Art of reading an article in the journal Abstract : “One swallow doesn’t make a summer” This is a famous quote by Aristotle. Reading scientific literature and making sense of the journal articles is important for researchers and clinicians. With an overflow of medical journals available, and similar articles published in various journals it is essential to develop a method to choose and read and interpret the right articles. The results and conclusion can then be translated in clinical practice. At the beginning, the journal has to be chosen and the concerned article selected. For a logical and step by step approach to reading a scientific manuscript, there are ten steps. With these steps, one should be able to read a scientific article with ease. The reader should begin by reading the title, abstract and conclusions first. If it appeals to the scientific mind, a decision is made to read the entire article. One can read and appreciate a scientific manuscript if a systematic approach is followed in a simple and logical manner.

Several biomarkers involved in oxidative stress may influence polycystic ovary syndrome (PCOS). Superoxide dismutase (SOD) has been commonly identified as dismutase enzyme catalyzes the conversion of superoxide to hydrogen peroxide and elemental oxygen, and could serve as an important biomarker in this direction. The objective of the present study to determine the precise role of SOD levels in women with PCOS using a meta-analysis approach. The electronic databases like PubMed, Google Scholar, Web of Sciences, Clinical trial.gov, Cochrane Database of Systematic Review were searched for obtaining relevant studies on the association of SOD level in women with PCOS. Pooled standardized mean difference with 95% CI was computed using the DerSimonian and Liard method. A total of 267 articles were screened, out of which 12 articles fulfilled the inclusion criteria of the present meta-analysis involving 558 cases and 529 controls. Analysis including overall studies observed a higher SOD level (statistically non-significant) in women with PCOS compared to controls (SMD 0.35, 95% Cl −0.91 to 1.62, P = 0.58), however, statistically significant higher SOD levels were noted in studies using serum as a source of sample (SMD 1.53, 95% CI 0.25 to 2.81, P = 0.019). In conclusion, women with PCOS exhibited increased SOD levels compared to controls suggesting that the byproduct of oxidative damage is expected to be increased in women with PCOS.

HPV is responsible for almost all cases of cervical cancer which in turn is one of the common causes of death among female genital malignancies. Cervical cancer being a preventable disease, screening plays a vital role in its reduction. In this era of advanced health care system and technologies this cancer is still in the increasing trend, especially in the Low and Middle Income Countries, which reflects the poor coverage of women for screening. Advances in screening tests and techniques for better and larger coverage of women is the need of the hour globally. Clinicians also need to be aware of the various promising technologies available for screening of cervical cancer precursors, application of which in general practice can be of immense help in cervical cancer reduction.

Background The present observational data from the fetal medicine unit aim to identify gaps in prenatal screening modalities employed in the primary obstetric care population in coastal Karnataka.

Methods A retrospective observational study of all referrals to fetal Medicine unit is over 2 years. For each fetal abnormality, we reviewed the literature to note the range of gestational age at which the abnormality should almost always be diagnosed. Taking this as standard, the gestational age at which each of these problems was diagnosed and referred was noted down. They were compared and analysed to understand the efficiency of prenatal screening practices in the referral population. The final perinatal outcome was also noted down in order to assess the impact on perinatal mortality/morbidity.

Results A total of 277 cases were referred to fetal medicine unit. Two hundred twenty-eight cases (82.31%) were low risk pregnancies. Among 277 cases, 200 (72.2%) had structural abnormalities, 7 (2.5%) chromosomal/ genetic abnormalities, 61 (22.02%) isolated soft markers, and 9 (3.2%) twin-related problems. Detection rate of structural abnormalities was 33% at 14 weeks and 52.22% at 20 weeks, considering those anomalies usually diagnosed by these gestational age windows. The primary reason for delayed diagnosis was non-performance of ultrasound “on time”, rather than missed diagnosis. Fifty-three per cent (106 out of 200) of all the fetal structural abnormalities were diagnosed beyond 20 weeks. Average gestational age at mid-trimester anomaly scan in this group was between 20 and 24 weeks. Sixty-one patients were referred due to isolated soft markers, 30 beyond 20 weeks. Eighty per cent of them did not have any aneuploidy screening in pregnancy.

Conclusion Practice of fetal medicine hugely depends upon appropriate prenatal screening practices in the referral population. There is an urgent need to bring in standard protocols for Prenatal Screening across all the primary obstetric care providers, both in the public and private sectors. Considering the huge burden of delayed prenatal diagnosis in our country, the proposed revision of MTP bill is a welcome change in fast-growing field of fetal diagnosis and therapy.

Background Induction of labor in women with previous cesarean section is associated by the fear of scar rupture, resulting in high rates of repeat scheduled cesarean section. Mechanical methods are being advocated as a safe method. We present our experience of vaginal birth rates and safety profile with single-balloon Foley’s catheter for induction of labor in women with previous one cesarean section.

Methods We studied 96 women admitted in Women and Children Hospital JIPMER, India, with a previous cesarean section at term having unfavorable cervix and undergoing induction of labor. Foley’s catheter inflated to 60 ml was used for cervical ripening for 24 h followed by strict oxytocin infusion protocol.

Results The mean Bishop score before induction of labor was 3.3 ± 0.88. Ripening with Foley’s catheter resulted in mean improvement in the Bishop score by 2.56 ± 0.67. Forty-seven percent women spontaneously expelled the Foley’s catheter, and 53.1% achieved contractions spontaneously. The successful vaginal birth rate was 40%. Emergency caesarean section was more likely in women with poor post ripening Bishop score, meconium stained liquor and abnormal fetal heart rate pattern during labour. There was one scar dehiscence, one neonate with low Apgar score. There was no rupture uterus.

Conclusion Induction of labor with Foley’s catheter resulted in a 40% successful vaginal birth rate and was found to be safe with only one scar dehiscence and no perinatal or maternal mortality. There was no perinatal or maternal mortality.

Aim To assess the available standards for respectful maternity care in a public maternity hospital by evaluation of responses to a questionnaire given to birthing women.

Methodology Assessment was done to find out the level of respectful maternity care provided under the most sensitive and important areas, namely (1) confidentiality and privacy, (2) physical harm or ill treatment, (3) dignity and respect, (4) left without care, (5) right to information, informed consent, and choice/preferences, by obtaining the response of birthing women.

Results Confidentiality and Privacy: No birthing woman (0%) expressed her opinion that she was dissatisfied with privacy provided, at any time of her stay in the hospital. Physical harm or ill treatment: It was significant to note that no woman reported being ill-treated or physically harmed. Dignity and Respect: A response of satisfaction regarding this important aspect of maternity care was received by nearly 95% of birthing women, A very small percent of 5.1% of women were not completely satisfied. Left without care or Attention given at all times:1.9% of women felt that they were not given immediate response when they called for any need. Right to information, informed consent, and choice/preferences: The greater majority of 95.7% of women were satisfied with methods engaged by hospital staff regarding right to information, informed consent and practices.

Conclusion The response from a significant majority of birthing women was that they had respectful maternity care given to them at Government hospital for Women and Children.

Aim Copper containing IUCDs are one of most effective mode of contraception for birth spacing. We conducted this prospective observational study to suggest a possible better period of insertion of IUCDs with cost-saving benefits.

Methods All married women in the reproductive age group desirous of Copper-T 375 IUD insertion in either immediate postplacental (PP), immediate postabortal (PA) or interval (INT) period were recruited. The women were asked to return for scheduled follow-up visits at 6 weeks, 6 months and 12 months. They were advised to visit family planning clinic any time if they experienced pelvic pain, discharge per vaginum, unusual bleeding or missed periods. At each visit, women were interviewed for any side effects they have experienced and were asked to elaborate. Pelvic pain was assessed from visual analogue scale. Continuation rate was measured at the end of one year.

Results Women in INT group (90.14%) had the highest continuation rate followed by PP (83.18%) and PA (80%) groups. Women in PP (AOR = 3.37, 95% CI 1.17–9.72) and PA (AOR = 4.53, 95% CI 1.33–14.04) groups had higher odds of discontinuation compared to INT group after adjusting for age, parity, working and education status. There was a significant difference between the groups when cumulative expulsion was considered (p = 0.045), but none when cumulative removal (p = 0.107) was taken into account.

Conclusion The continuation rate remained high in women who had insertion in the interval period compared to immediate postplacental and postabortal periods.

Purpose of the Study Chromosomal aneuploidies are major causes of perinatal death and childhood handicap. Awareness about screening and prenatal diagnosis for these disorders among obstetricians and primary care physicians is increasing. Since invasive tests like amniocentesis or chorionic villus sampling (CVS) are associated with a risk of miscarriage these tests should be carried out judiciously in pregnancies considered to be at high risk for aneuploidies and other genetic disorders. The purpose of our study was to examine the patterns, trends and outcomes of the various screening procedures and invasive tests results.

Methodology Retrospective observational study done over a period of 3 years and one month including 433 pregnant women with high risk for genetic disorders undergoing invasive prenatal testing like chorionic villus sampling, amniocentesis or cordocentesis. Data were collected from our department records regarding the maternal age, indication for invasive testing, past obstetric history, family history of genetic syndromes, ultrasound findings in the current sonographic examination and the results of the tests done. Any immediate or late complications of the procedure if any were telephonically addressed.

Results A total of 436 procedures on 433 patients (418 singleton,12 single fetus of twin, 3 both fetuses of twins) were done out of which 281 were amniocentesis(64.4%), 153 were chorionic villus sampling (35.1%) and 2 were cordocentesis(< 1%). Of the 436 procedures, 373(85.5%) were done for positive screening tests for chromosomal aneuploidies and 63(14.4%) were done for previous history of genetic syndromes. The positive predictive value of biochemical marker alone was around 2.7% and higher around 13% for a combined first trimester or a second-trimester screen along with ultrasound abnormalities. The higher the biochemical risk does not translate into higher chance of chromosomal abnormality. Nineteen percentage of fetuses with NT above 95th centile had chromosomal abnormality. Twenty-one percentage of fetuses with absent nasal bone in our study had trisomy 21.

Conclusion Aneuploidy screening is the most common indication for prenatal invasive testing with dual marker combined with nuchal translucency, nasal bone, tricuspid regurgitation and ductus venosus flow providing the best detection rates. The chance of an affected fetus in a patient with aneuploidy screen positive overall is only 6.7%.

Background Oocyte retrieval is a part of in vitro fertilisation (IVF) procedures performed on an ambulatory basis. Total intravenous anaesthesia (TIVA) with opioid is shown to improve quality of recovery (QOR) after ambulatory surgery. Opioid-free anaesthesia (OF) is gaining popularity in recent times as it is associated with lesser post-operative side effects related to opioids. Quality of recovery is considered as one of the principal end points in ambulatory surgery.

Aim To compare quality of recovery using QOR-15 questionnaire between opioid-free TIVA and opioid-based TIVA at 24 h after oocyte retrieval.

Settings and Design A prospective randomised control study.

Patients and Methods Sixty six patients undergoing oocyte retrieval were prospectively selected. They were randomised into two equal group. OF TIVA group with dexmedetomidine (D) and propofol or opioid-based TIVA with fentanyl (F) and propofol. The primary outcome measured was quality of recovery using QOR-15 at 24 h after oocyte retrieval. Secondary outcomes measured were incidence of bradycardia, post-operative nausea and vomiting, usage of rescue analgesia and total consumption of propofol.

Results A statistically significant difference in total QOR-15 was observed between two groups (p value = 0.021) at 24 h post-operatively. Usage of rescue analgesia and incidence of post-operative nausea and vomiting was less in opioid-free TIVA.

Conclusion Opioid-free TIVA improves post-operative QOR in patients undergoing oocyte retrieval.

Background The purpose of this work was to identify the results of pelvic exenteration for recurrent, persistent or locally advanced cervical cancer in terms of survival performed for 41 patients in Salah Azaiez Institute.

Patients and Methods We conducted a retrospective unicentric study. The association between PE and OS was estimated using the method of Kaplan–Meier using SPSS ver 24.

Results Median age at the time of intervention was 53.9 years old. FIGO stage IIB was the most frequent (46.3%). Eighteen patients had pelvic exenteration after neoadjuvant treatment. Resection margins were free of tumor in 83.3% of cases. Twenty-three patients underwent pelvic exenteration for recurrence of cervical cancer treated. The median time of recurrence was 23.4 months. Free resection margins were obtained in 69.5% of cases. Postoperative complications were noted in 61% of patients. Two deaths were seen in the early postoperative period. After a median follow-up of 40.5 months, 24.4% of recurrences were noted. Overall survival at 5 years was 51% and recurrence-free survival at one year was 39%. Prognostic factors which impact overall and recurrence-free survival were the size of recurrence and resection margins after exenteration. The time between the end of initial treatment and recurrence was the only predictive factor of recurrence after pelvic exenteration.

Conclusion Pelvic exenteration remains a curative treatment of cervical cancer in certain indications despite high morbidity. A rigorous preoperative selection of candidate may reduce the morbidity and improve the survival of patients.

Background Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in women of reproductive age with increased incidence of emotional disturbances and other psychopathology. We undertook this research to study the prevalence and severity of depression and anxiety as well as understand body image disturbances and self-esteem of the women of PCOS. We studied the relationship of depressive symptoms with self-esteem and body image disturbances.

Method A total of 105 patients diagnosed as PCOS were recruited from gynecology OPD after informed consent and ethics approval. A proforma along with Beck’s Depression Inventory, Hamilton Depression Rating Scale, Hamilton Anxiety Rating Scale, Body Image Concern Inventory and Rosenberg’ s Self-Esteem Scale were administered to patients for further assessment.

Results In total, 54 (51.43%) patients of PCOS had depression on BDI, 12( 11.43%) patients had body image disturbances an d 23 (21.90%) patients had a low self-esteem. A total of 21 patients( 20%) had mild and moderate depression while 5% had severe depression. Majority 53 (50.48%) of our patients had mild anxiety whereas severe to extreme anxiety was seen in about 31% of patients. Body image disturbances were seen in only 12(11.43%) patients and low self-esteem was present in 23 patients. No statistically significant correlation of depression was seen with body image or self-esteem.

Conclusions The results of this study indicate that there is a high prevalence of depression and anxiety in patients of PCOS than body image concerns and low self-esteem. Prognosis for patients would improve by liaison between gynecologist and psychiatrist.

Carcinosarcoma is a malignant mixed müllerian tumor with a highly malignant, biphasic tumor consisting of both epithelial and mesenchymal components. A 59 year old nulligravida came with postmenopausal bleeding. Hysteroscopy revealed highly vascular polypoidal mass with prominent vasculature. Gross examination of specimen showed a polypoid mass, occupying whole uterine cavity ad invading more than half of myometrium. Immunohistochemical analysis showed epithelial component AE1/AE3 and stromal component desi and p16. Tumor cells were negative for ER. As carcinosarcoma is a highly aggressive less common variant of endometrial cancer early diagnosis and aggressive treatment is important to minimize morbidity and overall survival.

Intractable seizures during pregnancy necessitate an extensive workup to ascertain the cause for convulsions. We report a case of idiopathic intractable seizures in pregnancy and discuss the challenges faced in her management. A 27-year-old normotensive G2P1L1 presented at 29 weeks with intractable seizures. No definite cause was found despite a detailed work-up. She was started on anticonvulsants, doses were escalated, and stepped up to four anticonvulsants with no response. A diagnosis of atypical eclampsia was made. She was started on magnesium sulphate and labour was induced. Even after delivery, she continued to have 3- 4 episodes of convulsions per day postnatally. She finally responded to pulse therapy of methylprednisolone after continuing to have seizures daily for 21 days. Such a presentation of intractable seizures unresponsive to four antiepileptics and of unknown etiology that finally responded to high dose steroid therapy has not been reported in the literature.

Vulvar hematoma during pregnancy is a rare event. Usually they develop due to trauma post delivery. Rarely such hematomas appear spontaneously intrapartum without any underlying cause. A 25 year old primigravida at 34 weeks with twin pregnancy was found to have developed spontaneously a vulvar hematoma intrapartum. Prompt recognition and timely drainage of the hematoma prevented any untoward complication and led to quick recovery.

We report a case of a 25-year-old female who presented with primary infertility with AMH value of 9 ng/ml, and ultrasound image suggesting the possibility of three ovaries seen in two different planes and no polycystic pattern in any ovary. Diagnostic laparoscopy performed in this patient revealed two ovaries on the left side, placed in normal anatomical position. Both having their individual ovarian ligaments connecting both the ovaries separately with the cornual end of the uterus on the left side. However, only the lateral one of the two ovaries on the left was attached to the lateral pelvic wall with infundibulopelvic ligament. The adnexa on the right side was normal. Biopsy confirmed this accessory tissue as an ovary. The “third ovary” in our case is a functional ovary. This explains the rise of AMH value. The ovary responded to ovulation induction, and follicles were retrieved thereafter which later showed fertilization. Hence, confirming their functionality. The occurrence of third ovary has been established in the literature. However, none of the definitions supports our finding, that is, the presence of third functional ovary attached with ovarian ligament and no infundibulopelvic ligament. Hence, we name this unique occurrence as “Superfluous Ovary”.

We discuss five technical modifications made over 8 years in the technique of robotic myomectomy at our institution. Universal preoperative MRI was the first modification. Precise hysterotomy incisions were planned by accurate myoma mapping. The second modification was to reduce the number of ports. We performed surgery with one 12-mm-port for the camera and one 8-mm-port on either side of the patient for scissors and fenestrated bipolar forceps. Third modification was to reduce the number of robotic instruments by using laparoscopic myoma screw instead of robotic tenaculum during enucleation and discard the use of a second needle driver and prograsp forceps. So instead of six instruments in classical technique, we now use only three instruments thus reducing the cost of instruments by 40–50%. The fourth modification was to use a single 30 or 45 cm barbed suture. A single long suture efficiently managed by wristed needle driver of robot was sufficient in most cases for hysterotomy closure. This reduces the time needed for multiple needle pass and cost due to reduced number of sutures used. The fifth modification was to not use the electro mechanical morcellator and commercially available bags. We do cold knife morcellation in indigenous plastic bags. Over a period of eight years, we have made robotic myomectomy efficient and reduced the cost of instruments by 40–50% as compared to the classical technique. This has enabled wider adoption of robotic myomectomy at our institution thus reducing open myomectomy in all types of myomas.

B-lynch compression sutures, applied as a life-saving procedure in cases of atonic postpartum haemorrhage can sometimes lead to life-threatening complications. We report a case of early uterine necrosis following B-lynch compression suture application for PPH at the time of LSCS, resulting in peripartum hysterectomy.