Monkeypox is a contagious viral disease that spreads between animals and people. The UK government guidance described the first case of ‘Monkey Pox’ in 1958, when it was found only in monkeys used for research purposes. Fortunately, for a third world fast developing country like India, monkeypox does not spread easily in the population but spread by close physical contact between people, and there is limited information available about the impact on pregnancy. The virus can enter the body through broken skin, the respiratory tract, or mucous membranes (the moist inner lining of cavities and some organs in the body). The signs and symptoms of monkeypox virus infection in people who are pregnant appear similar to those in nonpregnant people. The symptoms include fever, lymphadenopathy, lethargy, pharyngitis, headache, myalgias, and rash. Rash associated with monkeypox virus infection can be found in the anogenital area (most commonly reported location in this current outbreak), trunk, arms, legs, face, and the palms and soles. The diagnostic approach to a patient with suspected monkeypox virus infection is the same for pregnant and nonpregnant people. If a patient is present with signs and symptoms of monkeypox virus infection, diagnostic testing should be considered, especially if the person has risk factors for monkeypox virus infection. There are limited data on monkeypox infection during pregnancy. It is unknown whether pregnant people are more susceptible to monkeypox virus or whether infection is more severe in pregnancy. Monkeypox virus can be transmitted to the fetus during pregnancy or to the newborn by close contact during and after birth. Adverse pregnancy outcomes, including spontaneous pregnancy loss and stillbirth, have been reported in cases of confirmed monkeypox infection during pregnancy. Preterm delivery and neonatal monkeypox infection have also been reported. Monkeypox virus can be transmitted to the fetus during pregnancy or to the newborn by close contact during and after birth. Adverse pregnancy outcomes, including spontaneous pregnancy loss and stillbirth, have been reported in cases of confirmed monkeypox infection during pregnancy. Infection control practices for the care of patients who are pregnant with monkeypox infection are the same as those for patients who are not pregnant with monkeypox infection. This includes appropriate isolation of patients with monkeypox; training for health-care personnel on maternity and newborn care units on correct adherence to infection control practices and personal protective equipment (PPE) use and handling; and ensuring sufficient and appropriate PPE supplies are positioned at all points of care. Furthermore, visitors to pregnant or postpartum patients with monkeypox should be strictly limited to those essential for the patient’s care and well-being, and should have no direct contact with the patient. Use of alternative mechanisms for patient and visitor interactions, such as video-call applications, should be encouraged for any additional support. CDC also recommends pregnant, postnatal, and breastfeeding women should be prioritized for medical treatment as there is a significant risk to the baby. They also identify these groups as eligible for treatment.

Peripartum cardiomyopathy (PPCM) is a rare cause of heart failure (HF) that affects women late in pregnancy or in the early puerperium. There are several definitions for PPCM. While there are numerous potential mechanisms for Peripartum (post-partum) cardiomyopathy, its exact cause remains unknown1, but the etiopathogenesis is likely to be multifactorial. PPCM is uncommon before 36 weeks of pregnancy, and afflicted women generally present during the first month after delivery. PPCM should be differentiated from pre-existing cardiomyopathy, undiagnosed congenital heart disease, pre - existing valvular heart disease, myocardial infarction, pulmonary embolism and diastolic heart failure due to hypertensive heart disease. The principles for treating acute HF caused by PPCM are the same as those for acute HF caused by any other cause with some limitations during pregnancy. Prompt treatment is critical. There is no necessity for an early delivery unless the maternal or foetal health has deteriorated. In women who present with advanced HF with haemodynamic instability, urgent delivery, regardless of gestation, may be considered. Because women with PPCM have a significant chance of relapse in subsequent pregnancies, they need comprehensive contraceptive counselling. In general, the prognosis is good, with more than half of the patients regaining LV function spontaneously within six months of giving birth. Our aim is to put forth an in-depth review of the Peripartum Cardiomyopathy in contemporary practice.

Background Anemia continues to affect one-third of the global population and is one of the most common reasons for large-scale morbidity and mortality especially among women. The importance of iron-rich diet has always been the backbone of preventing iron deficiency anemia (IDA) in vulnerable age groups followed by oral iron therapy and parenteral iron therapy as the next options in management of iron deficiency.

Objective Objective of this survey was to assess the knowledge, attitude and practices of obstetricians and gynaecologists relevant to anemia in pregnancy and identify the practice gaps in management of anemia in pregnancy.

Methods This was a knowledge, attitude and practice (KAP) survey involving obstetricians and gynaecologists (ObGyns) across India. A validated questionnaire of twenty questions was used to assess knowledge, attitude and practice about anemia and its management. Results were expressed as percentages.

Results 1974 ObGyns participated in the survey. 88.7% ObGyns screen anemia in first trimester, 53.7% ObGyns perform CBC along with RBC indices. Majority of ObGyns estimate Hb thrice during antenatal period. 50% ObGyns do not consider thalassemia screening routinely and deworming regularly. 92.4% ObGyns believe that iron supplementation is required even if Hb > 11 g/dL. Majority of them prefer low-dose iron therapy, 59.9% prefer to use 100 mg oral iron daily. Almost half of ObGyns prefer to change iron salt when patients do not respond, instead of escalating to injectable iron. Interestingly 52% ObGyns evaluate serum ferritin before starting intravenous iron therapy. 43.5% perform Hb estimation as early as 2  weeks after IV iron therapy. Majority (82.2%) of ObGyns prefer blood transfusion as a treatment of choice when Hb < 5 g/dl at 34 weeks gestation. Only 40.5% of participants are aware of the exact cut-off for diagnosing postpartum anemia. Majority of the ObGyns are aware of the iron prophylaxis in postpartum period till 3–6 months. More than 90% ObGyns consider intravenous iron for severe anemia of postpartum period.

Conclusion The present KAP survey highlights the observation, perception and the practicing behaviour of obstetricians and gynaecologists on anemia in pregnancy and identifies practice gaps in anemia management.

Background The study was conducted to establish use of printed investigation sheets as checklists for timely workup and clinical evaluation of antenatal women with medical diseases; admitted in maternity ward, by third day of their hospital admission. This was aimed to standardize care, avoid repeated blood sampling of patients, avoid delay in starting the treatment and help teams perform optimally by systematic use of quality improvement (QI) tools.

Methods The present study was conducted in the Department of Obstetrics and Gynaecology at a tertiary care teaching hospital using point-of-care quality improvement methodology systematically. A QI team was made who formulated an aim statement, conducted a root-cause analysis, performed plan-do-study-act (PDSA) cycles. The outcome was measured as complete clinical evaluation of antenatal women with anaemia, hypertension, and/or diabetes by third day of admission in the maternity ward.

Results The baseline data showed that median percentage of patients with complete clinical evaluation was only 29.2%. After a root-cause analysis with fishbone tool, three PDSA cycles were conducted to achieve the target of 80%. After the third PDSA cycle, complete clinical evaluation in anaemia, hypertension, diabetes showed an improving trend with a median of 75%.

Conclusion Adopting simple principles of quality improvement, initiating use of printed investigation sheets as checklist can streamline and expedite clinical evaluation of antenatal patients with medical problems so as to avoid unnecessary delay in initiating the management in busy maternity wards.

Purpose of the study Placental growth factor (PLGF) is an angiogenic factor in pregnancy. To find out correlation of plasma levels of placental growth factor in first trimester of pregnancy in Indian women who develop maternal and perinatal adverse outcomes was the aim of the study.

Methods A prospective longitudinal noninterventional study was done in the department of Obstetrics and Gynecology after obtaining ethics approval. After enrolling patients in the first trimester (11 weeks to 13 weeks 6 days), a questionnaire was filled for demographic characteristics. Uterine artery doppler was done for every patient and blood sample (5 ml) was taken by venu puncture of median cubital vein. Serum levels of PLGF were measured by enzyme linked immunosorbent assay using Thermo Scientific Pierce Human PLGF kit (Thermo Fisher Scientific, Inc., Waltham, MA, USA). Patients were followed for their whole antenatal period and delivery outcomes.

Results Incidence of preeclampsia in our study was 9.3% (15/161) and fetal growth restriction (FGR) was 19.8% (32/161). Neither BMI nor nulliparity was found to have statistically significant correlation with development of preeclampsia. However, history of preeclampsia was found to be significant risk factor for prediction of preeclampsia (p value < 0.04). Plasma levels of PLGF were significantly lower in preeclampsia and FGR group and this difference was statistically significant (p value < 0.04). 7.5% still born occurred in complicated group and 10% needed NNU/NICU admission in this group.

Conclusion Measuring PLGF levels in first trimester of pregnancy can help in prediction of preeclampsia and FGR.

Introduction Outcomes of pregnancy in COVID 19-infected mothers are worse than in the general population. Due to immunological changes, antenatal women are more vulnerable to severe complications. The India has experienced two waves of the disease. We analysed whether the second wave of the disease had affected pregnancy outcomes differently by comparing pregnancy outcomes with those of the first wave.

Materials and Method The study population included all the women delivered in the same tertiary centre during both the waves. Maternal outcome parameters include maternal oxygen requirement, maternal ICU admission and maternal death. Foetal outcome parameters include APGAR scores, preterm deliveries and NICU admissions, maternal and foetal outcome parameters between the first and the second waves were compared.

Results Demographic parameters were similar in both the waves of COVID 19. No significant differences were found in pre-pregnancy comorbidities, high-risk pregnancies and mode of deliveries between the two waves. Maternal oxygen requirement increased in the second wave [first wave 6(4.7%) vs second wave 25(40.3%) (p-value < 0.001)]. There was also a significant increase in ICU admission [4(3.1%) vs 8(12.9%)], which was in positive correlation with maternal oxygen requirement during the second wave (r = 0.81, p < 0.001). However, there was no significant difference in maternal death [2(1.6%) vs 2(3.2%)]. No significant change noted in neonatal outcomes except for an increase in neonatal sepsis [0 vs 5(8.1%)].

Conclusion Mothers had more severe diseases during the second wave. But this did not translate into significant increase in maternal mortality and poor neonatal outcomes, possibly due to better preparedness.

Introduction Preeclampsia is one of the four leading causes for pregnancy complications, maternal–fetal and neonatal mortality. This study was aimed at comparing the incidence of retinopathy of prematurity in neonates of mothers with preeclampsia and neonates of healthy mothers.

Methods This cross-sectional study was performed among 213 mothers, including 49 healthy mothers and 164 mothers with preeclampsia whose neonates were admitted to the neonatal intensive care unit of Ghaem Hospital, Mashhad, Iran, during 2016–2021. The participants were chosen using the convenience sampling method. The data collection tool was a researcher-made checklist including items on laboratory evaluation, maternal and neonatal characteristics, and eye examination. The data were analyzed using t-test and Chi-square.

Results In the two groups, gestational age (P = 0.112), first-minute Apgar score (P = 0.209), and fifth-minute Apgar score (P = 0.949) were not significantly different. There was a significant difference between the two groups in terms of maternal age (P = 0.0001), type of delivery (P = 0.0001), premature rupture of membranes (P = 0.003), and eye condition (P = 0.033).

Conclusion The results of our study show that preeclampsia affects the prognosis of infants, and in neonates with preeclamptic mothers, the rate of premature rupture of the membranes, cesarean delivery, and retinopathy of prematurity were higher.

Introduction and Objectives VVF is conventionally repaired by open transvaginal or transabdominal routes. In last few decades, minimally invasive techniques (laparoscopic/robotic) for VVF repair have gained popularity. We have reported our experience of transvaginal vesicovaginal fistula (VVF) repair and compared it with the literature reported population matched cohort of VVF repair done by laparoscopic or robot-assisted techniques.

Material and Methods Intraoperative and post-operative parameters including aetiology of fistula, location, operative time, blood loss, major complications, hospital stay and success rate of 202 patients with simple VVF undergoing transvaginal repair at a tertiary care hospital from 1999 to 2019 were recorded. We also compared our transvaginal repair cohort (n = 202) with the literature reported cohort of 260 patients undergoing VVF repair by minimally invasive (laparoscopic and robot assisted) techniques in the systematic review by Miklos et al.

Results Most common aetiology of VVF in our series was post hysterectomy in 122 (60.39%) cases followed by trauma during emergency caesareans section in 80 (39.60%) cases. Transvaginal route had higher success rate than minimally invasive approach (99.50 vs. 96.50%, respectively). Mean operative time was lesser in transvaginal group than the minimally invasive group (63 ± 16 min vs. 161.56 ± 41.02 min, p < 0.01) with shorter mean hospital stay in transvaginal group (3 ± 1 days vs. 3.5 ± 1.16 days, respectively, p < 0.01). Mean estimated blood loss was significantly lesser in transvaginal repair (p < 0.01). 62% patients were sexually active at last follow-up. The cost of transvaginal VVF repair is significantly lower compared to repair by minimally invasive approach.

Conclusion Transvaginal VVF repair is comparable to minimally invasive approach in terms of post-operative outcomes and morbidity; however, transvaginal repair performs better in terms of cost and resource utilization.

Background Despite many advances, patients with a poor ovarian response to stimulation are one of the most important and challenging factors of infertility. Chronological and ovarian ages are two effective factors responsible for poor response to assisted reproduction treatment. The purpose of this study was to determine the effect of age and AMH level on the in vitro fertilization (IVF) outcomes in participants with a reduced ovarian reserve.

Methods In this retrospective cross-sectional study, 210 participants with anti-Mullerian hormone (AMH) < 1.1 ng/ml were included. The effect of age and AMH on pregnancy outcomes including dominant follicle count, serum estradiol level on the day of trigger administration, number of metaphase II (MII) oocytes, number of embryos, biochemical pregnancy, clinical pregnancy, abortion and live birth rate were evaluated.

Results The number of dominant follicle (p < 0.001), MII oocyte (p < 0.001), grade A (p < 0.001) and B (p < 0.001) embryos, serum estradiol level (p < 0.001), gonadotropin level ( p< 0.001), AMH (p = 0.001), biochemical pregnancy (p = 0.007), clinical (p = 0.01) pregnancy, and live birth rate (p = 0.003) were higher in participants younger than 35 years old. In univariable logistic regression, the chance of retrieving more than 3 oocytes in individuals over 35 years old was 97.1% lower than in individuals younger than 35 years old (p < 0.001).

Conclusion It has been concluded that the higher clinical pregnancy and live birth rate in participants younger than 35 years can be due to the higher AMH level in this group. Under the same conditions of AMH and other variables, age can affect the number of retrieved oocytes.

Background Genital tuberculosis is one of the leading causes of female infertility. Paucibacillary nature of the disease in the female genital system often makes its diagnosis difficult. No single test has been able to accurately diagnose genital tuberculosis. In this study we aim to compare conventional diagnostic tests for tuberculosis like Acid Fast Bacilli (AFB) Staining, Lowenstein Jensen (LJ) Culture and Histopathology with newer tests like PCR, MGIT 960, GeneXpert.

Methods This study included 67 infertile women from Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi. They were subjected to detailed history and routine investigations, namely Haemogram, ESR, Mantoux test, Chest X-ray and pelvic ultrasound to look for the findings of tuberculosis. A premenstrual endometrial aspirate was taken and was subjected to the AFB Staining, LJ Culture, Histopathology, PCR, MGIT 960, Gene Xpert, and the test results were compared.

Result and Conclusion 35.8% (24/67) of women were diagnosed with genital tuberculosis using the diagnostic criteria. With culture as the gold standard, the positivity of genital TB was 19.4% (13/67). Majority of infertile patients with low index of suspicion clinically were positive for genital tuberculosis. Therefore, all the patients of infertility should be routinely evaluated for genital tuberculosis. PCR and MGIT 960 have shown promising results in the newer methods. LJ culture and histopathology are still the most reliable and available diagnostic methods. The usefulness of AFB Staining and GeneXpert remains questionable.

Objective To study laboratory evidence of infection in STI/RTI cases managed by syndromic approach. To evaluate vaginal pH estimation as an additional supplementary tool for community screening of STI/ RTI cases.

Material and Methods Study was conducted in department of Gynecology and Obstetrics, Mahila Chikiksalaya Sanganeri gate Jaipur in collaboration with Department of Microbiology, SMS Medical College Jaipur, Rajasthan. STI cases screened by syndromic approach attending the STI clinic were included in study. Vaginal pH of these cases was measured with help of Jaipur pink V strip. Cases with vaginal pH more than five and less than 5 were grouped separately. Evidence of infection was assessed in both groups by performing predefined battery of tests. Results of both the groups were mboliza.

Results Laboratory evidence of infection was seen in 78% of syndromically screened RTIs/STI cases while screening by combined approach, i.e., syndromic approach and Vaginal pH estimation both, showed positive predictability of 92% with 75% sensitivity and 79% specificity.

Conclusion Laboratory evidence of infection was found in 92% of RTI/STI cases when screened by combined approach as compared to 78% in syndromic approach alone. Vaginal strips being user friendly can be used as additional tool for community screening of RTI/STI.

Background Menstruation and menstrual health management remains a challenge worldwide, largely owing to gender inequality, social and cultural stigma, inaccessibility, and poverty. Menstrual cups may offer solutions to the many challenges. The role of medical students in the promotion of women’s health cannot be understated.

Objectives To investigate the understanding and perception of medical students on the use, safety, and efficacy of the menstrual cup as a menstrual hygiene product.

Methods This was a prospective, cross-sectional, quantitative study conducted at the University of the Witwatersrand on medical students. Questionnaires were emailed to students. The study was approved by the Wits HREC (M200885). Statistical software SPSS® 23.0 was used.

Results Two hundred and fifteen participants were recruited. One hundred and seventy-eight were included and mboliza; 58.93% had a basic understanding of the menstrual cup as a menstrual hygiene product (p < 0.001). There was an association between the gender of the respondents and knowledge of the device (p < 0.0001). Females were 7.467 times more likely to have heard about it. There was an association between gender and understanding the cost-effectiveness (p = 0.01), the year of study, and understanding of how it works (p = 0.012). The majority perceived the menstrual cup as convenient in terms of use, comfort, hygiene, and safety.

Conclusion It is important that the menstrual cup is not only introduced to society but also promoted and receives endorsement by healthcare workers. There is an understanding regarding the use, safety, and efficacy of the MC and a willingness to advise for use.

Placenta mboliz spectrum (PAS), refers to the range of pathologic adherence of the placenta into the myometrium  namely placenta mboliz, increta and percreta. Maternal morbidity and mortality is high because of severe and sometimes life-threatening haemorrhage. We report a case of placenta percreta, where with the help of interventional radiologist, we could save the uterus and decrease the post operative morbidity. A 38 year old female was referred  at 24 weeks of gestation for suspected case of placenta percreta. With regular antenatal follow up, she underwent a elective classical caserean section (CS), at 34 weeks of gestation, with bilateral uterine artery embolization, where placenta was left in situ. She remained in close follow up, with clinical examination, ultrasonography (USG), magnetic resonance imaging (MRI) and beta human chorionic gonadotrophin (hCG) levels. Except a few minor post operative complaints patient remained stable. She had to undergo postoperative cystoscopy and methotrexate therapy for haemturia due to invasion of bladder by placenta. She was followed for next 6 months with successful outcome by getting almost complete resorption of placenta and attaining normal menstrual function. With  multi disciplinary approach in a case of PAS, we could manage to leave the placenta in situ during CS and consequently, we could overcome the life threatening complications of placenta percreta and bladder morbidities, were able to avoid hysterectomy and a successful postpartum outcome was achieved. Keywords- placenta percreta, uterine artery mbolization, classical caesarean section, methotrexate

Placenta mboliz spectrum (PAS), refers to the range of pathologic adherence of the placenta into the myometrium  namely placenta mboliz, increta and percreta. Maternal morbidity and mortality is high because of severe and sometimes life-threatening haemorrhage. We report a case of placenta percreta, where with the help of interventional radiologist, we could save the uterus and decrease the post operative morbidity. A 38 year old female was referred  at 24 weeks of gestation for suspected case of placenta percreta. With regular antenatal follow up, she underwent a elective classical caserean section (CS), at 34 weeks of gestation, with bilateral uterine artery embolization, where placenta was left in situ. She remained in close follow up, with clinical examination, ultrasonography (USG), magnetic resonance imaging (MRI) and beta human chorionic gonadotrophin (hCG) levels. Except a few minor post operative complaints patient remained stable. She had to undergo postoperative cystoscopy and methotrexate therapy for haemturia due to invasion of bladder by placenta. She was followed for next 6 months with successful outcome by getting almost complete resorption of placenta and attaining normal menstrual function. With  multi disciplinary approach in a case of PAS, we could manage to leave the placenta in situ during CS and consequently, we could overcome the life threatening complications of placenta percreta and bladder morbidities, were able to avoid hysterectomy and a successful postpartum outcome was achieved. Keywords- placenta percreta, uterine artery mbolization, classical caesarean section, methotrexate

Spontaneous hemoperitoneum in pregnancy is a rare and challenging obstetric emergency. It can present as acute abdomen with features of hypovolemic shock and requires high index of suspicion for diagnosis as various obstetric and non-obstetric causes have similar presenting features. Here we present a case of primigravida at 33 weeks of gestation who presented with acute abdomen, signs of shock and a pathological trace on cardiotocogram .She underwent laparotomy and cesarean section in view of suspicion of abruption placentae. Intraoperatively there was hemoperitoneum of 600ml with 750 grams clots and a small venous bleeder on the posterior surface of the uterus which was secured with hemostatic sutures. Patient got discharged along with the baby on seventh postoperative day. Timely intervention is paramount in reducing maternal morbidity and mortality.

Globally incidence of Non Hodgkin’s lymphoma (NHL) is 3% of which 1% occurs in extranodal lymphoma [1]. Among them, diffuse large B-cell lymphoma (DLBCL) is the most common subtype, accounting for 50% of the cases [2]. Plasmablastic lymphoma (PBL) is a rare and aggressive variant of DLBCL with plasmablastic features, commonly occurs in the oral cavity of human immunodeficiency virus (HIV) infected patients. Primary female genital system lymphoma (PFGSL) is a rare disease, accounting for 0.21-1.1% of extranodal lymphoma [2,3]. Here we report a unique rare case of Uterine PBL in an HIV/Epstein-Barr virus-negative patient that was initially diagnosed as endometroid carcinoma.