Background: Müllerian agenesis is a disorder of genital development characterized by absence of the vagina, an absent or hypoplastic uterus, and normal or hypoplastic fallopian tubes. Typically, the ovaries are entirely normal, although one or both also may be undescended, hypoplastic, or associated with an inguinal hernia. Affected patients often also have urologic anomalies (15-40) % (unilateral renal agenesis, ectopic or horseshoe kidney, and duplication of the collecting systems) and skeletal malformations (5-10) %, (e.g., hemiverterbrae and scoliosis, or the Klippel-Feil syndrome). The cause is unknown, although some cases are associated with chromosomal translocations or occur in familial aggregates, suggesting a genetic basis. Logically, müllerian agenesis might be attributed to an activating mutation in the gene encoding AMH or its receptor, causing excess AMH activity, but none have been identified. Aim: The aim of this study was to analyze and present rare cases of partial mullerian agenesis combined with renal and/or skeletal malformations, their causes, clinical features, diagnosis and treatment along with review of literatures. Methods: A retrospective observational study was conducted in the department of Bangabandhu Sheikh Mujib Medical University. All four cases presented with similar type of presentation and were diagnosed as partial Mullerian aplasia (cervico-vaginal agenesis) with other associated anomalies (renal, skeletal or cardiac anomalies) ie: MURCS association. Results: We analysed four cases of mullerian agenesis with renal and/or skeletal abnormalities presented with primary amenorrhoea with cyclical lower abdominal pain. Subsequently these patients were ascertained to have cervicovaginal agenesis with renal and skeletal abnormalities by physical examination and relevant investigations. Two (50%) patients had renal anomalies in the form of renal agenesis and one small malrotated kidney while 100% patients had skeletal abnormalities. One (25%) patient had congenital cardiac anomaly, one (25%) patient had history of cleft lip and cleft palate and one (25%) patient had history of imperforated anus at birth. Evaluation included clinical examination, whole abdominal ultrasound, skeletal survey and karyotyping along with some supportive investigations. Conclusion: The management is varied but multidisciplinary approach, psychological and social supports are the key points of managing such cases.

Introduction: The use of prostaglandin preparations with or without oxytocin infusion is widely recognized and accepted as a standard method of induction of labor. It has been shown to reduce induction time and the risk of failed induction. But the use of prostaglandin E2 is quite expensive and is not available in many developing countries. In such cases, misoprostol can also be used as an induction agent. The aim of the study was to assess the rate of successful induction of labor following intra-vaginal administration of misoprostol. Methods: This open clinical trial study was conducted at the Department of Obstetrics and Gynaecology, North East Medical College Hospital, Sylhet, Bangladesh. The study duration was 1 year and was conducted with a total of 100 patients who were admitted with term pregnancy and unfavorable cervix in the study hospital, fulfilling the inclusion and exclusion criteria. Result: Bishop’s score was significantly raised after 6 hours vaginal misoprostol [4.63 (SD ± 1.17) VS 5.82 (SD ± 1.60); p<0.001]. The mean induction to vaginal delivery time was 14.6 (SD ± 4.6) hours (range 6 to 23 hours); the induction to vaginal delivery time was<12 hours in 44.3% and 12-24 hours in 55.7% cases. The mode of delivery was vaginal in most of the cases (70.0%) and cesarean section was in 30.0% of cases. Fetal distress was the most frequent indication of cesarean section (63.3%), followed by arrested labor (20.0%) and failed induction (16.7%). The maternal obstetric complication was postpartum hemorrhage (3.0%) without any ruptured uterus, tachysystole, hypertonus uterus, or hyperstimulation. The maternal side-effects were nausea or vomiting (5.0%), diarrhea (2.0%), and fever (1.0%). Fetal outcomes were, normal baby (65.0%), APGAR score <7 at 1 min (27.0%), resuscitation needed (27.0%), neonatal unit admission (13.0%), meconium passage (8.0%) and intrauterine Fetal death (diagnosed before induction) (8.0%). Conclusion: Vaginal misoprostol seems to be a promising drug for labor induction with a high rate of success. Possible advantages of misoprostol may be the availability, ease of administration, well tolerability, and most notably its dual action in cervical ripening and labor induction. However, future studies focusing on dosing regimens and routes of application are needed.

Covid-19 pandemic has resulted in death of millions of people across the world. The impact of the disease on human health and the economic hardship on the affected countries have been severe. The public must routinely practice precautionary measures to control the spread of the disease, as no antiviral treatments are currently available. However, the level of awareness and practice of these preventive measures against Covid-19 infection among pregnant women, which constitute vulnerable groups have not been evaluated in our environment. The aim of the study was to determine the awareness and knowledge of pregnant women on Covid-19, its preventive measures and the practice of those preventive measures. It was a cross-sectional study among pregnant women attending antenatal care clinic at Usmanu Danfodiyo University Teaching Hospital, Sokoto. An interviewer administered questionnaire was used to obtain relevant information on sociodemographic characteristics and also their knowledge and practice of Covid-19 preventive measures. All the respondents were aware of Covid-19 infection and the source of information was from Television. All the respondents were aware of the various preventive measures of Covid-19 and the knowledge was good among 98.7% of the respondents. However, only 19.1% had good practice of the preventive measures. Educational status of the respondents was found to have significant association with knowledge of preventive measures (χ2= 9.5, p = 0.014).

Background: Pregnancy is associated with anatomic, physiological and metabolic adaptations to accommodate the fetus and prepare the mother for delivery. These adjustments are mediated by the hormonal influences of the placenta. The study is aimed at evaluating the pattern of changes of serum growth hormone and cortisol in normal pregnancy to access the possible effect of gestational age and parity on these parameters. Methods: A cross sectional study involving a total of 300 apparently healthy females (21-50yrs) with 200 and 100 pregnant females and non-pregnant controls respectively. The age of the subjects, last menstrual period, gestational age and parity were obtained using a simple questionnaire while the weight and height were obtained following standard protocols. Blood samples were obtained from the subjects and serum growth hormone and cortisol were analyzed using standard laboratory methods. Results: Serum growth hormone was found to reduce in pregnant subjects compared to the non-pregnant control with the lowest decrease observed in the second trimester (p<0.05). Conversely, serum cortisol increased among pregnant subjects compared to the non-pregnant control, showing a gestational age-dependent increase (p<0.05). Conclusion: Our findings suggest that serum growth hormone and cortisol vary with gestational age with growth hormone decreasing while cortisol increases. The present study also highlights that parity appears not to have any influence on serum growth hormone and cortisol during normal pregnancy.