International Journal of Reproduction, Contraception, Obstetrics and Gynecology

Uterine perforation in a 27-year-old woman, a rare complication of copper intra-uterine device: a case report

2025-05-30T06:48:01+0530

Uterine perforation by copper intra-uterine device (IUD) though rare presents as a management challenge to the clinician. A 27-year-old woman of African descent presented with missing strings of a copper IUD that was inserted 2 weeks ago. Ultrasonography (USG) showed device outside the uterus. The initially planned laparoscopic removal at a teaching hospital was unsuccessful due to diagnostic challenges. Copper IUD was successfully removed by laparotomy under USG guidance. Copper IUD is a safe and effective method of contraception. Uterine perforation is a rare complication. Early identification, counselling and prompt removal are necessary to avert further complications.

Abnormal uterine bleeding as first symptom of acute promyelocytic leukaemia: a case report and literature review

2025-05-30T06:49:51+0530

Abnormal uterine bleeding is common within gynaecology practice. It affects up to one-third of women during their lifetime. Hematological cancer is a rare form of coagulopathy leading to abnormal uterine bleeding. Uterine bleeding caused by coagulopathy as a complication of acute promyelocytic leukaemia can be fatal. The aim was to document a rare case of acute severe abnormal uterine bleeding as first symptom of haematological cancer (Acute Promyelocytic Leukaemia). She was a 45-year-old Para 2 woman who presented at the emergency room with chief complaint of uterine bleeding of six days duration. She also developed a throbbing headache that suddenly intensified, initially on the left side of her head, radiating to the periorbital area. Assessment of Acute promyelocytic Leukaemia complicated by Subarachnoid haemorrhage was made. She was referred to National Hospital Abuja for further management. Uterine bleeding caused by coagulopathy as a complication of acute promyelocytic leukaemia can be life threatening, hence early diagnosis and treatment is imperative.

Bilateral ovarian mature teratoma with unilateral torsion in a 42 years old female in a low-income country

2025-05-30T06:49:43+0530

Bilateral ovarian mature teratomas are rare. They occur mostly in the reproductive age group women. Serious complications such torsion required prompt surgical intervention. No case so far has been reported in the Haitian literature. We present a case of a 42-years-old female arrived at the Centre Medical Frere after a two-day delay due to limited healthcare access, experiencing acute abdominal pain and vomiting. After clinical and ultrasound examination, we concluded to the diagnosis of ovarian torsion with patient having bilateral ovarian mass which guided us considering different parameters to a total hysterectomy with salpingo-oophorectomy. Histopathology confirmed bilateral mature teratomas with torsion. This case helps bring awareness regarding the importance of regular gynecologic follow-up, along early detection and management especially in resource-limited settings where delayed care can lead to complications.

Spontaneous uterine rupture in a term pregnancy presenting with hemodynamic stability: a case report

2025-05-30T06:46:53+0530

Spontaneous uterine rupture is a rare but life-threatening obstetric emergency, particularly in women without prior labor or trauma but with a history of uterine surgery such as myomectomy. It is even more uncommon in primigravida women presenting with hemodynamic stability, making early diagnosis and management critical. We report the case of a 32-year-old G1P0 woman at term with a past history of open myomectomy performed three years prior. She presented with a two-week history of intermittent sharp left flank pain associated with nausea and an urge to have bowel movement. Despite being hemodynamically stable (BP 128/79 mmHg, pulse 73 bpm), clinical suspicion warranted further investigation. Obstetric ultrasound revealed uterine rupture with intrauterine fetal demise. Emergency exploratory laparotomy was performed under spinal anesthesia. Intraoperative findings revealed a complete fundal uterine rupture with the fetal trunk and lower extremities covered in amniotic membranes freely lying in the peritoneal cavity along with 200 ml of amniotic fluid. The fetal head remained trapped in a uterus contracted to approximately 22 weeks’ size. There was no hemoperitoneum or blood clots. A lower uterine segment incision was made to facilitate extraction; however, full delivery was not possible. To prevent further uterine injury, fetal decapitation was performed. The uterus was subsequently repaired in layers at both the fundal rupture site and the lower uterine incision. Hysterectomy was avoided. The patient and her spouse were later counseled on the high risk of recurrence with future pregnancies and advised against conception, exploring alternative options for parenthood and contraceptive use. This case emphasizes the need for a high index of suspicion for uterine rupture in pregnant women with a prior history of uterine surgery, regardless of parity or hemodynamic presentation. Prompt diagnosis, surgical intervention, and tailored postoperative counseling are crucial in preserving maternal health and guiding future reproductive decisions.

Silent uterine perforation and omental embedding of a Mirena® intrauterine device in a postpartum patient with undiagnosed uterine anomaly: a case report

2025-05-30T06:46:39+0530

Levonorgestrel-releasing intrauterine systems (LNG-IUS) are commonly used for long-acting reversible contraception. While generally safe and effective, they carry a rare but serious risk of uterine perforation, particularly in the presence of risk factors like recent childbirth, breastfeeding or congenital uterine anomalies. We present the case of a 35-year-old, gravida 5 para 3, female who presented with chronic abdominal pain and missing intrauterine device threads ten months after postpartum Mirena® insertion. Transvaginal ultrasound failed to visualise the device. A pelvic X-ray and computed tomography (CT) scan confirmed extrauterine migration, with the intrauterine device (IUD) embedded in the omentum. Laparoscopy revealed a scar on the posterior uterine wall suggestive of silent uterine perforation, and hysteroscopy demonstrated a subseptate uterus. The device was successfully removed laparoscopically. This case emphasises the importance of anatomical screening prior to IUD insertion, the need for post-insertion imaging, and timely investigation of symptoms. It highlights how silent uterine perforation and subsequent delayed diagnosis of IUD-related complications can be avoided through adherence to established clinical guidelines, such as those provided by the Royal College of Obstetricians and Gynaecologists (RCOG) and Faculty of Sexual and Reproductive Healthcare (FSRH) recommendations.

Spontaneous hemoperitoneum due to ruptured myoma vessels in a nulliparous woman

2025-05-30T06:46:54+0530

Spontaneous hemoperitoneum due to ruptured myoma vessels is a rare but potentially life-threatening condition. A 37-year-old nulliparous black West-African woman presented in hypovolemic shock with a tender and distended abdomen. During exploratory laparotomy, a large fundal subserosal myoma with an actively bleeding vein was identified yielding 2.2 l of hemoperitoneum for which myomectomy and peritoneal lavage was done. This case underscores the importance of considering spontaneous rupture of myoma vessels as a differential diagnosis of acute abdomen in women with uterine fibroids. Rapid diagnosis and surgical management are essential to prevent morbidity and mortality.

Struma ovarii with serous cyst adenoma: a rare case report

2025-05-30T06:49:54+0530

Struma ovarii is a rare ovarian teratoma of mono dermal variant constituting 1-4% of all benign teratoma. Any ovarian teratoma is called struma ovarii only when it consists of at least 50% thyroid tissue. Its coexistence is extremely uncommon with serous cystadenoma with only a handful of cases reported till date. Hereby we present a rare case of 36 years old women with hypothyroidism presented to our OPD with pain abdomen for past 3 months and ovarian mass. Clinicoradiologically possibility of an endometrioma was considered. Histopathological examination revealed coexisting double pathologies; of which struma ovarii was an incidental finding. This case is important, not only being rare, but it also highlights the importance of careful and extensive histopathological examination even in a seemingly simple cystic lesion of the ovary to avoid missing concomitant focal pathologies.

The hidden pain of surgical scars: exploring scar endometriosis

2025-05-30T06:49:50+0530

Scar endometriosis is a rare disease and is difficult to diagnose. The symptoms are nonspecific, typically involving pain at the incision site at the time of menstruation. It commonly follows obstetrical and gynaecological surgeries. The diagnosis is frequently made only after excision of the diseases tissue. The case reports of the patients with a troublesome scar after a caesarean section are presented. Surgical excision led to the diagnosis of scar endometriosis. The Pathogenesis, diagnosis and treatment of this somewhat rare condition are discussed.

Quadricuspid aortic valve in pregnancy: a case discussion

2025-05-30T06:49:42+0530

A quadricuspid aortic valve (QAV) is an exceptionally rare congenital heart anomaly first time identified in 1862. This condition involves the presence of four cusps in the aortic valve instead of three, leading to potential complication such as aortic regurgitation. In the reported case 29-year-old pregnant women at 29 weeks gestation presented in OPD for further follow up with no dyspnea on exertion. Electrocardiogram findings were normal and transthoracic echocardiography (TTE) revealed a QAV with three equal sized cusps and one smaller cusp accompanied with mild aortic regurgitation with no other additional anomalies observed. The patient underwent a normal vaginal delivery without any peripartum cardiac complications. While QAV is a rare congenital anomaly it is not uncommon to be associated with aortopathies. This condition makes pregnancy is in high-risk state. Close monitoring especially in second and third trimesters remains of utmost importance. Due to its rarity, the characteristics, natural history, and long-term outcomes of QAV are poorly defined. In general, aortic valve disease during pregnancy can be associated with higher maternal and fetal risks. Pre conceptional counselling is essential to assess and manage high these risks appropriately. For instance patient with significant AVD should be assessed and followed up by multidisciplinary team including cardiologists, obstetricians, cardiothoracic surgeons and anasthesiae both before and throughout pregnancy. In summary, while QAV is a rare congenital anomaly its association with pregnancy necessitates careful monitoring and management to ensure favorable outcomes for both mother and child.

A rare case of true broad ligament fibroid in postmenopausal women: a minimally invasive approach

2025-05-30T06:49:41+0530

Uterine leiomyomas are the most common benign tumors of the female reproductive tract, but broad ligament fibroids are rare, comprising less than 1% of cases. We report a case of a 62-year-old postmenopausal woman presenting with dull abdominal pain and backache. Clinical examination revealed a mobile pelvic mass consistent with a 12-week gravid uterus. Imaging suggested a right adnexal lesion, possibly a complex ovarian cyst or exophytic fibroid, with associated right-sided hydroureteronephrosis. Diagnostic laparoscopy identified a true broad ligament fibroid measuring approximately 6×6 cm. The patient underwent total laparoscopic hysterectomy with bilateral salpingo-oophorectomy and fibroid excision. Histopathology confirmed leiomyoma. Broad ligament fibroids can mimic adnexal masses and pose diagnostic challenges. Laparoscopic excision is a safe and effective treatment in experienced hands.

Postmenopausal dysgerminoma: unveiling a rare ovarian tumour a case report and review of literature

2025-05-30T06:48:18+0530

Ovarian germ cell tumours (OGCTs) account for 2-5% of ovarian malignancies with an annual incidence of 1:100000 and typically occurs in young women and adolescents. A pure ovarian dysgerminoma in a postmenopausal female is a rare phenomenon. We report a case of 48-year-old female postmenopausal since 3 years presented to gynaecology opd with pain lower abdomen. On clinical examination an abdominopelvic mass enlarged to 18-20-week gravid uterus size. All tumour markers were normal except lactate dehydrogenase raised to 1375. On imaging a well-defined large solid cystic heterogenous mass arising from left adnexa, suggestive of neoplastic etiology. Staging laparotomy done. A final diagnosis of ovarian dysgerminoma was made on histopathological examination.

Virilizing Leydig cell tumor of the ovary: from presentation to treatment - a case report

2025-05-30T06:48:13+0530

Leydig cell ovarian tumor is a rare sex cord-gonadal stromal tumor which constitutes less than 0.2% of ovarian tumors. As they produce testosterone, virilization is the most common presenting feature. This case report discusses a multiparous, 55 years old, postmenopausal lady who presented with complaints of excessive scalp hair loss and increased facial hair growth since two years. On examination she had androgenic alopecia, increased facial and midline body hair and clitoromegaly. Blood investigations done showed elevated S. testosterone. CT abdomen done showed no pathological lesions in the adrenal glands. MRI done in view of suspicion of Androgen secreting ovarian tumour showed mildly enlarged left ovary measuring 2×1.8 cm with altered signal intensity. She underwent total laparoscopic hysterectomy with bilateral salpingo-oophorectomy. Post operatively, histopathological examination was reported as Benign Leydig cell tumour of left ovary.

A precarious outcome of incidentally diagnosed Krukenbergs tumor in antepartum eclampsia case: a rare case report and review of literature

2025-05-30T06:48:11+0530

Kruckenbergs tumors are the rare metastatic tumors of ovary with its incidence of 1-2%. It’s occurrence along with pregnancy is very rare with reported incidence of 0.4-0.5%. The occurrence of Krukenbergs tumors along with gestational hypertension is also very rare and it has poor prognosis. The most common primary origin is from gastric site. We report a case of 28‑year‑old pregnant female presented with Antepartum Eclampsia with incidental findings of bilateral enlarged ovaries during caesarean section. The diagnosis of Krukenbergs tumor was made with histopathology and it’s primary origin was rendered by postoperative gastroscopy guided biopsy. Our case is enthralling in view of its unusual presentation, young age, and the diagnostic dilemma it poses. Our case report highlights the fact that early diagnosis of Krukenbergs tumor in pregnancy may be difficult at times owing to the masquerading effects, implying widespread metastasis and a poor maternal survival. Tumor resection with concomitant Chemotherapy was given as treatment. The main aim of this paper is to evaluate whether earlier diagnosis can be made in such cases. A thorough literature review was also conducted, unfortunately no methods can be used for early detection. Furthermore, no consensus regarding diagnostics or treatment avail till date. Hence the need for more research regarding this rare condition to offer recommendations about early detection, diagnosis and therapeutic approaches can be prompted.

Two true knots in the umbilical cord: a rare case report

2025-05-30T06:48:11+0530

True knots of the umbilical cord are infrequent but significant complications in obstetrics, occurring in approximately 0.3% to 2% of pregnancies. Their formation is often associated with factors such as increased fetal mobility, excessive amniotic fluid, and maternal conditions like diabetes. These knots can lead to serious outcomes, including fetal distress and stillbirth, necessitating careful monitoring and management. We present the case of a 30-year-old woman Gravida 1 Para 1 Live birth 1 (G2P1L1) with a known case of type 2 diabetes mellitus who presented at 36 weeks and 6 days of gestation with mild labor pains. Upon evaluation, she exhibited persistent fetal tachycardia and non-progressing labor despite augmentation efforts. An emergency lower segment cesarean section (LSCS) was performed, revealing two true knots in a lengthy umbilical cord measuring approximately 70 cm, along with one loop wrapped around the neck. The timely intervention resulted in a favorable outcome for both mother and baby. This case highlights the importance of recognizing and managing true knots in pregnancies complicated by diabetes and other risk factors. As these noted are mostly obscured on ultrasound and diagnosis is made only post placental delivery, it underscores the need for vigilant prenatal monitoring and a low threshold for surgical intervention in cases of fetal distress.

A case report on ovarian torsion after ovarian stimulation

2025-05-30T06:48:08+0530

Ovarian torsion is a rare but serious cause of acute abdominal and pelvic pain in women, accounting for 2.7% of gynecologic emergencies. The incidence of ovarian torsion has been reported to be increased due to ovarian hyper stimulation. The incidence increased to 6 % under stimulation for assisted reproductive technology (ART) and to 16 % with ovarian hyperstimulation syndrome (OHSS). Although the delay in diagnosis from symptom onset is common, rapid diagnosis of ovarian torsion is imperative to prevent morbidity. The gold standard to treat ovary torsion is surgery, and this is also the only way to confirm the torsion. Here is a case report of a 31-year-old lady with a history of infertility underwent two cycles of ovulation induction and intrauterine insemination (IUI), presented with acute pain abdomen as well as a history of a similar episode two months earlier. A preoperative diagnosis of an ovarian cyst with suspicion of torsion was made and laparoscopy was performed. Intraoperative diagnosis of left ovarian torsion due to dermoid cyst was done and ovary untwisted and fixed to the round ligament, cyst was removed, and ovarian tissue was conserved. Patient was followed up until pregnancy and delivery.

A rare ovarian Leydig cell tumour masquerading as postmenopausal bleeding: a case report

2025-05-30T06:48:05+0530

Ovarian Sertoli-Leydig cell tumors (SLCTs) are rare ones, accounting for less than 0.2% of ovarian malignancies. While typically associated with virilization, they can present atypically with postmenopausal bleeding. We report a 72-year-old postmenopausal woman with post-menopausal bleeding. The diagnosis was endometrial hyperplasia. The patient, with a history of diabetes, hypertension, and dyslipidemia, had postmenopausal bleeding lasting five days without features of virilization. Ultrasonography showed a bulky uterus with a fibroid, adenomyoma, and thickened endometrium. Endometrial sampling revealed focal hyperplasia without atypia. Despite progestin therapy, she had recurrent vaginal bleeding. Hence decision for surgical management was sought. Histopathology confirmed a 1 cm Leydig cell tumour in the right ovary, with no significant findings in the left ovary or tubes.

Alleviating ashermans: a success story

2025-05-30T06:48:02+0530

Asherman syndrome (AS) is characterised by formation of intrauterine synechia due to the destruction of basal layer of endometrium. It presents as oligomenorrhea, amenorrhoea and infertility. Treating Ashermans is a challenge. Patient XYZ, 28 years, presented with complaints of amenorrhea for 11/2 years. She was diagnosed with Ashermans Syndrome outside but the treatment did not work. We first gave cyclical hormones followed by hysteroscopic adhesiolysis. She conceived immediately after return of menses and delivered a term baby. Currently she has regular menstruation. Conclusion: Building up the endometrium on hormonal support pre- and post-surgery and instant conception on return of menstruation was the factor leading to successful management.

Huge serous cystadenoma in a postmenopausal woman: a case report

2025-05-30T06:47:04+0530

Ovarian tumors have been classified into three main groups: epithelial, stromal and germ cells tumors on the basis of their origin. Epithelial tumors are the most common type accounting for about 60% of all the ovarian tumors in adult. Serous and mucinous tumors are the most common epithelial tumors occurring in women at age group 60-70 years. Giant ovarian tumors have become rare because of the early detection of adnexal pathology with the advent of routine imaging modalities in the recent era of medical practice. In previous studies, large or giant ovarian cysts were described as cysts measuring more than 10 cm in diameter in a radiological scan or those cysts reaching above the umbilicus.

Recurrent transverse vaginal septum presenting as lactational amenorrhea: a rare presentation of a rare anomaly

2025-05-30T06:47:03+0530

Transverse vaginal septum is a rare congenital Mullerian duct developmental anomaly with varied presentations in different age groups. Depending on its location in vagina, it can be a high, middle or low transverse vaginal septum, thus causing hematometra with or without hematocolpos. Diagnosis of transverse vaginal septum in female with symptoms of obstructive vaginal pathology is usually made with a careful gynaecological examination and USG. MRI may also be considered particularly in women with recurrence to know septal thickness and any distortion in anatomy from previous surgery. We report case of a 22-year-old lactating mother presenting as lactation amenorrhea and lower abdominal pain. She was diagnosed as a case of recurrent low transverse vaginal septum with hematocolpos and hematometra. She underwent Y-V plasty with drainage of hematometra and hematocolpos with mould with drainage placement. On follow-up she resumed her menses and able to cohabitate normally after 3 months of surgery. In females with primary amenorrhea, differentiating imperforate hymen and transverse vaginal septum is important. Transverse vaginal septum is known for its high rate of recurrences after surgery and will require postop dilators and regular postop follow-up. Using Mould with drainage is suggested for allowing longer intervals for mould change particularly in patients with hematometra and hematosalpinx.

Beyond the striae: an atypical case of polymorphic eruption of pregnancy with vasculitic features

2025-05-30T06:47:02+0530

Polymorphic eruption of pregnancy (PEP), also known as pruritic urticarial papules and plaques of pregnancy (PUPPP), is the most common benign dermatosis of pregnancy. We report a case of a 26-year-old primigravida at 32 weeks gestation who developed an extensive pruritic rash initially on the abdomen and later spreading to the extremities, back, flanks, and palms, palpable purpura was observed on the lower extremities, suggesting a vasculitic component. Skin biopsy revealed features of both PEP and leukocytoclastic vasculitis, while direct immunofluorescence for IgA was negative. The patient was managed conservatively with complete recovery. This case highlights a rare presentation of PEP with vasculitic features, necessitating careful evaluation. Further research is needed to explore possible triggers, including immune mechanisms or viral associations, to refine diagnostic criteria and optimize management strategies.

A rare case report of twin reversed arterial perfusion sequence in monochorionic diamniotic twin and outcome of Dr. Pump and Mr. Acardiac acephalus in a tertiary care centre

2025-05-30T06:46:45+0530

Twin reversed arterial perfusion (TRAP) sequence or Acardiac twinning is a rare complication seen in monozygotic gestation. The reported incidence of Acardiac twin is 1 in 35000 births and 1 in 100 monozygotic twin gestation. In monochorionic twin pregnancies, a twin with poorly developed heart and upper torso (the “Acardiac”) is perfused by its co-twin (the “pump”) via superficial arterio-arterial or veno-venous anastomoses located on the placental surface, through which blood pumped backwards. Due to poor prognosis of TRAP sequence in monochorionic pregnancies, 100% mortality was reported in Acardiac twin due to its severe malformations and also due to heart failure and prematurity in pump twin 50-55% mortality was reported. We hereby report a case of 22-year-old primigravida, monochorionic diamniotic (MCDA) twins presented with abruption at 24 weeks of gestation, resulted fetal demise of pump twin. Our study also reviewed necessity of thorough sonological evaluation and therapeutic opportunities in monochorionic multifetal pregnancies.

Blinding clues: unveiling the ocular manifestations of preeclampsia

2025-05-30T06:46:41+0530

Preeclampsia is a hypertensive disorder of pregnancy that significantly contributes to maternal and fetal morbidity and mortality. Although its hallmark manifestations include hypertension and proteinuria, systemic complications affecting various organs, including the ocular system, are often under-recognized. Ocular manifestations range from mild visual disturbances to severe complications such as cortical blindness and retinal detachment. These complications reflect the systemic endothelial dysfunction and vascular permeability characteristic of preeclampsia. Early recognition of ocular symptoms can serve as a valuable indicator of disease severity and progression, prompting timely intervention. In this case, a 37-year-old gravida 2, para 1, at 30+6 weeks of gestation presented with severe hypertension (200/110 mm Hg), headache, and loss of vision. A diagnosis of posterior reversible encephalopathy syndrome (PRES) was suggested, likely secondary to cerebral edema associated with preeclampsia. The patient underwent emergency lower-segment caesarean section (LSCS) after stabilization with intravenous Labetalol and magnesium sulphate (MgSO₄). Postoperatively, her visual symptoms resolved within six hours, and an ophthalmological evaluation revealed a normal fundus examination. This case shows the importance of recognizing preeclampsia-induced ocular changes, as timely intervention can prevent irreversible complications such as optic neuropathy and permanent vision loss. Multidisciplinary management, including obstetric and ophthalmologic care, is critical to achieving favorable maternal and fetal outcomes. Routine monitoring and ophthalmological evaluations in high-risk pregnancies are essential to early detection and effective management. This case highlights the reversible nature of preeclampsia-induced ocular complications and emphasizes the role of expedited delivery in mitigating severe outcomes.

Gestational trophoblastic tumors: a case series of 18 cases at the university hospital center Mohammed VI of Oujda

2025-05-07T08:45:02+0530

Gestational trophoblastic tumors (GTTs) are rare but potentially life-threatening diseases arising from the abnormal proliferation of trophoblastic tissue following conception. Their clinical presentation, biological behavior, and metastatic potential vary significantly, complicating both diagnosis and management. We conducted a retrospective observational study over a 9-year period (July 2014 to June 2023) at the university hospital center Mohammed VI of Oujda. Eighteen patients diagnosed with GTTs, including invasive moles and choriocarcinomas, were analyzed in terms of epidemiological, clinical, therapeutic, and prognostic features. The mean age was 35.9 years (range: 19-52). All patients were married and unemployed. Most were referred from external healthcare centers and lived more than 60 km from the hospital. The predominant symptom was abnormal uterine bleeding. Diagnosis was based on abnormal β-hCG trends (89%) or histopathological confirmation (11%). Metastases were present in 43.75% of cases, most commonly in the vagina. Ten patients received chemotherapy: 8 with methotrexate monotherapy and 2 with EMA-CO. One patient underwent hysterectomy for hemorrhage. A favorable therapeutic response was observed, with β-hCG negativation achieved in 90% of patients after nine cycles. Fertility was preserved in most cases. No secondary malignancies were reported. Despite challenges in diagnosis and management, GTTs can be effectively treated with appropriate chemotherapy and close monitoring. Our experience underscores the need for early referral, standardized management protocols, and a national registry to improve patient outcomes.

Misoprostol versus combined regimen of mifepristone and misoprostol in termination of second trimester pregnancy

2025-05-07T08:45:00+0530

The present prospective study was conducted over 12 months at Dr. Mansukh Bhai K. Shah medical college and Sushilaben M. Shah multi-specialty hospital, Ahmedabad, serving predominantly lower socioeconomic groups. The objective was to assess the safety and efficacy of misoprostol alone versus a combined regimen of mifepristone and misoprostol in second-trimester pregnancy termination. A total of 18 patients were enrolled and divided into two groups. Group A received 200 mg oral mifepristone, followed 24 hours later by 200 mcg misoprostol administered vaginally every 4 hours up to a maximum of 4 doses or until expulsion occurred. Group B received only 200 mcg vaginal misoprostol every 4 hours, up to 4 doses. Success was defined as complete expulsion of the fetus and placenta without the need for surgical intervention. In group A, the success rate was 100%, and none of the patient’s required dilatation and evacuation (D and E). In contrast, group B had a success rate of 80%, with 2 patients (20%) requiring D and E. There were no failures in either group, defined as failure to abort within 72 hours of the last dose. The induction-abortion interval was shorter in the mifepristone-primed group. The study concludes that pre-treatment with mifepristone significantly improves the efficacy of second-trimester pregnancy termination with misoprostol, reduces the need for Surgical intervention, and shortens the induction-to-abortion interval. The combined regimen of mifepristone and misoprostol is thus more effective and safer than misoprostol alone.

Caesarean sections at full cervical dilation: a case series on outcomes and proactive measures in an Indian teaching hospital

2025-05-07T08:44:58+0530

This case series examines 20 cesarean sections performed at full cervical dilation at Khaja Banda Nawaz Teaching and General Hospital, India, from January to December 2024. Among 852 deliveries, 548 were cesarean sections, with 20 (3.65%) occurring at full dilation. Maternal complications included postpartum hemorrhage in 35% of cases, sepsis in 12%, blood transfusion in 15%, and one peripartum hysterectomy. Neonatal outcomes showed 10% NICU admissions, primarily for respiratory distress and sepsis. Deep transverse arrest was the leading indication in 66.15% of cases. The findings highlight the high morbidity associated with second-stage cesarean sections and propose proactive measures such as team training, standardized protocols, and enhanced monitoring to improve outcomes. These results emphasize the need for specialized care and further research in resource-constrained settings.

Optimizing delivery timing in selective fetal growth restricted dichorionic diamniotic twins: lessons from a case series

2025-05-30T06:46:50+0530

Authors aim to analyze the maternal and fetal outcomes in IVF -conceived dichorionic diamniotic (DCDA) twin pregnancies complicated by FGR in women of advanced maternal age, focusing on complications and management strategies. A retrospective analysis of five IVF-conceived DCDA twin pregnancies in women aged 30-49 years was conducted at our tertiary care center between August-October 2024. Establishment of presence of FGR in one or both twins, was done using Delphi criteria. Cases underwent systematic monitoring via serial ultrasound scans with Doppler and comprehensive maternal-fetal surveillance. The mean maternal age was 39.8 years, with a mean gestational age at delivery of 33+5 weeks. All deliveries were performed via cesarean section and the notable complications included a case of Edwards syndrome diagnosed postnatally, and one intrauterine fetal death at 34 weeks in a severely growth-restricted fetus. Maternal complications included pre-eclampsia, hypothyroidism, and obstetric cholestasis. The birth weight was in a range of 1.01-2.48 kg. The significant incidence of FGR and growth discordance in our cases emphasizes the need for regular fetal surveillance and Doppler studies in twin pregnancies. Our findings suggest that preventive cervical cerclage, timely antenatal corticosteroid administration, and appropriate timing of delivery are crucial elements in managing these pregnancies. The goals of management in these high-risk pregnancies are to optimize the time of delivery, minimize risks to both fetuses and balance risks of prematurity against risks of continued in-utero stay. Counselling the expecting couple is of paramount importance and due consideration should be given to maternal choice.

The case series of Eisenmenger syndrome and its pregnancy outcome in tertiary care centres of South India

2025-05-30T06:48:18+0530

The incidence of the Eisenmenger syndrome (ES) is very rare in the pregnant women, but it has significant association with materno-fetal morbidity and mortality. The prognosis of ES in terms of materno fetal outcomes and neonatal outcomes in the pregnant women is unclear. The main aim of this study is to evaluate the materno-foetal outcome of pregnancy with ES in a tertiary care centre. The case series had been observed in retrospective aspect at 2 tertiary care centres of South India, Government Thiruvarur Medical College and Hospital, Government Villupuram Medical College and Hospital, Tamil Nadu, India over a period of 1 year from 2023-2024. This study analysed the occurrence of ES in the pregnant women with cardiac disease and their materno-foetal outcomes in tertiary care centres of South India. In our study period, 41,718 cases were delivered, in which 6515 cases had cardiac disease, 1105 cases had congenital heart disease. Of these, 6 cases had ES during pregnancy. In our study, ES was noted in 1: 6953 pregnant women, 1:1086 pregnant women with cardiac disease, 1:184 pregnant women with congenital cardiac disease. The mean age was 23.4±0.52 and mean gestational age at delivery was 34±1.25 weeks. The mean pulmonary arterial pressure was 73 mmHg. In our study, 3 cases had preterm deliveries and 1 case had term delivery, 2 cases delivered vaginally, 2 cases had caesarean section and 2 cases had abortions. As per our study, nil maternal mortality reported. For achieving optimum outcomes in the pregnant women with ES, the well-equipped obstetric critical care unit with multidisciplinary approach must be ensured in a tertiary care centre.

A novel combined abdominal and vaginal approach for pelvic organ prolapse in young patients

2025-05-30T06:48:10+0530

In India, the incidence of genital prolapse is 1.5 –2 % in nulliparous women and 5–8 % in young multiparous women which is the highest in the world. Though pelvic organ prolapse (POP) is not a life-threatening condition, its impact on life-style and self- esteem of a woman is paramount. There is a gamut of conservative surgical treatment options for POP for patients where the uterus needs to be preserved. Surgical repair in young women is more challenging as anatomical correction and preservation of fertility and sexual functions have to be addressed with a durable solution. In our case series, all three patients had third degree uterocervical descent with elongated and hypertrophied cervices. Hence neither abdominal nor vaginal repair alone was expected to be sufficient for restoring patient's anatomy and sexual functions. Therefore, we came up with a novel combined abdominal and vaginal approach by carrying out cervical amputation vaginally and Virkud’s composite sling abdominally. The position and healing of the neo cervix was found to be excellent in all three cases during their post operative follow up. Through this case series, we highlight that the best surgical option for the treatment of POP should be tailored according to the patient’s need and expertise of the surgeon, as there are no clear guidelines for the choice of surgery for POP.

Transfusion challenges and management strategies in Bombay blood group pregnancies: a case series

2025-05-30T06:46:52+0530

The Bombay blood group (Oh phenotype) is a rare blood type characterized by the absence of the H antigen, rendering standard O group transfusions incompatible. Its rarity presents unique challenges in obstetric care, where transfusion preparedness is critical. We describe the clinical course, transfusion planning, and perinatal outcomes in three pregnant women with the Bombay blood group. Three antenatal patients with confirmed Bombay phenotype (O Rh[D] positive) were managed at our tertiary care center between 2023 and 2025. All were primigravidae or with precious pregnancies, and two had moderate anemia corrected with intravenous iron. Bombay-compatible blood units were arranged in advance through a rare donor registry. Case 1 had spontaneous vaginal delivery and required a single unit transfusion post-delivery, complicated by a mild allergic reaction. Case 2, with IVF conception and severe preeclampsia, underwent emergency caesarean section complicated by atonic postpartum hemorrhage (PPH) managed medically and with a Bakri balloon. One unit of Bombay blood was transfused postoperatively. Case 3 underwent elective caesarean delivery without transfusion. Key management strategies included early blood group identification, proactive donor coordination, and prioritization of non-transfusion approaches for anemia correction. Multidisciplinary collaboration with transfusion services ensured timely access to compatible blood and safe delivery. Pregnancy in Bombay blood group women requires individualized planning and a multidisciplinary approach. Early diagnosis, rare donor registry utilization, and non-transfusion anemia correction play pivotal roles in optimizing maternal and neonatal outcomes.

Cervical cancer in Asian countries: epidemiology, risk factors and challenges

2025-05-09T08:36:57+0530

Cervical cancer is one of the leading causes for cancer mortality in women worldwide especially in Asian region where, preventive strategies are underdeveloped, particularly in low-and middle-income countries (LMICs). The global cervical cancer burden and characteristics vary significantly, particularly between high-income (HICs) and LMICs. To obtain a systematic review of 20 peer-reviewed newspaper articles published within the range from 2010 to 2023, accessed through PubMed, Scopus and Google Scholar. Studies related to incidence, mortality, preventive measures and healthcare disparity in Asian countries were included. Findings from the review demonstrate that cervical cancer is inordinate burdened in South-Central Asia, with nearly 48% of the region's estimated cases occurring between India and Bangladesh. The screening coverage is a cause for concern, with only 33% of women in India and 7.5% of women in Bangladesh getting screened regularly. In stark contrast, HPV vaccination coverage is below 30% in most LMICs with over 70% in Japan and South Korea. Low levels of healthcare infrastructure, late-stage diagnoses, and cultural barriers to vaccine uptake represent some of these key challenges. Effective HPV vaccination and screening programs can prevent cervical cancer (CC) cases and deaths, but the availability and coverage of these interventions in Asian LMICs are uncertain. Better prevention and treatment can be achieved through improved healthcare infrastructure, but first cultural barriers need to be overcome.

Unani contraceptives: a substitute for contemporary unmet

2025-05-30T06:49:45+0530

The means of preventing unintended pregnancies are birth control and contraception. Today's advancements had given hundreds of contraceptives, giving people options but the primary reason that is unfulfilled, with the related adverse effects being the main concern. None satisfy the people's needs to the required extent. Therefore, it is imperative that we investigate and identify fertility-regulating drugs that are less expensive, universally accepted, safer and more effective in order to meet the millennium development goal and improve maternal health, the World Health Organization put efforts on the promotion of family planning. effective contraception is thought to be able to prevent 90% of abortion-related morbidity and mortality as well as 20% of pregnancy related morbidity and mortality. Research on more advanced, totally reversible, self-administered, less toxic, less costly contraceptives is therefore necessary. Many of these characteristics are found in contraceptives, as the traditional Unani scripture mentions. Unani physician has discussed the many contraceptive methods and medications. The effectiveness of many herbal medicines such as Suddab (Ruta graveolans), Abhal (Juniperus communis), Filfil daraz (Piper longum), Pudina (Mentha arvensis), Neem (Azadirachta indica), Anar (Punica granatum), Piyaz (Alium cepa) and wild carrot (Daucus carota) has been supported by scientific studies. Therefore, this article aims to examine the traditional Unani System of Medicine's approach to contraception in the context of existing scientific research.

Male contraception through womens eyes: trust, perceptions and challenges

2025-05-30T06:46:51+0530

Contraception has historically been considered a female responsibility, with most contraceptive methods designed for and marketed toward women. There is imbalance in contraceptive responsibility between men and women. Historically, contraception has largely been seen as a woman's responsibility, with a wide range of options available to them, while men have had only limited choices. This has led to a disproportionate burden on women to prevent unintended pregnancies. Traditional male contraceptive methods, such as condoms and vasectomy, either require consistent use or involve permanent sterilization, leaving men with fewer alternatives. However, advancements in reproductive health are paving the way for new male contraceptive options, including hormonal treatments, reversible vasectomy techniques and non-hormonal methods like sperm-blocking gels. The introduction of these alternatives presents an opportunity to distribute contraceptive responsibility more equally between genders. Women’s perceptions of male contraception play a crucial role in determining its success, as trust, reliability and shared responsibility are central concerns. Many women welcome these new options, seeing them as a way to ease their own contraceptive burden, but concerns over adherence, side effects and effectiveness remain. Society and healthcare providers have a significant role to play in ensuring male contraceptives are widely accepted, properly understood and integrated into reproductive healthcare frameworks. Shifting cultural norms and increasing education on male contraception can help normalize the idea that birth control is not solely a woman’s duty but a shared responsibility between partners. With ongoing research and growing awareness, male contraceptives have the potential to transform the picture of reproductive health, making contraception a more balanced aspect of family planning. As acceptance increases and reliable options become available, the responsibility of preventing unintended pregnancies will no longer rest disproportionately on women, but instead be a mutual commitment between partners, fostering greater equality and cooperation in reproductive decision-making. This article explores historical perspectives, current male contraceptive methods, emerging alternatives, women's attitudes toward these options, factors influencing trust and the role of society and healthcare providers.

Lessons from a private urban health centre in South India on why private healthcare system must step up cervical cancer screening

2025-05-30T06:46:44+0530

A 32-year-old frail mother of two children, 10 and two-year olds, presented to the urban health center in January 2025 with worsening white discharge per vaginum, significant weight loss, and back pain for three months. A vaginal examination revealed an ominous friable cervical lesion that bled profusely. Biopsy confirmed the diagnosis of poorly differentiated cervical cancer. Her only known risk factor was lower socioeconomic status. She was last seen by a health care professional three months ago for the same complaint and had the intrauterine device (IUCD) removed. A supportive husband and family decided to shift her care to a nearby cancer center in the government health system.

Risk factors, phenotypic-pattern and feto-maternal outcomes of preeclampsia with severe features in a low-resource setting: a prospective study

2025-05-30T06:48:19+0530

Background: Preeclampsia is exclusive to pregnancy and one of the leading causes of maternal and perinatal morbidity and mortality globally. This study aims to assess the prevalence, risk factors, phenotypic pattern and feto-maternal outcomes among women managed for preeclampsia with severe features at the Federal Medical Center Asaba.

Methods: Women managed for preeclampsia with severe features between 1^st June 2022 and, 31^st January 2023 were recruited and relevant data extracted and entered into a standardized proforma which was subsequently analyzed using the SPSS version 26. Categorical variables were expressed in frequencies and percentages while continuous variables were expressed as mean and standard deviation. The association test between the categorical variables was via the chi-square and Fisher exact test where necessary with a p<0.05 considered significant.

Results: The prevalence of preeclampsia with severe features was 19.3% with the late-onset type (63.7%) being the commonest. Maternal and perinatal outcomes were comparable in both phenotypical patterns except for NICU admission which was higher and significant for early onset. Nulliparity, chronic hypertension, and previous history of preeclampsia were the most commonly identified risk factors. Neonatal intensive care unit admission (43.8%), perinatal mortality (17.8%), admission into the intensive care unit (1.4%), and development of eclampsia (0.7%) were the most frequent fetomaternal outcomes.

Conclusions: This study revealed a high burden of preeclampsia with severe features and some of its complications. Interventions such as early antenatal care booking and prompt identification of at-risk women will reduce its burden.

Male factor infertility and assisted conception: a 2-year retrospective analysis of pregnancy rates and treatment outcomes

2025-05-30T06:47:01+0530

Background: Male factor infertility contributes nearly half of the burden of infertility among infertile couples, highlighting the importance of understanding the complex interplay between male reproductive health and fertility outcomes. To investigate the relationship between male factor infertility and pregnancy rates after assisted conception.

Methods: We retrospectively analyzed data of couples attending fertility clinics due to inability to conceive spontaneously. The study focused on the patients seen between October 2022 and September 2024.

Results: Of 298 couples evaluated for infertility during the period under review, 118 had seminal fluid abnormalities of varying degrees, projecting a prevalence of 39.6%. The mean and standard deviation (SD) of 2.26±1.30mL for volume, 15×106±16×106 cells/ml, 32×106±50×106 cells/ejaculate, 14.9±14.3% progressive motility, 15.8±12.5% non-progressive motility and 19.2±15.6% for normal morphology. Nearly 50% had Asthenozoospermia, 33.9% had Oligozoospermia and 13.9% had Azoospermia. Intracytoplasmic sperm injection (ICSI) as the predominantly performed treatment type due poor semen quality. Pregnancy rate and live birth rate were 55.9% and 40.7% respectively. There was no statistically significant correlation between semen parameters and pregnancy rate.

Conclusions: The findings of this study can inform the development of personalized treatment approaches for male infertility and highlight the need for further research to identify the role of individual factor that interferes with semen quality and how it affects fertility outcomes.

Intramuscular pentazocine versus rectal diclofenac for pain relief after caesarean section: a randomized controlled trial

2025-05-30T06:48:17+0530

Background: Caesarean section (CS) commonly causes moderate to severe pain in the first 48 hours after surgery with associated discomfort, delayed ambulation, difficulty initiating breastfeeding and prolonged hospital stay. Adequate analgesia after caesarean section is very important for the patient’s comfort, overall wellbeing and recovery. This study compared the analgesic effectiveness of intramuscular Pentazocine with rectal diclofenac following caesarean section and also the side effects of these drugs in Federal Medical Centre, Keffi, North Central Nigeria.

Methods: It was an open label single blinded randomized controlled trial carried out among 240 eligible patients scheduled for either elective or emergency caesarean section. Participants were randomised in the ratio 1:1 to use either rectal diclofenac or intramuscular pentazocine. The effectiveness of the drugs on post caesarean section pain relief and maternal satisfaction were assessed using Visual Analog scale (VAS) and Likert's scale respectively. The side effects of the drugs were also assessed.

Results: Majority of the participants had mild to moderate pain throughout the 24 hours period of the study with most having moderate pain. There was no statistically significance difference in the effectiveness of the drugs among the two groups (p=0.745), however maternal satisfaction was higher with the rectal diclofenac group compared with the intramuscular pentazocine group (p=0.017).

Conclusions: This study showed that suppository diclofenac and intramuscular pentazocine are comparable in pain relief post caesarean section but there was better maternal satisfaction with suppository diclofenac use compared to intramuscular pentazocine use.

Maternal-fetal obstetric outcomes in mothers of advanced maternal age: a cross-sectional analytical study at Saint-Joseph Hospital and the University Clinics of Kinshasa in the Democratic Republic of Congo

2025-05-30T06:48:06+0530

Background: Pregnancy in advanced maternal age is any pregnancy occurring after the age of 35. Both late-term and early pregnancies carry a high risk of maternal and fetal morbidity and mortality and are a public health concern. The objective of this study is to identify obstetric outcomes associated with pregnancies in advanced maternal age at Saint-Joseph Hospital and the University Clinics of Kinshasa in the Democratic Republic of Congo.

Methods: This is a cross-sectional analytical study of the records of mothers aged 16 to 50 who gave birth in the maternity wards of Saint-Joseph Hospital and the University Clinics of Kinshasa from 01 January 2018, to 31 December 2022, using non-probability convenience sampling for case selection. Descriptive analyses, analysis of variance (ANOVA), Chi-square tests and logistic regression were used in statistical analyses.

Results: Pregnancies in women with advanced maternal age (AMA) are associated with the risk of pre-eclampsia (aOR: 2.5, p=0.02 for women aged 35-39 and aOR: 3.5, p=0.001 for those over 40) and gestational hypertension (aOR: 12.3, p=0.025 for those over 40), and fetal outcomes associated with pregnancies in women with AMA are prematurity (aOR: 2.7, p=0.001 for women aged 35-39 and aOR: 2.4, p=0.002 for women over 40), low birth weight (aOR: 2.5, p=0.0000 for women aged 35-39 and aOR: 2.4, p=0.002 for women over 40), and low birth weight (aOR: 2.5, p=0.0000 for women aged 35-39). women over 40 years of age) and admissions to neonatal intensive care units (aOR: 2.5, p=0.004 for women over 40 years of age).

Conclusions: Obstetric outcomes associated with pregnancy in older mothers are preeclampsia, prematurity, low birth weight, and admissions to neonatal intensive care units. Our results are useful for prevention through screening and other therapeutic measures of these obstetric and neonatal outcomes in women with AMA with a view to improving their care in our hospitals in Kinshasa.

Assessment of contraceptive services for adolescents in the Burundian family welfare association and the youth-friendly centres in Bujumbura, Burundi

2025-05-30T06:47:59+0530

Background: Many sexually active adolescents throughout the world do not have access to modern contraception, which can result in unintended births. This study evaluates the quality, accessibility and effectiveness of contraceptive services provided to sexually active adolescents in Burundian Family Welfare Association and youth-friendly centres in Bujumbura / Burundi.

Methods: A mixed-methods study design with cross-sectional study and in-depth interviews was used, which recruited 25 healthcare providers and 25 adolescents for in depth interviews and self-administered questionnaires to 287 adolescents and 43 healthcare providers. SPSS version 25 was used to analyse the quantitative and thematic content for qualitative data.

Results: Among the independent variables, correlation analysis showed that adolescents' sexual experience (p<0.001), knowledge about contraception (p<0.001), fear of side effects (p<0.001) and lack of support/encouragement (p=0.011) influenced their use of contraceptive services. However, service utilization is negatively impacted by knowledge of contraceptive options. Barriers including lack of support and encouragement and fear of adverse effects may be the cause of this. On the provider side, lack of privacy/confidentiality (p=0.022) and limited availability of contraceptive methods (p=0.018) are factors influencing the provision of services to adolescents.

Conclusions: The lack of support from parents, the community and healthcare providers, as well as the fear of side effects, prevent adolescents from using contraceptive services. Teachers, parents and healthcare professionals are essential in helping adolescents learn about sexual and reproductive health.

The influence of cultural practices and socioeconomic factors on teenage pregnancy across selected primary health care centers in Akinyele local government area, Ibadan, Nigeria

2025-05-30T06:46:58+0530

Background: Teenage pregnancy is a significant contributor to maternal and child mortality and a driver of the cycle of ill health and poverty, particularly in low- and middle-income countries (LMICs). Globally, around 21 million girls aged 15-19 and 2 million under 14 give birth annually, with 95% of these births occurring in developing countries. In Nigeria, the burden of teenage pregnancy is exacerbated by cultural practices, socioeconomic challenges, and limited access to education and reproductive health services.

Methods: A cross-sectional study was conducted across selected primary health care (PHC) centers in Akinyele local government area (LGA), Ibadan, Nigeria. Twelve PHCs were randomly selected, one from each ward. A multi-stage sampling method was used to select teenage antenatal attendees. A sampling frame was developed from antenatal records, and eligible participants were chosen using computer-generated random numbers. Data were collected using a validated questionnaire with both open- and close-ended questions from July to August 2024. Statistical analysis was done using IBM SPSS version 27.0, with significance set at p≤0.05.

Results: Peer pressure (58.5%) and family pressure (46.5%) were the most reported causes of teenage pregnancy. Cultural barriers around sex education and contraception were reported by 80.3% of participants, with only 9.4% affirming open dialogue. Financial hardship and lack of educational opportunities were also cited by 78.7% as key contributing factors. The mean age of respondents was 17.5 years (SD±1.57).

Conclusions: Cultural and socioeconomic factors significantly influence teenage pregnancy, highlighting the urgent need for targeted interventions in education, family engagement, and reproductive health communication.

The prevalence, types, indications, and common complications associated with gynecological hysterectomy at Lautech teaching hospital, Ogbomoso, southwest Nigeria a five-year review

2025-05-30T06:46:43+0530

Background: Hysterectomy is a common major gynecological procedure performed on women.

Methods: This study was a retrospective study including all the gynecological hysterectomies done over a 5-year period in LAUTECH Teaching Hospital between 1st January 2020 and 31st December 2024. A total of 215 case files were retrieved out of 224 procedures done. Data were collected into proforma, cleaned, and analyzed using SPSS version 25. The results were expressed in frequencies, percentages, means, and standard deviation.

Results: The prevalence of the gynecological hysterectomy in Ogbomoso was 25.9%. The mean age in this study was 60.9±9 years. The most common indication for hysterectomy in this environment is symptomatic uterine fibroids. The preferred approach to the procedure was the transabdominal route, constituting 91.6%. Most of the patients (88.4%) who were offered hysterectomy had salpingo-oophorectomy. About 83.7% of patients stayed within five days in the hospital following the procedure. The mean blood loss in this study was 548±352.2. Slightly below one-fourth of the total number of patients who had hysterectomies suffered one form of complication or the other. These complications include hemorrhage (31.8%), surgical site infection (18.3%), anemia (22.7%), ureteral injury (13.6%), cuff cellulitis (9%), and bladder injury (4.6%). Most (72.6%) of the histological diagnoses were benign, and the rest were malignant in nature. The most common histological diagnosis was leiomyoma (27.9%).

Conclusions: Transabdominal hysterectomy is a common gynecological procedure in Ogbomoso, with symptomatic uterine fibroids being the leading indication for gynecological hysterectomy. Efforts should be made in the acquisition of skills for minimal access approaches, such as laparoscopic hysterectomy, in order to reduce complications associated with the procedure and further reduce the hospital stay.

Association of maternal serum ferritin level with preterm labor

2025-05-30T06:46:42+0530

Background: Preterm labor is a significant contributor to neonatal morbidity and mortality worldwide. Identifying reliable biomarkers for predicting preterm birth can improve maternal and neonatal outcomes. Serum ferritin, an acute-phase reactant and iron storage protein, may play a role in the pathophysiology of preterm labor. This study aimed to evaluate the association between maternal serum ferritin levels and preterm labor.

Methods: A case-control study was conducted in the Department of Obstetrics and Gynaecology at Dhaka Medical College Hospital from June 2022 to May 2023. A total of 88 pregnant women were enrolled using purposive sampling, including 44 with preterm labor (cases) and 44 with term labor (controls). Sociodemographic, obstetric, and biochemical data were collected, and maternal serum ferritin levels were measured. Data were analyzed using statistical package for the social sciences (SPSS) version 25, and comparisons between groups were made using the Mann-Whitney U test and Chi-square test where appropriate.

Results: There was no significant difference in maternal age between the two groups. However, serum ferritin levels were significantly higher in the preterm group (89.09±106.07 ng/ml) compared to the term group (32.13±31.40 ng/ml) (p=0.004). A weak but statistically significant negative correlation was observed between serum ferritin levels and gestational age (r=-0.313, p<0.05).

Conclusions: Elevated maternal serum ferritin levels are significantly associated with preterm labor. Serum ferritin may serve as a useful biomarker for identifying women at risk of preterm delivery, allowing for timely interventions to prevent adverse pregnancy outcomes.

Posterior reversible encephalopathy syndrome: a diagnostic dilemma

2025-05-24T07:49:38+0530

Background: Incidence of eclampsia 1 in 2000 to 3250. Seizures can occur antepartum, intrapartum, postpartum. PRES characterised by features like visual disturbances, headache, vomiting, seizures and altered sensorium .Hypertension major cause of PRES. Study aims incidence of PRES, asses clinical presentation, neuroimaging in PRES patients and maternal outcome.

Methods: PRES is neurological disorder characterized by symptoms like visual disturbances, headache, vomiting, seizures and altered sensorium. Eclampsia by definition have seizures as part of clinical syndrome. In our study, all patients diagnosed with PRES admitted in obstetric ICU from January 2023 to June 2023 at Gulbarga institute of medical sciences are included. They underwent CT scan for diagnosis of PRES. Abnormal findings included brain hypodense areas in posterior parietal lobe and occipital areas, posterior temporal lobes. To avoid misdiagnosis, it requires careful attention to clinical and radiographic presentation. Main criteria for PRES are Presence of neurologic symptoms or findings, presence of risk factors for PRES, absence of other possible causes of encephalopathy, Reversible course on follow up.

Results: Out of 22 patients admitted in obstetric ICU, 14 cases revealed PRES on neuroimaging. Eclampsia occurred in 20 antepartum and in 2 postpartum patients. Headache being predominant symptom, followed by altered mental status, visual disturbances.

Conclusions: Our study revealed the common finding of PRES in patients with eclampsia which suggested that PRES is a core component of pathogenesis of eclampsia in pregnancy. Hence early diagnosis and treatment is essential to avoid irreversible neurological damage and maternal morbidity and mortality.

Prediction of preterm labor using ultrasound measurement of cervical length at 11 to 14 weeks and 18 to 20 weeks

2025-05-09T08:36:59+0530

Background: Preterm birth (PTB) is the most important problems that pose dilemmas for both the obstetrician and neonatologist, as it is the leading cause of perinatal morbidity and mortality around the world. Routine cervical length screening during early pregnancy can predict PTB. Objectives were to predict the PTB with the use of ultrasonographic cervical length measurement at 11-14 weeks and 18-20 weeks of gestation.

Methods: This prospective observational study was conducted from 1^st March 2024 till 31^st March 2024 at department of obstetrics and gynaecology pacific institute of medical science Udaipur. Total 100 cases selected which are routinely advised for ultrasound during antenatal checkup at 11-14 weeks and 18-20 weeks. In this study all the analysis was performed using 10.0 version of statistical software SPSS.

Results: In this study most women (49.0%) belonged to the age group of 26-30 years. 78.0% of women had term births and 22.0% of women had PTBs. It was observed that 12 women had cervical length <25 mm at 18-20 weeks and 83% of them had PTBs while 16.6% had term birth.

Conclusions: Ultrasound measurement of cervical length in early pregnancy is a reliable and cost-effective method for screening of PTB. We observed that women with shorter cervix early on in pregnancy had a greater number of PTB s as compared to women with normal length of cervix.

Effects of weight training program on menstrual regularity and ovulation in women with polycystic ovary syndrome

2025-05-17T08:29:11+0530

Background: Polycystic ovary syndrome (PCOS) affects 7-15% of reproductive-aged women, causing ovulatory dysfunction and infertility. Weight training is a promising intervention, but evidence is limited by short-term studies and challenges in ovulation assessment due to elevated luteinizing hormone levels.

Methods: This 24-week comparative study at A.B.A. Star Women's Superspeciality Hospital in Karnataka, India, involved 100 women with PCOS allocated (1:1) to a weight training group (n=50) or a no-exercise control group (n=50). Participants voluntarily chose to join, with those willing to exercise assigned to the weight training group after providing informed consent and ruling out contraindications; others joined the control group. The weight training group completed three 60-minute sessions weekly. Menstrual regularity was assessed via diaries (normal: 21-35 days; oligomenorrhea: 36-199 days; amenorrhea: >199 days). Ovulation was measured using i-Know ovulation testing strips (days 10-21), confirmed by serum progesterone (≥5.0 nmol/l). McNemar’s test, paired t tests, ANOVA, and chi-square tests assessed changes (p<0.05).

Results: Participants (mean age 28.4±4.2 years, BMI 28.6±5.1 kg/m²) exhibited 89.2% adherence to weight training. The median OPK adherence was 85% (IQR 60%, 95%) initially, declining to 70% (IQR 50%, 90%) later. The weight training group engaged in 4.8±1.7 cycles, with 20% (10/50) improving their regularity (p=0.01 vs. baseline; p=0.03 vs. control), compared to 4.0±1.5 cycles and 5% (2/50) in the controls. Ovulation occurred in 70% (35/50) of the weight training group (2.3±1.4 cycles, p<0.001), while 30% (15/50) in the controls experienced ovulation (0.9±0.8).

Conclusions: Weight training significantly improves PCOS ovulation, offering a practical intervention. This study advances non-pharmacological PCOS management.

Population study for awareness about medical termination of pregnancy pills in population in India

2025-05-18T09:04:23+0530

Background: The present study was conducted as a home-based survey of 505 females in reproductive age group mainly in rural, semi urban and urban areas around Ahmedabad to identify the awareness about medical termination of pregnancy (MTP) pills in the population.

Methods: A home-based survey of 505 females in reproductive age group mainly in rural, semi urban and urban areas around Ahmedabad was done. Home visit was carried out by MBBS interns accompanied by ASHA workers.

Results: Among the population studied it was observed that termination of pregnancy by MTP pills was most commonly seen among women with previous 2 live children. Most of the women confirmed their pregnancy with a home based urine pregnancy kit. Majority of women have taken the pills as self-medication without any consultation with a qualified obstetrician, increasing not only the risk of complications like incomplete abortion and haemorrhage but also showing the poor status of drug regulations in the country.

Conclusions: Majority of women, have taken the pills as self-medication without any consultation with a qualified obstetrician. Out of the women who had taken the pills after prescription, most of them had gotten the prescription from a doctor while others women got the pills prescribed from a known medical professional. The study shows the easy availability of MTP pills in the market, however the knowledge about the use and side effects of these pills is not well understood.

Awareness about cervical cancer screening and prevention among women attending tertiary care centre

2025-05-30T06:47:05+0530

Background: Cervical cancer is the fourth leading cause of cancer-related deaths worldwide, with India accounting for the highest number of deaths. Cervical cancer screening is crucial for detecting abnormal cervical cells at the pre-invasive stage, also known as cervical pre-cancer. Early detection enables timely treatment, preventing the progression to cervical cancer. Two primary screening methods are employed: high-risk human papillomavirus (HR HPV) DNA testing and the Papanicolaou (Pap) smear. To assess awareness about cervical cancer screening and prevention among women attending outpatient departments at the tertiary care centre, Bhopal.

Methods: This present study employed a cross-sectional design to investigate cervical cancer awareness among 100 female patients aged 20 years and above attending G-OPD at People Medical College Hospitals and Research Centre from January 2024 to June 2024. Participants were selected using a multistage sampling technique to ensure representation and a pre-tested, self-administered questionnaire was employed.

Results: The majority of participants (61%) were aged 20-40 years. Awareness about PAP smear testing was low, with 53% unaware in the 20-40 age group. Knowledge about cervical cancer risk factors was alarmingly low, with 57% unaware in the 20-40 age group. HPV vaccine awareness was also limited, with 57% unaware in the 20-40 age group. Conclusions: The study reveals a concerning lack of awareness about cervical cancer screening, risk factors and HPV vaccination. Targeted education and awareness campaigns are necessary to promote cervical cancer prevention and early detection.

Comparative evaluation of human papillomavirus DNA and liquid-based cytology in screening of cervical cancer

2025-05-30T06:49:53+0530

Background: Cervical cancer ranks as the fourth most prevalent cancer among women worldwide with approximately 604,127 new cases and 341,831 deaths reported in 2020. It takes around 10-20 years for progression from mild dysplasia to invasive cancer, allowing early detection through screening .

Methods: This was a cross-sectional study conducted at the department of obstetrics and gynaecology at GSVM medical college Kanpur between december 2022 to december 2023 involving 241 women aged 30-65 years attending the gynecology OPD. Liquid-based cytology (LBC) and human papillomavirus (HPV) DNA testing was conducted on each woman irrespective of complain of presentation.

Results: The mean age of patients in this study was 39.65 years. HPV DNA had a higher sensitivity (95.24%) than LBC (89.68%). Specificity of HPV DNA (72.16%) was slightly lesser than LBC (79.92%). Positive and negative predictive value for HPV DNA and LBC are (46.1%, 96.22%) and (49.68%, 94.68%) respectively. Area under curve for HPV DNA (0.79) was higher than LBC (0.74) proving its higher diagnosing accuracy. The cluster analysis showed HPV+ clusters covered more area and distribution than LBC proving its better performance.

Conclusions: HPV DNA testing showed superior sensitivity compared to LBC. HPV DNA's higher diagnostic accuracy and broader coverage make it a more reliable screening tool.

Feto-maternal outcome in eclampsia at tertiary care hospital in an observational prospective study

2025-05-30T06:49:52+0530

Background: Eclampsia is a grave consequence of pre-eclampsia. It is defined as development of seizures in a woman with pre-eclampsia during pregnancy or puerperium that cannot be attributed to other causes. Pre-eclampsia complicated by generalized tonic clonic convulsions raises the risk to both mother and fetus. The current study is being done to analyse the cause, clinical course, it's management and feto-maternal outcome in patients of eclampsia.

Methods: prospective observational study at Gopinath maternity home, Obstetrics and Gynaecology department, Government Medical College, Bhavanagar including all antepartum, intrapartum and postpartum cases of eclampsia in 10-month period August 2023 to May 2024.

Results: The findings underscore the high prevalence of eclampsia among younger women, particularly primigravidae. The study also revealed that the majority of cases were managed as emergencies, reflecting the lack of adequate prenatal care and monitoring. These demographic and socioeconomic insights emphasize the urgent need for improved healthcare access and educational programs targeted at vulnerable groups to mitigate the risks associated with eclampsia.

Conclusions: The high incidence of eclampsia and its complications during this study indicate the need for early identification of risk factors and timely intervention to improve maternal and perinatal outcome. By giving mass awareness towards the importance of antenatal care, ensuring early detection of symptoms of pre-eclampsia in peripheral hospitals and providing adequate treatment, the incidence of eclampsia can be reduced effectively.

Evaluation of the efficacy and tolerability of 4 mg dienogest in women with adenomyosis and BMI >30

2025-05-30T06:49:49+0530

Background: To evaluate the efficacy and tolerability of 4mg dienogest in women with adenomyosis and BMI >30.

Methods: This prospective study, conducted at Lakshmi Madhavan Hospital Pvt Ltd, Tirunelveli, Tamil Nadu, between January and October 2023, included 110 women aged 30-40 years diagnosed with adenomyosis via ultrasonography and presenting with severe dysmenorrhea. These women, all with BMI >30, were administered 4mg Dienogest (2mg twice daily) for eight weeks, followed by a taper to 2mg once daily for 12 weeks. All participants received dietary counselling emphasizing reduced carbohydrate intake and lifestyle modifications. Data on symptom improvement, adverse effects, and adherence were collected and analyzed using STATA 11.0.

Results: A significant improvement in symptoms such as menorrhagia, dysmenorrhea, dyspareunia, and chronic pelvic pain was observed in 81% of participants. Adverse effects, including headache (15%), breast discomfort (10%), and mild weight gain (8%), were reported but were well-tolerated. Irregular bleeding led to discontinuation in 3% of cases. Women requiring the 4mg dose beyond eight weeks demonstrated poor adherence to dietary modifications. The overall success rate was 81% (n=89), with a failure rate of 19% (n=21).

Conclusion: The study suggests that a higher dosage of Dienogest (4mg) for a limited period is effective and well-tolerated in obese women with adenomyosis who do not respond to the standard 2 mg dose. However, individualized treatment and strict lifestyle adherence are essential for optimal outcomes.

An evaluation of feto-maternal outcome in oligohydramnios: a prospective study

2025-05-30T06:49:47+0530

Background: Oligohydramnios is defined as amniotic fluid index (AFI) below 5th centile for the gestational age. AFI is an index of foetal well-being. It is associated with increased pregnancy complications, perinatal morbidity and mortality. AFI assessment would help to identify women who need increased antepartum and intra-partum surveillance. It occurs in 1-5% of pregnancies at term. We intended to do a specific study at our centre IGMC, Shimla to compare the maternal and perinatal outcome in pregnant women having isolated oligohydramnios at term with those having normal AFI.

Methods: This was a prospective observational case control comparative study conducted in the department of Obstetrics and Gynecology at Indira Gandhi Medical College, Shimla between 1st July 2019 to 30th June 2020. 50 cases with AFI≤5cm and 50 controls with AFI 8-20cm at 37-42 weeks were enrolled. Maternal and neonatal outcomes were compared.

Results: There was more foetal growth retardation (FGR) in study group 28% as compared to 10% in control group, more induction of labour in study group 50% as compared to control group 38%. 46% of patients from study group while only 20% patients from control group underwent LSCS. Significant difference observed between 1- and 5-minute APGAR scores in both groups. Low birth weight <2.5 kg was seen in 24% of neonates from study group and 10% of neonates from the control group. 50% of neonates from the study group were admitted in NICU for complications.

Conclusions: AFI is a valuable screening test for predicting foetal distress in labour requiring caesarean section. Timely intervention is required to reduce perinatal morbidity and mortality.

Management of second trimester abortion beyond 20 weeks in a tertiary care setting

2025-05-30T06:49:46+0530

Background: Management of second-trimester abortion beyond 20 weeks is still unclear. To analyse the management of second-trimester abortions in a tertiary care setting.

Methods: A retrospective analysis was carried out over 1 year for the women undergoing 2nd trimester abortion after 20 weeks. The primary outcome was to find out the various regimens used for 2nd-trimester abortion. The secondary outcomes were the number of doses of drug required for completion of the abortion process, complications and side effects associated with the same. Other outcomes like the cause of abortion requirement beyond 20 weeks and the demographic profile of women have been noted. A review of literature was carried out on the management of 2nd trimester abortion beyond 20 weeks.

Results: A total of 57 medical termination of pregnancy (MTP) were carried out. Mifepristone followed by misoprostol was the method of choice in 93% of cases. Other methods adopted were foleys induction, mifepristone alone. The mean number of misoprostol doses used in termination between 20-24 weeks were 3-4 (400 mcg), While it was 4-5 doses (200mcg) beyond 24 weeks of gestation. Hysterotomy and hysterectomy were done as a result of complication arising out of the regimen followed in less than 1 % of cases.

Conclusions: The combination of 200 mg mifepristone and vaginally administered misoprostol is a safe, effective and non-invasive regimen for termination of pregnancy even beyond 20 weeks.

Eclampsia is still a nightmare for obstetrician-maternal and perinatal outcome in eclampsia patients at tertiary hospital and factors affecting the outcome

2025-05-30T06:49:44+0530

Background: Among the disorders that complicate pregnancy, pre-eclampsia and eclampsia are major causes of maternal and perinatal morbidity and mortality. Hypertensive disorders complicate 5% to 10% of all pregnancies and form a lethal trio with haemorrhage and infection. In India, the incidence of eclampsia ranges from 1 in 500 to 1 in 30 (0.5%-1.8%). Pre-eclampsia and eclampsia are a major cause of approximately 20% of all maternal deaths in USA and around half of them are associated with eclampsia. To study various factors associated with eclampsia and outcomes in eclampsia patients.

Methods: It is a prospective observational study conducted in the department of obstetrics and gynaecology in a tertiary care hospital in Central India. The study was conducted for duration of two years from November 2019 to October 2021.

Results: In our study we found that Maternal complications were present among 19.0% women with eclampsia. Among the patients with maternal complications, atonic PPH was present among 16.2% women, obstetric hysterectomy was required in 0.4%. Maternal mortality was present among 4.5% patients. Of maternal deaths, cerebrovascular accidents accounted for four maternal deaths followed by acute renal failure among three women. Pulmonary edema, HELLP syndrome and septicemia were the cause of maternal death among two, one and one women respectively. Among the newborns, 6.9% comprised of stillbirths and early neonatal death was observed among seven newborns 2.8%.

Conclusions: Improving the antenatal care by proper antenatal visits, early booking, meticulous BP records at each antenatal visit and special attention to high-risk groups such as primigravida, teenage pregnancy and pregnancy-induced hypertension and early referral and specialist care is important for the improvement in the maternal and perinatal outcomes.

Knowledge, perception and awareness associated with symptoms and complications of polycystic ovarian syndrome among college women

2025-05-30T06:48:16+0530

Background: This study aimed to assess the knowledge, perception, and awareness of polycystic ovarian syndrome (PCOS) symptoms and complications among college women’s in Chennai, India, to identify gaps in understanding and inform targeted educational interventions.

Methods: A cross-sectional survey was conducted among 292 female college students aged 18-25 years at Sri Ramachandra institute of higher education and research. A structured questionnaire evaluated participants' knowledge, perceptions, and awareness of PCOS symptoms, complications, and preventive measures. Data were analyzed using descriptive statistics.

Results: While 91.43% of participants had heard of PCOS, only 54.97% correctly identified androgen excess as a key factor. Awareness of symptoms like irregular menstrual cycles 82.19% and hirsutism 66.78% was relatively high, but knowledge of long-term complications such as diabetes 35.27% and heart disease 37.67% was low. Most participants recognized the importance of lifestyle interventions, with 77.05% endorsing regular exercise and 76.36% supporting dietary modifications. Allopathic medicine was the preferred treatment 70.89%, with minimal interest in alternative therapies.

Conclusions: The study reveals significant gaps in knowledge regarding the long-term complications of PCOS among college women’s. While awareness of common symptoms is relatively high, targeted educational programs are needed to improve understanding of the syndrome's broader health implications. Healthcare professionals should play a central role in disseminating accurate information to promote early detection and effective management of PCOS.

Awareness about breast cancer and breast self-examination among reproductive age group females attending outpatient department of tertiary health care hospital: a cross-sectional study

2025-05-30T06:48:14+0530

Background: Breast cancer (BC) is the most common type of cancer in Indian women. For every two women newly diagnosed with breast cancer, one woman died of it in India. Hence, this study was conducted to assess the awareness about breast cancer, and to assess knowledge regarding breast self-examination (BSE) among reproductive age group females.

Methods: A cross-sectional study was conducted in the out-patient department (OPD) at a tertiary health care hospital from April to September 2023 among 203 females of the reproductive age group (15-49 years) using a simple random sampling technique. A self-designed, pre-tested questionnaire was used to assess awareness about breast cancer and knowledge regarding BSE. Institutional Ethics Committee approved this study. Data was analyzed with statistical package for the social sciences (SPSS) version 20.0 and Microsoft excel.

Results: Study participants had a mean age of 28±8 years. Among the total participants of n=203, 93 (45.8%) were married, and 58 (28.6%) belonged to the upper socioeconomic class. A total of 175 (86.2%) women heard about BC. Among them (n=175), 133 (76.0%) women were aware of causes of BC, 89 (50.8%) knows about diagnosis, 77 (44%) had knowledge regarding treatment and 101 (57.7%) were known to preventive measures for BC. 86 (49.1%) women had knowledge about BSE, but among them only 52 (60.4%) knew proper technique and were practicing it monthly.

Conclusions: Overall awareness about BC and BSE was less and measures should be taken to improve BC awareness and BSE practices.

The interrelationship between abnormal vaginal discharge, genital hygiene practices, and sexual behaviours among women of reproductive age in Ibadan, Nigeria

2025-05-30T06:48:14+0530

Background: Abnormal vaginal discharge (AVD) is a common condition in women, often linked to infections and reproductive health complications. This study investigates the prevalence of AVD among women in Ibadan, Nigeria, and assesses its relationship with genital hygiene practices, and sexual behaviors.

Methods: A cross-sectional study was conducted among 366 women aged 18-49 using structured interviewer-administered questionnaires. Data were analyzed using Pearson correlation and linear regression models in statistical package for the social sciences (SPSS) 25.0.

Results: The prevalence of AVD was 42.1%, with 59.2% of affected women not seeking medical care due to financial constraints, stigma, or misconceptions. Poor genital hygiene (r=0.278, p=0.002) and risky sexual behaviours (r=-0.327, p=0.000) significantly increased AVD occurrence. Most women (90.2%) used water for genital cleaning, while 21.3% used soap and 16% relied on specialized hygiene products. Additionally, 41% of women used contraception, but only 27.1% used it consistently. Cultural influences such as: taboo, limited access to hygiene education, use of traditional herbs (OR=1.89, 95% CI: 1.02–3.51, p=0.042) also played a significant role in hygiene practices. Almost a quarter, 23.2%, of participants reported that AVD negatively affected their intimate relationships.

Conclusions: The findings underscore the necessity for public health initiatives that enhance genital hygiene education, promote safer sexual practices, and improve access to healthcare services. Addressing cultural and societal barriers such as stigma and religious norms is crucial to improving reproductive health outcomes and reducing complications associated with abnormal vaginal discharge among women in Ibadan.

Feasibility of laparoscopic sacrocolpopexy in pelvic organ prolapse: a single centre prospective observational study

2025-05-30T06:48:12+0530

Background: Pelvic organ prolapse (POP) is a prevalent gynaecological condition that significantly impacts women's quality of life across all age groups. Surgical treatment is often necessary, laparoscopic sacrocolpopexy (LSC), offers a minimally invasive option with promising results. This study done in a tertiary care laparoscopic and robotic centre (GEM Hospital, Coimbatore) aims to explore the advantages of laparoscopic sacrocolpopexy.

Methods: This is a prospective study conducted over a period of 5 years. The participants are women who attended the gynecology clinic and were detected to have prolapse symptoms with a grade 2 or more descent of anterior wall, apex or posterior wall of vagina. Participants were followed until the 6th month of post-operative period.

Results: A total of 54 women were included in the study, most of them being multiparous. 30 out of the 54 women were obese, that signifies the association of obesity with pelvic organ prolapse. 54 patients underwent laparoscopic sacrocolpopexy, of which 7 patients underwent concomitant total laparoscopic hysterectomy (TLH) with sacrocolpopexy. 4 patients underwent laparoscopic sacrocolpopexy along with paravaginal cystocoele repair. The average time calculated was 182 minutes. All the patients reviewed at 3 months and 6 months post-op, had no symptoms of descent and on examination, 2 patients had Bp point at the level of -1.

Conclusions: Laparoscopic sacrocolpopexy offers comparable objective and subjective cure rates to open surgery and is a safe and effective treatment for vaginal vault prolapse, providing long-term anatomical restoration and cure.

Effect of negative suction drain on abdominal wounds after obstetric and gynecological surgery

2025-05-30T06:48:09+0530

Background: Wound complications are common after gynecological surgery. The purpose of the study was to find out whether use of negative suction reduces wound complications in gynecological surgery

Methods: Patients undergoing obstetric and gynecological surgeries were taken into the study. The study group had negative suction drain in the subcutaneous plane. The control group had conventional layered closure of abdominal wound. Wound complications were noted in each group and compared.

Results: We found significant reduction in surgical site infections in the negative suction group. In patients who are obese and BMI>25 there were less delayed wound healing, surgical site infections and gaping in negative suction group.

Conclusions: The use of negative suction drain significantly reduced surgical site infections. In patients with BMI>25 there was significant reduction in the incidence of delayed wound healing, gaping and surgical site infections.

Assessment of the benefit of cervical cerclage in mothers diagnosed with short cervix

2025-05-30T06:48:08+0530

Background: Cervical incompetence is the inability of the uterus to retain a pregnancy in the absence of signs and symptoms of clinical contractions or labour or both in the second trimester of pregnancy. Cervical cerclages could be better management for pregnancy outcome. In the present study, we evaluated the pregnancy outcome in mothers diagnosed with short cervix who underwent cervical cerclage during second trimester in tertiary care institute.

Methods: This research was conducted as prospective analytical study during the period of 25 months from January 2021 to April 2022. The cervical cerclage was performed as per McDonald’s technique under short anaesthesia among the mothers who presented with short cervix was posted for cervical cerclage operation as per the standard procedure.

Results: In the present study, among 10 mothers with previous one second trimester miscarriage 7 cases (70.0%) reached full term, among 5 patients with previous two second trimester miscarriages 3 cases (60.0%) reached full term and among 2 patients with previous three second trimester miscarriages and 2 cases (100%) reached full term. Overall, 12 cases (70.58%) out of 17 patients with previous second trimester miscarriages had reached full term. Moreover, among 19 mothers with previous one preterm delivery 15 cases (78.94%) reached full term and among 8 mothers with previous two preterm deliveries and 5 cases (62.50%) reached full term. Overall, 20 cases (74.07%) of 27 mothers with previous preterm deliveries had reached full term. The majority of mothers (45, 97.82%) had live births. Only 1 case (2.17%) had second trimester miscarriage.

Conclusions: this study observed the cervical cerclages an effective method in management of short cervix and cervical incompetence.

Fetomaternal outcome in overweight and obese pregnant women in tertiary care hospital in Northeast India

2025-05-30T06:48:07+0530

Background: The global prevalence of overweight and obesity in 2014 was 39% and 13% respectively. Underweight is defined as BMI less than 18.5, normal weight as BMI from 18.5 to 24.9, overweight from 25 to 29.5 and obese as BMI of 30 or greater. Obesity is critically important to maternal and fetal health during the perinatal period. Obesity increases the risks of gestational diabetes mellitus, overt diabetes, pregnancy induced hypertension including gestational hypertension, pre-eclampsia, eclampsia, thrombo-embolic phenomena, infections, miscarriage.

Methods: A prospective cohort study was carried out in the Department of Obstetrics and Gynaecology, RIMS, Imphal, Manipur for duration of two years beginning from July, 2019 to August, 2021. Consecutive sampling method was followed to include 38 cases and 38 controls and analysis was done.

Results: Comparison of pre-eclampsia among the study groups showed 8 (21.1%) of exposed group and 1 (2.6%) of the non-exposed group developed preeclampsia. The association between overweight and obesity with GDM. 9 (23.7%) of overweight and obese women while 1 (2.6%) of non-obese women developed GDM. The distribution of neonates requiring neonatal resuscitation among the two study groups showed that 14 (36.84%) of neonates born by overweight and obese women required resuscitation as against 5 (13.16%) of neonates born by non-obese women.

Conclusions: It was evident from the study that maternal obesity has adverse maternal and fetal outcomes. Maternal obesity was strongly associated with antenatal complications like gestational diabetes mellitus, preeclampsia and increase in need for newborn resuscitation.

Prenatal invasive diagnostic testing for hemoglobinopathies: a retrospective cohort study at a tertiary care public hospital in central India

2025-05-30T06:48:06+0530

Background: Transfusion-dependent hemoglobinopathies such as sickle cell disease, thalassemia, etc. have a huge impact on the Indian economy due to the need for lifelong care and treatment of associated morbidities. Primary prevention strategies focus on awareness generation and pre-marital and pre-conceptional counseling to prevent the conception of a child with a homozygous genotype. Aim was to study the prevalence of carrier status of hemoglobinopathies, the couples at risk of carrying a fetus with major hemoglobinopathies, and the prevalence of fetal affection with major hemoglobinopathies in prenatal invasive testing.

Methods: It was a retrospective cohort study conducted at AIIMS, Nagpur. Study conducted from 24 months (June 2021-June 2023). All antenatal women screened for hemoglobinopathies with HPLC and diagnosed to have hemoglobinopathies.

Results: The 5,432 antenatal women were screened for hemoglobinopathy using high-performance liquid chromatography (HPLC). Out of these, 214 women were carriers of hemoglobinopathies. 53 couples were found to be at risk of carrying a fetus with major hemoglobinopathy. The 52 women underwent prenatal diagnosis (PND), 11 (21.1%) were found to be affected with major hemoglobinopathies and underwent medical termination of pregnancy (MTP). 24 babies were found to be carriers while 17 had no mutation.

Conclusions: Owing to the high prevalence of hemoglobinopathies and the continually increasing impact on global health each year, the benefit of carrier screening programs to control incidence of new cases is recognized worldwide.

Comparison of mattress and continuous suturing techniques using polyglactin 910 and chromic catgut for episiotomy repair: an observational study

2025-05-30T06:48:03+0530

Background: An episiotomy is an incision through the perineum to increase the vulvae outlet’s diameter and assist childbirth. Despite the fact that episiotomy is proven to benefit mothers, it is responsible for a significant percentage of both short-term and long-term postpartum morbidities. This study compares two different suture materials, namely polyglactin and chromic catgut, for episiotomy repair and short-term maternal morbidity.

Methods: This was a prospective observational study conducted in the Department of Obstetrics and Gynaecology, Government Medical College, Thrissur. The data was collected and analysed using SPSS software.

Results: A total of 400 participants who fulfilled the inclusion and exclusion criteria were studied. The majority of 214 women (53.5%) included in this study were between 20-25 years. 17(4.3%) women had edema (1 cm) at 24-48 hours after delivery. 43 (10.8%) women had more than 99-degree temperatures at 24-48 hours. 6 (1.5%) women had wound dehiscence at 6 weeks of them, 4 belonged to group 4. 98.3% had episiotomy wounds healed by primary intention.

Conclusions: There was a reduction in wound dehiscence and more healing by primary intention in the polyglactin group than in the chromic catgut group. There was no significant reduction in short-term pain, temperature, induration and oedema between these groups. Hence, this study recommends a more rapidly absorbable form of polyglactin than traditional chromic catgut for perineal repair.

Does the presence of blood on the catheter or the degree of difficulty in embryo transfer affect the outcome in ART

2025-05-30T06:48:03+0530

Background: Implantation may be impacted by the embryo transfer (ET) method. It's uncertain whether postprocedural blood at the transfer catheter tip is a true indicator of transfer difficulty because previous studies that examined its impact have produced conflicting findings. Our goal was to calculate the impact of blood at the moment of Embryo Transfer and the degree of difficulty associated with it on live birth rates (LBR).

Methods: This was a retrospective study conducted at Kamlesh Tandon test tube baby centre, Agra from July 2022 to April 2024. Patients underwent COS followed by Oocyte retrieval and fresh embryo transfers. Patients with high Serum Oestradiol levels and more than 15 oocytes were deferred for a fresh embryo transfer. A freeze-all policy was followed by a subsequent freeze thawed embryo transfer cycle. The Clinical Pregnancy Rates and the Live Birth Rates were calculated.

Results: Generalized estimating equations (GEE) for logistics regression with exchangeable correlation with robust variance was used to estimate the adjusted and unadjusted ORs in this retrospective cohort study. After conducting univariate modelling, all relevant confounders were taken into account in the final multivariate (adjusted) GEE model. At the moment of transfer, the ART specialist would subjectively assess embryo transfers as easy, medium or hard. Blood found at ET was linked to more challenging ETs, retained embryos in the catheter and mucus in the catheter. The degree of difficulty for ET had an adverse effect on the live birth rate (LBR), while ET with blood did not correlate with live birth in the univariate study. The only variables linked to an elevated LBR in the final multivariate GEE model, which took into account a patient's repeated cycles, were the blastocyst transfer, female age and the difficulty of the ET. The presence of blood in the transfer catheter was not linked to the chance of pregnancy and, therefore, was not an independent predictor of cycle outcome after correcting for confounding variables. This suggests that the transfer’s inherent complexity and its difficulties are factors that have a substantial negative predictive impact on pregnancy outcomes.

Conclusions: Optimizing ET will allow providers to maximize successful interaction of embryo and endometrium, leading to the establishment of a viable pregnancy. These data suggest that the presence of blood during a routine, easy ET is not detrimental to live birth.

A descriptive cross-sectional study of association between abnormal uterine bleeding and thyroid dysfunction

2025-05-30T06:48:04+0530

Background: Abnormal uterine bleeding (AUB) is one of the most common gynecological presentation, accounting for at least 20% of all outpatient visits. Thyroid dysfunction has profound effect on the female reproductive system. Both hypothyroidism and hyperthyroidism are associated with untoward menstrual changes. This study aims to find the prevalence of thyroid dysfunction among patients with diagnosed AUB.

Methods: A descriptive cross-sectional study was conducted in the Department of Obstetrics and Gynaecology at General Hospital Jayanagar, Bengaluru. After taking ethical clearance from the Institutional Review Committee, the study was conducted on 100 patients with AUB satisfying the inclusion and exclusion criteria from November 2020 to May 2022. Thyroid function test was done in all patients by radioimmunoassay on an automated analyzer. Data was collected using a questionnaire which includes patient’s profile, pattern of AUB, examination and thyroid profile.

Results: Out of 100 patients, it was found that 75% were euthyroid, 20% were hypothyroid, among which 15% had subclinical hypothyroidism and 5% had overt hypothyroidism and 5% were hyperthyroidism. The most common type of AUB was menorrhagia in 38%, followed by acyclical bleeding in 33%, polymenorrhoea in 11%, metrorrhagia in 8%, oligomenorrhoea in 7%, and hypomenorrhea in 3%. The maximum number of patients were between 30-40 years.

Conclusions: Thyroid dysfunction is one of the important causes of AUB with hypothyroidism being the most common type in patients with menorrhagia. It was reported that their symptoms improved with thyroid medication.

Adhesions in repeat caesarean sections: prevalence, predictive factors, and surgical outcomes

2025-05-30T06:47:01+0530

Background: Adhesion formation is a common sequela of repeat caesarean sections (CS), associated with increased surgical complexity and morbidity. This study aimed to identify maternal and surgical predictors of adhesion formation and to assess its intraoperative and postoperative consequences.

Methods: This cross-sectional cohort study was conducted at Sawai Mansingh Medical College, Jaipur, from June to December 2024. A total of 100 women undergoing repeat CS were included. Data on maternal demographics, surgical history, intraoperative findings, and postoperative outcomes were collected. Adhesions were graded as mild, moderate, or dense. Statistical analysis was performed using statistical package for the social sciences (SPSS) version 26, with p value <0.05 considered statistically significant.

Results: Adhesions were present in 35% of cases 15% mild, 11% moderate, and 9% dense. Significant predictors of adhesion formation included higher body mass index (BMI) (p=0.003), greater number of previous CS (p=0.0212), and higher parity. Adhesions were significantly associated with increased operative time (mean 60.56±8.46 minutes for dense adhesions), greater hemoglobin drop (1.10±0.25 g/dl versus 0.65±0.26 g/dl, p<0.001), higher rates of intraoperative blood transfusion (66.7% versus 7.7%, p<0.001), and visceral injury (44.4% versus 0%, p<0.001). Duration of hospital stay did not differ significantly between groups.

Conclusions: Adhesion formation in repeat CS is significantly associated with maternal risk factors and adversely impacts surgical outcomes. Anticipating adhesions through risk assessment and applying meticulous surgical techniques are essential to minimize complications.

Role of gut microbiome in gestational diabetes mellitus, in South Indian population

2025-05-30T06:46:52+0530

Background: Gestational diabetes mellitus (GDM) is one of the most common metabolic complications of pregnancy, characterized by glucose intolerance first recognized during gestation. Emerging evidence suggests that the gut microbiome an intricate community of microorganisms residing in the gastrointestinal tract plays a crucial role in metabolic health, insulin resistance, and inflammation. Alterations in gut microbiota composition have been implicated in the development of metabolic disorders, including type 2 diabetes mellitus (T2DM) and obesity.

Methods: This study was conducted to investigate the association between gut microbiome composition and GDM among pregnant women. A total of 124 pregnant women were enrolled, comprising 53 diagnosed with GDM and 71 healthy controls.

Results: This study revealed significant gut microbiome dysbiosis in women with GDM, characterized by reduced microbial diversity (lower Shannon, Chaol, and Simpson indices; p<0.01) and distinct taxonomic shifts compared to healthy controls. Pro-inflammatory genera like Bacteroides and Parabacteroides were enriched in GDM (p<0.001), while beneficial taxa such as Akkermansia and Ruminococcaceae were depleted (p<0.001). These microbial alterations strongly correlated with elevated fasting glucose and CRP levels (r>0.39, p≤0.002), suggesting a link between dysbiosis, hyperglycemia, and inflammation. Longitudinal analysis further showed worsening dysbiosis in late gestation, with Bacteroides increasing and Akkermansia declining by 36 weeks (p<0.01). The findings highlight the gut microbiome’s potential role in GDM pathogenesis in this population and support future interventions targeting microbial restoration.

Conclusions: Evidence from the study findings underscores the significant role of gut microbiota in GDM pathogenesis.

Identification of risk factors of premature rupture of membrane at a tertiary care centre: a case-control study

2025-05-30T06:46:50+0530

Background: Premature rupture of membranes (PROM) is a critical issue in obstetrics, occurring in 3-4% of pregnancies and accounting for 40-50% of preterm births. This study aims to identify risk factors associated with premature rupture of membranes in women who deliver at tertiary care centre.

Methods: This research is a case-control study conducted with 240 women at the Department of Obstetrics and Gynaecology, People's College of Medical Sciences and Research Institute, Bhopal. The study comprised 80 cases and 160 controls in a 1:2 ratio.

Results: There were no significant demographic differences between cases and controls. However, significant differences were found in past obstetric and gynecological histories. PROM was strongly associated with previous PROM (Adjusted OR: 4.62, 95% CI: 2.06-10.52), previous lower segment cesarean section (LSCS) (Adjusted OR: 2.08, 95% CI: 1.14-6.74), abnormal vaginal discharge (AOR: 2.35, 95% CI: 2.53-22.46) and urinary tract infections (UTI) (AOR: 3.40, 95% CI: 6.56-13.04).

Conclusions: Key risk factors for premature rupture of membranes include previous PROM, LSCS, abnormal vaginal discharge and UTIs. Addressing these factors is crucial for preventing PROM and enhancing maternal and fetal health outcomes.

Average gonadotropin dosage per follicle as a predictor of ovarian response

2025-05-30T06:46:49+0530

Background: In ovarian stimulation, oocytes retrieved are commonly used to assess response to gonadotropins. Markers like FORT, FOI, and OSI have been proposed but show poor prediction of IVF outcomes. Each is limited by various clinical and technical factors. A novel index, average gonadotropin dosage per preovulatory follicle offers better prediction of ovarian response and clinical pregnancy rate, aiding in personalized stimulation and helping anticipate OHSS risk and cycle cancellations

Methods: This retrospective cohort study included 238 sub fertile women who underwent IVF at the Institute of Reproductive Medicine, Madras Medical Mission Hospital, from January 2019 to December 2023. It aimed to evaluate a new marker, average gonadotropin dosage per preovulatory follicle as a predictor of ovarian response and pregnancy outcomes. The index was calculated by dividing the total gonadotropin dose by the number of 16–22 mm follicles on trigger day. Patients were grouped by the 50th percentile, and stimulation parameters, MII oocyte ratio, clinical pregnancy rate, and live birth rate were compared between groups.

Results: Group A showed significantly higher oocyte yield, MII oocyte ratio, and fertilization rate (p<0.001). Clinical pregnancy and live birth rates were higher in Group A with statistical significance compared to Group B

Conclusion: Average gonadotropin dose per follicle proved to an ovarian response predictor in our study.

Impact of multidisciplinary team simulation-based training of residents to improve the outcome of operative vaginal deliveries and obstetric emergencies

2025-05-30T06:46:48+0530

Background: Obstetric emergencies such as eclampsia, atonic postpartum hemorrhage and maternal collapse, use of vacuum or forceps for operative vaginal deliveries are high pressure situations where residents don’t feel very confident due to lack of practice. Use of high-fidelity simulation to improve the skill-set and confidence level was the main objective of this study.

Methods: This study was done in the D. Y. Patil University simulation lab over a period of 1 month. 42 postgraduate junior residents of the Department of Obstetrics and Gynaecology were included in the study. A pre and post workshop questionnaire on the subject and a confidence questionnaire were used to assess the residents. Three case-based scenarios were constructed on the high-fidelity simulator for the residents in the workshop followed by a debriefing of each case.

Results: The improvement in the knowledge and confidence for managing postpartum hemorrhage and eclampsia was from a mean value of 3.5±1.0 (2-6) and 4.7±1.0 (3-6) respectively in the pretest and a mean value of 8.2±0.8 (7-9) and 8.5±1.1 (6-10) respectively in the post test. The response time to postpartum hemorrhage and setup of eclampsia kit also had statistically significant p value of less than 0.0001.

Conclusions: Practice of obstetric emergencies, improving team building, communication and techniques of operative vaginal deliveries are all within the confines of a simulation laboratory. They are helpful in improving the proficiency of the junior residents and would eventually improve maternal and fetal outcomes.

Prevalence of hypertension among females with infertility, and its association with demographics

2025-05-30T06:46:48+0530

Background: Hypertension (HTN) is a major health problem accelerating worldwide, particularly among reproductive-age females. It may impair fertility through hormonal and vascular mechanisms. This study assesses the prevalence of HTN among females with infertility and its association with demographic and lifestyle factors.

Methods: A cross-sectional study was conducted over 12 months in the obstetrics and gynaecology department at Hind institute of medical sciences, Sitapur. A total of 384 infertile females aged 18-49 years were included. A predesigned proforma was used to gather demographic, dietary, and anthropometric data, as well as blood pressure (BP) measurements. The 2017 ACC/AHA guidelines were used to classify HTN. SPSS version 22 was used for the statistical analysis.

Results: The mean age of infertile females was 27.87 (6.58) years. The prevalence of HTN among infertile females was 33.1%. Overweight and obesity were present in 40.9% and 20.8% of participants, respectively. HTN was significantly associated with obesity (p<0.0001) and higher socioeconomic status (p=0.016). No significant associations were found with age, religion, family type, livelihood, type of infertility, diet, or junk food intake.

Conclusions: A high burden of HTN was observed among infertile women, particularly those with obesity and higher socioeconomic backgrounds. Integration of cardiovascular screening and lifestyle interventions into infertility care is essential.

Exploring the efficacy of centchroman as a postpartum contraceptive: an observational study

2025-05-30T06:46:46+0530

Background: Centchroman, a non-hormonal contraceptive, offers a safer alternative for postpartum women, particularly in India, where the responsibility of contraception largely falls on females. Despite its benefits, including minimal side effects and efficacy in pregnancy prevention, its adoption remains low. This study examines Centchroman’s effectiveness as a postpartum contraceptive in eastern India

Methods: This prospective observational study (March 2017–February 2018) recruited postpartum women from SCB Medical College, Odisha, meeting inclusion criteria. Participants took Centchroman following a structured regimen, with follow-ups at 1, 3 and 6 months. The primary objective was to determine contraceptive efficacy. Secondary objectives were to assess compliance, satisfaction and adverse effects. Data were analysed using SPSS using Statistics (Version 23.0).

Results: During the study, 785 eligible participants were counselled and 247 consented to use Centchroman, resulting in an acceptance rate of 31.5%. Most were aged 25–29, Hindu (79.7%) and from rural areas (59.5%). Compliance was high, with 96.2% satisfaction by the third follow-up. Common adverse events included delayed periods and heavy bleeding, which decreased over time. Milk secretion reduction was minimal. The main reasons for discontinuation were living apart from their husband (4.8%) and fear of side effects (4.4%). Centchroman showed high adherence, safety and effectiveness as a postpartum contraceptive.

Conclusions: This study highlights Centchroman as a safe, effective, non-hormonal postpartum contraceptive with high acceptability. Minimal adverse effects make it suitable for lactating mothers.

Comparative analysis of dehydroepiandrosterone and transdermal testosterone pre-treatment in POSEIDON group 3 and 4 women undergoing in vitro fertilization: a retrospective cohort study

2025-05-30T06:46:41+0530

Background: Patients classified under patient-oriented strategies encompassing individualised oocyte number (POSEIDON) groups 3 and 4 typically demonstrate suboptimal response to controlled ovarian stimulation (COS) in in vitro fertilization (IVF) cycles. Androgen-based pre-treatments like dehydroepiandrosterone (DHEA) and transdermal testosterone have been studied for their role in enhancing ovarian response, although direct comparative data are limited. Objective of the study was to evaluate and compare the effects of DHEA versus transdermal testosterone gel administered before stimulation on ovarian and embryological outcomes in women within POSEIDON groups 3 and 4 undergoing IVF.

Methods: A retrospective cohort study was conducted at a tertiary fertility centre in India between January 2018 and January 2020. Eligible women received either DHEA (75 mg/day for 12 weeks) or testosterone gel (12.5 mg/day for 21 days) before controlled ovarian stimulation (COS). All patients underwent antagonist protocol with dual trigger followed by IVF. Primary outcomes included number of oocytes retrieved, metaphase II (MII) oocytes, and follicular output rate (FORT). Secondary outcomes included fertilization rate, good-quality embryos, and stimulation burden.

Results: Of 237 women analysed, 144 received DHEA and 93 received testosterone gel. The testosterone group showed significantly higher mean oocyte yield (7.2 versus 5.4; p<0.01), MII oocytes (5.6 versus 4.0; p<0.01), and FORT (58.2% versus 49.3%; p<0.01). While fertilization rate (63.5% versus 61.2%; p=0.37) and embryo quality (59.1% versus 57.6%; p=0.75) were similar, testosterone-treated patients required fewer days of stimulation (9.7 versus 10.3; p=0.04) and lower gonadotropin doses (2291 IU versus 2576 IU; p<0.01). No OHSS cases occurred in either group.

Conclusions: This study supports the use of short-course transdermal testosterone as a more practical and efficient adjuvant strategy in poor prognosis IVF cycles. It may be especially valuable in resource-constrained settings, where cost-effectiveness and cycle efficiency are critical to success. Further prospective trials are needed to evaluate long-term reproductive outcomes.