Background: The current coronavirus disease 2019 (COVID-19) pandemic is one of the most challenging healthcare crises faced globally. Adequate information and understanding of the clinical presentation and impact of the disease on maternal and neonatal outcomes is the key to successfully manage a pregnancy with COVID-19.Objective: The purpose of the present study was to evaluate the clinical presentation of COVID-19 in pregnancy, its course during pregnancy and its effects on maternal and neonatal outcomes.Study design and setting: This study was a retrospective observational study conducted at Tata Main Hospital, Jamshedpur, a tertiary care hospital in Eastern India.Population and study period: All COVID-19-positive (by reverse transcription polymerase chain reaction or rapid antigen test) pregnant women admitted to the hospital from 15 th May 2020 to 15 th November 2020.Results: A total of 132 COVID-19-positive pregnant women were included in the study. Eighty-six women (65.15%) were asymptomatic, 45 women (34.09%) had mild symptoms and one woman had severe disease. Major co-morbidities seen were hypertensive disorders (pre-eclampsia, gestational hypertension and chronic hypertension) in 18 (13.64%) and diabetes (gestational diabetes, diabetes mellitus type 2) in 14 women (10.60%). The rate of preterm delivery was 28.69% (n=35). Caesarean section was done for 78 women (63.93%) and 44 (36.07%) delivered vaginally. Average birth weight reported was 2.59 kilograms. Forty babies (33.06%) were admitted to the neonatal intensive care unit. Two babies (1.65%) tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) within 24 hours of delivery.Conclusion: COVID-19 in pregnancy commonly presents as an asymptomatic or mild disease. It is associated with high rates of preterm births and neonatal admissions to the intensive care unit. Intrauterine and neonatal death rates remain low. Vertical transmission is possible; however, the incidence is low, and the majority of these neonates are asymptomatic.

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Complete hydatidiform mole with co-existing live fetus (CHMF) is a rare and high-risk pregnancy usually seen with ovulation induction protocols. These pregnancies are complicated with vaginal bleeding, pre-eclampsia, miscarriage, preterm delivery, fetal demise and the risk of gestational trophoblastic neoplasia (GTN). Here, we describe a case of CHMF and a second case of monozygotic twins: partial mole with live fetuses. The pregnancies were conceived after clomiphene citrate ovulation induction. Both cases presented with vaginal bleeding and hyperemesis in the early mid-trimester. The diagnosis was based on history, examination, ultrasound findings and high serum beta-human chorionic gonadotropin (βHCG) levels. A CHMF can be differentiated from a singleton partial molar pregnancy with similar ultrasound appearance by amniocentesis and karyotyping of the live fetus, which is a normal diploid. After adequate counseling, both women refused prenatal karyotyping and underwent the termination of pregnancy. The method of termination needs to be carefully decided. Surgical evacuation maybe difficult due to the well-formed fetus in the second trimester, and uterotonic agents can be associated with the risk of trophoblastic embolization and GTN. Termination with misoprostol followed by ultrasound-guided suction evacuation was successfully done in both cases. Histopathology and karyotyping confirmed the diagnosis of CHMF in the first and partial mole in the second case. βHCG normalized within 7 weeks postevacuation in both, with no increased risk of trophoblastic embolization or GTN. More studies are needed on the methods of termination in such pregnancies. Medical termination with misoprostol appears to be a viable option, though the optimal dosage is yet to be defined.

Objective: This study was undertaken to check the feasibility of the vaginal route as the primary route for all hysterectomies, in the absence of uterine prolapse, for benign conditions. Methods: During 2005 to 2007 an effort was made to perform as many hysterectomies vaginally with or without oophorectomy in women with benign or premalignant conditions in the absence of prolapse. Severe endometriosis, immobility of the uterus, uterine size more than 18 weeks and malignancy were excluded. Patients were classified into two groups -Group I -uterine size up to 12 weeks, with no risk factors and Group II -uterine size 12-18 weeks or with confounding factors like, mild to moderate endometriosis, nulliparity or LSCS in the past. The outcome was compared between the two groups and abdominal hysterectomies done for benign conditions. Statistical analysis was done by SE(d) between mean and proportion. Results: A total of 164 cases nondescent vaginal hysterectomies were done. Of these, 92 (56.1%) were in group I and 72 (43.9%) in group II. The operation time in Group II was significantly more than in group I (81.3 minutes with SD of 31.4 s. 62.6 minutes SE(d) between 2 means-7.49). Debulking techniques were required in 58.7% of the cases in group II compared to 2.1% in group I. Both the groups had one conversion each. The peroperative blood loss, pain score, hospital stay and return to normal activity, was comparable in both the groups of vaginal hysterectomy (VH) and significantly superior to those undergoing abdominal hysterectomies for benign conditions.Conclusion: The vaginal approach is possible in most benign conditions requiring hysterectomy and is superior to the abdominal route with respect to recovery and complication rates.

Background: Coronavirus disease 2019 (COVID-19) infection is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a single-stranded ribonucleic acid (RNA) β-coronavirus. Prolonged duration of symptoms, ill health, disability, and need for hospitalisation are all well-known features of severe COVID-19 disease. Objective: To describe the epidemiological, clinical and imaging characteristics of hospitalised patients of COVID-19 who required prolonged oxygen therapy after testing negative for SARS-CoV-2 and attempt to determine the associated factors leading to delayed recovery, failure to wean, and mortality. Material and Method: Prospective observational study from 9th September to 6th November 2020 in a tertiary care COVID hospital of Jharkhand. Included COVID-19-infected patients requiring oxygen to maintain a saturation of ≥95% after testing reverse transcription polymerase chain reaction (RT-PCR) negative. Patients were classified as Group I, those who could be weaned off oxygen, and Group II, those who could not be weaned off oxygen during their stay in the isolation ward. A detailed assessment for outcome in these two groups related to age, gender, presence or absence of co-morbidities, nature of co-morbidities and findings of high-resolution CT (HRCT) thorax was done to ascertain risk factors for failure to wean and adverse outcomes. Results: During the study period, 93 patients suffering from moderate to severe COVID-19 infection, could not be discharged from the hospital and were admitted to the post-COVID isolation ward after testing RT-PCR negative, due to breathlessness and need for oxygen therapy, with a male predominance, M:F ratio of 2.2:1. Of these 93 patients, 51 could be weaned off oxygen in the isolation ward. The mean and median age of patients who could be successfully weaned was 58.5±14.3 years and 60 years respectively, compared to a mean age of 64±12.4 years and a median age of 67 years for patients who could not be weaned off oxygen during the isolation period. Patients aged ≥60 years were at risk for prolonged requirement of oxygen compared to those <50 years of age, relative risk (RR) 1.43 (95%CI 0.9-2, p=0.051). Failure to wean in <50 years was noted in presence of co-morbidities, RR 4 (95%CI 1.5-10.6, p=0.005). Multivariable logistic regression analysis calculated an odds ratio (OR) of 12.22 (95%CI 2.4-61.5, p<0.002) in patients of coronary artery disease (CAD), and 3.34 (95%CI 1.01-10.9, p<0.046) in patients of diabetes, for failure to wean with delayed recovery in patients aged 50 years and more, having multiple co-morbidities. Presence of ≥three comorbid conditions was associated with increased risk of critical care unit (CCU) admissions (RR 2.1, p=0.02), failure to wean (RR 1.79, p<0.006), and death (p=0.02). Elderly male patients (mean age of 81.3±7.2years) with CAD and multiple comorbidities were at a high risk of mortality (p=0.01). Conclusion: Patients ≥50 years of age having ≥three co-morbidities are at increased risk of prolonged hospitalisation and oxygen t...