Background: To discuss a series of complex non-immune fetal anemia cases, including etiology, investigations, workup, diagnosis, and management. Materials and methods: Five complex non-immune cases of fetal anemia seen in our department are presented. Results: Of the five cases presented, all are live births with follow-up least up to 1.5 years of age. They are cases of hereditary spherocytosis, congenital dyserythropoietic anemia, MCDA twins-twin-twin transfusion syndrome (TTTS) post-laser co-twin demise-fetal anemia, placental chorioangioma, and massive fetomaternal hemorrhage. Conclusion: Non-immune causes of fetal anemia can be difficult to diagnose its etiology and hence complex to manage. Repeated intrauterine transfusions may be the only perinatal management. The perinatal morbidity/mortality and preterm delivery rates are increased, and some cases require long-term treatment including regular transfusions. We present our experience of a series of complex non-immune fetal anemia managed in a tertiary unit, review the literature, and suggest appropriate management.

Background: The aim of this study is to compare the accuracy and adequacy of endometrial sampling using pipelle biopsy with dilatation and uterine curettage (D and C) and hysterectomy specimen in the assessment of endometrium in patients of perimenopausal and postmenopausal age.Methods: One hundred fifty patients of perimenopausal and postmenopausal age who attended the Gynecology OPD of KIMS Hospital from June 2012 to May 2014 with complaints of abnormal uterine bleeding or who were found to have abnormally thickened endometrium by ultrasonography were included in the study.Results: Adequate specimen could be obtained through pipelle biopsy in 86.7% of the patients, compared to 76% with adequate sample in case of D and C. Comparing histopathology reports between Pipelle and DandC specimens, the confidence interval was 92.7%, 95% lying in the range between 86.54% to 96.53%. 68 of the 150 patients had undergone hysterectomy for various reasons. Comparing histopathology reports between Pipelle and hysterectomy specimens, the confidence interval was 94.2%; 95% of study population lies within the C.I range of 84.05 %-98.79% while accounting for the whole population, which shows that Pipelle endometrial sampling can be considered to be almost accurate as HPE by hysterectomy specimen. Comparing the difficulty of the procedure, Pipelle biopsy was found to be easier in perimenopausal patients when compared to post-menopausal patients and the difference was statistically significant. Mode of delivery did not seem to affect the ease of Pipelle endometrial sampling as per present observations.Conclusions: Endometrial tissue sampling using Pipelle was found to be as reliable as D and C and hysterectomy specimen on histopathologic examination for the assessment of endometrium in perimenopausal and post-menopausal age group. Pipelle endometrial sampling was found to be yield adequate specimen when compared with D and C.

Background: This is a retrospective study undertaken to analyse the maternal and fetal outcome of varicella infection during pregnancy. Methods: This is a retrospective observational study done in Kerala Institute of Medical Sciences, Trivandrum, a tertiary care hospital in South India. Sixty nine women infected with chickenpox during pregnancy from January 2009 to February 2018 (9 years) were taken for the study. Results: The incidence of chickenpox during pregnancy in our study was 33.7 in 10000 pregnancies. There were no spontaneous miscarriages. The incidence of congenital anomalies was 7.2% and when compared to the overall obstetric population of the nine year study period in which the incidence was 6.5 %, there was no statistical significance (p- 0.99). The incidence of preterm labour was 4.7% and when compared to the overall obstetric population in which the incidence was 15 %, there was a statistically significant less incidence (p- 0.035). The incidence of polyhydramnios was 4.7% and when compared to the overall obstetric population in which the incidence was 1%, there was a statistically significant increased incidence (p - 0.018). The incidence of fetal growth restriction was 13% and when compared to the overall obstetric population in which the incidence was 12.4%, there was no statistically significant difference (p- 0.963) Conclusions: The maternal and fetal complications with chickenpox infection during pregnancy were more when infected in the first trimester. Early treatment, screening and followup will reduce the maternal and fetal morbidity

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Objectives: To investigate the role of antenatal corticosteroids (ACS) on perinatal outcomes in pregnancies complicated by late fetal growth restriction (FGR). Methods: Secondary analysis of a multicentre prospective observational study (TRUFFLE 2 feasibility study) including singleton pregnancies from 32+0 to 36+6 weeks of gestation with FGR. Women who received ACS (cases), were matched with a control who did not receive ACS, based on gestational age at delivery ± 1 week and birth weight ± 100 g. Results: 90 cases were matched with controls. There were 7 cases of ACS which could not be matched to controls and were excluded from comparisons. Cases and controls were similar regarding gestational age at inclusion, EFW and UCR, gestational age at delivery and birth weight (table 1). No significant differences were observed for composite adverse outcome (31% vs. 38%; p = 0.43) or for any individual complication (table 1). Conclusions:The results of our study show no benefit of antenatal corticosteroids for fetal lung maturation in pregnancies complicated by FGR after 32 weeks in a matched control comparison. A randomised controlled trial is needed to assess the effect of ACS in late preterm FGR.Objectives: Describe perinatal outcomes in pregnancies with FGR stage 1 and to evaluate the potential impact of route of delivery. Methods: This was a retrospective cohort in pregnancies with stage 1 FGR, who had an ultrasound Doppler 15 days before delivery, with a confirmed birthweight below the 10 centile and normal or abnormal Doppler parameters, the presence of abnormal Doppler was not considered to define mode of delivery.