Background: This study was designed to compare the efficacy of two important screening modalities liquid-based cytology and conventional PAP smear. Both are cytological screening methods for cervical cancer. Materials and methods: A prospective split-sample cervical cytological study was performed in 220 women attending Gynaecology Out patient Department at Mata Gujri Memorial Medical College, MG University, Kishanganj, Bihar over a period of 2 years (September 2021–September 2023). Results: In a study of 220 conventional smears, 5.45% were unsatisfactory, while the majority (80%) were inflammatory. Among the 220 liquid-based cytology (LBC) smears, there were no unsatisfactory samples, and inflammatory smears were slightly less prevalent (78.18%). Dysplastic smears underwent human papillomavirus (HPV) testing, with 62.5% testing positive. Squamous intraepithelial lesions were more common in women over 40 and those with symptoms of vaginal discharge or an unhealthy cervix. Dysplastic lesions were more frequent in women who married early, had higher parity, or shorter intervals between deliveries. Neoplastic changes were associated with smoking and oral contraceptive pills (OCP) use. One human immunodeficiency virus (HIV) positive woman had carcinoma in situ. Conclusion: The most common finding in cervical smear cytology was inflammation, followed by normal cytology. Liquid-based cytology showed a higher case pick-up rate (ASCUS, LSIL, CIS) and allowed for HPV detection, providing an advantage in screening. Most patients with neoplastic changes were HPV-positive. Overall, LBC was more sensitive and specific than conventional PAP smear (CPS), with increased detection rates of ASCUS, LSIL, and CIS due to obtaining more satisfactory smears and offering HPV detection.

Background: Most patients attending a gynecologist's OPD complain of abdominal pain. Diagnosing of pelvic pain in women can be challenging because many symptoms and signs are insensitive and non-specific. We conducted a study on middle-aged women excluding obstetric reasons, and analyzed the various causes of pain. Materials and methods: A study was conducted on 200 women in the reproductive age-group (20–45 years) attending a charitable hospital's outpatient department over a period of 10 months to analyze the causes of lower abdominal pain. Before starting this study, inclusion criteria were defined all patients who were pregnant, were excluded from the study. After primary consultation with a Gynecologist, a provisional diagnosis was made and the patients were treated accordingly. As per the nature of symptoms, the patient was later asked to consult a Surgeon. In case of urinary symptoms, patient was advised to test urine sample for ‘routine, microscopy’ and if required an ultrasound of the abdomen was done. Patients were asked to follow-up with the report. Observation: The commonest cause of hypogastric and pelvic pain was found to be pelvic inflammatory disease in majority (31%) of the population. This was succeeded by excessive bowel gas in 20% women. About 16% had urinary tract infection (UTI) whereas 14% suffered from gastrointestinal infection. The remaining 19% included other causes. In all, 30 patients required hospital admission more than 24 hours, i.e., 15% of our study population for complete treatment. Conclusion: A uniform definition of lower abdominal pain and standardized evaluation of participants are lacking across the literature. Our study reflects that out of the known factors responsible for abdominal pain, a new entity as ‘excessive colonic gas’ emerged. Besides the pelvic inflammatory disease and UTIs which are easily and commonly diagnosed, a significant number of patients concurrently suffered from excessive bowel gas, while a few (20%) had ‘gaseous distention of abdomen’ as the sole cause of abdominal pain. This may be attributed to the sedentary lifestyle and non-nutritious diet which have become an integral part of routine life. Therefore, we need to revise our differentials while managing many ‘non-specific’ underlying causes as well as adopt a healthy lifestyle modification to decrease the recurrence.

Recurrent pregnancy loss (RPL) is a dreadful reproductive health burden that affects around 5% of couples worldwide who are trying to conceive. Luteal phase insufficiency is one of the factors that contribute to implantation failure and has been linked to miscarriages and unsuccessful assisted reproduction. Before the placenta assumes control of progesterone synthesis, the corpus luteum produces enough progesterone that leads to secretory changes in the endometrium to maintain early pregnancy. A deficiency in corpus luteum function is linked with implantation failure and ends up in miscarriage. The optimum period for implantation is 6–10 days following the peak of luteinizing hormone (LH); any earlier or later than this is linked to an increased chance of miscarriage. Women with polycystic ovaries, thyroid, and prolactin disorders frequently have luteal phase defects. Women with a history of recurrent miscarriage (RM) have been found to benefit from the treatment of the underlying disease and the use of progestational hormones like progesterone and human chorionic gonadotrophin. There are more uterine and peripheral natural killer (NK) cells in women who experience RM than in control women, according to several publications. However, there is no evidence linking it to miscarriage. The goal of the current study is to thoroughly assess luteal phase steroids in cases of unexplained miscarriage. The patients were split up into two groups for this study. Group I received progesterone with Deltacortril while group II received progesterone treatment.

This study aimed to assess the knowledge and practices regarding menstrual hygiene among adolescent girls (age-group 13–18 years) in rural areas of Bishnugarh, Hazaribag, Jharkhand. A total of 100 female adolescent respondents were randomly selected for data collection. A pretested schedule was employed to gather information on their general profiles, anthropometric assessments, 24-hour dietary recalls, knowledge, and practices related to menstrual hygiene. The study found that a substantial proportion of respondents (78%) fell within the 16–18 age-group, while 22% were aged between 13 and 15. Additionally, 99% of the respondents identified as Hindu, with 72% belonging to nuclear families and 28% to joint families. In terms of education, 44% were in the 11th grade, 23% in the 12th grade, 22% in the 10th grade, and 11% in the 9th grade. Furthermore, 67% of the families engaged in business, while 33% were involved in agriculture. The study revealed that 95% of the respondents’ mothers were illiterate, and 93% of the respondents had a non-vegetarian diet, while only 7% were vegetarian. Anthropometric assessments indicated that 42% of respondents had a normal body mass index (BMI), while 10% and 26% experienced Grade III and Grade I undernutrition, respectively. Dietary patterns showed that cereals, fats, and oils were consumed daily by all respondents, with lower frequencies of pulse, fruit, meat, and poultry consumption. Most respondents consumed roots and tubers daily. Regarding knowledge of menstruation, 56% of girls were aware of it before their menarche. The study found that 49% of girls experienced menarche at the age of 13, with 31, 15, and 5% experiencing it at ages 14, 15, and 16, respectively. Friends and mothers were identified as the primary sources of information about menstruation. In terms of menstrual hygiene practices, 40% of girls used cloth, 35% used sanitary napkins, and 25% used both cloth and sanitary napkins as menstrual absorbents. Most respondents (52%) changed their absorbent every 3 hours during the first 2 days of menstruation, and 92% changed their undergarments daily. The majority (91%) bathed daily, 92% washed their hands properly after changing the absorbent, and only 22% cleaned their pubic hair regularly. Among girls who washed their vaginal area daily during menstruation, 62.8% used soap for washing. Additionally, 54% of girls reported lower abdominal pain, and 17% reported fatigue and weakness during menstruation. Only 20% of respondents were aware of restrictions during menses. Notably, girls using cloth as menstrual absorbents were highly prone to menstrual morbidities, with 62.5% experiencing both fever and irritation in the vaginal area. Among those using sanitary napkins, 25.7% suffered from both fever and irritation and among those using both cloth and sanitary napkins, 16% experienced these symptoms. The study did not find significant results in the Analysis of Variance (ANOVA) tables for various nutritional aspects. In conclusion, this study highlights significant issues related to poor knowledge of menstruation biology, the presence of menstrual symptoms among girls, and low usage of sanitary napkins. It underscores the need for adolescent girls to receive accurate and adequate information about menstruation and its proper management. Formal and informal channels of communication, such as mothers, sisters, and friends, should be utilized to provide this information.

Introduction: One of the main risks of pregnancy is uterine rupture. Even in advanced nations, rupture of the gravid uterus continues to be a possibly lethal complication for both the mother and the fetus, despite advancements in obstetric care. Materials and methods: Study design: This retrospective research was conducted in a hospital. Study place: The Department of Obstetrics and Gynaecology at Katihar Medical College. Study period: June 2021–May 2023. Study population: A total of 18,521 antenatal admissions, of which 57 were admitted with a ruptured uterus. An analysis was conducted on the case studies of 57 patients with ruptured uterus treated at KMCH, Katihar between June 2021 and May 2023. Age, gestational age, parity, blood transfusion requirement, risk factors, surgical finding, surgical management type, clinical presentation, and morbidity as well as mortality of the mother and fetus were among the many characteristics that were recorded. Results: Incidence of the total 18,521 antenatal admissions during this period, 57 had ruptured the uterus giving an occurrence of 3.07/1,000 deliveries (0.3%). 54.4% of multiparous women and 59.7% of individuals with previously scarred uterus had a ruptured uterus. Repair was possible in only 29.8% of cases. The rate of perinatal mortality was 89.5, and 3.5% of deaths were maternal. Conclusion: Uterine rupture poses a significant and potentially fatal risk to both the mother and the unborn child. The occurrence of uterine rupture is high in underdeveloped nations, such as India, and it is significantly higher in unscarred uteruses than in developed nations.

Aims and objectives: Obstetric complications are becoming increasingly common in the present era, despite profound technological and healthcare advancements. The etiology is multifactorial, and our study aimed to review all obstetric patients admitted to the intensive care unit (ICU) in a Tertiary Referral Center over one year to characterize these patients about frequency, timing, and cause of admission and record the outcomes in terms of perinatal and maternal morbidity and mortality. Materials and methods: All antenatal and postnatal obstetric patients admitted to our center over one year in the ICU were reviewed. Obstetric data included gestational age at the time of admission and delivery, parity, type and place of delivery, indications of operative delivery, need for obstetric hysterectomy, and neonatal and maternal outcomes. Intensive care unit admitting diagnoses were divided into three categories respiratory failure, hemodynamic instability, and neurological dysfunction ICU-related data included the number of days in the ICU and the need for mechanical ventilation. Results: During the study period, the incidence of ICU admissions was 0.99%. Among these patients, 46% were aged 21–25 years. Primiparas accounted for 53%, and 61% had a gestational age of 34–42 weeks. Postpartum admissions to the ICU constituted 92%, with 81% due to obstetric complications, primarily eclampsia, and preeclampsia, which represented 46% of admissions. Medical complications accounted for 19% of admissions, with cardiac diseases being the most significant at 64%. Hemodynamic instability was the leading cause of ICU admission, at 50%, followed by neurologic complications at 33%. Of the ICU-admitted patients, 94% had already delivered, with 34% undergoing lower segment cesarean section and 34% having an obstetric hysterectomy for postpartum hemorrhage. Live births were 37% of all neonates, with 18% admitted to the neonatal ICU and subsequently discharged, and perinatal mortality stood at 39%. The overall maternal mortality rate in the ICU was 37%, predominantly due to hemodynamic shock. Ventilator support was successfully weaned in 51% of patients, who were then discharged. A further 12% were transferred to a higher-level facility, with the average duration of mechanical ventilation being 2 days and 6 hours. Conclusion: Eclampsia and preeclampsia were the leading causes of ICU admission. The leading cause of maternal mortality in the ICU was obstetric hemorrhage. The setting up of a high-dependency unit could lead to a decrease in the number of ICU admissions. Additionally, awareness of the importance of regular antenatal visits could help reduce obstetric complications.

Cesarean scar pregnancy (CSP) is defined as a condition where the product of gestation implants into the myometrial defect of a previous uterine incision and is increasingly becoming a common pathology due to the rise in cesarean deliveries. It is the most uncommon form of ectopic pregnancy and is difficult to diagnose and treat. These pregnancies can be associated with adverse maternal outcomes like rupture of the uterus, severe obstetric hemorrhage, and morbid implantation of the placenta. Cesarean scar pregnancy is considered precursor to the development of the morbidly adherent placenta and two primary risk factors are previous cesarean section and placenta previa. Cesarean scar pregnancies have been classified into two types. In the first type the gestational sac (G Sac) implants on the scar and progresses towards either the cervical-isthmic space or the endometrial cavity. This condition may result in live birth but with a major risk of severe hemorrhage at the area of implantation. In type II CSP, implantation occurs deeply into the defect of a prior lower segment cesarean section (LSCS) scar and further advances to involve the muscle and the serosal layer of the uterus. We examine a particular case of type II CSP where the diagnosis was initially delayed. Our patient, a G5P4A1L4 woman in her mid-forties with a history of two LSCSs, presented with severe lower abdominal pain, 2 months of amenorrhea, and a positive urine pregnancy test. An urgent ultrasound with a Doppler scan confirmed a cesarean scar ectopic pregnancy. The decision was made to forgo an magnetic resonance imaging (MRI) due to non-affordability and also because ultrasound with Doppler flow imaging, is the standard modality for diagnosing CSP. The preferred imaging modality is transvaginal scanning, which gives detailed information about the implantation site and its distance from the LSCS scar. A thorough abdominal scan conducted with a full bladder allows the determination of the gap between the G Sac and the urinary bladder. The patient received comprehensive counseling on the diagnosis, management options, and associated risks, and chose to undergo a total laparoscopic hysterectomy with bilateral salpingectomy. The surgery was made complex by intraperitoneal adhesions resulting from two prior surgeries, and the bladder was firmly attached to the uterus. Careful adhesiolysis, precise identification of ureters, coagulation of the uterine vessel pedicles at their origin, and impeccable hemostasis led to a successful surgical outcome without any unintended complications. The patient benefitted from early recovery and minimal blood loss. She was discharged on postoperative day two and the histopathology reports confirmed the diagnosis of CSP.