Unforeseen effects of COVID-19 on reproductive hormones and health of Indian women

Numerous systematic probes, clinical studies and research papers have been published to depict, interpret, explain and understand the impacts and underlying mechanism of the coronavirus disease 2019 (COVID-19) pandemic and its long-term effects on the female body. COVID-19 affects a number of organs, including the female reproductive function and hormonal profile. However, less attention has been given to the effects of COVID-19 on the female reproductive system due to their low morbidity. The available results of studies involving correlation that COVID-19 infection and ovarian function holds in women of reproductive age has been shown as harmless in most cases. Although, several studies have reported the involvement of COVID-19 infection in oocyte quality, ovarian function, and dysfunctions in the uterine endometrium and the menstrual cycle. The findings of these studies indicate that COVID-19 infection negatively affects the follicular microenvironment and dysregulate ovarian function. Although the COVID-19 pandemic and female reproductive health have been studied in humans and other animals, very few studies have examined how COVID-19 affects the female reproductive system. Our objective in this review is to enumerate, illustrate and categorize the effects of COVID-19 on the female reproductive system, including the ovaries, uterus, and hormonal profiles. We tried to bring forth the possible impact COVID-19 may have caused from the current literature and surveys published in various scientific reports and peer reviewed journal articles. The effects on oocyte maturation, oxidative stress, which causes chromosomal instability and apoptosis in ovaries, in vitro fertilization cycle, high-quality embryos, premature ovarian insufficiency, ovarian vein thrombosis, hypercoagulable state, women’s menstrual cycle, the hypothalamus-pituitary-ovary axis, and sex hormones, including estrogen, progesterone, and the anti- Müllerian hormone, are circled around here. The COVID-19 pandemic has significantly impacted the health of women. The scientific community encourages the development of recommendations for specialized care for women and strategies to prevent and respond to violence during and after the COVID-19 pandemic

A study of urinary tract infection in pregnancy and its effect on maternal and perinatal outcome

Background: Urinary tract infection (UTI) during pregnancy is very common in developing countries like India. UTI is caused by the growth of micro-organisms in the urinary tract. This study aims to determine the incidence of UTI in whole pregnancy and its adverse effects on mother and fetus. Methods: This is a prospective study conducted in outpatient department of ESIC medical college for one year from January 2017 to December 2017. A total of 182 pregnant women attending OBG OPD for ANC check-up without any medical disorders or previous adverse pregnancy outcomes of 18-35 years of age were included in the study. Urine routine and urine culture sensitivity were done for all. Results: Out of 182 pregnant women tested for UTI, the incidence of UTI in pregnancy was found to be 19%. Asymptomatic UTI was noted in 65% patients with UTI. Primigravida were commonly affected (56%). Highest cases were in 18 to 25 years (63%) age group. 56% cases showed 6-10 pus cells/HPF. Prevalence of UTI was more common in winter seasons. Commonest causative organism was E. coli in 38% cases. Maternal complications like anaemia (26%) and puerperal pyrexia (23%) were observed. Adverse fetal outcomes like preterm birth (35%) and fetal growth restriction (15%) were observed. Conclusions: In this study, the prevalence rate of UTI during pregnancy is high (19%). The physiological changes of pregnancy predispose the women to UTI so does the other factors such as age, sexual activity, hygiene, multiparty, previous history of UTI and socio-economic conditions. All pregnant women should be screened for UTI with a urine routine and urine culture, treated with antibiotics if the culture is positive and then retested for cure. Awareness has to be created about good hygienic practices and adequate hydration among pregnant women

Acute pancreatitis in pregnancy: a rare case report

Acute pancreatitis (AP) during pregnancy is a rare condition characterized by acute inflammation of pancreas due to premature activation of enzymes resulting in local pancreatic destruction and activation of an inflammatory cascade. This condition is most commonly caused by gall stones, hypertriglyceridemia, idiopathic factors. It’s very rare, incidence being 1 in 1000 to 1 in 12,000 pregnancies. Its more common in multigravida (75%) and relatively uncommon in first trimester. Patient usually present with acute severe pain abdomen radiating to back, nausea, vomiting, fever and anorexia. On examination there can be tachycardia, jaundice, epigastric tenderness, abdominal guarding and rigidity in severe cases. Serum amylase and lipase levels three times upper limit of normal value is diagnostic. Ultrasound remains imaging modality of choice. Vigorous fluid replacement is recommended. Prompt diagnosis and early treatment can prevent maternal and fetal morbidity and mortality. 23 years primigravida with 14 weeks of pregnancy came to outpatient with nausea and vomiting (10-15 episodes per day) and pain abdomen for 3 days. On abdomen examination epigastric tenderness was present. Serum amylase was 1246 Units/litre and serum lipase was 507.3 units/litre. She was given supportive care with IV fluids. Analgesics, antiemetics and antihistaminics were given. Gradually liquids were started and she recovered in 5 days

Prevalence of postpartum depression and associated risk factors in tertiary health care centre

Background: Postpartum depression (PPD) is defined as a depressive episode occurring during pregnancy or until 4-weeks post-childbirth. It is essential to diagnose postpartum depression since it can disrupt normal maternal and infant bonding and have a negative impact on both the short and long-term development of children. To determine the prevalence of postpartum depression and the associated risk factors in women delivering in a tertiary health care centre. Methods: A prospective observational study was conducted in a tertiary health care centre from January 2021 to June 2022 for a period of 18 months. Pregnant women were assessed using the Edinburgh postnatal depression scale (EPDS) at 2-3 days postpartum and at 6 weeks postpartum. The cut-off score for detecting major depression is a score greater than or equal to 13. Results: The study included 204 women, of which postpartum depression was present in 28 women. The prevalence of postpartum depression in this study group is 13.7%. Unplanned pregnancy, neonatal intensive care unit (NICU) admission of newborns, preterm delivery, lack of support from family, complications during pregnancy or birth, and delayed breastfeeding were significantly associated with postpartum depression. Conclusions: Psychological and emotional well-being should also be given priority in addition to the physical well-being of women. All women who are at high risk should be screened so that PPD can be detected earlier, and support should be extended in the form of counselling and treatment

Proteinuria assessment in preeclampsia: a comparative study

Background: Preeclampsia, a severe pregnancy-related hypertensive disorder, presents substantial maternal and fetal health risks. Accurate proteinuria assessment is crucial but traditional methods are cumbersome and error-prone. This study compares the spot urinary protein/creatinine ratio with 24-hour urine collection for proteinuria estimation in preeclampsia at Kamla Nehru State Hospital for Mother and Child. Methods: A cross-sectional study with 90 eligible pregnant women collected comprehensive medical data. Both spot urinary protein/creatinine ratios and 24-hour urine collections were analyzed. Strong correlation (r=0.942, p<0.0001) was observed. Results: Spot urinary protein/creatinine ratio demonstrated moderate diagnostic accuracy (AUC=0.3). Sensitivity was 100%, specificity 87.9%, with PPV and NPV at 90.4% and 92%, confirming its clinical utility for proteinuria diagnosis. Conclusions: This study validates the spot urinary protein/creatinine ratio as an efficient method for proteinuria assessment in preeclampsia, with a strong correlation and high diagnostic value. Widespread adoption has the potential to expedite diagnosis, enhance outpatient care, and improve outcomes for preeclampsia patients, addressing a crucial healthcare challenge in maternal and fetal health

A case control study to elicit fetal outcome in high-risk pregnancies and to study the various maternal parameters associated with fetal outcomes

Background: High risk pregnancies (HRP) threaten the health or life of the mother or her fetus. Perinatal mortality varies widely in some developed countries and more than 10 times higher in developing countries. For most women, early and regular prenatal care promotes a healthy pregnancy and delivery without complication. Methods: It is a prospective study conducted in BMC, Sagar of duration one year, keeping in mind the inclusion and exclusion criteria with 216 (108 control and 108 cases) patients included in our study. Results: study shows that there is a significantly high incidence of IUGR delivery and preterm delivery in HRP as compared to control. Conclusions: In our study we conclude that there is a high correlation between HRP and poor perinatal outcome thus identifying HRP is important because it is the first step towards prevention perinatal mortality and morbidity

Comparative study of diclofenac, paracetamol infusion, or a combination in post-caesarean patients for pain management

Background: The World Health Organization (WHO) has released fresh information showing that the number of caesarean sections performed worldwide has increased and now accounts for more than one in five (21%) deliveries. 89.8% of women experienced significant post-operative discomfort following a caesarean section and 84.2% reported to have moderate to severe pain. This study aimed to compare diclofenac, paracetamol infusion, and a combination of both in patients of post-caesarean for pain management. Methods: The study was a cross-sectional study carried out in the department of obstetrics and gynaecology at a tertiary care hospital in a rural area of Panipat, Haryana. A total number of 102 women who underwent caesarean section were taken for the study. They were divided into 3 groups each having 34 women. The first group was given diclofenac, the second was given paracetamol infusion and the third was given a combination of both for pain management. Results: In our study we have done visual analog score (VAS) scoring at 0, 1, 6, 12, 18 and 24 hours and we found that the mean VAS score in group 3 was highest when compared to other two groups. We also found that on comparing data of VAS score between the three groups the p value came out to significant that is p≤0.001. Conclusions: We found that combination therapy had good results in comparison to individual therapy and had fewer side effects

Pre-conception and pre-natal diagnostic techniques act-draconian or a considerate de jure tamer

Principles of gender equity are an integral part of constitution. The constitution confers equal rights and opportunities on women; bars discrimination on the basis of sex and denounces practices derogatory to the dignity of women. In spite of this, discrimination against women and girls is almost universal. Forced abortions of female foetuses and prenatal sex determination results in millions of girls not being allowed to be born just because they are girls. Pre-conception and pre-natal diagnostic techniques (PC and PNDT) act were enacted in 1994, amended and effectively implemented in 2003 and strictly amended in 2011, to curb this heinous crime of female foeticide that was taking place due to prenatal diagnostic techniques for determination of the sex of the foetus and thus, to balance the disturbed sex ratio of the country. To achieve the said purposes, the act imposes penalties for the offences committed under this Act, including clerical errors. However, according to the radiologists, the PC and PNDT act has become draconian for all practicing sonologists and radiologists instead of serving the purpose of saving the girl child. This article, explaining the provisions of PC and PNDT act, addresses the concerns of sonologists and radiologists in the light of the judgements passed by Hon’ble Supreme Court of India. It further discusses the hindrances occurring in the usage of evolved medical technology due to the provisions of the Act thereby paving way towards a much-needed legitimate decision to settle the ongoing country-wide debate

Menstrual product choice and the extent of period poverty among young adult females: findings from a cross-sectional study in Kerala, India

Background: In Kerala state, India, while there is higher coverage of hygienic methods for menstrual protection among young women, empirical evidence on menstrual hygiene management is limited. This study aims to present menstrual hygiene product choices and the extent of period poverty among young adult females in Kerala. Methods: A cross-sectional study was conducted in Kerala using a web-based Google form. Data were collected on menstrual product usage, perceptions and attitudes towards menstruation, awareness and use of government initiatives for menstrual hygiene management, perspectives on better management, period poverty, and associated factors. Results: The mean age of respondents was 21.7 years (SD±2.0). Cultural beliefs hindered the choice of menstrual products. Period poverty was reported by 25.5% of respondents, with higher rates among younger, lower social category, and unemployed individuals. Lower income and negative attitudes towards menstruation were significantly associated with higher period poverty. Conclusions: There is a need for free menstrual products for the financially disadvantaged. Further research is necessary to gain a comprehensive understanding of period poverty in this community

Ovarian teratoma induced encephalitis-an ignited brain in the pelvis

Ovarian teratomas, are common benign ovarian germ cell tumours that can yield diverse manifestations. Rarely they are associated with anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis, a serious, frequently overlooked pathology affecting young women. It is characterized by neuropsychiatric symptoms, seizures, involuntary movements, rapidly progressing to unresponsiveness and coma. Discerning the gynaecological origin of this neurological condition, especially in young women, followed by timely treatment, can significantly improve patient outcomes. We present a case of anti-NMDR encephalitis associated with ovarian teratoma in a 19-year-old female. The patient was successfully managed via ovarian cystectomy and immunomodulatory therapy. A multidisciplinary strategy remains pivotal in managing such cases