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Preterm birth is the second leading cause of neonatal morbidity and mortality. This study aimed to determine if there were differences in the microbiota between women experiencing preterm labor and those with full-term pregnancies. Additionally, we aimed to identify the vaginal microorganisms present and their antibiotic sensitivities in women undergoing spontaneous preterm labor. Women with a spontaneous onset of labor were recruited for the study. Those with spontaneous term labor were classified as Group A, while those with preterm labor were classified as Group B. Three high vaginal swabs were collected from the posterior fornix using a sterile swab and sent to the Microbiology Department for Gram staining, culture and sensitivity testing, and polymerase chain reaction analysis. The frequency of vaginal infection is more among women in spontaneous preterm labor than those in spontaneous term labor. Socioeconomic status and women with a previous history of preterm labor were found to be at high risk for preterm labor. The most common organism belongs to Gram-negative bacilli and is sensitive to third-generation cephalosporins. The study suggests that vaginal infections may increase the risk of preterm labor, with gram-negative bacilli commonly identified and mostly sensitive to third-generation cephalosporins. Routine screening for asymptomatic genital infections in antenatal women is recommended, regardless of preterm labor risk, as early identification and treatment could help prevent preterm labor.

Pregnancy in women with autosomal dominant polycystic kidney disease (ADPKD) complicated by significant cardiovascular disease is high risk. We report a multiparous woman in her late 30s with ADPKD, chronic hypertension and prior anterior wall myocardial infarction who was found to have a left ventricular mural thrombus at 12 weeks’ gestation. She was managed with anticoagulation, pregnancy-adjusted antihypertensive therapy and multidisciplinary care. Fetal growth restriction developed at 32 weeks, and emergency caesarean delivery was performed at 35 weeks for absent end-diastolic flow in the umbilical artery. A live infant was delivered with good neonatal outcome. The mother had an uncomplicated postpartum recovery, and follow-up echocardiography showed partial thrombus resolution. This case highlights the complex interaction between ADPKD, cardiovascular disease and pregnancy and underscores the importance of individualised anticoagulation, strict blood pressure control and coordinated multidisciplinary management to optimise maternal and fetal outcomes.

Hypokalemic periodic paralysis during pregnancy is a rare disease condition that presents during pregnancy. It manifests with acute muscular weakness associated with low potassium levels. We report a case of an antenatal woman presenting with leaking per vagina and weakness of four limbs at 33 weeks of gestation. She had similar episodes in the past but defaulted on taking oral potassium. On physical examination, she had hyporeflexia and flaccid paralysis of all limbs without sensory involvement. A neurology consultation was sought and diagnosed to have flaccid quadriparesis. Her investigations showed low serum potassium along with electrocardiography (ECG) changes. With potassium correction, her weakness improved within four days of initiating treatment. A week later, she had a spontaneous labour onset and delivered a healthy male baby. The peripartum period was uneventful. A timely diagnosis and management, avoiding precipitating factors, and preventing future attacks should be the primary goal of management.

Vasa previa is a rare but potentially life-threatening condition to the fetus. Timely antenatal diagnosis and delivery by cesarean section (CS) can lead to a favorable outcome. Here, we report a case of recurrent pregnancy loss (G3A2) with vasa previa, which was diagnosed prenatally by ultrasound. She was admitted at her 31st week with bleeding per vaginum (PV) provisionally diagnosed as antepartum hemorrhage (APH) and managed conservatively as placenta previa. Follow-up ultrasonography (USG) revealed vasa previa at 33 weeks. The fetus was delivered by lower segment cesarean section (LSCS) after careful separation of the membranes and avoiding damage to the vessels as there was velamentous insertion of cord with the lower margin of the placenta in the lower segment. The baby was cared for in the neonatal intensive care unit due to prematurity and discharged after six days. This case report highlights the importance of prenatal ultrasound in diagnosing vasa previa and planning an elective cesarean section with caution intraoperatively for the safe delivery of the baby.

AimThe aim of this study was to estimate the frequent existence of unexpected ovarian malignant lesions after laparoscopic surgery for an apparent benign adnexal mass and assess its clinical and ultrasound characteristics in postmenopausal women.MethodsWe re-examined the hospital records of 96 cases of postmenopausal women who underwent laparoscopic surgery for benign adnexal mass over five years. The age of the patient, parity, ultrasound findings, tumor markers level, intraoperative findings, and histopathological report were collected. Pearson's Chi-squared test and Fisher's exact test were used for statistical analysis, and a p-value of <0.05 was accepted as statistically significant.ResultsOf a total of 96, benign adnexal mass was in 93 (96.83%), an unexpected ovarian malignancy was observed in two (2.08%) cases, and one (1.04%) had a borderline ovarian tumor. Tumor marker CA-125 was done for all those cases of adnexal mass in postmenopausal women, and not a single case was found to have above 35 IU/ml, defined as the cut-off value for CA-125. Statistically significant differences were observed between the benign and malignant groups in relation to symptoms (p<0.05), ultrasound score (p=0.001), and bilaterality (p=0.013) of the tumor mass.ConclusionIn postmenopausal women, the critical concern for laparoscopic surgery of benign adnexal mass is unexpected malignancy. So it is essential to select patients carefully for laparoscopic surgery. If a benign-looking adnexal mass turned out to be malignant on the histopathological report, we should try to post the patient for subsequent staging laparotomy as soon as possible.

A 26-year-old primiparous female patient underwent caesarean section for persistent occipito-posterior position in 2018 at the Department of Obstetrics and Gynecology, Jawaharlal Institute of Postgraduate Medical Education & Research, Puducherry, India. Upon postnatal followup six weeks later, both mother and baby were reported to be fine. At eight weeks postpartum she had an episode of heavy vaginal bleeding which was treated symptomatically with tranexamic acid and antibiotics at a local hospital. One month after this, she had another episode of heavy vaginal bleeding at home and was referred to the emergency department at Jawaharlal Institute of Postgraduate Medical Education & Research. On examination, she was pale, had a pulse rate of 90 per minute and blood pressure of 120/70mm Hg. She had a transverse abdominal scar that had healed by primary intention and the uterus was involuted normally. On speculum examination, minimal bleeding was only noted through the cervix. Intravenous antibiotics was started with a suspicion of infective aetiology for haemorrhage. An ultrasound showed a normal-sized uterus with heterogeneous myometrial echotexture, due to the presence of multiple anechoic areas, and thin endometrial lining with no retrained products of conception [Figure 1A]. Colour Doppler sonography showed intense myometrial hypervascularisation with turbulent flow in the hypoechoic region suggestive of a pseudoaneurysm, near the uterine incision site on the right side involving the right uterine artery [Figure 1B]. Her haemoglobin at admission was 8.2 g/dL. She underwent bilateral uterine artery embolisation under fluoroscopic guidance which confirmed pseudoaneurysm in the right uterine artery. The pseudoaneurysm was embolised with platinum coils and gel foam particles; postembolisation images ensured a complete occlusion [Figure 2]. The patient did not have any further bleeding and was discharged five days later. She resumed normal menstruation two months following the procedure. Open in a separate window Figure 1 A:Greyscale two-dimensional ultrasound of a 26-year-old primiparous female patient after a caesarean section showing a normal-sized uterus with heterogeneous myometrial echotexture and thin endometrium lining.B:Colour Doppler sonography showed intense myometrial hypervascularisation with turbulent flow in the hypoechoic region, near the uterine incision site on the right side, involving the right uterine artery. Open in a separate window Figure 2 Selective right internal iliac angiogram images of a 26-year-old primiparous female patient after a caesarean section showing(A)the pseudoaneurysm in the right uterine artery which was embolised with platinum coils and gel foam particles and(B)the postembolisation occlusion that ensured a complete occlusion.

Atrial myxoma, a rare benign tumour of the heart, predominantly affects women in the reproductive age group. There is no consensus on the monitoring and treatment of atrial myxoma in pregnancy, as the experience is limited to a few cases reported in the literature. We report a case of a pregnant individual referred with suspected left atrial thrombus, finally diagnosed to have pedunculated left atrial myxoma and underwent successful resection along with caesarean section, resulting in good maternal–fetal outcomes.

Gynecological problems of adolescents occupy a special space in the spectrum of gynecological disorders because they are often different from the conditions that affect adult women. The objective of study was to determine the different gynecological problems in adolescent girls attending outpatient departments.Methods Adolescent girls of age 10–19 years were included in this study. Various gynecological problems were evaluated by detailed history taking and thorough clinical examination. Investigations like haemogram, coagulation profile, hormonal assays and ultrasonography were done wherever indicated. Descriptive analysis was done and results are expressed in terms of percentage.Results A total of 824 (8.33%) adolescent girls attended the gynecology outdoor patient department (GOPD) during the study period. Menstrual disorders (67.11%) were the commonest complaint, followed by vaginal discharge (18.68%) and UTI (9.8%). Menstrual disorders varied from irregular menstruation (55.15%), dysmenorrhea (30.74%) and amenorrhea (14.10%). Dysfunctional uterine bleeding was the commonest cause of menstrual irregularity followed by polycystic ovarian disease (PCOD). Teenage pregnancy (0.84%) and ovarian tumor (0.60%) was found in a few cases.Conclusion Adolescent girls’ gynecological problems should be evaluated thoroughly and managed accordingly. Adolescent health education needs to increase awareness and give further attention to gynecological problems.