We are fifteen months into the COVID-19 pandemic and infections and deaths are waxing and waning in many parts of the world. For the first time in history of mankind there has been such drastic behavioural change in humans. The coronavirus pandemic has drastically changed the way common people live, interact, and work. Social distancing, facial masks and hand sanitisation have to be followed in any closed space. Rules of communication and etiquette have been modified in personal growth, social life, and the business world, and even in medical communication. Beside changing social and work ethics like finishing all outdoor activities like shopping and work in one go before reaching home, measures taken to contain the virus have also reshaped greetings and the rules of everyday etiquette. The pandemic brought about a significant change in living from greetings from far to handshakin g, table and seating arrangements with social distancing, entertainment culture in open air, artistic activities rekindled while at home isolation, sports activities in open environment, and most importantly, professional behaviour codes of conduct. Expensive clothes, hair, makeup, and accessories will be replaced by simplicity and pastels, and natural colours will be preferred more in clothes. Most Consultants counsel one reliable relative in addition to the patient consistently and the number of relatives accompanying the patient is reduced to one. Instructions are given in clear writing to reduce time with the patient. Question and answers are to be kept at a minimum. However, as the pandemic in India is entering a “new phase” of the outbreak, we are on the brink of a third wave and governments and individuals need to take further responsibility and further actions to mitigate risk of infection and minimize transmission while maintaining social and economic activities at the same time. Vaccination also plays an important role in improving herd immunity. The Government of India on 19th May 2021 gave its approval to administer vaccination to lactating women who wish to take the dose. The Federation of Obstetric and Gynecological societies of India and The National Expert group on vaccine administration for Covid 19 state that “benefits outweigh the risks” and therefore women who breast feed must be educated about the vaccine and given the choice to make informed decision. Five and a half months into immunisation programme against Covid 19, pregnant Indian women have been allowed vaccination, paving the way for the entire adult population of the country to be vaccinated. 33.57 crore vaccine doses have been administered till date in India. Preventing COVID-19 transmission is heavily dependent on public compliance and private sector cooperation to the Government to suppress human to human transmission.

The endometrium is a dynamic target organ in a woman’s reproductive life. It undergoes cyclical change regulated by the fine balance between oestrogen and progesterone. The endometrial thickness (ET) varies according to the phases of the menstrual cycle. Endometrium contains both oestrogen and progesterone receptors, which respond to above hormones, irrespective of whether the woman is in reproductive or menopausal phase. Abundance of oestrogen leads to endometrial hyperplasia, and paucity causes endometrial atrophy. The initial best modality of assessing ET or aberration is high resolution transvaginal ultrasonogram. Thickened endometrium is always a clinical conundrum. Dilemma does remain as to the thickness of endometrium which requires intervention, mostly in symptomatic pre and perimenopausal women. In post-menopausal women with bleeding, the cut-off of ET that warrants investigation is almost defined. However, the cut-off value of ET in asymptomatic postmenopausal women; beyond which intervention is required, is still debated. Dilemma also exists about the cut-off of ET in both symptomatic and asymptomatic women on HRT and Tamoxifen. This article will discuss the above issues and reach at some consensus about the cut-off of ET after critical analysis of evidence and experience and will help clinicians in arriving at a proper decision in dealing with such clinically confounding situations.

Background India plays an important role in global research on gestational diabetes mellitus (GDM), but a bibliometric assessment of this research is lacking.

Objective To provide a comprehensive analysis of Indian GDM research during the last 30 years using select bibliometric indicators.

Methods The Scopus international database was used to retrieve publication data, using a defined search strategy. The analysis focused on research output of Indian authors and organizations and their collaborations. The qualitative performance was assessed in terms of relative citation index and citations per paper (CPP).

Results Overall, 100 countries participated in GDM research producing 13,193 publications during 1990–2019. India ranked ninth in global output (1182 publications, 3.1% share) and CPP of 18.6. Only 21.3% of publications had international collaboration and 9.4% were funded. Of the 235 organizations and 544 authors that participated in India’s research on GDM, the top 50 organizations and authors contributed 53.8 and 36.4% to national publication share, respectively. The leading productive organizations were AIIMS, New Delhi, KEMH, Pune and PGIMER, Chandigarh, whereas the most productive authors were S. Kalra, V. Seshiah and C.S. Yajnik. Indian Journal of Endocrinology and Metabolism, Journal of Clinical and Diagnostic Research, Journal of Obstetrics and Gynecology of India and Diabetes Research and Clinical Practice were the most productive journals.

Conclusions Indian research on GDM is lagging behind other countries which have a similar disease burden. Increasing national and international collaborations, and active support of national and international funding agencies is urgently required to produce quality research on GDM.

Background Previous studies have suggested that chronic periodontal infection may be associate with preterm births and low birth weight. The present study was conducted to evaluate the levels of interleukin-17 (IL-17) in saliva samples of pregnant females as a possible marker in determining whether or not an association exists between chronic periodontitis and preterm labor.

Aim The aim of the study is to assess the relation between the periodontal health status and preterm low birth weight of the new born on the basis of salivary IL-17 levels.

Materials and Methods This case–control study included a random sample of 40 female patients, aged 18 to 35 years, who were in their second trimester, assigned to two groups, Group 1 consisted of 20 pregnant females without periodontitis, Group 2 included 20 pregnant females with periodontitis. Saliva samples were obtained in the second trimester and postpartum. Saliva samples were measured by using ELISA for IL-17 levels.

Results IL-17 levels in saliva were significantly higher in Group 2 than that of Group 1(p < 0.001). There was no significant difference found between the preterm and low birth weight cases and periodontitis.

Conclusion This study did not find any association between the periodontitis and preterm deliveries and low birth weight cases on the basis of IL-17 levels in saliva.

Background/Purpose of the Study Foetal urinary tract dilation (UTD) abnormalities affect 1–5% of all pregnancies. However, exact incidence is difficult to estimate because of different terminologies used to define the condition and different grading systems to define its severity antenatally as well as postnatally worldwide. In order to overcome this problem, the new UTD classification system has been introduced in the year 2014 so as to have universal approach for diagnosis and management of UTD globally. Indian data about clinical utility of the UTD classification system and its role in prenatal prediction of severity of renal disease are lacking. The present study aims to investigate clinical utility of new UTD classification system in foetal UTD abnormalities and to evaluate the role of UTD classification system in antenatal prediction/prognostication of severity of UTD abnormalities.

Methods We conducted a single-centre retrospective study between April 2014 and January 2017, which included 70 infants with antenatally diagnosed UTD delivered in our hospital and managed in our paediatric unit postnatally. Pre- and postnatal ultrasound findings were noted, and UTD-A and UTD-P classification were applied retrospectively in all cases as per criteria defined in the new UTD classification. Postnatal outcome in all cases was evaluated in terms of need for immediate postnatal urosurgical intervention, presence of persistent UTD pathology and severity of renal impairment in relation to their pre- and postnatal UTD A and P risk categories.

Results None from UTD A1 risk group in the last prenatal scan showed significant postnatal UTD abnormality. In contrast to this, UTD A2–3 risk group in the last prenatal scan had persistent postnatal UTD pathology in 70% cases. All infants with abnormal postnatal UTD diagnosis were identified prenatally as UTD A2–3 (high risk). Nine infants (12.8%, n = 70) who needed urosurgical intervention postnatally were categorised as UTD A2–3 prenatally and UTD P3 postnatally.

Conclusion We found increased frequency of complications and urosurgical interventions in all infants with antenatal UTD A2–3 grades in the last prenatal scan in comparison with those with UTD A1 grades who showed complete resolution (100%) postnatally. Antenatal UTD classification may be useful in antenatal prediction and prognostication of postnatal severity, especially in high-risk cases (i.e. UTD A2–3).

Background In Low- and Middle-Income Countries like India, where the services and surgical care for Congenital Heart Disease (CHD) are available only in selected centres with geographical variations, it is important to detect Heart defects early and give the parents an opportunity to plan ahead for seeking appropriate care at the earliest. Several developments in recent years such as improvement of quality of ultrasound machines, sonographer’s experience, skills and better description of cardiac views have contributed to improve detection rate.

Methods A retrospective study was done between March 2016 and December 2019, and showed ultrasound evidence of CHD was included.

Results The total number of morphology scans done during study period was 50,435. The number of congenital anomalies detected was 1482, out of which CHD was detected in 334 (22.5%). Outcome of 50 pregnancies were not available while the rest (284) were available for follow up in post-natal period. There were 51 cases of CHD, missed on routine antenatal morphological screening, which were diagnosed in the post-natal period. There were 18 cases of over-diagnosed CHD on antenatal scan, but were found to have normal echo findings after birth.

Conclusion A systematic approach is crucial for practitioner to determine the patterns of associated defects. Use of step wise strategy helps in determining the correct diagnosis of isolated cardiac defect, associated with other system or a part of syndrome. Systematic audit of morphological scans could play an important role in improving the diagnostic accuracy, which in turn will lead to early detection.

Purpose of Study To study the role of uterine artery Doppler pulsatility index (UtA-PI), serum pregnancy-associated plasma protein-A (PAPP-A) and free beta human chorionic gonadotropin (fβ-hCG) levels, individually and in combination with each other, at 11–14 weeks of gestation for prediction of preeclampsia (PE).

Methods In a prospective observational study, a total of 100 low-risk gravid females were recruited at 11–14-weeks of gestation. UtA-PI, PAPP-A and fβ-hCG levels were estimated. These women were followed up until delivery for the development of PE and gestational hypertension (GH).

Results The best individual marker for screening PE and GH was UtA-PI with ROC AUC (± standard error) = 0.934 ± 0.028, p < 0.0001. UtA-PI at a cutoff value of ≥ 2.8 (95th percentile) had 77.8% sensitivity, 98.9% specificity, 97.8% NPV and 87.5% PPV in detecting PE. PAPP-A (MoM) at a cutoff value of ≤ 0.27 (5th percentile) demonstrated 44.4% sensitivity, 95.6% specificity, 94.5% NPV and 50% PPV. fβ-hCG (MoM) at a cutoff value of ≤ 0.5 (5th percentile) had a specificity of 94.5%. Among the combined markers, UtA-PI along with PAPP-A estimation served best with a sensitivity and specificity of 44% and 100%, respectively. Addition of fβ-hCG to either UtA-PI or PAPP-A levels was not found sensitive for detecting PE but yielded 100% specificity and 96% NPV.

Conclusion UtA-PI as a stand-alone test was found most useful for the prediction of PE. Addition of either or both of PAPP-A and fβ-hCG to UtA-PI did not improve the sensitivity of combined test with only a slight improvement in specificity and NPV. Their routine addition to UtA-PI studies is not recommended for prediction of PE at 11–14 weeks of gestation in low- and lower-middle-income countries (LMIC).

Background This study is to estimate the prevalence and to determine the risk factors for neonatal Covid-19 infection

Methods Retrospective analysis of all deliveries in Covid-19-infected mothers in a tertiary care centre in North Kerala from 15 April 2020 to 15 October 2020

Results Of the 350 Covid-19-positive pregnancies 223 delivered, two were intrauterine foetal demises. In total, 32 out of 221 newborns were Covid-19-positive (14.47%). The risk was more in vaginal delivery group (17.39%) compared to caesarean group (13.16%). The breastfeeding and rooming-in group (18.79%) had more infection than those babies who were not breastfed and separated from mother (1.78%).14 out of 86 (16.28%) babies delivered within 7 days of mothers turning negative became positive compared to 2 out of 23 (8.7%) babies delivered between 7 and 14 days of negative result (Odds ratio of 2.04). None of the babies delivered 14 days after negative result has become positive.

Conclusions The present study shows that neonatal Covid-19 infection is not rare. The risk is greater in vaginal delivery group and those babies who are breastfed and allowed to stay with mothers. Delaying delivery more than 7 days after mother becoming negative protects the newborn from getting infection

Introduction Fetal hydrops is a serious condition which has high morbidity and mortality. Incidences of immune hydrops have decreased by manifold after introduction of anti-D immunoglobulin. Intra-uterine fetal blood transfusion revolutionized the treatment of these affected fetuses after diagnosis of immune fetal hydrops. In this study we aim to evaluate the clinical characteristics of immune hydropic fetuses and perinatal outcome after institution of intra-uterine transfusions.

Materials and methods A retrospective study was carried out in pregnant women with immune fetal hydrops from October 2004 to December 2019 in our tertiary care hospital. After diagnosis of fetal hydrops, all the fetuses received intra-uterine transfusions. All the newborns were followed up till 3 months postdelivery. All the fetuses were divided in two groups: hydrops diagnosed below 32 weeks (Group A) and in second group hydrops diagnosed after 32 weeks gestation (Group B).

Results Total 63 patients were diagnosed to have hydrops during the study period. Group A had 48 fetuses and Group B had 15 fetuses. Average gestational age of diagnosis of hydrops in group A was 24.2 weeks and in group B it was 32.5 weeks. All the fetuses received intra-vascular intra-uterine transfusion. Pericardial effusion was found to be significantly associated with group A. Successful perinatal outcome was seen in 92% fetuses. 87% fetuses had complete resolution of hydrops before delivery. All the fetuses received phototherapy and intra-venous immunoglobulin after delivery, and 5 fetuses underwent exchange transfusion.

Conclusion Favourable perinatal outcome was achieved in hydropic fetuses with intra-uterine blood transfusions. Complete resolution of hydrops before delivery increases the chances of perinatal survival.

Background Customized clinical and administrative interventions in the form of a care pathway tool can improve VBAC outcomes and reduce the alarming rise in caesarean sections globally.

Objective To determine the effect of a locally tailored clinical pathway tool on VBAC outcomes in a private hospital in India.

Methods A pre- and post-implementation study was conducted in a private hospital in India. All women with one previous caesarean section term pregnancy and cephalic presentation were included at baseline from January 2013 to December 2015 (Phase 1) and from January 2016 to December 2018 (Phase 2) after ongoing implementation of a clinical pathway tool by all providers. Background characteristics and clinical outcomes in both phases were reviewed retrospectively from case files.

Results Overall 223 (13.42%) women among 1661 total births and 244 (11.62%) women among 2099 total births were included in Phase 1 and Phase 2, respectively. Total number of women who underwent trial of labour (TOLAC) increased from 36.77% to 64.34% (P < 0.001) and VBAC rate increased from 23.76% to 58.19% (P < 0.001) in Phase 2. There was no significant difference in perinatal morbidity and mortality in the two phases.

Conclusion A locally customized clinical care pathway tool implemented to support both mothers and care givers for TOLAC seemed to improve VBAC outcomes in a private setting in India.

Background Stress urinary incontinence (SUI) is involuntary leakage of urine on raised intra- abdominal pressure which adversely affects quality of life usually requiring surgical treatment.

Methods This is a prospective study of efficacy, cure rates and complications of tension free transobturator tape (TOT) surgery on 85 women with SUI. Pre-operatively and 6 months post-operatively International consultation on Incontinence Questionnaire – Short Form (ICIQ-SF) scores were calculated for all patients to know the severity of incontinence and efficacy of tape.

Results Mean age, parity, body mass index and mean duration of symptoms were 45.78 years, 2.68, 26.38 kg/m2 and 3.85 years, respectively. SUI was demonstrated in all cases on cough stress test and Bonney’s test. Mean operative time, blood loss, post-operative analgesic injections, post- operative stay and post- operative catheterisation were 23.28 min, 45.50 ml, 1.2 injections, 1.2 days and 1.2 days. Various complications noted were excessive bleeding (3.52%), urinary retention (7.05%), urinary urgency (8.23%), urinary tract infection (2.35%), surgical site infection (1.17%), groin pain (28.23%) and mesh exposure (3.52%). At 6 months follow-up, the complete cure rate was 83.52% , partial cure rate was 11.76% and failure rate was found to be 4.70% whereas it was 79.16%, 12.0% and 8.33% respectively at 3 years follow up. 2 patients (2.35%) required burch colposuspension and 12 patients (14.11%) required pelvic floor exercises and duloxetine therapy for their symptoms. Mean pre- operative ICIQ-SF score reduced post- operatively (17.8 ± 4.67 to 2.71 ± 1.42) (p value = 0.001).

Conclusion Study demonstrates short and long-term efficacy and safety of TOT for surgical management of SUI.

Objective To study the presence of isthmocele in post-cesarean women using USG and MRI and its correlation with risk factors.

Method This was a prospective observational study. A total of 90 patients were enrolled at the time of discharge of cesarean delivery and were advised to come for follow-up at 3–4 months for detection of isthmocele. A total of 82 patients reported for follow-up, and TVS and MRI Pelvis were done for visualization of isthmocele. If isthmocele was diagnosed, its correlation with risk factors was studied.

Results On TVS isthmocele was present in 11 patients and on MRI in 16 patients. Detection rate was 77.07% in comparison with previous studies. Compared to MRI, sensitivity of USG was 68.75%; however, the specificity and positive predictive value for both were 100%. The negative predictive value for USG compared to MRI was 92.96%. Shape of the isthmocele was triangular in most women. Obesity, prior history of cesarean delivery, elective cesarean, gestational diabetes, preeclampsia and prolonged active labor were associated with development of isthmocele.

Conclusion The study concluded that yield of diagnosis of isthmocele by MRI was better than TVS but not statistically significant. Further study with large sample size is needed to identify the best tool for diagnosis of isthmocele. Obesity, gestational diabetes, preeclampsia, prior history of cesarean, elective cesarean and prolonged active labor were associated with development of isthmocele.

Backgrounds To analyse the morbidity, mortality and survival pattern following surgery for borderline ovarian and malignant ovarian tumours.

Methods The medical records of 57 consecutive patients with invasive and borderline epithelial ovarian cancer patients registered and operated in our tertiary centre between 2015 to 2017 were reviewed. Patients were followed up for a minimum of 18 months to maximum of 42 months at an interval of 3 months with CA125 values. Various prognostic factors were analysed. The data descriptive statistics of frequency and percentage analysis were used for categorical variables and mean and standard deviation were used for continuous variables.

Results The most common age group was 51 years and above with the majority (56.2%) of women belonging to postmenopausal age group (32/57). In our study, 30 out of 57 women (52.6%) had stage III disease, 17 women had stage I disease (29.8%) and 7 women had stage 2 disease (12.3%). Majority of the women had serous epithelial ovarian tumour (47 out of 57 patients), which contributed to 82.4%. Grade 1 and 2 morbidity was encountered in 8 patients. Six patients had wound infection (grade 1), and 2 patients required blood transfusions (grade 2). One patient had grade 3 morbidity requiring re-laparotomy. Borderline tumours and early-stage epithelial ovarian tumours had good prognosis, less morbidity and good survival. The overall median survival was 25 months.

Conclusions With meticulous perioperative care, surgery for ovarian cancer in the primary and interval setting can be done with minimal morbidity and no postoperative mortality, especially in patients with co-morbidities. Grade is an important prognostic factor affecting the survival of patients with epithelial ovarian cancers undergoing surgery. Lymph node dissection helps achieve local control but may not improve the survival.

Background Cervical cancer is an AIDS-defining illness, and HIV-positive women are at high risk. The present study aimed to determine the magnitude of the problem, compare the performance of screening tests and assess factors affecting participation.

Methods HIV-positive women aged 30–59 years attend the anti-retroviral therapy (ART) clinics were screened by conventional Pap, HPV testing (Hybrid Capture 2) and visual inspection with acetic acid (VIA). A cohort of HIV-negative women from the community matched for age and parity were screened similarly. Screen-positive women underwent colposcopy and biopsy. Factors affecting participation were assessed.

Results Pap, VIA and HPV were positive in 48 (23.8%), 65 (32.2%) and 76 (37.6%) subjects, respectively, among HIV-positive women, and in 12 (5.9%), 10 (4.9%) and 12 (5.9%) subjects, respectively, among HIV-negative women. CIN2 + was present in 12 (6.4%) HIV-positive women and in 1(0.5%) HIV-negative woman (p =  < 0.004). Sensitivity of HPV, Pap and VIA for detection of CIN2 + lesions was 91.7%, 75.0% and 75.0%, respectively; specificity was 68.4%, 83.9% and 72.5%, respectively. Lack of availability of screening facilities in the ART clinic and long waiting times were a strong deterrent to participation among HIV-positive women.

Conclusions There was higher prevalence of HPV infection and CIN2 + lesions in HIV-positive women. VIA showed equivalent sensitivity to Pap and could be a good substitute in low resource settings. Setting up cervical screening services in ART clinics and sensitising physicians can improve outcomes among these women.

Background Uterovesical abscess, or bladder flap hematoma, refers to an infected collection in the space formed between the lower uterine segment and bladder during lower segment cesarean section. It presents as pain, fever, and anemia in the puerperal period, and can be diagnosed as a pelvic collection on ultrasound or magnetic resonance imaging. Laparotomy and drainage has traditionally been used for large abscesses, contributing to perinatal morbidity.

Conclusion Minimally invasive surgery extrapolated to the obstetric ward, can reduce maternal and neonatal morbidity.

Posterior reversible encephalopathy syndrome (PRES) is a clinical and radiological syndrome associated with a number of conditions including preeclampsia, eclampsia. We report three cases of PRES in eclamptic women and describe the management of these patients. All three women improved after multidisciplinary team management. PRES should be considered in women with severe form of eclampsia associated with coma or other neurological features.

Myomatous erythrocytosis syndrome (MES) is a condition where uterine myoma is associated with erythrocytosis. It is a rare condition which is even rarer in pregnancy. This is no report of MES in pregnancy in India. Our case is 31 years old G3P1L1A1 with previous 2 myomectomies who presented at 32 weeks with cellulitis of right lower limb and severe pre-eclampsia. She was already diagnosed to have uterine myomas in the 1st trimester sonogram. On routine investigations she was found to have erythrocytosis. Her erythropoietin levels were also elevated, and repeated sonograms showed progressive increase in the size of myoma. She was managed preoperatively with venesection and hydration. Later she was taken up for classical Cesarean section and myomectomy with tubal sterilization at 36 weeks. Postoperatively her haemoglobin and haematocrit dropped. Her erythropoietin levels also showed a marked downward trend. Histopathology of myomectomy specimen reported as leiomyoma. Erythropoietin and its receptor could not be demonstrated in the surgical specimen for the want of investigation felicities.

Endometrial Stromal Sarcoma is an uncommon gynaecological tumour. Extrauterine Endometrial Stromal Sarcoma (EESS), the extra uterine variant of its relatively more common counterpart is even rarer with only few case reports documented. We report a case of a 40-year woman with a diagnostically challenging bilateral adnexal tumours and synchronous invasive ductal breast carcinoma (IDC). The pathology specimen confirmed the diagnosis of EESS in the absence of florid endometriosis and synchronous hormone positive infiltrating duct cancer in the breast. Patient was started on adjuvant endocrine therapy and is disease free at 2 years. To the best of our knowledge, this is the first documentation of synchronous presentation of IDC and EESS, highlighting the possible role of hyper-estrogenemia as an etiological factor

Background Primary amenorrhea secondary to the uterine injury caused by a blunt trauma to the pelvis, in childhood is a rare problem. To the best of our knowledge this is the first case reported.

Methods We report a rare case of primary amenorrhea in a 17 year old girl and how systematic approach helped us to come to a diagnosis and treat the patient successfully. Results: Detailed history, biochemical testing, imaging, karyotype and diagnostic laparoscopy, revealed normal uterus which was seen separately from the cervix with the uterine transection seen at the lower uterine segment. Both the ovaries and tubes were normal with retrograde bleeding seen in the pouch of Douglas. Surgical correction was successful by laparoscopic anastomosis of uterus with the cervix resulting in her normal periods.

Conclusion We are presenting an unusual case of successfully treated uterine injury with uterine and cervical anastomosis. Uterine injury caused due to a road traffic accident at 2 years of age was missed and it presented as primary amenorrhea at the age of 16 years. Postoperatively she started menstruating regularly. Stepwise evaluation of a primary amenorrhea case leads to early diagnosis and early correction of the problem which helps in retaining the future fertility

We present a case of 46-year old female with hyperandrogenism due to leydig cell tumour of 30 left ovary which was masqueraded by adrenal incidentaloma. She was referred to 31 Endocrinology department for virilization work up. Her biochemical evaluation revealed 32 serum testosterone level of 418 ng/dl with normal adrenocortical hormones. In view of 33 normal transvaginal ultrasonography and computed tomography of abdomen and pelvis 34 showing right adrenal mass, she was subjected to laparoscopic right-adrenalectomy. But her 35 testosterone levels remained elevated after surgery. This mandated laparoscopic exploration 36 of ovaries, which ended in bilateral oophorectomy. Histopathological examination of left 37 ovary revealed a leydig cell tumour. Three-month post-surgery, her hirsutism regressed to a 38 large extent and shaving frequency reduced to once in two months. Thus, tumoural range 39 hyperandrogenism with normal adrenocortical hormones mandates evaluation for an ovarian 40 cause even in background of an adrenal mass.

Retroperitoneal intravenous leiomyomatosis is a rare benign tumor that can spread through veins carrying significant morbidity. The challenge of its management lies within the complexity of completely excising the tumor, which if carried out improperly can result in neurological or vascular complications requiring complex reparative surgeries. Here we present the successful resection of a retroperitoneal angio-leiomyoma by combining laparoscopic route, micro-surgical techniques and modern endoscopic tools.

Imaging in Uncommon Pelvic Complications of Pregnancy: A Pictorial Essay

Dilatation of foetal urinary collecting system is common. But cause of obstruction, if any, arise from soft tissues or developmental abnormalities of urinary tract or other paradox. A prenatal diagnosis of a ‘calculus’ inside ureter producing obstruction and ultimate back pressure changes in collecting system of a foetus is not reported so far. Other than inborn error of metabolism, what aetiological factors lead to this, are a matter of concern and great research. Here kidneys are not dysplastic. Amniotic fluid volume remains normal. Antenatal administration of calcium either orally or parenterally could be a contributory factor as it promotes nephrocalcinosis; and uretric calculus has it’s origin in kidneys as believed. There is no maternal symptom related to this entity. Here we report a unique case of foetal ureterolithiasis producing hydroureter and hydronephrosis.