Vestibular schwannoma unveiled by pregnancy: A case report and literature review.

BACKGROUND: Vestibular schwannomas - benign tumours originating from the vestibular nerve - are rare during pregnancy. The intricate interplay between the gravid uterus, maternal physiology and neoplastic growth imposes complexities that demand a careful and tailored approach. CASE REPORT: This article reports a case of a pregnant woman in her 30 s diagnosed with a large vestibular schwannoma exhibiting brainstem compression, peritumoral oedema and cranial nerve encasement at 36 + 5 weeks of gestation. A multi-disciplinary team collaborated to devise a treatment plan considering the delicate balance between fetal well-being and the urgent need for intervention. A conservative approach involving close monitoring, corticosteroid therapy to manage peritumoral oedema, and detailed fetal assessments was initially employed. As the patient neared full term, a carefully planned caesarean section was performed, followed by a successful craniotomy to resect the vestibular schwannoma. Both the mother and the newborn showed favourable outcomes postoperatively. In addition, a literature review of cases of vestibular schwannoma in pregnancy was undertaken to inform optimal management strategies and enhance understanding of this complex scenario. CONCLUSION: This case highlights the complexity of managing vestibular schwannomas in pregnant women, and underscores the importance of a tailored, collaborative approach. The condition was resolved successfully, emphasizing the significance of timely diagnosis, meticulous planning and a patient-centred approach in these rare and intricate cases.

Preference and Associated Factors for Cesarean Delivery Among Pregnant Women: A Cross-Sectional Study.

Objective: A cesarean delivery is regarded as a comparatively favourable and secure approach to childbirth when contrasted with vaginal delivery. Over the past decade, its frequency has risen in both industrialized and developing nations. Maternal request for cesarean delivery has been explained for the escalating rate along with other factors like anxiety, fear of childbirth, previous cesarean delivery, previous negative vaginal birth experience, maternal age, maternal education, and socioeconomic factors. Hence, this study was undertaken to assess pregnant women's tendency to have a cesarean birth and to investigate the factors associated with the inclination for cesarean delivery. Materials and methods: A hospital-based cross-sectional study was carried out in the Department of Obstetrics and Gynaecology of a tertiary care hospital, a systematic sampling procedure was utilized, and 368 antenatal mothers after 36 weeks of gestation, who do not have any specific medical reasons against vaginal delivery were included in the study. Data collection was done by questionnaire. The information regarding socio-demographic factors, preexisting comorbidities, current obstetric risk factors, emotional factors, previous delivery experience, and their information preference toward the mode of delivery were collected. Univariate and multivariate analysis were performed to identify the independent variables associated with preference for cesarean delivery. Results: The preference for cesarean delivery and non-preference for cesarean delivery was 114 (30.9%) and 201 (54.6%), respectively whereas 53 (14.4%) participants remained neutral. The Chi-square analysis revealed a notable connection between the inclination towards a preference for cesarean delivery and factors such as obstetric score, parity, comorbidities, and among obstetric risk factors such as pregnancy after in-vitro fertilization (IVF), with a history of abortion, and having a prior history of cesarean delivery. Nevertheless, no meaningful association was observed between the preference for cesarean delivery and the remaining variables. On multivariate logistic analysis, independent variables like preexisting anxiety or depression, pregnancy through IVF, and having a history of previous cesarean delivery have increased the odds of preferring cesarean delivery. The independent variables like increasing gestational age, graduates, and unemployed have decreased the odds of preferring a cesarean delivery. Conclusion: In conclusion, the prevalence of cesarean delivery is influenced by a complex interplay of medical, cultural, socioeconomic, and healthcare system factors. While cesarean delivery is essential in cases of medical necessity, efforts should be made to avoid unnecessary cesarean delivery that does not provide clear benefits over vaginal delivery. Balancing the risks and benefits of cesarean delivery and promoting evidence-based obstetric practices are crucial for ensuring optimal maternal and infant outcomes.

A prospective study on risk factors associated with the development of isthmocele after caesarean section.

OBJECTIVES: The primary objective was to detect the number of women developing isthmocele following lower segment caesarean section. The secondary objectives included analysing the risk factors associated with developing isthmocele and measuring the agreement between Transvaginal Ultrasonography (TVS) and Saline infusion Sonohysterography (SIS) in diagnosing Isthmocele. METHODS: This study was conducted in the Department of Obstetrics and Gynecology and focused on women who had undergone Lower Segment cesarean Section (LSCS). The study aimed to detect any indentation of at least 2 mm in the scar site, known as isthmocele, using Transvaginal Ultrasound (TVS) and Saline Infusion Sonography (SIS) between 6 weeks and 6 months after delivery. Along with the primary objective, the study also evaluated several secondary outcomes such as maternal comorbidities, closure techniques, and labor details. The evaluation of isthmocele followed the 2019 modified Delphi consensus approach. RESULTS: In our study, we found that 30% of our study population had isthmocele. We also observed that the number of previous caesarean deliveries, maternal BMI, duration of surgery, and characteristics of the previous CD scar were significantly associated with the development of isthmocele. When we compared the diagnostic methods, we found that TVS and SIS had similar limits of agreement for clinically important isthmocele parameters. However, we noticed a difference in the length and distance of isthmocele from the internal os, which we observed through Bland Altman plots. CONCLUSION: Our research has shown that women who have undergone multiple caesarean deliveries, have a higher maternal body mass index (BMI), and experienced longer surgery duration are at a significantly higher risk of developing isthmocele. To prevent its development, it is recommended to promote vaginal birth after caesarean delivery whenever feasible, manage maternal obesity early on, and provide adequate surgical training to medical professionals. Additionally, transvaginal ultrasound (TVS) is an effective method for detecting isthmocele and can be used interchangeably with saline-infused sonography (SIS).

A rare case of squamous cell carcinoma associated with a huge ovarian dermoid cyst in a postmenopausal woman.

Malignant transformation of mature cystic teratoma (MCT) is a well-known but uncommon phenomenon seen mostly in postmenopause women. We report a case of a 65-year-old postmenopausal woman with a malignant transformation of MCT and with a low-grade squamous intraepithelial lesion in her cervix. She was treated surgically by total abdominal hysterectomy with bilateral salpingo-oophorectomy with a preoperative diagnosis of right ovarian teratoma. Her postoperative period was uneventful. On follow-up, the histopathology report revealed a right ovarian dermoid cyst with well-differentiated squamous cell carcinoma; there was no evidence of malignancy elsewhere, including the cervix. Ascitic fluid was also free of malignant cells, and the disease was at stage Ia. The patient did not receive any adjuvant chemotherapy and was followed up with clinical examination postoperatively for 1 year, and there was no evidence of any relapse clinically. Preoperative diagnosis of malignant transformation of squamous cell carcinoma (SCC) is difficult, as there is no specific screening marker and no consensus or standard guidelines available regarding the optimum management of this relatively poorly known entity. Here we emphasize the need for a high index of suspicion of malignant transformation with the presence of factors such as elderly age, the huge size of the tumor, and large solid components in the tumor. Considering the scarcity of case reports and studies about SCC arising from MCT, every experience with malignant transformation of MCT should be reported for a better understanding of the disease presentation and management.

The burden of paraovarian cysts - a case series and review of the literature.

Introduction: A paraovarian cyst (POC) is a cyst in the broad ligament or mesosalpinx. Paraovarian cysts have an estimated prevalence of 5-20% amongst the adnexal masses. Despite the high prevalence and availability of advanced imaging modalities, an accurate pre-operative diagnosis of POC is still made in less than 50% of patients. Case reports: Two females with suspected ovarian torsion underwent laparotomy and had POCs. A 42-year-old hysterectomized female underwent surgery for a suspected POC which turned out to be a mesenteric cyst. Two females underwent laparotomy for suspected mesenteric cysts which turned out to be POCs. A nulliparous female with infertility conceived spontaneously after cystectomy of POC. Results: Optimal management of an adnexal mass depends on the knowledge of the origin and the exact nature of the mass. No clear-cut guidelines exist for the management of POCs despite their high prevalence. There is a need for further research on this topic to formulate clear-cut guidelines for their management. Conclusions: Radiologists and gynaecologists need to keep them in mind as differentials for patients with adnexal masses to ensure a correct pre-operative diagnosis in order to achieve an optimal outcome for these females. Gynaecologists need to be aware of the cases which can be managed conservatively and those that need surgery, along with the extent of the surgery required, taking care to protect the ovary at all costs, particularly in benign cases.

Effectiveness of school-based sexual and reproductive health education among adolescent girls in Urban areas of Odisha, India: a cluster randomized trial.

BACKGROUND: Various studies revealed that adolescent girls have limited knowledge pertaining to sexual and reproductive health (SRH). The current study assessed the effectiveness of SRH education among adolescent girls in urban areas of Odisha, India. METHODS: The study design was a cluster randomized trial, where the clusters composed of eight Odia (regional language) medium government girls' high schools in Bhubaneswar, the capital city of the state of Odisha, India. For the selection of study participants, adolescent girls who were studying in the ninth and tenth standards were recruited from each school. Eight schools were randomized through restrictive randomization at a 1:1 ratio, with four schools each in the intervention and control arm. Baseline and end-line assessments were done using a pre-tested, semi-structured questionnaire. Following baseline assessment, an intervention was given with the help of handbooks developed by the study authors to the schools in the intervention arm. Outcomes included change in knowledge, attitude and practices pertaining to SRH. RESULTS: In our study at baseline, there were a total of 790 students, where 469 (59.4%) students were in the intervention arm, and 321 (40.6%) students were in the control arm. At baseline, only 282 (60.1%) in the intervention arm and 171 (53.3%) in the control arm were aware that physical bodily changes due to puberty were normal. After the intervention, there was a statistically significant increase in knowledge in intervention group 367 (94.8%) (p-value < 0.001). Most students used sanitary pads as absorbent, 97.2% in the intervention group and 98.4% in the control group. However, after the intervention, the use of other absorbents reduced to zero in the intervention group with a statistically significant difference (p < 0.05). The number of students having awareness on different methods of contraception increased from 51 (10.9%) to 337 (87.1%) in the intervention arm (p < 0.001), and of those having awareness on STIs/RTIs increased from 177 (38.2%) to 371 (96.1%) in the intervention group (p < 0.001). CONCLUSION: From our study, there is a significant proportional change in knowledge, attitude, and practices pertaining to SRH. Our study recommends policymakers and program managers for the implementation of comprehensive SRH in the regular school curriculum. Trial registration CTRI/2021/01/030490, registered on January 15, 2021. Prospectively registered at https://ctri.nic.in/Clinicaltrials/login.php.

Adolescent girls lack adequate knowledge pertaining to sexual and reproductive health, for which they face various issues such as teenage pregnancy, unsafe abortions and sexually transmitted infections. Hence the authors conducted this study to assess the effectiveness of school-based sexual and reproductive health education among adolescent girls in Odisha state of India in terms of improving knowledge, attitude and practices pertaining to reproductive health. A total of eight vernacular (Odia language) medium schools were selected for the conduct of the study, and the schools were randomly assigned where four schools received SRH education, and the other four received no intervention. A baseline assessment pertaining to SRH was done among adolescent girls studying in ninth and tenth classes of all eight schools, and then education was given to the four schools in the intervention arm. Students were educated on topics such as puberty, menstrual health, pregnancy, contraception and STIs/RTIs with the help of handbooks prepared by the authors. After 3 months of providing education, an endline assessment was done for the adolescent girls in all eight schools. There was an increase in knowledge, attitude and practices pertaining to SRH among the students who received education when compared to those who didn't. Hence our study recommends policymakers and program managers include SRH education in the regular school curriculum.

Diagnostic Performance of Ultrasound-Based International Ovarian Tumor Analysis Simple Rules and Assessment of Different NEoplasias in the adneXa Model for Predicting Malignancy in Women with Ovarian Tumors: A Prospective Cohort Study.

Background: Comparative performance of various ultrasound models in diagnosing ovarian lesions has not been adequately studied. This study aimed to evaluate the diagnostic performance of the International Ovarian Tumor Analysis (IOTA) simple rules and Assessment of Different NEoplasias in the adneXa (ADNEX) models in women with ovarian lesions. Methods: Women 18-80 years, with an ovarian lesion planned for surgery were recruited in this prospective observational cohort study. Preoperative risk stratification was done by both IOTA simple rules and the ADNEX model. The diagnostic performance of both models was estimated using histopathology as the gold standard. Results: A total of 90 women were recruited into the study. The IOTA simple rules were applicable to 77 (85.5%) participants and the ADNEX model on 100% women. Both the simple rules and the ADNEX model had good diagnostic performance. The sensitivity and specificity of the IOTA simple rules for predicting malignancy was 66.6% and 91%, while that of the ADNEXA model was 80% and 94%, respectively. The maximum diagnostic accuracy for prediction of both benign and malignant tumors was obtained when cancer antigen-125 (CA-125) was combined with the IOTA ADNEX model (91.0%), but for Stage I malignancy, the maximum diagnostic accuracy was for ADNEX without CA-125 (91.0%). Conclusion: Both the IOTA models have a good diagnostic accuracy and are of paramount importance in differentiating benign from malignant tumors and predicting the stage of the malignant disease.

Fetuin B may be a potential marker for predicting maternal and neonatal outcomes in intrahepatic cholestasis: Prospective case-control study.

Objective: To investigate the levels of serum fetuin B in healthy pregnant women and women with intrahepatic cholestasis of pregnancy (IHCP) and their association with pregnancy outcomes. Materials and Methods: This was a prospective case-control study, we included sixty singleton pregnant women with IHCP and sixty healthy-matched pregnant women in their third trimester. The serum fetuin B levels of these patients were analyzed. All the patients were followed up prospectively until delivery and data related to maternal, perinatal, and neonatal outcomes were obtained. Results: Total bile acid levels and liver function tests were significantly higher in the IHCP group than in the control group (p<0.0001 and <0.0001, respectively). The serum fetuin B concentrations were higher in the IHCP group than in the control group, without any significant group difference (p=0.105). Preterm delivery, iatrogenic preterm delivery, and birth weight ≤2.500 gm are only significantly associated with serum fetuin B levels respectively (p<0.05). The diagnostic performance of serum bile acids [area under the curve (AUC)=0.998] was significantly better than that of fetuin B (AUC=0.586) (DeLong's test p≤0.001). Conclusion: We neither noted a significant difference between the IHCP and control groups concerning the serum fetuin B levels nor could we correlate its levels with adverse maternal and perinatal outcomes except with birth weight, thereby serum fetuin B was not an effective marker for use in shedding light on the pathophysiology of IHCP.

Routine third trimester ultrasonography in predicting adverse perinatal outcomes: a prospective cohort study at a tertiary-care hospital in Eastern India.

AIMS: Fetal growth restriction (FGR) may go undetected in the antenatal period with subjective clinical evaluation, and there is a growing propensity to perform a third-trimester scan, especially in the developed countries. The literature on the importance of the same in developing countries like ours, is scant. Hence, this study was undertaken to evaluate the role of routine third-trimester ultrasonography along with Doppler in predicting adverse perinatal outcome. METHODS: A prospective cohort study was conducted at a tertiary-care hospital, in which routine third-trimester ultrasonography was performed for 265 antenatal women, and included estimation of amniotic fluid index (AFI), estimated fetal-weight (EFW), and cerebroplacental ratio (CPR). Women were categorized as having normal parameters or having at least one abnormal parameter. Post-natal adverse perinatal outcomes including low birth-weight, hypoglycemia, poor Apgar scores, prolonged hospital stay, need for ventilatory support, neonatal asphyxia, neonatal sepsis and early neonatal death were recorded. Prediction analyses for sensitivity, specificity, positive and negative predictive values were done. Receiver Operating Characteristic (ROC) curves were plotted for threshold for each parameter for adverse outcome. RESULTS: Out of 260 women that were analyzed, 47.5% had no clinically identifiable risk factors, and 52.5% had at least one abnormal parameter. Sensitivity and negative predictive value for adverse outcome were highest for composite ultrasound finding (85.4% and 90.4% respectively). Specificity, positive predictive value and diagnostic accuracy were highest for CPR (97.8%, 86.7% and 76.9% respectively). CONCLUSION: Routine third trimester ultrasonography, including Doppler, can help in risk-stratification of otherwise clinically low-risk pregnancies.

A survey of the psychosocial impact of the COVID-19 pandemic on pregnant women attending a tertiary care centre of Eastern India - a cross-sectional study.

Introduction: The COVID-19 pandemic presented an unprecedented challenge, and, as during the SARS outbreak in 2002, there was scope of overestimation of risk by pregnant women, leading to increased fear and anxiety. The aim of this study was to assess the psychosocial impact of the pandemic on pregnant women so better-informed decisions can be taken to spread awareness and alleviate their anxieties. Material and methods: This was a cross-sectional study in a single tertiary care centre of Eastern India including 292 participants. The inclusion criteria were all pregnant women of any gestational age attending the All India Institute of Medical Sciences, Bhubaneswar for antenatal check-up or delivery. The exclusion criteria were patients with severe morbidities and patients not willing to participate. The primary outcome was to determine the psychosocial impact of the COVID-19 pandemic on pregnant women and to measure the anxiety level of pregnant women during the COVID-19 crisis. The secondary outcome was to determine the correlation between demographic aspects and psychosocial impact of COVID-19 pandemic on pregnant women. Results: A self-designed questionnaire was used. Anxiety was scored using the generalised anxiety disorder scale. More than half the participants (57.9%) were not at all worried about acquiring the infection. Of all, 99.3% were scored to have no anxiety and 0.7% had moderate anxiety. Significant association of the level of anxiety was found with living with people at high risk of contracting the disease (p = 0.002). Conclusions: The widespread awareness activities were effective and successful, as the pregnant women at the grassroots level faced minimal anxiety and were aware and assured. Studies like this help to provide feedback and formulate educational activities in future pandemics. The change in the effect on people, from panic in the previous pandemics to assurance in the current one, as found in our study, indicates the commendable work done to spread well founded information far and wide by the government, health care institutions, and workers.

Luteoma of Pregnancy Presenting as Ruptured Ectopic Pregnancy: A Case Report.

Luteoma of pregnancy is a rare, benign neoplasm arising from the ovary, which occurs due to pregnancy-induced hormones.This rare ovarian lesion was first described by Sternberg and Barclay in 1966. Our case is unusual as the ovarian mass was misdiagnosed as ruptured ectopic pregnancy. Only three such cases have been previously reported in the literature. A 28-year-old multigravida with three months of amenorrhea presented with vaginal bleeding, abdominal pain, and gradually increasing vertigo for six days with increased intensity in the last four hours. On examination, she was conscious and oriented, clinically moderate pallor was present, her pulse rate was 112 beats per minute (bpm), and her blood pressure (BP) was 98/68 mm Hg. On abdominal examination, there was no palpable abdominal mass, but left iliac fossa guarding and tenderness were present. On per-vaginal examination, the uterus was eight weeks in size, the right fornix was free, the left fornix was full and tender, and cervical motion tenderness was present. Her urine pregnancy test was positive. Transvaginal sonography was performed in the emergency setting, which showed a bulky uterus with thickened endometrium and a non-visualized right ovary, and the left ovary was seen adjacent to a hyperechoic collection in the pouch of Douglas of size 3.5×3.5×1.8 cm, likely organized hematoma; there was free fluid in the pouch of Douglas, and left forniceal tenderness was also present. In view of the clinical evidence of tachycardia and hypotension, an exploratory laparotomy was performed for suspected ruptured ectopic pregnancy, and the ovarian mass was excised. The histopathological examination (HPE) of the ovarian mass showed findings suggestive of luteoma of pregnancy. There is an extreme paucity of literature on luteoma of pregnancy. That, along with the rarity of the lesion, results in it often not being kept in mind as a differential diagnosis on clinical or radiological examination, thereby leading to more aggressive management. Obstetricians and gynecologists need to be aware of this condition so that it is kept as a differential diagnosis in patients presenting with adnexal masses. A vigilant outlook will help in preventing unnecessary radical surgery during pregnancy, thereby preserving the ovary and reducing morbidity in these young females.

The Unforeseen Impact of the COVID-19 Pandemic on Dismal Pregnancy and Fetal Outcomes.

India noticed a surge in maternal mortality and stillbirth rate during the COVID-19 pandemic. This rise in mortality is not always due to viral infection by COVID-19 but is probably contributed by other determinants. We present a case of maternal mortality with stillbirth in a multigravida, at 41 weeks' gestation, with bronchial asthma, severe preeclampsia, fetal bradycardia, severe symptoms of flu infection, and a previous cesarean delivery. She delivered a stillborn baby by emergency cesarean delivery and due to adverse obstetric consequences, she succumbed. Disruption of the overwhelmed healthcare system to cope with the COVID-19 pandemic has caused unsupervised pregnancy, unprecedented delays in reaching the hospital, delays in receiving proper care, and suboptimal care due to difficulty in differentiating actual severe preeclampsia from COVID-19-induced preeclampsia-like syndrome have resulted in preventable maternal mortality and stillbirth.

Advanced-stage Endometrial Stromal Sarcoma Presenting as Primary Infertility in a Young Nulligravida: A Case Report.

Endometrial stromal sarcoma (ESS) rarely causes infertility in young women. We report a nulligravida in her 30s who presented with primary infertility of 15 years. Hysteroscopy revealed a submucosal necrotic fibroid polyp. Ultrasonography detected multiple intramural fibroids. Open myomectomy with polypectomy was performed. Histopathology revealed low-grade ESS (LGESS) within the fibroid polyp. Subsequently, the patient underwent completion surgery. Her final diagnosis was estrogen-receptor positive LGESS stage IIIB, and she was suggested anastrozole adjuvant therapy and long-term surveillance. ESS with abnormal perimenopausal bleeding, though the most common presentation, may not always observed. Hence, a high index of suspicion of ESS should always be kept as a differential diagnosis in uterine fibroid polyp, though rare. Considering the scarcity of more extensive studies on ESS, reporting of cases will aid in formulating management protocols.

Anti-N-Methyl-D-Aspartate Receptor Encephalitis Associated with Mature Ovarian Teratoma in a Young Adolescent: A Case Report.

BACKGROUND: Ovarian teratoma has an uncommon association with anti-N-methyl-d-aspartate receptor (NMDAR) encephalitis. This is a life-threatening condition, and here, we describe a case of an adolescent girl with anti-NMDAR encephalitis caused by an ovarian teratoma. CASE: A 14-year-old girl presented with acute features of fever, severe headache, altered behavioral changes, delirium, autonomic instability, episodes of seizure, and involuntary movement over a period of 1 month. Upon investigation, electroencephalogram (EEG), computed tomography (CT), and magnetic resonance imaging (MRI) of her brain showed normal findings. Her serum and cerebrospinal fluid were positive for anti-NMDARs, and a diagnosis of anti-NMDAR encephalitis was made, so she received a course of intravenous methyl prednisolone and immunoglobulin and was discharged after her neurological status improved. Upon further workup, she was suspected to have a left ovarian dermoid cyst on transabdominal ultrasonogram, which was an incidental finding. Her tumor marker panel showed normal serum lactate dehydrogenase, beta human chorionic gonadotropin, inhibin, alpha-fetoprotein, and carcinoembryonic antigen and a cancer antigen 125 level of 71.5 U/L. She eventually underwent laparoscopic left ovarian cystectomy and received immunotherapy in the postoperative period. She was discharged in stable condition on postoperative day 4. On histopathological examination, the specimen revealed a mature cystic teratoma with glial component. One year after surgery, the patient has recovered completely and has no residual psychiatric or neurological symptoms. CONCLUSION: Complete recovery after surgery in cases of anti-NMDAR encephalitis with ovarian teratoma emphasizes the need for early recognition of the entity, search for underlying tumor, and tumor removal to improve the prognosis.

Intrapartum respectful maternity care practices and its barriers in Eastern India.

Background: Respectful maternal care (RMC) is increasingly recognized globally as critical to improving the quality of maternity care as women deserve respectful and dignified care. Numerous women face disrespectful maternal care during labor and delivery, especially in low- and middle-income countries, which dissuades them from seeking institutional care. Women, the consumers of care, are better positioned to report on the level of respectful care they receive. Health care workers' perspectives on barriers to delivering respective maternity care are seldom explored. Thus, this study aims to assess the levels of respectful maternity care and its barriers. Methods: This cross-sectional study assesses the level of RMC and its barriers in the labor room of tertiary care hospital in Odisha among 246 women selected by consecutive sampling technique by a questionnaire. Results: More than one-third of women reported good RMC. Although women rated high in domains of environment, resources, dignified care, and non-discrimination, non-consented care and non-confidential care were poorly rated. Barriers that adversely affect the delivery of RMC perceived by health care workers were lack of resources, staffing, uncooperative mother, communication issues, privacy issues, lack of policies, workload, and language problems. There was a significant association of RMC with age, education, occupation, and income. In contrast, residence, marital status, number of children, antenatal visit, type of institute of antenatal care, mode of delivery, and gender of health care provider were not associated with RMC. Conclusion: Given the above findings, we recommend vigorous efforts to improve the institutional policies, resources, training, and supervision of health care professionals on women's rights during childbirth to strengthen the quality of care for positive birth experiences.

Umbilical Hernia as Forerunner of Primary Umbilical Endometriosis: A Case Report.

Umbilical endometriosis is a type of cutaneous endometriosis that usually follows laparoscopic or surgical procedures that involve the umbilicus. Primary umbilical endometriosis (PUE) is an extremely rare condition and its association with an umbilical hernia is an equally rare condition. To date, only very few cases of PUE with umbilical hernia association have been reported in the medical literature. Report herein is a case of PUE associated with an umbilical hernia who presented with classical umbilical nodule symptoms with cyclical pain and bleeding due to menstruation. The patient underwent omphalectomy with abdominal wall defect repair using prosthetic mesh. The diagnosis was confirmed by histopathological examination of the excised umbilical nodule. This case report highlights a rare entity that should be considered as a differential diagnosis in females of the reproductive age group that presents with the umbilical nodule.

Effect of Preconception Care Intervention on Maternal Nutritional Status and Birth Outcome in a Low-Resource Setting: Proposal for a Nonrandomized Controlled Trial.

BACKGROUND: The provision of preconception care approaches such as maternal assessments and education on healthy lifestyle (including physical activity, nutrition, and dietary supplements such as folic acid), general and sexual health, avoidance of high-risk behavior, and immunizations has been shown to identify and reduce the risk of adverse birth outcomes through appropriate management and preventive measures. OBJECTIVE: The goal of the study is to determine the effect of an integrated preconception care intervention on delivery outcomes, which is a novel challenge for lowering unfavorable birth outcomes in India's low-resource setting. The main objectives are to investigate the relationship of birth outcomes to both maternal and paternal preconception health and determine the effect of preconception care intervention on improvement of maternal nutritional status and reduction of the risk of adverse birth outcomes such as prematurity, low birth weight, and maternal and neonatal complications. METHODS: A nonrandomized controlled trial design will be used for comparing 2 groups: preconception care with a standard maternal health care (MHC) program and an integrated MHC program (without preconception care). Two rural field areas of Khordha district, Odisha, will be selected for conducting the study. The study will enroll 782 married women between the ages of 18 and 35 years with their spouses, with 391 women in each group. The couples will receive preconception care based on their health circumstances, and they will be followed up at 3-month intervals before pregnancy. Following pregnancy, they will be followed up for 8 prenatal monitoring and care visits as well as 6 weeks after delivery as part of the standard MCH program. The preconception care intervention package includes couples counseling, contraceptive education and distribution, sex education, lifestyle modification, and nutritional supplementation of iron and folic acid, along with multivitamins if needed. RESULTS: The proposal was approved by the institutional ethical committee for conducting the study in June 2020 (Ref No: T/EMF/Nursing/20/6). Participants were enrolled in phase 1 in April 2021, phase 2 of offering preconception services will begin in August 2021, and study outcomes will be measured from 2023 to 2024. CONCLUSIONS: Through preconception care and counseling, the eligible couples will recognize, embrace, and implement the actions to improve their preconception health. Finally, it is expected that maternal and paternal health will have a significant impact on enhancing maternal nutritional status and birth outcomes. TRIAL REGISTRATION: Clinical Trials Registry-India CTRI/2021/04/032836; http://ctri.nic.in/Clinicaltrials/pmaindet2.php?trialid=48239&EncHid=&userName=CTRI/2021/04/032836. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/28148.

Synchronous colonic adenocarcinoma and well-differentiated neuroendocrine tumor arising in a mature cystic teratoma of ovary - rare presentation in a postmenopausal woman with literature review.

Mature cystic teratoma of the ovary (MCT) is rare in pre and postmenopausal age patients. Among various types of malignant transformation in MCT, adenocarcinoma is a rare subtype. Dual type tumors arising from ovarian MCT have been described in the literature very rarely. A 47-year-old postmenopausal female patient presented with abdominal mass for ten years. The radiological opinion was a dermoid cyst. Grossly, a 22 × 20 × 10 cm, unilocular cystic left ovarian mass with intact capsular surface and focal thickened wall measured 3.0 cm. Microscopically, it showed components of all three germ cell layers. In addition, features of colonic type adenocarcinoma and well-differentiated neuroendocrine tumor (carcinoid) were noted and confirmed by immunohistochemistry (IHC). We report this rare case of synchronous malignancy arising from an ovarian MCT with a clinicopathological review.