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Happy Gynecon 2020 Part II

Asia/Kolkata
Description

Dear Friends,

Greetings from Organizing Committee of Happy Gynecon 2020!

It is our great pleasure to invite you to the second part of 16th State Conference of Association of Obstetrics and Gynaecology of Chhattisgarh, 3rd October 2020.

The Late Prof. Dr. Shobha Sharma Gold Medals for best paper and poster will be presented live online during the second half of this conference.

We invite papers and posters on the theme of the conference which will be judged by national judges online. Please visit this page to submit abstracts.

So gear up for an academic extravaganza. Update yourself, get ICOG credit points, and increase your eligibility for ICOG Fellowship by presenting papers and posters. Here is to being a Happy Gynecologist!

Welcome All!

 

Dr. Asha Jain
President Raipur Obstetrics and Gynecology Society

    • 15:00 15:15
      Inauguration 15m
    • 15:15 15:45
      Paper Presentation
      • 15:15
        A COMPARATIVE STUDY OF MYO INOSITOL VERSUS METFORMIN IN WOMEN WITH POLYCYSTIC OVARY SYNDROME 10m

        A COMPARATIVE STUDY OF MYO INOSITOL VERSUS METFORMIN IN WOMEN WITH POLYCYSTIC OVARY SYNDROME

        DR.M.VIJAYASREE.,M.D.OBG.,FICOG.,ACME.,VICE PRESIDENT KHMOGS.,PROFESSOR and HOD.,DEPT. OF OBG.,MAMATA MEDICAL COLLEGE.,KHAMMAM.,TELANGANA STATE.,INDIA.
        PH:9542605279.,E MAIL ID hospitalstelangana@gmail.com

        ABSTRACT

        INTRODUCTION: Polycystic ovary syndrome (PCOS) is the most common endocrine disorder affecting 4 – 15 % of females. PCOS is a complex disorder with oligomenorrhoea, anovulation, and signs of androgen excess. It causes infertility due to menstrual dysfunction.

        AIMS AND OBJECTIVES:
        1.To evaluate the efficacy of Myo inositol and Metformin In women with polycystic ovary syndrome in relation to their safety, adverse effects and tolerability.
        2. To Compare the regulation of menstrual cycle, reduction in body weight, blood glucose and serum insulin levels In Both The Groups

        METHODOLOGY: This is a comparative study done in Dept of OBG.,MMC, Khammam over one year with sample size of 60 women with PCOS.They were divided into 2 groups:Group A:30 – Treated with Metformin 500mg tid ,Group B:30 – Treated with Myo Inositol 600mg bd. Women were enrolled after taking consent . History noted, Examination and Investigations done. Medications given for 3 months and follow up done for 3 months .Results were Analysed.

        RESULTS:Maximun women were in 21 - 30 years .Group A had more married women. Statistical analysis within the groups and between the groups showed significant difference in the body mass index at the end of 12 weeks (p=0.04). Menstrual cycle regularity was seen maximum in Group B . There was no statistically significant difference in relation to FSH within the groups and between the groups at the end of 12 weeks. Statistical analysis within the groups (p<0.05) and in between the groups showed a significant decrease in the LH level ,Fasting blood glucose levels and Fasting insulin levels at the end of 12 weeks.Gastrointestinal disturbances were reported in both the groups.

        CONCLUSION:Both Metformin and D-chiroinositol were effective in reducing LH levels, blood glucose and serum insulin levels. DCI better aids in weight reduction, regularization of menstrual cycles and ovulation and increases chances of pregnancy and thus, can be a better treatment option for PCOS.

        KEY WORDS:PCOS,Insulin resistance,D chiro inositol,Metformin

        Speaker: Dr Vijayasree Medarametla (Professor)
      • 15:25
        IVF/ICSI success rate in PCOD women in Fresh IVF cycle 10m

        Background: Polycystic ovary syndrome (PCOS) is a common endocrine disorder of women, which occurs in 5% to 13% in women of reproductive age. It is one of the major reason of infertility in women. Therefore, the prediction of clinical pregnancy in women with PCOS is more challenging.
        Aim: Our aim was to investigate the IVF/ICSI outcomes in PCOD patients.
        Material and Methods: In the present retrospective study, total of 126 women in 133 fresh IVF cycles were involved, where 42 patient were PCOD and 84 patient were non-PCOD (other factor of infertility). All the patients’ medical data of age, duration of infertility, factor of infertility, AMH hormone level, number of total retrieved oocyte, matured (M2) oocytes, day 3 cleaved embryos and biochemical pregnancy rates were used for this study and data were statistically analyzed by Student T-Test.
        Result: After statistical analysis, significantly higher AMH level, higher number of total oocyte, mature oocyte and day3 cleaved embryos were observed in PCOD group. The biochemical pregnancy rate was also found to be higher in PCOD group but it was not statistically significant.
        Conclusion: In the present study, number of oocytes and cleaved embryos were found to significantly higher in PCOD group but biochemical pregnancy was not significant.
        Key words: PCOD, AMH, Oocyte, Embryo, Biochemical Pregnancy

        Speaker: Dr Manoj Chellani (Aayush ICSI Test tube baby centre (Aayush Institute of medical science Pvt. Ltd. ) Raipur)
      • 15:35
        Atypical presentation of bladder leiomyoma-Dyspareunia 10m

        ABSTRACT-
        BACKGROUND-Bladder leiomyoma is rare, benign mesenchymal neoplasm of urinary bladder. It accounts for 0.43% of all bladder tumors; only 250 case reports were there in literature worldwide. The etiology is still unknown. Bladder leiomyoma can be asymptomatic; most common presenting symptoms might be obstructive symptoms, irritative symptoms or hematuria. We report a case of bladder leiomyoma presenting with dysparenuia and abdominal mass.
        CASE REPORT- A 42 year female presented to gynecological OPD with complains of dysparenuia, suprapubic abdominal mass and slight increase in frequency of micturation. On abdominal examination, a suprapubic mass was found with upper limit up to umbilicus and firm consistency, slightly more towards right side. A 20 weeks uterine mass also filling right fornix may be originating from right broad ligament or right ovary found on vaginal examination. Patient underwent laparotomy, a pedunculated extravesical leiomyoma was found and surgical excision for the same was done. Now patient is free of all above mention symptoms.
        CONCLUSION- This study highlights unusual presentation of bladder leiomyoma dysparenuia and abdominal mass. It is necessary to take both these symptoms when a female presenting with bladder leiomyoma. Surgical excision is wide enough and very effective, leaving a very low recurrence rate.

        Speaker: Prof. Pushpa Dahiya (PGIMS ROHTAK )
    • 15:45 17:35
      Competition: Poster Presentation
      • 15:45
        SUCCESSFUL PREGNANCY OUTCOME IN A CHRONIC KIDNEY DISEASE PATIENT 10m

        Pregnancy in patients with advanced chronic kidney disease is a challenging prospect.Even when fertilization is successful the clinical outcome of pregnancy is unfavourable with great frequency of spontaneous abortions and increased risk of perinatal mortality.
        We are presenting a case 30 wks period of gestation with beta thalassemia trait with pANCA positive with chronic kidney disease patient who was on hemodialysis was referred to us from nephrology department.She turned out to be covid positive.Emergency LSCS was done in covid operation theatre and delivered a preterm alive baby wh was shifted to NICU.Baby was discharged healthy from NICU after 30 days.

        Speaker: Dr shikha taru
      • 15:55
        MECONIUM PERITONITIS: A RARE TREATABLE CAUSE OF NON-IMMUNE HYDROPS. 10m

        BACKGROUND: Meconium Peritonitis is defined as an aseptic localised or generalised chemical peritonitis which results from perforation of the gut in utero with reported incidence of 1 in 35,000 live births. Although, no definitive reason is found in half of the cases, possible causes include bowel perforation as a result of obstruction such as intestinal atresia, meconium plugs, volvulus, internal hernia, mesenteric ischemia, Hirschsprung’s disease, torsion of a fallopian tube cyst, and cystic fibrosis. Secondary inflammatory response results in production of fluid(ascites), fibrosis, calcification, and sometimes cyst formation. It can be classified into 3 types as follows: generalised, cystic, and fibro adhesive types. Successful outcome with conservative management has been seen in limited number of cases, however, surgery is imperative when signs and symptoms of intestinal obstruction are present. With the evolution of neonatal care, the prognosis of meconium peritonitis has improved much. Favourable results have been seen when the condition was detected in utero rather than a neonatal diagnosis.
        CASE DESCRIPTION: A 32year multigravida, married non consanguineously, was referred to our hospital at 33 weeks 2days of gestation in view of isolated foetal ascites, diagnosed in antenatal scan at 32 weeks. Antenatal workup for immune and nonimmune hydrops was found to be negative. Foetal echo was done, which showed structurally normal heart with mild pericardial effusion and echogenic foci in both ventricles. Repeat ultrasound was done which showed moderate foetal ascites with few areas of calcification in the bowel loops and prominent IVC, there was also associated polyhydramnios. The probable diagnosis of meconium peritonitis was made. Neonatologist opinion was taken regarding foetal prognosis and further management. Subsequently spontaneous labour has set in and a preterm female hydropic baby was delivered at 35 weeks of gestation. The baby needed intubation and ventilator support. Postnatal X-ray revealed intrabdominal calcification, ultrasound showed gross thick particulated ascites with giant cyst compressing the Inferior Venacava and minimal bilateral pleural effusion. Emergency laparotomy revealed meconium pellets and perforation of ileum, Double barrel ileostomy was performed, following which oedema resolved and activity improved. Baby was doing well on a 10days follow up post-delivery.
        CONCLUSION: In conclusion, current survival rate in babies with meconium peritonitis is up to 90-100% in some centres with the improvements in the surgical techniques and postnatal care of the neonates. Even the exact mechanism of meconium peritonitis is still unknown, with the advances in antenatal treatment modalities, early diagnosis of the patients is more frequent.

        Speaker: Dr loukya kodumuri (PG-JR)
      • 16:05
        An Unusual Case of leiomyosarcoma of vagina Presenting as infected Vaginal Prolapse 10m

        Abstract
        Background: Vaginal leiomyosarcomas are very rare clinical entity but clinical presentation varies considerably. Primary vaginal leiomyosarcoma accounts for 0.062% of malignant neoplasm of female genital tract. We are reporting a case of vaginal leiomyosarcoma mimicking as infective vaginal prolapse.
        Case presentation: A 52 year old female presented with complaints of something coming out of vagina, intermittent bleeding and offensive vaginal discharge. Vaginal mass increased in size over the course of 3years. Local examination revealed a 7×7 cm irregular mass protruded through vulval outlet with multiple area of degeneration, focal hemorrhage and ulceration. On palpation, mass is moderately firm in consistency; originating from anterior vaginal wall. Vaginal myomectomy was done. On histopathology, leiomyosarcoma was diagnosed. Patient underwent total abdominal hysterectomy with bilateral salpingio-oophrectomy. Later on patient received radiotherapy. Cytology of peritoneal washings, biopsy of omentum, ovary and pelvic lymph node were found positive. Now, patient is well and free of disease.
        Conclusion: Primary vaginal leiomyosarcoma is very rare occurrence. Complete Surgical excision with adequate margins is modality of treatment. The rare entity of disease has rendered us to paucity of information about the disease. Post operative radiotherapy has been used to reduce the local reoccurrence of the disease. The histo-pathological examination is only confirmatory method to reach definitive diagnosis. We strongly recommend frozen section biopsy to exclude malignancy for all vaginal leiomyomas.

        Speaker: Sonia Sonia Dahiya (assistant professor,pgims,rohtal)
      • 16:15
        Successful medical management of uterine arteriovenous malformation (AVM) 10m

        Objective – AVM is a rare condition and can be life-threatening if not managed properly. The aim of this case report is to assess medical treatment of a symptomatic case of AVM.
        Background - Uterine AVM is abnormal and nonfunctional connections between the uterine arteries and veins. It present with abnormal vaginal bleeding ranging from frequent spotting to catastrophic hemorrhage; menorrhagia, metrorrhagia, menometrorrhagia, and postcoital bleeding . Uterine Artery Embolization is the first choice of treatment in symptomatic AVM in patients with expectations of future fertility. There have been few cases reported with successful medical management.
        Case summary- A 29 years patient , P1L1A1 presented with complaints of bleeding per vaginum for the last 10 days. She had a history of MTP pills taken by herself 6weeks back . On p/v examination, bleeding was minimal. USG was done s/o uterine AVM, Hb was 8 gm%, beta HCG was 0.256 Miu/ml. She was started on Tab. ovral -L. Her bleeding stopped but later she again presented to AIIMS emergency with complaints of profuse vaginal bleeding for 1 day and features of shock. Her Hb was 4.5 gm%. She was managed conservatively with tranexamic acid, blood transfusion. CECT pelvis done s/o few small tortuous arterial branches, mostly from right artery in anterior uterine wall. She was planned for uterine artery embolization, however she was put on ovral- L for continuous 3 cycles after which she had no complaints of vaginal bleeding.
        Conclusion- surgery is the preferred for treatment of AVM but it can also managed medically.

        Speaker: Neetu Kumari
      • 16:25
        A case of huge bilateral ovarian tumor in pregnnancy 10m

        DEPARTMENT OF OBSTETRICS AND GYNAECOLOGY, AIIMS RAIPUR
        “A case of huge bilateral ovarian tumor in pregnnancy”
        Objective- Management of ovarian tumor in 2nd trimester of pregnancy
        Background- The incidence of ovarian tumor in pregnancy is 1 in 2,000. The incidence of germ cell tumors (dermoid) is increased two fold during pregnancy. Malignant ovarian tumor is extremely rare during pregnancy.
        Case- 32 years, G2P1L1 at 22 weeks period of gestation with previous one cesarean section came to AIIMS obstetrics OPD with ultrasonography suggestive of ovarian cyst with hypothyroidism and was admitted for further evaluation and management. Ultrasonography –abdomen and pelvis was done with features suggestive of dermoid cyst, with tumor markers marginally raised. Preoperative workup was done and patient underwent laprotomy with bilateral oophorectomy under general anesthesia. Intraoperative period period was uneventful. Postoperative period was managed with uterine relaxants and antibiotics. Rest intranatal period was uneventful and patient underwent elective cesarean section at term.
        Outcome-Bilateral ovarian cyst, both ovaries not seen separately. Right side 10 x 8 cm , multilobulated, bosselated, cyst with intact capsule and left side 10 x 8 cm , multilobulated, bosselated, predominantly cystic with some solid areas with intact capsule.
        Conclusion- Ovarian tumors are common in pregnancy and if operative management is required then is best managed in 2 nd trimester.

        Speaker: Dr Purnima singh (postgraduate student)
      • 16:35
        : Recurrent spontaneous hemoperitoneum in endometriosis: Management and Challenges during the COVID-19 pandemic 10m

        Introduction:

        Spontaneous hemoperitoneum in endometriosis is rare. We present here the case of a nulliparous woman, who presented with recurrent spontaneous hemoperitoneum, and discuss the management and challenges faced during the COVID-19 pandemic

        Case:

        A 28 year old nulliparous woman was referred with abdominal distension and pain. Her last menstrual period was 20 days back. She had been evaluated earlier for primary subfertility. Diagnostic hystero-laparoscopy had been performed in 2015, where frozen pelvis was documented. Subsequently, she underwent 2 emergency laparoscopic procedures for hemoperitoneum, and histopathology of the right ovarian cystectomy specimen revealed ruptured corpus luteum. She had received a course of empirical antitubercular therapy. Paracentesis had been performed 5 times previously.

        Result:

        Upon presentation, her vitals were stable and pallor was present. There was mild abdominal distension. Ultrasonography revealed significant haemoperitoneum, and MRI confirmed endometriosis. Her hemoglobin was 6.8g%, urine pregnancy test was negative and coagulation profile was normal. She received 1 unit of packed cell transfusion. In view of COVID-19 pandemic and stoppage of elective laparoscopic surgeries, imaging guided pig tail catheter insertion and drainage was performed. Around 3.7 litres of haemorrhagic fluid was drained. Tubercular and bleeding disorder workup was negative. She was started on continuous OCPs and at 2 months follow up, she was asymptomatic with minimal ascites

        Discussion:

        MRI has greater specificity in the diagnosis of endometriosis. Hemoperitoneum predisposes to deep infiltrating endometriosis. During the COVID-19 pandemic with stoppage of elective laparoscopic surgeries, alternative methods of management have to be adopted

        Speaker: Dr Aditya Pati
      • 16:45
        “SCARY ROPE AT THE EDGE” SUCCESSFULLY HANDLED – THE VELAMENTOUS PLACENTAL CORD INSERTION. 10m

        INTRODUCTION
        Velamentous cord insertion is a complication of pregnancy, incidence being 0.1% - 1.8% where the umbilical cord is inserted in the fetal membranes. In normal pregnancies, umbilical cord inserts into the middle of placental mass and is completely encased by the amniotic sac. The vessels hence normally protected by Wharton's jelly, which prevents rupture during pregnancy and labor. We report a case of incidentally diagnosed velamentous cord insertion.
        CASE REPORT
        A 23 yrs Primigravida with 38 weeks of gestation came to labor room in spontaneous labor. On examination uterus term size, vertex presentation with moderate contractions and fetal heart of 144/min. On vaginal examination, cervix was 4 cm dilated, 40% effaced, station at -1 with intact membranes. She was being monitored and amniotomy was done.After amniotomy,there were persistant decelerations in the fetal heart. As the patient was remote for vaginal delivery (cervix 6 cm dilated) in view of same she was taken for LSCS. On preoperative findings,there was velamentous insertion of placental cord in the membranes,around 6 cm of cord traversing through the membranes and some part of vessels were lying in the lower uterine segment although unruptured. Postoperative period was uneventful. Mother and baby discharged on 5th day.
        CONCLUSION-
        We demonstrated that how careful monitoring of even low risk women is important to avoid the mishap like sudden fetal death. Antenatal sonographic evaluation of placental cord abnormalities should be done in routine practice so that such patients can be strictly monitored during their labour further,improving the perinatal outcome

        Speaker: Dr Smriti Anand (Asst Prof, Obs and Gynae,Pt B.D Sharma PGIMS medical colg Rohtak,Haryana)
      • 16:55
        THROBOCYTOPENIA IN PREGNANCY:- A CASE REPORT 10m

        A 27-years –old –G2P1L1 at 37+4 weeks period of gestation with prev 1 LSCS done 5 years back came from Kabir Nagar, Raipur with c/o pain abdomen since 2 days and decresed fetal movements since 1 day . Patient was on regular ANC follow up in AIIMS OPD.On admission NST done was reactive with category 1 .
        On admission ivestigations were sent suggesting thrombocytopenia with platelet count 29000/Ul with repeat test done same day suggesting counts 39000/uL.Patient previous reports done 1 month back were WNL.
        Peripheral blood smear sent suggested moderate thrombocyptopenia with count 60000/uL,All coagulation profile sent including PT,aPTT, INR were WNL.D-dimer and fibrinogen levels were mildly high. Direct coob testing and ANA was negative RFT was WNL .LFT was WNL except mild increase in levels of AST and ALT

        Speaker: Dr Dr. Pragati TRIGUNAIT (M.S)
      • 17:05
        TAKAYASU'S ARTERITIS IN PREGNANCY: A THERAPEUTIC CONUNDRUM DURING COVID 19 PANDEMIC 10m

        Introduction:


        Takayasu’s arteritis is a rare large vessel arteritis that predominantly involves the aorta and its primary branches affecting women in 80 to 90 percent cases.

        Case:


        A G3P1L0 female at 30 weeks gestational with preeclampsia and anhydramnios with history of IUFD complicated by preeclampsia. Obstetric ultrasonography revealed absent end diastolic flow in umbilical artery suggestive of stage II FGR with anhydramnios. She underwent emergency caesarean section for uncontrolled hypertension delivering a preterm male baby weighing 1300grams with a good APGAR score. In view of differential blood pressure intraoperatively a diagnosis of Takayasu’s Arteritis was thought of and patient was followed up.

        Computed tomography angiography of bilateral renal vessels revealed concentric
        circumferential wall thickening of distal descending thoracic aorta and bilateral proximal renal artery stenosis. The descending thoracic aorta was stenosed over a length of 13 cm with significant renal narrowing and post stenotic dilatation in the aorta and right renal artery.

        Her final diagnosis was takayasu’s arteritis angiographic type 3 with inactive disease by kerr’s score.

        Discussion:


        Treating obstetricians may not be readily familiar with the diagnostic criteria, clinical activity scoring and management in pregnancy. In developing countries like ours diagnosis is often delayed due to the insidious onset of the disease and non-specific early symptoms. The ongoing COVID-19 pandemic further complicates matters due to lockdown and disruptions in routine services.

        Conclusion:


        While the obstetric outcome was good, an early diagnosis helps in tailoring optimal management. The COVID-19 pandemic complicates matters as multidisciplinary approach, referrals and treatment get disrupted. Obstetrician’s motto should be an all round development of maternal health as highlighted in our case.

        Speaker: Dr Bhavya Bhardwaj
      • 17:15
        “SUCCESSFUL CASE OF PRENATALLY DIAGNOSED CONGENITAL PULMONARY AIRWAY MALFORMATION” 10m

        Congenital pulmonary airway malformation (CPAM) is a rare congenital lung mass of the foetus that can present as solid or cystic. The incidence of CPAM lesions is between 1:25,000-1:35,000 live births. This is often diagnosed prenatally with sonography and routinely followed through the term of the pregnancy. CPAM is classified into five different types. CPAM is predominant in males and may affect any lobe of the lung. The lesion is unilobar in 80%-95% of cases and bilateral in fewer. Outcome depends on CVR at presentation, if >1.6 there is 80% chance of developing hydrops.
        This is a case of 24 years old primigravida referred from private hospital at 22week of gestation with her obstetric ultrasound suggestive of congenital airway malformation with marked mediastinal shift with hypoplastic right lungs (type 3 CPAM) and CVR 2.1. Neonatologist and paediatric surgeon opinion were taken and follow up ultrasonography was done. A term alive female baby was delivered by emergency caesarean section and was shifted to NICU due to respiratory distress (grunt with tachypnoea ) and was on CPAP.CT thorax showed a thinned wall cystic lesion in anterior segment of left middle lobe with air fluid level within it and communicating with a mildly dilated bronchiolar airway adjacent to it .Baby was reviewed in paediatric surgery department after 1 month and was advised for conservative management .

        Early diagnosis and management of prenatally diagnosed CPAM can prevent both prenatal and postnatal complication with favourable outcome.

        Speaker: Dr HABUNG YARANG (POSTGRADUATE STUDENT)
      • 17:25
        A RARE CASE OF HERLYN-WERNER-WUNDERLICH SYNDROME/ OHVIRA SYNDROME 10m

        Introduction : Herlyn-Werner -Wunderlich syndrome, known as OHVIRA syndrome(Obstructed Hemivagina and Ipsilateral Renal Anomaly) a rare complex of structural abnormalities of the female genital tract,characterized by triad of Mesonephric duct induced mullerian anomalies. Its incidence has been reported between 0.1% and 3.8%.It usually presents at puberty with pelvic pain. MRI is the modality of choice for the diagnosis of HWW Syndrome.
        Method : A 15 years girl, presented to our department for right lower quadrant abdominal pain without fever, diarrhoea or urinary symptoms. Menarche occurred 5 months back, cycles were regular and last for 3 to 4 days which was associated with severe dysmenorrhoea. Her general physical examination and vitals were within normal limits. USG findings revealed empty right renal fossa. USG complemented by CECT confirmed uterus didelphus, two uterine bodies, two separate cervices with right sided obstructed hemivagina and right renal agenesis. Patient underwent surgery with resection of right uterine horn with hematometra which was not communicating with vagina.
        Intraoperative findings - Two horns of uterus seen. Left side was small with normal tubes and ovaries. Right side was large due to collection and with normal tubes and ovaries.
        Conclusion : The infrequency of HWW syndrome complicates its diagnosis and hence clinicians should consider mullerian duct anomalies among differential diagnosis in young female patients presenting with abdominal symptoms and menstrual complaints.

        Speaker: Ms Dr Priya Baghel (Surname)
    • 17:35 17:45
      Poster Presentation
      • 17:35
        Role of Histopathology for AUB in early detection of Malignancy 10m
        Speaker: Dr Priya Gaur
    • 17:45 19:45
      Competition: Paper Presentation
      • 17:45
        LEUKEMIA IN PREGNANCY MASQUERADING AS HELLP SYNDROME 10m

        BACKGROUND: Cancer is diagnosed in about 0.07% to 0.1% of pregnancies and represents the second most common cause of maternal death after gestation-related vascular complications. Acute myeloid leukemia (AML) accounts for more than two thirds of leukemia during pregnancy and has an incidence of 1 in 75,000 to 100,000. Pregnant women showed the same cancer frequency and localization when compared to nonpregnant ones of the same age. Acute leukemias rank third after breast and cervical cancer in association with pregnancy. Pregnancy often results in a delay in diagnosis. Because the early symptoms are non-specific, the diagnosis is generally made during the second and third trimester. It is estimated that 23% of acute leukemias diagnosed during pregnancy are detected in the first trimester, 37% in the second trimester, and 40% in the third trimester.
        During pregnancy, most leukemias are acute: two-thirds are myeloid and one-third are lymphoblastic. Nonspecific symptoms such as fatigue, weakness, dyspnoea, and pallor are easily attributed to the physiological changes occurring during pregnancy. The physiological changes associated with pregnancy can also mask certain laboratory abnormalities that are typically present in AML, such as anaemia of pregnancy, leucocytosis, or gestational thrombocytopenia. Recurrent infections and bleeding can reflect bone marrow failure.
        AML can cause leukostasis, thrombosis, and coagulopathy, which might be aggravated by gestation.
        CASE DESCRIPTION:
        A 31yr old multigravida, married non-consanguineously was referred to our institute with? coagulopathy with HELLP syndrome APH? Abruption at 38 weeks GA (by dates). She presented with complaints of pedal oedema, ecchymosis all over body and decreased urine output since10 days, following which she had urinary tract infection for which she was treated. She later presented with complaint of bleeding per vagina. On evaluation, her coagulation profile was deranged, raised serum LDH, low platelet count, peripheral smear showing more than 70% blast like cells and was having proteinuria. She was transfused with blood products following which she was found to be in labour and has delivered a term female baby by VBAC. Baby was shifted to NICU in view of grunting. Mother had PPH after delivery, which was managed with massive transfusion protocol and bleeding was controlled. But, she has collapsed suddenly nearly 4 hours after delivery preceding a spike in her blood pressure. She also had hematuria and gum bleeding. CCU intensivist call was done and all resuscitative measures tried but the patient succumbed to death.
        Conclusion: This is probably a case of acute AML type 3, based on her peripheral blood smear showing evidence of anaemia, thrombocytopenia and more than 70% blast like cells, presenting like HELLP syndrome. Death in this case is due to intracranial haemorrhage caused by DIC in leukemia. Early diagnosis and appropriate intervention could have prevented such circumstances.

        Speaker: Dr loukya kodumuri (pg jr)
      • 17:55
        A RARE CASE OF CONGENITAL HYDROCEPHALUS WITH MYELOSCHYSIS !! 10m

        DEPARTMENT OF OBSTETRICS AND GYNAECOLOGY, AIIMS RAIPUR

        ABSTRACT
        Neural tube defect (NTD) is a result of dysfunction in neurulation process between third and fourth week of gestation.Hydrocephalus is a disorder of cerebrospinal fluid physiology resulting in abnormal expansion of the cerebral ventricles and increased intraventricular pressure . Congenital hydrocephalus, most commonly involving aqueduct stenosis, has been linked to genes that regulate brain growth and development. The incidence of a congenital hydrocephalus is 2-3 of 5000 pregnancies.
        Here is a case of 25 year old third gravida with history of previous 2 vaginal deliveries, an intra uterine death at 7 month in 2017 and another pregnancy with neonatal death on day 3 due to meconium aspiration syndrome in 2018 , attended antenatal OPD of AIIMS Raipur at 34 week of pregnancy with her usg at 28 weeks suggestive of gross hydrocephalus with suspected fetal spina bifida at lumbosacral region and polyhydramnious . She delivered a preterm,alive, girl of 2.26kg with gross hydrocephalus and Myeloschysis on 25/1/20 by emergency caesarean section done at 35 weeks in view of 2nd stage arrest of labour .
        Fetus with NTD and Congenital hydrocephalus requires early diagnosis of the anomaly, and plan further management involving multidisciplinary approach comprising of obstetricians, radiologist, neonatologist and paediatric surgeons . The risks and benefits of mode of delivery prior to labor should be discussed.

        Speaker: Dr habung yarang (postgraduate)
      • 18:05
        Obesity rising trend and associated endometrial changes and postoperative complication 10m

        DEPARTMENT OF OBSTETRICS AND GYNAECOLOGY, AIIMS RAIPUR
        “Obesity rising trend and associated endometrial changes and postoperative complications”
        Objective- Management of low grade intraepithelial neoplasia and postoperative wound infection in obese patients with medical comorbidities
        Background- The prevalence of obesity is increasing in India and worldwide. Obesity is a recognized risk factor for endometrial intraepithelial neoplasias(EINs) and endometrial malignancy, and postoperative wound infection and thus, placement of an abdominal incision can be challenging in these patients. Certain medical conditions like hypertension, diabetes mellitus and hypothyroidism can also cause endometrial changes and affect wound healing postoperatively.
        Case- 52 years, P2L2A1, known case of hypertension, diabetes mellitus, hypothyroidism and controlled asthma, with postmenopausal bleeding diagnosed as Endometrial intraepithelial neoplasia-low grade underwent extrafascial hysterectomy on 10/12/2019 under general anesthesia. Intraoperative, there was difficulty due to abdominal obesity. Postoperatively patient developed wound infection and purulent discharge on day 8. Patient was managed conservatively with wound dressing, antibiotics according to wound swab culture and sensitivity report and vigorous management of blood sugars and other medical conditions, and patient underwent secondary resuturing on 29/12/2019.
        Outcome-Patient underwent secondary resuturing on 29/12/2019 after postoperative wound infection following extrafascial hysterectomy on 10/12/2019 for low grade EIN.
        Conclusion- The prevalence of obesity is increasing, obesity with other medical co morbidities (metabolic syndrome) is a known risk factor for EINs and endometrial cancer, and postoperative wound infections, which are also in rising trends, although timely recognition and management can decrease both morbidity and mortality.

        Speaker: Dr Purnima singh (doctor)
      • 18:15
        Sickle cell disease in pregnancy complicated by COVID-19 and preeclampsia- Challenges in management 10m

        Sickle cell disease (SCD) is a complex and life-threatening inherited blood disorder. Pregnancy in SCD is associated with both maternal and fetal complications. A recent meta-analysis showed a strong association between SCD pregnancies and pulmonary complications.
        The COVID-19 infection, caused by the SARS-CoV-2 coronavirus, can lead to an acute respiratory distress syndrome (ARDS) and multiple organ failure. Few reports have been published regarding the COVID-19 and pulmonary manifestations in a pregnant woman with SCD and also about the perinatal outcome.
        A 33 year old woman at 33 weeks of gestation with known case of sickle cell anaemia presented to AIIMS emergency ward with complaints of sudden onset of shortness of breath. Her COVID 19 testing was positive, blood investigations were within normal limits and she was managed with supplemental oxygen and antibiotics. During the hospital stay, she also developed fever and cough. Her repeat COVID 19 testing on 10th day was positive and her blood investigations and chest x-ray were suggestive of features of bilateral COVID pneumonia. She was started on 4 litres/min of supplemental oxygen, inj. LMWH, tab. HCQ and broad spectrum antibiotics. An emergency LSCS was done in view of fetal distress. Postoperatively, patient was managed in HDU and baby was shifted to NICU. Her general condition improved and her symptoms relieved on 17th day and baby was shifted to mother’s side.

        Speaker: Dr Deepthi Leelia Betzy
      • 18:25
        INCIDENCE OF RETINAL CHANGES IN PREGNANT WOMEN DUE TO PREGNANCY INDUCED HYPERTENSION AND ITS CORRELATION WITH PROFILE 10m

        ABSTRACT

        Background

        Pregnancy Induced Hypertension (PIH) is a hypertensive of pregnancy that occurs in absence of other cause of elevated blood pressure 140/90 mmHg or a rise of 30 mmHg of systolic pressure or 15 mmHg of diastolic pressure taken or two occasion after rest 4 hrs apart in combination with generalized edema and/or proteineuria, after 20 weeks of pregnancy when there is significant proteinuria it is termed as preeclampsia.

        Material and methods

        This observational study was conducted of 110 cases over a period of 12 months from March 2018 to February 2019 in Department of Obstetrics of Gynaecology in Kamla Raja Hospital, G.R. Medical College, Gwalior (M.P.). All the patients who fulfilled the diagnostic criteria of PIH admitted in the obstetric ward.

        Results

        The mean age of patients in study is 24.2 years (18-41 years). 63.63% of patients in study have no retinal changes. Retinopathic changes noted in 36.36% out of which grade I, grade II, grade III and grade IV have 11.82%, 8.18%, 10.19% and 5.45% cases respectively. In + proteinuria 10.9% of cases have positive findings, in ++ proteinuria 18.18% cases have positive findings, in +++ 7.27% cases have retinopathy but severity increases with a grade of proteinuria. 40% cases retinopathic changes of mild preeclampsia have positive finding, 36.36% in severe preeclampsia and 23.64% in cases of eclampsia. As overall severity of PIH increases retinopathies in patients increases.

        Conclusion

        Visual symptoms are few in patients with PIH and often absent unless the macula is involved. Sudden onset of headache, which is resistant to routine therapy in these patients, may be the warning symptom before the onset of first convulsion. By repeated fundus examinations at regular intervals one can assess the severity of the disease and also response to treatment instituted.
        Key words: Pregnancy induced hypertension, Proteinuria, Retinopathic changes

        Speaker: Dr Garima Yadav (Department of Obstetrics and Gynaecology, Gajra Raja Medical College, Gwalior)
      • 18:35
        RELATON OF METHOD OF HEAD DELIVERY IN SECOND STAGE CESAREAN TO MATERNO FETAL OUTCOME 10m

        Objective: The aim of this study was to determine the effect of method of head delivery during second stage cesarean on maternal and fetal outcome
        Materials and methods: This retrospective cohort study reviewed women with singleton pregnancies undergoing second stage cesarean over a period of 1.5 years. Details of delivery, maternal complications and neonatal outcome were noted. Fetomaternal complications were analyzed according to methods of head delivery.
        Result: Cesarean rate was 27.8% in our institute of which rate of second stage cesarean was 2.3%. The most common technique used for delivering fetus was patwardhan technique. Compared with other techniques ,blood transfusion was more frequent when push method was applied.Rate of neonatal admission remained same with different methods of head delivery.
        Conclusion: Second stage cesarean is technically challenging and usually accompanied by several maternal and fetal risks. Methods used for head delivery during cesarean has significant effect on maternal outcome.

        Speaker: Dr Deepti Dahiya (MBBS, DNB)
      • 18:45
        Umbilical Cord Circumference: the dark horse in Fetal Weight Estimation 10m

        Introduction: Fetal Weight Estimation remains a critical aspect of modern day obstetrics for monitoring the growth of fetus in-utero, specially in a high-risk setting. The dilemma in clinical decision making stems from the lack of accurate methods for fetal weight estimation, particularly in low and middle income countries.
        Objectives: To compare the diagnostic accuracy of newer methods (Umbilical Cord Thickness) of fetal weight estimation with the conventional methods within limited resources.
        Design: Prospective Cohort Study
        Methods: A total of 190 consenting women in early or latent phase of labour were roped in for the study, and fetal weight was estimated for each, using three different available techniques, viz. Clinical, Conventional Ultrasound and Newer Method, with the help of Johnson's formula, Dare's formula, Hadlock's formula, and Cord Circumferencem regression equation. Mean Percentage Error (MPE) was calculated for each method and a comparative analysis was done.
        Results: The analysis revealed MPE in decreasing order as Dare> Johnson> Cord Circumference > Hadlock. The sensitivity of Cord Circumference method and Hadlock's method was 91.2% and 91.7% respectively. However, both the sensitivity and specificity of Hadlock's method increased drastically when combined with Umbilical Cord method.
        Conclusion: Thus, this study advocates the use of Umbilical Cord Circumference for fetal weight estimation, in conjunction with the conventional methods, specially in high-risk areas, to reduce perinatal mortalities and morbidities, relating to, or resulting from inaccurate fetal weight estimation.

        Speaker: Dr Utkarsha Agarwal (MD)
      • 18:55
        Etiological factors for First single early Pregnancy Loss: Are they different from Recurrent Pregnancy Loss? 10m

        Purpose: The recommendations for investigation of pregnancy loss is to test only after 2 or more pregnancy losses. But in practice we find women with single pregnancy loss seeking explanation. The purpose of this study was to determine the identifiable causes and their proportion in women with first early pregnancy loss and to compare with that of women with Recurrent pregnancy los (RPL).
        Methods:This cross-sectional analytical study was undertaken between 2018-2019. Group A included 105 women with first single pregnancy loss and Group B included 105 women with recurrent pregnancy loss. The recommended investigations for etiological factors were done in both groups except karyotyping and thrombophilia screening was done in those with unknown etiology.
        Statistical Analysis: Etiological factors were expressed as proportions and comparison between 2 groups was done by unpaired-t test and Mann Whitney test.
        Results: Sociodemographic factors and Gestational age were similar in both the groups. Significantly more number of women with first single pregnancy loss (58%) had known etiological factors than women with RPL (43%) (p=0.038). Endocrine causes were commonest in both the groups (First pregnancy loss 36% vs RPL 21%; p=0.023). Out of the women with unknown causes, 18% women were positive for thrombophilia in each group and more than 50% of them were APLA Positive.
        Conclusion: Significant proportion of women with single first pregnancy loss have treatable etiological factors like those of RPL. Hence evaluation should be undertaken to achieve optimum outcome during next pregnancy and prevent RPL.

        Speaker: Dr Sonal Garg (JIPMER, Puducherry)
      • 19:05
        Molecular Markers In Endometrial Cancer : Pathogenesis,Prognostication and Practices 10m

        Dualistic classification for endometrial carcinoma by Bokhman is traditionally followed.This yields limited prognostic and predictive information. The breakthrough with TCGA (the Cancer Genome Atlas classification) provided a more reproducible,objective and has given a diverse genomic insight into the heterogeneity of the Endometrial cancer. Methods: This review looks into the practices to incorporate the molecular classification into the traditional classification system.Conclusion:Integerated molecular classification with some limitations enhaces the risk stratification and thus prognosticate endometrial carcinoma.This will help in delivering a more objective and individualised patient care.

        Speaker: Supriya Gupta (First year DNB SS student)
      • 19:15
        A RARE CASE OF MULLERIAN ANOMALY AND ASSOCIATED MULTIPLE SYSTEM ANOMALIES 10m

        Introduction
        Congenital mullerian malformations result from abnormal formation, fusion or reabsorption of the Müllerian ducts during fetal life. The process may be partial or total and can also have associated urinary tract anomalies as there is close embryologic relation exists between the development of the urinary and reproductive organs. Rarely other anomalies of cardiovascular ,vertebral and GI system can be present along with mullerian and renal anomalies.
        Case report
        Here is a rare case of 20 year nulligravida female a known case of moderate aortic stenosis with bicuspid aortic valve with segmentation anomalies in lower vertebra with right sided pelvic kidney and CECT suggestive of complex midline mass (?hydrosalpinx /pyosalpinx) and left ovarian cyst .She had a history of laprotomy outside where they were not able to remove the cyst.After proper preoperative evaluation at AIIMS she underwent laparoscopic evaluation followed by laparotomy and right ovarian endometriotic cyst excision with right salpingectomy in the same sitting. Intra operatively there was a left sided non communicating rudimentary with with right ovarian endometriotic cyst and right sided hydrosalpinx . There was also malrotation of gut and meckel’s diverticulum. Post operatively patient was stable and was discharged on day 5.
        Conclusion-
        Though there are many syndromes reported in literature that involve mullerian anomalies associated with other system involvement this was a rare case.And we need proper evaluation of other systems for any anomalies and multidisciplinary for such cases.
        Dr Pragyan Paramita Pradhan

        Speaker: Dr Pragyan Pragyan (PG)
      • 19:25
        Reliability of International Ovarian Tumor Analysis (IOTA) models in evaluating ovarian tumors at a tertiary care hospital 10m

        Abstract
        Title: Reliability of International Ovarian Tumor Analysis (IOTA) models in evaluating ovarian tumors at a tertiary care hospital

        Authors: Dr Neha Rashmi,1Dr Sweta Singh,1 Dr Jasmina Begum1
        Dr Mukund Namdev Sable2

        1Department of Obstetrics and Gynaecology, AIIMS Bhubaneswar
        2 Department of Pathology, AIIMS Bhubaneswar
        Background: The IOTA (international ovarian tumour analysis) group introduced standardized terms and rules in order to provide consistency in defining morphological features of ovarian masses1. The IOTA ADNEX model predicts the risk of ovarian mass being benign, borderline or malignant. This study aimed to test reliability of these risk prediction models in discriminating benign and malignant cyst.

        Material and methods: Patients diagnosed with ovarian tumour and underwent ultrasound examinations as per IOTA rules before surgery at AIIMS Bhubaneswar from August 2019 to August 2020 were included. Findings were correlated with histopathology.

        Result: Total 50 patients were included in this study. IOTA simple rules were applicable for only 48. For detection of malignancy in cases where IOTA simple rules were applicable the sensitivity - 83.3 %, specificity - 95.45 %, PPV:71.4%, NPV:97.6% Accuracy was 94%. On applying ADNEX model on five malignant cases, three were correctly classified into their categories.

        Conclusion: IOTA simple rules were highly sensitive and specific in predicting ovarian malignancy preoperatively. Standardized terms and rules make it reproducible, easy to learn and use.

        References:1. Timmerman D, Testa AC, Bourne T, Ameye L, Jurkovic D, Van Holsbeke C, et al. Simple ultrasound-based rules for the diagnosis of ovarian cancer. Ultrasound Obstet Gynaecol. 2008;31(6):681-90.

        Speakers: Dr Neha Rashmi (AIIMS Bhubaneswar) , Dr Sweta Singh (AIIMS Bhubaneswar)
      • 19:35
        Favourable Pregnancy Outcome in a Patient with Granulomatosis with Polyangiitis : Case Report 10m

        Abstract
        Objective: To present a case of successful pregnancy outcome in a patient with Granulomatosis with Polyangiitis (GPA).
        Background: GPA, formerly known as Wegener’s Granulomatosis is a rare necrotizing systemic vasculitis, presenting with classical clinical triad of manifestations involving upper and lower airway and Glomerulonephritis. An association of Antineutrophil cytoplasmic antibodies with GPA has been established and are present in most patients with active disease. Pregnancy with GPA is burdened with the risk of possible maternal and fetal complications, further leading to higher morbidity and mortality rate. Due to sparsity of Studies of GPA in pregnancy, management needs to be individualised. Diagnostic workup should include serological markers, radiological and histopathological examination. Cyclophosphamide combined with Prednisolone is the standard induction regimen.
        Case: 22 year, Multigravida at 35 weeks of gestation was referred to our department owing to 1 year diagnosis of GPA. During active phase, the disease manifested as Pneumonia and Acute kidney injury and P-ANCA was positive. She required pulsed Methylprednisolone and Cyclophosphamide followed by oral Prednisolone and Azathioprine for maintenance. The disease was in partial remission at the onset of pregnancy, but had flare up at 34-35 weeks of gestation and she presented with renal dysfunction. Neither the disease nor the treatment adversely affected the pregnancy and she delivered a healthy baby at 37 weeks.
        Conclusion: The unpredictable disease course and complications at unexpected gestation appears to be a major variable to take into account when assessing the risk of pregnancy with GPA. Early diagnosis, monitoring and timely intervention resulted in favourable pregnancy outcome in our patient.

        Speaker: Dr Arpana Verma (MBBS,MS)
    • 19:45 20:05
      Paper Presentation
      • 19:45
        Perinatal Outcomes in Stage II Fetal Growth Restriction 10m

        Abnormal umbilical artery flow with absent or reversed end-diastolic velocity (AREDV) during pregnancy is a strong indicator of placental insufficiency. It may be associated with IUFD, stillbirth, neonatal complications like respiratory distress syndrome, necrotizing enterocolitis, intraventricular haemorrhage, bronchopulmonary dysplasia, perinatal mortality, and long-term neurodevelopmental impairment. When AREDV occurs prenatally, a close follow-up or expeditious delivery should be contemplated.

        We describe 9 cases of high-risk pregnancy with absent end diastolic flow velocity with successful perinatal outcome. Out of nine cases 8 cases presented with fetal growth restriction. 2 cases terminated by LSCS at 30 weeks in view of reversed end diastolic flow velocity delivering very LBW babies which needed NICU admission. Remaining 6 cases delivered by LSCS after 34 weeks in view of stage 2 FGR. All the cases were monitored by serial Doppler study, delivered successfully at desired gestational age which improved the perinatal outcome with varying duration of NICU stay.

        Women with high-risk pregnancies, such as preeclampsia, gestational hypertension and fetal growth restriction, diabetes should be evaluated with umbilical artery Doppler velocimetry to reduce the possibility of perinatal mortality and morbidity. Although AEDF indicates a fetus under vascular stress, this finding alone will include a spectrum of response in the baby, from the well compensated to the irreversibly damaged. Early diagnosis, timely intervention with measures for fetal lung maturity and neuroprotection improves perinatal outcome.

        Speaker: Dr Nibedita Maharana (senior resident)