Ovarian cysts are common in premenopausal women, and most are physiological or benign. Assessment aims to identify lesions that require further investigation or treatment while avoiding unnecessary surgery and loss of ovarian tissue. This narrative review examines ultrasound characterization, malignancy risk assessment, tumor markers, surveillance, surgical management, and fertility considerations. Transvaginal ultrasonography (TVUS) is the first-line investigation, and lesion morphology should be interpreted alongside symptoms, age, and clinical history. The International Ovarian Tumor Analysis Simple Rules and ADNEX model, together with the Ovarian-Adnexal Reporting and Data System, provide structured approaches to risk assessment. Tumor-marker testing should follow the differential diagnosis. CA125 has limited specificity in premenopausal women, whereas suspected germ-cell or sex-cord stromal tumors may require other markers. Many confidently characterized simple cysts can be managed without intervention. Follow-up depends on lesion type, size, symptoms, and the imaging framework used; persistence alone does not establish malignancy. Indeterminate masses may require expert ultrasound or magnetic resonance imaging, and suspicious lesions warrant gynecological oncology assessment. Acute presentations require urgent evaluation outside elective surveillance pathways. When surgery is appropriate for benign disease, the approach should minimize morbidity and preserve ovarian tissue where feasible. Management therefore requires integration of imaging findings, clinical risk, reproductive priorities, and patient preferences.
Monochorionic monoamniotic (MCMA) twin pregnancy is rare and is associated with fetal loss, congenital anomalies, prematurity and umbilical cord entanglement. We report the management and outcome of a 29-year-old primigravida in whom a single placenta, two fetuses and no intertwin membrane were identified at 9 weeks of gestation. Surveillance included ultrasound assessment every 2 weeks from 16 weeks, umbilical artery and middle cerebral artery Doppler studies, fetal echocardiography at 20-22 weeks, and inpatient fetal surveillance from 30 weeks. A planned caesarean birth was performed at 32+1 weeks, consistent with guidance recommending planned preterm birth for uncomplicated MCMA twins. Two female neonates weighing 1.5 kg and 1.4 kg were delivered. Both received neonatal intensive care for 15 days and were discharged in stable condition. Maternal recovery was uncomplicated. Marked entanglement of the two umbilical cords was documented intraoperatively. This case illustrates that extensive cord entanglement may coexist with a favourable outcome when early diagnosis, structured surveillance, planned preterm caesarean birth and neonatal support are available.
Maternal undernutrition contributes substantially to adverse pregnancy outcomes in low- and middle-income countries. In India, anemia and deficiencies of vitamin B12, vitamin D, zinc, and folate remain widespread. Although iron-folic acid (IFA) supplementation is central to antenatal care, evidence suggests that multiple micronutrient supplementation (MMS) reduces low birth weight and small-for-gestational-age births compared with IFA alone. This review examined how global MMS evidence can inform context-specific strategies for Indian women. Published evidence on maternal micronutrient deficiencies, MMS, and international guidelines was synthesized with thematic analysis of seven regional advisory board meetings involving >90 Indian clinicians. Findings confirmed a high burden of micronutrient deficiencies and supported MMS over IFA alone. Expert panels favored a phased approach aligned with gestational physiology, beginning with folate, vitamin B12, and pyridoxine during preconception and early pregnancy, followed by iron, calcium, vitamin D, and DHA. Key barriers included gastrointestinal intolerance, complex dosing, and dietary insufficiency. These findings support transitioning from IFA-based supplementation toward a comprehensive, context-adapted strategy spanning preconception through lactation.
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.
