International Journal of Reproduction, Contraception, Obstetrics and Gynecology

Single-balloon versus double-balloon catheters for cervical ripening before induction of labour in term singleton pregnancies: a systematic review of randomized controlled trials

2026-08-28T08:46:43+0530

Mechanical balloon catheters are widely used for cervical ripening before induction of labour in women with an unfavourable cervix. The single-balloon Foley catheter and the double-balloon cervical ripening catheter are commonly used in clinical practice. However, evidence regarding their comparative effectiveness and safety remains inconsistent. A systematic review of randomized controlled trials was conducted in accordance with the preferred reporting items for systematic reviews and meta-analyses (PRISMA 2020) statement. A systematic search of the PubMed database was performed from database inception to 31 May 2026. Randomized controlled trials comparing single-balloon and double-balloon catheters for cervical ripening and induction of labour in term singleton pregnancies were included. Data on maternal and neonatal outcomes were extracted and synthesized narratively because of clinical and methodological heterogeneity among the included studies. Five randomized controlled trials involving 835 women met the inclusion criteria. Both catheter types were effective for cervical ripening and labour induction. Improvements in bishop score, induction-to-delivery interval, and mode of delivery varied across the included studies. Some trials reported shorter induction-to-delivery intervals or greater cervical ripening with the double-balloon catheter, whereas others found similar outcomes between the two devices. Maternal and neonatal outcomes, including caesarean section rates, APGAR scores, and neonatal intensive care unit admissions, were generally comparable. Current evidence does not demonstrate consistent superiority of either the single-balloon or the double-balloon catheter for cervical ripening and induction of labour in term singleton pregnancies. Both devices appear to be safe and effective mechanical methods. Catheter selection should be guided by clinical judgement, patient characteristics, resource availability, local practice, and cost. Further well-designed multicentre randomized controlled trials with standardized outcome measures are needed to strengthen the available evidence.

Fitz-Hugh-Curtis syndrome with intestinal obstruction in an elderly woman

2026-08-28T08:53:27+0530

Fitz-Hugh-Curtis (FHC) syndrome occurs as a complication of pelvic inflammatory disease, most commonly in young women, following Chlamydiae trachomatis infection of the genital tract. It is a rare condition, exceptional in elderly women and especially when it is revealed during an intestinal obstruction. This is why we report the case of a 65-year-old woman who presented with an occlusive syndrome whose diagnosis of FHC syndrome was made accidentally intra operatively. Thus, when the usual causes of febrile obstruction in a woman have been eliminated, whatever the age, the possibility of FHC syndrome must be raised by the clinician, even in the absence of pelvic symptoms.

Multiple uterine fibroids: risk for ectopic pregnancy – a case report and review of literature

2026-08-28T08:46:53+0530

Ectopic pregnancy is a medical emergency that still has a huge debilitating effect on maternal health. This condition can result in hemorrhagic shock with resultant morbidity and mortality when it is mis-diagnosed or there is delay in diagnosis and management. We present a 40year old multiparous lady with multiple uterine fibroids and without other identifiable risk factors for ectopic pregnancy who suddenly lapsed into shock and had a successful appropriate and timely intervention-Salpingectomy for ruptured ectopic pregnancy.

Squamous cell carcinoma of ovary in young premenopausal female: a case report and literature review

2026-08-28T08:53:33+0530

Mature cystic teratoma (MCT), also known as dermoid cyst, is a germ cell neoplasm commonly seen arising in the ovary of young females. It is usually benign but carries a malignant transformation risk of 0.5–2% of cases. Squamous cell carcinoma is the most common subtype of malignant transformation, followed by adenocarcinoma. We report a case of squamous cell carcinoma arising in a dermoid cyst of the ovary, presenting at an early stage, in a 44-year-old pre-menopausal female with a one-month history of lower abdominal pain and a large abdominopelvic mass on examination. Final histopathology confirmed squamous cell carcinoma of the left ovary arising from a mature cystic teratoma.

Condyloma acuminata in pregnancy: clinical profile and management

2026-08-28T08:53:24+0530

Condyloma acuminatum, also known as mucocutaneous external genital warts, is a benign neoplasm of the genital tract caused by human papillomavirus most commonly types 6 and 11. Here we present a case of 24-weeks unbooked primigravida who presented with complaints of vulval itching and a mass over the vulva for six months. Genital examination revealed multiple papillomatous growths arising from the vulva, no bleeding on touch. At 24 weeks of gestation vulval biopsy was performed and the report showed condyloma acuminatum. She presented in early labor pain with complete spontaneous resolution of the lesions at 39 weeks of gestation. She underwent a spontaneous vaginal delivery. Both mother and neonate were healthy in the postnatal period. This case highlights that condyloma acuminatum may regress spontaneously during pregnancy and is not an indication for caesarean section.

Case report: giant ovarian cyst torsion mimicking malignancy in a postmenopausal female

2026-08-28T08:49:09+0530

Ovarian torsion is a gynaecological emergency that is uncommon in postmenopausal women. Large adnexal masses in this age group frequently raise suspicion for malignancy due to their size and complex imaging features, posing a diagnostic challenge. We present the case of a 53-year-old postmenopausal woman who presented with acute abdominal pain and progressive abdominal distension. Imaging studies revealed a large complex adnexal cyst with features suggestive of ovarian malignancy and torsion. Emergency exploratory laparotomy demonstrated torsion of a giant ovarian cyst. Histopathological examination confirmed a benign ovarian cyst with no evidence of malignancy. This case emphasizes the importance of considering ovarian torsion as a differential diagnosis in postmenopausal women presenting with large adnexal masses and acute abdomen.

Live birth after intracytoplasmic sperm injection using self-sperm in a male with 46, XX karyotype resulting from complete chimerism following bone marrow transplant from a human leukocyte antigen matched sibling

2026-08-28T08:49:03+0530

Gonadal dysfunction and definitive infertility are common long-term non-malignant effects after bone marrow transplantation (BMT), particularly when chemotherapy is part of the conditioning regimen. We report a case of a 44-year-old male with a history of thalassemia major who underwent allogeneic bone marrow transplant at the age of 18 years from his human leukocyte antigen (HLA)-matched sister. He subsequently developed complete hematopoietic chimerism with a 46, XX karyotype and testicular failure secondary to chemotherapy. The patient presented with primary infertility and azoospermia. Medical management was continued for 10 months using gonadotrophins to stimulate spermatogenesis following which ICSI was done for the couple using self-semen to achieve live birth.

Exploring the uncharted: Takayasu arteritis masquerading as severe preeclampsia in a high-risk pregnancy: a rare case report

2026-08-28T08:48:57+0530

Takayasu's arteritis is a chronic vasculitis of medium and large vessels. The most involved vessel is the aorta and its major branches. The vessels are characterized by mononuclear infiltration and granulomatous inflammation of vascular media, which leads to arterial wall thickening with stenosis, occlusion, and aneurysmal dilation. Here we present a case of a 32-year-old female patient who presented with headache and mild epigastric pain. CT Aortogram was done which revealed severe stenosis of the left thoracic and upper abdominal aorta measuring 8 cm long along with left subclavian artery stenosis. Delayed diagnosis and lack of specific treatment could explain the extent and the clinical severity of the disease at the time of hospital admission. Therefore, early diagnosis and treatment are warranted. When the disease is dormant, the outcome seems favourable.

Protein S deficiency causing postpartum stroke following twin delivery in a multiparous woman: a case report and review of literature

2026-08-28T08:48:55+0530

Protein S deficiency is a thrombophilia known to cause venous thromboembolism. During pregnancy, it can present as deep vein thrombosis or adverse feto-maternal events such as stillbirth or intrauterine growth restriction. Its link to arterial thrombosis remains controversial. We report a case of a 31-year-old multiparous woman with no known comorbidities who developed acute left upper limb pain on postpartum day 20 following an uneventful twin delivery. Her condition progressed to giddiness, vomiting, seizures, and poor sensorium. Imaging studies revealed extensive ischemic infarctions involving the posterior circulation and thrombotic occlusions in the upper limb vasculature. She was managed with anticoagulation therapy, antibiotics for ventilator-associated pneumonia, and a left parieto-occipital decompressive craniotomy due to worsening sensorium. Thrombophilia workup identified isolated Protein S deficiency, while other markers of thrombophilia, including Protein C, antithrombin III, and factor V Leiden mutation, were normal. Despite complications, her sensorium improved with comprehensive management, and she was discharged on long-term anticoagulation. This case highlights the need for heightened awareness of postpartum thrombotic events in women with no antenatal complications. Protein S deficiency, though rare, should be considered in the differential diagnosis to ensure prompt and effective intervention, reducing morbidity and mortality in postpartum women.

Vaginal calculus formation around eroded vaginal mesh with actinomycosis presenting as postmenopausal bleeding in a post hysterectomy woman: a rare case report

2026-08-28T08:50:05+0530

Vaginal calculi are exceptionally rare and usually develop secondary to foreign bodies, chronic infection, urinary contamination, or eroded synthetic materials. Presentation as post-menopausal bleeding is uncommon and may mimic genital tract malignancy. The coexistence of mesh erosion, actinomycosis, and vaginal calculus formation is exceedingly rare. A 68-year-old postmenopausal multiparous woman presented with bleeding per vaginum. She had undergone abdominal hysterectomy approximately 20 years earlier. Pelvic examination revealed a hard posterior vaginal wall mass suspicious for malignancy. Examination under anesthesia and vaginoscopy demonstrated a vaginal calculus surrounding eroded mesh protruding through the posterior vaginal wall. Complete removal of the calculus and exposed mesh was performed. Histopathological examination revealed actinomycosis without evidence of malignancy. The postoperative course was uneventful. Vaginal calculus formation secondary to mesh erosion with associated actinomycosis should be considered in elderly women presenting with post-menopausal bleeding. Histopathological examination is essential for excluding malignancy and confirming the diagnosis.

The great pretender: ovarian actinomycosis presenting as pelvic inflammatory disease mimicking ovarian malignancy – a rare case report

2026-08-28T08:48:47+0530

Ovarian actinomycosis is a rare chronic granulomatous infection that often mimics ovarian malignancy, leading to diagnostic challenges. We report a case of a 38-year-old female presenting with abdominal pain, fever, and a complex adnexal mass favouring the suspicion of Pelvic inflammatory disease and malignancy. Surgical exploration and histopathology confirmed ovarian actinomycosis. This case highlights the importance of considering actinomycosis in differential diagnosis to avoid unnecessary radical surgery.

Laparoscopic salvage of fallopian tube herniation following cesarean section drain removal: a case report

2026-08-28T08:48:45+0530

Fallopian tube herniation through a surgical drain site is an exceptionally rare postoperative complication. Most historically reported cases have been managed via open relaparotomy and frequently necessitated partial or complete salpingectomy due to tissue ischemia or incarceration. We report a rare case of post-cesarean fallopian tube herniation that was successfully managed via timely laparoscopic reduction, resulting in the complete preservation of tubal viability and future fertility. A 20-year-old primigravida with severe preeclampsia and thrombocytopenia underwent an emergency lower-segment cesarean section for fetal distress. Intraoperatively, diffuse oozing from the operative field prompted the insertion of a pelvic drain. Following drain removal on postoperative day three, a tubular structure was noted protruding through the drain site. Clinical presentation was highly suggestive of fallopian tube prolapse. Diagnostic laparoscopy confirmed the herniation of a congested but viable left fallopian tube through the drain tract, accompanied by adjacent omental traction. The tube was successfully reduced laparoscopically without the need for a relaparotomy or salpingectomy. The patient recovered uneventfully and remained asymptomatic at her follow-up appointments. Fallopian tube herniation through a drain site is a rare, potentially fertility-threatening complication. Early clinical recognition coupled with prompt laparoscopic intervention facilitates the assessment and preservation of tubal viability, circumvents the morbidity of an open relaparotomy, and optimizes patient outcomes.

Pregnancy following five previous cesarean sections: a rare case of successful emergency repeat cesarean

2026-08-28T08:48:43+0530

Pregnancy following multiple previous cesarean sections is associated with significantly increased maternal and fetal morbidity. Grand multiparous Women with five or more prior lower segment cesarean sections (LSCS) constitute a particularly high-risk obstetric group due to increased chances of dense intra-abdominal adhesions, scar dehiscence, placenta previa, placenta accreta spectrum, classical ceasrean, hemorrhage, bladder injury, bowel injury, and uterine rupture. We report a rare case of a successful emergency classical ceserean section in a grand multiparous unbooked patient with five previous LSCS presenting with abdominal pain and scar tenderness at term gestation. A live male baby weighing 2.170 kg was delivered with Apgar scores of 7 and 9 at one and five minutes, respectively. Bilateral tubal ligation was performed. Management becomes challenging in unbooked patients presenting late in pregnancy or in labour. Despite multiple risk factors favorable maternal and neonatal outcome was achieved with timely diagnosis, careful perioperative planning, and multidisciplinary management.

Deep infiltrating endometriosis mimicking abdominopelvic tuberculosis in a premenopausal woman: a diagnostic challenge

2026-08-28T08:48:35+0530

Deep infiltrating endometriosis (DIE) is the most severe form of endometriosis and is characterized by infiltration of pelvic structures beyond the peritoneal surface. Its presentation may occasionally mimic other chronic inflammatory conditions, particularly peritoneal tuberculosis, posing a significant diagnostic challenge in tuberculosis-endemic regions. The coexistence of haemorrhagic peritoneal fluid, dense pelvic adhesions, adnexal masses, and elevated inflammatory markers can obscure the diagnosis and delay definitive management. A 42-year-old multiparous woman presented with chronic pelvic pain, dyspareunia, and dyschezia. On per-vaginal examination, the cervix was found to be pulled upwards and was associated with marked cervical motion tenderness. Comprehensive clinical and radiological evaluation was performed. Magnetic resonance imaging (MRI) findings were suggestive of deep infiltrating endometriosis. A tuberculosis workup was also carried out to exclude genital/ peritoneal tuberculosis. Following thorough evaluation, the patient underwent definitive surgical management in the form of total hysterectomy with bilateral salpingo-oophorectomy. The postoperative course was uneventful, and the patient experienced significant symptomatic relief following surgery.

Tubercular paraplegia in pregnancy with complete neurological recovery following antitubercular therapy: a case report

2026-08-28T08:48:33+0530

Spinal tuberculosis with paraplegia during pregnancy is rare and is a diagnostic and therapeutic challenge. Pregnancy, being a relatively immunocompromised state, may prompt rapid destruction of the vertebral body, resulting in an acute and profound neurological deficit. A 23-year-old G2P1L1 woman at 19+5 weeks presented with progressive bilateral lower-limb weakness; MRI showed D2 collapse with epidural collection and cord compression. Sputum Ziehl-Neelsen staining confirmed acid-fast bacilli, and first-line HRZE therapy was started. She recovered completely, continued pregnancy to term, and delivered a healthy male neonate by elective caesarean section. This case supports early MRI diagnosis and timely anti-tubercular therapy alone in selected patients with multidisciplinary care and close maternal-fetal monitoring can lead to complete recovery.

A rare case of vaginal leiomyoma: diagnostic challenges and management

2026-08-28T08:48:19+0530

Primary vaginal leiomyomas are rare benign smooth muscle tumors that can pose a diagnostic challenge due to their unusual location and nonspecific presentation. We report a case of a female aged 29 years, on her routine checkup for primary infertility. On examination Incidental vaginal mass was found, a well-defined mass visualized in the anterior vaginal wall extending into right vaginal wall indenting into vaginal canal. Cervix was not visualized. Imaging showed well-defined lesion suggestive of anterior vaginal fibroid of size 5.1 × 6.8 × 7.3 cm. The patient underwent diagnostic laparoscopy followed by complete surgical excision by abdomino-vaginal approach. Histopathological examination confirmed the diagnosis of leiomyoma. The postoperative period was uneventful, and the patient remained symptom-free on follow-up. This case highlights the importance of considering vaginal leiomyoma in the differential diagnosis of vaginal masses. Early diagnosis and surgical management result in excellent outcomes with minimal recurrence risk.

Favorable fetal outcome in a high-risk Rh-alloimmunized pregnancy with high indirect coombs titre complicated by systemic sclerosis: a rare case report

2026-08-28T08:47:14+0530

Rh alloimmunization remains an important cause of fetal and neonatal morbidity despite anti-D prophylaxis. Pregnancy in diffuse systemic sclerosis is uncommon and associated with significant maternal and fetal risks. The coexistence of these two high-risk conditions is rare. Case Presentation: 25-year-old G2P1D1 with diffuse systemic sclerosis and Rh-negative blood group was managed with serial antenatal surveillance. Indirect Coombs titres progressively increased from 1:256 at 32 weeks to 1:512 at 34 weeks. Serial ultrasonography showed no evidence of hydrops fetalis and until delivery, fetal surveillance findings remained reassuring, with reactive third-trimester non-stress tests. Elective cesarean section was performed at 34+2 weeks for severe Rh alloimmunization with breech presentation. A healthy male neonate weighing 2.5 kg was delivered and managed successfully with phototherapy for neonatal hyperbilirubinemia. Conclusion: Favorable outcomes can be achieved through multidisciplinary care, close surveillance, and timely delivery.

Tubal ectopic pregnancy with molar changes: an uncommon histopathological finding

2026-08-28T08:47:04+0530

Ectopic molar pregnancy is an uncommon form of gestational trophoblastic disease and is rarely suspected preoperatively due to its clinical similarity with non-molar ectopic pregnancy. We report a case of a 46-year-old multiparous woman presenting with amenorrhea, abdominal pain, and vaginal bleeding following unsupervised medical termination of pregnancy. Ultrasonography revealed a left adnexal mass suggestive of ectopic pregnancy. The patient underwent exploratory laparotomy with left salpingectomy. Histopathological examination demonstrated hydropic chorionic villi with trophoblastic proliferation, consistent with molar changes. Postoperative β-hCG levels showed an appropriate decline. This case highlights the importance of routine histopathological examination of ectopic pregnancy specimens, as definitive diagnosis cannot be established clinically. Early diagnosis is essential to ensure appropriate follow-up and to detect persistent gestational trophoblastic disease at an early stage.

Delayed recognition of twin-to-twin transfusion syndrome with adverse fetal outcome: a case report

2026-08-28T08:46:51+0530

Twin-to-Twin Transfusion Syndrome (TTTS) is a serious complication of monochorionic twin pregnancies resulting from imbalanced blood flow through placental vascular anastomoses. It produces a hypovolemic, growth-restricted donor twin and a volume-overloaded recipient twin at risk of cardiac compromise, and carries high perinatal morbidity and mortality if not diagnosed and managed promptly. A 32-year-old unbooked, unsupervised G3P2L2 woman presented at 26 weeks of gestation – at her first antenatal visit – with progressive abdominal distension, breathlessness, reduced urine output, and abdominal pain. Ultrasonography revealed a twin gestation with polyhydramnios in one twin and oligohydramnios with a stuck-twin appearance in the other, along with discordant growth and abnormal Doppler indices, findings compatible with Quintero Stage III TTTS. After counselling regarding all management options, therapeutic amnioreduction was performed for symptomatic relief. Spontaneous preterm labour supervened 14 hours later, and the patient delivered vaginally; the donor twin could not be resuscitated and the recipient twin suffered an early neonatal death. Gross placental examination confirmed monochorionic placentation. This case highlights how absence of early and regular ultrasonographic surveillance in a monochorionic twin pregnancy can delay recognition of TTTS until an advanced, poorly salvageable stage. Routine monochorionic-specific surveillance and prompt referral to a fetal medicine unit capable of fetoscopic laser therapy remain central to improving outcomes.

Caesarean scar ectopic pregnancy: a rare case managed by laparoscopy-guided suction evacuation

2026-08-28T08:46:32+0530

Caesarean scar ectopic pregnancy (CSEP) is a rare and potentially life-threatening form of ectopic pregnancy in which implantation occurs at the site of a previous caesarean section scar. Early diagnosis is essential to prevent serious complications such as uterine rupture and massive haemorrhage. We report the case of a 32-year-old multiparous woman with a history of one previous caesarean section who presented with amenorrhoea and abnormal vaginal bleeding following unsupervised intake of medical termination pills. Transvaginal ultrasonography revealed a gestational sac implanted at the caesarean scar site, which was further confirmed by magnetic resonance imaging. The patient was managed successfully with laparoscopy-guided suction evacuation, and the postoperative course was uneventful. This case highlights the importance of early imaging-based diagnosis and individualised management to achieve favourable outcomes while preserving future fertility.

Unruptured pregnancy in a right non-communicating rudimentary horn mimicking an adnexal ectopic pregnancy: a rare case report at 12 weeks

2026-08-28T08:46:29+0530

Pregnancy in a non-communicating rudimentary horn is a very rare form of ectopic pregnancy associated with Müllerian duct abnormality. The rudimentary horn has limited distensibility and carries a high risk of rupture and catastrophic intra-abdominal haemorrhage, while early diagnosis may be difficult because it can mimic a tubal ectopic pregnancy. A 28-year-old unbooked gravida 2 para 1 living 0 woman with 12 weeks of amenorrhoea presented with lower abdominal pain and vaginal bleeding for 2–3 days. Ultrasound suggested an approximately 12-week unruptured right adnexal ectopic pregnancy with absent fetal cardiac activity. Emergency exploratory laparotomy revealed an intact pregnancy in a right non-communicating rudimentary horn of a unicornuate uterus. The rudimentary horn and ipsilateral fallopian tube were excised after evacuation of the products of conception. The postoperative course was uneventful, and the patient was asymptomatic at six-week follow-up. This case highlights the diagnostic challenge of rudimentary horn pregnancy and the importance of early recognition and timely surgical management before rupture.

An uncommon companion to prolapse: Mönckeberg's medial calcific sclerosis of the uterine vasculature

2026-08-28T08:46:27+0530

Mönckeberg's arteriosclerosis, or medial calcific sclerosis, is an uncommon, non-atherosclerotic form of vascular calcification affecting the tunica media of small- and medium-sized muscular arteries. It occurs independently of intimal atherosclerotic disease, is typically non-obstructive, and is most often encountered in the peripheral arteries of the lower limbs in elderly patients, diabetics, and those with chronic kidney disease. Involvement of the uterine vasculature is exceedingly rare, with only a handful of cases described worldwide. We report a 60-year-old postmenopausal woman with no identifiable metabolic risk factors who presented with third-degree utero-vaginal prolapse and underwent vaginal hysterectomy with anterior colporrhaphy. Histopathological examination of the surgical specimen incidentally revealed medial calcific sclerosis of the uterine vessels, in addition to chronic cervicitis and senile cystic atrophy of the endometrium. This case adds to the sparse literature on Mönckeberg's arteriosclerosis at an atypical, visceral site and highlights the importance of histopathological vigilance in recognising this entity even in patients without conventional risk factors.

Clitoral abscess presenting as benign clitoral swelling in an adolescent: a gynecologist’s Halley’s comet

2026-08-28T08:46:25+0530

Clitoral abscess is an uncommon vulvar infection that is often overlooked because of its rarity to the vulvar lesions. Delayed diagnosis may result in significant pain, local complications and potential impairment of clitoral function. Clitoral abscess is an exceptionally rare cause of vulval pain and swelling, with fewer cases reported in the literature. Because of its rarity, diagnosis is frequently delayed and may mimic other vulvar lesions. We reported a 17-years-old, not sexually active female with acute painful swelling of clitoral hood for two days. Clinical examination revealed a fluctuant tender swelling measuring 4x3 cm. Incision and drainage was performed under general anaesthesia through a lateral incision to preserve the dorsal clitoral neurovascular bundle. Pus drained and sent for culture. Post operative antibiotics administered. Recovery was uneventful, with complete healing and no recurrence or sensory deficit on follow-up. Early recognition and meticulous surgical management are essential to preserve clitoral anatomy and function

Ruptured non-communicating horn of bicornuate uterus at 22 weeks of gestation presenting as hypovoluemic shock: a case report

2026-08-28T08:46:22+0530

Pregnancy in a non-communicating rudimentary horn is a rare form of ectopic pregnancy resulting from a müllerian duct anomaly and is associated with a high risk of uterine rupture (50-90%), massive intraperitoneal hemorrhage, and maternal morbidity. Diagnosis before rupture remains challenging due to nonspecific clinical presentation and limitations of imaging. This case is presented to highlight the importance of early recognition, prompt surgical management, and the possibility of successful subsequent pregnancy following excision of a ruptured rudimentary horn. A 33-year-old, G2P1L1 woman with a previous lower segment cesarean section, history of infertility treatment, and hypothyroidism presented at 22+1 weeks of gestation with acute abdominal pain, syncope, and hypovoluemic shock. Emergency laparotomy revealed rupture of a right non-communicating rudimentary horn with hemoperitoneum. Excision of the ruptured rudimentary horn with right salpingo-oophorectomy was performed, and the patient recovered following massive blood transfusion. One year later, she conceived spontaneously. Despite developing complete placenta previa, gestational diabetes mellitus, and hypothyroidism, she underwent emergency lower segment cesarean section at 31+2 weeks of gestation, resulting in the delivery of a healthy preterm male infant. Rudimentary horn pregnancy should be considered in women with acute abdominal pain and hemodynamic instability during the second trimester, even when a previous diagnosis of intrauterine pregnancy has been made. Because rupture commonly occurs before diagnosis, maintaining a high index of suspicion is crucial. Surgical excision remains the definitive treatment for ruptured cases. This report highlights that successful subsequent pregnancy is achievable following appropriate surgical management and careful antenatal surveillance.

Hypertension in pregnancy: effects on maternal and fetal health and long-term outcomes

2026-08-28T08:50:00+0530

Hypertensive disorders of pregnancy (HDP) are heterogeneous maternal-placental syndromes and continue to be a major cause of maternal and perinatal morbidity and mortality worldwide. Their clinical spectrum ranges from gestational and chronic hypertension to preeclampsia, eclampsia and HELLP syndrome with markedly different biological mechanisms and outcomes. This narrative review critically discusses the current knowledge on the pathophysiology, classification, diagnosis, complications, and long-term outcomes of HDP. Current evidence supports a multifactorial model whereby abnormal placentation and impaired spiral artery remodelling interact with maternal cardiovascular, metabolic, immune, genetic and environmental susceptibility to produce endothelial dysfunction and clinical disease. Imbalances in angiogenesis, in particular sFlt-1 and PlGF changes, have improved our understanding of disease biology and have provided clinically useful tools to assess risk in suspected preeclampsia. However, biomarker performance is dependent on gestational age, disease phenotype, population and clinical setting, which limits their universal applicability. Severe HDP can lead to eclampsia, HELLP syndrome, renal and hepatic dysfunction, stroke, placental insufficiency, foetal growth restriction, stillbirth, and medically indicated preterm birth. Emerging evidence links HDP with subsequent maternal cardiovascular and renal disease and potential long-term cardiometabolic effects in exposed offspring. Importantly, the evidence available indicates that no single biomarker or molecular pathway is sufficient to represent the heterogeneity of HDP. Therefore, future strategies should focus on integrating clinical features with angiogenic, placental, cell-free nucleic acid, metabolomic and proteomic markers, possibly supported by artificial intelligence.

Polycystic ovarian syndrome: an updated review of pathophysiology, clinical features, biomarkers, and management

2026-08-28T08:48:38+0530

Polycystic ovary syndrome (PCOS) is one of the most prevalent endocrine and metabolic disorders affecting women of reproductive age and represents a major global public health challenge. PCOS is a heterogeneous condition characterized by reproductive dysfunction, hyperandrogenism, insulin resistance (IR), and metabolic abnormalities, frequently accompanied by psychological distress that significantly reduces quality of life. Despite its high prevalence, diagnosis, treatment, and long-term management remain challenging due to its complex, multifactorial pathophysiology. This review provides a comprehensive overview of the epidemiology, diagnostic criteria, clinical manifestations, and etiological factors associated with PCOS, with particular emphasis on genetic susceptibility, epigenetic regulation, environmental exposures, dietary habits, and lifestyle factors contributing to disease onset and progression. Key pathophysiological mechanisms are explored, including IR, hyperandrogenism, follicular arrest, chronic low-grade inflammation, oxidative stress, mitochondrial dysfunction, and adipose tissue dysregulation. The clinical manifestations of PCOS reproductive, metabolic, hyperandrogenic, and psychological along with long-term complications such as type 2 diabetes mellitus (T2DM), cardiovascular disease (CVD), non-alcoholic fatty liver disease (NAFLD), endometrial disorders, infertility, and adverse pregnancy outcomes, are discussed. Emerging hormonal, inflammatory, metabolic, genetic, and molecular biomarkers are highlighted for their potential to improve diagnosis, phenotypic classification, and personalized therapy. Current treatments, including lifestyle modification, pharmacological interventions, nutritional supplementation, and emerging targeted therapies, are also summarized. A deeper understanding of the molecular mechanisms underlying PCOS is essential for enabling early diagnosis, optimizing individualized management, reducing long-term health risks, and improving outcomes through precision medicine, multidisciplinary care, evidence-based decision-making, and continued therapeutic innovation.

Acceptability and women’s perceptions on progesterone only contraception: a comprehensive review

2026-08-28T08:48:22+0530

Progesterone-only contraceptives (POCs) represent a crucial pillar of modern family planning, offering highly effective options free from oestrogen-related cardiovascular risks. This review systematically examines patient preferences, satisfaction rates, and acceptability profiles across the primary POC modalities: progesterone-only pills (POPs), subdermal implants, long-acting injectables, and levonorgestrel-releasing intrauterine systems (LNG-IUS). Based on multi-country trial networks, health technology assessments, and real-world database registry cohorts, this paper details how bleeding abnormalities, return-to-fertility expectations, and metabolic profiles drive patient adherence or premature discontinuation. While long-acting reversible contraceptives (LARCs) exhibit the highest objective continuation rates, individual consumer choices are profoundly shaped by non-contraceptive benefits, user autonomy, and cultural perspectives. Strategic, structured patient counselling that balances expected bleeding disruptions against highly effective, discrete therapeutic benefits remains the definitive clinical intervention to improve long-term user satisfaction and minimize unmet contraceptive needs.

Planned birth at 39 weeks in low-risk nulliparous women: mapping international evidence to India's national health mission framework

2026-08-28T08:47:20+0530

Global obstetric practice has shifted over the past decade from routine expectant management of low-risk term pregnancies toward active consideration of planned birth at 39 weeks, while India's public health system has, over the same period, achieved substantial gains in institutional delivery, antenatal coverage, and high-risk pregnancy tracking under the National Health Mission (NHM). This review synthesizes the international evidence for planned 39-week birth in low-risk nulliparous women, examines the small emerging Indian evidence base, weighs areas of continuing debate around implementation and external validity, and maps the resulting picture onto the operational architecture of PMSMA, LaQshya, and SUMAN. International randomized and cohort evidence consistently favors planned 39-week birth, with reduced caesarean delivery and reduced hypertensive disorders of pregnancy; the largest available cohort found a substantial reduction in perinatal mortality for planned birth overall, though this benefit was driven predominantly by scheduled caesarean rather than induction specifically. Two Indian trials identified to date, both small, point in the same direction as the international literature and do not show any caesarean-increasing effect of induction. Real-world implementation data complicate a purely reassuring picture, raising legitimate questions about indication creep, external validity, and systemic workload. The more consequential India-specific finding is infrastructural rather than physiological: national first-trimester registration has risen sharply, but this reflects administrative registration rather than confirmed dating ultrasound, making gestational-age precision the central prerequisite for any 39-week protocol in India. A phased approach, gated on confirmed dating and supported by prospective audit, offers a measured pathway for evaluating this practice in the Indian context.

Chhaya: a review of India's unique non-hormonal oral contraceptive

2026-08-28T08:47:01+0530

Centchroman, which is also marketed as “Chhaya” under the National Family Planning Programme of India. It is the world's only non-steroidal, non-hormonal, once-weekly oral contraceptive. It was first synthesised at the Central Drug Research Institute (CDRI), Lucknow in 1967 and licensed in 1991. Later in April 2016, Chhaya was introduced free of cost into India's national family plaining programme. Despite the safety profile, its uptake remains far below its potential. This review synthesizes the published Indian evidence on the clinical efficacy, safety, acceptability, and programmatic challenges of centchroman as a contraceptive, with an emphasis on the postpartum and post-abortion contexts. A narrative review of peer-reviewed studies, government guidelines, and quality-improvement (QI) initiatives conducted in India was performed. Across the studies, Pearl Index values ranged from 0.2 to 2.0 per hundred woman-years, satisfaction rates reach 77-95%, and delayed or irregular menses is the most consistently reported side effect (8-26%). Access barriers and preference for alternative methods are the leading reasons for discontinuation. QI interventions that emphasize structured counselling and supply-chain strengthening have dramatically increased acceptance rates. Centchroman is a safe, effective, and reversible contraceptive that occupies a unique niche in India's family planning landscape. Programmatic investment in counselling, drug availability, and mHealth support is needed to translate its pharmacological promise into wider use.

Conservative versus surgical management of placenta accreta spectrum following mid-trimester abortion: a case series

2026-08-28T08:53:06+0530

Placenta accreta spectrum (PAS) is a rare but potentially life-threatening obstetric condition characterized by abnormal placental adherence or invasion into the myometrium. Although it is commonly associated with previous cesarean delivery, PAS may rarely occur following spontaneous mid-trimester abortion in women without a uterine scar. We present two cases of placenta increta diagnosed after spontaneous mid-trimester abortion with retained products of conception and persistent vaginal bleeding. Both patients underwent transvaginal ultrasonography with colour Doppler followed by pelvic magnetic resonance imaging (MRI), which confirmed focal myometrial invasion. The first patient, a 31-year-old multiparous woman who desired future fertility, was managed conservatively with systemic methotrexate, serial serum beta-human chorionic gonadotropin (β-hCG) monitoring, and close ultrasonographic follow-up, resulting in complete resolution of retained placental tissue. The second patient, a 43-year-old multiparous woman with completed family and severe anemia underwent total laparoscopic hysterectomy with bilateral salpingo-oophorectomy after preoperative optimization with blood transfusion and had an uneventful postoperative recovery. These cases highlight that PAS should be considered in women presenting with persistent bleeding after spontaneous abortion, particularly when highly vascular retained products are identified on imaging. Early diagnosis using ultrasonography and MRI facilitates timely individualized management. Conservative treatment may be successful in carefully selected women desiring fertility preservation, whereas hysterectomy remains the definitive treatment in women with completed family or significant risk of hemorrhage.

Terminal lucidity in women with advanced gynecologic cancer: a case series and focused review of the literature

2026-08-28T08:47:17+0530

Terminal lucidity (TL) is characterized by an unexpected, transient restoration of mental clarity, coherent communication, or purposeful behaviour shortly before death. Although reported in patients with neurodegenerative disorders, psychiatric illness, and pediatric oncology, TL has not previously been described in women with advanced gynaecological malignancies. We retrospectively reviewed 20 consecutive deaths among women with advanced gynaecological cancers at a tertiary gynaecologic oncology centre during 2025. Three patients fulfilled predefined criteria for TL and demonstrated an unexpected return of coherent communication and meaningful interaction following profound cognitive or functional decline. In each case, the episode occurred within 48 hours of death, allowing patients to communicate with family members and express personal wishes. Families uniformly interpreted the episodes as evidence of recovery despite the subsequent rapid clinical deterioration. These observations suggest that TL may occur in advanced gynaecological cancer and shares characteristic features with reports from neurological, palliative care, and pediatric oncology populations. Greater recognition of this phenomenon may facilitate appropriate counselling of families and improve end-of-life care, although prospective studies are needed to better define its incidence, underlying mechanisms, and clinical significance.

Uterine haemostatic packing tape: a novel indigenous method for rapid point-of-care preparation

2026-08-19T09:37:50+0530

Controlling obstetric haemorrhage has remained a major clinical challenge and continues to drive innovations and the sharing of effective techniques. Packing of the uterine cavity and other bleeding cavities is sometimes the only feasible temporary or definitive intervention when uterine-conserving procedures, specialised equipment, or surgical expertise are unavailable. This technique has been practiced for decades. Conventionally, the packing material consists of a tape prepared by rolling surgical gauze into a narrow strip. Although chitosan-based haemostatic packs are available, they are expensive, not readily accessible, and often associated with inventory constraints. Furthermore, the width of the packing tape must be tailored to the size of the bleeding cavity and should be wider when packing an atonic uterus with a widely dilated cervix. We developed an indigenous packing tape using a surgical cotton sheet that can be prepared instantly at the point of care. In our obstetric practice, this packing material effectively addressed these limitations and proved to be an efficient option for uterine packing in postpartum haemorrhage (PPH) and for packing other bleeding cavities, which we have described in this communication.

Unmet needs, knowledge of contraception and self- reported barriers to contraceptive use among women of reproductive age in Osun State, Nigeria

2026-08-28T08:47:22+0530

Background: Unmet need for contraception has been a focus in addressing the high fertility rate, especially in developing countries such as Nigeria. The concept of unmet need implies the gap between women’s reproductive intentions and their contraceptive behaviour for family planning. This study assessed the knowledge and unmet need for contraception, including self-reported barriers to contraceptive use among women of reproductive age in Osun State, Nigeria.

Methods: A community-based cross-sectional study was conducted among 1,218 women of reproductive age. The respondents were recruited using a multistage sampling technique. Quantitative and qualitative data were collected using a semi-structured questionnaire and an FGD guide, respectively, and data were analysed using SPSS version 23.0.

Results: The mean age of respondents was 31 years (S.D 7.24 years). The unmet need for contraception among respondents was 36.2%. About 70% of respondents were able to list 1-2 methods of contraception, and 12.3% were able to describe the fertile period. Overall, 67.6% of respondents had good knowledge of contraception, 93.6% knew the correct use of OCP, 41.0% knew the correct use of injectables, and 35.1% knew the correct use of implants. About a quarter (23%) of respondents reported fear of side effects as a barrier to contraceptive use.

Conclusions: This study found a high level of unmet need for contraception among women of reproductive age in Osun State compared to the national average, even though there was good knowledge of contraceptives among respondents. Policymakers can strengthen family planning programs by understanding and using data on unmet need.

Perception of polycystic ovary syndrome in relation to fertility among women of reproductive age in Ekiti State, Nigeria: a cross-sectional study

2026-08-28T08:46:48+0530

Background: Polycystic ovary syndrome (PCOS) is one of the most common endocrine disorders affecting women of reproductive age and is associated with infertility, metabolic disorders, and adverse psychosocial outcomes. Despite its health implications, awareness and perception of PCOS remain inadequate in many low- and middle-income countries, including Nigeria. This study assessed the knowledge, perception, sources of information, and socio-demographic factors associated with knowledge and perception of PCOS among women of reproductive age in Ekiti State, Nigeria.

Methods: This community-based cross-sectional analytical study was conducted among 388 women aged 18-49 years using a multistage sampling technique from selected communities in Ekiti State, Nigeria. Data were collected using a structured, interviewer-administered questionnaire comprising socio-demographic characteristics, knowledge, perception, and health-seeking behaviour related to PCOS. Knowledge was assessed using 15 items, while perception was evaluated using 10 Likert-scale statements. Descriptive statistics were used to summarize respondents' characteristics, knowledge, perception, and sources of information. Associations between socio-demographic characteristics, knowledge and perception levels were determined using Pearson's chi-square test at a significance level of p<0.05.

Results: The respondents had a mean knowledge score of 9.50±4.33, with 44.1% demonstrating high knowledge, 26.5% moderate knowledge, and 29.4% low knowledge of PCOS. The overall mean perception score was 37.56±6.04, indicating a moderate perception, with 44.1%, 48.5%, and 7.5% of respondents exhibiting positive, moderate, and negative perceptions, respectively. Respondents demonstrated good knowledge of the symptoms, fertility implications, and lifestyle management of PCOS but had limited knowledge of its long-term complications, particularly its association with type 2 diabetes and cardiovascular disease. The Internet and social media (52.6%) constituted the major source of health information, followed by television/radio (16.8%) and healthcare workers (14.2%). Knowledge of PCOS was significantly associated with age, residence, marital status, educational level, occupation, monthly income, religion, parity, pregnancy history, and family history of PCOS (p<0.05). Similarly, perception of PCOS was significantly associated with age, residence, marital status, occupation, monthly income, religion, parity, pregnancy history, and family history of PCOS (p<0.05), whereas educational level showed no significant association with perception (p>0.05).

Conclusions: Women of reproductive age demonstrated moderate overall knowledge and perception of PCOS, with substantial gaps in understanding its long-term health consequences. Digital media emerged as the predominant source of health information, highlighting its potential as an effective platform for PCOS awareness campaigns.

Success rate of peripartum myomectomy during cesarean delivery: a hospital-based study

2026-08-28T08:49:12+0530

Background: Although cesarean myomectomy was traditionally avoided because of hemorrhage risk, recent evidence suggests that it may be feasible in carefully selected women with appropriate surgical expertise and hemostatic support. Therefore, this study aimed to determine the success rate and short-term maternal outcomes of peripartum myomectomy performed during cesarean delivery.

Methods: This hospital-based observational study included 150 consecutive women with sonographic and/or intraoperative uterine fibroids undergoing cesarean delivery with planned peripartum myomectomy under spinal anesthesia at Salauddin Specialized Hospital, Dhaka, Bangladesh, between 2023 and 2025. The primary outcome was successful myomectomy without hysterectomy or abandonment. Secondary outcomes included postpartum hemorrhage, hemoglobin drop, transfusion, uterine atony, infection, hospital stay and in-hospital mortality.

Results: Mean maternal age was 31.2±5.4 years and mean gestational age was 38.1±1.7 weeks. Previous cesarean section was present in 52.0% of cases, while 58.7% were emergency procedures. Post-delivery myomectomy was performed in 96.7%. Mean operative time was 78.5±19.6 minutes and median blood loss was 850 mL (IQR 650–1100). Single fibroids occurred in 61.3% of patients, with a median size of 6.5 cm, mainly subserosal or intramural. Procedural success was achieved in 92.0%; hysterectomy and abandonment each occurred in 2.7%. Postpartum hemorrhage occurred in 12.0%, transfusion in 14.7%, fever in 10.7% and wound infection in 6.0%. Median hospital stay was 4 days, with no maternal deaths.

Conclusions: Cesarean myomectomy achieved a 92.0% success rate, with low hysterectomy rates and no maternal mortality. With careful patient selection, experienced surgeons and adequate hemorrhage-control measures, the procedure may be a feasible option for avoiding subsequent surgery.

Nutritional status and pregnancy outcomes among adolescent mothers in a rural Bangladeshi population

2026-08-28T08:48:51+0530

Background: Adolescent pregnancy remains a significant public health concern, particularly in rural Bangladesh, where it is often associated with poor maternal nutritional status and adverse neonatal outcomes. This study aimed to assess the nutritional status of adolescent mothers and evaluate its association with pregnancy outcomes in a rural Bangladeshi population.

Methods: This was a hospital-based cross-sectional observational study conducted among 105 adolescent mothers (aged 15–19 years) in the Department of Obstetrics and Gynaecology, 300 Bedded Hospital, Narayanganj, Bangladesh, from January 2025 to December 2025, in the rural setting of Bangladesh. Data were entered and analyzed using statistical software (SPSS version 26). A p value of <0.05 was considered statistically significant.

Results: In this study of 105 adolescent mothers, most participants were 18–19 years old (61.0%) and primigravida (78.1%). Nutritional assessment showed that 37.1% were underweight and 53.3% were anemic. Regarding pregnancy outcomes, 24.8% had preterm delivery and 33.3% of newborns had low birth weight. Significant associations were observed between maternal underweight status and low birth weight (53.8% vs 20.7%, p=0.002), maternal anemia and preterm birth (44.4% vs 14.3%, p=0.008) and overall undernutrition with adverse pregnancy outcomes (61.5% vs 27.3%, p<0.001).

Conclusions: Present research indicates that undernutrition and anemia are the main health issues that affect girls who get pregnant at a young age in rural Bangladesh and that these conditions induce health problems like low birth weight and preterm delivery. Besides, underweight mothers had much higher incidences of adverse maternal and neonatal outcomes than those who had normal nutritional status.

A study of various fetal Doppler indices to assess outcome in growth restricted fetuses: a comparative and cross-sectional study

2026-08-06T10:45:42+0530

Background: Fetal growth restriction (FGR) poses significant risks of adverse perinatal outcomes. Accurate surveillance is essential to distinguish pathologically growth-restricted fetuses from constitutionally small infants and to optimize the timing of delivery.

Methods: A comparative cross-sectional observational study was conducted at Rajiv Gandhi Medical College among 118 singleton pregnancies (≥32 weeks) with diagnosed FGR. Comprehensive doppler velocimetry of the umbilical artery (UA), middle cerebral artery (MCA), and ductus venosus (DV) was performed and categorized into doppler grades 0 to 5. Primary outcomes evaluated were perinatal morbidity, neonatal mortality, APGAR scores, and birth weight.

Results: Normal doppler (grade 0) was present in 98 (83.1%) participants, while 20 (16.9%) exhibited abnormal doppler indices. Abnormalities in UA, MCA, and DV were strongly associated with adverse outcomes (p<0.001). Grade 0 doppler showed a high association with normal neonatal outcomes (odds ratio=24.14, p<0.001). Conversely, severe doppler deterioration (grade 4 and grade 5) was significantly associated with perinatal morbidity (p=0.037) and neonatal mortality (p=0.011), respectively. Infants with abnormal doppler had significantly lower gestational age at delivery (35.35±2.30 vs 37.22±0.58 weeks, p=0.001), lower APGAR scores at 5 minutes (6.10±3.09 vs 8.53±0.61, p<0.001), and reduced birth weights (1.67±0.44 kg vs 2.09±0.14 kg, p<0.001).

Conclusions: Fetal doppler surveillance effectively stratifies risk in growth-restricted fetuses. Abnormal doppler indices correlate strongly with hemodynamic compromise and adverse perinatal outcomes, providing critical evidence to guide timely clinical intervention prior to irreversible fetal acidemia.

Prevalence and determinants of postpartum depression among women attending tertiary care centre in North India

2026-08-11T07:26:22+0530

Background: Postpartum depression is a mood disorder that occurs within 4 weeks-1 year after childbirth and the symptoms may range anywhere from persistent sadness or, anhedonia, fatigue, sleep disturbance to difficulty bonding with the baby, suicide, thoughts of harming the baby. Postpartum depression has unknown etiology, but various risk factors such as history of psychiatric illness, relationship with the spouse, education level, domestic violence, lack of social support, financial status, younger age at pregnancy, obstetrics stress and complications plays important role.

Methods: An analytical cross-sectional study was conducted on 504 mothers of 6 week to 1year postpartum period attending OBG OPD, private medical college, Agra for regular check-up during time span of 6 months (1st October 2025 to 30th April 2026). Data was collected on various sociodemographic, obstetrics factors along with EPDS (Edinburgh Postnatal Depression Scale) score after getting informed consent from subjects.

Results: The study finding show 42.9%women had postpartum depression. Various factors such as young age, residence, religion, education, socioeconomic status, parity, number of children, birth spacing, number of female children and birth weight showed significant association through chi-square test but on applying binary logistic regression only young age, religion, education less than high school and unplanned pregnancy where significant predictors others variables association were not established.

Conclusions: Postpartum depression goes undiagnosed due to social stigma, guilt or the perception that sadness is normal. Screening tools like EPDS must be incorporated into mother and child health programmes, capacity building of grass root level workers to be done to bring about education, support and awareness to young and low educated women of the community.

Effect of vaginal preparation before caesarean section on post operative infectious morbidity

2026-08-28T08:53:30+0530

Background: Caesarean section (CS) is a common surgical procedure associated with postoperative infectious morbidities such as endometritis, wound infection, and urinary tract infection. Vaginal antiseptic preparation before CS has been proposed to reduce these complications by lowering bacterial load. This study aimed to evaluate the effect of vaginal preparation before CS on postoperative infectious morbidity.

Methods: This prospective study involved pregnant women undergoing caesarean delivery. Participants were divided into two groups: one undergoing vaginal cleansing with antiseptic solutions (povidone-iodine or chlorhexidine) before surgery, and the other receiving no vaginal preparation. Postoperative outcomes, including the incidence of endometritis, wound infections, urinary tract infections, and febrile morbidity, were recorded and compared between groups.

Results: Vaginal preparation significantly reduced the incidence of postoperative infections. A notable decrease in endometritis rates was observed among women who received preoperative vaginal cleansing, especially in cases of labor or ruptured membranes. Similarly, wound infection rates and urinary tract infections were lower in the intervention group. No serious adverse reactions related to antiseptic use were reported. Both povidone-iodine and chlorhexidine proved effective, with slight advantages seen for chlorhexidine in reducing overall morbidity due to its longer antimicrobial action and lower mucosal irritation.

Conclusions: Preoperative vaginal cleansing with antiseptics before caesarean delivery effectively reduces postoperative infectious morbidity, particularly endometritis. This simple, low-cost intervention is especially beneficial for high-risk cases, such as emergency CS s and cases with ruptured membranes. Routine adoption of vaginal preparation could enhance maternal outcomes and reduce healthcare burden.

A study of patients with hypertensive disorders in pregnancy and their fetomaternal outcomes at tertiary care center: a retrospective study

2026-08-28T08:53:29+0530

Background: Hypertensive disorders of pregnancy (HDP) are a major cause of maternal and perinatal morbidity and mortality worldwide, particularly in developing countries. These disorders complicate 5-10% of pregnancies and are associated with adverse fetomaternal outcomes. Objectives were to study the clinical profile of HDP and to evaluate their associated maternal and fetal outcomes at a tertiary care center.

Methods: This retrospective observational study was conducted in the Department of Obstetrics and Gynecology at a Cama and Albless Hospital over a period of 6 months. Pregnant women with gestational age ≥20 weeks diagnosed with HDP were included. Data regarding maternal age, parity, gestational age at admission, type of hypertensive disorder, mode of delivery, maternal complications, and fetal outcomes were collected and analyzed using descriptive statistics.

Results: A total of 30 women with HDP were studied. The majority of patients were in the age group of 25-34 years, with 40% being primigravidae. Gestational hypertension was the most common hypertensive disorder (63.3%), followed by Preeclampsia (16.7%) and eclampsia (3.3%). Cesarean section was performed in 86.7% cases. Common maternal complications included severe preeclampsia, eclampsia, placental abruption, and HELLP syndrome. Low birth weight in 0%, and NICU admission in 16.7% of neonates and no stillbirths were observed.

Conclusions: HDP are associated with significant maternal and perinatal morbidity. Early diagnosis, close antenatal surveillance, and timely referral to tertiary care centers are crucial in improving fetomaternal outcomes.

Comparison of reproductive outcomes in ICSI cycles after sperm selection techniques in advanced paternal age

2026-08-28T08:53:26+0530

Background: Advanced paternal age is associated with declining semen parameters, increased sperm DNA fragmentation (SDF), and oxidative stress, which may negatively affect ART outcomes. Microfluidic sperm sorting has been proposed as a method to reduce SDF and improve sperm quality compared to conventional density gradient centrifugation.

Methods: Single-center retrospective cohort study including 193 ICSI cycles performed between January 2023 and December 2024. Couples were stratified by male age (<40 years vs. ≥40 years) and further subdivided by sperm preparation method (density gradient vs. microfluidics), forming four subgroups (A1: <40/DG, n=56; A2: <40/MF, n=59; B1: ≥40/DG, n=33; B2: ≥40/MF, n=45). Inclusion criteria: ≥10 mature oocytes, ICSI, frozen double blastocyst transfer, and sperm concentration ≥5×10⁶/ml. Exclusion criteria: severe male factor infertility or donor gametes. Primary outcome: live birth rate. Secondary outcomes: clinical pregnancy, miscarriage, fertilization, and blastulation rates.

Results: No significant differences were observed in clinical pregnancy, miscarriage, or live birth rates between preparation methods within either age group (all p>0.05). Fertilization and blastulation rates were comparable across subgroups. A modest reduction in oocyte yield was noted in older males undergoing microfluidic preparation (A2 vs. B2; p=0.034), likely reflecting female- or cycle-specific factors. Demographic/clinical data are detailed in tables in the results section. Multivariate logistic regression showed that female age (OR 1.02, 95% CI 0.96–1.09, p=0.50) and subgroup membership were not significant predictors of clinical pregnancy. Pairwise comparisons with Tukey adjustment confirmed no significant differences between subgroups (e.g., A1 vs. B1: OR 1.91, p=0.515).

conclusion: Male age ≥40 years and sperm preparation method (microfluidics vs. density gradient) were not independent determinants of ART success in this cohort. Clinical decision-making regarding sperm selection should not be guided solely by paternal age or subgroup classification.

Spectrum of uterine malignancies and their oncological outcomes: a single centre experience

2026-08-28T08:53:17+0530

Background: Endometrial carcinoma is a significant contributor to the global female cancer burden. Its incidence in India is rising because of increasing life expectancy and metabolic risk factors, although Indian outcome data remain limited. This study aimed to evaluate the spectrum of uterine malignancies and assess their oncological outcomes in an Indian cohort.

Methods: This prospective observational study was conducted at a tertiary care centre over a five-year period (2020–2025). Seventy (70) women were included following histopathological confirmation of uterine malignancy. Data on clinical presentation, histological subtype, staging, treatment, and outcomes were recorded and analysed using descriptive statistics.

Results: The mean age was in the sixth decade, with 88.6% of patients being postmenopausal. Endometrioid adenocarcinoma was the most common histological subtype (75.7%), followed by serous carcinoma (7.1%), carcinosarcoma (4.3%), and clear cell carcinoma (4.3%). Most patients presented at FIGO Stage I (61.5%) and underwent primary surgical management. Adjuvant therapy was administered in 32.9% of cases based on stage and risk factors. At a median follow-up, 72.9% of patients were alive and recurrence was observed in only 1.4%. Binary logistic regression showed that none of the individual pathological factor’s tumour grade, histology, LVSI, myometrial invasion, or cervical stromal involvement significantly predicted lymph node involvement.

Conclusion: Endometrioid carcinoma remains the predominant uterine malignancy in Indian women, typically presenting in postmenopausal women at an early stage with favourable outcomes. Given the inability of conventional pathological risk factors to reliably predict nodal involvement, comprehensive surgical staging using sentinel lymph node mapping or systematic lymphadenectomy should be considered in all cases, irrespective of initial stage.

A study of second stage caesarean sections at term

2026-08-28T08:53:15+0530

Background: Caesarean section (CS) in the second stage of labour is a technically demanding procedure associated with significant maternal and neonatal morbidity. Its rising incidence, driven by declining use of instrumental vaginal delivery and increasing medicolegal concerns, makes it an important area of study. This study aimed to assess the incidence, indications, intraoperative and postoperative complications, and fetomaternal outcomes of second stage CSs at a tertiary care teaching hospital in North India.

Methods: A retrospective observational study was conducted in the Department of Obstetrics and Gynaecology, Christian Medical College and Hospital (CMCH), Ludhiana. Obstetric records of all patients who underwent CS in the second stage of labour between 1st January 2018 and 30th June 2020 were reviewed and analysed.

Results: Of 1372 total CSs performed during the study period, 103 (7.5%) were in the second stage of labour. The majority of women (79.6%) were aged 21-30 years; 66% were primigravidae. Induced labour was present in 56.3% of cases. Cephalopelvic disproportion was the most common indication (33.3%), followed by fetal distress (22.9%). The head push method was used in 71.8% of cases for delivery of the impacted fetal head. Uterine atony was the most common intraoperative complication (21.3%). The majority of women (72%) had no postoperative complications. Fifty-eight percent of neonates had no complications; birth asphyxia (10.7%) and meconium aspiration syndrome (6.8%) were the most common neonatal morbidities.

Conclusions: Second stage CS is associated with significant fetomaternal morbidity. Proactive antenatal assessment, judicious intrapartum management, and structured training in operative vaginal delivery and fetal head disimpaction techniques are essential to reduce its incidence and associated complications.

Lifestyle modifications before medicines: early intervention in adolescent polyendocrine metabolic ovarian syndrome

2026-08-28T08:53:13+0530

Background: Polycystic ovary syndrome (PCOS) is a common endocrine disorder. Recently its name has been changed as polyendocrine metabolic ovarian syndrome (PMOS), However, the term PCOS is inaccurate, implying pathological ovarian cysts, obscuring diverse endocrine and metabolic features, delayed diagnosis, fragmented care, and stigma. So, in this study PMOS term will be used instead of PCOS but references will be used for PCOS term because newer studies are less with new terms. PMOS is characterized by hyperandrogenism, ovulatory dysfunction, and ovarian morphology.

Methods: A retrospective observation study conducted at R. K. Hospital Indore over period of two years. Total 100 adolescents aged between 12 and 19 years, who were presenting with symptoms such as menstrual irregularities, acne, hirsutism, weight gain were screened. A questionnaire was distributed. Menstrual irregularity was seen in 85%, acne in 72%, hirsutism in 56% and weight gain in 50%. Life style modifications recommended to all include daily counselling, less sedentary behavior, exercise, proper sleep and reduce screen time.

Results: Following healthy lifestyle, menstrual irregularities reduced and most of patients improved with Acne, hirsutism and weight reduction.

Conclusions: Diagnosing PMOS is challenging since normal pubertal development overlaps typical features of syndrome. Healthcare providers should make the diagnosis of PMOS on evidence-based guidelines to prevent delayed, under diagnosis or over diagnosis. Psychological care, dietary care, lifestyle modifications are key steps. Support could significantly affect adolescent’s motivation and amp; ability to change their behaviours.

Effect of ecosprin on pulsatility index of uterine artery in all trimesters of pregnancy – cross sectional interventional study in Indian pregnant women

2026-08-28T08:49:15+0530

Background: Low-dose aspirin is recommended to prevent preeclampsia in high-risk pregnancies, primarily by enhancing placental perfusion. However, its routine efficacy in low-risk pregnancies and its direct impact on uterine artery hemodynamic remain under evaluation. This study investigated the effect of low-dose aspirin (75 mg/day) on uterine artery Doppler indices across all trimesters in a low-risk Indian population.

Methods: A prospective interventional study was conducted among 279 low-risk pregnant women attending a tertiary care hospital from March 2024 to December 2025. Participants were divided into a study group (n=115) receiving 75 mg aspirin daily at bedtime following ultrasonographic confirmation of fetal cardiac activity, and a control group (n=164). Uterine artery pulsatility index (UtA-PI) was assessed via Doppler ultrasonography across the first (11-14 weeks), second (18-22 weeks), and third (28-35 weeks) trimesters.

Results: Across all three trimesters, there was no statistically significant difference in mean UtA-PI between the study group and the control group (p>0.05). However, clinical outcomes varied notably: 2.94% of women in the control group developed preeclampsia, whereas 0% of participants in the low-dose aspirin study group developed preeclampsia.

Conclusions: Although low-dose aspirin (75 mg/day) did not significantly alter uterine artery Doppler pulsatility indices compared to controls, it demonstrated a clear clinical benefit by completely preventing preeclampsia. Given its high safety profile and low cost, universal initiation of low-dose aspirin early in pregnancy may serve as a valuable prophylactic strategy in low-resource settings where formal risk-stratification testing is unfeasible.

Comparative efficacy and safety of oral ferrous fumarate versus intravenous iron sucrose in pregnancy with iron deficiency anemia: a prospective comparative study

2026-08-28T08:53:10+0530

Background: Iron deficiency anemia (IDA) during pregnancy remains highly prevalent and is associated with maternal morbidity and adverse perinatal outcomes. Oral iron is widely used but limited by gastrointestinal intolerance and variable absorption, whereas intravenous (i.v.) iron sucrose may produce faster correction and improved iron stores. Objectives were to compare oral ferrous fumarate versus i.v. iron sucrose for improvement of hemoglobin and iron indices in pregnant women with IDA, and to compare adverse effects and pregnancy/neonatal outcomes.

Methods: In this prospective comparative interventional study, 164 pregnant women with biochemical evidence of iron deficiency were allocated to group A (oral ferrous fumarate 300 mg/day ≈100 mg elemental iron + folic acid; n=82) or group B (i.v. iron sucrose 200 mg on alternate days + folic acid; n=82). Hemoglobin and iron profile were assessed at baseline and repeated at 3 and 8 weeks. Adverse effects and obstetric/neonatal outcomes were documented. Between‑group comparisons used appropriate parametric/non‑parametric tests; p<0.05 was significant.

Results: Baseline characteristics and iron indices were comparable. Hemoglobin increased in both groups but was higher in group B at 3 weeks (10.05±0.73 versus 9.59±0.73 gm/dl; p<0.001) and 8 weeks (10.69±0.89 versus 10.32±0.77; p=0.006). Ferritin rose more in group B at 3 weeks (118.16±54.89 versus 58.87±16.99 ng/ml; p<0.001) and remained higher at 8 weeks (64.58±14.19 versus 56.59±14.82 ng/mL; p=0.001). Transferrin saturation improved more in group B at both follow‑ups (p<0.001). Oral iron caused more gastrointestinal adverse effects, whereas i.v. therapy showed more itching, thrombophlebitis and hypotension. Delivery and neonatal outcomes were comparable.

Conclusions: I.v. iron sucrose achieved faster and greater improvement in hemoglobin and iron stores with a route‑specific adverse‑effect profile, supporting its use in selected pregnant women needing rapid correction or with poor tolerance/adherence to oral iron.

A prospective randomized study comparing drug efficacy of tibolone, conjugated equine estrogen, combined estrogen and progesterone for symptomatic relief in postmenopausal women

2026-08-28T08:53:03+0530

Background: Menopause is linked to various vasomotor, psychological, and urogenital symptoms that greatly impact quality of life. Menopausal hormone therapy (MHT), such as tibolone, conjugated equine estrogen (CEE), and combined estrogen-progesterone treatments, is commonly used to alleviate these symptoms. Nevertheless, comparative data regarding their efficacy and safety remain limited.

Methods: This prospective randomized controlled trial involved 99 postmenopausal women aged between 45-65 years, divided into three groups: tibolone, CEE, and combined estrogen-progesterone (33 participants each). The severity of symptoms was measured at baseline, 3 months, and 6 months. Adverse effects and treatment tolerability were also evaluated. Statistical analysis was performed using SPSS software with significance set at p<0.05.

Results: Baseline symptom severity was similar across all groups, with the majority of participants having mild to moderate symptoms. Mean symptom scores stayed mostly consistent at 3 and 6 months in all groups, showing no statistically significant difference in overall symptom improvement. However, the occurrence of side effects differed between groups. Tibolone had the lowest rates of breast tenderness and vaginal bleeding, whereas CEE and combined therapy were associated with higher rates of these side effects.

Conclusions: While all three treatments showed similar effectiveness in managing overall symptoms, tibolone had a better safety profile. These results emphasize the importance of individualized treatment selection based on patient characteristics, symptoms, and tolerability.

An observational study to evaluate feto maternal outcome in labour management using the WHO labour care guide among women admitted to labour room in a tertiary care centre of South Gujarat

2026-08-28T08:53:00+0530

Background: Labour and childbirth are critical events that significantly influence maternal and neonatal outcomes. The world health organization (WHO) labour care guide (LCG) is an evidence-based, woman-centred tool designed to improve intrapartum monitoring through individualized labour assessment and timely clinical decision-making. This study evaluated fetomaternal outcomes associated with the use of the WHO Labour Care Guide in a tertiary care centre.

Methods: A prospective observational study was conducted in the Department of Obstetrics and Gynaecology, Government Medical College, New Civil Hospital, Surat, Gujarat, India, from March 2025 to March 2026. A total of 500 term pregnant women with singleton cephalic pregnancies in active labour (≥5 cm cervical dilatation) were included. Women with previous caesarean section, multiple gestation, malpresentation or high-risk pregnancies requiring immediate intervention were excluded. Labour was monitored using the WHO Labour Care Guide and maternal and neonatal outcomes were analysed.

Results: Among the 500 women, 452 (90.4%) had spontaneous vaginal delivery, 10 (2.0%) required instrumental delivery and 38 (7.6%) underwent caesarean section. Maternal complications occurred in 14 (2.8%) women, with postpartum haemorrhage being the most common. Most neonates had Apgar scores ≥8 at 1 minute (97.6%) and 5 minutes (98.0%). Normal birth weight (2.5–3.5 kg) was observed in 76% of neonates, while NICU admission was required in only 2.4%. Crossing the LCG alert threshold was significantly associated with adverse maternal outcomes (p<0.001).

Conclusions: The WHO Labour Care Guide is an effective tool for intrapartum monitoring and is associated with favourable maternal and neonatal outcomes, timely recognition of labour abnormalities and reduced unnecessary obstetric interventions.

Prevalence of gestational diabetes in Lucknow region

2026-08-28T08:52:58+0530

Background: Gestational diabetes mellitus (GDM) is one of the most prevalent complications of pregnancy and is associated with adverse maternal and neonatal outcomes, and is a risk factor for future development of type 2 diabetes mellitus. Objective was to find out the prevalence of GDM in Lucknow region by the fasting blood glucose (FBG) and 75 gm oral glucose tolerance test (OGTT).

Methods: The study was carried out as a cross-sectional study among second and third trimester pregnant women. The subjects were divided into normoglycemic and hyperglycaemic groups according to FBG, OGTT and urine glucose analysis.

Results: The overall prevalence of GDM was 9.6%. Sixty percent of all women affected were from urban areas and 40 percent were from rural areas. FBG value and OGTT value in the hyperglycaemic group were significantly high (p<0.001) and positive glucosuria (p<0.001) was observed.

Conclusions: Routine screening, antenatal monitoring, and lifestyle modification are important to minimize the undesirable outcomes of GDM and its long-term consequences of type 2 diabetes mellitus.

Maternal and fetal outcomes in cases of mild SARS-CoV-2 infections in pregnant women at a tertiary teaching hospital: a retrospective observational study

2026-08-28T08:49:17+0530

Background: The COVID-19 pandemic has posed unprecedented challenges including for pregnant women, a physiologically vulnerable group. There is limited data specifically on mild or asymptomatic SARS-CoV-2 infections during pregnancy and their effect on maternal and fetal outcomes. To analyse maternal and fetal outcomes in cases of mild SARS-CoV-2 infections in pregnant women hospitalized at a tertiary teaching hospital and to determine the rate of possible vertical transmission.

Methods: A retrospective observational study was conducted from June 2020 to June 2022 at the Department of Obstetrics and Gynaecology of Nowrosjee Wadia Maternity Hospital, a tertiary teaching hospital. Data of 152 pregnant women with confirmed mild or asymptomatic SARS-CoV-2 infection were retrospectively analysed from medical records. Statistical analysis used Chi-Square test, Fisher’s Exact test and Mann-Whitney U test. Significance was set at p≤0.05.

Results: A total of 152 hospitalized pregnant women were included. Majority (80.9%) were asymptomatic; 19.1% had mild symptoms (cough 5.3%, fever 4.6%). The live birth rate was 97.4%. LSCS was performed in 61.8% of cases. Perinatal COVID-19 infection was confirmed in only 1.3% of neonates (vertical transmission rate). NICU admission rate was 9.9%. Statistically significant differences between symptomatic and asymptomatic women were found in pulse rate (p=0.007), D-dimer levels (p=0.009), ECG findings (sinus tachycardia, p<0.0001) and neonatal birth weight (p=0.034). No significant differences were observed in mode of delivery, APGAR scores or NICU admission rates between the two groups.

Conclusions: Most pregnant women with mild or asymptomatic COVID-19 had favourable maternal and fetal outcomes. Symptomatic women showed significantly higher D-dimer levels, pulse rates and lower birth weights, indicating a need for targeted monitoring. Vertical transmission was rare. Routine COVID-19 screening of all pregnant women remains essential.

Bridging the donor gap: a prospective comparative study of obstetric and perinatal outcomes based on gamete sources in IVF at a tertiary care centre of South India

2026-08-28T08:49:14+0530

Background: The assisted reproductive technology (regulation) act of 2021 has standardized third-party gamete donation in India. However, the introduction of non-maternal genetic material creates an allogenic state that potentially compromises placentation and increases obstetric risks. This study evaluated maternal and perinatal outcomes across different gamete configurations in a South Indian tertiary care facility.

Methods: This prospective comparative observational study consecutively enrolled 125 IVF-conceived pregnancies over an 18-month period. The cohort was stratified into: autologous (n=98), donor sperm (n=11), donor egg (n=8), and dual donor (n=8). Relative risks (RR) and 95% confidence intervals (CI) were calculated. Multivariable logistic regression adjusted for maternal age and pre-existing comorbidities to identify independent predictors of adverse outcomes.

Results: In crude analysis, the dual donor cohort carried the highest risk for hypertensive disorders of pregnancy (HDP) (100% incidence; RR: 1.707) and severe pre-eclampsia (75% incidence; RR: 4.641). On multivariable regression, dual donor status emerged as the only significant independent predictor for HDP, showing a 12-fold increase in disease odds (OR: 12.06, 95% CI: 0.68–214.80, p=0.040). Isolated donor sperm or oocyte configurations did not show independent risk predictions for HDP or preterm delivery (p>0.05). Caesarean section rates were exceptionally high across all donor arms (81.8% to 100%). Perinatal outcomes, including neonatal intensive care admissions and congenital anomalies, were reassuringly similar across cohorts, although extremely low birth weight was selectively elevated across all donor categories.

Conclusions: Dual donor gamete use is an independent predictor of hypertensive disorders of pregnancy. The elevated clinical risks warrant early high-risk triaging, timely tertiary referral, and proactive first-trimester prophylactic strategies.

Thyroid dysfunction association with abnormal uterine bleeding

2026-08-28T08:49:00+0530

Background: Abnormal uterine bleeding (AUB) is one of the most frequent gynaecological complaints among women of reproductive age. Thyroid hormones play a crucial role in regulating menstrual physiology and their imbalance may lead to a spectrum of menstrual disorders ranging from Infrequent menses to Prolonged bleeding. To detect and evaluate thyroid functional abnormalities in women with AUB and to analyse different patterns of menstrual abnormalities associated with thyroid dysfunction across different age groups.

Methods: This was a cross-sectional observational study conducted in the Department of Obstetrics and Gynaecology, SSG hospital, Vadodara. A total of 370 women aged 15–49 years presenting with AUB were included fulfilling the inclusion and exclusion criteria. Detailed history, clinical examination and relevant investigations including thyroid function tests were performed. Patients were classified based on the bleeding patterns, PALM-COEIN system and thyroid status.

Results: Out of the total patients studied, 25.39% were found to have thyroid dysfunction, with hypothyroidism being the most common type. Thyroid abnormalities were more frequently seen in women aged 31–40 years. Multiparity was more common in hypothyroid AUB cases. Structural causes like fibroids and adenomyosis were more prevalent among euthyroid women, while functional bleeding patterns were common in thyroid dysfunction.

Conclusions: Thyroid dysfunction, especially hypothyroidism, is significantly associated with AUB, particularly in the 31–40 age group. Routine screening of thyroid function in AUB patients is recommended to enable early diagnosis and reduce the need for invasive procedures.

Association of abnormal thyroid stimulating hormone and serum prolactin levels in women of reproductive age with abnormal uterine bleeding

2026-08-28T08:48:59+0530

Background: Abnormal uterine bleeding (AUB) is a frequent problem in reproductive-aged women and carries substantial morbidity, anemia and reduced quality of life. The objective of this study was to evaluate the association between thyroid-stimulating hormone (TSH) levels and serum prolactin levels in women of reproductive age presenting with AUB.

Methods: This was a cross sectional, observational study carried out for 18 months in Department of Obstetrics and Gynecology, ESIC Medical College, Rajajinagar, Bengaluru. Twenty-seven women aged 19-49 years who had AUB were recruited. After clinical assessment, the serum TSH and prolactin levels were determined using chemiluminescence immunoassay (Siemens ADVIA Centaur). IBM SPSS Statistics version 25.0 was used to data analysis. Descriptive statistics, chi-square test, Pearson's correlation was applied and p value of <0.05 was regarded as statistically significant.

Results: The mean age of the study population was 34.06±9.42 years and majority of the women were multiparous (61.9%) and aged between 35-44 years (32.2%). The most common presentation was heavy menstrual bleeding (53.7%). The non-structural causes represented 63.7% of AUB, with ovulatory dysfunction being the most common cause (35.2%). In 40.0% of women, the TSH level was abnormal, with hypothyroidism (35.2%) and hyperthyroidism (4.8%). Twenty-seven.4% of participants had hyperprolactinemia. There was no correlation between TSH and prolactin levels (r=0.048, p=0.432).

Conclusions: Thyroid dysfunction and hyperprolactinemia are relatively frequent in women with AUB, but no significant relationship was found between TSH and prolactin levels. Regular hormonal testing may aid in early detection of any underlying glandular problems and help to guide treatment in women with AUB.

Fetomaternal outcome in twin gestation

2026-08-28T08:48:48+0530

Background: Twin pregnancies are among the major challenges faced by obstetricians globally. Increased maternal and fetal morbidity is observed with an increase in the incidence of twin pregnancies. The major problems occurring in twin pregnancy are prematurity, low birth weight, intrauterine growth restriction (IUGR), birth trauma and birth asphyxia. The incidence of twin gestation has increased mainly due to advanced maternal age and ART. Objectives were to evaluate maternal and neonatal complications and pregnancy outcomes in twin pregnancies.

Methods: A prospective study conducted in Baroda Medical College, Vadodara over the period of 1 year evaluated 178 women with twin pregnancies fulfilling the inclusion and exclusion criteria. After taking informed consent detailed history of patient, all routine antenatal investigations were done. Patients will be followed up till discharge from hospital.

Results: Majority of the women belonged to the age group 18-25 years. Maximum number of mothers 60.11% delivered between 32-36 weeks of gestation. Out of them 94.38% of the women conceived by spontaneous conception. Caesarean section (CS) was the most common mode of delivery 63.48% and vaginal delivery occurred in 36.5% mothers. Preterm labor is the most common complication occurring in 93.2% mothers, followed by hypertension in 30.8% mothers. Among those with hypertension 3.93% mothers also had oligohydramnios. Anemia occurred in 10.1% mothers among which 33.3% developed anemia post-partum.

Conclusions: Maternal complications during twin pregnancy were mainly preterm labor, diabetes, hypertension and anemia. Fetal complications were mostly related to IUGR. Active fetal surveillance can improve fetomaternal outcome.

Quality of life and associated factors among postmenopausal women in a rural village of Northern Kerala: a cross-sectional investigation

2026-08-28T08:48:40+0530

Background: Menopause is associated with several physical, psychological, vasomotor, and sexual symptoms that can adversely affect the quality of life (QOL) of women. Evidence on menopause-related QOL from rural communities in Northern Kerala remains limited. This study aimed to assess the QOL of postmenopausal women and identify the factors associated with it.

Methods: A community-based descriptive cross-sectional study was conducted among 300 naturally postmenopausal women aged 45-65 years residing in a rural village of northern Kerala from June to November 2023. Participants were selected using simple random sampling from a community sampling frame. Data were collected using a pretested questionnaire incorporating the menopause-specific quality of life (MENQOL) questionnaire. Descriptive statistics and Chi-square tests were used for analysis, with p<0.05 considered statistically significant.

Results: The overall mean MENQOL score was 3.45±0.73, indicating a moderate decline in QOL. The physical domain had the highest mean score (4.12±1.64), followed by the vasomotor (3.82±1.76) and psychosocial (3.38±1.58) domains, while the sexual domain had the lowest mean score (2.48±1.32). Mild and moderate decline in QOL were observed in 42.0% and 38.0% of participants, respectively. Age, educational status, occupation, socioeconomic status, marital status, BMI, chronic diseases, and physical activity were significantly associated with QOL (p<0.05).

Conclusions: Postmenopausal women experienced a moderate decline in menopause-related QOL, with the physical domain being the most affected. Comprehensive primary care interventions focusing on lifestyle modification, chronic disease management, and health education may improve the QOL of postmenopausal women.

Changing trends, indications and outcomes of hysterectomy: a six-year retrospective study at a tertiary care center (2020–2025)

2026-08-28T08:48:28+0530

Background: Hysterectomy remains one of the most commonly performed gynecological surgeries worldwide. Evaluating institutional trends helps improve surgical decision-making and patient outcomes. To analyze trends, indications, surgical approaches, complications and postoperative recovery among women undergoing hysterectomy over a six-year period.

Methods: A retrospective observational study was conducted at a tertiary care teaching hospital. Data from women who underwent hysterectomy between January 2020 and December 2025 were reviewed. Variables analyzed included surgical volume, type of hysterectomy, indications, age distribution, complications and recovery outcomes.

Results: A total of 1,061 hysterectomies were performed during the study period. Abdominal hysterectomy was the most common surgical approach (51.93%), followed by vaginal hysterectomy (38.40%) and laparoscopic hysterectomy (9.6%). Abnormal uterine bleeding and pelvic organ prolapse were the leading indications. The majority of patients were aged 40–49 years. A total of 103 complications were documented, with complication rates of 10.9% for abdominal, 7.8% for vaginal and 10.8% for laparoscopic hysterectomy. The association between surgical route and complications was statistically significant (p=0.004). Most patients were discharged within five days and selected postoperative recovery parameters improved over the study period. Postoperative symptom data were available from routine follow-up documentation but were not assessed using a validated quality-of-life instrument. Decreased sexual desire (60%) and sleep disturbance (45%) were more frequently documented.

Conclusions: Hysterectomy trends in our institution demonstrate a predominance of abdominal surgery with gradual improvements in postoperative recovery. Expanding minimally invasive surgical approaches and strengthening perioperative care may further enhance patient outcomes.

A study on fetomaternal outcomes in term pregnancies with isolated oligohydramnios

2026-08-28T08:48:24+0530

Background: Isolated oligohydramnios at term is still a matter of controversy among obstetricians, since there is conflicting evidence as to its effect on maternal and neonatal outcomes. The present study looked at the fetomaternal outcomes in term pregnancies which were complicated by isolated oligohydramnios.

Methods: A prospective observational study was conducted among 350 pregnant women with singleton term pregnancies (37–40 weeks) diagnosed with isolated oligohydramnios (amniotic fluid index (AFI)≤8 cm) at a tertiary care hospital in Puducherry, India. Women with maternal and fetal comorbidities, congenital anomalies, pre-labour rupture of membranes or intrauterine fetal demise were excluded. Participants were followed from admission until delivery and 1st week of neonatal period. The maternal, fetal and neonatal outcomes were analysed using SPSS version 21.0 and the associations between AFI and the obstetric outcomes were evaluated by means of appropriate statistical tests, taking p<0.05 as the criterion for significance.

Results: The average age of the mothers was 26.8±4.2 years and the average gestational age at the time of admission was 38.4±1.1 weeks. Caesarean section was carried out in 53.4% of the women, fetal distress being the most common reason (33.1%). A non-reassuring non-stress test (NST) was noted in 23.4% of the pregnancies. 25.4% of the newborns required admission to the neonatal intensive care unit (NICU) and 15.4% had an Apgar score of less than 7 at five minutes. Meconium aspiration syndrome (13.7%) was the most common neonatal complication. Women who had severe oligohydramnios (with an amniotic fluid index of 0 to 5 cm) had a considerably higher rate of caesarean delivery than those with an AFI of 5.1 to 8 cm (73.2% versus 39.9%, p<0.001). Both a lower AFI and non-reassuring NST were significantly linked to caesarean delivery and to adverse neonatal outcomes.

Conclusions: Though isolated oligohydramnios at term, there is higher need of obstetric intervention and poor perinatal outcomes that too when oligohydramnios is severe. Fetimaternal outcomes can be improved by early diagnosis by carrying out careful antenatal monitoring and by providing individualised obstetric care.

Comparative analysis of WHO labour care guide versus WHO modified partogram on labour outcomes

2026-08-28T08:47:15+0530

Background: Effective intrapartum monitoring is essential for improving maternal and neonatal outcomes while minimizing unnecessary obstetric interventions. The World Health Organization (WHO) labour care guide (LCG) is an updated labour monitoring tool that emphasizes individualized assessment and respectful maternity care compared with the WHO modified partogram. This study compared labour outcomes between these two approaches.

Methods: A prospective randomized controlled trial was conducted among 300 women with term singleton pregnancies in spontaneous active labour with cephalic presentation at a tertiary care centre. Participants were randomized to labour monitoring using the WHO labour care guide (n=150) or the WHO modified partogram (n=150). The primary outcome was mode of delivery. Secondary outcomes included labour characteristics, maternal complications, neonatal outcomes, and maternal satisfaction assessed using the birth satisfaction scale-revised.

Results: The WHO LCG group had a significantly higher normal vaginal delivery rate than the modified partogram group (85.33% versus 68.67%; p=0.001) and a lower caesarean section rate (14.67% versus 31.33%). The active phase of labour was significantly shorter (4.56±0.99 versus 4.95±1.13 hours; p=0.002). Non-progress of labour as an indication for caesarean section was less frequent (9.09% versus 42.55%; p=0.028). Maternal complications and neonatal outcomes were comparable, whereas maternal satisfaction was significantly higher with the WHO LCG (96.00% versus 88.67%; p=0.014).

Conclusions: The WHO labour care guide improved labour outcomes by increasing vaginal deliveries, reducing caesarean sections, shortening labour duration, and enhancing maternal satisfaction without compromising neonatal outcomes.

Association of serum ferritin concentration in early pregnancy with the risk of subsequent development of gestational diabetes mellitus

2026-08-28T08:47:10+0530

Background: Gestational diabetes mellitus (GDM) is among the commonest medical complications of pregnancy and South Asian women are affected at lower body mass indices than Western populations. Serum ferritin reflects body iron stores and is also an acute-phase reactant; iron-catalysed oxidative stress may impair insulin action. We examined whether early-pregnancy ferritin predicts subsequent GDM.

Methods: In this prospective observational study, 111 antenatal women at 12–18 weeks were enrolled consecutively at a tertiary teaching hospital. Fasting serum ferritin was measured by chemiluminescent microparticle immunoassay. Women were followed to 24–28 weeks, when GDM was diagnosed by 75g oral glucose testing using American Diabetes Association criteria. Analysis used Mann–Whitney U and chi-square tests, Spearman correlation, multivariable logistic regression and receiver operating characteristic (ROC) analysis.

Results: GDM developed in 24/111 women (21.6%). Median ferritin was higher in the GDM group (55.35 vs 24.00 ng/mL; p<0.0001). GDM prevalence rose across ferritin quintiles from 8.7% to 77.3% (p<0.0001). Ferritin correlated with glucose challenge values (ρ=0.576; p<0.0001) and independently predicted GDM after adjustment for age, BMI, gravida and haemoglobin (adjusted odds ratio 2.41 per 10 ng/mL; 95% CI 1.68–3.44). Area under the ROC curve was 0.865; a cut-off of 39.9 ng/mL gave 79.2% sensitivity, 92.0% specificity and 94.1% negative predictive value.

Conclusions: Elevated early-pregnancy serum ferritin is independently and gradedly associated with subsequent GDM and discriminates well between affected and unaffected women. Ferritin is inexpensive and already widely measured antenatally and may permit risk stratification well before conventional screening; multicentre validation is required.

Optimizing care for low-grade serous ovarian carcinoma: insights from a tertiary care centre

2026-08-28T08:46:59+0530

Background: Low-grade serous ovarian carcinoma (LGSC) is an uncommon epithelial ovarian malignancy with distinct tumour biology, relatively indolent behaviour, frequent advanced-stage presentation and limited sensitivity to conventional chemotherapy. This study evaluated the clinicopathological profile, treatment pattern, perioperative outcomes and survival of patients with LGSC managed at a tertiary cancer centre.

Methods: A retrospective review was conducted of 23 patients with histologically confirmed LGSC treated between 2014 and 2025. Demographic characteristics, clinical presentation, tumour markers, FIGO stage, disease distribution, chemotherapy response, surgical approach, completeness of cytoreduction, postoperative morbidity, recurrence and survival outcomes were analyzed descriptively.

Results: The median age was 47 years. Abdominal pain was the most common presenting symptom, reported in 17 patients (73.91%). Serum CA-125 was elevated in 19 patients (82.6%), with a median value of 89 U/ml. FIGO stage III disease was present in 18 patients (78.26%). Nine patients received neoadjuvant chemotherapy; objective response was observed in only 2 patients (22.2%), while 5 had stable disease and 2 progressed. Primary cytoreductive surgery was performed in 12 patients, interval cytoreduction in 9 and staging laparotomy in 2. Complete cytoreduction was achieved in 19 patients (82.6%). Grade III morbidity occurred in 21.7%, with no Grade IV/V complications or 30-day mortality. At 36-month median follow-up, recurrence occurred in 6 patients; 3 years overall survival was 75% and disease-free survival was 66%.

Conclusions: LGSC commonly presents with advanced peritoneal disease and poor chemotherapy response. Complete cytoreduction remains the key therapeutic goal.

Maternal and fetal outcomes in women with first-trimester threatened abortion: a prospective observational study from a tertiary care centre in North India

2026-08-28T08:46:56+0530

Background: Threatened abortion- vaginal bleeding before 20 weeks with a closed cervix and a viable intrauterine pregnancy- complicates roughly 15-25% of pregnancies and is associated with later adverse outcomes. Prospective regional data from north India remain limited. We described maternal and fetal outcomes in such women and examined their association with demographic factors.

Methods: This prospective observational study was conducted in the department of obstetrics and gynecology at a tertiary centre in Barabanki, Uttar Pradesh, over 18 months. Women aged 18-35 years with a singleton pregnancy and first-trimester vaginal bleeding (<14 weeks) were enrolled consecutively and followed to delivery. Maternal and fetal endpoints were recorded; categorical associations were tested by chi-square (p<0.05).

Results: Of 250 women, 41 (16.4%) progressed to abortion and 209 continued to delivery. Pre-eclampsia occurred in 30.4%, eclampsia in 9.6%, placenta previa in 7.6%, abruption in 4.0%, preterm premature rupture of membranes in 17.7% and preterm labour in 22.0%. The caesarean rate was 47.4%. Low birth weight occurred in 52.6%, NICU admission in 13.9% and stillbirth in 10.1%. Good maternal and fetal outcomes were recorded in 69.6% and 75.6%, respectively. Maternal outcome was associated with age (p<0.001), socioeconomic status (p=0.005) and locality (p=0.001); fetal outcome was associated with age (p<0.001), socioeconomic status (p=0.007) and locality (p=0.001).

Conclusions: Women with first-trimester threatened abortion carried a substantial burden of maternal and perinatal morbidity, concentrated among older, lower-socioeconomic and rural women. This group warrants intensified antenatal surveillance and early risk stratification.

A study on the effect of a low-dose magnesium sulfate regimen for the management of eclampsia

2026-08-12T09:40:20+0530

Background: Magnesium sulfate is the anticonvulsant of choice for eclampsia, but the standard Pritchard regimen uses repeated intramuscular injections and requires careful toxicity monitoring. This study compared a half-dose regimen with the standard Pritchard regimen.

Methods: In this prospective randomized study, 50 women with eclampsia were allocated equally to a low-dose group or a standard Pritchard group. The low-dose regimen comprised 2 g intravenous and 5 g intramuscular loading doses, followed by 2.5 g intramuscularly every four hours for 24 hours after delivery or the last seizure. The primary outcome was control of convulsions. Repeat dosing, treatment failure, clinical toxicity, perinatal outcome, injection-site discomfort, ambulation, magnesium sulfate use, and cost were assessed. Categorical data were compared using Fisher's exact test or the chi-square test.

Results: Convulsions were controlled in 25/25 women (100%) in the low-dose group and 24/25 (96%) in the Pritchard group (p=1.000). Repeat doses were required in 3/25 (12%) and 2/25 (8%), respectively (p=1.000). No treatment failure occurred with the low-dose regimen; one failure occurred in the Pritchard group in a woman with hepatic capsule rupture. No clinical evidence of magnesium toxicity was observed in the low-dose group. Live-birth rates were 88% and 92%, respectively (p=1.000). The low-dose regimen used half the magnesium sulfate and reduced the calculated drug cost by 50%.

Conclusions: The low-dose regimen achieved seizure control comparable to the standard regimen in this small study and reduced drug use and cost. Larger multicentre non-inferiority trials are required before routine substitution.

Impact of mid-trimester placental location on maternal and fetal outcome

2026-08-28T08:46:41+0530

Background: Mid-trimester placental location is routinely documented during fetal anatomy scans, but its potential to predict maternal and fetal complications remain under-researched. This study evaluated the impact of implantation sites anterior, posterior, fundal, or lateral on pregnancy outcomes.

Methods: A prospective cohort study of 200 singleton pregnancies was conducted between January 2024 and January 2026. Placental location was assessed via ultrasound between 18-24 weeks and correlated with subsequent maternal and neonatal events.

Results: Anterior placentas were most common (44%), followed by fundal (26.5%) and posterior (21%). Lateral placentation (8.5%) was significantly associated with maternal complications (70.6%), including pre-eclampsia (40%). Posterior location was linked to higher rates of GDM (64.3%), PROM (55.6%), low birth weight (23.8%), and poor 1-minute APGAR scores (44.4%).

Conclusions: Mid-trimester placental localization is a significant prognostic indicator of maternal and neonatal risk. Routine placental mapping at 18–24 weeks serves as a cost-effective screening tool for identifying high-risk pregnancies.

Intrapartum monitoring tools: a comparative analysis of WHO labour care guide versus the modified partograph in low-risk laboring women

2026-08-28T08:46:39+0530

Background: Traditionally partograph has been used to monitor labour. WHO introduced Labour Care Guide in 2020. The present study was undertaken to compare labour outcomes using the WHO Labour Care Guide (LCG) and the modified WHO partograph. This study aimed to study the WHO LCG and modified partograph in low-risk labouring women.

Methods: The study was a hospital based cross sectional randomised study done in the Department of Obstetrics and Gynaecology, from 2023 to 2024. 200 low risk labouring women divided into two groups. Group A was monitored using the Labour Care Guide (LCG), whereas Group B was assessed using the WHO modified partograph.

Results: The mean duration of active stage of labour was 121.90±44.91 min in Group A and 210.10±45.75 min in Group B. This was the most important observation in the study (p-value <0.001). Oxytocin was used in 10% of subjects in Group A and 37% in Group B. This difference was highly significant (p value <0.001). The caesarean section rate was more in Group B (21% vs 7%) as compared to Group A.

Conclusions: The study concluded that the WHO LCG is a safe, effective, and patient-centred alternative to the Modified WHO Partograph for labour monitoring. Its use was associated with a shorter active phase of labour, reduced need for oxytocin augmentation, and lower caesarean section rates without adversely affecting maternal or neonatal outcomes.

Knowledge regarding respectful maternity care among nurses working in obstetrics and gynaecology department of selected hospitals in Aizawl, Mizoram: a cross-sectional study

2026-08-28T08:46:37+0530

Background: Respectful maternity care (RMC) is a fundamental human right that ensures dignity, privacy, confidentiality, freedom from harm and mistreatment, and informed decision-making for women during pregnancy, labour, and childbirth. Nurses play a crucial role in providing respectful maternity care, and adequate knowledge of RMC is essential for its effective implementation. Therefore, assessing nurses' knowledge regarding RMC is essential identifying educational needs and improving the quality of maternal healthcare services.

Methods: A descriptive cross-sectional study was conducted among 60 nurses working in the Obstetrics and Gynaecology departments of selected hospitals in Aizawl, Mizoram. Data were collected using a self-administered structured questionnaire to assess knowledge regarding Respectful Maternity Care. The collected data were analysed using descriptive and inferential statistics with IBM SPSS version 20.

Results: The findings revealed that the majority of nurses (81.7%) had adequate knowledge regarding Respectful Maternity Care, while 16.7% had moderate knowledge and 1.6% had inadequate knowledge. A statistically significant association was found between knowledge regarding Respectful Maternity Care and professional experience in the Obstetrics and Gynaecology department (p = 0.049) as well as monthly income (p = 0.001). No significant association was observed between knowledge and other demographic variables such as age, educational qualification, and marital status.

Conclusions: The study concluded that nurses possessed satisfactory knowledge regarding Respectful Maternity Care. Continuous education, orientation programmes for newly recruited nurses, in-service training, workshops, and awareness programmes are recommended to further strengthen nurses’ knowledge and promote the provision of respectful and quality maternity care.

Role of cerebroplacental ratio at 35 to 36 weeks of gestational age in prediction of perinatal out come in asymptomatic pregnant Indian women: a prospective observational study

2026-08-28T08:46:34+0530

Background: Foetal hypoxia and adverse perinatal outcomes remain significant challenges in obstetrics. The cerebroplacental ratio (CPR)-calculated as middle cerebral artery pulsatility index (MCA PI) divided by umbilical artery pulsatility index (UA-PI)-reflects both placental vascular resistance and brain-sparing foetal adaptation. This study evaluated the predictive value of CPR for adverse perinatal outcomes in low-risk pregnancies.

Methods: A prospective cohort study was conducted at Sparsh Hospital, Kannauj, from October 2024 to March 2026, enrolling 100 asymptomatic, low-risk singleton pregnant women at 35 to 36 weeks of gestation. Participants underwent Doppler ultrasonography to measure UA-PI, MCA PI, and CPR. Participants were followed prospectively to evaluate neonatal outcomes, including Apgar scores and Neonatal Intensive Care Unit (NICU) admissions. Spearman’s rho correlation was used for statistical analysis.

Results: The mean Apgar score was 9.41±1.61. Mean Doppler values were: UA-PI 1.00±0.334, MCA PI 1.49±0.513, and CPR 1.59±0.601. No statistically significant correlation was observed between Apgar scores and UA PI (rho=-0.058, p=0.568), MCA PI (rho=0.107, p=0.296), or CPR (rho=0.174, p=0.087). However, among 9 patients with CPR <1, 8 babies (88.9%) required NICU admission. Conversely, only 2 of the 91 patients with normal CPR required NICU admission.

Conclusions: Although Doppler indices showed no linear correlation with routine Apgar scores, a threshold of CPR <1 at 35-36 weeks was strongly associated with poor perinatal outcomes and NICU admission in low-risk pregnancies. CPR assessment enables early identification of vulnerable foetuses, supporting closer surveillance and timely delivery.

Prevalence of abnormal Papanicolaou smear among women attending a tertiary care hospital in South Kerala

2026-08-28T08:46:20+0530

Background: Cervical cancer remains an important preventable cause of morbidity and mortality among women, particularly where access to vaccination, screening and timely treatment is limited. Persistent infection with high-risk human papillomavirus (HPV) is the necessary cause of virtually all cervical cancers. Although HPV-based testing is now preferred by the World Health Organization (WHO) for primary screening, conventional Papanicolaou (Pap) cytology continues to be used in many clinical settings, including opportunistic screening. This study assessed the prevalence and pattern of abnormal Pap smear findings among women attending a tertiary care hospital in South Kerala and explored selected socio-demographic, reproductive and clinical characteristics.

Methods: This hospital-based cross-sectional study included 175 sexually active women aged ≥18 years attending the Department of Obstetrics and Gynaecology, SUT Academy of Medical Sciences, Vattapara, Thiruvananthapuram, from March to June 2021. Socio-demographic, reproductive and clinical information was collected using a pre-tested semi-structured questionnaire. Conventional Pap smears were obtained using an Ayre’s spatula, fixed immediately and reported according to the Bethesda System 2001. Data were analysed using SPSS version 25.0. Categorical associations were assessed using the Chi-square or Fisher’s exact test, as appropriate.

Results: Of 175 participants, 140 (80.0%) were aged ≥35 years. Four women (2.3%; 95% CI approximately 0.9-5.7%) had abnormal cytology, while 171 (97.7%) had negative for intraepithelial lesion or malignancy (NILM) reports. The abnormalities were LSIL in 2 (1.1%), ASC-US in 1 (0.6%) and squamous cell carcinoma in 1 (0.6%). Vaginal discharge was the commonest presenting complaint (32.0%), while bulky cervix (31.4%) and cervical erosion (26.3%) were the commonest per-speculum findings. All four abnormal smears occurred among women aged ≥35 years; however, the association between age group and abnormal cytology was not statistically significant (Fisher’s exact test, p=0.585).

Conclusions: Although the prevalence of abnormal Pap cytology was low in this hospital-based cohort, clinically important lesions, including LSIL and invasive squamous cell carcinoma, were detected. The findings support continued opportunistic screening and strengthen the case for systematic, high-quality cervical screening programmes. Pap cytology remains useful where it is available, while HPV-based primary screening should increasingly be incorporated in accordance with contemporary national and international guidance.

From niche to norm: a 13-year single-centre retrospective analysis of oocyte cryopreservation trends in modern India

2026-08-28T08:46:45+0530

Background: Oocyte cryopreservation (OC) has moved from a niche, largely medically-indicated procedure toward a mainstream fertility preservation option, but India-specific outcome data remain limited. This study aimed to describe demographic trends, oocyte yield, cycle repetition, and utilization patterns among women undergoing planned OC at a single Indian fertility IVF unit over a 13-year period.

Methods: A retrospective cohort of 62 women who underwent planned OC between January 2013 and January 2026 was analysed. Age, indication, number of stimulation cycles, MII oocyte yield, and utilization status were recorded. Appropriate descriptive and inferential statistics were used, including comparison of pre- and post-COVID periods.

Results: The cohort comprised 62 patients undergoing 70 stimulation cycles, predominantly for elective/social indications (85.5%), with oncofertility accounting for 14.5% of cases. The most common age group was 30-34 years (32.3%), with a mean yield of 6.2 ± 4.1 MII oocytes per patient. Oocyte yield declined significantly with age (Spearman ρ = -0.26, p = 0.041). The annual rate of patients undergoing OC increased approximately 4-fold in the post-COVID era (rate ratio 4.00, 95% CI 2.21-7.25, p<0.001). Only 9.68% of patients underwent repeated stimulation cycles, with the highest proportion of repeat cycles occurring in the 34-36-year age group. However, utilization of cryopreserved oocytes remained low (9.7%, 95% CI 3.6-19.9%).

Conclusions: Our study highlights positive shifting trends even in a developing country like India, where oocyte cryopreservation is evolving as an accepted method for fertility preservation. Societal challenges, myths, and financial limitations underscore the low utilization rates, emphasizing the need for strengthened education and support to empower women in planning their reproductive journeys.