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Introduction: One of the prime causes of infertility is reproductive tract infections as they can produce marked cervical inflammation. These can be seen in Pap smears at various stages as cervical health plays an imperative role in blocking ascending infections. This study assesses infections and related changes in Pap smears from women with infertility and its association with clinical and microbiological findings. Materials and Methods: A prospective observational study was done for 3.5 years. Pap smears of women with infertility were taken, and those showing significant inflammation (>50%) were studied. Relevant history and "per-speculum" findings were noted. Pap smear changes, infections or intraepithelial changes, and lactobacilli were studied. High vaginal swab culture was done, and follow-up conception data were correlated. Results: Almost 50% of women with inflammatory smears showed the presence of an infection; of which the most common was candidiasis followed by bacterial vaginosis. Out of the 12 women whose culture reports were available, 11 showed growth (90%). Most women showed depleted lactobacilli. On follow-up, the conception rate despite assisted reproductive technology was significantly lower in women with Pap smear changes (P = 0.0002). Conclusion: These observations show a strong and significant association between inflammatory Pap smears, infections in the reproductive tract, depleted lactobacilli, and conception. It is advisable that a Pap smear should be done in all cases of infertility to look for infections and inflammation, and a follow-up with high vaginal swab culture should be done in cases where inflammation is detected in a Pap smear. [ABSTRACT FROM AUTHOR]

A young female presented with an acute abdominal pain and oliguria for 1 week following normal vaginal delivery. No history of hematuria was present. Patient was having lochia rubra. Sealed uterine rupture was suspected clinically. Initial ultrasound of the patient showed distended urinary bladder containing Foley catheter ballon with clamping of Foley catheter and particulate ascites. Abdominal paracentesis revealed hemorrhagic fluid. Contrast-enhanced computed tomography of abdomen revealed ascites, distended urinary bladder and no extraluminal contrast extravasation in delayed scan. As patient condition deteriorated, repeat ultrasound guided abdominal paracentesis was done which revealed transudative peritoneal collection with distended bladder. Cystoscopy revealed urinary bladder ruptures with exudate sealing the rupture site. Exploratory laparotomy was done and a diagnosis of extraperitoneal bladder rupture was confirmed. The rent was repaired in layers. She was put on continuous bladder drainage for 3 weeks followed by bladder training. It presented in a unique way as there was hemorrhagic peritoneal tap, no macroscopic hematuria and urinary bladder was distended in spite of urinary bladder wall rupture which delayed the diagnosis and treatment. Complete emptying of urinary bladder before second stage of labor and during postpartum period with perineal repair is mandatory to prevent urinary bladder rupture. [ABSTRACT FROM AUTHOR]