Polycystic ovarian syndrome is a common cause of ovarian dysfunction in women with anovulation world wide.50-70% of patients with PCOS exhibit metabolic abnormalities, including poor glucose tolerance and hyperinsulinemia. The prevalence of vitamin D deficiency in women with PCOS is about 67-85 per cent, with serum concentrations of 25(OH) D <20 ng/ml. It is suggested that there is an association between serum levels of vitamin D and metabolic parameters in women with PCOS, including fasting glucose levels, fasting insulin, insulin resistance, high blood pressure, lipid disorders, obesity, fertility and other clinical and laboratory- related parameters associated with PCOS. Given the high prevalence of vitamin D deficiency in the south Indian population, less number of studies, inconclusive studies, especially in the population of women with PCOS, as well as evidence from recent studies indicating a link between vitamin D levels with lab parameters, this study aimed to assess the relationship between vitamin D deficiency and insulin resistance in PCOS. Pearsons correlation showed 0.034 between HOMA IR and vitamin d levels indicating that vitamin d deficiency is associated with more HOMA IR values, the more insulin resistance. Pearsons correlation showed 0.05 between fasting insulin levels and vitamin d levels indicating the vitamin d deficiency is associated with more fasting insulin levels, the more insulin resistance. No significant relation is seen with fasting glucose insulin levels (Pearsons correlation value >0.05). In the study, it was found that a high percentage of PCOS women were vitamin D deficient. The study also showed a significant difference in the values of some clinical and metabolic parameters such as waist circumference, fasting insulin, HOMA-IR, BMI between PCOS women with and without vitamin D deficiency; however, no linear correlation was found between serum levels of vitamin D and baseline variables, except for HOMA IR values, fasting insulin levels, BMI, G120. In conclusion, our data confirm an association between vitamin D deficiency and Insulin resistance in patients with PCOS. Thus, vitamin D supplementation could be a beneficial treatment of PCOS women to abolish insulin resistance and regulate menstrual irregularities.

Background: Most women with a singleton pregnancy of cephalic presentation at 37+ weeks or later who have had a single prior lower segment cesarean delivery, with or without a history of prior vaginal birth, are candidates for planned VBAC and may be offered it for a trial of VBAC. Objective: The objective of this study is to determine the outcome of vaginal birth after caesarean section (VBAC) in a tertiary care hospital in Sylhet. Methods: This prospective study took place between April 2022 and February 2023 and lasted for a total of eleven months. A total of sixty patients were hospitalized in the gynecology and obstetrics department at North East Medical College, all of whom had a history of either one or two previous cesarean sections and were experiencing labor pain. 43 of these patients had their deliveries through the vaginal route. The remainder of the patients had cesarean sections because of fetal distress, scar tenderness, and the patient's wish during 1st stage of labor. Results: The VBAC success rate in this study was 71.67%. Among the 43 patients, the highest number of patients, 51.2%, came from the age range of 28-37 years, followed by 21 patients (48.8%), who were in the age category of 18-27 years. The majority of the patients (24, 55.82%) were in their second pregnancy, with 10 (23.25%) in their third pregnancy and 9 (20.93%) in their more than third pregnancy. Among the 43 patients, 42 (97.7%) had a previous caesarean section, while the remaining 1 patient (2.3%) had two previous caesarean sections. Most patients (58.14%) were admitted to the hospital between 35 and 38 weeks of pregnancy. Among the participants, 97.7% had normal placenta size, 88.4% had average bleeding, 79.1% had clear liquor and 97.7% had no scar rapture. The study shows an extremely low level of complication in VBAC. Conclusion: This study identified that, the success rate of vaginal birth after one caesarean section is very high. An evidence-based systematic review suggested that planned VBAC is a safe and appropriate mode of delivery for the majority of pregnant women with a single previous lower-segment caesarean delivery.

Premature rupture of membranes (PROM), also known as "pre-labour rupture of membranes," occurs when the gestational membranes burst after 37 weeks but before labor really starts. This study showed that PLR could be a new inflammatory marker for diagnosing preterm PROM. The study place was the Department of Obstetrics and Gynaecology, Sir Salimullah Medical College (SSMC) & Mitford Hospital (MH), Dhaka, Bangladesh, from May 2019 to October 2019. It was a case-control study. All mothers were selected by purposive sampling who were PPROM as cases. Age-matched non-PPROM pregnant women at term were also enrolled as control. Afterward, they were scrutinized according to eligibility criteria, and 200 mothers were enrolled. Among them, 100 were cases, and the other 100 were in control. A pre-tested, observation-based, peer-reviewed data collection sheet was prepared before the study. Data regarding clinical, biochemical, and surgical profiles were recorded. Data were compiled, edited, and analyzed. The P-value was determined by the chi-square test (categorical variables) and the student’s t-test (continuous variables). The p-value was significant at <0.05. The mean age of 100 patients from the case was 24.39±2.81 (age range: 18-36) years, and that of the control, like 100 normal pregnant women, was 24.31±2.34 (age range: 19-35). (P=0.49). The mean parity of case and control were 2.1±0.9 (range: 0- 5) and 1.98±0.2 (range: 0-3). The mean gravida of case and control were (3.1±1.2 vs. 3.4±1.4).The platelet count was found significantly higher in PROM or cases (241.6±58.7 vs 201.7±65.91000/mm3, p <0.001). PLR was higher (125.8±67.1 vs 105.2±48.6) in cases (P<0.001). So, there is a good opportunity to utilize PLR as an inflammatory marker to predict preterm PROM. PLR is used in many acute or chronic inflammatory conditions. Its use to predict preterm PROM is a new concept. For that reason, this study is rational and time demanding.

Introduction: Pre-eclampsia is a complex disorder characterized by hypertension and proteinuria after 20 weeks of gestation, posing risks to maternal and fetal health. It is linked to adverse outcomes worldwide, with varying incidence rates across regions. Risk factors include history, maternal age, and socioeconomics. The pathophysiology involves issues with spiral artery adaptation. The study aimed to analyze the associations between serum CRP concentration, maternal hypertension, and fetal outcomes in pregnant women. Methods: This cross- sectional analytical study was conducted at the Department of Obstetrics and Gynecology at the Institute of Child and Mother Health (ICMH), Matuail, Dhaka. It took place from January to December 2018. The study population comprised 120 pregnant women within the gestational age of 28-40 weeks. The women were categorized into three groups: Group A (control) consisted of normotensive pregnant women, Group B included pregnant women with mild pre-eclampsia, and Group C comprised pregnant women with severe pre-eclampsia. Ethical guidelines were followed, including IRB approval and participant consent. Data were analyzed using SPSS software, version, 22.0. Chi-Square, t-test, and ANOVA test were performed to determine associations among the study variables of the groups, where p<0.05 considered as the level of significance. Results: The study enrolled 120 participants divided into Groups A, B, and C. The majority fell within the 18-25 age range. The mean ages were 24.23±4.52 (Group A), 24.73±4.01 (Group B), and 24.26±3.07 (Group C). BMI was significantly higher in Groups A and B compared to Group C (p < 0.05). Gestational age was lower in mild and severe preeclampsia compared to normal pregnancies (p < 0.05). Cesarean section delivery was significantly more frequent in preeclamptic mothers (p < 0.001). CRP levels varied, with means of 3.07 (Group A), 9.67 (Group B), and 13.15 (Group C), showing significant differences (p < 0.05). Fetal birth weight was lowest in Group C (2.61) and highest in Group A (2.95). Severe preeclampsia patients had elevated CRP levels, with 93.3% exhibiting this trend (p < 0.05). Adverse neonatal outcomes were more common in preeclampsia cases, including prematurity, LBW, and neonatal complications (p < 0.05). Increased CRP levels were associated with low birth weight (p < 0.001) and lower APGAR scores (p < 0.01). Conclusion: Pre- eclampsia shows raised serum CRP levels, particularly pronounced in severe cases, with about 83% of patients affected. This heightened CRP connects to adverse fetal outcomes.

Introduction: Preeclampsia is an advanced objection characterized by the new start of hypertension and proteinuria or the new start of hypertension and important end-organ dysfunction with or without proteinuria in the last half of the prenatal period or post-delivery. Long-term, patients with preeclampsia are at enhanced risk for developing cardiovascular and renal disease. The aim of the study was to evaluate the maternal and perinatal outcomes in women suffering from preeclampsia. Methods: A case-control study was carried out in the Department of Obstetrics and Gynecology, Sir Salimullah Medical College Mitford Hospital, Dhaka from July 2020 to June 2021. A total number of one hundred twelve pregnant women (N=112), were enrolled in the study and fifty-six (n=56) were included as preeclampsia (Cases) and another fifty-six (n=56) were enrolled as normotensives (Controls). Data were collected using the predesigned semi-structured questionnaire. Verbal consent was taken before recruiting the study population. Completed data forms were reviewed, edited, and processed for computer data entry. The data analysis was performed using Statistical Package for the Social Sciences (SPSS) Version 25.0. Result: Respondents' mean age was 27.35 ± 4.85 (case) & 26.46 ± 4.86(control) years. Maximum study subjects had only primary education. The majority of the respondents were homemakers in all groups. Respondents' mean gestational age was 36.28 ± 2.12 (case) & 36.57 ± 1.82 (control) weeks respectively and was significant in both case and control groups (p=.001). There was no statistical difference according to gravida found between the cases and controls. Based on maternal outcomes, delivery by cesarean section was greater in cases than in controls (p<0.001), &eclampsia (p<0.001) and PPH (p=0.002) were significantly lower in controls than cases. Based on the neonatal outcome, birth weight was significantly lower in cases than in controls (p=0.020), and stillbirth was significantly lower in controls than cases (p=0.042). Conclusion: Preeclampsia may be linked to complications with the placenta initially in the pregnancy. A very little amount of maternal complications and fetal complications rose in this current analysis and the result of the findings was satisfactory.

Background: Prostaglandins have a central role in the cervical ripening and parturition, and have been widely used for induction of labor (IOL). This study aimed to compare the effectiveness and safety of Dinoprostone vaginal tape (Propess) over Dinoprostone vaginal tablets (Prostin) for IOL and find which has better outcome to be applied in clinical practice. Participants and Methods: A retrospective cohort study was conducted via reviewing of medical records of multipara women admitted to King Fahad Medical City, Riyadh between January-2021 and December-2022 for IOL by Propess or Prostin. Results: A total of 87 multipara women were included in the study; 39 (44.8%) were treated by Propess and 48 (55.2%) were treated by Prostin for IOL. Full dilatation of the cervix after induction of labour was reported among majority of women (94.2%): being 92.1% among women treated with Propess and 95.8% among those treated with Prostin, however, this difference was not statistically significant, p>0.05. Regarding mode of delivery, normal spontaneous vaginal delivery was reported among 84.9% of women; 86.8% among women treated with Propess and 83.3% among those treated with Prostin while emergency cesarean section delivery was reported among 10.5% of women; 7.9% among women treated with Propess and 12.5% among those treated with Prostin. However, these differences were not statistically significant, p>0.05. Conclusion: The success rate of IOL among multipara women was high; however, no difference was reported between Propess and Prostin as regards the effectiveness (maximum cervical dilatation) and safety (rate of emergency cesarean section).

Background: Preventing cervical cancer hinges on accurately detecting and treating high-grade cervical intraepithelial neoplasia (CIN2+) in individuals referred due to abnormal cervical cytology. While colposcopy has been a cornerstone in this process, concerns have arisen regarding its accuracy in CIN detection and differentiation. This study aims to assess the role of colposcopy in diagnosing and distinguishing various grades of CIN in clinically suspected patients. Methods: A descriptive cross-sectional study was conducted in the Department of Obstetrics & Gynaecology at Rajshahi Medical College Hospital, Rajshahi, over 12 months from February 2019 to February 2020. The study involved 110 women aged 20-70 years who presented with clinical symptoms indicative of precancerous cervical lesions. Initial evaluations included visual inspection with 5% acetic acid (VIA) and Reid colposcopy. Biopsy samples were collected from the identified lesions using the colposcope, and these samples underwent histopathological examination. The study compared the diagnostic accuracy of colposcopy, including sensitivity, specificity, positive predictive value, and negative predictive value. Results: Colposcopic evaluations revealed that 80% of the participants exhibited positive lesions (CIN), while 20% displayed negative lesions (normal cervix or cervicitis). Among the colposcopically positive lesions, 50% were graded as CIN-1, 29.5% as CIN-2, and 20.5% as CIN-3. Subsequent histopathological examination of the colposcopy-directed biopsies confirmed CIN or dysplasia in 44.5% of cases. Within this group, 36.7% had CIN-1, 34.7% had CIN-2, 12.2% had CIN-3, 10.2% had invasive squamous cell carcinoma, and 6.2% had carcinoma in situ. Colposcopy demonstrated a sensitivity of 83.7% in diagnosing CIN, with a specificity of 23%, resulting in an overall diagnostic accuracy of 55%. However, when differentiating high-grade CIN from low-grade lesions, colposcopy exhibited a high sensitivity of 92.3% and moderate specificity of 67.7%, with an overall diagnostic accuracy of 75%. Conclusion: This study concludes that colposcopy is highly sensitive in diagnosing CIN but has limited specificity in excluding patients with normal cervix or cervicitis. Nevertheless, it exhibits optimal sensitivity in differentiating CIN2+ and carcinoma in situ from low-grade lesions and maintains moderate specificity in excluding low-grade CIN. Colposcopy remains a valuable tool in preventing and managing cervical cancer, particularly in identifying high-risk lesions.

Background: Although the aetiology of preterm deliveries is largely unknown, it is said to be multifactorial and cervical insufficiency has been implicated. Hence, cervical cerclage is a necessary and common prophylactic obstetric procedure for preventing prematurity and associated recurrent second trimester miscarriages. Objectives: To evaluate the pattern, indications, and fetal outcome of cervical cerclage. Methodology: This was a retrospective study of 50 women who had cervical cerclage insertion at the University of Port Harcourt Teaching Hospital between January 1, 2021, and December 31, 2022. Data was obtained from the ward registers, theatre records, and case notes of the women, and entered into a structured proforma. Data analysis was done with SPSS version 25, and results are presented as frequency tables and charts. Results: The mean age of the patients was 35 ± 2.07 years. The mean of number of previous miscarriages was 2.46 ± 2.07, 56.8% were multiparous and 50% had a previous manual vacuum aspiration. Majority 35 (70%) of the women had prophylactic cerclage, 10 (20%) had cerclage following in-vitro fertilization and embryo transfer pregnancy, while 5(10%) had rescue cerclage. Most 29 (58%) of the prophylactic cervical cerclage insertion were done between 11-15 weeks, with MacDonald technique being the most common technique practiced. Of these, only 18 (36%) carried the pregnancy up to 36 weeks of gestation. Conclusion: Many of cervical cerclage procedures were performed for prophylaxis and resulted in improved fetal outcomes in women who had previously experienced mid-trimester losses or preterm delivery.