KeywordsVitamin D · Metabolic syndrome · Postmenopausal women · Insulin resistance · Obesity
The encounter with the rampant novel Corona virus infection has led the healthcare system across the world to update and modify its tools to fight this pandemic. Pregnancy, childbirth and breast feeding are a set of special situations to be dealt in women afflicted with Covid-19. Currently there is no universal consensus on managing the issue of breast feeding with rooming-in of the neonates in women with suspected or confirmed Covid-19. Literature is still evolving with contradictory guidelines from various authorities across the globe. This review intends to analyse the available evidence on managing breast feeding in such women and to derive a practically plausible approach in handling such situations.
Keywords Breast feeding with Covid-19 • Neonatal Covid-19 • Vertical transmission of Covid-19
Fetal growth restriction (FGR) is a failure of fetus to reach its expected biological growth, based on its genetically predetermined potential. Whenever effective fetal weight is less than, 10th percentile or 2 standard deviation of population-specific growth curve, it is considered small for gestational age (SGA). The FGR is associated with poor somatic growth with concomitant changes in placental and cerebral blood flow and/or biochemical markers along with EBW < 3rd percentile. It is an important cause of perinatal mortalities and morbidities. Ultrasound plays a definitive role in diagnosis and its management. This article is aimed to mini review the published guidelines on FGR and SGA and summarize the areas of consensus.
Keywords : FGR · SGA · IUGR · Growth potential
Medical genetics has evolved over a decade, and hence, all investigations are available for clinical practice. Many diseases are diagnosed accurately today because of new investigations. These advanced investigations are affordable, accessible and available in day-to-day practice. Hence, there is a need and it is a time for us to understand these advanced technologies. Karyotyping and rapid aneuploidy tests are basic tests, while chromosomal microarray and next-generation sequencing are advanced technologies. It is time to update the knowledge and utilize them in day-to-day practice. These tests are utilized both in prenatal diagnosis and in some clinical scenarios, which are elaborated in detail. Karyotyping is the basic tool to detect both numerical and structural abnormalities. It is advantageous in that it is accurate with error of 0.001% but has a resolution of up to 5 MB. Rapid aneuploidy detection tests are equally accurate and detect as good as 99%. They are FISH, QF-PCR and MLPA. They have high sensitivity and specificity, and results are available within 3 days of time. Hence, these tests are apt for Indian scenarios, where late detection of anomalies (18–20 weeks) is common. Chromosomal microarray is the hybridization technique which detects aneuploidy of all chromosomes. This is useful for detection of deletion and duplication in chromosomes. This is not available for prenatal diagnosis in India now, whereas this is available for prenatal diagnosis in developed countries. Whole-exome sequencing and whole-genome sequencing are advanced techniques which have been described and discussed at length.
Keywords: Karyotyping · Rapid aneuploidy detection tests · Chromosomal microarray · Whole-exome sequencing · Whole-genome sequencing
Ovarian cancer is the most lethal form of all gynecologic malignancies. The presenting clinical symptoms of ovarian cancer are very vague and often appear late in the course of disease. Hence, most patients are diagnosed at later stages. At present, there is no effective screening of ovarian cancer. Primary prevention could be considered a strategy to decrease the mortality from ovarian cancer, not only in women at high risk but also in those at low risk. Most ‘‘ovarian cancers,’’ and more specifically the high-grade serous carcinoma (HGSC) subtype of ovarian cancer, actually could originate in the fallopian tube. Women who have known BRCA1 or BRCA2 germline mutations should be counseled regarding bilateral salpingo-oophorectomy, immediately after completion of childbearing, as the best strategy for reducing their risk of developing ovarian cancer. If the patient is reluctant, they should be counseled regarding risk-reducing salpingectomy when childbearing is complete followed by oophorectomy in the future. For women at average risk of ovarian cancer, risk-reducing salpingectomy should also be discussed and considered with patients at the time of any abdominal or pelvic surgery, hysterectomy or tubal ligation.
Ovarian cancer, Screening for cancer, Fallopian tube origin, Bilateral salpingo-oophorectomy, Risk reductionThere are many etiological factors responsible for recurrent abortions. However, no explanation can be identified in approximately 40–50 % of women with recurrent miscarriage (RM). Several studies demonstrated that successful pregnancy is dependant on shifting of maternal immune response from (proinflammatory) Th1 toward (anti-inflammatory) Th2 phenotypes. It was suggested that unexplained RM might be due to immunologic factors. Recently, there is improved understanding regarding the role of the different immune cells and proteins that are important at each stage of a normal pregnancy. Various immune-based therapies with variable clinical evidences have been reported in women with RM with variable efficacy. Still there is lack of information about the mode of action and possible adverse effects of the treatment and a reliable marker for patient selection for immunopotentiation. Adequately powered placebo-controlled studies are required to study and treat couples with the so-called idiopathic recurrent miscarriage.
Immunomodulation, Pregnancy, Recurrent pregnancy loss, Immune systemObjective of this article is to appraise diagnostic aspects and treatment modalities in childhood ovarian tumor in background of available evidence. Literature search on Pubmed revealed various aspects of epidemiology, histopathological diagnosis, and treatment of pediatric ovarian tumor. 85 % of childhood tumors are germ cell tumors. The varied histopathological picture in germ cell tumors poses a diagnostic and therapeutic challenge. Immunohistochemistry and newer genetic markers like SALL4 and karyopherin-2 (KPNA2) have been helpful in differentiating ovarian yolk sac tumor from dysgerminoma, teratomas, and other pictures of hepatoid, endometrioid, clear cell carcinomatous, and adenocarcinomatous tissues with varied malignant potential. Before platinum therapy, these tumors were almost fatal in children. Fertility- conserving surgery with bleomycin, etoposide, and cisplatin has dramatically changed the survival rates in these patients. This modality gives cancer cure with healthy offspring to female patients with childhood ovarian tumor. Evidence also supports this protocol resulting in successful pregnancy rates and safety of cytotoxic drugs in children born to these patients.
Bleomycin, Etoposide and cisplatin (BEP), Germ cell tumor (GCT), Survival rate, Childhood ovarian malignancyAnti-Müllerian Hormone (AMH) is critical for physiologic involution of the Mullerian ducts during sexual differentiation
in the male fetus. In women, AMH is a product of the small antral follicles in the ovaries and serves to function as an autocrine and paracrine regulator of follicular maturation. As the size of the residual follicular pool depends on the quantity of
small antral follicles and declines over time, the serum AMH level in women follows a characteristic trajectory: a gradual
decline throughout the reproductive years and a precipitous drop at menopause, becoming undetectable soon after. Thus,
AMH is clinically useful as a screening tool for diminished ovarian reserve (Cui et al. in Fertil Steril 105(02):481–485,
2016). Perturbations in serum AMH are linked with a variety of pathological conditions, for instance, polycystic ovaries
syndrome (PCOS), the pathophysiology likely being the excess follicles in this syndrome which produce increased amounts
of AMH (Dumont et al. in Reprod Biol Endocrinol 13:137, 2015). AMH is also elevated in some ovarian tumors such as
adult granulosa cell tumors, and it can be used as a tumor marker to gauge response to therapy and monitor for recurrence.
Within the domain of assisted reproductive technology, serum AMH assays are widely used to derive prognostic information
such as the chance of successful ovarian stimulation, subsequent embryo quality and even pregnancy rates. Finally, in the
rapidly evolving field of oncofertility, serum AMH holds great promise as a predictor of ovarian reserve after completion
of cancer therapy. Our aim is to put forth an in-depth review of the clinical applications of AMH in contemporary practice.
Uterine niche is one of the emerging complications of caesarean section. With rising caesarean rates, the caesarean-related iatrogenic complications are also on the rise. These include placenta accreta, scar ectopic pregnancy and uterine niche which is a newer entity being described in the recent literature. Uterine niche, also described as uterine isthmocele, caesarean scar defect and diverticulum, is an iatrogenic defect in the myometrium at the site of previous caesarean scar due to defective tissue healing. Patients may have varied symptoms including abnormal uterine bleeding, post-menstrual spotting and infertility, though many women may be asymptomatic and diagnosed incidentally. Diagnosis is made radiologically by transvaginal sonography, saline instillation sonohysterography or magnetic resonance imaging. Occurrence of niche may be prevented by using correct surgical technique during caesarean. Patients may be managed medically; however, subfertility and persistent symptoms may require surgical correction either by hysteroscopic resection or transabdominal or transvaginal repair. This mini-review comprehensively covers the potential risk factors, clinical presentation, diagnosis and management of this increasingly encountered condition due to rising caesarean rates.
Uterine niche , Isthmocele , Caesarean scar defectMullerian malformations are not uncommon. Overall incidence ranges widely between 1 in 200 women and 4 in 100 women
(Chan et al. in Hum Reprod Update 17:761–771, 2011; Grimbizis et al. in Hum Reprod 28:2032–2044, 2013). Other way,
these observations suggest presently an increased number of Mullerian abnormalities are diagnosed with more details, following the use of newer diagnostic modalities. Most classifications that are available have limitations. Diagnosis was based
on imaging studies that had low diagnostic accuracy. It was focused mainly on the anomalies of the uterus. Less is known
about the anomalies of the cervix or the vagina in isolation or in combination with the utero-cervical and vaginal malformations. Improved diagnostic modalities and incorporation of assisted reproductive technology have improved the outcome
further. Therefore, a more expanded classification needs to be introduced with wider criteria for the clinicians. This will
make clinicians’ approach for the management more simple.
The ovarian cancer is one of the frequent cancers among women being diagnosed after cervical and breast cancer. The CA ovary is dreaded because even after successful treatment of the primary malignancy, the disease comes back and becomes resistant to conventional management. The prognosis in ovarian cancer management is mostly unsatisfactory, maybe because of the presence of ovarian cancer stem cells (OCSC). The hypothesis is that OCSC causes the recurrence of the ovarian malignancy. The OCSC can be identified by the presence of different markers and marker combinations. The assumptions are that CD44+, CD24+, CD117+, CD133+ and ALDH1+ could be the markers of ovarian cancer stem cells. The epithelial ovarian malignancy if proved as a stem cell disease, then it changes the entire management scenarios. Maybe, this will be the first step in managing the ovarian malignancy in the future.
Ovarian , Stem cells , Aggressiveness , Cancer , RecurrenceFungal skin infections are on the rise in India, and pregnant women are not immune to it. They are one of the commonest causes of secondary pruritus in pregnancy and can worsen the quality of life. Cutaneous dermatophytic infections have seen a recent emergence as a public health problem in India with increasing incidence as well as failure to appropriately respond to treatment. Vaginal candidiasis may cause obstetric and peri natal complications such as chorioamnionitis, premature rupture of membranes, preterm labor and neonatal candidiasis. Antifungal drugs are commonly prescribed in pregnancy. The common oral antifungals used are fluconazole, ketoconazole, itraconazole, terbinafine and griseofulvin; whereas the common topical antifungals are azoles, ciclopirox oleamine, terbinafine, amongst others. There have been reports of congenital abnormalities in the fetus and spontaneous abortions attributed to oral antifungals. Prescribing antifungal drugs in pregnancy needs careful consideration. In this article, we discuss the safety profile and recommendations regarding the use of these drugs during gestation. We have performed literature search of recent large-scale cohort, case control and meta-analysis studies and presented them in this review. Antifungals such as echinocandins, amphotericin B, flucytosine etc. which are indicated for systemic mycoses are beyond the scope of this article. Finally, we have given authors’ perspective regarding the justifiable use of these antifungals in pregnant women
Pregnancy · Mycoses · Antifungals · Congenital abnormalities · AbortionHPV is responsible for almost all cases of cervical cancer which in turn is one of the common causes of death among female genital malignancies. Cervical cancer being a preventable disease, screening plays a vital role in its reduction. In this era of advanced health care system and technologies this cancer is still in the increasing trend, especially in the Low and Middle Income Countries, which reflects the poor coverage of women for screening. Advances in screening tests and techniques for better and larger coverage of women is the need of the hour globally. Clinicians also need to be aware of the various promising technologies available for screening of cervical cancer precursors, application of which in general practice can be of immense help in cervical cancer reduction.
HPV · Cervical cancer · Screening · Tests · Techniques · AdvancesBehaviour change is the basic foundation in the management of obesity. Such behaviour change is difficult to achieve due to several psycho-social and behavioural barriers that often remain unidentified and unaddressed in a weight management program. This is even more challenging in postpartum and midlife women because of several biopsychosocial factors. The non-availability of psychologists or trained healthcare counsellors further complicates the attainment of behavioural changes. Therefore, clinicians who are often the first point of contact for treating these population groups, are hamstrung by the lack of a multidisciplinary approach for weight reduction. Some of the common psychological, social and behavioural barriers have been identified in this article, and evidence-based techniques such as goal setting, stimulus control, and cognitive restructuring are presented in a step-wise approach, to help clinicians cater to these population groups in a holistic manner.
Behaviour modification · Obesity · Postpartum · Midlife · Psychological interventionPeripartum cardiomyopathy (PPCM) is a rare cause of heart failure (HF) that affects women late in pregnancy or in the early puerperium. There are several definitions for PPCM. While there are numerous potential mechanisms for Peripartum (post-partum) cardiomyopathy, its exact cause remains unknown1, but the etiopathogenesis is likely to be multifactorial. PPCM is uncommon before 36 weeks of pregnancy, and afflicted women generally present during the first month after delivery. PPCM should be differentiated from pre-existing cardiomyopathy, undiagnosed congenital heart disease, pre - existing valvular heart disease, myocardial infarction, pulmonary embolism and diastolic heart failure due to hypertensive heart disease. The principles for treating acute HF caused by PPCM are the same as those for acute HF caused by any other cause with some limitations during pregnancy. Prompt treatment is critical. There is no necessity for an early delivery unless the maternal or foetal health has deteriorated. In women who present with advanced HF with haemodynamic instability, urgent delivery, regardless of gestation, may be considered. Because women with PPCM have a significant chance of relapse in subsequent pregnancies, they need comprehensive contraceptive counselling. In general, the prognosis is good, with more than half of the patients regaining LV function spontaneously within six months of giving birth. Our aim is to put forth an in-depth review of the Peripartum Cardiomyopathy in contemporary practice.
Peripartum cardiomyopathy · Heart failure · LV function · Cardiac MRIBackground Maternal health in India is likely to move towards an obstetric transition, wherein there is sustained reduction of maternal mortality and focus shifts towards improving quality of care. In such a context, reproductive concerns of special populations gain prominence. One such population group is women with disability.
What this review contains This mini-review examines the incremental importance given to people with disabilities and the sparse data available on the topic of reproductive concerns among women with disability. The attitudes of the women with disability towards childbearing and the association between disability and obstetric problems are discussed. The limited available data on specific medical and obstetric problems among women with disability are reviewed.
Conclusions The article calls for all obstetricians to display increased sensitivity and heightened cognizance towards the reproductive concerns among women with disability.
Holistic approach · High risk obstetrics · Maternal medicine · Disability · Rehabilitation · Differently abled · Divyangjan