Coronavirus disease 2019 (COVID-19) is caused by a novel coronavirus (severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)) which causes severe viral pneumonia rapidly leading to acute respiratory distress syndrome (ARDS). Pregnant women are considered more vulnerable to severe viral respiratory infections owing to the physiological changes in pregnancy. In COVID-19, patient can present with a variety of symptoms of which dyspnoea is one that is also commonly seen in the late stages of pregnancy. The clinical presentation as well as response to therapy is highly variable, and since no conclusive proven treatment is available yet, prevention and symptomatic treatment remains the mainstay of management. Thus, we report a case series of four SARS-CoV-2-positive obstetric patients who presented with severe ARDS in a tertiary care hospital, posing diagnostic and therapeutic challenges to the clinician, and were managed with a holistic multidisciplinary stepwise approach. Through this, an effort has been made to sensitize the attending obstetrician on diverse presentation of COVID-19 disease and to emphasize the importance of prevention, early pick up, and timely optimal management of pneumonia in pregnant females with COVID-19. The clinical presentation of respiratory illness due to SARS-CoV-2 in pregnancy can be mistaken for exaggerated physiological changes of pregnancy leading to delay in seeking medical care. During the current pandemic, high suspicion for COVID-19 should be kept. If found symptomatic, immediate care should be sought in a designated facility and managed accordingly preferably with a multidisciplinary approach.

The coronavirus disease 2019 (COVID-19) pandemic, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), presents an ongoing global threat. Common clinical features reported in early confirmed infections included fever, cough, and myalgias or fatigue. But as testing capacity and case numbers have increased worldwide, gastrointestinal (GI) symptoms such as diarrhoea, nausea/vomiting, abdominal pain, and loss of appetite have been increasingly recognized. Authors present a case series of gastrointestinal symptoms in COVID-19 patients and how they were managed at the hospital. However, correlations between the presence of fecal virus RNA and severity of digestive symptoms, namely, diarrhoea severity could not be established due to unavailability of the test in the hospital setting. Although knowledge about the viability of SARS-CoV-2 is limited, the virus could remain viable in the environment for days, which could lead to faeco-oral transmission. Various studies conducted on COVID-19 patients recommended routine stool sample testing with real-time RT-PCR after the clearance of viral RNA in a patient’s respiratory samples. Strict precautions to prevent transmission should be taken for patients who are in hospital or self-quarantined if their faecal samples test positive. Optimally, testing for COVID-19 should be performed using both respiratory and stool samples, if available.

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Background: The pelvic floor muscles (PFM) play an important role in supporting the pelvic and abdominal organs and controlling urinary and fecal continence, in addition to their role in the sexual function. The objective of this study was to compare pelvic floor muscle strength in primiparous 6 months after delivery and nulliparous women, to evaluate pelvic floor dysfunction (PFD) in these women and to find the association of PFD with pelvic floor muscle strength (PFMS).Methods: A total of 100 women were recruited in the cross-sectional study which included 28 nulliparous and 72 primiparous women 6 months after delivery. The assessment included general physical examination (GPE), POP-Q and assessment of pelvic floor muscle strength by modified oxford score and perineometer.Results: Endurance of PFMS measured by duration of contraction and number of contractions/min was higher in nulliparous. Mean of the duration of contraction was significantly higher in nulliparous group as compared to primipara i.e., 28.61 seconds and 23.9 seconds in nulliparous and primiparous group respectively (p=0.005). Mean of the number of contractions performed in one minute was significantly higher in nulliparous group as compared to primipara i.e., 31.04 and 19.97 in nulliparous and primiparous group respectively (p<0.0001). None of the nulliparous women had any PFD symptoms, while 4.17% of the primiparous patients had PFD in the form of bladder symptoms and 1.39% of them had PFD in the form bowel symptoms. Vaginal squeeze pressure was found to be affected by mode of delivery. It was lowest in instrumental delivery. It was 39.78±13.33 cmH20 in vaginal delivery, 51.42±12.88 cmH2O in Caesarean section and 31.67±14.36 cmH2O in instrumental delivery (p-0.039).Conclusions: Endurance of PFMS measured by duration of contraction and number of contractions/min was higher in nulliparous. Vaginal squeeze pressure was found to be affected by mode of delivery. It was lowest in instrumental delivery.

Fibroids are smooth muscle benign tumors. They arise most commonly from the uterus but may also rise from extra uterine sites like broad ligament. Uterine fibroids are the most common myomas, while uterine cervix and intraligamentary fibroids are statistically less frequent. This case report of Pseudo broad ligament fibroid with extensive cystic degeneration is presented for its rarity and diagnostic challenges as they mimic pelvic adenexal tumors. Following is the case report of a 40 year old, P4L4, postmenopausal female admitted in the department due to a diagnosed solid lesion in the left adnexa. Patient was asymptomatic 3 months back when she noted gradual swelling and distention over the abdomen. On abdomen examination, a generalized mass was palpable with minimal ascites. On ultrasonography, a large heterogenous mass measuring 200X215 mm seen in pelvic region, arising from left adnexa and extending towards abdomen. During laparotomy, left sided fibroid was removed and sent for frozen section analysis. Histopathological reports revealed spindle cells arranged in fascicles and interlacing bundle with focal areas of myxoid degeneration. Huge pseudo-broad ligament leiomyoma with cystic degeneration may present diagnostic difficulties in differentiating ovarian malignancies even on ultrasound and MRI. This differential diagnosis must be considered prior to surgical management.