Introduction: Eclampsia is a very serious and relatively frequent complication of pregnancy which is considered as ‘obstetrical tragedy’ to the unborn fetus the mother and to the obstetricians. Early diagnosis and proper treatment can reduce the maternal mortality due to eclampsia. Aim of the study: The aim of this study was to assess the maternal outcome of intensive care management for the critically ill eclamptic patients admitted in Dhaka medical college Hospital. Methods: This longitudinal prospective study was conducted in Eclampsia ward and ICU Ward of Dhaka medical college Hospital from January to December of 2004. Sixty Seven very critically ill eclampsia patients were included in this study. Relevant information regarding demographic, during pregnancy, complications, past history of eclampsia, history of antenatal check-up, including drug history were collected. Result: In this study among the 757 eclampsia patient, 67 (8.85%) were critically ill. Maternal mortality was 43.11% due to eclampsia. 70% patients had very high diastolic blood pressure, 44.77% patients have severe oliguria, and 61.69% patients had severe degree of proteinuria. 26.86% of patient’s level of consciousness was less than 5. Unavailability of bed is the prime (75%) cause of delay in shifting patient to ICU ward. Those treated by peritoneal dialysis recovered completely (100%). 25.37% patients had HELLP syndrome and 20.89% had CVA. The most common cause of maternal death in eclampsia ward was cerebrovascular accident 31.42% and in ICU multiorgan failure (33.33%). Mortality was very high among the patients who were with no ante-natal check-up (82.23%). Twenty patients received ICU support and mortality is 12 (60%), but among those 47 patients not received support mortality is 35 (75%). Conclusion: Many patients come to the Hospital at the terminal stages, not only with primary complications but also with many secondary complications. Therefore, a last minute best management effort should be given to everyone by when the complications are diagnosed, a teamwork approaches by multidisciplinary health care.

Background: Cervical cancer is a preventable disease unlike other cancers. HPV infections have a long incubation period to cause cervical cancer. Other risk factors like early age of conception, illiteracy, low socioeconomic status, use of OCPs for a long period of time, low folate level, high parity and smoking predisposes to cervical cancer. Materials and Method: Present study aimed to identify the risk factors responsible for HPV infections and its association with development of cervical carcinoma in women of age group 20 to 65 years with history of white discharge, blood-stained discharge; heavy menstrual flow, intermenstrual spotting, and postcoital bleeding attending Gynaecology OPD samples of cervical scrapping, Pap smear, Visual Inspection with Acetic Acid (VIA) and Visual Inspection with Lugols Iodine (VILI) was taken for detection for high-risk groups for cervical cancer and its association with different risk factors. Results: HPV infection prevalence in our study was 20% among total of 100 patients. PCR positivity was highest among the age group 30-39 years. HPV infection was highest among the age group 19-20 years. Multiparous women having 3 or more children had shown high positivity for HPV- DNA. Illiterate women and women with only up to primary education had shown the highest HPV infection and it was 18 %. Nonvegetarian women had highest HPV infection. Major symptom of the PCR positive cases was white discharge. PCR for HPV-DNA was 100% positive in women who had cervical growth. Conclusion: Our study shows the importance of Pap smear and HPV-DNA testing of women in our country where prevalence and risk factors are extremely high. It can identify and help in preventing or treating the condition at exceedingly early stage.

The process itself of staging of the disease during pregnancy and the treatment should comply with current standards, to the extent possible. Surgery and/or chemotherapy are considered to be fundamental methods of treatment for invasive cervical cancer during pregnancy. Tactics in the treatment of such patients is determined by a range of factors and depends on gestational age at the time of diagnosis, the stage of the disease, tumor size, as well as on the involvement of regional lymph nodes and the woman’s desire to continue pregnancy. Case Description: A 32 year-old patient, grand multipara, admitted for spontaneous metrorrhagia of low abundance during a 7 month pregnancy (date of last menstrual period is inaccurate) for which she consulted in the private sector where she underwent a gynecological examination that showed a tumoral process of the cervix, and then a biopsy that revealed a cervical squamous cell carcinoma. The patient was then referred to our departement for further care; we decided to perform a C-section at 34 weeks of ammenorrhea, giving birth to a male infant with a birth weight of 2300g, and then a CRC. Conclusion: The incidence of cervical cancer in pregnancy is itself not very high, and the symptoms are easily confused with other diseases in pregnancy. During pregnancy, gynecological examination is limited, and therefore, the rate of misdiagnosis is higher. The treatment of cervical cancer during pregnancy is related to many factors, such as tumor size, pathological type, period of gestation, lymph node involvement, and patients' willingness to maintain pregnancy.

Primary neuroendocrine carcinomas of the breast (NEBC) represent a rare subtype of breast cancer, accounting for 2-5%. They generally present a more aggressive clinical form with a strong tendency to local and distant recurrence compared to other types of invasive breast carcinoma and they do not present specific clinical or radiological characteristics. We report the case study of a 58 years old female patient with primary neuroendocrine carcinoma of the breast.

Acalvaria Is a rare congenital disease considered as a post-neurulation defect: It consists of the absence of Calvary bones, dura mater and associated muscles in the presence of a normal skull base and facial bones normal. Currently, there is no identified cause of Acalvaria. The main putative pathogenesis is the problematic migration of the membranous neurocranium from the normal positioning of the immature ectoderm. Although the malformation has been fatal to date with only a few survivors, the prenatal diagnosis of Acalvaria is of rather remarkable importance as it allows clinicians to plan appropriate and timely management. So that this fetus can benefit from surgical advances.

Renal agenesis is the absence of any trace of kidney, ureter, and therefore the absence of fetal renal function. It constitutes a major field of antenatal screening which presents until now certain limits during ultrasound diagnosis which remains the only accessible, inexpensive and reproducible means of exploration for making the diagnosis with a sensitivity of 85%. The neonatal prognosis is considered better in the unilateral Renal agenesis with functional contralateral kidney, but is always fatal in its bilateral form. The objective of our study is to clarify the ultrasound strategy that must be adopted in antenatal to make the diagnosis while highlighting the technical difficulties that can misdiagnose. An update on the epidemiological and etiopathogenetic nature of the anomaly will also be discussed.

Common fetal urinary tract abnormalities encompass a complex spectrum of abnormalities grouped under the name CAKUT, which can be detected antenatal by ultrasound with an incidence of 1 to 4 in 1,000 pregnancies. As such, they represent 15 to 20% of all birth defects. They remain responsible for 30 to 50% of cases of end-stage renal failure, so it is crucial to have an early diagnosis and medical or surgical management in order to minimize renal damage and to avoid or delay a possible renal failure. Through a study carried out within our structure comprising 36 cases, we will recall the most frequent fetal anomalies of the kidneys and urinary tract by specifying the ultrasound modalities and the prognosis of these various malformations as well as the recommendations for pre and postnatal management.

The objective of this work is to clarify by a retrospective study the prognostic parameters of breast cancer in young Moroccan women and to clarify the epidemiological histological and prognostic characteristics in a subgroup that have a metastatic relapse in order to determine the impact of the diferent prognostic factor on overall survival. During a period of 5 years, from January 2010 to December 2015, 325 women suffering from breast cancer were counted at the Radiotherapy Department of the Mohammed V Military Hospital of Instruction. Among them, 60 were aged 40 years and under. In our series, patients were followed up until April 2018, 13 cases of metastatic relapses were recorded, i.e. 21.7% of cases. In a single-factor study, the prognostic parameters were mean consultation time, age, family history of breast cancer, tumor size, histological type, number of lymph nodes invaded, lymphatic embolism, SBR grade, hormone receptor, and herecept-test status. The overall survival rate of all patients was 92,1% at 3 years and 88,9% at 5 years. Multifactorial analysis isolated 3 prognostic parameters: initial tumor size, the number of lymphaitic gonglion invaded and the molecular type.

Background: Miscarriage is the most common negative outcome in pregnancy worldwide. Its identification of modifiable risk factors is playing an important role in public health. Low vitamin D concentrations in pregnancy are widespread worldwide and the effects of vitamin D deficiency in pregnancy have been associated with some adverse pregnancy outcomes. We have very limited research-oriented information regarding the correlation between serum vitamin D deficiency and early spontaneous pregnancy loss. Aim of the study: The aim of this study was to evaluate the association of maternal serum vitamin D deficiency with early spontaneous pregnancy loss. Methods & Materials: This case-control study was carried out in the Department of Obstetrics and Gynaecology, Sir Salimullah Medical College and Mitford Hospital, Dhaka, Bangladesh during the period from September 2018 to August 2019. A total of 100 patients, 50 pregnant women having early spontaneous pregnancy loss (documented by ultrasonography as missed or incomplete abortion) was considered as the case (Group I). Age, gestational age and BMI matched another 50 women in their early live pregnancy (documented by ultrasonography) was served as control (Group II) in this study. The biochemical parameter measured in this study included fasting serum 25-hydroxy vitamin D level. Serum 25(OH)D level<20 ng/ml was classified as vitamin D deficiency and <10 ng/ml was classified as vitamin D severe deficiency. Statistical analyses of the results were obtained by using window-based computer software devised with SPSS version 22.0. Results: In analyzing vitamin D level (ng/ml) of the participants of this study it was found that more than half (52.0%) patients had severe deficiency (<10 ng/ml) in group I and 14(28.0%) patients in group II. 24(48.0%) patients had deficiency (10-20 ng/ml) in group I and 35(70.0%) in group II. Only 1(2.0%) patient had insufficiency (21-29 ng/ml) in group II. None of the patients had sufficient serum vitamin D levels. In comparing the serum vitamin D level (ng/ml) between group I and group II it was observed that the mean vitamin D level was 9.98±2.56 ng/ml in group I and 11.51±2.96 ng/ml in group II. The difference was statistically significant (p<0.05) between the two groups. Conclusion: Serum Vitamin D was significantly low in women with early spontaneous pregnancy loss as compared to pregnant women with early live pregnancy. Serum Vitamin D was deficient predominantly in both cases and control. Maternal serum vitamin D deficiency was significantly associated with early spontaneous pregnancy loss.

Background: The micronutrient folate and zinc has been associated with semen quality. Nutritional supplement with zinc and folate can help reverse some of the oxidative damage from environmental toxin and natural aging on spermatogenesis and sperm maturation. Till now there has been variable results in the research done on semen quality after folic acid and zinc sulfate supplementation. The objective of this study is to determine whether supplementation of folic acid and zinc sulfate has any beneficial effect on semen quality. Methods: This was a prospective, observational study carried out in the Department of Reproductive Endocrinology and Infertility, Bangabandhu Sheikh Mujib Medical University. Study participants are male partners of infertile couples, 70 in number, who attended the outpatient department and had abnormal semen parameters. Supplementation of folic acid and zinc sulfate was given to all male partners at a dose of 5mg tablet twice daily and 10mg tablet twice daily respectively for twelve weeks. Semen analysis was repeated after the period of three months supplementation of folic acid and zinc sulfate. Paired students t tests were performed for test of significance. Results: Oligoasthenoteratozoospermia is most common (40%) form of abnormality in semen parameter before supplementation. After supplementation 40% of report shows normozoospermia. Following supplementation of folic acid and zinc sulfate there was significant changes in sperm count (P<0.05), morphology (P<0.002), total motility (P<0.001). Regarding motility, all types of motility improved after supplementation including rapid-linear (P<0.001), slow linear (P<0.001), non-progressive (P<0.047). Number of immotile cell was reduced (P<0.001) after supplementation. Conclusion: An improvement in nutrition or supplementation with zinc and folate can have noticeable effects on semen quality and these may improve natural fertility and success rates with fertility treatment.

Background: Aged women who have infrequent menstruation and raised FSH are likely to have diminished ovarian reserve. Serum AMH is a novel marker of ovarian reserve but the test is expensive. The objective of this study is to determine serum AMH level in women who have high FSH and see how AMH and FSH correlate in this group of women. Methods: We did an observational cross sectional study of 87 infertile women, age 30-39 years, with oligomenorrhoea and high FSH (>10IU/L). Serum FSH was measured on day 2-4 and AMH was measured on any day of menstrual cycle. The women were divided into three groups based on FSH: 10-20 mIU/mL, 21-40 mIU/mL and >40 mIU/mL. Correlation of AMH with FSH was analyzed in all participants as well as within different groups. Results: The mean serum FSH D(2-4) was found 38.8±22.4 mIU/ml, range (min-max) (10.2-93.5) mIU/mL. Not all but 85.1% women had low (≤1.0 ng/ml) serum AMH level. Mean serum AMH was 0.74±0.59 ng/mL, range (min-max) (0.90-2.9 ng/ml). The serum AMH decreased in groups with higher FSH. The one way ANOVA shows that there is significant difference in AMH values between the groups. There is moderate (r = -- 0.537) negative correlation of AMH with FSH. The negative correlation of AMH with FSH is strongest (r = - 0.735) in the group having FSH in the range 10-20mIU/mL. The correlation is comparatively less (r = - 0.519, r = - 0.616) in groups with higher FSH. Conclusion: Not all the sub-fertile women with infrequent menstruation and FSH>10 mIU/mL have lower AMH (<1 mg/ml). A significant negative moderate correlation exist between AMH and FSH. The correlation is relatively stronger in the FSH range 10-20 mIU/mL.

To evaluate the efficacy of uterine artery embolization (UAE) for the treatment of symptomatic uterine fibroids in patients treated at Al Ain Hospital, United Arab Emirates. Medical records and radiological images of all patients undergoing UAE in Al-Ain Hospital between 1 January 2012 and 31 December 2017 were retrospectively analysed. 141 patients aged 23-50 years were included in the study. Single femoral access technique was used in all patients. Clinical improvement was assessed by questioning patients regarding symptomatic improvement and follow up MRI to see the reduction in size of the dominant leiomyoma. Data was analyzed using SPSS 22. All 141 patients underwent technically successful UAE. 55 were lost follow up and were not included into the final analysis. Out of the remaining 85 patients, 55.3% were nulliparous and 44.7% were multiparous. A significant number of females that is 70.5% had multiple uterine fibroids compared to 30% who had only single uterine fibroid. 71.7% patients had menorrhagia pre-operatively, 98.4% had complete resolution at 6 months. As per the size reduction, paired t-Test showed statistically significant reduction in the mean leiomyoma size from 8 cm to 6cm and then further to 5 cm at 6 months and 1 year respectively. Almost 91.8% of the patients who underwent UAE were satisfied with the improvement in their symptoms as an outcome compared to 8.2% who were unsatisfied. Uterine fibroid embolization represents a promising method of treating fibroid-related menorrhagia and pelvic pain. Further studies with larger number of patients and long-term follow-up are needed.

Background: GDM is a high risk factor in pregnancy & is associated with an increased risk of complications for both mother & baby during pregnancy as well as in postpartum periods. Screening & identifying these high risk women is important to improve short & long term maternal & fetal outcomes. Objective: To determine the fetal & maternal outcome and complications in pt presenting with GDM. Materials and Methods: The present cross-sectional observational study was performed at the Department of Obstetrics and Gynecology of the Jalalabad Ragib Rabeya Medical College Hospital, from June, 2018 to November, 2019. One hundren women who are diagnosed to have GDM were included in this study. Results: Complication of the maternal outcome during antenatal periods that 32(32.0%) patients had H/O GDM, 19(19.0%) had preterm delivery, 19(19.0%) had postpartum UTI, 18(18.0%) had pre-celapmsia, 16(16.0%) had UTI, 14(14.0%) had vulvovaginitis, 13(13.0%) had cervical tear, 12(12.0%) had polyhydramnios, 11(11.0%) had PROM and 11(11.0%) had postpartum hemorrhage. Complication of the fetus outcome during antenatal period showed that 19(19.0%) babies were NICU admission followed by 12(12.0%) had hyperbilirubinemia, 8(8.0%) had neonatal hypoglycaemia, 6(6.0%) had respiratory distress infection, 6(6.0%) had congenital anomalies, 5(5.0%) had prematurity, 5(5.0%) had polycythemia and 4(4.0%) had birth asphyxia. Conclusion: Maternal and perinatal morbidity and mortality is increased in women with GDM. Infections, preterm delivery, postpartum UTI, pre-celapmsia, UTI, vulvovaginitis, cervical tear, polyhydramnios, PROM and postpartum hemorrhage were the common maternal complications. Fetal complications include NICU admission, hyperbilirubinemia, neonatal hypoglycaemia, respiratory distress infection, congenital anomalies, prematurity, polycythemia and birth asphyxia most common cause.

Introduction: Female stress urinary incontinence is a common affection that affects women in the general population. It can be improved by non-invasive medical techniques. Aims: To determine the value of perineal rehabilitation in the treatment of female stress urinary incontinence through the experience of the Department of Physical Medicine and Rehabilitation CHU Med VI of Marrakech. Patients and methods: This is a prospective, monocentric study that included 10 patients with stress urinary incontinence. They benefited from a multimodal rehabilitation protocol carried out in a minimum of 10 sessions. Results: The muscle tone of the pubococcygeal bundles of the elevator muscles of the anus was significantly improved after rehabilitation. The improvement in tone was correlated with the reduction in the frequency of leaks. The subjective satisfaction rate reached 80%. Conclusion: Perineal rehabilitation appears from the experience of our department to be effective for the treatment of stress urinary incontinence. It should be offered as a first-line option.

Background: Birth weight is an indicator of the health status of a country. LBW remains a leading public health problem especially in developing country causes of childhood morbidity and mortality. Objectives: The objective of this study was to determine the relationship of nutritional status of mother influence neonatal outcome and the pregnant population admitted in labour ward of a tertiary level of public Hospital. Methods & Materials: It was a randomized cross-sectional study, conducted in Dhaka Medical College and Hospital of the Department of Obstetrics & Gynaecology over a period of six months from January 2010 to June 2010. All women who were admitted to labour room with term pregnant (>37 wks), which was confirmed by early USG or LMP. The indicator low birth weight <2.5 kg of the infant was examined as an outcome variable in association with different socio-economic status, educational qualifications and occupation of mother and health-related other variables. Results: More than 53% of LBW neonates were born to mothers who were illiterate, whereas 18.5% of LBW neonates were born to mothers who were educated up to the primary level. Maternal education, as well as higher socio-economic condition, reduces the incidences of LBW which was statistically significant. Poor ANC was associated with LBW babies after adjusting for maternal age and parity. Most of the multi gravid women present with moderate anaemia and greater than 60% of anaemic patients were not regular ANC and a total of 23% no ANC at all. The adverse fetal outcomes in this study were 44.2%. Low birth weight 28.3% and NICU admission 5.8% were the most common adverse birth outcome overall study period. Conclusion & Recommendation: Every mother with poor nutritional status should be screened during the antenatal check-up and should be considered a high-risk pregnancy. For these mother’s special emphasis should be given to provide health and nutrition education.

Background: The incidence of caesarean section varies from hospital to hospital and from community to community and it is much more in tertiary care hospital because of referral from other centres. Objective: The objective of this study was to investigate the caesarean section rates by evaluating the indications as per modified Robsons criteria and to determine the area of concern that requires maximum focus to decrease the overall caesarean section rate. Methodology: This cross-sectional retrospective study was conducted over a period of one year from January 2019 to December 2019 in the department of Obstetrics and Gynecology at Holy Family Red Crescent Medical College Hospital, Dhaka, Bangladesh. Result: Total number of deliveries for one year was 891. Out of them 162 were normal vaginal delivery and 729 were by caesarean section. Overall maximum caesarean section was contributed by group five Robsons criteria. Conclusion: Robsons ten group classification provides an easy way in collecting information about the indication of C/S and there by caesarean section rate. It is important that efforts to reduce the overall caesarean section rate should focus on reducing the primary caesarean section and increasing vaginal birth after the caesarean section.