Background: Stillbirth is a unique challenge faced by an obstetrician, with India being the largest contributor to world's stillbirth data. Recurrent stillbirth is even more challenging for the obstetrician and family. The current study aimed at assessing the recurrence of stillbirth, causes and associated peripartum complications, to formulate a management protocol at our center. Methodology: A retrospective cohort evaluation of the data at RMRI, Bareilly, was done from December 2020 to December 2022. All the patients with a history of previous >= 1 stillbirth were included. The recurrent stillbirth rate along with the parameters affecting its causation were studied. Results: Out of a total of 2,347 pregnant females, 62 patients were identified having previous stillbirth. 17% patients had history of >=2 stillbirths. Adverse perinatal outcomes was seen in 39 subjects (62%) (OR 1.7101; 95% CI 1.0183–2.8720). Hypertensive disorders of pregnancy and fetal growth restriction (FGR) were commonest medical complications associated in equal frequency (30.4%). 16% patients had early trimester abortions. Recurrence of stillbirth was observed in 8 patients, (recurrent stillbirth rate) = 12.9%. Majority of the cases were unbooked in the present pregnancy (63%). Hypertensive disorders of pregnancy was leading causative risk factor in recurrent stillbirth cases (37.5%). Conclusions: The management of pregnancies with previous stillbirth is a unique challenge with a markedly significant incidence of occurrence of adverse perinatal outcomes and rate of recurrence of stillbirth in subsequent pregnancies. Therefore, early bookings alongside supervised help can improve perinatal outcomes in such females.

Introduction: Amenorrhea has been described as the cessation or absence of the menses. Two types described in the literature are primary and secondary amenorrhea (SA). Although there are known similarities in the causation for the two types of amenorrhea, the conditions warrant timed evaluation. Aims and objectives: To determine the cytogenetic abnormalities in women with amenorrhea who presented in a tertiary health care hospital, South India. Materials and methods: This was retrospective descriptive record study. Patients with amenorrhea who had presented themselves for karyotyping at St. John's Medical College and Hospital were included in the study. The study included all patients during the past 1.5 years (January 1, 2020 to June 30, 2021). Results: A total of 54 patients presented to the Division of Human Genetics for cytogenetic analysis over a period of 2.5 years with history of amenorrhea. Out of the 54 patients, 11 patients had cytogenetical abnormalities and the others had a normal karyotype. And 9 (82%) patients presented with primary amenorrhea (PA) and 2 (18%) presented with SA out of the 11 who presented with amenorrhea. The mean age of the study subjects was 22 ± 6.7 years. Peripheral blood was the specimen that was analyzed in the 11 patients. About 36% of the patients had a history of being born of a consanguineous marriage out of the 11 patients. Conclusion: This study shows the possible cytogenetic abnormalities that are present in women in a case of amenorrhea. Although most women presenting with amenorrhea have a normal karyotype, its testing remains vital for genetic counseling. Key message: This article is one of the most recent studies that identified the various genetic mutations in women presenting with amenorrhea in an Indian population.

Background: Malaria poses a burden in the healthcare system worldwide. India is marching toward a vision of malaria-free country by 2027 and elimination by 2023. The National Strategic Plan for Malaria Elimination (2017–2022) was formulated based on this. Pregnant population is highly susceptible to the infection because of the changes in their immune system. These high-risk groups are of much concern because it contributes to the maternal and perinatal morbidity and mortality. Intrauterine growth restrictions, miscarriages, preterm births, low birth weight, congenital infections, and perinatal deaths have been reported in pregnancies infected with malaria. The ongoing pandemic situation of coronavirus disease-2019 (COVID-19) has created a challenge in identifying the spectrum of diseases with similar presentation like malaria especially in endemic areas. Case description: We present a series of 10 cases affected with malaria during pregnancy at a tertiary care hospital in Chennai. The study was conducted for a period of 10 months from September 2020 to July 2021 during the COVID pandemic. Out of these 10 patients, 3 patients were infected with COVID-19. Discussion: Clinical manifestations, management, and the maternal and fetal outcome of malaria-infected patients and difficulty in identifying and managing the cases in ongoing COVID-19 pandemic situation. Conclusion: The purpose of this study is to throw knowledge about identifying the infection during pandemic and the need for effective management as malaria is a preventable and curable infection.

Aim and objective: To correlate the association between postnatal umbilical cord coiling index (UCI) and perinatal outcome. Materials and methods: This is a cross-sectional study conducted on 220 booked singleton pregnant women with cephalic presentation immediate post-delivery. Both vaginal and cesarean deliveries were included. Umbilical cord coiling index was calculated and the variables assessed were gestational diabetes mellitus (GDM), anemia, hypertensive disorders, oligohydramnios, polyhydramnios, meconium-stained liquor, mode of delivery in the mother and preterm, fetal growth restriction (FGR) and neonatal intensive care unit (NICU) admissions in the fetus. Results: Hypercoiled group or UCI >90th percentile showed a significant increase in cases of FGR (p-value 0.007), GDM (p-value 0.001), and polyhydramnios (p-value 0.0001). Hypocoiled group or umbilical cord coiling index (UCI) <10th percentile showed a significant increase in cases of preterm (p-value 0.01), hypertensive disorders (p-value 0.0001), meconium-stained liquor (MSL) (0.0003), and NICU admission (p-value 0.0001). The study did not reveal any significant changes with regard to mode of delivery, anemia, or oligohydramnios among the three groups (hypercoiled, hypocoiled, and normocoiled). Conclusion: The present study shows that the umbilical cord coiling index is a useful predictor of adverse perinatal outcomes. Cases with abnormal UCI (hypercoiling and hypocoiling) had a higher incidence of complications such as FGR, GDM, polyhydramnios, hypertensive disorders, MSL, and NICU admission. There is a huge arena for research in this field and routine screening of UCI should be considered antenatally.

Background: Early pregnancy loss, either spontaneous or induced, causes physical morbidity that is usually short-lived. However, the psychological impact of abortion has not be studied adequately. Objectives: To assess the Goldberg Health Questionnaire-12 among women undergoing treatment for abortion-related issues. To describe the relationship between demographic, social, obstetric and medical factors on postabortion stress levels. Materials and methods: After IEC clearance, a cross-sectional questionnaire-based study was conducted on patients seeking abortion-related care. Those with prior psychiatric illnesses and those undergoing MTP for failure of contraception were excluded. The GHQ-12 was administered. Demographic, obstetric and medical factors were noted. Statistical analysis was performed to identify the association between GHQ scores and the variables. Results: About 106 participants with average age of 25.7 years, 86% Hindus, and 83% employed were studied. About 63.2% were multigravidae, 67.9% were in the first trimester, and 63.2% were spontaneous abortions. About 42.4% were medically managed. About 89% (94 patients) were found to have typical distress and 11% (12 patients) were found to have more-than-usual distress, suggesting a high prevalence of psychological distress. The presence of prior living issue (80% vs 35%, p-value = 0.013), presence of prior abortion (66% vs 21%, p-value = 0.002), presence of medical comorbidity (41.6% vs 15%, p-value = 0.038), and desire for future progeny (83% vs 13%, p-value < 0.0001) were associated with higher stress. Conclusion: Women undergoing abortion/MTP have psychological stress. Some patient factors like prior living issue, prior abortion, medical comorbidity, and desire for future progeny appear to influence higher stress levels.

Aim: To study the magnitude of different gynecological problems of adolescents attending the Outpatient and Inpatient Departments of Government Medical College, Kozhikode, the various causative factors and the treatment modalities. Materials and methods: This was a prospective study where a total of 400 girls in the age-group of 13–18 years attending the Outpatient and Inpatient Departments of Government Medical College, Kozhikode, between January 2019 and June 2020 satisfying the inclusion criteria were followed up to find out the type of gynecological problems and the treatment required. Data were collected by using pro forma after obtaining patients consent. Patients were followed up to study the type of gynecological problems and the treatment required. Data were entered in MS Excel spreadsheet and analyzed by using Statistical Package for the Social Sciences software. Results: Out of 400 adolescents, menstrual disorders were seen in 68.8% and ovarian tumors in 20.8% of girls. Around 6.0% had leukorrhea. Among 275 cases with menstrual problems, almost 81.8% of the cases were abnormal uterine bleeding (AUB). Around 12.0% of dysmenorrhea cases, 1.5% of primary amenorrhea cases, and 4.7% of secondary amenorrhea cases were also noted. Among 160 AUB cases, almost 15.0% of the cases were treated with blood transfusion or hematinic or hormones, and 85.0% of the cases were managed with hormones and hematinic. Conclusion: Heavy menstrual bleeding was the most common menstrual disorder in our study accounting for about 54.7% cases of which 12.2% girls required blood transfusion in view of severe anemia. Ovarian tumors were the second most common problem in our study (17.3%). Clinical significance: For early detection of adolescent problems and effective management of adolescent health, an adolescent clinic is the appropriate solution. They help improve their quality of life and help their transition into adulthood.

Aims: Owing to the continuous debate and dilemma regarding the appropriate approach for managing fibroids with pregnancy, this review aims to synthesize, analyze and build up evidence from the published studies, especially the recent ones, about the changing trends in the last decade regarding the management of uterine fibroids with pregnancy and the feasibility as well as safety of cesarean myomectomy in comparison to the traditional conservative approach of deferring removal of the fibroids 3–6 months post-partum. Materials and methods: This is a review of the literature, and all the co-authors searched for, gathered, and filtered the most recent publications on the subject through PubMed, Medline, Google search, and others. Findings: The prevalence of fibroids with pregnancy ranges between 0.1 and 3.9% however, the true rate may be higher than this presently reported incidence. Discussion: An increasing trend in diagnosing fibroids with pregnancy is currently clearly obvious, mainly due to the concept of delaying child-bearing as well as the steady increase in the rate of cesarean delivery which leads to more incidental findings of asymptomatic fibroids. Conclusions: Uterine fibroids in pregnancy represent a dilemma in both diagnosis and treatment. Ultrasonography remains the main diagnostic modality for fibroids during pregnancy despite its reduced sensitivity and specificity during pregnancy. Treatment of fibroids with pregnancy continues to be a matter of debate and controversy, where traditionally myomectomy used to be deferred until after delivery and maybe after puerperium. At present both caesarean myomectomy and also, myomectomy during pregnancy have places in modern obstetrics. Statement of significance: • The problem regarding the association of fibroids with pregnancy arises mainly from the challenges in both the diagnosis, where ultrasonography has a reduced sensitivity and specificity during pregnancy, as well as the controversy and debate in the treatment strategies of the condition. • The traditional known practice of managing fibroids in association with pregnancy, is to postpone the removal of fibroids until postnatal and even after puerperium to allow a time for uterine involution and shrinkage of the fibroid hence, minimizing the operative time and the associated blood loss with the potential risks of spontaneous miscarriage, placental dysfunction, fetal malpresentations and preterm birth especially with submucous and intramural fibroids. • This article highlighted the newly introduced interventions in the context of the management of fibroids with pregnancy including, techniques to prevent preterm delivery and achieve term birth in case of treatment delay until post-delivery, or the implementation of cesarean myomectomy as well as myomectomy during pregnancy.

Von Willebrand's disease is an inherited bleeding disorder, which perhaps can be a life-threatening emergency in pregnancy, delivery, and early puerperium, therefore, early diagnosis and minimizing or controlling blood loss is the main aim. It is a condition where the body is either in deficiency of factor VIII or its binding protein, which leads to increased tendencies of bleeding. Here, we will be discussing four cases, highlighting their diagnosis and clinical management. Our study aims to present different clinical scenarios where pregnant women with von Willebrand's disease presented to our clinical setup, citing the various complications during the peripartum period and their management to improve their obstetric outcome.

Tetralogy of Fallot (TOF) is one of the most common cyanotic congenital heart diseases (CHD), which presents with classical tetrad ventricular septal defect (VSD) with overriding aorta, pulmonary stenosis, and right ventricular hypertrophy. Women with uncorrected TOF have maternal hypoxemia with miscarriage, poor fetal growth, preterm delivery, or even fetal death with chances of maternal heart failure as its consequence event. We are reporting three cases of pregnancy in women having uncorrected TOF who were managed successfully at our institute. Pregnant women with class III–IV NYHA are counseled for MTP, as done in the third case here. However, if the patient refuses, we can proceed with the pregnancy with total bed rest and supportive care, as done in the first two cases. Intense monitoring is required throughout pregnancy as hypoxia and polycythemia both are related to poor maternal and fetal outcomes. Our findings in all three cases were comparable to published cases and studies like done by Veldtman et al., Balci et al., and Drenthen et al. So, patients with TOF during pregnancy need multidisciplinary team care consisting of obstetricians, cardiologists, anesthesiologists, and neonatologists among others. At the initial booking itself, these high-risk patients should be admitted for evaluation of the severity of TOF and its effect on pregnancy.

Aim and background: The incidence of cesarean scar pregnancy (CSP) varies from 1/1,800 to 1/2,500 of all pregnancies, which comprises almost six percent of all ectopic pregnancies, in patients with at least one previous cesarean section, and it has increased due to a rise in the number of cesarean deliveries and early detection due to better imaging modalities. Case description: In this case series, three women with early pregnancy presented to the emergency room at our hospital with complaints of lower abdominal pain and spotting or bleeding per vaginum. Diagnosis of CSP was made after performing a transvaginal ultrasound (TVUS) and CSP was successfully managed using systemic methotrexate (MTX) and uterine artery embolization (UAE) in one case and instillation of intracardiac potassium chloride (KCl) along with injecting MTX in the gestational sac in two cases. Beta human Chorionic Gonadotrophin (β-hCG) was measured every week for follow-up until negative. Conclusion: Cesarean scar pregnancy was managed using different modalities depending on the presenting complaints of the woman, clinical features, imaging, and the presence of cardiac activity. Clinical significance: Early detection and timely interventions in CSP are associated with reduced maternal morbidity and mortality.

Background: Metroplasty is a reconstructive surgery to repair congenital uterine anomalies. Anomalous uteri cause infertility and recurrent abortions due to defective implantation, restrictive fetal growth, and malpresentation. Aim: To discuss our experiences and surgical techniques with various cases of metroplasty in women with structural uterine anomalies with infertility or recurrent abortions at a tertiary care hospital in Mumbai. Case description: A descriptive study of case series of metroplasty conducted in a tertiary care hospital in women with bicornuate and didelphys uterus by opening the uterine cavities by incision on the medial aspect of the hemicolpos and approximating the myometrial edges and suturing them to create a single uterine cavity. Conclusion: By the unification of two smaller uterine cavities, metroplasty restores normal anatomy of the uterine cavity as is required for positive implantation and good obstetric outcomes. Clinical significance: After metroplasty, the chances of conception and probability of carrying conception to full term rise significantly.

Mayer–Rokitansky–Küster–Hauser syndrome (MRKH) is one of the causes of primary infertility, affecting about 1 in 4,500–10,000 women. These patients have vaginal stenosis but normal secondary sexual characteristics. In this case, we present a patient with MRKH who also has adenomyosis in rudimentary horns and an endometrioma in the right ovary. The patient has been experiencing cyclical abdominal pain for the last 15 years. There is evidence of endometriotic lesions in the myometrium of the remnant horn. Case description: Here we present a case of primary infertility in a 35-year-old woman who presented with dull aching abdominal pain for the last 15 years. She was frequently misdiagnosed with a fibroid in the right lateral uterine wall and a left ovarian endometrioma. The diagnosis was confirmed through MRI pelvis and histopathology of the specimen. The patient underwent surgery for the same and has been symptom-free since then. She is now planning for a surrogate child. Conclusion: Based on the imaging findings, intraoperative findings, and histopathological evaluation, it was concluded that this was a rare case of MRKH with functioning endometrium in the remnant horn. Adenomyosis can be explained by the unusual developmental anatomy of the uterus in patients with MRKH syndrome, which allows the endometrial cells to be misplaced within the myometrial layer. The possible explanation for the endometrioma is the theory of coelomic metaplasia as a cause of endometriosis, rather than retrograde menstruation. It is possible to have endometriotic tissue in the remnant horns of the uterus and endometrioma in the ovaries.

Background: For a woman, the absence of a vagina makes her devoid of both sexual well-being and motherhood. Vaginal agenesis is by no means rare and is a cause of primary amenorrhea. Mayer–Rokitansky–Kuster–Hauser (MRKH) syndrome affects 1/4000–1/10,000 females. Case description: Here we report a 39-year-old female, who presented with complaints of inability to have sexual intercourse. After history and physical examination, an MRI was done showing normal abdominal organs, hypoplastic uterus, and bilateral ovaries 1 cm × 1 cm. Karyotyping showed 46XX. Horse shoe labial flap vaginoplasty was done as per the technique of Purushothaman. The postoperative period was uneventful with the flap settling well. On follow-up at 3 months, she was able to successfully use 1/4th of the dilator 3 and reported having a satisfactory sexual life with her partner. Conclusion: Horse shoe labial flap vaginoplasty uses the entire hairless skin within the labia majora to create a neovagina. Being a new technique with simplified suturing techniques and augmented blood supply, it is a more reliable method with better results.

Ectopic pregnancies constitute around 1–2% of all pregnancies, out of which 0.4% will be tubal stump ectopic pregnancy. Tubal stump pregnancy is a type of pregnancy implanted in the remnants of the fallopian tube post-salpingectomy. We describe a rare case of ectopic pregnancy in a 33-year-old gravida 2 on the tubal stump despite previous salpingectomy done on the ipsilateral side due to ectopic in the ampullary portion of the fallopian tube. In the previous pregnancy medical management was tried, however, beta-HCG continued to rise and the patient had to undergo laparoscopic surgery. She conceived normally again 4 months later and an early scan at 5 weeks again suggested ectopic on the same side. Being early gestation, methotrexate was tried again but the patient presented with hemoperitoneum 2 days later. During the laparoscopic procedure, it was discovered to be a tubal stump ectopic on the ipsilateral side where salpingectomy was previously done. The tubal stump was completely removed with electrocautery. The patient needed one packed cell transfusion; however, she recovered well and was discharged after one day. Tubal ectopic pregnancy is difficult to diagnose and treat compared to regular ectopic pregnancy. The chances of rupture are higher due to the location of the pregnancy which increases morbidity and mortality. Hence even after salpingectomy, the tubal stump ectopic should be considered in diagnosis.

Introduction: Uterine fibroid during pregnancy are associated with high risk of preeclampsia in pregnant females with adverse obstetric complications. Materials and methods: Here we report a case of a 31-year-old female presenting with 36 weeks gestation with headache, blurring of vision and epigastric pain with severe preeclampsia. She was managed conservatively initially but her blood pressure could not be controlled and her symptoms were not relieved; hence, lower segment cesarean section was done for termination of pregnancy and multiple uterine fibroids were found intra operatively incidentally. Therefore, cesarean myomectomy was done and the patient was discharged on 9th postoperative day in satisfactory condition. Conclusion: Uterine fibroids are associated with high risk of preeclampsia during pregnancy, hence these patients must be closely monitored during antenatal period.

Pregnant women use digital media to maintain contact with professionals, for having entertainment, and to get emotional support. These factors contribute to excessive use of mobile phone use. There is no conclusive evidence for impact of digital gadgets on pregnancy and child birth. In the absence of guidelines for this group, successful integration of anticipatory guidance into the routine antenatal and postnatal care for healthy use of technology during pregnancy is crucial for strengthening both maternal and child health, especially in the current digital context.