No consistent evidence emerged of a strong association between the risk of PCOS and any known gene that is related to insulin signaling and glucose homeostasis. Moreover, recent genome-wide association studies are inconsistent in identifying the associations between PCOS and insulin metabolism genes. Many of the studies reviewed were limited by heterogeneity in the PCOS diagnosis and by not have having a sufficient number of study participants. Further studies are warranted to determine predisposing risk factors which could modify environmental factors and thus reduce the risk of PCOS. Large genome-wide association studies devoted solely to PCOS will be necessary to identify new candidate genes and proteins that are involved in PCOS risk.

Polycystic ovary syndrome (PCOS) is the most common and a complex female endocrine disorder, and is one of the leading cause of female infertility. Here, we aimed to investigate the association of single-nucleotide polymorphism of INS, INSR, IRS1, IRS2, PPAR-G and CAPN10 gene in the pathogenesis of PCOS. A hospital-based, observational case-control study was carried on 169 PCOS and 169 control women in the southern region of India. Genotype was carried out by real-time polymerase chain reaction. A chi-square (χ) test was performed and the genotypes were verified to comply with the Hardy- Weinberg equilibrium. Odds ratio and 95% confidence interval were calculated to assess the relative risk. Comparison of clinical characteristics of women with PCOS and controls reveal an increase in body mass index (BMI), luteinizing hormone / follicle stimulating hormone (LH/FSH) ratio, glucose levels, insulin, testosterone, hirsutism and antral follicular count in PCOS women. The variant rs1801278 (P = 0.002; OR = 2.88; 95% CI = 1.43, 5.80) show an association with PCOS. In the genotypic (P = 0.0002) and allelic models (P = 0.000), significance persisted even after Bonferroni correction. The genotypes of SNPs strongly influence BMI, LH, LH/FSH ratio, ovarian volume and antral follicular count in PCOS women. The study results were suggestive of a positive association between Gly972Arg of IRS1 and PCOS in the south Indian population, while INS, IRS2, PPAR-G and CAPN10 failed to show any association with PCOS in our studied population. Further studies focussing the role of IRS1 are warranted to delineate its implication towards PCOS.

Maheswari, et al.: A Case-controlled Comparative Study on Polycystic Ovary SyndromeThe objective of this study was to evaluate and compare the clinical, biochemical, hormonal and gynaecological aspects of polycystic ovary syndrome at a hospital in South India. The observational, case-controlled study was conducted from April 2011 to January 2014 and recruited 192 polycystic ovary syndrome patients and 205 normal women. Clinical history and biochemical and hormonal analysis were carried out. Correlation was tested between testosterone and other clinical findings. Variables were further analysed using logistic regression with adjusted odds ratio with a 95% confidence interval. About 16% of polycystic ovary syndrome women were obese and 91% reported to have an increased waist/hip ratio. Oligomenorrhea was observed in 74% women with polycystic ovary syndrome. The tested variables revealed that body mass index, waist/hip ratio, hirsutism, testosterone, insulin, ovarian volume and follicular count were elevated in polycystic ovary syndrome patients compared to the control subjects. Increased testosterone levels correlated positively with luteinizing hormone/follicle-stimulating hormone ratio (p=0.023), hirsutism (p=0.001) and antral follicular count (p=0.004) in polycystic ovary syndrome patients in the studied population. Waist/hip ratio could possibly be a better risk indicator than body mass index. Increased testosterone levels, ovarian volume and antral follicular count or combination of these have been considered to be risk factors in developing polycystic ovary syndrome patients.

Objective: To study the efficacy of mifepristone in preinduction cervical ripening in term pregnancy. Study design: This is a prospective observational study, done in a tertiary care hospital. Fifty pregnant women in the study group were given oral mifepristone 200 mg for preinduction cervical ripening (second dose after 24 hours if applicable) and another 50 pregnant women who underwent expectant management were included in the expectant group. The primary objective was to assess the effect of mifepristone on the change in Bishop score. The secondary objective was to assess the induction-delivery interval and the mode of delivery. Results: In this study, the mean modified Bishop score 24 hours after oral mifepristone (single dose) was (7.34 ± 1.533) which was statistically significant compared to the expectant group's Bishop score (4.28 ± 1.179) p <0.001. Similarly, the mean modified Bishop score 48 hours after oral mifepristone (two doses) was 7.50 ± 0.57 which was statistically significant when compared to the expectant group (4.28 ± 1.155) p <0.001. The requirement for further inducing agents has also been significantly less in the study group compared to the expectant group (p <0.001). Twenty-four percent went into spontaneous labor within 24 hours of the first dose of oral mifepristone without the requirement of a prostaglandin E2 (PGE2) gel. Augmentation with oxytocin was required in 60% of the study group and 86% of the expectant group in active labor. The mean duration between the initiation of PGE2 gel induction and delivery was 13.45 ± 4.536 hours in the study group and 20.41 ± 3.896 hours (p <0.001). Spontaneous vaginal delivery was 82% in the study group and 80% in the expectant management group. Conclusion: Oral mifepristone given for preinduction cervical ripening was found to be effective and safe with a reduction in the need for additional prostaglandins and oxytocin and also shorter induction-to-delivery interval with no serious maternal or fetal adverse effects.

Background: To study the role of MRI in diagnosing pregnancy-associated obstetric and gynecological complications. We prospectively studied 48 pregnant and postpartum women, aged between 20 and 45 years, who were referred for MRI between August 2016 and April 2018 with suspected pregnancy-associated obstetric and gynecological complication. MRI findings were confirmed by intra-operative or histological findings. Results: Out of the 48 patients, there were 32 women with suspected placenta accreta, 5 pregnant women with 6 ectopic pregnancies (1 patient had two gestational sacs), 3 with ovarian pathologies, 3 with uterine pathologies, 3 with abruptio placenta, and 2 with miscellaneous pathologies. In our study, there was an accuracy of 81.6% with sensitivity of 100% and specificity of 50%. There was 100% accuracy in predicting abruptio placenta, ovarian, uterine, and miscellaneous pathologies by MRI. There was 83.4% and 75% accuracy in predicting ectopic pregnancy and placenta accreta, respectively, by MRI. Conclusion: MRI is very useful to diagnose pregnancy-associated obstetric and gynecological complications. It will be an important complementary tool to sonography and thereby facilitate better patient management.