Fitz-Hugh-Curtis (FHC) syndrome occurs as a complication of pelvic inflammatory disease, most commonly in young women, following Chlamydiae trachomatis infection of the genital tract. It is a rare condition, exceptional in elderly women and especially when it is revealed during an intestinal obstruction. This is why we report the case of a 65-year-old woman who presented with an occlusive syndrome whose diagnosis of FHC syndrome was made accidentally intra operatively. Thus, when the usual causes of febrile obstruction in a woman have been eliminated, whatever the age, the possibility of FHC syndrome must be raised by the clinician, even in the absence of pelvic symptoms.
Mönckeberg's arteriosclerosis, or medial calcific sclerosis, is an uncommon, non-atherosclerotic form of vascular calcification affecting the tunica media of small- and medium-sized muscular arteries. It occurs independently of intimal atherosclerotic disease, is typically non-obstructive, and is most often encountered in the peripheral arteries of the lower limbs in elderly patients, diabetics, and those with chronic kidney disease. Involvement of the uterine vasculature is exceedingly rare, with only a handful of cases described worldwide. We report a 60-year-old postmenopausal woman with no identifiable metabolic risk factors who presented with third-degree utero-vaginal prolapse and underwent vaginal hysterectomy with anterior colporrhaphy. Histopathological examination of the surgical specimen incidentally revealed medial calcific sclerosis of the uterine vessels, in addition to chronic cervicitis and senile cystic atrophy of the endometrium. This case adds to the sparse literature on Mönckeberg's arteriosclerosis at an atypical, visceral site and highlights the importance of histopathological vigilance in recognising this entity even in patients without conventional risk factors.
Background: Effective intrapartum monitoring is essential for improving maternal and neonatal outcomes while minimizing unnecessary obstetric interventions. The World Health Organization (WHO) labour care guide (LCG) is an updated labour monitoring tool that emphasizes individualized assessment and respectful maternity care compared with the WHO modified partogram. This study compared labour outcomes between these two approaches. Methods: A prospective randomized controlled trial was conducted among 300 women with term singleton pregnancies in spontaneous active labour with cephalic presentation at a tertiary care centre. Participants were randomized to labour monitoring using the WHO labour care guide (n=150) or the WHO modified partogram (n=150). The primary outcome was mode of delivery. Secondary outcomes included labour characteristics, maternal complications, neonatal outcomes, and maternal satisfaction assessed using the birth satisfaction scale-revised. Results: The WHO LCG group had a significantly higher normal vaginal delivery rate than the modified partogram group (85.33% versus 68.67%; p=0.001) and a lower caesarean section rate (14.67% versus 31.33%). The active phase of labour was significantly shorter (4.56±0.99 versus 4.95±1.13 hours; p=0.002). Non-progress of labour as an indication for caesarean section was less frequent (9.09% versus 42.55%; p=0.028). Maternal complications and neonatal outcomes were comparable, whereas maternal satisfaction was significantly higher with the WHO LCG (96.00% versus 88.67%; p=0.014). Conclusions: The WHO labour care guide improved labour outcomes by increasing vaginal deliveries, reducing caesarean sections, shortening labour duration, and enhancing maternal satisfaction without compromising neonatal outcomes.
Background: Low-grade serous ovarian carcinoma (LGSC) is an uncommon epithelial ovarian malignancy with distinct tumour biology, relatively indolent behaviour, frequent advanced-stage presentation and limited sensitivity to conventional chemotherapy. This study evaluated the clinicopathological profile, treatment pattern, perioperative outcomes and survival of patients with LGSC managed at a tertiary cancer centre. Methods: A retrospective review was conducted of 23 patients with histologically confirmed LGSC treated between 2014 and 2025. Demographic characteristics, clinical presentation, tumour markers, FIGO stage, disease distribution, chemotherapy response, surgical approach, completeness of cytoreduction, postoperative morbidity, recurrence and survival outcomes were analyzed descriptively. Results: The median age was 47 years. Abdominal pain was the most common presenting symptom, reported in 17 patients (73.91%). Serum CA-125 was elevated in 19 patients (82.6%), with a median value of 89 U/ml. FIGO stage III disease was present in 18 patients (78.26%). Nine patients received neoadjuvant chemotherapy; objective response was observed in only 2 patients (22.2%), while 5 had stable disease and 2 progressed. Primary cytoreductive surgery was performed in 12 patients, interval cytoreduction in 9 and staging laparotomy in 2. Complete cytoreduction was achieved in 19 patients (82.6%). Grade III morbidity occurred in 21.7%, with no Grade IV/V complications or 30-day mortality. At 36-month median follow-up, recurrence occurred in 6 patients; 3 years overall survival was 75% and disease-free survival was 66%. Conclusions: LGSC commonly presents with advanced peritoneal disease and poor chemotherapy response. Complete cytoreduction remains the key therapeutic goal.
Spinal tuberculosis with paraplegia during pregnancy is rare and is a diagnostic and therapeutic challenge. Pregnancy, being a relatively immunocompromised state, may prompt rapid destruction of the vertebral body, resulting in an acute and profound neurological deficit. A 23-year-old G2P1L1 woman at 19+5 weeks presented with progressive bilateral lower-limb weakness; MRI showed D2 collapse with epidural collection and cord compression. Sputum Ziehl-Neelsen staining confirmed acid-fast bacilli, and first-line HRZE therapy was started. She recovered completely, continued pregnancy to term, and delivered a healthy male neonate by elective caesarean section. This case supports early MRI diagnosis and timely anti-tubercular therapy alone in selected patients with multidisciplinary care and close maternal-fetal monitoring can lead to complete recovery.
Pregnancy in a non-communicating rudimentary horn is a very rare form of ectopic pregnancy associated with Müllerian duct abnormality. The rudimentary horn has limited distensibility and carries a high risk of rupture and catastrophic intra-abdominal haemorrhage, while early diagnosis may be difficult because it can mimic a tubal ectopic pregnancy. A 28-year-old unbooked gravida 2 para 1 living 0 woman with 12 weeks of amenorrhoea presented with lower abdominal pain and vaginal bleeding for 2–3 days. Ultrasound suggested an approximately 12-week unruptured right adnexal ectopic pregnancy with absent fetal cardiac activity. Emergency exploratory laparotomy revealed an intact pregnancy in a right non-communicating rudimentary horn of a unicornuate uterus. The rudimentary horn and ipsilateral fallopian tube were excised after evacuation of the products of conception. The postoperative course was uneventful, and the patient was asymptomatic at six-week follow-up. This case highlights the diagnostic challenge of rudimentary horn pregnancy and the importance of early recognition and timely surgical management before rupture.
Gonadal dysfunction and definitive infertility are common long-term non-malignant effects after bone marrow transplantation (BMT), particularly when chemotherapy is part of the conditioning regimen. We report a case of a 44-year-old male with a history of thalassemia major who underwent allogeneic bone marrow transplant at the age of 18 years from his human leukocyte antigen (HLA)-matched sister. He subsequently developed complete hematopoietic chimerism with a 46, XX karyotype and testicular failure secondary to chemotherapy. The patient presented with primary infertility and azoospermia. Medical management was continued for 10 months using gonadotrophins to stimulate spermatogenesis following which ICSI was done for the couple using self-semen to achieve live birth.
Ectopic molar pregnancy is an uncommon form of gestational trophoblastic disease and is rarely suspected preoperatively due to its clinical similarity with non-molar ectopic pregnancy. We report a case of a 46-year-old multiparous woman presenting with amenorrhea, abdominal pain, and vaginal bleeding following unsupervised medical termination of pregnancy. Ultrasonography revealed a left adnexal mass suggestive of ectopic pregnancy. The patient underwent exploratory laparotomy with left salpingectomy. Histopathological examination demonstrated hydropic chorionic villi with trophoblastic proliferation, consistent with molar changes. Postoperative β-hCG levels showed an appropriate decline. This case highlights the importance of routine histopathological examination of ectopic pregnancy specimens, as definitive diagnosis cannot be established clinically. Early diagnosis is essential to ensure appropriate follow-up and to detect persistent gestational trophoblastic disease at an early stage.
Ectopic pregnancy is a medical emergency that still has a huge debilitating effect on maternal health. This condition can result in hemorrhagic shock with resultant morbidity and mortality when it is mis-diagnosed or there is delay in diagnosis and management. We present a 40year old multiparous lady with multiple uterine fibroids and without other identifiable risk factors for ectopic pregnancy who suddenly lapsed into shock and had a successful appropriate and timely intervention-Salpingectomy for ruptured ectopic pregnancy.
Background: Gestational diabetes mellitus (GDM) is one of the most prevalent complications of pregnancy and is associated with adverse maternal and neonatal outcomes, and is a risk factor for future development of type 2 diabetes mellitus. Objective was to find out the prevalence of GDM in Lucknow region by the fasting blood glucose (FBG) and 75 gm oral glucose tolerance test (OGTT). Methods: The study was carried out as a cross-sectional study among second and third trimester pregnant women. The subjects were divided into normoglycemic and hyperglycaemic groups according to FBG, OGTT and urine glucose analysis. Results: The overall prevalence of GDM was 9.6%. Sixty percent of all women affected were from urban areas and 40 percent were from rural areas. FBG value and OGTT value in the hyperglycaemic group were significantly high (p<0.001) and positive glucosuria (p<0.001) was observed. Conclusions: Routine screening, antenatal monitoring, and lifestyle modification are important to minimize the undesirable outcomes of GDM and its long-term consequences of type 2 diabetes mellitus.
Background: Twin pregnancies are among the major challenges faced by obstetricians globally. Increased maternal and fetal morbidity is observed with an increase in the incidence of twin pregnancies. The major problems occurring in twin pregnancy are prematurity, low birth weight, intrauterine growth restriction (IUGR), birth trauma and birth asphyxia. The incidence of twin gestation has increased mainly due to advanced maternal age and ART. Objectives were to evaluate maternal and neonatal complications and pregnancy outcomes in twin pregnancies. Methods: A prospective study conducted in Baroda Medical College, Vadodara over the period of 1 year evaluated 178 women with twin pregnancies fulfilling the inclusion and exclusion criteria. After taking informed consent detailed history of patient, all routine antenatal investigations were done. Patients will be followed up till discharge from hospital. Results: Majority of the women belonged to the age group 18-25 years. Maximum number of mothers 60.11% delivered between 32-36 weeks of gestation. Out of them 94.38% of the women conceived by spontaneous conception. Caesarean section (CS) was the most common mode of delivery 63.48% and vaginal delivery occurred in 36.5% mothers. Preterm labor is the most common complication occurring in 93.2% mothers, followed by hypertension in 30.8% mothers. Among those with hypertension 3.93% mothers also had oligohydramnios. Anemia occurred in 10.1% mothers among which 33.3% developed anemia post-partum. Conclusions: Maternal complications during twin pregnancy were mainly preterm labor, diabetes, hypertension and anemia. Fetal complications were mostly related to IUGR. Active fetal surveillance can improve fetomaternal outcome.
Takayasu's arteritis is a chronic vasculitis of medium and large vessels. The most involved vessel is the aorta and its major branches. The vessels are characterized by mononuclear infiltration and granulomatous inflammation of vascular media, which leads to arterial wall thickening with stenosis, occlusion, and aneurysmal dilation. Here we present a case of a 32-year-old female patient who presented with headache and mild epigastric pain. CT Aortogram was done which revealed severe stenosis of the left thoracic and upper abdominal aorta measuring 8 cm long along with left subclavian artery stenosis. Delayed diagnosis and lack of specific treatment could explain the extent and the clinical severity of the disease at the time of hospital admission. Therefore, early diagnosis and treatment are warranted. When the disease is dormant, the outcome seems favourable.
Background: Caesarean section (CS) is a common surgical procedure associated with postoperative infectious morbidities such as endometritis, wound infection, and urinary tract infection. Vaginal antiseptic preparation before CS has been proposed to reduce these complications by lowering bacterial load. This study aimed to evaluate the effect of vaginal preparation before CS on postoperative infectious morbidity. Methods: This prospective study involved pregnant women undergoing caesarean delivery. Participants were divided into two groups: one undergoing vaginal cleansing with antiseptic solutions (povidone-iodine or chlorhexidine) before surgery, and the other receiving no vaginal preparation. Postoperative outcomes, including the incidence of endometritis, wound infections, urinary tract infections, and febrile morbidity, were recorded and compared between groups. Results: Vaginal preparation significantly reduced the incidence of postoperative infections. A notable decrease in endometritis rates was observed among women who received preoperative vaginal cleansing, especially in cases of labor or ruptured membranes. Similarly, wound infection rates and urinary tract infections were lower in the intervention group. No serious adverse reactions related to antiseptic use were reported. Both povidone-iodine and chlorhexidine proved effective, with slight advantages seen for chlorhexidine in reducing overall morbidity due to its longer antimicrobial action and lower mucosal irritation. Conclusions: Preoperative vaginal cleansing with antiseptics before caesarean delivery effectively reduces postoperative infectious morbidity, particularly endometritis. This simple, low-cost intervention is especially beneficial for high-risk cases, such as emergency CS s and cases with ruptured membranes. Routine adoption of vaginal preparation could enhance maternal outcomes and reduce healthcare burden.
Background: Isolated oligohydramnios at term is still a matter of controversy among obstetricians, since there is conflicting evidence as to its effect on maternal and neonatal outcomes. The present study looked at the fetomaternal outcomes in term pregnancies which were complicated by isolated oligohydramnios. Methods: A prospective observational study was conducted among 350 pregnant women with singleton term pregnancies (37–40 weeks) diagnosed with isolated oligohydramnios (amniotic fluid index (AFI)≤8 cm) at a tertiary care hospital in Puducherry, India. Women with maternal and fetal comorbidities, congenital anomalies, pre-labour rupture of membranes or intrauterine fetal demise were excluded. Participants were followed from admission until delivery and 1st week of neonatal period. The maternal, fetal and neonatal outcomes were analysed using SPSS version 21.0 and the associations between AFI and the obstetric outcomes were evaluated by means of appropriate statistical tests, taking p<0.05 as the criterion for significance. Results: The average age of the mothers was 26.8±4.2 years and the average gestational age at the time of admission was 38.4±1.1 weeks. Caesarean section was carried out in 53.4% of the women, fetal distress being the most common reason (33.1%). A non-reassuring non-stress test (NST) was noted in 23.4% of the pregnancies. 25.4% of the newborns required admission to the neonatal intensive care unit (NICU) and 15.4% had an Apgar score of less than 7 at five minutes. Meconium aspiration syndrome (13.7%) was the most common neonatal complication. Women who had severe oligohydramnios (with an amniotic fluid index of 0 to 5 cm) had a considerably higher rate of caesarean delivery than those with an AFI of 5.1 to 8 cm (73.2% versus 39.9%, p<0.001). Both a lower AFI and non-reassuring NST were significantly linked to caesarean delivery and to adverse neonatal outcomes. Conclusions: Though isolated oligohydramnios at term, there is higher need of obstetric intervention and poor perinatal outcomes that too when oligohydramnios is severe. Fetimaternal outcomes can be improved by early diagnosis by carrying out careful antenatal monitoring and by providing individualised obstetric care.
Condyloma acuminatum, also known as mucocutaneous external genital warts, is a benign neoplasm of the genital tract caused by human papillomavirus most commonly types 6 and 11. Here we present a case of 24-weeks unbooked primigravida who presented with complaints of vulval itching and a mass over the vulva for six months. Genital examination revealed multiple papillomatous growths arising from the vulva, no bleeding on touch. At 24 weeks of gestation vulval biopsy was performed and the report showed condyloma acuminatum. She presented in early labor pain with complete spontaneous resolution of the lesions at 39 weeks of gestation. She underwent a spontaneous vaginal delivery. Both mother and neonate were healthy in the postnatal period. This case highlights that condyloma acuminatum may regress spontaneously during pregnancy and is not an indication for caesarean section.
Background: Caesarean section (CS) in the second stage of labour is a technically demanding procedure associated with significant maternal and neonatal morbidity. Its rising incidence, driven by declining use of instrumental vaginal delivery and increasing medicolegal concerns, makes it an important area of study. This study aimed to assess the incidence, indications, intraoperative and postoperative complications, and fetomaternal outcomes of second stage CSs at a tertiary care teaching hospital in North India. Methods: A retrospective observational study was conducted in the Department of Obstetrics and Gynaecology, Christian Medical College and Hospital (CMCH), Ludhiana. Obstetric records of all patients who underwent CS in the second stage of labour between 1st January 2018 and 30th June 2020 were reviewed and analysed. Results: Of 1372 total CSs performed during the study period, 103 (7.5%) were in the second stage of labour. The majority of women (79.6%) were aged 21-30 years; 66% were primigravidae. Induced labour was present in 56.3% of cases. Cephalopelvic disproportion was the most common indication (33.3%), followed by fetal distress (22.9%). The head push method was used in 71.8% of cases for delivery of the impacted fetal head. Uterine atony was the most common intraoperative complication (21.3%). The majority of women (72%) had no postoperative complications. Fifty-eight percent of neonates had no complications; birth asphyxia (10.7%) and meconium aspiration syndrome (6.8%) were the most common neonatal morbidities. Conclusions: Second stage CS is associated with significant fetomaternal morbidity. Proactive antenatal assessment, judicious intrapartum management, and structured training in operative vaginal delivery and fetal head disimpaction techniques are essential to reduce its incidence and associated complications.
Deep infiltrating endometriosis (DIE) is the most severe form of endometriosis and is characterized by infiltration of pelvic structures beyond the peritoneal surface. Its presentation may occasionally mimic other chronic inflammatory conditions, particularly peritoneal tuberculosis, posing a significant diagnostic challenge in tuberculosis-endemic regions. The coexistence of haemorrhagic peritoneal fluid, dense pelvic adhesions, adnexal masses, and elevated inflammatory markers can obscure the diagnosis and delay definitive management. A 42-year-old multiparous woman presented with chronic pelvic pain, dyspareunia, and dyschezia. On per-vaginal examination, the cervix was found to be pulled upwards and was associated with marked cervical motion tenderness. Comprehensive clinical and radiological evaluation was performed. Magnetic resonance imaging (MRI) findings were suggestive of deep infiltrating endometriosis. A tuberculosis workup was also carried out to exclude genital/ peritoneal tuberculosis. Following thorough evaluation, the patient underwent definitive surgical management in the form of total hysterectomy with bilateral salpingo-oophorectomy. The postoperative course was uneventful, and the patient experienced significant symptomatic relief following surgery.
Terminal lucidity (TL) is characterized by an unexpected, transient restoration of mental clarity, coherent communication, or purposeful behaviour shortly before death. Although reported in patients with neurodegenerative disorders, psychiatric illness, and pediatric oncology, TL has not previously been described in women with advanced gynaecological malignancies. We retrospectively reviewed 20 consecutive deaths among women with advanced gynaecological cancers at a tertiary gynaecologic oncology centre during 2025. Three patients fulfilled predefined criteria for TL and demonstrated an unexpected return of coherent communication and meaningful interaction following profound cognitive or functional decline. In each case, the episode occurred within 48 hours of death, allowing patients to communicate with family members and express personal wishes. Families uniformly interpreted the episodes as evidence of recovery despite the subsequent rapid clinical deterioration. These observations suggest that TL may occur in advanced gynaecological cancer and shares characteristic features with reports from neurological, palliative care, and pediatric oncology populations. Greater recognition of this phenomenon may facilitate appropriate counselling of families and improve end-of-life care, although prospective studies are needed to better define its incidence, underlying mechanisms, and clinical significance.
Background: Oocyte cryopreservation (OC) has moved from a niche, largely medically-indicated procedure toward a mainstream fertility preservation option, but India-specific outcome data remain limited. This study aimed to describe demographic trends, oocyte yield, cycle repetition, and utilization patterns among women undergoing planned OC at a single Indian fertility IVF unit over a 13-year period. Methods: A retrospective cohort of 62 women who underwent planned OC between January 2013 and January 2026 was analysed. Age, indication, number of stimulation cycles, MII oocyte yield, and utilization status were recorded. Appropriate descriptive and inferential statistics were used, including comparison of pre- and post-COVID periods. Results: The cohort comprised 62 patients undergoing 70 stimulation cycles, predominantly for elective/social indications (85.5%), with oncofertility accounting for 14.5% of cases. The most common age group was 30-34 years (32.3%), with a mean yield of 6.2 ± 4.1 MII oocytes per patient. Oocyte yield declined significantly with age (Spearman ρ = -0.26, p = 0.041). The annual rate of patients undergoing OC increased approximately 4-fold in the post-COVID era (rate ratio 4.00, 95% CI 2.21-7.25, p<0.001). Only 9.68% of patients underwent repeated stimulation cycles, with the highest proportion of repeat cycles occurring in the 34-36-year age group. However, utilization of cryopreserved oocytes remained low (9.7%, 95% CI 3.6-19.9%). Conclusions: Our study highlights positive shifting trends even in a developing country like India, where oocyte cryopreservation is evolving as an accepted method for fertility preservation. Societal challenges, myths, and financial limitations underscore the low utilization rates, emphasizing the need for strengthened education and support to empower women in planning their reproductive journeys.
Polycystic ovary syndrome (PCOS) is one of the most prevalent endocrine and metabolic disorders affecting women of reproductive age and represents a major global public health challenge. PCOS is a heterogeneous condition characterized by reproductive dysfunction, hyperandrogenism, insulin resistance (IR), and metabolic abnormalities, frequently accompanied by psychological distress that significantly reduces quality of life. Despite its high prevalence, diagnosis, treatment, and long-term management remain challenging due to its complex, multifactorial pathophysiology. This review provides a comprehensive overview of the epidemiology, diagnostic criteria, clinical manifestations, and etiological factors associated with PCOS, with particular emphasis on genetic susceptibility, epigenetic regulation, environmental exposures, dietary habits, and lifestyle factors contributing to disease onset and progression. Key pathophysiological mechanisms are explored, including IR, hyperandrogenism, follicular arrest, chronic low-grade inflammation, oxidative stress, mitochondrial dysfunction, and adipose tissue dysregulation. The clinical manifestations of PCOS reproductive, metabolic, hyperandrogenic, and psychological along with long-term complications such as type 2 diabetes mellitus (T2DM), cardiovascular disease (CVD), non-alcoholic fatty liver disease (NAFLD), endometrial disorders, infertility, and adverse pregnancy outcomes, are discussed. Emerging hormonal, inflammatory, metabolic, genetic, and molecular biomarkers are highlighted for their potential to improve diagnosis, phenotypic classification, and personalized therapy. Current treatments, including lifestyle modification, pharmacological interventions, nutritional supplementation, and emerging targeted therapies, are also summarized. A deeper understanding of the molecular mechanisms underlying PCOS is essential for enabling early diagnosis, optimizing individualized management, reducing long-term health risks, and improving outcomes through precision medicine, multidisciplinary care, evidence-based decision-making, and continued therapeutic innovation.
