Pruritus is a commonly described symptom during pregnancy. Despite its high prevalence, it is often considered trivial but causes significant patient discomfort. It is important to assess and investigate the patient thoroughly as some conditions have a detrimental outcome for both mother and fetus. There is extensive literature on pruritus due to pregnancy-specific dermatoses, however, the evaluation of pruritus merits a broader approach. Various other conditions such as certain infections, systemic diseases, and pre-existing dermatological conditions should also be considered. Awareness of these conditions in obstetricians will also ensure adequate treatment and timely referral, if necessary. The purpose of this article is to describe the etiology, clinical features, diagnostic approach, and management of pruritus in pregnancy.

Climate change is occurring rapidly, and this crisis should now be recognized as a “global emergency”. It is one of the major global health threats brought about by global warming, resulting from human activity due in large part to increasing levels of greenhouse gases. The ongoing climate crisis poses significant risks to women, pregnant mothers, unborn fetuses and offspring, who were exposed in-utero to climate stressors, especially those in marginalized communities where effects are magnified. A focus on education, research, and advocacy in responding to changing health consequences and global awareness are key to educating our professional healthcare providers, patients, the lay public, key personnel in the government and other leaders, and by making the changes necessary to address this crisis. Building on the pillars that FIGO has identified (advocacy, research interpretation, capacity building, and education), and following the footsteps of the FIGO Committee on “Climate Change and Toxic Environmental Exposures”, the baby steps yet focussed efforts taken by AOFOG through its recently formed “Climate Change & Pollution Working Group” will be highlighted in this review article. After all, investing in the health of women is investing in the health of current and future generations, and we, as healthcare providers along with health professional organizations should be in the forefront of environmental health advocacy to save the present generation and future generations through engagement as public opinion leaders.

Background Abnormally sited placenta is considered a major life-threatening condition for pregnant woman, and many debate about the way of early diagnosis and management to decrease the mortality and morbidity.

Aim of Study To evaluate the role of beta-human chorionic gonadotrophin (B-HCG) level in the first half of pregnancy as a marker for prediction of placenta previa.

Study Design This is a prospective study done in Al-Yarmouk Teaching Hospital from first of January 2020 till first of January 2021.

Material and Methods A total of 57 patients have been recruited. For all participated women in this study were sampled between 14 and 18 weeks of gestational age for serum human chorionic gonadotropins measured in international units. Patients who developed placenta previa were diagnosed on the basis of development of vaginal bleeding either late in the second trimester or early in the second trimester. After developing vaginal bleeding, all patients were sent for routine ultrasound scan to confirm the presence of placenta previa.

Result After recruiting a total of 57 women among which 14 patients were found to have placenta previa, ANOVA test shows a statistically significant difference between women with normal placenta and women with placenta previa P value < 0.001. Receiver operator characteristics curve was constructed to evaluate the optimum cutoff value for serum HCG between normal women and women with placenta previa sampled at 14–18 weeks of gestation. The optimum cutoff value is mean serum HCG > 105,380 IU in 14 weeks of gestation, and the sensitivity and specificity were calculated as 100% and 72.2%, respectively.

Conclusion B-HCG level in first half of pregnancy can be used as a predictor marker for placenta previa.

Objective The objective of this study was to evaluate the effectiveness of structured workshops in improving the knowledge and skills of obstetrics and gynecology residents for repairing high-grade perineal lacerations.

Materials and methods This quasi-experimental multicenter study evaluated the baseline knowledge of obstetrics and gynecology residents using an online patient-management problem (PMP) tool. After the initial evaluation, a workshop was conducted using sponge models to teach the practical technique for repairing high-grade perineal lacerations, including external and internal anal sphincter repair. The residents' knowledge was reassessed by PMP exams at 3 and 6 months after the workshop, and the scores were compared to the baseline statistics.

Result Eighty residents participated in the study, including 26, 22, and 32 at the first, second, and third-year levels of residency, respectively. The total PMP scores significantly improved after three months of the workshop, with an increasing total score from 15.5 (baseline) to 31.3 (p = 0.027) (range of total score from − 63 to + 52). The senior residents performed better before and after three months of the intervention. However, in the six-month follow-up, the total PMP score of all residents decreased to 12.3 with no significant difference with pre-education scores at all levels. Similar significant results were also reported for each PMP question at all levels of residency.

Conclusion The study found that obstetrics and gynecology residents had substandard knowledge in repairing perineal lacerations. Although the training workshop significantly increased residents' knowledge, its effectiveness diminished over time, indicating a need for continuous or periodic training.

Objective The objective of the study was to determine the quality of life in women after peripartum hysterectomy using a Hindi version of the SF-36 questionnaire.

Background There are long-term effects on quality of life in women after peripartum hysterectomy. The effects on physical, mental, and social functioning have a prolonged recovery. No studies have been done in Indian women after peripartum hysterectomy to evaluate quality of life.

Methods Patients who underwent peripartum hysterectomy from January 2017 to May 2021 were contacted to participate in the study. To determine the quality of life post-surgery, a Hindi version of the 36-item Short-Form Health Survey (SF-36) was used for a face-to-face personal interview-based assessment. The participants were divided into two groups based on the duration between surgery and the interview. The aggregate scores for the eight components of SF-36 were calculated, and responses were analyzed.

Results Out of the 138 post-hysterectomy women, 118 were enrolled in the study. Women who could not be contacted [14 (10.14%)] and those who died post-procedure [6 (4.35%)] were excluded. Out of the total, 43 assessed participants were within 2 years of surgery, and 75 were after 2 years of surgery. The group that was assessed after 2 years of surgery had a significantly lower quality of life in six, out of the eight aspects of SF-36 domains.

Conclusion Women after peripartum hysterectomy undergo a prolonged recovery phase with effects on physical, mental, and social functioning. A multi-disciplinary long-term follow-up including physiotherapy and psychotherapy is required and that should be guided by a dedicated clinical team.

Objective To study the impact of COVID-19 pandemic on maternal mortality ratio, aetiological and modifiable factors for maternal mortality and key interventions performed.

Method Retrospective exploratory study evaluating maternal mortality between April to November 2020 (study group) and 2019 (control group).

Results Demographic variations existed in the two groups. Increased maternal age and illiteracy were significantly more in the study group. Maternal mortality ratio (MMR) was significantly high in the study group (792 vs. 296 p value = 0.0). Hemorrhage accounted for 20% and COVID-19-related maternal deaths accounted for 15% deaths in the study group. Level 3 delay (delay in receiving care/inadequate care) was observed in 35% in the study group and 28% in control group (p value = 0.349). 17.5% of mothers in the study group as compared to 8% of control group were dead on arrival to hospital though not statistically significant (p value = 0.28). Significantly more women in study group died within 24 h of admission (45% vs. 20%, p value 0.04). Among the key interventions, the use of supplemental oxygen was significantly high in study group (p value = 0.02).

Conclusion Maternal mortality ratio was high in the pandemic year because of a significant decline in hospital delivery rate. The lesson learnt from this pandemic needs to be documented to guide better planning in the future to face similar situations.

Objective The aim of this research was to assess the role of robotics and its outcome in gynaecology both in benign and malignant cases in a single centre and provide a critical evaluation of possible advantages of robot assisted surgeries from surgeons’ point of view.

Design A single centre, retrospective observational study.

Population All women who underwent robotic gynaecological surgeries between 2015 and 2022.

Methods The Da Vinci Si™ robotic system was used for these surgeries performed by all surgeons at our quaternary care centre, and data were acquired retrospectively through electronic medical records. Descriptive statistical analysis of data was done. Main outcome measures included operative time, estimated blood loss, hospital stay, complications and conversion rates in all cases. Age was analysed as a demographic data.

Outcome A total of 211 robotic cases were performed including 172 hysterectomies, 20 myomectomies and 19 cases for other gynaecological indications. The mean operating time or hysterectomy and myomectomy was 113 and 129 min, respectively, and haemoglobin drop was 1.34 and 1.2 g/dl, respectively. No conversions to laparotomy were observed in either of the groups. The surgeries for 19 benign gynaecological conditions included ovarian cystectomy, cesarean scar repair and chronic cornual ectopic.

Conclusion Robotic surgical system helps accomplish several procedures with exceptional laparoscopic skills. Robotic surgery is safe in all types of gynaecological procedures and is a promising alternative for comprehensive gynaecologic surgical care.

Objective The purpose of this study was to examine the recurrence rates of ovarian endometrioma, dysmenorrhea, dyspareunia, and related complications between sclerotherapy and laparoscopic ovarian cystectomy in individuals aged 25 to 38.

Methods Eighty-eight women participated in this retrospective, single-center study between January 2020 and February 2022. Patients received either laparoscopy or sclerotherapy, depending on the opinion of the pertinent physician. In this study, the following parameters were retrospectively analyzed in follow-up visits 2, 6 and 12 months after sclerotherapy and laparoscopy: dysmenorrhea and dyspareunia by visual analog scale, complications following the intervention, and serial pelvic sonograms for endometrioma cyst recurrence. Moreover, serum Anti-Müllerian hormone (AMH) level before and 6 months after sclerotherapy/surgery were analyzed. The collected data were then analyzed using R software.

Results The results demonstrate the efficiency of both sclerotherapy and laparoscopic techniques in reducing endometrioma- related dysmenorrhea and dyspareunia over a 12-month period. There was no statistically significant difference in the occurrence of complications and recurrence rate between these two therapies, and both are equally beneficial. Also, the rate of AMH decline after laparoscopy was higher than sclerotherapy; however there was not a statistically significant change in serum level of AMH in laparoscopy compared to the sclerotherapy after 6 months.

Conclusion Considering all the data, it appears that sclerotherapy, with its lower cost, shorter hospital stay, and quicker return to activities, can be a laparoscopic alternative to endometrioma cyst removal. More studies are required.

Aim Abnormal uterine bleeding (AUB) is a common gynaecological complaint affecting around 10–30% women during reproductive years. It adversely affects a woman’s life, leading to psychological, medical, social and sexual problems. We aim to study the efficacy of a levonorgestrel intrauterine system (LNG-IUS) in 100 women suffering from AUB.

Methodology A retrospective study was carried out at a private nursing home in Mumbai over a period of 4 years. A total of 100 patients aged 30 years to 50 years (average age = 42.9 years) who underwent LNG-IUS insertion for abnormal uterine bleeding were studied. Cases were evaluated according to clinical findings, hemogram and transvaginal ultrasound. The women were called for follow-up at 1 week, 1 month, 6 months, 1 and 2 years to analyse type and amount of bleeding and development of amenorrhea.

Results At the end of 6 months, 75% patients experienced decreased menstrual blood loss. Five patients underwent removal of the LNG-IUS at the end of 6 months as they experienced no relief of symptoms. At the end of 2 years, 95% patients were fully satisfied with the LNG-IUS insertion.

Conclusion A levonorgestrel intrauterine system significantly reduces bleeding in menorrhagia due to benign causes and is found to be highly effective in the management of various gynaecological pathologies such as endometrial polyps, adenomyosis and endometrial hyperplasia when insertion perfomed after dilatation and curettage/polypectomy. It has proven to be superior to various surgical and other non-surgical treatment modalities.

Background Being considered a life-threatening condition, cesarean scar pregnancy (CSP) leads to loss of fertility, severe bleeding, and even maternal mortality. We intended to assess the effect of double-balloon cervical ripening catheter insertion on CSP termination before nine weeks of gestation.

Method All participants were diagnosed CSP by abdominal and transvaginal ultrasound. The cases were treated with a sterile, double-balloon cervical ripening catheter inserted with real-time transabdominal ultrasound guidance and removed three days later. The control group consisted of patients treated with systemic methotrexate with or without fetal reduction.

Results Thirty-five patients were eligible for double-balloon ripening and 32 for MTX therapy; the treatment in cases failed in five of the patients. Success rate difference between two methods was insignificant (Pearson Chi-square: 0.383, p-value: 0.536). There were significant differences regarding the time to normal menstruation (OR: 1.303) and the thickness of the myometrium after surgery (OR: 4.721), but there was no significant difference in the time resolve of either β-HCG or residue of pregnancy.

Conclusion Double-balloon cervical ripening insertion yields acceptable results for terminating CSP. This strategy does not cause bleeding and even prevents it with its tamponade properties. Additionally, this treatment is minimally invasive simple with low morbidity.

Background Regular menstruation represents reproductive health and quality of life of women. However, many women suffer from menstrual disorders at some point in their life. The occurrence of such abnormalities is affected by two key factors: BMI and physical activity. This study aims to analyse the relationship of these two factors to menstrual disorders.

Materials and Method A cross-sectional study was conducted among 502 women in Uttar Pradesh, India, from July 2021 to January 2023. Samples were selected using purposive sampling technique. The data were analysed using Pearson’s Chisquare test on MS Excel 2013 and IBM SPSS 29.0.0.0 (240) software.

Results Mean age of the research subjects was 25.84 + 6.30 years, mean weight was 60.29 + 11.22 kg, mean height was 155.34 + 11.77 cm, and mean BMI was 25.36 + 6.06 kg. 68.92% subjects had regular age at menarche. Most common menstrual disorders were PMS (41.63%) and dysmenorrhea (28.29%). As per BMI categories, most disorders were found in obese (94.87%) and underweight (93.62%) subjects. As per physical activity categories, most disorders were found in low (76.55%) and high (76.40%) category subjects. A significant relationship was found between menstrual disorder and BMI (χ2 = 80.49, p < 0.001) and physical activity (χ2 = 70.09, p < 0.001).

Conclusion The menstrual disorders in women are significantly related to their BMI and physical activity. Women are advised to focus on having a balanced, nutritious diet and indulge in moderate physical activity to improve their reproductive health and quality of life.