Indian Journal of Obstetrics and Gynecology

Many structural abnormalities of the umbilical cord can be identified with the aid of ultrasonography in the antenatal period. The umbilical cord contains two arteries and one vein surrounded by a gelatinous stroma (i.e., Wharton's jelly) and covered by a single layer of amnion. Umbilical cord, allows for the transfer of oxygen and nutrients from the maternal circulation into fetal circulation while simultaneously removing waste products. Haemangiomas are common benign neoplasms arising from endothelial cells which typically takes place in the skin and soft tissues. Umbilical cord hemangiomas consist of an angiomatous nodule containing and encompassed by edema and myxomatous degeneration of Wharton's jelly, often cystic. Prenatal sonographic differentiation between cord hemangioma and hematoma can be difficult but is possible, Doppler can allow visualization of the vascular architecture within a hemangioma, while a hematoma does not have internal blood flow. We report a case of, a 20 yr old Primigravida with 37 weeks 5 days pregnancy with intra uterine fetal demise with umbilical cord haemangioma.

Carcinosarcoma is a very rare, aggressive malignant neoplasm of the uterus and it is associated with poor prognosis. We are presenting a case of a 66-year-old multiparous postmenopausal women who had bleeding for a period of 3 months. On MRI Imaging there is a 6 cm lesion in the endometrial cavity, biopsy from the endometrium showed carcinosarcoma and she underwent extrafascial hysterectomy with bilateral slapingoophorectomy, omentectomy, and retroperitoneal lymph node dissection. Postoperatively ascites is positive for malignant cells, histopathology of specimen reported as carcinosarcoma FIGO grade 3 and lymph nodes are positive for malignancy. She received adjuvant chemotherapy with carboplatin and paclitaxel.

In females during the phase of embryonic development the mesonephric ducts also known as wolffian ducts usually degenerate although it can be a persistent remnants which may become clinically apparent. This remnant of vestiges which can persist is called as Gartner duct. Gartner ducts generally are located in the proximal anterolateral wall of vagina, however it can be found at other sites along the vaginal length. It can be confused with other vaginal cysts like skenes cysts, epidermoid cysts, inclusion cyst, sebaceuous cyst, urethral diverticula. Mostly found fortuitously within the lateral vaginal wall during routine examination as Gartner cyst are mostly asymptomatic presentation clinically. Even so the patient present with Symptoms the complaints could include dyspareunia, vaginal pain, and difficulty inserting tampoons with associated vaginal infections. The gartner cyst has low columnar epithelium which secretes mucinous material, when the duct is blocked or occluded it gets collected which forms the cyst thereby during vaginal examination usually a tense cyst is palpable or seen to bulge beneath the vaginal wall. The size and extension of the cyst can be confirmed by radiological imagings and later on by histopathological. In sympatomaticpatients marsupialization or excision of Gartner duct cysts are usually done.

Objective: To find incidence of congenital thrombophilia in unexplained infertility versus fertile female population with intend to determine if thrombophilia is a possible cause and which type of thrombophilia is more prevalent in unexplained infertility. Methods: Study group (Group A) comprised of 40 infertile patients of age between 20 40 years in whom no cause of infertility was identified. The control group comprised of 40 healthy women with proven fertility, matched for age, with no history of thrombo-embolic events. Both the groups were tested for inherited thrombophilia included Protein C, Protein S, Anti-thrombin III, Activated Protein C Resistance, Homocysteine, factor V Leiden (PCR), Prothrombin G20210 G gene and M THFR (677c/T)gene mutation. Results: Overall 14 (35%) subjects in the unexplained infertility group, and 5 (12.5%) in the control group were detected with positive thrombophilic factor (p value-0.023). Out of 14 positive cases, 7/14(50%) had more than one factor (35% had 2 and 15% had 3 factors)thus 23 thrombophilia factors in 14 women in group 1 in comparision of onlt 7 in 5 in (2 with 2 factors)group2 (p=0.005). Out of 23, Protein S (10%) and Antithrombin III (10%) had the highest frequency followed by Homocysteine (7.5%), Protein C (7.5%), MTHFR gene mutation (7.5%), prothrombin 20210 (5%), Factor V Leiden (5%) and APCR (5%)in group1 Out of the 7 thrombophilia factors in controls, Factor V Leiden mutation and APCR had the highest frequency (5%) followed by Protein S, Protein C, and Homocysteine (2.5%). APCR and Factor V leiden were similar in both groups whereas Hyperhomocysteinaemia combined with MTHFR gene mutation was more in unexplained infertility andprothrombin gene was found only in unexplained infertility Conclusion: There is significant association of thrombophilia with unexplained infertility Hyperhomocystinaemia combined with MTHFR gene mutation and APCR with prothrombin gene mutation are more likely to be associated with unexplained infertility. Thrombophilia evaluation may be included along with other tests in evaluation of unexplained infertility.

Aim: This study aims to describe the clinical features, obstetric and neonatal outcome of pregnancies complicated with COVID-19 infection. Methods: This is a longitudinal, single center, observational study conducted on all COVID-19 positive pregnant women who were admitted in our institution from July 2020 to June 2021. During the study period, a total of 195 pregnant women with COVID-19 infection confirmed by RT PCR test, were admitted and included in the study. Data were collected about the demographic profile, clinical characteristics, maternal and neonatal outcomes. Results: The mean age was 26 years (SD = 3.48). Majority patients (75.4%) were asymptomatic and 21.5% had mild symptoms. Only 2(1.02%) women had severe COVID pneumonia. Majority (89.6%) were admitted in 3rd trimester. Cesarean section rate in COVID-19 infected pregnant women was 60%. Most neonates were asymptomatic and only 2 of them tested positive on testing within 48 h of birth. Conclusion: There is no major effect of COVID-19 infection during pregnancy on maternal and neonatal outcome.

Background: Bacterial Vaginosis is one of the most common causes of abnormal vaginal discharge in women of reproductive age, which can have a major impact on quality of life. Although the treatment course of oral metronidazole for 7 days results in curative rate of 70%–80% at four weeks of treatment, but is associated with high rates of recurrence occurred within twelve months, reaching up to 40%–50%. Methods: A Randomized Prospective Interventional Study was done on 1000 reproductive age group females (pregnant or non-pregnant) diagnosed with bacterial vaginosis from November 2020 to October 2022 at department of Obstetrics & Gynaecology, Kanpur. The study group were divided into two subgroups - Group 1 were given metronidazole 500 mg for 7 days and probiotics for 14 days and group 2 were given metronidazole 500 mg for 7 days and placebo for 14 days. The patients were followed after 3 months to know the recurrence. Results: Majority of patients belonged to rural background (63.1%) with lower socioeconomic (46.6%) and belong to age group 20-35 years. It was observed that there was significant change in Amsel’s criteria and Nugent’s scoring in Group 1 as compared to Group 2. The rate of recurrence at the end of the treatment for Amsel’s criteria in group 1 were 1.03 as compared to group 2 was 1.68 and for Nugent’s scoring, the rate of recurrence at the end of treatment in group 1 was 3.17 as compared to group 2 was 4.78. Conclusion: Probiotics can be considered as one the adjuvant therapy for treating bacterial vaginosis and re-establishing equilibrium in the vaginal microflora thus, preventing the recurrences.

Background: Unexplained recurrent pregnancy loss (RPL) still poses a diagnostic and therapeutic challenge which can be quite distressing to the couples as well as to the gynaecologist. We aimed to study the prevalence of RPL at our tertiary care centre and to assess the efficacy of Applebaum scoring of endometrium for prediction of implantation in cases of unexplained RPL. Materials and Methods: The study enrolled 43 cases with history of unexplained RPL in non pregnant state and their endometrial evaluation was done with TVS and colour Doppler. 37 patients were taken as controls which were comparable in terms of socio-demographic factors in the age group of 18-35 years. TVS was done on 12th day of menstrual cycle. Results: The incidence of RPL at our center was found to be 3.68%. It was seen that pregnancy loss was more when endometrial thickness was <7mm or >14 mm. RPL was more when pulsatility index of uterine artery was >2.5 (p=0.004) which was statistically significant as compared to controls. It was observed that when total score was <13, the sensitivity and specificity of predicting implantation was 90.70% and 81.08% respectively. Conclusion: Applebaum scoring system can be a good predictor in patients with recurrent pregnancy loss especially when no cause has been identified, accordingly therapeutic intervention can be directed to increase endometrial thickness, its vascularity as well as its receptivity.

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