Torsion of hematosalpinx with bicornuate uterus

Torsion of fallopian tube is less frequent but significant cause of lower abdominal pain in reproductive age women that is difficult to recognize pre-operatively. Most of the cases with isolated fallopian tubal torsion have a delayed diagnosis and a subsequent delay of timely intervention that may result in failure to save the tubal function. Here we present a case of 22 years old female with torsion of hematosalpinx who presented with chronic lower abdominal pain that was successfully treated. Pre-operative imaging was non-specific. Laparoscopic detorsion and salpingectomy was performed, successfully preserving the ovaries

Maternal and fetal outcomes in pregnant women with Takayasu aortoarteritis: Does optimally timed intervention in women with renal artery involvement improve pregnancy outcome?

AbstractObjectiveTakayasu aortoarteritis (TA) is common in the Southeast Asian and Indian subcontinent regions with a female-to-male ratio of 8:1. Age at diagnosis is < 30 years in 90% of the cases. Because the disease is common in women of child-bearing age, management of pregnancy in these patients becomes an important issue. The purpose of this study is to evaluate the maternal and fetal outcomes in pregnancies with TA and also to evaluate whether early intervention for renal artery involvement is associated with improved outcomes.Materials and methodsWe collected data of 12 patients with 18 pregnancies prospectively from 2006 to 2012. The patients were divided into three groups and their outcomes were noted: (1) without renal artery involvement; (2) with renal artery involvement without intervention; and (3) with renal artery involvement for which intervention has been done.ResultsBody mass index of patients was between 18.5 kg/m2 and 23.2 kg/m2. Renal artery involvement and hypertension were seen in four patients. One patient had percutaneous transluminal balloon angioplasty and another had renal artery stenting. In patients without renal artery involvement, gestational hypertension was seen in 50%, pre-eclampsia in 10%, abortion in 10%, and intrauterine growth restriction (IUGR) in 40% of pregnancies. In patients with renal artery involvement without intervention, gestational hypertension was seen in 90%, pre-eclampsia in 20%, abortion in 60%, preterm in 20%, IUGR in 20%, fetal demise in 20%, and neonatal death in 20% of pregnancies. In patients with renal artery involvement for which intervention has been carried out, gestational hypertension was seen in 66%, and abortion and IUGR were seen in 33% of pregnancies.ConclusionPatients with renovascular involvement without intervention are at high risk of having maternal and fetal complications. Early intervention prior to conception in these women is recommended to prevent pregnancy complications

Etiology, Clinical Features, and Diagnosis of Vulvar Lichen Sclerosus: A Scoping Review

Objective. Vulvar lichen sclerosus (VLS) is a chronic inflammatory disorder, which affects women of all ages. With numerous controversies as regards to the nomenclature, diagnosis and its association with neoplastic conditions, we decided to conduct a scoping review on this subject. Data Source. A review protocol was developed, and the Knowledge Resource Services website was used to do a search of articles pertaining to VLS with keywords “Vulvar,” “Vulval,” “diagnosis,” “lichen sclerosus et atrophicus,” “kraurosis,” “vulvar dystrophy,” and “Lichen Sclerosus”. Study Selection. The search was limited to published data from the last ten years, i.e., from July 2009 onwards and in the English language. A total of 338 articles pertaining to VLS were obtained. Older data were accessed if particular information was sought for. Results & Conclusion. The presentation is bimodal, i.e., one in prepubertal girls (average age: 7.6 years) and the other in peri- and postmenopausal women (average age: 52.6 years). However, many cases also present during reproductive years. Studies suggest a multifactorial origin as far as etiology is concerned, including a genetic, autoimmune, hormonal, and local infectious background. It affects the genital labial, perineal, and perianal areas and manifests as a patchy, thin, glistening, ivory-white area. Diagnosis is mainly based on clinical features. Biopsy is seldom required. It has been well established as a precursor lesion of dVIN and vulvar carcinoma

Pregnancy with multiple sclerosis: The obstetricians' approach

Multiple sclerosis (MS), an inflammatory, demyelinating disease of central nervous system, is the most common cause of neurological disability in young females. MS occurs in India but is comparatively very less as compared to the West. Due to its rarity, obstetricians do not encounter pregnancies with MS in India often. We report a case of a 21-year-old, primigravida who presented to us at 9 weeks of pregnancy. She was a diagnosed case of MS for 4 years. Later in pregnancy, she had walking and gait difficulty. No change in drug dosage was required, and patient had a static course of disease during pregnancy. The patient had an emergency cesarean section. Pregnancy in women with MS is not considered high risk anymore; however, there are some challenges such as managing disability and modifying ongoing therapy. Multi-disciplinary approach is the mainstay of management. Due to severe disability of routine activities such as walking, nursing herself and the baby, pregnancy with MS poses big management challenge. Social issues should be taken care of prior to conception in Indian perspective

Intimate partner violence: Associated factors and acceptability of contraception among the women

Objective: To determine the prevalence of various types of domestic violence and to find out the impact of intimate partner violence (IPV) on adoption of contraceptive measures among the women who are victim to this. Materials and Methods: This questionnaire-based, cross-sectional study was conducted in the department of obstetrics and gynecology of a tertiary care hospital in Delhi. Four hundred and one postpartum females were randomly selected over a period of 5 months and were questioned about their age, parity, educational status, occupation, husband's education, monthly family income, and, if present, IPV in detail. These study participants were enquired about their contraceptive knowledge and use. Results: Sexual violence was seen in 38.4% of the cases, physical violence in 22.4% of the cases, and verbal abuse was seen in nearly 32.7% of the cases. In response to any of the three violence faced, only 23 women (11.79%) reacted by discussing with parents and friends. In 4.61% of the cases, the violence was so severe that she had to inform police. This study showed that higher percentage of women without IPV accepted immediate postpartum contraception methods as compared to those with IPV (35.9% vs. 25%, P = 0.023), but the overall frequency of using contraceptive methods was higher in those with IPV as compared to those without IPV (49% vs. 47%, P = 0.690). Conclusion: IPV is associated with increased contraceptive adoption

Does Intrauterine Instillation of Human Chorionic Gonadotropin Hormone (hCG) Before Embryo Transfer (ET) Improve Pregnancy Outcomes in in-vitro Fertilization (IVF) Cycles?

Objective: To study the effect of intrauterine instillation of human chorionic gonadotropin hormone (hCG) before embryo transfer (ET) on pregnancy outcomes in women undergoing in-vitro fertilization (IVF) cycles. Materials and Methods: The study was an age and anti-mullerian hormone (AMH) level-matched case–control study. Total 80 women of age group 25 to 40 years were recruited who were undergoing IVF for mild male factor, tubal factor, or ovulatory dysfunction. Two groups were formed and age matched. Study group (n = 40) received 800 IU of hCG 5 min before ET, whereas control group (n = 40) underwent direct ET without prior instillation of hCG. The pregnancy outcomes were compared between the two groups. Result: Primary outcome was implantation rate (IR). IR was significantly higher in study (hCG) group as compared to control group (30.95% vs. 15.29%, P = 0.016). Secondary outcomes were clinical pregnancy rate and live birth rate. Study group had higher pregnancy rate as compared to control group, but the difference was not statistically significant (40% vs. 25%, P = 1.0). Live birth rate was higher in study group but not significant (35.5% vs. 22.5%, P = 0.35). Abortions were comparable in both the groups. Conclusion: Intrauterine hCG before ET significantly improves IR and resulted in better IVF outcomes

Breast Stimulation in Low-Risk Primigravidas at Term: Does It Aid in Spontaneous Onset of Labour and Vaginal Delivery? A Pilot Study

Aims. The aim of the study was to elicit the safety and efficacy of breast stimulation as an intervention to prevent postdatism and as an aid in spontaneous onset of labour. Methods. Primigravidas with cephalic presentation, without any high-risk factor, were recruited between 36 to 38 weeks of gestation. 200 patients were recruited and randomized into two groups (n = 100). Breast stimulation was advised to one group but not to the other group. Bishop’s scoring was done at 38 weeks and repeated at 39 weeks of gestation. Maternal and fetal outcomes were compared in two groups. Result. Bishop’s score changed from 3.12 (±1.01) to 3.9 (±1.08) in control group and from 3.02 (±0.82) to 6.08 (±1.29) in breast stimulation group after one week (P value < 0.0001). The period of gestation at delivery was 39.5 (±2.3) weeks in control group and 39.2 (±2.8) weeks in intervention group (P value: 0.044). There were increased chances of vaginal delivery in intervention group (P value: 0.046). Duration of labor, hyperstimulation, presence of meconium stained liquor, postpartum hemorrhage, and neonatal outcomes were similar in both groups. Conclusion. Breast stimulation in low-risk primigravidas helps in cervical ripening and increases chances of vaginal delivery

Sero-prevalence of SARS-CoV-2 Antibodies among First Trimester Pregnant Women during the Second Wave of Pandemic in India'

OBJECTIVE: Data on the immune response to SARS-CoV-2 during pregnancy are lacking and the potential role and effect of SARS-CoV-2 vaccination in pregnancy is yet to be completely investigated. METHOD: This is a cross-sectional observational study wherein, pregnant women were tested for SARS-CoV-2 immunoglobulin M and immunoglobulin G levels, irrespective of their infective status or presence or symptomatology. RESULT: Of the 220 pregnant women tested, 160 (72.7%) were SARS-CoV-2 IgG positive, 37 (16.8%) were SARS-CoV-2 IgM positive and 27 (16.9%) were both IgG and IgM positive. The average antibody titre found was 10.49 BAU/ml (±14.0) and 0.6 (±0.55) for anti-SARS-CoV-2 IgG and IgM non neutralizing antibodies respectively. ROC analysis for SARS-CoV-2 IgG positivity showed a cut-off value of 1.19 with a sensitivity of 99.3% (0.99 AUC, 95% CI) and specificity of 98.3% (0.99 AUC, 95% CI) respectively. Similarly for SARS-CoV-2 IgM positivity showed a cut-off value of 1 with a sensitivity of 97.3% (0.99 AUC, 95% CI) and specificity of 98.9% (0.99 AUC, 95% CI) respectively. CONCLUSION: First trimester sero-molecular screening suggests high prevalence of COVID antibodies in the study population of pregnant women in first trimester, without the patients being symptomatic