International Journal of Reproduction, Contraception, Obstetrics and Gynecology

Antenatal care utilization among pregnant women in the third trimester in Wajir East Sub-County, Wajir County, Kenya

2026-04-29T10:55:16+0530

Background: Antenatal care (ANC) is essential for maternal health, as it facilitates better pregnancy outcomes. This study aims to examine the determinants of ANC utilization among pregnant women in their third trimester in Wajir East Sub-county, Wajir County, Kenya.

Methods: A community-based cross-sectional analytical design across 30 villages and linked health facilities (including Wajir County Referral Hospital) between July 2025 and September 2025, targeting 221 pregnant women in their third trimester. Systematic sampling was employed to recruit participants, and data were collected using structured questionnaires, of which 216 completed ones were analyzed. Descriptive statistics and logistic regression were used to assess utilization patterns and determinants. Key informant interviews with CHVs and facility staff provided qualitative insights.

Results: Third-trimester ANC attendance was low: 26.9% of women reported one visit, 50.5% reported two visits, and only 1.4% attended four or more visits. Major barriers included distance to health facilities (68.1%), lack of transport (51.4%), and financial constraints (28.7%). CHV and family support were key facilitators. Unemployment significantly reduced the odds of adequate ANC utilization (AOR=0.09, p=0.046). College/University education showed a significant association in the bivariate analysis (OR=0.16, p=0.023).

Conclusions: Most women attended only one or two ANC visits. Sociodemographic factors, especially education level and household income, had a significant impact on the use of ANC. Distance to health facilities, lack of transport, financial constraints, and cultural norms are major facilitators and barriers to ANC utilization.

Obstetric factors associated with cesarean section: a retrospective study of 1,485 births in Southern Brazil

2026-04-29T10:55:20+0530

Background: Cesarean rates have risen globally beyond recommended levels, without consistent improvements in maternal and neonatal outcomes. In Brazil, high rates persist despite policies promoting evidence-based, humanized care, with limited adherence in practice. This study aimed to identify factors associated with delivery mode in a hospital in southern Brazil to support vaginal birth and align practices with current recommendations.

Methods: A retrospective, descriptive, cross-sectional quantitative study was conducted based on the analysis of 1,485 medical records of parturients assisted through the Brazilian Unified Health System (SUS) who underwent vaginal or cesarean delivery between 2019 and 2021, in a hospital institution in Rio Grande do Sul, Brazil. Maternal characteristics, clinical conditions, and obstetric practices were assessed. Logistic regression analysis was performed to estimate odds ratios (ORs) and identify variables associated with mode of delivery.

Results: Among the 1,485 medical records of parturients, 47.9% had a vaginal birth and 52.1% underwent a cesarean section. Primiparity, absence of cervical dilation upon admission, absence of desire for vaginal delivery, non-performance of amniotomy, administration of oxytocin, as well as non-pharmacological measures were significantly associated with a greater likelihood of cesarean section. Primiparous women were more likely to undergo a cesarean section (OR=2.97), while advanced cervical dilation (7–10 cm) markedly reduced the odds of cesarean delivery (OR=0.03). Maternal preference for vaginal birth, amniotomy, and the use of non-pharmacological measures were also protective factors against cesarean section.

Conclusions: In conclusion, cesarean delivery is influenced by modifiable clinical and care-related factors, highlighting opportunities to reduce unnecessary interventions. Promoting evidence-based, woman-centered practices may contribute to increasing vaginal birth rates and improving maternal and neonatal outcomes.

Postpartum cardiovascular outcomes among pregnant women with known heart diseases

2026-04-29T10:55:23+0530

Background: Maternal heart disease has emerged as a major threat to safe motherhood and women’s long-term cardiovascular health, and the postpartum period is a time of heightened risk for cardiovascular disease-related maternal morbidity and mortality. Therefore, the present study aimed to evaluate the effect of preconceptional counselling on postpartum cardiovascular outcomes among pregnant women with known heart disease in Bangladesh.

Methods: This hospital-based cohort study was conducted at the Department of Obstetrics and Gynaecology, Fetomaternal Medicine Unit, Dhaka Medical College Hospital (DMCH); the Department of Fetomaternal Medicine, Bangabandhu Sheikh Mujib Medical University (BSMMU); and the National Institute of Cardiovascular Diseases (NICVD), Dhaka, Bangladesh from February 2020 to March 2021, including 73 postpartum women with heart disease. Demographic, obstetric, cardiac data, NYHA class, preconceptional counselling, and maternal outcomes were collected and analyzed using SPSS v26 (Chi-square, p<0.05).

Results: Among 73 pregnant women (39 known, 34 incidentally diagnosed), younger age, lower socioeconomic status, education, and parity differed significantly between groups (p<0.001). LUCS was more frequent in known cases, vaginal delivery in incidental cases (p<0.001). Rheumatic heart disease predominated (41/73), and NYHA class I was higher in known cases (p<0.001). Cardiac events occurred in 45.2%, mostly in incidental cases (63.6% vs. 36.4%, p=0.010; RR=1.96), particularly in multiparas; outcomes did not vary by disease type.

Conclusions: Awareness and early diagnosis of maternal heart disease, combined with timely multidisciplinary care, significantly reduce postpartum cardiovascular complications.

Risk factors and pregnancy outcomes of preterm birth at a tertiary hospital in Vietnam

2026-04-29T10:55:19+0530

Background: Preterm birth remains a leading cause of neonatal morbidity and mortality worldwide.

Methods: A comparative cross-sectional study was conducted on 272 women (136 preterm and 136 term deliveries) at Hue University of Medicine and Pharmacy Hospital from April 2024 to May 2025. Multivariable logistic regression analysis was used to identify independent risk factors.

Results: Independent risk factors for preterm birth included adverse marital status (aOR=23.56; 95% CI: 2.87-193.55), history of preterm birth (aOR=8.77; 95% CI: 2.69-28.61), premature rupture of membranes (PROM) (aOR=2.4; 95% CI: 1.16-4.85), abnormal amniotic fluid volume (aOR=3.87; 95% CI: 1.66-9.03), anemia (aOR=2.35; 95% CI: 1.20-4.61), preeclampsia (aOR=5.99; 95% CI: 2.12-16.95) and leukocytosis ≥15×10⁹/L (aOR=4.74; 95% CI: 1.86-12.11). Most cases were late preterm (76.5%). Neonatal outcomes were generally favorable, with 97.0% achieving Apgar scores of 8-10 at 5 minutes and a mortality rate of 1.5%.

Conclusions: Preterm birth is associated with multiple independent clinical and socio-demographic factors. Early identification of high-risk pregnancies may improve maternal and neonatal outcomes.

Barriers and facilitators of self-management behaviours among adults with type 2 diabetes in Harare, Zimbabwe: a grounded theory study

2026-04-29T10:57:17+0530

Background: Improving self-management in patients with type 2 diabetes can decrease complications, encourage healthier lifestyles, and enhance quality of life. While guidelines specify key self-management practices for optimal glycaemic control, many patients find it difficult to adhere to them, especially in developing countries. This study sought to identify the barriers and facilitators impacting diabetes self-management among adults with type 2 diabetes. Gaining insight into these factors is essential for developing patient-centred strategies that effectively help improve health outcomes.

Methods: The study was guided by Charmaz’s constructivist grounded theory. It employed two sampling methods: purposive and theoretical. Initially, purposive sampling involved selecting eight adults with type 2 diabetes to generate themes for further exploration. As categories emerged from data analysis, theoretical sampling was used to refine underdeveloped categories. A total of twenty-eight face-to-face semi-structured interviews were conducted.

Results: Data analysis revealed that living with type 2 diabetes involves engaging in self-management practices. Key facilitators included: receiving social support, being motivated to make changes, taking responsibility for the illness, and building a patient-healthcare professional relationship. On the other hand, barriers compromised: having financial difficulties, experiencing societal stigma, having health illiteracy, and experiencing food insecurity.

Conclusions: Patients with type 2 diabetes encounter various barriers and facilitators in managing their condition. The analysis highlighted how interpersonal, social, and economic factors affect their self-management behaviours for diabetes. These findings emphasise the need for interventions that are contextualised, culturally sensitive, and tailored to individual patients.

Association of hematological parameters of cord blood and birth weight of newborns in relation to maternal hemoglobin: a cross-sectional study from eastern Nepal

2026-04-29T10:59:37+0530

Background: Maternal anemia is a global public health problem and is common in developing countries. It may influence neonatal hematological parameters and birth weight. The objectives of the present study were to evaluate the relationship between maternal and cord-blood haemoglobin concentrations and the association of maternal anemia with neonatal birth weight in a tertiary-care centre in Nepal.

Methods: It was a qualitative cross-sectional study conducted over one year at the department of pathology, department of obstetrics and gynecology, and department of pediatrics, B. P. Koirala Institute of Health Sciences, Dharan, Nepal.

Results: Among the total 125 participants (pregnant women), 46 (36.80%) were anemic, with corresponding newborns’ mean cord blood hemoglobin of 13.81±1.32 gm/dl, whereas 79 (63.20%) were non-anemic, with corresponding newborns’ mean cord blood hemoglobin of 15.27±1.31 gm/dl. The p value was 0.00, indicating a significant difference between cord blood hemoglobin and maternal hemoglobin status, and the findings showed that a decrease in cord blood hemoglobin was associated with a decrease in maternal hemoglobin level. However, birth weight and other hematological parameters were not found to be associated (except for hematocrit) with mild and moderate degrees of maternal anemia.

Conclusions: A linear relationship was observed between maternal and cord blood hemoglobin, but not with birth weight. Maternal anemia, which is still a common complication of pregnancy, can be detected by simple and cheap screening tests, and if managed early, decreases neonatal hematological derangement.

Prevalence and risk factors of postpartum hemorrhage among caesarean delivery cases at Popular Medical College

2026-04-29T10:57:33+0530

Background: Postpartum hemorrhage (PPH) remains one of the leading causes of deaths in the world, which is a big challenge to obstetric care. Cesarean birth, though life-saving in nature. a lot of situations, is in a greater risk of hemorrhagic complications. This paper will seek to identify the incidence of postpartum bleeding and determine the risk factors of it in women undergoing caesarean. Popular Medical College delivery.

Methods: This is a cross-sectional study that was carried out in the Department of Obstetrics and Gynecology at Popular Medical College, Dhaka, Bangladesh from January 2024 to January 2025, 68 women who had caesarean delivery within the period of study. Analysis of the data was done in the SPSS version 25.0 by descriptive statistics.

Results: The prevalence of PPH was 20.6% in 68 caesarean births. Antenatal 42.6% of women had anemia and an anemic mom had a greater PPH. Placenta previa/accreta was present in 11.8% of incidences and exhibited the most significant association with PPH. Emergency caesarean section also. had an increased PPH rate. In total there was 16.2% blood transfusion among all women and in PPH cases, others had to be in the ICU and undergo surgery.

Conclusions: The research indicates that the prevalence of PPH among caesarean births at Popular medical is high (20.6%). College, with some of the main risk factors being antenatal anemia, placenta previa/accreta and emergency caesarean. Many the degree of PPH in this environment was such that affected women needed transfusion and critical care.

Association of subclinical thyroid disorder in hypertensive pregnant women attending a tertiary care hospital

2026-04-29T10:55:22+0530

Background: Subclinical thyroid disorders have gained increasing attention because thyroid hormones play an important role in cardiovascular function and blood pressure regulation, and pregnancy-related physiological changes further complicate the assessment of thyroid function. The purpose of the present study was to evaluate the association between subclinical thyroid disorder and hypertension in pregnant women attending a tertiary care hospital.

Methods: This cross-sectional comparative study at the Department of Obstetrics and Gynaecology, Dhaka Medical College Hospital (DMCH), Dhaka, Bangladesh (Feb 2020–Mar 2021), included 220 pregnant women (110 hypertensive, 110 normotensive) matched for age, parity, and gestational age. Socio-demographic, obstetric, and clinical data were collected, blood pressure measured, and serum TSH and FT4 analyzed using Siemens ADVIA Centaur XP CLIA with ATA trimester-specific ranges. Data were analyzed with SPSS 25 (p <0.05).

Results: Among 220 pregnant women (110 hypertensive, 110 normotensive), most were 18–25 years, 29–40 weeks gestation, and nulliparous, with no significant differences. Pre-eclampsia with severe features was most common (40%). Subclinical hypothyroidism was higher in hypertensive women (46.4% vs 14.5%, p=0.001) and associated with elevated BP. Hypertensive women had higher TSH (4.46 vs 2.28 µIU/ml) and lower FT4 (13.49 vs 15.78 pmol/l), most pronounced in pre-eclampsia (p≤0.001).

Conclusions: Subclinical hypothyroidism is the most common thyroid disorder in hypertensive pregnant women and is associated with higher blood pressure, suggesting early detection may help reduce the severity of pregnancy-related hypertension.

Therapeutic role of low-dose mifepristone in the management of uterine fibroids: clinical outcomes and contemporary perspective

2026-04-25T06:51:33+0530

Background: Uterine fibroids are the most common benign tumors of the female reproductive tract and are a major cause of menstrual disturbances and anemia. Conservative medical therapies are increasingly preferred over surgical options in women desiring uterine preservation. Mifepristone, a progesterone receptor antagonist, has shown promising results in reducing fibroid volume and associated symptoms. Objectives were to evaluate the clinical efficacy and safety of low-dose mifepristone (25 mg daily) in reducing fibroid size and improving clinical symptoms among perimenopausal women with symptomatic leiomyomas.

Methods: This prospective observational study was conducted from June 2024 to July 2025 at the Department of Gynecology, Government Peripheral Hospital, Tondiarpet, Chennai. Ninety-three perimenopausal women aged 35-50 years with ultrasonographically confirmed symptomatic fibroids were treated with 25 mg mifepristone daily for three months. Clinical parameters, uterine and fibroid volumes, hemoglobin, and endometrial thickness were evaluated before and after therapy.

Results: Amenorrhea was achieved in 92.7% of patients. Mean uterine and myoma volumes decreased to 63.7% and 53.6% of baseline, respectively. Mean hemoglobin levels increased by 2.8 g/dl (37%) post-treatment. Endometrial thickening was mild in most patients, with two cases of simple hyperplasia without atypia. Headache was the most frequent adverse effect (12%), with no major hepatic or renal complications reported. Hysterectomy was avoided in 87.8% of patients.

Conclusions: Low-dose mifepristone (25 mg daily) is a safe, effective, and affordable therapeutic option for managing symptomatic uterine fibroids in perimenopausal women. It significantly reduces fibroid and uterine volume, controls bleeding, and improves hemoglobin levels, minimizing the need for surgical intervention.

An observational study on indications and outcomes of induction of labour in a tertiary maternity unit

2026-04-08T07:11:52+0530

Background: Induction of labour (IOL) is the artificial initiation of uterine contractions when continuation of pregnancy may increase maternal or fetal risk. Common indications include post-term pregnancy, premature rupture of membranes (PROM), hypertensive disorders of pregnancy, oligohydramnios, and suspected fetal compromise. This study aimed to evaluate the indications for IOL and to assess associated maternal and neonatal outcomes in a tertiary maternity unit.

Methods: This prospective observational study included 172 term women (37-41 weeks) undergoing IOL at ACS Medical College, Chennai, over 8 months, from January to June 2025. Patients with spontaneous labour or prior caesarean were excluded. Maternal demographics, indications, induction methods, labour course, delivery mode, and maternal and neonatal outcomes were recorded.

Results: The mean maternal age was 27.8±4.2 years, with 61.6% nulliparous, 99.4% booked, and 0.6% unbooked cases. The main indications for IOL were post-term pregnancy (26.7%), PROM (22.1%), hypertensive disorders (14%), oligohydramnios (10.5%), and foetal compromise/IUGR (5.8%). Misoprostol/PGE₂ gel was used in 60.5%, Foley balloon±oxytocin in 17.4%, and ARM±oxytocin in 22.1% of cases. Spontaneous vaginal delivery occurred in 58.7%, operative vaginal delivery in 4.7%, and caesarean section in 36.6%. Indication for LSCS was primarily due to failed induction (46%) or foetal distress (28.6%). Maternal complications included PPH (9.3%) and hyperstimulation (4.1%). Neonatal outcomes included a mean birth weight 3010±420 g, Apgar <7 at 1 min in 8.1%, NICU admission 12.8%, and perinatal mortality 1.2%.

Conclusions: IOL in this tertiary unit effectively achieved vaginal delivery in most women. Post-term pregnancy, PROM, and hypertensive disorders were common indications. Prostaglandins were mainly used, with minor maternal and neonatal complications.

A study of the causes of referral of obstetric cases in a tertiary care centre and its outcome.

2026-04-08T07:11:53+0530

Background: This study aims to evaluate the frequency, causes, and outcomes of obstetric referrals at a tertiary care hospital.

Methods: An observational study was conducted at Civil Hospital Asarwa, B. J. Medical college Ahmedabad, over six months from December 2021 to May 2022. All referred cases for obstetrics indications were analysed for cause of referral, the facility from which they were referred their condition and outcome. Maternal outcomes in the form of maternal morbidity and mortality were noted.

Results: Out of a total of 3010 delivered patients, 229 (9.6%) cases were referred patients. The 87 out of 229 (37.9%) cases were already complicated when received at civil hospital Ahmedabad. Most of the cases 196 (88%) did not receive any treatment at referral hospital before being referred. Only 21.4% patients were referred with referral slips/chit having adequate information. The 183 (18.04%) patients required intensive care unit admission, and 5 maternal deaths were recorded out of those referred (2.1%).

Conclusions: The majority of referrals were from rural areas (36%) and medical colleges (18.9%). Such cross referrals should be minimised so as to decrease the burden on tertiary centres. Healthcare workers should be trained in essential and emergency obstetric care which will help in reducing unnecessary referrals, morbidity, and mortality.

Multifactorial determinants of infertility: a case control study integrating clinical, hormonal, nutritional, genetic and lifestyle factors in 664 couples

2026-04-02T06:48:44+0530

Background: Infertility is a multifactorial reproductive disorder influenced by male, female, genetic, infectious, nutritional and lifestyle factors. Despite advances in reproductive medicine, studies integrating multiple determinants of infertility with comprehensive evaluation remain limited. The present study aimed to evaluate the multifactorial determinants associated with infertility among couples attending a tertiary fertility centre.

Methods: This hospital-based case–control study included 412 infertile couples and 252 fertile couples. Participants underwent detailed clinical and laboratory evaluation. This included complete blood counts, hormonal profiling (follicle-stimulating hormone, luteinizing hormone, anti-Müllerian hormone, prolactin, thyroid-stimulating hormone, estradiol and progesterone), semen analysis, infectious disease screening, nutritional assessment (vitamin D, vitamin B12 and ferritin), imaging studies and selected genetic investigations. Associations between infertility risk factors were analysed using the chi-square test. Odds ratios with 95% confidence intervals were calculated and a p-value<0.05 was considered statistically significant.

Results: Among infertile couples, primary infertility was observed in 77.2% and secondary infertility in 22.8%. Male factors included abnormal semen parameters in 30.6% of cases. Smoking (odds ratio 3.8, 95% confidence interval 2.2–6.4, p<0.001) and increased sperm DNA fragmentation (odds ratio 4.5, 95% confidence interval 2.0–9.7, p<0.001) were significantly associated with infertility. Among female partners, low ovarian reserve (anti-Müllerian hormone <1.1 ng/mL) was observed in 174 women (42.2%) and was significantly associated with age ≥30 years. Additional contributing factors included endometriosis (18.9%), tubal blockage (14.6%), thyroid dysfunction (9.2%) and hyperprolactinemia (6.3%). Nutritional deficiencies were common, particularly vitamin B12 deficiency (70.9%), vitamin D deficiency (45.4%) and iron deficiency (41.0%).

Conclusions: Infertility is a complex condition resulting from multiple interacting determinants including male reproductive factors, diminished ovarian reserve, gynecological disorders, nutritional deficiencies and lifestyle influences. Comprehensive evaluation of both partners is essential for early identification of modifiable risk factors and improved infertility management.

Pathways of care for the obstetric cases referred to a tertiary care centre in North-East India: a prospective analysis

2026-04-10T07:04:28+0530

Background: The referral system is crucial in emergency obstetric situations thereby reducing maternal morbidity and mortality along with improving neonatal outcomes. We aim to study the baseline characteristics of referred obstetric patients, analyse the reason for referral and determine the feto-maternal outcome of the referred patients.

Methods: This was a prospective observational study conducted in a tertiary referral centre in Shillong, Meghalaya. Categorical variables were presented as frequency and percentages. Continuous variables presented as mean (SD). The predictors of adverse outcomes determined using chi square test. A p-value<0.05 was considered statistically significant.

Results: The total number of referred cases in the study period was 500. The majority 300 (61%) from the age group <30 years and multi-gravida 59%. The majority 282 (57%) referring centres were within the radius of 20 km from the tertiary health care institute. The commonest indication of referral was Labour abnormalities 47 (9%). The maternal outcomes accounts for 454 (90.8%) went for discharges, 38 (7.6 %) were shifted to ICU, 7 (1.4%) cases expired and 1 went for LAMA. Perinatal outcomes, 70.9% were Live Birth, 7.5% were shifted to the NICU, 7.5% were pre-term, 7.4% were stillbirth, and 6.7% were abortion cases.

Conclusions: In order to create an efficient referral system, the peripheral health care system must be strengthened with adequate, competent individuals and a robust referral mechanism in place. Prompt referrals accompanied with thorough and detailed referral slips may be helpful in facilitating early action.

Knowledge, attitude and practice toward birth preparedness and complication readiness among antenatal women: a cross-sectional study at a tertiary hospital

2026-04-09T07:08:18+0530

Background: Birth preparedness and complication readiness (BP/CR) is a key strategy to reduce maternal morbidity and mortality by minimizing delays in recognizing complications and accessing timely care. Despite improvements in antenatal care utilization, gaps in awareness of obstetric danger signs persist. The objective of the study was to assess the knowledge, attitude, and practice of BP/CR among antenatal women attending a tertiary healthcare facility.

Methods: A hospital-based cross-sectional study was conducted among 467 antenatal women (≥24 weeks gestation) at a tertiary care centre in Chennai between January and June 2025. Participants were enrolled using convenience sampling. Data were collected using a structured questionnaire assessing knowledge, attitude, and practice domains. Statistical analysis was performed using Stata v16, with associations tested using chi-square and t-tests.

Results: Only 36.8% of women demonstrated adequate knowledge of danger signs, whereas 64.9% had good knowledge of BP/CR components. A positive attitude toward BP/CR was observed in 70.2%, and 59.7% reported adequate preparedness. Adequate knowledge and practice were significantly associated with higher maternal education, employment, husband’s literacy, and higher socioeconomic status (p<0.05). Multiparity was associated with better knowledge, while later gestational age correlated with a more positive attitude.

Conclusions: Although attitudes and preparedness toward BP/CR were relatively favorable, awareness of danger signs remains inadequate. Strengthening antenatal counselling with emphasis on early recognition of complications, along with addressing socioeconomic disparities and promoting partner involvement, is essential to improve maternal health outcomes.

Comparative study of induced versus spontaneous labour in women to predict materno-fetal outcomes using a modified WHO partograph

2026-04-19T09:09:46+0530

Background: Labour outcomes differ significantly between induced and spontaneous onset, with implications for maternal and neonatal health. The modified WHO partograph provides an objective tool for monitoring labour progress and guiding timely intervention. This study aimed to compare induced versus spontaneous labour using the modified WHO partograph to predict maternal and foetal outcomes.

Methods: A prospective randomised clinical study was conducted on 300 patients with term pregnancies at ACS Medical College, Chennai, over six months. Patients were allocated to two groups: induced labour (n=150) and spontaneous labour (n=150). Labour was monitored using the WHO modified partograph, assessing the duration of labour phases, oxytocin augmentation, progress across alert/action lines, maternal complications and neonatal outcomes, including Apgar scores, meconium-stained liquor, NICU admissions and mortality.

Results: Induced labour was significantly associated with a significantly prolonged active phase (4.6 vs. 3.2 hrs, p<0.001) and second stage (38.4 vs. 30.2 min, p=0.02). Oxytocin augmentation (45.3% vs. 20.7%), alert line crossing (34.7% vs. 15.3%) and action line crossing (17.3% vs. 6.7%) were more frequent in the induced cases (p<0.05). Vaginal delivery was significantly more common in spontaneous labour (76.0% vs. 58.7%, p=0.004), whereas the caesarean delivery rate was higher in induced cases (34.0% vs. 18.7%, p=0.004). The incidence of meconium-stained liquor (12.7% vs. 6.0%, p=0.04) and NICU admissions (14.7% vs. 7.3%, p=0.03) were also significantly higher in the induced group.

Conclusions: Induction of labour is associated with prolonged labour, greater intervention needs, higher caesarean rates and increased neonatal complications compared to spontaneous labour. Spontaneous labour monitored with the modified WHO partograph showed more favourable outcomes.

Clinical research on the relative efficacy of letrozole and clomiphene citrate in achieving ovulation among women with polycystic ovarian syndrome

2026-04-25T06:51:32+0530

Background: Polycystic ovarian syndrome (PCOS) is a leading cause of anovulatory infertility. PCOS is the most common cause of infrequent periods (oligomenorrhoea) and absence of periods (amenorrhoea). It affects about 4% to 8% of women worldwide and often leads to anovulatory subfertility. Clomiphene citrate (CC) has been widely used for ovulation induction but is limited by endometrial effects and resistance. Letrozole, an aromatase inhibitor, has emerged as an alternative with potentially superior efficacy. Aim of the study was to compare the efficacy of letrozole and CC in ovulation induction among women with PCOS.

Methods: A prospective comparative study was conducted on 100 infertile women with PCOS aged 21–35 years at Government Peripheral Hospital, Tondiarpet, Chennai, from September 2024 to August 2025. Participants were allocated into two groups: letrozole (n=50) and clomiphene citrate (n=50). Follicular development and rupture were assessed by transvaginal ultrasonography. Statistical analysis was performed using statistical package for the social sciences (SPSS), with p<0.05 considered significant.

Results: The mean age was 26.3±2.5 years. The mean follicle number was lower in the letrozole group (1.5±0.89) compared with clomiphene (2.54±1.69). The mean number of ruptured follicles was significantly lower with letrozole (0.96±0.64) compared with clomiphene (1.48±1.07). Letrozole demonstrated a safer monofollicular response, while clomiphene induced multifollicular development.

Conclusions: Both agents are effective for ovulation induction. Letrozole offers a safer monofollicular profile with reduced risk of multiple gestations, making it preferable when minimizing multiple pregnancies is a priority.

An observational study aiming to evaluate maternal and fetal outcomes of pregnant women having polyhydramnios in a tertiary care center

2026-04-29T10:59:52+0530

Background: Aim of the study was to determine the effect of polyhydramnios in pregnancies that are more than or equal to 28 weeks on fetal outcome, maternal obstetrics complications and also to study the causes behind polyhydramnios.

Methods: A cross sectional retrospective and prospective observational research took place in Department of Obstetrics and Gynaecology of the Institute a tertiary care center on sample size of 90 cases in 3 years between January 2021 to January 2024.

Results: A significant association was found between amniotic fluid index (AFI) levels, gestational age, birth weight, APGAR scores at birth and fetal outcomes (p=0.001).

Conclusions: Early identification and management of pregnancies those with abnormal AFI levels are crucial for improving neonatal outcomes. Comprehensive antenatal care that includes regular monitoring of AFI, gestational age, antenatal care profile and fetal growth parameters, along with timely medical interventions, can help reduce adverse outcomes.

Carbetocin versus oxytocin in active management of third stage of labor: a randomized controlled trial

2026-04-29T10:59:41+0530

Background: Postpartum hemorrhage (PPH) remains a leading cause of maternal morbidity and mortality. Active management of the third stage of labor (AMTSL) using uterotonic agents significantly reduces the incidence of PPH. Oxytocin is the most commonly used uterotonic; however, its short duration of action may necessitate repeated dosing. Carbetocin, a long-acting oxytocin analogue, offers sustained uterine contraction with a single dose.

Methods: A single-blind randomized controlled trial was conducted at a tertiary care center over 18 months. A total of 200 pregnant women with singleton or multiple pregnancies ≥32 weeks of gestation undergoing vaginal delivery or cesarean section were enrolled. Participants were randomly allocated into two groups: the carbetocin group (100 µg intravenous single dose) and the oxytocin group (10 IU intramuscular or 20 IU intravenous infusion). The primary outcomes assessed were blood loss within 24 hours postpartum, uterine tone, and requirement of additional uterotonics. Secondary outcomes included changes in hemoglobin levels, need for blood transfusion, hemodynamic changes, and drug-related adverse effects.

Results: Mean blood loss in the 1st 24 hours postpartum was significantly lower in the carbetocin group compared to the oxytocin group (398±138.52 ml versus 467±189.65 ml; p=0.004). Fewer women in the carbetocin group required additional uterotonic agents. Post-delivery hemoglobin levels were significantly higher in the carbetocin group. No significant adverse effects were observed in either group.

Conclusions: Carbetocin is more effective than oxytocin in reducing postpartum blood loss during active management of the third stage of labor, with the added advantage of single-dose administration and a comparable safety profile. Carbetocin can be considered a suitable alternative to oxytocin, particularly in tertiary care and high-risk obstetric settings.

A three-year retrospective study of female sterilization failure at a tertiary care hospital

2026-04-29T10:59:40+0530

Background: This study aimed to analyze the demographic trends, clinical patterns, sterilization methods, timing of procedures, interval to failure, and etiological factors contributing to female sterilization failure over a continuous three-year period at a tertiary care hospital.

Methods: This descriptive cross-sectional study examined all cases of sterilization failure documented between January 2022 and December 2024. Data were retrieved from departmental sterilization audit sheets and included age, parity, method of sterilization, timing, interval to conception, and causes of failure. Statistical comparison was performed against established literature.

Results: A total of 60 sterilization-failure cases were recorded. The age group 26-30 years accounted for the largest proportion (38%). Most women were G2 (48.33%). The Modified Pomeroy Technique (MPT) was the most frequently used method and was associated with the majority of failures. The highest number of failures occurred between 1 and 5 years after sterilization. The leading cause of failure was tubal recanalization, accounting for 50% of cases, followed by non-ligation of tube and improper technique.

Conclusions: Sterilization failure still occurs despite being regarded as a permanent contraceptive method. Appropriate case selection, strict adherence to standardized surgical techniques, and improved counselling can reduce the incidence. Periodic audits should be mandated to identify preventable factors and training gaps.

Clinical profile, risk factors and management outcomes of ectopic pregnancy: a prospective study from a tertiary care hospital in Rajasthan

2026-04-29T10:59:38+0530

Background: Ectopic pregnancy remains a major cause of maternal morbidity and mortality in early pregnancy, accounting for 2-4% of all pregnancies worldwide. Advances in transvaginal sonography (TVS) and serum β-hCG estimation have improved early detection, yet delayed diagnosis persists, particularly in resource-limited settings. This study aimed to evaluate the clinical profile, risk factors, and management outcomes of ectopic pregnancy in women presenting to a tertiary care hospital.

Methods: A prospective observational study was conducted in the Department of Obstetrics and Gynecology at Ananta Institute of Medical Science and Research Centre, Rajsamand, over 12 months. A total of 58 patients with confirmed ectopic pregnancy were included. Detailed history, clinical examination, risk factor assessment, TVS, and β-hCG testing were performed. Treatment modality (medical, surgical, or conservative) was chosen based on hemodynamic stability, β-hCG levels, and imaging findings. Data were entered and analyzed using Statistical Package for the Social Sciences (SPSS) version 25.0. Results were expressed as frequencies and percentages.

Results: Most patients (60.3%) were in the 21-30-year age group. Common risk factors included pelvic inflammatory disease (22.4%), history of infertility treatment (17.2%), previous pelvic surgery (15.5%), and intrauterine contraceptive device use (13.8%). Abdominal pain (86.2%) and amenorrhea (79.3%) were the most frequent symptoms. The fallopian tube was the predominant site (84.5%), with the ampullary region most affected. Surgical management was required in 67.2% of cases, with salpingectomy being the most common procedure. Medical management with methotrexate was successful in 20.7%, while 12.1% were managed expectantly. Postoperative complications were minimal, with anemia and need for blood transfusion reported in 15.5%.

Conclusions: Ectopic pregnancy remains a significant health concern in reproductive-aged women. Early recognition of risk factors, timely diagnosis using β-hCG and TVS, and individualized management strategies can significantly improve maternal outcomes. Strengthening awareness and early referral systems remain critical in reducing morbidity and mortality.

A longitudinal study on short- and long-term complications following hysterectomy: a comparative analysis between abdominal and vaginal routes in women aged over 30 years at a tertiary care hospital in Puducherry, India

2026-04-29T10:59:35+0530

Background: Hysterectomy remains one of the most commonly performed gynaecological procedures worldwide. Understanding the short- and long-term complication profiles of abdominal hysterectomy (AH) and vaginal hysterectomy (VH) is essential for guiding surgical decision-making, particularly in resource-limited settings. This study aimed to compare short-term (≤30 days) and long-term (≤6 months) postoperative complications between AH and VH and to identify patient- and surgery-related predictors of postoperative morbidity.

Methods: A prospective longitudinal study was conducted among 110 women aged >30 years undergoing AH or VH at a tertiary care hospital. Participants were followed at regular intervals for six months. Baseline characteristics, intraoperative parameters, and postoperative complications were recorded. Group comparisons were performed using Chi-square and independent t-tests. Predictors of complications were examined using multivariable logistic regression.

Results: Baseline demographic and clinical characteristics were comparable between groups. VH was associated with significantly shorter operative time, lower blood loss, and reduced need for blood transfusion compared with AH. Short-term complications particularly wound infection and prolonged hospital stay were more common following AH. Long-term complications did not differ significantly between groups, with similar rates of chronic pelvic pain, urinary symptoms, and psychological distress. Higher BMI (≥28 kg/m²) emerged as the only significant independent predictor of postoperative complications (AOR 2.12, p=0.03).

Conclusions: VH offers clear short-term advantages over AH, including faster recovery and fewer immediate postoperative complications. Long-term outcomes, however, are broadly comparable between the two approaches. Elevated BMI significantly increases the risk of postoperative morbidity regardless of surgical route. These findings reinforce the importance of individualized surgical planning and preoperative optimisation to improve patient outcomes.

Study of iatrogenic preterm delivery in a tertiary center: a prospective observational study

2026-04-29T10:59:34+0530

Background: Iatrogenic preterm delivery, also known as provider-initiated preterm birth, involves planned delivery before 37 weeks of gestation.

Methods: A prospective observational study was conducted after getting clearance from the Institutional ethics committee the study was undertaken from December 2022 to June 2024. Data will be analysed using the SPSS 26.0 software (IBM, ARMONK, NY).

Results: In the study 68% patients were primigravida .72.45% patient were between 32-37 weeks of gestation. The risk of preterm births was higher among mothers with education lower than primary level in our studies. In our study 65% women belonged to lower socio-economic group. In this study, major risk factors included hypertensive disorders in pregnancy (37 cases), PPROM (37 cases), antepartum haemorrhage (16 cases). The most common indication for induction was PPROM and that for LSCS was failure of induction and PPROM with previous scarred uterus. The caesarean section rate in our study was around 81% which included cases of failed induction of labour (20%) and only 19% delivered vaginally following induction of labour. 37.7% delivered babies weighed between 1.5-–2 kg followed by 2-2.5 kg (23.6%) and 1-1.5 kg (21.7%). Most common maternal postnatal complication were anaemia (54.2%) followed by fever (16.7%) and breast engorgement (11.5%) whereas most common neonatal complications were hypoxia (15%), followed by neonatal hyperbilirubinemia (14%) and hypoglycaemia (8%).

Conclusions: For iatrogenic preterm birth, prevention may be targeted towards modifiable factors. Research into complications of pregnancy, such as pre-eclampsia and diabetes must focus on identifying pregnancies for which it is possible to delay birth while ensuring optimal maternal and neonatal outcomes.

Prevalence and clinical manifestations of polycystic ovarian syndrome among adolescent and adult women in Davangere, Karnataka

2026-04-29T10:57:38+0530

Background: The prevalence of a disease in a particular region is always a necessary tool for any control measures. There are no full-fledged published data on PCOS prevalence and clinical manifestation patterns in our study setting geographic location. This study aimed to study the prevalence and clinical manifestation of PCOS among adolescents and adult women.

Methods: This is a prospective cross-sectional observational study conducted with total of 426 participants. A structured questionnaire was given to all the participants and collected data was assessed. Questionnaire included the following components; (i) Knowledge assessment, (ii) Anthropometric assessment, (iii) Clinical history, and (iv) Menstrual history included irregularity as well as presence of oligomenorrhea after one year of menarche, wait gain and hirsutism/ androgen production assessment (skin problems, and hair distribution).

Results: 27% of adolescent PCOS cases were found to be in the age group of 10-18 years. While, 11% of adult women with PCOS were found to be in the age group of 19-45 years. Majority of the study participants with PCOS were found to be obese (49.1%) followed be overweight (31.7%), and non-obese (19.2%) indicating an association of BMI with PCOS. Majority of the PCOS cases i.e., 37.3% were presented with acne/oily skin followed by alopecia (17.4%), mood swings/depression (16.8%), pigmentation (16.1%), and hirsutism (12.4%).

Conclusions: PCOS is increasingly encountered during adolescence with clinical manifestation of acne/oily skin in our study setting. Furthermore, PCOS was associated with overweight and obesity. Therefore, our study is indicative of the fact that all overweight and/or obese adolescence with acnes and/or oily skin should be screened for PCOS for early diagnosis and management.

Implanon versus Copper-T as long-acting reversible contraception: a prospective comparative study at a tertiary care centre in Southern Rajasthan

2026-04-29T10:57:35+0530

Background: Long-acting reversible contraceptives (LARCs) such as sub-dermal etonogestrel implants and copper intrauterine devices provide highly effective contraception. However, their acceptance and continuation vary due to side effects and user preference. To compare Implanon and Copper T as long acting reversible contraceptive methods in terms of efficacy, acceptance, continuation and side effect profile among women attending a tertiary care centre in Southern Rajasthan.

Methods: A comparative prospective study was conducted in the Department of Obstetrics and Gynaecology, RNT Medical College, Udaipur, from March to August 2024. Women aged 18–45 years opting for either Implanon or Copper-T were enrolled. Data on efficacy, adverse effects, acceptance and continuation were collected and analysed using Jamovi software.

Results: Among 303 participants, 189 opted for Implanon and 114 for Copper-T. Continuation rate was significantly higher with Implanon (97.4%) compared to Copper-T (88.6%). No pregnancies were reported among Implanon users, while one pregnancy occurred in the Copper-T group (efficacy 99.1%). Implanon users commonly reported amenorrhoea (45.2%) and menstrual irregularities (40%), whereas Copper-T users experienced heavy menstrual bleeding (30%), dysmenorrhoea (24%) and abdominal pain (25%). Younger women (21–30 years) and lower parity women preferred Implanon, while higher parity women preferred Copper-T.

Conclusions: Both Implanon and Copper-T are highly effective LARC methods. Implanon demonstrated better acceptance and continuation, while Copper-T remains an effective non-hormonal alternative. Individualised counselling is essential to optimise contraceptive choice.’

Comparison of different treatment modalities in gestational diabetes mellitus and their maternal and fetal outcomes

2026-04-29T10:57:27+0530

Background: Gestational diabetes mellitus (GDM) is associated with significant maternal and fetal morbidity. Optimal management strategies after failure of lifestyle modification remain debated. Objectives were to compare maternal and fetal outcomes among women with GDM managed with medical nutrition therapy (MNT) alone, MNT with metformin, and MNT with metformin plus insulin.

Methods: This prospective observational study was conducted in a tertiary care teaching hospital over 18 months. Ninety pregnant women diagnosed with GDM were enrolled and managed as per institutional protocol and endocrinology consultation. Participants were grouped based on treatment modality: diet alone (n=51), diet plus metformin (n=27), and diet plus metformin with insulin (n=12). Maternal outcomes (mode of delivery, pre-eclampsia, puerperal sepsis, shoulder dystocia) and fetal outcomes (birth weight, NICU admission, congenital malformations, perinatal mortality) were analysed. Appropriate statistical tests were applied with p≤0.05 considered significant.

Results: Majority of women (56.7%) were managed with diet alone. Post prandial blood sugar differed significantly across treatment groups (p<0.001). Caesarean section rates increased with treatment intensity (27.5% in diet alone versus 83.3% in insulin group; p=0.004). NICU admissions were significantly higher in the insulin group (41.7%; p=0.027). No statistically significant differences were observed in pre-eclampsia, congenital malformations, or perinatal mortality among groups.

Conclusions: Most women with GDM can be effectively managed with medical nutrition therapy alone. Requirement of pharmacotherapy reflects higher glycemic burden and is associated with increased operative deliveries and NICU admissions, without a significant increase in major adverse maternal or fetal outcomes.

Impact of advanced maternal age on obstetric and neonatal outcomes: an Indian cohort analysis

2026-04-29T10:57:14+0530

Background: To describe clinical profile, labour characteristics, maternal and neonatal outcomes of advanced maternal age pregnancies.

Methods: This retrospective observational study evaluated maternal, labour, and neonatal outcomes among women of advanced maternal age (AMA), with comparisons across normal maternal age, very advanced maternal age (VAMA), and extremely advanced maternal age (EAMA) groups. Demographic characteristics, mode of conception, comorbidities, labour profile, and neonatal outcomes were analysed.

Results: A total of 99,467 mothers delivered during the study period (January 2013 and December 2023), with majority belonging to normal age group (91.40%). AMA accounted for 6.77%, VAMA was 0.73%, EAMA was 0.07% and teenage pregnancy accounted for 1.03%. Proportion of AMA increased significantly over time, rising from 5.79% in 2013 to 14.83% in 2023. Most AMA pregnancies were singleton (94.45%), with a mean BMI of 28.05 ± 4.99 kg/m²; 1.23% were morbidly obese. Although spontaneous conception predominated (83.15%), assisted reproduction especially IVF (12.07%) was significantly more frequent. AMA mothers had a higher comorbidity burden, with multi-system disease in 39.33%. Caesarean delivery was common with 68.03%, with higher preterm birth rates (21.13%). Neonates showed more growth abnormalities (SGA 16.28%, LGA 12.55%) and higher NICU admissions (17.43%), live birth rates remained high (98.30%). Risk severity increased progressively in VAMA and EAMA groups.

Conclusions: AMA is associated with increased maternal comorbidity, caesarean delivery, preterm birth, and neonatal morbidity. These risks escalate further with increasing maternal age, underscoring the need for targeted antenatal surveillance, individualized risk stratification, multidisciplinary care, specialized intrapartum and neonatal care pathways.

Obstetric and neonatal outcomes among high-risk pregnancy in Bengaluru

2026-04-29T10:57:13+0530

Background: High-risk pregnancy (HRP) significantly contributes to adverse maternal and neonatal outcomes. Early identification and appropriate management through antenatal care (ANC) services, including initiatives such as Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA), are crucial in reducing morbidity and mortality. This study aimed to determine the obstetric and neonatal outcomes among high-risk pregnancies in a rural area of Bengaluru, South India.

Methods: A retrospective cohort study was conducted in the rural field practice area of a Tertiary care hospital and Medical College. High-risk pregnant women registered at a Primary Health Centre between January 2022 and July 2023 were included. Descriptive statistics were expressed as proportions with 95% confidence intervals. Chi-square test was used to assess associations between variables.

Results: A total of 94 high-risk pregnant women were included (mean age 26.7±4.1 years). Most participants (97.9%) had more than four ANC visits, while 89.4% did not utilize PMSMA services. Referral to higher centres was made in 36.2% cases. Common high-risk conditions included previous lower segment cesarean section (31.9%), previous bad obstetric history (19.1%), hypothyroidism (11.7%), gestational diabetes (5.3%) and pregnancy-induced hypertension (5.3%). Term deliveries accounted for 87.2% and the cesarean section rate was 73.4%. Postpartum hemorrhage occurred in 14.9% cases. Live births constituted 92.6%, with 3.2% stillbirths and 4.3% neonatal deaths. Low birth weight was observed in 19.1% newborns. A statistically significant association was found between number of ANC visits and newborn status (χ²=45.97, p<0.01).

Conclusions: High-risk pregnancies were associated with considerable obstetric and neonatal complications, including high cesarean section rates and low birth weight. Although ANC coverage was satisfactory, utilization of PMSMA services was low. Strengthening early risk identification, improving program awareness and ensuring timely referral and comprehensive management are essential to improve maternal and neonatal outcomes.

Impact of previous caesarean section on outcomes of non-descent vaginal hysterectomy: a prospective comparative study

2026-04-29T10:57:12+0530

Background: With rising caesarean section rates, an increasing number of women undergoing hysterectomy have a scarred uterus. Previous lower segment caesarean section (LSCS) is often considered a relative limitation for non-descent vaginal hysterectomy (NDVH) due to concerns regarding adhesions and bladder injury. This study aimed to prospectively compare perioperative outcomes of NDVH in women with and without prior LSCS.

Methods: This prospective comparative observational study was conducted at a tertiary care centre from February 2024 to January 2025. Fifty women undergoing NDVH for benign indications were enrolled and divided into two groups: group A included women with previous lower segment caesarean section (LSCS) (n=10), and group B included women with no prior surgery (n=40). Operative time, estimated blood loss, intraoperative and postoperative complications, and conversion rates were compared. Statistical analysis was performed using the Mann–Whitney U test and Fisher’s exact test, with p<0.05 considered statistically significant.

Results: Baseline demographic parameters were comparable between the two groups. Mean operative time was 43±6 minutes in LSCS group versus 49±7 minutes in control group (p=0.08). Mean blood loss was 85±20 ml versus 120±25 ml (p=0.06). Conversion rate was 10% versus 5% (p=0.52). One case in previous LSCS group required conversion due to dense anterior abdominal adhesions and positive Sheth’s sign, while two cases in no prior surgery group were converted due to large transverse diameter of uterus. No bladder or bowel injury occurred in either group. Prophylactic salpingectomy was feasible in the majority of cases in both groups.

Conclusions: In this prospective cohort, previous LSCS was not associated with increased perioperative morbidity during NDVH. Larger studies are required to confirm these findings.

Knowledge, attitude and practice study on human papilloma virus vaccination among healthcare providers at a tertiary care hospital in Puducherry: a cross-sectional study

2026-04-29T10:57:12+0530

Background: Cervical cancer remains a major preventable cause of morbidity and mortality among women in India. HPV vaccination is recognised globally as a critical tool for elimination strategies. As India prepares to integrate HPV vaccines into the national immunisation programme, healthcare providers knowledge, attitudes, and practices (KAP) become pivotal. Their ability to counsel and recommend vaccination strongly influences community acceptance and vaccine uptake. This research aimed to study the knowledge, attitude, and practices related to HPV vaccination among healthcare providers in a tertiary care hospital in Puducherry, and to examine associations between sociodemographic factors and knowledge levels.

Methods: A descriptive cross-sectional study was conducted among 168 healthcare providers including doctors, nurses, paramedical staff, and interns. Data were collected using a validated self-administered questionnaire adapted from prior KAP surveys. Descriptive statistics and Chi-square/Fisher’s exact tests were used for analysis, with significance set at p<0.05.

Results: Most participants (82.7%) demonstrated good knowledge about HPV and its vaccination, although gaps remained regarding updated WHO dosing recommendations. Positive attitudes were observed in 76.2% of respondents only 28.6% had received the vaccine themselves, 41% routinely recommended it, and just 32.1% had counselled a patient in the past month (18.5%). Doctors exhibited significantly higher knowledge levels than nurses and paramedical staff (p=0.02), similar to prior findings on professional disparities.

Conclusions: Although healthcare providers showed strong awareness and favourable attitudes toward HPV vaccination, practical engagement, such as personal vaccination, patient counselling, and routine recommendations, remained limited. Strengthening provider competency will be essential as India moves toward nationwide HPV vaccine introduction.

Placental stiffness assessment using shear wave elastography in normal and preeclamptic pregnancies: a cross-sectional analytical study

2026-04-29T10:57:11+0530

Background: Preeclampsia is a multisystem hypertensive disorder associated with abnormal placentation and increased placental stiffness. Shear wave elastography (SWE) is a non-invasive imaging modality that quantitatively evaluates tissue elasticity. This study aimed to compare placental stiffness in normal and preeclamptic pregnancies and determine an optimal diagnostic cut-off value.

Methods: This hospital-based cross-sectional analytical study was conducted in the Department of Radiodiagnosis at Dr. S.N. Medical College, Jodhpur between January 2025 and December 2025. A total of 120 pregnant women between 27-40 weeks of gestation were enrolled: 60 normotensive controls and 60 preeclamptic patients. Placental SWE measurements were obtained using a Philips Affiniti 70 ultrasound system. Nine readings were taken from fetal, central, and maternal placental regions. Receiver operating characteristic (ROC) curve analysis was performed to determine diagnostic performance.

Results: Mean SWE was significantly higher in preeclamptic women compared to controls (4.59±0.41 m/s vs 2.51±0.10 m/s; p=0.068). Median SWE values yielded an AUC of 0.968. A cut-off value of 4.32 kPa demonstrated sensitivity of 86.7% and specificity of 96.7%. Central placental regions showed significantly higher stiffness in preeclamptic pregnancies.

Conclusions: Placental stiffness measured by SWE is significantly increased in preeclampsia. SWE may serve as a reliable, safe, and non-invasive adjunct tool for evaluating placental pathology and identifying pregnancies at risk.

Midtrimester cervical length as a predictor of labour outcomes: a prospective observational study

2026-04-29T10:57:10+0530

Background: Preterm birth remains a major contributor to neonatal morbidity and mortality worldwide. Mid-trimester cervical length assessment using transvaginal ultrasound is useful in predicting a spectrum of labour outcomes, including preterm birth, post-dated pregnancy, need for labour induction, and operative delivery.

Methods: This hospital-based prospective observational study was conducted at Justice K. S. Hegde Charitable Hospital from June 2023 to November 2024. Mid-trimester cervical length was measured using transvaginal ultrasound between 18 and 24 weeks of gestation in 96 asymptomatic primigravida and second gravida women with singleton pregnancies. Participants were followed until delivery, and labour outcomes were recorded. Statistical analysis was performed using statistical package for the social sciences (SPSS) version 20.0.

Results: The mean cervical length was 3.71±0.38 cm. Spontaneous labour occurred in 72.9% of participants, while 27.1% required labour induction. Vaginal delivery occurred in 72.9% and caesarean section in 27.1%. Cervical length showed a statistically significant association with the onset of labour (p=0.012) and mode of delivery (p=0.023), suggesting its potential role as an independent predictor of labour dynamics beyond traditional risk stratification. Shorter cervical lengths were associated with spontaneous labour, whereas longer cervical lengths were linked to labour induction and caesarean delivery.

Conclusions: Mid-trimester cervical length measurement by transvaginal ultrasound, even within the normal range, serves as a clinically relevant predictor of labour outcomes. Its integration into routine antenatal assessment may enable more precise risk stratification, improved counselling, and individualized obstetric management, extending its role beyond traditional preterm birth prediction.

A cross-sectional observational study of coagulation profile and platelet parameters in pregnancy induced hypertension cases

2026-04-29T10:57:19+0530

Background: Pregnancy-induced hypertension (PIH) is associated with significant alterations in coagulation profile and platelet parameters. Early detection of these changes can help predict complications such as preeclampsia, eclampsia, and HELLP syndrome. This study aimed to evaluate coagulation and platelet parameters in PIH and assess their correlation with disease severity.

Methods: This observational study was conducted in the department of obstetrics and gynecology after institutional review board approval and informed consent. A total of 100 patients with PIH were included between December 2023 and November 2024. Coagulation parameters (PT, aPTT) and platelet indices (platelet count, MPV, PDW) were measured and compared according to disease severity.

Results: The mean age of participants was 28.4 years (19-40 years), with 65% aged 25-35 years. The mean gestational age was 31.2 weeks, and most cases were diagnosed between 28-34 weeks. Primigravida women constituted 72% of the cohort. Elevated PT and aPTT levels indicated endothelial dysfunction and impaired coagulation, correlating with complications such as preeclampsia, eclampsia, and HELLP syndrome. A significant decrease in platelet count was observed, particularly in severe PIH cases. Mean Platel

Conclusions: Coagulation and platelet abnormalities correlate with PIH severity and can serve as early indicators of disease progression. Routine assessment of these parameters may aid in early detection, risk stratification, and improved management, thereby reducing maternal and fetal morbidity and mortality.

Hemodynamic havoc: complicated ectopic pregnancy may trigger acute kidney injury

2026-04-29T10:57:18+0530

Background: The incidence of complicated ectopic pregnancies highlights the need for awareness of risk factors, as well as associated morbidity and mortality. This study aimed to determine the incidence of acute kidney injury (AKI) in patients with complicated ectopic pregnancy and to assess associated morbidity and mortality.

Methods: A retrospective observational study evaluated the incidence of AKI in patients with complicated ectopic pregnancy and assessed related morbidity and mortality at hospitals in Prayagraj, UP, from January 1, 2010, to December 31, 2024.

Results: A total of 180 ectopic pregnancies (EPs) were diagnosed, comprising 70 (38.89%) cases in primiparous and 110 (61.11%) in multiparous females. EP locations included tubular (83.8%), cervical (1.11%), ovarian (0.005%), and cesarean scar (14.44%), with an observed increase in cesarean scar implantations. Prior to admission to the nephrology intensive care unit (nephro ICU), salpingectomy was performed in 83.88% of cases, hysterectomy in 14.45%, and subtotal hysterectomy in 1.67%. In addition to severe haemorrhage, primary clinical findings were shock, septicemia, acute respiratory distress syndrome, oliguria, and multiple organ failure. Renal replacement therapy was initiated in 65 patients; among these, 46 (71.5%) received haemodialysis and 19 (15.84%) underwent plasmapheresis. The occurrence of these complications, particularly those necessitating RRT, was associated with a poor prognosis.

Conclusions: Early diagnosis of ectopic pregnancy reduces complications, morbidity, and mortality. Patients recovering from AKI must follow up with nephrology to ensure long-term health. Public awareness and training healthcare professionals in ultrasound for early detection are essential.

A retrospective study of outcomes of induced labors in a tertiary care hospital in Puducherry

2026-04-29T10:57:16+0530

Background: Induction of labor (IOL) is a common obstetric intervention performed when continuation of pregnancy poses greater risk than delivery.

Methods: A retrospective observational study was conducted among 120 women who underwent induction of labor over a 6-month period. Data regarding demographic profile, indications, methods, maternal and neonatal outcomes were analyzed.

Results: Majority of women were aged 21-30 years (80.8%) and multiparous (55%). Most inductions were performed between 38-40 weeks. Vaginal delivery was achieved in 62.5%, while 30% required cesarean section. Maternal complications were minimal with 1.7% experiencing postpartum hemorrhage. Neonatal outcomes were favorable with 98.3% normal outcomes and minimal NICU admissions.

Conclusions: Induction of labor is a safe and effective intervention with good maternal and neonatal outcomes when appropriately indicated and monitored.

Breech extraction in intrauterine fetal demise in modern obstetrics: a 10-year retrospective study from the Bundelkhand region

2026-04-29T10:57:08+0530

Background: Breech extraction is a declining obstetric skill in modern practice; however, it continues to have relevance in selected situations such as intrauterine fetal demise (IUD), particularly in resource-limited settings. Proper technique is essential to minimise maternal morbidity.

Methods: This retrospective observational study included cases of intrauterine fetal demise delivered by breech extraction at a tertiary care centre in the Bundelkhand region between January 2016 and December 2025. Maternal demographic data, obstetric characteristics, indication for breech extraction, technique used, and maternal complications were analysed.

Results: A total of 50 cases were included. Breech extraction was successfully performed vaginally in all cases. The procedure was associated with minimal maternal morbidity, with postpartum haemorrhage and genital tract trauma being the most common complications. No maternal mortality was observed.

Conclusions: Breech extraction remains a safe and effective method of delivery in cases of intrauterine fetal demise when performed judiciously by experienced obstetricians, even in modern obstetric practice.

Maternal and fetal outcome in oligohydramnios diagnosed at or after 34 weeks of gestational age: a case-control study

2026-04-29T10:55:33+0530

Background: Oligohydramnios, a deficiency in amniotic fluid volume diagnosed at or after 34 weeks of gestation, is a common obstetric dilemma. While historically linked to adverse outcomes, optimal management remains controversial particularly in isolated cases, balancing the risks of prematurity against intrauterine compromise. Aim was to compare the maternal and fetal outcomes in pregnancy with oligohydramnios diagnosed at or after 34 weeks of gestation with those of normal amniotic fluid index (AFI).

Methods: A prospective case-control study was conducted in the Department of Obstetrics and Gynaecology at Al-Ameen Medical College and Hospital, Vijayapura, from February 2024 to January 2026. A total of 102 pregnant women were included, with 51 cases of oligohydramnios and 51 matched controls with normal AFI. All participants underwent detailed clinical evaluation, ultrasonography including AFI, Doppler and fetal biometry, and non-stress tests (NST).

Results: Baseline characteristics were comparable between groups, but hypertensive disorders were significantly higher in the oligohydramnios group (37.3% vs. 9.8%). Non-reactive NST patterns, abnormal fetal heart rate patterns, labour induction (60.8% vs. 17.6%), and caesarean section rates (58.8% vs. 17.6%) were more frequent among cases. Neonates in the oligohydramnios group had lower mean birth weight (2670 g vs. 2850 g) and higher NICU admissions (43.1% vs. 13.7%)

Conclusions: Oligohydramnios in late pregnancy may indicate placental pathology and is linked to increased maternal and perinatal complications, requiring careful evaluation, close fetal surveillance, and individualized multidisciplinary management rather than purely conservative care

Medical termination of pregnancy beyond 24 weeks: preliminary observations from a tertiary care institute in Northern India

2026-04-29T10:55:31+0530

Background: Despite increase in legally prescribed limit of gestational age to 24 weeks for medical termination of pregnancy (MTP) in India, a reasonable number of women request for MTP beyond 24 weeks of gestation. We present preliminary observations on women who underwent MTP beyond 24 weeks of gestation at our institute.

Methods: Current study included 32 women who underwent MTP beyond 24 weeks of gestation (after obtaining permission from permanent medical board) at our tertiary care institute in Northern India. Gestational age was calculated by menstrual history as well as ultrasonographic findings.

Results: Mean age was 28±4.8 years. Mean gestational age at time of MTP was 28 weeks and 2 days. Eight (25%) women were primigravida while 24 (75%) were multigravida. Nine (28.1%) women had past history of abortion. The most common indications for MTP were neurological defects (28.1%) followed by cardiac (21.9%), renal (18.8%) and musculoskeletal (15.6%) defects. Two women underwent surgical intervention while pregnancy was terminated medically in 30 (87.5%) women. All women were healthy at discharge.

Conclusions: MTP beyond 24 weeks of gestational age is safe. Future studies on reasons for delayed presentation may help us in further streamlining of MTP services.

Effectiveness of menstrual health and hygiene management training program among tribal women of Jharkhand

2026-04-29T10:55:30+0530

Background: Menstrual health is one of the many common biological processes that women experience and yet they face challenges to adapting healthier practices due to societal and cultural norms attached to the subject. The intensity of the issue is magnified for tribal women due to a lack of knowledge and accessibility to facilities. CInI (Collectives for integrated livelihood initiatives), Jharkhand based grassroot organization in collaboration with its 6 (FPC) farmer producer companies) implemented menstrual hygiene management (MHM) training for women from 7 blocks across 6 districts.

Methods: This study examines the effectiveness of the MHM program for tribal populations to assess their knowledge, attitudes and infrastructure facilities. A cross-sectional study was conducted amongst the MHM program attendees. Data was collected using questionnaires pre- and post-training from 465 participants.

Results: The post-training answers showed significant improvements in the understanding of menstruation. The 97.6% considered menstruation to be a normal biological process, and 43.4% adopted the practice of changing sanitary napkins three times a day.

Conclusions: The study highlights the need to tailor the menstrual health management program to the context of the community. The model leveraging existing community leaders and practitioners accelerates the program participation and outcome.

Fertility outcomes following laparoscopic management of endometriosis: a prospective study from a tertiary fertility centre

2026-04-29T10:55:28+0530

Background: Endometriosis is a common gynecological disorder affecting approximately 10–15% of reproductive-aged women and is strongly associated with infertility and pelvic pain. Laparoscopic surgery plays an important role in the diagnosis and management of endometriosis. This study aimed to evaluate fertility outcomes following laparoscopic management of endometriosis.

Methods: This prospective study was conducted at Sudha Sundar Fertility Hospital, Tamil Nadu between January 2018 and August 2022. A total of 53 women diagnosed with endometriosis who underwent laparoscopic surgery were included. Procedures included laparoscopic cystectomy, adhesiolysis, and fulguration of endometriotic lesions. Patients were followed up for fertility outcomes.

Results: Most patients belonged to the age group of 31–35 years (43.3%). Primary infertility was present in 86.7% of patients. Advanced disease (stage III–IV) was observed in the majority of cases. The overall pregnancy rate following laparoscopic treatment was 45.29%.

Conclusions: Laparoscopic management of endometriosis improves fertility potential and assists in planning further assisted reproductive techniques when required.

A clinical study of fetomaternal outcome in cases of abruption placentae in tribal population of North East Gujarat

2026-04-29T10:55:28+0530

Background: Abruptio placentae is a serious obstetric emergency characterized by premature separation of the normally implanted placenta, leading to significant maternal and perinatal morbidity and mortality. Early identification and prompt management are essential to improve outcomes. Objectives were to evaluate the fetomaternal outcomes in patients with abruptio placentae and to analyze the association of demographic, clinical, and hematological factors with the severity of abruption and neonatal outcomes.

Methods: This hospital-based observational study included 75 patients with clinically and/or ultrasonographically diagnosed abruptio placentae admitted to a tertiary care center. Maternal demographic characteristics, antenatal risk factors, clinical presentation, hematological parameters, and obstetric outcomes were analyzed. The degree of abruption was categorized into grades, and its association with maternal findings, hemoglobin levels, clinical signs, and neonatal outcomes such as birth weight, APGAR score, and fetal survival was assessed.

Results: Most patients were in the 18-25-year age group (48%), and the majority presented in the preterm period (83.99%). Hypertensive disorders and anemia were the most common risk factors. Grade 1 abruption was seen in 50.67% of cases, followed by grade 2 (32%) and grade 3 (17.33%). Severe anemia, pallor, and edema were significantly associated with higher grades of abruption. Low birth weight (<2000 g) was observed in 76% of neonates, and 53.33% had APGAR scores ≤6. Live births accounted for 57.33% of cases, while fetal loss occurred in 42.67%.

Conclusions: Abruptio placentae is associated with high maternal and perinatal risk, particularly in preterm pregnancies with hypertensive disorders and anemia. Early antenatal risk identification, timely referral, and prompt multidisciplinary management are crucial to improve fetomaternal outcomes.

Efficacy and safety of mifepristone as a sole induction agent in intrauterine fetal demise in scarred and unscarred uterus

2026-04-29T10:55:27+0530

Background: Termination of pregnancy in the second and third trimester due to intrauterine fetal demise (IUFD) or lethal fetal anomalies requires safe and effective methods of induction of labour. Mifepristone, an antiprogestin, has been used for cervical ripening and labour induction. This study aimed to evaluate the efficacy and safety of mifepristone as a sole agent for induction of labour in pregnancies beyond 20 weeks of gestation in women with both scarred and unscarred uterus.

Methods: This prospective clinical study was conducted in the Department of Obstetrics and Gynaecology at Shaheed Hasan Khan Mewati Government Medical College, Nalhar, Haryana over a period of one year after approval from the institutional ethics committee. A total of 54 antenatal women with gestational age >20 weeks requiring termination due to intrauterine fetal demise, lethal fetal malformation or PPROM were included. Tablet mifepristone 200 mg was administered orally at 12-hour intervals for a maximum of three doses. Patients were monitored for onset of labour and delivery. Primary outcome measured was successful vaginal delivery following induction with mifepristone alone. Secondary outcomes included induction-delivery interval, requirement of additional uterotonics and maternal complications.

Results: Most patients belonged to the age group of 18–24 years (48.14%), and the majority were multiparous. Scarred uterus was present in 24.07% of cases while 75.93% had unscarred uterus. A total of 87.04% of women delivered within 72 hours of the first dose of mifepristone without the need for additional uterotonics. Additional induction methods such as misoprostol or intracervical Foley’s catheter were required in 12.96% of cases. The majority of patients (59.25%) delivered between 24–72 hours following the first dose of mifepristone. No cases of uterine rupture, scar dehiscence, retained products of conception, or requirement of caesarean section or hysterotomy were observed.

Conclusions: Mifepristone is an effective and safe agent for induction of labour in pregnancies beyond 20 weeks with intrauterine fetal demise or lethal fetal anomalies in both scarred and unscarred uterus. Its use is associated with a high rate of successful vaginal delivery with minimal maternal complications.

The prevalence and risk factors for severe maternal morbidity at a tertiary care centre in western India

2026-04-29T10:55:26+0530

Background: Severe maternal morbidity (SMM) is an important indicator of maternal health, especially as maternal mortality declines. For every maternal death, 20-30 women experience significant pregnancy-related complications. SMM includes serious, potentially life-threatening conditions during pregnancy, labor, or the postpartum period. Although maternal near miss (MNM) has been widely studied, data on SMM remain limited. This study aimed to determine the prevalence of SMM and identify associated risk factors among women delivering at a tertiary care hospital in Vadodara, Gujarat.

Methods: This hospital-based cross-sectional study was conducted in the labor room of S.S.G. Hospital, Vadodara. Women aged 18 years or older undergoing delivery and fulfilling at least one CDC-defined SMM criterion were included. Socio-demographic characteristics, antenatal care details, obstetric history, pregnancy complications, mode of delivery, and maternal outcomes were recorded and analyzed descriptively.

Results: The prevalence of SMM was 72.38% (185 women). Most were aged 20-29 years (59.46%), and 87.03% were referred cases. Inadequate antenatal care (<4 visits) was observed in 36.76%. Hypertensive disorders (31.85%) and severe anemia (10.95%) were common complications. Caesarean section was performed in 40% of cases. Blood transfusion was required in 45.41%, and 5.41% had hospital stays exceeding 14 days.

Conclusions: SMM was markedly higher than MNM, underscoring its value as a tool for improving maternal healthcare. Hemorrhage, hypertensive disorders, anemia, inadequate antenatal care, and previous caesarean section were key contributors.

Introduction of heating pads in the labour room: a quality improvement project

2026-04-29T10:55:25+0530

Background: Thermal discomfort during labour can contribute to patient distress. During winter months in north India, maintaining patient comfort remains challenging despite standard heating, particularly in high-volume public sector labour rooms. Simple interventions addressing environmental comfort may improve patient experience. This project aimed to evaluate the feasibility and patient-reported thermal comfort associated with introducing heating pads in a government hospital labour room as a quality improvement (QI) initiative.

Methods: This before-and-after QI project was conducted in the labour room of a tertiary-care government medical college hospital in North India during winter. Baseline data on patient-reported thermal discomfort were collected through brief verbal interviews before the intervention. Reusable heating pads were then introduced as a non-invasive comfort measure. Post-intervention interviews assessed thermal comfort, perceived changes in pain or discomfort, willingness to recommend the intervention, and feedback from resident doctors. Changes in the proportion of patients reporting comfort were assessed using the chi-square test as a supportive analysis.

Results: Fifty-five women participated pre-intervention and 60 post-interventions. The proportion reporting thermal comfort increased from 49.1% to 76.7% after the implementation. Approximately two-thirds reported a reduction in pain or discomfort, and 88.3% would recommend the intervention. Most resident doctors reported improved patient comfort and greater ease during examinations or suturing.

Conclusions: Introducing reusable heating pads was associated with improved patient-reported thermal comfort and positive staff feedback. Such interventions may be feasible strategies to improve patient comfort in labour rooms and support patient-centred care in resource-constrained settings.

Age of menopause and determining factors in rural Telangana

2026-04-29T10:55:23+0530

Background: Menopause is the cessation of menstruation for one year at the end of reproductive life. The average age of menopause differs in different regions. Early menopause is a high risk for cardiovascular diseases, osteoporosis, and late menopause for breast, and genital cancers. As the age of natural menopause is affected by many factors and early and late menopause cause life-threatening diseases, the determination of the age of menopause is important for different geographical regions.

Methods: This prospective cross-sectional study was conducted in the outpatient department of Obstetrics and Gynecology, Mamata Medical College and General Hospital, Khammam, Telangana, India, over 09 months from 01 April 2024 to 31 December 2024. Women with natural menopause were asked pre-determined questions like name, age, occupation, education, etc. and answers were noted. Iatrogenic and premature menopause or unwilling women, were excluded. Descriptive statistical analysis and a p-value test were used to find the age of menopause and co-relation with determinants. Medcalc-24 was used for calculations. p-value< 0.05 was considered significant. The outcome was discussed critically and compared with other study reports.

Results: The average age of menopause was 47.05 +/- 04.39 years. A strong co-relation of the age of menopause with occupation (p-0.0002) and marital status (p-0.0003) was observed. The same co-relation with body weight (p-0.0232) and parity (p-0.0114) was significant. No significant co-relation was detected between the age of menopause and menarche or with education.

Conclusions: The age of natural menopause is an important indicator of health in postmenopausal women and varies in different geographical regions. It is required to formulate health strategies for a healthy postmenopausal life of women.

Overview of referred cases both referred in and referred out obstetric patients and outcome of referred out cases in tertiary hospital, Hassan Institute of Medical Sciences, Hassan

2026-04-29T10:55:22+0530

Background: An effective obstetric referral system is essential for ensuring timely management of high-risk pregnancies and reducing maternal morbidity and mortality. Tertiary care centers play a crucial role in managing complicated obstetric cases referred from peripheral health facilities. This study aimed to evaluate the pattern of obstetric referrals, including both referred-in and referred-out cases, and to assess the outcomes of referred-out patients at a tertiary care hospital.

Methods: A retrospective observational study was conducted at the Department of Obstetrics and Gynecology, Hassan Institute of Medical Sciences, Hassan. Data were collected from hospital records for the years 2021 and 2022. Information regarding total obstetric admissions, referred-in cases, causes of referral, monthly distribution of referrals, and outcomes of referred-out patients was analyzed using descriptive statistics.

Results: A total of 6,344 obstetric admissions were recorded in 2021, with 2,171 (34.2%) referred cases, while in 2022 there were 6,210 admissions with 3,307 (53.3%) referred cases, indicating an increase in referrals. The most common indications for referral included hypertensive disorders of pregnancy, anemia, previous caesarean section, fetal distress, preterm labor requiring NICU care, and PROM. System-related factors such as unavailability of obstetricians and patient request also contributed to referrals. Most referred-out patients were discharged after treatment; however, a small proportion were lost to follow-up and a few maternal deaths were recorded.

Conclusions: The study highlights a substantial proportion of obstetric referrals to tertiary care centers, mainly due to high-risk pregnancy complications and limitations in peripheral healthcare facilities. Strengthening antenatal care, improving infrastructure, and ensuring timely referral may help improve maternal outcomes.

Rescue cerclage revisited: the role of adjunctive pessary in cervical incompetence

2026-04-29T10:55:20+0530

Background: Emergency cervical cerclage is an established intervention for women presenting with painless cervical dilatation; however, outcomes are strongly influenced by the degree of cervical compromise at presentation and multiple other factors. Cervical pessary is a non-invasive option for preventing preterm birth, but its role as an adjunct to emergency cerclage remains inadequately explored.

Methods: This was a retrospective observational study in women with cervical insufficiency who underwent emergency cervical cerclage between January 2020 and December 2025 at a tertiary care centre in India. Pregnancy and neonatal outcomes were compared between women who underwent emergency cerclage with adjunctive pessary (Group A) and those who underwent cerclage alone (Group B). A predefined subgroup analysis was performed among women presenting with advanced cervical dilatation (≥2 cm).

Results: Thirty women were included (Group A, n=7 and Group B, n=23). Women in group A presented with significantly greater cervical dilatation at admission (2.57 vs 1.44 cm; p=0.002). Overall pregnancy outcomes, including latency period, gestational age at delivery, and neonatal survival, were comparable between groups. In the subgroup with cervical dilatation ≥2 cm at the time of presentation (Subgroup A, n=6; Subgroup B, n=6), early pregnancy expulsion occurred more frequently in subgroup B (50%) than subgroup A (0%), showing a trend toward statistical significance (p=0.053). Subgroup A demonstrated a longer mean latency period (10.8 vs 6.8 weeks), though this difference was not statistically significant (p=0.37).

Conclusions: In women undergoing emergency cervical cerclage, particularly those with advanced cervical dilatation, adjunctive pessary use may reduce pregnancy loss at earlier gestation and support pregnancy prolongation.

A study on fetomaternal outcome in late preterm labour (34 weeks – 36 weeks 6 days) in a tertiary care centre, Rajkot

2026-04-29T10:55:18+0530

Background: Preterm birth, defined as birth before 37 completed weeks of gestation, presents significant risks for short- and long-term health outcomes. This study evaluates risk factors, delivery modes and feto-maternal outcomes in late preterm labor.

Methods: This 1.5 years prospective observational study was conducted on 300 women delivering between 34 weeks and 36 weeks 6 days at P.D.U Medical College, Rajkot, from February 2023 to July 2024. Inclusion criteria involved spontaneous labor; induced labors and specific co-morbidities were excluded.

Results: The majority of patients were under 25 years (62%) and nulliparous (39.3%). Common risk factors included Gestational HTN (14.6%), UTI (11.3%) and prior abortions (17.33%). Most deliveries were vaginal (85.3%). Neonatal jaundice was the leading cause of NICU admission (8.33%). Low APGAR scores (<7) at 5 minutes were observed in 23.66% of neonates.

Conclusions: Late preterm labor is significantly associated with nulliparity and hypertensive disorders. While vaginal delivery is common, there is a high requirement for NICU care, particularly for jaundice and respiratory support. Collaboration between obstetricians and neonatologists is essential to improve outcomes.

Pseudomyxoma peritonei from an ovarian mucinous cystadenoma mimicking ovarian cancer

2026-04-29T10:57:19+0530

Pseudomyxoma peritonei (PMP) is a rare, borderline malignant condition, most commonly originating from the appendix, with ovarian origin being extremely rare. Rupture of ovarian mucinous tumours can result in dissemination of gelatinous mucus and tumour cells throughout the peritoneal cavity, leading to accumulation of ascites. We report a 56-year-old grand multiparous woman presenting with chronic abdominal pain and progressive distension. Physical examination revealed stable vital signs and overweight status (BMI 27 kg/m²). Laboratory investigations showed mild anaemia, and preoperative serum tumor markers (CA-125, CEA, CA 19-9) were evaluated. Imaging revealed a large multiloculated pelvi-abdominal cystic mass (22×19 cm) with massive ascites and peritoneal calcifications, suggestive of ovarian malignancy. An exploratory laparotomy revealed a 20 cm left ovarian mass with solid and multiloculated gelatinous components, with an appendix slightly enlarged, while the right adnexa and the uterus were unremarkable. Accidental intraoperative rupture released approximately 3 liters of gelatinous ascites. The patient underwent left salpingo-oophorectomy, appendectomy, multiple peritoneal biopsies, and cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (HIPEC). Histopathology confirmed PMP originating from an ovarian mucinous cystadenoma.The patient remains under regular surveillance. Complete cytoreductive surgery with HIPEC offers the best prognosis, though long-term follow-up is essential due to the risk of recurrence. Ovarian-origin PMP is rare and may mimic advanced ovarian malignancy. Accurate diagnosis relies on histopathology, and management requires complete cytoreduction combined with HIPEC, with vigilant long-term follow-up.

Expectant management of chronic abruption-oligohydramnios sequence in a resource-limited setting: a case report

2026-04-29T10:57:36+0530

The chronic abruption-oligohydramnios sequence (CAOS) is a rare obstetric condition that may follow a prolonged clinical course. We report the case of a 30-year-old woman who delivered a live newborn at Sainte-Thérèse Hospital in Hinche, 34 days after an ultrasound detected a retroplacental hematoma at 29 weeks and 4 days of gestation. The patient presented with vaginal bleeding accompanied by hypogastric and sacrolumbar pain. Initially hospitalized for preterm labor, a retroplacental hematoma was then detected on ultrasound. Two days later, she was readmitted for severe preeclampsia complicated by placental abruption, and a conservative approach was adopted. On day 32 of hospitalization, she delivered via cesarean section under spinal anesthesia. Despite the complication, the patient had a good outcome. This case illustrates that expectant management may be considered in cases of abruptio placentae that are likely to become chronic, even in a rural, resource-limited setting.

Posterior reversible encephalopathy syndrome presenting as refractory postpartum seizures in a resource-constrained setting: a diagnostic dilemma and maternal near-miss from Nigeria

2026-04-29T10:55:30+0530

Posterior reversible encephalopathy syndrome (PRES) is an uncommon complication of pregnancy, whose rarity may lead to delayed diagnosis adverse outcomes, especially when seizures persist despite standard anti-seizure regime for eclampsia. A 25-year-old primiparous with sickle cell haemoglobinopathy was admitted about 48 hours into the puerperium with generalized tonic-clonic seizures, severe hypertension and altered mental state. She was managed for eclampsia and suspected sepsis with magnesium sulphate, antihypertensives and antibiotic therapy, with transient improvement. She however deteriorated rapidly and lapsed into unconsciousness, prompting further evaluation. After a period of delay due to financial difficulties, computerized tomography scan revealed widespread bilateral vasogenic edema that was characteristic of PRES. Following the initiation of corticosteroid therapy, the seizures ceased and she achieved full neurological recovery without any deficit. This case depicts the diagnostic dilemma of persistent pregnancy-associated seizures, especially in resource-constrained settings. Heightened suspicion, early imaging and multidisciplinary vigilance are recommended for such patients.

Spontaneous peri-clitoral abscess in two nulliparous women: a case report

2026-04-29T10:55:29+0530

Peri-clitoral abscess in an uncommon vulvar infection with limited data available in the literature. Most published information consists of isolated case reports, and standardized management guidelines have not been established. We report two cases of peri-clitoral abscess in previously healthy women aged 22 and 33 years who presented with acute pain localized to the peri-clitoral region and swelling of the clitoral hood. Neither patient had identifiable risk factors such as trauma, prior vulvar surgery or hidradenitis suppurativa. Physical examination demonstrated localized erythema, edema, and a fluctuation consistent with abscess formation. Both patients underwent incision and drainage under anesthesia with careful preservation of the clitoral neurovascular bundle. Culture-directed antibiotic therapy was administered. Both patients experienced rapid postoperative improvement with complete resolution and no recurrence or functional complications at follow-up. These cases highlight that peri-clitoral abscess can occur in otherwise healthy women without identifiable risk factors. Early recognition, careful surgical drainage, and culture-guided antimicrobial therapy are essential for successful management while preserving clitoral neurovascular integrity.

A cornered conundrum: early diagnosis and management of an unruptured interstitial ectopic pregnancy

2026-04-10T07:04:35+0530

Constituting about 2.4% of all ectopic pregnancies, an interstitial ectopic pregnancy is a rare but life-threatening condition. Diagnosis can be challenging and it often presents late, with a high risk of catastrophic haemorrhage following rupture. Early diagnosis remains crucial for reducing maternal morbidity. We report a case of a spontaneously conceived interstitial ectopic pregnancy (IEP) diagnosed at an early gestational age in a hemodynamically stable patient presenting asymptomatically, for routine antenatal care, with no identifiable risk factors. Transvaginal ultrasonography and magnetic resonance imaging (MRI) pelvis revealed an eccentrically located gestational sac near the right uterine cornu, surrounded by a thin myometrial mantle, separate from the endometrial cavity. Serum β-hCG level was consistent with early gestation. Prompt diagnosis enabled timely surgical intervention before rupture. The postoperative course was uneventful and the patient recovered well. IEP poses significant diagnostic and therapeutic challenges due to its atypical location and risk of delayed rupture. Vigilant early imaging and high clinical suspicion are essential for timely intervention. Early recognition allows for planned surgical management, reducing maternal morbidity and mortality and improving reproductive outcomes.

The silent synechiae: female genital tuberculosis masquerading as resistant polycystic ovarian syndrome-induced amenorrhoea

2026-04-29T10:59:51+0530

Female genital tuberculosis (FGTB) is a significant cause of menstrual disturbances and infertility in tuberculosis-endemic regions. However, its diagnosis is frequently delayed due to its paucibacillary nature and nonspecific presentation. We report the case of a 28-year-old woman with a known history of polycystic ovarian syndrome (PCOS). She presented with secondary amenorrhoea of six months’ duration following the discontinuation of oral contraceptive pills (OCPs). While amenorrhoea is common in PCOS due to anovulation, this patient failed to exhibit withdrawal bleeding after a therapeutic challenge with progesterone and a subsequent course of OCPs. Pelvic ultrasonography provided false reassurance, showing polycystic ovarian morphology with normal endometrial thickness. A diagnostic hysteroscopy was performed to rule out outflow tract obstruction. It revealed filmy fundal synechiae and pale, unhealthy endometrium. Histopathology confirmed caseating epithelioid-cell granulomas with Langhans giant cells, and TB PCR detected Mycobacterium tuberculosis DNA. The patient was treated with a standard six-month anti-tubercular therapy (ATT) regimen under the national tuberculosis elimination programme (NTEP), resulting in the resumption of regular menstrual cycles. This case underscores the necessity of investigating structural causes, such as FGTB, in women with PCOS who present with atypical amenorrhoea refractory to hormonal withdrawal.

Pelvic congestion syndrome: a rarely recognized cause of chronic pelvic pain-clinical presentation and successful management: a case report

2026-04-29T10:59:50+0530

Pelvic congestion syndrome (PCS) is an underdiagnosed cause of chronic pelvic pain in women of reproductive age, resulting from venous insufficiency and retrograde blood flow in the ovarian and pelvic veins. The condition typically presents with chronic dull pelvic pain, pressure, and heaviness lasting longer than six months, often exacerbated by menstruation, prolonged standing, and increased intra-abdominal pressure. Due to its nonspecific symptoms and overlap with other gynecological disorders, diagnosis is frequently delayed. Imaging modalities such as transvaginal Doppler ultrasonography, CT venography, and MR venography play a crucial role in diagnosis. We report a rare case of PCS in a multiparous woman with longstanding chronic pelvic pain who had undergone multiple evaluations elsewhere without definitive diagnosis. Timely recognition and appropriate management at our center resulted in significant symptomatic improvement. This case highlights the importance of considering PCS in the differential diagnosis of chronic pelvic pain.

A third-trimester pregnancy complicated by moderate flame burn injury: clinical course and outcome

2026-04-29T10:59:39+0530

Burn injuries during pregnancy are rare but represent a significant obstetric emergency with potential adverse maternal and fetal outcomes. Physiological changes of pregnancy, combined with the systemic inflammatory response to burns, complicate resuscitation, infection control, and obstetric decision-making, particularly in late gestation. Management becomes more complex in the third trimester due to fetal viability and the need to consider timing and mode of delivery. We report a case of a 21-year-old multigravida at 36 weeks of gestation with moderate-severity accidental flame burns involving 20–25% total body surface area (TBSA). The patient was managed at a tertiary care centre with prompt maternal stabilization, multidisciplinary coordination, and elective lower segment caesarean section (LSCS). Both maternal and neonatal outcomes were favourable. This case highlights the importance of early referral to tertiary care, individualized obstetric decision-making, and multidisciplinary management in achieving optimal outcomes in third-trimester burn injuries.

Coexistence of Ogilvie syndrome and rectus sheath hematoma after cesarean section: a rare combination of two potentially life-threatening conditions

2026-04-29T10:59:36+0530

Ogilvie syndrome, or acute colonic pseudo-obstruction, occurs in less than 1% of patients undergoing surgery (organ transplant, orthopedic, gynecologic, and urologic surgeries), which increases both morbidity and mortality. Rectus sheath hematoma is another uncommon abdominal pathology, typically arising from trauma, anticoagulation or sudden increase in intra-abdominal pressure. The coexistence of these two entities in the same patient is extremely unusual and can pose significant diagnostic and management challenges.

Giant myelomeningocele presenting as obstructed labor: a rare cause of dystocia

2026-04-29T10:59:33+0530

Myelomeningocele is a severe open neural tube defect resulting from failure of neural tube closure during early embryogenesis. Although commonly diagnosed antenatally, large lesions may occasionally present intrapartum and cause obstructed labour. We report a case of a 25-year-old woman presenting in advanced labor with obstructed delivery. Antenatal ultrasonography revealed a large cystic lumbosacral mass with polyhydramnios. In view of obstructed labor, an emergency cesarean section was performed. Intraoperatively, a giant lumbosacral cystic mass was identified, causing obstruction at the pelvic brim. Aspiration of cystic contents facilitated delivery. Postnatal evaluation confirmed the diagnosis of giant myelomeningocele. Giant myelomeningocele is a rare but important cause of obstructed labor. Early antenatal diagnosis, regular antenatal care, and timely referral are essential to prevent maternal and neonatal morbidity.

Malignant Brenner tumour with mucinous cystadenoma in a post-menopausal woman: a rare case presentation

2026-04-29T10:59:32+0530

Brenner tumour is a relatively uncommon epithelial ovarian neoplasm accounting for 1.4–2.5% of ovarian tumours. Malignant variants are rare (<5%). A 65-year-old postmenopausal woman presented with abdominal pain, distension, weight loss and postmenopausal bleeding. RMI was 1098. MRI suggested malignant epithelial ovarian tumour. Staging laparotomy was performed. Histopathology confirmed malignant Brenner tumour (FIGO IA) with mucinous cystadenoma. Malignant Brenner tumour is rare and requires histopathological confirmation. Early-stage disease has favourable prognosis.

Morphological modulation of ovarian endometrioma with elagolix: a case report

2026-04-29T10:57:37+0530

Ovarian endometrioma is a common manifestation of endometriosis, an estrogen-dependent inflammatory disorder associated with chronic pelvic pain and dysmenorrhea in women of reproductive age. Although surgical cystectomy is often effective, it may compromise ovarian reserve which is a significant concern, particularly in young women, highlighting the need for effective medical alternatives. We report a rare case of non-surgical management of a large ovarian endometrioma using the oral gonadotropin-releasing hormone (GnRH) antagonist, Elagolix. A 21-year-old unmarried woman presented with severe dysmenorrhea and lower abdominal pain, and ultrasonography revealed a right ovarian endometrioma. She was initiated treatment with Elagolix 150 mg once daily. The patient experienced significant symptomatic relief with marked reduction in pain scores and no notable hypoestrogenic adverse effects. Follow-up imaging at week 10 demonstrated morphological changes within the cyst suggestive of necrotic transformation and reduced endometrial cell viability indicating inhibition of disease progression. This case highlights the role of individualized, dose-dependent hormonal modulation with Elagolix as a non-surgical option for managing ovarian endometriomas, achieving both clinical and radiological improvement with fertility-preservation.

Advanced uterovaginal prolapse in the presence of dense ventral uterine fixation: highlighting the dominant role of pelvic floor support

2026-04-29T10:57:35+0530

Uterovaginal prolapse is commonly attributed to multiparity and pelvic floor weakness, while dense anterior uterine fixation is generally presumed to limit uterine descent. We report a rare case of advanced uterovaginal prolapse occurring despite dense ventral uterine fixation. A 30-year-old multiparous woman presented with complaints of something protruding per vaginum for 1 year. Clinical examination revealed third-degree uterovaginal prolapse with associated anterior and posterior compartment defects. She was planned for laparoscopic uterine–preserving surgery. Intraoperatively, the uterus, along with both round ligaments, was found to be densely adherent to the anterior abdominal wall, consistent with ventral uterine fixation. Extensive adhesiolysis was required to restore uterine mobility, following which uterosacral ligament plication was performed. Due to distorted anterior anatomy, anterior compartment repair was completed vaginally. Postoperative recovery was uneventful with satisfactory anatomical correction. This case highlights that anterior uterine fixation does not necessarily prevent uterovaginal prolapse and emphasizes the dominant role of pelvic floor and apical support in maintaining uterine position.

Successful conservative management of a live asymptomatic cervical ectopic pregnancy: a case report

2026-04-29T10:57:33+0530

Cervical ectopic pregnancy (CEP) is a rare and potentially life-threatening condition, accounting for less than 1% of all ectopic pregnancies, with a high risk of severe haemorrhage and fertility loss. A 24-year-old woman presented with 7 weeks of amenorrhoea and a positive serum β-human chorionic gonadotropin test. Transvaginal ultrasonography revealed a well-defined gestational sac in endo-cervical region, having fetal pole, crown-rump length measuring 8.4mm corresponding to 6 weeks 5 days cervical ectopic gestation with cardiac activity. Internal os was closed, Colour Doppler showed significant peritrophoblastic vascularity. Initial management with intramuscular methotrexate was followed by ultrasound-guided intra-gestational sac methotrexate and potassium chloride injection caused gradual decrease of serum β HCG levels and almost disappreance of products of conception within 2 weeks, without the need for additional interventional treatment. Conservative treatment including intramuscular methotrexate followed by intra- gestational sac methotrexate and potassium chloride administration may be effective in treating cervical ectopic pregnancy that even curettage may not be compulsory.

A case report of serous cystadenofibroma in pregnancy

2026-04-29T10:57:26+0530

The presence of a giant adnexal mass in pregnancy is a very rare occurrence and is usually asymptomatic which is detected incidentally on a routine ultrasound examination of the first trimester or until it reaches a large size and becomes symptomatic. Serous cystadenofibroma is a cystic neoplasm containing fibrous component and ciliated epithelial cells surrounded by clear serous fluid with smooth or papillary surface with abundant vessels. We present a clinical case of a 24-year-old unbooked second gravida at 40 weeks 3 days who came in labour with a giant tumour of the right ovary. An emergency caesarean section was done followed by right salpingo-oophorectomy. Histopathological examination revealed the mass to be serous cystadenofibroma of the right ovary. We understood that proper antenatal evaluation and strict monitoring of tumour is necessary to decide the time and type of surgical treatment in order to avoid maternal or fetal complications.

From low anti-mullerian hormone to hope: holistic management in primary infertility - a case report

2026-04-29T10:57:17+0530

Anti-Mullerian Hormone (AMH) is produced by the ovaries that help assess a woman’s ovarian reserve. Between the ages of 20 and 25, AMH levels peak and then progressively drop with advancement in age and are no longer detectable in the menopausal and postmenopausal phases. A low AMH level suggests that a woman may have diminished ovarian reserve/ premature ovarian failure. While evaluating infertility, AMH helps clinicians make the best choices for managing women who are trying to conceive. There are various factors such as stress, diet, lifestyle which contributes to hormonal imbalances. This case report explains about Primary Infertility of an adult woman with low AMH level. The main objective is to demonstrate how the integrative approach of Yoga, Naturopathy and Acupuncture treatments can help with increasing AMH level. After one month of intervention, the AMH level has been significantly improved from 0.89 ng/ml to 1.36 ng/ml. No adverse effects were observed during and after the treatment. She conceived naturally after two months of follow-up. Thus Yoga, Naturopathy and Acupuncture treatments have been shown to improve the ovarian reserve without causing any adverse effects.

Delayed vesicovaginal fistula after abdominal hysterectomy attributed to oxidized regenerated cellulose: a case report

2026-04-29T10:57:15+0530

Vesicovaginal fistula (VVF) is a distressing complication following hysterectomy. While most cases result from direct surgical trauma or tissue devascularization, delayed fistula formation secondary to foreign body reaction is uncommon. Oxidized regenerated cellulose, widely used as a topical haemostatic agent, has occasionally been associated with inflammatory complications when placed adjacent to hollow organs. A 45-year-old woman without comorbid illness underwent total abdominal hysterectomy for symptomatic adenomyosis. Intraoperative dye testing confirmed bladder integrity. Minor vault bleeding was controlled using oxidized regenerated cellulose. Thirteen days postoperatively, she developed intermittent urinary leakage per vagina, noticeable when the bladder was distended. Retrograde dye testing demonstrated a small vesicovaginal fistula. Magnetic resonance urography confirmed contrast passage into the vagina. Computed tomography revealed multiloculated cystic lesions along the superior bladder wall, suggestive of inflammatory reaction to retained haemostatic material. Initial management included continuous bladder drainage, followed by definitive surgical repair after three months, resulting in complete recovery. Delayed VVF related to oxidized regenerated cellulose is rare but preventable condition. Careful placement of absorbable haemostatic materials near hollow viscera and early recognition of postoperative urinary leakage are essential to reduce morbidity associated with it.

Peripartum meningoencephalitis complicated by transient stress-induced cardiomyopathy: a case report

2026-04-29T10:57:15+0530

Acute meningoencephalitis in late pregnancy is a rare, life-threatening emergency. We report a complex case of peripartum meningoencephalitis associated with severe, transient left ventricular (LV) dysfunction and postpartum delirium. A 30-year-old G2A1 at 37 weeks gestation presented with a one-week history of fever, headache, and thrombocytopenia. Her condition rapidly deteriorated into irritability, neck rigidity, and altered sensorium. MRI brain revealed features of meningoencephalitis with a right hippocampal infarct; CSF analysis showed pleocytosis. Following an emergency cesarean section, the patient developed acute heart failure with an Ejection Fraction (EF) of 20% and elevated Troponin-I (1200.7 ng/ml). She required mechanical ventilation and inotropic support with dobutamine. Management included intensive care and broad-spectrum antimicrobials (Ceftriaxone, Vancomycin, Doxycycline, and Acyclovir). Remarkably, her EF recovered gradually to 45% and 60% within 48 and 72 hours respectively, suggesting stress-induced (Takotsubo) cardiomyopathy secondary to the neurological crisis. Despite a postoperative generalized seizure and transient delirium, she showed significant recovery and was successfully extubated on post operative day 4. Follow-up CSF analysis was negative for tuberculosis and bacterial panels. She was discharged on postoperative day 15 on cardiac and antiepileptic medications. This case highlights the "perfect storm" of physiological stress triggering transient cardiac dysfunction secondary to a primary neurological insult. It underscores the necessity of a multidisciplinary approach in managing peripartum neurological emergencies, where severe cardiac impairment may be fully reversible with prompt stabilization and delivery.

ivery.

Spontaneous recurrent pneumothorax after in vitro fertilization

2026-04-29T10:57:09+0530

Catamenial pneumothorax (CP) is a rare form of spontaneous pneumothorax occurring within 72–96 hours before or after the onset of menstruation, accounting for approximately 3–6% of cases, and is commonly associated with thoracic endometriosis. It typically affects women over 31 years of age and predominantly involves the right hemithorax, although atypical presentations may occur. We report the case of a 39-year-old woman with secondary infertility and multiple failed in vitro fertilization (IVF) attempts who developed recurrent spontaneous pneumothorax temporally associated with exogenous estrogen therapy during endometrial preparation. Initial IVF treatment resulted in a biochemical pregnancy; however, during preparation for a donor oocyte cycle with oral estradiol, she presented with acute chest pain and dyspnoea and was diagnosed with left-sided pneumothorax, managed conservatively. Recurrence was noted upon re-exposure to estrogen, with imaging confirming left upper lobe involvement. In view of this, a modified protocol using gonadotropin-releasing hormone agonist downregulation followed by transdermal estrogen was employed, after which embryo transfer was successfully performed, resulting in a twin pregnancy with an uneventful antenatal course and delivery at 35 weeks. This case highlights an atypical presentation of recurrent pneumothorax likely influenced by hormonal therapy, raising the possibility of occult thoracic endometriosis or estrogen-mediated pleural pathology. Recognition of this association is essential for optimizing management, and individualized, multidisciplinary approaches are recommended in the absence of standardized guidelines.

Pelvic Schwannoma presenting as a suspected broad ligament fibroid in a young woman

2026-04-29T10:59:42+0530

Schwannoma (neurilemmoma) is a benign peripheral nerve sheath tumor that commonly occurs in the head, neck, and extremities. Pelvic and retroperitoneal schwannomas are rare and often pose a diagnostic challenge due to nonspecific clinical and radiological features, frequently mimicking common gynecological conditions such as broad ligament fibroids. Laparoscopic excision is a safe and effective treatment modality, offering excellent outcomes when performed with careful identification and preservation of surrounding neurovascular structures.

Surgical management of symptomatic right ureteric calculus in a pregnant woman with moderate hydroureteronephrosis

2026-04-29T10:55:24+0530

Renal and ureteric calculi are relatively uncommon during pregnancy, often posing significant diagnostic and management challenges. This due to the physiological changes of pregnancy and need for fetal safety. We present a case involving a 30-year-old woman G4P2L2MTP1 at 21+5 weeks gestation presenting with a symptomatic right proximal ureteric calculus and right moderate hydroureteronephrosis. We opted for surgical intervention via ureteroscopy and Double-J (DJ) stenting as conservative efforts failed to prevent the risk of urosepsis. Post procedure antenatal care was uneventful, a healthy infant was delivered via emergency caesarean section at 36+1 weeks with the stent in situ, followed by successful removal of DJ stent 6 weeks postpartum. This case highlights the necessity of timely intervention and successful collaborative efforts of obstetric and urological teams.

Case report on uterine inversion secondary to endometrial stromal sarcoma: a diagnostic challenge

2026-04-29T10:55:17+0530

Nonpuerperal uterine inversion (NPUI) is rarer entity. They are usually preceded by various benign and malignant pathologies, in our case a 60-year-old multiparous woman presented with postmenopausal bleeding and the presence of a vaginal mass over the past four months. Her clinical examination revealed a large necrotic, malodorous growth filling the entire vaginal canal and cervix was not visualized due to the obstructive growth. Bimanual examination posed challenges due to the expansiveness of the mass. Imaging revealed endometrial hyperplasia and biopsy confirmed carcinoma of the endometrium. Examination under anesthesia revealed uterine inversion, correction of anatomy was done by Haultain’s procedure and complete staging was performed. Her histopathology revealed endometrial stromal sarcoma. We report this case due to challenging diagnosis of uterine inversion. Also, this case underscores the rarity of NPUI and its potential association with malignancies like endometrial stromal sarcoma.

Controlled ovarian stimulation in women with very high AMH-balancing yield, quality and safety: a case series

2026-04-29T10:55:26+0530

Anti-müllerian hormone (AMH) is widely used as a marker of ovarian reserve and a predictor of ovarian response during controlled ovarian stimulation in assisted reproductive techniques. While its role in predicting oocyte yield is well established, its association with embryo quality and developmental potential remains debated. This retrospective case series describes outcomes in three women undergoing IVF/ICSI with AMH levels >20 ng/ml, aiming to illustrate variability in response despite similar hormonal profiles. All patients underwent antagonist protocols with agonist trigger to reduce the risk of hyperstimulation. High yield of oocytes (19–34) and satisfactory fertilization rates (63–80%) were demonstrated by all. Day 3 conversion rates were high, however, blastocyst yield and quality varied. This reflected differences in oocyte morphology and developmental competence. Variability in oocyte quality and blastocyst formation among patients with similarly elevated AMH levels highlights the multifactorial nature of embryo competence.³ AMH should therefore be interpreted alongside age, oocyte morphology, and stimulation parameters, rather than as a sole predictor of embryological or clinical outcomes.

Implementation science for quality improvement: optimizing post-cesarean blood tests

2026-04-29T10:55:24+0530

Quality improvement (QI) and implementation science (IS) are distinct yet interrelated fields with a shared goal of enhancing healthcare quality. However, applying Implementation Science within QI is crucial, as it systematically aims to accelerate the pace, enhance the effectiveness, and amplify the ultimate impact of both improvement initiatives and their implementation.

Hyperthermia-induced infertility in women: an urgent narrative review of environmental and occupational risks: a literature review

2026-04-29T10:59:49+0530

Female infertility is a global health challenge with multifactorial causes, yet the role of exogenous hyperthermia as a significant and growing risk factor remains underappreciated in clinical practice. This narrative review synthesizes current evidence on how environmental and occupational heat exposure impairs female reproductive function, focusing on physiological mechanisms, epidemiological data, and preventive strategies. Hyperthermia exerts its detrimental effects through multiple pathways, including increased oxidative stress, disruption of the hypothalamic-pituitary-ovarian axis, and direct damage to oocyte quality and endometrial receptivity. Rising global temperatures and more frequent heatwaves, particularly in low-resource settings and among women in high-heat occupations such as agriculture, manufacturing, and food services, create a double burden of environmental and occupational heat stress with limited protective infrastructure. Current occupational safety guidelines are largely based on male physiology and fail to adequately safeguard female reproductive health. Recognizing hyperthermia as a tangible threat to fertility is critical, and there is an urgent need for female-specific research, revised occupational health standards, and clinical guidance for at-risk patients. Addressing this challenge requires coordinated efforts from gynecologists, occupational physicians, policymakers, and climate scientists to protect reproductive health in a warming world.

Management of abnormal uterine bleeding: good clinical practice recommendations

2026-04-29T10:59:39+0530

Abnormal uterine bleeding (AUB) refers to menstrual bleeding that deviates from normal in terms of frequency, regularity, duration, or volume. The PALM-COEIN classification system is the standardized framework for categorizing AUB, encompassing structural causes (polyp, adenomyosis, leiomyoma, malignancy PALM) and non-structural causes (coagulopathy, ovulatory dysfunction, endometrial, iatrogenic, not otherwise classified COEIN). Initial evaluation includes a comprehensive history and physical examination, with attention to signs suggestive of coagulopathy such as heavy bleeding from menarche, epistaxis, gum bleeding, or a positive family history. Laboratory investigations should include CBC, coagulation profile, thyroid function, and targeted testing for Von Willebrand disease in cases with suspected coagulopathies. Transvaginal ultrasonography is essential for evaluating the uterus, adnexa, and endometrial thickness; 3D-ultrasound or saline infusion sonography may be indicated for intracavitary or myometrial lesions. Medical management is typically first-line, with options including NSAIDs, tranexamic acid, hormonal therapies (COCs, progestins, LNG-IUS), and GnRH analogs depending on etiology, severity, and fertility preferences. Acute heavy bleeding is managed with high-dose oral progestins or COCs, and adjunctive use of tranexamic acid. In coagulopathies (AUB-C), nonhormonal therapies are preferred initially, with hematology consultation advised. Surgical interventions such as hysteroscopic polypectomy or myomectomy are reserved for refractory cases or where structural lesions exist. Hysterectomy is considered definitive for those who fail medical therapy or do not wish to preserve fertility, particularly in cases of malignancy or persistent hyperplasia. In adolescents, conservative medical management is emphasized. AUB requires a tailored, multidisciplinary approach to optimize outcomes and ensure long-term reproductive and overall health.

Quercetin as a promising phytotherapeutic candidate in preeclampsia: a narrative review

2026-04-29T10:55:32+0530

Preeclampsia, a pregnancy specific hypertensive disorder, is one of the major cause of maternal and fetal morbidity and mortality globally. It occurs after 20 weeks of gestational period with high blood pressure and proteinuria, primarily caused by abnormal placental development with impaired endothelial function, and widespread inflammation. Current treatment strategies focus on the management of clinical symptoms of this disorder by using pharmaceutical agents like aspirin, Methyldopa, labetalol, hydralazine or nifedipine. But, these drugs cause various adverse effects on pregnancy due to which the researchers have started to explore the potential of several natural bioactive phytoconstituents to discover a safer and healthy alternative. One of these compounds is quercetin, a flavonol that exhibits significant antioxidant, anti-inflammatory, and immune-regulating properties. Preclinical studies have revealed that it helps in maintaining endothelial balance by regulating many inflammatory mediators. Different innovative delivery methods such as nanoparticles and liposomes are being developed to improve its efficacy as a natural therapeutic. The present review will provide insight into the immunology of preeclampsia along with its management by using a multi- targeted and safe natural therapeutic agent i.e. quercetin which in future may be used as an augmented therapy aimed at improving the both maternal and child health.

Integrating nutrition and artificial intelligence in reproductive health: advancing precision fertility medicine

2026-04-29T10:55:21+0530

Nutrition is increasingly recognized as a critical, modifiable determinant of reproductive health in both men and women. A growing body of evidence demonstrates that dietary patterns, specific nutrients, and overall diet quality influence fertility potential in assisted reproductive technology (ART) outcomes, and pregnancy success. This review synthesizes recent evidence from systematic reviews, meta-analyses, randomized controlled trials, and mechanistic studies published between 2021 and 2026 to evaluate the impact of nutrition on reproductive outcomes across both men and women. Consistent findings indicate that adherence to healthy dietary patterns particularly Mediterranean and plant-rich diets characterized by high intake of fruits, vegetables, whole grains, nuts, seafood, and unsaturated fats is associated with improved semen quality, hormonal balance, oocyte competence, reduced oxidative stress, and enhanced clinical pregnancy and live birth rates. Conversely, diets high in ultra-processed foods, trans fats, refined carbohydrates, and red or processed meats are linked to impaired reproductive function, increased inflammation, and poorer fertility outcomes. Emerging evidence also highlights the role of targeted micronutrients and nutraceuticals, such as omega-3 fatty acids, zinc, selenium, and coenzyme Q10, in improving gamete quality and ART success, although heterogeneity across studies underscores the need for further well-designed trials. Importantly, advances in artificial intelligence (AI) offer new opportunities to integrate nutritional data with clinical, metabolic, and reproductive parameters, enabling personalized dietary recommendations and predictive modelling of fertility outcomes. The integration of AI-driven analytics with evidence-based nutritional strategies holds promise for optimizing preconception care, enhancing ART decision making, and advancing precision fertility medicine.