Derangements in coagulation profile due to on-going anticoagulant medication can complicate the most primitive physiology in a woman, ovulation. Unmonitored anticoagulant therapy can lead to an array of complications, one of which is intraperitoneal haemorrhage secondary to numerous medical and surgical conditions. The resultant haemoperitoneum can cause sudden hypovolemic shock, especially in a patient with compromised cardiovascular status. This report narrates the case of a 30 years old nulliparous female patient on anticoagulant therapy, operated for multiple cardiac defects and developed massive haemoperitoneum as a consequence of ovulation. The patient presented in shock to the Emergency Department with unstable haemodynamic status. A multi-disciplinary approach to the case converged on ruptured functional ovarian cyst as a working diagnosis. Conservative management of haemoperitoneum was decided upon, whereby correcting shock and providing pro-coagulant therapy along with blood products was the main line of management. All efforts failed soon after when the cyst wall ruptured catastrophically, leading to collapse of the general condition of the patient. Surgical approach was undertaken and a ruptured ovarian cyst wall was identified to be the cause. The cyst wall was subsequently repaired electrosurgically and the patient recovered well with an uneventful postoperative period. However, the characteristic feature of this case is the lack of follow-up due to lockdown restrictions of this continuum, the Coronavirus Disease-2019 (COVID-19) pandemic. The management of such cases must be carefully titrated, keeping in mind the risks and benefits of both pro-coagulant and anti-coagulant therapy wherein one can jeopardise the effects of the other.

When a patient is receiving anticoagulant therapy, the rupture of a corpus luteum cyst may go unrecognized in healthy women but becomes clinically relevant as it might exacerbate a hemoperitoneum episode. This report describes the case of a 26-year-old primipara who underwent surgical treatment for a heart defect and later experienced extensive hemoperitoneum. The patient reported to the casualty with symptoms of unstable hemodynamic status such as hypotension 90/60 mmHg and tachycardia 120 beats/minute. A multidisciplinary team decided upon surgical management after stabilizing the coagulation profile and correcting the shock with blood and blood products. The reason was discovered to be a ruptured cyst wall, which was fixed electrosurgically. The patient had a full recovery with no postoperative complications. The most noteworthy aspect of this case was the catastrophic hemoperitoneum caused by improper anticoagulant treatment monitoring. Management of such cases depends on the age of the patient, fertility, and calculating the long-term prognosis of the anticoagulation therapy for the patient.

Labour induction involves helping a woman to start her labour, before labour begins on its own, for a vaginal birth with the aid of artificial methods, such as medications or other medical techniques. Labour induction is done in cases where extending the pregnancy can threaten the mother or her baby's health, and delivery should result in better outcomes than continuing the pregnancy. Currently, nearly 25% of babies are born by labour induction in economically developed countries. It is often necessary in certain situations to induce labour by using ripening techniques that not only soften the cervix but also make it thin and dilated. Mechanical or pharmacological approaches are used for the artificial induction of labour. Because research articles evaluating the safety and efficacy of various ripening techniques of the cervix vary in terms of their findings, it remains uncertain as to which is the best way to induce labour. In light of this, to find out the most popular interventions for ripening of the cervix during labour induction, we performed a review of the literature that compares the use of a Foley catheter and prostaglandins (misoprostol and dinoprostone). Our findings show that using misoprostol orally is much better than using it vaginally. Foley catheter proved to be the least effective induction technique, despite the fact that it offers the lowest risk.

Introduction: Hypertensive disorders of pregnancy (HDP) are a group of obstetric disorders causing profound fetomaternal compromise, leading to adverse obstetric outcomes. High-sensitivity c-reactive protein (hsCRP), an inflammatory marker of systemic inflammation, is elevated in HDP and correlates with the severity of the disease. However, prediction and prevention of HDP and its associated fetomaternal complications remain elusive to most obstetricians. The present study aimed to evaluate the use of hsCRP as a prognostic marker of adverse fetomaternal outcome in HDP. Methods: The study included 132 third-trimester pregnancies with HDP who underwent hsCRP quantification at the time of presentation to the out-patient department and followed up till delivery. HsCRP quantification was done using immunoturbidimetry method. Results: Of the 132 cases studied, 72 had normal hsCRP levels while the remaining 60 had raised hsCRP levels. It was observed that patients with raised hsCRP levels had poorer fetomaternal outcomes at delivery as compared to those with normal hsCRP levels. Conclusion: The obstetric outcomes of patients with HDP worsened with increasing levels of hsCRP, as shown in our study, when compared to normotensive patients. Thus, hsCRP delivers promising results as a prognostic marker of adverse fetomaternal outcomes in patients of HDP.

Aim: Postoperative infections in gynecology are common throughout the surgical field. Infections create a major impact on surgeons as well as on patients. With the appropriate use of antibiotics, the chances of infections reduce immensely and prevent morbidity for the same. This review helps to understand the occurrence, preventable risk factors, and complications of postoperative infections with various gynecology surgeries. Background: The literature reviewed in this narrative article is obtained from various databases such as pubMed, Scopus, and Web of Science using medical subject headings (MeSH) compliant keywords such as surgical site infections, wound abscess, pelvic pathologies, and consultingrelated books. References from year old to new were assessed and relatable information was included. Review results: Studies included reflect the impact of postoperative infections in various surgeries and the timely use of antibiotics in controlling the outcome. Many factors like gender, duration of hospital stay, and co-morbidities also play a significant roles in the outcome. Conclusion:Studies depict the importance of recognizing the symptoms of the patient, and with the use of appropriate investigations, identifying the pathogens involved in postoperative period; eventually timely use of antibiotics in preventing such cases in the future. These steps shall help in reducing the overall burden for doctors, nurses, and on the patient's side as well. Clinical significance: The most common complications of gynecological surgeries include cellulitis, endometritis, and urinary tract infections (UTI). Early diagnosis and timely use of antibiotics to prevent further complications and morbidity in these patients are of utmost importance. Priority should be given to early detection and identification of risk factors associated with postoperative surgeries. Most of the common pathogens involved awareness regarding the use of antibiotics prophylactically and eventually prevention of postoperative infections under various gynecological surgeries.