International Journal of Reproduction, Contraception, Obstetrics and Gynecology

Knowledge, attitudes and perceptions towards utilization of bilateral tubal ligation among married women of reproductive age (15-49 years) in Kasgunga Ward, Homabay County, Kenya

2025-11-28T06:57:36+0530

Background: Approximately 20% of women of reproductive age in developing countries would prefer to ultimately stop bearing children after attaining their desired family size, however, they are faced with over 26% rate of unmet modern family planning methods such as bilateral tubal ligation (BTL). Objectives were to assess knowledge, attitude and perceptions on the utilization of BTL among the married women in Kasgunga ward and to measure the association between education level, income, number of children and the use of BTL.

Methods: A cross-sectional study design was used to collect data related to knowledge, attitude and perceptions among 399 married women in Kasgunga Ward, Homabay County, Kenya.

Results: Only 36 (35.1% of those who had reached the desired number of children said they would consider using BTL after discussing it with their husbands. Eighty-two (79.6%) of study participants cited not considering busing BTL as it was against their culture, and 137 (66%) that it was against their religious beliefs. Forty-nine (47.2%) of the women would go on to have BTL, whether or not their husbands approved of it. The cross-tabulation indicated that the use of BTL was most common among women with more than 5 children (80.0%) compared to 20.0% in women with 3-5 children and none in those with 0-2 children, with a statistically significant association, χ²(2)=107.75, p<0.001.

Conclusions: This study demonstrated that knowledge, attitudes, and perceptions influence the utilization of BTL among married women of reproductive age.

Caesarean delivery: rate, indications and pregnancy outcome at Suntreso government hospital; an analytical cross-sectional study

2025-11-28T06:58:49+0530

Introduction: Globally, caesarean section (CS) rates are increasing, revealing disparities across regions and socioeconomic groups, becoming a challenge due to its overuse or underuse with direct consequences on maternal and neonatal health. Despite this, the factors contributing to these trends and disparities remain insufficiently documented. This study determined the rate, associated indications and maternal and neonatal outcomes of caesarean section deliveries at the Suntreso Government Hospital, Ghana.

Methods: This retrospective study encompassed the entire number of women who gave birth within the study time period spanning from 1st January, 2021 to 31st December, 2021.

Results: Caesarean section rate over the study period was 33.1%. Previous caesarean section, fetal distress and severe oligohydramnios were the 3 commonest indications for CS. There were 13 adverse maternal outcomes. Maternal deaths after CS were 2 out of 1057 cases. About 91% of patients stayed in the hospital for longer than three days post-surgery. 41% of babies delivered were admitted to the Neonatal Intensive Care Unit (NICU) for various reasons. Pre-eclampsia/eclampsia, antepartum hemorrhage and fetal distress were some indications of caesarean section with significant association with adverse maternal and neonatal outcome.

Conclusion: Caesarean section rates were higher than the WHO standard. A repeat CS delivery was the commonest indication. CS should be performed when clinicians anticipate a better outcome for both mother and neonate.

Comparison of the effectiveness of Kegel exercise and biofeedback therapy on Wexner scores in postpartum fecal incontinence patients

2025-11-15T09:02:51+0530

Background: Fecal incontinence (FI) is a distressing postpartum condition affecting physical, psychological, and social well-being. Conservative treatments, including Kegel exercises and biofeedback therapy, are commonly employed, but comparative effectiveness remains uncertain. The Wexner score is a validated measure of FI severity.

Methods: This prospective randomized controlled trial enrolled 36 postpartum women with FI at Arifin Achmad General Hospital. Participants were randomized into Kegel exercise (n=18) or biofeedback therapy (n=18) groups. Wexner scores were recorded at baseline and after four weeks. Statistical analyses included paired and independent t-tests, with significance set at p<0.05.

Results: Baseline Wexner scores were comparable (Kegel 14.08±0.86 versus Biofeedback 14.94±0.86; p>0.05). After four weeks, the Kegel group showed a non-significant mean reduction of 0.8 (13.2±2.4; p=0.120), whereas the biofeedback group achieved a significant mean reduction of 5.3 (9.5±2.3; p<0.001). Between-group comparison confirmed biofeedback was significantly more effective than Kegel exercises in lowering Wexner scores (p<0.001). Sub-analysis indicated biofeedback significantly improved continence for liquid, solid, pad use, and lifestyle impact, but not for gas incontinence.

Conclusions: Biofeedback therapy significantly reduces Wexner scores in postpartum FI and should be considered the preferred conservative treatment for this population.

Contribution of anti-BHCG, CK18, hPL and Ki-67 antibodies in the diagnosis of choriocarcinoma in Senegal

2025-11-28T06:58:45+0530

Background: Gestational choriocarcinoma (GC) is a rare malignant tumour derived from the trophoblast of women of childbearing age. The aim of this study was to determine the contribution of immunohistochemistry in the diagnosis of choriocarcinoma and to evaluate its ability to specify whether or not it is gestational in nature in order to establish a diagnostic algorithm for trophoblastic diseases in general.

Methods: This is a retrospective, descriptive, bi-centric study spanning eight (8) years from 1 January 2013 to 31 December 2020. All cases diagnosed on hysterectomy specimens and with a formal conclusion of gestational choriocarcinoma were included. Immunohistochemical staining was performed on formalin-fixed, paraffin-embedded tissue sections using the manual method. We recorded the data collected in Excel 2007 software and the analysis was performed using Epi Info.

Results: We collected 25 cases of choriocarcinoma. The average annual frequency was 3.12. The average age of the patients was 38.1±9.7 years (standard deviation). Multiparous women were the most common, accounting for 57.14% of cases. Mixed-site tumours (intracavitary and intramural) were the most common, accounting for 48% of cases. Patients in FIGO stage I accounted for 88% of cases. Immunohistochemistry was performed on 14 samples, revealing 100% positive staining for anti-hCG, CK18 and hPL.

Conclusions: Gestational choriocarcinoma (GC) is a proliferation of trophoblasts (cytotrophoblasts and syncytiotrophoblasts). This study demonstrated the indispensability of immunohistochemistry in confirming the diagnosis and in assessing both the progression and therapeutic prognosis of the disease.

Association of thyroid dysfunction and hyperprolactinemia with subfertility in women at a tertiary care hospital

2025-11-28T06:58:43+0530

Background: Endocrine abnormalities, particularly thyroid dysfunction and hyperprolactinemia, are recognized contributors to female subfertility. Both disorders are potentially correctable causes of impaired reproductive function through their effects on the hypothalamic-pituitary-ovarian axis. This study aimed to investigate the association between thyroid dysfunction and hyperprolactinemia with subfertility in women attending a tertiary care hospital in Bangladesh.

Methods: This case-control study was conducted at the department of obstetrics and gynecology, BIRDEM General Hospital, from January 2022 to March 2024. A total of 100 women were enrolled in the study: 50 subfertile (cases) and 50 fertile (controls). The demographic and clinical characteristics were recorded. Serum TSH, FT3, FT4, and prolactin levels were measured using chemiluminescent magnetic microparticle assays. Thyroid status and prolactin levels were compared. The correlation between TSH and prolactin levels was assessed using Pearson’s test.

Results: Thyroid dysfunction was observed in 16% of subfertile women compared to 6% of controls. Hyperprolactinemia was significantly more frequent among cases (32% versus 10%, p=0.007). A moderate positive correlation was found between TSH and prolactin in the case group (r=+0.537, p<0.001) and a weak positive correlation in the control group (r=+0.263, p=0.065).

Conclusions: Thyroid dysfunction and hyperprolactinemia were more prevalent among subfertile women and were strongly associated. Routine screening for thyroid and prolactin abnormalities should be incorporated into infertility evaluations, as correction of these disorders may restore fertility.

Exploring the relationship between family planning and intimate partner violence: a mixed-methods study

2025-11-28T06:57:32+0530

Background: Family planning is vital for reducing maternal morbidity and mortality, but in many developing countries, women's access to it may be influenced or restricted by their partners due to prevailing gender norms. Given the inconsistent global and regional findings on the link between intimate partner violence (IPV) and family planning use, this study aims to examine their association within our local context.

Method: A descriptive cross-sectional study using qualitative and quantitative methods was carried out with 421 women, their spouses, and healthcare providers at the family planning clinic of the University of Benin Teaching Hospital in Benin City, Nigeria. Quantitative data were analysed using statistical package for the social sciences (SPSS) 25.0, and p values of less than 0.05 were considered statistically significant. The qualitative data were analysed thematically.

Result: The mean age group was 35.9±7.23, and the prevalence of IPV was 7.1%. Also, 92.6% reported that their husbands agreed with the chosen method of family planning, of which 87.2% did not require persuasion of their husbands before agreement. Of those whose husbands refused the family planning method, 19.4% attempted to convince their husbands, and 80.6% did not try to persuade them. About 30.0% experienced physical violence, 40.0% endured psychological violence, 13.3% faced sexual violence, and 16.7% experienced economic violence. The impact of family planning on IPV includes insomnia (73.3%), starvation (10.0%), suicidal ideation (10.0%) and body pain (6.7%). The qualitative analysis also showed cases of sexual, physical, and emotional IPV, especially from family planning.

Conclusion: Although the occurrence of IPV was low among the study population, it showed that IPV affects family planning demand. This underscores the importance of enhancing family planning acceptance among couples by implementing couple counselling, increasing public awareness, empowering women, ensuring legal protection, and incorporating intimate partner violence (IPV) prevention into family planning services.

Prevalence, risk factors, and bacterial pathogens responsible for surgical site infection after caesarean section: a retrospective study

2025-11-28T06:57:32+0530

Background: Surgical site infection (SSI) is one of the most common complications following caesarean section (CS), with a reported incidence of 3-20%. SSIs cause a significant burden on both the mother and the healthcare system and are associated with maternal morbidity and mortality rates of up to 3%.

Methods: A hospital-based retrospective study was conducted. Of 703 patient charts reviewed, 51 met the inclusion criteria. Data were extracted from medical records and analyzed using Statistical Package for the Social Sciences (SPSS).

Results: The prevalence of SSI was 7.3%. Most cases (96.1%) were classified as Class I SSI, while 3.9% were Class II; no cases of organ-space infection were identified. The mean age of affected patients was 27.5 years. Obesity was present in 68.8% of the cohort. The SSI rate was 17.6% among patients with rupture of membranes (ROM) before CS. Prolonged rupture of membranes (>18 hours) occurred in 13.7% of cases, while ROM <18 hours was noted in 3.9%. Anemia and postpartum hemorrhage each accounted for 2% of associated conditions.

Conclusions: At Georgetown Public Hospital, SSI following caesarean delivery remains a significant complication, with a prevalence of 7.5%. The most commonly isolated organisms were Staphylococcus aureus, followed by Escherichia coli, Klebsiella pneumoniae, and MRSA. Efforts to reduce preventable risk factors are essential to decreasing the overall burden of SSI after caesarean section.

Impact of gestational weight gain in diabetic mothers on maternal and fetal outcomes at delivery

2025-11-28T06:58:42+0530

Background: Adequate weight gain during pregnancy is crucial for healthy outcomes, while excessive weight gain is linked to adverse effects, including higher rates of cesarean sections, gestational diabetes, and complications during delivery. The aim of this study was to assess the impact of gestational weight gain on maternal and fetal outcomes in women with pregestational and gestational diabetes at delivery.

Methods: A cross-sectional study was conducted in the obstetrics and gynecology department of BIRDEM General Hospital-II, Dhaka during January 2023-June 2024. A total 102 pregnant women with pregestational diabetes and gestational diabetes mellitus (GDM) were consecutively selected from patients admitted after 37 weeks of gestation and divided in to GDM (n=51) and PGDM (n=51) groups.

Results: Among GDM patients, 49.0% had normal GWG, 31.4% excessive, and 19.6% inadequate, while in PGDM patients, 37.3% had normal, 37.3% inadequate, and 25.5% excessive GWG. Maternal complications occurred in 43.8% of GDM and 61.5% of PGDM mothers, with no significant difference. Fetal complications were comparable across GWG groups. Notably, newborns of PGDM mothers with normal GWG had higher rates of SGA and NICU admission compared to GDM, whereas normal birth weight was more common in GDM (p=0.014).

Conclusions: In GDM patients, excessive weight gain was linked to significantly higher cesarean section rates and while PGDM cases showed more fetal and maternal complications than GDM but not significant. However, most newborns had normal birth weights across all groups, and many outcomes did not differ significantly.

Correlation between maternal and cord blood haematocrit among term singleton deliveries at a tertiary hospital in Sub-Saharan Africa

2025-11-28T06:57:23+0530

Background: Anaemia in pregnancy is a major public health concern in sub-Saharan Africa as it contributes significantly to maternal and neonatal morbidity. Maternal haematocrit reflects the oxygen-carrying capacity of the red blood cells, and its relationship with cord blood haematocrit provides insight into fetoplacental oxygen transfer. The study aims to determine the correlation between maternal and cord blood haematocrit and to identify predictors of neonatal anaemia among term singleton deliveries at a tertiary hospital in sub-Saharan Africa.

Methods: This was an analytical cross-sectional study conducted at Benue State University Teaching Hospital, Makurdi, Nigeria. Ninety-five term pregnant women and their neonates were recruited consecutively. Maternal venous and umbilical cord blood samples were taken and analysed for haematocrit. Spearman’s correlation was used to assess the relationship between maternal and cord blood haematocrit, while binary logistic regression was used to identify the predictors of neonatal anaemia. A p value <0.05 was considered statistically significant.

Result: There was a significant positive correlation between maternal and cord blood haematocrit (ρ=0.299, p=0.003). Neonates of non-anaemic mothers had a higher median cord haematocrit [46.0 (44.8–48.0)%] than those of anaemic mothers [43.0 (39.5–47.5)%] (p=0.009). Logistic regression identified maternal anaemia as the only independent predictor of neonatal anaemia (AOR=0.19, 95% CI=0.07–0.50, p=0.001).

Conclusion: Maternal haematocrit showed a significant positive correlation with cord blood haematocrit, confirming maternal anaemia as a key determinant of neonatal anaemia among term singleton deliveries.

Placental morphological and histopathological changes in preeclampsia and eclampsia: a prospective case-control study using an objective scoring system

2025-11-12T10:25:12+0530

Background: The hypertensive disorders of pregnancy (HDP), particularly preeclampsia (PE) and eclampsia (EC) play a major role in maternal and perinatal morbidity. Despite extensive descriptive work on placental lesions in these conditions, only a few studies have attempted to objectively quantify the morphological damage. This study was undertaken to apply a structured histopathological scoring system to placental lesions in PE and EC and to determine whether the scores correlate with the severity of disease and adverse fetal outcome.

Methods: This prospective case-control study included 100 placentas: 50 from PE, 25 from EC, and 25 from normotensive pregnancies as controls. Gross and microscopic features were assessed using a semi-quantitative histopathological scoring system evaluating fibrin deposition, maternal floor infarction, syncytial knot, calcification, and villous basement membrane thickening. Scores were correlated with placental weight and fetal outcome, indicating uteroplacental insufficiency.

Results: Placenta; weight and thickness were significantly reduced in hypertensive cases compared with controls (p<0.001). Histological lesions such as fibrin deposition, maternal floor infarction, and syncytial knotting were markedly increased in the PE and EC groups (p<0.001). The median composite histopathological score was 4 in controls, 6 in PE, and 8 in EC. Higher scores were significantly associated with low placental weight and adverse fetal outcome.

Conclusions: Placental histopathological scoring offers an objective and reproducible approach to quantity morphological damage in PE and EC. The scoring system correlates with disease severity and fetal outcome, underscoring its potential value as a morphological marker of uteroplacental insufficiency.

Hormone receptors in gynecological cancers: focus on androgen receptor status

2025-11-07T07:00:56+0530

Background: Hormonal therapy and chemotherapy remain the primary treatment modalities for advanced and recurrent gynecologic malignancies. The presence or absence of hormone receptors has significant prognostic value in gynecological cancers. Previous studies have shown that high estrogen receptor (ER) and progesterone receptor (PR) levels in endometrial cancer predict favorable survival, while loss of PR expression in ovarian cancers correlates with recurrence. However, the role of androgen receptors (AR) in these cancers is not fully understood.

Methods: This observational study analyzed the immunohistochemical expression of AR, ER alpha (ERα), PR, and p53 in patients diagnosed with gynecologic cancers at a tertiary care center. Hormonal receptor expression was evaluated and correlated with tumor type and histopathological features.

Results: Prominent expression of ARs was observed across all categories of gynecological cancers included in the study. The expression profiles of ER, PR, and p53 varied among tumor subtypes, reflecting their potential prognostic and therapeutic significance.

Conclusions: Androgens appear to play a role in the pathogenesis of gynecological cancers. Hormonal expression profiling may guide future endocrine therapy strategies and could be considered as a potential salvage treatment option similar to that used in ovarian cancers. These findings underscore the importance of detecting hormone receptor expression in all gynecological malignancies.

Correlation between body mass index and serum anti-Mullerian hormone level in subfertile women at BIRDEM General Hospital, Dhaka

2025-11-28T06:58:42+0530

Background: Anti-Mullerian hormone (AMH) is a crucial marker for ovarian reserve, reflecting ovarian function due to its secretion by antral follicles. Obesity can adversely affect fertility, potentially altering AMH production. The aim of this study was to assess the correlation between body mass index (BMI) and serum anti-Mullerian hormone (AMH) level in subfertile women.

Methods: This cross-sectional analytical study was carried out in the department of obstetrics and gynecology, BIRDEM General Hospital, Dhaka, over a period of 18 months from January 2023 to June 2024.

Results: Between BMI≥25 kg/m² and <25 kg/m² groups there were no significant differences in age distribution (mean ages: 30.5 versus 30.4 years, p=0.912). There were no significant differences in education, occupation, or income distribution between two groups. Menstrual regularity and flow differed significantly, with more irregular cycles and heavier flow in the BMI≥25 group (p<0.0001 and p=0.049, respectively). Serum AMH levels were significantly lower in the BMI≥25 group (1.7 versus 3.1, p<0.0001). A negative correlation was found between serum AMH levels and BMI, indicated that serum AMH level decreases with increasing BMI (p<0.0001). Age and BMI were inversely significantly associated with serum AMH level adjusted for each other.

Conclusions: Higher BMI was associated with lower serum AMH levels in subfertile women, suggesting that elevated BMI may negatively impact serum AMH level which is a potential marker of ovarian reserve.

Upshots of second stage lower segment caesarean section

2025-11-28T07:00:21+0530

Background: Second stage caesarean section is done at full dilatation of cervix with head deeply engaged in the pelvis. Indicated in dystocias, unsuccessful trial of instrumental deliveries, non-reassuring fetal CTG, second stage arrest, deep transverse arrest. This study aimed to evaluate the indications, intraoperative and postoperative complications and fetomaternal outcome in second stage lower segment caesarean section (LSCS).

Methods: This was a retrospective study conducted at Gandhi Medical College, Secunderabad from August 2022 to 2023.

Results: Total 180 cases underwent second stage LSCS during this period. Among them majority of the age group belonged to 26-30 years (37.8%), unbooked cases (88.9%) and primi gravida (73.3%). Most common indications were cephalopelvic disproportion (38.8%) and fetal distress (14.6%). The commonly used method was Patwardhan method 33.3% followed by vertex 37.7%. The common complications were PPH (55.8%) and extension of incision site (16.7%). Fetal complications were birth asphyxia (45%), mortality (10%). Postoperative complications were febrile illness (16.1%), prolonged stay (35%) and anemia (20%).

Conclusions: A proper judgement and skilled obstetricians are required to perform a second stage LSCS.

Carbetocin versus oxytocin in the prevention of postpartum hemorrhage in cesarean section: a prospective randomised comparative study

2025-11-28T07:00:20+0530

Background: Postpartum hemorrhage is the leading cause of maternal mortality. The prevention of PPH can be best done by active management of the third stage of labour. Oxytocin is currently the uterotonic of choice. The study compared the efficacy of Carbetocin 100 µg intravenous bolus and oxytocin 10 IU intravenous infusion over 2 hours by measuring total blood loss, the need for additional uterotonic agents, and the need for blood transfusion. It is important to evaluate the efficacy of Carbetocin compared to oxytocin in low-income countries, especially where patient affordability is a major concern.

Methods: A prospective randomised comparative single-blinded study was conducted in the department of obstetrics and gynecology, Kurji Holy Family Hospital, Patna, Bihar. 100 patients undergoing elective cesarean section fitting in the inclusion criteria were randomly allocated by a sealed envelope system to either case study group A receiving Carbetocin 100 µg intravenous and control study group B receiving oxytocin 10 IU intravenous infusion. Three specific outcomes were measured: total blood loss, additional uterotonic use and the need for blood transfusion.

Results: In this study, Carbetocin was found to significantly reduce total blood loss in comparison to oxytocin (p<0.0001), the use of additional uterotonics was significantly less in the Carbetocin group (p=0.023), the need for blood transfusion was less in Carbetocin group but not significantly (p=0.538).

Conclusions: Carbetocin has better efficacy in comparison to oxytocin in reducing total blood loss, hence preventing PPH. The need for additional uterotonic agents is less with Carbetocin use. The need for blood transfusion was also less with Carbetocin use but needs larger studies to be proved. Carbetocin may be cost-effective.

Exploring and investigating the long-term ramifications of fertility preservation in men with a history of cancer: a 10-year retrospective follow-up study

2025-11-28T07:00:20+0530

Background: Cancer treatments such as chemotherapy, radiotherapy, and surgery can adversely affect male fertility, leading to temporary or permanent sterility. Sperm cryopreservation is the standard fertility preservation strategy for young male cancer patients prior to gonadotoxic therapy. However, utilization rates of stored samples remain low despite increased awareness and accessibility.

Methods: This retrospective study analyzed data from 136 male cancer patients who underwent sperm cryopreservation at Madras Medical Mission Hospital, Chennai, over a 10-year period. Patient records were reviewed to assess return rates for assisted reproduction, post-treatment semen analysis outcomes, and psychosocial factors influencing fertility-related decisions.

Results: None of the patients who banked sperm returned for assisted reproductive procedures. Post-treatment semen analysis was available for a subset of patients, among whom 82.9% demonstrated spontaneous recovery of fertility. Psychosocial barriers, including lack of a partner, financial constraints, and diminished reproductive intent, contributed to the non-utilization of cryopreserved sperm.

Conclusion: Although sperm cryopreservation offers an effective safeguard against treatment-induced infertility, its utilization remains minimal. The high rate of spontaneous fertility recovery and psychosocial limitations appear to influence decision-making. These findings highlight the need for individualized fertility counselling, systematic follow-up, and strategies to mitigate financial barriers. Integration of fertility preservation into comprehensive cancer survivorship programs is crucial to optimize reproductive outcomes and improve long-term quality of life in male cancer survivors.

Clinical and etiological aspects of vulvovaginitis: a prospective and cross-sectional study from North India

2025-11-28T07:00:19+0530

Background: Vulvovaginitis is the inflammation and infection of the vulva and vagina, which commonly presents with itching, vaginal discharge and burning. It accounts for more than 30% of cases in healthcare clinics. Most common vaginal infections include bacterial vaginosis, trichomoniasis and vulvovaginal candidiasis. Accurate assessment of risk factors and diagnosis of vulvovaginitis are essential key to initiate effective management, thereby alleviating associated complications. This study was aimed to study the clinical and etiological aspects of vulvovaginitis.

Methods: This was a tertiary care hospital based prospective cross-sectional study conducted on 250 women presenting with vulvovaginitis from January 2023 till August 2023. All patients presenting with vulvovaginitis were selected. Detailed history was taken. Demographic variables were assessed. Diagnosis was established based on clinical examination, microscopy, culture techniques and molecular assays.

Results: Vulvovaginitis was seen commonly in married, multiparous women of reproductive age group, mostly in lower class strata. Common risk factors encountered were diabetes, douching, sanitary napkin reuse and amongst OCP users. Most common characteristics of vaginal discharge were greyish white, thin, scanty and associated with malodour. The most common cause leading to vulvovaginitis was bacterial vaginosis followed by vulvovaginal Candidiasis and Trichomoniasis.

Conclusions: The reproductive age group was more susceptible to vulvovaginitis. Predisposing factors leading to vulvovaginitis included diabetes, multiple sexual partners, douching and sanitary napkin reuse. Bacterial vaginosis was the leading cause of vulvovaginitis (43.2%). Molecular tools may aid in the diagnosis of vulvovaginitis with unknown etiology. Primary prevention and timely diagnosis can avert complications and initiate treatment earlier.

Sociodemographic and clinical characteristics associated with perinatal outcome in high and low cerebro-umbilical ratio groups

2025-11-28T06:58:41+0530

Background: Perinatal morbidity and mortality are largely driven by preterm birth, intrauterine asphyxia from placental insufficiency, and complications related to operative deliveries and medication use. Therefore, this study aimed to assess the association between sociodemographic and clinical characteristics and perinatal outcomes across high and low cerebro-umbilical ratio groups. The aim of the study was to assess the association between sociodemographic and clinical characteristics and perinatal outcomes across high and low cerebro-umbilical ratio groups.

Methods: This prospective cohort study at the department of obstetrics and gynecology, BIRDEM General Hospital, Dhaka (November 2022-February 2024) included 106 women at 29-38 weeks gestation undergoing third-trimester Doppler. Maternal (gestational age, delivery) and fetal outcomes (birth weight, APGAR, respiratory distress, FGR) were assessed in relation to C/U ratio (cutoff 1.01). Data were collected via questionnaire, examination, and ultrasound, analyzed in SPSS 26.0 (p<0.05).

Results: C/U<1.01 was associated with lower education (24.0% versus 57.1% higher secondary), lower income (79,800 versus 68,357 BDT), higher BMI (35.1 versus 33.1 kg/m²), earlier delivery (33.9 vs 36.6 weeks), lower birth weight (1.9 versus 2.6 kg; 96% versus 12.5% LBW), more complicated outcomes (84.0% versus 21.4%), APGAR<7 (68.0% versus 19.6%), NICU admission (74.0% versus 21.4%), respiratory distress (60.0% versus 12.5%), and FGR (18.0% versus 0%). Maternal age, parity, and occupation were similar between groups.

Conclusions: A low cerebro-umbilical ratio is strongly associated with adverse perinatal outcomes, including lower birth weight, earlier delivery, and increased neonatal complications.

Comparative study of maternal and perinatal outcomes between elective and emergency caesarean section in term pregnancy at a tertiary care centre

2025-11-28T06:58:52+0530

Background: One of the most common surgical procedures done worldwide is the Caesarean section. The goal of the current study is to ascertain the problems and outcomes for mothers and newborns in two groups of pregnant women who had elective and emergency caesarean sections. So that measures can be taken to reduce morbidity and mortality in near future.

Methods: A prospective comparative observational study carried out in department of Obstetrics and Gynecology, Jawaharlal Nehru Hospital and Research Centre, Bhilai, Chhattisgarh. All patients who underwent caesarean section are divided into two groups elective and emergency. Two groups were compared on the basis of different parameters like age, parity, booking status, indication, maternal and neonatal complications.

Results: The incidence of caesarean section was 51.15%. The proportion of elective and emergency CS was 39.55% and 60.44% respectively. Most of the complications were more common in emergency group.

Conclusions: The incidence of caesarean section is high in JLNH&RC, Bhilai and overall complication rate was more common in emergency group.

Maternal mortality unveiled: insights from a tertiary care hospital in western India

2025-11-28T06:58:50+0530

Background: Maternal mortality remains a significant public health issue, especially in resource-constrained settings. Despite national and global efforts, India still contributes substantially to the global maternal death burden. Objectives were to evaluate patterns along with socio-demographic and clinical factors linked to maternal mortality, and to analyze types of delay that contribute to maternal deaths.

Methods: This cross-sectional study was conducted in the obstetrics and gynaecology department of tertiary care center, from March 2023 to August 2024. All maternal deaths during this period (n=47) were analyzed. Data were extracted from case records and analyzed using descriptive statistics. The maternal mortality ratio (MMR) was calculated per 100,000 live-births.

Results: Total 47 maternal deaths were reported among 12,356 live births, giving an MMR of 380.38. Most deaths occurred in the 20-30-year age group (74.46%), among illiterate (72.34%) and rural (59.57%) women. More than half of the maternal deaths (57.44%) were in multigravida and in unregistered cases (57.44%). 68.1% of women were referred from other centres, often critically ill. A significant number of women died [33 (70.21%)] during postnatal period of pregnancy. Hemorrhage (43.3%), sepsis (33.3%), and hypertensive disorders (23.3%) were the leading direct causes. Indirect causes included heart and nervous system disorders. Type 1 delays (59.6%) were the most common, followed by type 3 (27.7%).

Conclusions: Adequate and quality antenatal care, early identification of high-risk pregnancies, and strengthening referral systems are crucial. A multifaceted approach including health education, infrastructure improvement, and continuity of care is necessary to reduce maternal mortality.

A prospective observational comparative study on fetomaternal outcome and complications in obstetric patients with sickle cell disease or trait

2025-11-28T06:58:49+0530

Background: Sickle cell disease (SCD) and sickle cell trait (SCT) are associated with increased fetomaternal morbidity and mortality, particularly in endemic regions like central India. Despite improved obstetric care, adverse outcomes persist, especially in endemic regions of central India.

Methods: This prospective observational comparative study was conducted at the department of obstetrics and gynaecology, IGGMC and Mayo Hospital, Nagpur, from January 2023 to July 2024. A total of 190 pregnant women (95 with SCD/SCT and 95 controls with normal haemoglobin) were enrolled. Maternal and fetal outcomes were assessed and compared. Statistical analysis included Chi-square test and student’s t-test, with p<0.05 considered significant.

Results: Women with SCD had significantly higher rates of preeclampsia, severe anemia, and sickle cell crises compared with controls. Fetal outcomes such as intrauterine growth restriction, low birth weight, and preterm delivery were also significantly more frequent in the study group (p<0.05). Cesarean delivery and blood transfusion requirements were higher in SCD cases.

Conclusions: SCD and SCT adversely affect pregnancy outcomes, underscoring the need for multidisciplinary antenatal care, universal screening for sickle cell disease and delivery at tertiary care centres in endemic regions.

From participation to transformation: adolescents’ narratives of health and nutrition behavior change in a community-based project

2025-11-28T06:58:47+0530

Background: Adolescent girls are vulnerable to malnutrition, anaemia, and infections due to a lack of awareness and availability of services, putting them at a high risk of poor health, nutrition, and hygiene status. Hence, community-based interventions need to be implemented to spread awareness using different behavior change models. This study aimed to assess participants’ awareness, perceptions, and experiences with health, nutrition, hygiene, and environmental initiatives implemented under the Jagriti program in rural and urban areas.

Methods: Focus group discussions were conducted with adolescent girls. We performed thematic analysis to explore participants’ knowledge, practices, and feedback related to awareness campaigns, kitchen gardens, community-based events, digital interventions, and stakeholder meetings.

Results: Participants showed awareness of anemia, menstrual hygiene, nutrition, sanitation, and early marriage. The establishment of kitchen gardens improved dietary diversity and supported livelihood. Traditional and culturally accepted methods such as nukkad natak, rangoli making, and folk-art improved community engagement and knowledge retention. The digital interventions provided health education, but with limitations such as shared phone access and gender disparities. In addition, village and stakeholder meetings discussed waste segregation, cleanliness and hygiene, and air pollution for disease prevention; however, attendance remained a challenge.

Conclusions: The results emphasized the significance of multi-faceted, participatory strategies to increase awareness of health through cultural performances, digital interventions, and community involvement. Addressing barriers such as gender disparities, digital access limitations, and time constraints remains crucial to increasing the effectiveness of the program and its sustainability.

Assessment of the effectiveness of computer assisted teaching programme on knowledge regarding menstrual blood banking among B.Sc. nursing students at SRM College of Nursing, Kattankulathur, Chengalpet District

2025-11-28T06:58:46+0530

Background: Stem cells in menstrual blood have regenerative capabilities as the stem cells in umbilical cord blood and bone marrow. Cryo – cell patent – pending menstrual stem cells service offers women in their reproductive years the ability to store and preserve these cells for potential controversy. Cryo–cell is the only bank in the world that can offer women the reassurance and peace of mind that comes with the opportunity. The objective of the study was to determine the effectiveness of computer assisted teaching programme on knowledge regarding menstrual blood banking among BSc Nursing students in study group.

Method: The research approach was Quantitative approach. The research design adopted for the study was quasi experimental research design. The sample size was 302 BSc Nursing students in which 151 in study group and 151 in control group. The samples were selected by non-probability convenient sampling technique at SRM College of Nursing, Kattankulathur 30 samples per day were selected and conducted pretest on the same day, Computer assisted teaching were provided on menstrual blood banking for 15 minutes and post test was conducted on 7th day. The data was collected from the sample were tabulated and analysed and interpreted using both descriptive and inferential statistical method.

Result: The p value is less than 0.01 and is highly significant at 1% level.

Conclusion: Therefore, we can conclude that the knowledge level was increased in study group due to computer assisted teaching programme and it was effective in improving the knowledge of BSc Nursing students regarding menstrual blood banking.

Evaluation of safety, efficacy and continuation rates of post-partum intrauterine contraceptive device

2025-11-28T06:58:46+0530

Background: Postpartum intrauterine contraceptive device (PPIUCD) is a proven, safe, reversible, and long-acting method of contraception. Despite availability, its acceptance remains low. This study aimed to evaluate the safety, efficacy, and continuation rates of PPIUCD in a tertiary care hospital in Himachal Pradesh.

Methods: A prospective study was conducted from June 2023 to May 2024 among women >34 weeks gestation attending antenatal outpatient department (OPD), admitted in the labor room, and postpartum ward. PPIUCD insertion was performed either post-placental or intra-caesarean after counselling. Women were followed up at 6 weeks, 12 weeks, and 6 months to assess safety, efficacy and continuation rates.

Results: Of 500 women, the acceptance rate was 40%, significantly influenced by antenatal counselling. The main reasons for acceptance were long-term contraception (91.5%), safety (88%), and reduced clinic visits (62.5%). Refusals were attributed to poor knowledge (55.67%), partner/family disapproval (41.33%), preference for another method (35.33%), and fear of complications (33.67%). Most participants were 26–30 years (36.5%), multiparous (66%), graduates (48.5%), from rural areas (62%), and upper middle class (32.7%). Vaginal delivery accounted for 67.5% of insertions. The expulsion rate was 6.84%, with no significant association with type of insertion (p=0.24). At follow-up, 76.31% reported no complaints. Removal rate was 1.58%. Continuation was 91.58% and efficacy 100%, with no failures recorded.

Conclusion: PPIUCD is a safe, effective, and highly acceptable contraceptive option with excellent continuation and satisfaction rates. It is particularly advantageous in rural settings where access to follow-up and contraceptive services is limited.

Comparative effectiveness of mifepristone with misoprostol versus intracervical Foley’s catheter in mid-trimester missed abortion with scarred uterus

2025-11-28T06:58:41+0530

Background: Second-trimester pregnancy termination carries higher risks than first-trimester procedures, making pharmacologic methods preferable. Misoprostol is widely used, while intracervical Foley’s catheter aids cervical ripening and stimulates prostaglandin/oxytocin release. Combined mifepristone and misoprostol have been shown to shorten induction-to-abortion time compared to Foley’s catheter alone. This study aimed to evaluate the effectiveness of combined mifepristone and misoprostol versus intracervical Foley’s catheter for mid-trimester missed abortion in women with a scarred uterus.

Methods: This quasi-experimental study was conducted at the department of gynecology and obstetrics, Dhaka Medical College Hospital, including 72 women aged 18-35 years with missed abortion and prior cesarean section. Participants were divided into two groups: group I (n=36) received combined mifepristone and misoprostol, and group II (n=36) received Foley’s catheter alone.

Results: Group I had a lower mean gestational age (16.2±2.6 versus 23.1±2.0 weeks), higher abortion success rate (97.2% versus 94.4%), shorter induction-expulsion time (7-12 hours in 86.1% versus >18 hours in 58.3%), and fewer surgical interventions (2.8% versus 5.6%) compared to group II. Side effects were more frequent in group I (55.6% versus 27.8%). All differences were statistically significant (p<0.05).

Conclusions: Combined mifepristone and misoprostol is more effective than Foley’s catheter alone for mid-trimester missed abortion in scarred uterus, yielding higher success rates and shorter induction-expulsion times.

The study of length of umbilical cord and fetal outcome

2025-11-28T06:58:43+0530

Background: The umbilical cord is vital for fetal development, and its length can influence intrapartum complications, mode of delivery, and perinatal outcomes such as FGR, oligohydramnios, preterm delivery, operative delivery for fetal distress, fetal demise/stillbirth, meconium-stained liquor, cord accidents. This study investigated the impact of umbilical cord length on these factors in singleton pregnancies.

Methods: A retrospective study was conducted at SVP Hospital, Ahmedabad, from June 2024 to June 2025, involving 300 randomly selected singleton pregnancies. Inclusion criteria included primigravida and multigravida subjected to ultrasound, excluding malpresentations and multiple gestations. Data on cord length, nuchal loops, true knots, mode of delivery, and perinatal outcomes, including intrauterine fetal demise (IUFD), were analysed.

Results: Of the 300 cases, 58% were booked, and 68% were multigravida. Cord lengths of 66-75 cm were most common (32.33%), with short cords (<45 cm) and long cords (>90 cm) comprising 5.32% and 8.66%, respectively. Short cords were associated with a 31.25% IUFD rate, compared to 11.5% for long cords and 2.7% for medium cords (46-90 cm). Nuchal cords increased caesarean delivery rates (53.33% for one loop, 85.70% for three loops). True knots had a lower caesarean rate (42.86%). The overall IUFD rate was 5%.

Conclusions: Short and long umbilical cords are associated with increased IUFD and caesarean delivery rates, particularly with multiple nuchal loops. Antenatal ultrasound is crucial for identifying cord abnormalities to optimize outcomes.

From infection to hypertension: exploring the association between urinary tract infection and development of preeclampsia

2025-11-28T06:58:38+0530

Background: Preeclampsia remains a major cause of maternal and perinatal morbidity, presenting with hypertension and proteinuria after 20 weeks of gestation. Although multifactorial in origin, maternal inflammatory and endothelial dysfunction play crucial roles in its pathogenesis. Urinary tract infection (UTI), a common condition in pregnancy, has been proposed as a potential trigger for systemic inflammation contributing to preeclampsia. This study aimed to evaluate the association between UTI and the subsequent development of preeclampsia among pregnant women attending a tertiary care hospital in Chennai.

Methods: A prospective cohort study was conducted from October 2023 to October 2024 at Madras Medical College, Chennai. A total of 116 pregnant women were enrolled and categorized into UTI (n=58) and non-UTI (n=58) groups based on urine routine and culture findings. Participants were followed throughout pregnancy with serial assessments of blood pressure, urine albumin, and clinical parameters each trimester. Statistical analysis was performed using Chi-square and Fisher’s exact tests, and relative risk was calculated to estimate the strength of association.

Results: UTI occurred most frequently in the first trimester, whereas preeclampsia was mainly observed in the third trimester. Among women with UTI, 60% developed preeclampsia compared to 18.7% without UTI, yielding a relative risk of 3.2, signifying a significant association.

Conclusions: UTI in pregnancy was associated with a 3.2-fold increased risk of preeclampsia. Early identification and prompt treatment of UTI may reduce preeclampsia-related complications. Further large-scale studies are needed to confirm this relationship.

Gestational trends in uterine artery pulsatility index and maternal blood pressure among pregnant women at 11-14 weeks to 34 weeks of gestation

2025-11-28T06:57:42+0530

Background: Pre-eclampsia (PE) and fetal growth restriction (FGR) are significant obstetric complications associated with impaired placental perfusion and adverse maternal and perinatal outcomes. Uterine artery pulsatility index (PI) and maternal mean arterial pressure (MAP) are established biophysical markers for predicting these conditions. However, longitudinal evaluation of these parameters in low-resource populations remains limited. This study aimed to assess gestational trends in uterine artery PI and MAP from 11–14 weeks to 34 weeks of gestation and their association with pregnancy outcomes.

Methods: This prospective observational study was conducted over 18 months at a private medical college in Kerala, India. Pregnant women with singleton pregnancies at 11–14 weeks undergoing routine nuchal translucency scans were enrolled (n=128). Uterine artery Doppler and MAP were measured at 11–14, 20–24 and 30–34 weeks of gestation. PI was obtained using standard Doppler techniques and MAP was calculated from four arm measurements. Data were analyzed using paired-samples t tests, with p<0.05 considered statistically significant.

Results: The mean uterine artery PI decreased progressively from 1.6±0.4 at 11–14 weeks to 1.1±0.4 at 20–24 weeks and further to 0.8±0.2 at 30–34 weeks (p<0.01). MAP remained relatively stable across gestation, within normal physiological ranges. The cohort was predominantly young (21–30 years, 60.9%) and primigravida (57.8%).

Conclusions: Uterine artery PI shows a significant progressive decline with advancing gestation, reflecting normal uteroplacental adaptation, while MAP remains stable, indicating adequate cardiovascular adjustment. These findings support the utility of uterine artery Doppler and MAP monitoring in predicting adverse pregnancy outcomes and highlight the need for population-specific reference ranges.

Understanding the burden of menstrual health issues in a health university setting: a study from Kerala

2025-11-28T06:57:38+0530

Background: Menstruation affects women, often leading to several health issues that impact academic and work performance. Menstrual health receives limited attention in institutional settings, despite its prevalence. Objective: To estimate the burden of menstrual health problems.

Methods: A cross-sectional online survey was conducted among female staff, students and faculty members of Kerala University of Health Sciences (KUHS). A structured, self-administered online-questionnaire assessed the burden of menstrual health problems. Quantitative data were expressed as mean (SD) or median (IQR), qualitative data as frequency and percentage. The outcome variables were dichotomised as problems present or absent.

Results: The prevalence of menstrual health problems was 96.4% (95% CI 95.6 to 96.8%). More than half of them reported that menstrual bleeding impacted their daily activities and 39.7% were prevented from going to their institution. However, only 15.2% reported that they would take menstrual leave if it were implemented as a policy. About 31.6% of participants reported a change in menstrual pattern after COVID-19 infection. The overall prevalence of premenstrual symptoms (PMS) was 77.2%, with mild PMS 37.3%, moderate PMS 30% and severe PMS 9.9%.

Conclusions: Menstrual health problems are common and significantly affect women’s academic and professional life. Gender-sensitive institutional measures are essential to support women's health and productivity.

Association of gestational hypertension with hypothyroidism in pregnancy

2025-11-28T06:57:37+0530

Background: In recent years, the prevalence of hypothyroidism during pregnancy has been steadily increasing, a trend that is contributing to growing concerns about maternal and fetal health. Alongside the rising prevalence of hypothyroidism in pregnancy, gestational hypertension has emerged as an increasingly common and concerning complication.

Methods: The primary objective was to study the association of gestational hypertension with hypothyroidism in pregnancy and secondary was to assess perinatal outcomes in pregnancies complicated by hypothyroidism. This was a case–control study conducted in 102 cases and 102 controls over a duration of one year in a multispecialty Credence hospital in a urban setting.

Results: In our study, the distribution of age, parity, socioeconomic status, BMI, pre-existing complications- both medical and obstetric problems were comparable between groups . The odds of gestational hypertension were 2.15 times higher in cases compared to controls (OR: 2.15, 95% CI: 1.048–4.411) and this association was statistically significant (p=0.034). The incidence of preterm delivery was higher in hypothyroid women when compared to euthyroid women and was statistically significant OR=4.4 (95% CI: 1.203–16.096) (p=0.016). There was no statistically significant difference in the incidence of preeclampsia, FGR, anaemia, GDM, mode of delivery between the two study groups.

Conclusions: The results of this study provided evidence for an association between hypothyroidism and the development of gestational hypertension offering an understanding of how thyroid dysfunction influences the course of pregnancy, which is consistent with previous studies. Early detection and management of hypothyroidism may help to reduce gestational hypertension and improve overall pregnancy outcomes.

Incidence of complications in gynaecological laparoscopic surgeries: a prospective study from a single tertiary care centre

2025-11-28T06:57:36+0530

Background: Laparoscopy is a widely utilized procedure in gynecology due to its minimally invasive nature, offering numerous benefits such as reduced postoperative pain, quicker recovery, and shorter hospital stays. However, as with all surgical procedures, complications may arise, particularly in more complex surgeries. This study aimed to evaluate the incidence of complications associated with gynecological laparoscopic surgeries performed at a single centre.

Methods: A total 248 patients undergoing laparoscopic gynecological procedures at the centre during the study period were included. Informed consent was obtained from each patient, outlining the risks and the possibility of conversion to laparotomy if necessary. The study evaluated patient demographics, surgical history, body mass index (BMI), types of procedures performed, hospital stay durations, and the incidence of major and minor complications.

Results: Mean age of 31.51±8.79 years. Diagnostic laparoscopy was performed in 39.51% of cases, while advanced procedures accounted for 27.01%. Complications occurred in 21 patients (8.47%), with major complications seen in 2 patients (0.80%) and minor complications in 12 patients (4.84%). Laparoscopic hysterectomy had the highest complication rate at 18.33%, and 6 patients required conversion to laparotomy. No complications were observed in diagnostic or minor surgeries.

Conclusions: Laparoscopic surgery in gynecology is generally safe, with an overall complication rate of 8.47%, which aligns with reported literature. Complications were more frequent in complex procedures and in patients with previous abdominal surgeries. Continued improvements in surgical techniques and patient selection are essential for further reducing complication rates and enhancing surgical outcomes.

Evaluation of fetal outcome by biophysical profile in term pregnancy in women with less fetal movement

2025-11-28T06:58:40+0530

Background: Reduced fetal movement at term may indicate fetal compromise. Biophysical profile (BPP) is widely used to assess fetal well-being, yet its predictive value for neonatal outcomes in such cases requires further evaluation. This study aimed to assess the relationship between BPP scores and fetal outcomes, including Apgar scores, need for immediate resuscitation, and NICU admission, in term pregnancies with reduced fetal movement.

Methods: An analytical cross-sectional study was conducted at the department of obstetrics and gynecology, Dhaka Medical College and Hospital, Bangladesh, from August 2019 to July 2020. A total of 100 term pregnant women with reduced fetal movement were enrolled. Participants were classified into normal (≥8/10) and abnormal (≤6/10) BPP groups. Neonatal outcomes were recorded and analyzed using chi-square tests with significance set at p<0.05.

Results: Poor Apgar scores at one minute occurred in 33.3% of neonates in the abnormal BPP group versus 1.72% in the normal group (p<0.001). At five minutes, all neonates in the normal group had good Apgar scores, compared to 81% in the abnormal group (p=0.001). Immediate resuscitation was required in 33.3% of neonates in the abnormal group versus 1.72% in the normal group (p<0.001). NICU admission was significantly higher in the abnormal group (16.67% versus 1.72%, p=0.007).

Conclusions: Abnormal BPP scores were strongly associated with adverse fetal outcomes, while normal scores were highly reassuring. BPP remains an effective tool for evaluating fetal well-being in term pregnancies with reduced fetal movement.

A comparative study of the efficacy of letrozole versus clomiphene citrate for ovulation induction in anovulatory cycle in subfertile women

2025-11-28T06:57:35+0530

Background: Anovulation is a leading cause of female infertility, with clomiphene citrate (CC) and letrozole (LTZ) being commonly used agents for ovulation induction. While CC has been the first-line therapy, its anti-estrogenic effects may impair endometrial receptivity. LTZ, an aromatase inhibitor, offers a potentially superior alternative by enhancing follicular sensitivity without adverse endometrial effects.

Methods: This randomized controlled trial was conducted at the department of obstetrics and gynecology, Government Medical College and Hospital, Akola, Maharashtra, involving subfertile women with anovulatory cycles. Participants were allocated to receive either CC or LTZ. Outcomes assessed included ovulation rate, pregnancy rate, cycles to conception, single follicle formation, and endometrial thickness. Data were analyzed using appropriate statistical methods.

Results: Letrozole demonstrated higher ovulation and pregnancy rates compared to clomiphene citrate. LTZ was associated with improved endometrial thickness and a greater proportion of monofollicular development. Fewer side effects and complications were observed in the LTZ group. The number of cycles required for conception was lower with LTZ.

Conclusions: Letrozole is more efficacious than clomiphene citrate for ovulation induction in anovulatory subfertile women. It offers better endometrial receptivity, higher pregnancy rates, and fewer adverse effects, making it a preferable first-line agent in selected cases.

Immediate breastfeeding and skin-to-skin contact as a physiological approach to third-stage labour management: an observational study

2025-11-28T06:57:26+0530

Background: The third stage of labour is critical for preventing postpartum haemorrhage and ensuring maternal and neonatal safety. Early initiation of breastfeeding combined with immediate skin-to-skin contact (SSC) may enhance physiological uterine contraction and improve neonatal outcomes. This study aimed to assess the effectiveness of breastfeeding initiation and SSC immediately following delivery during the third stage of labour in a tertiary care hospital in India.

Methods: This observational study was conducted in the Department of Obstetrics and Gynaecology at Shimoga Institute of Medical Sciences, Shivamogga, Karnataka, India, over a six-month period from January 2023 to June 2023. The study included term pregnant women who delivered singleton infants. Immediately after birth, newborns were placed in skin-to-skin contact on the mother’s bare chest, and breastfeeding was initiated during the third stage of labour. Maternal outcomes assessed included the duration of the third stage of labour, changes in haemoglobin levels, and the requirement for additional uterotonics. Neonatal outcomes focused on breastfeeding success and morbidity.

Results: The median duration of the third stage was significantly shortened, with 90% of placental separation occurring within 10 minutes. Participants exhibited minimal haemoglobin drop and a reduced need for additional uterotonics (12%). Breastfeeding initiation within the first hour was achieved in 98% of neonates, with no adverse neonatal outcomes reported.

Conclusions: Initiating breastfeeding with immediate SSC during the third stage of labour appears to be a safe and effective physiological intervention that enhances uterine contraction, reduces maternal blood loss, and promotes successful neonatal adaptation. This low-cost approach holds promise for improving maternal and neonatal health outcomes, particularly in resource-limited settings.

A comparative study between cerviprime gel and misoprostol for induction of labour in term pregnancy with unfavourable Bishop’s score: a randomised controlled clinical trial

2025-11-28T06:57:33+0530

Background: Induction of labor (IOL) is a common obstetric intervention performed when benefits outweigh risks of continuing pregnancy. Cervical ripening using prostaglandins like dinoprostone (cerviprime) and misoprostol improves induction outcomes. This study compared their efficacy in term pregnancies with unfavorable Bishop’s score, evaluating induction and need for augmentation.

Methods: This randomized controlled clinical study was conducted over 18 months in the department of obstetrics and gynecology at a tertiary care centre among 100 term pregnant women (≥37 weeks) with an unfavourable Bishop’s score requiring induction of labour. Participants were randomized into two groups: 50 received intravaginal misoprostol (25μg, repeated every 4 hours) and 50 received intracervical dinoprostone gel (0.5 mg, repeated every 6 hours).

Results: A total of 100 pregnant women were studied, divided between the cerviprime and misoprostol groups. The mean age was comparable (33.09±9.56 years vs. 32.54±9.57 years). The time from induction to initiation of labour was significantly shorter in the misoprostol group (≤6 hours in 82% versus 58%; p<0.05). Vaginal delivery occurred in 84% of misoprostol cases and 76% of cerviprime cases. Misoprostol significantly shortened the induction-delivery interval (p<0.02). Oxytocin augmentation was required less often with misoprostol (46% versus 60%; p=0.16).

Conclusions: Vaginal misoprostol demonstrated greater efficacy than intracervical dinoprostone gel (cerviprime) for labour induction in term pregnancies with unfavourable Bishop’s scores, achieving shorter induction-to-delivery intervals without increasing maternal or neonatal complications, making it a safe and effective alternative.

Evaluating the outcomes of sublingual and vaginal misoprostol for labor induction

2025-11-28T06:57:30+0530

Background: To evaluate and compare the effectiveness, safety, and outcomes of 25 µg sublingual versus 25 µg vaginal misoprostol used for induction of labor at term.

Methods: This retrospective observational study was conducted from May 2021 to October 2022. To analysed the records of 200 antenatal patients who were in their third trimester, specifically beyond 37 weeks of gestation. The study identified case files of patients who received induction of labor through sublingual versus vaginal misoprostol for various indications. The data collection process involved a thorough examination of the case record form, capturing essential details such as patients age, parity, clinical presentations, examination findings, and results from clinical assessments and ultrasonography. Additionally, it included pre-induction CTG readings, Bishop scores, the method of administering tablet misoprostol, the quantity of tablets utilized, modes of delivery, fetal and maternal outcomes, any complications encountered, and NICU admissions.

Results: Vaginal delivery occurred in 90% of the vaginal group and 88% of the sublingual group. The mean induction-to-delivery interval was slightly shorter in the vaginal group. Oxytocin augmentation was more frequently required with sublingual misoprostol. Adverse effects such as fever, nausea, and diarrhea were occurring slightly more in the sublingual group without statistical significance. Non-reassuring cardiotocography was the leading indication for caesarean section. Neonatal outcomes showed no significant difference.

Conclusions: Both sublingual and vaginal misoprostol are equally effective and safe for term induction. The route may be individualized according to patient preference and clinical suitability.

Study of effectiveness, tolerability and safety of intravenous iron sucrose in moderate anaemia in pregnancy

2025-11-28T06:57:30+0530

Background: Iron deficiency is the most common cause of anaemia in pregnancy. The first choice in the treatment of iron deficiency anaemia for almost all patients is oral iron replacement because of its effectiveness, safety and low cost. Intravenous iron therapy is recommended during the second and third trimesters for women with moderate anaemia and those with noncompliance or intolerance to oral iron. This study aimed to assess the effectiveness, tolerability and safety of intravenous iron sucrose in moderate anaemia in pregnancy.

Methods: A longitudinal prospective study was conducted at a tertiary care center. The pregnant women with moderate anaemia with gestational age between 28 weeks and 34 weeks were administered intravenous iron sucrose in precalculated doses and rise in haemoglobin and other indices were measured after 3 weeks.

Results: Among 163 cases, baseline mean Hb level of 8.09±1.1 g/dl and serum ferritin level of 7.74±6.1 µg/l showed a statistically significant change to 12.07±1.4 g/dl and 89.12±62.43 µg/l respectively three weeks after treatment with intravenous iron sucrose. In addition, mean PCV, MCH and MCHC also improved significantly.

Conclusions: Parental iron therapy is safe and effective in increasing haemoglobin, serum ferritin and other hematological parameters in pregnant women with moderate anaemia. It can be used as a treatment of choice in patients with intolerance or non- compliance to oral iron therapy. Intravenous iron sucrose injection is found to be safe and tolerable with good efficacy in the treatment of moderate anaemia.

Maternal and fetal outcomes in pregnancy beyond 40 weeks of gestation: an observational study

2025-11-28T06:57:28+0530

Background: Pregnancy beyond 40 weeks, or postdated pregnancy, is associated with increased maternal and perinatal morbidity. The present study aimed to evaluate maternal and fetal outcomes in pregnancies extending beyond 40 weeks of gestation.

Methods: This prospective observational study was conducted among 200 pregnant women with gestational age >40 weeks admitted to the department of obstetrics and gynaecology, government medical college and hospital, Akola, Maharashtra. Data were collected regarding maternal demographics, mode of delivery, onset of labor, complications, and neonatal outcomes. Statistical analysis was performed using descriptive methods.

Results: The mean maternal age was 26.7±3.2 years, with 64.5% being primigravida. Sixty percent of women delivered at term (40-40+6 weeks), 30% at late term (41-41+6 weeks), and 10% beyond 42 weeks. Vaginal delivery occurred in 63.3% and caesarean section in 36.7% of cases. Labor induction was required in 45%, predominantly using prostaglandins. Maternal complications included oligohydramnios (25%), prolonged labor (20.5%), and postpartum hemorrhage (19%). Fetal complications included fetal distress (29%) and meconium-stained liquor (23%). NICU admission was needed in 18% of neonates, mainly for respiratory distress, hypoglycemia, and perinatal asphyxia. Most neonates (81.6%) had normal birth weight (2.5-3.9 kg), with 12.2% macrosomic.

Conclusions: While most postdated pregnancies had favourable outcomes, maternal and neonatal risks increased with advancing gestation. Early identification, timely induction, and vigilant intrapartum monitoring are essential to optimize outcomes in pregnancies beyond 40 weeks.

Psychosocial issues of newly diagnosed gynaecological cancer patients: a qualitative study

2025-11-28T06:57:28+0530

Background: The diagnosis of cancer generates significant anxiety and uncertainty. We aimed to identify the psychosocial needs and priorities of women newly diagnosed with gynaecological cancers.

Methods: The study employed a qualitative research design. In-depth interviews were conducted with patients and their attendants to explore their anxieties, information needs, expectations, and treatment priorities. After obtaining informed written consent, 16 patients were included. Data analysis was performed through conventional qualitative content analysis, following a descriptive-explorative approach. This process involved extracting codes, categories, and themes to better understand the patients' experiences.

Results: The content analysis of the transcripts brought forth five themes: 1) cause of cancer and its effects, 2) information needs and expectations, 3) concerns about prognosis and family, 4) dependence versus independence and 5) faith and hope in God. In our setting, patients with gynaecological cancer had low information needs regarding their disease stage and treatment options. They trusted their healthcare providers and preferred not to burden themselves with potentially distressing information. They sought information on prognosis and the chance of cure. Concerns about finances and daily living were prevalent, while worries about sexual activity were less common. Spiritual issues affected many and included despondency and faith in God.

Conclusions: Understanding patients' information needs and anxieties will enhance their care and treatment adherence.

Relationship between anti-Mullerian hormone and ovarian response after using letrozole in subfertile polycystic ovary syndrome patients

2025-11-28T06:58:39+0530

Background: Polycystic ovary syndrome (PCOS) is the most common cause of anovulation in reproductive-age women. Anti-Mullerian hormone (AMH) was higher in PCOS women due to increased antral follicles. This study examined the relationship between Anti-mullerian hormone and ovarian response after letrozole in sub-fertile PCOS patients.

Methods: This cross-sectional study was conducted in the Department of Obstetrics and Gynaecology, BIRDEM General Hospital, Dhaka, Bangladesh, from April 2022 to September 2023. 116 sub-fertile PCOS patients receiving Letrozole were purposively selected. Patients underwent transvaginal ultrasound (TVS) and were divided into two groups by follicle size: non-responder group (<16 mm) and responder group (≥16 mm). Data was analyzed using statistical package for the social sciences (SPSS) version 26.0.

Result: Most women were aged 21-30 years, with a mean age of group I at 30.2±3.7 and group II at 29.9±5.1. Most were primary subfertile; group I 35(65.5%) and group II 41(70.7%). Mean serum FSH was higher in group II, 9.28±5.6, than in group I, 7.19±3.64 (p<0.001). Mean AMH was higher in group II, 5.82±1.4, than in group I, 5.2±1.8 (p=0.054) but statistically non-significant. ROC curve showed AMH cut-off value of 5.12 with 62.1% sensitivity and 65.5% specificity. Patients with AMH <5.12 ng/ml had 3.1 times more chance of ovarian response versus those with AMH >5.1 ng/ml (OR=3.1; 95% CI (1.5-6.6), p=0.003).

Conclusion: Elevated serum AMH level is a risk factor for poor ovarian response in PCOS, which may require adjusting the letrozole dosage.

Conception rate of intrauterine insemination in a subfertile population cervical factor, mild male factor, unexplained infertility in tertiary care centre

2025-11-28T06:57:34+0530

Background: Intrauterine insemination (IUI) is a widely used assisted reproductive technique for subfertile couples, particularly those with cervical factor, mild male factor, or unexplained infertility. Despite its popularity, the effectiveness of IUI across different etiologies remains debated.

Methods: This observational study was conducted at the department of obstetrics and gynecology, Government Medical College and Hospital, Akola, Maharashtra. Subfertile women were categorized based on etiology- cervical factor, mild male factor, or unexplained infertility- and underwent IUI following standard ovulation induction protocols. Primary outcomes included conception rate per cycle and cumulative pregnancy rate. Secondary outcomes assessed endometrial thickness, follicular response, and cycle characteristics.

Results: IUI yielded variable conception rates across etiological groups. Women with cervical factor infertility demonstrated the highest conception rates, followed by those with unexplained infertility and mild male factor. Favourable endometrial thickness and monofollicular development were associated with higher pregnancy rates. The number of cycles required for conception was lowest in the cervical factor group.

Conclusions: IUI remains a cost-effective and minimally invasive first-line treatment for selected subfertile populations. Cervical factor infertility responds most favorably to IUI, while mild male factor and unexplained infertility show moderate success. Careful patient selection and individualized stimulation protocols enhance outcomes.

Status of respectful maternity care among postnatal women availing delivery services at a tertiary care centre: a cross-sectional study

2025-11-28T06:57:25+0530

Background: There are numerous reports of disrespectful, abusive, or neglectful treatment during childbirth from health facilities. Although India has substantially increased the number of hospital deliveries, the quality of intrapartum and immediate postpartum care for delivering mothers has not given much importance. Therefore, assessing mistreatment and quality of care during childbirth is vital for promoting respectful maternity care (RMC). Aim and objectives were to assess the status of RMC in tertiary care centre and to assess and compare various domains of RMC.

Methods: The cross-sectional study was conducted in the division of obstetrics and gynaecology, with 170 patients were enrolled and standard set of validated questionnaires was given to assess the RMC and socio-demographic status with appropriate statistical evaluation

Results: Data was collected using a predesigned and pretested questionnaire based on seven major categories as per the RMC. Results showed that 100% experienced at least one form of disrespect during their labor, childbirth, or postnatal period at the hospital.

Conclusions: The study sheds important light on the current state of RMC wherein mothers are noticing and reporting positive changes in maternity care, RMC still has scope of optimization in certain domains.

The silent signal of widened pulse pressure-aortic dissection in pregnancy

2025-11-07T07:00:57+0530

Aortic dissection in pregnancy is a rare but potentially life-threatening condition, often presenting with non-specific symptoms that can hinder timely diagnosis. Stanford type A dissections are especially perilous, with high risks of maternal and fetal mortality if not promptly treated with surgical intervention. A 35-year-old woman, G3P2 at 39 weeks’ gestation, presented with sudden-onset epigastric pain. Her blood pressure was 103/43 mmHg, with a widened pulse pressure of 60 mmHg - a subtle yet significant indicator. The initial examination was unremarkable however an urgent echocardiography and CT aortography confirmed a Stanford type A aortic dissection, extending from the aortic root to the infrarenal abdominal aorta. An urgent interdisciplinary discussion (MDT) was convened. Given the complexity of the case, which required the expertise of a highly experienced cardiothoracic surgeon, a surgeon was flown in from Peninsular Malaysia. She was transferred to the Sarawak Heart Centre, where she underwent an emergency caesarean section, delivering a baby boy weighing 2.7 kg. This was followed by a 13-hour Bentall procedure and coronary artery bypass grafting. Although the surgery was technically successful, she sadly succumbed to postoperative heart failure seven hours later. This case highlights the importance of early recognition and timely intervention in aortic dissection during pregnancy. Although rare, pregnancy associated aortic dissection carries significant risks for both mother and fetus. Despite the tragic outcome, the swift and coordinated response by the multidisciplinary team is commendable and reflects their commitment in providing high-risk care in a challenging and resource-limited setting.

A rare case of coexistence of bicornuate and septate uterine malformation

2025-11-28T06:58:51+0530

Congenital uterine anomalies result from defects in the formation, fusion, or resorption of the Müllerian ducts during embryogenesis. Patients commonly present with infertility, recurrent pregnancy loss, preterm labor, or abnormal fetal presentation, though some anomalies are detected incidentally on imaging. The most frequent congenital anomaly is septate uterus. We report an unusual case of coexistence of septate uterus with bicornuate morphology in a woman presenting with primary infertility.

Pregnancy, parathyroids, and a crisis of calcium: unmasking hypercalcemic crises in pregnancy and beyond: a dual case report

2025-11-28T06:58:45+0530

Hypercalcemia is a rare complication during pregnancy, but when it occurs, it can lead to significant maternal and fetal morbidity. Primary hyperparathyroidism is the most frequent cause; however, other uncommon mechanisms such as parathyroid hormone-related protein (PTHrP) secretion by uterine fibroids have been described. We presented two cases. The first involved a 36-year-old primigravida at 34 weeks with severe hypercalcemia associated with a large uterine fibroid. Her condition required intensive care, urgent hemodialysis, and emergency cesarean section. Despite intraoperative complications, both mother and infant survived. The second case was a 37-year-old woman at 24 weeks who was found to have hypercalcemia with elevated parathyroid hormone (PTH) levels while hospitalized for pulmonary embolism. She was not a candidate for surgery and was successfully managed with hydration, calcitonin, vitamin D, and cinacalcet, achieving near-normal calcium levels before delivery. Both pregnancies resulted in live infants. Hypercalcemia in pregnancy requires a high index of suspicion and multidisciplinary management. These two cases highlight rare but important clinical scenarios: fibroid-associated humoral hypercalcemia and the use of cinacalcet for refractory primary hyperparathyroidism during pregnancy.

Successful clinical pregnancy in a case of severe Asherman syndrome: a case report

2025-11-18T06:55:03+0530

Asherman syndrome presents significant reproductive challenges due to intrauterine adhesions and impaired endometrial receptivity. We report a 36-year-old woman with primary infertility and recurrent adhesion formation who underwent serial hysteroscopic adhesiolysis. While endometrial thickness (EMT) is traditionally pivotal for predicting embryo implantation success, our findings indicate that endometrial receptivity extends beyond thickness alone. Factors such as endometrial morphology, type, and blood supply play crucial roles. Because previous attempts failed to yield viable embryos a donor ovum embryo transfer was planned, before which she received three subcutaneous injections of recombinant granulocyte-colony stimulating factor (G-CSF) followed by ultrasound-guided intrauterine platelet-rich plasma (PRP) infusions for improving endometrial quality, vascularity and ultimately receptivity, Following the sequential regenerative protocol with optimized hormonal support, she achieved a viable singleton pregnancy. This case demonstrates that hysteroscopic adhesiolysis followed by multiple (here minimum 3) systemic G-CSF followed by local PRP may synergistically enhance endometrial regeneration in severe Ashermans syndrome. Controlled studies are needed to evaluate the efficacy and safety of this combined approach and optimising the dosage and sessions of the same.

Fertility preservation in a young female with rectal mucinous adenocarcinoma and tailgut cyst: a multidisciplinary case report

2025-11-28T06:57:24+0530

Colorectal cancer (CRC) in women of reproductive age is rare, and its coexistence with congenital lesions such as tailgut cysts is exceptionally uncommon. Moreover, fertility preservation during multimodal oncologic therapy remains an evolving domain in young rectal cancer patients. We report a 22-year-old female, gravida 2 para 1, who presented with altered bowel habits. Imaging revealed an irregular rectal mass with posterior fat plane loss and a presacral cystic lesion suggestive of a tailgut cyst. Biopsy confirmed moderately differentiated mucinous adenocarcinoma of the rectum. Given the need for pelvic radiotherapy, ovarian transposition was performed to preserve fertility. The patient subsequently received 28 sessions of radiotherapy followed by six cycles of neoadjuvant CAPOX chemotherapy (capecitabine and oxaliplatin). Abdominoperineal resection was later performed, during which the presacral lesion was excised and confirmed histologically as a benign tailgut cyst. Post-treatment monitoring showed normalization of carcinoembryonic antigen (CEA) levels and no evidence of recurrence. This case highlights the importance of a multidisciplinary approach incorporating early diagnosis, fertility-preserving surgical strategies, and contemporary chemoradiation protocols. While ovarian transposition demonstrated preserved ovarian function, long-term follow-up remains crucial. The coexistence of a tailgut cyst and rectal adenocarcinoma in such a young patient raises potential embryological and oncogenic associations that merit further investigation. Fertility preservation should be an integral component of CRC management in young women. This case underscores the feasibility of successful oncologic and reproductive outcomes through personalized, multidisciplinary care.

Uterine lipoleiomyoma: rare presentation of postmenopausal bleeding

2025-11-28T07:00:22+0530

Uterine lipoleiomyomas are rare benign tumors composed of mature adipose tissue and smooth muscle cells. They account for less than 0.2% of all uterine neoplasms and are typically asymptomatic, often discovered incidentally. Symptomatic cases presenting with postmenopausal bleeding are exceedingly rare. A 63-year-old postmenopausal woman presented with intermittent vaginal bleeding for one month. Imaging revealed a well-defined hyperechoic mass in the posterior uterine wall. Magnetic resonance imaging (MRI) confirmed the fat-containing lesion suggestive of lipoleiomyoma. She underwent total abdominal hysterectomy. Histopathology confirmed uterine lipoleiomyoma with no evidence of malignancy. Although rare, uterine lipoleiomyoma should be considered in the differential diagnosis of postmenopausal bleeding. Radiological evaluation is key, but histopathological confirmation is essential.

Angioleiomyoma of uterine cervix – a common tumour at rare site

2025-11-28T07:00:21+0530

Angioleiomyoma of the uterine cervix is a rare benign tumor of this site characterized by smooth muscle proliferation intermixed with prominent vascular structures. At cutaneous locations it presents as painful nodule however cervical angioleiomyoma clinically manifests with non-specific, mimicking other gynecological conditions such as fibroids or adenomyosis. No specific clinical or radiological features are noted hence histopathology remains the gold standard for diagnosis and sometimes immunohistochemistry is helpful in confirming smooth muscle origin. This case report details a case of uterine cervical angioleiomyoma in a 45-year-old woman presenting with abnormal excess uterine bleeding and pelvic pain. On radiology a diagnosis of cervical fibroid polyp was rendered. Following which surgical excision of the mass revealed the diagnosis, confirmed by histopathological and IHC evaluation. While angioleiomyoma is rare at this site may mimic benign or vascular tumors clinically or even microscopically. Hence correct and timely diagnosis is essential for appropriate clinical management.

Egg-sploring the unusual: ICSI in Klippel-Trenaunay-Weber syndrome

2025-11-28T07:00:17+0530

Klippel-Trenaunay-Weber syndrome (KTWS) is a rare congenital vascular disorder characterized by capillary malformations, venous and lymphatic anomalies, and soft tissue or bone overgrowth. Patients with KTWS face unique challenges in assisted reproductive technology (ART) due to their hypercoagulable state and the presence of extensive vascular malformations. Pregnancy can exacerbate these vascular complications, increasing maternal morbidity and mortality. In vitro fertilization (IVF) with gestational surrogacy offers a safer reproductive option. A 34-year-old woman with KTWS, a history of intermittent rectal bleeding, and extensive vascular malformations presented with primary infertility. Clinical and diagnostic evaluation revealed a reasonable ovarian reserve (AMH: 1.08 ng/ml) but significant vascular abnormalities in the mesenteric, splenic, hepatic, and colonic vasculature. A multidisciplinary approach was undertaken to minimize the risks associated with ovarian stimulation and oocyte retrieval. A GnRH antagonist protocol was chosen, with a dual trigger (Decapeptyl 200 mcg and hCG 10,000 IU) and careful anticoagulation management using low molecular weight heparin (LMWH). Nine mature oocytes were retrieved and cryopreserved without complications, and the patient was advised to proceed with gestational surrogacy. This case highlights the complexities of fertility management in patients with KTWS. The successful oocyte retrieval in a high-risk vascular patient demonstrates that, with meticulous planning and individualized care, ART can be safely performed. A multidisciplinary strategy, including anticoagulation adjustments and perioperative monitoring, is crucial in achieving favourable reproductive outcomes while minimizing risks. This case adds to the limited literature on ART in KTWS, reinforcing the feasibility of fertility preservation through a well-planned, multidisciplinary approach.

Beyond conduction defects: fetal myocarditis as a rare cardiac manifestation in anti-Ro/La positive lupus pregnancy

2025-11-28T07:00:16+0530

Fetal myocarditis is an uncommon yet potentially fatal complication of maternal systemic lupus erythematosus (SLE), in contrast to the more recognized congenital heart block (CHB). We report a case of a fetal myocarditis in young female with lupus and anti-Ro/SSA and anti-La/SSB antibodies positivity. This case emphasizes the importance of early fetal monitoring in lupus pregnancies and highlights the complex role of maternal auto antibodies in fetal cardiac inflammation.

Spindle cell variant of leiomyoma exhibiting myxoid change and calcification: a rare case report

2025-11-28T06:58:51+0530

Uterine leiomyomas, commonly referred to as fibroids, are the most prevalent benign tumors found in women of reproductive age, characterised by the proliferation of smooth muscle cells within the uterus. While the vast majority of leiomyomas are benign, a small percentage (approximately 1%) can undergo malignant transformation into leiomyosarcoma, complicating management and prognosis. Here we report a case of 51-year-old P1L1 presented to the outpatient department (OPD) with complaints of heavy menstrual bleeding for two years. Patient was examined and investigated. On clinical examination, a palpable pelvic mass of approximately 20×15 cm noted measuring about 24 weeks in size. On radiological examination, revealed a heterogeneously hyperechoic solid-cystic lesion measuring 12.5×10.5×7.6 cm with features suggestive of endometrial carcinoma. Total abdominal hysterectomy with bilateral salpingo - oophorectomy. Histopathological examination (HPE) report revealed endometrial hyperplasia without atypia. The myometrium reveals features of adenomyosis and leiomyoma. The subserosal fibroid consists of spindle cells in interlacing fascicles, with areas of calcification and focal myxoid change.

Broad ligament fibroid-a diagnostic and surgical challenge

2025-11-28T06:58:48+0530

Broad ligament fibroids, a rare subset of uterine leiomyomas, present unique diagnostic and surgical challenges due to their extrauterine location and potential to mimic adnexal masses. We present two illustrative cases: a 37-year-old parous woman with early satiety and abdominal pain found to have a 25×20 cm pseudo-broad ligament fibroid extending to the right lumbar region, successfully managed with ureteric catheterization and open enucleation; and a 50-year-old parous woman with abdominal pain from a 27×15×5 cm fibroid, treated via TAH+BSO with preoperative stenting. These cases highlight the diagnostic dilemmas posed by broad ligament fibroids, the indispensable role of MRI in surgical planning, and the importance of tailored approaches ranging from fertility-sparing techniques to definitive surgery. Both instances underscore the necessity of meticulous preoperative preparation, including ureteral protection strategies, and demonstrate how individualized management based on patient age, symptoms, and reproductive goals can lead to successful outcomes despite the anatomical challenges inherent to these rare tumors.

Recurrent ovarian cancer with BRCA reversion: a case study and comprehensive literature review

2025-11-28T06:58:47+0530

Herein, this report presents the case of a 48-year-old female with a history of breast cancer (2013) and subsequent high-grade epithelial ovarian cancer (2020), illustrating the complex evolution of therapeutic resistance in BRCA1-mutated malignancies. Following initial response to paclitaxel-carboplatin chemotherapy and complete surgical debulking, the patient experienced multiple disease relapses transitioning from platinum-sensitive to platinum-resistant states. Comprehensive molecular profiling via Tempus xF+ next-generation sequencing revealed a pathogenic BRCA1 mutation alongside a secondary BRCA1 reversion mutation, conferring partial restoration of homologous recombination repair and resistance to both platinum-based chemotherapy and PARP inhibitors. Subsequent therapies, including pemetrexed and liposomal irinotecan, were employed with limited success. This case underscores the dynamic molecular evolution of recurrent ovarian cancer under therapeutic pressure and highlights the critical role of serial genomic profiling in guiding personalized treatment strategies. Emerging approaches targeting alternative DNA repair mechanisms and novel antibody–drug conjugates may hold promise for overcoming resistance in BRCA-mutated, therapy-refractory ovarian cancer.

An unusual case of tubercular tubo-ovarian abscess in a sexually inactive female: a diagnostic dilemma

2025-11-28T06:58:44+0530

Tubo-ovarian abscess (TOA) is usually encountered in sexually active women as a complication of pelvic inflammatory disease (PID). Its occurrence in sexually inactive patients is extremely rare and suggests atypical etiologies, including genital tuberculosis (GTB). We report a rare case of a sexually naïve young woman with a giant TOA due to isolated ovarian tuberculosis. This case highlights the diagnostic dilemma when tuberculosis mimics adnexal malignancy or pyogenic abscess and underscores the importance of maintaining a high index of suspicion, particularly in tuberculosis-endemic regions.

Anterolateral vaginal cyst in an adult woman: a rare case of Mullerian cyst

2025-11-28T06:57:38+0530

Mullerian cysts are of embryological origin and are usually found incidentally during delivery or a routine gynaecological examination. They remain asymptomatic unless they become large enough to cause heaviness or pressure on the surrounding structures, here we are presenting case of 29-year-old multi para (P2L2 both NVD) with 4×3 cm mass arising from the anterior vaginal wall. Complete vaginal cyst excision done. The cyst was filled with grey brown solid homogenous material and histopathology of ciliated columnar epithelium with squamous epithelium later on confirmed the diagnosis.

Mucinous cystadenoma of ovary with third degree uterovaginal prolapse in postmenopausal woman: a rare case report

2025-11-28T06:57:35+0530

Mucinous tumours of the ovary represent a spectrum of neoplastic disorders, including benign mucinous cystadenoma, pseudomyxoma peritonei, mucinous tumors of low malignant potential (borderline), and invasive mucinous ovarian carcinoma. These tumors are related closely to each other and are distinct from other histologic subtypes of epithelial ovarian neoplasms from a clinical, histologic, and molecular standpoint. Mucinous cystadenoma of ovary presenting with 3rd degree uterovaginal prolapse is extremely rare. This case highlights the importance of choosing the appropriate route of approach and about maintaining the gynae oncological safety. In our case, total abdominal hysterectomy with bilateral salpingo oophorectomy with anterior colporrhaphy with McCalls Culdoplasty with Moschowitz repair and posterior perineorrhaphy was performed.

Low-dose warfarin therapy leading to embryopathy: a case report

2025-11-28T06:57:34+0530

The development of specific dysmorphic features known as warfarin embryopathy or fetal warfarin syndrome is more likely to occur in fetuses exposed to maternal consumption of warfarin. Nasal hypoplasia and stippling of the vertebrae or bony epiphysis are the most consistent characteristics. Anticoagulation in pregnant patients might be difficult to manage. According to current recommendations, heparin or low-dose warfarin (≤5 mg/day) should be used. We report the case of a pregnancy where the mother was anticoagulated with low-dose warfarin due to a mechanical mitral valve. Warfarin was required at a dose of 3 and 4 mg on alternate days and was switched to heparin from 10+4 weeks to 12 weeks. Nevertheless, the fetus presented with the signs of warfarin embryopathy. Through this report, we emphasize the need for optimising the choice and dosage of anticoagulants during pregnancy so as to provide the best maternal and fetal outcome.

Primary broad ligament fibroid: a case report with review of the literature

2025-11-28T06:57:31+0530

Fibroids are benign tumors with minimal malignant potential arising from estrogen-sensitive smooth muscles, which can be uterine and extrauterine in origin. The broad ligament is the most common site for extrauterine fibroids, and it is differentiated into primary and secondary. A fibroid arising from smooth muscles in the broad ligament without attachment to the uterus or connected to it by a vascular pedicle is classified as a primary broad ligament fibroid. Its significance lies in the retroperitoneal location in the parametrium, which distorts the anatomy and affects the surrounding viscera, making diagnosis as well as surgical management challenging. Patient is usually asymptomatic or has vague pain abdomen and bloating unless it grows to a large size, putting pressure on the ipsilateral ureter and bladder, and an abdominal mass may be detected, pushing the uterus to the other side, and development of symptoms. Diagnosis is usually incidental during pelvic surgery for other pathology. Neither clinical nor imaging studies can differentiate it from an adnexal mass. Treatment is myomectomy by laparotomy or a minimally invasive approach. In both methods, the procedure is high risk for injury to the ipsilateral ureter and uterine vessel and blood loss due to more tissue dissection. Preoperative planning and preparation in suspicious cases, and an experienced surgeon with adequate knowledge of pelvic anatomy, is the solution to avoid complications. Our patient, a 47-year-old parous premenopausal lady, reported to this institution with dragging pain abdomen with bloating was found to have a fibroid uterus and underwent total laparoscopic hysterectomy, during which a primary broad ligament fibroid of 09×07 cm was detected incidentally, and myomectomy was done. The presentation aims to report the rare case and add to statistics, to highlight the asymptomatic nature of the tumor and the challenging diagnosis, and its management.

The hidden face of ovarian cysts: a case of incidentally detected granulosa cell tumor

2025-11-28T06:57:27+0530

Adult granulosa cell tumors (AGCTs) are rare ovarian sex cord–stromal neoplasms that constitute 1–2% of ovarian malignancies and are often diagnosed late due to their nonspecific clinical, radiological, and biochemical features. We describe the case of a 50-year-old perimenopausal woman who presented with abnormal uterine bleeding and was found on ultrasound to have an endometrial polyp and a benign-appearing ovarian cyst, with normal tumor markers. She underwent laparoscopy-assisted vaginal hysterectomy with bilateral salpingo-oophorectomy, after which histopathological examination unexpectedly revealed an adult granulosa cell tumor in the left ovary, characterized by classic Call-Exner bodies and grooved (“coffee-bean”) nuclei. Immunohistochemistry demonstrated strong positivity for SF1 and Calretinin with focal Inhibin expression, confirming the diagnosis. The patient was staged as FIGO IA and placed on surveillance. This case highlights the importance of routine histopathological evaluation of adnexal masses even when preoperative findings appear benign, and underscores the need for long-term follow-up because AGCTs carry a risk of late recurrence.

Spontaneous rupture of an unscarred uterus during second trimester: a rare occurrence

2025-11-28T06:57:26+0530

The rupture of the uterus is one of the most serious obstetric complications a pregnant uterus can experience. Most ruptured uteri are associated with one or more risk factors and occur more frequently during the third trimester. As an obstetric emergency, it requires a high level of suspicion for prompt diagnosis and urgent intervention due to its life-threatening nature. We reported a 29-year-old primigravida without any known risk factors presenting with abdominal pain and vomiting at 20 weeks of pregnancy. Ultrasonography (USG) revealed free fluid in the paracolic gutter and Morrison’s pouch with a live intrauterine fetus. An exploratory laparotomy was planned in view of tachycardia and anemia. During laparotomy, hemoperitoneum was observed, and there was a 5 cm transverse fundal rent with placenta popping out from it. Emergency surgical management, including removal of the placenta and fetus along with fundal repair, was performed, and the patient recovered well. Symptoms such as acute abdominal pain during pregnancy should alert the surgeon to the possibility of uterine rupture, even in the absence of known risk factors. A prompt diagnosis and immediate intervention are crucial for achieving a good outcome in such cases.

Ovarian tumors: a case series from a tertiary care center

2025-11-28T07:00:18+0530

Ovarian cancer is the third most common malignancy among women in India and accounts for approximately 6% of cancer-related deaths, with late-stage presentation being frequent due to vague and nonspecific symptoms. This case series describes twelve patients with ovarian neoplasms diagnosed over six months at a tertiary care center, highlighting the clinical diversity and age-related distribution of these tumors. Most cases were observed in postmenopausal women above 50 years of age, with histopathological types ranging from high-grade serous carcinoma and mucinous carcinoma to mucinous cystadenoma, granulosa cell tumor, dysgerminoma, and metastatic malignant melanoma. Clinical manifestations included abdominal pain, distension, ascites, respiratory difficulty, and in one case, incidental detection during infertility evaluation. Risk factors such as nulliparity, delayed childbearing, and family history were noted. Management strategies varied from surgical excision for benign lesions to cytoreductive surgery with adjuvant chemotherapy for malignant cases. This study underscores the heterogeneity of ovarian tumors and the critical importance of early recognition, accurate histopathological classification, and individualized treatment planning. Despite advances in surgical and chemotherapeutic modalities, prognosis in advanced disease remains poor, emphasizing the need for improved screening strategies, molecular research, and targeted therapies to enhance survival and quality of life.

The prevalence of depression among diabetic patients in Sub-Saharan Africa and its impact on their glycaemic control: a systematic review

2025-11-28T06:58:52+0530

Type 2 diabetes poses a major global health challenge, especially in Sub-Saharan Africa, where healthcare systems are often weak and the condition's prevalence is increasing. A common but frequently overlooked complication in Sub-Saharan Africa is depression, which often goes undiagnosed and untreated. Depression is often associated with poor adherence to medication and self-care routines, leading to adverse outcomes like poor glycaemic control. Recognising how common depression is among diabetes patients and understanding the factors affecting glycaemic management in this region are crucial steps toward creating targeted interventions to improve type 2 diabetes mellitus treatment and enhance patients' quality of life. The study aimed to determine how common depression is among patients with type 2 diabetes mellitus in Sub-Saharan Africa and to examine the impact of depression on their glycaemic control. We conducted a comprehensive search of PubMed, PsycINFO, Scopus, ScienceDirect, Cochrane Library, Embase, Medline, and Google Scholar for studies on depression in individuals with type 2 diabetes mellitus in Sub-Saharan Africa and its impact on glycaemic control. Only peer-reviewed, English-language primary research articles published from January 2014 to January 2024 were eligible. Two reviewers independently selected and evaluated the articles using the Critical Appraisal Programme Tool and extracted data in accordance with preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. The review analysed 12 studies involving 3,709 participants across eight Sub-Saharan African countries. The reported rates of co-morbid depression varied, likely due to differences in sample size rather than regional factors. Five studies included gender data, showing a significant association between depression and being female. Glycaemic control rates ranged from 11.9% to 89.7%. Overall, the results demonstrated a strong link between depression among type 2 diabetes mellitus patients and poor glycaemic control (HbA1c >7%), although some studies found no such connection. The study revealed a high overall rate of comorbid depression among patients with type 2 diabetes in Sub-Saharan Africa. It also highlighted that diagnosing depression in these patients is usually associated with poor glycaemic control. Therefore, public health policymakers in the region should develop targeted strategies for screening, diagnosing, and treating depression in individuals with type 2 diabetes.

Scoping review of common bacterial organisms causing vaginal discharge and their antibiotic susceptibility profile in Indian subcontinent

2025-11-28T06:58:48+0530

Vaginal discharge (VD) is a major public health issue in the Indian subcontinent, where rising antimicrobial resistance (AMR) compromises syndromic case management (SCM). This scoping review maps the bacterial etiologies of VD and their antibiotic susceptibility across the Indian subcontinent. Based on the CoCoPop framework, a systematic search was conducted on PubMed, Scopus, Embase, Cochrane Library and Google Scholar up to 15 March 2025. Data was extracted from 107 eligible studies involving 37,846 women. Majority of women were from low socioeconomic status. Pathogens isolated amongst symptomatic women included Gardnerella vaginalis (0.38-74%), Staphylococcus sp. (0.9-52.5%), Mobiluncus sp. (4.29-42.13%) and Neisseria gonorrhoeae (0.14-40.34%). In asymptomatic women, Peptostreptococcus sp. (66.67%), Bacteroides sp. (33.33%), Streptococci sp. (25.64%) were identified. Diagnosis relied primarily on microscopy and culture over molecular methods. The key pathogens demonstrated moderate to high sensitivity to Penicillins, Tetracyclines, Macrolides, Sulfonamides and Fluoroquinolones. High sensitivity was reported for Cephalosporins against N. gonorrhoeae (89.5%) and Metronidazole (71%) against G. vaginalis. Aminoglycosides, Beta-Lactam/Beta-Lactamase Inhibitor combinations and Carbapenems demonstrated >70% sensitivity against resistant bacteria including S. aureus, E. coli, Pseudomonas sp. Antibiotic data on anaerobes and MIC data was scarce. High resistance rates challenge the efficacy of standard treatment kits. A strategic shift integrating affordable diagnostics with evidence-based regimens tailored to regional microbial resistance data optimizing treatment and combat antimicrobial resistance is essential.

Frontiers in fertility: a review of breakthroughs in assisted reproductive technology

2025-11-28T06:57:29+0530

Assisted reproductive technology (ART) is undergoing a transformation driven by emerging biomedical innovations. This review examines recent advances including modulation of the endometrial microbiome, non-invasive preimplantation genetic testing (niPGT) (usually referred as NIPT - non-invasive prenatal genetic testing), mitochondrial replacement therapy (MRT), and reproductive tissue engineering and evaluates their clinical efficacy, ethical implications, and impact on reproductive outcomes. For instance, niPGT has demonstrated up to 80% concordance with invasive testing and reducing biopsy-associated risks. Endometrial microbiota profiling is increasingly used to personalize embryo transfer timing, improving implantation up to 30% of previously unsuccessful in vitro fertilization (IVF) cycles. Innovations in ovarian tissue cryopreservation and 3D bioprinting of reproductive tissues offer fertility solutions for patients with cancer or congenital anomalies. However, these advancements in technology raise ethical concerns around embryo manipulation, germline modification, and equitable access. By synthesizing recent findings, this paper outlines the future trajectory of ART, emphasizing the need for evidence-based integration and regulatory oversight.