Aim: To study perineal massage and its effects on the incidence of episiotomy and perineal trauma during second stage of labor Materials and methods: This is an observational study conducted among 150 primigravida women admitted to labor ward, Gandhi Hospital. At commencement of second stage of labor, participants were randomized into massage and control groups, 75 each and frequency of episiotomy, perineal tears, and second stage of labor duration were compared. Results and analysis: Episiotomy incidence was 80 and 93.3% in massage and control group, respectively, indicating increased need of episiotomy in the later group. Time duration of second stage labor was reduced in the massage group. In both massage and control groups, the perineal tears incidence was similar. Conclusion: Perineal massage considerately declined episiotomy rates, time duration of second stage of labor.

Background: Abortion service as medical healthcare facility is an essential service a woman needs. Despite well-developed medical service centers in our country and the legalization of abortion, the incidence of illegal and unsafe abortion has not come down. This study was carried out to analyze the complications following self-medication of abortion pills and to suggest measures to prevent such practice. Methods: This was a retrospective observational study conducted in 125 women who came with history of (H/o) self-intake of abortion pills and presented at our hospital from January 2020 to December 2020. Result: In this study, majority of participants who took self-abortion pills were between 21 and 25 years (36%) of age, and most of them (61.6%) had completed their higher secondary education. Nearly half of the study participants (49.6%) who presented to Obstetrics and Gynecology OPD or in the emergency department were with a history of 2–3 months of amenorrhea. Incomplete abortion was found in 97 (77.6%) patients. Instrumental evacuation was required in 30 (24%) patients. Twenty-three (18.4%) patients were severely anemic. Transfusion of blood was required in 38 (30.4%) patients. Conclusion: Medical abortion is effective and safe when carried out under medical supervision. Unsupervised use of medical abortion pills is associated with many complications like incomplete abortion, rupture ectopic, and ruptured uterus. So, over-the-counter sale of medical abortion pills should be restricted.

Introduction: Hypertensive disorder of pregnancy is one of the leading causes of maternal and perinatal mortality worldwide. Preeclampsia complicates 2–8% of pregnancies globally. Despite the serious clinical consequences, there is currently no effective preventive measure for preeclampsia; hence, the focus has shifted to identifying good predictors for diagnosing the severity of preeclampsia. Material and methods: This was a prospective cohort hospital-based study done in our Department of Obstetrics and Gynaecology, SN Medical College, Agra, Uttar Pradesh, India over a period of 12 months from January 2020 to January 2021. A total of 400 women were found to be eligible for the study after meeting inclusion criteria. All patients underwent detailed evaluation and investigation and the risk was calculated using the preeclampsia integrated estimate of risk (fullPIERS) calculator. All patients were followed weekly till delivery. Adverse maternal and fetal outcome were assessed. If the predicted probability of the adverse outcome came out to be ≥30%, then the case was considered as high risk. T-test and Chi-squared test were used for statistical analysis as appropriate. Results: Considering our cut-off value ≥30% in our study, out of 384 patients, 82 were categorized into high-risk group; among them, 54 (65.85%) patients had adverse maternal outcome (χ² = 96.413, p ≤ 0.0001). Among 377 patients, excluding seven women who expired in antenatal period, 75 patients (19.89%) were categorized into high-risk group (≥30% predicted probability), among them, 59 (78.67%) patients had adverse fetal outcome (χ² = 96.413, p ≤ 0.0001). Conclusion: The fullPIERS model successfully stratifies population into clinically relevant high-risk categories by using few important clinical and biochemical parameters and does not require extensive laboratory testing. It is economically feasible and quick to use, and predicts probability of an adverse outcome. Thus, the timely referral to higher center will help in having a significant impact in reducing the maternal morbidity and mortality; and perinatal morbidity and mortality associated with preeclampsia in low resource settings.

Background and objectives: Amniotic fluid is the complex fluid surrounding the fetus in utero and gives a low resistance environment needed for the growth and development of the fetus. Clinical estimation of amniotic fluid volume forms a major part of the fetal assessment and outcome of pregnancy. A strong association between oligohydramnios and increased lower segment cesarian section (LSCS) rates and low birth weight exists. As very few studies have looked into perinatal outcomes and AFI, we conducted a study wherein we measured the amniotic fluid index (AFI) in mothers between 28 and 40 weeks of gestational age (GA) and looked into its association with maternal and perinatal outcomes. Methods: This was a descriptive observational study on 108 patients in the Department of Obstetrics and Gynaecology, St. Johns Medical College and Hospital, Bengaluru, Karnataka, India over a period of 2 years and we studied the association of AFI on maternal and perinatal outcomes. The data were collected from 6 November 2019 to 1 October 2021. Written and informed consent was obtained from patients agreeing to participate in the study. Ethical approval was obtained from the institutional ethics committee before the start of the study. Maternal and fetal outcomes were studied in the study subjects. Results: This clinical study was conducted over a duration of 2 years on 108 pregnant women in the third trimester at St. John's Medical College and Hospital, Bengaluru, Karnataka, India. Nine patients were diagnosed with oligohydramnios. Hence, the prevalence of oligohydramnios was 8.3% in the study group. The most common presenting complaint or need for admission was safe confinement 48 (44.4%), followed by abdominal pain 40 (37%) and oligohydramnios 6 (5.6%). Majority of the pregnancies had a GA of 37–40 weeks (74.1%). The most mode of delivery was by LSCS (100%) in the AFI <5 cm group. In the AFI <5 cm group, 7 neonates had birth weight 2.5–4 kg. Conclusion: Mode of delivery by LSCS seems to benefit the neonates in terms of lower incidence of non-reactive non-stress test (NST), low chance of meconium-stained liquor (MSL) and intrauterine death (IUD). Prompt decision for LSCS, even in the induced patients who are planned for vaginal delivery, is essential in preventing fetal morbidity such as MSL, fetal distress, and neonatal intensive care unit (NICU) admission.

Introduction: The physiological changes in the respiratory and cardiovascular systems in the immunosuppressed state of pregnancy may exacerbate clinical features and deteriorate outcomes due to COVID-19 infection. We aimed to compare the maternal and neonatal adverse effects in the first and second COVID-19 waves. Methodology: This study was a prospective cohort study conducted in a tertiary care COVID-19-dedicated hospital. In total, 104 (group A) and 96 (group B) COVID-19-positive pregnant women admitted during the first and second waves, respectively, were included in the study. Data on baseline variables, associated comorbidities, clinical presentations, management strategies, and neonatal and maternal outcomes were collected and compared using parametric and nonparametric tests and analyzed. Results: Around 2.08% in group A and 6.72% in group B of COVID-19-infected pregnant women, respectively, had moderate-to-severe disease and required intensive care unit stay. Almost 1.04% in group A and 3.84% in group B had maternal mortality, 13.4% and 19.8% babies of groups A and B required admission in neonatal intensive care units, and 8.6% and 7.3% of newborns in groups A and B had COVID-19-positive reports by reverse transcriptase polymerase chain reaction (RT-PCR) at birth, respectively. Of them, 2.1% newborns in group B had RT-PCR positive on day 7 of life and beyond, whereas none had positive RT-PCR reports on 7 days and beyond in group A. Conclusion: Dreadful maternal outcomes like requirement of ICU and mechanical ventilator and persistence of neonatal infections were higher during the second wave.

Objective: To assess the safety and effectiveness of 25 µg of oral misoprostol solution at the same dose as sublingual misoprostol for labor induction. Design: A prospective comparative trial. Materials and methods: The study included 82 women with term singleton pregnancies who were selected for labor induction. Forty-two patients received sublingual misoprostol every 3 hours, and 40 patients had oral misoprostol solution every 2 hours (six doses). Results: Within 24 hours of induction, 82.5% of the oral group's women delivered vaginally. The sublingual group had 66% women. The Chi-square test was applied to compare two routes, and the result revealed no statistically considerable difference with a p-value of 0.101. In comparison to the oral group (4.43 ± 2.8 hours), the sublingual group (6.25 ± 3.7 hours) had a longer mean interval between the last misoprostol dosage and the onset of labor. Sublingual and oral groups had mean induction to vaginal delivery intervals of 12 ± 5.2 hours and 9 ± 4.5 hours, respectively. A p-value of 0.02 indicated that the difference was statistically considerable. In the sublingual group, 14.2% of patients had meconium-stained liquor, and in the oral group, 10% of patients had meconium-stained liquor. Conclusion: As per the study outcomes, oral misoprostol solution and 25 µg of sublingual misoprostol are both secure and reliable approaches to induce labor in females with an unfavorable cervix. For several measurements, including induction time and vaginal birth rate, we discovered that oral misoprostol solution was more efficient than the sublingual method.

Background: Preterm birth (PTB) forms the prime etiology of mortality and morbidity in neonates worldwide. Our study compares serum epigenetic [microRNA-miRNA:150-5p, 223-3p, 302b-3p, 548ai] and proteomic profiling [interleukin-6 (IL-6), alpha-fetoprotein (AFP)] in prediction of preterm birth. Materials and methods: Blood was drawn from 88 pregnant women at 19–26 weeks of gestation who were followed until delivery. The concentrations of miR-150-5p, miR-223-3p, miR-302b-3p, and miR-548ai (Real-time polymerase chain reaction-RT-PCR) were compared with IL-6 and AFP [enzyme-linked immunosorbent assay (ELISA)]. Results: Our study had 75 term and 13 preterm deliveries. A “p” value of 0.003 for birth weight and preterm delivery; statistically noteworthy was appreciated. Upregulation of miR-150-5p, miR-223-3p, miR-302b-3p was seen in preterm patients with p-value of 0.021, 0.060, and 0.062, respectively. The area under the ROC curve (AUC-ROC) analysis for miR-150-5p (0.739) showed 46.15% sensitivity with 100% specificity and positive predictive value (p-value = 0.0042). miR-302b-3p had the highest sensitivity and negative predictive value of 84.6 and 96.1%, respectively. miR-223-3p defined a 100% positive predictive value and specificity. miR-548ai had 69.23% sensitivity, 44% specificity and p-value = 0.6884 (AUC-ROC). The IL-6 and AFP levels were not significantly different between two delivery groups (p-value = 0.466 and 0.399). Conclusion: miR-150-5p is an effective epigenetic biomarker for prediction of preterm labor compared to IL-6 and AFP. miR-223-3p, miR 302b-3p levels are upregulated in preterm women.

Aim: The aim of this study was to understand the obstetric management of autosomal recessive (AR) disorders. Background: Pregnancy is fickle in nature. While it can put a veil on a few diseases and cause their remissions, it can as well unmask several other disorders, making itself a window for diagnosis. Not only does it help salvage the mother from further complications of such disorders but also provides the obstetricians an opportunity to know whether her future progeny, nurturing within her currently, shall be affected by those disorders. Case description: Hereby, we discuss six cases of rare disorders of autosomal recessive origin in our case series that can possibly cause profound morbidity to both the fetus and the mother. Conclusion: While not encountered routinely, a knowledge of these goes a long way in securing the loose ends of the finer aspects of maternal and fetal outcomes in maternal autosomal recessive disorders. Clinical significance: Not only do these disorders cause poor outcomes on their own, but the drugs used to maintain their remissions are also often teratogenic and require reconsideration with astute preconceptional counseling. In lieu of the paucity of literature on this subject, this case series will be an invaluable addition to the obstetric management of autosomal recessive disorders.

Background: Cancer cervix is one of the leading causes of female mortality in India. Different methods are used for its screening as it has a long latent phase. Colposcopic-directed cervical biopsy of an unhealthy-looking cervix is taken as the gold standard in the diagnosis of cervical intraepithelial lesions. However, a relatively new colposcopy scoring system known as the Swede score has a high specificity and can omit the need of biopsy in preinvasive cervical lesions. Objective: To evaluate the efficacy of colposcopy using Swede score as a screening modality in unhealthy cervix and to correlate its finding with histopathology. Materials and methods: The present study has been conducted in the Department of Obstetrics & Gynaecology at a tertiary care facility of North India from 1st June 2020 to 31st May 2021. Among 99 patients who fulfilled the inclusion and exclusion criteria, colposcopy was done, and cervical biopsy was taken from the suspicious sites. The findings of colposcopy and histopathology were correlated. Result: About 23% (23/99) of the total patients had a Swede score of 5 or more, out of whom 43.47% (10/23) were found to have preinvasive or invasive lesions (p-value < 0.001). Using a Swede score >8, 80% (8/10) patients had preinvasive or invasive lesions with a significant p-value of <0.001. Swede score of 8 or above had an excellent specificity of 100% for high-grade lesions, although the sensitivity was 80%. However, on lowering the cutoff to 5, the sensitivity improved to 100% at the cost of specificity (85.23%). Conclusion and clinical significance: It was evident that colposcopy, using Swede score of >5 and even of >8 as cutoff, is definitely more sensitive and accurate in screening of unhealthy-looking suspicious cervix in Indian population and can be considered to use for treating the patients directly by excision or cryotherapy as a “see and treat” method, avoiding the need for cervical biopsy for histopathological confirmation.

Introduction: Hypertensive disorders of pregnancy are one of the leading causes of maternal and perinatal mortality worldwide. Preeclampsia complicates 2–8% of pregnancies globally. Despite the serious clinical consequences, there is currently no effective preventive measure for preeclampsia hence the focus has shifted to identifying good predictors for diagnosing the severity of preeclampsia. Materials and methods: This was a prospective cohort hospital-based study done in our department. A total of 400 women were found to be eligible for the study after meeting the inclusion criteria. All the patients underwent detailed evaluation and investigation and the risk was calculated using the full preeclampsia integrated estimate of risk (PIERS) calculator. All patients were followed weekly till delivery. The adverse maternal and fetal outcomes were assessed. If the predicted probability of the adverse outcome came out to be >30%, that case was considered as high risk. T-test and Chi-square tests were used for statistical analysis as appropriate. Results: Considering our cut-off value of >30% in our study, out of 384 patients, 82 were categorized into a high-risk group, among them 54 (65.85%) patients had the adverse maternal outcome. (X² = 96.413, p-value = < 0.0001). Among 377 patients, excluding seven women who expired in antenatal period, 75 patients (19.89%) were categorized into high-risk group (>30% predicted probability), among them 59 (78.67%) patients had the adverse fetal outcomes. (X² = 96.413, p-value = < 0.0001). Conclusion: The fullPIERS model successfully stratifies the population into clinically relevant high-risk categories by using a few important clinical and biochemical parameters and does not require extensive laboratory testing. It is economically feasible and quick to use and predict the probability of an adverse outcome. Thus timely referral to the higher centers will help in having a significant impact in reducing maternal morbidity and mortality and perinatal morbidity and mortality associated with preeclampsia in low-resource settings.

Background: This study aims to detect and compare the parathyroid hormone levels with the periodontal status of pregnant women longitudinally throughout their pregnancies. Methods: A longitudinal study evaluated 20 pregnant respondents that reported to the Gynaecology Department of SGT Medical College, Hospital & Research Institute, Gurugram, Haryana, India were evaluated throughout the entire duration of their pregnancy. The respondents were surveyed for oral health awareness, oral hygiene practices, and oral health knowledge using a self-administered questionnaire in both Hindi and English. The pregnant respondents were evaluated for their oral health status with the help of the community periodontal index for treatment needs. (CPITN). Further, for the detection of the parathyroid hormone levels, the blood sample was withdrawn from the pregnant respondents when they reported for their routine check-ups. We drew 2 mL of venous blood in a plain vial, and the serum was assayed for parathyroid hormone (PTH) level by the using chemiluminescent microparticle immuneassay (CMIA) method. The PTH levels were then compared with the periodontal status of the pregnant respondents and checked for their association. Results: The pregnant respondents evaluated for their oral health awareness exhibited unawareness regarding their oral hygiene, the pregnant respondents didn't comply with the required oral hygiene practices, and the oral hygiene knowledge was found to be severely diminished in the pregnant respondents. Post hoc comparison using Mann Whitney U test showed a significant difference only when community periodontal index (CPI) score two was compared with CPI score three rest of all the pairs failed to reach the level of statistical significance. Parathyroid hormone levels were found to be significantly more among subjects having CPI3 as compared to CPI2 readings. Conclusion: Through this study, it was concluded that there is an increased need for gynecologists and dentists to work in coalition regarding the all-around health of pregnant women. The importance of the parathyroid hormone being evaluated during the pregnancy was that the PTH levels of the pregnant women were correlated to their periodontal findings as they progressed in their pregnancies.

Objectives: Severe acute respiratory syndrome-coronavirus 2/COVID-19 infection is still a global concern, with pregnant women are considered as vulnerable population. Until now, the characteristics of pregnant women in Indonesia who are infected with COVID-19, as well as pregnancy and neonatal outcomes, are still unknown. This study aims to obtain national data, which are expected to be useful for the prevention and management of COVID-19 in pregnant women in Indonesia. Methods: There were 1,427 patients recruited in this retrospective multicenter study. This study involved 11 hospitals in 10 provinces in Indonesia and was carried out using secondary patient data from April 2020 to July 2021. COVID-19 severity was differentiated into asymptomatic-to-mild symptoms and moderate-to-severe symptoms. The collected data include maternal characteristics, laboratory examinations, imaging, pregnancy outcomes, and neonatal outcomes. Results: Leukocyte, platelets, basophil, neutrophils segment, lymphocytes, monocytes, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, alanine aminotransferase (ALT), aspartate aminotransferase (AST), C-reactive protein (CRP), urea, and creatinine were found to be significantly associated with severity differences (p < 0.05). Moderate–severe symptoms of COVID-19 also shown to have suggestive pneumonia findings on chest X-ray findings. Patients with asymptomatic-to-mild symptoms had significantly (p < 0.001) higher recovery rate, shorter hospital stay, less intensive care unit (ICU) admission, and had more vaginal delivery. Neonates from mother with mild symptoms also had significantly (p < 0.001) higher survival rate, higher birth weight, and higher APGAR score. Conclusion: Several laboratory and radiology components, as well as maternal and neonatal outcomes are related to the severity of COVID-19 in pregnant women in Indonesia

Background: Gestational diabetes mellitus (GDM) and adverse pregnancy outcomes are correlated. The oral glucose tolerance test (OGTT) is the gold standard method for screening GDM. Glycated hemoglobin (HbA1c) levels are a useful screening test for detecting GDM. The use of HbA1c in screening for GDM has been demonstrated by several studies. Objectives: To find the usefulness of HbA1c levels in diagnosing gestational diabetes mellitus and its association with adverse maternal and neonatal effects. Materials and methods: This prospective cohort study was conducted at Christian Medical Hospital, Ludhiana. About 500 antenatal women attending the outpatient department were subjected to 75 gm OGTT, and HbA1c and GDM being diagnosed using DIPSI criteria. The perinatal outcomes were compared in women with and without GDM. Results: Among the 500 antenatal patients evaluated, 23 were lost to follow-up and excluded from the study. The incidence of GDM was 16.8% (n = 80). Women with GDM and without GDM had a mean HbA1c level of 5.55 ± 0.74% and 4.95% ± 0.74%, respectively. The optimal HbA1c cut-off for diagnosing GDM was 5.15% with sensitivity of 74% and specificity of 69.8%. Conclusions: HbA1c with a cutoff of 5.15% can be used as a screening test and avoid the need of OGTT in approximately 50% of antenatal women.

Aim: To evaluate the role of free radical induced oxidative stress in the etiopathogenesis of unexplained infertility by biochemical estimation of oxidants and antioxidants levels. Objectives: • To evaluate the levels of malondialdehyde (MDA), superoxide dismutase (SOD), and glutathione reductase before antioxidant supplementation. • To compare the effect of antioxidants (vitamin C 790 mg/day, vitamin E 15 mg/day, zinc 10 mg/day, Se 55 μg/day) given for 6 months on fertility outcome in patients with unexplained infertility by evaluating the levels of MDA, SOD, and glutathione reductase post supplementation. Materials and method: This prospective study is carried out on 100 patients in LLR and associated hospital, Department of Obstetrics and Gynaecology, Kanpur, during the period from January 2014 to October 2015. Specific investigation of lipid peroxidation product MDA, SOD, and glutathione reductase (GR) was done initially at the 1st visit (baseline level) and then after supplementation of antioxidants for 6 months. Patients with other causes of infertility were excluded. Results: Out of 100 patients, 30 were controls with spontaneous conception, and 70 were patients with unexplained infertility. Out of these 70 patients, 36 were given antioxidants from outside. Levels of MDA were significantly higher, and levels of GR and SOD were significantly lower in patients with unexplained infertility when compared with patients with spontaneous conception. There was an improvement in pregnancy outcome by supplementation with antioxidants from outside. Conclusion: An imbalance in the level of oxidants and antioxidants leading to oxidative stress can affect the quality of gametes and can be the cause of unexplained infertility. Antioxidant supplementation from outside can improve fertility outcomes in these patients.

Introduction: Obstetric practice has branched to several spheres. Fetal medicine and genetics have now become an important part of high-risk obstetric practice. The importance of a detailed history can never be overemphasized. Pedigree charting greatly assists clinicians in history taking and deciphering not only the chance of a disorder being genetic but also the type of the disorder. This gives at a glance the family tree and disorders running in the family.

Aim: The aim of this study was to summarize different types of benefits that have been observed in the baby's development and the mother's psychological health during the postpartum period. Background: Breastfeeding is a natural process that plays a vital role in the physical as well as mental health of the mother and child. Breast milk is rich in contents such as proteins, fats, and vitamins, which are responsible for building the immune system of the baby. Lactation helps in decreasing the prevalence of infant mortality rate. It enhances the development of the physical health of the children. Breastfeeding protects the mother from many systemic conditions like endometrial cancer, ovarian cancer, breast cancer, etc. It has been observed that with an increase in healthy breastfeeding practices, there is a decline in the cases of maternal mental health issues reported mainly in the postpartum period. Review result: The authors have explained various types of advantages of breastfeeding on the child's and mother's health, their mechanism of action, effects on the baby, and mother–child relationship. Conclusion: The mother's mental health plays a crucial role in a healthy infant, and breastfeeding is key to it. The role of breastfeeding is therefore considered a boon for the mother because if there is a decrease in health issues in the child, the mother's mental condition improves automatically. Therefore, breastfeeding should be promoted at the national level. Clinical significance: Breastfeeding not only helps in reducing maternal stress and postpartum depression but also improves the physical health of the child and mother during the postpartum period. The clinicians should teach mothers about the importance and also the correct positions of breastfeeding. “Breastfeeding week” is celebrated every year from August 1 to August 7, as implemented by the Indian government.

Objective: Low levels of serum anti-Müllerian hormone (AMH) have been linked to heart disease. It's been suggested that it can help forecast the risk of preeclampsia. The goal of this scoping review is to present the most recent evidence on the function of AMH in preeclampsia prediction. Materials and methods: We looked through web-based databases and key terms like AMH, preeclampsia, predictor, and inclusion and exclusion criteria. Eight research papers were evaluated; however, two studies with retrospective cohorts and follow-up were removed, resulting in a final analysis of six investigations. There were 558 subjects examined in all. There were 243 with preeclampsia and 315 with normal blood pressure. Results: Three of the six studies found a statistically significant link between low AMH levels and preeclampsia (p = 0.05), while the other two studies were near to the level of statistical significance (p = 0.06). The current literature implies that low-blood AMH levels may have a prognostic value in women developing preeclampsia. Conclusion: Higher levels of serum AMH are associated with a decreased risk of preeclampsia, according to current research.

Introduction: Vaginal agenesis is an uncommon condition. This may occur as an isolated developmental anomaly or may be associated with other anomalies. Vaginal agenesis can impose immense psychological stress on a woman. The aim of vaginoplasty is to create a neovagina that has a satisfactory appearance, function, and feeling. A perineal approach with various surgical modifications is the most commonly performed technique. However, the material of graft varied from bowel transplants, thigh or subcutaneous abdominal flaps, split-thickness skin grafts, amnion, and oxidized regenerated cellulose etc. among various studies. Review: The electronic databases (PubMed, Google Scholar) were searched using a combination of the following search terms “Vaginoplasty”, “Neovagina”, and “oxidized regenerated cellulose”. The thirteen full-text case reports/series on epithelization of a neovagina using oxidized regenerated cellulose in vaginoplasty surgeries were reviewed. Discussion: The use of oxidized regenerated cellulose during vaginoplasty as a graft substitute can provide good surgical results such as epithelization of a neovagina, vaginal length achieved, and satisfactory sexual intercourse after surgery, without increasing the risk of operative complications and late post-operative complications. Conclusion: Vaginal reconstructive surgery using oxidized regenerated cellulose for epithelization is a simple, safe, and effective technique with promising results in terms of epithelization, achieving adequate vaginal length, and satisfactory sexual intercourse.

A fraction of the trophoblastic tissue that remains in the uterus after an abortion or a full-term vaginal delivery is referred to as “retained products of conception” that can have varied manifestations like persistent vaginal bleeding, acute abnormal uterine bleeding (AUB), abdominal pain, sepsis, chronic pelvic pain, shock, pyometra, hematometra and in long tern may lead to subfertility and secondary amenorrhea. Due to absence of diagnostic clues, resulted in missed or delayed diagnosis that further lead to trial therapies, thus possess a challenge to treating physician. The diagnostic modalities may include ultasonography with color Doppler, hysteroscopy, but the gold standard test is histopathological examination (HPE). We present unusual clinical presentations of retained POCs at our center for the benefit of widening the diagnostic horizon of this particular pregnancy complication.

An ectopic pregnancy refers to any gestation implanted outside of the normal intrauterine gestation site. A cesarean scar ectopic pregnancy (CSEP) is the rarest form of all ectopic gestations with CSEPs with an incidence of approximately 1 in 2,000 pregnancies. It refers to the implantation of the gestational sac on a previous cesarean scar and understandably, the incidence of CSEPs has increased lately due to the increase in the number of cesarean sections (CS) performed. It is extremely important to diagnose this condition early as it poses significant morbidity including risks of uterine rupture, rarely, if left undetected. Ultrasound remains an important modality in diagnosing such pregnancies. Here, we discuss three unique cases of scar ectopic pregnancy wherein each has been managed differently.

Aim: Ovarian cysts can be due to various etiologies and not all ovarian cysts need surgical removal. Background: Ovarian cysts can be functional to neoplastic varying from as small as 3 cm to a full-term gravid uterus. They remain asymptomatic but present lately as acute abdomen requiring emergency surgical intervention. However, ovarian cysts can also be due to an endocrine disorder requiring prompt diagnosis and treatment avoiding inadvertent surgery. Case description: This is a case report of a 13-year-old obese adolescent girl who presented with a 30-weeks palpable abdominopelvic mass. Ultrasound abdomen (USG abdomen) and pelvis revealed a large abdominopelvic multiloculated cystic lesion of size 21 cm × 15 cm × 15 cm. Elective laparotomy was planned. The investigations revealed alarmingly high thyroid stimulating hormone (TSH) values. Endocrinologist opinion was sought and juvenile hypothyroidism was diagnosed and treated with T. Levothyroxine. Surgery was withheld as the patient condition improved. Ultrasound pelvis (USG pelvis) (after 3 months) showed significant size regression to 5 cm × 3 cm, bilateral polycystic ovaries requiring nil surgical intervention. Conclusion: Hypothyroidism should be considered in the differential diagnosis of adolescent females presenting with multicystic ovarian tumors. Adequate thyroid hormone replacement therapy can prevent these patients from undergoing unnecessary and catastrophic ovarian resection. Surgical excision should be considered only when adequate thyroid replacement therapy fails to resolve ovarian enlargement or in emergency cases such as ovarian torsion and rupture.

Background: Extrauterine leiomyoma is a rare tumor that often presents a diagnostic challenge for the clinician. Secondary changes that commonly occur are hemorrhage, infection, degeneration, necrosis, and rarely sarcomatous transformation. We are reporting a case of true broad ligament fibroid to shed light on the diagnostic difficulties and surgical complications they can pose. Case description: A 73-years old multiparous lady with the last birth of child 40 years back, came with complaints of abdominal mass of approximate size of a football for the past 7 years with pain in lower abdomen associated with loss of appetite and weight loss for 2 months. On abdominal examination, there was a mass of 32–34 weeks size was found, which was arising out of the pelvis, non-tender, firm to cystic in consistency with regular margins, and mobile from side to side. The patient underwent an exploratory laparotomy. During operation, an abdominopelvic mass of approximately 35 cm × 28 cm × 20 cm was seen with a firm to cystic consistency next to the uterus and between the folds of the broad ligament. Conclusion: This case in a post-menopausal lady is rare in respect of its location in the broad ligament and also due to the degenerative changes in the leiomyoma which mimicked ovarian malignancy both clinically and radiologically, creating diagnostic challenges. Clinical significance: Preoperative diagnosis by Doppler ultrasound and magnetic resonance imaging (MRI) is important to prevent further injuries to pelvic organs. Surgery is the mainstay of treatment for broad ligament fibroid.

Aim: This case report is aimed to study the treatment approach in a case of Glanzmann's thrombasthenia (GT) with ovarian hematoma and hemoperitoneum. Background: Glanzmann's thrombasthenia is an extremely rare life-threatening bleeding disorder that often presents with heavy menstrual bleeding in reproductive-age females. Case description: A 25-year-old patient presented to emergency with abdominal pain and heavy menstrual bleeding and ultrasonography suggestive of ovarian hematoma and hemoperitoneum. The patient was managed with blood and platelet transfusion and a conservative approach was adopted. Combined oral contraceptive pills were started for heavy menstrual bleeding. Conclusion: Management of GT is a challenge. Being an autosomal recessive disorder besides menstrual blood loss control, partner testing, and preconceptional and premarital counseling is critical. Clinical significance: A rarity of diseases poses a problem with no standardized approach and treatment options are mostly reliant on case studies or expert opinions.

Aim: Due to the widespread use of first-trimester screening ultrasound, the incidence of adnexal masses in pregnancy has risen. However, the diagnosis of adnexal masses is not always straightforward and all differentials need a thorough evaluation. Background: Adnexal masses during pregnancy are not uncommon. Large simple ovarian cysts can mimic a mesenteric cyst rarely. Case description: A 21-year-old female with complaints of acute pain in the abdomen, with vomiting and two episodes of fever presented on the 7th day of vaginal delivery. She was diagnosed as having a large mesenteric cyst in the antenatal period, however, on repeat imaging and exploration, it was an adnexal mass with torsion detorsion. Conclusion: This case report highlights the importance of the diagnosis of adnexal masses accurately early during pregnancy and one of the potential challenges faced thereof. Clinical significance: An accurate diagnosis and planned management of the pregnancy with an adnexal mass can lead to favorable maternal and fetal outcomes. All differentials need thorough consideration.

Ovarian fibrothecomas are ovarian stromal tumors that can appear in a variety of clinical circumstances. Aim: In postmenopausal bleeding women, the study's goal is to determine the prevalence, diagnosis, therapeutic needs, and histological characteristics of ovarian fibromas and fibrothecomas. Case description: We present a case of ovarian fibrothecoma with postmenopausal bleeding and abdominal distension in a 64-year-old female with chronic renal disease, measuring 84.96 pg/mL serum testosterone and 18.5 ng/dL serum inhibin-B. A multiseptated cystic lesion measuring 3.6 × 2.4 cm with thin internal septae emerging from the right ovary is shown on MRI pelvis. Total abdominal hysterectomy was performed, as well as bilateral salpingo-oopherectomy. Conclusion: Ovarian fibrothecoma is a rather uncommon condition. The preferred treatment for postmenopausal women is surgical excision, which has an excellent prognosis. In our case, ovarian fibrothecoma with thickened proliferative endometrium, raised CA-125 level, and increased inhibin-B and serum testosterone levels mislead us to the diagnosis as malignancy. This case report represents the possibility of occurrence of benign ovarian tumors with clinical pictures of postmenopausal bleeding and to be wide enough to rule out benign causes.

Introduction: Acute stroke during pregnancy is a rare event, but its incidence is rising nowadays, and it has worse maternal and fetal outcomes. Material and methods: Here we report a case of 40-year-old female came with 9-month amenorrhea and left-sided upper and lower limb hemiparesis with severe preeclampsia. This was an upper motor neuron type lesion and was managed conservatively initially, and after stabilization her emergency lower segment cesarean section was done for obstetric indications under proper anesthetic guidance. She was managed with multidisciplinary approach and was discharged on the 8th postoperative day in a satisfactory condition. Conclusion: Acute cerebrovascular accidents during pregnancy are managed by early diagnosis, proper intervention, and multidisciplinary team approach, which reduces maternal and fetal mortality and morbidity.