Background:The yolk sac is the first extra embryonic structure that becomes sonographically visible within the gestational sac. It provides nutritional, metabolic, endocrine, immunologic, and hematopoietic functions during organogenesis in embryonic life, before placental circulation is established. Spontaneous abortion rates are significantly elevated where the yolk sac volume falls outside the 5 th to 95 th percentile. Abnormal morphological appearance of the yolk sac is also suggestive of serious growth disorders of the fetus. The aim is to find out the predictive value of yolk sac on outcome of the pregnancy and any probable relationship of the yolk sac pattern with the gender of the fetus. Methods: The present study was carried out on fifty patients in their first trimester of pregnancy. Patients were divided into their respective gestational age groups and according to the morphology of the yolk sac. Data were compared using Chi square test. p value less than 0.5 was considered significant. Results: Out of the fifty patients, twenty-nine were having regular yolk sac, eleven were with irregular yolk sac and ten were with hyperechoic yolk sac. There was a significant number of fetal demise in the cases with hyperechoic and irregular yolk sac. Also, there were hardly any live births in the few cases in which the yolk sac was either too small or too big. Conclusions: The present study concludes that along with a yolk sac of a given normal range for its size, it should also be of normal morphology for better prognosis of the pregnancy. Also, the increase in the number of female live births needs further studies as to whether there is any abnormality in the Y chromosome causing morphologically abnormal yolk sac and subsequent fetal demise.

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BACKGROUNDThe grade of dysplasia on cervical pap smears may be indicated by micronucleus (MN) scoring, much like cancers of oral cavity, urinary bladder and esophagus. METHODSThis is a cross sectional study. MN scores of 106 subjects comprising of all major diagnostic categories included in 'The Bethesda system, 2014 for reporting cervical pap smears' were taken. High grade squamous intraepithelial lesion (HSIL) and invasive carcinoma (IC) were further grouped as 'high-risk' and the rest, 'low-risk' to construct Receiver Operating Characteristic (ROC) curve to seek a cut-off delineating the two classes. Analysis of variance was used to determine significance of differences in MN scoring between the various groups. RESULTSDifference of mean MN scores of HSIL (9.4) and IC (10.7) was significant from the low-risk group but not within themselves. A huge difference in MN scores between low grade squamous intraepithelial lesion and HSIL is notable. The difference of mean age was significant between high and low risk groups. ROC curve delivered a cut-off of 5.15 to distinguish between the two categories with 85.7% sensitivity, 97.2% specificity and 93.3% accuracy. CONCLUSIONSSequential and significant increase of MN score from low to high grade dysplasia is established by current study. A cut-off of 5.15 MN score adequately detects HSIL and IC. Despite its performance, MN scoring is time-consuming, labour intensive and strenuous process, which might make it difficult to impose on laboratories and pathologists. HOW TO CITE THIS ARTICLE:Roy P, Mahanta TN, Saha D. Does micronucleus score really indicate dysplasia in cervical pap smears? if so, how far? J. Evid. Based Med.

Background: Understanding of the embryo-endometrium dialogue is still far from being understood. During conventional in vitro fertilization cycles, progesterone elevation on the day of human chorionic gonadotropin administration refers to rising progesterone levels in the absence of either premature or a luteinizing hormone surge. Most research have reported that elevated progesterone had an adverse impact on the endometrial environment of fresh cycles, leading to a decrease in pregnancy rates.Methods: The current study was undertaken at Swagat hospital and research Centre, Bongaigaon, Assam (India). Fifty patients undergoing in vitro fertilization (IVF) were selected for the study. Baseline estimation of follicle stimulating hormone (FSH), luteinizing hormone (LH), anti-Mullerian hormone (AMH), (estrogen) E2 and (transvaginal sonography) TVS was done. The patients were grouped on the basis of their progesterone levels on the day of hCG trigger, with the cutoff for defining premature progesterone rise being (progesterone) P4≥ 3ng/ml. Final oocyte maturation was induced with hCG. Oocyte retrieval was performed 34-36 h after hCG. Two to three embryos of day 3 cleavage stage were transferred under TVS guidance. The parameters obtained from each cycle were recorded. Statistical analysis was performed. Probability (P) value <0.05 was considered statistically significant. A sonographic confirmation of pregnancy was performed 2 weeks after β-hCG positive.Results: On dividing the patients into two groups, based on the cut off of P4 as 3ng/ml, it was observed that the no of cases that conceived was significantly higher in the subjects whose P4 level was less than or equal to 3ng/ml than the subjects whose P4 level was more than 3ng/ml.Conclusions: Elevated P4 i.e. Progesterone level just before trigger is a reflection of endometrial maturity that can cause disparity between endometrial and embryonic ageing and therefore hamper implantation or cause failure in assisted reproductive technology (ART).