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A 31-year female, G4P2L2A1 with two previous cesarean deliveries and one dilatation and curettage, was diagnosed with cervical ectopic pregnancy of 8 weeks and two days without any cardiac activity. She had a complaint of slight pain in the abdomen without any bleeding per vagina. She was initially managed with multi-dose systemic methotrexate therapy. The value of beta-HCG decreased by about 70%. She then underwent bilateral uterine artery embolization followed by ultrasound-guided suction evacuation with descending cervical artery ligation with cervical balloon tamponade. The patient was asymptomatic throughout her hospital stay. Her beta-HCG value dropped to 10 IU/ml and usg showed empty endocervical canal on weekly follow-up.: Conservation methods like systemic methotrexate or potassium chloride, along with minimally invasive techniques like bilateral uterine artery embolization, are among the most effective and safe fertility-sparing modalities in managing cervical ectopic pregnancy. Proper case selection and availability of required infrastructure at tertiary care centers are mandatory.

Yolk sac tumors (YST) are rare and rapidly developing neoplasm presenting in young females. They are second most common germ cell tumor after dysgerminomas. Fertility preservation is an important concern in treatment of patients of YST. We present a case of 22 years nulliparous female with rapidly evolving abdominal mass. The patient underwent fertility preserving surgery with four cycles of post operative bleomycin etoposide and paclitaxel (BEP) chemotherapy and is fairly doing well. BEP chemotherapy has successfully improved the treatment outcomes of YST patients.

Background: Health care workers (HCW) are the frontline warriors who are at a high risk of acquiring the COVID-19. HCW in obstetrical department are at high-risk due to their close proximity with the patient for examination, giving treatment and in delivery. The objectives of this study were to evaluate the positivity rate of COVID-19 in the initial 3 months of pandemic in health care personnel working in obstetric unit in a tertiary care hospital.Methods: Prospective cohort study was conducted in department of obstetrics and gynecology at tertiary care hospital in Delhi from 10 April to 10 June 2020. Predesigned questionnaire was used to record data of HCWs exposed to COVID-19 patients.Results: In a period of 3 months (April-June 2020), 152 health care workers were exposed to 30 COVID-19 patients. Out of this, 10 HCW were found to be positive on testing, showing a positivity rate of 6.58%. Positivity ratio was 6:3:1 among nurses, auxiliary workers and doctors respectively. Labor room was area of high infection as 80% of HCW were infected in the labor room .80% HCW acquired infection during patient care in hospital and 20% were infected in contact with asymptomatic COVID-19 positive HCW.Conclusions: Positivity rate in obstetric department is comparable to that of general population. Appropriate infection prevention measures like use of PPE, handwashing and maintain safe distance from the patient is the key to prevention of infection. Gloves and N95 masks have been shown to provide superior protection as compared to triple layer masks. Nursing staff and auxiliary workers should be reinforced the importance of use of PPE, hand hygiene and physical distancing.

Background: Hysteroscopy a minimally invasive approach for evaluating uterine cavity, and has become an indispensable diagnostic and therapeutic procedure. The main limiting factor while performing office hysteroscopy is the level of pain or discomfort encountered during the procedure. The pain is attributed mainly to the difficulty in entering the internal cervical os with the hysteroscope and while distending uterine cavity. It could be reduced if cervix is ripened before the procedure. The purpose of this prospective observational study was to compare the effectiveness, adverse effects and surgery-related complications associated with two different doses of sublingual Misoprostol (100 and 200 µg) given 2-4 hours before hysteroscopy.Methods: A randomised comparative study was conducted in the department of Obstetrics and Gynaecology of ABVIMS and Dr. RML hospital New Delhi, from 1st November, 2018 to 31st March, 2020. One hundred and twenty women, fulfilling inclusion criteria were subjected to hysteroscopy. Women received either 100 µg (Group I) or 200 µg (Group II) of sublingual Misoprostol 2-4 hours prior to hysteroscopy. The primary outcome of the study was cervical dilatation as measured by the largest number of Hegar dilator that could be inserted without resistance at the beginning of procedure. The largest dilator that negotiated cervical canal without resistance at the beginning of procedure was recorded as the baseline cervical width. The secondary outcomes were subjective assessment of the surgeon of the ease of dilatation of cervix and adverse effects of drug (i.e. vaginal bleeding, shivering, fever and pain as measured on visual analog scale).Results: The mean baseline cervical width as measured by first Hegar dilator that could be passed through the cervical canal without resistance was 6.6±0.62 mm in group I and 6.94±1.21 mm in group II respectively (p value=0.016). Adverse effects like vaginal bleeding, shivering was more in group II compared to group I. No statistically significant difference was found between group I and II with regards to visual analog scale.Conclusions: 100 µg Misoprostol can be used for cervical ripening prior to hysteroscopy with minimal adverse effects.