International Journal of Reproduction, Contraception, Obstetrics and Gynecology

Comparative fetomaternal outcomes of acarbose versus insulin in gestational diabetes mellitus: a systematic review and meta-analysis of randomized controlled trials

2026-06-27T06:56:15+0530

The prevalence of gestational diabetes mellitus (GDM) continues to increase globally, particularly in Southeast Asia. Currently, insulin remains the standard therapy for GDM, however its use is invasive and has been associated with hypoglycemia in up to 70% of patients. Acarbose is an alternative oral agent with minimal systemic absorption that works by inhibiting alpha-glucosidase enzyme. Therefore, this study aimed to evaluate the fetomaternal outcomes associated with acarbose therapy in pregnant women with GDM. A systematic search was conducted in PubMed, ScienceDirect, CENTRAL, Google Scholar, and MedRxiv following PRISMA guidelines. Outcomes were analyzed using mean difference (MD) and risk ratio (RR). A total of five studies involving 452 patients were included in the analysis. No statistically significant reduction in HbA1c levels was observed in either group. However, HbA1c tended to be lower in the acarbose group compared with the insulin group (MD=-0.11; 95% CI -0.24, 0.01; p=0.08). Similarly, no significant differences were found in birth weight (MD= -0.11; 95% CI -0.24, 0.01; p=0.08), macrosomia incidence (RR=1.31; 95% CI 0.62, 2.77; p=0.49), or neonatal hypoglycemia (RR=0.56; 95% CI 0.23, 1.36; p=0.20). Nevertheless, neonatal hypoglycemia occurred more frequently in the insulin group than in the acarbose group (20/138 vs 7/91, respectively). Acarbose may be a potential oral alternative for GDM management, demonstrating fetomaternal outcomes comparable to insulin. Nevertheless, future large-scale studies are required to confirm its efficacy and safety.

Atypical vulval cutaneous manifestation of chronic lymphocytic leukaemia following genital herpes masquerading as vulvar carcinoma: a case report

2026-06-27T06:59:10+0530

Chronic lymphocytic leukaemia/small lymphocytic lymphoma (CLL/SLL) is the most common adult leukaemia in Western countries, characterised by monoclonal proliferation of mature B lymphocytes and accounting for approximately 1% of all new cancers in the UK. Although it primarily affects lymphoid tissues, extra nodal involvement can occur, most frequently involving the skin and central nervous system. Involvement of the female genital tract is rare and presents significant diagnostic challenges. We report an unusual case of vulval involvement by CLL mimicking vulval carcinoma. An elderly woman presented with a 6-week history of vulval ulceration. Initial biopsy demonstrated chronic inflammation without evidence of malignancy. She was subsequently diagnosed with low-level CLL and managed conservatively with active surveillance. Over time, she developed worsening vulval pain, extensive ulceration, and recurrent infections requiring multiple hospital admissions. Imaging findings and clinical progression raised strong suspicion of vulval malignancy with nodal involvement; however, repeated biopsies remained non-diagnostic. Multidisciplinary histopathological review ultimately confirmed vulval infiltration by low-grade B-cell lymphoma consistent with CLL. The clinical picture was further complicated by concurrent herpes simplex virus type 2 infection and secondary bacterial infection. This case highlights the importance of considering leukaemia cutis in non-healing vulval ulcers in patients with CLL. Early multidisciplinary involvement, repeated adequate biopsies, and appropriate viral testing are essential to avoid misdiagnosis and ensure optimal management.

Multidisciplinary planning with prophylactic REBOA in cesarean delivery for a giant uterine leiomyoma: a case report

2026-06-27T06:59:03+0530

Large uterine leiomyomas during pregnancy may significantly influence the mode of delivery, hinder access to the uterine cavity and increase the risk of hemorrhage during cesarean delivery. Evidence regarding prophylactic aortic balloon occlusion (REBOA) in this context is limited. A 25-year-old primigravid woman with gestational diabetes, preeclampsia and early-onset fetal growth restriction was found to have a previously undiagnosed giant uterine leiomyoma measuring 17×14×13 cm on magnetic resonance imaging. Due to its size and location, a cesarean delivery was planned at 34+2 weeks with prophylactic REBOA placement. Blood loss was within the expected range and balloon inflation was not required. Maternal and neonatal outcomes were favourable. Prophylactic REBOA may be considered in selected high-risk cesarean deliveries.

A delicate balance: hereditary hemorrhagic telangiectasia and antiphospholipid syndrome in pregnancy with dual therapy

2026-06-27T06:57:49+0530

Hereditary hemorrhagic telangiectasia (HHT) and antiphospholipid syndrome (APS) are two rare disorders that present a challenge during pregnancy due to the competing risks of bleeding and thrombosis. This case presents a 26-year-old female, gravida 3, para 0-1-1-1, with a past medical history of HHT and APS receiving prophylactic anticoagulation. The patient presented to the antepartum ward (APW) at 32.1 weeks of gestation with complaints of hemoptysis and epistaxis. During this evaluation, nebulized tranexamic acid (TXA) was added as a treatment without interruption of anticoagulation therapy. This management resulted in complete resolution of symptoms without maternal or fetal complications. Therefore, nebulized TXA may represent a safe therapeutic option for hemoptysis in pregnant patients with HHT who require anticoagulation for APS. The findings highlight the importance of individualized, multidisciplinary care in a setting of complex diseases.

Endometrial stromal sarcoma in a large fibroid uterus presenting with sepsis-like picture, extensive pelvic thrombosis and severe menorrhagia

2026-06-27T06:57:54+0530

This case report aims to demonstrate the diagnostic challenges of uterine sarcomas, presenting with presumed benign symptoms. Missed clinical clues and consequently a delayed diagnosis demonstrates the importance of considering uterine sarcomas as a differential, particularly in premenopausal women. This case report describes the case of a woman in her early 40s, who presented with symptoms of fibroids, before receiving an incidental diagnosis of endometrial stromal sarcoma, almost a year after her initial hospital presentation. The patient had an extensive investigative period, repeatedly returning to hospital with symptoms including lower abdominal pain and heavy vaginal bleeding, and imaging and biopsies not pointing clinicians to the diagnosis. Many findings and reports presented clues which should have pointed towards an alternative diagnosis-raised LDH, extensive pelvic thrombosis, the presence of a pelvic lymph node, and lack of response to treatment-none of which were considered as consequences of a uterine sarcoma. Diagnostic interpretation was complicated by factors such as a raised BMI, continuous bleeding, and the need for anticoagulation, making the final diagnosis hard to reach. This case demonstrates the criticalness of considering uterine sarcomas as a mimic for benign gynaecological conditions and symptoms. Timely recognition and early consideration is critical to improve outcomes, and uterine sarcomas should always be discussed as a potential diagnosis, especially in premenopausal women.

The curious case of the missing Veress needle beveled outer sheath

2026-06-13T06:35:57+0530

This incident occurred during a laparoscopic sterilization camp in Bhongir more than four decades ago. The camp operated with four operating tables functioning simultaneously, each staffed by a surgeon and an assisting nurse. To maintain the rapid workflow, laparoscopic scopes and Veress needles were continuously cleaned, sterilized and immersed in Cidex solution for 10-15 minutes in accordance with the prevailing protocol. Those who have participated in such sterilization camps will readily understand the operational procedures and working environment involved. The first lady who had the X-ray, the 12 cm long Veress needle with the sharp beveled edge was in the abdomen. In Bhongir Government hospital got the theatre sterilized, the anaesthetist with Boyles apparatus and the surgeon had come in the ambulance from Nalgonda. The author could have performed the laparotomy, but thought it better to have a surgeon in case of any eventuality. There was apprehension to shift her in an ambulance to Hyderabad, with the needle with beveled edge in her abdomen. The Veress was identified in the abdomen by 3:30 pm and a laparotomy was performed at 8:30 pm. The patient was in a stable condition. The needle was covered by omentum and near the left paracolic gutter below the splenic flexure. The needle and part of the omentum covering it were excised. The outer sheath got broken from the handle, the handle was with the inner stylet. The patient made good postoperative recovery. Antibiotic coverage was given prior to laparotomy.

A silent vascular threat: uterine artery pseudoaneurysm in secondary postpartum haemorrhage

2026-06-27T07:11:29+0530

Secondary postpartum haemorrhage (SPH) is an important cause of postpartum morbidity occurring between 24 hours and 6 weeks after delivery. While retained products of conception and endometritis are common causes, rare conditions such as uterine artery pseudoaneurysm (UAP) can result in life-threatening haemorrhage and diagnostic difficulty. We report a case of recurrent SPH caused by UAP following caesarean section. A postpartum woman presented on the eighth postoperative day with massive vaginal bleeding and haemorrhagic shock after caesarean delivery for second-stage arrest. Initial ultrasonography suggested retained products of conception, and she underwent stabilization with blood transfusion followed by check curettage. Despite treatment, the patient developed two further episodes of recurrent haemorrhage requiring repeated admissions. MRI findings suggested scar hematoma, scar dehiscence, or endometritis, while diagnostic laparoscopy was inconclusive. Repeat Doppler ultrasonography by a senior radiologist raised suspicion of UAP, which was confirmed by CT angiography. Selective angiography revealed a pseudoaneurysm arising from the right uterine artery, and successful uterine artery embolization using NESTER coils achieved immediate control of bleeding. UAP should be considered in recurrent or severe SPH. Early diagnosis and timely uterine artery embolization provide effective, fertility-preserving management with excellent outcomes.

Non-puerperal uterine inversion with prolapsed pedunculated submucosal fibroid/polyp: a rare gynaecological emergency

2026-06-27T06:56:22+0530

Non-puerperal uterine inversion (NPUI) is a rare and potentially life-threatening gynaecological emergency, most commonly caused by a submucosal fibroid or endometrial polyp exerting traction on the uterine fundus. We report a case of a 40-year-old postmenopausal woman (P3L3) presenting with severe anaemia (haemoglobin 1.8 g/dl), per vaginal bleeding, and a 10×6×4 cm mass prolapsing through the vaginal introitus. Ultrasonography and contrast-enhanced computed tomography (CT) confirmed grade IV NPUI with a prolapsed pedunculated submucosal fibroid/polyp. Following multidisciplinary preoperative optimisation including blood transfusion, cardiac evaluation, and local wound care, the patient underwent polypectomy followed by total abdominal hysterectomy with bilateral salpingo-oophorectomy. An incidental left adnexal cystic lesion was also excised. The postoperative course was uneventful and the patient was discharged in stable condition. This case highlights the importance of early diagnosis using multimodality imaging and adequate preoperative optimisation prior to definitive surgical management. This case underscores the importance of multimodality imaging for diagnosis and multidisciplinary preoperative optimisation before definitive surgical management of NPUI. Total abdominal hysterectomy with bilateral salpingo-oophorectomy is safe and curative in postmenopausal women when surgery is appropriately timed.

Circumvallate placenta with placental abruption in a high-risk pregnancy

2026-06-27T07:11:27+0530

Circumvallate placenta is a placental morphological variation in which the fetal membranes fold back on the fetal surface, forming a thickened, elevated ring at the placental edge. This abnormal configuration can limit the functional exchange area at the feto-maternal interface. Clinically, it has been associated with complications such as antepartum haemorrhage, preterm birth, fetal growth restriction and adverse neonatal outcomes making its recognition important in obstetric practice.

A 14-year-old girl with primary amenorrhea and 46, XY karyotype: a case of Swyer syndrome

2026-06-27T06:59:21+0530

Swyer syndrome (46, XY pure gonadal dysgenesis) is an uncommon condition within the spectrum of disorders of sex development. Individuals are phenotypically female but possess nonfunctional streak gonads and typically fail to undergo spontaneous pubertal maturation. The condition often presents with primary amenorrhea and carries a notable risk of gonadal neoplasia. A 14-year-old girl presented with absence of menarche and poorly developed secondary sexual characteristics. Clinical assessment combined with endocrine evaluation demonstrated elevated gonadotropins consistent with primary gonadal failure. Cytogenetic analysis confirmed a 46, XY karyotype. Pelvic imaging identified a small uterus along with bilateral streak-like gonads. These findings were confirmed through diagnostic laparoscopy. Considering the established malignancy risk associated with dysgenetic gonads, bilateral gonadectomy was undertaken. Histological examination confirmed fibrous gonadal tissue lacking germ cells, supporting the diagnosis of gonadal dysgenesis. Following surgery, the patient was initiated on estrogen therapy, which led to progressive development of secondary sexual characteristics and pubertal development during follow up. This case highlights the importance of considering Swyer syndrome in adolescents with primary amenorrhea and delayed puberty. Early recognition, timely surgical management and appropriate hormonal therapy are essential to reduce long-term complications and support normal physical development. Coordinated multidisciplinary care plays a key role in achieving favourable outcomes.

A tale of two uteri: silent uterine rupture in a case of uterus didelphys

2026-06-27T06:59:15+0530

Uterine rupture is a rare but life-threatening obstetric emergency, often associated with previous uterine surgery or trauma. However, in the absence of such history, congenital uterine anomalies such as a didelphys uterus can pose unique challenges in pregnancy and labor. A didelphys uterus results from incomplete fusion of the Müllerian ducts during embryogenesis, leading to two separate uterine cavities, each with its own endometrium and often a duplicated cervix and vagina. Although pregnancies can occur in one horn, the structural weakness and altered uterine architecture can predispose affected women to poor obstetric outcomes, including miscarriage, malpresentation, preterm labor, and in rare cases, uterine rupture. This report presents a rare and clinically significant case of silent uterine rupture in a didelphys uterus, emphasizing the importance of early diagnosis, careful monitoring, and tailored obstetric management in such anomalies.

Persistent low-level β-hCG with a hypervascular intrauterine mass after medical abortion mimicking GTN: a diagnostic dilemma

2026-06-27T06:57:55+0530

Persistent elevation or plateau of serum beta-human chorionic gonadotropin (β-hCG) following abortion raises suspicion for gestational trophoblastic neoplasia (GTN). However, benign conditions such as retained products of conception (RPOC) and uterine vascular lesions may present with similar biochemical and imaging findings, creating a diagnostic challenge. A 27-year-old multiparous woman presented with persistent amenorrhea following unsupervised medical abortion. Ultrasound revealed heterogeneous intrauterine contents with increased vascularity. Serial β-hCG levels showed a plateauing trend. Due to suspicion of GTN, she received single-dose followed by multi-dose methotrexate therapy. Although β-hCG levels declined, they failed to normalize and imaging demonstrated a persistent hypervascular intrauterine mass. Considering the risk of haemorrhage with uterine instrumentation and the inability to exclude malignancy, total abdominal hysterectomy was performed. Histopathology revealed necrosed retained products of conception. Postoperatively, β-hCG levels became undetectable. Persistent low-level β-hCG with a hypervascular intrauterine lesion may mimic GTN. In selected patients with completed childbearing and diagnostic uncertainty, hysterectomy may serve as both a diagnostic and therapeutic intervention.

Genotype–phenotype discordance in Noonan syndrome: prenatal diagnosis in an asymptomatic mother

2026-06-27T06:57:53+0530

Noonan syndrome is a RASopathy with variable clinical expression. Prenatal suspicion is often based on ultrasound findings such as increased nuchal fold. Increased nuchal fold on prenatal ultrasound led to genetic evaluation and identification of a pathogenic MAPK1 variant in the foetus. Segregation analysis revealed the same mutation in the phenotypically normal mother also. The neonate after birth was clinically normal with no structural abnormalities. This case highlights the importance of prenatal markers and demonstrates that Noonan syndrome may be present without classical phenotypic features.

Multifocal cerebral cavernous malformations in pregnancy: a rare neuro-obstetric case

2026-06-27T06:57:50+0530

Cerebral cavernous malformations (CCMs) are rare vascular lesions characterised by clusters of dilated capillaries that may present with seizures or intracranial haemorrhage. Their coexistence with pregnancy poses diagnostic and management challenges. We report a 30-year-old G2P1L1 woman at 37 weeks gestation with a history of generalized tonic-clonic seizures (GTCS) and multifocal CCMs. She had no seizures during the antenatal period. Magnetic resonance imaging (MRI) revealed multiple cavernomas with evidence of prior haemorrhage. A multidisciplinary team opted for elective caesarean section, resulting in successful maternal and foetal outcomes.

A twin pregnancy with partial hydatidiform mole, low-lying placenta and coexistent twin pregnancy with fatal obstetrics haemorrhage: a rare catastrophic case report

2026-06-27T06:57:47+0530

The coexistence of twin gestation and partial hydatidiform mole (PHM) is an exceptionally rare obstetric condition, with fewer than 100 cases documented in world literature. A 28-year-old unbooked G4P3L2 woman presented to our tertiary care centre at 17 weeks and 4 days of gestation with a 15-day history of per vaginal bleeding and features of haemodynamic collapse (pulse rate 140 bpm; blood pressure 80/50 mmHg). Investigations revealed catastrophic anaemia (haemoglobin 3.1 g/dl), markedly elevated serum beta-hCG (>100,000 mIU/ml), coagulopathy (INR 2.83), and acute kidney injury (creatinine 1.31 mg/dl). Thyroid-stimulating hormone was suppressed at 0.005 uIU/ml, consistent with hCG-mediated thyrotoxicosis. Ultrasonography confirmed a diamniotic dichorionic twin gestation with an anterior placenta praevia displaying enlarged, heterogeneous echotexture covering the internal os. Emergency hysterotomy with B-Lynch compression sutures was performed. Intraoperative findings revealed vesicular products of conception alongside both male fetuses (each 182 g; Apgar scores zero). Placental biopsy demonstrated two discrete populations of villi irregularly shaped hydropic villi with cisterns, scalloping, and mild circumferential trophoblastic hyperplasia alongside normal tertiary villi confirming partial hydatidiform mole. No choriocarcinoma was identified. Despite aggressive resuscitation including inotropic support, mechanical ventilation, and multiple blood product transfusions, the patient developed refractory cardiac asystole and died approximately 14 hours postoperatively. This case underscores the lethal potential of PHM with twin gestation and placenta praevia, and highlights critical deficiencies in antenatal surveillance, referral systems, and resource availability that predispose unbooked patients to preventable maternal mortality. Enhanced first-trimester ultrasound protocols and routine beta-hCG measurement in twin pregnancies are urgently needed.

Neonatal pacing for immune mediated complete heart block diagnosed antenatally at 27 weeks: a case report with successful outcome

2026-06-27T06:57:46+0530

Congenital complete heart block (CCHB) is a rare condition, most commonly associated with maternal autoimmune antibodies such as anti-Ro/SSA. We report a case of antenatally diagnosed immune-mediated CCHB at 27 weeks’ gestation in a 27-year-old gravida 2 woman with positive antinuclear and anti-Ro/SSA antibodies. Fetal echocardiography revealed complete heart block in a structurally normal heart with a ventricular rate of 55 bpm. The pregnancy was managed with maternal dexamethasone and hydroxychloroquine, with close fetal surveillance. A late preterm infant weighing 2.4 kg was delivered at 36 weeks and required permanent pacemaker implantation within 24 hours of life due to persistent bradycardia. The postnatal course was uneventful, and at 3-month follow-up, the infant demonstrated stable pacemaker function with appropriate growth and development. This case highlights the importance of early diagnosis, multidisciplinary perinatal management, and timely neonatal pacing in achieving favourable outcomes in immune-mediated CCHB.

Pregnancy with chemotherapy induced cardiomyopathy (EF 30%): a tertiary care success story

2026-06-27T06:57:44+0530

Chemotherapy-induced cardiomyopathy in pregnancy represents a rare but high-risk clinical scenario, particularly when left ventricular ejection fraction falls below 30%. Limited literature exists on the peripartum management of such cases. A 23-year-old primigravida with a history of osteogenic sarcoma treated with chemotherapy presented at 36 weeks of gestation with chemotherapy-induced dilated cardiomyopathy and ejection fraction of 30%. The patient was hemodynamically stable on admission with vital signs of heart rate 100 bpm and blood pressure 120/80 mm Hg. Echocardiography revealed global left ventricular hypokinesia, trivial mitral regurgitation and dilated left atrium. Obstetric ultrasound showed normal foetal growth with normal doppler studies. A multidisciplinary approach was implemented involving obstetrics, cardiology, anaesthesiology and neonatology teams. Elective lower segment caesarean section was performed under combined spinal-epidural anaesthesia using 0.2% lignocaine with fentanyl. Comprehensive perioperative monitoring included central venous access, ICU preparedness, and availability of inotropic support. The procedure resulted in successful delivery of a healthy female neonate with estimated blood loss of 700 ml. The patient remained hemodynamically stable throughout the perioperative period and was discharged on postoperative day 8 without complications. This case demonstrates that pregnancy complicated by severe chemotherapy-induced cardiomyopathy can be successfully managed through coordinated multidisciplinary care, appropriate timing of delivery and regional anaesthesia techniques in a tertiary care setting. The favourable outcome achieved despite the patient's critically low ejection fraction emphasizes the importance of specialized cardio-obstetric expertise and comprehensive peripartum planning.

Management of traumatic brain injury with atypical eclampsia in late preterm gestation with compound presentation in a young primigravida

2026-06-27T06:57:43+0530

Traumatic brain injury (TBI) during pregnancy is rare but life-threatening. Coexisting obstetric complications such as atypical eclampsia further complicate diagnosis and management. A 19-year-old primigravida at late preterm gestation presented with multiple seizure episodes following a fall from stairs. She had no prior seizure disorder and was not booked for antenatal care. Clinical findings suggested antepartum atypical eclampsia with foetal distress associated with neuroimaging suggestive of extradural haematoma (EDH), intraparenchymal haemorrhage and un-displaced frontal bone fracture. Emergency caesarean section was performed. A live male neonate was delivered successfully. This case report highlights the importance of timely diagnosis and coordinated multidisciplinary management in patients presenting with concurrent obstetrics and traumatic neurological emergencies.

Cancer cervix (adenocarcinoma) with cardiac metastasis: a rare case report and review of literature

2026-06-27T06:57:42+0530

Carcinoma of the cervix is one of the leading malignancies in females worldwide, more prominent in developing countries. Squamous cell carcinoma is the most common histology with around 70% cases and Adenocarcinoma follows with 10-30%. Cardiac metastasis is very rare and difficult to diagnose with a reported incidence of 0.3% to 1.23% and is generally based on autopsy findings, only few cases of antemortem diagnosis of malignant pericardial effusion secondary to cervical carcinoma have been reported so far. The prognosis is poor and the longest reported survival so far is of 13 months. We hereby present a rare case report of adenocarcinoma of the cervix metastasizing to the heart and presenting with malignant pericardial effusion. The patient succumbed within one month of diagnosis.

The inner alchemy: a steroid cell transformation of ovary

2026-06-27T06:56:27+0530

Steroid cell tumors (SCTs) are an uncommon subset of ovarian sex cord-stromal tumors, accounting for approximately 0.1% of all ovarian neoplasms. They are categorized into three subtypes based on cellular origin: Leydig cell tumors, stromal luteomas, and SCTs not otherwise specified (SCT-NOS). SCT-NOS is characterized by an uncertain lineage and a higher likelihood of hormonal activity. These tumors are frequently functional, most commonly secreting testosterone, and may present with clinical features of hyperandrogenism, including virilization, hirsutism, and menstrual disturbances such as amenorrhea. Given their rarity and variable presentation, SCT-NOS tumors pose a diagnostic challenge and require careful clinical, biochemical, radiological, and histopathological correlation for accurate diagnosis and management. This case highlights a 20-year-old female who presented with virilization, sudden voice change, hirsutism, acne, and abnormal uterine bleeding. Ultrasound showed a solid nodule in the right ovary, and salpingo-oophorectomy was performed. Histology confirmed a SCT-NOS of the right ovary. Postoperatively, the patient made a remarkable recovery of menstrual symptoms, demonstrating the importance of prompt diagnosis and surgical management in such cases. During follow-up, she has remained asymptomatic, with no evidence of tumor recurrence on clinical or imaging evaluation.

Spontaneous regression of uterine fibroids in a perimenopausal woman: a case report on alternative approaches to symptom management

2026-06-27T06:56:24+0530

Uterine fibroids are the most common benign tumours in females, with the highest incidence in women aged 35 to 45 years. Although conventional treatments typically involve hormonal therapy, myomectomy, or hysterectomy, some patients seek non-surgical alternatives due to concerns about invasiveness, fertility preservation, or personal preferences. This case is notable for its use of an indigenous remedy, Lachesis, traditionally derived from snake venom, as a complementary treatment in managing symptomatic uterine fibroids. The novelty lies in the documented improvement following this alternative therapy, providing a potential avenue for further exploration in non-surgical management. A 40-year-old female presented with a three-year history of irregular, heavy, and painful menstrual cycles. Imaging studies revealed multiple uterine fibroids involving the body and posterior wall of the uterus, with subserosal extension. Despite multiple surgical recommendations, the patient declined operative intervention and instead pursued an indigenous treatment plan. She initiated therapy with Lachesis, an indigenous remedy known for its use in hormonal and circulatory disorders, after ensuring compatibility with tranexamic acid, which was prescribed for bleeding control. Over time, she reported progressive symptom relief, including reduced menstrual pain and improved cycle regularity. Serial follow-up ultrasounds showed a decrease in fibroid size, correlating with clinical improvement. Her medical history was notable for left oophorectomy in 2015 and a family history of fibroids, with both her mother and sister affected, the former undergoing hysterectomy and the latter opting for conservative management. This case suggests the potential of an indigenous, non-surgical approach in managing uterine fibroids, particularly in patients who refuse surgery. Although the precise mechanism of action of Lachesis in fibroid regression remains uncertain, its association with symptomatic and radiological improvement indicates a possible therapeutic role. These findings support the need for more rigorous investigation into alternative and complementary therapies. As patient demand grows for non-invasive treatment options, such cases underscore the importance of further clinical studies to evaluate efficacy, safety, and integration of traditional remedies into modern gynaecological care.

Gravid uterus herniating through a large infraumbilical incisional hernia in a woman with previous caesarean sections: successful medical termination of pregnancy with multidisciplinary management – a rare case report

2026-06-27T06:56:20+0530

Incisional hernia complicating pregnancy is exceedingly rare but potentially life-threatening. Herniation of the gravid uterus through an anterior abdominal wall defect creates unique obstetric and surgical challenges, particularly when the patient requests termination of pregnancy. Fewer than 50 such cases have been documented in world literature, most occurring in the third trimester. A 28-year-old multiparous woman (G4P2L2A1) at 12 weeks gestation presented with a large infraumbilical incisional hernia (defect 120×90 mm) through which the gravid uterus, bowel, and omentum were herniating, following two prior lower segment caesarean sections and a dilatation and curettage. She requested medical termination of pregnancy. A stepwise multidisciplinary protocol was adopted: mifepristone 200 mg orally, misoprostol 400 mcg vaginally (two doses), intracervical Foley catheter ripening (18 hours), and low-dose oxytocin augmentation. Manual reduction of the herniated uterus under ultrasound guidance preceded ultrasound-guided curettage. Histopathological examination confirmed complete evacuation of products of conception. Elective hernia repair by the General Surgery team completed definitive management. A systematic pharmacological and mechanical approach with prior manual uterine reduction can safely achieve medical termination of pregnancy in the setting of gravid uterine herniation, avoiding emergency laparotomy. Elective post-termination hernia repair is preferred. Multidisciplinary coordination and vigilant antenatal surveillance are essential in women with prior abdominal wall surgery.

Cornual type 3 retained products of conception – a fertility-sparing win with methotrexate

2026-06-27T06:56:17+0530

Retained products of conception (RPOC) with marked vascularity represent a diagnostic and therapeutic challenge due to the high risk of hemorrhage associated with surgical evacuation. Cornual localization further complicates management because of minimal myometrial thickness and proximity to major vascular structures. Cornual ectopic pregnancies are broadly classified into interstitial, angular, and true cornual types, each differing in anatomical location and clinical implications. Advanced imaging and individualized management are crucial, particularly in women desiring future fertility. We report a case of a 34-year-old multiparous woman with prior cesarean section who presented with amenorrhea of 2 months following dilatation and curettage for a blighted ovum. The patient was examined and was vitally stable. Further investigations were done. Her ultrasound with color Doppler demonstrated a highly vascular lesion with high peak systolic velocity in uterine cornua, with thin myometrium and findings to be correlated with beta human chorionic gonadotropin (β-hCG) and magnetic resonance imaging (MRI) SOS. Her β-hCG was negligible. Magnetic resonance imaging revealed a well-defined hyperintense lesion in the right uterine cornua with beak-like communication with the endometrial cavity, consistent with hyper vascular cornual RPOC. The patient was hemodynamically stable and desirous of future fertility and was managed conservatively with multidose methotrexate therapy. Serial Doppler follow-up demonstrated progressive reduction in vascularity and lesion size, followed by spontaneous expulsion. This case represents a diagnostic conundrum, as the patient presented with persistent amenorrhea following curettage rather than the typical bleeding seen with retained products of conception. The key differential diagnoses include Asherman syndrome, retained products of conception, chronic endometritis, and persistent trophoblastic activity. This case also highlights the need for a high index of clinical suspicion in atypical presentations, with supportive investigations aiding in differentiating hypervascular RPOC from cornual ectopic pregnancy and uterine arteriovenous malformation. Conservative medical management with methotrexate can be a safe and fertility-preserving option in carefully selected patients.

Socioeconomic factors influencing the quality of gynecological care in Al-Madinah, Saudi Arabia

2026-06-27T06:56:14+0530

Background: Gynecological care quality is shaped by complex socioeconomic, cultural, and psychosocial determinants. Evidence on these factors remains limited in the Arabian Gulf context. Objective was to evaluate socioeconomic, cultural, and psychosocial determinants of women’s satisfaction with gynecological care services in Al-Madinah, Saudi Arabia.

Methods: A cross-sectional descriptive study was conducted among 486 women attending gynecological services in the western region of Saudi Arabia. Data were collected through structured face-to-face interviews and analyzed using IBM SPSS Statistics version 25.0. Chi-square tests, Spearman correlation, and multiple linear regression identified predictors of satisfaction.

Results: Most participants were Saudi (77%) and resided in urban areas (97.9%), with the majority seeking care only when necessary (71.6%) and low insurance coverage (18.1%). Overall satisfaction was high (very satisfied: 35.6%; satisfied: 39.7%), particularly regarding privacy (82.1%) and trust in gynecologists (70.6%). Satisfaction correlated positively with awareness of preventive care (rs=0.352, p<0.001), cultural sensitivity (rs=0.270, p<0.001), and comfort discussing concerns (rs=0.528, p<0.001), and negatively with waiting time (rs=−0.185, p<0.001). Saudi nationality was a significant predictor of higher satisfaction (B=0.84, p=0.004).

Conclusions: Gynecological care in Al-Madinah is generally satisfactory but is influenced by socioeconomic and cultural factors. Improvements in preventive-care awareness, cultural competence, gender-concordant care, and insurance coverage may enhance quality and equity in women’s health services across Saudi Arabia.

Prognostic factors of preeclampsia at Laquintinie Hospital in Douala, Cameroon: a hospital-based study

2026-06-02T06:54:21+0530

Background: Preeclampsia (PE) remains a leading cause of maternal and perinatal morbidity and mortality in Sub-Saharan Africa (SSA). Delayed diagnosis and limited resources compromise outcomes. Identifying predictors of favorable maternal outcomes may improve risk stratification and targeted interventions. This study evaluated predictors of favorable maternal prognosis among women with PE at Laquintinie Hospital, Douala, Cameroon.

Methods: We conducted an analytical cross-sectional study with retrospective data collection over five years (March 2020-2025). Medical records of women with PE were reviewed. Bivariate and multivariate logistic regression analyses were performed to identify factors independently associated with favorable maternal outcomes.

Results: Among 333 women with PE, maternal complications occurred in 32.4% of cases: eclampsia (33%) and maternal death (29%), with fetal distress the leading fetal complication (37.7%). Independent predictors of favorable maternal outcomes were ≥4 antenatal visits (adjusted OR=2.47; p=0.004), no previous PE (adjusted OR=1.99; p=0.027), gestational age ≥37 weeks (adjusted OR=1.72; p=0.001), and preserved consciousness at presentation (adjusted OR=4.91; p=0.019). Notably, neurological status emerged as the strongest predictor of prognosis, underscoring the importance of early recognition of severe disease before neurological deterioration occurs.

Conclusions: Favorable maternal outcomes in PE are driven not only by clinical severity but also by timely engagement with antenatal care (ANC) services. Identifying ANC use, gestational maturity, previous PE, and neurological status as key prognostic indicators provides targets for strengthening surveillance and referral systems in resource-limited settings. These findings support prioritizing early detection and close monitoring of high-risk women to reduce preventable maternal complications and deaths.

Uptake of human papillomavirus vaccine among private and public female secondary school students in Asaba, Delta State, Nigeria: a comparative cross-sectional study

2026-06-27T07:11:32+0530

Background: Despite its availability, awareness and uptake of the human papillomavirus (HPV) vaccine have remained poor globally, especially in low and middle-income countries. The aim was to determine and compare the knowledge, attitude and uptake of HPV vaccine among private and public female secondary school students in Asaba, Delta State.

Methods: A comparative cross-sectional study of girls aged 10 and 18 years in public and private secondary schools in Asaba, Delta State. Interviewer-administered questionnaires were distributed to 200 eligible students after obtaining their assent and consent from their parents. The collected data were coded and analysed using SPSS version 26, and p<0.05 was considered significant.

Results: Only 24% (14% in private and 10% in public secondary schools), 14% (5% in private, 9% in public secondary schools) and 16% (6% in private, 10% in public secondary schools) of the respondents have heard of cervical cancer, HPV and HPV vaccine, respectively. There was a statistically significant association between school type and knowledge level (p=0.048). None of the respondents had received the HPV vaccine, with a lack of awareness being the reason for non-uptake in the majority of the respondents.

Conclusions: This study demonstrated poor knowledge of HPV/cervical cancer and a poor uptake of the HPV vaccine among respondents. Health education programs geared toward creating awareness among secondary school students and their parents in Delta State and other Nigerian states are highly recommended. Also, the government should make frantic efforts to sustain the HPV vaccine in the National Immunisation schedule.

Assessment of knowledge regarding cervical cancer among women aged 25 years and above attending Soavinandriana hospital, Madagascar: a cross-sectional study

2026-06-27T07:11:28+0530

Background: Cervical cancer remains a major public health concern in low- and middle-income countries, where limited access to screening and vaccination contributes to late diagnosis and high mortality. This study aimed to evaluate the level of knowledge regarding cervical cancer among women aged 25 years and above attending Soavinandriana Hospital, Madagascar.

Methods: A cross-sectional descriptive and analytical study was conducted among 200 women aged ≥25 years. Data were collected using a structured questionnaire assessing socio-demographic characteristics and knowledge of cervical cancer, including definition, HPV etiology, signs, screening, and vaccination. Knowledge was evaluated using a score ranging from 0 to 10 and categorized as insufficient (≤4), medium (5-6), or satisfactory (≥7). Statistical analysis was performed using the Chi-square test, with significance set at p<0.05.

Results: Although 71.5% of participants reported knowing about cervical cancer, only 53% correctly defined it, and 38% identified HPV as the causal factor. While 87% were aware that cervical cancer can be screened, 47% could not identify any screening method. Knowledge of HPV vaccination was particularly low, with 86.5% unable to name any vaccine. Overall, 44.5% of participants had insufficient knowledge, 37% had medium knowledge, and 18.5% had satisfactory knowledge. Professional sector was significantly associated with knowledge level (p<0.001), with healthcare workers demonstrating higher scores.

Conclusions: Despite existing prevention initiatives, important gaps persist in knowledge of cervical cancer, particularly regarding HPV infection and vaccination. Strengthened, targeted health education strategies are needed to improve awareness and enhance participation in screening and vaccination programs.

Risk factors for episiotomy among primiparous women in Madagascar: a retrospective case-control study

2026-06-27T06:57:48+0530

Background: Episiotomy remains one of the most frequently performed obstetric procedures worldwide, especially among primiparous women. Despite recommendations promoting restrictive use, the practice remains common in low-resource settings. This study aimed to identify factors associated with episiotomy among primiparous women delivering at the University Hospital of Gynecology and Obstetrics of Befelatanana, Madagascar.

Methods: A retrospective case-control study was conducted at the University Hospital of Gynecology and Obstetrics of Befelatanana from January 2018 to December 2019. Primiparous women who underwent vaginal delivery were included. Cases were women who received episiotomy and controls were women without episiotomy. Data were collected from medical records and analyzed using Epi Info and Microsoft Excel. Odds ratios (OR) with 95% confidence intervals (CI) were calculated.

Results: Among 2,903 primiparous women, the prevalence of episiotomy was 34.51%. A total of 855 cases and 1,710 controls were analyzed. Factors significantly associated with episiotomy were maternal age ≥35 years (OR=2.90; 95% CI: 1.89-4.02), uterine height ≥34 cm (OR=1.48; 95% CI: 1.25-1.76), gestational age >42 weeks (OR=4.10; 95% CI: 1.81-20.39), labor duration ≥12 hours (OR=9.03; 95% CI: 7.48-10.89), prolonged second stage of labor, breech presentation (OR=4.04; 95% CI: 1.51-10.80), instrumental delivery, occipito-sacral delivery, and birth weight >3500 g.

Conclusions: Episiotomy prevalence among primiparous women remains high in Madagascar. Restrictive use of episiotomy, improved intrapartum monitoring, and enhanced antenatal preparation may reduce unnecessary procedures and maternal morbidity.

Comparison between the effects of low-dose spironolactone plus metformin and metformin alone on hormonal and biochemical parameters of insulin resistance in women with polycystic ovary syndrome

2026-06-27T06:59:19+0530

Background: Polycystic ovary syndrome (PCOS) is a common endocrine disorder in reproductive-age women, characterized by insulin resistance and hyperandrogenism. Metformin improves insulin sensitivity, while spironolactone has antiandrogenic effects. Evidence regarding the short-term benefit of combining low-dose spironolactone with metformin remains inconclusive, particularly in South Asian populations. This study aimed to compare the effects of low-dose spironolactone plus metformin versus metformin alone on hormonal and biochemical parameters of insulin resistance in women with PCOS.

Methods: This randomized controlled trial was conducted at Bangabandhu Sheikh Mujib Medical University, Dhaka, from July 2023 to June 2024. Ninety women aged 18-40 years with PCOS (Rotterdam criteria), BMI 18-30 kg/m², and HOMA-IR>2 were randomized to receive either spironolactone (50 mg/day) plus metformin (1500 mg/day) or metformin alone (1500 mg/day) for 12 weeks. Hormonal and metabolic parameters were measured at baseline and post-treatment.

Results: Both groups showed significant improvements in BMI, waist circumference, serum LH, FSH, LH/FSH ratio, free testosterone, fasting glucose, fasting insulin, and HOMA-IR (p<0.05). The combination group demonstrated numerically greater reductions in LH (3.02 versus 1.92 µIU/ml), free testosterone (0.33 versus 0.22 pg/ml), and HOMA-IR (1.37 versus 1.11); however, none of the between-group differences were statistically significant (p>0.05).

Conclusions: Both low-dose spironolactone plus metformin and metformin alone significantly improve hormonal and insulin resistance parameters in women with PCOS. However, the addition of spironolactone does not provide a significant short-term advantage over metformin alone.

Evaluation of the impact of the Bwiza initiative on period poverty among high school girls in Burera District, Rwanda

2026-06-27T06:59:18+0530

Background: Period poverty remains a significant public health problem and a barrier for adolescent girls in low-income settings. Bwiza initiative was launched in 2022 to address this issue by providing menstrual health education and reusable menstrual products to high school girls in Burera, Rwanda. This study evaluated its impact on menstrual health knowledge, attitudes, practices, and school absenteeism.

Methods: A quasi-experimental cluster study design was employed, including two interventions and one non-intervention school. The same survey used in baseline assessment was administered, with slight modifications to capture additional variables related to Bwiza participation.

Results: A total of 273 female students aged 12-23 years participated. There was no statistical difference in good menstrual health knowledge between 2022 and 2025 (p=0.204), or between those who received Bwiza training and those who did not (p=0.853). Students in the non-intervention school were more likely to have good knowledge (22.1% versus 12.9%, p=0.048). Attitudes improved, with fewer girls considering themselves “unclean” or avoiding religious spaces during menstruation in 2025 than in 2022. Trained participants were less likely to feel insecure during menstruation (p=0.019). However, emotional discomfort, such as fear of odor (56.4%) remained prevalent. Use of unhygienic materials declined from 19% to 9.7%. Among those who received Bwiza products, over 70% found them comfortable, but only 55.6% reported sufficient supply. Absenteeism increased from 18.3% to 43.2%.

Conclusions: Despite improvements in attitudes and practices, persistent gaps highlight the need for comprehensive education, consistent product access, and strengthened school-based menstrual health support systems.

Effect of myo-inositol on ovulation induction outcomes in women with polycystic ovary syndrome

2026-06-27T06:59:14+0530

Background: Polycystic ovarian syndrome (PCOS) is a common endocrine condition affecting reproductive-aged women that is distinguished by insulin resistance, hyperandrogenism, and anovulation. Myo-inositol, an insulin-sensitizing drug, has emerged as a promising complementary therapy for enhancing reproductive outcomes. The study aimed to assess whether myo-inositol supplementation affected ovulation induction outcomes in women with PCOS undergoing reproductive treatments.

Methods: This investigation was carried out at Department of Obstetrics and Gynecology, Asgar Ali Medical Hospital, Dhaka, Bangladesh from January 2023 to December 2025. A prospective comparison study included 100 women diagnosed with PCOS based on the Rotterdam criteria. Participants were divided into two groups: the control group (n=50) received standard ovulation induction, and the myo-inositol group (n=50) received 2 grams of myo-inositol twice daily. The primary outcomes were ovulation confirmation and endometrial thickness. The data were entered and analyzed with statistical package for the social sciences (SPSS) version 26.

Results: Baseline characteristics were comparable among groups. The myo-inositol group had significantly greater ovulation rates (74.0% versus 56.0%, p=0.04) and endometrial thickness (8.1±1.4 mm versus 7.4±1.3 mm, p=0.01) than the control group. Mid-luteal progesterone levels were higher in the myo-inositol group (10.6±4.1 ng/ml versus 8.9±3.7 ng/ml, p=0.03). Multivariable analysis revealed that myo-inositol supplementation is an independent predictor of ovulation (adjusted OR 2.30, 95% CI 1.01-5.24, p=0.047).

Conclusion: Myo-inositol supplementation dramatically improves ovulation rates and endometrial growth in women with PCOS who are undergoing ovulation induction, making it an excellent adjuvant therapy for improving reproductive outcomes in this population.

Management of childbirth complications: personal and professional experiences of healthcare workers in Ibadan, Nigeria

2026-06-27T06:59:05+0530

Background: Maternal and perinatal mortality continue to pose significant public health challenges globally, despite decades of targeted interventions and initiatives aimed at improving their outcomes, the figures are still high in the sub-Saharan Africa. The study aimed to investigate personal and professional experiences of healthcare workers in Ibadan regarding childbirth complications and ways to mitigate them.

Methods: The study population comprises of healthcare workers from both public and private health facilities in Ibadan, Oyo State. A multistage random sampling technique was employed to select respondents who were healthcare workers from health facilities across Ibadan. A questionnaire was administered to them to obtain information on their biodata, the common childbirth complications they know, how they managed such and their suggestions for future mitigation of such complications. Analysis was done using Statistical Package for Social Sciences (SPSS) version 28 both descriptive and inferential statistical analyses were done.

Results: One hundred and thirty-nine (36.9%) of the respondents worked in secondary healthcare facilities, 126 (33.4%) in primary healthcare centres, 75 (19.9%) in tertiary hospitals, and 37 (9.8%) in private clinics. 273 respondents (72.4%)

of which 72.4% reported receiving specialized training on postnatal care while 27.6% were not trained. Infections were the most frequently identified complication in both mothers and babies (25%). Respondents’ suggestions for improving postpartum care practices included institutional, systemic, and community-level interventions.

Conclusions: Targeted investment in infrastructure, personnel, continuous professional training, and the implementation of evidence-based preventive care strategies at the primary and secondary levels would help mitigate postnatal complications.

Partner characteristics, fertility preferences and contraceptive use among married women in Nigeria

2026-06-27T06:57:52+0530

Background: Contraceptive use remains low in Nigeria, and decisions regarding family planning are often influenced by partner dynamics and fertility preferences. Understanding how these factors shape contraceptive behavior is essential for designing effective interventions.

Methods: This study used data from the 2018 Nigeria Demographic and Health Survey (NDHS), including 27,841 currently married women aged 15-49 years. The outcome variable was current contraceptive use (any method vs non-use). Descriptive statistics summarized respondents’ characteristics. Bivariate analysis assessed associations between partner characteristics, fertility preferences, and contraceptive use. Multivariable logistic regression was used to identify factors independently associated with contraceptive use, adjusting for socio-demographic and household variables.

Results: Contraceptive use among married women was low. Women whose partners had higher levels of education were more likely to use contraceptives. Partner fertility preference was a strong predictor; contraceptive use increased when partners desired fewer children. Women who had achieved their desired family size or had more children than desired had higher odds of contraceptive use. Similarly, the number and sex composition of living children were associated with contraceptive behaviour. Women not living with their partners had lower likelihood of contraceptive use. These associations remained significant after adjusting for confounders.

Conclusions: Partner characteristics and fertility preferences play a critical role in shaping contraceptive use in Nigeria. Interventions aimed at increasing contraceptive uptake should incorporate male involvement and address couple-level decision-making dynamics, alongside improving access to services.

Evaluation of labor progression in induced and spontaneous labor using modified WHO partograph in term primigravida: a hospital-based comparative study

2026-06-27T06:57:49+0530

Background: Induction of labor is commonly performed to improve maternal and neonatal outcomes; however, its effectiveness compared to spontaneous labor remains debated. Monitoring labor progress using the modified WHO partograph provides an objective way to assess outcomes. To compare the progress and outcomes of induced labor with spontaneous labor among primigravida women at term.

Methods: This cross-sectional study was conducted in the Department of Obstetrics and Gynaecology, Chattogram Medical College Hospital, Bangladesh, from March 2018 to February 2019. A total of 130 primigravida women at term (41⁰⁄₇–41⁶⁄₇ weeks) were selected using purposive sampling and divided equally into spontaneous labor (n=65) and induced labor (n=65) groups. Inclusion and exclusion criteria were applied to ensure comparability. Labor was monitored using the modified WHO partograph. Data on socio-demographic variables, labor progression, mode of delivery, maternal and neonatal outcomes were collected and analyzed using SPSS version 23. Statistical significance was set at p<0.05.

Results: There was no significant difference in socio-demographic characteristics between the groups. The induced group had significantly higher mean gestational age (41.61±0.48 vs 41.21±0.01 weeks; p<0.001) and BMI (24.07±1.32 vs 22.63±1.55 kg/m²; p<0.001). The rate of normal vaginal delivery was slightly higher in the spontaneous group (86.2%) compared to the induced group (78.5%), though not statistically significant. Caesarean section rates were comparable (9.2% vs 12.3%). Labor progression assessed by partograph showed no significant difference between groups, with most women remaining within the alert line. However, the duration of labor was significantly shorter in the induced group, with a reduced first stage (7.59±0.85 vs 10.53±1.04 hours; p<0.001) and second stage (45.05±8.28 vs 49.10±7.99 minutes; p=0.001). Maternal complications were minimal and comparable between groups. Neonatal outcomes, including Apgar scores, birth asphyxia, meconium aspiration and NICU admission, showed no statistically significant differences.

Conclusions: Induced labor is comparable to spontaneous labor in terms of maternal and neonatal outcomes among primigravida at term. Although induction shortens the duration of labor, it does not significantly increase adverse outcomes or operative delivery rates.

Knowledge, attitudes and practices regarding modern contraception in a referral hospital in Madagascar

2026-06-20T07:16:16+0530

Background: Modern contraception is essential for birth spacing and prevention of avoidable maternal and neonatal morbidity. This study assessed knowledge, attitudes and practices regarding modern contraceptive methods among women hospitalized at CHUGOB, Antananarivo, Madagascar.

Methods: A descriptive cross-sectional KAP survey was conducted from May to September 2019 among women aged 15-49 years. Data were collected using a structured questionnaire and analysed descriptively.

Results: Among 210 women approached, 207 participated, giving a response rate of 98.5%. Mean age was 37.07±8.64 years. Most women were married or cohabiting (70.0%), housewives (56.0%) and multigravidae or grand multigravidae (69.9%). Knowledge of contraception was high: 90.8% defined contraception as birth limitation or spacing and 64.2% knew at least two modern methods. Overall, 50.2% had used a modern contraceptive method, but only 30.0% were regular users. Injectables were the most commonly used method (44.0%), followed by oral contraceptives (25.0%). The main reasons for non-use were fear related to rumours of diseases caused by contraception (41.2%) and fear of side effects (37.1%). Health personnel and media were the main sources of information.

Conclusions: Awareness of contraception was high, but regular use remained limited. Patient-centred counselling, correction of misconceptions, better explanation of side effects and continued follow-up are needed to improve informed and sustained contraceptive use.

Maternal complications and success rates of vaginal delivery in women with a previous caesarean section: experience from Dhaka Medical College Hospital

2026-06-27T06:57:45+0530

Background: Caesarean section rates are rising globally, with previous caesarean sections being a leading reason for repeats. Vaginal birth after caesarean section (VBAC) is key to reducing this trend. However, local data on VBAC outcomes in Bangladesh are scarce. This study evaluated the success rate of vaginal delivery and maternal complications among women with previous caesarean sections who underwent a trial of labour at a tertiary hospital in Dhaka, Bangladesh.

Methods: This cross-sectional observational study was conducted at the Department of Obstetrics and Gynaecology, Dhaka Medical College Hospital, from April to October 2023. One hundred women with one or two previous caesarean sections who were planned for vaginal delivery were enrolled. Descriptive statistics were used for the analysis.

Results: The mean age of the participants was 29.8±11.4 years, with 62.0% living in urban areas. Most (82.0%) were at term gestation and fetal distress was the main reason for prior caesarean section (57.0%). VBAC success was 76.0%. Of the 24 failed labour trials, non-progress with impending uterine rupture led to repeat caesarean (19 cases). The maternal complication rate was 17.0%, with postpartum hemorrhage, wound infection and perineal injury rates of 9.0 %, 5.0% and 3.0%, respectively. No cases of uterine rupture were recorded.

Conclusion: VBAC is feasible and safe for carefully selected women in tertiary settings in Bangladesh. A 76.0% success rate and low serious complication rate support structured labour trial programs in well-equipped institutions.

Prevalence and risk factors for placental malaria parasitemia in a tertiary hospital in north-central Nigeria

2026-06-27T06:57:40+0530

Background: Malaria in pregnancy is a major public health problem in sub-Saharan Africa. Placental malaria is recognized as a complication of malaria in pregnancy in endemic areas with adverse effects on pregnancy. Aim was to determine the prevalence and risk of placental malaria parasitaemia at delivery in Federal University Teaching Hospital, Lafia.

Methods: This was a cross-sectional study where 200 pregnant women in labour were enrolled consecutively by convenient sampling after obtaining informed consents. Maternal, cord and placental blood samples were taken for thick and thin blood film for malaria parasites after delivery. Data analysed using IBM SPSS version 23. Chi square test and regression analysis used for degree of association and independent risk factors for placental malaria determination. A p-value of less than 0.05 was considered statistically significant.

Results: The prevalences of maternal peripheral blood parasitaemia was 18.5% (37/200), placenta parasitaemia was 17,5% (35/200) and cord blood malaria parasitaemia was 13.0% (27/200). The risk factors for placental malaria parasitaemia were non-use of intermittent preventive treatment (OR=0.408, p=0.000), non-use of insecticide treated nets (OR=0.043, p=0.000) and low level of education (OR= 0.012, p=0.000).

Conclusions: The significant contributors to placental malaria parasitaemia are low level of education, non-use of intermittent preventive treatment and non-use of insecticide treated bed nets. Girl child education, use of insecticide treated nets which should be made available and free, and use of IPT as directly observed therapy should be adhered to.

Determinants of the survival of patients operated on for breast cancer at the Yaoundé Gyneco-Obstetric and Pediatric Hospital

2026-06-27T06:56:26+0530

Background: In Cameroon, breast cancer remains a real public health problem and 5-year survival varies from 30 to 62%. Surgery improves survival. This study was conducted to determine that apart from surgery, what are the determinants of the survival of breast cancer patients at YGOPH.

Methods: This was a descriptive study with historico-prospective collection of data from breast cancer patients at YGOPH (2010-2020). Kaplan-Meier estimated survival and Cox regression looked for factors associated with survival. The origin date was the date of the surgery and the end date was the date of death or the latest news.

Results: The mean age of the 166 patients operated on was 48.27±12.44 years. About 48.2% had stage 4 (T4), 59% had lymph node invasion and 10.8% had metastases. Radical surgery was performed in 92.2% and 20% presented tumor recurrences. The 5-year survival was 62%. Independent factors associated with reduced survival were breast pruritus (HRa=9.74; p=0.004), retroareolar location of the tumour (HRa=2.5; p=0.035), lymph node invasion (HRa=2.66; p=0.008) and tumour recurrence (HRa=7.57; p=0.000).

Conclusions: The 5-year survival was 62%. Factors associated with reduced survival were breast pruritus, retroareolar location of the tumor, lymph node involvement, and tumor recurrence.

How can a heavy menstrual bleeding scoring system be utilized in practice?

2026-06-27T06:56:24+0530

Background: The objective of the study was to utilise a scoring system which aims to triage women with heavy menstrual bleeding (HMB) into hysterectomy or conservative options in practice. The design of the study was a retrospective study in a UK single centre.

Methods: A six-factor scoring tool to triage women with HMB was identified based on different published evidence. These factors are the presence of a uterine fibroid, chronic pelvic pain/endometriosis, adenomyosis, patient desire for hysterectomy, large uterine cavity and anaemia needing parental therapy. Each factor scores 1, apart from uterine cavity length which scores 2. Hysterectomy would be advised if the score is ≥3, otherwise conservative options would be indicated. For this tool to be clinically recognised, it needed to be validated retrospectively over one year. In order to validate this scoring tool, 327 women aged 25-54 referred with HMB between January 2021 and December 2021 were identified and reviewed. Data was retrieved from patients` records, then divided by outcome. The score was applied to the collected data, patients followed for two years. Differences and associations between variables were examined. Sensitivity and specificity of the scoring system in triaging women with HMB was measured. The application of the validated scoring tool in practice was considered depending on the validation outcome.

Results: 38/327 (11. 6%) of patients had hysterectomy. There was a significant association between having each factor of the score and hysterectomy and a significant association of having a total score of ≥3 and hysterectomy OR 6.23 (95% CI 4.80 – 7.67). The score has a calculated sensitivity of 0.84 (0.68-0.93), specificity of 0.99 (0.97-0.99) and positive predictive value of 0.91 (0.75-0.98). The strongest predictive factor for hysterectomy was large uterine cavity, followed by woman’s desire for hysterectomy, then adenomyosis (p<0.001). Other demographic and clinical variables did not predict hysterectomy as an outcome with the exception of dysmenorhea which when added to the score, it decreased positive predictive value affecting performance. To apply this validated scoring tool in practice, a prospective feasibility trial needs to be conducted prior to a definitive randomised control trial which is on the way.

Conclusions: To use this scoring tool to triage women with HMB in practice, it needed to be validated. Validation has confirmed that this scoring system has high sensitivity and specificity in predicting outcome. Further evaluation of this validated tool in a randomised clinical feasibility trial prior to the definitive trial is needed so the scoring tool can be utilised in practice.

Platelet count as a first line screening test for the detection of coagulation disorder in preeclamptic and eclamptic patients

2026-06-27T06:56:23+0530

Background: Pre-eclampsia and eclampsia are major obstetric complications and important causes of maternal morbidity and mortality in developing countries. Platelet count is a simple, inexpensive, and widely available investigation that may help detect coagulation disorders in these conditions. This study aimed to determine the sensitivity and specificity of platelet count for predicting coagulation disorders in pre-eclampsia and eclampsia.

Methods: This cross-sectional analytical study was conducted in the department of obstetrics and gynecology of Dhaka Medical College Hospital from June 2022 to May 2023. A total of 81 pregnant women were enrolled and divided equally into three groups: pre-eclampsia (n=27), eclampsia (n=27), and normotensive pregnancy (n=27). Platelet count, prothrombin time (PT), activated partial thromboplastin time (APTT), serum fibrinogen, and D-dimer were measured. Data were analyzed using SPSS version 26.

Results: Mean platelet count was significantly lower in eclampsia (186,296.3±91,728.6/μl) and pre-eclampsia (217,777.8±77,745.3/μl) compared to normal pregnancy (252,296.3±44,155.2/μl) (p<0.001). Thrombocytopenia was observed in 38.89% of pregnancy-induced hypertension cases. For detecting coagulation disorders, platelet count showed sensitivity of 45.45% and specificity of 90.00% in eclampsia, while sensitivity and specificity in pre-eclampsia were 46.51% and 81.82%, respectively.

Conclusions: Platelet count alone is not a reliable screening test for coagulation disorders in pre-eclampsia and eclampsia.

Laparoscopic surgery in gynecology: epidemiological, clinical and outcome aspects at the University Hospital Center of Gynecology and Obstetrics Befelatanana

2026-06-27T06:56:15+0530

Background: Laparoscopic surgery represents one of the most important surgical advances of the last decades. In Madagascar, its use in gynecology remains limited. This study aimed to describe the epidemiological, clinical and outcome characteristics of gynecological laparoscopic procedures at the University Hospital Center of Gynecology and Obstetrics Befelatanana (CHUGOB).

Methods: A retrospective descriptive study was conducted on 39 gynecological laparoscopic procedures performed between July 1, 2019 and December 31, 2020 at CHUGOB. Epidemiological, clinical, intraoperative and postoperative data were analyzed.

Results: Laparoscopy accounted for 4.12% of gynecological surgical procedures during the study period. The mean age of patients was 29 years. Infertility was the main indication (43.58%). Intraoperative findings were mainly tubal obstruction (32.55%) and abdominopelvic adhesions (23.25%). The mean operative time was 90.72 ± 20.2 minutes. Postoperative outcomes were uncomplicated in 71.79% of cases. The mean hospital stay was 2.86 days and the patient satisfaction rate was 92%.

Conclusions: Laparoscopy is a safe and effective surgical technique with good postoperative outcomes and high patient satisfaction. Its use should be encouraged as a first-line approach in gynecological surgery whenever conditions allow.

Factors associated with superficial surgical site infection after emergency cesarean section at Befelatanana University Hospital, Madagascar: a retrospective case-control study

2026-06-20T07:16:15+0530

Background: Surgical site infection (SSI) after emergency cesarean section is a preventable cause of maternal morbidity and additional cost, especially in resource-limited maternity hospitals. This study aimed to identify factors associated with superficial incisional SSI after emergency cesarean section at the University Hospital of Gynecology and Obstetrics of Befelatanana, Madagascar.

Methods: A retrospective case-control study was conducted from January 2020 to December 2021. Cases were women treated for superficial incisional SSI within 30 days after emergency cesarean section at term. Controls were women without SSI, selected at a ratio of two controls per case. Data were extracted from hospital records, antenatal cards, registers and interviews. Odds ratios (ORs), 95% confidence intervals (CIs) and p values were calculated.

Results: Among 12,708 deliveries, 4,857 were cesarean sections, including 3,897 emergency procedures. Sixty superficial SSIs were identified, giving a frequency of 1.5%; 120 controls were included. Factors significantly associated with SSI were age ≥35 years, absence of antenatal care, BMI ≥25 kg/m², premature rupture of membranes, membrane rupture ≥12 hours, labour ≥12 hours, operation duration ≥60 minutes, blood loss ≥1000 ml and operation by a specialist trainee.

Conclusions: Superficial SSI after emergency cesarean section was multifactorial. Strengthening antenatal care, timely labour management, optimized antibiotic prophylaxis, senior supervision, infection-prevention bundles and post-discharge wound surveillance may reduce post-cesarean SSI in this setting.

A comparative study of two breastfeeding assessment tools: LATCH scoring system and infant breastfeeding assessment tool

2026-06-05T07:05:08+0530

Background: Many mothers discontinue exclusive breastfeeding early because of poor latch, perceived insufficient milk, and limited postnatal support. The LATCH scoring system and the Infant Breastfeeding Assessment Tool (IBFAT) are widely used to assess breastfeeding, but comparative data on their value in predicting sustained exclusive breastfeeding are limited.

Methods: This prospective observational comparative study was conducted at M. S. Ramaiah Medical College and Hospital, Bengaluru, from June 2023 to May 2025. A total of 216 postpartum mothers of healthy term singletons were randomly allocated to the LATCH (n=108) or IBFAT (n=108) group. Each mother–infant dyad was assessed at 1 hour, 24 hours, and at discharge. Exclusive breastfeeding was determined by telephonic follow-up at six months. Data were analyzed in SPSS version 25.0 using chi-square, independent t-tests, and logistic regression; p<0.05 was considered significant.

Results: IBFAT scores were higher than LATCH scores at all three time points (mean difference approximately −1.9; p=0.001). Exclusive breastfeeding at six months was reported by 76.9% of mothers in the LATCH group and 73.1% in the IBFAT group (p=0.530). The 1-hour IBFAT score was significantly associated with exclusive breastfeeding at six months (p=0.002), whereas the 1-hour LATCH score was not (p=0.114). Scores at 24 hours predicted six-month outcomes in both groups (IBFAT p=0.001; LATCH p=0.02). Discharge scores were not predictive in either group.

Conclusions: IBFAT was more sensitive than LATCH in identifying effective early breastfeeding and predicting sustained exclusive breastfeeding. Routine use of IBFAT within the first 24 hours postpartum may improve early identification of dyads needing lactation support.

Efficacy of follitropin alfa versus follitropin beta in Indian women - impact on oocyte yield and pregnancy outcome: a retrospective study

2026-06-07T19:21:50+0530

Background: Recombinant follicle-stimulating hormone preparations, Follitropin alfa and Follitropin beta, are widely used for controlled ovarian stimulation in IVF/ICSI. Evidence comparing their reproductive outcomes in Indian women remains limited. This study aims to compare the efficacy of follitropin alfa and follitropin beta on oocyte yield and pregnancy outcomes among Indian women.

Methods: Women younger than 40 years who underwent their first ovarian stimulation cycle with either follitropin alfa or follitropin beta were included after applying the exclusion criteria. Their demographic data, follicular growth, gonadotropin dose used and duration of stimulation, oocyte yield, embryological and pregnancy outcome data are retrieved and compared.

Results: In this cohort of 177 patients 115 women underwent stimulation using follitropin alfa and 62 women with follitropin beta. Baseline demographic, clinical characteristics and ovarian indices were comparable. Follitropin alfa significantly produced higher oocyte (16.33±8.90 vs. 13.13±7.01) and top- intermediate quality embryo yield (8.92±5.46 vs. 7.19±4.04) than follitropin beta in a dose-independent manner, while clinical pregnancy rates (47.0% vs. 61.3%) and cumulative live birth rates (38.3% vs. 48.4%) were comparable between the groups in Indian women who underwent controlled ovarian stimulation.

Conclusions: The study provides encouraging evidence that in both the overall cohort and age-stratified analyses, follitropin alfa had a clear advantage in oocyte and embryo yield but no definitive superiority in final reproductive outcomes when compared to follitropin beta.

Intracytoplasmic sperm injection outcomes using ejaculated versus testicular sperm in severe male factor infertility: a retrospective study

2026-06-09T07:17:04+0530

Background: Intracytoplasmic sperm injection (ICSI) using testicular sperm is commonly performed in severe male factor infertility. However, differences in sperm maturity and function between ejaculated and testicular sperm may influence reproductive outcomes.

Methods: This retrospective cohort study included 92 ICSI cycles from 84 couples treated between January 2018 and December 2024 at the Institute of Reproductive Medicine, Madras Medical Mission. Cycles were grouped according to sperm source: fresh ejaculate (n=61), fresh testicular sperm aspiration (fresh TESA) (n=25), and frozen testicular sperm aspiration (frozen TESA) (n=6). Outcomes assessed included fertilization, embryo arrest, embryo transfer (ET), and clinical pregnancy rate (CPR).

Results: Baseline characteristics were comparable among groups. The number of normally fertilized oocytes (2PN) was significantly higher in the fresh ejaculate group than in fresh and frozen TESA groups (7.08±4.4 vs 5.12±3.1 vs 3.17±2.9; p=0.021). The number of frozen embryos was also significantly higher with ejaculated sperm (p=0.02). Embryo arrest was highest in frozen TESA cycles (33.3%) compared to fresh TESA (8%) and ejaculated sperm cycles (3.3%) (p=0.02). Clinical pregnancy rate per cycle was higher with ejaculated sperm (50.8%) than fresh TESA (36%) and frozen TESA (0%) (p=0.042).

Conclusions: ICSI cycles using ejaculated sperm were associated with better embryological outcomes compared to testicular sperm cycles. Frozen testicular sperm cycles demonstrated relatively poorer embryo developmental outcomes; however, interpretation is limited by the small sample size. Despite lower overall success, testicular sperm remains an important option when ejaculated sperm is unavailable.

Post-operative hyperglycaemia in non-diabetic patients following elective gynaecological surgeries: incidence and risk factors

2026-06-27T07:11:33+0530

Background: There is a dearth of information on the incidence, risk factors, and impact of postoperative hyperglycemia following Gynaecological surgeries. This study explores the incidence and predictors of postoperative hyperglycemia following elective Gynaecological surgeries and its association with postoperative outcomes.

Methods: The non-diabetic patients admitted for elective gynaecological surgeries who met inclusion criteria and were willing to participate were enrolled. Blood glucose was checked in the post-operative period at 2,6,12,24, and 48 hours, respectively. Hyperglycemia was defined as any blood glucose value of >126 mg/dl and clinically significant hyperglycemia as >180 mg/dl. All patients were followed up for 30 days. Outcome measures were the incidence of post-operative hyperglycemia and the relation of hyperglycemia with peri-operative parameters and infections.

Results: Out of the 200 patients, post-operative hyperglycaemia was observed in 61.5% of patients and 12.5% had severe hyperglycaemia. The mean BMI of patients with hyperglycaemia (25.8±3.8kg/m²) was significantly more than euglycemic ones (24.4±4.0kg/m² (p=0.019)). Procedures lasting >2 hours were significantly associated with hyperglycemia (p=0.002) and its severity (p=0.006). Post-operative infectious complications and the need for therapeutic antibiotics were higher among hyperglycaemic patients (p=0.053).

Conclusions: Postoperative hyperglycemia in non-diabetic patients following elective gynaecologic surgeries is associated with an increased risk of infections. Postoperative monitoring of blood glucose should be done for all patients. If universal monitoring is not feasible, then patients with high BMI undergoing open abdominal surgeries lasting more than 2 hours should undergo vigilant post-operative monitoring for hyperglycemia.

Demographic, clinical and operative profile of patients undergoing total laparoscopic hysterectomy for complex pathologies: a single centre retrospective analysis

2026-06-27T07:11:33+0530

Background: Total laparoscopic hysterectomy (TLH) is a gold standard for managing complex gynecological pathologies due to its minimally invasive nature and faster recovery. This study analyzes demographic, clinical, and operative profiles of patients undergoing TLH to optimize outcomes. The objectives were to evaluate the demographic, clinical, and operative characteristics of patients undergoing TLH for complex gynecological pathologies and assess surgical outcomes.

Methods: A retrospective observational study was conducted at a tertiary care center in Central India from January to December 2024. Data from 84 patients who underwent TLH for benign or complex indications were analyzed. Variables included age, body mass index (BMI), obstetric history, comorbidities, surgical indications, operative details, and histopathological findings. Statistical analysis identified trends in patient profiles and outcomes.

Results: The majority of patients were aged 41-50 years (64.3%), overweight (82.1%), and multiparous (59.5%). Common comorbidities were hypothyroidism (19%) and hypertension (11.9%). Abnormal uterine bleeding (AUB) was the primary indication (89.3%). Most surgeries (91.7%) were completed within 60 minutes using a 4-port technique, with minimal blood loss (94%). Endometrial biopsy revealed benign findings in most cases (45.2% secretory, 36.9% proliferative endometrium). The KMH technique was effective for large pathologies.

Conclusion: TLH is safe and effective for complex gynecological pathologies, particularly in perimenopausal women with AUB. Preoperative optimization and standardized techniques enhance outcomes.

Feto-maternal outcome among cases of thrombocytopenia during pregnancy: an observational study at a tertiary care hospital

2026-06-27T07:11:31+0530

Background: Thrombocytopenia is decline in the platelet count and second most common haematological aberration secondary to anaemia during pregnancy complicating 7-10% of all pregnancies. Gestational thrombocytopenia contributes to 70-80% of all cases of thrombocytopenia in pregnancy. Hypertensive disorders accounts for about 15-20% and immune thrombocytopenic purpura for 3-4%. Other etiologies are considered rare in pregnancy. This research work aims to study prevalence, aetiology and feto-maternal outcomes in cases presenting with thrombocytopenia during pregnancy.

Methods: This observational study was conducted over a period of one year from January 2025 to December 2025 at a tertiary care hospital involving 128 pregnant patients visiting indoor of Department of Obstetrics and Gynecology, East Point College of Medical Sciences and Research Centre, Bengaluru. The study includes pregnant women from third trimester with platelet count less than 100000/ul. Any pregnant or non-pregnant woman having diabetes or thrombo-embolic disorders were excluded from the study.

Results: Out of 128 patients, moderate thrombocytopenia was seen in 73.4% cases while severe thrombocytopenia in 26.6% cases. Majority of patients had no symptoms and decrease in platelet count was noted on investigation. There are 66 women with Gestational thrombocytopenia, 34 cases with preeclampsia, 13 cases with HELLP syndrome, 06 cases with ITP (Immune Thrombocytopenia Purpura), 3 cases of Hepatitis E and other etiology was seen in 6 cases. The vaginal delivery was carried in about 68 cases, Cesearean section in 29 cases and no delivery in 31 antenatal patients. 3 maternal deaths were seen due to immense blood loss and foetal death accounted in 2 cases due to prematurity and respiratory distress.

Conclusions: Maternal and foetal outcomes worsen with severity of thrombocytopenia. Hence, earliest detection of thrombocytopenia by investigations facilitates the prompt management. Management of pregnant women with thrombocytopenia requires multidisciplinary approach with collaboration among the obstetrician, haematologist and hepatologist.

A randomized study comparing flexible PPOS with flexible GnRH antagonist protocol in IVF outcomes

2026-06-27T07:11:29+0530

Background: To compare clinical efficacy of flexible PPOS and flexible GnRH antagonist protocol in ART.

Methods: A prospective randomized controlled study was conducted at RIDGE IVF Centre, Delhi, from July 2024 to June 2025. 100 women with normal ovarian reserve, aged 21–40 years, undergoing IVF/ICSI were randomly assigned to Group A (fPPOS, n=50) or Group B (flexible GnRH antagonist, n=50). Primary outcomes were number of oocytes retrieved, mature oocytes (MII), embryo formation, embryo quality on day 3 and day 5. Gonadotropin dosage, stimulation duration and clinical pregnancy rates were secondary outcomes.

Results: The two groups shared comparable baseline characteristics, including age, BMI, type of infertility and infertility duration. Although day 2 FSH levels were lower in Group A, serum AMH and AFC levels were comparable in both groups. The number of oocytes retrieved, MII oocytes and embryos formed were comparable (p>0.05). In either protocol, there were no instances of premature luteinization. On day 3 and day 5, neither the quality/distribution of the embryos differed significantly (p>0.05). Both groups had comparable clinical pregnancy rates (p=1.0) and β-hCG positivity rates (50 percent vs. 42 percent, p=0.42). There were no significant differences in duration of stimulation or total dose of gonadotropin used. No cases of OHSS were reported.

Conclusions: In IVF cycles, flexible PPOS and flexible GnRH antagonist protocols have comparable clinical and embryological outcomes. Flexible PPOS is a viable, patient-friendly alternative for frozen- embryo transfer cycles.

A study on prevalence of obesity and menstrual disturbances in women with polycystic ovary syndrome

2026-06-27T07:11:27+0530

Background: Polycystic ovary syndrome (PCOS) is a common endocrine disorder in women of reproductive age and is often linked with obesity and menstrual irregularities.

Methods: A community based cross-sectional study was conducted among 300 women with PCOS using a structured questionnaire to collect demographic data, treatment status, weight factors and menstrual characteristics. BMI categorized participants as normal weight, overweight or obese and menstrual patterns such as irregular cycles, painful periods and heavy bleeding were recorded.

Results: The findings showed a high prevalence of overweight and obesity, with many participants experiencing menstrual disturbances.

Conclusions: A strong association was observed between higher BMI and increased menstrual irregularities, highlighting the importance of early diagnosis, lifestyle modification and weight management in improving reproductive health outcomes in women with PCOS.

An observational study of intrauterine death in high-risk pregnancy at a tertiary care hospital

2026-06-27T06:59:20+0530

Background: Intrauterine death (IUD) is a major obstetric complication and a distressing event for both families and caregivers. Identifying the causes and associated obstetric conditions is important for developing preventive strategies and improving the quality of antenatal care. This study aimed to characterize the clinical and obstetric profile of IUD cases at a tertiary care hospital and to evaluate the associated maternal risk factors.

Methods: An observational study was conducted at LLRM, a tertiary care centre. Out of 5000 total deliveries during the study period, 149 cases of intrauterine death were identified and included in the analysis. Maternal demographic details, gestational age, obstetric complications, booking status, residence, mode of delivery and associated clinical conditions were recorded and analyzed.

Results: The IUD rate in this study was 29.8 per 1000 deliveries (2.98%). Most cases were in the age group of 21–25 years (51.0%), with a mean maternal age of 25.8 years. Multigravida women made up 64.4% of the cases. A large number of patients were unbooked (79.2%) and from rural areas (71.1%). Preterm labour was the most common associated complication (63.1%), followed by severe pre-eclampsia (27.5%), antepartum eclampsia (17.4%), antepartum haemorrhage (14.1%) and gestational diabetes mellitus (14.1%). Most patients (71.1%) had vaginal delivery, while 28.9% underwent caesarean section. Meconium-stained liquor was seen in 38.3% of cases.

Conclusions: Hypertensive disorders of pregnancy and preterm labour were the most common conditions associated with IUD in this setting. The high number of unbooked and rural patients highlights the importance of proper antenatal care. Early registration, regular antenatal check-ups and timely referral to higher centres remain the cornerstone for prevention of IUD.

A prospective observational study of maternal outcomes in very high-risk pregnancies in a tertiary care centre of South Gujarat

2026-06-27T06:59:20+0530

Background: Very high-risk pregnancy (VHRP) is associated with increased maternal morbidity and mortality. Early identification and appropriate management are essential to improve outcomes. This study aims to study maternal outcomes and complications in very high-risk pregnancies up to 7 days postpartum.

Methodology: This prospective observational study was conducted in the Department of Obstetrics and Gynaecology at a tertiary care center in South Gujarat. A total of 150 pregnant women fulfilling VHRP criteria as per Government of Gujarat guidelines were included. Detailed history, clinical examination, and investigations were recorded. Maternal outcomes, complications, and OBICU admissions were analyzed.

Results: Majority of women belonged to the 18–25 years age group (52%). Common VHRP conditions included Low BMI (25.3%), Previous 2 caesarean sections (23.3%) and Severe PET (21.3%). OBICU admissions were noted in a significant proportion of patients. OBICU admissions were commonly seen in severe PET (40.8%), Sickle cell disease (25.9%) and prev 2 caesarean sections (11.1%) while no OBICU admissions in low BMI criteria. Maternal complications commonly included puerperal pyrexia (20%) and sepsis (8.7%). Mortality rates were higher in severe PET (62.5%) and sickle cell disease (37.5%), however reduction in rates after implementation of VHRP criteria were seen.

Conclusion: VHRP is associated with significant maternal morbidity. Early identification, timely referral, and management at tertiary care centres significantly improve outcomes and reduce mortality.

Awareness and knowledge regarding cervical cancer and screening practices among women attending a tertiary care center in Bhavnagar, Gujarat: a prospective observational study

2026-06-27T06:59:18+0530

Background: Cervical cancer remains one of the leading causes of cancer-related mortality among women in developing countries, particularly in India. Despite being preventable through effective screening methods like the Pap smear, lack of awareness leads to late-stage presentation and poor outcomes. Objective was to assess the awareness and knowledge of cervical cancer and its screening methods among women attending a tertiary care center.

Methods: This prospective observational study was conducted among 100 women aged 30-60 years attending Gopinath Maternity Home and Sir T. Hospital, Bhavnagar. From January 2025 to March 2025, data were collected using a structured questionnaire assessing socio-demographic variables and knowledge regarding cervical cancer and screening.

Results: The majority of participants were in the 36-40 years age group and were married. Most women had limited knowledge regarding symptoms, risk factors, and screening methods. Only a small proportion correctly identified Pap smear as a screening tool and understood its significance.

Conclusions: Awareness regarding cervical cancer and its screening remains inadequate. There is a need for targeted educational programs to improve knowledge and promote early detection practices.

Clinical profile and fetal outcomes of liver disorders in pregnancy: a one-year retrospective study at a tertiary care centre

2026-06-27T06:59:17+0530

Background: Liver disorders in pregnancy are associated with significant maternal and perinatal morbidity and mortality. The spectrum includes pregnancy-specific conditions such as HELLP syndrome and intrahepatic cholestasis of pregnancy (IHCP), as well as coincidental hepatic diseases including viral hepatitis. Early diagnosis and timely management are critical for improving outcomes in affected mothers and neonates.

Methods: A retrospective observational study was conducted at Maharani Laxmi Bai Medical College and Hospital, Jhansi, from February 2025 to February 2026. A total of 200 pregnant women diagnosed with liver disorders were included. Data were collected from hospital records and analysed using the chi-square test with p<0.05 considered statistically significant.

Results: HELLP syndrome was the most common disorder (61%), followed by viral hepatitis (23%) and IHCP (16%). The mean patient age was 26.4±4.2 years. Intrauterine fetal demise (IUFD) was significantly higher in IHCP (21.9%) compared to HELLP (13.9%) and hepatitis (10.9%) (p=0.04). Preterm delivery (45.9%, p=0.01) and NICU admissions (51.6%, p=0.03) were significantly higher in HELLP syndrome. The difference in caesarean section rates across groups was not statistically significant (p=0.18).

Conclusions: HELLP syndrome is associated with significant maternal and neonatal morbidity, while IHCP demonstrates disproportionately higher fetal mortality despite lower prevalence. Viral hepatitis remains a clinically significant coincidental disorder. Early identification, multidisciplinary management, and timely obstetric intervention are essential to reduce adverse fetomaternal outcomes in pregnant women with liver disorders.

The ferritin-albumin ratio as a predictive biomarker for morbidity among obstetric patients admitted to a tertiary care center in Bundelkhand region

2026-06-27T06:59:16+0530

Background: Maternal morbidity and mortality remain significant public health challenges, particularly in resource-constrained regions. Early identification of at-risk obstetric patients is crucial to prevent severe complications. The ferritin-albumin ratio (FAR) is a composite biomarker reflecting inflammatory burden and nutritional status.

Methods: This prospective cohort study included 100 obstetric patients admitted to ICU over a 12-month period. Serum ferritin and albumin were measured at admission, and FAR was calculated. Clinical outcomes including organ dysfunction, shock, ARDS, DIC, AKI, and mortality were recorded. ROC curves and multivariable logistic regression were used to assess FAR’s predictive value.

Results: FAR was significantly higher in patients with severe morbidity (median 11.0 versus 8.5; p<0.001). ROC analysis showed FAR had modest predictive accuracy (AUC 0.61). Multivariable analysis confirmed FAR as an independent predictor of morbidity (adjusted OR 2.09; p<0.001), along with SOFA score, maternal age, and sepsis.

Conclusions: FAR is a simple, cost-effective biomarker that independently predicts severe maternal morbidity in critically ill obstetric patients. Integration into early risk stratification may improve maternal outcomes in low-resource settings.

Serum PAPP-A and uterine artery Doppler as predictors of preeclampsia

2026-06-27T06:59:15+0530

Background: Preeclampsia (PE) is a disorder that happens during pregnancy. It is marked primarily by symptoms such as high blood pressure and problems with organs that develop after 20 weeks of gestation. Recently, biomarkers like pregnancy-associated plasma protein A (PAPP-A) and uterine artery Doppler pulsatility index (PI) have been identified as new predictors of PE because they reflect the condition and throughput of the placenta. Therefore, the goal of this research was to determine how accurate maternal serum PAPP-A levels and uterine artery PI predict PE when used not only separately but also together.

Methods: This prospective cohort study was carried out in Department of Obstetrics and Gynecology and the Fetal-Maternal Medicine Department of Bangladesh Medical University (BMU) Dhaka during January 2024 to December 2024. The sample of the study consisted of 99 pregnant women who visited outpatient departments, their gestational age was between 12 and 20 weeks and they were normotensive. Statistical analysis was done through SPSS version 26.0. The association between PAPP-A levels and the development of PE, which was illustrated through odds ratios (ORs) with 95% confidence intervals (CIs), and a p-value less than 0.05 was regarded as statistically significant.

Results: ROC analysis showed that PAPP-A has moderate predictive ability for preeclampsia, with an AUC of 0.742 (95% CI:0.638-0.846, p=0.03). A cut-off value of ≥0.55 yielded good sensitivity (72.73-81.82%) and moderate specificity (68.18%), with a high negative predictive value (95.24-95.28%) but low positive predictive value (22.22%) and overall accuracy of 68.69%. Most PE cases (8 of 11) occurred in participants with PAPP-A <0.55, supporting its role as a predictor. Similarly, elevated uterine artery PI (≥1.61) was observed in 7 of 11 PE cases and showed high specificity (93.18%), high negative predictive value (95.35%), moderate sensitivity (63.64%), and overall accuracy of 89.90%, indicating a strong association between increased PI and the development of preeclampsia.

Conclusions: Low PAPP-A and high uterine artery PI show solid early signs of preeclampsia. Tracking these markers in first trimester pregnancies helps spot at-risk women. Early detection allows actions to be taken before complications arise. Interventions can reduce harm to mother and baby. The data supports real-time risk assessment without waiting for symptoms to appear.

An observational study on the magnitude of vitamin D levels in first trimester of pregnancy and the outcomes

2026-06-27T06:59:13+0530

Background: Vitamin D deficiency is a common public health concern during pregnancy and has been associated with impaired glucose metabolism, abnormal placentation, and adverse maternal and neonatal outcomes. This study assessed the magnitude of maternal vitamin D deficiency during early pregnancy and evaluate its association with maternal and neonatal outcomes.

Methods: A prospective observational study was conducted among 302 singleton pregnant women attending the department of obstetrics and gynecology, ESIMC and PGIMSR Rajajinagar, Bangalore, over 18 months. Serum 25-hydroxyvitamin D levels were measured between 12-18 weeks of gestation. Participants were followed until delivery. The maternal outcomes evaluated included gestational diabetes mellitus, hypertensive disorders during pregnancy, anaemia, hypothyroidism, mode of delivery, and preterm birth. Neonatal outcomes included birth weight, low birth weight, Apgar score, and NICU admission. Associations were analyzed using chi-square tests.

Results: Of the 302 participants, 63 (20.9%) were vitamin D deficient, 174 (57.6%) insufficient, and 65 (21.5%) sufficient, indicating that 78.5% had suboptimal vitamin D levels. GDM occurred in 63 (20.9%) women and showed a significant association with vitamin D deficiency (χ²=14.34, p<0.001). Preeclampsia (3.3%) was also significantly higher among deficient mothers (χ²=15.57, p<0.001). No significant association was observed with anaemia, hypothyroidism, low birth weight, preterm delivery, or mode of delivery. Among 286 live births, NICU admission occurred in 20.6% neonates and was markedly higher among deficient mothers.

Conclusions: Vitamin D deficiency is a public health problem. Patient awareness and pre-pregnancy counselling with adequate supplementation will improve maternal and neonatal outcomes and minimize the complications.

A retrospective observational study of predictors of adverse maternal and fetal outcomes in mothers with systemic lupus erythematosus in pregnancy

2026-06-27T07:09:35+0530

Background: SLE is a disease of reproductive age group and has implications on maternal and fetal health in pregnancy. This study was done to determine and analyze the predictors of adverse maternal and fetal outcomes in mothers with systemic lupus erythematosus in pregnancy.

Methods: Retrospective observational study was done to evaluate pregnancy outcomes in SLE mothers at Fernandez Hospital, Hyderabad, from January 2017 to December 2022. Data was obtained via electronic medical records. Descriptive analysis was done by mean and standard deviation for quantitative variables, and frequency and proportion for categorical variables. Chi-square test was used to test statistical significance between variables (p<0.05 was significant).

Results: SLE affects pregnancies causing adverse maternal (flares (18.95%), hypertensive disorders (22.18%), severe maternal morbidity (5.65%), fetal (preterm birth (38.71%), FGR (28.97%), perinatal death (3.17%)), and neonatal (congenital heart block (3.17%), neonatal lupus (3.96%), Binder’s facies (5.16%)) outcomes- especially when period of remission was <6 months (p<0.05). Anti-Smith, RNP and Scl-70 Ab were significantly associated with Binder’s facies and chondrodysplasia. Anti-Ro/La antibodies were associated with congenital heart block and endocardial fibroelastosis. Lupus nephritis was an independent risk factor for adverse outcomes. Chronic hypertension, past history of thrombosis and chronic kidney disease were risk factors for adverse outcomes (p<0.05). Heparin, HCQs and Azathioprine could also have a role in improving perinatal outcomes (p<0.05).

Conclusions: As SLE can cause adverse maternal, fetal and perinatal outcomes in pregnancy, all mothers with SLE should undergo preconceptional counselling to optimize outcomes.

Post-operative outcomes of enhanced recovery versus conventional approach in elective caesarean section: a prospective comparative study

2026-06-27T06:59:13+0530

Background: Caesarean section (CS) is one of the most common obstetric procedures in the world. The traditional post-operative management is known to lead to delayed recovery, extended hospital stays and maternal discomfort. Enhanced Recovery After Surgery (ERAS) is a multimodal perioperative, evidence-based approach. The objectives of this study were to compare the outcomes of ERAS with standard care for women who undergo elective caesarean section, with emphasis on bowel and bladder recovery, mobility and self-care, and hospital stay.

Methods: A prospective comparative study with 118 women who underwent elective CS was conducted, with 59 women in each group (ERAS and conventional). The groups were comparable with regard to baseline sociodemographic, obstetric, and laboratory parameters. Assessment of outcomes included time to first flatus, bowel movement, spontaneous voiding, ambulation, self-care ability, postoperative complications, duration of intravenous fluid therapy, removal of the catheter, hospital stay, and patient satisfaction. A p value of <0.05 was considered statistically significant.

Results: ERAS group had significantly earlier recovery of bowel and bladder function, earlier ambulation and more independence in self-care than the conventional care group (p<0.001). The ERAS group had a significantly shorter mean hospital stay (3.5±1.6 vs. 5.2±3.1 days, p=0.04), and more early discharges. ERAS participants had fewer postoperative complications, such as puerperal fever, paralytic ileus and wound infection. The patient satisfaction scores were also significantly higher in the ERAS group (p<0.001).

Conclusions: ERAS protocols have positive effects on postoperative recovery, hospital stay and morbidity following elective CS and should be routinely used in obstetric practice.

Comparative efficacy of oral versus vaginal micronized progesterone in the prolongation of preterm labour: a prospective comparative study

2026-06-27T06:59:12+0530

Background: Preterm labour is a leading cause of neonatal morbidity and mortality worldwide. Progesterone supplementation is an established strategy for preterm birth prevention; however, the optimal route of administration- oral or vaginal- remains debated, particularly regarding gestation prolongation. Objective was to compare the efficacy of oral versus vaginal micronized progesterone (200 mg daily) in prolonging gestation in women presenting with preterm labour.

Methods: A prospective comparative study was conducted at Maharani Laxmi Bai Medical College, Jhansi, from May 2025 to April 2026. One hundred pregnant women with preterm labour (24-36+6 weeks) were randomised to oral micronized progesterone 200 mg daily (group A, n=50) or vaginal micronized progesterone 200 mg daily (group B, n=50). Primary outcomes were mean prolongation of gestation (days) and mean gestational age at delivery (weeks).

Results: Both groups were comparable at baseline. The vaginal progesterone group demonstrated significantly greater mean gestation prolongation (20.14±4.58 versus 11.38±2.82 days; p=0.0001) and higher mean gestational age at delivery (35.81±1.09 versus 33.88±1.84 weeks; p=0.001). Deliveries at 33-36+6 weeks were more frequent in the vaginal group (94% versus 74%; p=0.02). Very preterm deliveries (24-29 weeks) occurred only in the oral group (2%).

Conclusions: Vaginal micronized progesterone is significantly more effective than oral progesterone in prolonging gestation in preterm labour, attributable to enhanced uterine bioavailability via the first uterine pass effect. It should be the preferred route in clinical management of preterm labour.

Diagnostic utility of serum anti-Müllerian hormone in different phenotypes of polycystic ovary syndrome: a case-control study from a tertiary care centre

2026-06-27T06:59:10+0530

Background: This study aimed to evaluate the diagnostic utility of serum Anti-mullerian hormone (AMH) in polycystic ovary syndrome (PCOS), to establish a cut off value, and to compare AMH levels across different PCOS phenotypes.

Methods: A case-control study was conducted in the Department of Obstetrics and Gynaecology at a tertiary care teaching hospital from July 2022 to June 2023. A total of 100 women aged 16-40 years were enrolled, including 50 PCOS cases diagnosed using the Rotterdam criteria and 50 age-matched controls with regular menstrual cycles. Participants underwent clinical evaluation, anthropometric assessment, transabdominal ultrasonography and serum AMH estimation using an enzyme-linked fluorescent assay. Receiver operating characteristic (ROC) curve analysis was performed to determine the optimal AMH cut-off for PCOS diagnosis.

Results: Mean serum AMH levels were significantly higher in women with PCOS compared to controls (7.10±2.70 ng/ml vs. 2.32±1.59 ng/ml; p<0.001). ROC analysis identified an optimal AMH cut-off of 4 ng/ml, yielding 90% sensitivity and 78% specificity, with an area under the curve of 0.895. Women with AMH ≥4 ng/ml had significantly increased odds of PCOS (odds ratio 31.9; 95% confidence interval: 10.2-99.9). Among phenotypes, AMH levels were highest in phenotype A and lowest in phenotype C.

Conclusions: Serum AMH is significantly elevated in PCOS and varies across phenotypes. It demonstrates excellent diagnostic performance and may serve as a useful adjunctive biomarker, particularly in settings where ultrasonography is limited.

A study to assess knowledge, awareness and attitude towards HPV vaccination among young adults in a tertiary health care setting

2026-06-27T06:59:08+0530

Background: Human papillomavirus (HPV) is one of the most common sexually transmitted infections worldwide and is a major etiological factor for cervical cancer and several other anogenital malignancies. Despite the availability of highly effective vaccines, HPV vaccination coverage remains suboptimal in many developing countries. This study was conducted to assess the knowledge, awareness and attitude regarding HPV vaccination among young adults in a tertiary health care setting.

Methods: A cross-sectional questionnaire-based study was conducted among 100 young adults aged 17-25 years in a tertiary health care teaching institution between January and March 2026. Data were collected using a structured and prevalidated questionnaire distributed through Google Forms. Information regarding knowledge of HPV infection, awareness of HPV vaccination, vaccination status and attitudes towards vaccination was collected and analyzed using descriptive statistics.

Results: Among the 100 participants, 96% had heard of HPV and 89% were aware that a vaccine against HPV is available. Eighty-five percent correctly identified cervical cancer and genital warts as HPV-related diseases. Ninety percent considered HPV vaccination important and 82% expressed willingness to receive vaccination. However, only 18% had been vaccinated. Lack of information, vaccine cost, fear of side effects and social stigma were the major barriers identified.

Conclusions: Although awareness and acceptance of HPV vaccination were generally satisfactory among young adults, actual vaccination uptake remained low. Educational interventions, increased accessibility and targeted awareness programmes are needed to improve HPV vaccine coverage.

Challenges in communication between mothers and adolescent daughters concerning sexual and reproductive health issues, Puducherry

2026-06-27T06:59:07+0530

Background: Mothers play a key role as an educator for adolescent girls especially with respect to sexual and reproductive health (SRH). However, these conversations are affected largely by the socio-cultural context and the rapport between them. Studying the communication between mother, daughter dyad would give key insights for planning interventional strategies. This study aims to explore challenges in communication between mothers and adolescent daughters regarding SRH issues and to assess mothers’ perceptions of the extent, barriers and facilitating factors influencing such communication.

Methods: An exploratory mixed-methods study (Qual→QUAN) was conducted in an urban slum of Puducherry. The qualitative component included four focus group discussions (two with mothers and two with adolescent girls), analysed using an inductive thematic approach. Findings informed the development of a semi-structured questionnaire for the quantitative cross-sectional survey among 210 mothers selected through cluster sampling. Data were analyzed using descriptive statistics.

Results: Four major themes of barriers emerged: maternal factors (perception that daughters are too young, embarrassment, poor knowledge), daughter-related factors (fear of disapproval and judgment), relationship issues (lack of trust, educational divide) and socio-cultural influences (restrictive norms, time constraints).While more than 90% of mothers reported talking about menstruation and sexual abuse, there was little discussion on contraception (7%), reproductive tract diseases (34%) or pregnancy. There was a significant discrepancy between perceived and real communication. Trust, friendly relationship, exposure to neighbourhood events and health worker involvement were the facilitating factors.

Conclusions: Complex interpersonal and sociocultural factors influence mother-daughter communication on SRH and there are differences between perceived and actual practices. To facilitate efficient communication, interventions should concentrate on improving parental understanding, building relationships based on trust and incorporating community and health system support.

A comparative study on the efficacy of saline infusion sonography and transvaginal sonography in abnormal uterine bleeding in premenopausal females

2026-06-27T06:59:06+0530

Background: Saline infusion sonography (SIS) and transvaginal ultrasonography (TVS) were widely used techniques for evaluation of cases with abnormal uterine bleeding (AUB). However, the superiority of these two techniques in terms of accuracy remains a question.

Methods: A total of 45 cases with AUB were subjected to both TVS and SIS and analysed for endometrial polyp or submucosal fibroids. The results of the imaging were compared with the histopathological results of the endometrium of the same patient. The data was analyzed using SPSS - Version 19.

Results: In diagnosing thickened endometrium, diagnostic accuracy of TVS was reported as 91.1% with sensitivity (Sn), specificity (Sp), positive predictive value (PPV) and negative predictive value (NPV) of 96.7%, 78.6%, 90.9% and 91.7%, respectively. Similarly, for SIS, diagnostic accuracy (DA) was 93.3% with Sn, Sp, PPV and NPV were 96.7%, 85.7%, 93.8% and 92.3%, respectively. In adenomyosis, diagnostic accuracy of TVS was reported as 95.6% with Sn, Sp, PPV and NPV of 100%, 94.7%, 77.8% and 100%, respectively. Similarly, for SIS, Diagnostic accuracy was 100% with Sn, Sp, PPV and NPV were also 100%. In diagnosing fibroid, diagnostic accuracy of TVS was reported as 100% with Sn, Sp, PPV and NPV of 87.5%, 100%, 100% and 97.4%, respectively. Similarly, for SIS, diagnostic accuracy was 100% with Sn, Sp, PPV and NPV were 100%, each.

Conclusions: We infer that SIS is found to be better efficacious in diagnosing different pathologies of AUB cases compared to TVS among the premenopausal women.

Awareness on cervical cancer, its screening and HPV vaccination among women of reproductive age group (15-49 years) in a tertiary care centre in Maharashtra

2026-06-27T06:59:05+0530

Background: In India, cervical cancer is the second most common cause of cancer among females after breast cancer. Human papilloma virus is one of the most common sexually transmitted infections worldwide among both men and women and is found to be the most common cause of cervical intraepithelial neoplasia (CIN) and cervical cancer in females. This study was undertaken to assess awareness of cervical cancer and its screening and vaccination among women of reproductive age group in a tertiary care centre in Maharashtra.

Methods: This was an observational study with all patients who attended the gynaecology outpatient department of Rajiv Gandhi Medical College and Chhatrapati Shivaji Maharaj Hospital, Kalwa, Thane and included all women in the age group of 15-49 years during the study period September 2025-March 2026.

Results: The majority of participants (25%) were aged between 26-30 years. Awareness about PAP smear testing was low, with 59% being unaware. Knowledge about cervical cancer risk factors was alarmingly low, with only 30% women not having awareness. HPV vaccine awareness was also limited, with 72% lacking awareness.

Conclusions: In our study, the most common risk factors of cervical cancer known were poor genital hygiene, tobacco use, followed by uterine infections. In our study, 63 % were aware of signs and symptoms of cervical cancer. Our study highlights an urgency to enhance women’s knowledge about HPV infection and cervical cancer. This can be effectively addressed via a multifaceted approach. Awareness campaigns using both print and electronic media should be used to disseminate accurate information to a wide audience, especially in underserved areas.

Off-label uses of botulinum toxin A in chronic itch-related dermatological disorders: a retrospective study

2026-06-27T06:59:04+0530

Background: Botulinum neurotoxin (BONT) produced by anaerobic clostridium botulinum exerts diverse biological effects by acting on various neurotransmitters like acetylcholine, substance P, glutamate, mast cell, calcitonin gene related peptide (CGRP). Initially linked with aesthetic dermatology, it is now explored in various dermatological conditions including rosacea, post-herpetic neuralgia, keloid and hypertrophic scars and itch related disorders. The aim to investigate the diverse dermatological applications of BONT A in chronic itch disorders and evaluate its therapeutic outcomes in a retrospective study.

Methods: A retrospective, single centre study was conducted from December 2018 to December 2023. Information of all patients who underwent intradermal botulinum toxin injections for chronic itch-related disorders was extracted from the database. Information including demographic profiles, diagnosis, previous medications, the dosage of toxin administered, duration of symptomatic relief and post-procedure complications were recorded. Treatment efficacy was assessed based on the patient reported improvement: mild (1-24%), moderate (25-49%, good (50-75%) and excellent (>76% improvement).

Result: A total of 33 patients (22 female and 11 male) were enrolled with diagnoses such as pruritus vulvae, scrotal dysesthesia, post-herpetic neuralgia, notalgia paresthetica, lichen simplex chronicus, and burning foot syndrome. Toxin was injected as 1 unit/cm² and total number of toxins administered depended on the area involved. Majority of patients reported good improvement (50-75%) in itching lasting for 3-5 months.

Conclusion: Intradermal BONT A injection showed promising long-lasting results in managing chronic itch related disorders which do not respond to conventional modalities of treatment.

Stepwise surgical repair of complete perineal tear (OASIS): a 20-year retrospective study of 200 referred cases at a tertiary care centre in Bundelkhand region

2026-06-27T06:57:57+0530

Background: Obstetric anal sphincter injuries (OASIS), comprising third- and fourth-degree perineal tears, are severe obstetric complications leading to significant maternal morbidity including fecal incontinence, perineal pain, wound dehiscence, dyspareunia, rectovaginal fistula formation, and psychological distress. This study aimed to evaluate demographic and obstetric characteristics of referred complete perineal tear cases managed at a tertiary care centre and to describe a standardized stepwise surgical repair protocol with functional and cosmetic outcomes.

Methods: A retrospective observational study was conducted in the Department of Obstetrics and Gynaecology, Maharani Laxmi Bai Medical College, Jhansi, Uttar Pradesh, India, from January 2005 to December 2025. A total of 200 referred cases of complete perineal tear were included. Surgical repair was performed after 24 hours of delivery.

Results: Among 200 patients, 50% were aged >25 years and 70% were primigravida. Post-term deliveries accounted for 55% of cases. Birth weight was >3 kg in 50% of cases. Episiotomy was not given in 85% of cases. Saddle anaesthesia was used in 75% patients. Hospital stay was 14 days in 55% of patients.

Conclusions: Complete perineal tears were more frequent among primigravida and post-term deliveries, especially with neonatal birth weight >3 kg. Delayed repair following a standardized stepwise anatomical reconstruction protocol resulted in satisfactory functional and cosmetic outcomes.

Fetomaternal outcomes in term premature rupture of membranes: a prospective observational study from tribal Gujarat

2026-06-27T06:57:57+0530

Background: Premature rupture of membranes (PROM) at term is a common obstetric condition associated with increased risk of maternal and neonatal complications if not managed appropriately. The duration between membrane rupture and delivery plays an important role in determining fetomaternal outcomes. Early diagnosis, timely induction of labour and proper monitoring are essential to minimize infection and adverse neonatal events, particularly in resource-limited settings.

Methods: This prospective observational study was conducted on 130 pregnant women with term PROM admitted to a tertiary care hospital. Detailed history, clinical examination and relevant investigations were performed according to a standardized protocol. Patients were monitored during labor and induction was carried out using prostaglandins, oxytocin, or misoprostol when indicated. Data regarding duration of PROM, mode of delivery, maternal complications, neonatal birth weight, APGAR scores, NICU admissions and neonatal complications were recorded and analyzed using descriptive statistics.

Results: The majority of women belonged to the 21-25 years age group (41.54%), and most were from rural areas (93.85%). Vaginal delivery was achieved in 74.62%, while 25.38% required cesarean section, mainly due to fetal distress (39.39%). Most mothers had no complications (69.23%), although pyrexia occurred in 22.31%. Neonatal outcomes were generally favorable, with the majority of babies weighing 2.5-3.0 kg (43.85%) and having good APGAR scores at 5 minutes. NICU admission was required in 16.15% of neonates, with respiratory distress being the most common complication.

Conclusions: Term PROM, when managed with timely induction, appropriate monitoring and prompt obstetric intervention, is associated with favorable maternal and neonatal outcomes. Early diagnosis and structured management protocols can significantly reduce complications and improve fetomaternal prognosis.

Maternal and perinatal outcomes in obese versus non-obese pregnant women at a tertiary care hospital in western India: a prospective comparative study

2026-06-27T06:57:56+0530

Background: Maternal obesity is increasing worldwide and in India and is associated with adverse pregnancy outcomes. This study compared maternal and perinatal outcomes in obese (body mass index ≥25 kg/m²) and non-obese (body mass index 18.5–24.9 kg/m²) pregnant women in a tertiary care hospital using Indian BMI cut-offs.

Methods: A prospective comparative analytical study was conducted in the Department of Obstetrics and Gynaecology, Krishna Institute of Medical Sciences, Karad, Maharashtra. A total of 204 women were enrolled and equally allocated to an obese group (n=102) and a non-obese group (n=102). Maternal outcomes included hypertensive disorders of pregnancy (HDP), gestational diabetes mellitus (GDM), mode of delivery, postpartum haemorrhage (PPH) and wound infection. Perinatal outcomes included preterm birth, birth weight, Apgar scores and neonatal intensive care unit (NICU) admission. Data were analysed using Chi-square test, Fisher’s exact test and Student’s t-test, with p<0.05 considered statistically significant.

Results: Obese women had higher rates of pregnancy-induced hypertension (25.5% vs 7.8%), eclampsia (3.9% vs 0%), GDM (29.4% vs 0%), lower-segment caesarean section (51.0% vs 37.3%), PPH (15.7% vs 3.9%) and preterm delivery (23.5% vs 11.8%). Neonates of obese mothers more often had macrosomia (17.6% vs 0%), low Apgar score at 1 minute (25.5% vs 13.7%) and 5 minutes (11.8% vs 3.9%), and NICU admission (41.2% vs 13.7%).

Conclusions: Maternal obesity defined by Indian BMI cut-offs is associated with markedly increased risks of GDM, HDP, operative delivery, PPH, macrosomia and NICU admission, supporting targeted preconception counselling and intensified antenatal surveillance in obese women.

The impact of birth companion on respectful maternity care and labor outcomes among primigravida in a rural tertiary care centre: a quasi-experimental study

2026-06-27T06:57:55+0530

Background: Respectful maternity care (RMC) and continuous labor support are essential components of quality intrapartum care. Although the World Health Organization recommends allowing a companion of choice during childbirth, this practice remains underutilized in many resource-limited settings. This study evaluated the impact of a birth companion on RMC perceptions and labor outcomes among primigravida women in a rural tertiary care centre.

Methods: A quasi-experimental study was conducted in the Department of Obstetrics and Gynaecology, RL Jalappa Hospital, Kolar, during January 2026 – March 2026. Ninety-six primigravida women were enrolled and allocated into a study group (n=48), who received continuous support from a female birth companion, and a control group (n=48), who received standard intrapartum care. Data were collected using validated RMC, childbirth experience questionnaire (CEQ), and maternal satisfaction scales. Statistical analysis was performed using statistical package for the social sciences (SPSS) version 25.0, with p<0.05 considered significant.

Results: The study group demonstrated significantly higher RMC scores (42.56±4.12 versus 34.23±5.87), CEQ scores (3.74±0.42 versus 2.89±0.51), and maternal satisfaction scores (41.62±3.84 versus 32.48±5.36) (all p<0.001). Normal vaginal delivery was more frequent in the study group (81.25% versus 62.50%; p=0.042), while cesarean section rates were lower (12.50% versus 29.17%; p=0.049). Active labor duration was significantly shorter (5.82±1.34 versus 7.46±1.72 hours; p<0.001). Neonatal outcomes were similar between groups.

Conclusion: Birth companion support significantly improved RMC perceptions, childbirth experience, maternal satisfaction, and labor outcomes. Integrating birth companion programs into rural tertiary care settings may be a cost-effective strategy to enhance the quality of maternal care.

Effect of dedicated antenatal counselling on insertion rate of post placental intrauterine contraceptive device

2026-06-27T06:57:52+0530

Background: Post placental intrauterine contraceptive devices (PPIUCDs) are a safe, effective and long-acting reversible contraceptive method. However, their acceptance remains low due to limited awareness and prevailing misconceptions. Antenatal counselling offers an opportunity to improve acceptance. To assess the impact of dedicated antenatal counselling on PPIUCD acceptance and to evaluate knowledge, attitudes and factors influencing refusal among antenatal women.

Methods: This facility-based prospective study was conducted among antenatal women delivering at a tertiary care centre. Participants received structured counselling during the third trimester and early labour. Data on awareness, perceptions, decision-making and acceptance of PPIUCD were collected and analysed statistically. Patients were followed up till delivery to see for acceptance of post placental IUCD.

Results: Awareness of IUCDs was observed in 77.6% of participants. Following counselling, the acceptance rate of PPIUCD increased to 25.9% compared to 6.5% reported previously. Decision-making was predominantly influenced by husbands (50.4%). Major reasons for non-acceptance included fear of complications (22.6%), desire for more children (21.2%), preference for other methods (16.6%) and husband refusal (12.5%). Knowledge was significantly associated with factors such as age, education, occupation and gravidity (p<0.05).

Conclusions: Dedicated antenatal counselling significantly improves PPIUCD acceptance by addressing misconceptions and enhancing awareness. Integrating repeated counselling into routine antenatal care and promoting partner involvement can further increase uptake and improve maternal health outcomes.

Fertility-related quality of life among women attending an infertility clinic in North India: a cross-sectional study

2026-06-27T06:57:51+0530

Background: Infertility is a significant reproductive health problem that adversely affects the psychological and social well-being of women. Fertility-related quality of life is increasingly recognized as an important component of infertility care. However, limited data are available from North India regarding the quality of life among women seeking infertility treatment. The present study aimed to assess fertility-related quality of life among women attending an infertility clinic at a tertiary care centre in North India.

Methods: A hospital-based cross-sectional study was conducted among 145 women attending infertility clinics at King George’s Medical University, Lucknow. Women aged 18–40 years diagnosed with primary infertility were enrolled using convenience sampling. Data were collected using a pre-tested semi-structured questionnaire. Fertility-related quality of life was assessed using the validated fertility quality of life (FertiQoL) scale comprising emotional, mind-body, relational, and social domains. Data were analysed using statistical package for the social sciences (SPSS) version 24. Descriptive and inferential statistical analyses were performed, and p<0.05 was considered statistically significant.

Results: The majority of participants were aged 26–30 years (50.3%) and had been undergoing infertility treatment for more than three years (55.1%). Poor quality of life was observed among 62.8% participants, while only 3.4% reported good quality of life. The emotional (63.4%), social (62.1%), and mind-body (60.7%) domains were the most adversely affected components of the FertiQoL scale. Poor quality of life was more common among women with prolonged treatment duration, inadequate emotional support, and higher treatment-related stress.

Conclusion: Infertility has a substantial negative impact on FertiQoL, particularly in emotional and psychosocial domains. Integration of psychological counselling and supportive interventions within infertility care services may help improve the overall well-being of affected women.

Comparative evaluation of oral labetalol, nifedipine and amlodipine in the management of postpartum preeclampsia: a prospective randomized study

2026-06-27T06:57:46+0530

Background: Postpartum preeclampsia is a major contributor to maternal morbidity and mortality worldwide. Persistent hypertension during the postpartum period can lead to severe complications such as stroke, pulmonary edema, renal dysfunction, and eclampsia if not managed appropriately. Oral antihypertensive agents including labetalol, nifedipine, and amlodipine are commonly used for postpartum blood pressure control; however, comparative evidence regarding their efficacy and tolerability remains limited.

Methods: A prospective randomized comparative study was conducted over a period of 12 months in the Department of Obstetrics and Gynecology at a tertiary care hospital. A total of 120 women diagnosed with postpartum preeclampsia were randomly allocated into three equal groups of 40 patients each. Group A received oral labetalol, group B received oral nifedipine, and group C received oral amlodipine. Patients were monitored for blood pressure control, time required to achieve target blood pressure, requirement of additional antihypertensive therapy, duration of hospital stay, and adverse drug reactions.

Results: All three drugs effectively reduced postpartum blood pressure. Nifedipine showed the fastest reduction in systolic and diastolic blood pressure and least requirement for additional antihypertensive therapy. Amlodipine demonstrated smoother blood pressure control with better tolerability, whereas labetalol was effective but required more frequent dosing. Duration of hospital stay was shortest in the nifedipine group.

Conclusions: Oral nifedipine, labetalol and amlodipine are effective antihypertensive agents in postpartum preeclampsia. Nifedipine demonstrated rapid blood pressure control, whereas amlodipine provided sustained control with better compliance and fewer adverse effects.

A study comparing the caesarean section rates in various groups of Robson classification in a tertiary care hospital and its comparison with the predicted rate by the World Health Organisation C-model

2026-06-27T06:57:43+0530

Background: The incidence of cesarean section is increasing worldwide. The World Health Organisation (WHO) C-section model can be used to predict the incidence of cesarean section. The purpose of this study is to determine the incidence of cesarean section across various Robson groups and compare it with the WHO C-section model.

Methods: 683 women who delivered after 22 weeks of gestation were studied. WHO C Model predicted caesarean rates were studied in various Robsons group. The observed caesarean section rates in various groups were compared with the predicted caesarean section rates in various Robsons groups.

Results: We found high rates of caesarean section among various Robsons groups when compared with the predicted WHO C-model. Fetal distress and caesarean sections on maternal request were the commonest cause of caesarean section in our study.

Conclusions: We observed higher rates of section in our study when compared with the predicted WHO C model. Adhering to strict labour ward protocols and the use of sensitive methods of fetal monitoring, like fetal scalp pH, may reduce the number of sections.

Dietary intake and its association with body composition and hormonal profile among women with polycystic ovary syndrome from Chandigarh capital region, India

2026-06-27T06:57:41+0530

Background: Polycystic ovary syndrome (PCOS) is globally prevalent endocrine and metabolic disorder among women in the reproductive age. The present study is an attempt to assess dietary intake and their relationship with hormonal profile and body composition variables in overweight/obese and non-obese women having PCOS.

Methods: The sample consisted of 250 PCOS women, aged from 18 to 45 years living in Chandigarh Capital region (CCR) was collected from tertiary hospital. The dietary intake of PCOS women was evaluated by employing 24-hours dietary recall method for three consecutive days. The hormonal history of follicle stimulating hormone, luteinising hormone, free testosterone and fasting insulin were obtained from medical record of the patients. Visceral fat and total body fat percentage of each subject has been assessed by using bioelectrical impedance method.

Results: Analysis of the data exhibited that the intake of total energy, protein, calcium, iron, and vitamin A were higher in non-obese women than their overweight/obese counterparts, while both the groups of PCOS women depicted inadequate dietary intake as compared to RDA values. Interestingly, intake of carbohydrate and fat content of overweight/obese as well as non-obese PCOS groups was higher than the recommended dietary allowance (RDA), which may be responsible to disturb the hormonal level and biochemical characteristics in PCOS women. The luteinising hormone recorded a positive and significant correlation with fat intake (r=0.2) and calcium intake with free testosterone in overweight/obese PCOS women (r=0.2).

Conclusions: Therefore, inadequate diet intake than recommended dietary allowance in PCOS women may leads to disturb hormonal profile. Hence, diet modifications with low carbohydrate and fat intake as well as weight management is first-line strategy to control furtherance of PCOS among women.

Determinants of birth asphyxia: a cross-sectional multi-centric study in the state of West Bengal

2026-06-27T06:56:26+0530

Background: World Health Organization Sustainable Development Goals has set a target of reducing neonatal mortality to less than 12 per 1000 live births by 2030. Birth asphyxia is one of the leading causes of neonatal morbidity and mortality. The purpose of this study was to explore the factors influencing or related to the development of birth asphyxia.

Methods: This was a cross-sectional case control study conducted from March 2024 to March 2025 at three hospitals catering to a population of about five million. Two hundred and two neonates with birth asphyxia were identified and information including demographic, ante-partum and intra-partum variables were collected on a pre-designed questionnaire. Descriptive statistics were used to determine the prevalence of birth asphyxia in cases and controls as per each of the independent variables described above and significance was determined. A bivariate regression was done for those variables which showed significant (p<0.05) association and which had shown significance in other related studies.

Results: Bivariate regression analysis showed educational status (p<0.001), socio economic status (p<0.001), booking status (p<0.023), anemia, (p<0.027) parity (0.018) and meconium-stained liquor (p<0.029) as independent significant variables.

Conclusions: Findings of this study highlight the fact that while medical factors contributing to birth asphyxia have to be addressed there is also need to seriously consider and address the medical care seeking behavior of pregnant women and her family which is influenced by educational and socioeconomic status. The impact of any health welfare scheme would be dependent on this important element.

Acceptability and clinical outcomes of levonorgestrel-releasing intrauterine system in the management of abnormal uterine bleeding among perimenopausal women: a prospective interventional study

2026-06-27T06:56:25+0530

Background: The objective of the study was to evaluate the acceptability and clinical outcomes of the levonorgestrel-releasing intrauterine system (LNG-IUS) in the management of abnormal uterine bleeding (AUB) among perimenopausal women.

Methods: This prospective single-arm interventional study without a comparator group study was conducted in a tertiary care teaching hospital from March 2022 to March 2025. A total of 120 perimenopausal women aged 40-55 years presenting with AUB and opting for conservative management were enrolled. LNG-IUS was inserted following appropriate clinical evaluation and counselling. Participants were followed up at 1, 3, 6, and 12 months. Outcomes assessed included bleeding pattern, dysmenorrhea, continuation rate, expulsion, and need for hysterectomy. Data were analyzed using SPSS version 26.

Results: The mean age of participants was 49.21 years, and the majority were multiparous (82.5%). Adenomyosis (53.3%) and fibroid uterus (45.0%) were the predominant etiologies. A progressive reduction in breakthrough bleeding was observed during follow-up. At one year, 30.0% of women achieved amenorrhea, while 69.2% reported light menstrual bleeding. The continuation rate of LNG-IUS at one year was 64.2%, whereas 35.8% of participants opted for hysterectomy. Device expulsion occurred in 2.5% of cases.

Conclusions: LNG-IUS may serve as an effective and acceptable conservative treatment option for perimenopausal women with AUB. It significantly improves bleeding patterns and may reduce the need for surgical intervention in appropriately selected patients.

The emotional toll of infertility: a study of perceived stress, well-being and couple satisfaction in women undergoing fertility treatment

2026-06-27T06:56:22+0530

Background: Infertility is a life-altering condition that can place significant emotional and relational strain on individuals and couples. While the psychological consequences of infertility are well-documented, its specific impact on perceived stress (PSS), couple satisfaction (CS), and overall wellbeing remains underexplored. This study aimed to examine the impact of PSS on CS and psychological wellbeing (PWB) among individuals undergoing infertility treatment compared to naturally fertile individuals with at least one child.

Methods: Participants included individuals from two groups: those undergoing infertility treatments (e.g., IVF, IUI) and those with natural fertility. Standardized questionnaires were administered to assess PSS, CS, and PWB. Data was analyzed using correlation and group comparison techniques.

Results: A significant negative correlation was found between PSS and CS in both groups, indicating that increased stress levels were associated with lower relationship satisfaction regardless of fertility status. However, no significant differences emerged between the groups in terms of overall PWB.

Conclusions: Infertility may compromise CS but does not necessarily diminish broader PWB. These findings highlight the need for targeted psychological interventions and counseling to reduce stress and improve relationship quality in couples undergoing infertility treatment. Future research should explore specific dimensions of wellbeing that may be uniquely affected by infertility.

Impact of lifestyle factors and digital device exposure on semen quality and sperm DNA fragmentation in infertile men

2026-06-27T06:56:18+0530

Background: Lifestyle and environmental factors may influence semen quality and sperm DNA integrity. This study evaluated the associations of lifestyle habits, digital device use, substance use, abstinence duration, and socioeconomic factors with semen parameters and sperm DNA fragmentation index (DFI) in infertile men.

Methods: This retrospective observational study included 195 infertile men attending the Infertility Clinic at Ashirwad Hospital, Raipur India, between 2022 and 2024. Participants were categorized according to physical activity, occupation, dietary habits, digital device use, substance use, abstinence duration, and annual income. Semen analysis and DFI assessment were performed according to WHO 2021 recommendations. Factors associated with DFI were evaluated using a multivariable generalized linear model adjusted for major confounders.

Results: Active smoking was independently associated with increased DFI and was the strongest predictor of sperm DNA fragmentation (p<0.001). High daily mobile phone use (6-12 hours/day) was also associated with elevated DFI (p=0.030), whereas laptop use and total screen exposure showed no significant association. Prolonged abstinence (>2 days) was associated with increased sperm DNA fragmentation. Vegetarians had significantly higher normal sperm morphology (p=0.004), although dietary pattern was not independently associated with DFI. Physical activity, occupational activity, and annual income showed no independent associations with DFI.

Conclusions: Active smoking, prolonged mobile phone use, and extended abstinence duration were independently associated with increased sperm DNA fragmentation in infertile men. These findings highlight the importance of modifiable lifestyle factors in male reproductive health and support lifestyle counselling during infertility evaluation to improve sperm genomic integrity.

From diagnosis to delivery: a retrospective analysis of diabetes in pregnancy at a tertiary care centre in South India

2026-06-27T06:56:17+0530

Background: Diabetes in pregnancy is increasing globally, driven by rising obesity and lifestyle changes. In India, gestational diabetes mellitus (GDM) affects up to 15–20% of pregnancies and contributes substantially to obstetric and neonatal morbidities. Early identification and standardized management pathways are essential. Our objective is to review the clinical patterns, management strategies, and maternal–fetal outcomes of diabetic pregnancies, highlighting key trends useful for improving antenatal care pathways.

Methods: A retrospective descriptive study was conducted among 55 pregnant women diagnosed with diabetes and managed between January and December 2025 at a tertiary care institution in South India. Maternal demographic details, comorbidities, treatment modalities, obstetric complications, and pregnancy outcomes were obtained from medical records and analyzed descriptively.

Results: Most women were aged 20-30 years (50.9%) and were primiparous (74.5%). A family history of diabetes was present in 24 (43.6%). Diabetic pregnancies showed diverse comorbid profiles, with hypertensive disorders, thyroid dysfunction, and ART conception frequently co-existing. A significant proportion (81.8%) required pharmacologic therapy for diabetes. Growth abnormalities showed distinct maternal risk patterns LGA linked to endocrine immune factors, while FGR clustered around placental dysfunction (PE, PIH, ART, twins). A sizeable proportion (40%) delivered before term due to maternal or fetal indications, highlighting the need for anticipatory delivery planning. Delivery decisions were influenced predominantly by maternal complications and fetal status. Emergency LSCS was largely driven by pre-eclampsia and fetal distress, showing how rapidly clinical status can evolve in diabetic pregnancies.

Conclusion: Maternal and fetal outcomes in diabetic pregnancies are strongly influenced by associated comorbidities such as hypertensive disorders, hypothyroidism, and assisted conception. Early diagnosis, multidisciplinary antenatal surveillance, and individualized delivery planning are essential to improve pregnancy outcomes in diabetic women.

Clinical perspectives on herbal galactagogues in lactation care: a nationwide cross-sectional survey of Indian gynaecologists

2026-06-27T06:56:16+0530

Background: Breastfeeding is a biologically complex process with critical implications for maternal and infant health. Despite strong global and national recommendations, suboptimal breastfeeding practices and high prevalence of perceived lactation insufficiency remain major challenges. Increasing interest in integrative lactation support has led to widespread clinical use of herbal galactagogues; however, systematically generated real-world data on clinician perspectives in India remain limited.

Methods: A nationwide, cross-sectional, questionnaire-based survey was conducted among practicing gynaecologists across India to assess awareness, prescribing practices, perceived effectiveness, safety, patient acceptance, and unmet needs related to herbal galactagogues in lactation care. A structured 30-item questionnaire was administered, and descriptive statistical analyses were performed. Responses were anonymized and summarized as frequencies and percentages.

Results: Completed questionnaires from 416 gynaecologists were included in the analysis. Herbal galactagogues were frequently integrated into routine lactation management, with 70.67% of respondents reporting first-line use. Early initiation was common, with 56.25% initiating therapy immediately postpartum. Participants perceived herbal galactagogues as effective, rating “highly effective” (51.44%) or “moderately effective” (41.59%). Based on their clinical experience, 80.77% believed rapid onset of action (within 3 days). Safety and tolerability were rated positively; 60.82% participants never experienced any adverse effects in their patients. A large majority (88.70%) opined / affirmed that herbal galactagogues reduced reliance on formula supplementation.

Conclusions: This nationwide survey demonstrates widespread clinical incorporation of herbal galactagogues into lactation care among Indian gynaecologists, with favorable practice-based opinion regarding early use, perceived effectiveness, and safety. The findings indicate routine positioning of these formulations within early lactation management and highlight the need for prospective, standardized studies to further clarify their clinical role and inform evidence-based guideline development.

Prevalence and determinants of premenstrual syndrome among females of the reproductive age group (15-49 years) in Jammu

2026-06-27T06:56:13+0530

Background: Premenstrual syndrome (PMS) is one of the most common gynaecological conditions among females which is characterised by a constellation of behavioural, physical and emotional symptoms occurring during the luteal phase of the menstrual cycle. In developing countries like India PMS remains unrecognised even today. There is very little data available regarding the burden of PMS and determinants among women in Jammu.

Methods: A cross-sectional study among 500 females aged between 15–49 years in both urban and rural settings of Jammu was conducted. Convenience sampling was used to select respondents for the study. Data was collected using a structured pre-tested questionnaire which covered menstrual history, socio-demographic characteristics, lifestyle factors and PMS symptoms based on standardised criteria. Descriptive statistical analysis was conducted to estimate prevalence and chi-square test were applied to assess association. A p value <0.05 was considered statistically significant.

Results: The overall prevalence of PMS was found to be 68.4 (n=342). Among the affected females 42.7% had moderate symptoms, 31.6% severe symptoms and 25.7 mild symptoms. Abdominal cramps were the most commonly reported symptoms among these females which were 72%, fatigue 61.8%, irritability 58.2% and mood swings 65.5%. Premenstrual syndrome prevalence was significantly higher among younger females aged between 15 to 24 years 72.8% (p<0.05). The lifestyle and factors like sedentary life style 76.9% and frequent consumption of junk food 78.5% were highly associated with PMS. A strong association was observed with levels of stress, with prevalence increasing from 51.7% in low stress individuals to 82.6% among females with high stress (p<0.05). Menstrual irregularity 75.8% and dysmenorrhea 81.3% where are also highly associated with premenstrual syndrome.

Conclusion: PMS is highly prevalent among women of reproductive age in Jammu, with a large portion experiencing moderate to severe symptoms. Lifestyle and psychological factors especially physical inactivity, diet and stress play an important role in its occurrence. Targeted interventions focusing on modification of lifestyle, awareness for women and integration of PMS management into primary health care and education are recommended.

Clinico-demographic profile, endoscopic findings and pregnancy outcomes in women with primary infertility: a decade of experience

2026-06-27T06:56:12+0530

Background: Infertility affects a significant proportion of reproductive-age couples worldwide. Conventional investigations may fail to identify subtle pelvic and intrauterine pathologies that contribute to infertility in all cases. Combined hystero-laparoscopy offers the advantage of simultaneous diagnosis and treatment of such abnormalities. Objective was to analyse the clinico-demographic characteristics, endoscopic findings, management strategies, and pregnancy outcomes of women with primary infertility over a 10 year period at a tertiary care center.

Methods: This retrospective observational study included 304 women who underwent combined hystero-laparoscopy for infertility evaluation at a tertiary care center. Demographic characteristics, hysteroscopic findings, laparoscopic findings, therapeutic interventions, and subsequent pregnancy outcomes were analysed. Continuous variables were expressed as mean±SD, while categorical variables were presented as frequencies and percentages.

Results: The mean age of the study population was 29.1±4.1 years, and the mean duration of infertility was 7.6±3.0 years. Primary infertility was observed in 84.2% of women. Combined hystero-laparoscopy detected pelvic or intrauterine abnormalities in 72.4% of patients. Hysteroscopic abnormalities were identified in 11.8%, whereas laparoscopic abnormalities were noted in 68.4%. Polycystic ovaries (40.8%), endometriosis (23.7%), and pelvic adhesions (13.2%) were the most common findings. Following evaluation and appropriate surgical management, an overall conception rate of 59.2% was achieved. Women with endometriosis demonstrated lower conception rates compared with those without endometriosis.

Conclusions: Combined hystero-laparoscopy remains a valuable diagnostic and therapeutic modality in infertility, particularly in women with unexplained infertility or suspected pelvic pathology. The procedure enables detection and correction of abnormalities that may not be identified through routine investigations and is associated with favourable reproductive outcomes.

A comparative study of various oxytocics in management of third stage of labour

2026-06-27T06:56:11+0530

Background: Postpartum hemorrhage (PPH) is a leading cause of maternal mortality, with a global incidence of 2-11% following vaginal delivery. Active management of the third stage of labour (AMTSL) through prophylactic uterotonic administration is the cornerstone of PPH prevention. Comparative data on oxytocic agents from Indian tertiary care settings remain limited.

Methods: A prospective observational study was conducted at the Department of Obstetrics and Gynecology, Government Medical College, Akola, Maharashtra, from February 2024 to March 2026. A total of 224 women with uncomplicated term vaginal deliveries were allocated to five groups: Group A-Oxytocin 10 IU IM; group B-Misoprostol 600 µg sublingual; group C-Methylergometrine 0.2 mg IM; group D-Carboprost 250 µg IM; group E-Carbetocin 100 µg IV. Primary outcomes were duration of the third stage, haemoglobin (Hb) drop, and time to uterine tone. Secondary outcomes included side effects, blood transfusion requirement, and need for repeat dosing.

Results: Carbetocin demonstrated the shortest third stage (3.93 min), fastest uterine tone (1.86 min), lowest Hb drop (0.43 g/dL), no blood transfusions, lowest side effect rate (4.7%), and lowest repeat dose requirement (2.3%). Oxytocin and methylergometrine showed comparable efficacy. Misoprostol had the longest third stage (6.17 min), slowest uterine tone (8.47 min), and highest side effect rate (26.1%). Carboprost was effective but associated with a higher side effect burden (23.9%).

Conclusions: Carbetocin demonstrated superior efficacy and tolerability for AMTSL. Oxytocin remains the recommended first-line agent given its safety and cost profile. Misoprostol is viable in resource-limited settings despite its higher side effect rate.

A prospective comparative interventional study of intravenous labetalol and oral nifedipine in the management of severe preeclampsia at a tertiary care hospital

2026-06-27T06:56:10+0530

Background: Severe preeclampsia is an obstetric emergency requiring prompt blood pressure control to prevent maternal and perinatal morbidity. Intravenous labetalol and oral nifedipine are both recommended first-line agents, yet comparative data from Indian tertiary care settings remain limited.

Methods: A hospital-based prospective non-randomized comparative interventional study was conducted at the Department of Obstetrics and Gynecology, Government Medical College, Akola, Maharashtra. One hundred and fifty women with severe preeclampsia were allocated equally to intravenous labetalol (Group A, n=75) or oral nifedipine (Group B, n=75) per treating-unit protocol from November 2022 to October 2023. Blood pressure was recorded at baseline, 30 minutes, 1 hour, 2 hours, 6 hours and 24 hours. Maternal complications and perinatal outcomes were compared.

Results: Both agents produced progressive, clinically meaningful reductions in systolic and diastolic blood pressure. Systolic blood pressure was lower in the nifedipine group at several time points, but baseline systolic pressure also differed between groups, requiring cautious interpretation. Maternal complication rates were comparable (no complication: labetalol 74.7% vs. nifedipine 72.0%; p=0.287). Birth-weight distribution was similar. Five-minute Apgar scores and NICU admission rates differed significantly in favour of nifedipine (p=0.043 each), though absolute event numbers were small.

Conclusions: Intravenous labetalol and oral nifedipine were both effective first-line options for acute blood pressure control in severe preeclampsia. Oral nifedipine offers practical advantages when IV access is limited. IV labetalol remains valuable when titratable parenteral therapy is preferred. Prompt protocol-based treatment is more important than rigid preference for either drug.

The role of vitamin D in reducing the risk of preeclampsia: a systematic literature review

2026-06-27T06:59:11+0530

Preeclampsia is a major cause of maternal and fetal complications worldwide. Vitamin D has been suggested as a possible factor that may influence its development, but existing evidence is inconsistent. To evaluate the association between vitamin D and the risk of preeclampsia and to assess the effect of vitamin D supplementation during pregnancy. A systematic review was conducted following PRISMA 2020 guidelines. Studies published from 2012 to 2026 were searched in PubMed, Scopus, Web of Science, EMBASE, Cochrane Library and Google Scholar. Keywords included “vitamin D,” “preeclampsia,” “pregnancy-induced hypertension,” and “supplementation”. Eligible studies included randomized controlled trials, cohort studies and case-control studies involving pregnant women. Data on study design, vitamin D exposure and outcomes were extracted. Risk of bias was assessed using the Newcastle-Ottawa Scale and Cochrane tool. Fifteen studies were included. Most observational studies showed that low vitamin D levels were linked with a higher risk of preeclampsia. Several trials reported that high-dose or early supplementation reduced risk, especially in deficient or high-risk women. However, some studies found no clear benefit, particularly with low doses or late pregnancy supplementation. The findings were inconsistent due to differences in dose, timing and baseline vitamin D status. Low vitamin D levels may increase the risk of preeclampsia. Supplementation appears beneficial mainly when started early and in deficient women. However, evidence is not fully consistent. More large and well-designed trials are needed to establish clear clinical recommendations for vitamin D use in pregnancy.

Clinical spectrum and management outcomes of caesarean scar ectopic pregnancy: a case series

2026-06-27T07:11:30+0530

Caesarean scar ectopic pregnancy (CSEP) is uncommon in routine obstetric practice, but when it occurs it can become rapidly dangerous. Implantation within a previous caesarean scar carries a real risk of severe haemorrhage, uterine rupture and loss of fertility if the diagnosis is missed or delayed. With rising caesarean section rates in India, clinicians encounter this condition more often, yet management remains individualized rather than protocol driven. We reviewed seven consecutive women diagnosed with CSEP at a tertiary care centre in India. All patients were haemodynamically stable at presentation. Diagnosis was based primarily on transvaginal ultrasound, with MRI used selectively when imaging was equivocal or myometrial thinning was significant. All women were initially offered medical management using methotrexate, with folinic acid and letrozole added in selected cases. Patients were followed with serial β-hCG measurements and repeat imaging. Surgical intervention was reserved for non-responders or those who developed clinical deterioration. Five of seven women (71.4%) responded well to conservative medical treatment, showing a gradual fall in β-hCG levels and resolution of the scar pregnancy on imaging. Two patients (28.6%) ultimately required surgery. One underwent laparoscopic excision of the scar ectopic with uterine repair, while the other required obstetric hysterectomy following uncontrolled bleeding during attempted hysteroscopic evacuation. Our experience suggests that stable women diagnosed early in the first trimester can often be managed successfully with medical therapy under close surveillance. Nevertheless, CSEP remains unpredictable and timely escalation to surgery is crucial when clinical or biochemical trends are unfavourable.

Circumferential excision with vaginal flap reconstruction and mucocutaneous anastomosis: a novel surgical technique for adult female urethral prolapse

2026-06-27T06:56:21+0530

Urethral mucosal prolapse in adult women is an uncommon and often underdiagnosed condition presenting as circumferential eversion of the urethral mucosa through the external meatus. Existing surgical techniques vary in recurrence risk and cosmetic outcome, with no universally accepted approach. We describe the Circumferential Excision with Vaginal Flap Reconstruction and Mucocutaneous Anastomosis (CVMA) technique and present a prospective case series of ten adult women with confirmed urethral mucosal prolapse who underwent CVMA between August and November 2025 after failure of conservative therapy. Patients were followed at 1, 3 and 6 months. Results: The mean patient age was 42 years. Complete circumferential prolapse was confirmed in all cases, with redundant tissue ranging from 1.5 to 3 cm. Mean operative time was 45±10 minutes with no intraoperative complications. Transient urinary urgency was noted in 3 patients (30%) in the first postoperative month, resolving with conservative management. All patients reported satisfactory cosmetic outcomes with no recurrence at six months. CVMA is a safe and reproducible technique offering durable anatomical correction, periurethral reinforcement, and favourable cosmetic results. Larger prospective studies are warranted to validate these findings.

Impact of advanced maternal age on assisted reproductive technology outcomes: biological mechanisms, clinical implications and management strategies

2026-06-27T07:11:26+0530

Delayed childbearing has increased the number of women of advanced maternal age (AMA) seeking assisted reproductive technology (ART). AMA, defined as ≥35 years, is linked to reduced ovarian reserve, poor oocyte quality, and higher pregnancy risks. Despite advances in IVF, ICSI and frozen embryo transfer (FET), maternal age remains a key factor affecting success rates. This review summarizes the biological changes associated with reproductive aging and their impact on ART outcomes such as implantation, pregnancy rates, miscarriage and perinatal outcomes. Literature shows that aging leads to mitochondrial dysfunction, chromosomal abnormalities and reduced embryo quality, resulting in lower pregnancy and live birth rates and higher miscarriage rates in women ≥35 years. While FET may improve uterine conditions, it cannot fully overcome the decline in oocyte quality. AMA is also associated with increased risks such as hypertension, gestational diabetes and preterm birth. In conclusion, advanced maternal age significantly affects ART outcomes, and careful patient counselling and individualized treatment strategies are essential to improve success rates.

Holistic approaches to polycystic ovary syndrome: a narrative review of non-pharmacological management

2026-06-27T06:57:51+0530

Polycystic ovary syndrome (PCOS) is the most common condition-affecting women of reproductive age, with range of reproductive, metabolic, and psychological issues. Available treatments include both pharmacological and non-pharmacological treatments. While pharmacological treatments are effective but having adverse effects. whereas non-pharmacological safer and free from such risks. The aim of this study is to explore the role of non-pharmacological treatments in PCOS. A comprehensive literature search was conducted across PubMed, CINAHL, Web of Science, and Google scholar to identify relevant studies published between 2012 and 2025. The search included peer-reviewed articles in the English language with full-text.200 articles were screened, and data extracted based on study objectives, methodology, and key findings. Following the application of inclusion and exclusion criteria, 21 articles were retained for the review. This narrative review synthesizes evidence on Ayurveda, Yoga, Homoeopathy, diet, physical activity, acupuncture, and acupressure for PCOS management. Ayurveda formulations such as Rajahpravartini Vati, Ashokarishta, Kumaryasava, etc. regulate cycles and support fertility; Yoga improves insulin sensitivity, reduces stress, and enhances hormonal balance; Homoeopathy improve menstrual regularity and quality of life. Dietary modifications and exercise contribute to weight reduction and metabolic outcomes; while acupuncture and acupressure beneficiary for restoring menstrual cycles, lowering testosterone and LH levels. Non-pharmacological treatment is safe, holistic, and enhance reproductive, metabolic, and psychological outcomes, contributing to quality overall health in women with PCOS.

Medico-legal safeguards in obstetrics and gynaecology: a narrative review of legislative frameworks and preventive strategies

2026-06-27T06:56:19+0530

Obstetrics and gynaecology (OB-GYN) is recognized as one of the most litigious medical fields worldwide. The nature of care often involves two lives simultaneously, with high emotional and ethical implications, which makes it vulnerable to legal scrutiny. Legal actions usually arise from allegations of medical negligence, improper consent, or failure to meet standard protocols during antepartum, intrapartum, or postpartum care. However, understanding the application of relevant legal frameworks can help mitigate the risk of litigation. Any guidelines or acts stated by the government, if diligently followed, significantly reduce the risk of litigation by promoting transparency, ethical standards, patient safety, proper documentation and accountability. This narrative review was conducted through a systematic search of PubMed, Medline, and Google Scholar, supplemented by Government of India legislative documents and guidelines from professional bodies including FOGSI, WHO, and ICMR. Nine key legislative frameworks were identified as relevant to OB-GYN practice in India-the medical termination of pregnancy (MTP) act (1971, amended 2021), pre-conception and pre-natal diagnostic techniques (PCPNDT) act (1994, amended 2003), assisted reproductive technology (ART) Act (2021), surrogacy (Regulation) act (2021), protection of children from sexual offences (POCSO) act (2012), Family planning indemnity scheme (FPIS) (2005), clinical establishments act (2010), Indian medical council ethics regulations (2002), and the consumer protection act (CPA) (1986, amended 2019). Common medicolegal pitfalls included deficiencies in informed consent, inadequate documentation, errors in foetal and neonatal management, surgical oversights, and delayed emergency referrals. Comprehensive understanding of applicable laws, combined with clinical documentation, valid informed consent, and systematic risk management, substantially mitigates medicolegal vulnerability in OB-GYN practice.

Impact of culture and religion on assisted reproductive technologies in India: a comprehensive review

2026-06-27T06:56:19+0530

Assisted reproductive technologies (ART) have emerged as important medical interventions for infertility; however, their acceptance and utilization are strongly influenced by cultural and religious beliefs, particularly in a diverse country like India. This review explores the impact of cultural diversity and religious perspectives on the perception and practice of ART in the Indian context. Indian society places significant importance on marriage, parenthood, lineage continuation, and family honour, which contributes to the social stigma associated with infertility, especially for women. Regional cultural variations across North, South, East, West, and North-East India further shape attitudes toward infertility treatment, access to fertility services, and acceptance of procedures such as in vitro fertilization (IVF), gamete donation, and surrogacy. Religious beliefs also play a major role in reproductive decision-making. Hinduism generally demonstrates a permissive approach toward ART, whereas Islam restricts third-party reproduction to preserve lineage. Christian perspectives vary across denominations, with Roman Catholic teachings opposing most ART procedures, while protestant groups may permit selected interventions. Buddhism and Sikhism are comparatively flexible, whereas Jainism adopts a cautious ethical stance emphasizing non-violence. The review additionally discusses the ethical and socio-legal implications of surrogacy and highlights the influence of recent Indian legislation, including the surrogacy (Regulation) Act, 2021 and the Assisted reproductive technology (Regulation) Act, 2021. Understanding these cultural and religious dimensions is essential for promoting culturally competent fertility counselling, ethical reproductive healthcare, and equitable access to ART services in India.

Management of constipation in women: the role of milk of magnesia and liquid paraffin combination from a gynecologist's perspective

2026-06-27T06:56:12+0530

Constipation is highly prevalent, affecting approximately 15-20% of the general population, with women impacted nearly twice as often as men. It significantly impairs quality of life, psychological well-being, clinical outcomes, and healthcare utilization. From a gynecological perspective, constipation extends far beyond pregnancy-related concerns and remains an under-recognized clinical burden in routine practice. While pregnancy-associated constipation is well acknowledged, non-pregnancy etiologies-including anorectal disorders, PCOS or related hormonal fluctuations and menopause, gynecological postoperative states, endocrine dysfunction, and drug-induced causes (notably opioids and iron therapy)-are frequently overlooked. Milk of magnesia (MoM), particularly in combination with liquid paraffin, offers a distinct dual-action advantage in the management of constipation-combining osmotic stool softening with surface lubrication. Its non-fermentative osmotic mechanism promotes water retention within the intestinal lumen, effectively softening stools without causing gas or bloating, while liquid paraffin enhances ease of passage through lubrication. In women, constipation frequently manifests as hard stools, delayed transit, and painful defecation, especially in scenarios such as menopause, hormonal imbalances, anorectal disorders, and postoperative recovery. In these contexts, therapy must deliver relief that is both effective and gentle. MoM’s predictable onset of action, coupled with its favorable tolerability profile, makes it an ideal choice where rapid yet non-irritating relief is required. By addressing both stool consistency and transit comfort, this dual-action approach ensures a more comprehensive and patient-friendly solution to constipation management. Its non-habit-forming profile and low incidence of bloating are advantageous in constipation patients with anorectal disorder, iron-induced gastrointestinal effects, and menopausal symptoms. In postoperative gynecologic patients, MoM supports early bowel recovery without inducing spasmodic activity, thereby minimizing strain on surgical repairs and mitigating opioid-related constipation. Overall, MoM, alone or in combination with liquid paraffin, remains a clinically relevant and practical therapeutic option for managing diverse non-pregnancy-related causes of constipation in women, particularly when rapid symptom relief, tolerability, and adherence are prioritized. This manuscript reviews the role of MoM (magnesium hydroxide), particularly in combination with liquid paraffin, in managing constipation associated with these non-pregnancy-related conditions in women. Clinical evidence and guidelines support the use of magnesium-based osmotic laxatives in chronic constipation, while evidence for MoM-based combinations in specific non pregnant etiologies remains limited and largely extrapolated from pharmacology, clinical experience, and selected studies.