INTRODUCTIONSecond trimester termination contributes approximately 10% to 20% of all induced abortions cases and about 65% to 70% of all fatal complications are related to induced abortions. Various agents are used to ripen the cervix and stimulate uterine contractions and induce abortion after 12 weeks, but available data regarding their safety and effectiveness are limited.1,2 Various agents include hypertonic saline, or hyperosmolar urea, injected intra-amniotically; ethacridine lactate administered intraor extra-amniotically; prostaglandin analogues administered parenterally or intra-or extra-amniotically; and oxytocin injected intravenously or intramuscularly. These methods and routes of administration, however, are invasive and likely to be less safe, and the time to complete abortion is longer when compared to the use of methods such as misoprostol alone, combined dinoprostone and misoprostol combined mifepristone and misoprostol.2-5 Second trimester abortion also includes surgical procedure, but it can result in complications like uterine perforation, cervical incompetence, uterine ABSTRACT Background: The addition of dinoprostone gel (PGE2) to standard regimen of second trimester abortion using vaginal misoprostol (PGE1) reduces failure rate and decrease induction abortion time interval. We evaluated the role and efficacy of vaginal dinoprostone gel with vaginal misoprostol in women undergoing second trimester abortion. Objective of present study was to assess the safety and effectiveness of vaginal dinoprostone gel plus vaginal misoprostol for second trimester termination of pregnancy. Methods: This study was a prospective cohort involving 100 women with 12-20 weeks gestation requesting termination of pregnancy. In study group 0.5mg dinoprostone gel applied vaginally followed by 400µg misoprostol every four hourly (max 3 doses) after six hours of dinoprostone gel application. The mean age of the women study was 27.2 years and mean gestational age was 18.9 weeks. The primary effectiveness of the study was the efficacy of the treatment to terminate pregnancy at 20 hrs. Secondary outcomes were induction abortion interval, failure rate, side effects. statistical analysis of study was carried out using chi square test. Results: At 20 hours, the complete abortion rate was 100%. Within 16 hours 98% women aborted without any significant side effects. Mean induction abortion interval was 14.56 hours. Conclusions: Combination of vaginal dinoprostone gel (PGE2) plus misoprostol (PGE1) is effective, safe and alternate method for second trimester pregnancy termination with. In this protocol induction to abortion interval time is less as compared to other methods of second trimester pregnancy termination.

Umbilical vein varix is an uncommon vascular anomaly. The varix may be the initial presentation of an underlying congenital portosystemic shunt adversely affecting the fetus as we demonstrate in this case. To be able to label a varix as an isolated finding necessitates a thorough evaluation of the fetal venous system as well. Serial ultrasound of the fetus can help in detecting changes in the varix, thrombosis, growth restriction, as well as heart failure if there is another underlying venous anomaly. Early postnatal imaging is essential to exclude other associations to optimize the neonatal outcome. The prognosis is good if it is an isolated finding. How to cite this article: Sharma KA, Kour Isher H, Dadhwal V, et al. Lessons from Umbilical Vein Varix. Int J Infertil Fetal Med 2020;11(1):30–32.

OBJECTIVES: Omicron was declared as a variant of concern by WHO on 26 Nov 2021. Omicron is highly transmissible, but the disease severity and morbidity were lesser compared to the Delta variant. However, COVID-19 Vaccine efficacy was reduced for the Omicron variant whereas it was highly efficacious for the Delta variant. Hence, for evidence-based counseling in pregnant patients about expected outcomes depending on their vaccination status, this prospective cohort study was conducted. STUDY DESIGN: This study was conducted in Base Hospital Delhi Cantt, New Delhi, India during the third wave of SARS-CoV-2 i.e. from Jan 2022 to Mar 2022. All COVID-19-positive patients who were admitted for delivery were followed up till discharge from the hospital. The outcomes in terms of severity of COVID-19 infection, period of gestation at the time of delivery, intrapartum/postpartum complications, fetal distress, meconium staining of liquor, the requirement of neonatal intensive care unit admission were documented and data was analyzed to assess clinical severity of the disease in fully/partially vaccinated+unvaccinated women. RESULTS: During the specified period, 22.32% was the positivity rate among the delivered patients. Of 61.78% were fully vaccinated and 24.39% were either not vaccinated or partially vaccinated. The risk of symptomatic COVID-19 illness, the requirement of supportive management, and maternal and neonatal outcomes in both groups were comparable. CONCLUSION: Unvaccinated or partially vaccinated parturient had no increased risk of symptomatic COVID-19 illness or requirement of supportive management in terms of oxygen inhalation or ventilation as compared with fully vaccinated pregnant women. The study also reported comparable maternal and fetal outcomes in vaccinated and unvaccinated/ partially vaccinated pregnant women. Further studies are required to ascertain whether the comparable outcomes were due to the decreased severity of the disease caused by the omicron variant.

Introduction: After the ACOG guideline in 2007 recommending that all women, regardless of age, should be offered aneuploidy screening before 20 weeks of gestation. This protocol in the name of the fetal aneuploidy screening program was slowly introduced in various Indian hospitals. This observational study was performed to analyze population-based trends of prenatal testing (serum screening and invasive testing) for aneuploidy over 3 years (2017)(2018)(2019). Materials and methods: A retrospective single-center study was carried over a period of 3 years (January 2017 to December 2019). This hospital was a tertiary care hospital with fetal medicine unit that had approximately 3,000 annual births. Analysis of data of all pregnant women undergoing prenatal testing before 20 weeks of gestation was collected in the following subheads: (1) aneuploidy screening data, (2) invasive testing data [amniocenteses and chorionic villus samplings (CVSs)], and (3) tertiary care hospital birth statistics from January 2017 to December 2019. Results: Over a period of 3 years, aneuploidy screening was accepted by the target population and at present >85% target population undergo aneuploidy serum screening. Annual numbers of invasive prenatal tests climbed steadily from 2017 to 2019. The proportion of invasive testing performed for abnormal serum screening (ASS) increased steadily from 51% in 2017 to 72% (p < 0.05) in 2019. While the indications abnormal ultrasound finding (AUS) showed a steady decline over the same timeline but an indication of previous baby affected with aneuploidy (PBAA) remained in the same range. By 2019, the most common indications for invasive tests were positive ASS (72%) and AUS abnormality (15%). The diagnostic yield of all invasive tests for a major chromosome abnormality over a 3-year study period was 4.7%. The rate of CVS to amniocentesis rose to 17.5% in 2019 from 4.6% in 2017. Fewer complications of invasive tests were observed as compared to previous studies. Conclusion:The study demonstrates a rise in aneuploidy serum screening and its acceptance in the pregnant population. Abnormal serum screening is the main indication of prenatal invasive testing. This study also adds to the safety profile of invasive testing.

<p>Prenatal screening for chromosomal abnormalities has two components i.e. prenatal screening (maternal serum screening and cell-free fetal DNA screening) and prenatal diagnosis (chorionic villus sampling, amniocentesis, and cordocentesis). Prenatal testing in the past decade is evolving towards non-invasive methods to determine the chromosome abnormality disorders in the fetus without incurring the risk of miscarriage. Conventional tools for prenatal screening included maternal age, maternal serum markers, ultrasound marker (nuchal thickness), and their combinations. With the increased risk of screening test patients were offered diagnostic tests (chorionic villus sampling, amniocentesis, and cordocentesis). After the availability of noninvasive prenatal tests for commercial use in 2011, a great marketing drive is there to establish it as a master tool for prenatal testing. However various society guidelines i.e. ACOG, RCOG, and ISUOG have clearly stated that cell-free fetal DNA based noninvasive prenatal tests is a screening test, not a diagnostic test. In the succeeding paragraph, we will review current trends in the field of cell-free fetal DNA noninvasive prenatal tests and the relevance of invasive testing in the context of noninvasive prenatal tests. Noninvasive prenatal tests does not entirely replace invasive prenatal testing procedures. Positive noninvasive prenatal tests findings must be confirmed by diagnostic tests based on an invasive sample source, mainly chorionic villus sampling or amniocentesis due to false positive and false negative reports of cell-free fetal DNA based tests. Continuing research and development efforts are focused on overriding noninvasive prenatal tests limitations. Recent studies show that procedure-associated risks in the case of prenatal invasive testing are very low as compared to previous studies. Prenatal invasive testing will remain as the backbone of prenatal diagnostic testing until the limitation of noninvasive prenatal tests is overcome.</p>