Background and aim: Liver disorder is relatively rare in pregnancy and its association with stillbirths has not been much investigated. We undertook the index study to find the incidence of stillbirth in pregnant women with liver disorders and to compare the maternal characteristics in pregnant women with liver disorders delivering live births. Methodology: Retrospective data from 3 years were extracted from the neonatal–perinatal database encompassing the stillbirth registry. All pregnant women who had stillbirths, with preexisting or diagnosed as having a liver disorder during the index pregnancy were included for analysis. Results: The incidence of stillbirths due to liver disorder in pregnancy was 4.4%. There was a significant difference between the two groups of women with liver disorders delivering stillbirths and livebirths in terms of the number of antenatal visits [p < 0.05, odds ratio (OR) = 2.43 (1.47–4.03)], the incidence of hypertension of pregnancy [p = 0.026, OR =1.94 (1.07–3.53)], and abruption [p < 0.05; OR = 7.9 (4.09–15.24)]. Women who delivered stillbirths had higher odds of fetal growth restriction [p = 0.058; OR = 2.03 (0.97–4.27)], acute fatty liver of pregnancy (AFLP) [p < 0.05; 100 (10.75–1000)], hepatitis E virus (HEV) infection [p < 0.05; 3.58 (2.02–6.33)] and jaundice [p <0.05; 2.60 (1.50–4.51)]. Conclusion: The incidence of stillbirths due to liver disorders in pregnancy was 4.4%. Hypertension of pregnancy, abruption, fetal growth restriction, and low birth weight were significantly associated with stillbirths. Among all hepatic disorders, jaundice due to medical disorders and HEV were found significantly high in women with stillbirths.

Aim: To analyze the different types of benign vulvar tumors that required surgery and to correlate with the histopathological findings postoperatively. Materials and methods: This retrospective study was conducted over a period of 1 year in a tertiary care hospital in Southern India. A total of 11 benign solid vulvar masses which were operated between July 2022 and June 2023 were included in the study. Demographic data, description of the mass, time taken to seek medical attention, surgical procedure and pictographic histopathological findings were studied. Results: The study population ranges from 26 to 45 years with a mean age of 35.8 ± 7.33 years. The mean time taken to seek medical care for the detected mass was 16.25 ± 17.23 months. The earliest presentation was noted 6 months after detection, while one patient presented 6 years after the appearance of the mass. The largest mass was 12 × 15 cm in size. All the masses underwent complete surgical excision with no postoperative complications. The most common pathological finding was fibroepithelial polyp, noted in four patients, followed by leiomyoma of the vulva and vulvar hemangioma. The other masses were reported as vulvar endocervicosis, epidermoid cyst, and lipoma, respectively. It is important to note that these tumors, though benign, can cause functional, sexual, and emotional impairment. These women were followed up 6 months postoperatively and did not show any recurrence. The quality of life assessment using the VR-12 validated scale indicated the improvement in all 11 women after surgery. Conclusion: Surgical excision of benign vulvar masses not only mitigates the risk of premalignant tumors of the vulva, but also greatly improves the quality of life. Clinical significance: • This study helps us understand benign vulvar masses and the importance of surgical removal of these masses to prevent risk of malignancy. • Surgical excision helps to greatly improve the quality of life in these women.

Objective: To compare the outcomes of the two techniques of blunt uterine extension. Materials and methods: A randomized controlled trial was conducted from April to July 2022 after the institutional human ethics committee approval. All pregnant women at or beyond term undergoing cesarean were included. Computer-based randomization was generated. A total of 521 patients were screened. As required, 154 patients were recruited and 77 were equally randomized in the cephalad-caudad (CC) and transverse (TS) expansion groups. The primary outcome was the estimation of unintended intraoperative injuries and drop in the hemoglobin (Hb) level (postoperatively). Secondary outcomes were to determine the postoperative complications. Results: Higher number of unintended injuries were noted in the TS expansion compared with CC expansion group, 2 (2.6%) vs 1 (1.3%); p = 1.0, similar to the unintended uterine artery injury [7 (9.1%) vs 6 (7.8%); p = 0.7]; however, both the parameters did not show any statistical difference. A clinically relevant case of significant broad ligament hematoma injury happened in the TS group. Postpartum hemorrhage (PPH) occurred in 4 (5.2%) patients of TS group of which one needed blood transfusion, while none occurred in the CC group. The mean difference in drop of Hb was not significant (TS vs CC, 0.9 ± 1.1 vs 1.0 ± 1.1; p = 0.3). The mean difference of visual analog scale (VAS) scores was not significant (2.8 ± 1.6 vs 2.5 ± 1.6; p = 0.2). There were no case of endometritis, fever, or sepsis. Conclusion: The cephalad-caudad blunt expansion technique is equally safer than the transverse expansion.

Background: A menstrual cup is a menstrual hygiene device which is inserted into the vagina, made of silicone can be reused for 10 yrs. Today in the era of reduce, reuse and recycle, menstrual cup provides a suitable, safe, and feasible option for sustainable menstruation. This study aimed to assess the awareness, acceptability, and feasibility of menstrual cup among student population. Materials and methods: A descriptive longitudinal study done including the female medical and dental undergraduates. All eligible participants consenting to participate were provided with a predesigned questionnaires. The data collected were entered in MS Excel and analyzed into descriptive statistics like percentages. Results: 462 female students received the questionnaire, out of which 459 completed the questionnaire. Of the total participants, 93.5% were aware of the cup as a menstrual sanitary product with social media as the leading source of information (75%). In the study, 5.9% were active cup users. The main reason cited for not using the cup was lack of information regarding the correct insertion and removal techniques (45%) and the fear of insertion (31%). Among the cup users, the common problem faced was difficulty in insertion and removal (66.6%), while 46% of the users did not face any problems or difficulties with usage of the cup. About 75% of the non-users showed a willingness to change over to cup. Conclusion: From our study, it can be inferred that though the awareness regarding availability and safety of the cup is on the rise in the last few years, the popularity is still low. Thus, more awareness programs regarding proper usage technique, safety, and additional benefits of the menstrual cup needs to be arranged particularly focusing on the student population.

Introduction: Immunization is the most effective form of prevention against coronavirus disease-2019 (COVID-19) related complications during pregnancy. This study was done to see the prevalence of the COVID-19 immunization status in pregnant women delivering in a tertiary level Government Hospital in New Delhi, India, and associated side effects of COVID vaccine in pregnancy. Materials and methods: A prospective cross-sectional study was conducted from 1st July 2022 to 31st December 2022 in a tertiary level, Government Hospital in New Delhi, India. The Institutional Ethical Committee provided approval for the study. A written questionnaire was given to all consecutive pregnant women delivering in the hospital, after taking written consent and details of COVID vaccine, number of doses, time of immunization (antenatal/postpartum), COVID infection status (antenatal/postnatal period) and adverse reactions encountered. Observation and results: Women (842) were included in the study, out of which 87% (605/842) were vaccinated and 12.6% (218/842) were unvaccinated. The majority (70.4%) received Covishield while 29.6% received Covaxin. Adverse effect following vaccination was experienced by 9.2% (68/842) women and was mild. Conclusion: The total vaccine coverage among the women enrolled in the study was 87%. There was no statistically significant difference (p-value = 0.095) in the side effects profile of the Covaxin and Covishield vaccines. Among the hesitancy factors observed in the unvaccinated group, safety concern regarding vaccines was the most dominant factor.

Introduction: Breast pumps represent valuable tools to promote continued breastfeeding. Aim: Describe the characteristics of the global scientific production of breast pumps indexed in Scopus. Materials and methods: Descriptive study based on bibliometric methodology. A search equation was created using keywords and logical operators. We found 362 articles in Scopus and selected 292 that met the selection criteria. Visibility, impact, and collaboration indicators were estimated using the SciVal tool. Results: The University of Western Australia had the most publications, although the University of Toronto (18.6) in Canada had the highest average number of citations per publication. The most productive authors were Geddes Donna Tracy and Lai Ching Tat; however, Meier Paula Primmer had 67% more expected citations than the overall average. National collaboration was present in approximately 50% of the publications. Articles in first-quartile journals are published in higher numbers and with a positive trend from 2013 to 2022. Most of the most productive journals were positioned in the Q1 quartile, of these, the Journal of Human Lactation and Breastfeeding Medicine had the most publications. Conclusion: Research on breast pumps increased, especially in journals positioned in the first and second quartile. National cooperation is the most frequent, with the United States as one of the countries with the most institutions among the most productive.

Background: An effective referral system is key to access timely emergency obstetric care in order to prevent maternal and perinatal mortality. The criticality of referrals makes it necessary to understand its pattern at the health system level. This study was conducted with an objective to document the patterns, primary reasons of obstetric case referral and the maternal and perinatal outcome of the referred cases in Government Medical College, Mahasamund in rural Chhattisgarh. As a systematic monitoring of referrals majorly helps to identify current gaps and timeliness of referral in providing essential obstetric care. Methods: The study is based on the health records and details on referral forms from referral center and peripheral health facilities. This follow-up study was conducted in between July 2022 and June 2023 (12 months). All referred patients for obstetrics indications above 20 weeks and patients with postpartum indications were included. Descriptive statistics were used to analyze demographic details, referral patterns, reasons of referrals, referral communication and documentation, time and mode of transfer and delivery outcomes. Results: According to our study, out of a total of 5,962 delivered patients, 1,281 (20.5%) cases were referred patients. Maximum cases, i.e., 567 (44.2%) were in the age-group of 24–29 years. The major reasons for referring patient were hypertensive disorders of pregnancy (11.2%), previous cesarean section (9.8%), and PPH (9.5%). There were six maternal deaths (0.5%) and discharge rate was 96.2%. Conclusion: The present study showed that illiteracy and ignorance of female regarding healthcare requirements and poor infrastructure came out to be a major contributor of poor pregnancy outcome. Timely referral is crucial for a satisfactory maternal and fetal outcome. To reduce the number of unnecessary referrals and to reduce burden on tertiary care hospitals, healthcare workers should be trained in essential and emergency obstetric care which will help in reducing morbidity and mortality.

Background: Dysovulatory infertility is a major cause of infertility. It is treated with ovulation induction complemented with an assisted reproductive technique such as intrauterine insemination (IUI) and timed intercourse (TI). The data to compare the efficacy of IUI vs TI in super-ovulated cycles is limited. Aim: Comparison of pregnancy rates following IUI vs TI in letrozole and follicle-stimulating hormone (FSH) cycles in dysovulatory infertility. Method: Following the history and examination of subjects enrolled, baseline hormonal levels were done on day 2, transvaginal ultrasonography (TVS) for number and size of follicles and endometrial thickness was done on days 8, 10, and 12, and ultrasonography (USG) to confirm ovulation was done on day 14, if confirmed, it was followed by IUI or TI. Urine pregnancy test (UPT) at 2 weeks established successful conception. Those not conceiving received another cycle, to a maximum of 3 cycles. Result: A total of 120 subjects received 320 cycles. Intrauterine insemination shows better conception rates than TI (p-value < 0.05). The clinical pregnancy rate for the IUI group is 18.5% (28 in 154 cycles) and 10% (16 in 166) in the TI group. The success rate is positively correlated with younger age of patients, better educational status, and higher socioeconomic status. Conclusion: Intrauterine insemination combined with letrozole and FSH-stimulated dysovulatory infertility is an effective method to improve pregnancy outcomes.

Background: Intravenous iron administration is routinely used to treat moderate anemia during pregnancy. Iron sucrose has the disadvantage of repeated doses and increased hospital visits. Ferric carboxymaltose provides rapid replacement of iron storage in a single dose. In this study, we compare the safety and efficacy of the two parenteral iron complexes in the treatment of iron deficiency anemia in pregnancy from gestation age of 14–38 weeks. Methodology: The Obstetrics and Gynecology Department at Rajshree Medical Research Institute in Bareilly conducted this comparative investigation. In order to conduct the study, a total of 100 pregnant women who were diagnosed with moderate anemia between the ages of 14 and 36 weeks of gestation were divided into two groups at random (n = 50) (Group A: Iron sucrose complex (ISC); Group B: Ferric carboxymaltose). Result: In group A of the study, the majority of the patients were women between the ages of 26 and 30 (38%) and between 31 and 35 (44%), respectively. In group A, 8% of patients and 6% in group B had nausea. In group A, 1% of patients reported abdominal pain, whereas in group B, there were no complaints. Conclusion: There aren't many randomized controlled trials comparing ferrous carboxymaltose and ISC in pregnant women between 14 and 28 weeks along with very few prospective studies on FCM. The present study concludes Ferric carboxymaltose to be more efficient with no life-threatening reaction compared with ISC for treatment of moderate iron deficiency anemia in 14–36 weeks of gestation.

Aim and background: It is imperative to achieve precise diagnosis of prelabor rupture of membranes (PROM) and preterm prelabor rupture of membranes (PPROM) by recognizing specific amniotic fluid indicators in vaginal environment. The study included assessment of creatinine levels in vaginal fluid along with determining its cut-off value to diagnose PROM/PPROM. Methods: Sixty women with singleton pregnancy of 28 weeks or more period of gestation, were enrolled in the study to be categorized in two equal groups of 30 each. Study group comprised of patients having confirmed PROM and control group included pregnant women with intact membranes. Vaginal fluid samples were collected in a sterile syringe in study patients. In controls, 5 mL of normal (0.9%) saline was instilled into vaginal cavity, and 3 mL of vaginal fluid was collected to be sent for creatinine estimation. Results: The mean value of levels of creatinine in vaginal fluid in study groups was (1.15 ± 0.55 mg/dL) and control groups was (0.15 ± 0.16 mg/dL) showing a significant difference (p < 0.001). The value of creatinine in vaginal fluid to detect PROM/PPROM was 0.7 mg/dL, with sensitivity of 86.67% and specificity of 100%. The positive predictive value (PPV) was 100% and negative predictive value (NPV) was 88.24% with an accuracy of 93.33%. Conclusion: Creatinine estimation in vaginal fluid is an easy, reliable, as well as readily available method to diagnose PROM/PPROM. Clinical significance: Accurate diagnosis of PROM/PPROM, using an easily available and reliable method is important to guide the clinical management in high-risk pregnancy.

The present study is aimed to determine the effect of nesting on physiological parameters among preterm babies admitted to Neonatal intensive care unit (NICU) of Amala Institute of Medical Sciences, Thrissur, Kerala. Objectives are to analyze the physiological parameters among preterm babies, determine the effect of nesting on physiological parameters among preterm babies, and also to find the association between physiological parameters with baseline variables. The research approach is quantitative approach and the research design is cross-over design. The study is based on Ludwig Von Bertalanffy, general system model. Twenty preterm babies were selected by purposive sampling technique. Samples were randomly allocated for nesting and routine care. Tools used were a structured questionnaire to determine the baseline variables and a physiological parameter datasheet to record physiological parameters after nesting and routine care. The calculated t-value and p-value of heart rate are 0.26 and 0.797 respectively, respiratory rate is 0.163 and 0.109, temperature is 0.113 and 0.910 and oxygen saturation is 2.74 and 0.009 respectively after nesting and routine care. Hence the t-value of oxygen saturation is statistically highly significant at 0.05 level irrespective of other physiological parameters that are maintained stable and showed differences but statistically not significant after nesting and routine care. The study findings depict that heart rate and respiratory rate were decreased, mean body temperature was increased but statistically not significant after nesting as compared to routine care. The study findings reveal that nesting is beneficial in sustaining stable physiological parameters among preterm babies.

Background: Pregnancy complicated with pulmonary artery hypertension (PAH), lies at increased risk of maternal and neonatal complications. Although studies have reported mortality rates of up to 56% associated with pregnancy in PAH, however, with a multidisciplinary approach including obstetrics, anesthesia, and cardiology, care in women with PAH has improved. It is necessary to investigate if such a modern multidisciplinary approach has led to a reduction in maternal mortality and has improved maternal and fetal outcomes. Aim: Our study evaluates maternal and fetal outcomes in pregnant women with PAH in a tertiary care setting in North Eastern India with a multidisciplinary approach. Materials and methods: This retrospective, hospital-based, time-bound study was done on 54 pregnancies complicated by PAH, over one and a half years. Patients were evaluated for the development of any cardiac complications like arrhythmia, congestive cardiac failure, thromboembolism, and atrial fibrillation. Maternal obstetric complications were evaluated like postpartum hemorrhage, anemia, and pregnancy-induced hypertension. Gestational age at delivery and mode of delivery were also noted. Fetal complications like preterm delivery, fetal growth restriction, intrauterine fetal death, and congenital cardiac disease were noted. Results: The mode of delivery was LSCS in the majority (77.7%), with the mean gestational age of delivery being 38 weeks and 5 days. On the assessment of PAH, the mild degree was seen in the majority of cases (55.6%), moderate PAH in around 29.6%, and a severe degree of PAH was seen in only 14.8% of cases. The majority of cardiac defects associated with PAH were congenital cardiac diseases in the form of ASD and VSD (68.5%). The majority of patients had spinal anesthesia (42.85%) during LSCS. General anesthesia was used in only 10 cases (23.8%). Preterm deliveries and fetal growth restriction were seen in around 14 and 33% of cases respectively, with no intrauterine fetal death. Cardiac complications occurred in 11% of cases and maternal obstetric complications occurred in 29.6% of cases. No maternal death was noted in the study group. On further analysis, it was seen that maternal complications were significantly higher among those with a higher degree of PAH (p = 0.006). Also, the baby's birth weight was significantly lower with an increase in the severity of PAH. On Bonferroni post hoc analysis, the association was between mild and severe PAH (p < 0.01) and between moderate and severe PAH (p = 0.016). Conclusion: Our study has shown no maternal mortality over a group of 54 pregnant women. This study thereby appraises the contribution of a multidisciplinary approach in the management of these patients.

Aims and background: To evaluate biomarkers in the quadruple test that can predict hypertension in pregnancy and other adverse pregnancy outcomes. Materials and methods: Retrospective data collection from medical records of anonymous pregnant women above 18 years old who had attended antenatal care at Phrapokklao Hospital, performed the quadruple test, and delivered at Phrapokklao Hospital in the period July 2020–March 2022. The exclusion criteria were fetal chromosome anomaly and maternal diabetes mellitus. The biomarkers in the quadruple test of participants were calculated and compared to whether they were related to pregnancy-induced hypertension or other adverse pregnancy outcomes. Results: Gestational hypertension correlated to high-risk quadruple test, age, multiparity, and BMI. The area under the ROC curve between beta-hCG and gestational hypertension was (AUC) 0.692. We found that beta-hCG of 2.86 MoM was the mean of beta-hCG in participants who had hypertension. Other adverse pregnancy outcomes weren't correlated with quadruple test results. Conclusion: Age, BMI, parity, and high-risk quadruple test were associated with gestational hypertension. Nevertheless, only beta-hCG could be assisted in predicting gestational hypertension and preeclampsia. Clinical significance: Clinicians should be careful about gestational hypertension in high-risk quadruple test pregnancy.

Introduction: Peripartum hysterectomy is a rare emergency obstetric surgery, usually performed in emergency situations such as massive obstetric hemorrhage. Emergency peripartum hysterectomy (EPH) can follow a vaginal delivery or a cesarean section. Materials and methods: Our study is retrospective. It is done at the Department of Obstetrics and Gynaecology, Bangalore Medical College and Research Institute (Tertiary care teaching hospital in South India) from January 2018 to December 2023. Results: Out of 90,956 deliveries, EPH was performed in 162 cases. 0.178% is the incidence of EPH or it is about 1.8 per 1,000 deliveries. The commonest reason for EPH was abnormal placentation (43.8%). Atonic uterus (22.8%) and rupture uterus (20.3%) mostly secondary to scar rupture were the 2nd and 3rd most common causes of EPH. Discussion: Uncontrollable hemorrhage secondary to atonicity, ruptured uterus, and sepsis were once considered the principal risk factors for EPH. However, presently risk factors have changed and it is the abnormal placentation that considered to be the main indication for EPH. In this study, the most common indications of EPH were abnormal placentation, atonic uterus, ruptured uterus, and abruption. There were 13 maternal deaths (8.02%) in our study. A relatively low perinatal mortality rate (21.6%) is found in this study. Conclusion: Reducing the number of unnecessary cesarean deliveries, particularly repeat cesarean deliveries, in light of the evidence linking placental pathology with cesarean delivery, will help mitigate the number of EPH.

Objective: The aim of this study was to explore the correlation between insulin resistance (IR) and serum anti-müllerian hormone (AMH) in those women with polycystic ovarian syndrome (PCOS). Methodology: This study was a prospective observational study conducted on women attending a gynecology clinic, in whom PCOS was diagnosed by the Rotterdam criteria and those who fulfilled the inclusion criteria, from January 2020 to July 2021. Detailed history, complete physical examination, and signs of hyperandrogenism were noted. A hormone profile and ultrasonography for ovarian morphology were done. Correlation between AMH and IR was done in four phenotypes of PCOS. The results were analyzed with the help of appropriate statistical tests. Results: The mean IR was 2.35 ± 0.87 in phenotype A, 2.20 ± 0.74 in phenotype B, 1.83 ± 0.91 in phenotype C and 1.69 ± 0.75 in phenotype D. The mean values of both AMH and IR showed a decreasing pattern from phenotype A to phenotype D. The results were statistically significant (p-value = 0.004). Conclusion: This study concludes that a positive correlation exists between IR and AMH in different phenotypes of PCOS.

Background and aim: Hemoglobinopathies pose to be a major risk factor for pregnancy leading to potentially fatal maternal and neonatal complications. The aim of our study was to compare maternal and neonatal outcomes of pregnancy in women with a hemoglobinopathy and without a hemoglobinopathy. Materials and methods: The present study is a comparative retrospective analysis of 153 pregnant women with hemoglobinopathies and 153 pregnant women without hemoglobinopathies who were treated between June 2020 and May 2023, in Dhiraj Hospital, Vadodara. We analyzed various data regarding maternal as well as neonatal outcomes and complications in hemoglobinopathies. Results: Among the maternal outcomes, the rate of previous miscarriage, intrauterine growth restriction (IUGR), postpartum hemorrhage (PPH), and anemia were significantly increased in women with hemoglobinopathies. Among the neonatal outcomes, the rate of anemia and low birth weight were significantly increased in all type of hemoglobinopathic pregnancies. Hepatic encephalopathy, septicemia, jaundice, perinatal death, and fetal acidosis were also increased in sickle cell disease (SCD) pregnancies. Conclusion: It is pivotal to supervise pregnancies with hemoglobinopathies for minimal morbidity and mortality in mother as well as fetus. Timely multispecialty intervention can help in improving the fetomaternal outcomes.

Background: Pregnancy being an immunocompromised state, when complicated with neoplasm, challenges its management and outcomes. The study aims to find a middle path for optimum maternal, fetal, and oncological outcomes. Aim and objective: To understand a multidisciplinary approach towards care and management of cancers concomitantly prevalent with pregnancy and their outcomes. Methodology: An observational retrospective study was conducted at a Tertiary Care Hospital. Case description: This case series involves multiple cases diagnosed as neoplasms during pregnancy. Brain tumors in pregnancy are extremely rare. Here citing four cases with CNS tumors complicating the natural course of pregnancy. Also, including other tumors like 4 cases of Hematological malignancies during pregnancy. Conclusion: A multidisciplinary approach paves the way for optimum management of pregnancy with the neoplasm. Each case is unique and desires a new set of management protocols. The cases mentioned below describe the best possible treatment available and provided in various cases of neoplasms complicating pregnancy.

Aims and objectives: We present our analysis in managing post lower segment cesarean section (LSCS) wound dehiscence presented in the department of plastic and reconstructive surgery with an emphasis on the nutritional status mainly anemia and hypoproteinemia, wound organisms, and management strategies in our department. The objectives are to study the effect of perinatal anemia and hypoproteinemia contributing to abdominal wound dehiscence, time of presentation, and spectrum of microorganisms in the gaped wound.

Introduction: In the field of gynecology as time advances, various emerging treatment modalities occupy the space in the field of reproductive and cosmetic gynecology after many years of research and after doing various randomized trials in recent 20–30 years. Among these therapies, some modalities of treatment that came under minimal invasive therapies include fractionated carbon dioxide (CO₂) laser therapy which uses fractional beams of light to cause effects on the epithelium, platelet-rich plasma (PRP) therapy which acts locally as a regenerative mechanism, and energy-based radiofrequency therapy which uses the effect of thermal energy to treat various epithelial lesions are emerging nowadays. The treatment depends upon patients’ profile, acceptance, and affordability but these therapies have better patient compliance. Conclusion: The minimally invasive therapies have a shorter duration of treatment, quick recovery time, long-lasting effects, and better patient compliance with few side effects. So, it is time to switch over to these therapies rather than conventional treatment.

Recurrent pregnancy loss (RPL) mainly occurs due to the disorders that cause intrauterine fetal demise or damage, such as fetal, maternal, and paternal chromosomal structural and numerical abnormalities. Approximately, 15–20% of all clinically recognized pregnancies result in the first trimester (before 20 weeks of gestational age) in spontaneous recurrent abortion. Besides all internal factors like Anatomical, immunological, and coagulation factors, genetic factors appear to be most associated with reproductive organ damage and multiple pregnancy loss. Some factors are unexplored as mentioned in the previous research articles, and there is an enormous need to research for establishing the proper etiology and prognosis. This review is all about the various factors responsible for RPL and is mainly focused on the genetic factors involving many unexplored genes associated with recurrent miscarriages. In this review, searched the articles with keywords that were published recently from various journal searches such as Google Scholar, Science Direct, and the National Center for Biotechnology Information (NCBI) platform.

This narrative review assesses the effectiveness of two intravenous medications, intravenous carbetocin and intravenous oxytocin, in treating the third stage of labor during normal deliveries with a focus on preventing postpartum hemorrhage (PPH). Intravenous carbetocin, a synthetic analog of oxytocin with an extended duration of action, has emerged as a potential alternative to the well-established intravenous oxytocin, which is commonly used but may require repeated administrations. A systematic approach was employed for this review, involving literature search, establishment of eligible articles, data extraction, quality assessment, and data synthesis. Studies directly comparing carbetocin and oxytocin were included, and their findings, strengths, and limitations were evaluated. In conclusion, the comparative analysis of these medications offers valuable insights into PPH prevention. Carbetocin exhibits promise in reducing PPH incidence and the need for additional uterotonic agents, potentially improving patient care. However, treatment decisions should be tailored to the specific clinical context and patient population. Further research is necessary to establish carbetocin's definitive superiority over oxytocin in various clinical settings. Both drugs play essential roles in preventing and managing PPH, thereby enhancing maternal outcomes and mitigating the burden of this critical postpartum complication.

This narrative review delves into cervical health during pregnancy, specifically focusing on the frequency and associated risk factors of abnormal Pap smears conducted in the 1st trimester. Pregnancy is a transformative journey for women, characterized by profound physiological changes, yet the performance and implications of Pap smears during this crucial period remain underexplored in the literature. In pursuit of comprehensive and reliable insights, this review strictly adheres to ethical guidelines, drawing exclusively from published, peer-reviewed sources while upholding the privacy and confidentiality of human subjects involved in the studies. Employing a qualitative data analysis and interpretation approach, the review presents results descriptively and thematically. Through this systematic approach, our review offers a holistic overview of abnormal Pap smears in the 1st trimester of pregnancy while identifying the factors associated with their occurrence. This synthesis of existing knowledge ensures the relevance and reliability of our findings, effectively addressing the research question. Understanding the implications of abnormal Pap smear results during the initial stages of pregnancy is paramount for maternal and fetal well-being. As such, this review contributes to bridging the gap in the literature by shedding light on this relatively understudied intersection of cervical health and pregnancy. Doing so provides valuable insights that can guide healthcare professionals in offering informed and appropriate care to pregnant women, ultimately promoting the health and safety of both mothers and their unborn children.

Introduction: Gestational trophoblastic neoplasia (GTN) is a malignant form of gestational trophoblastic diseases originating from abnormal proliferation of placental trophoblasts. Owing to unusual and variable presentations, the diagnosis is sometimes delayed and become catastrophic. Though, survival outcomes are good following chemotherapy, but still surgery becomes first choice in hemodynamically unstable patient which is to be followed by chemotherapy depending upon the World Health Organization (WHO) prognostic score. The reproductive outcomes following chemotherapy is variable. Here, we are reporting a case series of GTN with varied presentation giving different lessons which were managed to best of our possible efforts. Case discussion: The first case highlights the management of women who had ruptured choriocarcinoma post manual vaginal examination for which hysterectomy was performed as a life-saving procedure followed by chemotherapy. The other case surprised the clinician with metastatic perforating invasive mole along with unusual finding of ovarian and iliac vein thrombosis. Although, planned for chemotherapy, hysterectomy with debulking was done for hemoperitoneum. The last case perplexed us with the normal twin conception just following the completion of chemotherapy for post-molar high-risk GTN and is continuing her viable pregnancy. Conclusion and clinical implication: Our case series imparted few lessons to obstetricians. Pelvic examination in GTN needs to be guarded so as to prevent untoward life-threatening complications. Invasive mole may present lately with devastating rupture uterus with exuberant pelvic vein thrombosis (PVT). Spontaneous conception with good reproductive outcome may still occur immediately following completion of multi-agent chemotherapy in high-risk GTN.

Pregnancy developing in the scar of a previous lower segment cesarean section (LSCS) is a rare occurrence. Scar ectopic pregnancy is difficult to diagnose and manage, and if not treated effectively in the early stages of pregnancy, it may cause significant maternal morbidity or fatality. In this case series, we have discussed the different clinical presentations, blood profiles, imaging, and different treatment modalities. Customized surgical approaches were employed to successfully manage all the patients. Awareness and knowledge regarding this entity among clinicians and radiologists is imperative in order to avoid potentially fatal complications such as uterine rupture, torrential hemorrhage, and death.

Background: Male infertility accounts for around 50% of the total burden of infertility. Teratozoospermia, morphological abnormalities of sperm, is known to be a significant condition that leads to male infertility. Acephalic spermatozoa syndrome (ASS), previously misdescribed as pinhead spermatozoa, is a rare genetic condition related to faults in the protein-coding genes of the head-tail coupling apparatus (HTCA) of sperm. This condition manifests with spermatogenic failure with the presence of headless sperms and sperms with tail insertion defects in the ejaculate. The main etiology of ASS is the error in SUN5 or PMFBP1 genes, which is diagnosed using whole-exome sequencing. Intracytoplasmic sperm injection (ICSI) is the only method to circumvent infertility regardless of the etiology of the defects. However, due to various reasons, these technologies do not always guarantee success for all couples seeking reproductive assistance. Case description: A 33-year-old male presented with primary infertility and was diagnosed with teratozoospermia with predominant acephalic spermatozoa. On further genetic analysis, he was found to have a pathogenic nonsense variant in the PMFBP1 gene that is linked with spermatogenic failure. Intracytoplasmic sperm injection was performed for the patient; however, there was no fertilization despite the injection of ordinary-appearing sperms. Conclusion: Although ICSI is possible for most patients irrespective of the etiology of defects, the outcomes can be complex in different types of ASS and do not guarantee successful fertilization and pregnancy. Identification of genetic mutations and the proteins encoded by the genes may help define their prognosis and may also indicate the possible need for sperm donors.

A rare congenital condition known as fetal megacystis, characterized by an unusual enlargement of the fetal urinary bladder, exhibits a distinctive keyhole appearance. This anomaly was identified during a routine prenatal ultrasound of a male fetus at 21 weeks gestational age. The degree of fetal megacystis can vary, often exceeding the normal bladder measurement of 7–8 mm during the first trimester. The atypical configuration of the bladder and urethra, leading to a narrowed and elongated shape, imparts the keyhole appearance to the bladder. While the exact etiology remains uncertain, it is believed to be associated with various factors, including genetic disorders and urinary tract obstruction. This condition can profoundly affect the health and development of the affected fetus, potentially resulting in renal dysfunction, urinary tract infections, and organ damage. Other congenital anomalies, such as those involving the kidneys, lungs, or skeletal system, may also be linked to this condition. The management and treatment approach is contingent upon several factors, including the severity of the condition, the presence of associated anomalies, and the patient's gestational age. Close monitoring through regular ultrasound examinations may be recommended in milder cases to track the condition's progression. Interventions such as fetal urinary bladder catheter implantation or neurosurgical procedures may be viable options in more severe instances.

B-Lynch uterine brace sutures or uterine compression sutures not only help in achieving hemostasis but also preserve fertility and are an effective time-tested therapy. Here, we are reporting a case of 26-year-old lady who had undergone an emergency cesarean section for central placenta previa in her first pregnancy. She had a massive postpartum hemorrhage (PPH), for which B-Lynch sutures were done. Subsequently, she failed to conceive for 3 years because of severe pelvic adhesions and uterine deformation which was found intraoperatively as a consequence of previous use of B-Lynch suture. She delivered a late preterm baby through emergency C-section due to previous lower segment cesarean section (LSCS) with scar tenderness.

Introduction: Belly dancer dyskinesia (BDD) is a visible, involuntary, semicontinuous, waving, and writhing type of abdominal wall movement, which resembles those of a belly dancer. The etiology is unknown, but it is thought to be due to cerebral, spinal, hormonal, or drug-induced effects. Epilepsy as one of the factors of BDD, is considered to have a high risk in pregnancy, where 25–33.3% of seizures will increase during pregnancy. Case summary: A 33-year-old multigravid woman in her 34th week of gestation, who had a prior vertical incision C-section, presented with painless, intermittent rhythmic repetitive waving involuntary movements of the abdominal wall with no involvement of other parts of the body since 1 year ago. She was referred from a local hospital after suffering from generalized absence seizures with bizarre abdominal wall movement and irregular abdominal contraction. Basic laboratory tests, including complete blood count (CBC), liver enzymes [(alanine transaminase (ALT), aspartate transaminase (AST), serum creatinine level, and blood urea nitrogen (BUN)] levels were normal. Head-CT showed left temporal infarction. Head-MRI with contrast showed lacunar infarcts in bilateral centrum semilobar, perivascular space in bilateral corona radiate, and bilateral centrum semilobar. Electroencephalography (EEG) results showed wave slowing on the right and left temporal. During hospitalization, she suffered sudden abdominal pain with increasing abdominal wall movements and hematuria then she underwent an emergency cesarean section, and intraoperatively we found an incomplete uterine rupture. Right now she is treated with trihexyphenidyl, levetiracetam, carbamazepine, and haloperidol. She had significant improvement in terms of frequency and degree of abnormal movement. Discussion: Belly dancer dyskinesia in pregnancy is so rare that only four cases were reported in 2021 worldwide. To our knowledge, there has been no article discussing BDD with incomplete uterine rupture. The etiology of this condition is still multifactorial. Belly dancer dyskinesia is also known to arise from drug induction, which is most commonly caused by antidopaminergic drugs. The management of BDD can be challenging depending on the underlying etiologies. Conclusion: Belly dancer dyskinesia is a rare type of movement disorder with no clearly understood etiologic agent, pathogenesis, and effective treatment. To understand the etiology and possible mechanisms or pathogenesis as well as to determine the best effective treatment, thorough investigation is important.

Ovarian ectopic pregnancy is a rare manifestation of ectopic pregnancy. Our patient who was presented at our tribal valley hospital at 4⁺² weeks came in with complaints of amenorrhea and intermittent vaginal spotting, occurring every 5 days and lasting for 5 days. An ultrasound examination revealed an intricate left adnexal mass, characterized by an irregular shape and lack of vascularity, measuring 4.83 × 3.92 cm. Additionally, another cystic lesion measuring 4.95 × 4 cm was found adherent to it. A left ovariectomy was performed, with the ectopic pregnancy being included in the excised tissue, along with a left partial salpingectomy. Furthermore, as per the patient's request for a permanent method of contraception, a right tubectomy using Parkland's technique was carried out. Ovarian ectopic pregnancies exhibit diverse features upon presentation, making ultrasound a crucial tool in diagnosing this condition, particularly when accompanied by a positive beta-HCG report.

Introduction: It is unheard of in the present day to cure prolapse without the use of medication by using plastic balls. A 70-year-old woman who has been 20 years into menopause and visited our OPD complaining of foul-smelling vaginal discharge. In addition, she occasionally had lower abdominal pain and social humiliation because of the offensive odor. There were no evident vulval/cervicovaginal growths or uterovaginal prolapses identified, and there was no history of fever or vaginal hemorrhage. On per speculum and per vaginal examination, a ring-shaped foreign body with a diameter of around 8 cm followed by a ball of 12 cm diameter was visualized and felt. She described an insertion that had been performed 20 years prior as prolapse therapy. There was no trauma associated with the removal of the foreign body. Following that, she received supportive care and a cautious approach to management. Conclusion: Gynecologist ought to be mindful of this and understand how it is extracted.

There is a global increase in the incidence of varying degrees of morbidly adherent placenta, which results from abnormal implantation of the placenta into the uterine wall, without intervening decidua. This condition confers increased morbidity and mortality for the mother and baby, as well as places a tremendous burden on the personnel and infrastructure of hospitals. Hence this study was conducted. Aims: To estimate the incidence of placenta accreta spectrum (PAS) and to study the demographic pattern of patients presenting with PAS. Materials and methods: A total of 41 patients who presented to our department at GMC Kozhikode, Kerala, from January 2018 to June 2019, with an antenatal diagnosis of PAS, confirmed intraoperatively, were included in the study, and their demographic data were analyzed. Results: The incidence of PAS was 1.7/1,000 deliveries. A total of 82% were in the age-group 26–35 years, 78% were multigravidas and 22% were grand multis. Only 2% were diagnosed intraoperatively and 92% were diagnosed before 36 weeks. All patients had a history of one or two previous cesarean sections (CS); with 0.45% of all women with previous CS having adherent placenta and 3.5% of all women with previous two CS during the study period having adherent placenta. All the patients had placenta previa. Conclusion: Placenta previa, previous CS, and history of curettage were the main risk factors. The incidence increases with an increasing number of CS. Antenatal diagnosis was possible in most, probably due to a high index of suspicion. Thus, early antenatal diagnosis in women with risk factors helps early referral to tertiary centers that are well-equipped. Planned procedures by a multidisciplinary team are the cornerstone for improving maternal and perinatal outcomes in women with morbidly adherent placenta.