Manish R Pandya

Introduction: Iron Isomaltoside 1000 (Fur-IV) is a combination of iron and isomaltoside 1000(carbohydrate) which are strongly bound allowing slow and controlled release thereby reducing risk of free iron toxicity and offers high dose flexibility and administration and convenience. It is shown to be effective in treating iron deficiency anaemia across multiple therapeutic groups and compared to IV iron sucrose, Ferric carboxymaltose, and oral iron. It is effective and well tolerated in treatment of anaemia across different therapeutic areas with favourable safety profile. Aims & Objective: To observe the rise in level of haemoglobin concentration in gynaecological patients suffering from iron deficiency anaemia via single infusion of iron isomaltoside 1000 (Fur-IV). Study Design: A prospective, observational study. Materials and Methods: Total 50 women who were attending OPD or an indoor patient of obstetrics and gynaecology department who were diagnosed with iron deficiency anaemia and confirming to inclusion criteria were enrolled and observed in this study. Written and informed consent were taken from all patients and data were recorded in the case record form. Detailed medical history and iron demand of the patient were taken and calculated before administration of IV Iron Isomaltoside 1000 by our department of OBGY. Data of the patients who were enrolled in the study were recorded including their haemogram report before administration and repeat haemogram at 1 and 2 week after administration. We did the study from May, 2021 to June, 2022 in OBGY department of Scientific Research Institute, Surendranagar, Gujarat, India. Results: There were no serious adverse events (AE) reported. Only 6 patients reported adverse events [mild nausea, vomiting n=2; fetal bradycardia, n=2; pruritus, n=1; giddiness, n=1. Mean change in Hb is evaluated in 50 patients, increased significantly from 8.63 ± 1.18 gm/dl at baseline to 10.74 ± 1.08 gm/dl (difference of 2.11 ± 0.77 gm/dl; p < 0> Conclusion: Iron isomaltoside 1000 (Fur-IV) has demonstrated robust efficacy in patients suffering from Iron deficiency anaemia due to pregnancy. The wide dosing range of Iron isomaltoside allows iron correction in a single visit with minimal risk of anaphylaxis and is thus cost?effective for health?care system.   Keywords: Parenteral iron infusion, Iron isomaltoside 1000 (Fur-IV), Iron deficiency anaemia.

Introduction: Cervical ectopic pregnancy is the implantation of conceptus in the cervical glands and fibrous cervical wall below the level of internal os. It is a rare and potentially life threatening condition associated with a high rate of maternal morbidity and accounts for less than 1% of all ectopic gestation. It may turn into an obstetric emergency, if not detected and treated early due to risk of severe hemorrhage. This entity can be diagnosed at early gestational age with help of ultrasonography and conservative approach of management help to preserve fertility. Case Report: A 32- year female treated for secondary infertility via in-vitro fertilization(IVF) and embryo transfer(ET) with previous three dilation and curettage following previous missed conceptions presented with vaginal bleeding and Transvaginal ultrasonography revealed a cervical ectopic pregnancy of 5 weeks and 3 days with cardiac activity present. She was managed successfully by PGF2 alpha analogue administration preceding dilation and curettage of endocervical canal and cervical packing with hemocoagulase soaked gauze. Complete hemostasis was achieved and discharged after an uneventful hospital stay. Conclusion: Endocervical curettage is one of the minimally invasive management strategy in cervical ectopic pregnancy with cardiac activity and sufficient for full recovery with preservation of reproductive capacity. Our case demonstrates a new strategy combining systemic intramuscular prostaglandin and curettage for treatment of cervical ectopic pregnancy which may provide an efficient and safe alternative to embryocides at early gestational age.   Keywords: Cervical ectopic pregnancy, ART, Transvaginal ultrasonography, PGF2 alpha analogue, Endocervical curettage

Objective: To evaluate efficacy and safety of the FotonaSmooth device in treatment of SUI (stress urinary incontinence) patients after treating them with Er: YAG laser using both objective and patient-reported outcomes. Introduction: Stress urinary incontinence (SUI) is a leakage of urine during moments of physical activity that increases abdominal pressure, such as coughing, sneezing, laughing, or exercise. It is most common seen health problem among women of certain age and it is most common type of urinary incontinence in women. Here, SUI is treated using intravaginal laser therapy by using non ablative Er: YAG (erbium-doped yttrium aluminium garnet) laser with SMOOTH mode technology. Study Design: The 96 parous women with SUI were treated according to IncontiLaseclinical treatmentprotocol by using non-ablative Er: YAG (erbium-doped yttrium aluminium garnet) laser with SMOOTH mode technology at Vcare laser centre state of art centre for cosmetic gynaecology, Indore, Madhya Pradesh. At baseline, at 2 months and at 9 months after treatment patients were clinically examined, answered questionnaires for SUI severity and sexual function assessment. King‘s Health Questionnaire (KHQ); UDI-6 (Urogenital Distress Inventory, Short Form) Questionnaire; 3D Voiding Diary ; Satisfaction Questionnaire (0-3) which was used for assessment of relief of symptoms (complaints) and satisfaction. Patients were monitored for side-effects and discomfort during treatment period and follow-up period. Results: A total of 96 patients suffering from mild-to-moderate stress urinary incontinence underwent treatment with an Er:YAG (2940 nm) laser in non-ablative fractional mode, which requires 2-3 sessions with one month interval (Out of 96 patients- 96 patients completed the first session; 72 patients completed two sessions and 30 patients completed three sessions). Out of which 75% patients were very satisfied with the treatment and outcome. The Enrolment of study participants was started in September 2017 and completed in April 2019. Conclusion: The non-ablative Er: YAG laser therapy improves the impact of SUI symptoms in parous women significantly better than placebo by improving the quality of life and sexual function; it also provides a promising minimally invasive safe treatment for stress urinary incontinence (SUI) confirmed by the preliminary results.   Keywords: Erbium-YAG laser, Intravaginal laser therapy, Non-ablative smooth mode, Stress urinary incontinence, Neocollagenesis, Sexual dysfunction

Dextrocardia is a clinical condition in which heart is located on the right side of the chest cavity. Dextroversion is a result of early interruption of normal embryological development and therefore, rarely occurs without other cardiac and noncardiac anomalies. Isolated dextrocardia is a benign condition. It can often be associated with other congenital anomalies which can lead to failure to thrive, breathing difficulties, recurrent infections in new borns and neonates. It presents in situs solitus and situs inversus. Among them Dextrocardia with situs solitus is very rare. We are here presenting a case of dextrocardia with situs solitus.   Keywords: Dextrocardia, Situs solitus, Situs inversus, Dextroversion.

Introduction: Clomiphene citrate has been traditionally used as the drug of the choice for treatment of women with anovulatory infertility. In the last decade, an aromatase inhibitor, letrozole has emerged as an alternative ovulation induction agent among anovulatory women with polycystic ovarian syndrome. Letrozole has a definitive role in anovulatory women who have not responded to the clomiphene citrate therapy is confirmed by literatures. Anovulatory dysfunction is a common problem and is responsible for about 40% of female infertility and among causes; PCOS (polycystic ovarian syndrome) is the leading cause. Clomiphene citrate is considered as the drug of choice for the first line treatment of anovulatory dysfunction for a variety of reasons. Clomiphene citrate has some side effects like multi-follicular development and cyst formation and resistance of clomiphene are areas of concern and desire for an effective alternative persists. An aromatase inhibitor, letrozole, was introduced into infertility practice in the year 2000 and is regarded as a second line option, particularly in women with clomiphene resistance, and it has found acceptance in various clinical situations and the indications for use have expanded., Aim & Objective: To compare the efficacy of letrozole and clomiphene citrate (CC) for ovulation induction in infertile women. Materials and Methods: The study included 100 women presented with anovulatory infertility. The infertile women were divided into 2 groups of 50: Group A received 100 mg Clomiphene Citrate from day 3 to day 5 and continue up to 5 consecutive days of menstrual cycle, Estradiol Valerate 4 mg on the 12th day of menstruation until 16th day of menstruation; Group B treated by 5 mg Letrozole from day 3 to day 5 of the menstruation and continue up to 5 consecutive days as Group A, Estradiol Valerate 4 mg on the 12th day of menstruation until 16th day of menstruation given to Group B, with visits to determine ovulation and pregnancy, followed by tracking of pregnancies. Participants were of 20 to 39 years age, had normal uterine cavity and had a male partner with a sperm concentration of at least 14 million per millilitre; and during the study the women and their partners agreed to have regular intercourse with the intent of conception. The live birth during the treatment period was the primary outcome. Results: Women who received letrozole had more cumulative live births than those women who had received clomiphene citrate (36 out of 50 [72%] vs. 28 out of 50 [56%]), without significant differences in overall congenital anomalies, there were no congenital anomalies. With letrozole as compared to clomiphene the cumulative ovulation rate was higher. Higher incidence of hot flushes was associated with a clomiphene, and letrozole was associated with fatigue and dizziness. Rates of other adverse effects were almost similar among these 2 groups. A significant difference in the follicular and endometrial development was evident among these 2 groups. Conclusion: Compare to clomiphene, an aromatase inhibitor, letrozole was associated with higher live-birth and ovulation rates among infertile women. The results of the study demonstrated letrozole is superior to clomiphene citrate in the maintenance of endometrial thickness. Keywords: Clomiphene citrate, Letrozole, Infertility, Polycystic ovarian syndrome (PCOS), Anovulation, Pregnancy rate.

Background: One of the most frequent causes of neonatal mortality or NICU admission of neonates especially in premature infants is Neonatal Respiratory Distress Syndrome (NRDS). Antenatal steroids are the most important and widely utilized interventions for improvement of neonatal outcomes like reducing incidence of respiratory distress syndrome (RDS), reducing neonatal NICU (neonatal intensive care unit) admission rates and also improve outcomes of pre-term infants. Antenatal steroids (ANS) like betamethasone 12 mg are given at 24 hourly IM at 28-34 weeks of gestation to mother. For administration of corticosteroids at less than 24 weeks of gestational age decision should be made at a senior level by taking all clinical aspects into consideration. Objective: To observe the effect of Betamethasone administration IM in pregnant women at risk of preterm delivery and fetal outcomes in terms of development of Respiratory Distress Syndrome (RDS) and Neonatal Intensive Care Unit (NICU) admission rate by giving it between 28 to 34 weeks of gestation. Introduction: Antenatal corticosteroids (betamethasone) play an important role for prevention of respiratory distress syndrome and reducing NICU admission rate of new borns and also reduce neonatal mortality and morbidity but benefits related to the time between administration of corticosteroid and delivery needed to be explored. Benefits of the injection betamethasone administration IM 12 mg between 24 hours and seven days on pre-term delivery has been established. Methods: This was prospective study conducted in private setup from November 2020 to March 2021 in Scientific Research Institute, Surendranagar, Gujarat, India. Study comprised of 100 women with single tone pregnancies (28 – 36 weeks gestational age) in age group of 19 – 33 years not in labour, but at risk for pre-term delivery based on fetal or maternal indications. These pregnant women were treated with two doses of 12 mg Betamethasone Intramuscularly apart of 24 hourly for maturation of fetal lungs. Conclusion: Antenatal corticosteroids like betamethasone have a significant benefit on neonatal outcome even if used after 34 weeks of pregnancy. This was given prophylactically to those who are known to have increased risk of pre-term labour. Antenatal steroid like betamethasone 12 mg IM is also of benefit to reduce neonatal respiratory distress syndrome (NRDS) and NICU admission rates by giving it at 28-34 weeks of gestational age. Keywords: Betamethasone injection IM, Antenatal women, Pre-term labour, Caesarean delivery, Normal delivery, Neonatal morbidity and mortality NICU admission.

Background: Induced labour is one in which pregnancy is terminated artificially, any time after fetal viability is attained by a method that aims to secure vaginal delivery. It is one of the important procedures in obstetrics. The key factor for a successful induction is the cervical status, consistency and dilatation which is determined by the Bishop’s score. Prostaglandins are more effective in cases of unfavourable cervix or in the pregnancies remote from the term. Misoprostol, a prostaglandin E1 analogue is relatively inexpensive, can be easily stored at room temperature and has fewer systemic adverse effects. 1 It has rapid absorption both orally and vaginally. Objective: To determine the efficacy and safety of vaginally administered misoprostol for third trimester cervical ripening or induction of labour in a study conducted on 100 patients in Mahaveer Hospital, Scientific Research Institute, Surendranagar, Gujarat. Materials and Methods: This was prospective study conducted in private setup from October 2020 to February 2021. Study population comprised of 100 subsequent pregnant women who required induction of labour were recruited after applying inclusion and exclusion criteria. The progress of labour was charted on the partograph. The mean induction delivery interval, mode of delivery, maternal and neonatal outcome and complications were observed. Keywords: Induction of labour, Misoprostol, Vaginal route, Oxytocin.

Corona virus disease also known as Covid -19 pandemic has represented major impact to health system and societies world-wide. There is no particular high risk seen among mother and fetus. In addition to these aspects specifically to Covid -19 and gestation that should be known by specialist in order to correctly diagnose disease, classify severity, distinguish obstetric complications with specific signs of Covid -19 and for taking most appropriate management decision. The pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has exposed vulnerable populations to global health crisis. Mother and fetuses are particularly susceptible to poor outcome. There are very limited data how SARS-CoV-2 behaves in pregnant women & their infants. We pearly reviewed 52 gravida infected with covid-19 pneumonia. Out of which 25 symptomatic patients admitted to our hospital while 27 asymptomatic but Covid positive patients care taken on OPD basis followed by home quarantine for 14 days. Aims & Objectives: 1) To summarize the clinical features of Covid-19 in pregnancy; 2) Any intervention helps for better maternal and perinatal outcome. 3) Safety profile of Remdesivir in third trimester of pregnancy with Covid-19 pneumonia. Materials and Methods: This was a single-centre; meta-analysis performed at Sunshine global hospital Vadodara Gujarat designated hospitals for pregnancy with COVID-19 in the epicentre of the SARS-CoV-2 outbreak and medical consultation/collaboration with Scientific Research Institute, Surendranagar, Gujarat. We included pregnant women with COVID-19 from inpatient & outpatient department. Keywords: Pregnant women, Fetus, RTPCR, D-Dimer, CRP, Remdesivir, Covid -19.

A case of fetus papyraceous (Fetus Compressus) found at delivery or Earlier by ultrasound examination of fetus describing dead fetus which is flattened, mummified and compressed between membranes of living fetus and uterine wall. It may occur in both varieties of twins, but more common in monozygotic twins.1 This is the state which occurs if one of fetuses dies early. Fetus Papyraceous is a rare condition an associated with obstetric complications. Searching for a Fetus Papyraceous should be a routine part of placental examination. Keywords: Fetus Papyraceous, Fetus Compressus, Multiple Pregnancy, Intrauterine Death.

Maternal morbidity & mortality has been a major World Health Organization concern over the years, especially in developing countries like India. Uterine Rupture during pregnancy is a rare situation. The diagnosis is not always obvious & morbidity & maternal & fetal mortality is still high. Early clinical diagnosis is paramount to maternal survival. This paper reports uterine rupture with severe hypovolemic shock managed at Sunshine Global Hospital Manjalpur, Vadodara. This is an Exceptional case that we observe for the first time.

Ovarian cysts are sacs containing fluid or semisolid material that develop in or on the surface of an ovary. 1 Ovarian cysts can develop at any time in a female’s life from infancy to puberty to menopause, including during pregnancy Method: Inj. Placentrex 1Amp I/M were given to the patient alternate day for 10 days along with Tab Nimesulide 100mg + Serratiopeptidase 10mg twice a day after meal. Results: 95% patients were cured after the 1st course. (Another 5% patients were given another medicine) Conclusion: Inj.placentrex is very effective in treatment of functional ovarian cyst.

A hydrosalpinx is a condition that occurs when the fallopian tube is blocked and fills with serous or clear fluid near the ovary (distal to the uterus). The blocked tube may become substantially distended giving the tube a characteristic sausage-like or retort-like shape. The condition is often bilateral and the affected tubes may reach several centimeters in diameter. The blocked tubes cause infertility. A fallopian tube filled with blood is a hematosalpinx, and with pus a pyosalpinx. Keywords: Haemetosalpinx, Bicornuate uterus, Contua, Ehsre, Esge.

Robertsonian translocations carry reproductive risks that are dependent on the chromosomes involved and the sex of the carrier Robertsonian translocation (14:15)(q10;q10)4p is rare and account for only 0.6%. We describe a case with rob (14;15) in which the phenotype includes: Generalized hypotonia, respiratory distress, high arch palate, left ear-grooves abnormal, prominent nasal bridge, left impatent nasolacrimal duct, dysmorphic face. Chromosome analysis with peripheral blood was performed, while the karyotype was interpreted as 45,XX, der (14;15)(q10;q10)4p.out of two chromosome number 4, one Chromosome 4 has found deleted from &#39;p&#39; arm small arm In wolf-hirschhorn Syndrome. Molecular studies associated with spinal muscular atrophy and progressive muscular dystrophy also had negative findings. We suggest that rob(14;15)(q10;q10)4p could be Related to clinical presentation like this case. Keywords: PGD, reproductive risks, Robertsonian translocation, Chromosomes, Down syndrome, Aneuploidy, Trisomy, Translocation (genetics), Mosaicism, Preimplantation diagnosis.

Craniosynostosis is a condition of one or more of the fibrous sutures in an infant skull prematurely fuses by turning into bone (ossification).1 Premature fusion of cranial sutures may have an effect on cranial shape an less frequently on brain growth.2 There is a changing in the growth pattern of the skull and the skull can’t expand perpendicular to the fused suture, craniosynostosis can lead to abnormal head shape and abnormal facial features and results in increased intracranial pressure leading possibly to visual difficulty, sleeping impairment, eating problem, or impaired mental status with a significant reduction in IQ. Keywords: Preterm labor, IUGR, Hydrocephalus, Fetal anomalies, Increase intracranial pressure.

Congenital left ventricular aneurysm is a rare but potentially lethal condition. We describe a case of isolated congenital left ventricular aneurysm diagnosed at 28 weeks of gestation. In addition to standard imaging, we utilized color-coded transthoracic tissue Doppler techniques to further evaluate the aneurysm postnatally. Keywords: Fetal echocardiography, Ventricular aneurysm, Congenital heart disease, Prenatal ultrasound.

Fetal hydrothorax were diagnosed during ultrasound examination in asymptomatic women in the second trimester of pregnanancy.1 Fetal hydrothorax is a condition in which fluid accumulates in the fetal chest, in the space between the lungs and the chest wall (known as the pleural space). This fluid may also be referred to as “pleural effusion.” Fetal hydrothorax usually develops when there are leaky or obstructed veins or lymphatic channels. occasionally, the fluid leakage may result from a mass (such as a lung mass), infection or chromosome problem, but in many instances no specific cause for the leaky fluid may be found. Keywords: Preterm labour, Pulmonary hypoplasia, Congestive hert failure, Fetal hydrothorax, Amniocentesis, Thoracentesis, Down syndrome, Idiopathic neonatal pleural effusion, Nonchylous, Respiratory distress idiopathic neonatal pleural effusion, Nonchylous, Respiratory distress, Bronchopulmonary dysplasia, Induction of labour.

Introduction: Phocomelia is a type of meromelia, in which there is partial agenesis of limb buds. Tetraphocomelia is a severe combination of limb defects in which total or partial agenesis of upper and lower limbs is seen, leading to the proximity of limbs to the trunk of the fetus resembling the flipper of a seal “an aquatic animal”.1 Keyword: Tetraphocomeia, Thalidornide syndrome, phocomelia, Limbs defects, Teratogenic agents, Hydroamniosis, Genetic inheritance.

Leiomyomas are the most common benign tumor of the uterus and affect 40 % to 50% of women older than 35yrs of age. Usually they are asymptomatic(70% to 80%).approximately 5% of leiomyoma are of submucosal type being least common but usually are more symptomatic. symptomatic leiomayomas are managed with either medical therapy or surgical management in the form of myomectomy or hysterectomy. multiple submucosal fibroid in pregnancy is a rare and often complicate with a fetal morbidity and mortality.1          Keywords: Fibroids, Miscarriage, Preterm labor, Fetal anomalies, Myomectomy, Hystrectomy, Uterine artery embolization.

Introduction: Palliative care is an approach that improves the quality of life of patients and their families facing the problems associated with life-threatening illness, through prevention and relief of suffering by means of early identification, assessment and treatment of pain, and other problems – physical, psychosocial, and spiritual. Objective: The goal of Moments of Life: Made Possible by Hospice “SAMVEDANA” is to make aware the public about the choices we all have when facing a life-limiting illness and start having benefit of it to reduce their agony. The Aim is “To put life into their days and not just days into their life” - The idea is to help the person have a meaningful life, not just to live somehow till deaths concerned with quality of life. Materials and Methods: This was achieved with a study of 21 patients attended day care hospice during three- month study period. McGill quality of life questionnaire, and a new measure of patient satisfaction with hospice care were used. Result: All patients were getting appropriate psychosocial and spiritual support in addition to the medical / nursing interventions. Palliative care at Hospice Samvedana Affirms: 1.        Life and regards dying as a normal process. 2.        Neither hastens nor postpones death. 3.        Provides relief from pain and other distressing symptoms. 4.        Is a team approach. 5.        Is individual specific – depends on assessment of patient and family needs. 6.        Shifts emphasis from technology to people – “high touch-low tech”. 7.        Is a partnership between the patient & the team. Conclusion: It can be concluded that satisfaction with hospice care was associated with quality of life more than symptoms. Patients can assess their care and can provide valuable information for improving palliative care. Training of medical officers and health care professionals, and sensitization of the public through awareness campaigns are vital to improve the scope and coverage of palliative care. Process of translating palliative care plan into action requires strong leadership, competent management, political support and integration across all levels of care. Keywords: Samvedana, palliative care, hospice, Patient satisfaction, Quality of life.

Accessory fallopian tube is a rare, congenital and developmental mullerian duct anomaly. The documented incidence is around 6-10% in women seeking for infertility treatment. We observed accessory fallopian tube in a patient during routine checking of operative field, ovaries and fallopian tube during caesarean section. Accessory fallopian tube is congenital anomaly which is attached with ampullary part of main fallopian tube. Accessory fallopian tube is common site for pyosalpinx, hydrosalpinx, cystic swelling and torsion which can lead to infertility and other complications. The ovum released by ovary may also captured by accessory fallopian tube which can lead to infertility or ectopic pregnancy. During the embryological development of female urogenital system, development of fallopian tube occurs from cranial un fused portion of mullerian ducts. This duct is derived from mesoderm, the middle layer of germ cell layers in the embryo. Bifurcation of cranial end of mullerian duct results in accessory fallopian tube.   Keywords: Accessory fallopian tube, Mullerian duct, Infertility, Ectopic pregnancy, Pyosalpinx.

Background: Genitourinary Syndrome of Menopause (GSM) is the condition which combines the conditions of vulvovaginal atrophy (VVA) and urinary tract dysfunction which are associated with oestrogen deficiency. GSM is treated using vaginal laser therapy by using non-ablative Er: YAG laser therapy to evaluate the effectiveness and safety of this therapy. The present study was planned to evaluate the safety and objective improvement in symptoms of GSM with Er:yag vaginal / urethral laser treatment in sextual and urinary symptoms of post / peri menopausal women on long term basis. Materials and Methods: A prospective study was conducted at V care laser centre from 2020 on words to till date. Total sample population enrolled was 74 among them 53 completed 1 follow up and 29 had completed 2 follow up. Data were collected before and subsequent 2 follow ups over next 12 months on parameters like dryness, dyspareunia, itching/ burning and lower urinary tract symptoms, data were collected using VLQ (vaginal laxity questionnaire), VHIS (vaginal health index score), FSDS-R (The female sexual distress scale – revised)and Satisfaction questionnaire (0-3) assessed on FSFI. Result: The study showed symptomatic improvement among patients with GSM like no pain or mild pain among 79.31% and 20.39% respectively, no itching (72.41%) at the end of 2 follow up. There was an improvement in vaginal condition (normal – 93.10%) at the end of 2 follow up. Majority of patients reported no sexual distress (82.7%). Conclusion: The non-ablative Er: YAG laser therapy is efficacious and safe modality for treatment of symptoms in cases of genitourinary syndrome of menopause. It also offers a promising, minimally invasive safe treatment for SUI.   Keywords: Genitourinary syndrome of menopause (GSM), Erbium YAG laser, Non­ ablative Smooth mode, Vaginal atrophy.