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Introduction: Obstetrics teleconsultation is a new concept to enable health-care services in the COVID pandemic by limiting in-person visits. This study describes the methodology of mobile-based teleconsultation, preliminary findings, and the experience of the obstetricians. Material and Methods: The data of pregnant women who got registered for teleconsultation in early phase of COVID pandemic lockdown were reviewed and analyzed. A qualitative analysis was performed to assess the experience of obstetricians (consultants, senior residents, and junior residents) via an online electronic survey. Results: The majority of obstetrics teleconsultations were for routine antenatal care (75%) and fetal medicine consultation (12.3%). Out of 187 women, 29.9% were advised to continue antenatal care at local hospitals, whereas 33.6% were asked to follow up via teleconsultation. Most of the obstetricians (73.68%) felt that they were able to satisfy the pregnant women and rated the teleconsultation satisfactory. Conclusion: Obstetrics telemedicine found to be beneficial for providing routine antenatal care services via reducing physical visits and overcrowding in outpatient departments, promoting antenatal care at local hospitals, and making specialized (maternal–fetal medicine) care accessible even during COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

We compared two combined methods for cervical ripening before induction of labour (IOL) Women (n = 150) were randomised into Foley's-misoprostol (n = 75) and Foley's-dinoprostone (n = 75) groups. A single dose of vaginal misoprostol tablet (25 µg) or intracervical dinoprostone gel (0.5 mg) were used alongwith intracervical Foley's. The primary outcome was induction-delivery interval (IDI) and secondary outcomes were change in Bishop's score, oxytocin requirement, caesarean section (CS) rate, chorioamnionitis and neonatal outcome. The mean parity, gestation and indications for IOL were similar in the two groups. The IDI (19 h 37 min and 19 h 20 min; p =.683), cervical ripening time, oxytocin requirement, CS rate (18.7 and 25.4%, p =.322) and neonatal outcome were similar. Hyperstimulation developed in 2.7% women with Foley's-misoprostol and in 1.3% with Foley's-dinoprostone (p =.55). No woman had chorioamnionitis. Thus, these two combined methods of cervical ripening and IOL were observed to be similarly efficacious. A low incidence of hyperstimulation and no chorioamnionitis may be attributed to using a single dose of prostaglandins. Misoprostol may be substituted for dinoprostone in resource limited countries. What is already known on this subject? Combined methods for cervical ripening (intracervical Foley's plus prostaglandins) before induction of labour (IOL) may be similarly or more efficacious than individual methods. Most studies comparing various combined methods have used repeated doses of prostaglandins. A combined method using repetitive doses of prostaglandins may increase the risk of hyperstimulation and also of infection consequent to repeated vaginal examination to administer prostaglandins. These two concerns may be offset by combining a single dose of prostaglandin with intracervical Foley's catheter. What do the results of this study add? Two combined methods for cervical ripening using a single dose of vaginal misoprostol (25 µg) or intracervical dinoprostone gel (0.5 mg) co-administered with intracervical Foley's catheter were found to be similarly efficacious. The IDI (19 h 37 min and 19 h 20 min; p =.683), cervical ripening time, oxytocin requirement, CS rate (18.7 and 25.4%, p =.322) and neonatal outcome were similar. The incidence of hyperstimulation was low (2.7 and 1.3% with Foley's-misoprostol and Foley's-dinoprostone, respectively) and no woman had chorioamnionitis. What are the implications of these findings for clinical practice and/or further research? Combined methods for cervical ripening using a single dose of prostaglandins (misoprostol or dinoprostone) were observed to be similarly efficacious. Misoprostol is a cheaper alternative to dinoprostone and may be utilised in resource limited countries. These methods may be compared with each other in more number of women in order to identify which combined method is more efficient and safe. Clinical Trials Registry of India: CTRI/2017/12/010738 [ABSTRACT FROM AUTHOR]

Fetal akinesia and contractures can be caused by mutations in various genes that lead to overlapping phenotypes with contractures, rocker bottom feet, cerebellar hypoplasia, ventriculomegaly, growth retardation, pulmonary hypoplasia, cystic hygroma and cleft palate in various combinations. Cerebro‐oculo‐facio‐skeletal (COFS) syndrome is a condition resulting from defects in DNA repair pathway, and genes involved include ERCC1 (COFS), ERCC2 (XPD), ERCC5(XPG), and ERCC6 (CSB). It is a severe disorder presenting in fetal or neonatal period with microcephaly, arthrogryposis, prominent nose, and kyphoscoliosis, and leads to early death in childhood. We report a baby with antenatally identified arthrogryposis in which the homozygous pathogenic variant in exon 8 was identified in ERCC5 gene, by targeted next generation sequencing. This was predicted to cause premature chain termination in the protein. ERCC5 gene is mainly implicated in xeroderma pigmentosum, sometimes in COFS syndrome. [ABSTRACT FROM AUTHOR]

Early-stage endometrial cancer may have microscopic omental metastases which is associated with a poor prognosis. There are no standard guidelines for omentectomy in early-stage endometrial cancer without risk factors. Brenner tumor is a rare ovarian tumor which is usually benign, but rarely, it may be malignant. Some Brenner tumors are endocrinologically active. Various studies have shown an association of Brenner tumor with endometrial hyperplasia, polyp, or early-stage carcinoma, probably due to its estrogen-secreting nature. We report a rare case of well-differentiated endometrioid adenocarcinoma of the uterus with <50% myometrial invasion with omental metastases associated with benign Brenner tumor of the ovary in a postmenopausal female. [ABSTRACT FROM AUTHOR]

Aim: To compare the efficacy of pre-incision intravenous single doses of cefazolin versus cefazolin plus azithromycin as an antibiotic prophylaxis in cesarean delivery (CD). Methods: This was a single-center, double blind, randomized controlled trial conducted in the PGIMER, Chandigarh. 200 women undergoing elective/emergency cesarean section were randomized. Group A received single dose of cefazolin plus placebo while Group B received single dose of cefazolin plus azithromycin. Primary outcome evaluated was occurrence of surgical site infections (SSI); secondary outcomes included incidence of febrile morbidity, UTI, endometritis, neonatal outcome, total cost of antibiotics, and duration of hospital stay in both the study arms. Descriptive statistics and χ2 tests were used for analysis of the data. Result: There was an overall significant reduction in the incidence of SSI (15% vs 3%; P = 0.03), endometritis (8% vs 2%; P = 0.048), and post-operative febrile morbidity (17% vs 3%; P = 0.001) with the addition of azithromycin to cefazolin. Duration of hospital stay was almost two days lesser for the cefazolin plus azithromycin group. Subgroup analysis of patients with SSI showed the age, duration of ruptured membranes, and type of anesthesia as important predictors of infection rate. Study observed statistically significant reduction in requirement of additional post operative antibiotics, phototherapy for neonates, hospital stay and cost of therapy in cefazolin plus azithromycin group (P < 0.05). Conclusion: Tertiary care hospitals in developing countries such as India can opt for the cefazolin plus azithromycin as antimicrobial prophylaxis during CD to maximize the efficacy as well as for decreasing the cost burden of postoperative infections. [ABSTRACT FROM AUTHOR]

Background. The phenomenon of vanishing carcinomas, first described in context of prostatic carcinomas, has been documented in endometrial carcinomas as well. Methods. The archives of the department were searched for case files of endometrial carcinoma diagnosed on endometrial curetting/biopsy but which did not reveal any cancer on the subsequent hysterectomy specimen. Clinical and pathological correlation was established. Results. A total of 5 cases were retrieved with biopsy-diagnosed endometrial carcinomas, 4 endometrioid and 1 serous type, which on subsequent hysterectomies did not reveal any tumor. These 5 cases represented 1.56% of total hysterectomies in our series. All were Stage Ia tumors, which on follow-up (mean = 18.2 months) did not show any local reoccurrence. Adjuvant therapy was instituted in 1 case in the form of pelvic irradiation in view of the serous histology. In all cases, the primary diagnosis was reconfirmed and any remote possibility of incorrect patient identification, laboratory errors, and institution of hormonal therapy were adequately ruled out along with an extensive endometrial sampling in hysterectomy. Conclusion. The recognition of "vanishing endometrial carcinoma" as a distinct entity is of utmost importance to avoid mislabeling them as medical errors. [ABSTRACT FROM AUTHOR]

Objective: To study the effect of "early amniotomy" {initiating induction of labor (IOL) with amniotomy followed by oxytocin} versus "late amniotomy" (initiating IOL with oxytocin followed by amniotomy 4-8 h later) in induced labor.Methods and Materials: One hundred and fifty women with Bishop's score of ≥6 undergoing IOL were randomized into "early amniotomy" and "delayed amniotomy".Results: Early amniotomy resulted in a reduced induction-delivery interval (IDI) (7.35 versus 11.66 h with delayed amniotomy, p = .000) but higher the caesarean section (CS) rate was observed (10.7 versus 2.7% with delayed amniotomy, p = .049). With early amniotomy, the proportion of women delivering within 12 h was higher (86.7 versus 60%, p = .000) and the maximum oxytocin concentration used was lower (30.05 versus 39.68 mU/min, p = .001) as compared to delayed amniotomy. The neonatal outcomes were similar in the two groups. Early amniotomy detected meconium prior to initiating uterine contractions with oxytocin in three women who underwent CS for meconium.Conclusion: Initiating IOL with amniotomy in women with a favorable cervix was efficacious in expediting delivery, but it resulted in a higher CS rate. The higher CS rate was partly due to CS for meconium detected as a result of early amniotomy. Clinical Trials Registry (CTRI), India: Registration number CTRI/2015/01/005418. [ABSTRACT FROM AUTHOR]

Objective: To study the effect of "early amniotomy" {initiating induction of labor (IOL) with amniotomy followed by oxytocin} versus "late amniotomy" (initiating IOL with oxytocin followed by amniotomy 4-8 h later) in induced labor., Methods and Materials: One hundred and fifty women with Bishop's score of ≥6 undergoing IOL were randomized into "early amniotomy" and "delayed amniotomy"., Results: Early amniotomy resulted in a reduced induction-delivery interval (IDI) (7.35 versus 11.66 h with delayed amniotomy, p = .000) but higher the caesarean section (CS) rate was observed (10.7 versus 2.7% with delayed amniotomy, p = .049). With early amniotomy, the proportion of women delivering within 12 h was higher (86.7 versus 60%, p = .000) and the maximum oxytocin concentration used was lower (30.05 versus 39.68 mU/min, p = .001) as compared to delayed amniotomy. The neonatal outcomes were similar in the two groups. Early amniotomy detected meconium prior to initiating uterine contractions with oxytocin in three women who underwent CS for meconium., Conclusion: Initiating IOL with amniotomy in women with a favorable cervix was efficacious in expediting delivery, but it resulted in a higher CS rate. The higher CS rate was partly due to CS for meconium detected as a result of early amniotomy. Clinical Trials Registry (CTRI), India: Registration number CTRI/2015/01/005418.

Anti-epileptic drugs are associated with several foetal effects which necessitate a rational use of these drugs and early identification of the various adverse manifestations. This article gives a comprehensive review of foetal adverse effects described with various anti-epileptic drugs. The risk of malformations is increased 2-3 folds compared to general population, especially sodium valproate, more with polytherapy. The various manifestations of foetal anticonvulsant syndrome include developmental delay, malformations like facial clefts and neural tube defects, ocular abnormalities, learning difficulties, and digital hypoplasia. There is less data on effects of new anticonvulsant drugs, but they appear to be safer. The risk of teratogenicity is high with traditional drugs and with polytherapy; the newer agents like lamotrigine and oxcarbazepine are relatively safe. Individualisation of the drug therapy, optimisation of the dose and concurrent folic acid administration are important measures to reduce the potential risk to the foetus.

Primary ovarian pregnancy is a rare form of ectopic pregnancy that must be demonstrated with use of 4 Spiegelberg criteria. It is usually diagnosed at laparotomy or laparoscopy, although it may resemble a hemorrhagic corpus luteum. Successful conservative management of ovarian pregnancy with methotrexate has been reported only occasionally. This may be partly because of the rarity of this condition and partly because when medical treatment is successful, the patient does not need to undergo laparotomy or laparoscopy, and an occasional ovarian pregnancy may have been diagnosed as a tubal pregnancy. We present a case of ovarian pregnancy (diagnosed at laparotomy) for which initial medical management with methotrexate failed despite favorable prognostic factors. Whether the unusual location (ovary) could have contributed toward treatment failure is unknown.

Management options for postpartum hemorrhage (PPH) include oxytocics, prostaglandins, genital tract exploration, ligation or angiographic embolization of uterine/internal iliac arteries, and hysterectomy. After excluding uterine rupture, genital tract lacerations, and retained placental tissue, efforts are directed toward contracting the uterus by bimanual compression and oxytocics. If these are not successful, one must resort to surgical techniques. At this stage, an alternative option to remember is uterovaginal packing. Easy and quick to perform, it may be used to control bleeding by tamponade effect and stabilize the patient until a surgical procedure is arranged. Uterovaginal packing may sometimes obviate the need for surgery altogether. Two cases, a primary and a secondary PPH, managed recently with uterovaginal packing are reported. Despite concerns about concealed hemorrhage or the development of infection with this intervention, none of these problems were encountered, and uterine packing was successful even in the case of secondary PPH with documented infection.