IntroductionPreeclampsia is a major contributor of maternal and perinatal morbidity and mortality. Uterine artery waveform and biomarkers like pregnancy-associated plasma protein-A (PAPP-A) may reflect the pathophysiology of preeclampsia. Thus, we aim to find out whether abnormal uterine artery pulsatility index (PI) and low serum PAPP-A in the first trimester can predict preeclampsia. MethodologyAntenatal women at 11-13 +6 weeks of gestation visiting All India Institute Of Medical Science (AIIMS) in Raipur were enrolled after informed consent. Uterine artery Doppler was done with the early anomaly scan at 11-13 +6 weeks. Serum levels of PAPP-A were analyzed. The women were followed up at intervals up to delivery. Incidence of preeclampsia and gestational hypertension was noted. ResultsThe incidence of preeclampsia was 12.7%, and that of gestational hypertension was 4.9%. The mean uterine artery PI among those who developed hypertension in pregnancy was 2.007, which was significantly higher than the unaffected group (p=0.01). The first-trimester uterine artery PI as a screening tool showed a sensitivity of 68%, specificity of 52.99%, and detection rate (DR) of 55.63%.The mean PAPP-A MoM of the affected group was 0.67 which was significantly higher than the unaffected group (p<0.001). The first trimester PAPP-A as a screening tool showed a sensitivity of 28%, specificity of 90.6%, and DR of 79.58%. ConclusionBoth the tests were concluded to be good predictors of hypertension in pregnancy. Identification of high-risk factors, screening, and surveillance are of utmost importance in order to predict preeclampsia and initiation of preventive therapy.

Background: Research examining the role of vitamin D deficiency and the development of menstrual disorders in women is of widespread interest. Studies have been published showing that supplementation with high-dose vitamin D can lead to the restoration of the menstrual cycle. We lack adequate information regarding the effect of vitamin D levels on the physiology of menstruation and further on fertility in women of reproductive age due to the contradictory results reported by studies. Objective: To study the association of 25-hydroxy vitamin D with menstrual cycle characteristics including long and short cycle length and cycle irregularity. Materials and Methods: In this cross-sectional study, serum vitamin D levels of 166 women attending an outpatient department with menstrual irregularities after excluding all obvious causes of menstrual disorders (n = 83) between April-June 2019 were measured and were compared with women of similar profiles with complaints other than menstrual irregularities (n = 83). Results: A decreased level of vitamin D was associated with a 13.3 times odds of an irregular cycle (OR (95% CI): 13.30 (5.79-30.60), p < 0.001). 25-hydroxy vitamin D was not associated with age or body mass index. We found a significant difference (p < 0.001) in mean vitamin D levels among the females with irregular cycles vs. regular cycles. Conclusion: Vitamin D plays a role in the physiology of reproduction specific to the menstrual cycle and ovulation. Long-term prospective studies assessing the exact cutoff value and the exact dose of supplementation required are needed. Key words: Menstrual disturbances, Ovulation, Reproductive period, Vitamin D deficiency, Dietary supplements, Polycystic ovarian syndrome.

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The term placenta accreta or placenta accrete syndrome is used to describe a spectrum of an abnormal placental implantation and firm adherence which are classified according to the depth of invasion into the uterus. A 28-year-old elderly primigravida presented AIIMS OPD to for the 1st time at 13+2 weeks of gestation with brownish discharge per vaginum. Ultrasonography done showed 12 weeks single intrauterine pregnancy with subchorionic haemorrhage of 3.7×2.52 cm with placenta being fundoanterior. She underwent myomectomy 2 years back and during her antenatal care in 3rd trimester growth scan at 30+2 weeks of gestation placenta was fundoanterior with loss of retroplacental hypoechoic in the upper margin of placenta at the myomectomy scar site with small extra uterine collection seen measuring 7.6×2.3 cm and hence possibility of placenta accreta was suggestive by the above findings confirmed by MRI. Emergency cesarean section done at 36+6 weeks of gestation for leaking per vaginum. Manual removal of placenta was tried but it failed and soon atonic PPH developed. Seeing no response with uterotonics internal iliac artery ligation was also attempted but failed. Immediate decision for hysterectomy was taken as a life-saving method. On adhesiolysis in the fundal region placental tissue perforating uterine serosa was visible on the surface of uterus, hence diagnosis of placenta percreta was confirmed which was further confirmed on histopathological report. Currently hysterectomy or local resection is preferred over conservative management with methotrexate.

Background: Cervical cancer is the second most common cancer among women in developing countries including India. Human papilloma virus (HPV) infection of the cervix is the most common risk factor for cervical cancer. HPV infection is widespread and occurs soon after becoming sexually active. Lack of hygiene and multiple sexual partners increases the risk of chronic HPV infection. HPV vaccine offers protection against cervical cancer. However the knowledge about HPV and vaccine is very limited among the general public. Knowledge among doctors is essential to provide timely advice to the target population.  This study aims to measure the awareness among female medical students in a medical college in Kerala.Methods: 1st to 4th year female medical students of Amrita School of Medicine were administered an anonymous, validated self-administered pretested questionnaire. Only students who had volunteered and given consent were included in the study. 165 students participated in the study.Results: The overall knowledge about cervical cancer its causation and prevention was good only in about 40%. However 83% had a positive attitude towards HPV vaccine and were willing to take the vaccine.  Only 6% had been vaccinated against HPV.Conclusions: There is a need to emphasize the aetiology and preventive measures of cervical cancer in the curriculum of MBBS students. In-depth knowledge among future doctors is essential for dissemination of knowledge to general public and timely preventive intervention.