Indian Journal of Obstetrics and Gynecology

Monozygotic and monoamniotic twins has maximum complications among these conjoined twins is a rare complication. Development of conjoined twin in monozygotic twins depend upon the period at which the division occurs. If division occurs after 13 days of ovulation the conjoined twins will form. Conjoint twins is a rare entity. This report presents a case of a primigravida at 18 weeks gestation with parapagus conjoined twins. Which was diagnosed by ultrasonography and underwent into second trimester termination.
 

Background: Squamous cell carcinoma (SCC) transformation in mature cystic teratoma of the ovary (MCTO) is a rare but aggressive malignancy, occurring in 1.5%–2.3% of primary ovarian cancers. It predominantly affects postmenopausal women and often presents at an advanced stage due to its asymptomatic progression and nonspecific imaging findings. Optimal diagnostic strategies, treatment approaches, and prognostic indicators remain inadequately defined. Case Description: A 57-year-old postmenopausal woman presented with a two-month history of abdominal pain and distension. Imaging revealed a large, solid-cystic left adnexal mass suspicious for malignant transformation. Staging laparotomy confirmed a 10×9.5×7 cm mature cystic teratoma with SCC transformation, involving the ovarian surface and uterine corpus. The patient underwent total abdominal hysterectomy, bilateral salpingo-oophorectomy, and infracolic omentectomy, achieving R0 resection despite intra operative cyst rupture. She received six cycles of adjuvant paclitaxel-carboplatin chemotherapy and remains in clinical remission 15 months post-treatment. Literature Review: SCC transformation in MCTO is aggressive with poor prognosis, largely dependent on FIGO stage and complete cytoreduction. Preoperative imaging lacks specificity, making early diagnosis challenging. While chemotherapy is beneficial in advanced cases, no standardized regimen exists. Clinical Relevance: This case highlights the importance of early detection, surgical resection, and adjuvant therapy in managing SCC-transformed MCTO. Further research is needed to establish standardized treatment protocols and improve diagnostic accuracy for this rare malignancy.

We report a rare case of invasive mole causing uterine rupture and massive hemoperitoneum, masquerading as ectopic pregnancy. A 22-year-old woman presented with severe abdominal pain and shock at 6 weeks gestation. Imaging suggested ectopic pregnancy, but laparotomy revealed 2000cc of hemoperitoneum and a perforated uterus with grape-like vesicles and active bleeding. Despite evacuation and devascularization, bleeding persisted, necessitating a life-saving total abdominal hysterectomy.

Semaglutide, a glucagon-like peptide-1 receptor agonist, has demonstrated efficacy in improving glycemic control and promoting weight loss in individuals with type 2 diabetes. Recent studies suggest that semaglutide may also exert beneficial effects on reproductive physiology, particularly in women with polycystic ovary syndrome (PCOS). This review provides a comprehensive summary of the current evidence on the effects of semaglutide on fertility. We examine its mechanisms of action on insulin sensitivity, hormone regulation, and ovarian function, highlighting the potential benefits for women with PCOS. The review also discusses the potential risks and limitations of using semaglutide as a fertility treatment, including its unknown effects on pregnancy and lactation. The evidence suggests that semaglutide may improve fertility outcomes in women with PCOS by enhancing insulin sensitivity, regulating hormone levels, and promoting weight loss. However, further research is needed to fully elucidate the effects of semaglutide on reproductive health and to establish its safety and efficacy as a fertility treatment. This review aims to provide a comprehensive overview of the current evidence and to inform future research directions.

Background and Objective: Cesarean delivery (CD) is the most common surgery performed in obstetrics. Most of the CDs are performed by Pfannenstiel incision, a low transverse suprapubic incision. The skin wound of the CD is generally closed with nonabsorbable or absorbable monofilament sutures. In this study, we compared the patient satisfaction and wound outcomes of poliglecaprone 25 (Monocryl) absorbable monofilament suture with polyamide (Ethilon) nonabsorbable monofilament suture for Pfannenstiel skin closure following CD. Methods: A prospective comparative study was conducted on women who were undergoing CD in the Department of Obstetrics and Gynaecology, AIIMS Rishikesh. A total of 132 women were included in the study as per eligibility criteria. Of these, 66 women had Pfannenstiel skin closure with Polyamide sutures and another 66 women with Poliglecaprone 25 sutures. The primary outcome measures were patient satisfaction and scar assessment. The secondary outcome measures were skin closure time and wound outcomes. Results: Both groups had similar baseline demographic characteristics like age, body mass index, and co-morbidities. However, polyamide suture group had the larger proportion of previous CDs.The mean patient satisfaction score was significantly higher in poliglecaprone 25 suture group (p<0.001). The Modified  Hollander cosmetic scale was used for scar assessment, the score was significantly higher in the polyamide suture group (p<0.001), which suggests a significantly better cosmetic appearance in poliglecaprone 25 suture group than polyamide suture group. Skin closure time was significantly higher in the poliglecaprone 25 suture group (p<0.001). Wound seroma, wound gap and wound infection were comparable in both groups. None of the patients in both groups developed wound hematoma. Approximately 6.3% of patients in the polyamide suture group required wound resuturing.  Conclusion: Subcuticular stitch using poliglecaprone 25 absorbable suture is superior to the interrupted mattress stitch using polyamide suture for Pfannenstiel skin closure following CD with respect to patient satisfaction, cosmetic appearance and better wound outcomes.
 

Background: Pregnancy-related low levels of 25-hydroxyvitamin D [25(OH)D] are a common but avoidable issue. Neonatal 25(OH) D levels and the related health effects are directly impacted by low pregnancy 25(OH) D levels. There is little information and comprehension on the therapeutic significance and ramifications of these correlations. Methods: This was a prospective observational study conducted among pregnant women over a period of 4 months. Serum vitamin D levels were measured in all the included subjects at the first interaction. Data on date of delivery, birth weight, length and gestational age were collected prospectively for all the patients at the time of delivery. Statistical analysis was performed using the SPSS 20 software database. The qualitative and quantitative data were presented as percentages and means ± SD, respectively. The risk factors were analysed univariately using the chisquare test and the student’s “t” test. For multivariate analysis, every variable that had a P value less than 0.05 in the univariate analysis was chosen. A significance threshold of p<0.05 was established. Results: The prevalence of vitamin D deficiency was 41%, of which nearly 14% had critically low levels, with a majority, 52%, belonging to the 25-35 years. Although the incidence of vitamin D deficiency (67/131), as well as critically low levels (23/47), was more frequent among gravida 2, the difference was not statistically  significant (p = 0.13 and 0.09, respectively). There was no statistically significant difference in the maternal complications and outcomes between those with and without vitamin D deficiency. The maternal outcomes were not different even among women with critically low levels compared to those without. The incidence of low birth weight was significantly higher in the cohort with critically low levels of vitamin D (42% vs. 16%, p = 0.004). The incidence of other neonatal outcomes was not different.  Conclusion: The prevalence of vitamin D deficiency was higher among pregnant women aged 25-35 years. A higher incidence of low birth weight was observed.