Obesity is a disease caused by excessive fat storage in the body. It is an energy balance problem. Obesity can prepare the ground for many diseases. Secondary amenorrhea is the condition of not having menstruation for 6 months. In Traditional Chinese Medicine, it is thought to be caused by Qi and blood deficiency. The 43-year-old nurse applied due to obesity, inability to have menstruation, edema and nodules in goiter. TSH was 4.25, T3 2.87, T4 1.07mU/L. The 78.6 kg 150cm tall TA was 100/70 mmHg.Ten sessions of acupuncture were performed. Yin-tan, DU-20,21, LU-9, H-7, PC-6, SI-3, ST-24,25, REN-7,9, KID-3-6, SP -6.9 uterus, zero, jerome, shen-men hunger, kidney, points were pinned with disposable acupuncture needles. The patient, whose edema was resolved in the second session, started to have menstruation in the third session and lost 9kg in total. The patient had regular periods during the 1-year follow-up. TSH fell to 3.18mU/L.

Background: Vulvar hematomas are more frequent in the obstetric population generally as a consequence of episiotomies, precipitated or instrumental deliveries. The most common causes in the general population are accidental trauma or spontaneous rupture of blood vessels. Management in both etiologies depends on size, involvement of adjacent organs, hemodynamic compromise, and the existence of fractures or lacerations that need to be repaired. Edema is a common complication usually resolved with conservative management. Clinical presentation: We present two cases. A traumatic vulvar hematoma in a 22-year-old patient and an obstetric vulvar hematoma in a 30-year-old primigravida which already presented pitting edema prior to delivery. Both cases required surgical drainage due to clinical evolution and poor pain control. Conclusions: The approach can be conservative or surgical depending on several factors but the use of intravenous analgesia is essential for pain management. Although hematomas related with traumatic causes are less frequent than puerperal ones, they can be very dangerous if they are associated with arterial bleeding that leads to hemodynamic instability.

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 follow-up will reduce the maternal and fetal morbidity

A 38-year-old female patient diagnosed as secondary infertility, anosmia, myoma uteri, Hashimoto thyroiditis with the history of many unsuccessful IVF attempts regained her ability of smell, her thyroid antibody levels normalised, her basal hormones, AMH levels, ovarian follicular development and ovulation improved after 6 months of treatment with homeopathy and nutritional supports. In this case report, it is observed that many gynecological problems accompanied by infertility, anosmia and autoimmune problems like Hashimoto’s thyroiditis can be improved with a holistic approach to individual supportive therapies and homeopathy. It is hoped that this case report can be a reference for future studies in this field.

Background: Injectable gonadotropins stimulate multi-follicular recruitment and allows retrieval of multiple oocytes for assisted reproduction. The widespread utilization of gonadotropin releasing hormone agonist (GnRHa) to induce oocyte maturation for oocyte retrieval has nearly eliminated the risk of severe ovarian hyperstimulation syndrome (OHSS), and only a few cases have been reported in the literature. The rarity of severe OHSS may lead to the mistaken conclusion that gonadotropin stimulation can be safely administered with limited monitoring, even in high-risk patients. We present an unusual case of a woman with limited monitoring due to the COVID pandemic who developed severe OHSS before GnRH agonist trigger and oocyte. Case Presentation: A 29-year-old nulliparous woman with polycystic ovarian syndrome (PCOS) initiated ovarian stimulation for oocyte retrieval. She had a robust initial response, and developed worsening abdominal pain, bloating, nausea, vomiting, and decreased appetite before retrieval. GnRH agonist was given to “trigger ovulation and retrieval scheduled due to the low reported incidence of severe OHSS. Symptoms progressed, and on the morning of retrieval, ultrasound demonstrated bilaterally enlarged ovaries >10cm and 48 oocytes were retrieved for a planned cryo-all cycle. She was hospitalized on the day of retrieval for severe OHSS and had two large-volume paracenteses. She was stable and discharged home by day 5, and symptoms markedly improved with the onset of menses. She has an ongoing pregnancy from her first frozen embryo transfer. Conclusion: We add a rare case of severe OHSS with a GnRHa trigger and cryo-all protocol with the onset of symptoms before GnRH agonist administration. Although rare, severe OHSS may still occur with a GnRHa trigger, and caution is needed when an initial robust response is identified. Here we also provide an opportunity to review the important patient risk factors for the development of OHSS and measures to reduce the risk in excessive responders.