The worldwide incidence of placenta accrete spectrum (PAS) is increasing day by day, mostly due to the increasing trends in caesarean section (CS) rates. PAS is accountable for high maternal morbidity and mortality as it is associated with extensive haemorrhage, which often requires hysterectomy, multiple blood and blood product transfusions, ureteric and bladder injuries and prolonged ICU stay. The aim of this case series is to highlight the importance of early diagnosis and high degree of suspicion of PAS for a planned management in decreasing maternal morbidity and mortality. Antenatal patients who were associated with PAS and managed in obstetrics and gynaecology department, Kalinga institute of medical sciences, Bhubaneswar during the time period of 2 years were critically reviewed and are being presented as case series. High degree of suspicion, pre operative radiological diagnosis, well preparedness and multidisciplinary approach help us in reducing the maternal mortality and morbidity significantly. Conservative management of PAS can preserve future fertility but should only be done in hospitals with 24 hour emergency care and enough expertise as it carries high chances of maternal complications.

Background: Every year globally, an estimated 15 million babies are born preterm and this number is rising over major parts of the world. Severe morbidity is common in neonates born before 32-34 weeks of gestation. Management of prematurity is a team approach by the obstetrician and the pediatrician. Methods: This prospective observational study was conducted in the Department of Obstetrics and Gynecology, NCH, Surat from October 2019 to October 2020. 120 consenting consecutive subjects fulfilling inclusion criteria were enrolled. Results: The most common risk factor for preterm labor in my study was PPROM (premature rupture of membranes). 27% subjects were diagnosed with threatened preterm labor. 22% subjects delivered preterm due to advanced labor. Labor arrest with tocolytic drug nifedipine was attempted in 30 subjects without any complications, which was successful in 19 subjects. The most common maternal complication in preterm labor was postpartum hemorrhage. All neonates were admitted to NICU, amongst them 45 developed complications. The most common complication in preterm neonates was respiratory distress. The rate of early neonatal death was 6.6%. Conclusions: Inspite of advances in antenatal care and neonatal services, preterm birth remains a burden to families. Strengthening of referral systems to make sure that high risk patients are managed at tertiary care centers with NICU facilities will improve the neonatal outcome.

Laparoscopy has many advantages over open surgery including less post-operative pain, earlier return of normal bowel function, shorter hospital stay, and earlier recovery. Bowel injury is a serious complication of gynecological laparoscopy. The most common site of bowel injury is the small bowel, followed by the large bowel and stomach. This is in agreement with a recent systematic review which has shown that the incidence of bowel injury in gynecologic laparoscopy is 1 in 769.3. Air saline test performed to check bowel integrity by inserting the rectal probe and filling the cavity with normal saline. After performing total laparoscopic hysterectomy with bilateral salphingoopherectomy with retroperitoneal lymphnode dissection done initially after pushing air from rectal probe into the bowel, no bubble was noted but after pushing sigmoid into the pool of saline, escape of air was seen. After suction, a 2×2 cm incidental sigmoidal injury was detected. Bowel injury is a serious complication in laparoscopic surgeries and routine intraoperative checking of bowel integrity by air saline test with the help of rectal probe is a useful modality of intraoperative bowel repair.

Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome is rare congenital anomaly with complete absence of uterus and upper part of vagina. Fibroids are one of the most common benign tumours arising in women. Fibroids arising from Mullerian remnants are very rare. These fibroids often pose difficulty in diagnosis and management. Here, we report a rare case of fibroids arising from Mullerian remnants in MRKH syndrome and the treatment provided for the patient.

Background: Group B Streptococcus (GBS)/Streptococcus agalactiae (S. agalactiae) is a common rectovaginal colonizer, thereby a potential agent of neonatal and maternal infection. This study estimates the trends of isolation of GBS, its antimicrobial profile in urine culture and the demographic characteristics of these patients over a 7-year period. Methods: A record-based study was conducted, which included all the urine culture reports of GBS/S. agalactiae from January 2014 to December 2020. The trend of occurrence of GBS bacteriuria, demographic characteristics and antimicrobial susceptibility pattern were analyzed. Results: Out of 137 urine samples which grew GBS/S. agalactiae, 55(40.15%) were from antenatal women. Most of the isolates were from females (72.26%), with a male preponderance noted among the elderly population (age>60 years). The predominant age group affected were adults between 20 to 59 years. The majority of the isolates (60.58%) were susceptible to all the four tested antibiotics, namely, ciprofloxacin, nitrofurantoin, ampicillin and vancomycin. Ciprofloxacin resistance was observed in 32.85% (45/137) isolates, 5.84% (8/137) isolates were resistant to ampicillin and 2.92% (4/137) were resistant to nitrofurantoin. Conclusions: All the isolates were susceptible to vancomycin. GBS/S. agalactiae is an important agent of bacteriuria in antenatal women as well as in non-pregnant population, especially the elderly males. Emerging resistance to various group of antibiotics warrants routine susceptibility testing.

Background: Iron deficiency anemia is the most common haematological health problem among pregnant women but can be prevented by effective measure. The study aimed to evaluate the efficacy and safety of intravenous ferric carboxymaltose (FCM) in comparison with intravenous Iron sucrose (IS) for treatment of iron deficiency anemia in pregnancy. Methods: A prospective interventional comparative study was conducted from (June 2021-June 2022) at a tertiary care hospital. Pregnant women diagnosed with moderate to severe iron deficiency anaemia were screened for the study. One hundred patients were randomized to receive either intravenous FCM or IS. Treatment effectiveness was assessed by repeat Haemoglobin (Hb) and RBC indices measurement after 4 weeks of completion of therapy. Safety was assessed by analysis of adverse drug reactions during infusion and 2 hours after infusion. Results: Mean rise in Hb at 4 weeks was significantly higher in FCM group (1.67±0.47 Vs 1.07±0.25; p<0.0001) as compared to IS group. There was also rise in other biochemical parameters like MCV and MCHC in both groups. Numbers of visits were significantly less in FCM group. No serious adverse events were noted in either group. Conclusions: Intravenous ferric carboxymaltose is more effective and safer as compared to intravenous iron sucrose in the management of anemia during pregnancy. It has advantage to administer large dose in single sitting which reduce overall cost of therapy and hence will lead to better compliance in community setting.

Background: Cervical carcinoma is the third most common cancer in women worldwide and firth most common cause of cancer related deaths. Human Papilloma virus, the most common cause of cervical cancer, causes functional inactivation of pRb, resulting in overexpression of p16INK4a. The overexpression of p16INK4a correlates well with the degree of cervical dysplasia and neoplasia. The present study is done to determine the IHC expression of p16INK4a so that it may be used as a biomarker for HPV and may play a role in the prevention, diagnosis and prognosis of cervical neoplasm. Methods: The present study was conducted on 60 formalin-fixed, paraffin-embedded specimens of cervical neoplasms, which comprised 47 cases of squamous cell carcinoma followed by 8 cases of adenocarcinoma, 3 cases of HSIL and 2 cases of LSIL. These were then subjected to IHC by p16INK4a. Cytoplasmic and nuclear positivity for p16INK4a was noted. Results: Overall 95% cases were positive for p16INK4a expression, 100% cases of adenocarcinoma, 98% cases of squamous cell carcinoma, 100% cases of HSIL and 0% cases of LSIL were positive for p16 expression. Conclusions: The present study showed statistical correlation of immunoreactivity of p16INK4a with histological type was clinically significant (p value <0.0001). In our study, p16INK4a immunohistochemical expression increased with increasing degree of dysplasia and with presence of cervical carcinoma.

Background: Aim of the study was to determine association of maternal serum triglycerides (TG) at term and macrosomia in gestational diabetes mellitus (GDM). Methods: A cross sectional study was carried out in the department of obstetrics and gynaecology, RIMS, Manipur. The study was conducted for 2 years duration from September 2019 to August 2021 and 85 singleton term pregnant women with GDM were included. All the patients were subjected to check fasting serum TG, FBS, PPBS. Descriptive statistics like mean, standard deviation and Inferential statistics like Chi-square test was used for comparing study variables between large for gestational age (LGA) and non LGA group. T-test was used to compare the mean values of age, pre-pregnancy BMI, pregnancy weight gain, OGTT, FBS, PPBS, fasting serum TG between LGA and non LGA group. Results: The observed mean TG values in LGA and non LGA group in our study was 262.35±26.08 and 158.18±13.24 mg/dL respectively. The serum TG values in the LGA group mothers was significantly higher when compared to the non LGA group. The mean weight gain in pregnancy 15.17±1.82 and 9.60±1.47 in LGA and non LGA respectively. The mean BMI comparison among LGA and non LGA are 27.7±1.74 and 22.94±1.6 respectively. Conclusions: It is observed that maternal fasting serum TG may be a strong predictor of foetal size irrespective of the glycemic status. Our study clearly pointed out the usefulness of measuring serum TG in GDM pregnancy. In addition to maternal hypertriglyceridemia, pre-pregnancy BMI, excessive weight gain in pregnancy significantly associated with foetal macrosomia in GDM mothers.

Background: A maternal near miss (MNM) is an event in which a pregnant woman is on the verge of dying but doesn't die. Despite the fact that most maternal deaths can be avoided, efforts to reduce maternal mortality have not always been successful. This study aimed to identify and analyze the frequency of maternal near-misses (MNMs) cases and causes of maternal near miss due to severe obstetric complications. Methods: A retrospective observational study was carried out at Department of Obstetrics and Gynecology, Heritage Institute of Medical Sciences, Varanasi. The study duration was from January 2021-June 2022. Purposive sampling was used to collect the total of 2053 samples. Results: The study involved in total of 56 maternal near miss cases which includes total of ten maternal deaths. The majority of the respondents have more than 20 years of the age (82.1%) where near miss cases were higher in multiparous women (73.2%). First delays (delay in women seeking help) were almost a third in numbers to affect the maternal mortality and morbidity. Hypertension (32%). hemorrhage (20%) and anemia (14%) were the major leading cause of obstetrical complications. About 66% of the maternal near miss cases needed the interventional management that was ICU admission, mechanical ventilation (41.1%) and blood transfusion (32.1%). Conclusions: Pregnancy hypertension, postpartum hemorrhage, and severe anemia continue to be important determinants of maternal morbidity. First-referral unit facilities and training should be improved so that they can better respond to basic obstetric emergencies such as hypertension, anemia and hemorrhage.

Background: Proteinuria is a major indicator of hypertensive disorder of pregnancy. The gold standard for diagnosis of significant proteinuria is based on a 24hour urine collection which is cumbersome, time-consuming, and inconvenient to patients. A need, therefore, exists for a rapid, valid, and accurate test to identify significant urinary proteinuria. Methods: We conducted an observational cross-sectional hospital-based study wherein a total of 150 pregnant women who met the criteria of preeclampsia were taken. Spot urine samples for calculating the urine P/C ratio were taken immediately before 24hr urine collection. Correlation between 24hour urine protein and spot PCR was then determined by Pearson’s correlation coefficient(r). Results: The correlation coefficient (r) between 24hr urine protein and spot PCR was found to be 0.734 (n=150) which was highly significant with p<0.001. In this study, population the ROC curve analysis revealed the sensitivity of 90.3% and specificity of 97.3% with AUC 0.958 for a cut-off value of spot PCR as 0.43 to detect significant. Conclusions: Spot PCR is an accurate, valid, steady fast, reliable, and time-saving test which may be used as an alternative method for determining significant proteinuria in patients with pregnancy-induced hypertension.