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Introduction: As the pregnancy advances beyond term, the risk of perinatal morbidity and mortality increases. Hence to prevent these complications associated with postterm pregnancy, induction of labor is done, as per our institution protocol between 40 and 41 weeks of gestation. Induction has its own drawback, so it is essential to identify the women with high chances of failure of induction of labor, to prevent the morbidities associated with induction failure., Aim: To study the role of ultrasonographic fetal adrenal gland enlargement for the prediction of success of labor induction among primigravida beyond 40 weeks gestation., Material and Methods: Low-risk primigravidas beyond 40 weeks gestation, scheduled for induction of labor, were enrolled for the study. Fetal adrenal gland dimensions were measured by using abdominal probe Philips HD 7XE and general electronics logiq P6 pro or any ultrasound machine equipped with 7.5-10 MHz linear array probe and 3.5-5 MHz curved array probe., Results: The fetal adrenal gland length, width and ratio were statistically significant between the successful versus failed induction groups. The cutoff fetal zone ratio > 0.36 for the prediction of successful induction of labor had 90% sensitivity, 89% specificity, 93% PPV and 75% NPV., Conclusion: Fetal zone enlargement (fetal zone ratio > 0.36) is a strong predictor of successful induction of labor as compared to TVL and Bishop's score. It can be used for screening the women, who are destined for induction failure, so that adverse effects of induction of labor can be avoided., Competing Interests: Disclosure of Potential Conflict of InterestNone., (© Federation of Obstetric & Gynecological Societies of India 2023. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.)

Background and Objective: Oxidative stress is one of the pathophysiological factors of pPROM and Vit. E being antioxidant may have preventive role. Study was conducted to estimate maternal serum vitamin E levels and cord blood oxidative stress markers in pPROM cases., Methods: This was a case-control study including 40 pPROM cases and 40 controls. Maternal serum vitamin E levels were measured at recruitment. Cord blood was collected at delivery for estimation of telomere length and mtDNA copy number as oxidative stress markers. Levels were compared using student's t test or Mann Whitney test. For correlation Pearson coefficient was used., Results: Maternal serum vitamin E levels were normal in pPROM cases. Cord blood telomere length was more in pPROM than controls (428.99 ± 290.65 vs 322.35 ± 180.33) ( p value 0.05). Cord blood mtDNA copy number was more in pPROM than controls (516.46 ± 443.55 vs 384.77 ± 328.27) ( p value 0.13) though it was not significant. mtDNA copy number had negative correlation with Vit. E levels but it was statistically not significant ( p value 0.49). There was no association of vitamin E levels with telomere length ( p value 0.95)., Interpretation and Conclusion: pPROM was not associated with vitamin E deficiency. There was insignificant oxidative stress in cord blood as measured by mtDNA copy number but cord blood telomere length measurement did not detect any oxidative stress in pPPROM cases., Competing Interests: Conflict of interestThe authors declare that they have no potential conflict of interest., (© Federation of Obstetric & Gynecological Societies of India 2022.)

Competing Interests: Conflict of interestThe authors have no conflicts of interest to declare that are relevant to the content of this article.

Purpose of the Study: To estimate and to compare the levels of cervical phIGFBP-1 among primigravida with prolonged pregnancy, with and without successful induction of labor (IOL)., Methods: A diagnostic study (cross-sectional study design) was conducted in our institution from November 2016 to April 2018 on 84 primigravida at ≥ 41 weeks with uncomplicated singleton pregnancy. The results were analyzed using SPSS software and receiver operating characteristics curves to determine the best cutoff using Youden Index. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive (+ LR) and negative likelihood ratio (- LR) were calculated. P value < 0.05 was considered significant. Logistic regression analysis was used to determine the predictive ability of the three markers for successful IOL., Results: The cutoff level of phIGFBP-1, Bishop score (BS) and transvaginal cervical length (TVL) were 7.8 µg/l, 3 and 3.5 cm, respectively. The sensitivity, specificity, PPV, NPV, + LR and - LR of phIGFBP-1 (> 7.8 µg/l) were 0.87, 0.87, 0.89, 0.85, 6.76 and 0.15, respectively. Using logistic regression analysis, phIGFBP-1 was found to be the best predictor of successful IOL (OR 44.200; 95% CI 12.378-157.831, p  < 0.001)., Conclusion: phIGFBP-1 is a strong independent predictor successful IOL as compared to TVL and BS in primigravida with prolonged pregnancy., Competing Interests: Conflict of interestThe authors declare that they have no conflict of interest., (© Federation of Obstetric & Gynecological Societies of India 2020.)

Purpose of the Study: Intrauterine contraceptive devices ( IUCDs) are highly effective form of long-acting reversible contraception having least number of complications. We aimed to find the incidence, risk factors and the management done for incarcerated and transmigrated intrauterine contraceptive devices at a Tertiary Care Teaching Hospital during past 5 years., Methods: A cross-sectional retrospective analysis of 5 years (January 2013-December 2017) was done, and the case records from Medical Record Department and Family Planning Unit of our institution were analysed., Results: Total number of IUCD insertions done in last 5 years (from January 2013 to December 2017) in our institution was 4557. Misplaced IUCDs requiring surgical interventions were 71 (1.6%) out of which 63 (88.7%) were incomplete perforations or embedded and 8 (11.3%) were complete perforations or transmigrated IUCDs. Transmigration sites were omentum, uterovesical fold, mesentery and bladder. Laparotomy was needed in 4 (5.6%), and 2 (2.8%) needed each laparoscopy and cystoscopy. Main risk factors identified were postpartum previous on or two caesarean sections, low parity, grade of operator and IUCD and uterocervical length discrepancy., Conclusion: The risk of perforation should not be a reason to defer IUCD insertion and every effort should be made to bring down its failure and complication rates., Competing Interests: Conflicts of interestThere are no conflicts of interest for any of the authors.

Objective: To compare the efficacy and safety of mifepristone followed by misoprostol with misoprostol alone in the management of early pregnancy failure (EPF)., Study Design: A randomized double-blind placebo-controlled clinical trial., Methods: Ninety-two women with EPF ≤12 weeks were recruited and randomly allocated to receive either mifepristone 200 mg ( n  = 46) or placebo ( n  = 46). Forty-eight hours later, patients in both the groups were given 800 µg misoprostol per-vaginum. If no expulsion occurred within 4 h, repeat doses of 400 µg misoprostol were given orally at 3-hourly interval to a maximum of 2 doses in women ≤9 weeks by scan and 4 doses in women >9 weeks by scan., Results: Pre-treatment of misoprostol with mifepristone significantly increased the complete abortion rate (86.7 vs. 57.8%, p  = 0.009) and, hence, reduced the need for surgical evacuation (13.3 vs. 42.2%, p  = 0.002), induction to expulsion interval (4.74 ± 2.24 vs. 8.03 ± 2.77 h, p  = 0.000), mean number of additional doses of misoprostol required (0.68 vs. 1.91, p  = 0.000), and side effects., Conclusion: Use of mifepristone prior to misoprostol in EPF significantly improves the efficacy and reduces the side effects of misoprostol alone., Competing Interests: Compliance with Ethical StandardsNone.

Objective: To evaluate the demographic profile, high risk factors, fetomaternal outcome and management options in morbidly adherent placenta (MAP)., Study Design: Retrospective analysis., Methodology: Review of 20 case records of women with MAP during year 2001-2006., Results: The mean age and parity of the women was 27.7 ± 4.2 years and 2.5 respectively. 70 % women had previous uterine scar, and similar number had placenta previa. 60 % women presented with antepartum hemorrhage and 20 % with retained placenta. 85 % women underwent hysterectomy with 5 % requiring internal iliac artery ligation, another 5 % partial cystectomy and 15 % bladder repair. Blood loss was between one and nine litres requiring an average of six units whole blood and 4 units FFP. There were six (30 %) maternal deaths. 55 % of the newborns were preterm and the perinatal mortality was 33.3 %., Conclusion: Cesarean section and placenta previa are significant risk factors. MAP is associated with high fetomaternal morbidity and mortality.