The novel corona virus or covid 19 is still an enigma to healthcare providers and it is only five to ten years later we might be able to understand what right and what wrong was followed for prevention and treatment of this condition by large multicentric retrospective analysis and guidelines can be issued for the same. Till such authentic information is released, we have to resort to all the available sources of information. Distance learning technology or remote learning had distanced us from actual research and people believe and practice all sort of myths in the attempt to keep away the disease.
World health organisation has taken misinformation during covid 19 pandemic into cognisance and is working actively to educate people and stop the spread of myths.
Infodemiology is art of transmission of information to another person during the pandemic without doing any harm to the other person. Even the scientists all over the world are working very hard to keep up with the millions of studies and data that have come out since COVID-19 appeared. It is a challenge to stay up to date on the information details we need and how to procure them. Sharing information, the correct one for the time is a big dilemma.
All of this is called the infodemic: a huge flood of information on the COVID-19 pandemic. Infodemiology is the study of that information and how to manage it effectively without any harm. There are pointers one can refer to navigate this wave of information and decide who and what to trust, and what information can be passed on to benefit the individual.
Information is defined as what we call things that are accurate to the best of our current knowledge. Misinformation is what emerges to be false information on further investigation. As a matter of fact, it is information that was not made with the only malicious intention of hurting others. At the farther end of the spectrum is disinformation. Misinformation and disinformation spread in the community same way like viruses. Before sharing something, always ask yourself some important questions. The misinformation can also be reported online for misconduct.

Stress urinary incontinence (SUI) is a common type of urinary incontinence adversely affecting the quality of life of women. For mild SUI, life style changes, pelvic floor exercises and medical treatment with duloxetine may help. Most patients of moderate to severe SUI usually require surgical treatment. Various surgical treatment options include Kelly’s plication, Burch colposuspension, bulking agents and sling surgeries. Although, suburethral fascial slings including the autologous rectus fascia slings were in vogue before 1990, they were overtaken by minimally invasive, faster and easier artificial midurethral slings (tension free vaginal tape and transobturator tape). However, observation of serious long-term and life changing complications of synthetic midurethral slings like mesh erosion, chronic pelvic pain and dyspareunia led to their adverse publicity and medico legal implications for the operating surgeons. This led US FDA (Food and Drug Administration) to issue a warning against their use. Currently, their use has significantly decreased in many countries, and they are no longer available in some countries. This has led to renaissance of use of natural autologous fascial sling, especially rectus fascia for surgical management of SUI. Although performing rectus fascia sling surgery is technically more challenging, takes longer, has more short-term morbidity like voiding dysfunction, their long-term success is high with very little risk of serious complications like mesh erosion, chronic pelvic pain and dyspareunia. However, multicentric trials and longer follow ups are needed before it’s routine recommendation This review discusses the role of autologous fascial sling (especially rectus fascia) for the surgical management of SUI in the current time and the need of ongoing training of this procedure to gynecology residents and urogynecology fellows.

The ovarian cancer is one of the frequent cancers among women being diagnosed after cervical and breast cancer. The CA ovary is dreaded because even after successful treatment of the primary malignancy, the disease comes back and becomes resistant to conventional management. The prognosis in ovarian cancer management is mostly unsatisfactory, maybe because of the presence of ovarian cancer stem cells (OCSC). The hypothesis is that OCSC causes the recurrence of the ovarian malignancy. The OCSC can be identified by the presence of different markers and marker combinations. The assumptions are that CD44+, CD24+, CD117+, CD133+ and ALDH1+ could be the markers of ovarian cancer stem cells. The epithelial ovarian malignancy if proved as a stem cell disease, then it changes the entire management scenarios. Maybe, this will be the first step in managing the ovarian malignancy in the future.

Background Hypertensive disorders of pregnancy lead to pathological changes in various organ systems of mother and fetus which contributes to maternal and fetal morbidity and mortality. It is a multisystem disorder which can involve end organs like kidneys, liver, eyes, hemopoietic system and placenta. Retinal involvement, though quite common, is rarely investigated. It is a unique site where the blood vessels can be directly observed. Observing retinal vasculature may provide clue to status of similar vessels in other parts of body including placental circulation.

Methods Hospital-based descriptive study which included 150 patients diagnosed as preeclampsia/eclampsia, who were admitted in the intensive care unit. Written consent was obtained from study subjects. Data were collected by history taking and examination of the subjects using pre-structured questionnaire. Ocular examination was carried out by ophthalmolo-gist, which included anterior segment examination, visual acuity and dilated fundus examination. Multiple qualitative and quantitative parameters were studied. Data were analyzed by SPSS 14.0 software.

Results Ocular symptoms were seen in 22% of severe preeclampsia and in 100% of eclampsia patients. Blurred vision was the most common ocular complaint. Fundus changes were seen in 48.7% total study subjects. Arteriolar narrowing was the most common finding on fundus examination. Systolic blood pressure and serum creatinine were found predictive of changes in fundus (p =   .000). Incidence of fetal growth restriction was found to be significantly associated with fundus involvement (p value .000).

Conclusion Ophthalmic examination including fundus examination should be a routine in the investigational armamentarium of hypertensive disorders of pregnancy.

Abstract

Introduction Immune thrombocytopenia (ITP) complicates 1–2 cases/10,000 pregnancies in India. Management of these patients is a challenge as it is associated with potential risks of maternal bleeding episodes and neonatal alloimmune throm-bocytopenia (NAITP).

Objective To study the maternal and fetal/neonatal outcome of pregnancy in Indian patients with ITP and identify the risk factors for NAITP.

Materials and Methods In this retrospective study, all ITP patients with pregnancy who were diagnosed and treated at our center over 8 years (August 2010– August 2018) were evaluated for their hematological, obstetrical, and fetal outcomes.

Results Twenty-nine pregnancies in 27 ITP patients were studied. The mean interval between the diagnosis of ITP and each pregnancy was 29 ±   14.9 months. The mean baseline platelet count was 0.18 ±   0.05 X  109/L. Twenty-seven (93.1%) cases were treated with oral prednisolone. Twenty deliveries (69.0%) were vaginal and 9 (31.0%) deliveries were by cesarean sec-tion. There were no major bleeding episodes during pregnancy or delivery.The mean neonatal platelet count was 1.23 ±   0.58 ×   109/L at birth. NAITP was seen in 3 (3.5%) neonates. No bleeds or intrac-ranial hemorrhages were observed. Only maternal platelet count < 50 X  109/L at delivery showed a statistical correlation with NAITP (p =   0.022). There was no positive correlation between NAITP and the duration of maternal ITP, the timing of ITP onset, or type of treatment.

Conclusion Successful outcome of pregnancies in ITP patients is possible, and the risk of maternal bleeding and NAITP is low.

Abstract

Introduction Ensuring safety of the mother along with the delivery of a healthy baby is the ultimate objective of all obste-tricians. Labour induction is increasingly becoming one of the most common obstetric interventions in India. The aim of the study is to compare the feto-maternal outcome of induction of labour versus spontaneous labour in postdated women.

Method This was a prospective observational comparative study. A total of 100 patients were selected, 50 who had induc-tion of labour (study group) and 50 who had spontaneous labour (control). A structured proforma and partographs were used to obtain data.

Result 42% nulliparous women had induction of labour as compared to 29% multiparous women. The rate of cesarean sec-tion (58%) was substantially higher in those who had been induced. Non-progression of labour or failure of induction was the commonest indication for cesarean section. Post-partum haemorrhage was a complication found more commonly in the study group. Perineal tears were found more commonly in the control group.

The mean birth weight of babies born to mothers who had been induced was significantly higher than that of those born to women who went into spontaneous labour. The APGAR scores were comparable in both groups. There was a higher incidence of hyperbilirubinemia in the study group.

Conclusion Although induction of labour is a relatively safe procedure, some foetal and maternal risks were found to be higher in induced group than in those with spontaneous labour. Induction must be carried out only when necessary and not as a routine elective procedure.

Abstract

Aim  Application of Flash glucose monitoring (FGM) system to evaluate glycaemic variability (GV), patient satisfaction and clinical utility in pregnant women with diabetes

Methods This prospective study was conducted in a tertiary care teaching hospital on 70 pregnant women with diabetes where blood sugar levels were monitored by FGM and self-monitoring of blood glucose (SMBG)

Results FGM generated 19,950 readings versus 1470 readings by SMBG over 3 days. Glucose values measured by FGM and SMBG had significant positive correlation (r > 0.89; p <   0.001). Significant difference (p < 0.001) was present between minimum glucose values by FGM (52.49 ±   15.42 mg/dl) and SMBG (72.74 ±   18.30 mg/dl). FGM (20.9%) was able to pick exact duration of hypoglycaemia, while one-third of this duration was missed by conventional SMBG (14.7%; p < 0.05). Hypoglycaemic episodes were observed in 92.9% women by FGM as compared to 45.7% by SMBG (p < 0.001).  No  signifi-cant difference was observed in maximum glucose level or duration of hyperglycaemia by both methods. FGM identified hyperglycaemia in 74% women vs. 52% by SMBG (p < 0.001). GV calculated by using MODD by FGM was 118.4 ±   52.4 mg/dl and by SMBG was 83.2 ±   53.2 mg/dl (p < 0.001). 100% women preferred AGP vs. SMBG.

Conclusion This is the first study to evaluate FGM for GV and patient satisfaction in women with GDM. Significant cor-relation was observed in glucose values by FGM and SMBG. FGM was more sensitive in detecting GV and hypoglycaemic excursions as compared to SMBG. All women preferred FGM over SMBG. Use of FGM gave new insights in clinical man-agement of challenging cases.

Abstract

Background The risk of mortality for the mother and the newborn is aggravated during birth in low- and middle-income countries due to preventable causes, which can be addressed with increased quality of care practices. One such practice is intrapartum fetal heart rate (FHR) monitoring, which is crucial for the early detection of fetal ischemia, but is inadequately monitored in low- and middle-income countries. In India, there is currently a lack of sufficient data on FHR monitoring.

Methods An assessment using facility records, interviews and observation was conducted in seven facilities providing ter-tiary, secondary or primary level care in aspirational districts of three states. The study sought to investigate the frequency of monitoring, devices used for monitoring and challenges in usage.

Results FHR was not monitored as per standard protocol. Case sheets revealed 70% of labor was monitored at least once. Only 33% of observed cases were monitored every half hour during active labor, and none were monitored every 5 min during the second stage of labor. More time was observed for monitoring with a Doppler compared with a stethoscope, as providers reported fluctuation in readings. Reportedly, low audibility and a perceived need of expertise were associated with using a stethoscope. High case load and the time required for monitoring were reported as challenges in adhering to standard monitoring protocols.

Conclusion The introduction of a standardized device and a short refresher training on the World Health Organization and skilled birth attendant protocols for FHR monitoring will improve usage and compliance.

Background Karyotyping has been the gold standard for prenatal chromosome analysis. The resolution should be higher by chromosome microarray analysis (CMA). The challenge lies in recognizing benign and pathogenic or clinically significant copy number variations (pCNV) and variations of unknown significance (VOUS). The aim was to evaluate the diagnostic yield and clinical utility of CMA, to stratify the CMA results in various prenatal referral groups and to accumulate Indian data of pCNVs and VOUS for further interpretation to assist defined genetic counseling.

Methods Karyotyping and CMA were performed on consecutive referrals of 370 prenatal samples of amniotic fluid (n = 274) and chorionic villi (n = 96) from Indian pregnant women with high maternal age (n = 23), biochemical screen positive (n = 61), previous child abnormal (n = 59), abnormal fetal ultrasound (n = 205) and heterozygous parents (n = 22).

Results and Conclusion The overall diagnostic yield of abnormal results was 5.40% by karyotyping and 9.18% by CMA. The highest percentage of pCNVs were found in the group with abnormal fetal ultrasound (5.40%) as compared to other groups, such as women with high maternal age (0.81%), biochemical screen positive (0.54%), previous abnormal offspring (0.81%) or heterozygous parents group (1.62%). Therefore, all women with abnormal fetal ultrasound must undergo CMA test for genotype– phenotype correlation. CMA detects known and rare deletion/duplication syndromes and characterizes marker chromosomes. Accumulation of CNV data will form an Indian Repository and also help to resolve the uncertainty of VOUS. Pretest and posttest genetic counseling is essential to convey benefits and limitations of CMA and help the patients to take informed decisions.

Purpose To compare between postplacental insertion of levonorgestrel intrauterine system versus copper intrauterine device regarding expulsion rates, patient satisfaction, complications, and continuation rates.

Methods This prospective observational study was conducted on 1100 participants divided in to two groups: group (1) CU-IUD group and group (2) LNG-IUS group where women were assigned for postplacental insertion of either CU-IUD or LNG-IUS, respectively. Follow-up at 6 weeks, 3 and 6 months postpartum and data were collected and analyzed to evaluate outcomes.

Results No statistical difference between both groups regarding patients’ characteristics, the overall expulsion rate was higher in LNS-IUS group than CU-IUD group; 77 patients (14%) and 50 patients (9%), respectively, (P value < 0.05), odds ratio: 1.63 at CI: (1.12–2.37). No significant difference between the two groups regarding pain intensity, perforation, abnormal uterine bleeding, and clinical endometritis (P > 0.05). Overall satisfaction rate at six months was 478(87%) in the CU-IUD group and 472(85.8%) in the LNS-IUS group (P value > 0.05), odds ratio: 1.1 at CI: (0.78–1.55). Continuation rate at s6 months was comparable between the two groups 485 (88.2%) and 480 (87.3%) in CU-IUD group and LNS-IUS group respectively, (P value < 0.05), odds ratio: 1.09 at CI: (0.76–1.56).

Conclusion The rate of expulsion of LNG-IUS is higher than copper IUD when inserted postplacental, yet the continuation and acceptability rates were comparable between the two groups.

Abstract

Background/Purpose There is an increasing trend in the utilization of long-acting reversible contraceptive (LARC) meth-ods globally. The study assessed the utilization of LARC methods and its determinants in a tertiary hospital, southwestern Nigeria using a mixed method study.

Methods A cross-sectional study of women attending the Family Planning Clinic of the tertiary hospital was conducted between November 1, 2018 and October 31, 2019 using both quantitative and qualitative methods. Quantitative data was collected using structured questionnaire while in-depth interviewer topic guide was used to obtain qualitative data from the respondents. The quantitative and qualitative data obtained from the respondents were analyzed using SPSS version 22 and open code version 3.6.2, respectively, and the determinants of utilization of LARC methods were identified using multivariate regression model.

Results The current utilization rate of LARC methods was 65.6% and implants accounted for 75% of LARC used. Higher education (p =   0.035), more than 3 living children (p =   0.030), previous use of LARC (p =   0.028), good knowledge (p = 0.025) and positive attitude of the women about LARC (p =   0.026) were significant determinants of utilization among the women. Limiting size of family was the commonest reason among LARC users, while partner disapproval, fear of procedure and side effects were reasons given by non-users.

Conclusions The utilization rate of LARC methods are high, and this should be sustained through improved information dis-semination, education of women and involvement of male partners in reproductive health matters including family planning.

Abstract

Purpose of the Study  The aim of this study was to show the clinical results of postoperative evaluation of cases of imperforate hymen that presented at our center during a 21-year period.

Methods A Foley’s catheter was inserted in 74 patients of imperforate hymen who reported to the Department of Obstetrics and Gynecology, Meram Faculty of Medicine, Necmettin Erbakan University, between January 1, 1996, and December 31, 2016 with history of pelvic pain. In each case, the hymen was opened via a circular incision from the central of the distended. A Foley’s catheter was inserted, and estrogen cream was prescribed for application on the hymenal structure for 14 days. The catheter was removed after 14 days.

Results  The mean age of the patients at the time of this study was 28.3 ±   2.6 years, and the mean age at diagnosis was 13.2 ±   2.5 years. Twenty-nine (96.6%) patients had experienced vaginal bleeding during their first sexual intercourse expe-rience, and one patient (3.4%) had not. Fourteen out of the 30 married women had become pregnant, of whom nine had delivered vaginally and five had delivered via a cesarean section. After undergoing renal ultrasound, none of the patients had any apparent anomalies. Only one patient had a uterine anomaly, which was a bicornuate uterus.

Conclusion A circular incision with insertion of Foley’s catheter prevents many social problems by preserving the hymen’s architecture and allowing vaginal bleeding to occur during the first sexual intercourse experience.

Placental chorioangioma has been noted to be the most common benign tumour of the placenta, being diagnosed as an incidental finding. Conversely however, large sized tumours (> 4cm) have adverse fetal (polyhydraminos, fetal cardiomegaly, hydrops fetalis, intrauterine growth restriction) and maternal (gestational hypertension, antepartum haemorrhage, pre eclampsia) outcomes, requiring close monitoring and follow up. We present a case report of a 26 year old, primigravida, 31 weeks + 5 days of gestation, referred to the Department of Obstetrics and Gynaecology, SRIHER for an early delivery. Placental chorioangioma being a rare case in the field of obstetrics; there is a lack of management guidelines / treatment protocols. Our case is one wherein timely interventions and prompt institutional delivery led to a successful feto-maternal outcome. Ultrasonography with doppler remains the gold standard for diagnosis. Invasive techniques – embolizaton and fetal transfusion - used to prolong gestation, despite minimal experience with the same, have proven to have a successful outcome.

Abstract

Vulvar necrosis is a rare complication after lower limb fractures and hip surgeries either due to direct damage to internal pudendal artery or post-surgery ischemic necrosis due to use of a perineal post. We present a series of 3 cases post-orthopedic surgeries with vulvar necrosis. All three patients presented to us after history of orthopedic surgeries which used a perineal post intraoperatively. They developed vulvar edema and blackish discoloration 6–8 h after the orthopedic procedure and referred for further management. Traction post-related vulvar necrosis can have major psychological and functional consequences; hence, formulating measures for prevention and promptly diagnosing the condition and ensuring early management to maintain the functionality of vulva is of utmost importance.

Abbreviations
NSAIDs Non-steroidal anti-inflammatory drugs
EUSOL  Edinburgh University solution of lime

Introduction : Ursodeoxycholic acid (UDCA) is the mainstay of treatment in intrahepatic cholestasis of pregnancy (ICP), which improves pruritus and normalizes bile acids in most cases. A case with severe ICP, not controlled on UDCA alone, and managed successfully by adding rifampicin is being reported.

Case report : A 28-year-old women was diagnosed as a case of early onset severe ICP with elevated bilirubin at 17+6 weeks. As patient did not respond to UDCA therapy, oral rifampicin was added which reduced bilirubin. Patient went into spontaneous preterm labour at 31+6 weeks and delivered a baby with 9/9 Apgar score. Conclusion: Adding Rifampicin to UDCA enhances bile acid excretion and is an option for severe refractory ICP.

Abstract

Background We report a case of afibrinogenemia in a lady, which was detected for the first time during her pregnancy.CaseA 24-year-old G4A3 was referred as a case of vaginal bleeding, after a cervical cerclage at 14 weeks of gestation. Elastometry targeted correction of coagulopathy was done initially, and targeted cryoprecipitate transfusion was done to maintain her gestation. She underwent induced vaginal delivery at 34 weeks of gestation. Fourteen days postpartum, the mother and child were discharged home well.

Conclusion Coagulation factor deficiency should be considered as a rare cause for RPL. Serum fibrinogen level of 50–100 mg/dl during pregnancy seems to be a safe and adequate target to maintain in pregnant patients with afibrinogenemia.

Background Dislodgement and breakage of instruments in laparoscopy is a rare event which not only surmounts the anxiety of the team, but also imposes an exceedingly onerous situation for the patient. Frequently a broken fragment of an instrument is confined to an area remote from the primary operative site and gets entrapped in the bowel loops or in the omentum.

Method We present the intraoperative loss of the distal tip of three 5-mm laparoscopy instruments (monopolar L-hook, myoma screw and tenaculum) in the abdominal cavity during endoscopy.

Result Various retrieval methods for laparoscopy instruments have been described.

Conclusion The distal working tips of laparoscopic instruments have delicate functioning and tend to fall off or break during usage. Maintenance of instruments used in endoscopy requires special care and should be done as outlined by the manufacturer. Reporting of such incidents should be encouraged and published despite the discomposure accompanying it as it aids in better understanding and learning to handle these situations.

This is a short commentary on one of the unusual complication of laparoscopic surgeries, which is difficult to diagnose, thus creating new challenges for a treating surgeon.

Background Uterine fibroid is a common gynaecological condition. But, one of its variants, called as parasitic fibroids, is a rare one and is difficult to diagnose because of their varied presentations. But, with the increase in laparoscopic surgeries, especially where morcellator is used, cases of parasitic fibroid are increasing.

Case Discussion Description A forty-two-year-old female presented with abdominal pain, not related to any gastrointestinal or urinary complaints. Patient had history of laparascopic myomectomy followed by morcellation in the past. Ultrasonography was suggestive of mass in right iliac region adjacent to ascending colon with whorl like appearance. Tumour markers were sent, diagnostic laparoscopy was performed which was suggestive of parasitic fibroid, arising from previous surgical port.

Conclusion Complications of parasitic fibroid can occur when morcelletor is used in laparoscopic surgeries, because of the growth of tissue which have spread in pelvic cavity. To prevent this complication, endobag morcellation should be used.

Clinical Significance History of morcellation, should be asked to females, presenting with varied abdominal complaints, and history of laparoscopic surgery, possibility of parasitic fibroid should be considered in these patients.