Introduction: Recurrent pregnancy loss (RPL) is considered as a significant public health problem. In many studies, Factor V Leiden mutation is considered to have significant relationship with unexplained recurrent pregnancy loss. Aim of the study: The aim of this study was to determine the association of Factor V Leiden mutation with unexplained recurrent pregnancy loss. Methods: This case-control study was conducted in the out-patient Department of Fetomaternal Medicine, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh, from November 2020 to April 2021 (6 months). Sample size was taken as 40 for each case and healthy control group. Result: Mean (±SD) age was found 28.2±4.9 years in RPL group and 27.1±5.24 years in non-RPL group. Maximum number of patients fell into the BMI category of 23.0-26.9 kg/m2 (BMI for Asian women) in both groups. Among the RPL cases, 30% had experienced consecutive 2 pregnancy losses with mean (±SD) number of losses 3.07±1.14. About more than half percentages (n=23, 57.5%) shared the primary RPL group. In this study, normal homozygous FVL mutation was equally distributed among RPL patients and control individuals. Only 2 cases (5%) were found positive for Factor V heterozygous mutation (GA) in the RPL group. G allele occurred in most of the cases (97.5%) of RPL. Two cases aged 25 years and 35 years respectively were found positive for heterozygous mutation of Factor V Leiden. Both of them exhibited 3 consecutive recurrent second trimester pregnancy losses. Factor V Leiden was found in higher prevalence (100%) in 2nd trimester recurrent pregnancy loss sub-group of cases and revealed significant association (p <0.001) between two variables. Conclusion: The impact of Factor V Leiden mutation has not stated any causal association with unexplained recurrent pregnancy loss. The results do not support Factor V mutation screening as an initial approach in Bangladeshi women suffering from recurrent pregnancy loss.

Background: Growing cases of ovarian tumor recently documented in worldwide and developing countries like Bangladesh. Objective: In this study our main goal is to evaluate menopausal status score and laboratory profile in all cases of Ovarian Tumor. Method: This cross sectional study was carried out at Department of Obstetrics and Gynaecology, Jalalabad Ragib Rabeya Medical College, Sylhet from January 2019 to December 2019 where a total of 60 women who diagnosed with ovarian tumor were included as a sample size. Results: During the study, mean age was 41.4 (SD±14.7) years and 42 (70.0%) cases were premenopausal and 18 (30.0%) cases were post-menopausal. In addition, of the benign ovarian tumours 29 (76.3%) cases had ultrasonogram score 1 and 9 (23.7%) cases had ultrasonogram score 3; while of the malignant ovarian tumours 3 (13.6%) cases had ultrasonogram score 1 and 19 (66.4%) cases had ultrasonogram score 3. Besides that, Of the benign ovarian tumours 8 (21.1%) cases had serum CA-125 level ≥35U/ml and 30 (78.9%) cases had serum CA-125 level <35U/ml; while of the malignant ovarian tumours 20 (90.9%) cases had serum CA-125 level ≥35U/ml and 2 (9.1%) cases had serum CA-125 level <35U/ml. Besides that, most common benign tumour was mucinous cystadenoma (26.7%) whereas in malignant tumors case seruos cystadenocarcinoma (23.3.0%) were seen commonly. Conclusion: According to our study we can conclude that, premenopausal women were more prone to develop ovarian tumor. Where in benign tumors cases majority were mucinous cystadenoma whereas in malignant tumor cases,serous cystadenocarcinoma was seen commonly. Also, most of the benign tumor had ultrasonogram score 1 where as in malignant cases opposite scenario was seen.

Introduction: There should be a gap between pregnancies for the sake of both mother and child. Post-partum contraceptive is required to delay pregnancy after delivery and to pursue family planning. Aim of the study: The aim of this study was to evaluate the knowledge and practice of post-partum contraceptives in pregnant women. Methods: This cross-sectional study was conducted in the Department of Obstetrics and Gynaecology, Khulna Medical College, Khulna, Bangladesh during the period from January 2019 to December 2020. Result: In this study, the mean age was 25.91 years (SD± 4.97 years) ranging between 16-39 years. In this study, most of the pregnant women (69%) did not get any postpartum FP during the hospital discharge. In this study, most of the pregnant women (77%) had ANC in their last pregnancy. In this study, most of the pregnant women (76%) did not get postpartum family planning counseling during ANC checkups. For most of the pregnant women (84%), the resumption of menstruation after the last pregnancy was less than 6 months. In this study, the current pregnancy of most of the study people (76%) was unplanned/unintended. There was no unplanned pregnancy loss (abortion) between last and current pregnancy for most of the pregnant women (80%). For most of the pregnant women (76%), the gap between last and current pregnancy was 1-2 years. In this study, most of the pregnant women (79%) did not have adequate knowledge and practice of contraceptives. Most of the pregnant women (14%) did not use any contraceptive due to a lack of knowledge. Followed by 10% did not use due to ignorance, 4% did not use due to irregular meetings with husband and 3% did not use as the family did not allow. In this study, most of the pregnant women (31%) did not use any method for postpartum contraceptives after the last pregnancy. Followed by, 20% used POP, 17% used condom, 15% used OCP, 10% used injection, 3% used PPIUD, 3% used LAM and 1% used implant. Conclusion: Most pregnant women do not have adequate knowledge and practice of contraceptives. Most pregnant women do not use any post-partum contraceptives. Women, using post-partum contraceptives, prefer POP, condoms, and OCP. The husband is the decision-maker for contraceptive usage in most cases.

The most common surgical emergency encountered during pregnancy is acute appendicitis [1]. The diagnosis of acute appendicitis during pregnancy is often challenging mainly because of physiological and anatomical changes during pregnancy. From a therapeutic point of view, the approach depends on the gestational age and the evolutionary stage of the appendicitis. The maternal-fetal prognosis depends on the severity of the condition and the delay in treatment. Appendectomy should be performed in patients presenting a highly suggestive clinical and ultrasonographic picture, preferably by laparoscopy in order to avoid more severe complications which could be life-threatening for the mother or infant.

Background: Caesarean section rate has been on the increase in the past few years. Previous caesarean sections are a major indication for caesarean sections. The risks associated with repeat caesarean sections have brought about the need to adopt vaginal birth after caesarean section (VBAC) as the preferred mode of delivery in a previously scarred uterus. Aims and Objectives: To determine the pregnancy outcome and complications of vaginal birth after caesarean section at the University of Port Harcourt Teaching Hospital. Materials and Methods: This was a retrospective descriptive study of 121 women with one previous caesarean section who presented at the labour ward of the University of Port Harcourt Teaching Hospital between January 1, 2010, and December 31, 2019. Data was obtained from the case notes, ward, and theatre registers, encoded into a spreadsheet, and analyzed using SPSS 22.0. The results are presented as means, rates and proportions. Associations between variables were assessed using students t-test and Pearson’s correlation. Statistical significance was considered at P<0.05. Results: There were 20,661 deliveries during the period under review. Of these, 175 had vaginal birth after caesarean section (VBAC). However, only 121 case notes were available for analysis. About one third, 44 (36.36%) of the women had previous successful VBAC and 5 (4.13%) had augmentation of labour. Perineal laceration was the most common complication 38 (31.4%). Majority of the babies 103 (85%) had APGAR scores > 7 in the first minute, while 10 (8.55%) were admitted in the Special Care Baby Unit. Maternal age, socioeconomic status, gestational age at delivery and birth weight were not significantly associated with the outcome of VBAC. Conclusion: Vaginal Birth after Caesarean Section is safe and should be recommended in carefully selected women with previous caesarean section, to reduce the morbidities associated with repeat caesarean sections.

Introduction: Breech is the commonest mal-presentation where increased perinatal and maternal mortality and morbidity are reported compared to cephalic presentation. This unwanted outcome can only be prevented by planned delivery methods. The aim of the study was to compare fetal outcomes in all delivery methods among the primiparous and multiparous women and thereby helping in preparing appropriate delivery protocol in breech presentation. Methods: This prospective study was done at the Department of Obstetrics & Gynecology of Rangpur Medical College with a total of 104 pregnancies. Appropriate cases of breech presentation were included and all necessary information was noted including predictive factors, management details, and outcome of the delivery. Result: Among the 104 participants of the study, 53 were primiparous pregnancy, and 51 were multiparous pregnancy cases. In total, 28 out of 104 had vaginal deliveries, and 76 had a delivery through cesarean section. The cesarean section had a much higher prevalence (81.13%) among primipara cases. 22 of the primipara and 20 of the multipara cases had planned for vaginal delivery, but successful vaginal delivery was observed to be 22.7% in primiparous women and 45% among multiparous women. The mean age was 24.58 years among the primiparous women and 28.9 years among the multiparous. A higher percentage of multiparous cases (80.4%) had no fetal complications compared to primiparous cases (71.7%). Among neonatal complications, birth traumas were significantly more frequent in the primiparous compared with multiparous. 43.4% of neonates needed admission from the primipara group compared with 33.3% in multipara. Among maternal complications, a higher percentage of multipara women suffered from different morbidities compared to primiparous, which was statistically significant as a whole. Conclusion: Proper planning of delivery methods is important to decrease both maternal and fetal morbidities and mortality irrespective of parity. Primiparous mothers with breech presentation are more prone to undergo cesarean deliveries and thereby develop postoperative complications. But multiparous mothers have more complications during the delivery process. Overall neonatal complications especially birth traumas are more common among the babies of primiparous mothers.

Chancroid is a sexually transmitted disease (STD) caused by the Gram-negative bacterium Haemophilus ducreyi and is characterised by necrotising genito-perineal ulcers which may be accompanied by inguinal lymphadenitis or bubo formation with possible spread to the thigh. We presented a rare case of a 23year old polytechnic undergraduate who presented to the hospital with complaints of extensive painful ulcer in her vulva for over ten (10) days. On culture of the swab from the ulcer, Haemophilus Ducreyi and E Coli sensitive to Ceftriazone, Ofloxacin and Gentamycin were isolated. Patient was treated with IV Ceftriazone for 5 days and Ciprofloxacin for 10 days with good recovery. The case highlighted the need for increased vigilance in managing genital ulcers in contemporary clinical practices and for carefulness in the choice of a sexual partner and practices among adolescents and young girls.

Background: Using an evidence-based guideline for obstetric risk assessment in the primary and secondary healthcare settings in Nigeria has been shown to aid appropriate referral cascade of patients to tertiary centres. Aim: To assess the impact of inappropriate obstetric risk assessment and late referral to tertiary care facilities in Rivers State on perinatal morbidity and mortality. Material and methods: The study was of prospective cross-sectional design involving 475 patients who were referred from primary and secondary healthcare facilities to the labour ward of Rivers State University Teaching Hospital in Nigeria. The appropriateness of their obstetric risk assessment and referral cascade to a tertiary centre was assessed, using a preformed evidence-based guideline and the results were associated with the perinatal morbidity and mortality. Data were analysed using Epi Info 2020. Results: The perinatal outcome in women that needed to be referred in the first trimester to tertiary centres was worse than that in those women who were appropriately referred and the differences were statistically significant in terms of birthweight less than 2500 grams [170(54.66%) versus 8(24.24%), X2 = 9872 p<0.002]; birth asphyxia [78(19.02%) versus 0(0%), X2 =7.926 p<0.0003]; admission to SCBU [85(20.73%) v 0(0)%); X2=8.916 p<0.0001] and foetal death [77 (18.78%) v 0(0%); X2=7.787 p<0.0003r]. The differences were also worse in terms of the number of patients who had preterm birth at 28-37 weeks, FGR and large for date (LFD) babies but the differences were not statistically significant. Furthermore, the perinatal outcome in women that needed to be referred in the first trimester to tertiary centres was also worse than that in those who needed an earlier referral to tertiary centres and the differences were statistically significant in terms of birth asphyxia (X2=2.341, p<9.045); admission to SCBU (X2=2.699, p<0.055) and foetal death (X2=2.291, p<0.047). The differences were also worse in terms of the number of patients who had preterm births, neonatal birth weight, LFD babies and FGR but not statistically significant. Conclusion: Perinatal morbidity and mortality were worse in patients who needed to be referred to a tertiary centre from a primary and secondary healthcare facilities than in those who were appropriately referred and those that needed an earlier referral. There is therefore an urgent need for adoption of evidence-based guideline for obstetric risk assessment and referral cascade in Nigeria.

Introduction: Fistulas are abnormal connection between two body parts that is not supposed to be there. Differenc types of fistulas can occur among both male and female, but obstetric fistulas are more common among women. Because of the physical, psychological, and social repercussions of urine leakage, people with Vesicovaginal Fistula become severely incapacitated. These fistulas are typically caused by hindered labor and trauma. The most prevalent kind of fistula is vesicovaginal fistula, which is a serious condition that can bring physical, emotional, and social issues for both the afflicted and their family. Fistulas are more common in underdeveloped nations. The study's goal was to look at the socio-demographic features of fistula patients in a specific area. Aim of the study: The aim of the study was to observe the social demographic characteristics of fistula patients of Rangpur region. Methods: This prospective descriptive study was conducted at the Department of Obs and Gynae, Rangpur Medical College Hospital, Rangpur, Bangladesh. The study duration was 2 years, from September 2006 to September 2008. A total of 50 patients were selected for the present study following the inclusion and exclusion criteria. Result: 60% of the patients were between the age of 21-30 years, and 38% were between 31-40 years. 62% of the precent study participants had low socio-economic status. 72% of the women were of smaller stature (≤145 cm). 84% of the patients had vesicovaginal fistula, 12% had mixed type of fistulas. 24% had associated complications. Successful outcome was observed in 84% of cases. Conclusion: The study showed that obstetric fistula is more common among the women of lower social economic class with low availability of medical facilities. Women of small stature are at higher risk of fistulas, and among the different types of fistulas, vesicovaginal fistulas are the most common.

Background: Abortion is defined as the loss or termination of a pregnancy before 20 weeks of gestation or when the fetus weighs less than 500 g. Induced abortion is defined as the use of medications or surgical intervention to stop pregnancy after implantation but before the embryo or fetus has become independently viable. The purposeful termination of a pregnancy, known as induced abortion, is one of the most common gynecological treatments. In this study, attempts have been made to show the clinical presentation, management, and outcome of patients. Aim of the study: The study aimed to assess the outcome of a patient after induced abortion. Methods: It was a prospective observational study. The study was conducted at the Department of obstetrics and gynecology, Dhaka Medical College Hospital, Dhaka, Bangladesh during May-Oct'2007 from all induced abortion cases admitted in different maternity units, 80 cases are randomly selected for the study. Proper ethical consent was taken from the concerns. All necessary investigation was done, and necessary pieces of information were noted in a preformed data collection sheet. Finally, the results were analyzed and presented in different tables using a computer and the SPSS database. Result: In this study, it has been seen that around 45.5% of gynecology patients are of abortion, and the incidence of induced abortion was 16% among all gynecological admission. The majority of abortion cases (58.75%.) were conducted by untrained persons. Among the patients, 8.75% had adequate knowledge about MR, while 51.25% had unreliable or incorrect information regarding MR. 55% of cases had used contraceptives. A total of 76.25% of patients got admission within 1 month of their complications. Among all cases, 92.5% were improved while the death rate was 7.5%. Amongst 23 specimens of high vaginal swab culture 15 (65.22%) patients showed growth of Escherichia coli, 3 (13.5%) of staphylococcus, 3 (13.5%) of pseudomonas, 1 (4.34%) of protus, 1 (4.34%) of klebsiella. Conclusion: All this can be reduced by improving socioeconomic condition, educational status, popularizing family planning, and modernization of existing laws in relation to abortion.

Anti-neoplastic drugs are known to have teratogenic effects on the fetus. In this case report we are presenting a case of a patient who got operated for breast carcinoma, conceived while on chemotherapy and underwent termination of pregnancy in the second trimester. Fetal haemorrhage and ecchymosis lead to further evaluation of the case, which revealed fetal thrombocytopenia, a rare teratogenic effect of the anti-neoplastic drugs.

Background: Partograph is a simple, of low cost but most important tool for record of progress of labour In the developing country like ours, where both pregnancy and maternal mortality rate is so high, the use of this inexpensive partograph is essential. Objective: To assess the importance of partographic control of labour in preventing prolongs labour and its consequences, thereby decreasing maternal morbidity and mortality and improvement of neonatal outcome. Method: This study was done in the Obstetrics and Gynaecology department of Institute of Child and Mother Health, Matuail, Dhaka. Total 196 patients were included in this study. Data were collected by predesigned data collection sheet. Data were analyzed by using Statistical Package for Social Science (SPSS) version 14. Result: 74% of these patients had spontaneous vaginal delivery, 7.14% required assisted delivery (forceps or ventouse) and 18.9% needed caesarean section. Caesarean section was done in 18.9% patients because of fetal distress (32.4%) and prolonged labour (67.6%) due to malrotation and cephalopelvic disproportion. Patients with non-engaged head in labour required more intervention than who had engaged head. With the use of partograph, unnecessary interventions were reduced. It was found that 66.7% of the patients were delivered within 7 hours and all patients were delivered within 10 hours from active phase of labour. Thus prolonged labour and its consequences, such as obstructed labour and ruptured uterus, can be avoided by using partograph. In 100% of the patients, crossing the action line in partograph required interference, but 92.5% within alert line of partograph delivered vaginally spontaneously and 7.5% required assisted delivery (forceps or ventouse). When IDR was 1 cm/hr 85.1% women delivered spontaneously. When IDR was <0.4 cm/hr, 100% of patients required some kind of interference. Thus, the maintenance of partograph in labour enables the obstetricians to recognize very early dystocic labour and act accordingly. Conclusion: With the help of a partogram, time of delivery can be estimated and if the progress is slow, an appropriate interference at the right time can be instituted before the labour becomes dangerously protracted. IDR very helpful in making early decisions about the prognosis for the type of labour. With the use of partogram and its scientific application, the result showed that operative interventions were reduced, duration of labour was within normal limit and there was no obstructed labour and no maternal or perinatal mortality.

Introduction: cystic adenoid carcinoma of the Bartholin gland is a very rare tumor with a low incidence of 1% of female genital malignancies; it is characterized by its aggressive nature and frequent recurrence. Case report: We report a case of a cystic adenoid carcinoma of Bartholin's gland in a 38-year-old female patient who was treated surgically with good evolution. Conclusion: Adenoid cystic carcinoma is a very rare tumor of the Bartholin gland, whose diagnosis is based on the anatomopathological study.

The stomach is one of the frequent sites of metastasis from invasive lobular carcinoma of the breast. The clinical presentation and the endoscopic findings for metastasis carcinoma are nonspecific and may mimic that of a primary gastric tumor. The distinction between these two neoplasms may be very difficult but essential as the basis of the treatment is different. Histological and immunohistochemical analyses are the gold standard for establishing the diagnosis of the primary site. We report the case of a 68-yearold patient with metastatic breast cancer mimicking a primary stomach cancer.

Introduction: Usually, eclampsia is the commonest cause of convulsions in pregnancy next being epilepsy. Moreover, in developing countries like Bangladesh, perinatal condition in eclampsia is a major concern of infant injury. So, proper treatment planning and initiatives against eclampsia can save many lives by decreasing the total mortality and morbidity of child and mother. The aim of our study was to assess the perinatal outcomes of pregnant women with eclampsia in a tertiary care hospital in Bangladesh. Methods: This cross-sectional observational study was conducted at the Department of Obstetrics and Gynaecology in Rangpur Medical College, Rangpur, Bangladesh during the period from January 2020 to December 2020. Proper written consents form all the participants were obtained and the ethical committee of the mentioned hospital had approved the study before starting the intervention. In total 78 pregnant women with eclampsia were selected as the study population. A predesigned questioner was used in collecting patient data. All data were processed, analyzed and disseminated by using MS Office and SPSS version 23 as per need. Result: As final outcome we observed, there was not any case of multiple pregnancy or maternal mortality. Among total 78 fetus, cases of stillbirth (SB), early neonatal death (END), perinatal death (END + SB) and death after birth were found as 8%, 12%, 19% and 4% respectively. So, total case of neonatal death was found 35% whereas the survival rate was 65%. As neonatal complication among survived babies, frequencies of jaundice, septicemia and respiratory distress were found in 27%, 24% and 18% babies respectively who were noticeable. As maternal complication, cases of ICU admission, acute kidney injury and haemorrhagic stroke were found as 4%, 3% and 1% respectively. Conclusion: Stillbirth may be considered as the main component and prematurity may be considered as another important cause of perinatal mortality in obstetric management of delivery in pregnant mothers with eclampsia. Early referral of eclamptic patients, early resuscitative measures as well as good neonatal care can improve perinatal outcomes in such cases.