OBJECTIVE:Quality of colposcopy determines accurate diagnosis and treatment planning. India and low-middle income countries have varied resource settings offering colposcopy services; this group's objective was to develop defined standards for colposcopy with quality assurance in them to reach the goal of cervical cancer elimination. METHODS:An expert group comprising colposcopists, gynecologists, and gynecologic oncologists collated existing literature and guidelines. A framework applicable to India and similar low-middle income countries with diverse resources for providing colposcopy services in a standardized manner, stratified according to basic and advanced colposcopy centers, was formulated and circulated among experts. The revised version was deliberated in a face-to-face meeting to finalize the standards. Public comments were incorporated in the final document. RESULTS:Basic and advanced colposcopy centers were defined; essential and desirable components at these centers were specified. Recommendations for quality assurance evaluation and audits of ongoing services at both types of centers were also defined. Guidelines and recommendations for advanced centers suited for training were made. CONCLUSIONS:These good clinical practice recommendations will guide the provision and assessment of colposcopy services and can be widely applicable to all low-middle income countries.

PURPOSE:To compare early clinical outcomes in patients with locally advanced cervical cancer (LACC) treated with positron emission tomography-computed tomography (PET-CT) versus CT-guided intracavitary brachytherapy (ICBT) after external beam radiation therapy (EBRT). MATERIALS AND METHODS:Patients with carcinoma cervix, stage IIB to IIIB, receiving EBRT with concurrent weekly cisplatin were randomized into two arms: PET-CT versus CT-guided ICBT arms. High-risk clinical target volume (HRCTV), rectum, bladder, and sigmoid colon were contoured. Planning, local control (LC), overall survival (OS), and toxicities were evaluated. RESULTS:Fifty patients (25 in each arm) were recruited from September 2019 to April 2021. The mean dose to HRCTV D90 and D95 was 87.7 Gy (SD 6.1 Gy) and 83.04 Gy (SD 5.5 Gy) in PET-CT and 85.6 Gy (SD 6.4 Gy) and 80.6 Gy (SD 5.7 Gy) in CT arm (P value 0.13). The mean dose to bladder, rectum, and sigmoid colon was 80.3 Gy (SD 8.2 Gy), 70 Gy (SD 6.1 Gy), and 66.2 Gy (SD 7.4 Gy) in PET-CT and 79 Gy (SD 6.9 Gy), 70.2 Gy (SD 7.2 Gy), and 64.9 Gy (SD 6.3 Gy) in the CT arm (P value 0.58, 0.88, and 0.55). On intention to treat analysis, the 6 months LC rate was 79.1% in PET-CT and 72.7% in CT arm (P value 0.3). On per protocol analysis of 46 patients, OS was 82.9% in PET-CT and 89% in CT arm at 2 years (P value- 0.6). No Grade III/IV Bowel/Bladder toxicities were reported. CONCLUSION:Results of our study have shown comparable outcomes in terms of LC, OS, and toxicities between both arms; however, LC was slightly better in PET-CT arm, though not statistically significant. Further studies with a larger sample size should be conducted to establish the role of PET-CT-guided ICBT in LACC.

INTRODUCTION:Adipokines like leptin and adiponectin are hypothesized to play a role in the development of obesity-related cancers like endometrial cancers by influencing inflammation, angiogenesis, apoptosis, and tumorigenesis. We aimed to study the association between serum leptin and adiponectin and the risk of endometrial cancer. METHODS:We conducted a case-control study to determine the serum levels of leptin and adiponectin in 55 cases of newly diagnosed endometrial cancer and 25 cases of matched controls. We also sought to determine the association between serum adipokine levels and histopathological factors such as grade, myometrial invasion, and tumor metastasis after categorizing them into tertile datasets. RESULTS:Compared to controls, patients with endometrial cancer had higher median levels of leptin (59.7 vs 38.0 ng/mL, P = 0.001) and lower levels of adiponectin (8.5 vs 9.5 ug/mL, P = 0.906). Leptin to adiponectin (L: A) ratio in cases was significantly higher than those in controls (8.6 vs 4.2, P = 0.001). The receiver operating curve for L: A ratio at a cut-off of 5.4 was able to reliably differentiate between cases and controls with a sensitivity of 69.1% and specificity of 64.0%. Higher levels of leptin and L: A ratio were significantly associated with the risk of endometrial cancer after adjusting for age and BMI (OR T3 vs T1 = 8.53, 95% CI, 1.26-57.75; P = 0.028 and OR T3 vs T1 = 7.93, 95% CI, 1.62-38.85; P = 0.011, respectively). Neither prognostic indicators (grade, stage, and myometrial invasion) nor survival outcomes were significantly affected by serum leptin and adiponectin levels. CONCLUSION:Higher levels of serum leptin and Leptin to adiponectin (L: A) ratio significantly correlated with endometrial cancer risk. Though adiponectin levels were lower in cases than in controls, this did not reach statistical significance. Adipokine levels did not show any correlation with prognostic histopathological factors.

To evaluate the performance of WHO and INTERGROWTH-21 (IG-21) fetal growth charts in the Indian population. A total of 250 pregnant women were recruited in this prospective observational pilot study carried out at a tertiary care hospital, New Delhi, India. Women underwent ultrasound scans for fetal biometry twice during their pregnancy, at 24–26 weeks and 34–36 weeks gestation. Measured values were plotted on WHO and INTERGROWTH-21 fetal growth charts. The 10th, 50th, and 90th centiles of fetal biometry were calculated for the study population, and prepared study charts were compared to the two growth charts for respective centiles. There was an agreement for both WHO and IG-21 charts with all the centiles of study charts for HC in both the 2nd and 3rd trimesters. However, the WHO chart had an agreement with the study charts for FL at all centiles but IG-21 underestimated FL in both trimesters. WHO chart was in agreement with the study population for BPD at 10th and 50th centiles only and IG-21 overestimated BPD at all centiles in both trimesters. For AC, both WHO and IG-21 charts have an agreement with study charts at the 10th and 50th centile at all gestations. However, for the 90th centile, IG-21 underestimates AC and the WHO chart agrees with the study population in 2nd trimester only. For EFW in the 2nd trimester, both WHO and IG-21 charts agreed to the study charts at all centiles but in the 3rd trimester WHO chart overestimates and IG-21 underestimates the study population for the 10th and 50th centiles. According to this pilot study, neither WHO nor IG-21 charts are a good fit for the Indian population, and locally developed fetal growth charts are needed.

The primary objective was to evaluate maternal and neonatal outcomes in pregnant women aged 40 years or older, compared to those aged 35–39 and 20–34 years. The secondary objective was to assess caesarean section rates and indications in the same age groups. This retrospective case–control study was conducted at the Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, from January 2014 to July 2020.After taking ethical clearance, pregnant women who delivered after 24 weeks of gestation from January 2014 to July 2020 were recruited in this study and divided into three groups: 40 years and above (group A), 35–39 years (group B), and controls aged 20–34 years (group C). Multiple pregnancies were excluded. 43 pregnant women aged 40 years above and 99 pregnant women aged 35–39 years who delivered during the study period were included in groups A and B respectively, while 100 control cases were randomly allocated to group C. Their case records were analysed Statistical analyses included t-tests/ANOVA for continuous variables and Chisquare/Fisher’s exact tests for categorical data, with p < 0.05 considered statistically significant. Infertility was highest in women aged ≥ 40 years (30.23

Objective: Human Chorionic Gonadotropin (hCG) plays a crucial role in embryo implantation and in maintenance of pregnancy. An immuno-contraceptive approach involves the use of a recombinant hCG beta-LTB vaccine formulated with adjuvant Mycobacterium indicus pranii (MIP), to prevent pregnancy without disturbing ovulation, hormonal profiles, and menstrual cycles in women. The present work in mice was designed to address issues encountered in clinical trials conducted with hCG beta-LTB vaccine, with focus on two primary concerns. Firstly, it aimed to determine the optimal vaccine dosage required to induce a high level of anti-hCG antibodies. Secondly, it aimed to assess the safety profile of the vaccine, specifically injection site reactions in the form of nodules, observed in some of the subjects.Methods and Results: Studies undertaken indicate that a 2 mu g dose of the protein version of the vaccine, administered in mice through the intramuscular route, can induce high anti-hCG titres. Furthermore, administering a booster dose enhances the antibody response. Our findings suggest that the concentration and frequency of administration of the adjuvant MIP can also be reduced without compromising vaccine efficacy.Conclusion: The issue of nodule formation at the injection site can be mitigated either by administering the vaccine along with MIP intramuscularly or injecting hCG vaccine and MIP at separate intradermal sites. Thus, protein vaccine administered at a 2 mu g dose via the intramuscular route addresses both efficacy and safety concerns. The Phase I/II clinical trials initiated with the recombinant hCG vaccine in women revealed inadequate antibody titres in all subjects, alongside the development of nodules at the injection sites in some participants. Studies were undertaken in mice to propose potential strategies for mitigating injection site reactions and enhancing the antibody response. It was concluded that the optimum dose of the protein version of the vaccine to get high antibody titres, is 2 mu g administered intramuscularly while upholding safety standards.

Background and Aims:Magnesium sulfate (MgSO4) has been demonstrated to have analgesic property in various clinical settings. This study explores if addition of MgSO4 to ropivacaine increases its analgesic efficacy when infiltrated continuously in the postsurgical wound following total abdominal hysterectomy. Material and Methods:This randomized controlled trial was conducted at a tertiary care referral hospital in New Delhi, India. Fifty-two patients were randomized into two groups to receive the intervention of which 48 were able to complete the study. The first group (n = 26) received 0.25% ropivacaine infiltration and the second group (n = 26) received 0.25% ropivacaine with 5% MgSO4 at the incision site for 48 h postoperatively. Primary objective was to compare the total postoperative opioid (morphine) consumption by the study participants in both the groups and the secondary objectives were pain scores at rest and at movement, patient satisfaction score, and wound quality of life on the 7th postoperative day among the two groups. Results:Both the groups were comparable in their demographic characteristics. The median morphine consumed at 48 h postoperatively was 16.5 [0-77] mg in the ropivacaine group and 13[1-45] mg in the ropivacaine with MgSO4 group and the difference was statistically insignificant (P = 0.788). There was no statistical difference between the groups with respect to the pain scores, patient satisfaction, or wound quality of life at 7 days. Conclusion:The addition of MgSO4 to ropivacaine does not confer any additional postoperative analgesic benefits over ropivacaine alone in continuous wound infiltration following total abdominal hysterectomy.

Caesarean section is associated with post-operative surgical complications such as wound disruption, induration and hematoma. It is essential to optimize surgical techniques to ensure the best possible outcomes for women undergoing caesarean section. This was a randomized controlled trial done at a tertiary care centre. A total of 300 women undergoing first caesarean section were randomly allocated to absorbable subcuticular sutures (n = 100), non-absorbable nylon sutures (n = 100) and surgical staplers (n = 100) for skin closure. Post-operative wound complications, pain, cosmetic appearance, closure time, and surgeon’s and patient’s satisfaction were recorded post-operatively on day 3, days 7–10 and at weeks 4–6. The primary outcome was rate of wound disruption among the women in three groups at three occasions. The secondary outcomes were wound infection rate, induration, swelling, cosmetic appearance, pain, surgeon’s satisfaction, patient’s satisfaction and closure time. Significantly more women developed wound dehiscence in the stapler group (p = 0.039) at post-operative days 7–10 while in sub-group analysis, a similar outcome was seen between the other two groups (p = 0.999). The patient’s and surgeon’s satisfaction and cosmesis were maximum with absorbable subcutaneous monocryl sutures and minimum with stapler skin closure. Pain was maximum after non-absorbable nylon sutures, while application time was minimum in staplers application. Present study suggests a benefit with sutures compared to surgical staplers in terms of wound dehiscence, infection, cosmesis and patient’s satisfaction. Among the methods of skin closure, absorbable subcuticular monocryl and non-absorbable nylon sutures have similar outcomes with marginal benefit in absorbable subcuticular monocryl sutures.

ObjectiveBorderline ovarian tumors (BOT) are characterized by atypical epithelial proliferation without stromal invasion and majority are diagnosed in women of reproductive age group desirous of fertility preservation.MethodsA retrospective review of medical records of patients diagnosed with BOT and on regular follow up at the All India Institute of Medical Sciences New Delhi, during a nine-year study period from March 2014 to March 2023 was performed. Surgical treatment was classified as radical or fertility sparing surgery (FSS). Surgical staging was defined as complete, partial or un-staged.ResultsMedian age of 91 women was 34 years. Follow up period ranged from 4 to 222 months (median 77 months). Among 68 premenopausal women, 31 (46 %) underwent radical surgery and FSS in 37 (54 %) cases. Median time to conception in 29 women with future fertility wishes was 13 months (range, 4 to38 m). Seven of 29 cases (29 %) required ovulation induction. The pregnancy rate was 82.7 % and live birth rate was 80 %. Eight cases (8.7 %) had a recurrence (7- un-staged, 1- partially staged) and median time to recur was 36 months. There was no significant difference in recurrence between cystectomy/oophorectomy. Ovary was the site of recurrence in all surgically salvaged cases except peritoneal cavity in 1 case with mortality. Relapse free survival at 5 and 10 years in FSS and radical surgery group were similar.ConclusionFSS is a safe procedure and should be considered in young patients desirous of future fertility along with a comprehensive peritoneal staging. Reproductive outcomes are excellent.

OBJECTIVE:To determine the clinical manifestations, risk factors, treatment modalities and maternal outcomes in pregnant women with lab-confirmed COVID-19 and compare it with COVID-19 negative pregnant women in same age group.DESIGN:Multicentric case-control study.DATA SOURCES:Ambispective primary data collection through paper-based forms from 20 tertiary care centres across India between April and November 2020.STUDY POPULATION:All pregnant women reporting to the centres with a lab-confirmed COVID-19 positive result matched with controls.DATA QUALITY:Dedicated research officers extracted hospital records, using modified WHO Case Record Forms (CRF) and verified for completeness and accuracy.STATISTICAL ANALYSIS:Data converted to excel files and statistical analyses done using STATA 16 (StataCorp, TX, USA). Odds ratios (ORs) with 95% confidence intervals (CI) estimated using unconditional logistic regression.RESULTS:A total of 76,264 women delivered across 20 centres during the study period. Data of 3723 COVID positive pregnant women and 3744 age-matched controls was analyzed. Of the positive cases 56·9% were asymptomatic. Antenatal complications like preeclampsia and abruptio placentae were seen more among the cases. Induction and caesarean delivery rates were also higher among Covid positive women. Pre-existing maternal co-morbidities increased need for supportive care. There were 34 maternal deaths out of the 3723(0.9%) positive mothers, while covid negative deaths reported from all the centres were 449 of 72,541 (0·6%).CONCLUSION:Covid-19 infection predisposed to adverse maternal outcomes in a large cohort of Covid positive pregnant women as compared to the negative controls.

Management of central nervous system (CNS) metastases from epithelial ovarian cancer (EOC) is an unmet need. We analyzed data on 41 such patients to evaluate predictors of outcome. Between January, 2010 and December 2020, among 1028 patients with EOC treated at our institute 41 (3.98%) developed CNS metastasis. Median age of patients was 48 years, ranging from 22 to 75 years. Primary outcome measure was progression free survival (PFS). Overall survival (OS), and analysis of prognostic factors were secondary outcome measures. An intention to treat analysis was done. We also performed review the literature (n=2253) as regards to clinicopathological and radiological features, treatment received, survival outcomes and prognostic factors. Median time from diagnosis of EOC to CNS metastasis was 27 months (range: 0 to 101 months). 33(80.5%) patients had FIGO stage III-IV at baseline and serous carcinoma (75.6%) was common pathology subtype. Thirteen (31.7%) patients had isolated CNS metastasis and 28 (68.3%) had intra-abdominal disease in addition. Nineteen (46.3%) patients achieved complete response post treatment with surgery, radiation and chemotherapy. Median PFS and OS from the time of CNS metastasis is 12 (range:1 to 51) months and 33 (range: 1 to 71) months, respectively. Absence of extracranial disease and lower serum CA-125 at diagnosis of CNS metastasis were predictive of superior PFS and OS on multivariate analysis. CNS metastasis is a late event in EOC, post multiple lines of treatment. Patients with disease limited to brain and treated with surgical resection and chemoradiation have best outcome.

BACKGROUND AND OBJECTIVE:Female genital tuberculosis (FGTB) is an important type of extrapulmonary tuberculosis (TB) associated with morbidity especially infertility in developing countries. Laparoscopy may be difficult and hazardous in FGTB. The aim of the study was to observe the difficulties and complications of laparoscopy in FGTB cases. MATERIALS AND METHODS:It was a prospective study over 12 years' period on 412 cases of diagnostic laparoscopy performed on FGTB cases with infertility. All patients underwent history taking and clinical examination and endometrial sampling for acid-fast bacilli (AFB) microscopy, culture, polymerase chain reaction (PCR), gene Xpert (last 212 cases) and histopathological evidence of epithelioid granuloma. Another 412 cases of diagnostic laparoscopy in the absence of FGTB performed during same time were taken as controls from the pool of non-TB cases. Various difficulties and complications were noted in both groups and statistical analysis was done. RESULTS:Mean age, parity, body mass index and duration of infertility were 26.8 versus 25.4 years, 0.32 versus 0.28, 23.15 versus 25.28 Kg/m 2 and 4.15 versus 5.12 years, respectively. Primary and secondary infertility was seen in 78.6% and 20.38% of cases in the study group and 74.75% and 25.24% in the control group, respectively. Endometrial biopsy showed AFB microscopy in 5.3%, culture in 6.3%, epithelioid granuloma in 15.77% and on peritoneal biopsy granuloma in 6.55%, positive PCR in 368 (89.32%) and positive gene Xpert in 38 out of 212 (17.92%, out of last 212 cases). Definite findings of FGTB were seen in 171 (41.50%) cases. Probable findings of FGTB were seen in 241 (58.49%) cases. Various complications were difficulty in the creation of pneumoperitoneum or insertion of trocar and cannula in 16.74% and 13.10% of cases as compared to 1.94% and 1.69% in the control group. Excessive bleeding was seen in 5.09% versus 0.97% cases, respectively. Various injuries observed were bowel injury in 1.69% versus 0.24% cases (small bowel in 1.21% vs. 0.24%, large bowel in 0.48% vs. 0.1%), while bladder injury was seen in 0.97% versus 0.24% cases, subacute intestinal obstruction was seen in 5.8% versus 0.72% cases respectively while flare up of TB was seen in 5.09% versus 0% in cases and controls, respectively. Wound infection was seen in 8.48% versus 1.25% cases, respectively. INTERPRETATION AND CONCLUSION:FGTB is associated with increased complications and difficulties as compared to laparoscopy in other cases.

Objective: Endometrial cancer is the most common form of cancer affecting female reproductive organs. Most common histologic type endometrioid carcinoma constitutes 75 to 80% of all cases. Studies on Dkk1 expression profiles and its inhibitory role in Wnt signaling pathway in genesis and development of endometrial carcinoma are very few. This study aims to investigate Dkk1 expression in endometrial carcinoma and its correlation with Wnt/β-catenin pathway. Methods: A total of 160 formalin fixed paraffin embedded samples including 50 cases each of endometrial atypical hyperplasia and endometrioid endometrial carcinoma along with 30 cases each of proliferative and secretory endometrium were included in this study. We investigated expression pattern of Dkk1, E-cadherin, β-catenin and c-myc in endometrial atypical hyperplasia and carcinoma as well as compared with that of proliferative and secretory endometrium. Immunohistochemistry and analysis were performed from July, 2018 to June, 2020. Results: We showed decreasing pattern of immunopositivity for Dkk1, E-cadherin and β-catenin from proliferative/secretory endometrium to endometrial atypical hyperplasia and endometrioid carcinoma. Increasing c-myc immunopositivity was noted from proliferative/secretory endometrium to endometrial atypical hyperplasia and endometrioid carcinoma. Moreover, decreasing Dkk1 immunopositivity was well correlated with both E-cadherin, β-catenin and c-myc immunopositivity. Conclusion: Decreasing Dkk1 positivity from benign endometrium to endometrioid carcinoma suggests a negative regulatory function of Dkk1 in endometrioid carcinoma. Dkk1 is downregulated in Wnt signaling pathway in endometrioid endometrial carcinoma. Thus, Dkk1 can show promise as a biomarker for screening endometrioid carcinoma. Future researches can study the reactivation of the Dkk1 gene that could be a valuable strategy for antagonizing Wnt signaling pathway. Keywords: Endometrioid carcinoma, Dkk1, Wnt/β-catenin pathway, β-catenin, E-cadherin

To evaluate the role of placental vascularisation indices using 3D-Power Doppler and placental elasticity using Shear Wave Elastography (SWE) in Fetal Growth Restricted (FGR) pregnancies and to assess their correlation with perinatal outcomes. This prospective case–control study was conducted from June 2018–2020. Thirty women with FGR and thirty controls (24–36 weeks) underwent grayscale and Doppler ultrasonography followed by measurement of vascularisation indices and SWE from the central and peripheral parts of fetal and maternal surfaces of the placenta. Participants were followed till delivery and perinatal outcomes were noted. Vascularisation indices were significantly reduced among FGR vs. controls: Vascularisation Index (VI): 20.90 ± 5.46 vs. 31.49 ± 3.89, Flow Index (FI): 26.29 ± 1.70 vs. 30.85 ± 2.02, Vascularisation- Flow Index (VFI): 7.06 ± 2.42 vs. 12.37 ± 2.43, p < 0.001. The mean placental SWE (17.36 ± 1.50 kPa) in FGR pregnancies was significantly higher as compared to controls (4.14 ± 1.14 kPa), p < 0.001. Neonatal polycythaemia and hyperbilirubinemia were significantly increased in FGR pregnancies with higher SWE value. Receiver operating characteristic curve-based cut-off of VI for intensive care requirement was 23.0 (sensitivity: 75

Chronic myeloid leukemia (CML) management during pregnancy is challenging. In this retrospective study, hospital records of CML patients treated between 2000 and 2021 were screened to identify patients who tried to conceive/got pregnant (planned and unplanned) on TKIs (tyrosine kinase inhibitors)/were pregnant at CML onset/fathered a child. We found ninety-three pregnancies involving thirty-three women and thirty-eight men, and they were analyzed for the pregnancy outcomes and the strategies utilized for CML management during pregnancy and the pre-conception period. There were two women and four men with primary infertility and five women with secondary infertility. TKIs were discontinued before conception in four planned pregnancies and at the time of recognition of pregnancy in unplanned pregnancies ( n = 21). Unplanned pregnancy outcomes were two miscarriages, eight elective terminations, and eleven live births. Planned pregnancies led to four healthy babies. Outcomes of pregnancies at CML onset ( n = 17) were six live births, one stillbirth, five elective terminations, and five abortions. Except for one child with congenital micro-ophthalmia, no other child born to the women on TKI had any malformations. Thirty-eight men fathered 51 healthy children. All but two patients (one planned and one unplanned pregnancy) lost their hematological responses during pregnancy and gained their previous best response after restarting TKI. In women who were pregnant at CML onset, complete cytological remission (CCYR) was achieved between 7 and 24 months (median:14 months) after starting TKI. During pregnancy, intermittent hydroxyurea ± TKI (in the second and third trimesters) was used to keep WBCs less than 30,000/mm3. Outcomes of pregnancies in CML patients can be optimized with our approach. TKIs (Imatinib and Nilotinib) can be safely used in the second and third trimesters. Delayed initiation or interruption of TKI during pregnancy does not negatively affect response to TKIs.

Background & objectives:Female genital tuberculosis (FGTB) is an important variety of extrapulmonary TB causing significant morbidity, especially infertility, in developing countries like India. The aim of this study was to evaluate the laparoscopic findings of the FGTB.Methods:This was a cross-sectional study on 374 cases of diagnostic laparoscopy performed on FGTB cases with infertility. All patients underwent history taking and clinical examination and endometrial sampling/biopsy for acid-fast bacilli, microscopy, culture, PCR, GeneXpert (only last 167 cases) and histopathological evidence of epithelioid granuloma. Diagnostic laparoscopy was performed in all the cases to evaluate the findings of FGTB.Results:Mean age, parity, body mass index and duration of infertility were 27.5 yr, 0.29, 22.6 kg/m2 and 3.78 years, respectively. Primary infertility was found in 81 per cent and secondary infertility in 18.18 per cent of cases. Endometrial biopsy was positive for AFB microscopy in 4.8 per cent, culture in 6.4 per cent and epithelioid granuloma in 15.5 per cent. Positive peritoneal biopsy granuloma was seen in 5.88 per cent, PCR in 314 (83.95%) and GeneXpert in 31 (18.56%, out of last 167 cases) cases. Definite findings of FGTB were seen in 164 (43.86%) cases with beaded tubes (12.29%), tubercles (32.88%) and caseous nodules (14.96%). Probable findings of FGTB were seen in 210 (56.14%) cases with pelvic adhesions (23.52%), perihepatic adhesions (47.86%), shaggy areas (11.7%), pelvic adhesions (11.71%), encysted ascites (10.42%) and frozen pelvis in 3.7 per cent of cases.Interpretation & conclusions:The finding of this study suggests that laparoscopy is a useful modality to diagnose FGTB with a higher pickup rate of cases. Hence it should be included as a part of composite reference standard.

Context The concept of simulation-based teaching has become a standard practice for health education in the present era. However, there is a paucity of literature on integrating simulation-based teaching in the conventional training of undergraduate medical and nursing students. Aim To explore the effectiveness and benefits of e-learning along with low-fidelity simulation in obstetrics and gynecology among undergraduate medical and nursing students at a tertiary care center in India. Methodology It was a prospective study conducted on 53 final-year undergraduate medical students and 61 final-year undergraduate nursing students. All students underwent a knowledge-based pre-test followed by exposure to an e-learning module on four selected obstetrics and gynecology skills, namely, conducting normal delivery, episiotomy suturing, pelvic examination, and insertion of intrauterine device. Students practiced these four skills on low-fidelity simulators. After this, they underwent a post-test assessment and gave feedback. A focused group discussion was conducted to explore their experiences. Results There was a statistically significant difference between the pre-test and post-test knowledge scores of all the students (p =< 0.001). Students found this teaching strategy useful and reported an increase in self-assessed confidence. Focused group discussion revealed various themes like improved satisfaction and ability to practice repeatedly without fear of harming patients. Conclusions Based on the results, this teaching methodology should be integrated as an adjunct method of teaching in the undergraduate curriculum from the first year itself, which will motivate students to participate in clinical care and will result in quality improvement of health care.