Objective: Assessing the findings of hysteroscopy and histologic diagnosis in women who have abnormal uterine bleeding (AUB). The scenario is a sequential retrospective series of patients in a tertiary care hospital. Patients: From January 2012 to December 2022, 1,090 individuals with AUB had hysteroscopies with biopsy. Methods: Hysteroscopies were performed using 2.9- or 4-mm telescopes, and the distension solution was glycine or saline. With a 5-mm grasper or resectoscope, biopsies were performed. Histologic evaluation of biopsies and prevalence of hysteroscopic findings are the primary outcome measures. Results: Normal uterine cavity and cervical canal were found in 759 (69.62%) patients. Submucous fibroids were diagnosed in 22 women. Endometrial polyps were discovered in 26 (2.38%) of the patients. Endometrial hyperplasia was detected in 166 (15.22%) of the women, while endometrial cancer was diagnosed in 4 of them (0.36%). Conclusion: The most common histologic diagnosis was normal endometrium.

Objective: Evaluation of the viability of office hysteroscopy in an Indian context at a single center. To encourage budding gynecologists to perform office hysteroscopy, which is possible with successful results with the correct strategy, method, and setting. Methods: Observational analysis in retrospect. Between January 2011 and January 2022, 4827 women had office hysteroscopy at our center. Around 1627 instances of office hysteroscopy with a Bettocchi 2.9 scope and a Hamou endomat were performed from 2011 to 2022 and 3200 hysteroscopies with Bettocchi 1.9 scope and Endometrial automatic suction irrigation system (EASI) (2011–2022). The distension media utilized was regular saline. Hamou endomat parameters included a 200 ml/min drip rate, a 75-mm Hg irrigation pressure, and a 0.15 suction bar. Bettocchi 4 (1.9 mm) and Bettocchi 5 (2.9 mm) scope settings with EASI were 45 mm Hg. An experienced operator with office hysteroscopy training performed the hysteroscopy. Every operation was performed during the early proliferative period (4th–11th day). Key outcome measurements were complications, success and failure rates. Results: In roughly 4821 of instances, hysteroscopies were successful; however, 35 patients had pathology that required a two-step treatment. The majority of the hysteroscopies (2470; 51.2%) were diagnostic ones, while the remaining (2357; 48.83 %) were surgical ones. A vasovagal attack affected just two patients (2 of 4827). Conclusion: Together with reduced pressure, continuous flow irrigation, and vaginoscopic technique, advising the patient for ambulatory hysteroscopy played a crucial role in the outpatient environment in helping the patient deal with discomfort and anxiety. This method is made easier by recent developments in technique and apparatus, which may stimulate a wider acceptance by the gynecological community.

Aim: To study the effectiveness of mid-trimester cervical consistency index (CCI) and cervical length (CL) in predicting spontaneous preterm labor (PTL) in low-risk pregnancies. Materials and methods: This is a prospective cohort study conducted from March 2020 to March 2021 in the Department of Obstetrics and Gynecology of a tertiary care teaching hospital, Mahatma Gandhi Medical College and Research Institute (MGMCRI), Puducherry, India. The study included pregnant women between 19 + 0 weeks and 24 + 6 weeks. The total study population was 307. Transvaginal ultrasound was performed and CCI and CL was measured. The gestational age at delivery of the participants was noted. Analysis of collected data was done by Statistical Package for Social Sciences (SPSS) software, version 17.0. Results: Out of the 307 participants included in the study, 10.4% had preterm delivery. Mean CCI in term delivered women was 71.9 ± 9.4 and for the pre-term group was 59.3 ± 7.5 with a mean difference of 12.6, which was statistically significant. The area under the curve (AUC) was 0.87 with 95% CI (0.83–0.91) and it was significant with p < 0.05. The optimum cut-off value of CCI was 65% with a sensitivity of 78.1%, specificity of 80.4, positive predictive value (PPV) of 74.1%, and negative predictive value (NPV) of 83.7%. The positive and negative likelihood ratios were 4 and 0.27%, respectively. Conclusion: From this study it may be concluded that mid-trimester CCI can be an effective parameter in predicting spontaneous PTL in low-risk pregnant women. Clinical significance: This study is one of the few studies which helps in the prediction of spontaneous PTL in low-risk pregnant women. Mid-trimester CCI measurement can be a useful predictor of spontaneous PTL in pregnant women with normal CL.

Background and objectives: It is vital to understand the function of every gene in the human genome, which determines the outcomes of an offspring based on copies of genes and the resulting phenotypes. Consanguinity is the sexual union or marriage between two individuals within their relatives (such as second cousins), sharing a common gene pool or biological ancestor. Hence, with the minimal information on consanguinity and the possible associated genetic mutations present in the South Indian population. Methods: The data were collected by reviewing all the assessments done among parents identified to have 2nd- and/or 3rd-degree consanguineous marriage or genetic syndromes or any genetic abnormalities. The data analyzed were based on the records reviewed from 1st January 2018 to 31st May 2021, and ethical approval was obtained. Type of genetic mutations, fetal variables, maternal variables, paternal variables, and association of phenotypic outcomes in an individual born of consanguineous union were evaluated. Results: The study evaluated 529 parents with genetic syndromes or any genetic abnormalities, who were assessed in terms of consanguinity status and outcomes of the most recent pregnancy. It was found that more than half of the parents, 307 (58.0%), had a live baby born with congenital anomalies followed by 102 (19.3%) parents who had a normal live baby, abortions 90 (17.0%), and IUD 6 (1.1%). Conclusion: The incidence increases with the consanguinity, and therefore, it is imperative to educate our population against consanguineous marriages and thereby bring down the incidence of genetic syndromes. Mental and physical disabilities are the main outcomes of these conditions.

Aim: This study was carried out to determine the vaginal bacteriological pattern along with their antibiotic susceptibility pattern in pregnant women with preterm prelabor rupture of membranes (PPROM) and to compare them with those without PPROM. The association of PPROM with neonatal and maternal complications was also studied. Materials and methods: This is an observational comparative study conducted in the year 2020 at a tertiary care teaching hospital located in Puducherry, India. The study included singleton pregnancies between 28 0/7 and 36 6/7 weeks of gestation with PPROM along with gestational age matched women without PPROM. A high vaginal swab was taken from all the candidates and sent for aerobic and anaerobic cultures. Organisms isolated along with their antibiotic susceptibility were noted and compared between the two groups. The software used was Statistical Package for the Social Sciences (SPSS) software, version 17.0 (IBM, Armonk, NY, USA). Results: This study demonstrated an overall incidence of PPROM of 2.8%. A positive culture rate of 35.2 and 9.3% was found among pregnant women with and without PPROM, which was found to be statistically significant. The commonest organism isolated was Escherichia coli (52.6%) which was 100% sensitive to imipenem and meropenem and 90% to cefoperazone–sulbactam and was found to be resistant to ampicillin in 90% of cases. Neonatal complications such as respiratory distress and sepsis were found to be significantly higher in the PPROM group than in the comparison group. Conclusion: There is no change in the vaginal microbiota in the last two decades, but the sensitivity pattern of antibiotics has changed considerably from the commonly used antibiotics to higher-generation antibiotics. This indicates indiscriminate use of antibiotics which has resulted in antibiotic resistance. This could be the probable reason for the increase in neonatal and maternal morbidity in PPROM. Clinical significance: The vaginal microbiological flora and the antibiotic susceptibility pattern of the population in this area was studied and a significant change was noted over the past years which will help in formulating newer and better treatment protocols in the future which would help in reducing neonatal and maternal morbidities.

Background: The second most common malignant tumor in developing countries including India is cervical cancer. Lack of awareness, asymptomatic nature of the disease, and poor health-seeking results in delayed diagnosis and bad prognosis. The present study aims to estimate cervical cytological abnormalities in women of the largest tribal part of India. Materials and methods: About 280 women from six districts of Santhal Pargana (the largest tribal area of India) were given a Papanicolaou smear test from August to October 2022 in AIIMS Deoghar to find an infection, cervical lesions, and reactive changes. Data on the sociodemographic and reproductive characteristics of the study population was collected through a structured questionnaire. Information, education and communication (IEC) clearance was obtained. The collected data have been analyzed through statistical package for social studies (SPSS). Results: The study results show the presence of abnormal cervical cytology to be 9.3% of the study population. Out of 280 participants, 23 (8.2%) showed normal cytology and 232 (82.9%) were inflammatory. A diagnosis of atypical squamous cells of undetermined significance (ASC-US) was present in 18 (6.4%) cases, atypical glandular cells (AGC) in 3 (1.1%), and 5 (1.8%) patients had a low-grade squamous intraepithelial lesion (LSIL) exhibiting koilocytic atypia. White discharge per vagina and poor hygiene were associated significantly with abnormal cervical cytology. Conclusion: Abnormal cytology was found in 9.3% of the participants and a history of white discharge per vagina and poor hygiene were significantly associated. Regular screening and educating them on clinical features and hygiene helps to prevent cancer of the cervix among them.

Background: Maternal expulsive force with direct compression from the fetal head exerts downward force on the pelvic floor during childbirth during childbirth; the pelvic floor is exposed to direct compression from the fetal head and to downward pressure from maternal expulsive efforts. These create alterations in the muscle's nerves and connective tissue. As parity increases, cumulative effect gives rise to various long-term and short complications. Materials and methods: This present observational study is planned to evaluate the lower genital tract injuries following vaginal delivery with regard to their frequencies, types, severity, and complications. Most of the studies are conducted in primiparas. This study would be conducted in multiparas sustaining lower genital tract injuries; it may help to evolve the checklist of do's and don'ts. Results: Out of 144 patients studied, 68.7% of patients had previous delivery. Out of which 51.4% had maximum injuries if compared to those with 2 or more injuries. Women with basal metabolic index (BMI) in the overweight and obese categories were more susceptible to lacerations with 2.6 and 1.98 odds ratios respectively. Induction and oxytocin also affect lower genital tract injuries causing a significant increase in their numbers whereas episiotomies have no significant change in lower genital tract injuries. Conclusion: This study would give insight into various factors such as parity, labor induction, prolonged labor, precipitate labor, injudicious use of oxytocin, improper technique of episiotomy, assisted vaginal delivery, and instrumental delivery affecting the lower genital tract.

Introduction: Acute fatty liver of pregnancy (AFLP) is a rare obstetric emergency requiring immediate attention and intensive care to avoid adverse outcomes to the mother and fetus. As this condition poses many complications and is varied in its clinical presentation, we studied the perinatal outcomes in women diagnosed to have AFLP. Materials and methods: This was a retrospective study that involved all patients over the past 6 years who presented with AFLP. Clinical signs and other altered biochemical parameters were included. Results: In our study, 19 women were diagnosed to have AFLP. The mean age of the study population was 25.74 ± 3.7 years. 14 (73.68%) women were below the age of 30 years. Gestational age of more than 37 weeks was seen 13 (68.42%) women. Ten primigravidae (52.63%) and nine multiparous (47.3%) women were found to present with AFLP. The mean blood loss at the time of delivery for a lower section cesarian section and vaginal delivery was 787.5 ± 494.07 mL and 280 ± 44.72 mL, respectively. The preferred treatment at the time of admission was transfusion of fresh frozen plasma (FFP) (Mean: 7.00 ± 9 pints), followed by transfusion of platelet (Mean: 2.37 ± 3.515 pints), transfusion of packed red blood cells (Mean: 2.21 ± 3.691 pints) and cryoprecipitate (Mean: 0.0 ± 2 pints). Nine (47.37%) women were delivered through emergency lower segment cesarean section (LSCS) and all 4 (21.05%) pregnant women who succumbed to AFLP underwent an LSCS. Among the newborn, 13 (65%) of them were low birth weight and 2 (10.53%) had fetal distress. Conclusion: This study showed a higher maternal mortality rate of 21% in comparison to other studies. Health professionals should be sensitized about this condition and the use of the existing scoring system available to help in detecting AFLP at an early stage to reduce maternal mortality and adverse fetal outcomes.

Aim: The purpose of this retrospective study was to examine the association of ventriculomegaly in cases of CNS anomaly and to study the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of ventriculomegaly in predicting CNS anomaly. We have also tried to compare the predictive value of ventriculomegaly in predicting CNS anomaly to cardiac axis deviation in predicting cardiac anomaly. Materials and methods: Over a period of 5 years, all cases of CNS anomalies with or without ventriculomegaly with gestational age more than 14 weeks were reviewed for the size of lateral ventricles, other CNS findings, extra-CNS structural anomalies. Ventricle size up to 7.0 mm was considered normal, the size from 7.1 to 10.0 mm was considered as prominent ventricle, from 10.1 to 14.9 mm was considered as mild ventriculomegaly and the size of ≥15 mm was considered severe ventriculomegaly. Results: In total, there were 206 CNS anomalies detected in 165 patients. The commonest CNS anomaly detected was agenesis of corpus callosum (ACC) and partial agenesis of corpus callosum (PACC). Our data show that although ventriculomegaly is a strong marker for suspecting intracranial structural abnormality, anomalies of posterior fossa, PACC, and intracranial cysts may be present with normal-sized ventricles. Conclusion: From our study, we can conclude that ventriculomegaly does not predict the presence of structural CNS abnormality, and a normal size ventricle rules does not rule out the presence of structural CNS anomaly. Ventriculomegaly is not a strong marker in CNS anomaly like cardiac axis deviation in cardiac anomaly.

Introduction: Coronavirus disease 2019 (COVID-19) infection leads to significant morbidity and mortality in women during pregnancy. As seen with other viral diseases in the past, vaccination, currently, is the most-effective eradication method and all pregnant women should be offered COVID-19 vaccination, if no contraindication exists. Despite approval by national and international authorities, many pregnant women are still hesitant to accept the vaccine. Materials and methods: The current study is a retrospective cohort study involving 100 COVID-19 positive pregnant women and 300 negative women who delivered over 3 months. Their demographic, clinical data, vaccination details, and perinatal outcomes were recorded. Results: A low vaccination rate against COVID-19 among pregnant women (26.25%) was reported. A total of 79 (79%) women in COVID-19 and 216 (72%) in non-COVID-19 group were unvaccinated. Most of the women in both groups received Covishield vaccine rather than Covaxin. The most common reasons for not getting the vaccine were unawareness about the vaccination approval in pregnancy (49%) followed by its unknown safety status (10%). Conclusion: The prime barrier to maternal vaccination remains the safety concern associated with the COVID-19 vaccine. Vaccination strategies, when created keeping in mind the attitudes of these priority groups will help increase its uptake during the current pandemic.

Objective: To describe the characteristics, activities, and counseling performed during prenatal care in Peruvian women. Materials and methods: A descriptive study was conducted on 17,244 women registered in the Peruvian Demographic and Family Health Survey. The variables corresponding to the activities, characteristics, and counseling performed during prenatal care were analyzed. The information was processed after weighting, stratification, and grouping by clusters of the database. Frequencies and percentages were calculated with 95% confidence intervals. Results: Around 82% of women had their first prenatal care before 14 weeks, and 91.2% attended 6 or more visits. The obstetrician (81.9%) provided this service the most, followed by the physician (39.9%) and the nurse (8.2%). Fetal heartbeat auscultation (99.9%) and weight measurement (99.7%) of the women were frequent. In addition, counseling on obstetric complications (100%) and where to receive professional assistance (98.6%) were the topics reported by the highest proportion of women, while women's rights were less frequently addressed (80.5%). Conclusion: Most of the women had early, sufficient prenatal care performed by the obstetrician, and the measurement of the woman's weight and the topic of obstetric complications were the most frequent procedure and counseling, respectively. Clinical significance: Prenatal care is a relevant maternal health service for the prevention, diagnosis, and timely treatment of maternal–fetal complications.

Objective: The aim of this study is to evaluate the efficacy of minimal effective dose of magnesium sulfate (MgSO₄) for control of convulsions in eclampsia and also at reducing the MgSO₄-related toxicity thus by reducing the dose of MgSO₄ and also to analyze the maternal and perinatal outcomes among these patients. Design: The prospective observational study was carried out between January 2019 and January 2022 at Dr. Shankarrao Chavan Govt Medical College and Hospital, Nanded, Maharashtra. Setting: Tertiary care hospital, Nanded, Maharashtra. Materials and methods: Injection of MgSO₄ 14 gm loading dose was given at the admission in eclampsia cases, and further doses of MgSO₄ were given with close monitoring of patients and a reduction in the number of doses of MgSO₄ doses was done as per the patient's condition. If the patient gets the next episode of convulsion, immediately 2 gm IV MgSO₄ drip was given. Results: In our study, out of 200 patients, 2.5% of them had received only a loading dose of MgSO₄, whereas maximum (61.5%) of them had received 20–24 gm of MgSO₄. During the observation period of 5–7 days post delivery, none of the patients had any complications like repeat convulsions, loss of consciousness, or intracranial hemorrhage, even after reducing the possible doses of MgSO₄. The recurrence rate of convulsions is 7%. Total MgSO₄ doses were administered (in grams) with a mean of 24.83 gm among the study population. There was no significant correlation between doses of MgSO₄ received, and the number of convulsions reoccurred with p-value > 0.05. Conclusion: It appears that treatment of eclampsia cases should be individualized by considering the level of consciousness, laboratory parameters, induction delivery interval, convulsion to delivery interval, number of convulsions, and hence deciding further maintenance doses to be given or omitted. Due to the low toxicity profile, reduced monitoring, cost-effectiveness, and equally effective in comparison with the Pritchard regimen, the present regimen is recommended.

Background: Menstrual cycle is an important indicator of a woman's health, and innocuous alterations in menstrual pattern can affect women profoundly. With the increase in the vaccination drive across the Indian subcontinent, women have reported irregularities in menstrual pattern after coronavirus disease-2019 (COVID-19) vaccination. Through this study, we aimed to assess the pattern and severity of menstrual irregularities observed in Indian women post COVID-19 vaccination and determine its association with vaccine type and dosage. Materials and methods: It was a prospective cohort study conducted over a period of 1 year. Women visiting gynecology outpatient department who voluntarily consented to participate in the survey and who had received at least one dose of Government-of-India-approved COVID-19 vaccine at least 3 months prior were eligible for recruitment in the study. All symptomatic or asymptomatic COVID-19-infected individuals with confirmed reverse transcriptase polymerase chain reaction (RT-PCR) positive report within the past 14 days were excluded from the study. A structured survey questionnaire was used to obtain data pertaining to alterations in menstrual pattern, duration, and severity of menstrual dysfunction. During the first 6 months, eligible participants were recruited. All recruited patients were prospectively followed up for the next 6 months to assess the persistence and severity of their menstrual irregularity. Results: A total of 355 women participated. Majority of the study population were less than 30 years of age. Among the recruited women, 82% had previously regular menstrual cycles and 6.5% had a polycystic ovarian morphology. Almost 91.8% women had received at least two doses of the COVID vaccine. Of them, 87.9% women had received Covishield (Astra Zeneca/Serum Institute of India) and 11.5% had received Covaxin (Bharat Biotech). Five women had a history of recent (within 3 months of vaccination) use of hormonal contraception. Of the 33 women afflicted with disordered menstrual pattern, 57.6% were less than 30 years of age. Early onset of menstrual flow (30.3%) followed by reduced flow in 24.2% and heavy flow in 21.2% was the most common complaint recorded. Around 72.7% experienced symptoms within the first month of vaccination. Only two cases required medical attention. Of the 33 women who reported experience symptoms of menstrual alteration after COVID-19 vaccine, all have recovered at 6-months follow-up. Conclusion: Transient menstrual abnormalities have been reported to succeed vaccination with Covishield (Astra Zeneca/Serum Institute of India) and Covaxin (Bharact Biotech). Most alterations were mild and self-limiting. Further large-scale multicentric trials are needed to confirm the findings of this exploratory survey.

Introduction: Pregnancy is the most precious time in every woman's life. Pregnant women were facing an unprecedented situation in the COVID era, where going to hospitals for routine antenatal checkups had become worrisome as most of the hospitals were inundated with COVID-19-infected patients. Also, mothers who are infected with COVID-19 are more prone to give birth to preterm babies and are also at higher risk for other poor pregnancy outcomes. So, assessing the worry and well-being becomes utmost important. Hence, this study is planned to assess the worry and well-being among pregnant women. Materials and methods: About 359 pregnant women who attended PMSMA camps at four primary health centers (PHC) were interviewed using worry and well-being scales. Results: The prevalence of worry among the pregnant women was 50.97%. Variables such as Muslim religion (OR = 2.9), pregnancy-related complications (OR = 1.8), abortion history (OR = 2.5), vaccinated with two doses of Covishield (OR = 2.8), and worried about getting infected with COVID-19 (OR = 2.3) were the predictors/risk factors of worry among pregnant women. Muslim religion (OR = 1.8), history of abortion (OR = 2.1), vaccinated with two doses of Covishield (OR = 2.4) and being worried of getting infected with COVID-19 (OR = 2.3) were the predictors of low well-being among pregnant women. Conclusion: A significant percentage of pregnant women attending PHC for ANC checkups were suffering from worry and lower-level well-being. Queries concerning the pregnancy and COVID-19 should be addressed. Counseling should be given to high-risk pregnant women who have pre-existing comorbidities.

Aim: This study aims at finding the association of serum anti-Müllerian hormone (AMH) levels at 11–14 weeks of gestation in the prediction of preeclampsia. Materials and methods: Antenatal patients between 11 and 14 weeks of gestation were recruited after providing written informed consent. Serum AMH was done for all patients. They were then categorized into the low AMH group and the normal AMH group. They were followed for the development of preeclampsia till 7 days postpartum and the pregnancy outcomes of both groups were compared. Conclusion: The occurrence of preeclampsia in patients with normal AMH levels was low accounting for 34.4% compared to patients with low AMH levels where preeclampsia was 65.6%. The occurrence of preeclampsia at a tertiary care hospital was 16.6%. The frequency of preeclampsia in patients with low AMH was 9 times higher than normal AMH levels. Thus, low AMH levels at 11–14 weeks can predict preeclampsia so should be incorporated into first-trimester screening. Clinical significance: Biomarker maternal serum AMH has recently been related to preeclampsia and its connection with the placenta and heart muscle would suggest its role in preeclampsia and cardiovascular risk later in the life of women with low AMH levels.

Introduction: The alarming rise of cesarean deliveries in the past decades has even questioned the ethics of the medical fraternity. This study was conducted to reduce the burden of morbidities associated with repeat cesarean deliveries. In this study, we compared the safety and efficacy of different methods of induction of labor (IOL) in cases with previous one cesarean section. Materials and methods: After following strict exclusion criteria, 78 patients were found to be eligible to participate in the study. After history, examination and investigations, and USG, patients were assigned to any one of the methods for the IOL. (PGE2 group) (n = 31). Patients with Bishops score >4, with cervical dilatation >1.5 cm, middle/anterior position of cervix, were 31 in number. For these patients, Prostaglandin E2 (PGE2) gel was inserted in the posterior fornix. PGE2+ Foley catheter (n = 22). In some patients with similar Bishops score, after instillation of PGE2, intracervical Foley catheter was inserted and inflated with 30 mL saline. Patients with intrauterine death of fetus, or multiple congenital malformations were diagnosed on USG, 200 mg of Mifepristone was administered orally, followed by PGE2 gel after 8 hours (Mifepristone + Foley + PGE2 (n = 12) Similarly, in 12 patients with intrauterine death/multiple congenital malformations, after 8 hours of 200 mg of Mifepristone, intracervical foley catheter balloon and PGE2 were instilled in post-fornix. In all cases, oxytocin augmentation was done with an infusion set as per protocol. Labor was immediately terminated by performing immediate cesarean in the following circumstances. Severe maternal distress, severe fetal distress, non-progress of labor, signs of impending scar dehiscence. Results: We observed an overall success rate of TOLAC as 68% by various methods of induction. Maximum success was observed in group D by using mifepristone along with PGE2 and Foleys, in which fetal prognosis was not desired. Our greatest predictor of success was a previous vaginal delivery (Odds Ratio, OR = 24.4), followed by initial Bishops score >5, (OR = 20.3), and BMI <28 (OR = 5.3). We encountered a scar dehiscence rate of 2.5%, which presented as rent in the uterus which was not bleeding. Both patients were managed conservatively with uneventful puerperium. Conclusion: This study compared different conventional methods of induction in patients with previous one lower segment cesarean section (LSCS). The most important predictor of a successful trial of labor after cesarean deliveries (TOLAC) is a vaginal delivery before or after a cesarean and a favorable preinduction Bishops score >5. On comparing various methods of induction, the addition of mifepristone in cases where fetal prognosis is not desired, accelerated and completed vaginal birth after cesarean section safely. The combination of chemical and mechanical methods of induction resulted in increasing the success rate of TOLAC without increasing any complications. The most common indication of repeat cesarean was non-progress of labor causing cervical dystocia and non-decent of the head. Strict, vigorous, and vigilant intrapartum maternal and fetal monitoring and judicious use of mechanical and chemical methods have definitely, substantially resulted in successful TOLAC deliveries.

Aims: Gestational diabetes mellitus (GDM), one of the most prevalent and notorious medical disorders complicating pregnancy, is known to be associated with chronic low-grade inflammation which triggers endothelial injury and platelet activation. Mean platelet volume (MPV) has been hypothesized to be higher in GDM which may aid in early diagnosis and appropriate management of this complication. The aim of our study was to determine whether an association exists between MPV and the diagnosis of GDM and to compare various platelet indices in pregnant women with and without GDM. Materials and methods: All participants underwent a 50 gm glucose challenge test. If the 1 hour blood glucose level was = >140 mg/dL, these women were further subjected to a 100 gm oral glucose tolerance test which was interpreted according to the Carpenter and Coustan criteria. Women diagnosed with GDM were considered as cases (N = 73) and those with a negative screening test as controls (N = 73). Other platelet parameters were measured and then compared between the two groups. Results: The difference in MPV (p = < 0.001) and platelet count (p = 0.01) between cases and controls was found to be statistically significant. Pregnant women with GDM had a significantly higher MPV and lower platelet count. In addition, a statistically significant positive correlation was found between the GCT value and the MPV and an inverse correlation was noted between the GCT value and the platelet count. Conclusion: A significant difference between the values of MPV and platelet count in patients with GDM as compared with healthy pregnant women, at the time of diagnosis, aids in supporting evidence that mean platelet volume may be used as a marker for GDM. A positive correlation between MPV and value of GCT and an inverse relationship between the platelet count and GCT values further suggests that these markers may also be used to study disease severity and worse blood sugar derangements may be expected when they are deranged. Clinical significance: Our study has proven that the value of MPV in patients with a fresh diagnosis of GDM lies in the high normal range, when compared with healthy matched controls. This and the knowledge of differences in other platelet parameters would help not only in prediction and early diagnosis of pregnant women with GDM but also provide a tool to better predict complications and improve maternal and neonatal outcomes.

Introduction: Coronavirus disease-2019 (COVID-19) is an infectious disease that is currently a pandemic. Pregnant women are one of the populations that are susceptible to this infection because of physiological changes during pregnancy. In a meta-analysis study, it was shown that preeclampsia significantly occurred in pregnant patients infected with COVID-19 compared to the group without COVID-19 infection. Inflammatory markers that play an important role in these two diseases are neutrophil-to-lymphocyte ratio (NLR) and procalcitonin. Materials and methods: This research is a descriptive study using total sampling, including all pregnant women with COVID-19 infection at RSUP Prof. Dr. I.G.N.G. Ngoerah Hospital, Denpasar, Bali, from April 2020 to June 2021 with a diagnosis of preeclampsia and without preeclampsia. Results: A total of 152 patients were found, of which 16 patients were diagnosed with preeclampsia and 136 patients were without preeclampsia. Most cases of COVID-19 with preeclampsia and non-preeclampsia occurred in the maternal age range of 20–35 years. The majority of pregnant patients with COVID-19 are asymptomatic in both preeclampsia and non-preeclampsia. COVID-19 patients with preeclampsia each had 1 case with comorbid anemia, chronic hepatitis B, and heart failure. Meanwhile, non-preeclampsia had the most comorbid anemia, followed by asthma, HIV, and obesity. Pneumonia on chest X-ray is more common in non-preeclampsia patients. Proportionally, 78.95% were in the high NLR category, while for procalcitonin 26.32% were in the high category, 15.79% were in the low category and the rest were not examined. The NLR levels in preeclampsia and non-preeclampsia in both low and high categories are almost the same. Procalcitonin levels tended to be the same between the preeclampsia and non-preeclampsia groups. Conclusion: The median NLR and procalcitonin were almost uniform in the preeclampsia and non-preeclampsia groups, but proportionally most of them had high NLR and procalcitonin levels. The increase in NLR and procalcitonin in the preeclampsia group may be explained by one of the underlying pathophysiologies of preeclampsia inflammation.

Aim and background: There is a lack of comprehensive and recent data on rhesus (Rh)-negative pregnancies in India. The aim of this study is to examine the demographics, isoimmunization status, usage of prophylactic treatment, and complications associated with Rh-negative pregnancies in India. Materials and methods: This is an interim analysis of an ongoing real-world observational study targeting the recruitment of 20,000 Rh-negative pregnant women throughout India. This article presents data from 1,421 participants who were followed prospectively for 3 months. Participants’ demographics, obstetrics history, usage of prophylactic treatment, and pregnancy-related complications were recorded. Data were analyzed using descriptive statistics for all the outcome variables. Results: The maximum number of participants belonged to the West region (47.4%). The mean gestational age of the participants was 37.7 weeks. There was an equal representation of primigravida and multigravida participants in the study population. The available indirect Coombs test data showed that most of the participants (116 of 125) were negative for circulating antiglobulin in the current pregnancy. However, isoimmunization during the current pregnancy occurred in 9 participants (9 of 125; 7.2%). Overall, 25.7% of the participants received anti-D prophylaxis during their current pregnancy. Conclusion: This real-world evidence study demonstrates that most Rh-negative women carrying Rh-positive fetus are at risk of becoming sensitized to the Rh antigen. Despite the availability of prophylactic treatment, there are women who are getting sensitized. Hence, there is a need to create awareness among the Indian population about the Rh-disease-associated risks and available preventive measures to reduce the mortality rates. Clinical significance: Anti-D prophylaxis is the most effective method to prevent sensitization in Rh-negative pregnant women. Anti-Rh (O) D immunoglobulin is a must administered drug both in antenatal and postnatal phases of pregnancy to prevent Rh-negative pregnant women from getting sensitized. Thus, further reducing the burden of Rh-sensitization in India and having healthy motherhood.

Objective: To evaluate the effects and safety of monthly intraovarian injection of autologous platelet-rich plasma (PRP) for three consecutive cycles prior to in vitro fertilization and embryo transfer (IVF–ET) on ovarian reserve markers in women with poor ovarian response (POR) as per Bologna criteria. Materials and methods: This is a prospective cohort study of 66 women diagnosed as poor ovarian responders as per the Bologna criteria were recruited in the study from 1 January 2018 to 31 December 2020. Platelet-rich plasma was prepared from peripheral blood and PRP activation was achieved with 0.1 cc of 10% calcium gluconate. Platelet-rich plasma injection into ovarian stroma was performed transvaginally, under ultrasound guidance, into both ovaries using a 35 cm single lumen 17G needle between D7 and D12 of the menstrual cycle in three consecutive cycles. Antral follicle count (AFC) and anti-müllerian hormone (AMH) were measured from the second to fourth day of menstruation before the first PRP treatment and immediately following last PRP administration. Ovarian stimulation and in vitro fertilization (IVF) embryo transfer were performed immediately following the last PRP administration. The primary outcomes were the change in AFC post-PRP treatment. Secondary outcomes were increased in serum AMH, the total number of oocytes retrieved and clinical pregnancy rates. Results: Sixty-six women were included. After three cycles of ovarian PRP administration, there was a significant increase in AFC mean (SD) 4.85 (4.65) compared to pre-treatment AFC. There was a statistically significant difference between pre- and post-treatment AFC (5.21 vs 10.06, p < 0.0001). Improved post-treatment AFC was not limited to younger patients; when stratified by age, significant AFC improvements were seen in patients of age less than 35 years as well as more than 35 years (p < 0.0001). Furthermore, the significant increase was seen in mean serum AMH level following PRP treatment (1.18 vs 0.93, p < 0.0001). The improvement in serum AMH levels were seen across all age patients (<35 years vs ≥35 years). The mean (SD) number of oocytes retrieved were 7.49 (4.45) and pregnancy rate was 25%. The PRP treatment was well tolerated. Conclusion: Intraovarian PRP injections are effective to improve AFC, AMH prior to antiretroviral therapy (ART) in poor ovarian responders, and results in reasonable number of oocytes retrieved following ovarian stimulation.

Appendicular mucinous neoplasm is a rare malignancy with varying symptoms. Presence of mucinous ascites indicates pseudomyxoma peritonei (PMP). Pseudomyxoma peritonei (PMP) is mostly due to appendicular neoplasm. Ovarian mass with mucinous ascites is mostly metastatic in 80% cases. Therefore, extensive workup by imaging and tumor markers should be done before proceeding for surgery. Appendicular mass is most likely to be diagnosed by imaging usually contrast-enhanced computed tomography (CECT). Here, we present an unusual case of 44-year-old nulliparous patient presenting with PMP and eventually diagnosed to have mucinous adenocarcinoma of appendix.

Aim: A case of Wernicke's encephalopathy (WE) due to hyperemesis gravidarum is presented for its rarity and favorable outcome of pregnancy due to timely diagnosis and management. Background: Wernicke's encephalopathy is a rare reversible neurological complication of hyperemesis gravidarum due to vitamin B1 (thiamine) deficiency. Hyperemesis gravidarum (HG) is associated with prolonged starvation and electrolyte imbalance leading to Wernicke's encephalopathy, which is a triad of ocular signs, ataxia, and confused mental state. It also leads to a serious complications like central pontine myelinolysis (CPM). During pregnancy, Wernicke's encephalopathy has poor outcomes in mother and baby. A fifth gravida presented at 14 weeks of gestation with Wernicke's encephalopathy was treated with thiamine, recovered after 34 days, and delivered by cesarean section at 36.5 weeks, a live healthy baby. Conclusion: A favorable outcome of pregnancy can be there with a high index of suspicion, timely diagnosis, and management with thiamine. Clinical significance: Immediate supplementation of thiamine in antenatal women with prolonged vomiting in pregnancy, especially before starting intravenous glucose can prevent this reversible neurological condition.

Fibroids in early pregnancy were associated with an increased risk of hypertensive disorders of pregnancy. It has been seen that fibroids undergo rapid and remarkable growth during pregnancy, particularly in the first half. The effects of fibroids on blood pressure (BP) may be amplified by the rapid expansion of fibroids during pregnancy; we present a unique case report where a normotensive patient with uterine fibroid developed preeclampsia at 34-weeks gestational age.

Condyloma acuminatum also called as mucocutaneous external genital wart is a benign neoplasm of genital tract, caused by human papilloma virus usually by types 6 and 11. An unbooked case during pregnancy came for checkup in antenatal outpatient department (OPD) with genital lesions. On genital examination, multiple warty lesions were seen on vulva and anal region. She was counseled for available treatment options but she did not come to receive any therapy. She came at 38 weeks in early labor with same lesions and delivery was done by emergency lower segment cesarean section (LSCS) uneventfully. Postoperatively, mother and baby were doing well. Lesions were disappeared after delivery spontaneously. Condyloma acuminatum is a condition which can be managed conservatively during pregnancy.

Aim: To identify different causes of vulvovaginal swelling and step-by-step identification and management options. Background: Vulvovaginal cysts may start as asymptomatic cysts but may enlarge to big sizes and varied histopathology, needing immediate as well as long-term medical attention. We have reviewed three cases of vulvovaginal cysts with unusual presentations. Case description: The first case presented was a giant dumbbell-shaped Bartholin cyst presenting as a labial cyst. The second case with a provisional diagnosis of Bartholin's cyst came out to be aggressive angiomyxoma on immune histopathology. The third case presented with pus in the urine, occasionally painful urination, and a vaginal cyst which turned out to be a urethral diverticulum on cystoscopy. Conclusion: A meticulous clinical history and examination of the patient supported by a few investigations help a gynecologist to formulate a plan of management to deliver the desired results to the patient. Clinical significance: The most important clinical parameter for the vulvovaginal cyst is the site of occurrence. Later differential diagnosis is made, and investigation and treatment (surgical or medical) are planned according to the suggested approaches and ideas mentioned in the paper. Management protocols can be as straightforward as cystectomy or may require a multiprong, multidisciplinary approach and multiple sitting.

Background: Coronavirus infectious disease-2019 (COVID-19) is a respiratory system disease caused by the novel coronavirus severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), which started in Wuhan province of China and soon became a pandemic involving almost all the countries of the world. COVID-19-infected people with all age-groups, from neonates to pregnant women, were also infected with varying presentations. Pregnancy is a high-risk condition for developing severe COVID-19, and these patients need to be monitored closely. Objectives: We are reviewing a case series of all pregnant women who succumbed to COVID-19 pneumonia in a tertiary care teaching hospital in the capital city of New Delhi in India to understand the clinical profile of pregnant patients dying of COVID. Study design: It is a retrospective case series review, where case records of all pregnant women who were admitted to a teaching tertiary care hospital for a period of 1 year from the start of the pandemic were reviewed. Results: In this retrospective review, case records of all 282 pregnant women admitted to our hospital were reviewed. Eight pregnant women suffering from COVID-19 died in our hospital. Detailed analysis of all 8 mortalities among pregnant women infected with COVID-19 was done. Clinical profile and laboratory values of all these cases were analyzed and discussed in the review. Conclusion: COVID-19-related maternal deaths are not uncommon. Fever is almost the universal symptom of presentation and all fevers in the pandemic should be evaluated for COVID-19 owing to the ongoing pandemic. Severe acute respiratory syndrome coronavirus-2 causes respiratory tract infection and widespread inflammation, which culminates in multiorgan failure in some pregnant women. The course of illness in patients who die because of COVID is very aggressive, and these patients develop septic shock early in the course, possibly owing to the immunosuppressed state of pregnancy.

Background: Catatonia is a complex and easily misdiagnosed condition that if not detected timely, can be lethal despite having effective treatment. Catatonia may be viewed as a disorder of the basal ganglia–thalamocortical circuit. The purpose of our study is to focus on the fact that catatonia can be a common postoperative problem due to the stress factors of the surgery itself as well as the other associated social stresses related to pregnancy and childbirth. Case description: We, hereby report a case series of three rare cases of postoperative catatonia who had the only similarity of being anxious for a male issue. All cases had an emergency cesarean section followed by which they developed symptoms of catatonia, were diagnosed by lorazepam challenge test, and had an excellent recovery with lorazepam. All possible differential diagnoses were ruled out. Conclusion: Catatonia needs to be kept in mind as a possibility post-surgery especially by an obstetrician. An overall multidisciplinary approach to catatonia will help in improving effective maternal care. Clinical significance: This case series emphasizes on the significance of early recognition, appropriate evaluation, and targeted management of postpartum psychiatric complications to ensure optimal maternal mental health outcomes.

Progesterone is extensively used in pregnancy support and the increasing incidence of high-risk pregnancy may need further extensive progesterone usage. While intrahepatic cholestasis of pregnancy (IHCP) is primarily a third trimester problem, few cases of early onset IHCP are documented. In this context, a series of three cases of IHCP among pregnant patients who used progesterone is described. Mechanisms of this otherwise rare occurrence are discussed. Association between progesterone use and early onset IHCP merits further study.

Aim: Anemia is a serious global health problem amongst pregnant women with iron-deficiency being the most common cause. This adversely impacts the outcome of pregnancy in both the mother and the fetus. Oral iron has been the standard of care for treatment for this condition but due to its potential for severe adverse effects sometimes parenteral iron complexes have an important role as the newer complexes have a higher efficacy and safety profile. Background: Both intravenous iron sucrose (IS) vs ferric carboxymaltose (FCM) are interchangeably used for the treatment of iron-deficiency anemia (IDA) in pregnancy when oral iron is not tolerated but the superiority of one over the other is equivocal. Result: After a comprehensive literature search as per PRISMA guidelines 22 studies (3 randomized trials and 19 observational) revealed a significantly higher rise in hemoglobin [standardized mean difference of 0.59 gm/dL (95% confidence interval 0.26–0.93 gm/dL) in favor of carboxymaltose group (p = 0.001)] and ferritin levels [standardized mean difference of 54.85 µg/L (95% confidence interval 36.33–74.37 µg/L) in favor of carboxymaltose group (p = 0.001)] along with lesser adverse effects with FCM as compared to IS [26% lesser with FCM vis-a-vis IS group (p = 0.001)]. Conclusion: Both intravenous IS vs FCM are interchangeably used for the treatment of IDA in pregnancy when oral iron is not tolerated. Ferric carboxymaltose has an upper edge over IS due to a higher rise of hemoglobin and ferritin levels along with lesser adverse effects and also its convenience in use. However, side-effects of the FCM need to be analyzed more definitively to convincingly accept its superiority in the treatment of IDA in pregnancy.

Background: The trend of increasing caesarean section rates in most countries worldwide has been referred to as “an epidemic”. In India, there has been a 400 and 300% rise in caesarean section rates in private and public hospitals, respectively. The rising trend of caesarean section has resulted in the rise of multiple repeat caesarean sections which are known to be associated with an increase in both maternal and perinatal morbidity and mortality. Hence, we decided to study maternal and neonatal outcomes and complications in patients with previous two lower segment caesarean sections (LSCSs). Herewith presenting a study that analyzes the risk associated with previous two caesarean deliveries such as bleeding and need for transfusion, bladder and bowel adhesions, and injuries and uterine rupture. Materials and Methods: This is a retrospective observational study conducted in the Department of OBGYN at D Y Patil Hospital Navi Mumbai after IEC approval, where data on 192 cases of 4087 confinements of ANC patients with previous two LSCSs were collected, and maternal and fetal outcomes were analyzed. Results: In our study, incidence rate of patients with previous two LSCSs was 5% (192 of 4087 patients). Among the cases with previous two LSCSs, placenta previa was observed in 6% of our patients. Two percent of our patients had abnormal placentation. Around 28% of our patients had severe adhesions with advancement of the bladder, 15% of our patients had atonic postpartum hemorrhage (PPH), and 12% of our patients required a blood transfusion. Bladder and bowel injuries were noted in 8% of our cases. Scar rupture was seen in 2% of our patients and scar dehiscence in 6% patients. Two percent patients needed an obstetric hysterectomy (OH) and 19% patients needed intensive care unit admission. As far as neonatal outcome is concerned, 70% of our neonates were fine and were roomed with the mother, 25% required neonatal intensive care unit admission. Conclusions: Decreased rates of vaginal birth after caesarean section and increasing rates of caesarean delivery have resulted in the increase in previous two LSCS rates along with its potential complications. As the number of caesarean deliveries increases, the risk of morbidity also increases.