Patient harm unknowingly or knowingly due to adverse uncertain events occurring while in hospital is one of the leading causes of morbidity and mortality worldwide. It is very significant in Obstetric practice. Conditions like wrong drug administered to wrong patient, anaphylactic reactions to certain drugs, post-partum haemorrhage due to certain conditions and delayed decision making are all contributing to patient harm. Patient safety is a new health care discipline that has emerged due to the growing complexity of health care systems with multiple employees involved and the rise of patient harm in health care facilities. World Patient Safety Day was established in 2019 by the Seventy-second World Health Assembly through the adoption of resolution WHA 72.6 – “Global action on patient safety”. The overall objectives of the Day celebrations are to enhance global awareness of patient safety, increase public engagement in health care safety, and promote global action to prevent and reduce avoidable harm in health care. Each year a different theme is selected to shed light on a priority area critical to patient safety and ultimately the achievement of universal health coverage. The theme selected for World Patient Safety Day 2021 is “Safe maternal and new born care”, due to the significant burden of risks and harm women and new borns are exposed to when receiving care during childbirth. The issue has been further compounded multiple times by the COVID-19 pandemic, which has led to the disruption of essential health services due to breaks in supply chains, women’s inability to access care,, and the shortage of skilled health professionals. This year’s campaign slogan – “Act now for safe and respectful childbirth!” – calls on all stakeholders to accelerate the actions necessary for ensuring safe and respectful childbirth. It is envisaged that the momentum generated by World Patient Safety Day 2021 will revamp stakeholders’ efforts to achieve universal health coverage for all women and new borns and ultimately achieve the maternal and new born SDG 3 targets. “ACT NOW FOR SAFE AND RESPECTFUL CHILDBIRTH!”

Female genital tuberculosis (FGTB) is an important cause of significant morbidity and infertility.

Gold-standard diagnosis by demonstration of acid fast bacilli on microscopy or culture or detection of epithelioid granuloma on histopathology of endometrial or peritoneal biopsy is positive in only small percentage of cases due to its paucibacillary nature. Use of gene Xpert on endometrial or peritoneal biopsy has improved sensitivity of diagnosis. Composite reference standard (CRS) is a significant landmark in its diagnosis in which combination of factors like AFB on microscopy or culture, positive gene Xpert, epithelioid granuloma on endometrial or peritoneal biopsy, demonstration of definite or probable findings of FGTB on laparoscopy or hysteroscopy. There have been many advances and changes in management of FGTB recently. The program is now called National Tuberculosis Elimination Program (NTEP), and categorization of TB has been stopped. Now, patients are divided into drug-sensitive FGTB for which rifampicin (R), isoniazid (H), pyrazinamide (Z) and ethambutol (E) are given orally daily for 2 months followed by three drugs (rifampicin, isoniazid and ethambutol (RHE) orally daily for next 4 months. Multi-drug-resistant FGTB is treated with shorter MDR TB regimen of 9–11 months or longer MDR TB regimen of 18–20 months with reserved drugs. In vitro fertilization and embryo transfer have good results for blocked tubes and receptive endometrium, while surrogacy or adoption is advised for severe grades of Asherman’s syndrome.

Purpose of Study To evaluate the knowledge, attitude and perception of HIV/AIDS among antenatal women and to correlate them with their socio-demographic profile.

Methods We conducted this study on 400 pregnant women attending the antenatal clinic of our hospital for the first time irrespective of their period of gestation, age and parity. All the participants were interviewed with the help of a predesigned questionnaire which included their socio-demographic details and questions to assess their knowledge and attitude toward HIV/AIDS. Data were analyzed using SPSS version 22 and expressed in the form of percentage, frequency distribution, mean, standard deviation and p value.

Results Antenatal women of the study population were having unsatisfactory knowledge about HIV/AIDS and prevention of MTCT. 26% women were totally unaware of any entity like HIV. 44% participants did not know the most common way of spread of HIV. Only half of the subjects knew the correct preventive measures for HIV/AIDS. 54% knew about MTCT, but only 24% knew about its transmission through breast milk. Knowledge and attitude was found to be significantly improving with socioeconomic status.

Conclusion Indian antenatal women have poor awareness and wrong perception about HIV/AIDS and its mother to child transmission (MTCT). Targeted educational interventions can be formulated to increase awareness among antenatal women about prevention of vertical transmission of HIV.

Introduction Pregnancy is characterized by a series of metabolic changes that promote insulin resistance. This could be due to increase in the plasma levels of one or more pregnancy-related hormones such as oestrogen, progesterone, prolactin, cortisol, and human placental lactogen (HPL). The increased insulin resistance in pregnancy is associated with development of diabetes which has implications for the future gestations also.

Aims and Objectives To determine status of insulin resistance in pregnant women and correlate the presence of insulin resistance with obstetric outcome.

Material and Method A prospective cohort study was conducted in the Department of Obstetrics and Gynaecology, KGMU, Lucknow, over a period of one year. Total 150 pregnant women were enrolled from OPD, out of which 136 women were followed up till delivery. Insulin resistance was calculated by HOMA IR index, twice in whole antenatal period (first in early pregnancy and second in late pregnancy). All women were also tested for GDM by DIPSI test (plasma glucose value after 2 h of 75 gm glucose load irrespective of last meal) as per protocol.

Results In our study, we found 71 women out of 136 (52.2%) were GDM. Total 30 women out of 136 (22.05%) were GGI (Gestational Glucose Intolerance), and total 38 out of 136 (27.9%) women were found to have insulin resistance using HOMA IR ≥ 2 as cut off. Significant correlation was found in between BMI and insulin resistance (p = 0.001) and between GDM and insulin resistance (p = 0.001). Relative risk of development of complications like Preeclampsia, neonatal hypoglycemia, and respiratory distress syndrome was higher in women having insulin resistance and GDM.

Conclusion Obstetric complications like preeclampsia, neonatal hypoglycemia, and respiratory distress syndrome are more likely to occur in women with insulin resistance, but larger studies are required to delineate whether insulin resistance alone without development of GDM will have the same implication

Background Parent to child transmission is the major mode of spread of HIV. An effective national health program (PPTCT) has been designed under NACO which helps in reducing the spread of HIV by vertical transmission and improving the life of the women and her baby.

Methods A retrospective study was done at a tertiary care hospital, including pregnant women registered and delivered, and those who came directly in labour at the hospital during a period of 10 years from January 2010 to December 2019. Pretest counselling, HIV testing, Post-test counselling were done, and antiretroviral prophylaxis was given as per the NACP guidelines. Sociodemographic characteristics, obstetric outcome and efficacy of PPTCT services were analysed.

Results Out of the 63,947 antenatal mothers included, 61,061 (95.4%) accepted HIV testing. 177 of these tested positive (0.289%) with a significant reduction in the seroprevalence over the decade. Majority of seropositive women were primigravida; housewives from urban areas, from low income and educational background and with no history of any contraceptive use. Out of 718 live births, the MTCT rate was found to be 4.5% at 6 weeks over the whole decade and was noted to be 1.8 % at 18 months which is well within the goal of PPTCT program and hence elucidating the success. Seventy-four spouses of the 177 seropositive women tested positive, 55 tested negative and 49 did not undergo the HIV testing. Decline in the number of partners not undergoing testing was elicited. The discordant couple rate in the study was 31% and showed variable trend over the decade.

Conclusions Our study has observed an overall increase in efficacy of PPTCT in terms of increased utilization of PPTCT through the decade, decrease in the vertical transmission and seroprevalence rate, increase in the acceptance rates of HIV testing by partner almost conquering the goal of NACO.

Background The physical characteristics which are known to affect the ovarian reserve are age, body mass index (BMI), occupational exposures, age at menarche and menstrual cycle length. A correlation between different physical characteristics and the ovarian reserve will help to identify areas which need to be tackled to increase the chances of fertility of women in India.

Methods In this retrospective, observational study, namely the MOTHER Study, data of women between 18 and 45 years of age, attending the selected fertility centers across different states in India were taken for evaluation. Demographic information along with information on factors potentially related to fertility like age of menarche, menstrual cycle length and occupational factors were collected by review of medical records at screening visit. Most recent AMH assay and antral follicle count (AFC) where the subject has not taken any contraceptives 12 months prior to the test were collected.

Results Age of woman, years of marriage, years of infertility and smoking have shown effect on ovarian reserve testing like AMH and AFC. The other physical characteristics which were evaluated and considered to affect the ovarian reserve like body mass index BMI, occupational exposures, age at menarche and menstrual cycle length have not shown statistically significant correlation.

Conclusion Age of woman and years of infertility are inversely proportional to ovarian reserve markers, namely AMH and AFC. Addictions like smoking and alcohol affect ovarian reserve.

Introduction Endometriosis associated pelvic pain (EAPP) is the most common complaint of patients with endometriosis. Nearly, 70% of females with endometriosis present with EAPP while endometriomas are found in 17–44% of patients.

Material and Methods A short-term single centre study was carried out in 56 patients in the age group of 15–35 years with complaints of pain and diagnosed as endometriosis either by imaging studies and/or by laparoscopy was given dienogest 2 mg OD, and effect of treatment was seen as improvement of pain score over a period of 3 months. The effect of dienogest was also seen on size of endometrioma. Patients were followed up at 1 and 3 months.

Results and Discussion Out of 56 patients, 38 (67.8%) patients reported their pain relief within 2–5 days after starting dienogest. Out of 41 patients (73%) who had severe pain at enrollment, only 1 patient (1.79%) complained of severe pain at the end of 1 month with dienogest. Successful reduction in endometriotic cyst size (>50%) was seen in 3 patients (5.3%) at the end of 1 month with dienogest. Out of 56 patients, 41 patients (73.2%) had significant pain relief (>30%) at three months of treatment. At the end of 3 months, seven patients (12.5%) had significant cyst size reduction (>50%) with dienogest. No major side effects were noted.

Conclusion Dienogest is well tolerated drug for endometriosis showing significant relief of pain. However, it was seen that though endometriomas did not grow during treatment, significant regression was uncommon.

Background An Operational Framework document for population-wide screening of common cancers in India was launched in 2016. The target age for screening is 30–65 years for cervical, breast and oral cancers. This study was designed to review the frequency and distribution of cervical lesions among women aged 21–29, 30–65 and > 65 years.

Study Design A retrospective review of all satisfactory cervical smears (n = 79,896) received over a ten-year period (2010– 2019) was conducted. Three age bands were defined: 21–29 years, 30–65 years and > 65 years. The frequency and distribution of the various epithelial cell abnormalities (ECAs) across the three age bands were calculated. Cytohistologic correlation was performed wherever available.

Results Of the 1357 ECAs (1.7% of all smears), about 16.9% were seen in the age band 21–29 years, while 4.5% presented in > 65 years of age. About 80% of the ECAs seen in younger women were low-grade squamous lesions, while 75% of lesions in women > 65 years were high-grade squamous abnormalities. Among the total 512 significant high-grade and malignant (squamous and glandular) lesions, 5.6% presented in women 21–29 years, while 10.1% were seen in > 65 years of age.

Conclusion Majority of the significant cervical lesions would be detected if the screening focuses on the 30–65 years age group. However, about 19% of high-grade squamous preneoplastic lesions (ASC-H/ HSIL) and 13% of preneoplastic glandular lesions (AGC-N) are likely to be missed if women 21–29 years and > 65 years are excluded. The cost of screening incurred by including these age groups has to be weighed against the benefits derived, especially in low-resource settings. In the absence of universal implementation of HPV immunization, there is a felt need to enhance cervical cancer awareness and encourage screening, more so in high-risk category and symptomatic females beyond the selected age group.

Patients of Von Willebrand disease are prone to high amounts of bleeding throughout their life. The chances of bleeding in such patients in the antenatal period is 10 times more as compared with normal women. The risk of bleeding is also comparatively high during parturition and also in the post-partum period. Therefore, healthcare providers should be vigilant for complications that they arise to such patients in the antenatal period, during delivery and in the post-partum period. we managed one such case of Von Willebrand disease in pregnancy with factor transfusion and vigilant monitoring and had a successful delivery with healthy baby.

Lymphoma of ovary is very rare. Involvement of ovary by lymphoma is usually secondary to disseminated systemic disease. Primary involvement of ovary by lymphoma is rare and is seen in only 1.5% of all ovarian neoplasms. Hereby we report a youngest case of ovarian lymphoma from India in 11year old girl presenting with abdominal mass and pain. Ovarian tumor was diagnosed on computed tomography and oophorectomy was done through laparotomy. Diagnosis of ovarian lymphoma was made on histopathology and immunohistochemistry. The primary ovarian lymphomas are rare and possess significant diagnostic challenge when occur due to nonspecific radiological features and diagnosis can only be made after histopathological and immunohistochemical examination of the tumor.

Ichthyosis uteri is an exceedingly rare condition in which the entire surface of the endometrium is replaced by stratified squamous epithelium. It is a benign lesion and its association with benign and malignant conditions has been reported in the literature (Bewtra, Xie, Hunter, Jurgensen (Arch Pathol Lab Med 29:e124–e125, 2005)). Originally described as an endometrial response to iatrogenically introduced caustic substances, similar changes have since been described in association with a variety of inflammatory conditions of the endometrium. It is concluded that a squamous cell carcinoma of the cervix extended proximally into the endometrium (Bagga, Jaswal, Datta, Mahajan (Indian J Pathol Microbiol 51:267–268, 2008)). The possibility of significant cervical pathology should be considered when plaques of squamous epithelium with low-grade dysplastic changes are identified in an endometrial biopsy or curettage.

“Kabadi’s stitch” is a novel, reversible, conservative method of treating utero-vaginal prolapse by cervico-vaginal fixation to immobilize the prolapse in elderly, surgically unfit women. For a long time, vaginal constriction by introital stitch or vaginal wall approximation has been practiced as a conservative method. Unlike colpocleisis, this novel method has the advantage of accessibility of cervix and uterus and more so reversible and very simple to perform.

Introduction Congenital transformation zone (CTZ) of the uterine cervix is a non-neoplastic, rare condition resembling high-grade lesions on colposcopic examination which leads to diagnostic dilemmas.

Case Description A multiparous woman was screened for cervical cancer. Visual inspection using acetic acid was positive for which further evaluation with colposcopy was done. An aceto-white lesion resembling high-grade precancerous condition was seen. Punch biopsy was taken from multiple areas and the histopathology report demonstrated chronic cervicitis with increased maturation of the superficial layers of squamous epithelium. The lesion persisted on the follow-up colposcopy even after a course of antibiotics.

Discussion CTZ could be difficult to differentiate from cervical premalignant lesions. The main aim of this article is to help other colposcopists to understand this physiological variant.

Conclusion The CTZ is a physiological entity and differential diagnosis for cervical premalignant lesions on colposcopy.

The introduction of oocyte vitrification has propelled the field of oncofertility. However, it is becoming increasingly common to offer planned oocyte cryopreservation to healthy, fertile women due to a lack of a partner or other personal issues. The aim of this article is to discuss the pros and cons of planned oocyte cryopreservation along with potential exploitation issues by unregulated clinics and international agencies. This article further encourages obstetricians and gynecologists to discuss these issues of planned oocyte cryopreservation with their patients to empower them to make an educated decision based on research and science rather than be susceptible to entities that stand to gain monetarily by prompting women to fear a childless future.