Aim: To diagnose a rare congenital liver disorder, Dubin-Johnson Syndrome (DJS), compounded by pregnancy and its several differential diagnoses that impede the progress toward diagnosis. Background: Icterus, or jaundice, is defined as the yellow discoloration of the skin, more so of the sclera. While it classifies as one of the most common symptoms in medical literature, it gains added significance when it arrives in congruence to pregnancy. And with that added significance comes the increased risk of maternal and fetal morbidities and mortalities. Case description: Here, we discuss a 19-year-old antenatal patient with refractory hyperbilirubinemia whose etiology eluded our team, until a final shot at it through liver biopsy helped us fetch a surprising diagnosis of DJS. Conclusion:A nonfatal clinical syndrome with very few comorbidities, pregnancy at worst, worsens the icteric component without producing too many adverse fetomaternal outcomes. Clinical significance: The aid of a sound algorithm to rule out other more morbid causes of hepatic dysfunction in pregnancy.

Aim: To understand varied approaches for surgical management of large ovarian cysts to minimize cosmetic, intraoperative, and postoperative complications. Background: In the current era of medical practice, giant ovarian tumors have become a rarity due to increased awareness eventuating in early diagnosis. They cause mechanical pressure symptoms on the gastrointestinal, respiratory, and urinary tract and also cosmetic and postoperative complications related to large unsightly incisions required for surgery. Case description: We describe our experience of five such cases and suggest diverse and successful surgical approaches in the management of voluminous ovarian masses, which include techniques such as laparoscopic excision using a specimen retrieval bag, mini-laparotomy, and laparotomy via a vertical midline or transverse incision with or without intraoperative decompression of the cyst. Clinical significance: Enumerating methods that decrease complications like intraoperative spillage of cyst contents, unsightly scars, and early postoperative recovery in the management of ovarian tumors. Conclusion: Choosing the best route for accessing the cyst and then choosing the best possible way for astute management of ovarian tumors.

Aim: Acute abdomen constitutes 5-10% of all emergency department visits and is the leading cause of hospital admissions. The clinical scenario of two patients with the same underlying pathology may look different or similar with the disease entities very distinct. Background: Diagnosis of acute abdomen requires meticulous history taking, a thorough evaluation of symptoms, evaluation, and prudent use of investigations to specify the disease and management which many times could be surgery. Accurate knowledge is essential for appropriate and timely decisions. The clinical presentation included pain in the abdomen (16.6%), pain in the abdomen and vomiting (44.4%), pain in the abdomen in shock (39%), and abdominal tenderness (33.3%). Discussion: Retrospective study conducted in a tertiary care center after ethical committee approval. The term acute abdomen refers to any serious acute intra-abdominal condition accompanied by pain, tenderness, and muscular rigidity, for which emergency surgery should be contemplated. It is often indicative of a clinical course of abdominal symptoms that can range from minutes to hours to weeks and is commonly used synonymously for a condition that requires immediate surgical intervention. Conclusion:Diagnosis of pelvic pain in women can be challenging because many symptoms and signs are insensitive and non-specific. As the first priority, urgent life-threatening conditions (e.g., ectopic pregnancy, appendicitis, and ruptured ovarian cyst) and fertility-threatening conditions (e.g., pelvic inflammatory disease, and ovarian torsion) must be considered. Clinical significance: A good clinical acumen along with diagnostic intervention aids in diagnosing acute abdomen aptly.

Aim: Hysterectomy's role and efficacy for symptomatic uterine fibroids are well-established and undisputed. Before performing a hysterectomy in a large uterus, lowering uterine vascularity can aid in optimizing the surgery, reducing operating time, and, most importantly, minimizing the blood loss during the procedure. Background: Uterine artery embolization (UAE) was introduced for the management of symptomatic uterine fibroids (leiomyomas) in 1995. Uterine artery embolization treatment of fibroids is performed worldwide. Case description: A 40-year-old female with complaints of dysmenorrhea and heavy menstrual bleeding with a palpable 28-week mass arising from the pelvis with severe anemia was treated by performing preoperatively UAE followed by abdominal hysterectomy to minimize the blood loss. Conclusion: This case report encourages offering UAE before abdominal hysterectomy to reduce intraoperative blood loss, thereby enhancing rapid postoperative recovery for large uteri. Clinical significance: Performing UAE before hysterectomy reduces perfusion of myometrium as well as the fibroid, thereby minimizing the blood loss and need for blood transfusions, thus encouraging its use in the management of large fibroids.

Background:The hitherto rising rate of cesarean sections is affecting women's obstetric careers by its inherent operative complications and on the other hand, the fetal complications arising from morbid trials of labor has its own medicolegal repercussions. In this scenario, Robson's Ten Group Classification System (TGCS) provides a comprehensive and conclusive system for classifying indications of cesarean sections and helps to curb down rates of cesarean sections. Methodology: The present study was conducted by retrospective data collection in a tertiary care center from January 2019 to December 2019. The study center is a major teaching hospital in Mumbai, which is also a referral center for all peripheral hospitals as well.Result: The rate of cesarean sections in our institute is 44.24%. The rate of cesarean sections (CS) is undoubtedly high. This is attributable to high-risk women coming into labor, and the condition in which these women come warrants the doctor to proceed for CS directly for maternal and fetal salvage. Conclusion:The major focus to bring down CS rates should be to reduce primary CS rates by encouraging good and ethical trials of labor. Encouraging instrumental vaginal delivery, whenever not contraindicated, also will bring down CS rates. Clinical significance: This study helps us understand the lost art of vaginal delivery and rising rates of poorly indicated cesarean sections and the type of indications for which cesarean sections are performed. It helps us introspect and improvise our clinical judgment on this topic.