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Teratomas are most frequent germ cell tumors of ovary with an incidence of 15%–20% of all ovarian neoplasm while endometriomas are present in 25.5%–45% of women with pelvic endometriosis. In spite of their increased individual incidence, association of cystic teratomas and ovarian endometriomas is extremely rare. Our case is that of a 33-year-old nulligravida who presented with heavy menstrual flow and pain during periods for last few months, ultrasonography revealed 74 × 57 mm mass in right adnexa-likely ovarian dermoid, enlarged left ovary with two small cysts of size 33 × 29 mm and 25 × 20 mm likely endometrioma, managed by laparoscopy, found to have left ovarian endometrioma of 6 × 6 cm and right ovarian dermoid cyst of 10 × 8 cm size, histopathology confirmed the same. This association of teratoma in one ovary and endometrioma in other ovary of same patient poses a surgical challenge, when it affects young and nulliparous women. Further follow up is mandatory for this simultaneous finding of ovarian endometriosis with coincidental dermoid cyst to assess ovarian reserve, recurrence of either of the cysts, and it also presents a challenge to clinicians to predict the post-operative course of such cases.

Background/purpose of study In view of restrictions on patients because of COVID-19 pandemic, face-to-face consultations are difficult. This short commentary tells us about the feasibility of telemedicine in this scenario in obstetrics and gynaecology. Methods The database from our teleconsultation application (Apollo 247 and Askapollo) was analysed to assess feasibility of telemedicine and to design a triage pathway to reduce hospital visits for non-emergency situations and also to identify emergency cases without delay during this lockdown phase. Existing guidelines by Ministry of Health and Family Welfare (MOHFW), Government of India, were accessed. Results This was a single-doctor experience of 375 consultations done over 65 days. We also designed a triage pathway for obstetrics and gynaecology cases, and we discussed general practice for obstetricians and gynaecologists with its utility and limitations. Conclusion Telemedicine has provided us the opportunity to manage women health problems and pregnancy concerns during this pandemic of COVID-19, except a few instances where face-to-face consultation or hospital visit is must. If we implement the triage pathway, we can minimize the risk of exposure for both patients and healthcare teams during COVID-19 pandemic.

To present a case of didelphys uterus with severe pelvic pain and primary infertility with focal adenomyosis of outer myometrium (FOAM) of the left hemiuterus and tips and tricks for hemihysterectomy as a fertility preserving surgery.Descriptive step-by-step video demonstration of a case of didelphys uterus with adenomyosis of the hemiuterus. Local institutional review board approval for publication was obtained.Endometriosis Centre, Apollo Hospitals, Hyderabad, India.Women with uterus didelphys with FOAM of the left hemiuterus with severe pelvic pain and infertility.A 30-year-old woman presented with chronic pelvic pain and severe progressive dysmenorrhea with primary infertility for 3 years. She was diagnosed with uterus didelphys and longitudinal vaginal septum 3 years back and underwent hysteroscopy for septal resection and diagnostic laparoscopy for pain in an outside setting; however, no laparoscopic intervention was performed. The patient was diagnosed with FOAM of the left hemiuterus involving 75% of the hemiuterus. After detailed discussion and counseling regarding different options, laparoscopic hemihysterectomy was performed as pelvic pain relief was a major expected outcome along with fertility preservation.Pain relief with improved quality of life and fertility preservation.The postoperative period was uneventful. The patient was discharged on the second postoperative day with no complaints. Her chronic pelvic pain and dysmenorrhea resolved. She was not prescribed any medication after the surgery. During the routine follow-up, she had a regular menstrual cycle with a visual analogue score of 0/10.The safe removal of a hemiuterus in case of a didelphys uterus with pathology of hemiuterus through a minimally invasive technique is possible, which cures the pain caused by adenomyosis and enables quick recovery while preserving future fertility.

Purpose: The objective of this study was to evaluate and compare the diagnostic performance of ultrasonography (USG) assessment using structured reporting with intraoperative laparoscopic assessment in deep infiltrating endometriosis (DIE) using the recent update of the #ENZIAN classification.Methods: This was a retrospective study conducted in Tertiary Multi-disciplinary Endometriosis Care Hospital over a period of 8 months which included 50 patients who underwent a planned laparoscopic endometriosis excisional surgery after a dedicated USG assessment using International Deep Endometriosis Analysis (IDEA) protocol and #Enzian score (updated Enzian classification), between Feb 2021 to Sept 2021 at Apollo Hospitals, Hyderabad. The pre-operative USG findings were reported in a structured reporting format and intra-operative findings were classified using the standard #ENZIAN classification. No prospective interventions were done. A review of pre-operative ultrasound and laparoscopic findings as per the #Enzian.Results: Sensitivity and the negative predictive value of ultrasound were 86% and 84.2% for peritoneal lesions, 97% and 93.3 % for left ovarian lesions, 93% and 91.6% for right ovarian lesions, 91% and 84% for left tubal lesions, 90% and 86.3 % for right tubal lesions, 93% and 75 % for uterosacral ligaments, 93.3 % and 97% for rectal lesions and sensitivity and negative predictive values were 100 % for rectovaginal lesions, adenomyosis, and ureteric lesions as confirmed on laparoscopy. Conclusion: Dynamic ultrasound assessment with a structured report based on IDEA protocol and #ENZIAN score is accurate for mapping of pelvic endometriosis in all forms, and it correlates with laparoscopic findings, thus helps surgeon for better planning and providing a road map for surgeons. From a clinical perspective, a uniform and shared reporting system across imaging and therapeutic modalities will simplify communication, improving patient management by conservative or surgical treatments, avoiding multiple repeat surgeries, and improving quality of treatment.

Evaluate inter-rater and intrarater reliability of a novel scoring tool for surgical complexity assessment of endoscopic hysterectomy.Validation study.Academic medical center.Total of 11 academic obstetrician-gynecologists with varying years of postresidency training, clinical practice, and surgical volumes.Application of a novel scoring tool to evaluate surgical complexity of 150 sets of images taken in a standardized fashion before surgical intervention (global pelvis, anterior cul-de-sac, posterior cul-de-sac, right adnexa, left adnexa). Using only these images, raters were asked to assess uterine size, number, and location of myomas, adnexal and uterine mobility, need for ureterolysis, and presence of endometriosis or adhesions in relevant locations. Surgical complexity was staged on a scale of 1 to 4 (low to high complexity).Number of postresidency years in practice for participating surgeons ranged from 2 to 15, with an average of 8 years. A total of 8 obstetrician-gynecologists (72.7%) had completed a fellowship in minimally invasive gynecologic surgery. Six (54.6%) reported an annual volume of50 hysterectomies. Raters reported that 95.4% of the images were satisfactory for assessment. Of the 150 sets of images, most were found to be stage 1 to 2 complexity (stage 1: 23.8%, stage 2: 41.6%, stage 3: 32.8%, stage 4: 1.8%). The level of inter-rater agreement regarding stage 1 to 2 vs 3 to 4 complexity was moderate (κ = 0.49; 95% confidence interval [CI], 0.42-0.56). Moderate inter-rater agreement was also found between surgeon raters with an annual hysterectomy volume50 (κ = 0.49; 95% CI, 0.40-0.57) as well as between surgeon raters with fellowship experience (κ = 0.50; 95% CI, 0.42-0.58). Intrarater agreement averaged 80.2% among all raters and also achieved moderate agreement (mean weighted κ = 0.53; range, 0.38-0.72).This novel scoring tool uses clinical assessment of preintervention anatomic images to stratify the surgical complexity of endoscopic hysterectomy. It has rich and comprehensive evaluation capabilities and achieved moderate inter-rater and intrarater agreement. The tool can be used in conjunction with or instead of traditional markers of surgical complexity such as uterine weight, estimated blood loss, and operative time.

Endometriosis affects 10%–15 % of reproductive age group population. Pelvic endometriosis usually involves ovaries, and it is reported to involve both ovaries in one-third to one-half of cases. Ovarian endometriomas rarely exceed 10–15 cm in diameter. Our case is that of a 31-year-old P1L1 who presented with increasing abdominal girth, and imaging revealed a huge cystic mass extending till the diaphragm around 29 × 24 × 19 cm3 which was later found to be a case of recurrent endometriosis. This was managed by laparoscopy, and the volume of the chocolate fluid evacuated was approximately 11,300 mL. It is rare for endometriomas to grow up to such a large size. This case stresses the importance of suspicion of recurrent endometrioma even in atypical presentations and the need for follow-up in known cases of endometriosis to identify early recurrence.

Umbilical endometriosis is the most common cutaneous form and is seen mostly secondary to surgical scar and rarely occurs as primary umbilical endometriosis. The objective of this retrospective case series evaluation is to report the presentation, diagnosis, and management of patients with primary umbilical endometriosis.We present a retrospective, observational and descriptive review of cases presenting with primary umbilical endometriosis among Indian women managed in two private tertiary care centres between 2018 and 2020. Patients were assessed at the gynaecological outpatient department. We analysed age, parity, presenting symptoms and duration, associated symptoms, imaging, size of the lesion, associated pelvic endometriosis or any pelvic pathology, management, and histopathological diagnosis for confirmation in all four patients.The patients were aged between 25 and 31 years with an average of 28 years with no previous history of any abdominal surgeries. The mean duration of the symptoms presented in these cases was 25.5 months, with a range from 18 to 48 months. The diagnosis was made by clinical examination supported by imaging followed by complete surgical excision and confirmation on histopathology.Primary umbilical endometriosis is a rare disease with a limited number of cases reported in the literature and should be included in the differential diagnosis if women present with umbilical lesions with cyclical pain. Diagnosis is clinical but can be aided by high resolution imaging such as Ultrasound (US) and Magnetic Resonance Imaging (MRI). Complete surgical excision is the treatment of choice.

Background: Ovarian cysts in pregnancy are encountered in approximately 1 in 100 cases. Of these, most are benign. One such non-neoplastic lesion is Large Solitary Luteinized Follicular Cyst of Pregnancy and Puerperium (LSLFCPP). They are a rare lesion with unknown pathogenesis. They grow rapidly to very large sizes, causing symptoms. They are hormonally inactive. Maternal and fetal outcome is usually unaffected. Objective: we present a case of a Large Solitary Luteinized Follicular Cyst of Pregnancy and Puerperium encountered incidentally during the management of ruptured ectopic pregnancy. A 25 year old G2A1 with 7 weeks 3 days gestational age by dates presented to the emergency department with the chief complaints of sudden onset of pain in the lower abdomen accompanied by nausea and giddiness since 12 hours. What sets our case apart from rest in literature is it’s diagnosis very early in pregnancy. Also, it is, to our knowledge, the only case reported in literature, in an ectopic pregnancy. Conclusion: LSLFCPPis a rare, yet important entity to be kept in mind when evaluating patients with large ovarian cysts in pregnancy. Comprehensive management is the need of the hour, in order to ensure ideal maternal and fetal wellbeing.

Objective of the study was t o examine the outcome differences between women presenting in early and late phase of labor. We evaluated all low - risk women with t erm (37 – 42 weeks), singleton , vertex presentation who presented in early labor ( 4cm cervical dilatation at admission only 9.6% nulliparas and 5.9% multipara required Caesarean section. Women presenting at

Study Objective To develop a very low cost, easily available uterine model for spatial orientation and practicing hysteroscopic surgeries. We are describing a very low cost novel uterine model (resembles uterus in shape and size) where a variety of hysteroscopic exercises can be practiced by residents. Design Pilot design of a novel uterine model /trainer utilized during simulation in a hysteroscopy workshop. Setting Single day hysteroscopy workshop for residents and fellows of Obstetrics and Gynecology Patients or Participants 100 Gynecology residents and practitioners who attended the workshop Interventions The hysteropractor or the uterine model is constructed using a mold to perform several exercises using the hysteroscopic instruments and its hardware. All the gynecologists were made to do diagnostic hysteroscopy to operative hysteroscopic procedures such as polypectomies, septal resections, tubal cannulations using bell peppers and saline tubing and other vegetable models with hysteropractor. They also performed resections using brinjal and potato by monopolar and bipolar energy sources. Gynecologists were asked to rate confidence in performing hysteroscopic procedures using a 5-point agreement scale pre and post simulation with the trainer. Measurements and Main Results The hysteropractor is reusable low-cost model and the materials used for exercises cost almost nothing. Teaching and training can be done through various reality simulators and animal models but cost and availability is a constraint. With this model they get the feel of practicing on something which looks similar to uterus in shape and size as well. All gynecologists performed the exercises well and there was a significant increase in confidence levels post workshop p = 0.004 Conclusion Our low-cost novel uterine model can be used for resident training in hysteroscopic procedures and improve their confidence in performing hysteroscopic procedures and reduce complications

A 27-year-old nulliparous woman presented with pain in the lower abdomen for six months. She was diagnosed to have bilateral dermoid cysts. Ovarian dermoid tumors can be bilateral in up to 15% of cases. After laparoscopy, we found that she had 7 dermoid cysts on the left side and 2 dermoid cysts on the right side, which is a rare occurrence. All the dermoid cysts were enucleated laparoscopically. The cysts were placed in an endobag and retrieved by morcellation. A one year follow up showed no evidence of recurrence or granulomatous peritonitis.

Adolescent anemia is a global health problem. Prevalence of anemia in girls in India is estimated to be around 56%. Various risk groups are prone to anemia and it leads to long-term consequences. Government has launched national programs to fight adolescent anemia by identifying high-risk groups, supplementing with iron and folic acid tablets and raising awareness about the nutritional anemia. How to cite this article Bindra V. Anemia in Adolescence. World J Anemia 2017;1(1):18-19.