Primary umbilical endometriosis is very rare.Painful umbilical nodule in a sub fertile woman can clinically be diagnosed as umbilical endometriosis. The treatment is surgical excision of umbilicus but subfertility is difficult to manage.

Objective: To evaluate ovarian cysts detected in patients who had undergone previous hysterectomy and to study the clinical, pathological and surgical characteristics in these patients. Material and Methods: An observational study was conducted in the department of Obstetrics and Gynaecology, Mamata Medical College, Khammam over a period of 3 years on patients who had undergone previous hysterectomy. A detailed history, clinical presentation was taken from patients who had ovarian cysts was included in the study. The previous records, characteristics of ovarian cysts and management were evaluated in these patients. Results: A total of 700 post hysterectomy patients presented to OPD of them 66 patients identified with ovarian cysts were included in the study. Most of them (68%) underwent hysterectomy at the age of 40-50 years; abdominal hysterectomy was common mode of surgery (82%). AUB–L was the major indication for hysterectomy (44%), in 65% cases both the ovaries were preserved, pain abdomen was the commonest symptom patient had presented with (47%). The cysts were analysed with ultrasound and CA-125 levels and managed surgically in 44%, followed in 47% and 9% of them were referred to oncology. Histopathologically epithelial tumors were most common. Conclusion: All the post hysterectomy ovarian cysts should be managed individually based on symptoms, signs and size. Clinical evaluation and necessary investigations are to be done for better management either follow up or surgery. Not all post hysterectomy ovarian cysts need surgery.

Leiomyoma is the most common benign tumor of uterus but rarely it may be seen in round ligament, uterosacral ligament, inguinal canal and vagina. Vaginal fibroid more commonly arises from anterior vaginal wall and present with varied clinical features. Here we report a case of primary subfertility with vaginal leiomyoma, arising from anterior wall of vagina. Case Description: A 31-year-old nulliparous lady attended the Reproductive Endocrinology and Infertility Clinic with the complaints of infertility and something coming down per vagina for 6 years. Vaginal examination revealed a mass originating from anterior and lateral vaginal wall, pulling the cervix up. On bimanual examination, a 3x3 cm mass is felt through the anterior and lateral vaginal wall but upper limit could not be delineated. Transvaginal sonography showed a mixed echogenic, predominantly hypoechoeic mass in lower part of cervix and anterior vaginal wall. Myomectomy was done through vaginal route along with laparoscopy with chromopertubation test and hysteroscopy. Histopathology report revealed leiomyoma. She was counseled for IVF due to bilateral tubal block on dye test.

Introduction: Amniotic fluid is necessary for normal musculoskeletal development, gastrointestinal tract and lung development. It protects the fetus from trauma against umbilical cord and infections by bacteriostatic property. Oligohydramnios, a deficiency in the amount of amniotic fluid, occurs in 3.9-5.5% of all pregnancies. Most common cause of oligohydramnios is idiopathic (52%). Second commonest cause is PIH (25%). Oligohydramnios may influence maternal, perinatal outcomes. The Amniotic Fluid Index (AFI) is the more commonly employed technique for assessing adequacy of amniotic fluid volume. The sonographic diagnosis of oligohydramnios is usually based on an AFI ≤ 5 cm or on a single deepest pocket of amniotic fluid ≤ 2 cm. Aim: 1) To study the maternal and perinatal outcome in pregnancies with gestational age 34 weeks and above with AFI less than or equal to 5. 2) To compare the maternal and perinatal outcomes of such pregnancies with pregnancies where AFI is 8 to 24. Materials and Methods: The present study was Prospective Analytical hospital-based study conducted at Nazareth Hospital for one-year i.e. (8th September 2017 to 7th September 2018) in the department of Obstetrics & Gynaecology. Patients with AFI less than and equal to 5 was taken as study group (Group I) and AFI 8-24 was taken as comparator group (Group II). This study included 50 number of cases and 100 number of control to compensate for 10% dropouts. Results: Among those women diagnosed with oligohydramnios (</=5) , 44% of patients belonged to primi gravida, most common antepartum complications associated was found to be hypertensive disorder (28%), There was more incidence of induction of labour (65.7%), (64%) underwent caesarean section, fetal distress ( 65.6%) was most common indication, 8% of patients had babies where APGAR score was below 7, 20% of patient had low birth weight babies, 20% babies was admitted in NICU. Conclusion: 1) Amniotic fluid index measurement can be used as a useful adjunct to other fetal surveillance methods, to identify those infants at risk of poor perinatal outcome. 2) AFI </= 5cm is associated with high incidence of thick meconium stained liquor, fetal distress, operative delivery and caesarean section for fetal distress, poor APGAR score, low birth weight, meconium aspiration and perinatal morbidity. 3) As a result, amniotic fluid assessment as an antepartum mode of fetal monitoring, helps an obstetrician better anticipate likely associated problems and plan a timely and appropriate mode of management.

Cervical ectopic pregnancy is a rare form of ectopic pregnancy with implantation of fertilized ovum in the cervical canal below the internal os. Incidence of cervical pregnancy varies 1:1000-95000 and associated with high maternal morbidity and mortality due to high chances of pregnancy being misdiagnosed. To reduce maternal mortality, it is indeed necessary to understand the importance of correct diagnosis by clinical or radiological or biochemical methods available. Here we present a case of a 36-year-old female reported to us in Noble hospital as a misdiagnosed case of cervical ectopic pregnancy with catastrophic bleeding. Management of the cervical ectopic pregnancy is dependent on several factors such as the patient's gestational age, fetal cardiac activity, stability of the patient, patient's interest in retaining future fertility, and the availability of resources and expertise of the practicing gynaecologist. The cervical ectopic pregnancies though rare, do occur, and their incidence is increasing. A high index of suspicion, clinical and radiological correlation, especially in cases with previous uterine scars can pick up this rare entity preoperatively. If diagnosed early conservative management can be offered. However, missed diagnosis can lead to high morbidity and mortality.

Introduction: Abnormal uterine bleeding (AUB) is the most common reason for gynecological visits for perimenopausal bleeding and may account for more than 25% of all hysterectomies. The perimenopause is often characterized by irregularities in the menstrual cycle in volume and frequency. This is due to fluctuating estrogen levels. These changes are unique for each woman and are unpredictable. Although irregular bleeding patterns are normal and expected to be part of perimenopause, the incidence of uterine pathology and associated medical complications increase in this age group [3]. The more accurate diagnosis of endometrial pathology better the chances for alternative treatment and hysterectomies could be avoided. The accuracy or the superiority of the relatively non-invasive methods like TVS, Hysteroscopy, and SIS over histopathology have not been clearly established. Thus this study was undertaken to compare the diagnostic efficiency of TVS over the histopathology study of the endometrium and to test their agreement. Materials & Methods: 48 cases of perimenopausal women above 40 yrs. age not yet attained menopause. Patient with AUB in any other age group, any vaginal or cervical cause of bleeding, Patient with blood dyscrasias, Pregnancy related causes of bleeding, Patient with h/o of drug intake (Anticoagulant & hormone replacement therapy) has been excluded. The cases were studied for a period of 11 months in Noble hospital & research Centre. Detailed history & clinical examination including per vaginal and per speculum examination carried out. All the patient then subjected to transvaginal ultrasound & endometrial sampling. Results were correlated between transvaginal ultrasound & histopathology in these patients. Results: In this study, 72.4% of women with normal endometrium had an endometrial thickness of less than 12mm below which there was no endometrial pathology. Above this cut off level of 12mm, 88.6 % were found to be associated with endometrial pathology. The sensitivity and specificity were found to be 61.9% and 77.8%. Distribution of histopathology findings differ significantly between groups of cases with less than 12mm and more than 12 mm endometrial thickness (P-value < 0.048). Conclusion: Transvaginal sonogram is a simple, non-invasive convenient way to indirectly visualize the endometrium & endometrial cavity. The vaginal probe examination if incorporated into the gynecologist office setting and when combined with bimanual pelvic examination can enhance our anatomic diagnosis. Transvaginal sonography is useful as a first step diagnostic procedure in the evaluation of perimenopausal bleeding. When combined with dilatation and curettage it can supplement the shortcomings of dilatation and curettage.

Introduction: Cesarean delivery is increasing in both developed and developing countries. Though it is considered as a lifesaving surgical procedure for the pregnant women and the neonate, it has various risk factors and complications. Objective: The aim of this study was to assess the epidemiology and the results of the cesarean section in a single center of Bangladesh. Study Design: Retrospective observational study. Place and Duration of the study: The study was conducted in the department of Gynae & Obstetrics, Sher E Bangla Medical College Hospital, Barishal, Bangladesh, during the period from January 2019 to December2019. Methods: This is a retrospective observational study. Among the total number of cesarean patients, we recruited 75 women who were age 25-35 years with gestational age 37-42 weeks of pregnancy. Those who were less than 37 weeks of gestational age, the patients with multiple pregnancy complications, and those who were referred were excluded from the study. Written consent was taken. Collected data were compiled and analyzed using computer-based software, statistical package for social science (SPSS). Result: In this study, a total of 75 women who had a cesarean delivery were included. The baseline characteristics of the study people were: maximum 45(60.0%) study people were from the age group of 25-35, multipara was 54 (72.0%), and primipara was 21 (28.0%), most of the study people 39(52%) had normal BMI 10(25.3%) had overweight, 9(12.00%) had obese, 8(10.7%) had underweight. The majority 22(29.3%) of the study people were secondary educated. Most of the study people 37(49.3%) had 37-42 gestational age. The indications of cesarean delivery, 31 (41.3%) had repeat cesarean delivery, 12 (16.0%) had failed to progress, 9 (12.0%) had fetal distress, 8 (10.7%) breech presentation, 7 (9.3%) had antepartum hemorrhage, 6 (8.0%) had hypertension and 2 (2.7%) had diabetes mellitus. SAB was used in 61 (81.33%), pfannenstiel incision was used in 70 (93.3%), and the average operating time was 51.2 minutes. Subcuticular was mostly used 42(56%) for skin stitch followed by vertical mattress in 33(44.0%). Intraoperative antibiotic was used in 11 (14.7%), postoperative antibiotic was used in 9 (12.0%), both of these mentioned antibiotics were used in 6 (8.0%), and no antibiotic was used for 49 (65.3%). Conclusion: Repeat cesarean deliveries were found in most of the study people of the cesarean section. Surgical site infection was the most common complication.

Objective: The objective of the study was to explore the prevalence of different conditions in infertile men with severe male factor, based on endocrine evaluation and scrotal ultrasound. Materials and methods: The retrospective study was carried out on 86 infertile men with azoospermia and severe oligospermia who attended the Male infertility clinic of the department of Reproductive Endocrinology and Infertility of Bangabandhu Sheikh Mujib Medical University. They had evaluation with serum testosterone, follicle stimulating hormone (FSH), luteinizing hormone (LH), prolactin and thyroid stimulating hormone (TSH). In addition they had scrotal ultrasound. Results: Most (88.37%) of them had azoospermia. Severe oligospermia was present in 11.63%. Testosterone deficiency was detected in 34.9%. Non-obstructive forms (pre-testicular and testicular causes) comprised 62.8%. Scrotal abnormalities suggestive of obstructive and non-obstructive varieties were overlapping with endocrine diagnoses. Conclusion: Majority of men with severe male factor infertility has non-obstructive azoospermia which has poor chance of sperm retrieval for in vitro fertilization and intracytoplasmic sperm injection (IVF-ICSI). Substantial proportion of them has testosterone deficiency which needs to be treated if they do not opt for IVF-ICSI with poor prognosis or donor oocytes.

Background: Eclampsia is a life-threatening emergency that continues to be a significant cause of maternal mortality worldwide Aim: To study the incidence of eclampsia and factors influencing maternal outcome in Karnataka population Materials and Methods: A total of 50 eclampsia cases of > 32 weeks of gestation age utilized for the present study. Patients with medical complications like anaemia, pre-existing hypertensive, diabetes, vascular or renal disease, multiple gestations, and polyhydramnios excluded from the study. The eclamptic management by Zuspan regimen, anti-hypertensive management, and obstetric management by vaginal route or cesarean section was planned for the patients in our study. The mothers followed up for evidence of a decrease in BP followed by other complications of eclampsia for six weeks, and the babies delivered are followed up during the early neonatal period for difficulties in the present study Results: The majorities of the patients belong to low socio-economic status 94%, belong to middle class 6% in the present study. The Maternal deaths occurred in the low socio-economic group with an incidence of 4.3%. Maternal mortality increases with an increase in the first fit-admission interval was observed in the present study. Maternal mortality was higher in patients with higher Blood Pressure levels at the time of admission. The Incidence of eclampsia was 0.64%, followed by maternal mortality was 0.4% in the present study. The maternal mortality was significantly higher in patients who had six or more episodes of convulsions. The maternal mortality was 10% in convulsion delivery interval >24 hours and 4.2% in convulsion delivery interval were 13-24 hours. Maternal mortality was not observed in convulsion delivery interval <12 hours in the present study. Conclusion: The incidence of eclampsia is high due to the high referral of eclampsia cases, and reflecting poor antenatal care in the present study suggests that early attention and intensive management are essential for improving the maternal outcome in eclamptic patients.