We entered the field of Obstetrics and Gynaecology very keen to learn, always do well for patients, and become the practicing consultants we are today. We believe in reproductive rights of our women and evidence-based medicine: together these help us provide optimal care. Staying up to date with literature is very important for any clinician who seeks to practice thoughtful, evidence-based medicine. The recent six studies are as follows 1. Gestational age at time of COVID-19 and outcome (September 2021) 2. COVID-19 vaccination does not increase risk for miscarriage (September 2021) 3. Joint statement from ASA/APSF on preoperative COVID-19 testing regardless of vaccination status (August 2021) 4. Timing of delivery in fetal growth restriction (August 2021) 5. Fertility and pregnancy outcomes among female surgeons (July 2021) 6. Delayed cord clamping versus cord milking in preterm infants (April 2021)

Background Serum leptin has been considered as an important measurable diagnostic and prognostic biomarker for polycystic ovarian syndrome (PCOS), although its evidence for use in clinical practice is limited. We aim to synthesize the available evidence on the clinical use of serum leptin values in PCOS by doing a systematic review and meta-analysis of studies.

Objective To conduct a meta-analysis to determine the pooled effect size of the association of leptin levels in patients with PCOS.

Methods We searched electronic databases, i.e., PubMed, Google Scholar, Web of Science, ClinicalTrials.gov, and Medline from inception to September 2020, keeping filters for human studies and published in the English language. We used the random-effects model if heterogeneity between the studies was>50%; otherwise, a fixed-effect model was applied to determine the standardized mean difference with 95% CI for comparison of leptin level between cases and controls. All the statistical analyses were completed using software STATA version 13.

Results The meta-analysis included a total of 35 studies involving 2015 cases and 1767 controls that suggested statistically significantly higher leptin levels in the women with PCOS as compared to controls (SMD, 1.76, 95% CI 1.28 to 2.23, P<0.001). In the stratified analysis when only high methodological quality studies were included, we did not observe a statistically significant difference in the leptin level between PCOS and controls (SMD 0.68, 95% CI −0.09 to 1.46). Analysis restricted to low methodological quality studies observed statistically significant high leptin levels in PCOS women as compared to controls (SMD 2.24, 95% CI 1.65 to 2.83).

Conclusion The available evidence suggests that elevated leptin levels may be associated with risk of PCOS as compared to controls; however, failure to observe the similar association in high methodological quality studies demands further well designed adequately powered studies to validate the findings.

Fungal skin infections are on the rise in India, and pregnant women are not immune to it. They are one of the commonest causes of secondary pruritus in pregnancy and can worsen the quality of life. Cutaneous dermatophytic infections have seen a recent emergence as a public health problem in India with increasing incidence as well as failure to appropriately respond to treatment. Vaginal candidiasis may cause obstetric and peri natal complications such as chorioamnionitis, premature rupture of membranes, preterm labor and neonatal candidiasis. Antifungal drugs are commonly prescribed in pregnancy. The common oral antifungals used are fluconazole, ketoconazole, itraconazole, terbinafine and griseofulvin; whereas the common topical antifungals are azoles, ciclopirox oleamine, terbinafine, amongst others. There have been reports of congenital abnormalities in the fetus and spontaneous abortions attributed to oral antifungals. Prescribing antifungal drugs in pregnancy needs careful consideration. In this article, we discuss the safety profile and recommendations regarding the use of these drugs during gestation. We have performed literature search of recent large-scale cohort, case control and meta-analysis studies and presented them in this review. Antifungals such as echinocandins, amphotericin B, flucytosine etc. which are indicated for systemic mycoses are beyond the scope of this article. Finally, we have given authors’ perspective regarding the justifiable use of these antifungals in pregnant women

Aim To determine the socio-demographic characteristics and pregnancy outcome of Rh D alloimmunized women monitored with MCA PSV (middle cerebral artery peak systolic velocity).

Materials and Methods In total, 363 Rh D alloimmunized women attended antenatal clinic or obstetric emergency between January 2006 and December 2014. MCA PSV was the screening method for detection of fetal anemia. Intrauterine blood transfusion (IUT) was given when MCA PSV was > 1.5 MOM. Totally, 162 women (164 fetuses) received 492 transfusions. Forty-eight women had fetal hydrops at presentation. Five women (three received IUT) were lost to follow-up. Pregnancy outcome of 358 women and socio-demographic characteristics of 363 women were analyzed.

Results The perinatal mortality was 421, 66 and 87 per 1000 live births in hydrops group, non-hydrops IUT group and non-IUT group, respectively.

Conclusion Rh alloimmunization is still a major cause of perinatal morbidity and mortality. The higher gravidity, previous history of pregnancy wastage, still births and hydrops increase the requirement of intrauterine transfusion. MCA PSV is an excellent tool for monitoring of Rh alloimmunized pregnancies to detect fetal anemia. Early detection and monitoring by MCA PSV improve its outcome.

Background Progesterone is essential for the maintenance of a healthy pregnancy. Any defect in the secretion of human chorionic gonadotropin or progesterone is associated with a significantly increased risk of first-trimester abortion. Progesterone is frequently prescribed to patients presenting with per vaginal (PV) bleeding in early pregnancy and a history of recurrent pregnancy loss.

Methods Pregnant women up to 12 weeks of gestation with a history of more than two early pregnancy losses and presenting with vaginal bleeding were included in this study. All subjects were randomized to receive either vaginal progesterone 600 mg/day or oral dydrogesterone 30 mg/day. A detailed history—including menstrual history, previous pregnancies, previous miscarriages, and other risk factors–was obtained. The mean time required for the cessation of PV bleeding and continuation of pregnancy up to 24 weeks and till term was compared.

Results A total of 200 patients were randomized to vaginal progesterone 600 mg/day (n = 100) or oral dydrogesterone 30 mg/day (n = 100). While 74 patients had two miscarriages in the progesterone group, 68 patients had two miscarriages in the dydrogesterone group. The time required for complete cessation of bleeding was significantly lesser among patients who received oral dydrogesterone compared to those who received intravaginal progesterone (53.90 ± 9.09 vs. 94.60 ± 7.29 h, p < 0.0001). Numerically higher number of patients receiving oral dydrogesterone had a successful continuation of pregnancy up to 24 weeks of gestation, as well as till full term compared to progesterone group (70 vs. 75).

Conclusion Oral dydrogesterone is preferred over vaginal progesterone in patients presenting with vaginal bleeding during early pregnancy and a history of recurrent early pregnancy loss

Background Recent evidence suggests that thyrotropin (TSH) levels are population specific because of differences in ethnicity. As a result, the 2017 ATA guidelines state that treatment may be tailored as per the laboratory-specific reference ranges of TSH for the local population instead of using a fixed upper limit of 2.5 mIU/L during pregnancy.

Methodology This was a cross-sectional study in which we collected detailed clinical data of 604 pregnant women along with their TSH and spot urinary iodine excretion levels. Reflex testing for thyroid peroxidase antibodies (TPOAb) was done in women with TSH levels > 2.5 mIU/L in 1st trimester and 3.0 mIU/L in 2nd and 3rd trimester. After excluding 295 women who had high risk factors as per ATA 2017 guidelines and those who were TPOAb positive, we calculated the reference range for TSH in an iodine-sufficient low-risk cohort of 309 women.

Results With median urinary Iodine of 255 µg/l, our population had more than required iodine levels. The 5th and 95th percentiles of TSH in our study cohort of 604 women were 0.64 and 7.81 mIU/L, respectively, while the 5th and 95th percentiles of TSH for the low-risk cohort of 309 women were 0.59 and 4.48 mIU/L, respectively.

Conclusion An upper limit of 4.5 mIU/L for TSH level during pregnancy can be used to guide management decisions for low-risk North Indian women.

Objective Nearly 1.5 billion people of an Asian country are living their lives without a country-specific over-the-counter (OTC) drug list. A study was planned to assess the understanding and practice of OTC medication consumption in the pregnant population.

Methods A questionnaire-based cross-sectional study evaluating different perspectives on OTC drug consumption was planned in around 500 pregnant women attending tertiary care outpatient antenatal clinics. The association of knowledge, attitude and practice versus indications, knowledge regarding harmful effects possible, reasons for choosing OTC medication, the practice of consulting nonmedical persons and drug interactions with the disease or prescription medications was determined. Regression analysis was performed in statistical software R.

Results Seven percent (36/516) of pregnant women were found to consume oral antimicrobials without prescription. Local chemist consultation was the most common channel (72.48%) to procure the OTC medicines. Participants with good knowledge score showed an odds ratio (OR) of 1.87 (95% C.I.; 1.28–2.73), 1.6 (95% C.I.; 0.99–2.63), 1.66 (95% C.I.; 1.14–2.42) and 2.66 (95% C.I.; 1.49–4.89) for self-medication encouragement tendency possible, restricting sale of OTC medications, the habit of reading drug leaflets and understanding the potentially harmful effects, with OTC drugs, respectively. Right-attitude participants showed an OR of 1.89 (95% C.I.; 1.29–2.80) and 1.8 (95% C.I.; 1.19–2.76) for identifying knowledge of acetaminophen overdose and liver damage link as well as the disease symptom masking possibility with OTC, respectively. Participants with insufficient knowledge and attitude scores showed an association with more OTC antacid-antiemetics and analgesic use, respectively.

Conclusion Antenatal pregnant women need to be guided on avoiding OTC antimicrobial usage. Both obstetricians and regulators have to play an active role in educating pregnant women and contributing to developing country-specific OTC drug lists with the guidelines.

Purpose We aimed to assess the effect of TOT procedure on sexual function and quality of life in sexually active patients.

Materials and Methods Forty-one patients with SUI aged 18–70 years participated in this study during 2015–2019. Sexual function was evaluated by Female Sexual Function Index (FSFI), Incontinence Impact Questionnaire (IIQ-7) and Urogenital Distress Inventory Questionnaire (UDI-6) prior to TOT surgery and six months after surgery.

Results The mean IIQ-7 and UDI-6 scores were significant lower after surgery (P < 0.001). The mean FSFI score was 22.69 ± 5.48 prior to surgery and 29.79 ± 4.12 in the sixth month after surgery (P < 0.001). We found significant changes in all FSFI domains except for pain. Two patients complained of new dyspareunia after surgery. There was also a direct significant correlation between education and sexual function improvement in terms of desire (P = 0.031).

Conclusion TOT can significantly enhance sexual function with low rate of complications in patients with SUI.

Background Laparoscopic port entry is crucial and vital step in any laparoscopic surgery. As laparoscopy is widely used, complications related to it are also increasing which are not seen in conventional laparotomy.

Aim The present study was undertaken to compare the ease of primary trocar entry after pneumoperitoneum at 20 mmHg pressure and direct trocar entry without pneumoperitoneum.

Methods Total 100 nulliparous patients who presented for elective gynaecologic laparoscopic surgery were enrolled for the study. In operating theatre, randomization of patients was done using a sealed envelope technique which divides patients into two equal groups and assigned as either low-pressure group or high-pressure group. Verres needle insertion and trocar entry was done by fellowship trainee in laparoscopy assisted by senior laparoscopy surgeon.

Result In high-pressure group we had trocar entry in first attempt in 80% of patient, second attempt in 20% where as in direct trocar entry group required first attempt in 88%, second attempt in 10% and third attempt in 2%. Time taken for trocar entry between two groups was significantly different requiring 4.42 ± 0.55 min for high pressure and 1.2 ± 0.28 min for direct trocar entry.

Conclusion The study concluded that high-pressure trocar entry requires more time; require less attempts, easier and surgeon will be more comfortable in repeating the same technique than direct trocar entry.

Background Laparoscopic management of endometrial cancer is beneficial in view of decreased operative morbidity and post-operative recovery. In the case of early gynaecological malignancies, it is a safe and feasible mode of surgery.

Methods A prospective study was conducted in our tertiary centre in the period January 2017–December 2019. The study included 51 patients diagnosed with endometrial carcinoma. Demographic details and operative findings have been recorded.

Results The mean age was 55.47 years; 64.7% were post-menopausal. 86.2% had stage IA disease. All patients underwent laparoscopic staging. The mean operative time was 115 min, estimated blood loss was 82.5 ml, pelvic nodal yield was 13.53, and para-aortic nodes were 20.78. There were no conversions to laparotomy or any intra-operative complications, and none of the patients had recurrence. During post-operative follow-up, 2 patients had lymphocyst, 1 had chylous ascites and 1 had port site hernia. Average hospital stay was 3 days.

Conclusion In our study, we found that laparoscopic management of endometrial cancer is less morbid and has better post-operative recovery.

Delayed postpartum haemorrhage caused by partial or complete dehiscence of uterine scar is extremely rare. A case, hereby, is presented of delayed severe postpartum haemorrhage presenting as late as 44 days following LSCS. Patients with delayed postpartum haemorrhage should evaluated for uterine scar dehiscence. If missed, the consequences can be catastrophic with prolonged severe maternal morbidity.

Accessory and cavitated uterine mass is rare developmental Mullerian anomaly. There is a non-communicating uterus-like mass that occurs contiguously along wall of uterus often underdiagnosed and needs expertise to identify. To raise awareness, provide information about this pathology and emphasize role of coronal 3D ultrasound in its diagnosis. A 28-year-old married female presented with dysmenorrhea and chronic pelvic pain. On ultrasound, a homogeneously isoechoic mass was noted in right lateral wall of uterus with central echogenicity. On 3D reconstruction, the main uterine cavity was normal and both cornu were visualized without any recognized Mullerian anomaly. No communication with the main endometrial cavity seen. On laparoscopy, mass was located under right round ligament insertion. Sectioning revealed chocolate colored fluid. ACUM is non-communicating uterus-like mass. It resembles uterus both macroscopically and microscopically. It represents a cavitated mass lined by endometrial glands and stroma surrounded by irregular smooth muscle cells. Criterias for diagnosing ACUM are (1) accessory cavitated mass located under round ligament; (2) normal uterus, fallopian tubes, and ovaries (3) surgical case with excised mass and pathological examination; (4) accessory cavity lined by endometrium with glands and stroma; (5) chocolate-brown fluid contents. On ultrasound, they appear solid isoechoic masses with central cystic areas separate from ovaries. 3D reconstruction can be used to rule out Mullerian anomaly. ACUM is a rare surgically treatable cause of dysmenorrhea, often underdiagnosed due to lack of knowledge about entity. 3D ultrasound can be highly accurate in making the diagnosis.

NMDA encephalitis is a rare but potentially fatal condition triggered by dermoid cysts of the ovary. We present a case of a young lady with behavioural changes that progressed to abnormal movements and coma. Evaluation revealed anti-NMDA antibodies and a teratoma in the ovary. She underwent tumor removal and immunotherapy, with subsequent recovery. The case highlights the need for awareness among the patients and gynaecologists of this unique entity.

Pigmentation on hysteroscopy is a rare finding. The authors describe a case where hysteroscopy revealed hemosiderin pigmentation on fundal endometrium. Hemosiderin pigmentation is a marker of a number of uterine afflictions including Adenomyosis and endometritis among others.

Body stalk anomaly, with a prevalence of 0.12 in 10,000 births, occurs when abdominal organs develop outside the abdominal cavity while remaining attached to the placenta in the fetus. This article relates to a rare case of Body Stalk anomaly detected in the first trimester of pregnancy. The images presented are characteristic to the anomaly. A postnatal evaluation confirmed the findings and helped in comprehensive counseling of the patient.