Estimation of serum 25 hydroxy vitamin D level and its correlation with metabolic and endocrine dysregulation in women with PCOS

Background: Polycystic ovarian syndrome is the most common hormonal disturbance in the reproductive age women, with prevalence of 5-10%. Vitamin D deficiency is common in women with or without PCOS. The aim of this study was to assess association of serum vitamin D level with metabolic and endocrine dysregulation in women with PCOS.Methods: This cross-sectional study was done over a period of one year. 100 women of age group 20-40 years were divided in group A 30 (BMI >30 mg/m2) with PCOS, group B 20 (BMI <25 mg/m2) with PCOS, group C 50 controls and were investigated for serum FSH, LH, LH/FSH ratio, S. total testosterone, S. postprandial insulin level, glucose insulin ratio, 25 hydroxy vitamin D level.Results: LH/FSH ratio >2 (33.33% in obese and 50% in non-obese), serum total testosterone level >0.8ng/ml (80% in obese and 75% in non-obese) (p value was significant between study group as well as between study and control group). Serum fasting, postprandial blood glucose, postprandial serum insulin level was elevated in obese than non-obese PCOS. 25 (OH) vitamin D deficiency <20 ng/ml (56.675% in obese and 45% in non-obese). So, vitamin D deficiency was more common in obese PCOS.Conclusions: PCOS is more common in age group of 20-40 years. There is more Insulin resistance in obese PCOS as compared to non-obese PCOS. Vitamin D deficiency is comparatively more common in obese PCOS population than in non-obese PCOS.

Foetus Papyraceous

Fetus papyraceous or compress is the compressed, mummified, parchment-like remains of a dead twin which is retained in-utero after intrauterine death in the second trimester. It is an uncommon finding. The incidence of fetus papyraceous is reported as 1 in 17,000 to 1 in 20,000 pregnancies. Incidence of fetus papyraceous in twin pregnancy is 1 in 184 to 1 in 200 pregnancies. A case of fetus papyraceous which was discovered following expulsion of a Twin at 17 weeks and 1 day of gestation with low lying placenta in a monochorionic monoamniotic twin pregnancy is reported here

Antepartum hemorrhage and its maternal and perinatal outcome: An experience at a hospital in North India

Introduction and Aim: Antepartum hemorrhage (APH) is one of the deadliest complications in obstetrics. It can complicate about 2–5% of pregnancies. It contributes significantly to maternal and perinatal mortality and morbidity during pregnancy and childbearing worldwide. The aim of this study was to determine maternal and fetal outcomes in patients presenting with APH. Materials and Methods: This was a retrospective study. Pregnant women with >28 weeks gestation reporting to the Department of Obstetrics and Gynecology from May 2021 to April 2022 were included in the study. Ethical approval from the institutional ethical committee was taken. Result: This study included 76 patients of APH. Most patients in the analysis were found to be second gravida (30%). Anemia was the most common associated morbidity (51.31%). 58% of these patients were of placenta previa, 14% were of abruption, and 10% were of accreta. Among all patients, 94.74% recovered well. 2.63% of cases could not be saved and resulted in maternal mortality. The proportions of babies alive, intra-uterine death (IUD), and intubated were 86.84%, 11.84%, and 1.32%, respectively. 17.1% of patients required a lifesaving cesarean hysterectomy. Conclusion: APH is an obstetrical emergency that requires timely diagnosis and early intervention. Swift management is required to improve maternal and fetal outcomes

Emergency Peripartum Hysterectomy in a Tertiary Care Centre of North India during COVID-19 Pandemic: A Retrospective Study

Introduction: The pandemic of Coronavirus Disease 2019 (COVID-19) had a significant impact on obstetric surgeries. Obstetric surgical procedures during the COVID-19 pandemic affect individuals who are suspected or proven to be high-risk endeavors. Aim: To evaluate the demographic characteristics, indications, intraoperative and postoperative complications, and foetomaternal outcomes in the women who had an Emergency Peripartum Hysterectomy (EPH) during the first and second waves of the COVID-19 at a tertiary care centre in North India. Materials and Methods: This was a retrospective cohort study, conducted in the Department of Obstetrics and Gynaecology at a tertiary care centre in Uttar Pradesh, India, including women who underwent EPH operated from March 2020 to May 2021 in terms of demographic characteristics, indications, intraoperative and postoperative complications, and foetomaternal outcomes. Information about their self-reported health issues due to traumatic birth (when they came for a follow-up visit at five weeks) were also obtained. Simple frequency, percentage, and proportion were calculated using descriptive statistics. Results: A total number of 1827 deliveries were conducted and out them 11 cases underwent emergency peripartum hysterectomy at the institute during the time frame of the COVID-19 pandemic. All of the patients were in the age range 21-34. All of these were unplanned pregnancies and arrived at various gestational ages. Eight cases had the previous scarring on the uterus, with six women having morbidly adhered placenta. All of the women in the study cohort were unbooked, and 72.73% (8 out of 11) of them were referred to the centre because they had high-risk factors. Due to substantial blood loss, five females required Critical Care Unit (CCU) support. The study sample had a poor newborn outcome, with three early neonatal deaths out of 11 deliveries. As a part of their 5th-week follow-up, after the women had been stabilised and discharged from the ICU, they were asked to share their major issues related to health, psychological status and social interaction. The main worries revolved around the newborn child’s and COVID-19 positive husband’s health. Pregnant women who delivered during the COVID-19 pandemic had a significant rate of postpartum depression and Post-traumatic Stress Disorder (PTSD). Conclusion: The predominant cause of EPH in the study population was a morbidly adherent placenta. It is critical to protect women’s physical and psychological health during traumatic childbirth in order to mitigate the pandemic’s already-existing harmful impacts

Obstetric use of nitroglycerin: Anesthetic implications

Nitroglycerin has been used in anesthetic practice for induced hypotension and managing perioperative hypertension and myocardial ischemia. Contrary to the continuous low dose infusions (5-20 mcg/min) used for the same, intravenous bolus dosages are sometimes administered at the behest of obstetricians for removal of retained placenta. Use of nitroglycerine in managing retained placenta is undertaken as a last resort when other measures fail to relax the uterine smooth muscles. Intravenous nitroglycerine relaxes smooth muscle cells by releasing nitric oxide thus causing prompt cervico-uterine relaxation. However, administration of nitroglycerine in this manner is not without risks which should be kept in mind while using it for obstetric purposes. We hereby report a case of 22-year-old female scheduled for manual removal of placenta where unpredictable and unexpected hypoxemia was observed following nitroglycerine administration