“A very encouraging trend. Happy to see this change. Our emphasis on furthering all aspects relating to women empowerment remains very strong.” -Prime Minister Narendra Modi

Since decades, India is battling maternal mortality and one of the country’s efforts has been to improve maternal health by screening for anaemia and to bring down the Maternal Mortality Ratio (MMR). MMR is the number of maternal deaths during a given time period per 100,000 live births during the same time period.[1] Maternal mortality in a region (district) is a measure of the reproductive health of women in the area. Every district has a quality control enquiry of all maternal deaths. The enquiry is conducted by a committee appointed for the same by the district administration. Post-mortem of all maternal deaths is recommended, unless there are contraindication for the same. Many women in reproductive age-span die due to complications during and following pregnancy and childbirth or abortion. It may be classified as directly or indirectly related to pregnancy or preventable/ non preventable.

The targeted interventions by the Government of India with the objective of addressing all aspects of maternal care have translated into a consistent decline in MMR over the last eight years. Health in a holistic manner, by providing excellent healthcare facilities to pregnant women, right from early stages of diagnosis of pregnancy to postpartum care. Schemes have been designed keeping in mind the requirement of a range of medical facilities, right from testing and regular check-ups, to facilities for smooth delivery and further on to postnatal care of both mother and child.

Pradhan Mantri Surakshit Matritva Abhiyan, for instance, seeks to improve the quality and coverage of diagnostics and counselling services, along with providing assured comprehensive and quality antenatal care free of cost.

Pregnant Women are among the major target groups of POSHAN Abhiyaan- the government’s flagship programme to improve nutritional outcomes

To ensure a pregnancy without any financial woes for the women, the Government has launched the Pradhan Mantri Matru Vandana Yojana (PMMVY), a direct benefit transfer (DBT) scheme under which cash benefits are provided to pregnant women in their bank account directly to meet enhanced nutritional needs and partially compensate for wage loss.

Providing a positive birthing experience to pregnant women has been made an imperative through programmes like Surakshit Matritva Anushasan (SUMAN), and Labour Room & Quality Improvement Initiative (LaQshya). SUMAN aims to provide assured, dignified and respectful delivery of quality healthcare services at no cost and zero tolerance of denial of services to any women and new born visiting a public health facility in order to end all preventable maternal and new born deaths and morbidities. This initiative has been built on the progress of schemes like Janani Shishu Suraksha Karyakram (JSSK) and ­Janani Suraksha Yojana (JSY).

Pregnant women are affected by Gastro-intestinal and Liver disorders. These are related or not related to pregnancy. Unrelated conditions are pre-existent or co incidental during pregnancy. Pregnancy may promote symptoms / alter course of new or pre-existing disease resulting in complications only during pregnancy. This in turn can have adverse effect on clinical course affecting mother and fetus. The management remains same but its effect on mother and fetus needs to be kept in mind with pro-active treatment. Severe liver diseases though rare during pregnancy can occasionally be life threatening. Pregnancy after bariatric surgery / liver transplant is possible but with thorough counselling and needs multidisciplinary approach. Endoscopy for GI problems, if required can be carried out by Gastroenterologist with special attention. Hence, this article, for quick reference to tackle GI and Liver disorders in pregnancy. Gastro-intestinal · Liver · Pregnancy

Aim and Objective

To determine the efficacy of antenatal corticosteroids given in the late preterm period.

Methodology
We conducted a retrospective case–control study on patients with singleton pregnancies who were at a risk of delivering in the late preterm period (34 weeks to 36 weeks 6 days). A total of 126 patients who had received antenatal corticosteroids (prenatal administration of either betamethasone or dexamethasone, minimum one dose) during the late preterm period were taken as cases, and 135 patients who had not received steroids antenatally due to various reasons, for example, who were clinically unstable, presented with active bleeding, non-reassuring foetal status that obligated an imminent delivery and those in active labour were included as controls. The various neonatal outcomes like APGAR score at one and five minutes, incidence of admission and duration of stay in neonatal intensive care unit (NICU), respiratory morbidity, requirement of assisted ventilation, intraventricular haemorrhage (IVH) necrotizing enterocolitis, transient tachypnea of the newborn, respiratory distress syndrome, use of surfactant, neonatal hypoglycaemia, hyperbilirubinemia requiring phototherapy, sepsis and neonatal mortality were compared between the two groups.

Results
The baseline characteristics of both groups were comparable. There was a lower incidence of admissions to neonatal intensive care unit (NICU) (15% vs. 26%, p = 0.05), respiratory distress syndrome (5% vs. 13%, p = 0.04), requirement of invasive ventilation (0% vs. 4%, p = 0.04) and hyperbilirubinemia requiring phototherapy (24% vs. 39%, p = 0.02) in the babies of the group that received steroids compared to the control group. The rate of overall respiratory morbidity in the neonates was lowered after giving steroids (16% vs. 28%, p = 0.04). The incidence of neonatal necrotizing enterocolitis, hypoglycaemia, IVH, TTN, sepsis and mortality between the two groups was not significant (p > 0.05).

Conclusion
Antenatal corticosteroids administered to patients between 34 and 36 weeks 6 days of gestation reduce respiratory morbidity, requirement of invasive ventilation, respiratory distress syndrome, hyperbilirubinemia requiring phototherapy and the incidence of NICU admissions in the newborns.

Antenatal corticosteroids · Late preterm · Respiratory morbidity · Respiratory distress syndrome · Neonatal intensive care unit (NICU) · Hyperbilirubinemia · Phototherapy · Invasive ventilation

Background
Due to the significant role of male in decision making in India, they may decide if, when and where a woman may access antenatal, delivery and postnatal care; and whether or not to provide financial resources to travel to these services. Men's involvement in maternity care is recognized as a key strategy in improving maternal health and accelerating the reduction of maternal mortality. This study explores key components and challenges to male involvement in maternal health care (MHC).

Methods
Focus group discussions (FGDs) were conducted with a purposive sample of the community key stakeholders from the field practice area of All India Institute of Medical Sciences, (AIIMS) Rishikesh from October 2020 to January 2021. Manual thematic analysis with a semantic approach was used for the data analysis. Themes were prioritized using Participatory rural appraisal (PRA) technique.

Results
Twenty-three participants represented the heterogeneous group of key stakeholders. Stakeholders identified the need for improved awareness regarding MHC services among men. Husband involvement is affected by availability (work stations at different places), literacy, gender-based work domain and social cultures, finances and health facility environment.

Four major themes were identified: Male involvement in antenatal, intranatal; postnatal care; and barriers to male involvement in MHC. Sub-themes under male involvement in antenatal care; intranatal care; and postnatal care were further prioritized via PRA as ‘very important’; ‘important’ and ‘not so important’ and scores were given as 3, 2 and 1 respectively.

Conclusions
Male involvement is a key strategy to improve pregnancy outcome; however, different challenges exist in their involvement in the maternal health care. Current study helped to contextualize the perception regarding importance of male involvement in MHC; and the situation of study area in order to understand social and cultural factors that shape the behavior and practices of men in relation to their involvement.

Perception · Male involvement · Maternal health care · Husbands’ involvement · MHC

COVID 19 pandemic is one of the biggest challenge to health system of developing as well as developed countries. Because of the novelty of the virus, limited data were available regarding perinatal outcome. The objective of this study is to find out the perinatal outcome in COVID-19 infected mothers who delivered during COVID Pandemic.

Methodology
A cross sectional study was carried out at PCMC’S Post-Graduate Institute and YCM Hospital Pune (Maharashtra) from 1 May 2020 to 31 October 2021 which was a dedicated COVID hospital during COVID pandemic. A total of 362 maternity patients (including 5 twin pregnancies) having COVID 19 infection who gave birth to 367 Newborns were studied. Maternal COVID -19 infection was diagnosed either by RTPCR test or Rapid Antigen test. Demographic variables, maternal symptoms, labour and neonatal outcome were recorded. RT PCR of neonates at birth was performed. Data was analyzed statistically by using Epi Info Software.

Aim
To analyze the perinatal outcome among COVID-19 infected mothers who delivered during Covid pandemic.

Objectives
Study was conducted with the primary objective to analyze the labour outcome, maternal symptoms and secondarily to study maternal demographic profile and to compare disease severity during 1st and 2nd wave of COVID and to detect possibility of vertical transmission of COVID-19 in neonates of covid positive mothers.

Results
74.2% patients from young reproductive age (21–30 years age) were affected. All socioeconomic classes were affected. 61% patients were multigravida. Normal BMI was noted in 49.8%. 28.2% deliveries were preterm. Caesarean section rate was 50.5%. Following obstetric high risk factors were noted—anaemia in 34.2% followed by previous LSCS in 26.2% cases and preeclampsia in 18.7% Overall 54.6% patients were asymptomatic while 45.4% were symptomatic. Symptomatology between 1st and 2nd wave showed statistical significance (p value < .05%) for mild, moderate and severe symptoms. Myalgia, cough, fever and fatigue were common presenting symptoms. 14% patients required ICU/HDU care. HDU/ICU requirement showed statistical significance (p value < .05) between 1st and 2nd wave. Overall maternal mortality was 1.1% (4 maternal deaths in 2nd wave) with no mortality in 1st wave. 96.4% were live births. Birth weight was more than 2.5 kg in 62% cases and 21.3% cases required NICU. Vertical transmission of COVID was seen in 1.1% cases.

Conclusion
Pregnant patients with moderate and severe disease are at higher risk of perinatal complications. ICU/HDU management with multidisciplinary management may reduce morbidity and mortality. Neonatal affection due to COVID may not be severe but may increase prematurity due to iatrogenic intervention.

COVID-19 · SARS-CoV-2 · Perinatal Outcome · Neonatal Outcome · Preterm labour

Background
Many resource-constrained centres fail to meet the international standard of 30 min of decision-to-delivery interval (DDI) of Category-1 crash caesarean deliveries. However, specific scenarios like acute foetal bradycardia and antepartum haemorrhage necessitate even faster interventions.

Methods
A multidisciplinary team developed a “CODE-10 Crash Caesarean” rapid response protocol to limit DDI to 15 min. A multidisciplinary committee analysed a retrospective clinical audit of maternal–foetal outcomes over 15 months (August 2020–November 2021), and expert recommendations were sought.

Results
The median DDI of twenty-five patients who underwent a “CODE-10 Crash Caesarean delivery” was 13 ± 6 min, with 92% (23/25) of DDIs falling below 15 min. Seven neonates required intensive care for more than 24 h with no maternal or neonatal mortality. DDIs during office and non-office hours were not significantly different (12.5 ± 6 min vs 13 ± 5 min, p = 0.911). Transport delays caused the two instances of DDI > 15 min.

Conclusion
The novel "CODE-10 Crash Caesarean" protocol may be feasible for adoption in a similar tertiary-care setting with appropriate planning and training.

Caesarean section · Decision-to-delivery interval · Quality improvement · Patient safety

Introduction
Practice of starting and sustaining breastfeeding is affected by many conditions, mode of delivery is one of the major factor influencing it. Purpose of the study was to see if the mode of delivery affects the subsequent lactation in early postpartum period and to raise awareness among the community about the importance of mode of delivery in early initiation of breast feeding.

Materials and Methods
Present study was a hospital based observational, comparative prospective study. A sample size of 120 subjects in each group (caesarean delivery CD Group and vaginal delivery VD group) was required. Serum prolactin and LATCH score both at 1st hour and 24th hour were compared in both groups.

Results
Mean LATCH score at 1st hour and 24th hour of CD Group was 5.44 ± 0.68 and 7.12 ± 0.95, respectively. The mean LATCH score at 1st hour and 24th hour of VD Group was 7.12 ± 0.94 and 8.1 ± 1, respectively. Mean serum prolactin level at 1st hour and 24th hour of CD Group was 259.68 ± 33.99 and 309.99 ± 42.27, respectively. Mean serum prolactin level at 1st hour and 24th hour of VD Group was 304.91 ± 42.07 and 333.34 ± 42.65, respectively. The mothers delivered by caesarean had main problem with latch (L) and hold (H) of the baby as compared to mothers delivered vaginally.

Conclusion
Mode of delivery has a direct impact on early initiation of breast feeding. Caesarean delivery is a cause for delay in initiation of breastfeeding.

Breastfeeding · Lactation · Caesarean delivery · Vaginal delivery · LATCH score · Prolactin

Introduction
The study aimed to evaluate COVID-19 associated psychological distress among pregnant and postpartum women during the second wave of COVID-19 in India.

Methods
A cross-sectional survey was done using a pre-validated tool involving 491 participants attending a tertiary-care hospital during the second wave of COVID-19 in India.

Results
Three-fourths of participants experienced negative emotions such as fear and various features of depression. Participants (75%) reported COVID-related news on TV/Radio/Newspapers including social media as the major trigger for these negative emotions. Loss of social support mainly affected postpartum women (p < 0.001) and working women (p < 0.001). Inability to access healthcare services had negative associations with age (p < 0.001), education (p < 0.001), and socioeconomic class (p < 0.001). Various coping strategies being followed by participants included watching TV/Videos or reading books (93%), resorting to social media (77%), spending more time praying and meditating (86%), and engaging in hobbies (56%).

Conclusion
During the second wave, the COVID-19 pandemic had a significantly high negative impact on the psychological and social well-being of pregnant and postpartum women. Hence, it is important to initiate appropriate preventive and corrective steps by the policymakers for any future waves of the pandemic.

Developing country · COVID-19 · Pregnant women · Postpartum women

Background
Levonorgestrel Intra Uterine System insertion for contraception is preferred in the follicular phase. However, the ideal time of insertion for Abnormal Uterine Bleeding is not stated clearly. The aim of our study is to find out the effect of timing of insertion on expulsion and irregular bleeding pattern post insertion.

Methods
A follow-up study of patients with LNG-IUS for AUB was conducted. They were grouped into four based on the day of insertion from Last Menstrual Period (LMP). The pattern of irregular bleeding post insertion was compared with odds ratio and the expulsion rate was compared with log rank test.

Results
The most common indication for the 76 patients was ovulatory dysfunction (39.4%) followed by Adenomyosis (36.84%). Those who had LNG-IUS insertion from day 22–30 had quicker expulsions of 25% of patients by 3 months. By 6 months and later expulsion rate was much higher in the luteal phase than the follicular phase (p < 0.03). The least risk of moderate or heavy bleeding was for the 8–15 day group when compared to the 22–30 day group, the odds ratio being 0.03 [95% CI: (0.01–0.2)].

Conclusion
Based on expulsion rate alone, insertion of LNG-IUS at any time in the follicular phase is ideal. Considering both expulsion rate and pattern of bleeding the ideal time would be late follicular phase, that is 8–15th day.

Abnormal uterine bleeding (AUB) · Last menstrual period (LMP) · Levonorgestrel intra uterine system (LNG IUS) · Expulsion rate · Follicular phase · Luteal Phase

Background
COVID-19 pandemic led to an alarming rise in sickness absenteeism among the radiologists. Anticipating a continued shortage of experienced radiologists in future COVID waves, it is essential to train the medical professionals in basic skills related to ultrasonography to enable them to perform basic Obstetrics and Gynecology (OG) scans safely in emergencies. Virtual reality simulation training is an alternative to conventional ultrasound training.

Methods
A cross-sectional study was conducted during 8-day-long workshop to identify the trainees’ basic, after training knowledge and skills in OG ultrasound and to document their perceptions of the training. Statistical analysis was done using descriptive statistics (percentages and mean standard deviations) and paired t test for comparisons.

Results
A total of 80 health care professionals underwent ultrasound simulation training. It was found that the post-test score in the knowledge domain, instrument handling, basic gynecological skills, and first-trimester antenatal ultrasound skills in the practical domain was significantly higher than the pre-test score (P-value < 0.0001). Out of 80 participants, 45 (56.25%) agreed that ultrasound simulation is an ideal method of teaching and training basic OG skills to the novice. Sixty-six out of 80 (82.5%) felt that the principles of handling a human mannequin are the same as those of real patients. Forty-eight participants out of 80 (60.0%) felt that ultrasound simulation can be used as an ideal tool for self-assessment of health care professionals.

Conclusion
The study showed that ultrasound-based simulation can provide a realistic setting for training and assessment of novices in learning basic skills.

COVID-19 · Virtual reality simulation training · Ultrasonography · Skill assessment

Background
Polycystic ovary syndrome (PCOS) is one of the most common endocrine disorder having most impact on women of reproductive age group, affecting their quality of life (HRQOL) and psychological well-being.

Objective
This paper aims to determine QOL among women affected with PCOS attending a multidisciplinary clinic using PCOSQ tool and its association with socio-economic status, phenotypes, anxiety, depression and metabolic comorbidities and evaluate the coping strategies adapted by these women.

Design
Retrospective study.

Setting
Integrated multidisciplinary PCOS clinic.

Patient(s)
Two hundred and nine women diagnosed with PCOS as per Rotterdam criteria.

Results
Infertility was an important condition for reduced HRQOL and psychological morbidity across all socio-economic status and phenotypes. The poor psychological status and obesity were identified as determinants of HRQOL among women affected with PCOS. Those who suffered from anxiety, depression and showed lower HRQOL used emotional maladaptive coping strategies.

Conclusion
Results reveal that HRQOL of PCOS women is worsened in the presence of comorbidities. Maladaptive and disengagement coping strategies used by women may worsen their psychological status. Holistic assessment of comorbidities and its management can help improve HROL of affected women. Personalised counselling based on the assessment of coping strategies used by women could empower women to cope better with PCOS.

Polycystic ovary syndrome · Quality of life · Coping strategies · Anxiety · Depression

Introduction: Non-Invasive Prenatal Testing (NIPT) screens for common chromosomal abnormalities like Trisomy 13, 18, and 21 and sex chromosomal aneuploidies with high sensitivity and specificity and is also available to screen for rare autosomal aneuploidies (RAAs). Trisomy 22, one of the RAAs, leads to spontaneous abortion in most cases but in rare cases, live births are reported with severe fetal-placental outcomes. Genome-wide NIPT can help in the early detection of rare aneuploidies and help with the management of pregnancy outcomes and recurrence risk. Case presentation: A 26-year-old primi gravida opted for NIPT at 16 weeks 4 days of gestation. Her clinical indication included absent nasal bone and increased risk (1 in 149) for Trisomy 21 on Second Trimester Screening. NIPT revealed a low risk for common chromosomal aneuploidies, however, genome-wide screening data revealed an incidental finding of Trisomy 22. The pregnancy was terminated in view of Tetralogy of Fallot observed in a follow-up ultrasound examination. Confirmatory testing of a chromosomal microarray on the product of conception sample revealed mosaic gain (~30%) involving chromosome 22. Discussion: This is the first case study from India that describes a true fetal mosaic Trisomy 22 detected through NIPT. It addresses the challenges of genetic counseling for rare aneuploidies. It further adds evidence to the clinical utility of genome-wide NIPT for detecting RAAs and their pregnancy implications

Leiomyomatosis Peritonealis Disseminata (LPD)/ Parasitic Leiomyoma is a rare variant of smooth muscles nodules occurring outside the uterus. According to FIGO classification, parasitic leiomyoma is of type 8, and Kelly and Cuccess in 1909 first described parasitic leiomyoma. Extra uterine leiomyoma are rare and occur with unusual growth pattern or in unusual location that make their identification more challenging both clinically and radiologically. The clinical presentation is non specific and depends on the site of recurrence. Most patients are asymptomatic and if symptoms occur they are abdominal / pelvic mass, pressure or abdominal distension etc., A fibroid away from the uterus with a history of Lap myomectomy / hysterectomy with Power Morcellation gives us a clue of LPD / Parasitic leiomyoma. Surgical excision is the main treatment.

India is presently in the midst of a major health crisis with the second wave of corona virus spreading at an alarming rate and claiming more lives than ever before. Although the pandemic is affecting the lives of all sections of society, adolescent girls being a vulnerable group are affected in dual manner, not just by the direct effects of the virus but also by many still underrated indirect effects. The present article aims to highlight the indirect yet sinister effects of COVID-19 on physical, mental, social, sexual and reproductive and psychological health and well-being of adolescent girls and other issues like their personal safety, peer support and long-term health issues.

adolescent health · COVID-19 · childhood obesity