The decision regarding oophorectomy during gynaecological surgeries, especially in perimenopausal and postmenopausal women, has historically posed a significant dilemma. Traditionally, it was widely believed that conserving the ovaries held no benefits, leading to a common practice of recommending Bilateral Salpingo-oophorectomy alongside hysterectomy for benign conditions in women aged 40–45 and above. Given our evolving comprehension of postmenopausal ovarian function and the genetic susceptibility to ovarian epithelial cancers, the decision regarding oophorectomy poses a dilemma. Oophorectomy is recommended for women with a higher risk of ovarian cancer and ovarian conservation is necessary with women with higher risk of co-morbidities. This paper reviews the available literature on these aspects of oophorectomy. Despite a wealth of literature narrating the advantages and disadvantages of oophorectomy, covering aspects such as ovarian cancer risk, myocardial infarction incidence, and post-oophorectomy peritoneal cancer, there is a notable absence of a comprehensive evaluation system for risk stratification. The objective of the present paper is to address this gap by consolidating existing literature into a risk stratification system. This system will provide treating physicians a tool that facilitates more informed, case-specific decisions in collaboration with patients and their families. While recognizing that the ultimate decision must be tailored to the individual case and agreed upon mutually by the surgeon, patient, and family, the proposed system seeks to streamline risk stratification. This, in turn, should aid in determining the most suitable course of treatment that maximizes benefits for the patient.

Background: During the Covid-19 pandemic, reproductive health of women was disproportionately affected due to difficult access to safe abortion and contraceptive services. This study aims to assess the impact of the Covid-19 pandemic on the prevalence of MTP cases and to find out the clinicodemographic profiles of women undergoing MTP during three Covid-waves in different hospitals-Government and private sectors in India.

Methods: This retrospective multicentric cohort study was conducted during three Covid-19 pandemic waves. The records were retrieved from the centers’ medical record section and the MTP register from the Department of Obstetrics and Gynaecology.

Results: On an average, 1.1 women/day underwent MTP during covid waves compared to 1.9 women/day during the pre-covid 2019. The first Covid wave’s average MTP/day was very low (0.71) compared to the third (2.88) and second wave (1.12), respectively. These differences were statistically significant (p<0.0001). The most common indication for MTP was contraceptive failure 245(50.9%), followed by eugenic/congenital anomalies 88(18.9%). A total of 244 cases (50.6%) reported for MTP ≤ seven weeks and 114(23.6%) presented between 7 and 12 weeks. More than half (54%) of the women underwent surgical methods for abortion as the unavailability of medical abortion (MA) drugs. IUCD and sterilization were severely affected during the first and second Covid waves.

Conclusion: Safe abortions are essential services for reproductive-age women. With the uncertainty of future Covid-like an emergency, we should strengthen our telemedicine network so that women can reach out early and MMA can be initiated to reduce the number of surgical abortions and unwanted pregnancies.

Background Lower limbs edema is one of the common problems in late pregnancy. This study aimed to determine the effect of modified Berger–Allen exercises on lower limb swelling in late pregnancy.

Materials and Methods This randomized clinical trial was conducted on 105 pregnant women suffering from lower limbs edema. Samples were randomly placed in three groups: modified Buerger–Allen exercises for five days, modified Buerger–Allen exercises for ten days, and the control group. Foot circumferences and volume and pain were measured before and after the study.

Results There was a significant difference between the average of right and left ankle circumference, right and left heel circumference, right and left foot circumference, left foot volume and pain score after the 5-day intervention group (p < 0.05). In the 10-day intervention group, there was a significant difference in all averages of ankles, heels, foot circumference and volume, and pain score 10 days after the intervention, compared to before the intervention (p < 0.05).

Conclusion Performing innovative modified Buerger–Allen exercises in pregnant women with lower limbs edema may reduce their pain and swelling. It can also reduce the leg areas in pregnant women with lower limb edema in late pregnancy

Introduction Robson ten-group classification system is recommended by WHO (World health organization) as a global standard for assessment and monitoring caesarean section (CS) rates. This classification is simple and robust. It is prospective, easily reproducible and clinically relevant.

Methodology We conducted a prospective observational study of CS births at a tertiary care institute. Caesarean births in a tertiary care hospital were classified using Robson classification system as recommended by WHO. The study was conducted for period of 6 months duration. The ethics committee of the institute approved this study. We enrolled 4771 consecutive women who delivered during this study period. We included patients who had vaginal delivery as well as those who had delivery by CS. Both live births and stillbirths (of at least 500-g birth weight or at least 22 weeks gestation (according to WHO recommendations) were included in this study.

Results During this study period, we had 4771 deliveries, out of which 2231 pregnant women (46.76%) were delivered by CS as compared to 2540 vaginal deliveries. Women with previous CS (term with single cephalic pregnancy) were included in Robson group 5.Group 5 had the highest CS rate (13.41%). Robson group 5, 1 and 10 were the largest contributors to the high CS rates at our institute.

Conclusion In our study, 4771 deliveries were conducted during this study period (6 months). Out of 4771 deliveries, CS was done in 2231 pregnant women (46.76%). 2540 women had vaginal deliveries. Group 5 (13.41%) which comprised of women with previous CS had the highest CS rate followed by group 1 and group 10. The second largest contribution was from Group 1 with CS rate of 9.01%. Robson Group 1 included nulliparous term women with single cephalic pregnancy in spontaneous labour. Group 10 was the third largest contributor to the overall CS. Group 10 included women who delivered preterm (single cephalic presentation). Group 10 contributed to 8.09% of overall CS rate. We should make every effort to provide CS for women requiring this procedure, rather than work towards achieving a specific rate for CS.

Aim Compare the impact of the intervention on the outcome of pregnancy of patients receiving obstetric care with and non-COVID-19 diagnosis at a tertiary referral hospital located in the region of East Java, Indonesia.

Methods This was a cross-sectional analysis of 694 pregnant women. These patients’ information was acquired based on the medical data obtained from the hospital. The Mann–Whitney test was used to analyze the disparities among the factors examined in this research investigation.

Results There was a statistically significant difference in length of stay (LOS). It has been shown that individuals diagnosed with COVID-19 often exhibit a longer length of stay (LOS) in healthcare facilities compared to those who do not have the infection. More than fifty percent of patients gave birth by cesarean section, 83 in COVID-19 group and 283 in non-COVID-19 group. The most prevalent complications among COVID-19 patients were maternal infectious and parasitic diseases (1.3 vs 0%), prolonged labor (12.3 vs 9.6%) and puerperal complications (0.6 vs 0%). In 40.9% of COVID-19 patients, acute respiratory distress syndrome (ARDS) was encountered. Infection due to COVID-19 had no discernible impact on the outcomes of pregnancy.

Conclusion Numerous interventions, including cesarean delivery in COVID-19 and non-COVID-19 patients, require reevaluation. It is imperative to undertake a comprehensive reassessment of the health care delivery system, with particular emphasis on enhancing the efficacy of the referral system.

Background Given the underutilization of contraception in India, this study was undertaken to gauge cisgender female clients’ knowledge of, attitudes toward, and barriers to contraceptive usage in North India.

Methodology The present study was done at a tertiary care Institute in North India, where 209 structured interviews were conducted with cisgender female patients attending the outpatient department. One-way chi-square tests for independence, Kruskal–Wallis test, and Wilcoxon test were applied to quantitative data. Themes from qualitative questions were coded and analyzed.

Results Differences in awareness among contraceptives were found to be highly statistically significant (H (9) = 1022.3, p < 2.2 e−16). Friends or colleagues comprised the predominant information source for most contraceptive methods. Participants’ contraceptive usage was low, with 27.27% stating no prior use and 47.47% indicating occasional use (X2 (3, N = 198) = 66.121, p < 2.89 e−14). Lack of perceived need, concern for side effects, fear and desire for children were top reasons for non-use of contraceptive methods. Majority of the participants (79.45%) expressed comfort speaking with their spouse about contraception, 47.18% with a medical provider, 32.82% with friends, 15.38% with family, 2.05% with a health educator, and 3.59% with no one. Participants indicated little prior contraceptive counseling experience.

Conclusion Our study shows differential levels of awareness, usage, and barriers on contraceptive methods among participants. Results also suggest the importance of spouses and friends in clients’ contraceptive decision- making process and their limited counseling experience with health care providers.

Introduction Medical disorders complicating pregnancy have recently emerged as the most common cause for maternal morbidity and mortality and it is important to predict mortality risk when they present in moribund state to emergency obstetric care so as to take and timely effective measures to prevent mortality.

Methods This prospective observational study was conducted over 6 months among pregnant and post-partum women with medical disorders who sought emergency obstetric care at a tertiary care hospital. Severity of morbidity was assessed using SOFA and APACHE II scores at admission.

Results Of the 128 women, 87.5% were pregnant, and 12.5% were post-partum. Hypertensive disorders, cardiac disorders, neurological disorders and infective disorders were 24.2%, 22.6%, 14% and 9.4%, respectively. The optimal cut-off SOFA score was 2 (AUC = 0.739) with 66% sensitivity and 71% specificity and APACHE II score cut-off was 6 (AUC = 0.732) with a sensitivity of 60% and specificity of 78% in predicting severe maternal morbidity. The median scores of APACHE II and SOFA are 14 and 4, respectively, for non-survivors and for survivors it was 4 and 1.

Conclusion Hypertensive disorder was the most common medical disorder, but severity was high in cardiac disorder. SOFA and APACHE II scores are good predictors of morbidity and mortality risk.

Postpartum hemorrhage is a long-running and frequent cause of maternal death in most developing countries and is associated with uterine atony. Nowadays, balloon tamponade has gained popularity due to its advantages. It is a technically simple, safely applied, time saver, and easily removed in a low-risk method and also needs less expertise and no special equipment. Despite all advantages, the Bakri balloon is very expensive in less developed countries and not available everywhere, especially in limited resource settings. Such disadvantages prompted us to perform an innovative, cost-effective, and practical method relying on low-resource equipment and named it “Glove Balloon.” A 26-year-old woman presented in her third pregnancy underwent an elective cesarean section. Following the surgeon’s mention of low segment atony, the patient returned to the operating room quickly. The bleeding continued despite the administration of uterotonic drugs, and because of active bleeding, the decision was made to apply a glove balloon. After gently inserting the glove balloon into the uterus, 500 ccs of saline was inflated into the balloon, and the bleeding stopped shortly afterward. The patient was discharged on the third postoperative day and remained well after. We believe that junior obstetricians and midwives should consider all options, even new strategies, to stop hemorrhages before considering invasive surgical procedures. The “Glove Balloon” is an innovative, practical uterine tamponade balloon that can make the difference between life and death in treating postpartum hemorrhage cases and should be considered a life-saver tool in all settings.

Nearly 25% cases of pyrexia of unknown origin (PUO) may be associated with malignancies but this fever can be attributed to a multitude of causes. In contrast, neoplastic fever by definition is a diagnosis of exclusion and a rarely reported presenting symptom of cancer. We share our experience of yolk sac tumour in an 18 year old unmarried girl who presented with high grade fever as the chief complaint. No cause could be found for her fever even after extensive workup and she failed to respond to empirical antibiotics. Response to oral Naproxen (Naproxen test) suggested the diagnosis of neoplastic fever in this patient. The patient was taken up for staging laparotomy after resolution of fever and unilateral salpingoophorectomy and omectectomy was done. The patient stayed afebrile following appropriate surgical management which further corroborated our diagnosis of neoplastic fever. This unsual presentation should be further studied and considered early on incases of malignancies to avoid delay in diagnosis and management.

Introduction Ovarian carcinosarcoma constitutes 1-4% of all ovarian cancers. The more common site of sarcoma in the pelvis is the uterus. In this paper, we are reporting a case of ovarian carcinosarcoma along with a brief literature review on this aggressive disease. Our case was initially operated at non- oncology centre and referred to us after incomplete surgery.

Case details A 44 year old non- hypertensive and non- diabetic nulliparous female presented to outpatient department with history of sub-total hysterectomy and right oophorectomy done for ovarian tumour at peripheral hospital one month back. Histopathological examination showed malignant spindle neoplasm. Immuno-histo-chemistry was suggestive of ovarian carcinosarcoma/ mixed mullerian tumour with stromal overgrowth. The patient underwent completion surgery and with completion of cytoreduction (CC) score of zero. Final histopathological examination revealed it to be a stage IIIC disease with intra-abdominal metastasis. The patient completed platinum based adjuvant chemotherapy within stipulated time. However, the disease progressed within one month of completion of chemotherapy and the patient is currently recieving second line agent.

Conclusion Given that carcinosarcoma are rare, prospective datas are lacking and case reports, series and observational studies contribute to the understanding of natural course of the disease. This case report stresses upon the need to widen our vision for the rare histologies and their timely diagnosis and appropriate management. This case also affirms the aggressive behaviour of the disease as cited in the previous literature.

An intrauterine contraceptive device is a temporary method of contraception accepted widely all over the world. Although it is safe, complications may occur likewise with any other foreign body. Uterine perforation and extra-uterine migration are rare but serious complications. Here, we describe a case of spontaneous fracture and transmigration of the intrauterine contraceptive device (CU-T 380 A) in the urinary bladder resulting in vesical stone formation.

Body dysmorphic disorder (BDD) was first described centuries ago but it is still unknown to many clinicians. Although onset of body dysmorphic disorder occurs in adolescent age but BDD has received very little attention in adolescent psychiatry literature. Here we are discussing a case report of 14 year girl suffering from belief of splitting of her clitoris. She would watch it in mirror multiple times and feel disgust due her malformed genital part. She would often become very distressed and force her family member for genital surgery. She was taken to gynaecologist. She was referred and treated successfully with use of SSRI and cognitive behaviour therapy.

Background: Postpartum depression (PPD) prevalence in the Indian settings is around 20%. Despite recommendations and strong advocacy, there are large gaps in knowledge and identification of PPD. In the background of reduced adherence to universal screening for PPD, it was attempted to ascertain if some specific groups of women could benefit from selective screening.

Methodology: A comparative, questionnaire-based study among postpartum patients was conducted. Patients were divided into control group (80 women who had good neonatal outcomes) and study group (80 women who had adverse neonatal outcomes). “Adverse neonatal outcomes” was defined as women who experienced stillbirth or a neonatal mortality or neonate needing NICU care. Demographic characteristics and delivery details were noted. The Edinburgh postpartum Depression scale (local translation where applicable) was administered by a single investigator to women when they came for their post-delivery follow up or in the postnatal ward (2-3 weeks after delivery). Patient characteristics and the EPDS scores were noted and compared between the two groups using appropriate statistical tests

Results The groups were similar in their baseline characteristics (age, religion, marriage duration, gravidity and education). EPDS score in those with good neonatal outcomes was lesser than that of those with adverse neonatal outcome (10.07 +/- 4.47 vs11.04+/-4.18 – p value 0.045). Proportion of women who tested positive (higher chance of PPD) was higher (p value 0.0488) in the group with adverse neonatal outcomes (45% vs 28.75%).

Implications: The results of this study should not be misconstrued as “those with good neonatal outcomes do not require screening for PPD”. Rather, PPD screening which is not being done at all, should be done in atleast one selected group (adverse perinatal outcomes group) on priority.

Conclusion: The study implies that this group of patients (with adverse neonatal outcomes) should be considered for prioritization in screening for PPD.