Introduction: Dilatation and curettage (D&C) is one of the most common minor procedures in gynecology performed mainly as an outpatient basis procedure for the evaluation of abnormal uterine bleeding (AUB). Various forms of analgesia used include local anesthesia like paracervical block (PCB) or intracervical block, intrauterine instillation of local anesthetic agent, rectal/oral/parenteral use of nonsteroidal anti-inflammatory drugs (NSAIDS) and opioids, sedatives and hypnotics, and even general anesthesia. This study was undertaken to compare various routes of local analgesia for the D&C procedure. Aim: The aim of this study was to compare the pain scores before and after administering the local anesthetic agent 2% lidocaine in D&C procedure. Design: The design of this study includes a prospective interventional study (September 2016 to August 2018) in 220 AUB patients attending gynaecology clinics of Kasturba Hospital, Manipal, Karnataka, India. Method: The visual analog scale (VAS) was used for pain assessment, and SPSS16 was used for data analysis. Result: During cervical dilatation, paracervical block has better pain relief and during curettage intrauterine instillation lidocaine provides adequate pain control, and the combined use of paracervical and intrauterine lidocaine is superior for pain relief and also provides long-lasting pain relief even following the procedure. Conclusion: Lidocaine administration is safe, effective, and can be a good alternative to other forms of analgesia, both regional and general.

Introduction: Antioxidant can be defined as any substance that significantly delays and prevents the oxidation of an oxidizable substrate (oxidant). So that the causal relationship of menopause and the imbalance of oxidant–antioxidant becomes a reciprocal relationship and influences each other, decreases in antioxidant levels have been researched can cause oxidative stress, which triggers apoptosis in ovarian reserves. Objective: The purpose of this study is to compare the serum total antioxidant capacity (TAC) levels between early-menopausal and normal-menopausal women. Methods: This is an observational analytic study with a case–control design with 20 women with early menopause and normal menopause were included according to the inclusion and exclusion criteria by consecutive sampling, then the characteristic data were collected and grouped according to the study group. A blood test was done to assess serum TAC in the participants. Data were collected and processed, and statistical analysis was carried out. Results: It was found that there were differences in age at menopause in the group of participants who experienced early menopause and normal menopause. There were differences in TAC levels based on body mass index and TAC levels in early menopause and normal menopause. Conclusion: There are differences in serum TAC levels between early menopausal and normal menopausal women.

Aim and primary objective: To study the clinical presentations, maternal and neonatal outcomes in pregnant women with coronavirus disease 2019 (COVID-19) infection. Secondary objective: To compare the clinical profile between the first and the second waves and to determine the risk factors associated with the maternal outcomes. Materials and methods: This retrospective cohort study was carried out in pregnant women with confirmed COVID-19 infection who delivered from May 2020 to Dec 2021 in six hospitals in South India. Data on maternal demographics, severity of disease, and maternal and neonatal outcomes were collected from the medical records. Women who tested positive for COVID-19 infection were grouped into two cohorts, those who tested positive in the first wave between April and September 2020 and those who tested positive in the second wave between March and September 2021. A comparison was made between the two waves and risk factors for the outcomes were also analyzed. Results: There were 471 COVID-positive pregnant women in the study, 252 in the first wave and 219 in the second. Demographic characteristics did not differ significantly between the two waves. The common symptoms of COVID-19 were cold/cough (50%) and fever (40%) and were similar in both the waves. Compared to the first wave, more women were symptomatic in the second wave (58.9% vs 24.21%) and needed hospitalization (55.71% vs 44.84%). Maternal morbidity/mortality (hospitalization for COVID treatment, oxygen administration, and maternal deaths) was significantly more in the second wave. Obstetric complications, cesarean section rates, preterm delivery, low birth weight babies, and neonatal intensive care unit admissions were not different between the two waves. There were six maternal deaths and three neonatal deaths in the second wave and none in the first. Symptomatic COVID was associated with increased maternal morbidity and mortality. Cesarean section rates were higher in those symptomatic after 34 weeks of gestation. Conclusion: This study demonstrated that the severity of COVID and maternal and neonatal outcomes was significantly worse in the second wave. Symptomatic women were more affected though there were no identifiable risk factors. Clinical significance: This study shows that different variants of the virus may cause different severity of presentation. The significant morbidity and mortality of the second wave reinforces the need for vaccination in reproductive age women.

Aims and background: Any pregnancy duration extending beyond 294 days is prolonged. These pregnancies do have higher chances of complications. Pregnancies beyond 40 weeks or 280 days are also associated with compromised fetomaternal outcomes. This study aims to evaluate the fetomaternal outcome in pregnancies after 40 weeks of gestation. Materials and methods: In this prospective observational study of 14 months duration, both primigravida and multigravida crossing 40 weeks of pregnancy were included. Complicated pregnancies and fetal anomalies were excluded. The spontaneous labor or induction rate, mode of delivery, and fetomaternal complications were evaluated. The statistical analysis was done using SPSS software. Results: Most primigravidas needed induction of labor compared to multigravida. The induced group had higher cesarean section rates, 59.37%, than the spontaneous group, 19.44%, which is statistically significant. Maternal morbidities at <40 weeks pregnancies are found in 16.58% of cases and 29.6% of cases between 41 and 42 weeks. Perinatal morbidity is seen in 35.7% of pregnancies in less than 41 weeks and 100% of cases crossing 42 weeks. Conclusion: Pregnancies beyond 40 weeks are associated with higher complication rates, which increase as gestational age (GA) increases. Clinical significance: All pregnancies beyond 40 weeks should be categorized as high risk and monitored intensively.

Aim: To understand and classify the causes of stillbirth as per recode classification system and delineate the demographic details of patients prone to stillbirth. Materials and methods: A prospective, observational study conducted in a tertiary care center with a study population of 250 assessed for causes of stillbirth and maternal and fetal high-risk factors. Patients diagnosed with stillbirth clinically or via ultrasonography after 28 weeks of gestation were included after taking appropriate consent. Results: In maternal demography Majority of the stillbirths occurred in the age group of 26–35 years with the gestational age between 28 and 32 weeks of gestation. Multigravidas were more prone to stillbirth. About 74.8% were delivered via the vaginal route of which 1.2% was instrumental and the remaining underwent C-sections. A predilection of 1.6% more was seen towards the male gender. 40.8% were macerated stillbirths and thus majority was seen to occur in the antepartum period. Application of the Relevant Condition at Death (ReCoDe) Classification system showed maximum stillbirths occurring due to maternal causes commonest of which was a hypertensive spectrum of disorders amounting to 40.4% followed by anemia (21.6%). Amniotic fluid risk factors were next where the commonest cause of oligohydramnios (19.6%) was followed by meconium-stained liquor. In fetal risk factors, the most common cause seen was congenital lethal anomalies amounting to 14% followed by fetal growth restriction which was merely 10%. Placental causes of stillbirth showed preponderance in cases of abruption placenta. In corroboration to other studies, only 12.4% were left unexplained. Conclusion: As seen, ReCoDe classification system allowed us to classify 87.6% of the cases, thus leaving only 12.4% of stillbirths unexplained. The most common cause of stillbirth in our study was a hypertensive spectrum of disorders in pregnancy followed by various other maternal disorders in pregnancy such as anemia, jaundice, heart disease, etc. It was followed by amniotic fluid causes which was followed by fetal causes and then placental causes. Clinical significance: Relevant Condition at Death classification system becomes an effective classification system that can be applied in developing countries to help in the reduction as well as prevention of stillbirth.

Aim: To compare vitamin D levels in the serum of women in the first three months of gestation with bacterial vaginosis (BV) occurrence in a tertiary care hospital. Materials and methods: Bacterial vaginosis diagnosis was done using the Nugent scoring system. It has been considered as one of the best standards to diagnose BV. Vitamin D analysis was done using ELISA method. Results: About 66.7% of pregnant women positive for BV in the first trimester of pregnancy were with vitamin D deficiency, 22% of women who had a normal vaginal flora had sufficient measures of vitamin D in the serum. In this study, the subnormal and deficient measures of vitamin D had a good and significant association in women with BV with a p-value of 0.007. Conclusion: In women in the first trimester of pregnancy, BV has significant association with deficient measures of vitamin D in the serum. Clinical significance: Bacterial vaginosis presenting as vaginal discharge is mainly caused by increase in the levels of anaerobic bacteria. There is a balance between Lactobacillus species, which is present in abundance and maintains the normal pH of the vaginal fluid with anaerobic bacteria, which is altered in BV. It is said to be a polymicrobial clinical syndrome that can lead to preterm birth and its related complications. In developing countries, public health diseases are given importance and one among them is vitamin D deficiency. Interestingly, deficient measures of vitamin D have been found to be increasingly linked to the symptomatic presentation of several medical and immunological conditions that can lead to hypertension, diabetes in pregnancy, and can also lead to preterm labor. In this study, we tried to see if there is any relationship between BV and deficiency of the levels of serum vitamin D in the first trimester of pregnancy. Diagnosing BV and vitamin D deficiency in the first trimester gives us ample opportunity to treat and reduce the obstetric complications.

Background: Accurate preoperative initial evaluation of adnexal masses to distinguish between benign and malignancy is essential to plan the extent and surgical mode. The purpose of our study was to assess the effectiveness and precision of the international ovarian tumor analysis (IOTA) scoring model in low-resource settings of peripheral islands of India. Material and Methods: A retrospective study of all cases operated for adnexal mass in our department between 2017 and 2021 was carried out in this medical college. Cases of adnexal mass were subjected to IOTA scoring, tumor markers, and clinical profile analysis and were classified as presumptively benign, malignant, or inconclusive to decide the mode of surgery. The diagnostic performance of the IOTA system was evaluated and different variables were analyzed. Result: Among total of 53 patients, 32 (60.3%) could undergo laparoscopic management. Only one case of the borderline endometrioid tumor was missed as benign by the scoring system (3.1%). The sensitivity of the IOTA regression system was 93%, the specificity 83.78%, and the positive and negative predictive values were 71% and 96% respectively. The negative likelihood ratio was 0.07 and accuracy was around 86%. None of the cases needed intraoperative conversion. Conclusion: International ovarian tumor analysis (IOTA) scoring system is a simple, clinically feasible diagnostic tool that accurately distinguishes benign from malignant adnexal pathologies and can guide in deciding on a laparoscopic approach. Clinical significance: Benefits of laparoscopy can be provided even in low-resource setup by use of the IOTA ultrasonic scoring model.

Introduction: Recent pandemic of COVID-19 has shaped economic, social, and political aspects of human civilization. Pregnant women were also affected during the pandemic. Effect of COVID-19 infection on pregnancy outcome as the pandemic progressed through various phases (first, second, and third waves) is of importance. Methodology: A cross-sectional study carried out in a dedicated COVID tertiary care maternity unit during three waves of pandemic. Around 405 pregnant women with active COVID-19 infection at the time of delivery giving birth to 411 newborns (6 cases of twins) were enrolled to study the perinatal outcome. Primary outcome of study was to analyze the perinatal outcome in COVID-19-affected pregnant women and secondary outcome of study was to understand the sociodemographic profile of women affected by COVID-19 and to compare the maternal and fetal affection in all three phases of the COVID-19 pandemic. Results: Among three phases, most commonly affected age-group was 21–25 years (44.2%). Among the affected women, body mass index (BMI) was normal in 49.9% of women. Phase-wise affection did not show any statistical difference for maternal age, BMI, socioeconomic class, parity, and gestational age. Overall 48.6% of women were symptomatic. Symptomatology and high dependency unit (HDU)/intensive care unit (ICU) requirement showed statistical significant difference in three waves of pandemic (p < 0.001). The second wave had severe affection than the first and third waves. All four (1%) maternal mortalities during study period were noted in the second wave. Commonest obstetric high risks noted were anemia, 34.6% cases, followed by previous lower segment cesarean section (LSCS), 27.2% cases, and preeclampsia, 18.8% cases. Preterm delivery rate was found to be 27.4%. Obstetric high risks and preterm delivery rate did not show any statistical difference in all three phases of COVID. Cesarean section rate was 48.1% in COVID-19 pregnant population. Cesarean section rate among three phases showed statistical significance with highest (54.7%) in the first wave of COVID-19 pandemic. Neonatal transmission rate was 1.02% in our study. Stillbirth rate and neonatal intensive care unit (NICU) admission did not show any statistical difference in three waves of COVID-19 infection. Conclusion: The second wave of COVID-19 was more severe compared with first and third waves with more symptomatic cases requiring HDU/ICU admission and high maternal mortality. Neonatal outcome did not show statistical difference in three stages of COVID-19 pandemic.

Introduction: Misoprostol, a prostaglandin analog, is frequently used to treat miscarriages medically by causing myometrial contractions that help the pregnancy tissue to be expelled. Mifepristone, a competitive progesterone receptor antagonist, primes the myometrium for prostaglandin exposure. Aim: By contrasting mifepristone combined with misoprostol with misoprostol alone in first-trimester missed miscarriage, to evaluate the potential challenges such as the requirement for an operation. Objective: To reduce the chances of surgical intervention in first-trimester missed miscarriage. Study design and participants: This study was done in the Saveetha Medical College and Hospital, Chennai, in two years of duration from September 2020 to August 2022. Materials and methods: In the first 13 weeks + 6 days of pregnancy, 150 women who had first-trimester missed miscarriages confirmed by pelvic ultrasound were recruited. Seventy-five women (group A) were randomly allocated to receive mifepristone 200 mg, 48 hours later 400 μg misoprostol per vaginally at 3 hourly intervals to a maximum of three doses were given. Seventy-five women (group B) were randomly allocated to receive 400 μg misoprostol per vaginally at 3 hourly intervals to a maximum of three doses were given. Results: In total 29.33% of 75 women within the mifepristone plus misoprostol group required surgical intervention to complete the miscarriage, versus 56% of 75 women within the misoprostol alone group. Conclusion: We recommend that women with a first-trimester missed miscarriage should be offered mifepristone pretreatment before misoprostol to increase the chance of successful miscarriage management, while reducing the necessity for surgical evacuation like D&E especially in primigravidas.

Purpose: To assess the feasibility and efficacy of a nonhormonal soy isoflavone vaginal gel in improving vulvovaginal estrogen-deprivation symptoms in postmenopausal women. Materials and Methods: It was a single-center, prospective study. We identified postmenopausal women having at least one of the following self-assessed moderate to severe symptoms of vulvovaginal atrophy (VVA). Participants used soy isoflavone gel (0.5%) twice weekly for 12 weeks. Vulvovaginal symptoms and pH were assessed at three time points [baseline (T1), 4 weeks (T2) and 12 weeks (T3) with clinical evaluation, the Vaginal Health Index, Vaginal Assessment Scale, and the Vulvar Assessment Scale]. Efficacy and tolerability were assessed using the Patient Global Impression of Improvement (PGI-I) Scale and adverse effects were also recorded. In the results of 95 patients, the mean age was 55 years (range, 31–78), 68% (n = 69) were partnered, and 60% (n = 61) were sexually active. Vaginal Assessment Scale/Vulvar Assessment Scale scores significantly improved at all assessment points (all p = 6.5) and decreased from 26% at T1 to 19% at T3 (p = 0.18). Conclusion: Soy isoflavone vaginal gel (0.5%) use on a daily basis for 12 weeks leads to significant improvements in the symptoms of VVA in postmenopausal women. Topical isoflavones are a good treatment option for VVA, especially in women who either do not wish to use hormonal therapy or have contraindications to its use.

Background: Adnexal torsion is a common diagnostic challenge in an emergency setting. It has an incidence of 2–15%. Diagnosis is mainly based on clinical symptoms and imaging techniques such as ultrasound and magnetic resonance imaging (MRI), however, a normal ultrasound scan does not exclude adnexal torsion and the decision to operate should be made on clinical grounds. Methodology: Data from 24 patients who were known cases of adnexal torsion was retrieved from the hospital registry to conduct a retrospective analysis of patients. Conclusion: Appropriate diagnosis and timely surgical gynecological intervention are of utmost importance to preserve ovarian function.

Introduction: The erudition of the fecundity period is essential for women for both successful conceiving and effective contraception with a need for research in developing a cost-effective, easy-to-use, multiuse, home-based method for prediction of ovulation. Aim: To evaluate the ferning patterns in saliva among various phases of the menstrual cycle (Follicular, Ovulatory, and Luteal) in normally menstruating women using a compound light microscope. Setting and design: A total of 45 healthy women between the ages of 18 and 25 who had a regular menstrual cycle participated in the current study. Methods and materials: Selected individuals were instructed on how to collect samples and when. The presence, absence, and intensity of the ferning pattern were determined by examining the dried saliva smears under a low power objective (10×). Following the Wilcoxon Signed Rank Test, Friedman's Test was used to statistically analyze the data. Results: The present study's findings indicate that among all study participants, there is a strong positive link between the occurrence of salivary ferning and the timing of ovulation. The maximum intensity of ferning is observed in the mid-day of the menstrual cycle in a subsection of women who were evaluated on multiple days in the ovulatory phase. Conclusion: The salivary fern test is a non-invasive and cost-effective method can serve as a reliable indicator of ovulation for effective conception or contraception and that the technique can be taught easily and effectively to the participants. Clinical significance: The presence of the salivary ferning pattern throughout the ovulatory phase of the menstrual cycle will serve as an aid in defining the women's fertile time and, consequently, will further help for successful conception or contraception.

Introduction: Precise risk assessment of adnexal masses preoperatively is important for early diagnosis and better prognosis of ovarian malignancy. Although, there are many models for the prediction of ovarian malignancy, risk of malignancy index-1 (RMI-1) and International Ovarian Tumor Analysis-Simple Rules (IOTA-SR) are the most used. The aim of our study was to compare the diagnostic accuracy of IOTA-SR with RMI-1 for preoperative differentiation of benign and malignant adnexal masses. Materials and methods: A total of 121 women with adnexal masses, planned for surgery were enrolled in the study. Serum CA-125 was done, and an ultrasound examination was performed at the time of preoperative assessment by consultants. RMI-1 score of more than 200 was the cut-off value used to denote malignancy. IOTA-SR was applied to find the nature of the mass. Based on the histopathology report the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated. The diagnostic accuracy of RMI-1 and IOTA-SR were compared. Results: The study included 121 adnexal masses, out of which 110 (90.9%) were benign, 8 (6.6%) were malignant and 3 (2.5%) were borderline ovarian tumors. About 22.3% of the cases were found to be inconclusive by IOTA-SR. Sensitivity, specificity, PPV, and NPV of RMI-1 were 63.6, 100, 100, and 96.4%, respectively, whereas that of IOTA-SR was 100, 96.4, 73.3, and 100%, respectively. The diagnostic accuracy of IOTA-SR was better than RMI-1 (AUC = 0.98 vs 0.87). Conclusion: The model, IOTA-SR, for the prediction of ovarian malignancy, has better diagnostic accuracy and higher sensitivity when compared to RMI-1 in preoperative discrimination of benign and malignant adnexal mass.

Background: Turner syndrome is characterized by the absence of part or the entire X chromosome in a woman, resulting in short stature, gonadal dysgenesis, and congenital anomaly. Based on karyotype, Turner syndrome is categorized as classical (45XO) and mosaic. The aim of this study is to evaluate the relationship of the karyotype with the puberty stage, volume of the uterus, and volume of the ovary in adolescents with Turner syndrome who underwent estrogen therapy. Methods: A cross-sectional study was done at the Cipto Mangunkusumo National Hospital since July to December 2018. Pubertal staging was based on Tanner stage. Uterine and ovary volume were measured using transrectal sonography. Results: Of 21 study subjects, 8 had classical karyotype and 13 had mosaic karyotype in 12–21-year-old subjects. There was an association between karyotype and Tanner M stage (mammae stage) (p = 0.035). Breasts development in Turner syndrome with mosaic karyotype showed better development compared with classic karyotype. No association was found between karyotype and the volume of the uterus and ovaries. Conclusions: Karyotype is associated with Tanner mammae stage but not with uterine and ovary volume in adolescents with Turner syndrome who underwent estrogen therapy.

Autoimmune polyglandular syndrome type 2 (APS-2) or Schmidt syndrome is defined as a coexistence of autoimmune thyroid disease, primary adrenal insufficiency, and/or type 1 diabetes mellitus. The presentation of APS-2 is rarely encountered during pregnancy since there is reduced fertility owing to the adrenal and thyroid insufficiency individually and can present with multiple complications. We present a case of a 25-year-old G2A1, who is a known case of Schmidt syndrome diagnosed preconceptionally when presented with nausea, vomiting, diffuse and progressive hyperpigmentation spots over palmar creases, soles with elevated ACTH and decreased level of cortisol, and resolution of symptoms when started on steroid replacement therapy. The patient was followed up regularly throughout the pregnancy and delivered by cesarean section and developed gestational hypertension, which was treated. We present this case to conclude that pregnancy with Addison's disease can be managed successfully with proper monitoring and multidisciplinary management approach.

Aim: This case aims to report how timely management with catheter-based thrombolysis was life-saving for a near-miss case of postpartum pulmonary embolism (PE). Background: Near-miss cases describe women who underwent and overcame a serious medical condition while pregnant, giving birth, or after giving birth. During pregnancy and puerperium, there is an increase in the risk of deep venous thrombosis (DVT), PE, stroke, cerebral venous sinus thrombosis (CVST), etc., due to physiological changes that occur, resulting in a state of hypercoagulability. Case description: A 35-year-old female presented in puerperium with dyspnea and chest discomfort of 12-hour duration. She had a full-term normal vaginal delivery 13 days ago. She was later diagnosed with PE and was treated successfully with catheter-directed thrombolysis. Conclusion: Near-miss cases of PE require proficient assessment of the presentation, risk factors, and treatment options. As such, cases are associated with increased mortality when treatment is delayed. Due to the acute presentation of the patient, the decision for catheter-directed thrombolysis was made for immediate resolution of the thrombus. We believe this procedure was lifesaving in this situation and is an effective therapeutic choice in such scenarios. Clinical significance: Acute PE is a catastrophic situation that is mostly seen in the postpartum period. The clinical picture of PE is nonspecific in pregnancy. It is associated with significant mortality in the absence of therapy. Thrombolysis has been utilized frequently with positive results.

A cesarean scar pregnancy is an extremely rare and serious condition associated with grave complications. So, early diagnosis and individualized treatment are a must. We report a case of cesarean scar ectopic pregnancy that presented with complaints of bleeding per vaginum (PV) followed by a history of medical termination of pregnancy (MTP) pill consumption. A higher expected risk of rupture necessitated an exploratory laparotomy for excision of a cesarean scar pregnancy. In our case, uterine repair could be done, thus preserving the future fertility.

Introduction: A rare case report of bladder extragastrointestinal stromal tumor is being reported, which presented as a leiomyoma on imaging studies in a patient with recurrent postmenopausal bleeding. This is the fifth case being reported in the literature. Case description: A 54-year-old woman reported to outpatient department (OPD) of a tertiary level government hospital with recurrent postmenopausal bleeding. The general physical examination of the patient was normal and vital signs were stable. On abdominal examination, a firm mass was felt arising from the pelvis corresponding to a 16-week size uterus. The ultrasound (USG) report mentioned a 12 × 12.7 × 10.8 cm well-defined heterogeneously hypoechoic lesion with areas of central necrosis arising from the anterior wall of the uterus. Contrast-enhanced computerized tomography (CECT) was reported as a subserosal degenerative fibroid with bilateral normal ovaries. The patient was investigated and planned for hysterectomy in view of recurrent postmenopausal bleeding with a large fibroid. Intraoperatively, the uterus, bilateral tubes, and ovaries were found to be normal. A 16 × 14 cm yellowish-firm mass with multiple areas of cystic degeneration and necrosis was seen on the right side, which appeared to be arising from the bladder. A hysterectomy with bilateral salpingo-oophorectomy was done. A tumor was seen arising from the posterior wall of the supratrigonal region of the bladder. A complete resection of the tumor was done and the bladder was repaired in two layers. Metastasis and any other primary foci were ruled out. On immunohistochemistry (IHC), the tumor was positive for CD117, desmin, and DOG1. The final impression was a gastrointestinal stromal tumor of the urinary bladder. Conclusion: Extragastrointestinal stromal tumor of the urinary bladder is a very rare tumor, which is difficult to diagnose preoperatively. Immunohistochemistry, is required to diagnose.

Aim: The aim of this study was to assess the outcome of Turner mosaic variant with multidisciplinary management. Background: Turner syndrome is a complex developmental disorder in individuals with short stature associated with 45X genotype. A mixture of genotypes are also present in approximately 50% of all cases. Individuals with a mosaic 45 X/46XY genotype have a variety of phenotypic presentations, which are not correlated with the percentage of mosaicism. Case description: A case of an 18-year-old girl evaluated for primary amenorrhea who looked phenotypically normal female. Turner mosaic was suspected. Karyotyping and fluorescent in situ hybridization (FISH) of sex chromosomes revealed 46X/46 XY mosaic variant. During chromosomal analysis along with karyotyping, a detailed FISH analysis for sex chromosomes is required in order not to miss out presence of Y chromosome. Conclusion: Turner mosaic with XY variant is a rare condition and management requires multidisciplinary approach. Prophylactic gonadectomy has to be done to prevent gonadoblastoma. Clinical significance: This case is presented to emphasize the importance of proper genetic analysis in order not to miss out the presence of Y chromosome in Turner mosaics.

Fetal papyraceous (also known as vanishing twin) is a rare condition defined as intrauterine death of one fetus in early twin pregnancy, with retention of that fetus for up to 10 weeks causing mechanical compression of the little fetus, which looked like parchment paper. It can also occur in triplet and higher order pregnancy. The primary concern of vanishing twins is on the alive fetus and mother. It can cause coagulopathy, preterm labor, obstructed labor, and postpartum hemorrhage in the mother and congenital anomaly and intrauterine death in the surviving fetus. Herein, we present a case of fetus papyraceous in a diamniotic and dichorionic twin pregnancy that was retained in the uterus for 5 months.

Aim: The aim of the case report is to demonstrate a case of successful assisted reproductive technology treatment in a woman with endometrial hyperplasia without atypia. Background: Endometrial hyperplasia (EH) is a premalignant lesion of endometrial carcinoma, and its incidence is three times higher than endometrial carcinoma. The impact of endometrial hyperplasia on fertility and advanced fertility treatments is not clear. However, the regression of endometrial hyperplasia without atypia following progesterone therapy has shown favorable fertility outcomes and is recommended before advanced fertility treatment. Case description: A 41-year-old woman with a history of subfertility for 11 years and a history of heavy menstrual bleeding for 3 years, presented for assisted reproductive technologies (ART) treatment. Owing to heavy menstrual bleeding and persistently high endometrial thickness, she underwent a hysteroscopic assessment and endometrial sampling, which revealed endometrial hyperplasia without atypia. She was treated with six cycles of continuous oral progesterone and a repeat endometrial sampling after six months which revealed secretory endometrium. She underwent transfer of two embryos and had a singleton gestation. She had a successful pregnancy with an uneventful antenatal period and delivered a 2800 gm baby by elective cesarean section. Conclusion: Disease regression should be achieved before starting fertility treatment and ART treatment is more successful compared with natural conception in a patient with endometrial hyperplasia. Clinical significance: Even though there is no robust evidence to suggest endometrial hyperplasia without atypia has a negative impact on ART, free radical generation, and oxidative stress reactions shown in the pathogenesis of endometrial hyperplasia might negatively impact ART. Successful fertility treatment is possible after successful treatment of endometrial hyperplasia.

Sertoli-Leydig cell tumors are rare sex-cord stromal tumors. They arise from the sex cord sertoli cells and from the stroma of the genital ridge, the Leydig cells. They are generally of low-grade malignancy and rarely they can be poorly differentiated when they have a very aggressive course and poor prognosis. Majority of the tumors are characterized by androgen secretion. Most of the Sertoli-Leydig cell tumors occur in younger women less than 30 years of age, which necessitates the need for conservative management. A case of Sertoli-Leydig cell tumor of the ovary occurring in a 19-year-old girl, presenting with virilizing features is presented. She was treated with unilateral salpingo-oophorectomy and adjuvant chemotherapy.

Background: Obstructed hemivagina and ipsilateral renal anomaly (OHVIRA) syndrome is a rare complex Mullerian anomaly with an incidence of 1:20,000. The commonest presentation is pain in the abdomen and progressive dysmenorrhea. Other rare symptoms could include vaginal discharge, fever, infertility, or acute abdomen. Case description: A 15-year girl presented with acute retention of urine which required catheterization. She had attained menarche 8 months back. On evaluation, the ultrasonography report revealed the presence of uterine didelphys with right side pelvic collection and absent kidney on the same side of the collection. On magnetic resonance imaging (MRI), a right obstructed hemivagina was clearly seen along with other findings suggesting the OHVIRA syndrome. Laparoscopically, a bulge was seen just below the right uterine horn which caused the retention of urine. Septal resection was performed vaginally, following which her symptoms subsided. Clinical significance: Suspect OHVIRA syndrome in adolescent girls when there is a renal anomaly with Mullerian defect. The patient can also present with acute retention of urine because of hematocolpos. Early detection and treatment will help to prevent complications of endometriosis and adverse fertility outcomes.

Xanthogranulomatous oophoritis is a benign chronic inflammation causing massive destruction of involved organs. The disease is characterized by the infiltration of lipid-laden histiocytes or xanthoma cells along with giant cells, lymphocytes, and neutrophils. Diagnosis is often difficult as signs and symptoms are nonspecific and definitive evidence comes from histopathology. We report a case of 27-year-old female presenting with infertility and an adnexal mass. Intraoperatively on laparoscopy, it was an ovarian abscess. Later on, through histopathology, it was diagnosed as xanthogranulomatous oophoritis. Xanthogranulomatous inflammation in the ovaries is very rare, and when present, it can be a diagnostic challenge. The disease can mimic both benign and malignant ovarian masses, as such high degree of clinical suspicion combined with histopathology can aid in establishing the diagnosis.

Aim: To describe a case of pregnancy with Bell's palsy in a preeclamptic woman Background: Preeclampsia is a common obstetric morbidity, which has been studied extensively, of which neurological problems are also well known. Facial nerve palsy is usually attributed to herpetic lesions or is autoimmune in nature. An interesting case of pregnancy with Bell's palsy in a preeclamptic woman is described here. Case description: A 20-year-old primigravida with 36 weeks gestational period, was referred to our tertiary care center in view of raised blood pressure. She had a history of cold and fever around 1½ months prior to this presentation, following which she developed weakness over left side of the face. The immediate reason for referral was the elevation of blood pressure to 150/100 mm Hg, development of proteinuria (+2 on dipstick), and ultrasound report that showed intrauterine growth restriction. She had received an injection of betamethasone 12 mg intramuscular prior to referral. Her neurological examination showed left-sided facial deviation, left-sided ptosis. In addition, tablet labetalol 100 mg twice a day was initiated. The ultrasound report showed fetal growth with an estimated fetal weight of 2260 g, amniotic fluid index of 6.7 cm, grade III maturity of placenta, and reduced cerebroplacental ratio (1.06). After the induction of labor, due to intrapartum monitoring showing fetal heart decelerations, an emergency lower segment cesarean section was performed. Conclusion: Though Bell's palsy is commonly reported to occur in the background of chronic hypertension and obesity, it can occur in an otherwise low-risk patient. Occurrence of Bell's palsy may be the precursor toward the development of a preeclamptic state. Clinical significance: Occurrence of Bell's palsy should raise the obstetrician's level of vigilance towards maternal/fetal surveillance.

Maternal alloimmunization is uncommon and highly variable, and general obstetricians are not familiar with, non-ABO, non-D alloimmunization. Therefore, when a woman with anti-D alloimmunization, who has received antibody prophylaxis, still develops fetal anemia in a subsequent pregnancy, it is commonly labeled as inadequate prophylaxis or a coincidental non-immune cause of fetal anemia. We report a similar case of unusual and multiple alloimmunization, where anti-D, anti-C, and anti-U antibodies were present resulting in hemolytic disease of the fetus and newborn (HDFN). The case emphasizes the need for routine and periodic antibody screening in all pregnant women, irrespective of their ABO and Rh status, which will allow monitoring from early pregnancy and timely intervention to avoid poor fetal and neonatal outcomes.

The female genital tract is formed by the paramesonephric ducts (Mullerian ducts). Most of the time, Paramesonephric ducts do not form properly, fuse together, or are reabsorbed during fetal development, leading to congenital uterine abnormalities. Outflow tract obstruction (hematometra, hematosalpinx), endometriosis, dysmenorrhea, infertility, and chronic pelvic pain are all more common in women with congenital Mullerian anomalies, as are obstetric complications, such as recurrent pregnancy loss, ectopic pregnancies, uterine rupture, preterm labor, malpresentations, and abortions. Dysmenorrhea is a common issue among adolescent girls who seek medical attention at the outpatient clinic due to a congenital uterine anomaly. Since there are multiple presentations and they are difficult to diagnose and manage, this topic remains an interesting field of study in obstetrics and gynecology. A case report of a unicornuate uterus that has noncommunicating functioning rudimentary horn and hematometra. The patient was a young, unmarried woman who presented with significant, acute abdominal pain.

Aim: The aim of this study was to report a case series of ovarian hyperstimulation syndrome in voluntary oocyte donors and discuss their management and clinical course. Background: Ovarian hyperstimulation syndrome is a rare, iatrogenic complication occurring in artificial reproductive technology cycles. Recently, with the boost in the use of oocyte donors in ART, it has been noted that voluntary oocyte donors who undergo controlled ovarian hyperstimulation to induce superovulation in them are increasingly suffering from this syndrome. This syndrome varies from mild-to-severe and may become potentially lethal, the pathophysiologic hallmark of which is the accumulation of massive extravascular exudate combined with profound intravascular volume depletion. Case description: Seven voluntary oocyte donors who have undergone multiple cycles of superovulation and oocyte retrieval presented with moderate-to-severe ovarian hyperstimulation syndrome (OHSS) and required admission. Clinical examination and ultrasonography confirmed the diagnosis of ovarian hyperstimulation syndrome. Most of these patients were optimally managed by conservative methods while two developed complications and required emergency laparotomy. Clinical significance: With proper precautions and early detection, the deleterious effects of this condition can be prevented, and progression to a life-threatening ailment can be avoided. Donors must be thoroughly investigated and their donations must be well-spaced to avoid these negative impacts on their health. Understanding this condition will allow better management of donors at ART centers and prompt recognition of such complications by the clinician.

In today's digital age, social media has become an integral part of our lives, offering vast opportunities to connect, share information, and engage with a global audience. Beyond its role in fostering social connections, social media platforms have also emerged as powerful tools for promoting and disseminating research. Researchers and institutions alike are recognizing the immense potential of leveraging social media to increase the visibility and impact of their work. In this article, we will explore the various ways social media can be utilized to promote research and the benefits it brings to the scientific community.