pregnancy losses were enrolled in the study and underwent an endometrial biopsy. Hematoxylin and eosin (H&E) staining was done on all endometrial biopsies and plasma cells were identified by their classical morphology. Immunohistochemical (IHC) staining was done for CD-138. Identification of one or more plasma cells on the biopsy was diagnosed as CE. Luteal phase defect was diagnosed as a morphological lag on endometrial biopsy dating of more than 2 days compared to the menstrual cycle day. Results: Sixty-five patients were included in the analysis. Approximately 32.31% were CD-138 positive for CE and 58.46% were positive for LPD. The sensitivity and specificity of H&E in diagnosing CE were 38.1% and 70.45%, respectively, taking IHC CD-138 as the gold standard. Approximately 61% with CE also showed LPD on endometrial biopsies. There was also a positive and statistically significant correlation between the number of pregnancy losses and the number of days’ lag in LPD (p < 0.0001). Conclusion: Endometrial factors as a cause of unexplained RPL cannot be ignored. It is possible that CE may predispose to LPD or the two may have a cumulative effect leading to RPL. Endometrial biopsy is a cost-effective diagnostic tool, and the treatment of CE and LPD is established and economical. We believe that it is prudent to look for and treat these conditions, which can lead to improvement in pregnancy outcomes. Clinical significance: Endometrial biopsy provides an insight into the etiopathogenesis of RPL and should be a part of the routine workup.

Introduction: Menopausal symptoms have defected the quality of life of elderly women. Several studies have examined a nonhormonal bioadhesive moisturizer gel, such as polycarbophil, for genitourinary syndrome of menopause (GSM) therapy. However, there was no such study in Indonesia. Thus, this study aims to compare the efficacy of polycarbophil moisturizer gel and placebo for women with GSM. Materials and methods: A randomized clinical trial with a total of 40 subjects was enrolled in Cipto Mangunkusumo General Hospital, Jakarta from April to December 2019. Subjects were divided into polycarbophil group (n = 21) and the placebo group (n = 19). Polycarbophil and placebo were given two times per week for 3 weeks. Genitourinary syndrome of menopause symptoms (vaginal dryness, itching, dyspareunia, dysuria, and burning sensation) and vaginal health index scores (VHIS), including vaginal elasticity, fluid volume, pH, epithelial integrity, and vaginal moisture, were assessed before and after the intervention. Results: Most of the GSM symptoms, especially vaginal dryness and dyspareunia, improved in week 2 for both interventions. Related to VHIS, polycarbophil gel improved the vaginal fluid volume, pH, and moisture, while placebo improved epithelial integrity. The polycarbophil gel was found to significantly (p <0.001) raise the vaginal pH compared with placebo. Overall, there were 18 subjects (85.7%) from the polycarbophil group who felt an improvement of symptoms after therapy, while only 11 subjects (57.9%) from the control group felt it. Conclusion: Polycarbophil gel may raise vaginal pH in postmenopausal women with GSM. The overall VHIS efficacy between polycarbophil and placebo was relatively the same.

Aim: In light of the severe acute respiratory syndrome by a coronavirus-2 (SARS-CoV-2) pandemic, it was proposed that a variety of complications have occurred in women during pregnancy, which has further extended to the fetus, causing higher rates of morbidity and mortality. The objective of this study was to identify the complications that arose due to the coronavirus and asses how it impacted the pregnancy, the fetus, and the neonate. Materials and methods: Our study was a descriptive and observational study, which investigated the various aspects, obstetric, fetal and neonatal outcomes, and the complications arising in mothers affected with by SARS-CoV-2 virus. All women who tested positive after 20 weeks of gestation were included in the study and their pregnancy was followed up till delivery, and neonatal outcomes were noted. Results: About 220 women infected with SARS-CoV-2 were studied and outcomes were illustrated. The mean age of the study population was 26.87 years [±4.96 Standard Deviation (SD)]. About 90% of the study population had a mild illness. The main obstetric outcomes noted were preterm labor, preeclampsia, eclampsia, intrauterine growth restriction (IUGR), and intrauterine fetal demise (IUD). Only 4.1% required a cesarean section for worsening conditions. Neonatal intensive care unit (ICU) admissions were also noted to be higher, with a possibility of vertical transmission in six babies. Conclusion: Severe acute respiratory syndrome by a coronavirus-2 can have serious implications and can pose a great risk in pregnancy if not caught and treated early. Therefore, it is vital to screen those at high risk for the virus to prevent severe complications from taking a toll on the mother and fetus. Clinical significance: By identifying the main complications occurring in pregnancy, we can prevent the same by anticipating and monitoring carefully, thereby reducing mortality and morbidity rates.

Background: Our aim is to use the survey data to analyze how healthcare professionals evaluate their lifestyle habits and well-being. The novel concept of happiness score has been evaluated with respect to different factors. Methods: A cross-sectional study was conducted for a period of 3 months. An assessment of lifestyle factors was done over the happiness score. Data were collected through the questionnaire method. The study period comprised between June 2021 and August 2021 with a sample size of 377. Health markers such as diabetes, hypertension, and lack of sleep were analyzed for different subgroups. We were also able to assess the dietary eating habit of doctors irrespective of the socio-demographic characteristics by random selection in different states. Generalized linear modeling was used to examine the association between the categorical variables and their respective happiness score. Results: Our study has shown a positive association between lifestyle factors that affect the happiness score. It is truly highlighted with two major significant components such as dietary habits and profession have been plotted by using a violin plot against the happiness score value. Conclusion: The aggregation of food components played a significant role in assessing the quality with respect to their lifestyle. There is no significant intake of alcohol and tobacco as recorded in the dataset. Happiness score value has been estimated which will help in forecasting the future happiness score for doctors depending on their lifestyle patterns.

Aim: Pregnant women worry about the pain they will experience throughout childbirth as well as labor process, and physical comfort can be achieved by a variety of nonpharmacological methods. The aim was to evaluate the effectiveness of Dick-Read method vs sacral massage on labor pain and progress of labor among the parturient mothers admitted in the labor room in Rajiv Gandhi Government Women and Children's Hospital (RGGW and CH), Puducherry. Materials and methods: In quantitative and quasi-experimental two groups pre- and posttest, control group design was used, a sample of 120 parturient mothers by using purposive sampling. A labor pain assessment scale was used to assess the level of labor pain, and a checklist was used to assess the progress of labor. Descriptive and inferential statistics were used to analyze the data. Results: The result showed that the mean posttest level of labor pain was significantly decreased in experimental group II compared with experimental group I. The researcher found low and moderate positive correlation between posttest mean score of level of labor pain and progress of labor among parturient mothers, and there was no significant association of the posttest level of labor pain and significant association of the progress of labor in experimental groups I and II. Conclusion: Sacral massage was more effective in reducing the level of labor pain, and there was progress of labor compared with Dick-Read method among parturient mothers. Clinical significance: As a nonpharmacological intervention, it is easy to administer, cost-effective, and harmless among parturient mothers. This intervention may use healthcare practitioners when providing care to women during the labor process.

Transitional cell carcinoma (TCC) or urothelial carcinoma is the most common type of urinary bladder cancer. It roughly accounts for 95% of bladder cancer. It can occur due to cigarette smoking, aniline dye used in paint industry, and agrochemicals. TCC can be papillary, sessile, or carcinoma in situ. These patients most commonly present with hematuria and dysuria. Also, increase in frequency and urgency are also noted. Here, we present a case of high-grade transitional cell carcinoma of bladder which, presented as a pelvic mass with no history of hematuria or dysuria. All the tumor markers were normal and imaging was suspicious, so diagnostic laparoscopy was planned, which ultimately converted to laparotomy due to intraop bleeding. It was subsequently shown to be originated from bladder. This case also indicates the role of good imaging analysis in a pelvic mass despite normal tumor marker, and it subsequently helps in the planning of the management.

Ovarian dermoids mostly remain asymptomatic during pregnancy. Large dermoids may present with torsion, hemorrhage, or rupture. However, a dermoid cyst causing fetal growth restriction (FGR) and oligohydramnios is a very rare entity. The authors report a case of a large ovarian dermoid (15 × 12 cm) hampering intrauterine fetal growth. Due to the coronavirus disease-2019 (COVID-19) lockdown, the patient was unable to get ultrasound examinations in early gestation, and thereby, surgical intervention was not possible during the second trimester. As a result, this growing teratoma finally led to FGR by either exerting a pressure effect upon the uterus or by dwindling its blood supply.

Aim: Hysterectomy's role and efficacy for symptomatic uterine fibroids are well-established and undisputed. Before performing a hysterectomy in a large uterus, lowering uterine vascularity can aid in optimizing the surgery, reducing operating time, and, most importantly, minimizing the blood loss during the procedure. Background: Uterine artery embolization (UAE) was introduced for the management of symptomatic uterine fibroids (leiomyomas) in 1995. Uterine artery embolization treatment of fibroids is performed worldwide. Case description: A 40-year-old female with complaints of dysmenorrhea and heavy menstrual bleeding with a palpable 28-week mass arising from the pelvis with severe anemia was treated by performing preoperatively UAE followed by abdominal hysterectomy to minimize the blood loss. Conclusion: This case report encourages offering UAE before abdominal hysterectomy to reduce intraoperative blood loss, thereby enhancing rapid postoperative recovery for large uteri. Clinical significance: Performing UAE before hysterectomy reduces perfusion of myometrium as well as the fibroid, thereby minimizing the blood loss and need for blood transfusions, thus encouraging its use in the management of large fibroids.

Aim and background: Parasitic leiomyoma is an extremely rare variant of uterine leiomyoma occurring outside the uterus. The majority of the patients with uterine leiomyoma are asymptomatic. However, it may present with vague symptoms. Case description: We present a case report of parasitic leiomyoma in a 39-year-old pregnant woman at 38 + 6 weeks who presented with a complaint of discomfort in the lower abdomen. On abdominal ultrasound, there was a large mass measuring about 12.7 cm × 9.6 cm × 13.6 cm in the anterior wall of the uterus in the lower uterine segment on the right side, abutting and indenting the posterior wall of the urinary bladder. During cesarean section, the growth was noted to be hooked to the dome of the bladder instead of the uterus. Histopathological examination confirmed the diagnosis of parasitic leiomyoma. Clinical significance: Although, parasitic leiomyoma is an infrequent subtype of uterine leiomyoma, we report a challenging case of parasitic leiomyoma with all its particularities.

Aim: This case report is aimed at studying the maternal and foetal outcome in pregnancy with congenital heart disease complicated with Eisenmenger's syndrome (ES). Background: Eisenmenger's syndrome is the presence of a reversed or bi-directional shunt at the aortopulmonary, interatrial, or interventricular level along with pulmonary artery hypertension (PAH). This causes severe maternal hypoxemia and life-threatening complications. Case description: We report a rare case of 31-year-old primigravida with 34 weeks gestation diagnosed with congenital heart disease complicated with ES for the first time in the index pregnancy. On evaluation for her breathlessness at 34 weeks gestation, she was found to have a 23 mm ostium secundum ASD with bidirectional shunt with severe pulmonary artery hypertension with PASP of 155 mm Hg. Her pregnancy was further complicated with gestational thrombocytopenia and intrauterine growth restriction (IUGR). She was managed by a multidisciplinary team at our tertiary care center with sildenafil (vasodilator), diuretics, oxygen therapy, antenatal steroids and ultrasound obstetric Doppler surveillance for IUGR. She underwent an emergency caesarean section under epidural anesthesia at 35 weeks gestation in view of breech presentation in preterm labor. Postoperatively she was monitored closely in cardiac ICU for 3 days and later shifted to ward. She was then discharged 2 weeks later with same medications continued and advice regarding need for cardiac follow-up and contraception in order to avoid future pregnancies. Conclusion: Eisenmenger's syndrome in pregnancy is associated with a high maternal morbidity and mortality. The ES patient with PAH should be monitored closely and managed in a tertiary facility with a multidisciplinary teamwork if they choose to continue their pregnancy for a favorable maternal and foetal outcome as in our case. Clinical significance: Pregnancy is best avoided in patients with ES on account of very high maternal and fetal morbidity and mortality. Successful maternal and fetal outcome of pregnancies complicated with ES needs thorough management by multidisciplinary teamwork in a tertiary facility.

Primary malignant diseases of the vagina are quite uncommon, particularly in adults. They constitute about 2% of gynecologic malignancies, the least common among them being sarcomas (3%). Very few cases have been reported in the literature due to the rarity of the disease. A 36-year-old lady presented with complaints of irregular and excessive bleeding per vaginum of 3-months duration. There were no specific findings on general examination of the patient. The per-speculum examination revealed an ulceroproliferative growth arising predominantly from the anterior vaginal wall extending from the anterior and right lateral fornices till introitus, filling the vaginal cavity. The cervix and all other fornices were free, so was the rectum. The MRI of the local part showed a 6 × 4 cm lesion arising from upper anterior vaginal wall causing obliteration of the vaginal cavity with extra serosal extension and abutment of base of bladder. The biopsy and the immunohistochemistry of the lesion were suggestive of high-grade sarcoma (Vimentin+, CD10+, p53+, ki 67–80%, SMA-, Desmin-, myogenin-, and Pan CK-). The patient received 3 cycles of neoadjuvant chemotherapy (AIM regimen – Doxorubicin, Ifosfamide, and Mesna) due to the bulky nature of the disease. The response assessment MRI revealed 25% decrease in the size of the lesion with infiltration of the posterior wall of the bladder. The patient underwent laparoscopic anterior pelvic exenteration. The postoperative histopathology revealed the growth to be high-grade fibrosarcoma with focal undifferentiated pleomorphic sarcoma-like areas with bladder wall infiltration (pT3). Sarcomas of the vagina are exceedingly rare. Surgery plays a major role in management. Postoperative radiation therapy may help in decreasing local recurrence. The benefits of chemotherapy, with its morbidity and possible mortality, remain unproven. Prognosis may be associated with tumor grade and stage. Owing to the rarity of the disease, treatment guidelines are still unclear and need further exploration.

Background: Primary abdominal pregnancy occurs when the gestational sac attaches directly to the abdominal peritoneum. It is difficult to establish a confirmed diagnosis in an acute setting and half of them are only confirmed during operation. Most of the cases were diagnosed at the time of the surgery which increases the chances of morbidity and mortality if prior suspicion is not considered which leads to grave injury to the female psychologically as well as physically. Case description: We present a case of an abdominal pregnancy of a 26-year-old woman conceived after ovulation induction and presented with a symptom of spotting and pain abdomen and operated laparoscopically. The patient recovered completely after surgery and followed up weekly till β-human chorionic gonadotropin (β-hCG) normalized. Conclusion: A high suspicion of abdominal pregnancy should always be kept in the mind because of the various presentations, especially in early pregnancy. Early diagnosis and management are the foremost goal to prevent this life-threatening condition. A combined multidisciplinary approach should be opted for the management of abdominal ectopic pregnancy and laparoscopy has a miraculous approach to diagnosing and treating abdominal pregnancy.