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Background Endometrial pathology is a recognized contributor to infertility and recurrent implantation failure, but its detection during hysteroscopy, particularly in the absence of visible lesions, is challenging. Chromohysteroscopy, involving the use of methylene blue dye, has shown promise in improving diagnostic accuracy. Methods This interventional cross-sectional study compared the diagnostic accuracy of chromohysteroscopy and conventional hysteroscopy, using histopathology as the gold standard. A total of 100 consenting infertility patients were included, in a sequential step, hysteroscopy followed by chromohysteroscopy using methylene blue dye was performed to enhance the detection of subtle endometrial pathologies. Results Among the 100 women who underwent diagnostic hysteroscopy, 76 exhibited normal findings, while 24 had abnormal findings. During chromohysteroscopy, 62 cases displayed a light staining pattern, and 38 cases exhibited dark staining. Histopathological analysis of biopsy tissue from the dark-stained areas revealed endometrial pathology in 84.2% (32/38) and normal endometrium in 15.8% (6/38) cases. In contrast, biopsies from the light-stained areas indicated abnormal endometrium in only 3.23% (2/62) cases, with the remaining 96.77% having a normal histology. Chromohysteroscopy demonstrated a significantly higher diagnostic accuracy (92%) for endometrial pathology compared to conventional hysteroscopy (58%). Notably, chromohysteroscopy's sensitivity was 94.12%, and its specificity was 90.9%. The staining patterns observed during chromohysteroscopy correlated well with histological findings, highlighting its effectiveness in identifying structurally damaged endometrium. Conclusion Chromohysteroscopy emerges as a valuable diagnostic tool for assessing endometrial pathology, especially in infertility cases. This technique offers superior accuracy compared to conventional hysteroscopy, providing clinicians with a more precise means of diagnosis and potential targeted treatments. [ABSTRACT FROM AUTHOR]

Background: Endometrial pathology is a recognized contributor to infertility and recurrent implantation failure, but its detection during hysteroscopy, particularly in the absence of visible lesions, is challenging. Chromohysteroscopy, involving the use of methylene blue dye, has shown promise in improving diagnostic accuracy. Methods: This interventional cross-sectional study compared the diagnostic accuracy of chromohysteroscopy and conventional hysteroscopy, using histopathology as the gold standard. A total of 100 consenting infertility patients were included, in a sequential step, hysteroscopy followed by chromohysteroscopy using methylene blue dye was performed to enhance the detection of subtle endometrial pathologies. Results: Among the 100 women who underwent diagnostic hysteroscopy, 76 exhibited normal findings, while 24 had abnormal findings. During chromohysteroscopy, 62 cases displayed a light staining pattern, and 38 cases exhibited dark staining. Histopathological analysis of biopsy tissue from the dark-stained areas revealed endometrial pathology in 84.2% (32/38) and normal endometrium in 15.8% (6/38) cases. In contrast, biopsies from the light-stained areas indicated abnormal endometrium in only 3.23% (2/62) cases, with the remaining 96.77% having a normal histology. Chromohysteroscopy demonstrated a significantly higher diagnostic accuracy (92%) for endometrial pathology compared to conventional hysteroscopy (58%). Notably, chromohysteroscopy's sensitivity was 94.12%, and its specificity was 90.9%. The staining patterns observed during chromohysteroscopy correlated well with histological findings, highlighting its effectiveness in identifying structurally damaged endometrium. Conclusion: Chromohysteroscopy emerges as a valuable diagnostic tool for assessing endometrial pathology, especially in infertility cases. This technique offers superior accuracy compared to conventional hysteroscopy, providing clinicians with a more precise means of diagnosis and potential targeted treatments. [ABSTRACT FROM AUTHOR]

Cervical ectopic pregnancy (CEP) is a rare and challenging condition that requires prompt management to prevent complications. We present a case of a 27-year-old woman with a history of prior uterine surgeries who presented with vaginal spotting. Ultrasonography revealed an empty uterine cavity and a growing gestational sac with a viable foetus in the cervical canal. Despite methotrexate therapy, her beta-human chorionic gonadotropin hCG levels continued to rise, necessitating an alternative treatment approach. Bilateral uterine artery embolisation (UAE) was performed to reduce the risk of haemorrhage before hysteroscopic resection of the pregnancy. The combined approach of UAE and hysteroscopic resection successfully managed the CEP, leading to a favourable outcome. This case highlights the importance of early detection, tailored interventions and multidisciplinary collaboration in the management of CEP. UAE, in conjunction with hysteroscopic resection, offers a promising treatment option for CEP, minimising complications and preserving reproductive health. [ABSTRACT FROM AUTHOR]

Purpose: Swyer syndrome is one of the rare causes for disorders of sexual development. Case report: An 18-year-old girl presented with complaints of inability to attain menarche. Physical examination revealed underdeveloped breast with absent pubic and axillary hair; however, the vagina was well canalized. Her hormonal profile was of hypergonadotropic hypogonadism. USG and MRI demonstrated hypoplastic uterus with very small ovaries. Chromosomal analysis reported 46 XY genetic makeup. Given the higher risk of malignancy in dysgenetic gonads, the patient underwent laparoscopic gonadectomy and had been put on hormone replacement therapy. Conclusion: Swyer syndrome, though a very rare entity, should be kept in mind while evaluating primary amenorrhea. Gonadectomy should be performed early once diagnosis is made to avoid the risk of malignancy. [ABSTRACT FROM AUTHOR]

Background: Myoma is the most common benign monoclonal neoplasm of the uterus with increased frequency during reproductive years of women. Case Presentation: A twenty two year old female presented with abdomen lump, dysmenorrhoea, and heavy menstrual bleeding. Multiple myomas were diagnosed based on clinical and radiological findings. Abdominal myomectomy was performed and 75 myomas were enucleated followed by reconstruction of uterus. The second case was a 28 year old married woman presented with heavy menstrual bleeding and dysmenorrhoea. Ultrasound reported single posterior wall myoma of 8x6.3x5.8 cm in size. Laparoscopic myomectomy was performed. At follow-up visit, both cases were completely free of any symptoms. Conclusion: Myomectomy is a feasible and safe option and a uterine preserving surgery even in the presence of multiple myomas. Setting appropriate criteria in selecting patients for abdominal myomectomy rather than MIS is essential to avoid conversion and associated morbidity. [ABSTRACT FROM AUTHOR]

To assess the risk of neonatal SARS-CoV-2 infection born to the women with confirmed SARS-CoV-2 infection. This prospective study was conducted at single tertiary hospital from September 2020 and May 2021. 50 pregnant women with confirmed SARS-CoV-2 infection and 50 neonates were included for analysis. We performed comprehensive testing of all biological samples for vertical transmission including the cord blood immunoglobulin. We detected SARS-CoV-2 in one fetal membrane and one amniotic fluid sample. We also demonstrated presence of anti-SARS-CoV-2 IgM antibodies in cord blood of 3 neonates. Though none of the samples of vaginal secretion, breast milk and nasopharyngeal swab from neonates were tested positive for covid infection via RT-PCR. We demonstrated presence of anti-SARS-CoV-2 IgG antibodies in the cord blood which had shown positive correlation with increasing disease to delivery interval and disease severity. Vertical transmission of SARS-CoV-2 is possible. As virus was not detected in cervicovaginal secretions and breast milk so vertical transmission through this mechanism seems unlikely. Presence of IgG in cord blood is suggestive of passive immunity acquired from mother. This finding has greater clinical implication as large number of expecting mothers are being vaccinated. [ABSTRACT FROM AUTHOR]

Objective: The most-dreaded complications of dermoid cyst spills are chemical peritonitis, iatrogenic implantation of malignant cells, and recurrences. This study recorded the incidence of chemical peritonitis after dermoid-cyst excision with intraoperative cyst spilling and examined short- and long-term postoperative complications and recurrence rates. Materials and Methods: This retrospective analysis included 72 females who underwent ovarian cystectomies and who had ovarian dermoid cysts excisions from January 2016 to December 2020. Data pertaining to types of procedures, intraoperative cyst ruptures, chemical peritonitis, readmissions, and recurrences were analyzed. Results: Females (72) underwent dermoid-cyst excisions (laparotomy: 12; laparoscopy: 60). The mean age of presentation was 29.3 ± 11 years, mean cyst volume was 488.08 ± 1852.8 cc; 88.9% of cysts ruptured during excision; 0 cases of chemical peritonitis; and 1 patient had a cyst recur 4 months after removal. The laparotomy group, had a higher incidence of raised cancer antigen–125 levels (p < 0.001), torsions (p < 0.05), salpingo-oophorectomies (p < 0.001), estimated blood losses (p < 0.003), and longer operative times (p < 0.002), compared to the laparoscopy group. However, there was no significant difference between the 2 groups in spillages, chemical peritonitis, postoperative complications, and recurrences. In a subgroup analysis of laparoscopy cases, spillage was commonly associated with larger cysts (p < 0.0001), cystectomies (p < 0.0001), and longer operative times (p < 0.06). Conclusions: Intraoperative cyst content spillage does not influence the outcome of dermoid-cyst removal. Hence, laparoscopy is a safe and effective method of managing dermoid cysts. (J GYNECOL SURG 38:221) [ABSTRACT FROM AUTHOR]

Introduction: MRKH syndrome, is a spectrum of congenital anomalies of unknown aetiology characterised by a variable degree of utero-vaginal agenesis in women with normal secondary sexual characteristics and a 46, XX karyotype. Case report: A 16 year old unmarried presented with absence of menses and chronic pelvic pain. MRKH with endometrioma was diagnosed on MRI. Laparoscopic removal of the Mullerian mass with endometriotic cyst was done. The diagnosis was subsequently confirmed on histology. Conclusion: This case highlights the atypical presentation of MRKH and reinforce the Sampsons theory of retrograde menstruation in the development of endometriosis. Patient with chronic pelvic pain and MRKH syndrome should be evaluated for endometriosis. [ABSTRACT FROM AUTHOR]

Hidradenoma papilliferum (HP) is a rare benign tumor of the apocrine gland and is commonly seen at the anogenital region. A 32-year-old post-hysterectomy woman presented with excessive vaginal discharge and itching. Small polypoidal mass was noted at vault. Excision of the lesion was done, and histopathology confirmed HP. The patient is symptom free following excision. This case report highlights the presence of pluripotent cells in the vagina and their differentiation into any cell lineage. [ABSTRACT FROM AUTHOR]

Objective: Arteriovenous malformation (AVM) can occur in cesarean scar ectopic pregnancy. The presence of retained product of conception can pose a diagnostic dilemma and clinical presentation could be similar. Case report: A 27 year old female presented with continuous vaginal bleeding for two and half months following dilatation and evacuation (D&E) done for cesarean scar pregnancy (CSP) of 10 weeks 4days period of gestation. Sonography with color Doppler revealed dilated tortuous vessels around the mass in lower uterine segment suggesting CSP with AVM. Digital subtraction angiography confirmed the diagnosis. Bilateral uterine artery embolization achieved complete devascularisation as confirmed on post intervention angiogram. Patient became symptom free since then. Conclusion: Uterine artery embolization is an effective mode of treatment of AVM complicating CSP if future fertility is desired. [ABSTRACT FROM AUTHOR]

Introduction: To evaluate the safety and efficacy along with the impact on uterine and fibroid vascular indices of 2 repeat 12-week courses of ulipristal acetate (UPA) among Indian women. Material and methods: Ninety-four premenopausal women aged 18-45 years with at least 1 symptomatic fibroid of size ranging from 1 cm to 10 cm were included in the study. All participants received 2 courses of 5 mg of UPA orally for 12 weeks starting from the 5th day of their menstrual cycle with a 2-menstrual-cycle break in between. The efficacy was measured in terms of time to amenorrhoea, percentage of women who achieved amenorrhoea for the last 35 consecutive days, reduction in uterine and fibroid volume, as well as its vascularity at the end of the first and second treatment cycle. Results: Eighty-six women completed the first treatment cycle whereas only 65 women completed the second treatment course. Seventy-nine per cent of women achieved amenorrhoea for 35 consecutive days during the first treatment cycle. Median time to amenorrhoea was 7 days and 5 days during the first and second treatment cycle, respectively. Percentage reduction of the mean fibroid volume was 32% and 52% after the first and second treatment cycle, respectively. We observed an increase in fibroid vascular indices (pulsatility index and resistive index) suggesting reduction in fibroid vascularity. Serum oestradiol remained at mid-follicular phase. No serious drug emergent side effect was noted. Conclusions: Two interrupted repeat course of 5mg UPA is well tolerated efficient and safe in symptomatic fibroid among Indian women. [ABSTRACT FROM AUTHOR]

Introduction: Abnormal Uterine Bleeding (AUB) affects 14-25% of women of reproductive age group and accounts for 66% of hysterectomies. Accurate diagnosis of the cause of AUB will reduce the hysterectomy burden, but the ideal evaluating tool to accurately diagnose the cause of the same is debatable. Aim: To evaluate the diagnostic accuracy of transvaginal sonography and hysteroscopy in the evaluation of abnormal uterine bleeding, using histopathological diagnosis as gold standard. Materials and Methods: This retrospective descriptive study was conducted on patients who underwent transvaginal sonography and hysteroscopy for evaluation of abnormal uterine bleeding from January 2017 to January 2020. Data including demographic details, sonographic details, pre-operative diagnosis, anaesthesia used, operative notes, complications and histopathological diagnosis were obtained from clinical record sheet of the patients. Sensitivity, specificity, diagnostic accuracy of TVS and hysteroscopy was calculated using MedCalc software version 19.2.6. Results: A total of 214 patients were enrolled in the study. Hysteroscopy reported >95% diagnostic accuracy for all intrauterine pathology compared to TVS which revealed diagnostic accuracy of 73.13% for polyp, 77.1% for endometrial hyperplasia and 73.6% for all other pathology. Hysteroscopy revealed strong to almost perfect correlation with histopathological diagnosis for all pathology compared to TVS which demonstrated weak correlation for various intrauterine pathology. Conclusion: Hysteroscopy should be used as initial evaluating tool in AUB as it is simple and minimal-invasive with high diagnostic accuracy. [ABSTRACT FROM AUTHOR]

A 28-year-old woman presented with a 1-year history of severe progressive dysmenorrhea following suction evacuation and tubal ligation. Sonography showed a bicornuate uterus with hematometra in the left horn. Hysteroscopy ruled out a diagnosis of a congenital Müllerian anomaly, as both ostia appeared normal. Under laparoscopy, a mass was seen on the left fundal region near the insertion of the round ligament, and needle aspiration of a chocolate-colored fluid confirmed the diagnosis of an adenomyotic cyst. The cyst was excised. The patient recovered well and has been symptom-free since surgery. Adenomyotic cyst is a rare entity in young women and must be differentiated from obstructive Müllerian anomaly. Laparoscopy is the preferred minimally invasive modality for managing this rare disorder. [ABSTRACT FROM AUTHOR]

Hidradenoma papilliferum (HP) is a rare benign tumor of the apocrine gland and is commonly seen at the anogenital region. A 32-year-old post-hysterectomy woman presented with excessive vaginal discharge and itching. Small polypoidal mass was noted at vault. Excision of the lesion was done, and histopathology confirmed HP. The patient is symptom free following excision. This case report highlights the presence of pluripotent cells in the vagina and their differentiation into any cell lineage. [ABSTRACT FROM AUTHOR]

Broad ligament is the common extrauterine site for fibroid. We present a case of huge broad ligament fibroid with cystic degeneration. Patient presented with abdominal swelling and mild pain abdomen. On abdominal examination, a large tense cystic mass of 34 weeks gravid uterus size arising from pelvis was noted. Cervix was pulled up and all fornices were full with mass on pelvic examination. Ultrasound suggested adnexal mass as ovaries were not seen. Contrast‐enhanced computed tomography abdomen too reported adnexal mass likely of ovarian origin. On laparotomy, 6 L of straw color fluid drained from the mass which was seen arising from left broad ligament, bilateral ovaries were separate from the mass and appeared healthy. Enucleation of mass was done to ease the hysterectomy and careful evaluation of ureteric course was done throughout the surgery to avoid its injury. Total hysterectomy with bilateral salpingo‐opherectomy and pelvic lymphadenectomy was performed. This case is being reported for its rare incidence, diagnostic dilemma and surgical challenge. [ABSTRACT FROM AUTHOR]

Background: Dermoid cyst accounts for 10-20 % of all ovarian tumors. Traditionally giant ovarian cysts have been removed through a midline laparotomy. Here we report a case of laparoscopy-assisted removal of a giant dermoid cyst in an adolescent girl. Case Presentation: A 17-year-old girl presented with a complaint of abdominal distension for 7 months. Abdominal examination revealed a well-defined tense cystic mass arising from the pelvis and extending up to the epigastric region. CT scan of abdomen and pelvis reported a mature teratoma of size 25.5x19.9x35cm of the right ovary. Laparoscopic excision of the cyst was performed following extracorporeal drainage of the cyst. Conclusion: Laparoscopy-assisted removal of a giant ovarian dermoid cyst is a feasible mode of treatment irrespective of its size provided malignancy has been ruled out. [ABSTRACT FROM AUTHOR]

Verrucous carcinoma is a rare variant of cervical carcinoma, usually occurs in postmenopausal group. Etiology is still not understood but it is thought to be associated with chronic irritation and inflammation. Histological diagnosis is usually difficult since the pathologic findings may be benign especially if biopsy specimen contains only surface epithelium. Prognosis of this histological subtype is better compared to the well-differentiated Squamous Cell Carcinoma (SCC) of cervix. We present a case of verrucous carcinoma where patient came for routine check-up and on pelvic examination; cervix was replaced by friable, cauliflower like warty growth, clinically staged as stage 1B. Punch biopsy was taken from the growth and it reported benign pathology but due to high index of suspicion, repeat biopsy was taken and second histopathology also reported benign pathology. Contrast Enhanced Computed Tomography (CECT) whole abdomen was advised as clinical picture and Histopathological Examination (HPE) was not matching. CECT reported mass confined to the cervix, features consistent with carcinoma cervix. So she underwent radical hysterectomy with pelvic lymphadenectomy. Final histopathology reported verrucous carcinoma of cervix. She is under regular follow-up and free of disease since 1 year. [ABSTRACT FROM AUTHOR]

India aims to eliminate rubella and congenital rubella syndrome (CRS) by 2023. We conducted serosurveys among pregnant women to monitor the trend of rubella immunity and estimate the CRS burden in India following a nationwide measles and rubella vaccination campaign. We surveyed pregnant women at 13 sentinel sites across India from Aug to Oct 2022 to estimate seroprevalence of rubella IgG antibodies. Using age-specific seroprevalence data from serosurveys conducted during 2017/2019 (prior to and during the vaccination campaign) and 2022 surveys (after the vaccination campaign), we developed force of infection (FOI) models and estimated incidence and burden of CRS. In 2022, rubella seroprevalence was 85.2% (95% CI: 84.0, 86.2). Among 10 sites which participated in both rounds of serosurveys, the seroprevalence was not different between the two periods (pooled prevalence during 2017/2019: 83.5%, 95% CI: 82.1, 84.8; prevalence during 2022: 85.1%, 95% CI: 83.8, 86.3). The estimated annual incidence of CRS during 2017/2019 in India was 218.3 (95% CI: 209.7, 226.5) per 100, 000 livebirths, resulting in 47,120 (95% CI: 45,260, 48,875) cases of CRS every year. After measles-rubella (MR) vaccination campaign, the estimated incidence of CRS declined to 5.3 (95% CI: 0, 21.2) per 100,000 livebirths, resulting in 1141 (95% CI: 0, 4,569) cases of CRS during the post MR-vaccination campaign period. The incidence of CRS in India has substantially decreased following the nationwide MR vaccination campaign. About 15% of women in childbearing age in India lack immunity to rubella and hence susceptible to rubella infection. Since there are no routine rubella vaccination opportunities for this age group under the national immunization program, it is imperative to maintain high rates of rubella vaccination among children to prevent rubella virus exposure among women of childbearing age susceptible for rubella. [ABSTRACT FROM AUTHOR]

Objective: Quadratus lumborum (QL) block has emerged as a good option to be included in multimodal analgesia for abdominal surgeries. The aim of the present study was to compare the effectiveness of the QL block with the more established transversus abdominis plane (TAP) block along with a control group in terms of duration of analgesia as the primary outcome in total abdominal hysterectomy (TAH). Methods: This randomised, double-blind, controlled trial was performed after ethics committee approval and written informed consent. Ultrasound-guided QL (group Q) and TAP (group T) blocks were administered on either side using 20mL of 0.25% bupivacaine after surgery under general anaesthesia, and group C did not receive any intervention. Results: There was a significant difference in the duration of analgesia among the groups (P = .00). It was significantly longer in group Q (mean = 8.05 hours; 95% CI, 7.28, 8.81) compared to group T (mean = 5.59 hours; 95% CI, 4.63, 6.45) and group C (mean = 1.19 hours; 95% CI, 1.04, 1.34). The verbal rating score (P = .001) and the cumulative analgesic consumption (P = .00) were the least in group Q. There was no complication in any of the groups. However, the level of satisfaction in patients receiving QL blocks did not differ significantly than in those receiving TAP block. Conclusion: It is highly recommended to include QL block as a part of multimodal analgesia in TAH as it is superior to TAP block in analgesic effect. [ABSTRACT FROM AUTHOR]