International Journal of Reproduction, Contraception, Obstetrics and Gynecology

Medication-induced labor with prostaglandins in viable fetuses: a 31-month retrospective study in the gynecology and obstetrics department of Amath Dansokho hospital/Kédougou/Senegal

2026-03-28T08:03:23+0530

Background: To analyze the indications, methods, and outcomes of labor induction with prostaglandins at the Gynecology and Obstetrics Department of Amath Dansokho Regional Hospital in Kédougou, Senegal.

Methods: We conducted a retrospective cohort study including 2,750 deliveries from January 1, 2023, to July 31, 2025. All pregnant women ≥28 weeks receiving prostaglandin-induced labor were included (n=501). Exclusion criteria were intrauterine fetal death, abnormal fetal heart rate on admission, prophylactic cesarean, and incomplete records. Data on sociodemographic, obstetric history, induction indications, induction method, and maternal and neonatal outcomes were analyzed using SPSS 27. Patients were classified as “Exposed” (induced) and “Unexposed” (spontaneous labor).

Results: Labor induction frequency was 18.2%. Main indications were post-term pregnancy (29.4%), hypertensive disorders (28.9%), and preventive induction (19.3%). Misoprostol (91.6%) was the primary induction agent, administered vaginally at 25 µg per dose. Induction success was 97.6%. Vaginal delivery occurred in 85% of induced patients, and cesarean section risk was significantly lower compared to spontaneous labor (14.8% vs. 25.9%; RR=0.57, p<0.001). Uterine rupture occurred in 0.6% of cases. Neonatal outcomes, including Apgar score <7 at 5 minutes, neonatal resuscitation, transfer, and stillbirth, did not differ significantly between groups.

Conclusions: Labor induction with prostaglandins is a safe and effective strategy in a resource-limited and geographically isolated setting, reducing cesarean section rates without compromising neonatal outcomes. Preventive induction and structured monitoring protocols are practical approaches to improve maternal and neonatal safety in low-resource contexts. These findings support the use of context-specific guidelines and further research on optimal induction protocols in similar settings.

Comparative effects of pentoxifylline and coenzyme Q10 on sperm motility in subfertile men with asthenozoospermia: a randomized controlled trial

2026-03-28T08:09:52+0530

Background: Asthenozoospermia, characterized by reduced sperm motility, is a leading cause of male subfertility. While both pentoxifylline and coenzyme Q10 have demonstrated beneficial effects on semen parameters, comparative evidence regarding their efficacy remains limited. This study aimed to assess and compare the effects of pentoxifylline and coenzyme Q10 on sperm motility and other seminal parameters in sub fertile men with asthenozoospermia.

Methods: This randomized controlled trial was conducted at the Department of Reproductive Endocrinology and Infertility, Bangladesh Medical University, from April 2022 to March 2023. A total of 104 subfertile men diagnosed with asthenozoospermia were randomly assigned to receive either pentoxifylline (400 mg twice daily) or Coenzyme Q10 (100 mg twice daily) for three months. Semen parameters, including ejaculate volume, sperm concentration, total and progressive motility, total motile sperm count, and morphology, were evaluated before and after treatment. Statistical analysis was performed via SPSS v26.0, with p<0.05 considered significant.

Results: Baseline demographic characteristics were comparable between the two groups. Both treatments resulted in significant improvements in sperm motility and total motile sperm count after three months. However, the pentoxifylline group demonstrated significantly greater improvements in total sperm motility (41.28±12.38% vs. 36.15±11.84%), progressive motility (32.30±10.26% vs. 24.95±10.40%), total motile sperm count (55.04±41.18 vs. 32.85±25.62 million), and ejaculate volume (2.83± 0.96 ml vs. 2.32 ± 0.96 ml) than did the CoQ10 group (p<0.05). No significant differences in the sperm concentration or morphology were detected between the groups.

Conclusions: Both pentoxifylline and Coenzyme Q10 effectively improve semen quality in men with asthenozoospermia, but pentoxifylline appears to be more effective in enhancing motility-related parameters and the ejaculate volume. Pentoxifylline may be considered a preferred first-line option in the pharmacologic management of asthenozoospermia.

Analysis of delays in the stages of breast cancer care at the University Clinics of Kinshasa

2026-03-28T08:05:05+0530

Background: The DRC faces the paradox of high mortality and low incidence of breast cancer due to late consultations and delayed treatment; however, it lacks studies detailing the different delays of breast cancer management. We initiated this study to assess these delays and identify the associated factors.

Methods: This was a cross-sectional study conducted on 201 records of women followed for breast cancer at the University Clinics of Kinshasa (UCK) from January 2020 to December 2024. Population characteristics and delays were described using descriptive statistics, logistic regression was used to identify factors associated with delays.

Results: The mean age was 48±12 years. 90.8% of patients were diagnosed at advanced stages, 67% received chemotherapy as first treatment. The median patient delay was 365 days, the median diagnostic delay was 26 days, the median treatment delay was 39 days, the median health system delay was 67 days, the median total delay was 398 days. Single women had a higher risk of consultation delay (aOR=2.48; p=0.02), diagnostic delay (aOR=1.79 p=0.01) and treatment delay (aOR=3.67; p=0.04). Women who followed alternative pathways had a higher risk of delay in consultation (aOR=9; p=0.01), diagnosis (aOR=3.27; p=0.02), and treatment (aOR=3.27; p=0.01). Consulting for symptoms other than breast lump was associated with a higher risk of treatment delay (aOR=3.44; p=0.02).

Conclusions: Efforts must be made to address the causes of delayed consultations and to improve the patient care pathway.

Gestational diabetes mellitus and its fetomateranal outcome: a prospective observational study

2026-03-18T07:57:09+0530

Background: Gestational diabetes mellitus (GDM) is a common metabolic disorder of pregnancy associated with significant maternal, fetal, and long-term metabolic complications. It contributes to hypertensive disorders, operative delivery, neonatal morbidity, and increased future risk of type 2 diabetes in both mother and offspring. Evaluating fetomaternal outcomes in GDM is essential for improving clinical management and reducing adverse pregnancy outcomes.

Methods: A prospective observational study was conducted among 100 antenatal women, including 60 diagnosed with GDM and 40 with normal glucose tolerance for 18 months from September 2023 to February 2025. Participants were followed throughout pregnancy to assess maternal complications, delivery outcomes, neonatal health, and the influence of glycemic control. Clinical, laboratory, and outcome data were systematically recorded and analyzed using appropriate statistical methods, with significance set at p≤0.05.

Results: GDM pregnancies demonstrated higher maternal morbidity, including increased pre-eclampsia (28% versus 10%), caesarean delivery (55% versus 30%), and postpartum complications compared with non-GDM pregnancies. Neonatal complications were also more frequent in the GDM group, particularly macrosomia (25% versus 5%), hypoglycemia (18% versus 5%), respiratory distress, and greater neonatal intensive care unit admissions with longer hospital stay. Poor glycemic control and insulin-treated cases were associated with worse maternal and fetal outcomes. Postpartum follow-up indicated progression to type 2 diabetes in a proportion of mothers, highlighting persistent metabolic risk.

Conclusions: GDM is strongly associated with adverse maternal and neonatal outcomes as well as long-term metabolic consequences. Early detection, strict glycemic control, individualized management, and sustained postpartum surveillance are essential to reduce complications and improve both immediate and future health outcomes.

A retrospective study of blood transfusion practices in obstetrics at Hassan Institute of Medical Sciences

2026-03-18T07:57:08+0530

Background: Blood transfusion is an integral component of obstetric care and an important indicator of maternal morbidity management. Obstetric hemorrhage remains a leading cause of maternal mortality worldwide. Common causes of transfusion in obstetrics include postpartum hemorrhage, antepartum hemorrhage, abortion, ectopic pregnancy, anemia, and coagulation disorders. Evaluating transfusion practices helps assess institutional quality of care.

Methods: A retrospective analysis was conducted of obstetric patients admitted to the OBG Department at Hassan Institute of Medical Sciences from 2021–2022. Data were obtained from blood transfusion registers, ICU and HDU admission records, anemia registers, and complication registers to evaluate transfusion indications and patterns.

Results: A total of 475 patients in 2021 and 435 in 2022 required blood transfusion, showing an 8.4% reduction in 2022. Anemia in pregnancy was the leading indication (39.8% in 2021; 36.8% in 2022), followed by abortion (22.9% and 25.3%). Postpartum hemorrhage accounted for 10.7% and 10.1% of cases, respectively. Overall, 706 units of blood products were transfused in 2021 compared to 649 units in 2022. Packed red blood cells constituted the majority of transfusions (78.7%), followed by platelet concentrates (10.2%) and fresh frozen plasma (8.6%).

Conclusions: Maternal anemia and obstetric hemorrhage remain the predominant indications for transfusion. Strengthening antenatal anemia management, early risk identification, and appropriate blood component therapy are essential to further reduce transfusion requirements and improve maternal outcomes.

A cross-sectional study on knowledge, attitude and practice of antenatal care among antenatal women attending a tertiary care hospital and its association with sociodemographic factors

2026-03-20T08:33:40+0530

Background: Antenatal care (ANC) is essential for maternal and perinatal health through early detection of complications, nutritional support, immunisation, and health education. This study evaluated the knowledge, attitude, and practice (KAP) regarding ANC among antenatal women attending a tertiary care hospital and examined their association with sociodemographic factors.

Methods: A cross-sectional study was conducted among 420 antenatal women at ACS Medical College and Hospital, Chennai, over six months. Data on socio demographics, obstetric history, and ANC-related KAP were collected using a structured questionnaire. Scores were categorised, and associations with participant characteristics were analysed using descriptive statistics and chi-square tests.

Results: Of the 420 women, 244 (58.1%) demonstrated good knowledge, 126 (30.0%) average knowledge, and 50 (11.9%) poor knowledge. Attitudes were positive in 378 (90.0%), neutral in 17 (4.0%), and negative in 25 (6.0%), while practices were good in 294 (70.0%), fair in 84 (20.0%), and poor in 42 (10.0%). Participants aged 26–30 years had the highest knowledge (131, 53.7%), positive attitude (176, 46.6%), and good practices (143, 48.6%). Graduates (61.5%, 55.6%, 65.6%) and multigravidae (61.5%, 57.7%, 62.9%) consistently performed better than less educated or primigravida women. Employed women reported higher levels of knowledge (84.4%), attitude (62.2%), and practices (59.9%) compared to housewives. Women married at <25 years, with first pregnancy at 18–25 years, and those in the first trimester also showed higher KAP. Socioeconomic differences were minimal, though women from the lower middle class reported slightly better knowledge and practices.

Conclusions: Most antenatal women demonstrated good knowledge, positive attitudes, and appropriate practices. KAP outcomes were significantly influenced by age, education, parity, occupation, and early pregnancy, highlighting the need for targeted education for younger, less educated, and primigravida women.

Experience of respectful maternity care and its determinants among women and midwives

2026-03-28T08:09:58+0530

Background: Respectful Maternity Care (RMC)is an approach to care that highlight the fundamental rights of women, new-borns, and families, and that promotes impartial access to evidence‐based care while recognizing the unique needs of both women and new-borns.

Methods: In a cross-sectional analytical study assessing experience of Respectful Maternity Care and its determinants among women and midwives, 33 midwives and 99 postnatal mothers from a tertiary care hospital, in central Kerala were enrolled in the study using convenience sampling. Structured and standardized questionnaire were used to collect data.

Results: The mean score of overall experience on RMC was higher among midwives (68.76) as compared to women (60.59). The domain wise comparison of RMC experiences revealed that midwives’ scores on providing comfort (92.8) and participatory care (85.7) were significantly (p<0.001) higher as compared to score obtained by women for providing comfort (75) and participatory care (71.4). The mean score for the factor 3 (Mistreatment) was same for both groups which was found to be the least (80). The study revealed significant disparity between the perception of caring experience on RMC among midwives and women.

Conclusions: More evidence-based interventions need to be implemented to ensure agreement on quality of RMC care provided by midwives and care received by women in the intrapartum care unit.

Abnormal uterine bleeding in perimenopausal women: correlating PALM-COEIN classification with histopathological findings

2026-03-28T08:09:56+0530

Background: The most prevalent menstruation issue during perimenopause is abnormal uterine bleeding (AUB). A categorization system (PALM-COEIN) for the etiology of AUB in non-gravid women has been created by the International Federation of Gynecology and Obstetrics working group on menstrual disorders. Aims and objectives were to analyse the structural (PALM) and functional (COEIN) components of the PALM-COEIN system of AUB in perimenopausal women and correlate it histopathologically.

Methods: This prospective analytical study was conducted over 18 months at LLRM Medical College, Meerut, involving 172 perimenopausal women aged 40-49 years presenting with AUB. Ultrasonography was done and etiology of AUB was ruled out by PALM–COEIN classification and then was correlated with histopathology findings.

Results: Heavy and prolonged bleeding was the most common complaint (26.1%). Ultrasonographic (USG) findings revealed adenomyosis in 26.7% of cases, followed by fibroids (22.0%) and thickened endometrium (16.8%). Histopathological examination identified proliferative phase endometrium as the most prevalent finding (31.98%), followed by simple cystic hyperplasia (14.53%) and benign polyps (13.95%). A significant correlation was observed between USG and histopathological findings (p<0.001).

Conclusions: This study findings emphasize necessity for integrating clinical assessment, imaging, and histopathological evaluation to accurately identify underlying causes of AUB and guide appropriate management strategies.

Comparative study between three-dimensional transvaginal ultrasound and hysteroscopy in evaluating uterine abnormalities among infertile women

2026-03-28T08:09:54+0530

Background: Objectives were to assess the diagnostic accuracy of three-dimensional transvaginal ultrasound (3D TVUS) compared to hysteroscopy in detecting uterine cavity abnormalities in infertile women.

Methods: This prospective study included 67 infertile women who underwent both 3D TVUS and hysteroscopy. The findings from both modalities were compared to evaluate their concordance and diagnostic performance.

Results: Of the 67 patients, 29 (43.3%) exhibited a normal uterine cavity on both 3D TVUS and hysteroscopy. Among the 38 patients with uterine abnormalities, the distribution was as follows: polypoidal endometrium: 3 patients, submucosal fibroids: 9 patients, endometrial polyps: 15 patients, uterine septum: 6 patients, intrauterine adhesions: 3 patients and endometrial hyperplasia: 2 patients. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of 3D TVUS for detecting uterine abnormalities were calculated, with hysteroscopy serving as the gold standard.

Conclusions: 3D TVUS demonstrated high diagnostic accuracy in detecting uterine cavity abnormalities and showed substantial agreement with hysteroscopy findings. Given its non-invasive nature, 3D TVUS can be considered a reliable initial screening tool for evaluating uterine abnormalities in infertile women.

Dietary knowledge, dietary practices, and utilization of antenatal care services among undernourished pregnant women: a cross-sectional study

2026-03-28T08:03:03+0530

Background: Maternal undernutrition remains a major public health concern in low- and middle-income countries and is associated with adverse maternal and neonatal outcomes. Adequate dietary knowledge and practices during pregnancy are essential for optimal maternal and fetal health. Antenatal care (ANC) services provide an important platform for nutrition counseling and micronutrient supplementation; however, gaps in knowledge, practices, and adherence persist among undernourished pregnant women.

Methods: A cross-sectional study was conducted among 70 undernourished pregnant women (BMI<18.5 kg/m²) attending antenatal clinics in selected health facilities, Bangalore. Data were collected using a structured questionnaire covering socio-demographic characteristics, dietary knowledge, dietary practices, and ANC utilization. Statistical analysis was performed using Jamovi (version 2.5.3) and RStudio. Descriptive statistics, Mann-Whitney U test, Chi-square test, and Fisher’s exact test were applied, with significance set at p<0.05.

Results: The median age was 24 years; most participants had secondary education and were homemakers. Inadequate dietary knowledge (87.1%) and poor practices (71.4%) were prevalent, with no significant association (p=0.265). ANC utilization was high (≥6 visits). Adherence was moderate for folic acid (67%) and calcium (63%), but low for iron (39%). Barriers included nausea, vomiting, and forgetfulness. Income was significantly associated with knowledge and practice levels (p=0.046).

Conclusions: Despite adequate ANC utilization, substantial gaps exist in dietary knowledge and practices among undernourished pregnant women. Strengthening nutrition counseling and addressing adherence barriers and socioeconomic constraints are essential to improve maternal nutrition and pregnancy outcomes.

A study on histopathological spectrum of hysterectomy specimens for abnormal uterine bleeding in a tertiary hospital in Madhya Pradesh

2026-03-28T08:09:53+0530

Background: AUB (abnormal uterine bleeding) impacts the quality of life of women. Leiomyoma and adenomyosis are the most common cause of AUB. For exact diagnosis, histopathological examination of hysterectomy specimen is required. Sometimes in histopathology we find carcinomas and other pathologies. So, it is clear that histopathogical examination of the hysterectomy specimen should always be done. In our study also we had two cases of carcinoma detected on histopathology.

Methods: In our study we took 100 patients coming to Obstetrics and Gynaecology department at Sukh Sagar Medical College and Hospital for a period of fourteen months from March 2024 to May 2025. A total of 100 patients of reproductive age group, perimenopausal and post-menopausal women with diagnosis of abnormal uterine bleeding who underwent abdominal hysterectomy were taken.

Results: A total of 100 cases were included in our study. Maximum number of patients were in the 36-42 years age group. Heavy menstrual bleeding was the commonest clinical presentation. Leiomyoma in the uterus, chronic cervicitis in the cervix and follicular cysts in the ovaries were the commonest histopathology noted. One specimen showed endometrial carcinoma and one specimen had leiomyosarcoma.

Conclusions: The findings in present study emphasise the importance of histopathological examination of all hysterectomy specimens to detect malignancies even in the cases which suggest a benign pathology on preoperative assessment.

Adverse obstetric outcomes in congenital Müllerian anomalies: experience from a high-risk pregnancy unit

2026-03-28T08:09:50+0530

Background: Congenital Müllerian anomalies are associated with increased risk of adverse obstetric outcomes. Data from Indian centers remain limited, especially from high‑risk obstetric units.

Methods: A 10‑year retrospective record‑based cross‑sectional analysis was conducted at a tertiary care center from August 2011 to July 2021. A total of 53 pregnant women diagnosed with congenital uterine anomalies were included. Outcomes assessed included preterm birth, abortions, PPROM, malpresentation, fetal growth restriction, and placenta accreta spectrum/postpartum hemorrhage..

Results: The most common anomaly was bicornuate uterus (41.5%, n=22), followed by unicornuate uterus (26.3%, n=14), septate/subseptate uterus (15%, n=8), arcuate uterus (15%, n=8), and uterus didelphys (n=1). Preterm birth occurred in 30 women (56.6%), abortion in 13 (24.5%), PPROM in 11 (20.7%), malpresentation in 15 (28.3%), fetal growth restriction in 15 (28.3%), and placenta accreta spectrum and/or postpartum hemorrhage in 10 cases (18.8%).

Conclusions: Congenital Müllerian anomalies substantially increase obstetric risk, particularly preterm birth, PPROM, malpresentation, and hemorrhage. Early identification and risk‑stratified antenatal surveillance are essential in resource‑limited settings.

Correlation of placental histopathology in fetal growth restriction with fetal outcome

2026-03-28T08:05:33+0530

Background: Fetal Growth Restriction (FGR), affecting 5-10% of pregnancies worldwide, is a significant cause of perinatal morbidity and mortality. The placenta plays a central role in the pathogenesis of FGR, with various histopathological abnormalities contributing to impaired fetal growth. Understanding the relationship between placental pathology and neonatal outcomes can guide clinical management and improve future pregnancy outcomes. This study aimed to find out the specific placental histopathologies present in FGR pregnancies and correlate them with the type and severity of FGR as well as neonatal outcome.

Methods: An analytical cross-sectional study was conducted on 92 FGR pregnancies at Government Medical College, Chandigarh over 18 months. Placental samples were examined histologically, and findings were correlated with clinical data including doppler studies, birth weight, Apgar scores, NICU admission and neonatal mortality. Statistical analysis was performed using SPSS version 25.0, with significance set at p<0.05.

Results: Early-onset FGR was observed in 36.9% and late-onset in 63.1% of cases. Placental histopathological analysis indicated that the most common abnormalities were syncytial knots (88%), fibrinoid necrosis (85.9%), and dystrophic calcifications (52.2%). Early-onset FGR was significantly associated with doppler abnormalities such as absent or reversed end-diastolic flow (AEDF/REDF) and poorer neonatal outcomes like low birth weight, low Apgar scores, higher NICU admissions (42.9%), and increased neonatal mortality (31.8%). Placental abnormalities detected in early-onset FGR includes massive peri villous fibrin deposition (MPVFD), chorioamnionitis, and diffuse dystrophic calcification.

Conclusions: FGR is a complex condition with multifactorial etiology, often associated with multiple placental lesions. Placental abnormalities, particularly MPVFD, chorioamnionitis, diffuse dystrophic calcification are strongly associated with FGR severity and adverse neonatal outcomes. Routine placental histopathological examination in FGR cases provides valuable insights into its etiopathogenesis and optimizing fetal outcomes in subsequent pregnancies.

A prospective observational study on correlation between the BMI of pregnant women and materno-fetal outcome

2026-03-28T08:05:29+0530

Background: Body Mass Index (BMI) during pregnancy is crucial to stipulate health risks. High pre-pregnancy BMI and/or excessive weight gain during pregnancy has negative implications on pregnancy outcomes, putting the health of mother and infant at risk also it amplifies the burden of chronic disease. Hence, public initiatives aiming in reduction of maternal and fetal morbidity and mortality can be vitalised by identification of high-risk population based on BMI leading to implementation of targeted interventions, such as nutritional counselling, weight management programs, and close monitoring during pregnancy.

Methods: This prospective observational study was conducted over a period of over 10months of duration from January 2025 to October 2025 among 500 pregnant women coming to ANC OPD who fulfilled the selection criteria and agreed to participate in study. The study aimed to assess the feto-maternal outcomes in pregnant women of different BMI categories.

Results: Out of 500 pregnant females, majority of pregnant females were in normal BMI category 59% (295) while rest were underweight 13% (65), overweight 22% (110), and obese 6% (30). The antenatal and postnatal complications were more in overweight and obese patients in comparison to normal weight and underweight. Also, the instrumental delivery and lscs rate were higher among the women with high BMI.

Conclusions: In developing countries like India both underweight and obesity poses a significant impact on the outcome of pregnancy. Achieving an optimal weight gain for every pregnant woman is the basis for the development of a healthy population and an essential factor in the physiological course of pregnancy and childbirth and thus contributing to reduction in maternal and fetal mortality and morbidity.

Pregnancy outcomes in HIV-infected women

2026-03-28T08:05:24+0530

Background: HIV infection during pregnancy remains a significant public health concern in India despite a declining prevalence. Mother-to-child transmission (MTCT) continues to be the primary source of pediatric HIV infection. Early identification of HIV-positive pregnant women and timely initiation of antiretroviral therapy (ART) under the Prevention of Parent-to-Child Transmission (PPTCT) programme are critical for reducing MTCT and improving maternal and neonatal outcomes.

Methods: A retrospective observational study was conducted at SVP Hospital and SCL Hospital from January 2015 to December 2024. Fifty HIV-seropositive pregnant women attending antenatal care or presenting in labor and receiving ART were included. HIV testing, counseling, ART initiation, and follow-up were performed in accordance with National AIDS Control Organization (NACO) guidelines. Maternal demographics, obstetric complications, CD4 counts, mode of delivery, and neonatal outcomes, including HIV status at 18 months, were analyzed.

Results: Among the 50 women, 28% were newly diagnosed during labor, while 72% were known HIV-positive cases. Most women were aged 25-30 years (44%) and were primigravida (44%). Maternal complications included anemia (40%), fetal growth restriction (26%), pulmonary tuberculosis (14%), and preterm delivery (16%). The live birth rate was 92%. Cesarean section was performed in 84.7% of cases for obstetric indications. CD4 counts were >200 cells/mm³ in 98% of women. Nevirapine prophylaxis was administered to all live-born infants. Of the 46 infants tested at 18 months, only one (1%) was HIV-positive. Low birth weight was observed in 32.6% of neonates, and neonatal mortality was 2.2%.

Conclusions: Effective implementation of PPTCT services, including universal antenatal screening, early ART initiation, institutional delivery, neonatal prophylaxis, and follow-up per NACO guidelines, significantly reduces MTCT of HIV. Strengthening early antenatal registration and ART adherence can further improve outcomes.

The impact of obesity on maternal and fetal outcome

2026-03-28T08:09:53+0530

Background: Maternal obesity has emerged as a major global health concern, exerting profound effects on pregnancy and long-term offspring health. The obesogenic intrauterine environment influences fetal growth, metabolic regulation, and developmental programming, thereby increasing the risk of adverse maternal and neonatal outcomes. This study aimed to investigate the influence of maternal obesity on maternal and fetal outcomes during pregnancy.

Methods: A case-control study was conducted in the Department of Obstetrics and Gynecology of a tertiary care centre from July 2023 to December 2024. A total of 72 pregnant women were enrolled, comprising 36 obese (BMI ≥30 kg/m²) and 36 non-obese women with singleton pregnancies. Data were collected using a structured proforma covering sociodemographic characteristics, obstetric history, laboratory parameters, antenatal sonography, maternal complications, and neonatal outcomes. Statistical analysis was performed using SPSS 24.0; Chi-square and t-tests were applied with a significance level of p<0.05.

Results: Obese women demonstrated higher pre-pregnancy weight and BMI, with comorbidities reported more frequently. LSCS rates were high in both groups, with a greater proportion among obese women (94.44%). Neonates of obese mothers showed significantly higher birth weights (p<0.001), wider variation in neonatal RBS (p=0.0045), and more USG abnormalities (p=0.0016). Fetal complications including jaundice, hypoglycemia, macrosomia, and congenital defects were observed exclusively in the obese group.

Conclusions: Maternal obesity is associated with significant adverse fetal and neonatal outcomes, particularly increased birth weight, metabolic instability, and abnormal antenatal imaging. Strengthening preconception counseling, weight optimization, and close antenatal surveillance is essential to mitigate obesity-related pregnancy risks.

Management of iron deficiency anemia in pregnancy: a cross-sectional survey on iron formulations and taurine perception

2026-03-28T08:05:22+0530

Background: Iron deficiency anemia (IDA) is a widespread health concern with multiple treatment options, yet obstetrician gynecologist preferences and clinical outcomes vary considerably. Taurine is gaining attention as a potential adjunct due to its role in erythropoiesis and antioxidant effects.

Methods: Cross sectional survey was conducted among 197 practicing obstetricians and gynecologists in India. A structured 9 item questionnaire assessed iron salt preferences, side effect experiences, perceptions of tablet size and patient compliance, and views on prescribing taurine containing iron supplements. Data were analyzed using descriptive statistics.

Results: Ferrous ascorbate was the preferred iron salt for 98.47% of obstetrician gynecologist, with 84.77% reporting minimal side effects. Tablet size was deemed important for compliance by 97.46% of respondents. A total of 91.87% favored prescribing taurine enriched formulations for fetal wellbeing, and 91.37% had previously prescribed R. B. Tone Rapid. Moreover, after 8 weeks of ferrous ascorbate therapy in IDA, a 25% rise in hemoglobin from baseline was the most commonly expected outcome (57.86%), followed by 50% (26.40%) and 40% (15.73%). R. B. Tone Rapid was preferred in cases of IDA (81.21%), fetal growth restriction (26.9%), and maternal obesity (28.42%). Additionally, majority of Obstetricians and Gynecologists (63.96%) recommended organizing a hemoglobin detection camp at their clinic.

Conclusions: Obstetrician gynecologist demonstrated a strong preference for ferrous ascorbate and expressed confidence in taurine containing iron therapies. The findings support a shift toward better tolerated, functionally enhanced supplements in pregnancy related IDA. Further research is needed to validate these perceptions and inform treatment guidelines.

Efficacy and safety of Y-spur in the treatment of male infertility disorders: an open-label clinical endpoint study

2026-03-28T08:05:22+0530

Background: Idiopathic male infertility has a complex etiology that includes oxidative stress, hormonal dysregulation, genetics, lifestyle choices, and environmental pollutants that can affect spermatogenesis and lower the quality of sperm. A polyherbal formulation, Y-Spur Capsule contains various herbs that support reproductive health through different methods, improve semen quality, lowers oxidative stress, and increase sperm count, motility, morphology, and testosterone levels.

Methods: 30 males aged 18-45 years, diagnosed with idiopathic male infertility were enrolled in the study and followed for 9 months.

Results: Statistically significant and sustained improvements were observed over a period of 9 months compared to their baseline values in a. semen volume (1.85±0.48 to 2.11±0.51), b. sperm concentration (11.6±1.96 to 17.7±2.37), c. total sperm count (14.4±3.06 to 22.93±2.32), d. total motile sperm (14.1±2.92 to 50.13±6.27), e. normal sperm morphology (2.67±0.48 to 11.47±1.87) (p=0.0001).

Conclusions: The progressive improvement in sperm morphology and motility further supported the overall enhancement of sperm quality and reproductive potential and the safety evaluations confirmed that Y-Spur was well tolerated. In addition, Y-spur was well tolerated among the subjects and was considered safe when consumed over a period of 9 months.

Factors influencing the pregnancy outcome in normotensive women undergoing frozen embryo transfer cycles

2026-03-28T08:05:21+0530

Background: Infertility is defined as a failure to conceive within one or more year of regular unprotected intercourse. Assisted Reproductive techniques have been developed rapidly over the past few decades helping couple who are unable to conceive naturally. The overall clinical pregnancy rate of ART is over 50%. Many factors can influence the success of a clinical pregnancy such as maternal age, ovarian reserve, duration of infertility, type of infertility, hormonal levels and endometrial receptivity. Maintaining a normal blood pressure level is generally considered positive for fertility outcomes, as elevated blood pressure can negatively impact a woman's ability to conceive, potentially leading to issues with ovulation, implantation and increased risk of miscarriage. However, there are still some unknown risk factors that could affect the pregnancy outcome of ART.

Methods: This study included 80 normotensive women who underwent frozen embryo transfer cycles. Blood pressure was measured on all the women undergoing frozen embryo transfer. Female patient’s age, unique health identification, body mass index, type of infertility, blood pressure, endometrium thickness, number of embryos transferred, embryo grade and beta human chorionic gonadotropin were recorded.

Results: Among 80 normotensive women who underwent frozen embryo transfer, all factors were non-significantly associated with the clinical pregnancy rate. Factors that resulted in higher clinical pregnancy rate includes higher blood pressure, primary infertility, PCOS, overweight, day 4 embryo transfer, endometrium thickness >9 mm and morula grade embryo transfer. This could be because of limited sample size and time restrictions.

Conclusions: There is no significant association between blood pressure, type of infertility, polycystic ovarian syndrome, day of embryo transfer, embryo grade, body mass index and endometrium thickness with pregnancy rate in normotensive women undergoing frozen embryo transfer cycles. Further investigations with randomized trials are required to confirm the confounding nature of the factors analysed and their influence on pregnancy outcome in normotensive women undergoing frozen embryo transfer.

Efficacy of thymosin alpha-1 as an immunomodulatory adjuvant in patients with recurrent implantation failure: a real-world retrospective analysis

2026-03-28T08:05:13+0530

Background: Recurrent implantation failure (RIF) remains a major challenge in assisted reproductive technology (ART), affecting approximately 10–15% of couples undergoing treatment. Immune dysregulation is considered an important contributor to implantation failure. Thymosin Alpha-1, an immunomodulatory agent, has shown promising results in difficult-to-treat infertility cases. This study evaluated the real-world effectiveness of Thymosin Alpha-1 as an adjuvant therapy in patients with RIF in an Indian clinical setting.

Methods: This retrospective, observational study was conducted at a private infertility center in India. Medical records of adult women aged over 30 years diagnosed with RIF over a one-year period were analyzed. All included patients received Thymosin alpha-1 (1.6 or 3.2 mg daily or on an alternate-day regimen) for a minimum of 118 days. Demographic characteristics, comorbidities, infertility-related conditions including polycystic ovary syndrome (PCOS), endometrial features, immunological parameters, treatment regimens and outcomes were evaluated.

Results: Most patients were aged 31–35 years (41.1%), followed by 36–40 years (25.6%). Thyroid disorders (5.6%) and diabetes (2.2%) were uncommon, while 82.2% had no comorbidities; latent tuberculosis was present in 13.3%. Anovulatory cycles were observed in 17.8% of patients and 71.1% had a thin endometrium. Immunological parameters showed marked variability, including mean CD16+56 natural killer cell counts of 175±103 cells/µl and mean TNF-α levels of 18.4±41.2 pg/ml. PCOS was identified in a subset of patients. All patients with RIF (n=90) who received thymosin alpha-1 therapy for at least 118 days demonstrated positive reproductive outcomes, regardless of dosing regimen.

Conclusions: Thymosin alpha-1 therapy was associated with encouraging outcomes in patients with RIF, supporting its role as an effective immunomodulatory adjuvant.

Efficacy of chlorhexidine gluconate in reducing surgical site infections after emergency caesarean delivery: a randomized controlled trial

2026-03-28T08:05:06+0530

Background: Caesarean delivery (CD) is a major, life-saving surgical procedure, with emergency CDs posing a greater risk for Surgical Site Infections (SSIs) due to compromised preoperative preparation. SSIs are common hospital-acquired infections, significantly increasing morbidity and healthcare costs. Preoperative skin antisepsis is critical for SSI prevention, with recent evidence suggesting Chlorhexidine Gluconate (CG) may be superior to Povidone Iodine (PI). This study was done to compare the efficacy of CG versus PI for skin antisepsis before emergency CD at AIIMS Bhubaneswar.

Methods: This was a parallel-arm, single-blinded, randomized controlled trial. Four hundred and fifty women undergoing emergency CD were randomized to receive either CG or PI for preoperative skin antisepsis. Participants were observed for 30 days duration postoperatively to assess the primary outcome of SSI development. Secondary outcomes included hospital stay, re-suturing, readmission, and pyrexia. Statistical analysis involved Chi-square, Fisher's exact, and Wilcoxon-Mann-Whitney U tests.

Results: SSI occurred in 1.8% (4/225) of the CG group and 6.2% (14/225) of the PI group, a statistically significant difference (p = 0.016). Most SSIs were superficial, with no significant difference in type between groups. No significant differences were found in secondary outcomes. Higher BMI was significantly associated with SSI in both groups, and prolonged surgery duration in the CG group.

Conclusions: CG significantly reduced SSI incidence compared to PI in emergency CD. This supports CG's superior antiseptic properties and suggests its use can effectively mitigate SSI risk in this high-risk population.

Neonatal consequences of gestational diabetes mellitus: evidence from a prospective observational study

2026-03-28T08:03:29+0530

Background: Gestational diabetes mellitus (GDM) alters the intrauterine metabolic environment and is associated with several neonatal complications. Despite standardized screening and management protocols, adverse neonatal outcomes continue to occur in pregnancies complicated by GDM. Objective of the study was to evaluate neonatal outcomes in pregnancies affected by gestational diabetes mellitus and compare them with outcomes in normoglycemic pregnancies.

Methods: A prospective observational study was conducted on 200 pregnant women delivering at a tertiary care hospital. Women were categorized into GDM and non-GDM groups based on “Diabetes in Pregnancy Study Group India” (DIPSI) diagnostic criteria. Neonatal outcomes including birth weight, APGAR scores, requirement for resuscitation, and NICU admission were analyzed.

Results: Gestational diabetes was present in 17% of the study population. Neonates born to mothers with GDM had significantly higher mean birth weight than those born to non-GDM mothers (p<0.001). The need for resuscitation at birth was significantly greater in the GDM group. NICU admissions were more frequent among neonates of GDM mothers, though the difference was not statistically significant.

Conclusions: Pregnancies complicated by GDM are associated with an increased risk of adverse neonatal outcomes, particularly macrosomia and immediate neonatal compromise. Focused intrapartum monitoring and preparedness for neonatal intervention are essential to reduce perinatal morbidity.

Study of hysteroscopy with ultrasonography and its correlation with histopathology in case of abnormal uterine bleeding in perimenopausal and postmenopausal female: a comparative study

2026-03-28T08:05:28+0530

Background: Abnormal uterine bleeding (AUB) is a common gynecological problem in perimenopausal and postmenopausal women, requiring accurate evaluation to distinguish benign from premalignant and malignant causes. Ultrasonography (USG) is widely used as an initial screening tool, whereas hysteroscopy provides direct visualization of the uterine cavity. Histopathology remains the gold standard for definitive diagnosis. This study aimed to compare the diagnostic performance of USG and hysteroscopy against histopathology in women presenting with AUB.

Methods: A cross-sectional observational study was conducted on 100 women aged ≥40 years presenting with AUB at a tertiary care center. All participants underwent detailed clinical evaluation followed by transabdominal ultrasonography, diagnostic hysteroscopy and endometrial sampling for histopathological examination. Diagnostic parameters including sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and overall accuracy were calculated for USG and hysteroscopy using histopathology as the gold standard.

Results: The majority of participants were aged 41–50 years (59%). Menorrhagia was the most common presenting symptom. USG identified endometrial hyperplasia in 10% of patients, whereas hysteroscopy detected hyperplasia in 18%. Histopathology confirmed hyperplasia in 12% and carcinoma in 1% of cases. For diagnosing hyperplasia, USG showed a sensitivity of 83.33% and specificity of 100%, while hysteroscopy demonstrated a sensitivity of 83.33% and specificity of 90.90%. Overall diagnostic accuracy was higher for hysteroscopy.

Conclusions: Hysteroscopy demonstrated superior diagnostic capability compared to ultrasonography in detecting endometrial abnormalities, particularly focal lesions. USG remains a useful initial modality; however, hysteroscopy enhances diagnostic precision and should be considered in the evaluation of women with persistent or unexplained AUB.

Correlation of clinical features, thyroid status and endometrial histopathology in abnormal uterine bleeding

2026-03-28T08:03:28+0530

Background: Abnormal uterine bleeding (AUB) is considered as one of the most common but yet a challenging problem presenting to the gynaecologist. AUB is defined as abnormal changes occurring in the frequency of menstruation, duration of flow or amount of blood loss. Its impact on women's physical, social, emotional and maternal quality of life is substantial. A detailed clinical assessment, thyroid profile, measurement of endometrial thickness on sonography and histopathological evaluation of endometrium is crucial for diagnosing the underlying causes of AUB.

Methods: A cross-sectional study was conducted over 18 months at a tertiary healthcare centre. This study enrolled 245 patients aged over 35 years presenting with complaints of AUB. Clinical data of all patients were collected via structured interviews and examinations. They were subjected to thyroid function test and ultrasonography for endometrial thickness. Endometrial samples were obtained through dilatation and curettage (D and C) and analysed histopathologically. The clinical presentation was correlated with histopathological findings of the endometrium.

Results: The majority of patients were in the age group 41-45 years (31.8%), with a mean age of 44.8 years. Menorrhagia was found to be the most common bleeding pattern (57.1%), followed by menometrorrhagia (30.2%) and postmenopausal bleeding (12.7%). Endometrial hyperplasia without atypia was the predominant histopathological finding (63.3%), followed by proliferative phase (17.1%) and secretory phase (14.3%). Endometrial carcinoma was identified in 3.7% of cases.

Conclusions: Histopathological examination is the gold standard investigation for patients presenting with AUB. Clinicopathological correlation aids in accurate diagnosis, early detection of premalignant lesions and appropriate management, thereby improving patient outcomes.

Vitamin D deficiency in women with polycystic ovarian syndrome- a cross-sectional observational study in Indian subcontinent

2026-03-28T08:03:26+0530

Background: Polycystic Ovarian Syndrome (PCOS) affects up to 18% of reproductive-age women, presenting with menstrual dysfunction, hirsutism, and metabolic complications. Vitamin D deficiency (VDD) shares features such as insulin resistance and obesity. Although global studies link hypovitaminosis D to metabolic risk, evidence in Indian women remains limited and inconsistent. This study assessed the prevalence of VDD and its association with metabolic and endocrine parameters in Indian women with PCOS.

Methods: A cross-sectional study was conducted at Army Hospital Research and Referral, New Delhi, over 18 months (February 2022-February 2024). A total of 170 women (18-40 years) diagnosed with PCOS by Rotterdam criteria were enrolled. Participants were stratified by serum 25-hydroxyvitamin D (25(OH)D) levels: Group I (<30ng/ml) and Group II (≥30 ng/ml). Evaluations included anthropometry (BMI, waist circumference), hormonal profiles (LH, FSH, AMH, TSH), and metabolic markers (fasting glucose, insulin, HOMA-IR, HbA1c, cholesterol).

Results: Most participants (89.4%, n=152) had suboptimal Vitamin D levels, while only 10.6% (n=18) were sufficient. Comparative analysis showed no significant differences (p>0.05) between groups in age, menstrual irregularities, Ferriman-Gallwey scores, ovarian morphology, or biochemical markers (LH, FSH, AMH, insulin, HOMA-IR, BMI). Spearman correlation confirmed no significant linear association between 25(OH)D levels and metabolic or hormonal variables.

Conclusions: Hypovitaminosis D is highly prevalent among Indian women with PCOS. However, Vitamin D status did not significantly influence metabolic or endocrine dysfunction in this cohort, suggesting it may represent a comorbid condition rather than a causal factor. Larger longitudinal studies are warranted to clarify causal pathways and therapeutic relevance.

Fetomaternal outcomes of hyperlipidemia in pregnancy

2026-03-28T08:03:24+0530

Background: Maternal lipid levels increase physiologically during pregnancy; however, excessive elevations may be associated with adverse maternal and neonatal outcomes. This study aimed to evaluate maternal lipid profile patterns and their association with fetomaternal outcomes.

Methods: This prospective observational study was conducted on 100 singleton pregnant women with gestational age >28 weeks attending the antenatal clinic and labour room of Pt. B.D. Sharma PGIMS, Rohtak. Detailed history, clinical examination, and body mass index (BMI) assessment were performed. Lipid profiles were analyzed using auto-analyzers. Hyperlipidemia was defined as total cholesterol >200 mg/dL, triglycerides (TGs) ≥150 mg/dL, high-density lipoprotein (HDL-C)≤45 mg/dL, or low-density lipoprotein (LDL)≥130 mg/dL. Participants were followed until delivery and maternal and neonatal outcomes were recorded.

Results: Hyperlipidemia was observed in 98% of the study participants. Elevated TGs were seen in 86% and elevated LDL in 37%. Hypercholesterolemia was significantly associated with induction of labour (35.71%, p=0.024). Pre-eclampsia occurred in 22.45% cases, PROM in 21.43%, intrahepatic cholestasis of pregnancy (IHCP) in 8.16%, fetal growth restriction in 3.06% and gestational diabetes mellitus (GDM) in 1.02%. Low HDL levels were significantly associated with maternal anaemia (p=0.012) and elevated LDL levels with IHCP (p=0.049). Low birth weight was observed in 35% neonates and 26.53% required NICU admission, most commonly due to prematurity.

Conclusions: Maternal hyperlipidemia was associated with increased maternal complications such as pre-eclampsia, IHCP, and anaemia, as well as neonatal prematurity and NICU admissions. Monitoring lipid profiles during pregnancy may help identify women at risk of adverse fetomaternal outcomes.

Recurrent pregnancy loss and thyroid abnormalities: a case control study from a tertiary care hospital in Delhi

2026-03-28T08:03:13+0530

Background: To evaluate the association of thyroid dysfunction and thyroid autoimmunity with recurrent pregnancy loss (RPL) and to assess their impact on pregnancy outcomes.

Methods: This hospital-based case–control study was conducted at a tertiary care centre. Fifty-nine pregnant women with a history of two or more consecutive pregnancy losses were enrolled as cases and compared with 59 age-matched pregnant women with no prior pregnancy loss. Thyroid function tests and anti–thyroid peroxidase (anti-TPO) antibodies were assessed in all participants. Pregnancy outcomes were followed until delivery.

Results: Thyroid dysfunction was significantly more prevalent among women with RPL compared to controls (35.6% vs. 18.6%, p=0.03). Subclinical hypothyroidism was the most common abnormality, observed in 25.4% of cases and 13.6% of controls. Anti-TPO antibody positivity was higher among cases than controls (20.3% vs. 13.6%), though this difference was not statistically significant. Increasing severity of thyroid dysfunction was significantly associated with a higher number of pregnancy losses (p=0.004). Among women with RPL, those with thyroid dysfunction had lower live birth rates compared to euthyroid women (61.9% vs. 81.6%, p=0.04), along with higher rates of miscarriage and neonatal intensive care unit admission.

Conclusions: Thyroid dysfunction, particularly subclinical hypothyroidism, is more common in women with recurrent pregnancy loss and is associated with adverse pregnancy outcomes. Routine screening for thyroid dysfunction and thyroid autoimmunity should be considered in the evaluation of women with RPL.

A cross-sectional study of cervical Papanicolaou smear changes in antenatal women

2026-03-28T08:03:11+0530

Background: Cervical cancer is a preventable malignancy characterized by a prolonged preinvasive phase that allows early detection. Despite effective screening tools, coverage in India remains inadequate. This study evaluates cervical cytological findings in pregnant women and highlights antenatal care as a valuable opportunity for opportunistic cervical cancer screening, especially in settings where routine screening coverage is low.”

Methods: This hospital-based cross-sectional study was conducted in the Department of Obstetrics and Gynaecology, RIMS Imphal. A total of 354 pregnant women fulfilling the inclusion criteria underwent Papanicolaou (Pap) smear screening. Cytological findings were reported according to the Bethesda system. Associations between Pap smear findings and variables were analysed using chi-square test.

Results: Most participants were aged 21-30 years (72.4%) followed by 31-35 years (13%). Pap smear findings revealed negative for intraepithelial lesion or malignancy (NILM) in 76.8% of cases. Inflammatory smears were observed in 9.6%, bacterial vaginosis in 5.4%, unsatisfactory smears in 7.9%, and low-grade squamous intraepithelial lesion (LSIL) in 0.3%. A statistically significant association was observed between socio-economic status and Pap smear findings (p<0.01). No significant association was found with education level or age at marriage.

Conclusions: The findings highlight that antenatal care provides an important opportunity for opportunistic cervical cancer screening. Incorporating Pap smear screening into routine antenatal services may improve early detection of cervical abnormalities and strengthen cervical cancer prevention strategies in low-resource settings.

Fetomaternal outcomes of abruptio placentae: a tertiary care experience

2026-03-28T08:03:10+0530

Background: Abruptio placentae is the premature separation of a normally situated placenta after 20 weeks of gestation and before delivery of the fetus. It is a major cause of antepartum hemorrhage and is associated with significant maternal and perinatal morbidity and mortality. This study aimed to determine the incidence, risk factors, complications and fetomaternal outcomes of abruptio placentae in a tertiary care center.

Methods: This retrospective study was conducted at Bangalore Medical College and Research Institute, Bengaluru, including Vani Vilas Hospital and GOSHA Hospital, from January 2021 to August 2021. Demographic details, obstetric history and maternal risk factors were recorded. Gestational age was determined by last menstrual period and ultrasonography. Diagnosis was based on clinical features and ultrasonographic findings and confirmed by retroplacental clots or hematoma at delivery. Other causes of antepartum hemorrhage were excluded.

Results: The incidence of abruptio placentae was 0.95%. The most affected age group was 20–25 years and 52% were multiparous. Hypertensive disorders of pregnancy were present in 38.46% of cases, with severe preeclampsia in 23.07%. Vaginal delivery occurred in 66.35% cases, while 33.65% underwent cesarean section. Anemia was observed in 52.88% cases. Stillbirth occurred in 56.73% cases. Major maternal complications included postpartum hemorrhage (23.07%), disseminated intravascular coagulation (12.5%) and ICU admission (21.15%).

Conclusions: Abruptio placentae remains a significant contributor to maternal and perinatal morbidity and mortality. Early identification of high-risk pregnancies, timely referral, availability of blood bank facilities and prompt multidisciplinary management are essential to improve outcomes.

Correlation of maternal serum bile acid induced placental inflammation by Gpbar-1 and NF-κB pathway with fetal outcome in intrahepatic cholestasis of pregnancy: a case control study

2026-03-28T08:03:09+0530

Background: Intrahepatic cholestasis of pregnancy (IHCP) is a pregnancy-specific liver disorder associated with adverse fetal outcomes. Elevated maternal serum bile acids (BAs) trigger placental inflammation through the G-protein-coupled bile acid receptor 1 (Gpbar-1) and nuclear factor Kappa-light-chain-enhancer of activated B cells (NF-κB) signaling pathway. This study investigates Gpbar-1 and NF-κB gene expression in placental tissue of IHCP patients and its correlation with fetal outcomes.

Methods: This prospective case-control study, conducted between November 2019 and October 2021 at a tertiary care hospital, included 30 diagnosed IHCP cases and 30 gestational age-matched healthy controls. Serum bile acid levels were measured (using Elisa), and placental tissue was analyzed post-delivery using quantitative reverse transcription PCR (RT-qPCR) for Gpbar-1 and NF-κB gene expression. Maternal and fetal outcomes such as preterm delivery, fetal distress, low APGAR score, meconium-stained liquor, and NICU admission were recorded.

Results: Serum bile acid levels were significantly higher in IHCP cases (p<0.001). Gene expression analysis showed a 2.192-fold upregulation of Gpbar-1 (p=0.019) and a 2.396 -fold upregulation of NF-κB in IHCP placentas (p=0.029). Adverse fetal outcomes were not significantly correlated with higher gene expression.

Conclusions: Elevated bile acid levels in IHCP activate the Gpbar-1/NF-κB pathway, leading to placental inflammation and adverse fetal outcomes. Targeting this pathway may improve pregnancy outcomes in IHCP. Further research on anti-inflammatory therapies is recommended.

Placental thickness measurement at second and third trimester and its association with fetomaternal outcome

2026-03-28T08:03:05+0530

Background: Placenta is responsible for adequate foetal growth and development by performing nutritional, endocrine, excretory, respiratory and countless other important functions. Studying the architecture and morphology of placenta on USG antenatally can tip-off about health of the foetus in utero.

Methods: A prospective observational study was conducted at Kasturba Hospital, Delhi, from August 2023 to October 2024. The minimum required sample size was estimated to be 36 Considering a 95% confidence level, 90% power and an absolute error of 5% and a correlation coefficient of 0.51 between placental thickness and neonatal birth weight as reported by Gauri Raghunath Shinde et al.1 A total of 42 pregnant women were enrolled in the study in their first or second trimesters. Ultrasonography for placental thickness (PT) was performed at 25 and 35 weeks period of gestation (POG). Patients were followed up till delivery and various foetal and maternal outcomes such as birth weight, Pregnancy Induced hypertension (PIH), intrauterine growth restriction (IUGR), Gestational Diabetes Mellitus (GDM), Intrahepatic Cholestasis of pregnancy (IHCP) among many more were recorded. Statistical analysis was performed using SPSS-25 and a p-value <0.05 was considered significant.

Results: Mean PT at 25 weeks POG was found to be 26.29+4.47 mm and at 35 weeks POG was found to be 33.23 ±5.74 mm. Posterior wall placentae were found to be thicker as compared to anterior wall implanted placentae (at 25 weeks POG mean PT for anterior vs posterior placentae were 24.72 vs 27.57; at 35 weeks POG mean PT for anterior vs posterior placentae were 30.22 vs 35.44). Birth weight was found to increase with increase in PT (at 25 weeks POG Pearl’s correlation coefficient R= 0.36, p=0.02; at 35 weeks POG Pearl’s correlation coefficient R= 0.479, p=0.002). Pregnant Women (PW) with normal PT (>-2SD;<2SD) and thick PT (>2SD) at 25 weeks POG had mean birth weights 2.85kg and 3.13kg respectively. PW with thin (<-2SD), normal thickness (>-2SD; <2SD) and thick placentae (>2SD) at 35 weeks POG had mean birth weights 2.51kg, 2.85kg and 3.18kg respectively.

Conclusions: Measurement of PT antenatally on sonography can indicate about health of foetus in utero and its outcomes in the postnatal life.

A study on epidural analgesia in labour and its foetomaternal outcomes in a tertiary care centre

2026-03-28T08:03:05+0530

Background: Epidural analgesia is considered the most effective method for labour pain relief. However, concerns persist regarding its influence on labour progression, operative delivery and neonatal outcomes. This study evaluated foetomaternal outcomes associated with epidural labour analgesia.

Methods: This prospective observational study was conducted over a period of eleven months in a tertiary care teaching hospital. Sample size was calculated using nMaster software with 80% power and 95% confidence, yielding a minimum of 34 participants per group; 50 women were enrolled in each group (total n=100) to enhance power. Parturients were allocated into epidural (n=50) and non-epidural (n=50) groups. Maternal outcomes included pain scores assessed by the Numerical Rating Scale (NRS), duration of labour stages and mode of delivery. Neonatal outcomes included Apgar scores at 1 and 5 minutes and neonatal intensive care unit (NICU) admissions. Statistical analysis was performed using Student’s t-test and Chi-square test, with p<0.05 considered significant.

Results: Pain scores were significantly lower in the epidural group at all measured intervals after 15 minutes (p<0.0001). The duration of the first and second stages of labour was significantly prolonged in the epidural group. There was no statistically significant difference in caesarean section rates, instrumental deliveries, Apgar scores or NICU admissions between groups. Maternal complications were minimal and comparable.

Conclusions: Epidural labour analgesia provides effective pain relief without increasing caesarean section rates or adversely affecting neonatal outcomes, although it is associated with a modest prolongation of labour.

Maternal and fetal outcomes in cases of accidental haemorrhage at a tertiary care centre: a prospective observational study

2026-03-28T08:03:07+0530

Background: Accidental haemorrhage is a major obstetric emergency associated with significant maternal and perinatal morbidity and mortality. Early recognition and timely management are crucial to improve outcomes, especially in resource-limited settings where anemia and hypertensive disorders are common.

Methods: A prospective observational study was conducted in the Department of Obstetrics and Gynaecology at NHL Municipal Medical College Ahmedabad Gujarat a tertiary care teaching hospital from December 2022 to March 2025. All pregnant women ≥28 weeks’ gestation diagnosed with accidental haemorrhage were included. Women with bleeding due to other causes or <28 week’s gestation were excluded. Maternal demographics, risk factors, clinical features, management, and maternal and fetal outcomes were analysed. The collected data were compiled and analysed using Microsoft Excel 2019 (Microsoft Corporation, USA). Descriptive statistics were applied, and the results were expressed as frequencies and percentages.

Results: Among 11,560 deliveries, 105 cases of accidental haemorrhage were recorded (incidence 0.90%). Most women were unbooked (64.76%) and from lower socio-economic class (67.62%). Common risk factors were anemia (61.90%) and hypertensive disorders (47.61%). Abdominal pain (71.42%) and vaginal bleeding (61.90%) were the main symptoms. Cesarean section was performed in 56.20% cases. Blood transfusion was required in 66.66%. Major maternal complications included anemia (66.66%), shock (31.42%), PPH (22.85%), and DIC (7.61%), with no maternal mortality. Live birth rate was 63.80%, while perinatal mortality was 44.75%, largely due to prematurity and asphyxia.

Conclusions: Accidental haemorrhage remains a serious contributor to adverse fetomaternal outcomes. Strengthening antenatal care, early detection of anemia and hypertension, timely referral, and availability of comprehensive emergency obstetric care can substantially reduce morbidity and mortality.

Overcoming adenomyosis in in vitro fertilization: a case series

2026-03-28T08:05:27+0530

Adenomyosis is increasingly diagnosed in infertile women and is associated with adverse in vitro fertilization (IVF) outcomes. Individualizing ovarian stimulation and embryo transfer strategies may improve reproductive outcomes. This retrospective case series includes three women with imaging-confirmed adenomyosis who underwent IVF using a gonadotropin-releasing hormone (GnRH) antagonist protocol with a freeze-all strategy, followed by frozen embryo transfer (FET). Clinical characteristics, stimulation parameters, embryological outcomes, and pregnancy outcomes were evaluated. All patients completed ovarian stimulation with satisfactory oocyte yield and embryo development. Frozen embryo transfer was performed following GnRH agonist down-regulation and hormone replacement therapy. All three patients achieved ongoing clinical pregnancy. Favorable IVF outcomes can be achieved in women with adenomyosis using an antagonist protocol combined with a freeze-all strategy and frozen embryo transfer. Larger prospective studies are required to validate these findings.

Medico-legal responsibilities of obstetricians in caring for minor survivors of sexual assault with advanced pregnancy: key lessons from recent court judgments

2026-03-28T08:05:32+0530

Recent high court rulings have clarified how clinicians should manage pregnancies in minor survivors of sexual assault under the medical termination of pregnancy (MTP) act when read with the protection of children from sexual offences (POCSO). These rulings have clarified ambiguities in the acts and removed procedural barriers that delay essential care: when an investigating officer (IO) or child welfare committee (CWC) presents the survivor, ultrasound and other indicated evaluations should proceed without insisting on identity cards; termination within 24 weeks may be undertaken by the requisite registered medical practitioners with guardian consent and the survivor’s informed assent. The judgments also affirm the documentary first hierarchy for age proof under the Juvenile Justice Act and discourage non-essential radiological age estimation in pregnancy. For pregnancies over 24 weeks, the Delhi High Court has ruled for immediate constitution of a medical board to examine the survivor and place its opinion before the competent authority or court, enabling timely judicial decisions; the Gujarat High Court emphasized reproductive autonomy and a broad, lived-experience view of mental health harm. For obstetric services, these instructions read as plain functional requirements: standard operating procedure (SOPs) that codify the ≤24-week protocol, readiness to constitute a medical board only for >24 week cases, standardized dual-consent forms, complete records, coordinated communication with IO/CWC, and routine psychological counselling. Implementation of these directions can limit avoidable delays, align practice with law, and safeguard the dignity and safety of this vulnerable population.

Complex gastroschisis with severe neonatal compromise in a preterm infant: a case report

2026-03-11T08:38:53+0530

Gastroschisis is a congenital full-thickness abdominal wall defect characterized by herniation of abdominal viscera most commonly the small intestine-through a paraumbilical defect without a protective sac. The defect typically occurs to the right of the umbilical cord insertion, resulting in direct intrauterine exposure of the bowel to amniotic fluid, which can cause inflammation, thickening, compromised motility, and significant neonatal morbidity. In contrast to omphalocele, gastroschisis is usually isolated and un-associated with chromosomal abnormalities; however, outcomes worsen in the presence of prematurity, complex bowel pathology, or additional structural anomalies. We report a case of a 36-year-old multiparous woman at 34-35 weeks of gestation presenting with uterine contractions and vaginal bleeding. Prenatal ultrasonography demonstrated an anterior abdominal wall defect with eviscerated bowel loops floating freely within the amniotic cavity, consistent with gastroschisis, along with fetal hydrothorax suggesting severe intrauterine compromise. A premature neonate was delivered via cesarean section with a birth weight of 1670 g and severely depressed Apgar scores, requiring immediate resuscitation. Postnatal findings confirmed extensive bowel exteriorization, marked physiological instability, and multiple associated congenital anomalies. This case illustrates a severe, complex presentation of gastroschisis in a preterm infant with profound neonatal compromise. Early prenatal diagnosis and coordinated perinatal management remain essential to improving outcomes in high-risk cases.

Management of a large spontaneously ruptured dermoid cyst: a case report from large tertiary hospital in Australia

2026-03-28T08:05:20+0530

Mature cystic teratomas (MCT), more commonly known as dermoid cysts (DC), are the most common type of ovarian growth, a type of germ cell tumor. MCT are typically small and not prone to spontaneous ruptures, we present a case of a large MCT which had spontaneous rupture. This is a case of 37-year-old nulligravida, with no medical history who presented to emergency department because of abdominal pain. She was admitted, diagnosis and radiographical findings plus the clinical examination led to identification of large pelvic mass, with possible DC, and due to associated pain was undertaken for surgery.

Turning obstruction into opportunity: successful obstetric outcome in a rare and complex case of OHVIRA syndrome variant

2026-03-21T08:06:34+0530

Obstructed hemivagina and ipsilateral renal anomaly (OHVIRA) syndrome, also known as Herlyn–Werner–Wunderlich syndrome, is a rare Müllerian duct malformation characterized by uterine didelphys, obstructed hemivagina, and ipsilateral renal agenesis. Although rare, it bears significant gynaecological and reproductive consequences. We report a case of 24-year-old nulligravida who presented to us with chronic pelvic pain, dysmenorrhea, and persistent foul-smelling vaginal discharge. Magnetic resonance imaging demonstrated uterine didelphys with a distended obstructed left hemivagina and absent left kidney, turning clinical suspicion into reality. She underwent examination under anaesthesia followed by an exploratory laparotomy with drainage of hematopyometra, partial excision of the transverse vaginal septum, left endometrioma drainage, and left tubal delinking. Postoperative recovery was uneventful, with complete resolution of symptoms and restoration of vaginal patency. Ten months later, she conceived spontaneously, with the pregnancy localized to the right uterine horn which was meticulously monitored. At 32 weeks and 6 days of gestation, spontaneous preterm labour ensued, necessitating an emergency lower segment caesarean section. A live male neonate was delivered, and both maternal and neonatal outcomes were favourable. This case highlights the indispensable role of advanced imaging in precise anatomical delineation and emphasizes that timely, individualized surgical correction can restore reproductive potential. Despite increased risks of preterm birth and operative delivery, successful spontaneous conception and live birth are achievable in carefully managed women with OHVIRA syndrome. Early recognition remains crucial to prevent infection, endometriosis, and long-term reproductive morbidity in affected women.

Caesarean scar pregnancy: a rare case report

2026-03-28T08:09:59+0530

Cesarean scar pregnancy (CSP) is a rare and potentially dangerous form of ectopic pregnancy occurring when a blastocyst implants in the cesarean section scar, leading to abnormal gestational development between the myometrium and the scar tissue. Incidence ranges from 1/1800 to 1/2500 pregnancies and is increasing with rising cesarean delivery rates. CSP commonly presents with abdominal pain and vaginal bleeding. Diagnosis is facilitated by transvaginal sonography, and MRI is valuable when sonography results are inconclusive. A case of a 27-year-old woman with a previous cesarean section is reported, presenting with elevated beta-hCG and an ultrasound revealing a fetal pole in the lower uterine segment with minimal myometrium between the scar and the gestational sac. The patient underwent laparotomy and excision of the scar pregnancy, with histopathological examination confirming chorionic villi invasion through the myometrium. CSP is categorized into three types based on myometrial thickness and location, each with varying risks and management strategies including medical treatment, surgical intervention, and a combination of methods. Early diagnosis and management are crucial to avoid severe complications, with decision-making guided by the patient’s future fertility desires.

Mayer-Rokitansky-Küster-Hauser syndrome: a case report and surgical approach for neovagina construction

2026-03-28T08:09:57+0530

Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome is a rare congenital anomaly characterized by agenesis or hypoplasia of the uterus and upper two-thirds of the vagina in phenotypically normal females with a 46, XX karyotype. Despite normal ovarian function and secondary sexual characteristics, affected individuals present with primary amenorrhea. We report the case of a 21-year-old female presenting with primary amenorrhea and normal secondary sexual development. Pelvic MRI demonstrated complete uterovaginal agenesis with small fibrofatty structures suggestive of uterine buds, and normal bilateral ovaries. Hormonal profile was within normal limits, except for mildly elevated thyroid-stimulating hormone. After multidisciplinary counselling, the patient underwent neovaginoplasty using a modified McIndoe technique with an amniotic membrane graft and foam mold support. Postoperative care included gradual mold dilations and psychological support. At follow-up, the neovagina maintained adequate depth (>8 cm) and caliber, with satisfactory functional outcome and no early complications. Surgical neovaginoplasty using amniotic grafts is a safe and effective option for MRKH patients when nonsurgical methods are unsuitable. Success depends on meticulous surgical technique, structured postoperative dilation, and comprehensive psychological counseling.

A Pandora's box: cystic neoplasm of the ovary

2026-03-28T08:09:55+0530

Ovarian cyst is a rare neoplasm of the female reproductive system, accounting for approximately 2% to 3% of all ovarian pathologies. Germ cell tumours arise from the ovarian germinal elements. They are classified into as benign, borderline (proliferative), and malignant. Most tumors are benign, with malignant tumors accounting for less than 5% of cases. We now describe a case of large right ovarian cyst which was managed with right salphingo-oopherectomy and was subsequently reported to have ovarian germ cell tumor.

A rare presentation of pemphigoid gestationis in pregnancy

2026-03-28T08:09:51+0530

Pemphigoid gestationis (PG) is a rare autoimmune bullous dermatosis that may arise or worsen during pregnancy due to dynamic immunological and hormonal changes. This report describes a case of a 36-year-old gravida three, para two woman who developed non-pruritic erythematosquamous lesions at six months of gestation, with no prior history of similar complaints. Clinical evaluation and dermatologic consultation supported the diagnosis of PG, and the patient responded well to topical corticosteroid therapy. Her antenatal course remained uncomplicated, and she delivered a healthy infant via elective caesarean section at 39 weeks. Postpartum recovery was favourable, with near-complete resolution of lesions by four months. This case highlights the importance of early recognition, individualized management, and multidisciplinary care in optimizing maternal and foetal outcomes. Regular counselling is essential to address the disease course, associated risks, and the potential for postpartum relapse or recurrence in subsequent pregnancies.

The hidden twist: chronic uterine inversion masquerading in plain sight

2026-03-28T08:05:30+0530

Spontaneous non puerperal uterine inversion is an exceedingly rare gynaecological event. When it occurs, it is often due to an intrauterine polypoid mass attached to the uterine fundus, eventually pulling the uterus inside out over time as the mass increases in time. Here we present the cases of postmenopausal women presented with mass per vagina. A clinical diagnosis of chronic uterine inversion due to pedunculated submucous fibroid was made and was surgically managed.

Periurethral abscess in pregnancy: a rare incidence

2026-03-28T08:05:29+0530

Periurethral abscess in pregnancy has a rare incidence. The article showcases 2 case report of periurethral abscess in 3^rd trimester of pregnancy, presenting symptoms, clinical features, imaging modalities for confirmation of the abscess and prompt management of the abscess with description of various modes of approach in dealing with such abscess.

Leprosy in pregnancy, years after the eradication era

2026-03-28T08:05:27+0530

Hansen disease or commonly known as leprosy, is a chronic bacterial infection caused Mycobacterium leprae. It affects skin, peripheral nerves and mucosa of the upper respiratory tract and eyes. Although Hansen’s disease was eliminated as a public health problem globally in the year 2000 and in India by 2005 the reduction in number of new cases has been gradual with more than 10,000 cases being reported from countries like India, Brazil and Indonesia as per data reported in 2023. The true incidence of leprosy in pregnancy is not well reported in the post-eradication era. We report a case of leprosy first detected in pregnancy.

An unusual combination of mature cystic teratoma and ovarian carcinoid tumour: rare case report of an ovarian synchronous tumour

2026-03-28T08:05:26+0530

Synchronous bilateral ovarian tumours of the ovary are exceedingly rare entities characterized by the coexistence of two distinct neoplasms within the same anatomical site without histological intermixing. This case report presents a unique instance of a synchronous bilateral ovarian tumours comprising a mature cystic teratoma and an ovarian carcinoid tumour in a 46- year-old perimenopausal woman who presented with lower abdominal heaviness, a palpable mass, and right lower limb swelling. Radiological investigations revealed a large, complex right ovarian mass and a smaller left ovarian cystic lesion. A preoperative diagnosis of a neoplastic ovarian mass was made, and the patient underwent exploratory laparotomy. Intraoperative findings revealed bilateral adnexal masses; frozen section suggested benign pathology. Definitive surgery included total abdominal hysterectomy with bilateral salpingo-oophorectomy. Histopathological examination confirmed a mature cystic teratoma in the left ovary and a carcinoid tumour in the right ovary. Immunohistochemistry supported the diagnosis, showing CD56 positivity and a Ki-67 index of 15%. This case highlights the importance of considering synchronous bilateral ovarian tumours in the differential diagnosis of complex ovarian masses, especially when imaging reveals both solid and cystic components. Early recognition and accurate histopathological diagnosis are critical for guiding appropriate surgical management and ensuring optimal patient outcomes.

Vulvar varicosities in pregnancy - concealed veins, unexpected complications: a rare case report

2026-03-28T08:05:25+0530

Vulvar varicosities are an uncommon manifestation of venous congestion during pregnancy, reported in 2-4% of pregnant women and usually resolving spontaneously after delivery.¹ Rarely, they may be associated with intrapartum or postpartum complications such as rupture and hematoma formation.³ We report a primigravida with unilateral vulvar varicosities presenting in active labor who underwent vaginal delivery with preventive intrapartum measures. Postpartum development of a vulvar hematoma required surgical evacuation, followed by imaging-guided conservative management⁶. The patient developed a postpartum vulvar hematoma requiring incision and drainage, blood component therapy, and close monitoring. Imaging demonstrated a residual organized hematoma with extensive vulvovaginal varicosities and no active arterial bleeding. Conservative management resulted in gradual resolution and complete recovery. Vulvar varicosities are not an absolute contraindication to vaginal delivery; however, vigilant postpartum surveillance is essential. Early recognition and timely intervention can prevent significant maternal morbidity.

Dichorionic diamniotic twin pregnancy complicated by single intrauterine fetal demise secondary to severe early-onset fetal growth restriction: a case report

2026-03-28T08:05:24+0530

Twin pregnancies are associated with increased maternal and perinatal morbidity compared with singleton gestations. Single intrauterine fetal demise (IUFD) complicates a small proportion of twin pregnancies but poses significant diagnostic and management challenges, particularly when it occurs in the second or third trimester. Although adverse outcomes are more commonly reported in monochorionic twins, dichorionic diamniotic (DCDA) pregnancies may also be affected, especially in the presence of severe placental insufficiency and early-onset fetal growth restriction (FGR). A 39-year-old multigravida (Gravida 2) with a history of one prior missed miscarriage conceived a DCDA twin pregnancy following ovulation induction. Early anomaly scans showed structurally normal fetuses. At 22 weeks of gestation, Twin B demonstrated severe early-onset FGR (below the 1st centile), oligohydramnios, and abnormal umbilical artery doppler with absent to reversed end-diastolic flow, suggestive of significant placental insufficiency, while Twin A showed appropriate growth and normal doppler parameters. Despite close antenatal surveillance with serial ultrasonography and doppler studies, follow-up imaging at 26-28 weeks revealed intrauterine fetal demise of Twin B, with ultrasonographic features including spalding sign and marked growth restriction corresponding to 19-20 weeks of gestation. The surviving Twin A remained hemodynamically stable with normal growth and reassuring doppler findings. This case underscores that DCDA twin pregnancies are not immune to severe complications such as single IUFD, particularly in the setting of early-onset FGR and placental insufficiency. Early diagnosis, meticulous fetal and maternal surveillance, and individualized management are essential to optimize outcomes for the surviving twin and ensure maternal safety.

A novel genetic variant in loss of heterozygosity

2026-03-28T08:05:23+0530

An interesting case of loss of heterozygosity (LOH) and BOH with a history of second degree consanguineous marriage with manifestation of congenital fetal malformation in all her previous pregnancies. A case of missed clinical diagnosis and poor correlation of available clues and data due to lack of awareness, poor history taking and repeated irrelevant investigations, relying mostly on sonography and adhocism. This case is being reported as consanguinity is extremely widespread in the subcontinent and patients seldom get answers to recurrent miscarriages and fetal loss. On evaluation, the affected fetus had novel – likely pathogenic genetic variant not yet classified.

Antenatal diagnosis of spontaneous fetal bladder rupture presenting as progressive urinary ascites secondary to posterior urethral valves: a case report

2026-03-28T08:05:14+0530

Fetal urinary ascites is a rare antenatal finding most commonly associated with lower urinary tract obstruction, particularly posterior urethral valves (PUV). Spontaneous fetal bladder rupture leading to urinary ascites represents a protective “pop-off” mechanism that may reduce intrarenal pressure and preserve renal function. Antenatal differentiation of urinary ascites from hydrops fetalis is crucial, as prognosis and management differ significantly. We report a case of progressive fetal urinary ascites detected at 29 weeks of gestation, characterized by increasing ascites, a persistently collapsed bladder, and evolving oligohydramnios on serial ultrasonography. Fetal MRI at 35 weeks demonstrated a 4-mm defect in the anterior bladder wall with associated hydroureteronephrosis, confirming antenatal bladder rupture. The neonate was diagnosed postnatally with urinary ascites and PUV on micturating cystourethrogram, and underwent successful valve ablation followed by vesicostomy, with favourable renal outcome. This case highlights the importance of meticulous serial sonographic surveillance, the complementary role of fetal MRI in confirming bladder wall defects, and the value of coordinated perinatal management in improving neonatal prognosis in foetuses with urinary ascites secondary to bladder rupture.

A case report on a rare case of abdominal ectopic pregnancy

2026-03-28T08:05:12+0530

Abdominal pregnancy is a rare and potentially life-threatening form of ectopic pregnancy, accounting for approximately 1-2% of all ectopic gestations and associated with high maternal morbidity and mortality. Due to its variable presentation and diagnostic challenges, it is often misdiagnosed as an intrauterine pregnancy, leading to delayed management. We report a case of a 35-year-old sterilised woman, gravida 5 para 3, who presented at 26 weeks of gestation with three months of amenorrhea followed by irregular vaginal bleeding for 20 days. Initial evaluation suggested an intrauterine pregnancy with fetal demise; however, failure of induction and further ultrasonographic evaluation revealed an abdominal ectopic pregnancy with the fetal head located in the pouch of Douglas. The patient underwent exploratory laparotomy with en-masse removal of the fetus and placenta. Intraoperatively, the placenta was found adherent to the sigmoid mesentery without invasion of major pelvic organs. Postoperative recovery was largely uneventful, and the patient was discharged in stable condition. This case highlights the importance of maintaining a high index of suspicion for abdominal pregnancy, especially in patients with atypical clinical findings and poor response to induction. Early diagnosis, appropriate imaging, meticulous surgical planning, and a multidisciplinary team approach are crucial to reduce maternal morbidity and mortality associated with this rare condition.

Between the devil and the deep blue sea: puerperal sepsis and pituitary apoplexy following obstetric hysterectomy for postpartum haemorrhage

2026-03-28T08:05:11+0530

Sheehan’s syndrome, or postpartum pituitary necrosis, is a rare but life-threatening complication of severe postpartum hemorrhage (PPH). Its diagnosis is often delayed or obscured when confounded by concurrent critical illnesses. We report a case of acute Sheehan’s syndrome masked by severe puerperal sepsis to highlight the diagnostic challenges involved. A 38-year-old multiparous woman developed severe atonic PPH following a vacuum-assisted delivery, necessitating an emergency subtotal hysterectomy. Her postoperative course was complicated by severe sepsis, multi-organ dysfunction, and recurrent hypoglycaemia. Despite aggressive sepsis management, her condition remained critical. A pivotal diagnostic clue was her complete failure to lactate. Hormonal assays revealed panhypopituitarism (low follicle-stimulating hormone (FSH), luteinizing hormone (LH), thyroid-stimulating hormone (TSH), and cortisol), and a computed tomography (CT) scan of the brain confirmed an empty sella. The patient stabilized only after the initiation of hormone replacement therapy (hydrocortisone and thyroxine). Sheehan’s syndrome should be suspected in any patient with a history of severe PPH who presents with non-specific signs of critical illness, particularly refractory hypoglycaemia and failure to lactate. Concomitant sepsis can mask these features, delaying diagnosis. Early recognition and multidisciplinary management are essential for survival.

Chronic uterine inversion in a nulligravida female: an extremely rare case

2026-03-28T08:05:04+0530

Chronic non-puerperal uterine inversion is an extremely rare gynecological condition in which the uterine fundus turns inside out through the cervix. It usually occurs secondary to benign uterine pathology and is exceptionally uncommon in nulligravid women. The condition often presents with a chronic course and vague symptoms, leading to delayed diagnosis and treatment. A 22-year-old nulligravid woman presented with a seven-year history of a gradually enlarging vaginal mass, pelvic heaviness, and irregular spotting. She had no history of prior pregnancies, surgeries, or systemic illness. Examination revealed a patulous cervical os with the uterine fundus seen protruding through it. Laboratory evaluation showed severe anemia (hemoglobin 4.2 g/dl) with otherwise normal parameters. Pelvic ultrasonography demonstrated the uterine fundus prolapsed into the cervical canal, and magnetic resonance imaging (MRI) confirmed chronic uterine inversion with a characteristic “cup-shaped” appearance. After correction of anemia with four units of whole blood and supportive therapy, laparotomy with an anterior cervical constricting incision (Haultain-type) was performed. The uterus was successfully reinverted and anatomically restored. Postoperative recovery was uneventful, and the patient was discharged on the fifth postoperative day with complete resolution of symptoms. Chronic non-puerperal uterine inversion should be considered in women presenting with a long-standing vaginal mass and bleeding. MRI plays a crucial role in diagnosis. Timely surgical correction after preoperative optimization provides excellent anatomical restoration and preserves future reproductive potential.

Acute convulsions following sublingual misoprostol administration for postpartum hemorrhage: a report of two cases

2026-03-28T08:03:27+0530

Misoprostol is widely used for the prevention and treatment of postpartum hemorrhage (PPH) because of its efficacy, affordability, and ease of administration. However, the sublingual route is associated with rapid absorption and higher peak plasma concentrations, which may increase the risk of systemic adverse effects. We report two cases of primigravida women who developed acute altered mental status, hallucinations, and generalized tonic–clonic seizures following administration of 800 µg sublingual misoprostol after vaginal delivery. Extensive evaluation excluded common obstetric and neurological causes of postpartum seizures. Both patients recovered completely with supportive management and anticonvulsant therapy. These cases highlight the possibility of severe neurotoxicity associated with high-dose sublingual misoprostol and emphasize the need for cautious use and careful monitoring in the postpartum period.

Beyond transvaginal retrieval: laparoscopic oocyte aspiration in three challenging cases

2026-03-28T08:03:26+0530

Laparoscopic oocyte retrieval is a surgical method for retrieving oocytes, primarily used when standard transvaginal approaches are not feasible due to anatomical or pathological barriers. This technique is especially relevant for fertility preservation in patients with pelvic tumors, inaccessible ovaries, or when concurrent pelvic surgery is indicated. We report 3 cases in which transvaginal approach was difficult and hence laparoscopy was used.

Midwife-assisted management of obstructed labour during second-stage caesarean section using the Patwardhan technique: a case report

2026-03-28T08:03:25+0530

Obstructed labour is a preventable yet life‑threatening obstetric emergency that contributes substantially to maternal and perinatal morbidity and mortality, particularly in low‑ and middle‑income countries. Early identification and timely intervention are critical to improving outcomes. Midwives frequently serve as first responders during labour and play a pivotal role in recognizing deviations from normal progress, initiating emergency measures, and coordinating multidisciplinary care. To describe the successful midwife-assisted management of obstructed labour during a second-stage caesarean section using the Patwardhan technique. This case report describes the management of a primigravida woman with second‑stage obstructed labour and foetal distress, in whom prompt midwifery assessment using the partograph and rapid escalation of care resulted in an emergency caesarean section performed with the Patwardhan technique. Favourable maternal and neonatal outcomes highlight the essential role of midwives as frontline guardians in obstetric emergencies.

Vulvar leiomyoma in a postmenopausal woman mimicking common labial swelling: a rare case report

2026-03-28T08:03:17+0530

Vulvar leiomyoma is a rare benign smooth muscle tumor that accounts for a very small proportion of gynecological and vulvar neoplasms and is often misdiagnosed as more common vulvar swellings such as Bartholin gland cysts. We report a case of a 58-year-old multiparous postmenopausal woman who presented with a painless, slow-growing vulvar mass of 10 years’ duration. Clinical examination revealed a well-circumscribed, firm, non-tender mass involving the right labia majora. The patient underwent complete surgical excision of the lesion. Histopathological examination confirmed the diagnosis of vulvar leiomyoma. The postoperative course was uneventful, with no evidence of recurrence on follow-up. This case highlights the importance of considering vulvar leiomyoma in the differential diagnosis of long-standing labial swellings, particularly in peri- and postmenopausal women. Complete surgical excision remains the treatment of choice and provides both definitive diagnosis and excellent prognosis.

Prenatal diagnosis of caudal regression syndrome in a non-diabetic mother: a rare case report

2026-03-28T08:03:15+0530

Caudal regression syndrome (CRS) is a rare congenital malformation characterized by partial or complete agenesis of the sacrum and variable involvement of lumbar spine and lower limbs. It is classically associated with maternal diabetes, though sporadic cases in non-diabetic mothers have been reported. We report a case of a 25-year-old gravida 2 para 1 live 1 woman with previous lower segment caesarean section (LSCS) three years back, non-diabetic, who was diagnosed prenatally at 20 weeks of gestation with CRS on level II ultrasonography. There was a significant family history of type 2 diabetes mellitus in the patient’s mother, along with a history of three intrauterine fetal deaths (IUFDs). The fetus showed abrupt termination of the spine at the lumbosacral level with an absent sacrum and hypoplastic lower limbs. This case highlights that CRS can occur even in the absence of maternal diabetes, emphasizing the importance of detailed anomaly scanning and consideration of genetic and familial factors.

An uncommon cause of severe dysmenorrhea in a 16-year-old: accessory cavitated uterine mass

2026-03-28T08:03:14+0530

Accessory cavitated uterine mass (ACUM) is a rare Müllerian anomaly characterized by the presence of an accessory cavity lined with functional endometrium within an otherwise normal uterus. It commonly presents in adolescents and young women with severe dysmenorrhea that is often resistant to medical therapy and may be misdiagnosed as adenomyosis or fibroid. We report the case of a 16-year-old girl presenting with severe cyclical dysmenorrhea for two years that was unresponsive to hormonal therapy. Ultrasonography revealed a focal lesion in the left lateral myometrium with a small cystic component, and magnetic resonance imaging demonstrated a well-defined thick‑walled cystic lesion with internal blood‑fluid level and no communication with the endometrial cavity, suggestive of ACUM. The patient underwent successful laparoscopic excision of the lesion. Intraoperatively, a cavitary mass containing thick chocolate‑coloured fluid was identified and excised, followed by uterine reconstruction. Histopathological examination confirmed a cavity lined by functional endometrium surrounded by smooth muscle. Postoperatively the patient experienced significant relief from dysmenorrhea. This case highlights the importance of considering ACUM in adolescents with severe dysmenorrhea unresponsive to conventional therapy and emphasizes the role of MRI and laparoscopic excision as both diagnostic and definitive treatment.

Diagnostic pitfalls of a degenerating uterine fibroid mimicking ovarian cystadenoma

2026-03-28T08:03:14+0530

Uterine leiomyomas, commonly called fibroids, are benign smooth muscle tumors of monoclonal origin. As leiomyomas enlarge, they can outgrow their blood supply, resulting in various types of degeneration, such as hyaline, cystic, myxoid or red degeneration and dystrophic calcification. Degeneration is a common complication occurring in approximately two thirds of all fibroids. Hyalinization being the most common type of degeneration, occurring in up to 60% of cases, cystic degeneration seen in about 4% of leiomyomas which may be considered extreme sequelae. Although fibroids typically have a characteristic USG appearance, degenerating fibroids can have variable patterns and pose diagnostic challenges. I am presenting case of 45 years old perimenopausal female, who was diagnosed with ovarian cystadenoma on MRI findings. But intra operative posed a greatest diagnostic dilemma.

A long journey to birth: a case of refractory fetal SVT

2026-03-28T08:03:16+0530

Fetal tachyarrhythmias occur in approximately 0.4-0.6% of pregnancies, with supraventricular tachycardia (SVT) representing the most common subtype. Although digoxin has traditionally been used as first-line therapy, accumulating evidence indicates that monotherapy is frequently insufficient, particularly in sustained or accessory pathway–mediated SVT. Nevertheless, the optimal timing and escalation strategy for combination therapy remain controversial. We report a case of sustained fetal SVT diagnosed at 29 weeks of gestation in a non-hydropic fetus, managed using a response-guided, stepwise escalation approach. Initial dual transplacental antiarrhythmic regimens failed to achieve sinus rhythm despite therapeutic maternal drug levels and close surveillance. Owing to persistent tachycardia, triple therapy with digoxin, sotalol, and flecainide was initiated under intensive maternal–fetal monitoring, resulting in successful and sustained conversion to sinus rhythm without maternal or fetal adverse effects. This case underscores the importance of individualized, decision-oriented treatment escalation rather than prolonged reliance on monotherapy. Careful maternal electrocardiographic monitoring combined with serial fetal echocardiography enabled the safe administration of triple therapy and was associated with a favorable perinatal outcome.

A rare case of incomplete Pentalogy of Cantrell diagnosed on antenatal ultrasound

2026-03-28T08:09:57+0530

Pentalogy of Cantrell (POC) is a rare and complex congenital anomaly characterized by midline defects involving the abdominal wall, sternum, diaphragm, pericardium, and heart. The condition is often fatal and poses significant diagnostic and management challenges. We report a rare case of incomplete POC diagnosed during a routine second-trimester anomaly scan in a primigravida. The pregnancy was medically terminated after thorough counseling. This case highlights the importance of early prenatal diagnosis, multidisciplinary evaluation, and the ethical considerations involved in the management of complex fetal anomalies.

Management of polycystic ovary syndrome with arcuate uterus through individualized homoeopathy: a case report

2026-03-28T08:03:06+0530

Polycystic ovary syndrome (PCOS) is the most common endocrinopathy among reproductive-aged women. It is manifested by irregular menstrual cycles, polycystic ovaries, acne, excess unwanted hair growth, obesity, etc. PCOS can affect a female’s fertility. This was a case of 22 years female suffering from PCOS reported here was treated successfully within 1 year by a single individualised homoeopathic medicine Pulsatilla in centesimal potency with repetition as per requirement. The improvement is evident from regularity of menstrual cycle and also from the ultrasonography (USG) reports. Modified Naranjo criteria for homoeopathy score (+8 on the ‘−6–+13’ scale) proved the causal attribution between the homoeopathic medicine and the outcome in the patient. This case study reveals a certain role of homoeopathic treatment in PCOS and demonstrates the potential of homoeopathy in this type of conditions.

Laparoscopic Davydon’s vaginoplasty for a case of Mayer-Rokitansky–Küster-Hauser syndrome: a case report

2026-03-28T08:03:04+0530

Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome is a congenital Mullerian anomaly characterized by agenesis of uterus and upper vagina in women with normal secondary sexual characteristics and normal ovarian function. Creation of a functional neovagina is essential for sexual function and psychological wellbeing. Laparoscopic Davydov vaginoplasty utilizes autologous peritoneum and offers excellent anatomical and functional outcomes. We reported a case of a 21‑year‑old female presenting with primary amenorrhea diagnosed with MRKH syndrome and successfully managed with laparoscopic Davydov vaginoplasty. The procedure was completed without complications. A neovaginal length of 8 cm was achieved with satisfactory anatomical outcome. Laparoscopic Davydov vaginoplasty is a safe, minimally invasive, and effective technique for vaginal reconstruction in MRKH syndrome.

Recent advances in oral contraceptive pills: a review of evolving formulations and innovations

2026-03-28T08:05:34+0530

Recent innovations in oral contraceptive pills (OCPs) focus on reducing adverse effects and enhancing user control. Key advancements include low-dose/extended-cycle formulations, customization for conditions like polycystic ovary syndrome (PCOS), and improved safety profiles. User-centric features like over-the-counter (OTC) availability (Opill), smart packaging, and digital health integration further improve accessibility and adherence. Since the FDA approved Enovid in 1960, OCP development has continued to evolve. Modifications such as lower doses and extended cycles aim to minimize side effects (e.g., cardiovascular and metabolic) while maintaining efficacy. Customization addresses specific health conditions, improving patient suitability. This review aims to highlight how these developments improve efficacy, reduce side effects, and enhance convenience. This review also outlines key advancements in OCPs, associated explicitly with innovations in formulation, safety, and user-friendliness. For this purpose, this review synthesizes developments in OCP technology and delivery, based on established scientific literature and regulatory milestones. It examines formulation changes, safety enhancements, and user-focused innovations with key examples, including Opill's OTC approval and digital health tools. Thus, this review concludes that innovations in OCPs, spanning formulations, safety, and user experience, offer significant benefits that feature customization, OTC access, and digital integration, empowering women and improving adherence. These advancements also promise a more effective, accessible, and user-controlled contraceptive future.

Governmental healthcare provisions, benefits and quality care of abortion services in India: a narrative review

2026-03-28T08:03:16+0530

Abortion services are a critical part of reproductive healthcare, empowering individuals to make informed choices about their pregnancies. India has progressive legislation such as the Medical Termination of Pregnancy (Amendment) Act, 2021, and multiple national and state-level initiatives to improve access to safe abortion services. However, unsafe abortions remain prevalent due to limited awareness, provider shortages, and social stigma. This narrative review synthesizes peer-reviewed literature, government policy documents, and program reports on abortion services in India. The review examines legal provisions, service delivery availability, quality-of-care, and benefits of services by national and state-level programs. The review identified persistent gaps between legal provisions and service delivery, including uneven availability of abortion services, shortages of trained providers, limited financial protection for elective abortions, and deficiencies in quality-of-care such as informed consent and respectful care. Strengthening implementation of existing policies, expanding provider capacity, improving infrastructure, and promoting rights-based, stigma-free abortion care are essential to ensure equitable access to safe abortion services in India.

Caesarean section: a journey not always smooth: complications of caesarean section

2026-03-28T08:03:08+0530

Caesarean section (CS) is one of the most commonly performed obstetric procedures worldwide, with rates rising significantly over the past decades. While lifesaving, CS is associated with a spectrum of maternal and neonatal complications. Maternal risks include hemorrhage, uterocervical lacerations, urinary tract injury, postpartum infections, venous thromboembolism (VTE), chronic pelvic pain, uterine rupture, placenta previa, placenta accreta spectrum, caesarean scar ectopic pregnancy, caesarean scar niche, endometriosis, secondary infertility, and acquired uterine arteriovenous malformations (AVMs). Neonatal complications include superficial injuries, cephalhematoma, fractures, nerve injuries, lower Apgar scores, respiratory distress, increased NICU admissions, and long-term risks of asthma, obesity, and immune-related disorders. The increasing prevalence of CS underscores the importance of understanding its short-and long-term impacts on maternal and child health, emphasizing the need for careful risk assessment, preventive strategies, and informed clinical management.