International Journal of Reproduction, Contraception, Obstetrics and Gynecology

From paper records to digital platforms: web-based applications in maternal and child healthcare in India

2026-05-28T20:00:21+0530

India's maternal and child health (MCH) landscape has undergone a significant digital transformation over the past decade. The shift from paper-based records to web and mobile-based platforms has enabled more systematic tracking, monitoring, and delivery of essential health services. Digital tools are now central to India's national health programmes, particularly those addressing reproductive, maternal, neonatal, and child health (RMNCH). This review describes key web-based and mobile applications currently in use for MCHcare in India, with a focus on their features, scope, and role in programme delivery and monitoring. A narrative review was conducted using published literature, government reports, and programme documentation available up to January 2026. Applications reviewed include the reproductive and child health (RCH) portal, ANM Online (ANMOL), POSHAN tracker, U-WIN, electronic vaccine intelligence network (e-VIN), and Kilkari. Each platform serves a distinct yet interlinked function: beneficiary registration and tracking, nutritional surveillance, immunisation management, vaccine logistics, and health communication. Together, they form an increasingly integrated digital MCH ecosystem. However, persistent challenges, including poor network connectivity, limited digital literacy, device availability, cost sustainability, and data security concerns, continue to constrain their effectiveness, particularly in resource-limited settings. Web-based applications have strengthened the delivery and monitoring of MCH services in India. Realising their full potential requires sustained investment in digital infrastructure, workforce capacity building, and governance frameworks that ensure data privacy and interoperability.

Current guidelines for management of breech presentation: a comparative review of Royal College of Obstetricians and Gynaecologists, American College of Obstetricians and Gynecologists and the Federation of Obstetric and Gynaecological Societies of India recommendations

2026-05-28T19:59:11+0530

Breech presentation remains a significant obstetric challenge, with variations in management strategies across different professional bodies. Clinical decisions are influenced by evolving evidence and institutional preferences. This review is aimed to compare and analyze current recommendations for the management of breech presentation from Royal College of Obstetricians and Gynaecologists (RCOG), the American College of Obstetricians and Gynecologists (ACOG), and the Federation of Obstetric and Gynaecological Societies of India (FOGSI). A narrative review of published guidelines and official recommendations from RCOG, ACOG, and FOGSI was conducted. Key domains analyzed included external cephalic version (ECV), criteria for vaginal breech delivery, intrapartum management, and indications for caesarean section. All three organizations support ECV as a first-line intervention in eligible women. While ACOG and RCOG permit planned vaginal breech delivery under strict selection criteria, FOGSI emphasizes institutional capability and clinician expertise. Differences exist in patient selection, intrapartum monitoring, and thresholds for caesarean delivery. Although core principles remain consistent, variations in recommendations reflect regional practices and medico-legal considerations. Standardization and skill-based training are essential to optimize outcomes in breech presentation.

Non tubal ectopic pregnancy: challenges in diagnosis and management

2026-05-28T20:00:24+0530

Nontubal ectopic pregnancies (NTEP) are pregnancies that implant at sites other than the fallopian tube. Their overall incidence has been rising in recent years. NTEPs can occur at various sites such as in the cervix, ovary, abdomen, uterine cornua, interstitial part of tube, myometrium or caesarean scars. Absence of typical risk factors or tubal pathology makes the diagnosis and management of these NTEPs particularly challenging. Regardless of the location, early detection is critical for successful conservative treatment, improving outcomes and averting catastrophic complications in NTEP. This case series includes ten cases of NTEPs with unique locations and presentations. Four of them were caesarean scar pregnancies and two each of interstitial and cervical pregnancies. We also had two rarest types of NTEPs, one with intramyometrial pregnancy and the other with tubal stump ectopic pregnancy after salpingectomy done for ruptured tubal ectopic on the same side. The management of NTEPs encompasses medical treatment with methotrexate or surgical methods, most of them being uterus conserving and very rarely hysterectomy. The treatment in each case in our series was tailored according to the clinical presentation and need for conservation of future fertility. The outcome in all our cases was good in spite of difficulties faced in the diagnosis and decision for selection of the most appropriate modality of treatment. This case series emphasizes the fact that in spite of availability of advanced radiological aids, NTEPs can sometimes be difficult to diagnose. Hence a high degree of suspicion and proper counselling of the patients is needed to approach them judiciously so as to avoid severe complications.

Silent yet deadly: a case series of chronic ectopic pregnancies presenting atypically

2026-05-28T20:00:15+0530

Chronic ectopic pregnancy is a potentially life-threatening condition that is diagnostically challenging because of a variety of clinical presentations. Often, chronic ectopic may pose diagnostic conundrum due to unusual presentations. Pelvic inflammatory disease is a widespread female problem worldwide which could lead to ectopic pregnancy among reproductive age women. This series aims to diagnose it early and assess the co-relation between pelvic inflammatory disease and chronic ectopic pregnancy. This hospital-based case series was conducted in the Department of Obstetrics and Gynaecology, ESIC Model Hospital, Bapunagar, Ahmedabad, Gujarat over a period of 4 years from December 2021 to December 2025. A total of 7 patients were included in the study. Data was collected retrospectively and analyzed. We must keep ectopic pregnancy as differential diagnosis in all reproductive age group women presenting with pain in abdomen regardless of other symptom particularly with pelvic mass. Occurrence of ectopic pregnancy has a strong association with pelvic inflammatory disease. Negative urine pregnancy test does not rule out chronic ectopic pregnancy. Use of MTP pills without prior confirmation of intra-uterine pregnancy mask the symptoms and delays the diagnosis of an existing ectopic gestation. Pelvic inflammatory diseases have a strong causal association with chronic ectopic pregnancy.

Clinical profile and maternal outcomes in placenta accreta spectrum disorder: a case series from a tertiary care centre in north India

2026-05-28T20:00:13+0530

Placenta accreta spectrum (PAS) disorder, encompassing placenta accreta, increta, and percreta, represents an increasingly prevalent and life-threatening obstetric complication, with its incidence rising sharply in parallel with escalating global caesarean section rates. We present a case series of four patients diagnosed with PAS who were managed at a tertiary care centre in North India between January and March 2026. All four patients had a history of at least two prior lower segment caesarean sections, and presented with varying degrees of placental invasion identified on ultrasonography and magnetic resonance imaging (MRI). The gestational ages at presentation ranged from 15.5 to 37 weeks, with clinical features including antepartum haemorrhage, anaemia, and haemodynamic instability in select cases. All four patients underwent obstetric hysterectomy; bilateral internal iliac artery ligation was performed in three cases to achieve haemostasis, and bladder injury necessitating intraoperative repair was encountered in three cases. Massive transfusion protocols were instituted across all cases. Three patients recovered satisfactorily and were discharged without long-term morbidity; one patient succumbed to refractory haemorrhage and disseminated intravascular coagulation in the postoperative period. This series underscores the critical importance of antenatal suspicion, early radiological diagnosis, timely referral to tertiary centres, and planned delivery by a dedicated multidisciplinary team. Strengthening surveillance in women with prior uterine surgery and ensuring institutional preparedness for complex pelvic surgery and massive transfusion are essential to improving maternal outcomes in PAS.

Maternal near-miss following severe postpartum hemorrhage: a case series of 22 women from a tertiary care center

2026-05-28T19:59:17+0530

Maternal near-miss (MNM) events are important indicators of the quality of obstetric care, with postpartum hemorrhage (PPH) remaining one of the leading causes of severe maternal morbidity, particularly in low- and middle-income countries. This case series aimed to evaluate the clinical profile, management strategies, and outcomes of women experiencing MNM events secondary to severe PPH at a tertiary care referral center. A retrospective analysis of 22 women fulfilling the World Health Organization (WHO) MNM criteria following severe PPH during the study period was conducted. Demographic details, obstetric characteristics, etiological factors, clinical presentation, interventions, and maternal outcomes were analyzed descriptively. The mean age of the women was 27.6±4.1 years. Atonic PPH was the most common etiology, accounting for 63.6% of cases, followed by traumatic PPH (22.7%) and retained placental tissue (13.6%). Hemorrhagic shock and severe anemia were common clinical severity indicators. Massive blood transfusion was required in 18 women (81.8%), uterine tamponade in 12 cases (54.5%), and surgical intervention in 6 cases (27.3%). All patients required intensive monitoring and multidisciplinary management, with intensive care unit admission in all cases. No maternal deaths were recorded, and the median duration of hospital stay was 8 days. The findings highlight that severe PPH continues to be a major contributor to MNM events, and favorable maternal outcomes depend on prompt recognition, timely referral, standardized PPH management protocols, availability of blood products, and coordinated multidisciplinary critical care.

Role of ultrasound markers in predicting early pregnancy loss: a systematic review

2026-05-12T07:02:00+0530

Early pregnancy loss (EPL), defined as pregnancy loss before 13 weeks’ gestation, affects approximately 10–20% of pregnancies and represents a major source of clinical uncertainty within early pregnancy assessment units (EPAUs). Although several ultrasound parameters are routinely measured in early pregnancy, their predictive value for EPL is not consistently applied in clinical practice. A structured review of English-language literature published over the past 10 years was conducted using PubMed, OVID, CINAHL, and Biomed Central databases to evaluate ultrasound markers associated with EPL. Evidence consistently supports predictive value for routinely obtained markers, including crown–rump length (CRL), fetal heart rate (FHR), gestational sac measurements (GSD/MSD), and yolk sac diameter (YSD). Several studies indicate that abnormalities in yolk sac (YS) characteristics and gestational sac (GS) growth may precede changes in FHR or CRL in pregnancies that subsequently miscarry. More recent data refine subchorionic haematoma (SCH) risk stratification, demonstrating a graded association between miscarriage risk and SCH burden expressed as a proportion of GS size, including in assisted reproduction populations. Emerging studies propose gestation-specific predictive thresholds and integrative models using ultrasound indices with or without biochemical markers, while machine-learning and artificial intelligence approaches show high discrimination in selected cohorts. Incorporating routinely measured ultrasound markers into structured early pregnancy assessment may improve counselling and risk stratification, although broader validation is required before advanced predictive models can be adopted routinely.

Harlequin ichthyosis: challenges in antenatal diagnosis, neonatal management and outcomes: a case-illustrated systematic review

2026-05-22T06:49:37+0530

Harlequin ichthyosis is a rare and devastating autosomal recessive congenital disorder characterized by severe hyperkeratosis, profound disruption of the skin barrier and very high neonatal mortality. We performed a systematic review of the literature to synthesize current evidence regarding its genetic basis, antenatal diagnosis, neonatal management and clinical outcomes, and to contextualize these findings using an illustrative case from our institution. A structured search of PubMed, Scopus and Google Scholar was undertaken and relevant studies were reviewed qualitatively. Harlequin ichthyosis is caused predominantly by biallelic mutations in the ABCA12 gene, leading to defective lipid transport and catastrophic impairment of epidermal barrier function. Antenatal diagnosis remains challenging and is frequently missed on routine ultrasound, particularly in the absence of a previously affected child, though late sonographic signs and molecular testing can permit prenatal detection in selected cases. Advances in neonatal intensive care and early use of systemic retinoids have improved survival in some infants; however, mortality remains substantial, especially in resource-limited settings. Our case highlights the dramatic presentation and rapid clinical deterioration when antenatal diagnosis is missed. Early recognition, delivery in a tertiary care setting, aggressive multidisciplinary neonatal management and appropriate genetic counselling remain central to improving outcomes and guiding family decision-making in this otherwise often fatal condition.

Impact of intensive antenatal monitoring on perinatal outcomes among women with previous perinatal deaths in Nigeria: a prospective cohort study

2026-05-06T06:50:21+0530

Background: Stillbirth and perinatal mortality remain major public health challenges in low- and middle-income countries, particularly in Nigeria, where rates remain among the highest globally. Women with previous perinatal deaths are at significantly increased risk of recurrence. This study evaluated the impact of an intensive antenatal monitoring protocol on pregnancy outcomes among such high-risk women in Ile-Ife, Nigeria.

Methods: This prospective cohort study was conducted at the Fetal Medicine Unit of Obafemi Awolowo University Teaching Hospitals Complex between January 2021 and December 2024. Eighty-one pregnant women with a history of one or more perinatal deaths were recruited. In addition to routine antenatal care, participants received structured monitoring including early risk stratification, low-dose aspirin where indicated, fetal anomaly scanning, uterine artery Doppler, and serial fetal growth and umbilical artery Doppler assessments. Primary outcomes were stillbirth, early neonatal death, and perinatal mortality rates. Secondary outcomes included preterm birth, mode of delivery, and detection of fetal growth restriction (FGR).

Results: A total of 84 neonates were delivered. The perinatal mortality rate was 59.5 per 1,000 total births, lower than national estimates. Five perinatal deaths (5.9%) were recorded, comprising four stillbirths and one early neonatal death. Preterm birth occurred in 59.5% of cases, with most being provider-initiated due to hypertensive disorders and FGR. FGR was detected in 4.9% of pregnancies. Caesarean section rate was 69.1%.

Conclusions: Intensive antenatal monitoring among women with previous perinatal deaths was associated with improved perinatal outcomes compared to national averages. Scaling up structured surveillance strategies may contribute significantly to reducing perinatal mortality in high-risk populations in resource-limited settings.

Diagnostic performance of platelet-lymphocyte ratio in preterm premature rupture of membranes

2026-05-28T19:59:06+0530

Background: Preterm premature rupture of membranes (PPROM) is a significant contributor to preterm birth and is associated with considerable maternal and neonatal morbidity, with diagnosis often challenging due to nonspecific clinical presentation and limited reliable markers. Therefore, the present study aimed to evaluate the diagnostic performance of platelet-to-lymphocyte ratio (PLR) in PPROM.

Methods: This cross-sectional study was conducted in the Department of Obstetrics and Gynaecology, Dhaka Medical College Hospital, Bangladesh (June 2022-May 2023). Sixty pregnant women (30 PPROM, 30 controls) at 28–36⁺⁶ weeks’ gestation were enrolled to evaluate PLR in PPROM. Exclusions included multiple gestations, systemic disorders, malignancy, fetal anomalies, and pregnancy complications (GDM, preeclampsia). Data were analyzed using SPSS v26, with p<0.05 considered significant.

Results: A total of 60 participants (30 per group) were included with comparable baseline characteristics (mean age: 27.57±5.14 vs. 28.33±5.02 years; p=0.561). No significant differences were observed in parity or ANC status. Platelet count (269.63±63.40 vs. 207.43±46.50×10³/mm³; p<0.001) and PLR (123.15±27.73 vs. 104.48±26.09; p=0.009) were significantly higher in Group A, while lymphocyte count was not significant. ROC analysis showed AUC 0.697 with cut-off ≥117.7, sensitivity 53.3%, specificity 76.7%, and accuracy 65%.

Conclusions: PLR shows moderate diagnostic utility as a supportive biomarker in PPROM.

Maternal and perinatal outcomes associated with advanced maternal age in an urban tertiary hospital in Nigeria: a prospective cohort study

2026-05-28T20:01:43+0530

Background: Advanced maternal age (AMA) is increasingly common worldwide and is associated with heightened maternal and perinatal risks. However, evidence from low- and middle-income countries, including Nigeria, remains limited. This study assessed the association between advanced maternal age and selected maternal and perinatal outcomes in an urban Nigerian tertiary hospital.

Methods: This was a prospective cohort study conducted at the Department of Obstetrics and Gynaecology, Lagos State University Teaching Hospital, Ikeja. Pregnant women with singleton gestations who booked for antenatal care in the first trimester were consecutively recruited and followed until delivery. Participants were categorized into advanced maternal age (≥35 years) and normal maternal age (<35 years). Data on socio-demographic characteristics, obstetric history, and maternal and perinatal outcomes were collected using a standardized questionnaire. Statistical analysis was performed using statistical package for the social sciences (SPSS) version 26. Associations were assessed using Chi-square tests and logistic regression, with statistical significance set at p<0.05.

Results: A total of 119 women were enrolled, of whom 45 (37.8%) were of advanced maternal age. Women in the AMA group were predominantly multiparous (70.3%), compared with an equal distribution of primiparous and multiparous women in the normal maternal age group (p=0.047). Advanced maternal age was strongly associated with mode of delivery, with significantly higher caesarean section rates among AMA women (77.8% versus 43.7%; p<0.001). Although not statistically significant, clinically relevant trends were observed in the AMA group, including higher rates of obesity and preterm delivery. Increasing maternal age was associated with higher odds of pregnancy-related diagnoses, though this did not reach statistical significance.

Conclusion: Advanced maternal age in this cohort was strongly associated with multiparity and a markedly increased likelihood of caesarean delivery.

Assessment of childbirth experience in a tertiary care hospital: a cross-sectional questionnaire-based study

2026-05-19T07:11:58+0530

Background: Childbirth is a multidimensional experience influenced by physical, emotional, interpersonal, and environmental factors. Understanding women’s experiences during childbirth is essential to improving the quality of maternity care and promoting positive maternal outcomes.

Methods: A descriptive cross-sectional study was conducted among 150 postpartum women within 72 hours of delivery at a tertiary care teaching hospital. The childbirth experience questionnaire (CEQ), consisting of four domains - Own Capacity, Professional Support, Perceived Safety, and Participation was administered in English or Kannada. Sociodemographic, obstetric, and neonatal data were collected using structured proforma through interview of mother and review of hospital records. CEQ domain and total scores were converted to a 0-100 scale. Data were analyzed using descriptive statistics, t-tests, ANOVA, Pearson correlation, and multivariate linear regression. A p value <0.05 was considered statistically significant.

Results: The mean total CEQ score was 67.7±9.8, indicating a moderately positive childbirth experience. Highest scores were observed in Professional Support (78.6±10.1) and Perceived Safety (74.3±11.8), while Own Capacity (61.2±13.5) and Participation (56.8±14.9) were lower. Vaginal delivery was associated with significantly higher CEQ scores compared to caesarean section (p=0.01). Labour analgesia use was also associated with higher CEQ scores (p=0.03). Pain scores showed a negative correlation with childbirth satisfaction (r= –0.33), while perceived control correlated positively (r=+0.42). Independent predictors of positive childbirth experience included vaginal delivery, higher professional support, lower pain, and greater participation.

Conclusions: Although women reported strong support and perceived safety, their sense of control and involvement in decision-making required improvement. Enhancing respectful maternity care and promoting shared decision-making may improve childbirth experiences.

Clinical impact of thymosin alpha 1 as an adjuvant in enhancing frozen embryo transfer outcomes: a self-controlled study

2026-05-06T06:50:23+0530

Background: Endometrial immune milieu when studied appeared to be dysregulated in 81.7% of women with recurrent implantation failure (RIF). Thymosin alpha 1, a small peptide secreted from the thymus gland has the ability to favourably alter the maternal immune milieu conducive for embryo implantation and maintenance of pregnancy. This study plans to evaluate the impact of empirical use of Thymosin alpha 1 as an adjuvant in improving the pregnancy outcomes in women with more than two failed frozen embryo transfers (FETs).

Methods: Women who experienced two prior failed FETs despite good-quality embryos underwent endometrial preparation for their next FET cycle using hormone replacement therapy (HRT) supplemented with exogenous Thymosin alpha 1. Pregnancy outcomes were then compared to those from the immediately preceding cycle.

Results: In this cohort of 27 patients with two prior FET failures, addition of Thymosin alpha 1 in the subsequent FET cycle significantly improved implantation rates (63.4%; p<0.001) biochemical and clinical pregnancy rates (66.7%; p<0.001), and ongoing pregnancy rates (59.3%; p<0.001). No significant difference was observed in mean Thymosin dose between pregnant and non-pregnant women (22 mg vs. 20.3 mg; p=0.373).

Conclusions: The study provides encouraging evidence that thymosin alpha 1 could be an useful adjunct for improving pregnancy outcomes in women with RIF.

Stage matters: comparing day 4 versus day 5 versus day 3 frozen embryo transfers

2026-05-06T06:50:23+0530

Background: Morphological grading of embryo transfer remains as key determinant for in vitro fertilization (IVF) success. Though day 5 embryo transfer has more implantation potential, day-4 transfer is considered in cases where we suspect a risk of “no embryo to transfer.” Aim was to compare the pregnancy outcomes of day-4 versus day 3 versus day-5 frozen embryo transfer.

Methods: This is a retrospective comparative study. 672 sub-fertile women who underwent intracytoplasmic sperm injection (ICSI) during a period of 6 years (2019-2025) were included in the study. These women totally underwent 947 embryo transfers. Fresh embryo transfers were excluded from the study. Patients were followed up till delivery and their pregnancy outcomes were studied.

Results: The clinical pregnancy rate of day 4 embryo transfer was not statistically significant when compared with day 3 and day 5 groups (p=0.13). The live birth rate and miscarriage rate in day 4 embryo transfers were comparable with other two groups and was approaching clinical significance (p=0.06). The preterm delivery rate was lower in day 4 group when compared to other two groups and was statistically significant (p=0.006). The number of ectopic pregnancies was also less in day 4 group when compared to others (only two in day 4 group, five in day 3 group and three ectopic pregnancy in day 5 group).

Conclusions: In this study, day 4 embryo transfer gives comparable results when compared with blastocysts in terms of clinical pregnancy rate, reduced miscarriages, preterm deliveries and ectopic pregnancies.

Incidence and etiological profile of second trimester abortion: a prospective observational study

2026-05-08T06:44:01+0530

Background: Second trimester abortion, occurring between 14 and 24 weeks of gestation, is associated with higher maternal morbidity compared to first trimester termination. Despite its relatively lower incidence, it contributes disproportionately to abortion-related complications. Understanding the incidence and etiological factors is essential for improving preventive and clinical strategies. The aim was to determine the incidence and most common causes of second trimester abortion in a tertiary care center.

Methods: This prospective observational study was conducted in the Department of Obstetrics and Gynaecology at Government Raja Mirasudhar Hospital, Thanjavur Medical College, over a period of one year. A total of 315 women with second trimester abortion (14–24 weeks gestation) were included. Data regarding sociodemographic characteristics, obstetric profile, type of abortion (spontaneous or induced), and etiological factors were collected and analyzed. Descriptive statistics were used, and results were expressed as mean±standard deviation, frequencies, and percentages. Appropriate statistical tests were applied, with p<0.05 considered significant.

Results: The mean age of participants was 24.21±5.13 years. Induced abortions constituted 82.5% of cases, while spontaneous abortions accounted for 17.5%. The majority of abortions occurred between 17–19 weeks of gestation (45.7%). Among spontaneous abortions, unexplained causes were most common (52%), followed by cervical incompetence (13%) and uterine anomalies (11%). A statistically significant association was observed between age and type of abortion (p<0.05).

Conclusion: Second trimester abortion is predominantly induced, reflecting increasing reliance on medical termination for late-detected pregnancies and fetal anomalies. Among spontaneous abortions, a significant proportion remains unexplained, highlighting the need for improved diagnostic evaluation. Early identification of preventable causes such as cervical incompetence and enhanced antenatal care was essential to reduce maternal morbidity.

Knowledge, attitude and acceptance of Down syndrome screening among pregnant women

2026-05-06T06:50:22+0530

Background: Down syndrome (DS) is the most common chromosomal disorder, characterized by intellectual disability and various congenital anomalies. With increasing access to prenatal screening and diagnostic tools, understanding pregnant women’s knowledge, attitudes, and acceptance (KAA) of DS is crucial for informed decision-making and supportive care.

Methods: A cross-sectional study was conducted among 260 pregnant women. Data were collected using a structured questionnaire assessing demographic information, knowledge of DS, attitudes toward children with DS, and acceptance of prenatal screening and possible outcomes. Statistical analysis was performed to determine correlations between sociodemographic factors and participants’ responses.

Results: In a cross-sectional study of 260 pregnant women, 54.2% demonstrated adequate knowledge about DS and its screening, awareness varied, with only 44.2% understanding the difference between screening and diagnostic tests. A positive attitude toward screening was observed in 53.5%, and 63.8% showed acceptance, though fewer (56.9%) were willing to undergo invasive testing. Significant associations were found between higher knowledge and factors like primigravida status, higher education, and socioeconomic class. Similarly, satisfactory overall KAA (51.5%) was linked to these variables.

Conclusions: The study revealed that over half of pregnant women had satisfactory KAA regarding DS screening, particularly among primigravidae, graduates, and those from higher socioeconomic groups. While awareness of basic screening was good, gaps remained in diagnostic understanding and invasive testing acceptance, highlighting the need for targeted antenatal counseling to strengthen informed decision-making-fulfilling the study’s objectives effectively.

Knowledge, hygiene practices and health seeking behaviour for leucorrhoea among women university students

2026-05-19T07:11:58+0530

Background: Leucorrhoea and its awareness, hygiene practices, symptomatology and health consciousness were evaluated among female students at Rama Devi Women’s University. The survey aims to fill knowledge gaps, decrease stigmas and encourage early intervention to improve reproductive health outcomes.

Methods: A cross-sectional, web-based questionnaire survey (July 2024 - February 2025) among 356 female students of Rama Devi Women’s University, Bhubaneswar included both qualitative and quantitative demographic data on menstrual hygiene practices, awareness, symptoms and health-seeking behaviour regarding leucorrhoea. Data were analysed using R software (V-4.3.3) for descriptive statistics, correlation analysis, Principal Component Analysis (PCA) along with word cloud generation to visually demonstrate themes from open-text responses.

Results: Among the 356 female students (ages 18-25), the majority were unmarried (98%) and from urban areas (68%). Approximately, 38% changed their menstrual products every 4-6 hours and 15% do it once a day. Leucorrhoea awareness was alarmingly low (10%) and 94% lacked formal diagnosis. Strong association (r=0.86) between junk food intake, poor sleep and leucorrhoea symptoms were observed, while poor menstrual hygiene was linked to abnormal discharge and itching. PCA identified clusters of poor hygiene, junk food consumption and low awareness of psychosomatic symptoms, while word cloud showed great interest in menstrual and reproductive health education.

Conclusions: This study highlights significant gaps in awareness and health-seeking behaviour relating leucorrhoea with young Indian women. Poor menstrual hygiene and unhealthy lifestyle practices were significantly associated with the incidence of symptoms, yet diagnosis was still very low. The findings indicate the immediate need for further educational strategies as well as stigma reduction. Evidence suggests that a multifaceted combination of awareness, hygiene promotion and early diagnosis is essential for improvements in the reproductive health outcomes.

Risk factors and fetomaternal outcome in gestational diabetes mellitus: a prospective observational study from a tertiary care hospital of Delhi

2026-05-22T06:49:36+0530

Background: Gestational diabetes mellitus (GDM) is defined as glucose intolerance of varying severity with onset or first recognition during pregnancy. The objectives of the study are to evaluate the risk factors of GDM and their causative role.

Methods: A total of 121 antenatal women were enrolled after informed consent and screened for GDM between 24 and 28 weeks of gestation using Diabetes in Pregnancy Study Group of India (DIPSI) criteria. Participants were classified into the GDM group (≥140 mg/dl; n=25) and non-GDM group (<140 mg/dl; n=96). Maternal risk factors were assessed and participants were followed up for evaluation of maternal and fetal outcomes.

Results: GDM showed a significant association with age ≥30 years (52% vs 16%, p<0.001), BMI >25 kg/m² (44% vs 25%, p=0.033), weight gain >10 kg (44% vs 6.3%, p=0.001), positive family history of diabetes (24% vs 4.2%, p=0.001). Maternal complications were significantly more frequent in the GDM group including LSCS (60% vs 35.4%, p=0.045), pre-eclampsia (16% vs 4.2%, p=0.034), induction of labour (40% vs 18.8%, p=0.025), UTI (20% vs 6.3%, p=0.003), polyhydramnios (8% vs 3%, p=0.046), and PPH (20% vs 6.3%, p=0.033). Neonates of GDM mothers had birth weight ≥3.5 kg (12% vs 1%, p=0.008), macrosomia (4% vs 0%, p=0.049) and NICU admission (32% vs 11.5%, p=0.012).

Conclusions: Early screening is recommended in patients with advanced maternal age, obesity, excessive gestational weight gain, or positive family history of diabetes. Appropriate and timely diagnosis and management of GDM can significantly reduce adverse maternal and neonatal outcomes; hence, early detection is essential.

Impact of Atosiban administration on live birth rates in patients undergoing frozen embryo transfer: a retrospective self-controlled study

2026-05-28T20:00:12+0530

Background: To evaluate the impact of Atosiban, an oxytocin receptor antagonist, on live birth rates (LBR) and other pregnancy outcomes in patients with a history of failed frozen embryo transfer (FET) cycles.

Methods: This was a retrospective, self-controlled study conducted at a single tertiary care center between January 2018 and December 2024. A cohort of 73 patients who had undergone at least one unsuccessful FET cycle (Cycle 1) without atosiban and a subsequent FET cycle with Atosiban administration (Cycle 2) were included. Each patient served as her own control. The primary outcome was the live birth rate. Secondary outcomes included biochemical pregnancy, clinical pregnancy, miscarriage, and implantation rates. Statistical analysis involved paired t-tests for continuous variables and Fisher's exact test for categorical outcomes.

Results: The administration of Atosiban in Cycle 2 was associated with a significant improvement in pregnancy outcomes. The live birth rate increased from 0% in Cycle 1 to 26.0% in Cycle 2 (p<0.001). Similarly, the clinical pregnancy rate rose from 2.7%-43.8% (p<0.001), and the biochemical pregnancy rate increased from 11.0%-65.8% (p<0.001). The implantation rate showed a non-significant increase from 50% in Cycle 1 to 55% in Cycle 2 (p=0.372).

Conclusions: In a self-controlled cohort of patients with previous FET failure, Atosiban administration at the time of embryo transfer was associated with a statistically and clinically significant increase in live birth rates. These findings support Atosiban as a valuable therapeutic option to improve implantation success in this challenging patient population.

Assessment of stress prevalence among pregnant women in Kerala

2026-05-28T20:01:52+0530

Background: Pregnancy is a period of significant physiological and emotional transformation. This is a stressful time, which may have a negative impact on mother and baby health. The present study was conducted with the aim of finding the prevalence of stress level among pregnant women in Kerala and to check the correlation between emotional intelligence (EI) and perceived stress among the pregnant women.

Methods: A cross-sectional study was conducted to observe among 130 pregnant women at a tertiary care center in Kochi, Kerala. The stress level was measured by perceived stress scale (PSS) and emotional intelligence was assessed in four areas: self-awareness, self-management, social awareness and relationship management. Descriptive statistics, Pearson’s Chi-square test and Spearman’s rho test were used in the statistical analysis.

Results: A total of 130 pregnant women with 84.6% reporting moderate stress, 9.2% high stress and 6.2% mild stress. There was a significant negative correlation between levels on stress and social awareness, the only individual domain of emotional intelligence. Demographic factors were not significantly related to stress levels such as employment status, medical comorbidities and socioeconomic class.

Conclusions: Relatively high stress levels are common among most pregnant women in this area. Prevention of urinary tract infection (UTI) can be crucial in enhancing emotional intelligence skills, especially social awareness, which must be targeted and utilized by specific antenatal screening and psychological support systems for whole mother well-being.

An observational study on level of serum lipid profile in early second trimester as a predictor of pre-eclampsia and relation of different dyslipidemias with pre-eclampsia

2026-05-28T20:01:50+0530

Background: Preeclampsia (PE) is a pregnancy condition that affects 2–8% of pregnant women worldwide and significantly increase the incidence of morbidity and mortality for both mother and newborns. Dyslipidemia has been implicated as a predictor of PE due to its role in endothelial dysfunction and vascular damage. This study aimed to evaluate the serum lipid profile in the early second trimester (14–20 weeks) as a predictor of Preeclampsia and to investigate the relationship between PE risk and dyslipidemia.

Methods: This descriptive observational study was conducted at BRD Medical College, Gorakhpur, from May 2023 to April 2024. A total of 171 pregnant women (14–20 weeks gestation) were included, with exclusion criteria such as preexisting hypertension, diabetes, and multiple pregnancies. Fasting blood samples were analyzed for lipid profiles, and participants were categorized based on National Cholesterol Education Program (NCEP) guidelines into normal or abnormal lipid profile groups. Blood pressure was monitored, and participants were followed until 48 hours postpartum to confirm PE diagnoses.

Results: Among the participants, 21.6% developed PE, with dyslipidemia observed in 71.3% of the total sample. Key lipid profile parameters (triglycerides, total cholesterol, LDL, and VLDL) were significantly elevated in those with PE, while HDL was reduced. The most accurate lipid predictor of PE was total cholesterol, with an accuracy of 68.2%, sensitivity of 81.1%, and specificity of 55.3%.

Conclusion: The study emphasizes how early second-trimester lipid profile can be used to predict PE. Increased PE risk was linked to elevated levels of LDL, VLDL, total cholesterol, and triglycerides. Early identification and management of dyslipidemia could reduce maternal and neonatal complications, underscoring its importance in antenatal care.

Sexual and reproductive health experiences of young adult women with hearing impairment: a qualitative study

2026-05-28T20:01:47+0530

Background: Adolescence is a time of rapid change. For young people who are deaf or hard of hearing, this period can be even more challenging. The aim of this study is to understand the sexual and reproductive health experiences of young women with hearing impairment.

Methods: A qualitative exploratory study was conducted using in-depth interviews with 53 participants including young adult women with hearing impairment, their mothers, teachers, psychologists, and healthcare providers. Data were collected using category-specific interview guides. Thematic analysis was used to identify barriers in accessing sexual and reproductive health (SRH) knowledge and services.

Results: The study identified several challenges. Young women in our study struggle to communicate, preventing them from asking questions and understanding answers. Many times, they get no information about their bodies, health or relationships. However, this study shows that when young people receive accessible language, guidance and encouragement, their confidence and ability to seek help improve greatly. Many feel alone or left out. But the study also found that when young people are given the right words, signs and support, they start to feel better about themselves. We identified four central themes namely, communication barriers; information gaps; physical, emotional, social consequences and systemic challenges.

Conclusion: The findings highlight the urgent need for SRH education and services for hearing-impaired people. There is a need to ensure that young people have the right language, information, and support, as this is fundamental to equity, wellbeing, and human rights.

Study on various risk factors leading to meconium-stained amniotic fluid in pregnancy and its effects on labor

2026-05-28T20:01:44+0530

Background: Meconium-stained amniotic fluid (MSAF) is a common intrapartum finding, particularly in term and post-term pregnancies, and is often regarded as a marker of fetal compromise. While meconium passage may occur as a physiological phenomenon reflecting fetal maturity, it can also signify intrauterine hypoxia and is associated with adverse maternal and neonatal outcomes. The presence of MSAF poses significant challenges in intrapartum management due to its association with abnormal cardiotocographic (CTG) patterns, increased operative delivery rates, and neonatal complications such as meconium aspiration syndrome (MAS). Identification of maternal and obstetric risk factors and assessment of fetal monitoring parameters are therefore crucial to optimize labor management and improve perinatal outcomes. Objectives were to evaluate maternal risk factors, CTG patterns, and perinatal outcomes in pregnancies complicated by MSAF.

Methods: A prospective observational study was conducted in a tertiary care hospital over two years. Seventy women ≥34 weeks gestation with MSAF during labor were included. Meconium was classified as thin or thick. Continuous intrapartum CTG was interpreted using NICE 2017 guidelines. Maternal, intrapartum, and neonatal outcomes were analyzed.

Results: Thin meconium was observed in 60% and thick meconium in 40% of cases. Pathological CTG patterns and cesarean section rates were significantly higher in thick meconium. Neonatal morbidity including low Apgar scores, respiratory distress, ICU admission, and meconium aspiration syndrome was more common in thick MSAF.

Conclusions: Thick MSAF associated with abnormal CTG predicts adverse perinatal outcomes. Close intrapartum monitoring and timely intervention are essential.

Role of tranexamic acid in prevention of blood loss during cesarean section

2026-05-28T20:01:44+0530

Background: Postpartum hemorrhage remains one of the leading causes of maternal morbidity and mortality worldwide. Cesarean section is associated with significantly greater blood loss compared to vaginal delivery. Tranexamic acid (TXA), a synthetic antifibrinolytic agent, has shown promise in reducing perioperative bleeding by inhibiting plasminogen activation and preventing fibrin degradation. The objectives were to evaluate the efficacy of tranexamic acid in reducing intraoperative and postoperative blood loss during cesarean section, to assess postoperative hemoglobin drop, and to determine the need for blood transfusion.

Methods: A prospective randomized controlled study was conducted over three months in the Department of Obstetrics and Gynecology. Sixty women undergoing cesarean section were randomized into two groups of 30 each. Group A received 1 g intravenous TXA 10 minutes prior to skin incision, while group B received normal saline. Blood loss was estimated by suction bottle volume, sponge weight, and postoperative drain output. Hemoglobin was measured preoperatively and 24 hours postoperatively.

Results: The mean intraoperative blood loss was significantly lower in the TXA group (420 ml) compared to the control group (610 ml) (p<0.001). Postoperative hemoglobin drops and need for blood transfusion were also significantly reduced in group A. The incidence of postpartum hemorrhage was lower in the TXA group.

Conclusion: Prophylactic administration of tranexamic acid significantly reduces blood loss during cesarean section and is safe and well tolerated. It may be considered a valuable intervention in obstetric practice to prevent postpartum hemorrhage.

Sequential first and second trimester ultrasound screening for early detection of fetal anomalies: a prospective observational study

2026-05-28T20:01:42+0530

Background: First-trimester ultrasonography at 11–13⁺⁶ weeks plays a vital role in early detection of chromosomal abnormalities and structural fetal anomalies. When combined with a second-trimester anomaly scan at 18–24 weeks, it enhances diagnostic accuracy and improves pregnancy management.

Methods: This prospective observational study was conducted at a tertiary care centre from January 2023 to January 2025 and included. The expected prevalence of fetal anomalies (3–5%) and, this sample size 220 randomly selected singleton antenatal women between 11–13⁺⁶ weeks of gestation was considered adequate to assess the detection rate with reasonable accuracy. First-trimester evaluation included nuchal translucency (NT), nasal bone, ductus venosus Doppler, tricuspid regurgitation, and early fetal anatomical survey. All participants subsequently underwent a detailed anomaly scan at 18–24 weeks.

Results: This prospective observational study included 220 singleton antenatal women who underwent sequential ultrasound screening at 11–13⁺⁶ weeks and 18–24 weeks of gestation. A total of 11 foetuses (5%) were diagnosed with anomalies, of which 10 cases (4.55%) were detected during the first-trimester scan and 1 case (0.45%) during the second-trimester scan. Detected anomalies included chromosomal abnormalities (Trisomy 21,18, and 13), increased nuchal translucency, and structural defects involving the central nervous system, cardiac system, abdominal wall, and genitourinary system. Increased NT (>95th percentile) was observed in 6.4% cases. Anomalies were slightly more common in multigravida women and referred cases.

Conclusions: In the present study, sequential first and second trimester ultrasound screening proved effective in early detection of fetal anomalies, enabling timely counselling and appropriate pregnancy management.

Incidence of preeclampsia and fetal growth restriction among antenatal women with normal uterine artery Doppler at 11-14 weeks

2026-05-28T20:01:41+0530

Background: Preeclampsia remains a leading contributor to maternal morbidity and mortality worldwide, while fetal growth restriction is associated with an increased risk of adverse neonatal outcomes, including preterm birth, low birth weight, and long-term developmental challenges. Early prediction and prevention of these conditions are crucial for improving maternal and fetal outcomes. This study aims to estimate the incidence of preeclampsia and fetal growth restriction in antenatal women with normal uterine artery Doppler at 11-14 weeks.

Methods: A prospective observational study for a period of one and a half year, clinical data and demographic data were collected, analysed and the p-value will be calculated by the Pearson Chi-square test. The significance level will be set a p<0.05.

Results: Despite normal uterine artery Doppler indices at 11–14 weeks, the study population showed a 7.3% incidence of preeclampsia and 36% fetal growth restriction. These women also had higher risks of small-for-gestational-age neonates, gestational hypertension, and diabetes. Maternal age, body mass index (BMI), socioeconomic status, education, and parity were significantly associated with adverse outcomes, and fetal growth restriction was notably linked to preeclampsia.

Conclusion: The study highlights that even with normal uterine artery Doppler PI at 11–14 weeks, women remain at risk for preeclampsia and fetal growth restriction. Early identification and monitoring, including aspirin therapy and attention to borderline PI values, may help prevent adverse outcomes. The findings support further research combining Doppler with biochemical markers for improved early prediction.

Patterns of semen analysis among men attending screening camp organized by a specialty reproductive health institution: a retrospective observational study

2026-05-28T20:00:39+0530

Background: Male factors infertility alone account for 20-30% of infertility cases, but when combined with female factors or other factors, their overall contribution increases to approximately 50% of infertility cases globally. Semen analysis has a sensitivity of 89.6%. There is limited data on semen parameters in the general male population, as most studies focus on infertile couples. We aim to estimate the burden of semen abnormalities and their pattern among general population of men attending screening camps.

Methods: This is a retrospective study based on camp based medical records of a speciality reproductive center. A total of 421 individuals' data was obtained from the medical records. The semen analysis was done at the campsite by the experienced andrology team.

Results: The mean age observed was 35.39±6.36. The majority of the study population are of age 31 to 35 (31.59%). Nearly 40% (147) of individuals have abnormal sperm parameters. Commonly observed abnormalities are asthenozoospermia, oligoasthenoteratozoospermia, Severe oligo astheno teratozoospermia with 28.74%, 19.76, and 23.35, respectively. Azoospermia was observed in 16.77%. We found a statistically significant negative association between age and sperm concentration and motility (total and progressive) with p<0.05.

Conclusion: The sperm concentration was highest in the age group 31 to 40 years, but progressive and total motility declined significantly with increasing age. These trends suggest that male fertility subtly deteriorates even within a relatively young cohort.

A study to compare combination of Foley’s catheter with misoprostol versus mifepristone with misoprostol in second trimester abortion

2026-05-28T20:00:36+0530

Background: Second trimester abortion, which is the interruption of pregnancy between 13 and 28 weeks of gestation, accounts for roughly 10–15% of all induced abortions worldwide. Although second trimester procedures are less common than first trimester ones, they account for an unequal share of abortion-related complications and maternal health issues due to the later gestational age at which they are performed. Typical reasons for second trimester abortions include fetal abnormalities found during standard ultrasounds, intrauterine fetal death, and maternal health concerns like severe hypertension, heart disease, or mental health disorders.

Methods: Study was carried out at Department of Obstetrics and Gynecology, R.N.T. Medical College, Udaipur (Rajasthan). Study period: April 2024 to March 2025.

Results: Findings indicate that a method-wise comparison of two protocols for second trimester abortion—Foley catheter with Misoprostol and Mifepristone with Misoprostol, involving 33 participants each. The average interval from induction to abortion was notably reduced in the Foley group (11.27±3.36 hours) in contrast to the Mifepristone group (29.75±3.92 hours), with a p-value of 0.0, reflecting strong statistical significance. The median induction time was 10.4 hours for Foley and 29.1 hours for Mifepristone, with the overall induction time varying from 5.1 to 18.2 hours in the Foley group and 24.2 to 37.6 hours in the Mifepristone group.

Conclusions: To conclude, the Foley catheter combined with misoprostol is a quicker and more economical approach, making it especially appropriate for low-resource environments or scenarios that require reduced induction times. Conversely, mifepristone combined with misoprostol offers a more thorough and dependable uterine evacuation, minimizing the requirement for surgical procedures.

Comparison of Pritchard and low dose magnesium sulphate regimen in patients with severe preeclampsia and eclampsia

2026-05-28T20:00:27+0530

Background: Hypertensive disorders of pregnancy, particularly preeclampsia and eclampsia, remain major contributors to maternal and perinatal morbidity and mortality. Magnesium sulphate (MgSO₄) is the drug of choice for seizure prophylaxis and control, but the optimal dosage regimen balancing efficacy and safety remains debated. The aim and objectives of the study were to compare the efficacy, safety, and maternal–fetal outcomes of the standard Pritchard regimen with low-dose MgSO₄ regimens (Zuspan and Dhaka) in patients with severe preeclampsia and eclampsia.

Methods: A prospective observational study was conducted in the Department of Obstetrics and Gynaecology, M. L. N. Medical College, Prayagraj, over one year, including 150 women diagnosed with severe preeclampsia or eclampsia. Participants were allocated to three groups receiving Pritchard, Zuspan, or Dhaka regimens. Maternal and perinatal outcomes, adverse effects, and recurrence of convulsions were compared using appropriate statistical tests.

Results: The recurrence of convulsions was comparable among the three groups (p=0.67). However, adverse effects such as loss of deep tendon reflexes (36.4% versus 10.4% versus 8.5%), decreased urine output (32.7% versus 6.3% versus 4.3%), and respiratory depression (23.6% versus 4.2% versus 2.1%) were significantly higher in the Pritchard group (p<0.05). Maternal and perinatal outcomes, including mortality and neonatal intensive care unit (NICU) admissions, showed no statistically significant differences.

Conclusion: Low-dose MgSO₄ regimens (Zuspan and Dhaka) are as effective as the Pritchard regimen in controlling eclamptic seizures but have fewer adverse effects, making them safer, more tolerable, and cost-effective, especially in resource-limited settings.

Effectiveness of an educational intervention on knowledge of postnatal exercises among antenatal mothers

2026-05-28T20:00:26+0530

Background: Postnatal exercises are important for maternal recovery after childbirth, supporting physical and psychological well-being and reducing postpartum complications. However, many antenatal mothers have limited awareness and practice of these exercises. Early educational interventions during the antenatal period can improve understanding and promote healthy postnatal practices.

Methods: A pre-experimental one-group pre-test post-test study was conducted among 60 antenatal mothers in a tertiary care hospital using a non-probability sampling technique. Knowledge was assessed before and after an educational intervention using a validated questionnaire. Data were analyzed using descriptive and inferential statistics, including the paired t-test and chi-square test.

Results: Knowledge scores improved from 6.93±2.99 in the pre-test to 12.67±3.41 in the post-test, showing a statistically significant difference (t=16.23, p<0.001). No significant association was found between baseline knowledge and selected demographic variables.

Conclusions: The findings indicate that the educational intervention effectively enhanced understanding of postnatal exercises among antenatal mothers. Including such sessions in routine antenatal care may support better maternal outcomes.

Efficacy and safety of tranexamic acid in reducing blood loss in lower segment caesarean section: a prospective, randomised, double-blind and case-controlled study

2026-05-28T20:00:26+0530

Background: Cesarean section (CS) rates are rising globally, and postpartum haemorrhage remains a major cause of maternal morbidity. Tranexamic acid (TXA), an antifibrinolytic agent, has been shown to reduce bleeding in various surgical settings, but its routine prophylactic use in CS requires further evaluation. This study aimed to assess the efficacy and safety of preoperative intravenous tranexamic acid in reducing blood loss during lower segment cesarean sections (LSCS).

Methods: This prospective, randomized, double-blind, placebo-controlled study was conducted at a tertiary care hospital in Chennai, India, from December 2015 to November 2016. A total of 100 term women undergoing LSCS under spinal anaesthesia were randomly assigned to receive either 1 gm TXA (n=50) or placebo (30 ml 5% dextrose, n=50) intravenously 20 minutes before skin incision. Both groups received 10 IU oxytocin after delivery. The primary outcome was estimated blood loss (EBL) calculated from changes in haematocrit. Secondary outcomes included postoperative hemoglobin (Hb), packed cell volume (PCV), the need for additional uterotonics, maternal side effects, neonatal APGAR scores, and thromboembolic events up to 6 weeks postpartum.

Results: The mean EBL was significantly lower in the TXA group compared to the placebo group (332. 62±172. 66 ml versus 413. 38±252. 21 ml; p=0.043). Postoperative Hb and PCV were preserved in the TXA group (with declines of 0.01 gm/dl and 0. 04%, respectively), whereas significant decreases occurred in the placebo group (declines of 1.00 gm/dl and 2.10%; p<0.0001). No patient in the TXA group experienced EBL>1000 ml versus two (4%) in the placebo group. Additional uterotonics were needed in 6% (TXA) and 12% (placebo) (p=0.294). Maternal side effects were mild and similar between groups (8% each). No thromboembolic events were observed in either group. Neonatal APGAR scores and NICU admission rates were comparable.

Conclusions: Preoperative intravenous tranexamic acid significantly reduces blood loss during and after caesarean section, with an excellent safety profile for both mother and neonate. Prophylactic TXA should be considered as a routine intervention in LSCS, particularly in settings where blood transfusion resources are limited.

Analysis of iatrogenic bladder injury in benign hysterectomy and risk factors in a tertiary care hospital

2026-05-28T20:00:22+0530

Background: Hysterectomy is the most common major gynecological surgery, and iatrogenic bladder injury is the commonest visceral injury during the procedure. High morbidity, economic, and legal implications are expected if not diagnosed and managed intra-operatively. Though the high-risk factors increase the incidence of this complication in benign hysterectomy, it may occur without any risk factor. This study was aimed at finding the incidence of iatrogenic bladder injury in benign hysterectomy, the risk factors and their significance level, and to discuss the methods to avoid this complication.

Methods: This retrospective observational cross-sectional study was conducted in the Department of Obstetrics and Gynecology, Mamata Medical College and Hospital, Khammam, over four years, including all gynecological hysterectomy cases for benign indications, excluding obstetric and malignant cases. All the relevant data predicting iatrogenic bladder injury, and also no risk cases, were collected from the medical records of the institution. Statistical analysis was done by standard descriptive statistics, frequency tables, and percentages for categorical variables using Microsoft excel-2021. The significance of risk factors was assessed by calculating p values, ORs, and 95% CIs. A p<0.05 was considered significant.

Results: Total abdominal hysterectomy (TAH) was the major approach (72.04%) of surgery. The overall incidence of bladder injury was 01.09%. and such injury occurred in 01.51% in TAH, as all the 19 cases of bladder injury occurred in this approach. The maximum number (n=11) of bladder injury occurred in post-caesarean cases (p=0.0041), followed by pelvic inflammation (n=06) with a p=0.0450.

Conclusions: Thorough knowledge of regional anatomy, risk factor assessment, careful and sharp dissection, and supervision by a surgeon of high volume will reduce the incidence of bladder injury in hysterectomy for benign indications.

Clinical predictors of successful trial of labour after two or more previous caesarean sections: development of a structured selection protocol from a prospective observational study

2026-05-28T20:00:20+0530

Background: Trial of labour after caesarean (TOLAC) in women with two or more previous lower segment caesarean sections (LSCS) remains underutilized because of concerns regarding uterine rupture and adverse maternal outcomes. Identification of reliable predictors may improve patient selection and optimize vaginal birth after caesarean (VBAC) success rates.

Methods: This prospective observational study was conducted over 18 months at a tertiary care teaching hospital in Maharashtra, India. A total of 113 women with ≥2 previous LSCS were included. Predictor variables including scar thickness, Bishop score, gestational age, maternal age, body mass index (BMI), previous vaginal delivery, neonatal birth weight and onset of labour were analysed using chi-square test followed by multivariable logistic regression.

Results: Among 113 women, 80 (70.80%) underwent TOLAC, of whom 65 (81.25%) achieved successful VBAC. Scar thickness >3 mm (p<0.001), Bishop score >6 (p<0.001), previous vaginal delivery (p<0.01), gestational age 37–40 weeks (p<0.001), BMI <30 kg/m² (p<0.05), neonatal birth weight <3.2 kg (p<0.05) and spontaneous onset of labour (p<0.05) were significant predictors. Multivariable logistic regression identified scar thickness >3 mm and Bishop score >6 as independent predictors.

Conclusions: TOLAC after ≥2 previous LSCS can be safely offered to carefully selected women. Integration of scar thickness and cervical favourability into structured institutional selection protocols improves VBAC success rates and supports evidence-based decision-making.

Revisiting active phase of labor in primigravida with the help of E-partograph

2026-05-28T20:00:20+0530

Background: Considering various geographical variations and the changing dynamics of medical health care provision, there is a need to revise the labor curve and find a geographical area, age and gestational age specific labor curve.

Methods: Observational study conducted in obstetrics and gynaecology department, M.G.M. Medical College, Indore, where all laboring primigravidas after applying inclusion criteria are monitored systematically with e-partogram for fetal heart sounds, uterine contractions, cervical dilatation and foetal head descent.

Result: Mean dilatation at adequate contraction is 5.8 cm means that active phase started from 5 to 6 cm of cervical dilatation onwards. The mean cervical dilatation rate in the active phase was 1.06 cm/hour with lowest acceptable rate of 0.44 cm/hour. Mean interval between adequate contraction and delivery (mean active phase duration) is 5.2 hours. At the statistical limits, the ‘active labor’ duration was 14 hours (mean + 2 SD) and the dilation rate was 0.44 cm/hour (mean − 2 SD).

Conclusion: Contrary to the generally held view, this study showed that nulliparous Indian women with spontaneous labor onset have longer ‘active’ labor duration and, slower dilation rates. If we follow Friedman’s labor norms, it could result in increased interventions. Hence, it would be sagacious to prepare a personalized labor curve for the local population served, based on their distinctive characteristics features together with shifting the definition of active phase onset to 6 cm could be beneficial in terms of unnecessary referral prevention, decreasing caesarean rates and increasing normal delivery rates.

Fetomaternal outcomes in pregnancies complicated by thrombocytopenia: a retrospective study

2026-05-28T20:00:18+0530

Background: Thrombocytopenia is defined as a platelet count below 1.5 lakh/mm³. After anaemia, it is the second most common haematological disorder encountered during pregnancy. It affects approximately 6-15% of pregnancies, with an average incidence of around 10%.

Methods: This was a hospital-based retrospective observational study conducted in the Department of Obstetrics and Gynaecology at C. U. Shah Medical College and Hospital from 1 January 2024 to 31 August 2024. A total of 75 pregnant women with thrombocytopenia out of 700 delivered cases during the study period were included in the study.

Results: Out of 700 delivered cases, 75 women were found to have thrombocytopenia, while 625 had normal platelet counts. The incidence of thrombocytopenia in the present study was 10.7%. Gestational thrombocytopenia was the most common cause. Postpartum hemorrhage was the most common maternal complication, while intrauterine growth restriction and prematurity were the most common neonatal complications.

Conclusions: Thrombocytopenia in pregnancy is associated with significant maternal and neonatal morbidity. Routine antenatal platelet count monitoring facilitates early diagnosis and timely management, thereby improving fetomaternal outcomes.

Retrospective descriptive study of postpartum hemorrhage: a hospital-based study

2026-05-28T20:00:17+0530

Background: Post-partum hemorrhage (PPH) remains one of the leading causes of maternal morbidity and mortality worldwide. Despite improvements in obstetric care, it continues to be a major contributor to preventable maternal deaths. This study aimed to determine the prevalence, etiological factors, risk determinants, management patterns, and maternal outcomes of post-partum hemorrhage in a tertiary care hospital.

Methods: This retrospective descriptive study was conducted in the department of obstetrics and gynecology, Sri Venkateshwaraa Medical College Hospital and Research Centre, from June 2022 to May 2025. A total of 2,510 deliveries were recorded during the study period. Cases of primary PPH were identified according to the World Health Organization definition (blood loss ≥500 ml after vaginal delivery or ≥1000 ml after caesarean section within 24 hours). Data were analysed using descriptive and inferential statistics.

Results: Among 2,510 deliveries, 70 women developed PPH, giving a prevalence of 2.8%. The majority of affected women were aged 20-34 years (82.9%) and multigravidas (52.9%). Uterine atony was the most common cause (78.6%), followed by traumatic causes (17.1%) and retained placental tissue (4.3%). Induced labour (17.1%) and prolonged labour (11.4%) were the leading associated risk factors. Medical management was successful in 90% of cases, while 10% required surgical intervention, including uterine artery ligation, compression sutures, and obstetric hysterectomy. Blood transfusion was required in 45.7% of patients. One maternal death (1.4%) occurred due to disseminated intravascular coagulation and hypovolemic shock.

Conclusions: The prevalence of PPH in this hospital-based study was 2.8%. Uterine atony remained the predominant cause. Early recognition, prompt medical management, and timely intervention to surgical procedures were effective in reducing maternal morbidity and mortality.

Injectable contraceptive medroxyprogesterone acetate: utilization and experiences among currently married women residing in tea gardens of a block in Darjeeling district, West Bengal, India

2026-05-28T20:00:16+0530

Background: India has included injectable medroxyprogesterone acetate (MPA) into the Antara Programme to address its high efficacy, though adherence remains a concern. This study assessed the utilization patterns and experiences of currently married women using injectable MPA in tea gardens of Darjeeling district, West Bengal.

Methods: A community-based cross-sectional study was conducted from October 2023 to September 2024 in all tea gardens of Naxalbari block. Complete enumeration included 127 currently married women aged 15–49 years who had received at least one MPA dose in the previous year from sub-centres. Participants were eligible for up to four doses annually. Data were collected through face-to-face interviews using a pre-designed, pre-tested schedule after informed consent, and analyzed using descriptive statistics.

Results: Most participants were aged 21–25 years (34.6%), with a mean age of 26.7±5.8 years, and 50.3% were primiparous. Injectable MPA was the first contraceptive for 55.9% of women, and 95.3% received information from ASHA workers. All women received the first dose, while 84, 75, and 23 received the second, third, and fourth doses, respectively. Side effects were reported by 100, 64, 60, and 19 women after successive doses. Overall, 81.9% discontinued use mainly due to side effects, predominantly amenorrhea. No pregnancies were reported within the three-month effective period after any dose.

Conclusions: Injectable MPA is an effective contraceptive, often used as a first method by young women. ASHA workers facilitate its uptake, but side effects especially amenorrhea is the primary cause for discontinuation.

Effect of oral contraceptive pill on central corneal thickness and intraocular pressure in young females

2026-05-28T20:00:10+0530

Background: The usage of oral contraceptive pills (OCP) consisting of estrogen and progesterone can interfere with central corneal thickness (CCT) results due to hormonal fluctuations. This study assessed the impact of oral contraceptive pill usage on central corneal thickness estimations in healthy young women.

Methods: This prospective study comprised forty women utilizing OCP for contraception (group 1) and forty control subjects utilizing OCP (group 2). All participants revealed no history of systemic or ocular medical conditions. CCT measurements were acquired using an ultrasonic pachymeter, and intraocular pressure (IOP) readings were evaluated with a noncontact tonometer during a patient's hospital visit. Demographic information and body mass index (BMI) scores of participants were documented.

Results: The mean ages were 28.5±6.08 for OCP+ patients (group 1) and 28.3±5.85 for OCP- patients (group 2) (P=0.88). The mean central corneal thickness (CCT) in group 1 was substantially higher than in group 2, with measurements of 575±39.4 μm and 518±28.8 μm, respectively (p=0.001). The average intraocular pressure (IOP) was 15.6±1.52 mmHg in group 1 and 15.1±1.14 mmHg in group 2 (p=0.16). The mean BMI values were 28.5±6.08 kg/m² for group 1 and 28.3±5.85 kg/m² for group 2 (p=0.91).

Conclusions: Our data suggested that CCT values were significantly elevated in patients utilizing OCP. Ophthalmologists must acknowledge the potential for increased CCT in these individuals.

Pregnancy outcome in women with first trimester vaginal bleeding: a prospective cohort study

2026-05-28T20:00:10+0530

Background: 15 –25% of all pregnant women experience first trimester vaginal bleeding, a major obstetric hazard to the growing embryo. This study aimed to study the maternal and fetal outcome in women with first trimester vaginal bleeding.

Methods: This was a prospective study conducted in Department of Obstetrics and Gynecology, Credence Hospital, Thiruvananthapuram, Kerala over a period of 18 months. All women with singleton pregnancy with first trimester vaginal bleeding, were included and compared with group without history of first trimester vaginal bleeding during the same period. A detailed history was taken, the characteristics of all the patients and outcome of mother and baby were noted and data was collected through self-administered pretested structured questionnaire.

Results: It showed that study variables such as age, socio-economic status, BMI, obstetric score, chronic hypertension, hypothyroidism were found to have no statistically significant association with vaginal bleeding. Mode of conception, H/O bleeding in previous pregnancies, pre gestational diabetes were statistically significant. Variables such as GDM, PROM, FGR, preterm delivery, mode of delivery, gestational age were examined as statistically significant risk factors of first trimester vaginal bleeding. Incidence of miscarriage, gestational diabetes, PPROM, FGR, Preterm delivery, Low birth weight, Low APGAR score and NICU admissions were higher in subjects with first trimester bleeding when compared to comparative group.

Conclusions: Such high-risk cases need utmost care and well-equipped medical center so that risk can be reduced or prevented.

Comparative evaluation of salivary pH, gingival status and dental caries among menstrual and post-menopausal women in Chengalpattu district, Tamil Nadu: a cross-sectional study

2026-05-28T20:00:08+0530

Background: Hormonal fluctuations during different life stages in women can influence oral health, particularly salivary pH, gingival status, and dental caries susceptibility. Aim was to compare salivary pH, gingival status, and dental caries experience among menstrual and post-menopausal women in the Chengalpattu district.

Methods: A cross-sectional study was conducted among 80 women, divided into two groups: menstrual women (n=40) and post-menopausal women (n=40). Salivary pH was measured using pH indicator strips. Gingival status was assessed using the Loe and Silness Gingival Index (1963), and dental caries experience was recorded using the DMFT index (1938). Data were analyzed using SPSS software.

Results: The mean salivary pH was significantly lower in post-menopausal women (5.91±0.81) compared to menstrual women (6.46±0.98) (p<0.05). The mean DMFT score was significantly higher among post-menopausal women (10.23±5.97) than menstrual women (4.33±3.73) (p=0.000). No significant difference was noted in gingival index scores between the groups (p=0.8).

Conclusions: Post-menopausal women exhibited lower salivary pH and higher dental caries experience, suggesting that hormonal decline during menopause may adversely affect oral health. However, gingival health remained comparable between the two groups. Regular preventive dental care is essential, especially for women undergoing menopausal transition.

An audit of competency based medical education for Indian medical graduates: a facilitators' perspective

2026-05-28T19:59:20+0530

Background: The implementation of competency-based medical education (CBME) in India represents a transformative shift in undergraduate medical training, aiming to align graduate competencies with societal health-care needs. While the framework is conceptually robust, its success depends largely on faculty engagement and institutional readiness. Objectives were to explore faculty perceptions regarding the implementation of CBME, identify perceived strengths and operational challenges, and highlight areas requiring institutional support for sustainable delivery.

Methods: A cross-sectional, questionnaire-based pilot audit was conducted among undergraduate medical faculty involved in CBME delivery. A structured tool incorporating Likert-scale items and open-ended questions was used. Quantitative data were analyzed descriptively, while qualitative responses underwent thematic analysis.

Results: Thirty-three faculty members participated. Most respondents acknowledged CBME as educationally superior to the traditional curriculum and better aligned with competency attainment. However, substantial challenges were reported, including inadequate faculty strength, excessive documentation workload, time-intensive competency mapping, and uneven faculty sensitization.

Conclusions: Although CBME is well accepted in principle, significant structural and operational barriers limit its effective implementation. Addressing faculty workload, manpower shortages, and training gaps is essential to ensure fidelity to CBME objectives.

Thyroid dysfunction and autoimmune thyroid disease in women with polycystic ovarian syndrome: a case-control study

2026-05-28T19:59:20+0530

Background: Polycystic ovarian syndrome (PCOS) is one of the most prevalent endocrine disorders affecting women of reproductive age. It is a multifactorial condition characterized by chronic anovulation, hyperandrogenism, and polycystic ovarian morphology. Emerging evidence suggests a link between PCOS and thyroid dysfunction, indicating shared pathophysiological and possibly autoimmune mechanisms. The main objective was to determine the prevalence of thyroid dysfunction and thyroid autoimmunity in women with PCOS and evaluate their association with clinical, metabolic, and endocrine parameters.

Methods: This hospital-based case–control study consisted of 126 women, comprising 63 cases diagnosed with PCOS and 63 age- and parity-matched healthy controls. Clinical, biochemical, and hormonal parameters were evaluated, including thyroid function tests (TSH and FT4), anti-thyroid peroxidase antibodies (anti-TPO), lipid profile, glucose metabolism, and gonadotropin levels. Data were analysed using SPSS version 20, with p<0.05 considered statistically significant.

Results: Thyroid dysfunction was significantly higher among PCOS women (26.98%) than controls (7.9%) (p=0.015). Subclinical hypothyroidism was the most frequent thyroid disorder (23.8% vs 7.9%). Anti-TPO antibody positivity was observed in 15.9% of PCOS women compared to 1.6% of controls (p=0.005). PCOS participants had higher BMI, triglycerides, total cholesterol, fasting glucose, HbA1c, LH and LH/FSH ratio, and free testosterone levels than controls.

Conclusions: Thyroid dysfunction and autoimmunity are significantly more prevalent among women with PCOS and appear to contribute to the metabolic and hormonal derangements characteristic of the syndrome. Routine screening for thyroid function and autoimmunity should be integral to the clinical evaluation and management of PCOS.

Maternal urinary iodine status during antepartum and postpartum periods and its association with neonatal TSH: a hospital-based study from eastern India

2026-05-28T19:59:18+0530

Background: Iodine requirement increases during pregnancy and early postpartum, and inadequate iodine intake may adversely influence neonatal thyroid function. Region-specific data from eastern India remain limited. Objective was to assess maternal urinary iodine concentration (UIC) during antepartum and postpartum periods and evaluate its association with neonatal thyroid-stimulating hormone (TSH).

Methods: This hospital-based prospective observational study (December 2024 to April 2025) included 70 mother-neonate dyads. Maternal midstream urine samples were collected during antepartum and postpartum periods, and UIC was measured using the Sandell-Kolthoff method. Neonatal screening samples were obtained on day 3-5 of life, and TSH and free T4 (fT4) were measured by chemiluminescent immunoassay. Maternal iodine status was categorized using WHO pregnancy cut-offs. Associations between maternal UIC and neonatal thyroid parameters were evaluated using Spearman’s correlation. Receiver operating characteristic (ROC) analysis was performed to assess the ability of maternal UIC to predict neonatal TSH >5 mIU/l.

Results: Mean antepartum and postpartum UIC were 255.6±78 µg/l and 249.6±82 µg/l, respectively. Iodine deficiency (<150 µg/l) was observed in 18.6% (antepartum) and 22.9% (postpartum) of mothers. Mean neonatal TSH was 4.44±3.1 mIU/l and mean neonatal fT4 was 3.04±1.1 ng/dl; 47.1% of neonates had TSH ≥5 mIU/l. Antepartum UIC showed a significant inverse correlation with neonatal TSH (ρ=−0.625, p<0.001), and postpartum UIC also correlated inversely with neonatal TSH (ρ=−0.503, p<0.001). No significant association was observed between maternal UIC and neonatal fT4. Antepartum UIC demonstrated good predictive performance for neonatal TSH>5 mIU/l (AUC=0.830) at a cut-off of 222.8 µg/l (sensitivity 69.7%, specificity 94.6%).

Conclusions: Maternal UIC during both antepartum and postpartum periods is inversely associated with neonatal TSH, highlighting the influence of maternal iodine status on neonatal thyroid function. Despite overall iodine sufficiency, a subset of mothers remained iodine-deficient, underscoring the need for continued monitoring of iodine nutrition during pregnancy and early postpartum.

A prospective observational study on clinical profile and maternal outcome of pregnant women with PROM greater than 28 weeks to onset of labour

2026-05-28T19:59:15+0530

Background: Prelabour rupture of membranes (PROM) is a common obstetric condition associated with significant maternal morbidity. This study aimed to study clinical profile, associated etiological factors and maternal outcome in pregnancy with PROM.

Methods: This prospective observational study was done at a tertiary health care centre in south Gujarat. All consenting women with PROM (28 weeks to onset of labour) admitted in labour room of a tertiary health care centre in south Gujarat were enrolled in this study.

Results: Majority of patients belonged to age group of 18-25 years (53.3%). Majority of the patients were from normal BMI (76.3%), literate (62.7%), primigravida (54.7%). The majority of women 66.7% presented with leaking per vaginum, while 33.3% presented with abdominal pain without cervical dilatation with incidental detection of PROM. With respect to gestational age, 58% of pregnancies resulted in term delivery, while 42% resulted in preterm delivery. In our study 69.33% had moderate anemia, 25% had positive high vaginal swab for bacterial vaginosis. 70.3% had poor bishop’s score, 61.3% of our subjects requires induction of labour, 79.7% subjects had leaking to delivery interval was >12 hours. In this study, 54.6 cases underwent LSCS. Most common indication of LSCS was fetal distress (48.8%). Puerperal pyrexia was the most common maternal complication (14.3%), 30.7% of our subjects had lactational failure.

Conclusions: PROM is a significant obstetric condition associated with increased maternal morbidity. Infection-related complications are the major contributors. Early diagnosis, timely antibiotic therapy, and appropriate obstetric management can significantly improve maternal outcomes.

An observational study on different gynaecological problems in adolescents in a tertiary care centre

2026-05-28T19:59:15+0530

Background: Adolescence (10–19 years) is a transformative period marked by significant biological and physiological changes. In India, adolescents constitute over 21.4% of the population. Gynaecological concerns, particularly menstrual irregularities, are prevalent during this phase due to the immaturity of the hypothalamic-pituitary-ovarian axis. This study aims to identify and analyse the wide spectrum of gynaecological disorders among adolescent females to improve reproductive health outcomes for future.

Methods: A hospital-based, single-centre cross-sectional observational study was conducted at LLRM Medical College and hospital in Meerut, Uttar Pradesh, India, from September 2025 to February 2026. The study included 500 adolescent females (10-19 years) attending the outpatient department. Data were collected through detailed clinical histories, physical examinations, and necessary investigations (blood tests and imaging). Statistical analysis was performed using frequencies and percentages.

Results: The majority of participants belonged to the mid-adolescent group (14-16 years; 53.8%) and resided in urban areas (63%). A significant "dual burden" of nutrition was observed, with 18.6% underweight and 38.4% overweight/obese. Educational levels were notably low with 43.4% being school dropouts. Menstrual problems were the leading complaint (69.6%). Oligomenorrhoea being the most common specific disorder (54.31%) among menstrual disorder. The most common clinical diagnosis was Polycystic Ovary Syndrome (17.8%), followed by Abnormal Uterine Bleeding (11.4%) and simple ovarian cysts (9.6%). Other findings included vaginal discharge (13.8%) and pelvic inflammatory disease (6.8%).

Conclusions: Menstrual disturbances and PCOS constitute the primary gynaecological burden among adolescents in this region. The high prevalence of these conditions along with nutritional imbalances and low educational status highlights a critical need for targeted health education and adolescent-friendly reproductive health services. Early intervention and lifestyle modifications are essential to mitigate long-term reproductive morbidity.

Comparison of Edinburgh postnatal depression scale scores between high-risk pregnancy and normal pregnancy

2026-05-28T19:59:14+0530

Background: Postpartum depression (PPD) is a significant perinatal mental health disorder with a reported prevalence of 8-20% globally. Obstetricians serve as the frontline clinicians best positioned to screen for PPD. However, universal screening remains inconsistently implemented in routine clinical practice. This study aimed to compare Edinburgh postnatal depression scale (EPDS) scores between women with high-risk pregnancies and those with normal pregnancies, and to identify specific high-risk subgroups that may warrant targeted screening.

Methods: A prospective analytical study was conducted between January 2020 and July 2021 in the department of obstetrics and gynecology at Vydehi Institute of Medical Sciences and Research Centre, Bengaluru. One hundred postpartum women were enrolled. The validated EPDS questionnaire was administered 72 hours post-delivery in a private setting. An EPDS score of ≥9 was used as the positive screening threshold. Statistical analysis employed unpaired t-tests and chi-square tests as appropriate.

Results: Of 100 women screened, 51 (51%) had an EPDS score of ≥9. Four variables were statistically significantly associated with a positive screen: employment status (47.1% employed vs. 18.4% housewife with EPDS≥9; p=0.002), lower gestational age (mean 37.37±3.50 weeks versus 38.46±1.38 weeks; p=0.043), neonatal NICU admission (27.5% versus 4.1%; p=0.001), and delayed breastfeeding initiation (33.3% versus 12.2%; p=0.012). Age, religion, educational status, duration of marriage, parity, mode of delivery, presence of comorbidities, neonatal gender, and birth weight did not demonstrate statistically significant associations.

Conclusions: Employed women, women who delivered preterm, mothers whose neonates required NICU admission, and those with delayed breastfeeding initiation demonstrated significantly higher EPDS scores. These groups should be prioritised for postpartum depression screening in clinical practice.

Association between umbilical cord coiling index and adverse perinatal outcomes: a prospective observational study

2026-05-28T19:59:13+0530

Background: The umbilical cord coiling index (UCI) has been proposed as a valuable parameter in predicting adverse perinatal outcomes. Abnormal coiling patterns, including hypocoiling and hypercoiling, are thought to reflect aberrant vascular development, potentially resulting in compromised fetal well-being. Objectives were to determine the association between UCI patterns (normocoiling, hypocoiling, and hypercoiling) and maternal and neonatal outcomes in singleton pregnancies.

Methods: A prospective observational study was conducted from November 2023 to November 2024 at a tertiary care center. A total of 250 pregnant women with singleton pregnancies beyond 28 weeks of gestation were enrolled. Postnatally, UCI was calculated by dividing the number of complete vascular coils by the total cord length in centimeters. Values below the 10^th percentile were labeled hypocoiled (<0.07), and above the 90^th percentile were labeled hypercoiled (>0.4). Outcomes, including mode of delivery, birth weight, meconium-stained liquor, APGAR scores, NICU admissions, and maternal risk factors, were analyzed.

Results: Out of 250 cases, 199 (79.6%) showed normocoiling, 26 (10.4%) had hypocoiling, and 25 (10%) exhibited hypercoiling. Hypercoiled cords were significantly associated with preterm delivery 11 (44%), very low birth weight 10 (40%), NICU admission 15 (60%), and low APGAR scores at 1 and 5 minutes is 20 (80%) and 13 (52%) respectively. Hypocoiled cords showed a strong association with meconium-stained liquor 15 (57.7%) and high cesarean delivery rates 22 (84.6%). Maternal comorbidities did not show statistically significant differences among the groups.

Conclusions: Both hypocoiled and hypercoiled umbilical cords are significantly associated with adverse perinatal outcomes. UCI serves as a useful postnatal marker and has potential as a prenatal predictive tool for identifying fetuses at risk.

Role of hysteroscopy in evaluating patients with abnormal uterine bleeding and its correlation with histopathology

2026-05-28T19:59:10+0530

Background: Abnormal uterine bleeding (AUB) is a common gynaecological complaint with diverse aetiologies that often require precise evaluation to guide management. Hysteroscopy, by allowing direct visualization of the uterine cavity, has emerged as a superior diagnostic tool compared to traditional methods such as dilation and curettage. Objectives were to determine the spectrum of intrauterine abnormalities contributing to AUB through hysteroscopic evaluation, assess the diagnostic potential of hysteroscopy, and correlate its findings with histopathology.

Methods: An analytical observational study was conducted in the department of obstetrics and gynecology at Sparsh Hospital, Bangalore, from January 2023 to December 2024, involving 210 women with AUB. All participants underwent detailed clinical evaluation, transvaginal sonography (TVS), hysteroscopy, and endometrial biopsy. Hysteroscopic findings were compared with histopathological results, and diagnostic validity parameters- sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and overall accuracy- were calculated using SPSS v20.

Results: Most patients were aged 41-50 years (35.24%). Heavy menstrual bleeding was the commonest presentation (36.6%). Hysteroscopy revealed endometrial polyps (30.47%) and hyperplasia (21.4%) as predominant findings. Histopathology confirmed polyps in 28.5% and hyperplasia in 18.08%. Hysteroscopy showed sensitivity of 95.18%, specificity of 84.92%, PPV of 82%, NPV of 96.31%, and diagnostic accuracy of 90.05% in comparison to histopathology.

Conclusions: Hysteroscopy is a highly accurate, safe, and minimally invasive diagnostic modality for evaluating AUB. When combined with histopathology, it serves as the gold standard for identifying intrauterine pathology and guiding appropriate management.

Optimizing in vitro fertilization outcomes in non-receptive endometrium using combined histological dating and endometrial receptivity array: a retrospective study

2026-05-28T19:59:09+0530

Background: Precise identification of the window of implantation (WOI) is crucial for optimizing embryo transfer and improving assisted reproductive technology (ART) outcomes. While the endometrial receptivity array (ERA) evaluates molecular receptivity, histological endometrial dating is a simpler, cost-effective alternative. However, comparative evidence is limited. This study assessed concordance between ERA and histological dating and evaluated whether their combined use improves outcomes in patients with non-receptive endometrium.

Methods: This retrospective study included 886 women undergoing ART between January 2021 and December 2025. Patients were categorized as ERA-receptive (n=562) or ERA non-receptive (n=324). Among non-receptive patients, outcomes were compared between those who underwent histological endometrial biopsy (EB) and those who did not. Subgroup analysis was conducted based on histological phase (proliferative versus secretory). Primary outcomes included clinical pregnancy, implantation, live birth, miscarriage, and ongoing pregnancy rates.

Results: ERA-receptive patients showed significantly higher clinical pregnancy and implantation rates compared to non-receptive patients. Within the non-receptive group, histological evaluation was associated with improved clinical pregnancy (38.38% versus 23.02%), implantation (17.99% versus 9.73%), and live birth rates (31.82% versus 15.08%). Secretory-phase endometrium demonstrated superior clinical pregnancy (44.53% versus 24.59%) and live birth rates (40.15% versus 13.11%) compared to proliferative phase.

Conclusions: Both ERA and histological dating are associated with improved ART outcomes. Histological assessment provides complementary value in ERA non-receptive patients. An integrated molecular and histological approach may enhance embryo transfer timing and improve reproductive success.

Correlation between maternal haemoglobin and Bishop score at admission, duration of active phase of labour, Apgar score and neonatal birth weight in normal vaginal delivery: a hospital-based observational cross-sectional study

2026-05-28T19:59:03+0530

Background: Maternal anaemia is one of the most prevalent nutritional disorders complicating pregnancy, particularly in low- and middle-income countries. It is associated with adverse maternal and neonatal outcomes; however, its influence on intrapartum parameters such as Bishop score and duration of active phase of labour remains inadequately explored.

Methods: A hospital-based observational cross-sectional study was conducted in the Department of Obstetrics and Gynaecology, Maharani Laxmi Bai Medical College, Jhansi, Uttar Pradesh, from May 2025 to April 2026. A total of 200 eligible term pregnant women undergoing normal vaginal delivery were enrolled. Maternal haemoglobin was measured at admission using an automated haematology analyser. Bishop score, duration of active phase of labour, Apgar scores at 1 and 5 minutes, and neonatal birth weight were recorded. Data were analysed using Chi-square test and ANOVA.

Results: No statistically significant association was found between maternal haemoglobin levels and Bishop score (p=0.56) or duration of active phase of labour (p=0.38). Although lower Apgar scores at 1 minute were more frequent among severely anaemic mothers (53.85%), this did not reach statistical significance (p=0.06), and 5-minute scores showed no significant difference (p=0.41). A highly significant association was observed between maternal haemoglobin and neonatal birth weight (p<0.0001), with 88% of severely anaemic mothers delivering low birth weight (LBW) neonates. NICU admission rates were also significantly higher in anaemic mothers (p=0.004). An inverse relationship between Bishop score and labour duration was also demonstrated (p=0.01).

Conclusions: Maternal haemoglobin levels do not significantly influence Bishop score or the duration of the active phase of labour but have a strong and significant impact on neonatal birth weight and NICU admission rates. Early detection, prevention, and effective management of maternal anaemia during antenatal care are essential to improve neonatal outcomes.

Effect of malignancy on semen quality in men undergoing fertility preservation prior to cancer treatment

2026-05-28T19:58:52+0530

Background: Advances in cancer therapy have significantly improved survival rates, making fertility preservation an essential component of cancer care in young men. While gonadotoxic effects of chemotherapy and radiotherapy are well established, the impact of malignancy itself on semen parameters prior to treatment remains controversial. To evaluate semen parameters in men with various malignancies prior to chemotherapy or radiotherapy and to compare semen quality between testicular and non-testicular cancers.

Methods: This single-center retrospective study included 130 male cancer patients referred for sperm cryopreservation between January 2015 and December 2024. Patients who had received prior chemotherapy or radiotherapy were excluded. Semen samples obtained before initiation of cancer treatment were analyzed for sperm concentration, total motility and progressive motility according to World Health Organization (WHO) criteria, 6th edition 2021. Semen parameters were compared across different malignancy types, including testicular and non-testicular cancers.

Results: The mean age was 25.25 years. Out of 130 patients, 104 patients (80%) had abnormal morphology. Normozoospermia was observed in 13.07% of patients, while 86.9% had at least one semen abnormality. Testicular malignancies were associated with a significantly higher proportion of subnormal sperm concentration (<16 million/ml) compared to non-testicular cancers (58.1% vs. 35.6%, p=0.015). Total sperm motility showed a significant association with cancer type (p=0.034), with hematological and musculoskeletal malignancies demonstrating higher rates of reduced motility. Progressive motility did not differ significantly between testicular and non-testicular cancers.

Conclusions: A substantial proportion of men with cancer exhibit impaired semen parameters even before initiation of gonadotoxic therapy. Testicular malignancy is significantly associated with reduced sperm concentration, while systemic malignancies may adversely affect sperm motility. Early referral for fertility preservation should be strongly recommended for all reproductive-age men diagnosed with cancer.

Giant cervical leiomyoma presenting as severe abnormal uterine bleeding and symptomatic anaemia in a perimenopausal woman: a case report

2026-05-19T07:11:56+0530

Cervical leiomyoma is a rare benign smooth muscle tumor arising from the uterine cervix, accounting for less than 5% of all uterine fibroids. Large cervical myomas may cause abnormal uterine bleeding, pelvic pressure symptoms, urinary complaints, and operative difficulties due to distortion of adjacent pelvic anatomy. A 52-year-old multiparous woman was referred with recurrent heavy vaginal bleeding for three months, worsening over the preceding ten days with passage of blood clots. She developed symptomatic anemia requiring blood transfusion. Pelvic examination revealed a large smooth mass occupying the vaginal canal arising from the cervix. Ultrasonography demonstrated a well-defined cervical mass measuring 9.12×7.38×8.11 cm. The patient underwent total abdominal hysterectomy with bilateral salpingo-oophorectomy. Giant cervical leiomyoma should be considered in women presenting with severe abnormal uterine bleeding and a cervical mass. Proper diagnosis and definitive surgical management are essential for favorable outcomes.

Ethanol sclerotherapy twice and one laparoscopic surgery for stage IV pelvic endometriosis and bilateral ovarian endometrioma over two decades: a case report

2026-05-08T06:44:02+0530

In January 2008, Mrs. BP, at the age of 28 years, a para one, live child one, previous lower segment caesarean section (LSCS), and an ovarian cyst, left endometrioma, underwent laparotomy and ovarian cystectomy under spinal anaesthesia. On 12 July 2008, a scan revealed well defined cystic lesions in the right adnexa, 5.0×4.8 cm, and 2.3×2.1 cm and left ovary two cysts measuring 1.8×1.2, and 2.6×1.6 cm. In December 2008, operative laparoscopy was performed. Adhesiolysis, fulguration with dessication of all the visible endometriotic lesions, right ovarian chocolate cystectomy, 10×8 cm. was done. Left ovary had a 1.5 cm endometriotic cyst, that was drained and cyst wall cauterized. Pouch of Douglas, the bowel was pulled up. Methylene blue chromotubation for the patency of the fallopian tubes was positive on both the sides. Diagnosis, stage IV endometriosis. She was treated with ovulogens for two or three cycles. This resulted in ovarian cyst formation, hence stopped. On 17 April 2010, ultrasonography (USG) evidence of a large recurrent right ovarian endometrioma of 10×9 cm one and a half years after the laparoscopic management of stage IV endometriosis in 2008. The first ethanol sclerotherapy (EST) was done in this case on 27 November 2010, under USG guidance. She conceived spontaneously in 2018. Second delivery by LSCS in USA, a boy 4.125 kg on 05 December 2018. Left ovarian chocolate cyst noted in February 2020, EST was done a second time. Aspirated 120 ml of chocolate thick material. On 24 February 2020, injected 7 ml of absolute alcohol into the left ovarian chocolate cyst under ultrasound guidance. She had a second child, she could avoid a repeat major surgery, both the objectives could be achieved and were facilitated by EST done on two occasions. EST serves to ameliorate endometriosis and serves as an additional modality of treatment in select cases.

Deep-infiltrating endometriosis with primary presentation as obstructive uropathy: report of two cases

2026-05-28T20:01:51+0530

Endometriosis can have a broad spectrum of presentation and may sometimes affect/encase ureters leading to scarring, adhesion formation and obstruction resulting in backpressure changes in kidneys and ureters. Ureteral endometriosis is generally asymptomatic for long term. By the time symptoms arise, renal damage can be irreversible. Two of our cases had an unusual presentation of flank pain, mimicking urological pathology. Both had obstructive uropathy without any of the typical gynecological features of endometriosis like dysmenorrhea, chronic pelvic pain or infertility. One had a unilateral nonfunctional kidney due to long standing hydroureteronephrosis, for which a nephrectomy was done. In other, obstructive uropathy was managed with bilateral percutaneous nephrostomy. Fertility-preserving surgery for endometriosis was done in both the cases. To conclude, endometriosis can have non-gynecological presentation also. So, in reproductive age females presenting with obstructive uropathy, endometriosis should always be kept as differential diagnosis. Endometriosis can be a silent killer for kidneys.

Pseudoxanthomatous salpingitis masquerading as a tubo-ovarian malignancy in a patient with endometriosis: a rare case report

2026-05-28T20:01:50+0530

Pseudoxanthomatous salpingitis (PXS), also known as pigmentosis tubae, is an extremely rare benign inflammatory condition of the fallopian tube characterised by the presence of lipofuscin- and hemosiderin-laden macrophages within the lamina propria. Owing to its gross appearance and radiological findings, it may closely mimic tubo-ovarian malignancy, leading to diagnostic dilemma. We report a case of a 40-year-old nulligravida with a history of endometriosis who presented with acute abdomen and was radiologically diagnosed as a complex ovarian mass with markedly raised CA-125 levels. Intraoperatively, a tubo-ovarian mass with chocolate-coloured fluid was noted. Histopathological examination revealed features consistent with pseudoxanthomatous salpingitis associated with ovarian endometriosis. This case highlights the importance of considering PXS in the differential diagnosis of tubo-ovarian masses, especially in patients with endometriosis, to avoid overtreatment. Early recognition of this rare entity can help avoid overtreatment, especially in fertility-desiring patients.

A rare case report on ovarian dermoid in hysterectomy patient

2026-05-28T20:00:38+0530

Ovarian dermoid cysts, or mature cystic teratomas (MCT), are benign germ cell tumors, accounts for about 10-20% of ovarian tumors. It contains tissues derived from ectoderm, mesoderm, and endoderm. While common in younger women, they are rare in postmenopausal and hysterectomized individuals, with a small percentage exhibiting malignant potential. Here we present a case of 59 years old patient, who was hysterectomised 31 years ago who presented with complaints of abdominal pain. Ultrasound image revealed left ovarian dermoid cyst. patient underwent diagnostic laproscopy followed by minilaprotomy and left ovarian cystectomy. The postoperative period was uneventful. Histopathology confirmed MCT. ovarian dermoid cysts should remain in the differential diagnosis of adnexal masses in post hysterectomy patients, early imaging and appropriate surgical management prevent complications such as torsion and rupture.

Conservative management of cerebral arteriovenous malformations in pregnancy

2026-05-28T20:00:36+0530

We report two cases of pregnant women diagnosed with unruptured cerebral arteriovenous malformations (AVM), each with distinct clinical presentations. One had history of focal seizures since adolescence. The other woman had history of an unevaluated focal neurological deficit prior to conception. During pregnancy, assessment with neuroimaging revealed an unruptured AVM. In both cases, a multidisciplinary team involving obstetricians, neurologists, neurosurgeons, and anesthesiologists was engaged to formulate the management plan. Considering the stability of the patients, conservative management was chosen and the pregnancy was closely monitored. The patient remained neurologically stable throughout gestation. Delivery planning aimed to minimize maternal hemodynamic stress and the risk of AVM rupture. Both cases underwent Caesarean delivery delivery in controlled conditions. There were no intraoperative, postpartum or neonatal complications.

The psychiatric ovarian cyst - a case report on psychotropic drug induced large ovarian mass

2026-05-28T20:00:29+0530

Psychotropic medications used in bipolar affective disorder (BPAD) can disrupt the hypothalamic–pituitary–gonadal axis, leading to hyperprolactinemia, anovulation, and polycystic ovarian morphology. We report the case of a 29-year-old woman with BPAD on long-term multidrug therapy who presented with secondary amenorrhea, infertility, and a large multiloculated ovarian cyst. Evaluation revealed hyperprolactinemia and features mimicking polycystic ovary syndrome. Management included discontinuation of prolactin-elevating drugs and temporary use of endoxifen for psychiatric stabilization. Ultrasound-guided aspiration of enlarged follicles confirmed the functional nature of the cyst. However, persistent follicular enlargement suggested impaired ovulation, likely related to the anti-estrogenic effects of endoxifen. Following its withdrawal, ovulation induction with letrozole and intrauterine insemination resulted in successful conception. This case highlights the reversible nature of psychotropic-induced endocrine dysfunction and emphasizes the importance of individualized, multidisciplinary management.

Postpartum expulsion of a massive degenerated intramural–submucosal fibroid following emergency caesarean section: a rare case report

2026-05-28T20:00:24+0530

Large uterine fibroids complicating pregnancy may cause significant obstetric morbidity, including malpresentation, foetal growth restriction, and postpartum complications. Spontaneous fibroid expulsion following caesarean delivery is extremely uncommon, particularly when involving large intramural lesions. A 37-year-old primigravida with a rapidly enlarging intramural–submucosal fibroid presented with severe early-onset foetal growth restriction and abnormal Doppler studies. She underwent an emergency lower segment caesarean section at 31+ weeks, delivering a preterm male neonate. Postpartum recovery was initially uneventful; however, the patient developed persistent fever and subsequently presented on postoperative day 32 with severe abdominal pain and a large foul-smelling mass protruding through the vagina. Imaging revealed absence of the previously documented fibroid and presence of a large necrotic mass extending from the uterine cavity to the vaginal canal, consistent with spontaneous fibroid expulsion. Due to extensive necrosis and infection, a total abdominal hysterectomy was performed. Massive intramural fibroids in pregnancy require close surveillance even after caesarean delivery. Postpartum expulsion, though rare, may occur and prompt recognition is essential to prevent sepsis and maternal morbidity.

Jain's point -a safe laparoscopic entry technique to avoid bowel injury

2026-05-28T20:00:18+0530

Laparoscopic entry is a critical step in minimally invasive surgery, often associated with iatrogenic complications such as bowel or vascular injury. Jain’s Point, a novel entry site located in the left upper quadrant, has been proposed to reduce these risks, especially in patients with previous abdominal surgeries. We present a case where Jain’s point allowed safe laparoscopic access in a patient with abdominal wall adhesion with bowel due to prior surgery.

The lantern on the dome of St. Paul's sign in cervical fibroid: a rare presentation and successful outcome

2026-05-28T20:00:14+0530

Uterine fibroids represent the most common benign tumours of the uterus and are typically located in the uterine body. Cervical fibroids are rare, accounting for only 1–2% of cases. We present the case of 24-year-old female, who was p1+0. She presented to our side with complaints of lower abdominal pain, menorrhagia and frequent micturition since past 1 year. Non-tender, firm, immobile abdominal mass equivalent to a 28-week gravid uterus, with smooth surface and regular margins, was detected on examination.” Ultrasound showed bulky uterus with large fibroid compressing bilateral lower ureter leading as bilateral mild hydronephrosis. Computed tomography report showed similar findings, large posterior fibroid with central degenerative changes with bilateral hydroureteronephrosis secondary to extrinsic ureteric compression by the fibroid. Surgical management consisted of total abdominal hysterectomy with bilateral salpingo-oophorectomy. Histopathological analysis confirmed cervical leiomyoma with marked inflammatory changes. Recovery was uneventful. Giant cervical fibroids require careful preoperative planning and awareness of ureteric and vascular anatomy. When complications occur after conservative surgery, hysterectomy may be the safest option. The “lantern on Saint Paul’s dome” sign aids clinical and radiological diagnosis.

Menstrual resumption following a two-week Shakti Bandha asana intervention in polycystic ovarian syndrome: a case report

2026-05-28T19:59:21+0530

Polycystic Ovarian Syndrome (PCOS) has a global prevalence of 4-20% and is a leading cause of secondary amenorrhea and infertility. Conventional management options are increasingly less preferred by some women warranting the exploration of integrative, non-pharmacological strategies such as yoga for more comprehensive and sustainable management. The main objective of this case report was to evaluate the effect of Shakti Bandha Asana (SBA) in the management of PCOS-associated secondary amenorrhea. A 22-year-old female, previously diagnosed with PCOS, presented with amenorrhea for the past six months following the self-discontinuation of hormonal therapy. She was instructed to practice SBA for a duration of two weeks, following which menstrual resumption was observed. Improvements were noted in C-reactive protein levels and Polycystic Ovary Syndrome Questionnaire scores, while ovarian morphology and lipid profile showed mixed results. These findings suggest that a two-week SBA intervention may facilitate menstrual resumption, reduce inflammatory status and improved health-related quality of life in patients with PCOS-associated secondary amenorrhea.

Conservative management of symptomatic acute pancreatitis with cholelithiasis in late pregnancy

2026-05-28T19:59:19+0530

Acute biliary pancreatitis in pregnancy is rare and poses significant maternal-fetal risks. This paper presents a 26-year-old primigravida at 32+2 weeks gestation presented with epigastric pain and bilious vomiting. Diagnosis confirmed via elevated pancreatic enzymes and ultrasonography showing cholelithiasis. A Conservative management followed with bowel rest and intravenous fluids; the patient remained stable and later delivered a healthy infant at term. This paper also brings forward how early recognition and a multidisciplinary approach allow for successful non-operative management and favorable outcomes.

Successful full-term vaginal delivery in a patient with large adnexal lymphangioma: a rare case report

2026-05-28T19:59:18+0530

Adnexal masses during pregnancy are increasingly detected because of routine obstetric ultrasonography. Most are benign and resolve spontaneously; however, persistent large masses require careful evaluation because of complications such as torsion, rupture, hemorrhage, and obstruction during labour. Lymphangioma is a rare benign tumour arising from lymphatic vessels, and its occurrence in the adnexa is extremely uncommon. We report a case of a 27-year-old multigravida with a large multiloculated left adnexal cystic mass measuring approximately 19×12×16.5 cm detected antenatally. The patient remained asymptomatic throughout pregnancy and was managed conservatively with close surveillance. She subsequently had spontaneous full-term vaginal delivery with favourable maternal and neonatal outcomes. This case highlights that careful monitoring and individualized management can allow successful vaginal delivery even in the presence of large benign adnexal masses.

Maternal congenital renal tract anomaly as a possible risk factor for preterm prelabor rupture of membranes and placental abruption: a rare case of contracted kidney with duplex ureter

2026-05-28T19:59:16+0530

Congenital renal tract anomalies are uncommon in pregnancy but may predispose to adverse obstetric outcomes. We report the case of a 26-year-old primigravida with a contracted kidney and duplex ureter who developed preterm prelabor rupture of membranes (PPROM), followed by placental abruption at 32 weeks of gestation. Chronic structural renal abnormalities may contribute to recurrent infections and persistent inflammation, leading to weakening of foetal membranes and vascular compromise. This case highlights a possible pathophysiological association between congenital renal anomalies, PPROM and placental abruption. Early recognition and multidisciplinary management are essential to optimize maternal and fetal outcomes.

Aggressive angiomyxoma of the vulva presenting as a massive perineal mass

2026-05-28T19:59:13+0530

Aggressive angiomyxoma is a rare benign but locally infiltrative mesenchymal tumour that predominantly affects women of reproductive age. It commonly arises in the pelvis and perineal regions and is characterized by slow growth and a high recurrence rate. We report a case of a 39-year-old multiparous woman presenting with a progressively enlarging vulval swelling over 12 years. Imaging revealed a well-defined soft tissue lesion without infiltration of adjacent structures. Complete surgical excision was performed, and histopathological examination confirmed aggressive angiomyxoma. This case highlights the importance of considering aggressive angiomyxoma in the differential diagnosis of large vulval masses and emphasizes the role of complete surgical excision and long-term follow-up.

Post partum seizures without hypertension: a case report of neurocysticercosis mimicking eclampsia

2026-05-28T19:59:12+0530

Postpartum seizures are most commonly attributed to eclampsia; however, alternative etiologies must be considered when classical features such as hypertension and proteinuria are absent. Neurocysticercosis (NCC) is the leading cause of acquired epilepsy in endemic regions, including India, accounting for nearly 30% of epilepsy cases in such populations. We report a case of a 23-year-old primigravida at 33 weeks and 6 days of gestation who underwent emergency lower segment cesarean section for placenta previa with active vaginal bleeding. The postoperative period was uneventful initially. On postoperative day 3, she developed a focal seizure without hypertension or proteinuria, for which magnesium sulfate was empirically initiated for suspected atypical eclampsia. A recurrent focal seizure with preserved awareness occurred on postoperative day 5, prompting neurology consultation. Magnetic resonance imaging of the brain revealed multiple ring-enhancing lesions consistent with NCC. The patient was managed with antiepileptic drugs, anti-parasitic therapy, and corticosteroids, with clinical improvement and no further seizure episodes during hospital stay. This case underscores the importance of considering NCC in the differential diagnosis of postpartum seizures in endemic regions, particularly when classical eclamptic features are absent, and highlights the indispensable role of early neuroimaging in guiding management.

Twin pregnancy complicated by fetus papyraceous: a case report

2026-05-28T19:59:07+0530

Fetus papyraceous is a rare complication of multiple gestation resulting from intrauterine demise of one fetus during early or mid-pregnancy followed by compression by the growing co twin. We report a case of a 21-year-old primigravida with dichorionic diamniotic twin pregnancy complicated by intrauterine demise of one twin at approximately 17 weeks gestation. Serial ultrasonography revealed a macerated compressed fetus consistent with fetus papyraceous while the surviving twin continued to demonstrate normal growth parameters whereas fetus papyraceous was twin A and was the presenting fetus. A conservative approach to manage pregnancy with close antenatal surveillance was done. At 34 weeks 3 days of gestation, patient had spontaneous onset of labor with fetus papyraceous as the presenting twin, Hence A decision for lower segment caesarean section and a healthy female baby weighing 1.886 kgs with Apgar of 7 and 9 at 1 and 5 minutes respectively was delivered. A flattened parchment like fetus papyraceous was delivered along with placentae. Early diagnosis and appropriate monitoring are essential for favorable maternal and fetal outcomes.

Partial imperforate hymen mimicking urethrovaginal fistula: a diagnostic pitfall

2026-05-28T19:59:05+0530

Partial imperforate hymen, a rare congenital anomaly, often evades diagnosis until adulthood, presenting atypically as infertility, menouria, or dyspareunia. Misdiagnosis risks unnecessary investigations and delays in fertility care. This case report emphasizes the importance of recognizing atypical presentation of partial imperforate hymen, which may mimic as urethrovaginal fistula and to demonstrate how thorough clinical evaluation and vaginoscopy can lead to accurate diagnosis and successful management. A woman in her thirties presented with infertility, menouria, and dyspareunia. Initial assessment suggested urethrovaginal fistula, but magnetic resonance imaging (MRI) excluded fistulous communication. Detailed gynaecological examination combined with vaginoscopy led to the identification of a normal vaginal pouch, behind the lower fused hymenal membrane consistent with the diagnosis of a partial imperforate hymen, which was managed surgically. The patient recovered well and resumed normal sexual activity, with improvement in symptoms and plans for natural conception. This case highlights the importance of careful genital examination and office vaginoscopy in women presenting with menouria, to avoid misdiagnosis of genitourinary fistula and unnecessary investigations.

Antenatal diagnosis and management of type III vasa previa

2026-05-28T19:59:00+0530

Vasa previa is rare but potentially life-threatening condition for fetus, in which unprotected fetal vessels traverse the membranes over or near the internal cervical os, placing the fetus at risk of rapid exsanguination if undiagnosed. The risk is increased in pregnancies conceived by in vitro fertilization (IVF). With prior written consent of the patient, we report a rare case of type III vasa previa in an IVF pregnancy, diagnosed antenatally and managed successfully. A 26-year-old primigravida with IVF conception was found to have placenta previa on mid-trimester scan. Serial ultrasonography with color Doppler from 28 weeks demonstrated persistent unprotected fetal vessels near the internal os. The pregnancy was managed with close antenatal surveillance, corticosteroid administration, and planned hospitalization. An elective cesarean section at 35 weeks resulted in the delivery of a healthy neonate. Placental examination confirmed Type III vasa previa. This case underscores the importance of targeted ultrasound screening and planned delivery in improving perinatal outcomes.

A silent breach, a collapsing bowel: deadly convergence of uterine perforation and gut ischemia

2026-05-28T19:58:54+0530

An unusual presentation of postmenopausal women presenting as acute abdominal case with obstipation for 1 day with picture of sepsis. On further evaluation X Ray abdomen indicated air under diaphragm and provisional diagnosis of intestinal perforation was made. Patient underwent exploratory laparotomy for the same and intraoperatively it turned out to be relatively uncommon a case of non-traumatic spontaneous uterine perforation in a non-gravid uterus along with small bowel gangrene. This report highlights the diagnostic challenges and management considerations.

Ovarian hyperstimulation syndrome in a spontaneous pregnancy: a diagnostic dilemma

2026-05-28T19:58:53+0530

Spontaneous ovarian hyperstimulation stimulation (sOHSS) is an extremely rare condition reported in a spontaneously/ naturally conceived pregnancy. It is most commonly associated with multiple gestation, hypothyroidism, and polycystic ovarian syndrome (PCOS). Severe form is a rare entity in a singleton pregnancy with spontaneous ovulation. These cases can very well be misdiagnosed as an acute abdomen in pregnancy and may lead to unnecessary exploratory laparotomy or a malignancy. The following case reports a 20-year-old female with a spontaneous normal singleton pregnancy presenting with acute abdomen, vomiting and distention of the abdomen. Ultrasonography reveals a 5.5-week viable intrauterine single fetus with bilateral multilocular cystic ovarian masses with ascites. The patient was managed conservatively with oral cabergoline and resolution of symptoms with eventual uncomplicated pregnancy.

The first case of ethanol sclerotherapy in 1998. Management of recurrent endometriosis after TAH+BSO – report of three cases

2026-05-19T07:11:55+0530

The first case of Ethanol sclerotherapy (EST) in 1998. Management of Recurrent Endometriosis after TAH+BSO, three cases are presented. The objective is to bring to focus the pitiable plight of these women suffering from severe pain abdomen prior to surgery and again after surgery due to recurrent disease. The dilemma of the doctor in deciding the best possible method of managing these cases. To present the different methods adopted to alleviate the pain and treat recurrences three decades ago. To discuss the current management trends. Case Report 1: Mrs. L. 46 years P2 L2 was operated for stage IV endometriosis. TAH+BSO was done on 5.2.96. A scan was done on 27.7.97 revealed an endometriotic cyst in the pelvis, 4.9x4.8 cms and 40 ml of thick chocolate material was aspirated vaginally. Ethanol, 5 ml was injected in the cyst. By three months there was reformation of endometrioma and a repeat second aspiration was done. Danazol 400 mgs/day, in divided doses was given for three months. Two years after TAH+BSO, third time aspiration of 7 ml thick chocolate liquid was done from 2 cms cyst and 4 ml spirit, absolute alcohol was injected on 15.1.98. We present our first case of ethanol sclerotherapy to treat recurrent endometriotic cyst after hysterectomy and bilateral salpingo oophorectomy in 1996-1998. In two other cases ERT had resulted in early recurrence of endometriosis, hence should be avoided. Endometriosis being a recurrent disease, the management decisions had to be individualized. We have discussed about Ethanol sclero therapy, reasons for recurrence after TAH+BSO, and the side effects of Danazol.

Atosiban dosing in preterm labour-made easy for all

2026-05-28T20:01:49+0530

Preterm labour remains a significant contributor to neonatal morbidity and mortality, particularly in low-resource settings where timely and appropriate interventions may be challenging. Tocolysis plays an important role in delaying delivery and facilitating antenatal corticosteroid administration. Among available agents, Atosiban, a selective oxytocin receptor antagonist, is widely used due to its favorable safety profile and targeted mechanism of action.