International Journal of Reproduction, Contraception, Obstetrics and Gynecology

Assessment of perioperative hemodynamic changes following spinal anesthesia in patients undergoing surgery for ruptured ectopic pregnancy

2026-10-30T07:54:03+0530

Background: Ruptured ectopic pregnancy requires urgent surgical intervention, and sympathetic blockade following spinal anaesthesia may exacerbate haemodynamic instability in patients with significant blood loss. Objective was to assess perioperative hemodynamic changes and factors associated with hypotension following spinal anesthesia in patients undergoing surgery for ruptured ectopic pregnancy.

Methods: This prospective observational study enrolled 46 women undergoing emergency surgery under spinal anaesthesia at Addin Momin Medical College and Hospital over 12 months (January 2015-February 2026). Heart rate (HR), systolic and diastolic blood pressure (SBP, DBP), mean arterial pressure (MAP), and oxygen saturation (SpO₂) were monitored perioperatively. Repeated-measures ANOVA and binary logistic regression were used for statistical analysis.

Results: The mean age was 27.4±5.2 years. HR, SBP, DBP, and MAP declined significantly following spinal anaesthesia (all p<0.001), with SBP decreasing from 108.4 to 92.1 mmHg and MAP from 80.9 to 68.1 mmHg at 10 minutes. SpO₂ remained stable (p=0.324). Hypotension occurred in 37.0% of patients and bradycardia in 10.9%; 37.0% received ephedrine and 60.9% required blood transfusion. Estimated blood loss >1000 ml (OR=3.56, p=0.008), preoperative hemoglobin <9 gm/dl (OR=2.84, p=0.021), and ASA III status (OR=2.31, p=0.047) were significant predictors of hypotension.

Conclusions: Spinal anesthesia was associated with significant perioperative hemodynamic changes, particularly hypotension. Adequate resuscitation, careful monitoring, and prompt management are essential to optimise patient outcomes.

Sociodemographic factors influencing antenatal booking time at antenatal clinic of mother and child hospital, Akure, Ondo State, Nigeria

2026-10-30T07:56:20+0530

Background: Early initiation of antenatal care (ANC) is crucial for optimal maternal and fetal outcomes. The World Health Organization (WHO) 2016 model recommends the first contact during the first trimester, and at least eight contacts overall. Nigeria continues to experience high maternal mortality, with 512 deaths per 100,000 live births reported in the 2018 NDHS.

Methods: A cross-sectional study was conducted at Mother and Child Hospital, Akure, between June 2023 and April 2024. Systematic random sampling recruited 1,043 pregnant women presenting for booking. Data on age, parity, education, occupation, spouse characteristics, and religion were collected via structured questionnaire. Gestational age at booking was categorized by trimester. Chi-square tests examined associations (p<0.05).

Results: Mean age was 32.0±4.93 years. Booking distribution: first trimester 20.6% (n=215), second trimester 62.4% (n=651), third trimester 17.0% (n=177). Maternal age was significantly associated with booking time (χ²=54.926, p=0.018): women aged 15-25 years had the highest first-trimester booking (28.6%) versus 20.1% for 26-35 years and 18.1% for 36-45 years. Parity was also significant (χ²=17.980, p=0.008): nulliparous women booked earliest (25.3% first trimester), while grand-multiparous women had the lowest (16.7%) and highest third-trimester booking (66.7%, standardized residual +2.99, p<0.01). Maternal education, spouse education, maternal occupation, spouse occupation, and religion showed no statistically significant association.

Conclusions: Only one in five women booked in the first trimester. Younger age and nulliparity predicted earlier booking, while grand-multiparity predicted severe delay. Interventions must target experienced mothers who may underestimate risk.

Prevalence of central obesity/increased waist to hip ratio among women with polycystic ovarian syndrome who attend gynecologycal clinics in tertiary care hospitals in Sri Lanka

2026-10-30T07:57:18+0530

Background: Polycystic ovary syndrome (PCOS) is an endocrine disorder with important reproductive and metabolic consequences, including a recognised association with central obesity. Objectives were to describe prevalence of central obesity (increased waist to hip ratio) among women with polycystic ovarian syndrome who attend to gynecological clinics in tertiary care hospitals in Sri Lanka.

Methods: A descriptive cross-sectional study was conducted at the gynecology clinic of Colombo South Teaching Hospital Sri Lanka, from January to December 2025. Women diagnosed with PCOS by the modified Rotterdam criteria within the preceding three months were recruited by convenience sampling (n=165); those with other causes of hyperandrogenism, current pregnancy, or ongoing dietary or lifestyle modification were excluded. Waist and hip circumferences were measured and the waist-to-hip ratio calculated, with 0.85 taken as the cut-off for central obesity. Data were analyzed using SPSS version 28.0.

Results: For waist circumference, the largest proportion measured <80 cm (n=53; 32.1%). For hip circumference, most measured 101-110 cm (n=74; 44.8%), and the commonest waist-to-hip ratio category was 0.81-0.90 (n=52; 31.5%). The mean age was 28.9 (SD= 5.6 years). Anovulation was present in 90 participants (54.5%) and hyperandrogenism in 143 (86.7%). The commonest phenotype was classic (Frank-A) PCOS (n=71). Central obesity was identified in 93 participants (56.0%; 95% CI 48.4-63.6). Anthropometric measures differed significantly across phenotypes, being highest in classic PCOS (mean waist-to-hip ratio 0.95) and lowest in the ovulatory and non-hyperandrogenic phenotypes (p<0.001).

Conclusions: Central obesity was common among women with PCOS and differed significantly by phenotype, being greatest in classic PCOS. The waist-to-hip ratio may serve as a simple marker to identify women with PCOS at higher metabolic risk who warrant screening and preventive intervention.

Pattern of high-risk histopathological features among surgically treated endometrial cancer patients in Bangladesh

2026-10-30T07:56:05+0530

Background: Endometrial cancer shows heterogeneous biological behavior, and postoperative risk stratification depends strongly on histopathological findings. Conventional features such as International Federation of Gynecology and Obstetrics (FIGO) stage, tumor grade, histological subtype, tumor size, deep myometrial invasion, lymphovascular space invasion, and lymph node metastasis remain clinically important, particularly in settings where molecular classification is not routinely available. The aim of this study was to describe the pattern of high-risk histopathological features among surgically treated endometrial cancer patients at a tertiary cancer center in Bangladesh.

Methods: This observational cross-sectional study included 31 histologically confirmed endometrial cancer patients who underwent primary surgical treatment at the Department of Gynecological Oncology, National Institute of Cancer Research and Hospital, Dhaka, Bangladesh, between January and December 2020.

Results: The mean age of the patients was 58.6±9.8 years, and 27 patients (87.1%) were postmenopausal. Stage I disease was the most frequent individual stage, present in 18 patients (58.1%); however, advanced-stage disease, FIGO stage III–IV, was present in 12 patients (38.7%). The most frequent high-risk feature was tumor size >2 cm, observed in 21 patients (67.7%), followed by deep myometrial invasion in 16 patients (51.6%). Lymph node metastasis was present in 12 patients (38.7%), grade 3 tumor in 11 patients (35.5%), papillary serous adenocarcinoma in 11 patients (35.5%), and lymphovascular space invasion in 9 patients (29.0%).

Conclusions: High-risk histopathological features were common in this cohort, emphasizing the importance of detailed histopathological assessment for postoperative risk stratification in surgically treated endometrial cancer.

Teratogenic potential of ginger extract using chicken embryo development model

2026-10-30T07:50:27+0530

Background: Ginger (Zingiber officinale) is widely used as a food and folk remedy, including during pregnancy, and is often presumed safe, yet evidence on its developmental toxicity is limited. This study evaluated the teratogenic potential of ginger extract using the chicken (Gallus gallus domesticus) embryo model.

Methods: This experimental study was conducted at the Philippine Science High School Ilocos Region Campus, Ilocos Sur, from November to December 2024. Seventy-two fertilized native chicken eggs were allocated to six groups (n=12) with four ginger extract concentrations (0.01, 0.1, 0.25, 0.5 mg/ml), saline (negative control), and retinol (positive control). Each received a single 0.1 ml injection on day 3 of incubation, and eggs were opened on days 12, 15, 18, and 21 to assess mortality, heart rate, weight, and crown-rump length (CRL). Data were analyzed by MANOVA with LSD post hoc tests.

Results: Mortality was 0% at 0.01 mg/ml and in the negative control, 16.66% at 0.1 mg/ml, and 33.33% at 0.25 mg/ml, 0.5 mg/ml, and in the positive control. Weight differed significantly among groups on day 15 (p=0.039) and day 21 (p=0.021); the multivariate effect was significant only on day 21 (p=0.002). Heart rate and CRL showed non-significant dose-related trends.

Conclusions: Higher ginger extract concentrations were associated with greater embryonic mortality and altered weight, whereas the lowest concentration had no observable effect. Ginger is not established as a teratogen, and findings cannot be extrapolated directly to human intake, larger studies are warranted.

Gestational diabetes mellitus and fetomaternal outcomes: a study of obstetric and neonatal complications in a tertiary care setting

2026-10-30T07:57:07+0530

Background: Gestational diabetes mellitus (GDM) is associated with major maternal and neonatal complications contributing to perinatal morbidity. This study evaluated fetomaternal outcomes and predictors of adverse neonatal outcomes among women with GDM.

Methods: This prospective observational study was conducted at Sylhet MAG Osmani Medical College Hospital, Bangladesh, from January to December 2025. A total of 120 pregnant women with GDM who delivered at the tertiary hospital were included. Participants received either diet therapy alone or diet plus insulin according to glycemic control. Maternal complications, mode of delivery, and neonatal outcomes were recorded. Data were analyzed using SPSS version 26 with descriptive statistics, chi-square tests, and logistic regression.

Results: Mean maternal age was 29.8±4.6 years, and 61.7% were multigravida. Treatment consisted of diet alone in 43.3% and diet plus insulin in 56.7%. Maternal complications included pregnancy-induced hypertension (21.7%), preeclampsia (15.0%), and polyhydramnios (18.3%). The cesarean section rate was 53.3%. Neonatal complications included macrosomia (23.3%), hypoglycemia (21.7%), respiratory distress syndrome (15.0%), and NICU admission (28.3%). Compared with the diet-only group, insulin-treated women had significantly higher rates of cesarean delivery (73.5% versus 26.9%, p=0.001), macrosomia (32.4% versus 11.5%, p=0.006), and NICU admission (38.2% versus 15.4%, p=0.005). Independent predictors of NICU admission were maternal age ≥35 years (OR=1.92), BMI≥30 kg/m² (OR=2.38), insulin therapy (OR=2.76), poor glycemic control (OR=3.12), and preterm delivery (OR=2.54).

Conclusions: GDM is associated with substantial maternal and neonatal morbidity, particularly among women requiring insulin therapy, emphasizing the need for strict glycemic control and specialized tertiary-level care.

Hysteroscopic evaluation and analysis of uterine cavity: a retrospective institutional study

2026-10-30T07:54:09+0530

Background: Hysteroscopy provides direct visualization of the cervical canal and uterine cavity and is widely used for the diagnosis and management of intrauterine abnormalities. It allows identification of lesions such as endometrial polyps, submucosal fibroids, uterine septa, and endometrial hyperplasia, with the advantage of permitting therapeutic intervention when indicated. Objective was to evaluate the hysteroscopic findings among patients undergoing diagnostic or operative hysteroscopy and to assess their relationship with clinical presentation, ultrasonographic findings, and histopathological outcomes.

Methods: This retrospective observational study was conducted in the department of gynecology and obstetrics, Holy Family Red Crescent Medical College and Hospital (HFRCMCH), from July 2024 to June 2026. A total of 32 patients who underwent rigid hysteroscopy were included. Normal saline was used as the uterine distension medium. Data regarding demographic characteristics, clinical indications, ultrasonographic findings, hysteroscopic findings, histopathological results, and procedure-related complications were retrieved from the medical records and analyzed.

Results: Among the 32 patients who underwent hysteroscopy, abnormal intrauterine findings were identified in 29 (90.6%) cases. The largest proportion of patients belonged to the 41-50-year age group (31.3%), and 93.8% were multiparous. Postmenopausal bleeding was the most common indication for hysteroscopy (34.38%). Endometrial polyps were the most frequently identified hysteroscopic abnormality (34.38%). No procedure-related complications were documented during the study period.

Conclusions: In this institutional series, hysteroscopy identified intrauterine abnormalities in the majority of patients and was performed without documented procedure-related complications. The findings support its clinical utility as a minimally invasive method for direct assessment of the uterine cavity in appropriately selected patients.

Role of gestosis score in predicting pregnancy-induced hypertension among primigravid women

2026-10-30T07:50:37+0530

Background: Pregnancy-induced hypertension (PIH) remains an important cause of maternal and perinatal morbidity. Early identification of women at increased risk may facilitate closer antenatal surveillance and timely intervention. Objective was to evaluate the role of the gestosis score in predicting PIH among primigravid women.

Methods: This prospective observational cohort study was conducted in the department of obstetrics and gynecology, Dhaka Medical College Hospital, Dhaka, Bangladesh, from January to December 2021. A total of 150 primigravid women with singleton or multiple pregnancies presenting before 20 weeks of gestation were enrolled. The gestosis score was calculated at the initial antenatal assessment using predefined maternal risk factors, and participants were categorized according to a cutoff of <3 or ≥3. Women were followed prospectively until delivery for the development of PIH. The discriminatory performance of the score was assessed using sensitivity, specificity, predictive values, diagnostic accuracy, and receiver operating characteristic (ROC) analysis.

Results: PIH developed in 26 (17.3%) participants. Women with a gestosis score ≥3 had a significantly higher incidence of PIH than those with a score <3 (35.6% versus 5.5%, p<0.001). Family history of hypertension, family history of pre-eclampsia, and overweight/obesity were significantly associated with PIH. At a cutoff of ≥3, the gestosis score showed 80.8% sensitivity, 69.4% specificity, 35.6% positive predictive value, 94.5% negative predictive value, and 71.3% diagnostic accuracy. The area under the ROC curve was 0.821 (95% CI: 0.738-0.904; p<0.001).

Conclusions: The gestosis score demonstrated good discriminatory performance for PIH among primigravid women and may serve as a simple tool for early risk stratification and targeted antenatal surveillance. However, external validation in larger and more diverse populations is required before its routine clinical implementation.

Knowledge, attitude and perception of menstruation and menstrual hygiene among secondary school students in a semi-urban area in South-South Nigeria

2026-10-30T07:54:01+0530

Background: Menstrual health is an important aspect of adolescent reproductive health. However, inadequate knowledge, negative attitudes and barriers to menstrual hygiene management remain concerns, particularly among students with disabilities. This study assessed menstrual knowledge, attitudes and hygiene practices among female students attending an inclusive secondary school in Benin City, Nigeria.

Methods: A descriptive cross-sectional study was conducted among 269 female students at Ihogbe College, Benin City, between June and July 2025. Participants were selected using stratified sampling. Data were collected using a semi-structured questionnaire and analysed using SPSS version 25. Associations were assessed using Chi-square and Fisher’s exact tests, with statistical significance set at p<0.05.

Results: The mean age was 15.4±2.5 years, and 26 participants (9.7%) had disabilities. Overall, 63.2% demonstrated good menstrual knowledge, while 81.0% had good menstrual hygiene practices. Feelings of shame and insecurity during menstruation were reported by 34.6% and 48.7%, respectively. Sanitary pads were used by 96.7% of participants, although 36.1% delayed changing menstrual materials until returning home. Good hygiene practice was significantly associated with menstrual knowledge (p<0.001) and disability status (p=0.032).

Conclusions: Although menstrual hygiene practices were generally good, knowledge gaps and negative attitudes persisted. School-based menstrual education and disability-inclusive hygiene support may improve menstrual health experiences among students.

Breastfeeding practices and experience of mothers during the first seven days of delivery

2026-10-06T09:27:48+0530

Background: Breastfeeding significantly reduces neonatal morbidity and mortality. The early postnatal period, particularly first seven days after delivery, plays a decisive role in establishing effective breastfeeding practices. Understanding breastfeeding practices, maternal experiences, and associated factors during this critical window is essential for designing targeted interventions. Aim was to assess breastfeeding practices and experiences of mothers during the first seven days after delivery and to identify maternal and delivery-related factors influencing these practices.

Methods: A hospital-based observational study was conducted among 235 postnatal mothers over 6 months using a pre-validated structured questionnaire, including socio-demographic characteristics, mode of delivery, antenatal breastfeeding education, delivery to initiation of breastfeeding interval, exclusive breastfeeding status till day 7 postpartum, pre-lacteal feeding, and breastfeeding-related difficulties.

Results: The 59.6% mothers were aged 20-30 years, and 56.1% were primipara. Breastfeeding was initiated within two hours of birth by 40% of mothers. Exclusive breastfeeding till day 7 postpartum was practised by 75.74%. Pre-lacteal feeds given by 15.7% colostrum feeding practised by 95.7% of participants. Vaginal delivery was significantly associated with early initiation of breastfeeding and exclusive breastfeeding compared to caesarean section (p<0.05). Antenatal Breastfeeding education showed a strong positive association with colostrum feeding (p<0.001). Lack of family support, nipple pain, and perceived insufficient milk were the most common breastfeeding difficulties. Primipara mothers experienced higher breastfeeding difficulties than multipara mothers (p<0.01).

Conclusions: Breastfeeding practices during the first seven days postpartum need to be strengthened. Antenatal breastfeeding counselling, early postnatal lactation support, and family support are essential to improve early initiation, exclusivity, and overall breastfeeding experiences.

Maternal and obstetric characteristics of stillbirths at a rural tertiary care centre in Chhattisgarh, India: a retrospective descriptive study

2026-10-17T07:45:26+0530

Background: A baby who dies after 28 weeks of pregnancy, but before or during birth, is classified as a “stillbirth”. It remains a major yet preventable public health challenge, particularly in rural India where timely access to quality maternal and obstetric care is often limited. This study aimed to identify and describe determinants contributing to stillbirths in a rural setting at a tertiary care centre, Rajnandgaon, Chhattisgarh.

Methods: A retrospective descriptive study was conducted using clinical records of all deliveries from June 2021 to May 2025. Among 12,636 deliveries, 417 stillbirths were identified. Data on maternal age, booking status, distance of the patient's residence from the study centre, gravida status, gestational age at delivery, fetal weight, characteristics of stillbirth and associated maternal risk factors were collected, checked and analysed using descriptive statistics.

Results: The stillbirth rate in this study was 33 per 1,000 births (3.3%). Majority of patients were unbooked (81.3%) and living 31-50 km away from the study centre (38.1%). Primigravidae contributed 49.2% of the total. Most stillbirths occurred <37 weeks (57.7%), with fresh stillbirth 65% and macerated 35%. Key contributing factors were recorded as unexplained in 34.5%, preeclampsia in 8.8% and meconium-stained liquor in 6.7%.

Conclusions: The study highlights gaps in antenatal care, intrapartum monitoring, and healthcare access in rural areas. Strengthening obstetric services and community awareness programs is absolutely crucial to reducing the stillbirth rate in rural scenario.

A comparative study of efficacy of tranexamic acid in reducing blood loss during and after cesarean section: a randomised control study

2026-10-30T07:56:14+0530

Background: Excessive bleeding during and after cesarean section is a major cause of maternal morbidity. TXA acid has been proposed as an effective intervention to reduce blood loss, but evidence from randomized trials is limited. This study aimed to evaluate the efficacy and safety of TXA acid in decreasing intraoperative and postpartum hemorrhage following cesarean delivery.

Methods: This prospective, randomized, controlled trial enrolled 120 women undergoing cesarean section at a tertiary care hospital. Participants were randomly assigned to receive either intravenous tranexamic acid (15 mg/kg in 100 ml Ringer’s lactate solution, n=60) or placebo (plain Ringer’s lactate, n=60) after cord clamping. The primary outcome was total blood loss from placental delivery until 2 hours postpartum. Secondary outcomes included change in hemoglobin levels, blood pressure, and adverse events.

Results: The tranexamic acid group had significantly lower intraoperative blood loss (421.9±27.9 ml compared to controls (845.9±256.6), p<0.001). Postpartum blood loss from end of surgery to 2 hours was also lower with tranexamic acid (30.8±3.7 ml versus 41.28±3.6 ml, p<0.001). Number of mops and drapes soaked were also less in the interventional group compared to control. Postoperative hemoglobin remained stable in the tranexamic acid group but dropped in controls (p<0.001). No significant differences in adverse events were observed between groups.

Conclusions: Prophylactic administration of TXA acid significantly reduced intraoperative and postpartum blood loss following cesarean section while maintaining postoperative hemoglobin levels, without increasing adverse effects. These findings support the use of tranexamic acid as an effective adjunct for hemorrhage prevention in cesarean deliveries.

Comparative study of platelet profile in GDM and non-diabetic pregnancy in a tertiary care centre

2026-10-30T07:56:13+0530

Background: Gestational diabetes mellitus (GDM) is a common metabolic complication of pregnancy associated with significant maternal and neonatal morbidity. Increasing evidence suggests that platelet activation and altered platelet indices reflect underlying inflammation and insulin resistance in GDM. Objectives were to compare platelet profile parameters between gestational diabetes mellitus and non-diabetic pregnancies and to evaluate their predictive value for GDM.

Methods: This hospital-based comparative cross-sectional study was conducted at a tertiary care centre in Puducherry among 60 pregnant women, including 30 women with GDM and 30 age-matched non-diabetic controls. Platelet parameters were analyzed using an automated hematology analyzer. Statistical analysis included independent sample t-test and ROC curve analysis.

Results: The mean platelet count was significantly lower in the GDM group (2.41±0.46×10⁵/µl) compared to controls (2.78±0.52×10⁵/µl; p=0.006). MPV (11.2±1.1 versus 9.6±0.9 fl; p<0.001), PDW (15.8±2.1 versus 13.6±1.7%; p<0.001), PCT (0.21±0.05 versus 0.24±0.04%; p=0.014), and P-LCR (32.4±5.6 versus 26.8±4.9%; p<0.001) were significantly higher in the GDM group. ROC curve analysis showed that MPV had the highest diagnostic accuracy (AUC 0.82; sensitivity 76.7%; specificity 80.0% at ≥10.5 fl).

Conclusions: Platelet indices are significantly altered in gestational diabetes mellitus and demonstrate good predictive value. These inexpensive hematological markers may aid in early identification and risk stratification of GDM in routine antenatal care.

Complication of over-the-counter use of medical abortion pills including ectopic pregnancy: a prospective observational study from a tertiary care centre

2026-10-30T07:56:12+0530

Background: Over-the-counter (OTC) availability of medical abortion pills has led to widespread unsupervised self-administration, increasing clinical complications and the risk of missed ectopic pregnancy.

Methods: A prospective observational study was conducted on 50 women presenting with a history of self-administered abortion pills between October 2025 and March 2026 at a tertiary care centre in northern India. Clinical presentations, diagnostic findings, and therapeutic management were systematically analyzed using IBM SPSS Statistics software.

Results: Bleeding per vaginum was the most common presentation (84%). Major complications included incomplete abortion (68%), severe anemia requiring blood transfusion, and ruptured ectopic pregnancy (8%). All ectopic pregnancies identified were ruptured at presentation and required emergency exploratory laparotomy, with intraoperative hemoperitoneum ranging from 400 to 800 ml.

Conclusions: OTC use of abortion pills is associated with significant morbidity, including life-threatening ruptured ectopic pregnancy. Proper medical evaluation prior to abortifacient use is indispensable. Stricter enforcement of drug distribution regulations and enhanced public awareness regarding safe abortion practices are urgently needed.

Comparison of maternal and fetal outcomes in non-obese and obese women

2026-10-30T07:56:11+0530

Background: Maternal obesity is a growing public health problem with negative maternal and perinatal outcomes. The aim of this study was to assess and compare the maternal and foetal outcomes of obese and non-obese pregnant women.

Methods: The study was case–control conducted at Department of Obstetrics and Gynecology, ESICMC & PGIMSR, Bengaluru from April 2024 to September 2025. 180 pregnant women were recruited and divided into obese (n=90) and non-obese (n=90) groups. Women who were pregnant with a single foetus and who were aged 19–42 years were included. The participants were followed during the pregnancy, delivery and postpartum period. Data was collected and analysed with SPSS version 26 and p<0.05 was regarded as statistically significant.

Results: Mean BMI was significantly higher in obese than non-obese women (33.56±4.01 vs. 22.32±1.53 kg/m²). Obese women were more likely to have comorbidities than normal weight women (73.3% vs. 41.1%, p<0.001), such as gestational diabetes mellitus (24.4% vs. 8.9%) and preeclampsia (24.4% vs. 6.7%). The rate of preterm birth (24.4% vs. 12.2%) and lower-segment caesarean section (54.4% vs. 36.7%) were higher in obese women. The intrauterine fetal death rate was only in obese women (4.4%). Obese women were more likely to be admitted to NICU (83.7% vs. 43.3%, p<0.001) mainly because of neonatal hypoxia and birth asphyxia.

Conclusion: Maternal obesity was significantly linked to greater rates of antenatal comorbidities, operative delivery, and adverse neonatal outcomes, and preterm delivery. Better antenatal monitoring and prompt obstetric intervention is recommended in obese pregnancies.

Epidemiology, risk factors and prevalence of maternal and neonatal outcomes with critical care requirements in hypertensive disorders of pregnancy: a prospective observational study

2026-10-30T07:57:18+0530

Background: Hypertensive disorders of pregnancy (HDP) remain a leading cause of maternal and neonatal morbidity and mortality worldwide. This study examined maternal and neonatal outcomes across the different HDP subtypes and identified factors linked to ICU and NICU admission.

Methods: In this prospective observational analytical study, 144 pregnant women diagnosed with gestational hypertension, non-severe pre-eclampsia, severe pre-eclampsia, eclampsia, chronic hypertension, or superimposed pre-eclampsia (as defined by FOGSI guidelines) were enrolled. Maternal characteristics, maternal complications, ICU admission, neonatal complications, NICU admission, and mortality were recorded from hospital records. Data were analyzed using the Chi-square test, Fisher’s Exact test, multivariate logistic regression, odds ratio estimation, and ROC curve analysis.

Results: Severe pre-eclampsia and superimposed pre-eclampsia emerged as independent predictors of maternal ICU admission, while eclampsia and superimposed pre-eclampsia independently predicted NICU admission. Maternal ICU admission was strongly linked to neonatal NICU admission (χ²=13.09, p<0.001). The predictive model performed well, with an AUC of 0.8789, sensitivity of 83.6%, and specificity of 85.7%.

Conclusions: Severe HDP subtypes carry a substantially higher risk of adverse maternal and neonatal outcomes. Early recognition, close monitoring, and timely intervention remain central to improving prognosis in hypertensive pregnancies.

Thyroid dysfunction in pregnancy and its feto-maternal outcome: a prospective observational study

2026-10-30T07:57:10+0530

Background: Thyroid disorders constitute the most prevalent endocrine abnormality encountered during pregnancy, with well-documented potential for significant adverse effects on both maternal and fetal health. Physiological adaptations unique to gestation alter thyroid hormone economy, making diagnosis and interpretation of thyroid function tests particularly challenging in this population. The burden of undetected thyroid dysfunction in pregnant Indian women remains incompletely characterised, with most available evidence derived from non-Indian cohorts.

Methods: This prospective observational study enrolled 150 antenatal women attending the Department of Obstetrics and Gynaecology, Dr. D.Y. Patil Hospital, Nerul, Navi Mumbai, over 16 months (March 2023–June 2024). Thyroid function tests (T3, T4, TSH) were performed each trimester using chemiluminescent and ELFA techniques, with trimester-specific TSH reference ranges as per the 2011 American Thyroid Association guidelines. Maternal and feto-neonatal outcomes were documented at delivery.

Results: The prevalence of thyroid dysfunction was 28%, with hypothyroidism accounting for 25.3% (overt 8.7%, subclinical 16.7%) and hyperthyroidism for 2.7%. Thyroid dysfunction was significantly associated with preterm delivery (p=0.001), low birth weight (p=0.001), and lower APGAR scores at 1 minute (p=0.015) and 5 minutes (p=0.001). Higher rates of NICU admission (p=0.012), stillbirth, IUGR, abortion (p=0.004), and miscarriage (p=0.006) were observed in women with thyroid disorders. No significant associations were found with maternal age (p=0.969) or mode of delivery (p=0.686).

Conclusions: Thyroid dysfunction in pregnancy carries a significant burden of adverse feto-maternal outcomes. The high observed prevalence underscores the need for universal thyroid function screening in early pregnancy and the pre-conceptional period to enable timely detection and management.

Histopathological study of endometrial abnormalities in women with abnormal uterine bleeding in a rural population

2026-10-30T07:56:08+0530

Background: Abnormal uterine bleeding (AUB) is one of the most frequently encountered gynecological complaints and may occur across different reproductive age groups. It can substantially impair quality of life and may arise from functional disturbances or structural abnormalities of the uterus and endometrium. Histopathological evaluation of endometrial tissue remains an important diagnostic modality for identifying the underlying pathology, particularly in resource-constrained rural settings where access to advanced diagnostic facilities may be limited. This study aimed to evaluate the histopathological patterns of endometrial abnormalities among women aged 19–65 years presenting with AUB in a rural population and to determine the frequency and spectrum of organic and non-organic endometrial findings.

Methods: This cross-sectional observational study was conducted in the Department of Obstetrics and Gynaecology, F.H. Medical College and Hospital, Agra, from September 2023 to February 2025. A total of 278 women aged 19-65 years presenting with AUB and undergoing endometrial sampling were included. Endometrial tissue was obtained through biopsy or dilatation and curettage, processed routinely, stained with hematoxylin and eosin, and examined by light microscopy. Data were analyzed using descriptive statistics.

Results: The highest proportion of patients belonged to the 31–35-year age group (30.93%). Menorrhagia was the most frequent bleeding pattern, accounting for 55% of cases. Among organic causes of AUB, endometrial hyperplasia was the predominant histopathological finding (76.60%), followed by endometritis (17.02%), endometrial carcinoma (4.26%), and endometrial polyps (2.13%). Among non-organic causes, secretory endometrium was the most frequent histopathological pattern (53.70%), followed by proliferative endometrium (44.44%), disordered proliferative endometrium (1.39%), and atrophic endometrium (0.46%).

Conclusions: Histopathological examination of endometrial tissue provides valuable diagnostic information in women presenting with AUB and facilitates the identification of benign, premalignant, and malignant endometrial abnormalities. It remains a practical and accessible diagnostic approach, particularly in rural and resource-limited healthcare settings.

Effectiveness and safety of labetalol with magnesium sulfate in preeclampsia patients and its effect on maternal and fetal outcomes: a prospective observational study at a tertiary care teaching hospital in central India

2026-10-30T07:56:07+0530

Background: Preeclampsia is a major contributor to maternal and neonatal morbidity and mortality, particularly in developing countries. Labetalol and magnesium sulfate are commonly used for blood pressure control and seizure prophylaxis, respectively. However, evidence regarding their combined effectiveness in routine clinical practice in Central India remains limited.

Methods: A prospective observational study was conducted from October to December 2025, including 50 women with preeclampsia and 50 women without preeclampsia. Blood pressure in preeclampsia patients was recorded at baseline, 1 hour, and 4 hours after combined therapy, along with serum total protein levels measured before and after treatment. Maternal and fetal outcomes, along with adverse drug reactions, were assessed up to 48 hours postpartum.

Results: Among the preeclampsia group, systolic and diastolic blood pressure decreased significantly (p<0.0001) following treatment, and total serum protein levels increased after treatment. Compared to the non-preeclampsia group, the preeclampsia group exhibited higher rates of low birth weight (82% versus 36%), preterm birth (68% versus 18%) and cesarean delivery was more frequent (76% versus 66%) but not significant (p=0.378). Adverse drug reactions were mild.

Conclusions: Combined therapy was associated with effective short-term blood pressure control; however, adverse maternal and fetal outcomes were observed in women with preeclampsia.

Mode of delivery and fetomaternal outcomes in patients with postpartum haemorrhage: a retrospective study at a tertiary care centre in India

2026-10-30T07:56:06+0530

Background: Postpartum haemorrhage (PPH) remains an important cause of maternal mortality, particularly in low and middle-income countries including India. Although several obstetric risk factors contribute to PPH, the association between mode of delivery and fetomaternal outcomes remains an area of ongoing research. This study aimed to compare fetomaternal outcomes among women with PPH following vaginal, caesarean and instrumental deliveries and also to identify factors associated with severe maternal morbidity.

Methods: A retrospective study was conducted in the Department of Obstetrics and Gynaecology at a tertiary care hospital in India. Medical records of women diagnosed with PPH between January 2023 to January 2025 were reviewed. Data on demographic characteristics, obstetric variables, mode of delivery, causes of PPH, type of management, maternal complications and neonatal outcomes were collected and analysed.

Results: Among 225 women with PPH, 110 (48.8%) had vaginal deliveries, 73 (32.4%) caesarean deliveries and 42 (18.6%) instrumental deliveries. Uterine atony was the commonest cause of PPH, particularly among vaginal deliveries. Blood transfusion was required in 29% of vaginal, 16% of caesarean and 9% of instrumental deliveries. ICU admission, obstetric hysterectomy, disseminated intravascular coagulation and prolonged hospital stay were more frequent following vaginal delivery. Low Apgar score, NICU admission and neonatal mortality were also more frequent among vaginal deliveries.

Conclusions: Among women with PPH, vaginal mode of delivery was associated with higher maternal morbidity and adverse neonatal outcomes. Early recognition and prompt multidisciplinary management are essential to improve fetomaternal outcomes.

Clinical study assessing the severity of nausea and vomiting of pregnancy using PUQE score and pregnancy outcomes

2026-10-30T07:56:04+0530

Background: Nausea and vomiting of pregnancy (NVP) is a common condition that varies from mild symptoms to severe hyperemesis gravidarum. The Pregnancy-Unique Quantification of Emesis (PUQE) score provides an objective assessment of symptom severity. This study evaluated the severity of NVP using the PUQE score and its association with maternal and fetal outcomes.

Methods: This prospective observational study was conducted in the Department of Obstetrics and Gynaecology at a tertiary care hospital attached to a medical college after ethical approval. A total of 130 pregnant women aged 18–40 years with intrauterine pregnancy of less than 22 weeks presenting with nausea and vomiting were enrolled after informed consent. Demographic, obstetric, clinical, laboratory, and ultrasonographic data were recorded. Severity was assessed using the modified PUQE score. Participants were followed until delivery, and maternal and fetal outcomes were evaluated.

Results: Higher PUQE scores correlated with increased risk of maternal complications such as preterm birth, proteinuria, gestational hypertension, and persistent pelvic girdle pain, and hospital admission. Severe cases were also associated with adverse perinatal outcomes, including low birth weight and increased risk of preterm delivery, NICU admission whereas women with mild-to-moderate scores generally had favourable outcomes.

Conclusions: The PUQE score is a simple and effective tool to objectively assess NVP severity. Its use in clinical practice may help identify women at risk of complications, allowing timely interventions that improve maternal health and optimize fetal outcomes.

A comparative study to assess awareness and practices concerning menstrual hygiene among adolescent girls in schools located in rural and urban areas using a standardised menstrual practices questionnaire

2026-10-30T07:56:04+0530

Background: Menstrual hygiene is integral to the health and well-being of women and girls. In India, menstruation remains a taboo, leading to poor awareness, unsanitary practices, and an increased risk of reproductive tract infections. Rural women face greater challenges than their urban counterparts due to limited resources, inadequate education, and cultural restrictions.

Methods: It was a cross-sectional comparative study carried out in JSS Hospital Mysuru. This comparative study involved 171 girls aged 13-16 years from schools in rural and urban areas. Data were collected using a standardized questionnaire covering awareness and practices related to menstrual hygiene. Statistical analysis, including chi-square tests and logistic regression, was conducted using SPSS v25. Results were considered statistically significant at p < 0.05.

Results: Urban girls demonstrated better menstrual hygiene practices: 58.6% used disposable sanitary pads at home compared to 46.4% in rural areas. Genital washing twice daily was reported by 54% of urban girls versus 33.3% in rural areas. Proper disposal of menstrual waste was higher among urban respondents, while rural girls often resorted to burning (22.6% and 5.7% respectively). Urban girls also exhibited higher adherence to hygienic drying practices for reusable materials.

Conclusions: The study highlights significant rural-urban disparities in menstrual hygiene practices, with urban girls benefiting from better awareness and resources. Addressing these gaps through education, policy interventions, and improved access to menstrual hygiene products is crucial to achieving equity in menstrual health.

Clinical and subclinical chorioamnionitis in preterm births and late miscarriages: a prospective cohort study

2026-10-30T07:56:03+0530

Background: Preterm birth is the leading cause of neonatal mortality worldwide and is associated with long-term neurodevelopmental morbidity. Nearly 40-50% of preterm births and up to two-thirds of late miscarriages are infection-related. Chorioamnionitis, a common intrauterine infection, significantly contributes to early-onset neonatal sepsis and maternal complications. Clinical chorioamnionitis is diagnosed using Gibb’s criteria, whereas subclinical chorioamnionitis is confirmed only on histopathology and is more prevalent. This study aimed to determine the incidence of clinical and subclinical chorioamnionitis in spontaneous preterm deliveries, preterm premature rupture of membranes (PPROM) and late miscarriages.

Methods: This prospective cohort study was conducted over one year at a tertiary care center. One hundred antenatal women between 16 and 36+6 weeks with preterm labour, PPROM, or late miscarriage were enrolled. Clinical features, laboratory parameters like white blood cell count (WBC), C-reactive protein (CRP), high vaginal swab, urine culture, and neonatal outcomes were recorded. Placental tissues were examined for histopathology, and neonatal sepsis, if present, was documented.

Results: Fifty seven percent had PPROM, 42% spontaneous preterm labour, and 1% late miscarriage. Elevated WBC (>15,000) was seen in 38%, and 52% had CRP levels twice normal. Positive high vaginal swabs were noted in 39%. 10% had positive urine culture. Incidence of clinical, microbiological, and histopathological chorioamnionitis was 7%, 11%, and 34%, respectively. Four cases met criteria for triple I, and six neonates developed early-onset sepsis.

Conclusions: Clinical criteria showed high specificity but low sensitivity, missing 79.4% of histological cases. WBC and CRP had moderate predictive value. Early diagnosis remains crucial to balance prematurity risks against infection-related morbidity. Better diagnostic tools are needed to identify underlying intrauterine inflammation.

Analysis of secondary amenorrhea in reproductive age group: a prospective observational study

2026-10-30T07:56:02+0530

Background: Secondary amenorrhea is a clinically important and has diverse hypothalamic, pituitary, ovarian and endocrine causes. Identification of the underlying cause is essential as persistent anovulation may affect fertility and long-term health. The topic was undertaken due to the scarcity of data from central India. Objective was to identify the etiology and review the differential diagnosis of secondary amenorrhea among women of reproductive age.

Methods: A prospective observational study was conducted in the department of obstetrics and gynecology, JLNHRC, Bhilai, Chhattisgarh, over 18 months. 72 women of reproductive age having secondary amenorrhea were enrolled. Patients with pregnancy, lactation, menopause or using Mirena or depot medroxyprogesterone acetate were excluded. Detailed clinical evaluation, UPT, CBC, serum TSH, serum prolactin, pelvic ultrasound and progesterone challenge test were performed. Etiological patterns and associations with BMI, lifestyle, stress and dietary habits were analysed.

Results: The participants were between 16-35 years. 44 (61.1%) were unmarried. Among 28 married women, 17 had associated infertility. 44 (61.1%) were overweight or obese. PCOS was identified in 21 (29.2%), hypothyroidism in 16 (22.2%) and hyperprolactinemia in 6 (8.3%) women. In 33 (45.8%) no specific cause was identified by available preliminary evaluation and these were classified as probable functional hypothalamic amenorrhea (FHA). Among women with PCOS, BMI was significantly associated with diagnosis (p<0.001). Probable FHA showed significant associations with lifestyle (p=0.004), dietary habits (p=0.0026), BMI (p=0.015) and stress (p=0.028).

Conclusions: Secondary amenorrhea has a heterogeneous etiology. A structured clinical assessment with basic laboratory investigations and pelvic ultrasonography can identify a substantial proportion of causes without immediately resorting to extensive hormonal testing. Obesity, lifestyle, dietary habits and psychological stress are modifiable, while persistent or atypical cases require further endocrine and structural evaluation.

Did the COVID-19 vaccination during pregnancy impact obstetric outcome?

2026-10-30T07:54:10+0530

Background: The COVID-19 wave hit the world in 2019-20. However, vaccination for covid in pregnant women was still a light behind the wall. Gradually it was accepted and the vaccination was introduced for pregnant women also. This article helps to know the effect of the two commonly used COVID-19 vaccines on obstetric outcome. Aim was to study the safety of COVID-19 vaccination on pregnant women by analyzing its impact on course and outcome of pregnancy.

Methods: This was a cross-sectional study including 427 pregnant women and aims to study the safety of COVID-19 vaccination on pregnant women by analyzing its impact on course and outcome of pregnancy.

Results: Of the total number of women who received the vaccination, 258 (60.4%) received both the doses and 169 (39.6%) received only a single dose of vaccine. In terms of pregnancy outcomes, 30 (6.56%) had abortion and the remaining 427 of them continued the pregnancy up to 3rd trimester. Out of 427, 421 delivered liveborn infants. 6 IUDs and 10 spontaneous first trimester abortions were documented in our study. No fetal anomalies were identified in our study group. The incidence of FGR and oligohydramnios was 0.5%. (0.5%) had PIH. 0.9% of the mothers developed GDM. Preterm deliveries were noted in 15.2%. 8 cases (1.9%) had meconium-stained amniotic fluid at birth. 63.9% had a normal vaginal delivery and remaining 36.1% underwent LSCS. No significant changes were observed with respect to the birth weight of babies among vaccinated women. NICU admissions were noted for preterm care, birth hypoxia and hyperbilirubinemia. However, no serious neonatal morbidity was noted.

Conclusions: The study has not demonstrated any untoward effects on the course of pregnancy nor the fetus at birth, due to receiving covid vaccines. Thus, it can be safely considered during pregnancy.

A clinicoradiological profile in confirmed and probable cases of genital tuberculosis in a tertiary care centre

2026-10-30T07:54:09+0530

Background: Female genital tuberculosis (FGTB) is an important cause of infertility and chronic gynecological morbidity in tuberculosis-endemic regions. Diagnosis is often difficult because of nonspecific symptoms and the low sensitivity of conventional tests. This study evaluated the clinical, laboratory, radiological, histopathological, and hysterolaparoscopic findings in women with suspected FGTB.

Methods: This hospital-based observational study included 70 women with clinically suspected FGTB. Participants underwent clinical assessment, microbiological investigations including mycobacterial culture and GeneXpert, histopathological examination of endometrial samples, pelvic ultrasonography, magnetic resonance imaging (MRI), and diagnostic hysterolaparoscopy where indicated. Data were analyzed using descriptive statistics, and categorical variables were compared using the Chi-square or Fisher’s exact test.

Results: Women aged 31-40 years formed the largest age group (44.3%), while 45.7% belonged to the lower socioeconomic group. Clinical suspicion of FGTB was recorded in 74.3% of participants, whereas microbiological confirmation was obtained in 32.9%. Histopathology showed the highest positivity (37.1%), followed by GeneXpert (32.9%) and mycobacterial culture (25.7%). Tubal thickening was the most common radiological finding on both ultrasonography and MRI. Hysterolaparoscopy commonly showed periostial fibrosis, pale endometrium, intrauterine adhesions, hydrosalpinx, and pelvic adhesions. On integrated assessment, 32.9% of women had confirmed FGTB, 18.6% probable FGTB, 35.7% possible FGTB, and 12.8% had no evidence of FGTB.

Conclusions: FGTB remains difficult to diagnose using a single investigation. An integrated approach combining clinical assessment, histopathology, microbiological testing, imaging, and hysterolaparoscopy may improve diagnostic confidence and facilitate earlier diagnosis.

A comparative study of maternal and fetal outcomes in women with or without epidural analgesia during labour

2026-10-30T07:54:08+0530

Background: Epidural analgesia is considered the gold standard for labour pain relief . Despite its widespread acceptance, concerns continue regarding its influence on labour progression, mode of delivery, maternal complications, and neonatal outcomes. Our study aimed to compare maternal and fetal outcomes between women receiving epidural analgesia and those undergoing labour without epidural analgesia.

Methods: A hospital-based observational comparative study was conducted at a tertiary care centre, from October 2025 to April 2026. Seventy primigravid women with single term pregnancies were enrolled, 35 women received epidural analgesia using low-dose Ropivacaine with Fentanyl, while 35 women underwent labour without epidural analgesia. Maternal haemodynamic parameters, labour characteristics, mode of delivery, maternal complications, pain relief, neonatal Apgar scores, need for neonatal resuscitation, and NICU admission were compared between the two groups.

Results: Baseline demographic and obstetric characteristics were comparable between both groups. Epidural analgesia produced excellent pain relief with stable maternal haemodynamics. A transient reduction in systolic blood pressure was observed during the first 15–20 minutes after epidural administration without clinically significant adverse effects. The duration of the second stage of labour was slightly prolonged in the epidural group; however, there was no statistically significant increase in caesarean delivery or adverse neonatal outcomes. Apgar scores, neonatal resuscitation, and NICU admissions were comparable between the groups.

Conclusions: Low-dose epidural analgesia is a safe and effective technique for labour pain management. It provides superior maternal comfort without adversely affecting maternal or neonatal outcomes and should be offered to eligible women delivering in tertiary care centres.

Clinical governance of hysterectomies in a rural tertiary health care centre

2026-10-30T07:54:08+0530

Background: Hysterectomy remains one of the most performed gynecological surgeries worldwide. Despite the availability of medical therapy and minimally invasive procedures, hysterectomy continues to be widely practiced, particularly among rural women. Understanding the clinical determinants influencing hysterectomy and evaluating the adequacy of prior conservative treatment is essential for improving gynaecological care. Objectives were to assess the clinical and sociodemographic factors influencing hysterectomy and to evaluate the provision and adequacy of conservative management prior to surgery in a rural tertiary care setting.

Methods: This hospital-based cross-sectional analytical study included 200 women who underwent hysterectomy at MGIMS Sewagram, Maharashtra during the study period. Data were obtained from medical records and included sociodemographic characteristics, presenting symptoms, uterine size, menopausal status, histopathological findings, type of hysterectomy, oophorectomy status, and prior conservative management.

Results: Most women were aged 40-50 years (66.0%) and multiparous (76.0%), with 91.0% residing in rural areas. Abnormal uterine bleeding was the most common presenting symptom (40.1%). Leiomyoma was the predominant histopathological finding (41.5%). Abdominal hysterectomy was the most frequently performed procedure (66.0%). Only 49.0% of women received conservative management prior to surgery, of whom just 18.0% received treatment for more than six months, indicating limited adequacy of medical therapy.

Conclusions: Hysterectomy in this rural population was performed for benign gynecological conditions, with inadequate utilisation of conservative treatment in many cases. Strengthening early diagnosis, ensuring adequate trials of medical therapy and expanding access to minimally invasive approaches may help reduce potentially avoidable hysterectomies.

Association between maternal vitamin D deficiency and pregnancy outcomes: a prospective study

2026-10-30T07:54:07+0530

Background: Cardiovascular risk is strongly influenced by excess adiposity, particularly abdominal fat accumulation. Body mass index (BMI) is routinely used to classify general adiposity but does not describe fat distribution. Waist-to-height ratio (WHtR) incorporates waist circumference relative to stature and may therefore better reflect central adiposity and associated metabolic risk. The aim is to compare WHtR and BMI for identifying increased cardiovascular risk among urban adults in Hyderabad, Telangana.

Methods: A cross-sectional observational study was conducted among 70 adults aged 18–60 years. Weight, height, waist circumference and blood pressure were measured using standard procedures. Fasting plasma glucose and lipid profile were assessed. BMI and WHtR were calculated, and increased cardiovascular risk was defined as the presence of at least two non-anthropometric cardiometabolic abnormalities: elevated blood pressure, elevated fasting glucose, hypertriglyceridaemia and/or reduced HDL-C. Associations were examined using group comparisons and Pearson correlation. Receiver operating characteristic (ROC) analysis was used to compare the discriminatory performance of BMI and WHtR.

Results: The mean age was 41.6±10.8 years. BMI ≥25 kg/m² was present in 39 (55.7%) participants, whereas WHtR ≥0.50 was present in 45 (64.3%). Participants with WHtR ≥0.50 had significantly higher frequencies of elevated blood pressure, elevated fasting glucose, hypertriglyceridaemia, reduced HDL-C and clustering of at least two cardiometabolic abnormalities. WHtR correlated more strongly than BMI with the measured cardiometabolic variables. ROC analysis showed an AUC of 0.82 (95% CI: 0.72–0.92) for WHtR and 0.71 (95% CI: 0.59–0.83) for BMI.

Conclusions: In this study population, WHtR showed better discrimination than BMI for the defined cardiometabolic risk outcome. WHtR may be a useful adjunct to BMI in simple cardiovascular risk screening among urban Indian adults.

Effect of the WHO labour care guide on cesarean delivery and intrapartum interventions: a randomized controlled trial

2026-10-30T07:53:59+0530

Background: The World Health Organization (WHO) Labour Care Guide (LCG) promotes individualized intrapartum care. This trial compared caesarean delivery and maternal and neonatal outcomes among women monitored with the LCG versus the modified partograph.

Methods: In this single-center randomized controlled trial, 266 low-risk women with singleton, term, cephalic pregnancies in spontaneous labour were allocated to LCG or modified-partograph monitoring (133 per group). The primary outcome was caesarean delivery. Risk ratios (RRs) with 95% confidence intervals (CIs) were calculated for binary outcomes.

Results: Caesarean delivery occurred in 41/133 (30.8%) women in the LCG group and 39/133 (29.3%) in the modified-partograph group (RR 1.05, 95% CI 0.73-1.52; P=0.894). Active labour was longer with the LCG (mean difference 1.4 hours, 95% CI 0.92-1.88; P<0.001). Oxytocin augmentation (18.0% vs 39.1%; RR 0.46, 95% CI 0.30-0.70) and amniotomy (6.0% vs 55.6%; RR 0.11, 95% CI 0.05-0.22) were less frequent with the LCG (both P<0.001). Neonatal intensive care unit admission was similar (16.5% vs 19.5%; P=0.633).

Conclusions: The LCG did not reduce caesarean delivery but was associated with fewer intrapartum interventions and longer active labour, without evidence of worse short-term neonatal outcomes.

Quality of life and psychological health among women undergoing medically assisted reproductive treatments

2026-10-30T07:53:58+0530

Background: Infertility affects an estimated 15-20% of married couples in India, and women undergoing medically assisted reproduction (MAR) are exposed to considerable psychological strain. This study assessed depression, anxiety, stress and fertility-related quality of life (QoL) among women undergoing MAR and compared women with primary and secondary infertility.

Methods: A cross-sectional study was conducted among 150 women undergoing in vitro fertilisation (IVF)-based MAR treatment (75 with primary and 75 with secondary infertility) at two fertility hospitals in Chennai, India, from June to September 2025. Participants were selected by purposive sampling. Psychological health was assessed using the depression anxiety stress scales-21 (DASS-21) and QoL using the fertility quality of life (FertiQoL) tool. Data were analysed using the chi-square test, independent samples t-test and one-way ANOVA.

Results: Depressive, anxiety and stress symptoms of at least mild severity were present in 76.0%, 85.3% and 86.0% of the women, respectively. Stress severity was significantly associated with type of infertility (χ²=13.38, p=0.01); moderate to extremely severe stress was seen in 58.7% of women with primary infertility and 37.3% of women with secondary infertility. Women with secondary infertility had higher total FertiQoL scores (64.06±9.38 versus 55.82±10.15; p<0.001). Infertility duration of more than 7 years was associated with depression, anxiety and stress, and with the lowest total FertiQoL score (52.5±12.3).

Conclusions: Psychological distress was common among women undergoing MAR. Women with primary infertility and those with a longer duration of infertility were most affected. Routine psychological screening and psychosocial support should be included in fertility care.

Association of maternal serum uric acid levels with gestational diabetes mellitus: a hospital-based case-control study

2026-10-30T07:53:57+0530

Background: Gestational diabetes mellitus is a common metabolic complication of pregnancy. Serum uric acid has been investigated as an inexpensive biomarker linked to insulin resistance and metabolic dysfunction. This study examined the relationship between maternal serum uric acid and its association with glycaemic control.

Methods: This case-control study enrolled 120 pregnant women between 24 and 40 weeks of gestation- 60 with GDM and 60 normoglycaemic controls. Demographic and clinical data were recorded, and serum uric acid was measured using an enzymatic uricase-peroxidase method. We assessed its association with GDM, random blood sugar (RBS), glycated hemoglobin (HbA1c) and treatment modality were evaluated and receiver operating characteristic (ROC) analysis were performed.

Results: Women with GDM were older and more often overweight or obese than controls. Serum uric acid was significantly higher in the GDM group: 50.0% of cases had levels above 5.7 mg/dl, compared with 18.33% of controls (p<0.003). Uric acid correlated with RBS (r=0.29, p=0.02) and, more strongly, with HbA1c (Spearman ρ=0.690, p<0.001). Women who required insulin had higher mean uric acid than those managed on medication alone (6.70±0.86 versus 5.35±1.18 mg/dl; p<0.001). ROC analysis gave an area under the curve of 0.7325, with an optimal cut-off of ≥5.1 mg/dl (sensitivity 71.67%, specificity 66.67%).

Conclusions: Maternal serum uric acid was associated with GDM and with markers of poorer glycemic control and greater treatment intensity. It may be a useful adjunctive biomarker, but its moderate discriminatory power means it cannot stand alone as a diagnostic test.

Post-operative analgesic effect of wound infiltration with bupivacaine versus mixture of bupivacaine and tramadol in caesarean section under spinal anaesthesia: a randomized double-blind interventional controlled study

2026-10-30T07:51:37+0530

Background: Caesarean section is among the most frequently performed obstetric surgical procedures worldwide. Effective postoperative analgesia is crucial for promoting maternal comfort and facilitating recovery. Multimodal analgesic approaches are commonly used to optimize pain control, and wound infiltration is considered a simple, safe, and effective technique. This study aimed to assess and compare the postoperative analgesic efficacy of wound infiltration using a combination of bupivacaine and tramadol with that of bupivacaine alone following caesarean delivery.

Methods: This prospective, randomised, double-blind trial was conducted at Sawai Man Singh Medical College and Attached Hospitals, Jaipur, India, from February 2021 to [Month 2021] (CTRI/2021/02/031140). Sixty parturients aged 18–35 years, ASA physical status I–II, undergoing caesarean section under spinal anaesthesia were randomised into two groups of 30. Group T received wound infiltration with tramadol 2 mg/kg mixed in 0.25% bupivacaine (total 20 ml), and Group B received 20 ml of 0.25% bupivacaine. The time to first rescue analgesia, Numerical Rating Scale (NRS) pain scores, diclofenac consumption over 24 hours, patient satisfaction and adverse effects were compared.

Results: The time to first rescue analgesia was significantly longer in Group T than in Group B (6.60±1.61 vs. 3.21 ±0.65 hours; P<0.001). Total 24-hour diclofenac consumption was significantly lower in Group T (96.67±26.60 vs. 184.00±40.54 mg; mean difference 87.33 mg, 95% CI 69.61–105.05; P<0.001). Patient satisfaction was higher in Group T (P=0.001), and adverse effects were comparable between groups.

Conclusions: Subcutaneous wound infiltration with a combination of tramadol and bupivacaine following caesarean section prolongs the pain-free period and reduces postoperative analgesic requirements, thereby enhancing maternal comfort and satisfaction.

Outcomes after unsupervised self-administration of abortion pills presenting at a tertiary care hospital in Eastern India

2026-10-30T07:52:46+0530

Background: Medical abortion is safe and effective when used according to standard guidelines. However, unsupervised self-administration may result in resource wastage and maternal morbidity. This study assessed outcomes and complications associated with unsupervised abortion pill intake in a tertiary care hospital in Eastern India.

Methods: A retrospective cross-sectional study was conducted at Calcutta National Medical College and Hospital from January to December 2025 after institutional ethical approval. Women presenting after abortion pill intake without supervision of a registered medical practitioner were included. Women with spontaneous abortion or medically supervised termination were excluded. Detailed data regarding Sociodemographic characteristics, clinical presentation, complications etc were collected from hospital records and analysed using standard statistical methods and recorded.

Results: Among 152 women, 38.8% were aged 26–30 years and 57.2% were from rural areas. Unintended pregnancy was the commonest reason for abortion (63.9%), while influence of friends or relatives (30.9%) was the leading reason for avoiding medical consultation. Vaginal bleeding was the commonest presenting complaint (64.5%). Incorrect dosage occurred in 59.8% and 38.2% took pills beyond 9 weeks of gestation. Surgical intervention was required in 54.6%, including laparotomy for ectopic pregnancy in two cases. ICU admission was required in 17.7%. No maternal death occurred. Incorrect dosage (aOR 2.57, 95% CI 1.25–5.27), gestational age >9 weeks (aOR 3.84, 95% CI 1.79–8.26) and increasing age were significantly associated with complications.

Conclusions: Unsupervised self-administration of abortion pills were associated with substantial maternal morbidity. Appropriate counselling, adherence to recommended regimens and access to supervised abortion services are essential to reduce preventable complications.

A study on traditional beliefs and practices on newborn care among the mothers in selected hospitals Shillong, Meghalaya

2026-10-30T07:50:41+0530

Background: Traditional beliefs continue to influence newborn care practices despite improvements in maternal and child health services. While some cultural practices are beneficial, others may adversely affect neonatal health. The present study assessed traditional beliefs and practices regarding newborn care among mothers attending selected hospitals in Shillong, Meghalaya.

Methods: A quantitative descriptive cross-sectional study was conducted among 160 mothers of infants aged 0–6 months attending the North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences (NEIGRIHMS) and Ganesh Das Government Maternal and Child Health Hospital, Shillong, Meghalaya. Participants were recruited using a consecutive sampling technique. Data were collected using a structured questionnaire on socio-demographic characteristics and semi-structured questionnaires on traditional beliefs and newborn care practices. Data were analyzed using IBM SPSS Statistics version 26. Frequencies and percentages were used for descriptive analysis, and the Chi-square test was used to examine associations between newborn care practices and selected socio-demographic variables. Statistical significance was set at p<0.05.

Results: Overall, 68.1% of mothers demonstrated adequate newborn care practices, while 31.9% had inadequate practices. The commonly reported practices included hand hygiene before handling the newborn (91.2%), colostrum feeding (83.1%), avoidance of pre-lacteal feeding (82.5%), and dry cord care (80.0%). Potentially harmful practices included bathing within 24 hours of birth (30.6%), pre-lacteal feeding (17.5%), application of substances to the umbilical cord (15.6%), and use of herbal remedies (14.4%). Traditional beliefs concerning maternal dietary restrictions (76.9%), the influence of maternal diet on breast milk (53.1%), and elders’ involvement in newborn-care decisions (45.0%) were also reported. Marital status was significantly associated with overall newborn care practices (p=0.034).

Conclusions: Although most mothers reported adequate newborn care practices, certain traditional beliefs and potentially harmful practices persisted. Culturally sensitive, evidence-based health education involving mothers and family members is essential to reinforce safe newborn care while respectfully addressing practices that may place newborns at risk.

Evaluation of the risk factors in pregnant females with hypertensive disorder of pregnancy

2026-10-30T07:51:35+0530

Background: Hypertensive disorders of pregnancy (HDP) are important causes of maternal and perinatal morbidity. This study evaluated readily identifiable maternal and pregnancy-related factors associated with HDP.

Methods: This analytical cross-sectional study enrolled 211 pregnant women beyond 20 weeks of gestation at Deen Dayal Upadhyay Hospital, New Delhi, from May 2022 until completion of recruitment. Participants were categorized as HDP (n=61) or normotensive (n=150). Maternal age, body mass index (BMI), previous preeclampsia, multifetal gestation, and assisted reproductive technology (ART) conception were recorded. Categorical variables were compared using the chi-square test; p<0.05 was significant.

Results: The mean age was 27.63±4.93 years and mean BMI was 22.09±3.08 kg/m². HDP occurred in 61 (28.9%) participants. Maternal age group was not associated with HDP (p=0.141). BMI>35 kg/m² occurred in 2/61 (3.3%) women with HDP and 0/150 normotensive women (p=0.026). Previous preeclampsia was present in 8/61 (13.1%) and 2/150 (1.3%), respectively (p=0.0001). Multifetal gestation occurred in 10/61 (16.4%) and 3/150 (2.0%), respectively (p=0.0001). ART conception was not significantly associated with HDP (p=0.348).

Conclusions: Higher BMI, previous preeclampsia, and multifetal gestation were significantly associated with HDP, whereas maternal age and ART conception were not.

A retrospective study of surgical site infections post caesarean section in a secondary care hospital

2026-10-30T07:51:33+0530

Background: Surgical site infection (SSI) is an important healthcare-associated complication following caesarean section and may result in maternal morbidity, prolonged hospital stay, increased healthcare expenditure, and delayed wound healing. Identification of associated risk factors and strengthening preventive practices are essential, particularly in secondary-care settings. Aim was to determine the frequency, pattern, and associated patient-related risk factors of SSI following caesarean section and to identify measures that may contribute to improved infection prevention and postoperative care.

Methods: A retrospective study was conducted at a secondary-care health facility from April 2020 to March 2024. Hospital records of women who underwent caesarean section and subsequently developed SSI were reviewed. Available demographic, obstetric, surgical, and postoperative data, including wound-related complications and management up to 6 weeks after surgery, were analysed.

Results: During the four-year study period, 4,948 caesarean sections were performed, of which 519 (10.4%) were complicated by SSI. Among women with SSI, 122 (23.5%) had superficial wound infections, while 397 (76.4%) developed severe wound gaping requiring re-suturing. The most frequently identified risk factors were obesity (28%), anaemia (24%), and a history of previous surgery (22%), followed by personal hygiene-related factors (14%) and other or unspecified factors (12%). The annual number of caesarean sections increased progressively from 935 to 1,426, whereas the SSI rate declined from 8.1% in 2020-2021 to 6.8% in 2023-2024.

Conclusions: SSI remains a significant postoperative complication following caesarean section, with obesity, anaemia, and previous surgery being prominent associated factors. The decline in SSI rates despite increasing caesarean volumes underscores the potential value of strengthened infection-prevention practices and postoperative surveillance. Early identification of high-risk women, adherence to aseptic surgical practices, appropriate perioperative care, and timely management of wound complications may reduce SSI-related morbidity and improve the quality of obstetric surgical care.

Maternal outcomes in postpartum haemorrhage: a prospective observational study of 100 women at a tertiary referral centre in Kutch, Gujarat

2026-10-30T07:50:33+0530

Background: Postpartum haemorrhage is the leading direct cause of maternal death worldwide and the commonest cause of maternal death in India. Outcomes at district-level referral centres serving rural populations are less well described than those at urban teaching hospitals. This study evaluated maternal outcomes in such a setting.

Methods: This prospective observational study included 100 women with postpartum haemorrhage at a tertiary referral centre in Bhuj, Gujarat, between April 2024 and October 2025. Demographic profile, aetiology, management and outcome were recorded. A composite severe maternal outcome was defined a priori as obstetric hysterectomy, transfusion of four or more units, or maternal death. Associations were tested using Fisher's exact test.

Results: Seventy-four women were unbooked, 68 rural and 54 referred after delivering elsewhere. Mean age was 29.2 years (SD 5.6) and mean parity 3.56 (SD 2.13). Uterine atony was the leading cause (68%), followed by genital tract trauma (19%). Surgical intervention was required in 66%, most commonly uterine packing (30%); hysterectomy in 12%. Blood products were transfused in 80%. Postpartum anaemia was the commonest morbidity (34%). Eight women died (8%). Severe maternal outcome occurred in 17% and was associated with caesarean delivery (27.9% versus 8.8%, p=0.016) and previous caesarean section (35.0% versus 12.5%, p=0.040), but not with anaemia or preeclampsia.

Conclusions: Case fatality was substantially higher than in comparable published series. Severe maternal outcome clustered around operative delivery and uterine scar rather than antenatal risk factors, suggesting that reducing the interval to definitive haemorrhage control matters more than antenatal risk stratification in this setting.

Sociodemographic and lifestyle factors associated with semen status among men undergoing infertility evaluation

2026-10-30T07:50:26+0530

Background: Male infertility is multifactorial, and semen abnormalities may be associated with sociodemographic and lifestyle factors. This study evaluated associations between demographic, behavioural, lifestyle, and socioeconomic factors and distinct semen-status categories among men undergoing infertility evaluation.

Methods: An observational study was conducted among 501 men undergoing infertility evaluation at an infertility care centre, Raipur, from 2023 to 2026. Participants were classified as having normozoospermia, non-azoospermic abnormal semen parameters, or azoospermia. Sociodemographic, lifestyle, behavioural, and socioeconomic factors were assessed. Pearson’s chi-square test was used for unadjusted associations, followed by multinomial logistic regression with normozoospermia as the reference outcome. The model was adjusted for age, BMI, smoking, alcohol, smokeless tobacco, education, computer use, fast-food consumption, mobile-phone use, sleep duration, physical activity, and annual family income.

Results: Among 501 men, unadjusted analyses showed significant associations with smoking (p=0.002), alcohol consumption (p=0.007), educational attainment (p<0.001), and computer use (p=0.029). The multinomial regression model was significant (χ²=71.8, df=46, p=0.009; McFadden pseudo-R²=0.084). Educational attainment remained significantly associated with semen status (LR χ²=13.555, df=6, p=0.035). Low educational attainment was associated with higher adjusted odds of azoospermia compared with graduation-level education (AOR=3.617, 95% CI 1.098-11.920; p=0.035). No other individual adjusted comparison was statistically significant.

Conclusions: Smoking and alcohol consumption were significantly associated with semen status in unadjusted analyses. After adjustment, educational attainment remained significantly associated with semen status, with low education associated with higher odds of azoospermia. These findings highlight the relevance of lifestyle and sociodemographic factors in male infertility.

Healthcare-seeking and treatment experiences among women with primary infertility: a cross-sectional community study

2026-10-30T07:50:24+0530

Background: Primary infertility affects women’s emotional, family life, and may lead seeking continuous treatment. Understanding the healthcare-seeking behaviour and treatment experiences of women help identify the barriers they face. With this intention present study was undertaken to assess socio-demographic associations, recognition of infertility, healthcare access pathways, burdens of infertility care among women with primary infertility across rural and urban communities.

Methods: A community-based, cross-sectional study conducted in Dharwad district of Karnatak during 2025. Total 230 women diagnosed with primary infertility were interviewed. Data were assessed using descriptive and inferential bivariate metrics (χ² analysis) on SPSS software version 20.0.

Results: Socio-demographic characteristics revealed separate residential variations, with significantly high among advanced educated women (44.8% versus 28.9%; p=0.023) and specific salaried patterns observed among urban groups. Rural women presented higher tendencies of child marriage (29.8% versus 22.4%; p=0.001), within consanguineous unions (37.7% versus 19.8%; p=0.003). No significant rural-urban variation observed across treatment paths, frequency of facilities visits, or avoiding public facilities, with 85.7% women heavily dependent on private systems. More than half of the women (53.5%) discontinued treatment due to severe psychological distress (86.2%) and unaffordable medical costs (55.3%).

Conclusions: Though socio-demographic indicators vary across rural and urban residents, the real-world treatment paths, treatment dropouts, psychological and economic distress patterns remain entirely similar. Public welfare policies must integrate low-cost reproductive treatment packages and mandated psychological care and effective counselling services within facilities.

Timing of resuscitative hysterotomy and maternal outcomes after cardiac arrest: a systematic review and meta-analysis

2026-10-30T07:54:01+0530

Resuscitative hysterotomy (RH) is undertaken during maternal cardiac arrest to relieve aortocaval compression and improve maternal resuscitation. The optimal timing and magnitude of maternal benefit remain uncertain because evidence is observational. PubMed/Medline, Scopus and Embase evidence reported in the registered 2026 base meta-analysis was updated through 31 July 2026 using targeted searches. Eligible primary studies reported maternal or neonatal outcomes according to time from arrest to RH. Random-effects synthesis was used in the base analysis. The primary outcome was maternal survival in relation to arrest-to-hysterotomy time; secondary outcomes included neonatal survival, maternal survival to discharge, neurological outcome and ROSC. An exploratory random-effects logit meta-analysis of survival proportions was undertaken across three major evidence syntheses, but was not used for causal inference because of overlap. The base search identified 762 records; 12 studies (507 patients) were included and 8 studies (176 patients, including 111 undergoing RH) contributed to quantitative synthesis. Maternal survivors underwent hysterotomy at a pooled mean time of 12.55±4.85 minutes, significantly earlier than non-survivors (p=0.023; I²=71%). Neonatal survival was associated with a pooled mean time of 10.25±5.50 minutes (p=0.034; I²=85%). The exploratory review-level analysis yielded a pooled maternal survival proportion of 19.8% (95% CI 3.8-60.4%; I²=94.3%), but this estimate is highly vulnerable to overlap and case-mix differences. A 2026 tertiary-centre cohort reported two hysterotomies completed at four minutes with 100% neonatal survival; maternal RH-specific survival was not separately reported. Earlier RH is associated with better maternal and neonatal survival, but the evidence is very low certainty, heterogeneous and confounded. The five-minute target remains an operational goal rather than an absolute futility threshold. Prospective registries with patient-level timing and neurological outcomes are required.

Premenopausal ovarian cysts: a practical evidence-based approach to risk assessment, tumor markers, surveillance and surgical management

2026-10-09T06:55:53+0530

Ovarian cysts are common in premenopausal women, and most are physiological or benign. Assessment aims to identify lesions that require further investigation or treatment while avoiding unnecessary surgery and loss of ovarian tissue. This narrative review examines ultrasound characterization, malignancy risk assessment, tumor markers, surveillance, surgical management, and fertility considerations. Transvaginal ultrasonography (TVUS) is the first-line investigation, and lesion morphology should be interpreted alongside symptoms, age, and clinical history. The International Ovarian Tumor Analysis Simple Rules and ADNEX model, together with the Ovarian-Adnexal Reporting and Data System, provide structured approaches to risk assessment. Tumor-marker testing should follow the differential diagnosis. CA125 has limited specificity in premenopausal women, whereas suspected germ-cell or sex-cord stromal tumors may require other markers. Many confidently characterized simple cysts can be managed without intervention. Follow-up depends on lesion type, size, symptoms, and the imaging framework used; persistence alone does not establish malignancy. Indeterminate masses may require expert ultrasound or magnetic resonance imaging, and suspicious lesions warrant gynecological oncology assessment. Acute presentations require urgent evaluation outside elective surveillance pathways. When surgery is appropriate for benign disease, the approach should minimize morbidity and preserve ovarian tissue where feasible. Management therefore requires integration of imaging findings, clinical risk, reproductive priorities, and patient preferences.

Elagolix as an oral substitute for injectable GnRH antagonists in IVF: a review and recent developments

2026-10-30T07:57:08+0530

During controlled ovarian stimulation for in vitro fertilization (IVF), a luteinizing hormone (LH) surge can trigger the release of a premature oocyte before scheduled oocyte retrieval. Suppressing this surge is critical in order to achieve a successful round of IVF. Gonadotropin Releasing Hormone (GnRH) antagonists bind to the GnRH receptor in the pituitary gland and prevent endogenous GnRH from stimulating LH release. This is a rapid and reversible blockade used by clinicians to enable successful IVF outcomes. Traditionally, injectable antagonist agents like ganirelix/cetrorelix have been popular but are reported as painful and expensive. Recently, new literature regarding the use of elagolix, an oral non-peptide GnRH antagonist, as a potentially less invasive and cheaper alternative has been published. This review critically appraises the present evidence on elagolix as an oral alternative for LH surge suppression in IVF. A literature search was conducted using PubMed as the primary database, supplemented by Google Scholar to identify additional relevant sources. Search terms included combinations of phrases like “elagolix,” “IVF,” “GnRH antagonist,” “ovarian stimulation,” “ganirelix,” “cetrorelix,” “HPO axis.” Studies were included if they reported original data or reviewed existing evidence on GnRH antagonist use in the context of ovarian stimulation for IVF. Studies examining elagolix’s use in the management of endometriosis-associated pain were also included. Reference lists of identified studies were further reviewed to pull additional relevant information. This search yielded additional studies that met the inclusion criteria. Across the available studies, elagolix demonstrates comparable LH suppression to injectable GnRH antagonists, offering a reduced injection and per-cycle cost burden for IVF patients. However, this evidence is limited to a small number of majorly retrospective and a few prospective cohort studies. No randomized controlled trials have been published to date. Dosage and safety data relevant to elagolix’s use in IVF also remains scarce. According to our analysis, elagolix shows promise, but larger clinical trials and prospective studies are needed to solidify elagolix as a cost-effective and hypoalgesic alternative.

Doing enough without doing everything: evidence-based management of recurrent first-trimester miscarriage in resource-limited settings

2026-10-30T07:50:40+0530

Recurrent first-trimester miscarriage is a common but difficult problem in obstetric and gynaecological practice. The difficulty is greater in resource-limited settings, where genetic testing, specialised coagulation assays and advanced imaging may be unavailable or unaffordable. This narrative review examines a practical question: which investigations and treatments are sufficiently useful to justify their cost and burden in women with recurrent early pregnancy loss? A focused literature search of PubMed/MEDLINE, the Cochrane Library and major professional guidelines was updated to October 2026. The evidence supports a careful reproductive and medical history, assessment of maternal age and modifiable risk factors, evaluation of uterine anatomy, thyroid function testing and appropriately prioritised testing for antiphospholipid syndrome. Glycaemic assessment should be risk-directed. Genetic analysis of miscarriage tissue is informative when available, but routine inherited thrombophilia, natural-killer-cell, broad immunological and infection screening have limited first-line value. Folic acid remains appropriate preconception care but is not a specific treatment for recurrent miscarriage. Aspirin and heparin should principally be used for appropriately diagnosed antiphospholipid syndrome. Vaginal micronized progesterone has the clearest evidence in women with previous miscarriage who develop bleeding in a subsequent intrauterine pregnancy; evidence for routine progestogen use in otherwise unexplained recurrent miscarriage is weaker. Routine prednisolone is not supported. Resource limitation should therefore favour selective investigation, cause-directed treatment and structured early-pregnancy supportive care.

Maternal micronutrition beyond iron-folic acid: global evidence and Indian perspectives from preconception to lactation: an expert consensus

2026-10-09T06:55:55+0530

Maternal undernutrition contributes substantially to adverse pregnancy outcomes in low- and middle-income countries. In India, anemia and deficiencies of vitamin B12, vitamin D, zinc, and folate remain widespread. Although iron-folic acid (IFA) supplementation is central to antenatal care, evidence suggests that multiple micronutrient supplementation (MMS) reduces low birth weight and small-for-gestational-age births compared with IFA alone. This review examined how global MMS evidence can inform context-specific strategies for Indian women. Published evidence on maternal micronutrient deficiencies, MMS, and international guidelines was synthesized with thematic analysis of seven regional advisory board meetings involving >90 Indian clinicians. Findings confirmed a high burden of micronutrient deficiencies and supported MMS over IFA alone. Expert panels favored a phased approach aligned with gestational physiology, beginning with folate, vitamin B12, and pyridoxine during preconception and early pregnancy, followed by iron, calcium, vitamin D, and DHA. Key barriers included gastrointestinal intolerance, complex dosing, and dietary insufficiency. These findings support transitioning from IFA-based supplementation toward a comprehensive, context-adapted strategy spanning preconception through lactation.

Fetal MRI imaging protocols: current standards, optimization strategies and emerging techniques

2026-10-30T07:54:11+0530

Prenatal Magnetic resonance imaging helps to assess the fetus and the pregnancy structures. Maternal obesity, fetal position, or oligohydramnios do not significantly affect MRI image visibility of the fetus, and the ossified skull does not interfere with visualisation of the brain. Many authors have mentioned practical approaches and imaging applications for diagnosis, but there is a lack of a complete standardised imaging protocol for fetal MRI. Different diagnostic centres or hospitals use different sequences, slice thickness, field strength or motion correction methods. This variability in protocol reduces reproducibility and comparison across studies. Thus, there is a need for a standardised fetal MRI protocol. The objective of this review is to provide an overview of fetal Magnetic resonance imaging sequences (SSFSE, SSFP, IVIM, DWI), their applications and parameters, limitations, and safety of fetal magnetic resonance imaging. Magnetic resonance imaging using a T2-weighted sequence of a gravid uterus shows the fetus and pregnancy structures (umbilical cord, placenta and amniotic fluid). T1-weighted sequences are mostly used to demonstrate haemorrhage, calcification, and obesity. The assessment is done in a system-oriented approach that involves the fetal brain, spine, face, neck, chest, abdomen, pelvis, extremities and pregnancy structures. It is an interesting choice of investigation for indications such as congenital anomalies (holoprosencephaly, encephalocele), vascular anomalies (malformations, infarction, twin pregnancy complications), mass (hemangioma, teratoma), etc. Fetal Magnetic resonance imaging is said to be completed when the evaluation of the fetus, placenta, umbilical cord and amniotic cavity is carefully completed.

A comprehensive review on hypertensive disorders of pregnancy: risk stratification, predictors and preventive strategies

2026-10-30T07:54:56+0530

Hypertensive disorders of pregnancy (HDP), particularly pre-eclampsia, are important causes of maternal and perinatal morbidity and mortality. Because effective prevention must begin before clinical disease is established, antenatal care should include early risk assessment and timely initiation of evidence-based prophylaxis. Pre-eclampsia is a heterogeneous, multisystem disorder in which abnormal placentation and placental stress contribute to an imbalance between pro-angiogenic and anti-angiogenic factors, systemic endothelial dysfunction, and end-organ injury. This review summarises the pathophysiology of pre-eclampsia; examines clinical risk assessment, the HDP-Gestosis Score, mean arterial pressure (MAP), uterine artery Doppler and angiogenic biomarkers; and compares key recommendations from the World Health Organization (WHO) and the NICE/RCOG clinical framework. Low-dose aspirin is recommended for pregnant women at increased risk, with dose and timing determined by the applicable guideline and local protocol. Calcium supplementation is recommended by WHO in populations with low dietary calcium intake. Combined clinical and first-trimester multimarker screening can improve identification of pregnancies at risk of preterm pre-eclampsia, but no screening test replaces ongoing blood-pressure assessment and clinical surveillance. Implementation should prioritise validated tools, clear referral pathways, equitable access to antenatal care and accurate counselling.

Microplastics in pregnancy: placental transfer, maternal exposure and adverse pregnancy outcomes: a literature review

2026-10-30T07:50:36+0530

Microplastics (MPs) are widespread environmental contaminants detected in human tissues, including the placenta, raising concerns regarding maternal exposure and fetal health. The objective is to review evidence on microplastic presence in pregnancy-related tissues, toxicity mechanisms, and maternal–fetal outcomes. Literature from PubMed, Scopus, Embase, and Google Scholar was reviewed. MPs have been detected in placenta and reproductive tissues. Experimental evidence suggests that microplastics may induce oxidative stress, inflammatory responses and placental injury associated with fetal growth restriction and placental dysfunction. Further prospective studies with standardized methods are required to establish clinical significance.

Pregnancy outcomes in women diagnosed with Hodgkin lymphoma during pregnancy: a review of the literature

2026-10-30T07:50:35+0530

Hodgkin’s lymphoma (HL) is one of the most common haematological malignancies to complicate pregnancy due to its peak incidence in the reproductive age. Constitutional symptoms of the disease may be mistaken for early pregnancy symptoms, delaying diagnosis. Pregnancy neither affects the course nor is it associated with the recurrence of HL. HL has an excellent prognosis with 90% five-year survival if the disease is detected in the early stage and treated adequately. However, treating a pregnant woman with HL is challenging. A multidisciplinary approach is required to diagnose, stage, and start appropriate treatment at the proper gestation to achieve the best pregnancy outcome without compromising the status of the mother. Care should be taken to provide both psychological and emotional support to the couple throughout the pregnancy by a trained healthcare provider. This review offers insight into the presentation, management, and feto-maternal outcomes of pregnant women with HL over the last 15 years.

Cervical leiomyoma associated with cervical elongation and pelvic organ prolapse in a nulliparous woman: a uterine-preserving surgical approach

2026-10-30T07:57:09+0530

Cervical leiomyomas are rare and may present with unusual clinical manifestations. Cervical elongation secondary to cervical leiomyoma is uncommon and may be associated with pelvic organ prolapse (POP). We present a 40-year-old nulliparous woman with a 4×3 cm cervical leiomyoma associated with marked cervical elongation and POP. She underwent surgical management with a Manchester–Fothergill procedure combined with sacrospinous hysteropexy. The leiomyoma was removed en bloc during cervical amputation, followed by cardinal ligament plication and sacrospinous hysteropexy. At 3- and 6-month follow-up, the patient remained asymptomatic with no evidence of recurrent prolapse. This case highlights the potential association between cervical leiomyoma, cervical elongation, and POP and demonstrates a uterine-preserving surgical approach that addresses both the elongated cervix and apical support defect.

Symptomatic uterine leiomyoma mimicking a myeloproliferative neoplasm with suspected red degeneration and secondary thrombocytosis post-caesarean section: a case report

2026-10-30T07:54:12+0530

Uterine leiomyomas are common benign tumours and may undergo red degeneration when their blood supply is compromised. Postpartum red degeneration is uncommon and can present with clinical and laboratory features that resemble infection or haematological disease. We describe a 35-year-old para 1 woman who presented four months after Caesarean section with lower abdominal pain, fever, night sweats, weight loss and generalised malaise. She had known large uterine leiomyomas. Blood tests showed microcytic anemia, raised inflammatory markers, a C-reactive protein concentration of 299 mg/l and marked thrombocytosis, with a peak platelet count of 1380 x 10^9/l. Pelvic magnetic resonance imaging demonstrated a large posterior uterine leiomyoma with features suggestive of acute red degeneration. Diffuse low T1 signal in the visualised pelvic bone marrow raised the possibility of an underlying marrow disorder. Following haematology, radiology and gynaecology review, the differential diagnosis included a severe reactive inflammatory response due to fibroid degeneration and a myeloproliferative neoplasm. The patient underwent laparotomy and myomectomy. Histopathological examination confirmed a benign leiomyoma with extensive red degeneration, infarction and acute-on-chronic inflammation. Her symptoms and inflammatory markers improved after surgery. This case illustrates that red degeneration of a postpartum leiomyoma may produce marked reactive haematological abnormalities and mimic a myeloproliferative disorder. Correlation of the clinical course with imaging, haematological assessment and histopathology was essential in establishing the diagnosis.

Spontaneous heterotopic pregnancy: a case report

2026-10-30T07:53:56+0530

Spontaneous heterotopic pregnancy is a rare pathology. It is a diagnostic and therapeutic emergency due to the risk of hemorrhagic complications of ectopic pregnancy. This report discusses a case of ruptured spontaneous heterotopic pregnancy whose ectopic location was tubal, associated with an intrauterine pregnancy death at 07 weeks of gestation. Surgical treatment was done by laparotomy.

Successful management of a monochorionic monoamniotic twin pregnancy with extensive cord entanglement

2026-10-09T06:55:54+0530

Monochorionic monoamniotic (MCMA) twin pregnancy is rare and is associated with fetal loss, congenital anomalies, prematurity and umbilical cord entanglement. We report the management and outcome of a 29-year-old primigravida in whom a single placenta, two fetuses and no intertwin membrane were identified at 9 weeks of gestation. Surveillance included ultrasound assessment every 2 weeks from 16 weeks, umbilical artery and middle cerebral artery Doppler studies, fetal echocardiography at 20-22 weeks, and inpatient fetal surveillance from 30 weeks. A planned caesarean birth was performed at 32+1 weeks, consistent with guidance recommending planned preterm birth for uncomplicated MCMA twins. Two female neonates weighing 1.5 kg and 1.4 kg were delivered. Both received neonatal intensive care for 15 days and were discharged in stable condition. Maternal recovery was uncomplicated. Marked entanglement of the two umbilical cords was documented intraoperatively. This case illustrates that extensive cord entanglement may coexist with a favourable outcome when early diagnosis, structured surveillance, planned preterm caesarean birth and neonatal support are available.

Peripartum cardiomyopathy complicating major postpartum haemorrhage with pre-eclampsia and HELLP syndrome

2026-10-30T07:52:33+0530

Peripartum Cardiomyopathy (PPCM) is a rare, potentially life-threatening cause of heart failure, developing in the later stages of pregnancy, or immediately postpartum. Diagnosis can become challenging as obstetric emergencies may provide differing explanations for cardiovascular collapse. We demonstrate a rare case of acute severe biventricular failure occurring very soon after an emergency Caesarean section for a pregnancy complicated by HELLP syndrome in the setting of post-partum pre-eclampsia and severe postpartum haemorrhage. The diagnostic value of an urgent echocardiogram in an obstetric emergency is underlined and the challenges faced by clinicians in managing two serious medical emergencies at the same time are highlighted.

Successful live birth following mechanical hysteroscopic adhesiolysis with MyoSure for Asherman syndrome: a case report

2026-10-30T07:50:25+0530

Asherman syndrome is characterised by symptomatic intrauterine adhesions that may cause menstrual disturbance, pelvic pain and subfertility. We describe a 28-year-old G3P1 woman who developed dysmenorrhoea, oligomenorrhoea and difficulty conceiving after a term vaginal birth complicated by severe postpartum haemorrhage, manual removal of an adherent placenta and subsequent suction curettage for retained products of conception. Initial hysteroscopy demonstrated extensive uterine cavity obliteration, and adhesiolysis was attempted by hydrodilatation. At repeat hysteroscopy approximately 16 months postpartum, persistent adhesions obscured the left tubal ostium. Mechanical adhesiolysis was performed using the MyoSure hysteroscopic tissue removal system with concomitant laparoscopic observation. Subsequent hysteroscopic inspection demonstrated restoration of the uterine cavity, and laparoscopic tubal dye-study confirmed bilateral tubal patency. An intrauterine Foley balloon was retained for seven days, with postoperative oral antibiotics and four weeks of oestrogen-based therapy. The patient conceived four months later and delivered a live male infant at term. She subsequently underwent total laparoscopic hysterectomy for persistent severe dysmenorrhoea after completing her reproductive goals. This case documents a successful reproductive outcome following MyoSure-assisted adhesiolysis. MyoSure may provide a non-electrosurgical option for adhesiolysis in selected patients; however, comparative evidence is insufficient to establish superiority over conventional techniques or determine the optimal postoperative regimen.

Pre-operative ultrasound diagnosis and laparoscopic management of live unilateral twin tubal ectopic pregnancy: a case report

2026-10-30T07:50:23+0530

Live unilateral twin tubal ectopic pregnancy is an uncommon form of ectopic pregnancy and may be difficult to recognise before surgery. We report two women, both aged 31 years, with live unruptured left tubal twin ectopic pregnancies diagnosed on transvaginal ultrasound (TVS). Both were haemodynamically stable and presented with mild pain and vaginal spotting. TVS showed a left adnexal gestational sac separate from the ovary containing two embryos with cardiac activity. One woman had a previous interstitial ectopic pregnancy, while the other was a primigravida with no recognised risk factors for ectopic pregnancy. After counselling regarding management options, both women chose surgical treatment and underwent urgent laparoscopic left salpingectomy. Histopathology confirmed tubal pregnancy in both cases. These cases illustrate that twin tubal ectopic pregnancy can occur with or without recognised risk factors. Careful TVS assessment can establish the diagnosis before rupture and facilitate timely laparoscopic management.

Left ovarian torsion in type 2 Mayer-Rokitansky-Küster-Hauser syndrome: a rare case report

2026-10-30T07:56:10+0530

Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome is a rare congenital anomaly of Müllerian duct development, occurring in approximately 1 in 4,500-5,000 female births, and is the second most common cause of primary amenorrhea after gonadal dysgenesis. Ovarian torsion complicating MRKH syndrome is exceptionally rare, with only a small number of cases described in the literature to date. We report the case of a 20-year-old unmarried woman with primary amenorrhea who presented with acute lower abdominal pain of three days' duration, nausea, vomiting, and a palpable abdominal mass. She was initially managed as suspected adnexal torsion or a degenerating uterine fibroid or pregnancy related complication. Ultrasonography and magnetic resonance imaging (MRI) demonstrated absence of the uterus and cervix, vaginal agenesis, right renal agenesis, and a large left ovarian cyst with a twisted vascular pedicle showing the “whirlpool sign”, consistent with Type 2 MRKH syndrome complicated by left ovarian torsion; a preoperative chest radiograph was unremarkable. Emergency exploratory laparotomy confirmed an 8×7 cm left ovarian cyst with two complete turns of torsion of the pedicle, a fibrous band, and a small rudimentary uterine remnant. Detorsion, cystectomy, ovarian reconstruction with ovarian drilling were performed while preserving of viable ovarian tissue. Histopathology confirmed a benign (serous) simple ovarian cyst, and recovery was uneventful. Ovarian torsion is a rare but important complication of MRKH syndrome that can be easily overlooked because of the syndrome's atypical pelvic anatomy. A high index of suspicion, supported by ultrasonography and MRI, together with prompt fertility- and function-preserving surgery, remains key to a favourable outcome. This case adds to the limited published literature on this association.

Silent malignancy in plain sight: a rare case of dual carcinomatous and sarcomatous transformation in a giant cervical polyp

2026-10-30T07:57:11+0530

Cervical polyps are common benign gynecological lesions. Although malignant transformation is exceedingly rare (occurring in <1.7% of cases), it presents a distinct clinical challenge because preoperative screening including Pap cytology and pelvic ultrasonography often yields normal findings. A 52-year-old perimenopausal woman (P2L2) presented with irregular menstrual cycles and intermenstrual spotting. Speculum examination revealed a large, pedunculated cervical polyp measuring approximately 5 cm. Both preoperative cervical cytology (NILM) and transvaginal ultrasound were reassuring. The patient underwent polypectomy, dilation and curettage (D&C), and endocervical curettage. Histopathological examination revealed sheets of highly dysplastic cells infiltrating vascular stroma with atypical mitosis. Immunohistochemistry (IHC) demonstrated carcinoma foci along with atypical stromal cell proliferation favoring a low-grade endometrial stromal sarcoma (ESS) with focal high-grade sarcomatous change. Stalk margins showed no lymphovascular invasion. Following multidisciplinary team (MDT) review and staging pelvic MRI/chest CECT showing no distant disease or residual invasion, total laparoscopic hysterectomy with bilateral salpingo-oophorectomy was performed. Final pathology showed no residual malignancy, and the patient remains disease-free under regular surveillance. Giant cervical polyps, even when presenting with benign physical characteristics and normal cytology/imaging, can harbor complex focal malignancies with mixed carcinomatous and sarcomatous components. Routine histopathological and immunohistochemical evaluation of all excised cervical lesions is essential for timely diagnosis and optimal oncologic management.

Acquired complete labial adhesion in a reproductive-age woman: a rare case report and review of literature

2026-10-30T07:56:03+0530

Labial adhesion (labial fusion or agglutination) is commonly encountered in prepubertal and postmenopausal women owing to hypoestrogenic states. Its occurrence in women of reproductive age is rare and sparsely documented in the literature. A 26-year-old unmarried woman presented with dysuria, recurrent urinary tract infections (UTIs), and perineal pruritus. She reported regular menstrual cycles and exhibited normal secondary sexual characteristics. Examination revealed complete fusion of the labia minora obscuring the urethral meatus, clitoris, and hymenal opening. Laboratory investigations were unremarkable except for a positive urine culture. Pelvic magnetic resonance imaging (MRI) demonstrated normal uterine and ovarian morphology. Surgical adhesiolysis was performed with successful anatomical reconstruction. At 6-month follow-up, the patient remained asymptomatic with no recurrence and reported satisfactory sexual function. Labial adhesion can occur in reproductive-age women even in the absence of identifiable risk factors. Early recognition and appropriate surgical management yield excellent outcomes. Labial adhesion should be considered in the differential diagnosis of reproductive-age women presenting with recurrent urinary symptoms or vulvar discomfort. Timely intervention can prevent chronic urogenital morbidity and improve quality of life.

Fetal umbilical vein varix: antenatal diagnosis and perinatal outcomes

2026-10-30T07:56:01+0530

Fetal intra-abdominal umbilical vein varix (FIUVV) is an uncommon fetal vascular abnormality characterized by focal dilatation of the extrahepatic intra-abdominal umbilical vein. A 29-year-old gravida 2 para 1 woman with one previous lower-segment caesarean section was diagnosed with an isolated FIUVV at 28 weeks of gestation during routine ultrasonography. The varix measured 12.3 mm and showed normal venous flow without thrombus. First-trimester screening and the detailed anomaly scan were normal. Serial weekly ultrasonography demonstrated progressive enlargement of the varix to 15.2 mm at 34 weeks, with subsequent development of turbulent flow and progressive fetal growth restriction, while umbilical artery, middle cerebral artery, and ductus venosus Doppler indices remained within normal limits. In view of the progressive enlargement, turbulent flow, fetal growth restriction, and previous caesarean delivery, an elective caesarean section was performed at 34 weeks+5 days. A live female neonate weighing 2295 g was delivered and had an uneventful neonatal course. This case highlights the importance of confirming FIUVV with color Doppler, assessing for associated fetal abnormalities, monitoring fetal growth and changes in the varix, and individualizing delivery planning when concerning sonographic features develop.

A dangerous mimic of retained products of conception: acquired uterine arteriovenous malformation

2026-10-30T07:54:06+0530

Uterine arteriovenous malformation (AVM) is a rare but potentially life-threatening vascular abnormality characterized by abnormal communication between uterine arteries and veins without an intervening capillary bed. Although congenital AVMs occur infrequently, acquired lesions are increasingly recognized following uterine instrumentation, caesarean delivery, miscarriage, or dilation and curettage. Early diagnosis is essential because inappropriate uterine evacuation may precipitate catastrophic hemorrhage. This report demonstrates a case of a 28-year-old multiparous woman who presented with severe vaginal bleeding one month after suction evacuation for a missed abortion at 12 weeks of gestation. On admission, she was hemodynamically stable but moderately anemic with a hemoglobin of 9 g/dl and serum β-human chorionic gonadotropin (β-hCG) of 73.72 mIU/ml. Transvaginal ultrasonography with color Doppler demonstrated multiple tortuous vascular channels within the posterior myometrium exhibiting high-velocity turbulent flow suggestive of uterine AVM. Computed tomography angiography confirmed an acquired AVM involving branches of the uterine artery. The patient underwent successful bilateral uterine artery embolization using foam gel particles, resulting in immediate cessation of bleeding. Repeat evacuation for retained products of conception was safely performed after embolization. She recovered uneventfully and was discharged on postoperative day four. This case highlights the importance of considering uterine AVM in women presenting with delayed post-abortal hemorrhage. Prompt diagnosis using Doppler ultrasonography and CT angiography followed by uterine artery embolization can effectively control bleeding while preserving fertility.

Beyond conventional brachytherapy: a customized intracavitary approach for carcinoma cervix in an elderly patient

2026-10-30T07:54:05+0530

Brachytherapy remains cornerstone in treatment of gynaecological carcinoma for both definitive and adjuvant treatments. Due to rapid dose-gradient fall of brachytherapy, targets receive high dose with low dose to organ at risk and hence increasing tumor control. We present a rare case report of locally advanced case of Carcinoma cervix treated at our center with customised brachytherapy applicator comprising of tandem and cylinder. This application is simple and feasible in resource constraint setting offering similar local control and toxicity as compared to traditional Fletcher suit applicator. We Present a Case report of patient treated with this customised applicator with tandem and cylinder with acceptable toxicity and local control.

A case report of metastatic ovarian cancer presenting as acute abdomen with obstructed umbilical hernia

2026-10-30T07:54:05+0530

Sertoli-Leydig cell tumours (SLCTs) are rare ovarian sex cord-stromal neoplasms, accounting for less than 0.5% of ovarian tumours. They predominantly occur in young women and are frequently associated with androgenic manifestations. Advanced-stage disease in elderly postmenopausal women is exceptionally uncommon. Here , we present a 76-year-old postmenopausal woman with acute abdominal pain and vomiting due to an obstructed, irreducible umbilical hernia. Emergency laparotomy revealed a friable omental mass within the hernial sac, approximately 2 L of ascites and a large 15×15 cm left ovarian mass densely adherent to the rectosigmoid, bladder, uterus, pelvic sidewall and abdominal wall, with multiple peritoneal tumour deposits. Frozen section showed a poorly differentiated malignant neoplasm, with carcinosarcoma considered. Comprehensive cytoreductive surgery including total abdominal hysterectomy, bilateral salpingo-oophorectomy, peritonectomy, omentectomy, rectosigmoid resection and lymph-node assessment was performed. Definitive histopathology demonstrated a poorly differentiated (Grade 3) Sertoli-Leydig cell tumour with heterologous mucinous and cartilaginous differentiation. The tumour showed surface involvement and rupture, parametrial involvement and extrapelvic peritoneal deposits, with negative regional lymph nodes. No virilising features were documented. This case highlights an exceptionally rare presentation of advanced poorly differentiated SLCT in a postmenopausal woman, masquerading as an acute surgical abdomen due to an obstructed umbilical hernia. SLCT should be considered in the differential diagnosis of ovarian malignancy even in elderly women without androgenic manifestations. Heterologous differentiation may mimic epithelial ovarian carcinoma or carcinosarcoma on frozen section, underscoring the importance of definitive histopathological and immunohistochemical evaluation.

An unexpected bump in the vagina: prolapsed fallopian tube after hysterectomy

2026-10-30T07:54:04+0530

Fallopian tube prolapse (FTP) after hysterectomy is an uncommon complication accounting to 0.1% of all hysterectomies without salpingectomy. It may present as vaginal discharge, vaginal bleeding and pain in lower abdomen. It is mostly misdiagnosed as granulation tissue due to its appearance. A 27-years old P3A1L2 woman underwent abdominal hysterectomy 8 months back for heavy menstrual bleeding with chronic cervicitis at a private hospital. Following the surgery, she developed complaint of pain in abdomen and vaginal discharge from last 5 months which was profuse and did not subside despite multiple medications. A per speculum examination revealed a mass like fimbrial end of fallopian tube, which was confirmed on biopsy. She was taken for exploratory laparotomy and on identifying the vault one fallopian tube was seen entrapped within it while the other tube was well visualized entirely. The vaginal vault was opened and prolapsed tube was gently separated from it, and bilateral salpingectomy and vault closure was done. The post-operative period was smooth and finally patient was relieved of her troublesome ailment. Post hysterectomy transient vaginal discharge is a common problem, but it is important to perform the basic examination of the patients to find out the cause. A prolonged duration of vaginal discharge should be dealt with more caution and compassion, especially considering rarest of entities like fallopian tube prolapse.

Placenta percreta with bladder involvement: a case report at a tertiary care centre

2026-10-30T07:54:03+0530

Placenta accreta spectrum (PAS), encompassing placenta accreta, increta, and percreta, represents one of the most severe and life-threatening obstetric conditions. The rising incidence of Placenta Accreta Spectrum parallels the increasing rates of caesarean delivery. Caesarean hysterectomy with the placenta left in situ remains the standard management strategy for placenta percreta; however, even in tertiary care settings, it is associated with significant maternal morbidity. Early antenatal diagnosis facilitates planned delivery and multidisciplinary management, thereby improving maternal outcomes. We report a case of placenta percreta managed at a tertiary care centre, highlighting intraoperative challenges, postoperative complications, and adherence to FOGSI-recommended management protocols.

Velamentous cord insertion with low-lying placenta and fetal growth restriction in a singleton pregnancy: a case report

2026-10-30T07:54:02+0530

Velamentous insertion is where the umbilical cord does not insert into the placenta- but rather into the membranes, where the umbilical arteries and vein traverse the membranes along the uterine wall unprotected by Wharton jelly before entering the placental margin which in turn causes various complications. This renders vessels vulnerable to compression and rupture leading to adverse outcomes such as Fetal Growth Restriction, preterm delivery, abnormal fetal heart rate patterns and perinatal morbidity. A 29-year-old primi, 38 weeks 1 day, GDM on OHA, with low lying Placenta with Velamentous cord insertion complicated with FGR with normal Doppler was take up for Elective Caesarean section and a baby of 1.8 kg was delivered. Gross examination showed a cord away from placenta running through the membranes. There is a correlation between cord insertion and higher incidence of FGR and cesarean deliveries. Velamentous insertion of cord is taken as a high -risk pregnancy and enhanced care should be provided. Systematic evaluation of placental cord insertion during routine scans is vital for early recognition and improved perinatal prognosis and to prevent complications like FGR, IUFD, massive hemorrhage.

A benign illusion: elevated CA 19-9 and bilateral xanthogranulomatous salpingitis hiding behind pelvic endometriosis

2026-10-30T07:54:00+0530

Xanthogranulomatous salpingitis (XGS) is a rare, benign, chronic inflammatory tubal condition that frequently mimics advanced malignancy, and its concurrent presentation with endometriosis is exceptionally rare. We present the case of an asymptomatic 44-year-old female who was found to have a complex tubo-ovarian mass and an elevated CA 19-9 during a routine solid organ donor evaluation. Suspecting malignancy, diagnostic laparoscopy was performed. Crucially, intraoperative frozen section analysis revealed benign pathology, prompting a fertility-sparing surgical approach involving left mass excision, right salpingectomy, and endometriosis resection. Final histopathology unexpectedly confirmed bilateral XGS with concurrent pelvic endometriosis. This case highlights that XGS can develop entirely silently alongside endometriosis, likely driven by chronic hemorrhage rather than bacterial infection. Intraoperative pathological evaluation is imperative to prevent the radical oncological overtreatment of complex, adherent adnexal masses.

Giant ovarian mucinous cystadenoma in an 8-year-old prepubertal girl: a rare paediatric case

2026-10-30T07:54:55+0530

Ovarian tumours in the paediatric population are uncommon, and epithelial tumours constitute only a small proportion of these cases. Mucinous cystadenomas are benign epithelial tumours typically seen in adult women and are rarely reported in prepubertal girls. Giant ovarian cysts are also uncommon today because early imaging often leads to earlier detection. We report a rare case of a giant right ovarian mucinous cystadenoma in an 8-year-old prepubertal girl presenting with progressive abdominal distension and pressure symptoms. Imaging revealed a large multiloculated cystic mass arising from the right adnexa without suspicious malignant features. The patient underwent exploratory laparotomy with right salpingo-oophorectomy, and histopathology confirmed benign mucinous cystadenoma. Early diagnosis and appropriate surgical management with preservation of reproductive potential remain essential in paediatric patients.

Hemorrhage in a pituitary microprolactinoma presenting as primary infertility with mild hyperprolactinemia

2026-10-30T07:50:44+0530

Pituitary apoplexy is usually associated with macroadenomas and overt neuro-ophthalmic symptoms. Hemorrhage within pituitary microadenomas is rare and may present subtly, resulting in delayed diagnosis. A young woman presented with primary infertility and mildly elevated serum prolactin levels. Following initiation of cabergoline therapy, she developed new-onset severe headache. Magnetic resonance imaging revealed hemorrhage within a previously undiagnosed pituitary microprolactinoma. Conservative management with modification of dopamine agonist therapy led to symptomatic improvement. Mild hyperprolactinemia may occasionally mask underlying pituitary pathology. Severe headache after dopamine agonist initiation should prompt early neuroimaging, regardless of adenoma size. Early recognition allows appropriate conservative management and preservation of fertility.

Second-trimester uterine rupture in a scarred uterus presenting as an acute abdomen: a diagnostic challenge

2026-10-30T07:50:43+0530

Uterine rupture is an uncommon but potentially catastrophic obstetric emergency, most often seen during labour in women with a scarred uterus. Rupture occurring in the second trimester, before the onset of labour, is far less common and can be mistaken for a surgical acute abdomen. We describe a 29-year-old woman, gravida 4 para 1, with a history of one previous cesarean section and two earlier uterine evacuations, who presented at 23 weeks of gestation with severe, diffuse abdominal pain and an episode of syncope. Ultrasonography on admission, together with medical and surgical assessment, did not establish a cause, and she subsequently deteriorated, with hypotension, tachycardia, and a sharp fall in haemoglobin. Repeat ultrasonography and an ultrasound-guided abdominal tap demonstrated haemoperitoneum, and emergency laparotomy revealed rupture along the previous cesarean scar together with a defect in the right broad ligament. The uterus was repaired and preserved successfully. This case highlights the need to consider uterine rupture in a woman with a scarred uterus presenting with acute abdomen, even before the third trimester and in the absence of labour.

OHVIRA syndrome: a rare mullerian anomaly with diagnostic and management challenges: a case report and review of literature

2026-10-30T07:51:36+0530

Herlyn–Werner–Wunderlich syndrome, also known as OHVIRA syndrome is a rare complex congenital developmental anomaly characterized by the triad of uterine didelphys, obstructed hemivagina, causing hematometrocolpos and ipsilateral renal anomaly. A 19-year-old nulligravida presented with foul-smelling vaginal discharge for 11 months and cyclical lower abdominal pain for 2 months. She had regular menstrual cycles since menarche. Examination revealed a single cervix with an anterolateral vaginal bulge draining mucopurulent discharge. Imaging with ultrasonography and MRI confirmed uterine didelphys, hematocolpos, right renal agenesis and hemivaginal septum. The patient had undergone prior aspiration elsewhere. Diagnostic hysterolaparoscopy confirmed the findings. Excision of the vaginal septum revealed the obstructed cervix and a vaginal mould was placed postoperatively. The patient remains asymptomatic on follow-up and has conceived. High index of suspicion during evaluation of obstructive reproductive tract anomalies, early diagnosis through imaging modalities, multidisciplinary approach, timely surgical management and follow up yield good reproductive outcomes and quality of life.

Antenatal myomectomy for acute abdomen caused by red degeneration of a large pedunculated leiomyoma: a case report

2026-10-30T07:51:34+0530

Uterine fibroids are one of the the most common benign tumors in women of reproductive age. During antepartum, intrapartum, and postpartum periods, hormonal changes can lead to fibroid enlargement and a range of pregnancy related complications. The most common complication of fibroids in pregnancy is acute abdominal pain, usually caused by red degeneration or torsion of a pedunculated subserosal fibroid. Abdominal pain during pregnancy caused by red degeneration of leiomyoma creates a diagnostic and therapeutic dilemma because of its peculiar and acute presentation. We present the case of a 35 years old, African primigravida, presenting with acute onset right-sided abdominal pain at 19 weeks of gestation. Magnetic resonance imaging revealed a live fetus along with a large degenerating subserosal myoma, abutting the uterine fundus and extending up to liver. In view of persistent abdominal pain not responding to conservative management, emergency exploratory laparotomy was performed. A large 21×15.5×12 cm fibroid was removed, weighing 1.850 kg. The postoperative course was uneventful. Histopathology confirmed infarct type degeneration with extensive hemorrhage and necrosis. At 38 weeks of gestation, she had an uncomplicated vaginal delivery of a healthy baby. Myomectomy is preferably avoided in gravid uterus, however, it may be individualized and performed for selected symptomatic cases following appropriate counselling.

Scar niche pregnancy successfully managed by laparotomy and excision of a caesarean scar ectopic pregnancy

2026-10-30T07:50:40+0530

Caesarean scar pregnancy (CSP) is a rare form of ectopic pregnancy in which the gestational sac implants within a previous caesarean section scar. Its recognition is increasing with rising caesarean delivery rates and improved ultrasonography. Transvaginal ultrasonography is the primary diagnostic modality, assessing gestational sac location and residual myometrial thickness. Management depends on gestational age, clinical stability, and fertility preferences, with options including medical therapy and surgical intervention. Early diagnosis and appropriate treatment are essential to prevent haemorrhage, uterine rupture, and other serious maternal complications while preserving fertility. A 31-year-old woman, G3P1L1A1, presented at approximately 7 weeks of gestation with vaginal spotting without abdominal pain or discomfort. She had a history of one caesarean delivery four years earlier and suction and evacuation for abortion seven months previously. Transvaginal ultrasonography revealed a caesarean scar ectopic pregnancy, with the gestational sac predominantly within the scar niche, a crown–rump length of 3.4 mm, and residual myometrial thickness of approximately 2.1 mm. Her serum β-hCG was 13,895 mIU/ml, and haemoglobin was 8.6 g/dL. After transfusion of two units of packed red blood cells, she initially received two intramuscular doses of methotrexate (50 mg) with leucovorin rescue. However, β-hCG increased to 14,554 mIU/ml on day 4, prompting surgical intervention. Laparotomy revealed a 2-cm bulge at the previous caesarean scar. The ectopic pregnancy was evacuated vaginally under direct supervision, followed by excision of the scar and two-layer uterine repair. The patient tolerated the procedure well. There has been an increase in scar ectopic pregnancy cases alongside rising caesarean section rates. Various medical and surgical treatments have been explored, but no consensus exists on the best approach. The authors advocate for laparotomy with scar ectopic tissue excision, especially in resource-limited settings lacking advanced technology or expertise.

Vulvar endometriosis away from a previous episiotomy scar mimicking a vulvar boil: a case report

2026-10-30T07:51:32+0530

Vulvar endometriosis is an uncommon form of extra pelvic endometriosis. It is frequently associated with previous perineal trauma or episiotomy, although lesions may occasionally occur away from sites of previous trauma. The condition may mimic other common vulvar lesions and therefore requires a high index of suspicion. A 40-year-old woman, para 1, presented with a painful vulvar swelling that was initially treated as a vulvar boil. She had undergone a full-term vaginal delivery with right mediolateral episiotomy 8 years earlier. Examination revealed a small, approximately 1–2 cm haemorrhagic cystic lesion on the right labia majora, distinctly away from the episiotomy scar. The lesion was tender and mobile, with no attachment to the underlying perineal muscles or abnormality of the overlying skin. Initial treatment with antibiotics and topical antifungal therapy did not result in improvement. On subsequent presentation around the premenstrual period, the lesion had enlarged and developed bleeding, with symptoms showing a clear cyclical relationship with menstruation. Complete surgical excision was performed under sedation and local anaesthesia. Histopathological examination confirmed vulvar endometriosis. There was no recurrence during 1 year of follow-up. Vulvar endometriosis should be considered in the differential diagnosis of a painful or recurrent vulvar lesion, particularly when symptoms show a cyclical relationship with menstruation, even when the lesion is located away from a previous episiotomy or other site of perineal trauma. Complete excision with histopathological confirmation is an effective diagnostic and therapeutic approach.

Quirk of fate: a case report of complete uterine torsion in early third trimester

2026-10-30T07:51:31+0530

Uterine torsion is an abnormal rotation of the uterus along its fixed longitudinal or vertical axis by an angle more than 45 degrees. Uterine torsion ranges from 60 to 720 degrees with 180 degrees being the most common. Here is a 30-year-old G3P1L1A1 with singleton pregnancy with 29 weeks 2 days gestation with previous LSCS admitted in our hospital with severe pain abdomen. The pain started 4 hours back. On examination patient was hemodynamically unstable. Abdominal examination revealed a tense, tender uterus with absent fetal cardiac activity. Clinical diagnosis of Placental abruption with intrauterine fetal demise was made. Emergency LSCS done in view of detoriating haemodynamic status under GA. Dilated and torturous pelvic vessels with couvelaire uterus noted. After extraction, while exploring the posterior aspect of the uterus, uterine torsion of 360 degrees noted. On derotation of uterus, pelvic congestion relieved and uterus started to contract and retract.

A rare case of unruptured cornual pregnancy at 13 weeks

2026-10-30T07:56:00+0530

Interstitial pregnancy is a rare form of ectopic pregnancy in which implantation occurs within the interstitial portion of the fallopian tube. Although it may remain asymptomatic for longer than other tubal ectopic pregnancies, rupture can result in severe intra-abdominal haemorrhage because of the vascularity and distensibility of the surrounding myometrium. We report a 24-year-old primigravida diagnosed with an unruptured left interstitial pregnancy at 13 weeks of gestation during routine ultrasonography. The patient was haemodynamically stable and underwent exploratory laparotomy with left cornual resection and ipsilateral salpingectomy after counselling and informed consent. A well-formed fetus with placenta was identified within the resected specimen. The postoperative course was uneventful, and serial serum β-human chorionic gonadotropin measurements were followed until complete biochemical resolution. This case highlights the possibility of an unruptured interstitial pregnancy persisting beyond the first trimester and the importance of early ultrasonographic localisation of pregnancy. Timely diagnosis permits planned treatment before rupture and catastrophic haemorrhage.

Assessing the suitability of ChatGPT and Google Gemini for patient education on the surgical management of gynaecological malignancies

2026-10-30T07:56:09+0530

Artificial intelligence (AI)-based conversational tools like ChatGPT and Google Gemini are increasingly being explored for their potential in patient education. In gynaecological oncology, clear and accessible communication about surgical options such as hysterectomy is vital. This study investigates the effectiveness of these tools in generating patient-friendly educational content. Educational content on total hysterectomy, radical hysterectomy, laparoscopic hysterectomy, abdominal hysterectomy, and supracervical hysterectomy was generated using ChatGPT and Google Gemini. Responses were analysed for word count, sentence structure, grade level, ease score, similarity percentage, and reliability. An independent sample t test was used for comparison. Shapiro-Wilk and Levene’s tests were used to assess normality and variance equality, respectively. The analysis showed no statistically significant differences between ChatGPT and Google Gemini across all assessed metrics (p>0.05). Both tools produced similar content in terms of word count, sentence length, readability (ease score and grade level), and reliability. The average reliability score was slightly higher for Gemini, while ChatGPT showed slightly better readability. Both ChatGPT and Google Gemini demonstrate comparable effectiveness in generating suitable educational content on surgical management of gynaecological malignancies. With appropriate oversight, they can serve as supplementary tools in enhancing patient understanding and shared decision-making in clinical settings.

Improved semen quality and successful conception following probiotic supplementation in men with infertility

2026-10-30T07:53:59+0530

Male infertility contributes significantly to global infertility burden, with abnormal semen parameters being a common underlying factor. Emerging evidence suggests that probiotics may influence reproductive health through modulation of inflammatory and metabolic pathways; however, clinical outcome data remain limited. We report eight men presenting with abnormal semen parameters and infertility who received probiotic supplementation for a defined duration. Semen analysis was performed before and after supplementation according to standard guidelines. Clinical outcomes, including natural conception, were documented. All eight participants demonstrated improvement in one or more semen parameters, including sperm count, motility, and/or morphology following probiotic supplementation. Notably, successful conception was achieved in all cases within a defined follow-up period. The degree of improvement varied across individuals but showed a consistent trend toward normalization of semen profiles. This study highlights a compelling association between probiotic supplementation and improvement in semen parameters, with successful fertility outcomes. These observations support the growing potential of probiotics as an adjunctive strategy in male infertility and warrant further validation through controlled studies.

Systemic lupus erythematosus in pregnancy: experience from a tertiary care center in Northeast India

2026-10-30T07:50:37+0530

Systemic lupus erythematosus (SLE) is a chronic autoimmune disorder that most commonly affects women in the reproductive age group. Although pregnancy is allowed with low disease activity, individuals diagnosed with SLE have a higher risk of complications from pregnancy (for both the mother as well as the fetus) than the general population. Such risks may include spontaneous abortions, intrauterine fetal demise, preeclampsia, eclampsia, intrauterine growth restriction (IUGR), and preterm delivery. Pregnant women who have active disease at conception or during early pregnancy, have lupus nephritis in the past, or have antiphospholipid syndrome are at increased risk of obstetrical complications. This retrospective study was carried out at All India Institute of Medical Sciences, Guwahati (Northeast India). This case series includes 3 pregnant patients with SLE as reviewed in the study for maternal and fetal outcomes.

In two patients in our case series, caesarean section was provided one for failed induction and another for a non-reassuring non-stress test. Both infants were normal at birth without any cardiovascular anomaly and were sent for neonatal evaluation for neonatal lupus, which was normal. The third patient required medical termination of pregnancy at 25 weeks of gestation in view of worsening maternal condition. Anticoagulants, steroids and immunosuppressants also pose high risks for the mother and the unborn child. The best approach to management will have to be multidisciplinary with medical, obstetric, and neonatal supervision in order to achieve a good prognosis.

A case series of labiaplasty for a rare medical condition: bilateral fibroepithelial polyps of the labia minora in a young female

2026-10-30T07:50:34+0530

Fibro epithelial polyp (FEP) of labia minora is extremely rare benign mesenchymal tumor of female lower genital tract, mostly occurring in reproductive age groups. It is characterized by polypoid proliferations of stroma and tend to be either small fleshy masses or pedunculated in appearance. The lesions are often small and histologically benign in nature. However vulvar lesions like angiofibroblastoma, angiomyxoma, and sarcoma must be excluded by histopathological examination. Reactive hyperplastic processes in sub-epithelial mesenchymal tissues in the vulvo-vaginal area hypothecated a significant role in its development, potentially influenced by factors such as hormonal changes, inflammation, and underlying health conditions like obesity and diabetes mellitus. So far, there are very few published case reports on labial masses especially from labia minora FEPs. In this article we present three cases of fibro epithelial polyp of labia minora in young women who presented to us with complaints of bilateral labial hypertrophy. We excised the growth by performing labiaplasty by edge resection technique and histopathology of the excised tissue confirmed the diagnosis of FEP of the labia minora.