Before the mid-1950s, Early Cord Clamping (ECC) meant clamping the umbilical cord within one minute of birth. Delayed Cord Clamping (DCC), on the other hand, involved clamping the cord more than five minutes after birth. After birth, because of noticing changes in blood volume and the absence of clear guidance on the best timing, early cord clamping became a usual practice, typically happening within 15-20 seconds of birth. The objective of the study is to identify the effects of DCC and early skin-to-skin contact on mother’s physiological parameters, breastfeeding behaviour, and post-partum haemorrhage compared to Early Cord Clamping. A group of 300 mothers and their newborns were studied after the mothers agreed to participate. The mothers were split into two groups, each with 150 participants. Group A experienced DCC and ESS contact, while Group B had Early Cord Clamping. The study's results showed similar findings in both groups regarding the average Hb level and maternal blood loss. Postpartum haemorrhage was less among DCC compared to early group with significant difference was observed. This study discovered that DCC with ESSC has a positive impact on preventing postpartum haemorrhage. This is achieved through improved breastfeeding and bonding. The study found that the side effects of DCC and ESSC are not significant. So, DCC and ESSC should be practiced in term uncomplicated deliveries.

Background: Previous study conducted against immediate tying and cutting of the umbilical cord and suggested waiting until the child had taken repeated breaths and the pulsation in the cord had ceased to prevent potential weakness in the child. A comparative study between delayed cord clamping (DCC) and early cord clamping (ECC) was carried out on a select group of primigravida without any high-risk factor and delivering at term. The objective of the study was to identify the effects of delayed cord clamping and early skin to skin contact on new born infant’s physiological parameters (temperature, weight, SpO2= saturation of peripheral oxygen, Apgar score= appearance, pulse, grimace, activity, and respiration, Hb=haemoglobin level). Methods: Study sample consisted of 300 mothers and their new born after gaining mother’s acceptance. They were divided into 2 groups of 150 each. Group A underwent delayed cord clamping and early skin to skin contact and group B early cord clamping. Newborns monitored 24 hours for hypothermia, apnoea, oxygen needs. Results: The findings of the present study were equivalent among both groups regards the mean neonatal haematological parameters were comparable and slightly elevated hemoglobin level and weight status among late cord clamping compared to early cord clamping group with significant difference was observed at 24 hour later. Conclusions: This study was found that DCC does have a beneficial effect on temperature, Apgar score, SpO2, Hb level and weight status of new born. Therefore, it is believed that DCC and early skin to skin contact (ESSC) provides effective thermal control with a reduced risk of hypothermia.

BACKGROUND:Neutrophil extracellular traps (NETs) being one of the predominant activities of neutrophils has become its key defense mechanism owing to its extensive role in inflammation and infection. However, the mechanisms regulating NET formation or NETosis still remains to be better understood. Our earlier whole genome transcriptomic data revealed two G-protein couple receptors (GPCRs) - complement component 5a receptor 1 (C5aR1) and leukotriene B4 receptor 1 (LTB4R1) were downregulated in term low birth weight (tLBW) newborns with deficient NET formation abilities. Neutrophils employ C5aR1 and LTB4R1 for mediating their immune responses, inflammation and antimicrobial activity. Hence, this study was aimed to explore the role of two GPCRs, C5aR1 and LTB4R1 including their downstream signaling molecules in NETs induction and regulation. METHODS:The validation of the transcriptomic data for C5aR1 and LTB4R1 was done using quantitative real time PCR. Pharmacological inhibition of C5aR1 and LTB4R1 using W-54011 and LY223982 on neutrophils of adults and newborns' was done to study their impact on NETosis. Extracellular DNA release, Reactive oxygen species (ROS) generation, expression of NET proteins, and signaling molecules downstream to C5aR1 and LTB4R1 were quantified using plate reader based assay, immunofluorescence, and western blotting. Myeloperoxidase (MPO)-DNA quantified by flow cytometry. Knockdown studies using siRNA against C5aR1 and LTB4R1 were done in HL-60 cells derived surrogate neutrophils and expression of downstream molecules of the two GPCRs, C5aR1 and LTB4R1 signaling axis along with NET proteins was quantified by western blotting. RESULTS:The expression of C5aR1 and LTB4R1, extracellular DNA, ROS and NET associated proteins (NE, CitH3, PAD4 and MPO) was notably increased upon NET induction in healthy adults and normal birth weight (NBW) newborns' neutrophils. Pharmacological inhibition of these two GPCRs led to substantial reduction in NETosis, extracellular DNA, ROS generation, and expression of NET associated proteins like CitH3, NE, PAD4, MPO along with downstream signaling molecules Rap1a, B-Raf and pERK. Our observations suggest a precise role of C5aR1 and LTB4R1 on induction of NETs via Rap1a/B-Raf/ERK signaling axis. CONCLUSION:The C5aR1 and LTB4R1 signaling via Rap1a/B-Raf/ERK axis acts as a signal-relay mechanism to regulate NET formation in neutrophils. Further, C5aR1 and LTB4R1 signaling cascade along with NET-associated proteins are remarkably downregulated in tLBW newborns' neutrophils leading to impaired NETosis in them. Therefore, C5aR1 and LTB4R1 and their signaling molecules could provide an effective therapeutic target for compromised NETosis like tLBW newborns.

Fibroid is a common benign neoplasm more often located in the uterus and less commonly seen in the adnexa and other supporting structures of uterus like broad and uterosacral ligament. The incidence of extra uterine leiomyomas is <1%. A 48-year-old female para one live one presented with chief complaints of mass per abdomen for 2 years and prolonged heavy bleeding for 15 days. Based on the clinical and radiological findings, a diagnosis of tubo-ovarian mass was made. The patient underwent staging laparotomy. However, intraoperatively, she was diagnosed with uterosacral ligament fibroid of size approximately 40×45 cm. Total abdominal hysterectomy with bilateral salpingo-oophorectomy was done. There was no associated complication. Histopathology confirmed the mass to be leiomyoma. Uterosacral ligament fibroid is encountered very rarely. Our case report intends to bring to light the necessity of keeping the various possible locations of leiomyoma in mind and in considering adnexal mass as an important differential diagnosis of leiomyoma and vice-versa before operating. Leiomyoma is often confused with ovarian mass or neoplasm posing a diagnostic difficulty to a gynaecologist as well as radiologist thereby posing a challenge to the operating surgeon while performing surgery.

Low birth weight (LBW) is a leading cause of newborn's mortality however the underlying defects in cellular immunity and immune mechanisms leading to severe neonatal infections in term LBW (tLBW) newborns are not well understood. Neutrophil extracellular traps (NETs), or NETosis, is an innate immune defense mechanism of neutrophils involved in trapping and killing of microbes. The efficiency of NET formation in cord blood derived neutrophils of tLBW and normal birth weight (NBW) newborns in the presence of toll like receptor (TLR) agonist inductions was evaluated. The NET formation was observed to be substantially impaired in tLBW newborns along with NET proteins expression, extracellular deoxyribonucleic acid (DNA) release and reactive oxygen species generation. The placental tissues from tLBW newborns delivery also showed minimal NETosis. These findings suggest impaired NET formation to be an important factor underlying the deficient immune status of tLBW newborns making them susceptible to life- threatening infections.

The incidence of recurrent spontaneous abortion (RSA) showed an increasing trend, its pathogenesis is still unclear.At present, it is considered that the pathogenic mechanisms were related to antiphospholipid antibodies (APA) syndrome, which was mediated by the APA induced autoantibody and cause implantation failure.IL6 play an important role in cell-mediated immunity.

Aim: To determine which of the two parameters between antral follicle count (AFC) and anti-Müllerian hormone (AMH) had better correlation with age in healthy females, and also to estimate the strength of correlation between AMH and AFC.Materials and methods: This was a prospective, cross-sectional study comprising 1,181 fertile women of age 20-40 years, who were divided into four age groups, i.e., group I (20-24 years), group II (25-29 years), group III (30-34 years), and group IV (35-40 years).AFC and AMH were measured on third day of menstrual cycle.Pearson correlation and linear regression analysis were used.Statistical Package for Social Sciences, trial version 20, was used for the statistical analysis.A p-value of <0.05 was considered statistically significant.Results: The correlation coefficients between AFC and age, AMH and age, AMH and AFC were r = -0.403,r = -0.824and r = 0.328; p <0.001, respectively.A strong positive correlation (r = 0.986, p <0.001) was noted between AMH and age in group I, while strong negative correlations (p <0.001) were noted in other groups.The correlations between AFC and age (r = -0.177)and AMH and AFC (r = 0.175) were significant (p <0.05)only in group IV.Age accounted for 16.3% variation in AFC and 67.8% variation in AMH.Conclusion: AMH correlated better with age than AFC.There was a weak correlation between AMH and AFC.Clinical significance: The counselling of a woman about her reproductive potential should be based on both AFC and AMH taken together, apart from chronological age, to avoid false sense of security or unnecessary alarm.

Introduction Preeclampsia and eclampsia are important causes of maternal morbidity. Preeclapmtic women secrete misfolded proteins in the urine. Buhimschi et al had developed a new test for diagnosis of preeclampsia. This test is based on staining of misfolded protein with Congo red dye. Misfolded proteins are derived from syncytiotrophoblast microparticles (STBMs). These STBM are membrane bound vesicles and contain misfolded proteins. In preeclampsia, glomeruli of kidneys are disrupted and these damaged protein reach the urine. Aim and Objective This study aimed to investigate the role of urinary congophilia in early prediction of preeclampsia. Materials and Methods This test was done in 250 pregnant women attending the Gynaecological Outpatient Department. Urine sample of early morning was taken and test was done in the Department of Biochemistry. The included pregnant women were of gestational age between 14 and 18 weeks. The staining of urine with Congo red dye was done and washed with methanol. The retention of dye was interpreted with naked eye. The more retention of dye, the more chances of developing preeclampsia later. The patients were followed-up till delivery. The patents who developed preeclampsia later part of pregnancy were recorded. Mean arterial pressure (MAP) and past history and body mass index were also recorded. Results Out of 250 patients, 30 developed preeclampsia later. A total of 34 patients were having positive urinary congophilia and only 20 patients developed preeclampsia later. MAP more than 90 mm Hg is abnormal but 66.7% of patients who developed preeclampsia had MAP >90 mm Hg. In 16.7% of patients, who developed preeclampsia later, had positive past history of hypertension. In 66.7% of patients, who were positive for urinary congophilia, later developed preeclampsia. Conclusion Preeclampsia and eclampsia are important causes of maternal mortality and morbidity. So, early detection can prevent complications and timely management. Urinary congophilia is one of such test which can help in early prediction of preeclampsia. If it is combined with past maternal history and MAP, it gives more good results. The detection rate is much higher if signs and symptoms of preeclampsia are noticed timely.

Female genital tuberculosis (FGTB) can be asymptomatic or even masquerade as other gynecological conditions. Conventional methods of FGTB diagnosis include various imaging, bacteriological, molecular, and pathological techniques that are only positive in a small percentage of patients, leaving many cases with undiagnosed condition. In the absence of a perfect diagnostic method, composite reference standards (CRSs) have been advocated in this diagnostic study. This study assesses the agreement between traditional diagnostic modalities using CRS and prevalent TB groups among different fallopian tube infertility manifestations. A total of 86 women with primary and secondary infertility were included in the study and subjected to bacteriological, pathological, and radiological examination for the diagnosis of FGTB. Results were evaluated statistically for concordance of the diagnostic tests to the CRS by sensitivity and specificity, while PPV and NPV were calculated for the performance of diagnostic tests of FGTB. We observed that 11.2% of women were found to be true positives by means of CRS. The positive findings by CRS were as follows: ultrasonography (13.9%), laparoscopy (14%), hysteroscopy (12%), GeneXpert (4.8%), culture (4.8%), polymerase chain reaction (4.8%), and histopathology (6.4%). GeneXpert and culture were found to have a perfect agreement with CRS. Hysterosalpingography, laparoscopy, and hysteroscopy have a fair agreement with CRS. Out of 43 women with tubal factor infertility, 6 women were found in the definitive TB group with mixed conditions of tubal manifestations. This study evaluates and demonstrates the reliability of the collective assessment of various diagnostic methods with CRS findings that help in identifying different TB groups of genital tuberculosis patients from all infertile patients by applying the criteria of CRS.

Andrographis paniculata, commonly known as the “King of Bitters” has traditionally been used as a medicinal herb. The metabolite composition of A. paniculata is generally determined by its properties, which may be influenced by a range of factors, one of which is the part of the plant extracted. The objective of this research is to identify and characterize the putative metabolite composition in n-hexane extract of stem and leaf using gas chromatography-mass spectrometry. A total of 22 different phytobioconstituents were identified, including flavonoids, terpenoids, fatty acids, phenolic acids, quinones, alkaloids and vitamin. The pharmacokinetic properties of the identified phytobioconstituents, like drug-likeness and toxicity, were also predicted by ADME/Tox analysis. Phytobioconstituents, predicted to be drug-like can be further investigated as ligands by using in silico docking approaches, for disease targets. The study provides empirical evidence for future study that might lead to their therapeutic applications and industrial product development.

Introduction: Preeclampsia and eclampsia are one of the leading causes of maternal mortality. Magnesium sulphate is the drug of choice to prevent and avoid recurrences of convulsions. Pritchard is the standard regimen of Magnesium sulfate (MgSO4). But keeping in view the small stature and low Body Mass Index (BMI) of Indian women low dose regimen of MgSO4 (Dhaka regimen) is also effective. Aim: To compare the efficacy of Pritchard and Dhaka regimen in control of convulsions in severe preeclampsia and eclampsia Materials and Methods: A prospective observational study was done at Institute Of Medical Sciences-Banaras Hindu University, Varanasi, Uttar Pradesh, India, in Department of Obstetrics and Gynaecology in collaboration with Department of Biochemistry from January 2019 to December 2020. Two groups were made. In group I standard Pritchard regimen (n=48) and in group II Dhaka regimen (n=36) was given. Outcome was measured in terms of recurrence of convulsions, MgSO4 toxicity. Various parameters age, BMI, APGAR score, mode of delivery, birth weight were also measured. Student t-test was used to compare two groups. Results: The mean age in group I was 26.48 +/- 4.677 years and in group II was 24.64 +/- 3.743 years. Incidence of preeclampsia and eclampsia was 8.92%. The maternal mortality due to preeclampsia and eclampsia was 30.05%. Recurrence of convulsion was seen in two cases in group II and one case in group I. Serum magnesium level was statistically significant at 30 minute and at 4 hours. Various parameters like age (p-value=0.056) duration of stay in hospital (p-value=0.110) BMI (p-value=0.304) Mode of delivery (p-value=0.186) was not statistically significant. Conclusion: The low dose Dhaka is as effective as Standard Pritchard regimen. Magnesium sulphate toxicity was seen in three cases in Pritchard and not in single case in Dhaka regimen. It is a better choice for women of short stature of Asian women as it is less toxic.

ObjectivePreeclampsia and eclampsia are one of major cause of maternal mortality. Various parameters like pulsatility index (PI) and resistivity index (RI) of color Doppler are helpful in detection of preeclampsia and intrauterine growth restriction. The reference ranges of the various parameters like uterine artery PI and RI are mainly from western countries. The reference range for Indian Population is lacking. So the objective of the study is to construct reference range of uterine artery for women from eastern India.Material and MethodIn this study, total 201 pregnant patients were included. Color Doppler of normal pregnant women was done at 18 to 22 weeks and then followed up at 28 to 32 weeks gestation. The uterine artery PI and RI was measured during pregnancy. The obtained data were tabulated and 5th, 25th, 50th, 75th, 90th and 95th percentile was calculated. The reference range was constructed according to gestational age starting from 18 to 22 weeks and then from 28 to 34 weeks. Statistical analysis was performed using SPSS.ResultThe main parameter observed are pulsatility and resistivity index of left and right uterine arteries first at 18 to 22 weeks and then followed up at 28 to 34 weeks. Our data suggests that as the gestational age increases both pulsatility and resistivity index decreases. The cut off value for reference range was taken up to 95th percentile. Anything above 95th percentile is abnormal. The reference range for left uterine artery pulsatility index was found to be 1.19 to 1.16 at 18 to 22 weeks, 1.09 at 28 weeks while 0.89 at 34 weeks. Similarly, the reference range for resistivity index was found to be 0.61 at 18 to 22 weeks while it decreases to 0.54 at 28 to 34 weeks.ConclusionReference range of uterine artery doppler indices for the local population is very useful tool to early prediction of Preeclampsia and IUGRs of that population and can aid in timely treatment of mother and baby. Our data shows decrease in pulsatility and resistivity index with increase in the gestational age.

Background: Platelet function disorder (PFD) is turning out to be a major cause of heavy menstrual bleeding (HMB) in women. One should suspect for this entity and should look for it in all girls who have this issue since menarche to impart proper management. Objectives: This study was carried out to find the incidence of PFD in Patients with HMB referred to our tertiary care teaching hospital. Materials and Methods: Platelet aggregation in response to ristocetin-induced platelet aggregation (RIPA), Adrenaline, adenosine diphosphate, and Collagen was studied in 50 women with HMB and in the equal number of age-matched healthy women. Bleeding time and Platelet count were also measured. Results: Glanzmann's thrombasthenia (GT) was detected in 5 and Bernard Soulier Syndrome (BSS) in 2 women with HMB. Macrothrombocytopenia was observed in BSS. RIPA was also significantly reduced in BSS but normal in GT. Coagulopathies should always be doubted in the presence of significant anemia. One should carry out the Platelet function studies when screening parameters like prothrombin time, partial thromboplastin time, von Willebrand factor, and factor VIII activity level are normal. Normal platelet count and morphology in addition suggest functional defects in platelets which can be detected by various aggregation studies, electron microscopy, flow cytometry, and thromboelastography. Conclusion: The clinicians treating women with HMB should be aware of PFD as an important etiology and the platelet function should be studied in all women with HMB in a phase-wise manner in order not to miss the diagnosis and also to make it more cost-effective.

To correlate the clinical, hormonal, biochemical and ultrasound parameters in adolescent patients with polycystic ovarian syndrome (PCOS) and to compare them with adult patients. This was a prospective, correlational study. 50 adult (20–35 years) and 50 adolescent patients (15–19 years) who had features of PCOS (Rotterdam Criteria, 2003) were selected. The control group comprised of 50 women of same age in each group with normal parameters. Pelvic ultrasound was done in early follicular phase (3–5th day of menstrual cycle). Assessment of hormonal and biochemical parameters (LH/FSH ratio, free testosterone level, lipid profile and fasting glucose/insulin ratio) and grey-scale ultrasound was done. No significant difference was observed in menstrual pattern in adults and adolescents with PCOS. The mean values of serum LH/FSH ratio and free testosterone were significantly higher in both adult and adolescent PCOS patients as compared to their controls (p < 0.001). The mean value of serum insulin was significantly higher (p < 0.001) with positive correlation (adult: r = 0.655, p < 0.01; adolescent: r = 0.451, p < 0.01) of serum insulin with free testosterone. Hyperandrogenemia without hyperinsulinemia was found in 56% adolescent and 60% adult PCOS patients. 82% adolescent and 88% adult PCOS patients showed multiple follicles (> 5) on ultrasound. The ovarian morphology had positive correlation with serum LH and free testosterone. The mean ovarian volume was significantly higher in adult (10.48 ± 4.38 vs. 4.17 ± 0.91) and adolescent (11.08 ± 5.82 vs. 4.23 ± 0.89) PCOS patients, when compared with controls, respectively. No statistically significant difference was noted in PCOS between adults and adolescents.

Background: Antral follicle count (AFC) and anti-Mullerian hormone (AMH) have been used as indicators of ovarian reserve in infertile women. There still exists a debate about the association between the two parameters.Objective: The objective of the study was to find out the relationship between AFC and AMH in infertile women. Methods: This was a prospective, hospital-based, cross-sectional study, in which 1083 infertile women (aged 20–40 years) with primary infertility were included. They were divided into four age groups, i.e., Group I (20–24 years), Group II (25–29 years), Group III (30–34 years), and Group IV (35–40 years). AMH and AFC were measured on 3rd day of menstrual cycle. Pearson correlation and linear regression analysis were done to find out the relationship between age, AFC, and AMH. Statistical analysis was done using IBM SPSS Statistics for Windows, version 20 (IBM Corp., Armonk, N.Y., USA). A P < 0.05 was considered statistically significant.Results: There was modest negative correlation of AFC with age (r = −0.476, P < 0.001). AMH showed strong negative correlation with age (r = −0.844, P < 0.001) and modest positive correlation with AFC (r = 0.400, P < 0.001). For separate age groups also, statistically significant correlations (P < 0.05–P < 0.001) were noted between age, AFC, and AMH. Age explained 22.7% variation in AFC and 71.2% variation in AMH.Conclusion: There was a significant correlation between AMH and AFC in infertile women. AFC showed a continuous decline with increasing age. However, AMH increased with age till third decade of life and showed negative correlation with AFC. Thereafter, AMH started decreasing with age and showed positive correlation with AFC.

Background: Coronavirus (COVID-19) has emerged as a rampant pandemic and the entire world is struggling against it. The entire nations are trying to device measure like national lockdowns, diverting resources towards fighting coronavirus, extensive media coverage, closing of elective services in hospitals. All this has influences the masses to a deep level. Coronavirus not only is morbid for the sick, but also the healthy pregnant females seeking health care and impacted them more mentally than physically.Methods: In this study 103 pregnant females from the entire nation of India were made to answer a well thought and made questionnaire which aimed at assessing the mental state and impact of coronavirus on the pregnant females.Results: Majority of the females answered that they felt anxious and were undergoing stress due to the coronavirus. They fear impending doom for the child and also are struggling a lot to seek apt healthcare for themselves and their children because of the ongoing pandemic.Conclusions: Coronavirus has not only affected people who are directly affected with the virus, but also who are still not affected but are mentally stressed because of it. National lockdown and alteration in the healthcare services are also stress- inducing for the pregnant females.

Introduction:In spite of many advances in management of hypertrophic scars,the lesions remain difficult to prevent and treat.There is also no consensus regarding the best treatment to reduce or prevent hypertrophic scarring.Many herbal preparations have been used from time to time but no study has been carried out to evaluate the changes in gene expression of cytokines following their application. Materials and Methods:Eighty five patients with hypertrophic scar, eighteen months or more in duration, were part of the study.The last thirty of these patients, after informed consent, were subjected to biopsy of hypertrophic scars and blood sampling before starting the herbal cream application and then after 6 months of continuous application for expression of cytokines, TGFβ1 and TNF α.Clinical response was assessed in all the 85 patients by using Vancouver Scar Scale (VSS) and POSAS (Patient Observer Scar Assessment Scale) before and after the treatment.There were thirty controls. Results:The VSS showed significant improvement in the hypertrophic scars treated with the herbal cream at 6 months of continuous use.The POSAS in our study also revealed remarkable improvement in the appearance of scar and other associated symptoms like pain and itching, with good to excellent response in 81.16% (a more than 4 points improvement based on VSS scale).One to three points' improvement was seen in 16 (18.82%)cases on POSAS.There was down-regulation of TGFβ1 and TNFα gene expression wasincreased at 6 months of treatment. Conclusion:The herbal cream in use in the study significantly improved the hypertrophic scar not only on the surface but alsoat the cellular and molecular levels as characterized by down-regulation of TGFβ1 and up-regulation of TNFα.

Polycystic ovarian syndrome (PCOS), a commonly prevalent endocrinopathy among reproductive age group women, is most often associated with obesity. Increased insulin resistance appears to be the central pathophysiologic mechanism responsible for various complications of PCOS. This makes 'weight loss' as the first-line treatment approach in PCOS. So various trials have tried to compare metformin (an insulin-sensitizing agent) and orlistat (an anti-obesity drug) aiming to achieve weight loss and hence higher ovulation rate for the group of obese PCOS patients. Keeping an eye on all these background facts, we designed this systematic review and metaanalysis to compare the effects of metformin and orlistat on various aspects of PCOS and to pick the better among the two drugs.This is a systemic review of randomized control trials that studied the effectiveness of orlistat versus metformin in terms of improvement in ovulation rate, weight loss, lipid profile, etc. Systematic literature search over the period January 2000-December 2016 was performed in the following electronic databases: Medline, embase, google scholar, pubmed and The Cochrane Library and only randomized controlled clinical trials were included in our study. All authors carefully went through all sources of information independently.According to this study, weight loss, testosterone level after 4 weeks of treatment, total serum cholesterol and triglyceride level showed significant fall in orlistat-treated group.Our review shows that orlistat is a more effective drug than metformin and should be the preferred drug in obese PCOS in combination with weight loss.