Aim: To assess cardiac diastolic function by echocardiography in pregnancies complicated by hypertensive disorders and in normotensive pregnant women, correlate the severity of hypertensive disorders in pregnancy with the severity of cardiac diastolic dysfunction, and determine if cardiac diastolic dysfunction assessed by echocardiography can be used as a prognostic tool for the severity of hypertensive disorders in pregnancy with regard to heart failure. Methodology: This is an observational comparative study conducted on 160 singleton pregnant women between 20 and 40 weeks of gestation over a period of 6 months and 160 subjects are placed in two groups—80 in hypertensive group and 80 in normotensive group. Transthoracic Doppler echocardiography is carried out on these patients and cardiac diastolic dysfunction grading is done per echocardiographic guidelines of the American Society. Results: In this study, all the normotensives had normal diastolic function (100%) whereas a significant percentage (32%) of the subjects in the hypertensive group had diastolic dysfunction (p-value < 0.0000001). There is no significant association between the severity of hypertensive disorders with the severity of diastolic dysfunction of p-value 0.2. Conclusion: A significant percentage of subjects in the hypertensive group had diastolic dysfunction when compared to the normotensive group. Thus, diastolic function by Doppler echocardiography may be a good prognostic tool in hypertensive disorders of pregnancy so that early admission, continuous monitoring, and planned delivery can be instituted to prevent cardiac complications like heart failure.

Introduction: A thin endometrium is a significant contributor to failed embryo implantation. A considerable percentage of women who have thin endometrium are resistant to conventional therapeutic approaches. Administering platelet-rich plasma (PRP) directly into the uterus can potentially augment the thickness and vascularity of the endometrium, thereby enhancing its receptivity and encouraging embryo implantation. Human chorionic gonadotropin (HCG) plays a crucial paracrine role during implantation of embryos. This research aimed to compare the efficacy of PRP and HCG in patients who had previously had unsuccessful implantation. Materials and methods: A retrospective study was conducted at Wardha Test Tube Baby Centre, Sawangi (Meghe), Wardha, over 1 year. About 40 infertile women with previously failed implantation undergoing frozen-thawed embryo transfer who have a persistently thin endometrial lining (< 7 mm) despite standard hormone replacement therapy were given intrauterine PRP or intrauterine HCG injection and were analyzed and compared. An increment in endometrial thickness (ET) and obstetric outcomes were assessed. Results: Among the cases assessed, group A exhibited a significantly higher mean ET (7.72 ± 0.33) after intrauterine PRP infusion than group B (7.35 ± 0.31) with intrauterine HCG infusion (p-value –0.001). The distribution of implantation rate, clinical pregnancy rate (CPR), and live birth rate was considerably more in the PRP cohort (75, 54.2, and 80%, respectively) than in the HCG group (40, 30.2, and 45%, respectively) (p-value < 0.05). Amidst the two groups, there were no appreciable variations in the distribution of the biochemical pregnancy rate (BPR) and miscarriage rate (p-value > 0.05). Conclusion: With intrauterine PRP administration, ET significantly increased along with notable improvements in CPR, IR, and live birth rates (LBR). In our study, the cycle cancellation rate was zero.

Aim and background: Among various causes of maternal mortality, the leading direct cause of maternal mortality is bleeding. More than half of postpartum hemorrhages are brought on by insufficient uterine contraction following placental delivery [Atonic postpartum hemorrhage (PPH)]. Several uterotonics are available, including oxytocin and carbetocin. This study is the first to use carbetocin via the intramyometrial route for the prophylaxis of postpartum hemorrhage. We aim to contrast the safety and effectiveness of intramyometrial injection of carbetocin vs intramyometrial injection of oxytocin to prevent postpartum bleeding during cesarean delivery. Materials and methods: In the Obstetrics and Gynecology Department of Shri BM Patil MCH & RC, BLDE (DU), Vijayapura, Karnataka, India, this randomized parallel trial was conducted from August 2021 to July 2022. Women in group I received 100 μg carbetocin intramyometrially immediately after birth of baby but before separation of placenta, injected into the anterior uterine wall. Women in group II received 10 units of oxytocin intramyometrially immediately after birth of baby but before separation of placenta, injected into the anterior uterine wall. The outcomes measured were total blood loss and uterine tone at 1, 3, 5, and 10 minutes after injection, hemodynamic parameters, need for blood and blood products and additional uterotonics and adverse events. Results: The difference in the preoperative and postoperative hemoglobin was nearly equal in both the groups 0.943 gm/dL in group I and 0.912 gm/dL in group II (p-value < 0.001). The tone of the uterus was well contracted from 5 minutes in both the groups. Additional uterotonics were used for 2 cases in group I and 4 cases in group II. These findings are consistent with non-inferiority as seen in the champion trial. Two patients in group I and one in group II underwent blood transfusions. Group I showed no adverse consequences, whereas group II only showed one case of a statistically insignificant negative event. Conclusion: Intramyometrial injection of carbetocin is non-inferior to intramyometrial injection of oxytocin in terms of efficacy and safety. Clinical significance: This study explores an alternative route for the administration of carbetocin for postpartum hemorrhage prophylaxis. This study opens up the prospective of better local action, possible quick action in emergencies and fewer systemic side effects compared to the traditional route.

Aims and objectives: To focus on comparison of forceps-assisted vs manual method of fetal head extraction during lower segment cesarean section (LSCS). Comparative study to identify the safety, effectiveness, and ease of obstetric forceps for delivery of head in cesarean section. Methods and materials: After getting ethics approval, the total 66 mothers from the ANC, attending antenatal OPD, and Emergency admitted for cesarean section in different indications fulfilling the selection and exclusion criteria. These were selected, randomized, and allowed into two groups such as group A (n = 33) = cases (forceps) and group B (n = 33) = controls (manual) in each group consisting of 33 patients. The data collection, data analysis, and the outcomes of individual groups analyzed as primary outcomes, secondary outcomes, newborn outcomes were tabulated and statistically significant calculated by GRAPH-PAD software. Results and analysis: In our study, the primary outcomes were statistically significant as weight, BMI, estimated intraoperative loss, drain volume in 48 hours, the weight of mops, PCV-drop, and the hemoglobin drop complicated with chest discomfort, required transfusion as blood, FFP, platelets, volume expanders needed intensive and/or critical care. The outcomes were significant in operation time with U-D time, difficulties head delivery and assisted fundal pressure, required conversion and ultimately failure to deliver. Intraoperative events were significant as extension/laceration-associated angle hematoma, stitch line hematoma, window at stitch site, cut through and apposition failure with major hazards landed in major operations. The indicators of the secondary outcomes in postoperative and follow-up period were revealed statistically significant as mobilization time, oral feeding time, pain and discomfort, analgesics requirement, developed febrile illness, and wound complications necessitated hospital stay with recovery-satisfaction and costs. The newborn outcomes were observed significant in form of I-D time, meconeum stain, weight, preterm, IUGR, cried at birth with Apgar score, needed essential newborn care (ENC), and NICU admission. Conclusion: Considering the outcomes, with proper selection of patient(s), application of forceps produced statistically significant better outcomes during cesarean operation than manual extraction. Recommended routine forceps application in cesarean delivery.

Aim and background: Due to the high human-to-human transmissibility of coronavirus disease-19 (COVID-19), it has gained immense global recognition and had a devastating impact. Because of the novel nature of disease, various predisposing factors contributing to disease severity and mortality remain doubtful. This study was performed to determine the association between cycle threshold (CT) value for RT-PCR COVID-19 and severity of the disease to emphasize the role of CT value in patient management, as a lot of emphasis was being laid on reporting of CT values to the clinicians. The association between clinical symptoms and CT values was also determined in addition to its association with mortality. Methods: The study was conducted for a period of 18 months from January 2021 till June 2022. It included 212 COVID-19-positive patients who were diagnosed by RT-PCR test for COVID-19. Informed consent and history of the patients were recorded along with their clinical parameters. Data was analyzed statistically using a two-tailed t-test and the Chi-square test. Results: Although a significant association was seen between CT value and symptoms, the severity of the disease was not found to be significantly associated with CT value. Also, no statistically significant association was found between CT value and mortality due to the disease. Conclusion: Although CT value is indirectly related to the viral load, it should have no impact on patient management as the immune system shows a different response in every individual. Clinical significance: Our study adds valuable insights to this evolving landscape, emphasizing the importance of considering multiple variables in comprehensively understanding the relationship between CT values and COVID-19 severity.

Aim and background: Diastasis recti abdominis (DRA) is a disorder that can persist in 35–60% of women postpartum, leading to issues like core function issues, urine incontinence, and low back pain (LBP). Diastasis recti abdominis has been associated with modifications in spinal alignment, notably an elevation in lumbar curvature, potentially affecting the distribution of loads. Diastasis recti abdominis is a potential cause of postural abnormalities, and evaluating the relationship between them will be beneficial for the medical professionals to understand the need for abdominal muscle strengthening in the postpartum period and how it affects quality of life. Thus, this study aims to explore the relationship between postural changes and DRA in the postpartum phase. Materials and methods: This cross-sectional study design was conducted to find the relationship between spinal curvature and DRA using a bubble inclinometer, and a caliper respectively. A total of 102 patients underwent screening based on inclusion and exclusion criteria. An independent t-test and Karl Pearson's correlation method were used to find a comparison and relation of spinal curvature (thoracic kyphosis angle and lumbar lordosis angle) between with and without DRA groups, while a p-value < 0.05 was considered statistically significant. Results: The results of the present study stated that DRA was positively correlated (p < 0.05) with kyphosis angle (r = 0.322) and lordosis angle (r = 0.774). The findings of the current study also indicate a positive correlation between body mass index (BMI) and both DRA and the lordosis angle. Conclusion: This study revealed a strong positive correlation between DRA and lordosis angle and a weak positive correlation between DRA and kyphosis angle in postpartum women. Clinical significance: These findings emphasize the importance of holistic postpartum care to address musculoskeletal changes, providing insights for interventions to improve core muscle function and alleviate chronic spinal pain.

Background: Anovulation is the leading cause of infertility. Among causes of anovulation, polycystic ovarian syndrome (PCOS) is the prime one. Ovulation induction (OI) is the most common mode of treatment for anovulatory infertility. Clomiphene citrate (CC) has been used as a first-line drug for ovulation induction for a long back. Letrozole, an aromatase inhibitor (AI), is now a widely used ovulation-inducing agent because of the lack of antiestrogenic side effects, which is a significant concern in CC. Different studies reported congenital abnormalities in babies born with letrozole use. Any search instrument has not seen studies on developmental milestone delays in babies born by letrozole use. Objective: The purpose of the study was to follow-up on the growth and developmental milestones of babies born after treatment with AI, an off-labeled OI drug. Materials and methods: This cohort study was conducted in the infertility care and research center (ICRC), Dhaka, Bangladesh. A total of 1,895 babies were recruited in this study. Among them, 1,059 babies were in the “study group” who were born by OI with letrozole and 836 were in the “control group” who were born spontaneously. The main outcome measures were postnatal growth and developmental milestones of the babies born using letrozole as OI. Others are congenital abnormalities, birth weight, and birth asphyxia. A p-value < 0.05 was considered significant. Results: Gestational age, birth weight, and birth defect rate were similar in both groups. The height and weight of the babies in both groups were compared to observe whether there was any developmental delay in babies born by letrozole, and it was not significant between the study and control groups. Physical, mental, and cognitive development of babies were assessed according to CDC criteria; the difference between the two groups is not statistically significant. There was a milestone developmental delay in 3.12% of babies in the letrozole group and 3.83% of babies in the spontaneous group. Three babies (0.28%) had delayed mental development due to autism in the letrozole group, and 2 (0.24%) in the spontaneous group. However, the difference is not statistically significant. Conclusion: According to the study's results, there does not appear to be a higher risk of congenital anomalies, postnatal growth retardation, or developmental delay in babies of women who received letrozole as OI compared to spontaneous pregnancies.

Background: Intimate partner violence is seen at each and every level in the society. Psychological violence is the most prevalent form of intimate partner violence. The present study has been done to assess the prevalence of intimate partner violence among the tribal population of Jharkhand. Materials and methods: It is a prospective cross-sectional study carried out at the outpatient department at a tertiary care teaching hospital in Jharkhand from July 2021 to December 2021. Participants of this study were tribal women, aged 16–55 years coming for health checkups at the Outpatient Department of Obstetrics and Gynaecology. Data from participants who gave consent for the study were collected by interview using a questionnaire and subsequently interpreted. Results: A total of 360 women consented to participate in this study. The prevalence of intimate partner violence in this study was found to be 38.88%. Physical violence was present in 51.43% of victims, 8.57% reported partner-controlling behavior, 20% experienced psychological abuse, and 34.29% were subjected to sexual abuse. Conclusion: Intimate partner violence is the most overlooked and sensitive problem that needs attention and immediate redressal at all levels.

Background: Accessory and cavitated uterine masses (ACUMs) are rare congenital mullerian anomalies where isolated cavitated lesions are located in the lateral myometrium with no communication with the uterine cavity or fallopian tube. The diagnostic criteria for the diagnosis of ACUM includes: (1) isolated mass in lateral myometrium/broad ligament, (2) no communication with a fallopian tube or uterine cavity, (3) cavity has myometrial mantle surrounding the endometrium, (4) cavity lined by functional endometrium, (5) contains dark brown hemorrhagic fluid. The woman usually presents at a younger age with dysmenorrhea. Even though there is an assumption that ACUM can be asymptomatic, there is a scarcity of data. Case description: We present a case of ACUM which was mistaken for a rudimentary horn in a woman who was evaluated for new-onset menstrual irregularity. Conclusion: Knowledge and awareness of this entity will help us to consider preoperative diagnosis of ACUM and provide better treatment options to women. Clinical significance: All women diagnosed to have ACUM may not require surgical intervention if it is an incidental finding when evaluated for other conditions.

Background: Chronic myeloid leukemia (CML) is a hematological malignancy caused by the expression of the aberrant oncogene “BCR-ABL” attributed to t (9:22) Philadelphia translocation. The coexistence of pregnancy and CML is rare; less than 1 in 100,000. Managing a case of CML in pregnancy remains a clinical dilemma due to serious ethical and therapeutic implications which chemotherapy during pregnancy can pose for the fetus like various congenital malformations, abortion, and intrauterine growth restriction. Case description: We present a case report of a 28-year-old female at 34.2 weeks of gestation with previous 2 lower segment cesarean sections in preterm labor. The patient was a known case of CML on Imatinib mesylate, who opted to discontinue chemotherapy in view of her ongoing pregnancy. She subsequently presented in labor in accelerated phase of CML, further complicated by placental abruption. Following an emergency cesarean section and ensuing disseminated intravascular coagulation (DIC), she ultimately succumbed to tumor lysis syndrome despite multidisciplinary critical care management. Conclusion: The treatment of pregnant women with CML is challenging due to limited therapeutic options with sparse data regarding safety in pregnancy. Conception should be planned after achieving major molecular response and continuation of pregnancy and chemotherapy needs to be individualized after detailed counseling involving the obstetrician and the hemato-oncologist. Our case report, hereby, aims to emphasize the importance of preconceptional counseling, shared decision-making, and rigorous follow-up during pregnancy.

Non-Hodgkins lymphomas (NHLs) are lymphoproliferative malignancy occurring most commonly among adults and adolescents. The incidence of female genital tract extranodal primary non-Hodgkin lymphoma is very rare. Most cases have been described in perimenopausal and postmenopausal age-groups (mean age being 40–59 years). We are reporting the case of a 60-year-old postmenopausal female presenting with bleeding per vaginam, abdominopelvic mass, and finally diagnosed with primary uterine B-cell lymphoma. Primary extranodal non-Hodgkin lymphomas of the uterine corpus and vagina are extremely uncommon. Often underdiagnosed because of both unexpected sites and clinical resemblance with other more common gynecological malignancies. Primary extranodal non-Hodgkin lymphomas of the uterine corpus and vagina completely differ from other gynecological malignancies in the management and prognosis; hence, diagnosis becomes crucial. High levels of clinical suspicion, advanced imaging, laboratory facilities, and immunohistochemical analysis may help in early diagnosis and management of the disease.

Vulvar verrucous carcinoma (VC) is a rather uncommon type of genital cancer which presents as an invasive, locally restricted, slow-growing tumor. We describe a case of a female in her late 50s who was a diagnosed case of systemic lupus erythematosus (SLE), idiopathic thrombocytopenic purpura presenting with vulvar VC. Risk factors associated with VC are human papilloma virus (HPV) infection, hormonal imbalances, and diabetes mellitus. This patient was immunosuppressed which made her susceptible toward malignancy. This case report represents the intricate interplay between malignancy and autoimmune disorders.

Aim and background: Thrombocytopenia is defined as a decrease in the number of platelets. It is one of the, if not the most, common coagulation disorders that can complicate obstetrics. A normal count is arbitrarily set as 1,50,000–4,50,000 platelets per microliter. Case description: Thrombocytopenia unique to pregnancy can be gestational thrombocytopenia, preeclampsia-induced thrombocytopenia, HELLP syndrome, and acute fatty liver of pregnancy (AFLP). While the remaining causes that coincide with pregnancy include disseminated intravascular coagulation (DIC), immune thrombocytopenic purpura (ITP), hematological malignancies, pseudothrombocytopenia, Wilson's disease, and autoimmune disorders. The former necessitate urgent delivery to optimize maternal and fetal outcome, following which there is spontaneous resolution of thrombocytopenia. While in the latter, pregnancy doesn't compound the issue and is a mere coincidence and hence the inciting factor needs to be eradicated to resolve the thrombocytopenia and often even requires use of blood products. Conclusion: We attempt to discuss few cases of thrombocytopenia, seen at a tertiary care center and its multidisciplinary approach toward management. Clinical significance: The unique problem with thrombocytopenia in obstetrics is the diagnostic hurdle it can pose to determine whether the pregnancy is a latter event to pre-existing thrombocytopenia, or if pregnancy is the causative factor for the same. This, in turn, can significantly alter the mode and time of termination and hence the neonatal outcome.

Infertility is a prevalent health issue which affects ~15–20% of couples worldwide. Almost one-half of idiopathic infertility cases have been accepted to be caused by genetic basis, yet the basic causes are obscure. The reason for the present review is to comprehend and acquire information on the current status of examination on the genetics of females and its relationship with infertility. This article reviews the effects of single-nucleotide polymorphisms (SNPs) present in follicle-stimulating hormone receptor (FSHR), luteinizing hormone/choriogonadotropin receptor (LHCGR), luteinizing hormone subunit beta (LHβ), anti-Mullerian hormone receptor (AMHR), and estrogen receptor (ESR) on female infertility. To investigate the strength of the relationship between SNPs and infertility, 74 articles were studied from multiple sources such as PubMed, Medline, and Google Scholar. Further more, a conclusion can be drawn that SNPs do have an impact on infertility irrespective of ethnicity and more research needs to be done in this area to understand the correlation of polymorphisms and infertility in order to benefit the population affected by it.

The induction of labor in full-term pregnant females is a critical aspect of obstetric care aimed at mitigating important maternal and fetal risks correlated with prolonged pregnancies or medical conditions necessitating expedited delivery. Misoprostol [Miso], a synthetic prostaglandin E1 analog, has been promoted as a pharmacological agent for labor induction due to its effectiveness and ease of administration. Nonetheless, the optimal route of misoprostol administration remains a subject of ongoing debate. This comprehensive review systematically examines clinical trials, cohort trials, and randomized controlled trials (RCTs) to understand the comparative effectiveness of sublingual (SL) and vaginal (VAG) misoprostol for inducing labor in full-term pregnant females. Key findings reveal that both routes are adequate, with the choice dependent on patient-specific factors and preferences. Sublingual administration offers advantages regarding the faster onset of labor and reduced maternal fever risk but is associated with a higher incidence of shivering. Standardized dosing protocols, tailored to individual patient characteristics, are vital for safe and effective induction. Incorporating shared decision-making is integral for patient satisfaction and positive outcomes. Ultimately, the choice between SL and VAG misoprostol for labor induction should be guided by a comprehensive patient assessment in consultation with healthcare providers. Further research and clinical trials are needed to refine our understanding of these methods’ comparative efficacy and safety.

Osteoporosis, a common skeletal disorder characterized by diminished bone density and strength, poses a significant public health challenge worldwide, particularly among the aging population. This abstract explores the rising importance of omega-3 fatty acids in the management and preventing of osteoporosis. This comprehensive review delves into the molecular process underlying the effect of fatty acids on the metabolism of bone. Preclinical and clinical research data elucidates the beneficial effects of omega-3 fatty acids on bone density, bone formation, and the reduction of bone resorption. Additionally, the anti-inflammatory characteristics of these fats were examined, shedding light on their potential to mitigate the prolonged low-grade inflammation related to osteoporosis.