International Journal of Reproduction, Contraception, Obstetrics and Gynecology

Rare and life-threatening complications in early pregnancy

Jharna Behura — 2026-02-25

Rare complications in early pregnancy can cause risks to maternal health and foetal viability. Ovarian malignancy complicating early pregnancy poses diagnostic and therapeutic dilemmas. Anatomical and hormonal changes obscure typical presentations and limit interventional options. Spontaneous early fundal rupture in a case of previous caesarean is a rare occurrence, often arising from prior uterine surgery, congenital anomalies, or invasive trophoblastic disease, and may present with sudden pain and intra-abdominal haemorrhage. An early intrauterine foetal demise with undiagnosed fundal placenta accreta, in a case of previous two caesarean, characterized by abnormal adherence of chorionic villi to the myometrium—can lead to catastrophic bleeding, complicating diagnosis and management. Together, these conditions exemplify the complex interplay of early gestational physiology and pathological disruption, requiring heightened clinical vigilance and multidisciplinary care for optimal outcomes.

Preventable maternal deaths: a 6-year retrospective study of healthcare deficiencies in Yaoundé’s teaching hospitals, Cameroon

Essiben Felix — 2026-02-25

Background: This study aimed to investigate the management deficiencies contributing to maternal mortality in teaching hospitals in Yaoundé.

Methods: This was a retrospective cross-sectional analytical study conducted from November 2024 to April 2025 at the Yaoundé University Teaching Hospital (CHUY), the Yaoundé Central Hospital (HCY), and the Yaoundé Gynaeco-Obstetric and Paediatric Hospital (HGOPY). We analyzed maternal death review reports and medical records of 257 cases occurring between January 2019 and April 2025. We examined the circumstances of death, identified management deficiencies, and investigated the determinants of each failure. Data were analyzed using SPSS version 25.0.

Results: The median age of the deceased women was 30 years (range: 16–45). Most deaths occurred postpartum (63.0%; 162/257), and the majority of patients (80.9%; 207/257) were referrals from other health facilities. Direct obstetric causes accounted for 91.1% (234/257) of deaths, dominated by hemorrhage (47.0%; 110/234) followed by hypertensive complications (29.1%; 68/234). Severe malaria (52.2%; 12/23) and HIV complications (17.4%; 4/23) were the most frequent indirect causes. The primary management deficiencies identified were delays in reaching the health facility (79.8%; 205/257) and delays in receiving adequate care (30.7%; 79/257). These failures were primarily attributable to inadequate transportation during referral (75.5%; 194/257), delayed access to diagnostic investigations (30.0%; 77/257), late referrals (25.7%; 66/257), and stockouts of essential medicines (17.9%; 46/257) or blood products (16.3%; 42/257). Most of the deaths analyzed were preventable (88.7%; 228/257).

Conclusions: The analysis of maternal deaths highlighted substantial structural and organizational deficiencies. Improved adherence to clinical management protocols, together with reliable provision of essential medical supplies are crucial for reducing maternal mortality.

A prospective randomized pilot study comparing the short protocol with gonadotropin and gonadotropin-releasing hormone agonist to the combination of gonadotropin and gonadotropin-releasing hormone antagonist for ovulation stimulation in poor responder patients undergoing in vitro fertilization treatments

Keziban Saylam Donmez — 2026-02-25

Background: This study aimed to evaluate the effect of gonadotropin-releasing hormone antagonist for ovulation stimulation in poor responder patients undergoing in vitro fertilization treatments.

Methods: Patients who had previously undergone two IVF cycles and had collected fewer than 5 oocytes in their last attempt, with a baseline FSH value below 15 IU/L, were selected to be included to the study. The patients were randomly included to one of the treatment groups. Before treatment, patients used oral contraceptive pills for 21 days. In Group A, recombinant gonadotropin was used with GnRH agonist in a short protocol. In Group B, recombinant gonadotropin was used with GnRH antagonist cetrorelix.

Results: A total of 24 patients were included in the study. In Group A (11 patients), recombinant gonadotropin was used with GnRH agonist in a short protocol. In Group B (13 patients), recombinant gonadotropin was used with GnRH antagonist cetrorelix. The characteristics of the previous cycles for patients were also similar in both groups. Statistically, it was observed that the estradiol values in Group A were higher during ovulation induction. No significant difference was observed in the amount of gonadotropin used and stimulation durations in both groups. No significant difference was found in the number of oocytes collected. One pregnancy occurred in Group A, while 2 pregnancies occurred in Group B. A positive correlation was found between the baseline FSH value and the amount of gonadotropin used in Group B.

Conclusions: There was no statistically significant difference in term of oocytes, embryo and pregnancy in the two groups. Larger-scale studies are needed to obtain definitive results.

Maternal and perinatal outcomes in term pregnancies with meconium-stained amniotic fluid: a cross-sectional study from a tertiary care hospital in Nepal

Birendra Bhagat — 2026-02-25

Background: Meconium, the gastrointestinal excreta of the fetus, was first described by Aristotle. Meconium-stained amniotic fluid (MSAF) has traditionally been considered a sign of fetal distress in presentations other than breech and is associated with adverse fetal outcomes. However, some consider fetal passage of meconium to be a physiological phenomenon that may still pose environmental hazards to the fetus before birth. This study was conducted to evaluate the maternal risk factors associated with MSAF and its effect on fetal outcome in terms of morbidity and mortality.

Methods: This hospital-based cross-sectional study was conducted in the Department of Obstetrics and Gynecology, National Medical College, Birgunj, over a period of 12 months from July 2020 to July 2021. A total of 184 pregnant women fulfilling the inclusion criteria were enrolled. The cases were divided into two groups: thin meconium-stained and thick MSAF. Data analysis included various maternal and fetal parameters. Maternal risk factors and fetal outcomes were evaluated.

Results: Among the 184 cases, 31.72% had thin MSAF, while 68.28% had thick meconium. The associated maternal risk factors included pregnancy-induced hypertension, anemia, oligohydramnios, intrauterine growth restriction, and prolonged labor. Cesarean section was performed in 63.03% of cases, primarily due to non-reactive cardiotocography. Of the 184 neonates, 30.43% required admission to the neonatal intensive care unit due to low Apgar scores. Perinatal death occurred in eight cases: three due to meconium aspiration syndrome (MAS), two due to sepsis, two due to birth asphyxia, and one due to pneumonitis.

Conclusions: The presence of thick MSAF is associated with increased perinatal morbidity and mortality, as well as significant maternal risk factors.

Determinants and outcomes of teenage pregnancy in Uganda: a case study of Hoima

Leonard Ssebwami — 2026-02-25

Background: Uganda has one of the highest rates of teenage pregnancy in the world at 25%, more than twice the global estimate of 11% of all births. A remarkable number of girls start childbearing at a very early age in Uganda and is an overwhelming growing public health issue with enormous contribution to high maternal and perinatal morbidity and mortality.

Methods: This was a cross-sectional study conducted from June to August 2025 involving 326 women delivering at Hoima Regional Referral Hospital (HRRH), western Uganda. Interviewer administered questionnaires were used to obtain data. Descriptive statistics, binary logistic regression and chi-square analyses were utilized to elucidate the determinants of teenage pregnancy using IBM SPSS 24. Variables in final multivariate model were significant when p<0.05. The measure of association was reported as odds ratios with corresponding 95% confidence interval and p-value.

Results: Of the 326 women who delivered at HRRH during the study period, 87(27%) had teenage pregnancy. High level of education (AOR=0.2, 95%CI: 0.84-0.92, p=0.037; AOR=0.3, 95%CI: 0.12-0.58, p=0.001]), and good income status (AOR=0.4, 95%CI=0.15-0.96; p=0.040) were protective of teenage pregnancy. Early marriage and lack of awareness about contraception were associated with high odds for teenage pregnancy, (AOR=3.8, 95%CI=1.39-10.15; p=0.009) and (AOR=3.8, 95%CI=1.94-7.34; p=0.000) respectively.

Conclusions: The prevalence of teenage pregnancy in Hoima is alarming, compared to regional and global figures. Girl education, improved income status, discouraging early marriages and promoting awareness on use of contraception are essential in preventing teenage pregnancy in Hoima and its catchment areas.

Effectiveness of intermittent preventive treatment for malaria with sulfadoxine-pyrimethamine in women attending antenatal clinic at the University of Benin Teaching Hospital

Benice N. Onuoha — 2026-02-25

Background: Intermittent preventive treatment for malaria using sulfadoxine-pyrimethamine (IPT-SP) is one of the methods proposed by the World Health Organization (WHO) to reduce the burden of malaria in pregnant women. This study evaluated the practice of IPT-SP in UBTH in terms of compliance with the WHO recommendations and maternal outcome; and to explore factors that may facilitate or hinder its implementation.

Methods: This study was a mixed method, using the explanatory sequential design. The study population were 420 booked women at term selected randomly. A written informed consent was obtained. A semi-structured questionnaire was used to obtain data from personal identification card, case notes, and computerized system. Trained medical doctors collected information and peripheral blood samples for malaria parasite (MP) testing and packed cell volume (PCV) using rapid diagnostic test (RDT) kit and automated haemoglobinometer. The results were grouped into sub-optimal (IPT-SP <3) and optimal (IPT-SP ≥3). The qualitative study was an in-depth interview of stakeholders and focus group discussion with booked women not up to term receiving IPT-SP. Quantitative data were analysed using IBM SPSS with P <0.05; thematic analysis was used for qualitative data.

Results: Of the 420 booked women, 60% (252) were given ≥3 doses while 40% (168) were given <3 doses. However, 17% (43) of those who collected ≥3 doses did not swallow up to 3 doses. Thus, 211 (50.2%) had suboptimal dosing while 209 (49.8%) had optimal dosing. A total of 45 (10.7%) were MP positive, of which 91.1% (41) had suboptimal dosing and 8.9% (4) had optimal dosing; (p<0.0001). A total of 30 (7.1%) had PCV<30%, out of which 83.3% (25) had suboptimal dosing (p<0.0001). Mean PCV in suboptimal group was 27.33±2.17 and 35.65±3.23 in optimal group; (p<0.001). Major factors were absence of directly observed therapy (DOT), ignorance and lack of proper knowledge among caregivers and recipients, while caregiver dedication was a positive factor.

Conclusions: There is significant difference in maternal malaria parasitaemia and anemia between suboptimal and optimal IPT-SP dosing in UBTH. The impediments to IPT-SP distribution are comparatively easy to overcome.

Incidence of hepatitis B virus infection and associated risk factors among pregnant women in SSMC, Mitford Hospital

Ireen Akhter — 2026-02-25

Background: Hepatitis B is a global health problem, affecting approximately 2 billion people worldwide, and remains a significant cause of chronic hepatitis, liver cirrhosis, and hepatocellular carcinoma, with pregnant women at particular risk due to vertical transmission. Therefore, this study aimed to provide a comprehensive assessment of the incidence of HBV infection and associated risk factors among pregnant women in a tertiary care hospital in Bangladesh.

Methods: This cross-sectional analytical study at the Department of Obstetrics and Gynaecology, Sir Salimullah Medical College and Mitford Hospital (SSMCMH), Dhaka, Bangladesh, from August 2020 to January 2021, included 288 pregnant women who were interviewed for demographic, obstetric, and HBV risk factors, screened for HBsAg by rapid ICT with ELISA confirmation, and analyzed using Excel, Epi Info 6, and SPSS 17 (p<0.05), with ethical approval, confidentiality, and statistician-supervised quality assurance.

Results: Of 288 pregnant women screened, 13 (4.5%) were HBsAg-positive. Positive women were older (30.7±3.4 years), all housewives, with business as the most common husband’s occupation. Significant risk factors were HBV-positive husband [4 (30.8%)] and family HBV history [2 (15.4%)]. Most positive women were para 2 [7 (53.8%)], had first para-abortion [8 (61.5%)], third gravida [5 (38.4%)], gestational age ≤37 weeks [9 (69.3%)], and irregular antenatal care [9 (69.2%)]. Among ICT-positive women, 12 (92.3%) were confirmed HBsAg-positive by ELISA.

Conclusions: Hepatitis B virus remains prevalent among pregnant women in Bangladesh, highlighting the need for routine screening and identification of associated risk factors to ensure effective maternal and neonatal protection.

Accuracy of glycosylated fibronectin-based cut-off levels for predicting gestational diabetes mellitus

Sadia Mahfiza Khanam — 2026-02-25

Background: Gestational diabetes mellitus (GDM) is a common metabolic complication of pregnancy and is associated with adverse maternal and neonatal outcomes. Early identification of women at risk remains challenging, as routine screening is typically performed in mid-pregnancy. This study aimed to assess the accuracy of first-trimester maternal serum glycosylated fibronectin cut-off levels for predicting GDM.

Methods: A prospective cohort study was conducted at the Department of Obstetrics and Gynecology at Dhaka Medical College Hospital, Dhaka, Bangladesh, from December 2020 to November 2021. Ninety-five pregnant women with singleton pregnancies between 10 and 15 weeks of gestation were enrolled. Maternal serum glycosylated fibronectin was measured using ELISA. Participants were followed until delivery and GDM was diagnosed using WHO criteria at 24-28 weeks. Statistical analysis was performed using SPSS version 23.

Results: Most participants were aged 21–30 years (66.3%) and overweight (75.8%). Women who developed GDM had significantly higher mean glycosylated fibronectin levels than non-GDM women (226.7±73.3 vs. 114.2±57.9 µg/ml; p<0.001). Among women with glycosylated fibronectin ≥145.0 µg/ml, 83.3% developed GDM, whereas only 16.7% of GDM cases occurred below this threshold. Mean body mass index was also significantly higher among women with elevated glycosylated fibronectin levels (p=0.01).

Conclusions: Elevated first-trimester maternal serum glycosylated fibronectin is strongly associated with subsequent development of GDM and may serve as an effective early screening biomarker for identifying high-risk pregnancies.

A comparative study on the efficacy of drotaverine and valethamate on cervical dilatation during labour: a prospective study from a tertiary care hospital of Rajasthan

Mitali Khatri — 2026-02-09

Background: Numerous drugs have been used to shorten the active phase of labour. how rationale is to use these drugs to shorten the active phase of labour? do they really shorten the duration of labour? What adverse effects do they have on the baby and the mother? These questions were the basis to perform the present study of comparing two of such drugs, injection drotaverine and injection valethamate bromide in primi and multigravidas.

Methods: A randomised control trial was conducted to compare the efficacy of drotaverine and valethamate on cervical dilatation during labour among 140 cases (70 cases each) in Department of Obstetrics and Gynaecology, RNT Medical College, Udaipur (Rajasthan).

Results. The mean duration of first stage of labor was 190.87±38.7 minutes in the Drotin group, 257±44.54 minutes in the epidosin group and 286.68±103.1 minutes in the control group. These differences were statistically significant. There was no significant difference in the duration of second and of third stage.

Conclusion: Baseline cervical dilatation and effacement were comparable in both the groups. The rate of cervical dilatation was significantly faster among drotin group than valethamate. Mean injection to delivery interval was also significantly shorter in valethamate group compared to Drotin group.

Paternal age and reproductive outcomes in donor intracytoplasmic sperm injection cycles

Haritha Kannan — 2026-02-06

Background: Advanced paternal age has emerged as a potential contributor to adverse reproductive outcomes, though its role remains less clearly defined than that of maternal age. Donor oocyte intracytoplasmic sperm injection (ICSI) cycles provide an ideal model to study paternal effects by minimizing oocyte-related confounding effect. Objectives were to evaluate the impact of paternal age on clinical pregnancy rate (CPR) and live birth rate (LBR) in donor oocyte ICSI cycles.

Methods: This retrospective observational study analysed 101 donor oocyte ICSI cycles performed at Madras Medical Mission, Chennai from 2020 to 2025. Male participants were stratified into paternal age groups: <40 years, 40-45 years, and >45 years and their outcomes in donor ICSI cycles studied. Recipient female partners ages were between 27 and 45 years. Statistical analysis was performed using chi-square tests, with p<0.05 considered significant.

Results: The overall CPR was 51.4%, and the LBR was 34%. A declining trend in CPR and LBR was observed with increasing paternal age; however, these differences were not statistically significant (CPR: p=0.39; LBR: p=0.71). Miscarriage rates were higher in men aged 40 years and above (miscarriage rate p=0.340).

Conclusions: Although advancing paternal age did not significantly affect CPR or LBR in donor oocyte ICSI cycles, a negative trend was observed. These findings highlight the importance of incorporating paternal age into infertility counselling and reinforce the need for larger prospective studies.

Prevalence of abnormal amniotic fluid index and its association with maternal and perinatal outcomes: a retrospective observational study

Vidhi Singh — 2026-02-25

Background: Abnormal amniotic fluid volume is an established indicator of fetal wellbeing and has been linked to increased maternal and perinatal morbidity. Ultrasonographic assessment using the amniotic fluid index (AFI) enables early identification of high-risk pregnancies and guides obstetric decision making. Objectives of the study was to determine the prevalence of abnormal amniotic fluid volume and evaluate its association with adverse maternal and perinatal outcomes.

Methods: This retrospective observational study was conducted at a tertiary care teaching hospital and included 300 consecutive singleton pregnancies beyond 28 weeks’ gestation with documented AFI measurements. Amniotic fluid volume was categorized as oligohydramnios (AFI ≤5 cm), normal AFI (5.1–23.9 cm), and polyhydramnios (AFI ≥24 cm). Maternal outcomes assessed included induction of labour, mode of delivery, postpartum hemorrhage, and maternal intensive care unit (ICU) admission. The primary perinatal outcome was a composite of meconium-stained liquor, neonatal intensive care unit (NICU) admission, low Apgar score at 5 minutes (<7), and low birth weight (<2500 g). Statistical analysis included chi square tests and multivariable logistic regression.

Results: Of the 300 pregnancies, 240 (80%) had normal AFI, 45 (15%) had oligohydramnios, and 15 (5%) had polyhydramnios. Cesarean delivery was significantly more frequent in pregnancies with abnormal AFI (53.3% in oligohydramnios and 46.7% in polyhydramnios) compared to normal AFI (29.2%; p=0.001). Abnormal AFI was associated with significantly higher rates of meconium-stained liquor, NICU admission, low Apgar score, and low birth weight (all p<0.001). On multivariable analysis, abnormal AFI remained independently associated with adverse perinatal outcomes.

Conclusions: Abnormal amniotic fluid volume, particularly oligohydramnios, is associated with increased obstetric intervention and adverse perinatal outcomes. AFI is a simple, non-invasive, and effective tool for identifying high risk pregnancies and optimizing maternal and neonatal care.

Decoding hypertensive disorders in pregnancy: a tertiary center experience of risk, delivery, and outcome

Garima Singh — 2026-02-25

Background: Hypertensive disorders are a major cause of maternal and perinatal morbidity and mortality worldwide. This study aimed to investigate the prevalence, risk factors, clinical manifestations, and maternal and fetal outcomes associated with hypertension in pregnancy.

Methods: This prospective observational study was conducted in the Department of Obstetrics and Gynaecology at a tertiary care teaching hospital in Navi Mumbai over a defined study period. Pregnant women diagnosed with hypertensive disorders of pregnancy were included. Clinical and obstetric data were collected, including demographic characteristics, gestational age, parity, mode of delivery, and neonatal outcomes. Data were analyzed using descriptive statistics and appropriate inferential tests, with a p value of <0.05 considered statistically significant.

Results: The mean age of participants was 31.04±4.8 years. Most women were multigravida or grand multipara (61.2%). Caesarean section was the predominant mode of delivery (82.7%). The most common neonatal birth weight was between 2 and 2.5 kg (23.5%). No statistically significant association was observed between demographic or obstetric factors and mode of delivery, although obesity showed a trend toward significance (p=0.07).

Conclusions: Hypertensive disorders during pregnancy are prevalent and associated with adverse maternal and fetal outcomes. Early identification of risk factors and close monitoring of high-risk pregnancies are crucial for improving outcomes.

Clinicopathological study of ovarian tumors

Zenab Hasan — 2026-02-25

Background: Ovarian tumors are a significant gynecological concern with high morbidity and mortality due to late-stage diagnosis. Their deep pelvic location and vague early symptoms, such as abdominal pain and bloating, contribute to diagnostic delays. Understanding the clinicopathological profile of ovarian tumors is essential for timely diagnosis, accurate classification, and optimal treatment planning. The aim of the study is to evaluate the clinical presentation and pathological features of ovarian tumors and assess their implications for diagnosis and patient management through a comprehensive clinicopathological study.

Methods: A prospective observational study was conducted over one year in the Department of Obstetrics and Gynecology, LLRM Medical College and SVBP Hospital. Fifty female patients with histopathologically confirmed ovarian tumors were enrolled. Clinical data, imaging findings, and pathological diagnoses were analyzed. Tumor types, symptomatology, and diagnostic correlations were evaluated using SPSS v21.0, with p<0.05 considered statistically significant.

Results: The mean age of patients was 48.3 years. Most belonged to the lower middle socioeconomic class. Abdominal pain (60%) was the most frequent symptom. Benign tumors accounted for 65% of cases, followed by malignant (25%) and borderline (10%). Mean tumor sizes progressively increased from benign to malignant (5.4 cm to 8.9 cm). USG and histopathology findings showed high concordance in malignancy detection but varied slightly for benign and borderline lesions.

Conclusions: Ovarian tumors most commonly present with nonspecific symptoms and are predominantly benign. Tumor size correlates with malignancy. Histopathological confirmation remains essential for accurate diagnosis, reinforcing its role in guiding management.

Menstruation physiology knowledge and hygiene practices among adolescent girls from rural and urban backgrounds: a comparative study

Indu Khare — 2026-02-25

Background: Proper menstrual hygiene practices are needed for optimum health and dignity of women. One such practice is use of menstrual cup which has not gained widespread acceptance due to lack of awareness and inadequate promotion. A mixed method study conducted to assess the prevalence, practice and effectiveness of technology assisted intervention on knowledge and attitude of menstrual cup usage among working women at selected institution, Salem.

Methods: With formal consent, the prevalence and practice of menstrual cup usage was assessed from working women along with the pre and post-test level of knowledge and attitude.

Results: Strong positive approach was found among the samples who felt comfortable and happy, and even recommended to others. Among 120 working women, only 4 (3.3%) of them were using menstrual cup. Highest percentage of them had moderately adequate knowledge (60.50%) and neutral attitude (15.7%) in pretest with the mean score of 9.13±2.93 and 60.4±9.6 respectively. Whereas, highest percentage of them had adequate knowledge (81.56%) and positive attitude (52.6%) in post-test with the mean score of 14.13±3.22 and 70.47±10.7 respectively which is highly significant at p≤0.001 level. Also, high positive correlation (r=0.89) was found between knowledge and attitude. Significant association was found between selected variables.

Conclusions: The study concluded that though many of the women have heard of menstrual cup, the usage is lesser due to lack of awareness about the usage, its benefits and fear of using. Hence measures need to be taken to promote awareness.

A mixed method study to assess the prevalence, practice and the effectiveness of technology assisted intervention on knowledge and attitude of menstrual cup usage among working women at a selected institution, Salem

M. Kanagadurga — 2026-02-25

Methods: With formal consent, the prevalence and practice of menstrual cup usage was assessed from working women along with the pre and post-test level of knowledge and attitude.

Prospective comparative study of misoprostol alone versus mifepristone plus misoprostol for second-trimester pregnancy termination

Vanishree Mangalsing Chavhan — 2026-02-25

Background: Second-trimester medical termination of pregnancy (MTP) is legally permitted in India up to 24 weeks under the MTP Act. Misoprostol is widely used for this purpose, but its efficacy may be enhanced by pre-treatment with mifepristone. This study aimed to compare the efficacy and safety of misoprostol alone versus mifepristone followed by misoprostol for second-trimester pregnancy termination.

Methods: A prospective, randomized comparative study was conducted at SKNMC&GH, Pune, involving 61 women between 13-24 weeks gestation. Group I (n=31) received oral mifepristone followed by vaginal misoprostol; Group II (n=30) received misoprostol alone. Primary outcome was induction-to-abortion interval; secondary outcomes included misoprostol dose requirement, need for surgical intervention, and complications.

Results: Group I showed a significantly shorter induction-to-abortion interval (7.8±2.3 hrs vs. 11.6±3.1 hrs; p<0.001), required fewer misoprostol doses (3.1±0.9 vs. 4.8±1.2; p<0.001), and had lower curettage rates (6.5% vs. 23.3%; p=0.04). Complete abortion rates were high in both groups (93.5% vs. 86.7%; p=0.37). Stratified analysis confirmed consistent benefits across parity groups and gestational age ranges.

Conclusions: Mifepristone pre-treatment significantly improves procedural efficiency and reduces intervention burden in second-trimester medical abortion. The combined regimen is recommended for safer and more predictable outcomes under the MTP framework.

Do karyotypic abnormalities exist in young infertile women with diminished ovarian reserve?

Nikita Naredi — 2026-02-25

Background: Women are endowed with a finite number of oocytes, which decrease in number and quality over time. Environmental factors, hormonal influence, iatrogenic and genetic factors impact the ovarian reserve. Diminished ovarian reserve indicating a reduction in the quantity and quality of ovarian follicular pool in women of reproductive age affects 10% women seeking fertility treatment. Objective was to find out karyotypic abnormalities in young infertile women with diminished ovarian reserve.

Methods: This retrospective study was carried out over a period of one year at the Assisted Reproductive Technology Centre of a tertiary care public sector hospital. Medical records including the infertility data of 784 couples who underwent In vitro fertilization cycle during the study period was analysed. A total of 104 women with diminished ovarian reserve as evidenced by anti-Mullerian hormone (AMH) value less than 1.1 ng/ml were included in the study.

Results: Out of 104 women with DOR, only 5 women (5 %) had slight variation in karyotype like 46XX 1qh+, 46XX 15ps+, 46XX 16qh+ which are normal polymorphic variations seen in general population. Remaining 99 (95%) women had normal female karyotype (46 XX).

Conclusions: Women with diminished ovarian reserve mostly have a normal female karyotype.

Third trimester oligohydramnios and pregnancy outcome in a tertiary care hospital

Basanta Manjari Hota — 2026-02-25

Background: Amniotic fluid has an important function in achieving a successful pregnancy outcome. An amniotic fluid Index of <08 cm is considered oligohydramnios and is expected to result in an adverse pregnancy outcome. Many of its etiologies are preventable and treatable with early diagnosis and timely intervention.

Methods: The present retrospective, cross-sectional study was conducted in the Department of Obstetrics and Gynecology, Mamata Medical College, Khammam, Telangana, from 1^st January 2024 to 31^st December 2024, including all eligible oligohydramnious cases. Detailed patient data were collected from the Department of Medical Records, analyzed using standard descriptive statistics, and the significance of the correlation of the degree of oligohydramnios on pregnancy outcome was determined using p-values in Microsoft Excel 21. Results were discussed critically and compared with those of other studies.

Results: A total of 74 oligohydramnios cases constituted an incidence of 05.90%. Mean age was 24.20±04.21years, 79.73% caesarean delivery, <7 Apgar score at 01 min in 60.81%, and 58.11% at 05 min, 56.76% low birth weight, and neonatal intensive care unit (NICU) admission was 56.76%. Significant differences were found in mode of delivery, meconium-stained liquor, Apgar score, and NICU admission between the two groups of oligohydramnios.

Conclusions: Adverse pregnancy outcome in the third trimester oligohydramnios can be reduced, with adequate antenatal care, though not completely preventable. The study aimed to determine the incidence of oligohydramnios in the third trimester of pregnancy, the contributing factors prevalent in the region, and the effect on pregnancy outcome.

The impact of embryo quality and endometrial thickness on frozen embryo transfer cycles

Anshika Gupta — 2026-02-25

Background: Endometrial thickness and embryo quality are critical factors influencing implantation rates in IVF cycles. This study aimed to study how endometrial thickness impacts implantation rate in FET cycles and study the relationship between the quality of the transferred embryos and the occurrence of successful pregnancy.

Methods: This study retrospectively analyzed 100 embryo transfer cycles that were performed in fertility centers associated with SPOVUM TECHNOLOGIES PRIVATE LIMITED, Rajajinagar, Bangalore. ET assessment was performed with grayscale ultrasound on the day of embryo transfer. Embryo grading ranked embryos based on morphological features of each embryo indicating its viability and developmental potential.

Results: Out of 100 patients, successful pregnancy was achieved in 56 patients, giving implantation rate of 56% (56/100). Patients with endometrial thickness (ET) <9 mm on the day of embryo transfer had significantly lower implantation rates compared to those with ET ≥9 mm (p = 4.68 × 10⁻⁵). Implantation rates by embryo grade were 65% for excellent, 60% for fair, and 14% for poor-grade embryos. Higher implantation rates were observed following transfer of blastocysts with Grade A and B trophectoderm (TE) (p = 0.002833). Associations between successful implantation and patient age, as well as embryo grade, were statistically significant (p = 3.451 × 10⁵ and 3.511 × 10⁻⁴, respectively).

Conclusions: Ultrasound assessment of endometrial thickness and vascularity helps optimize Day 5 embryo transfer timing and implantation. Overall blastocyst quality strongly influences pregnancy outcomes. The study supports incorporating TE and ICM morphological grading to improve embryo selection criteria.

Maternal and perinatal outcomes in pregnancies conceived after infertility treatment at a tertiary care centre in Chhattisgarh: a prospective observational study

Sonalika A. Bhad — 2026-02-25

Background: Infertility affects 10-15% of couples in India, with increasing reliance on ovulation induction, intrauterine insemination (IUI), and assisted reproductive technologies (ART). Pregnancies conceived following infertility treatment have been associated with higher maternal and perinatal risks. Objective of this study was to evaluate maternal and fetal complications in pregnancies conceived after infertility treatment and identify factors influencing maternal-neonatal morbidity.

Methods: A prospective observational study was conducted over 12 months at a tertiary care center in Chhattisgarh. Sixty antenatal women who conceived after infertility treatment (OI, IUI, IVF, fertility-enhancing surgery) were enrolled. Demographic, clinical, obstetric, and neonatal outcomes were analysed using descriptive statistics.

Results: Mean maternal age was 31.8 years; 68.3% had primary infertility. PCOS was the most common female cause (56.7%). IVF accounted for 40% of conceptions, while OI+TI accounted for 43.3%. Medical complications included gestational hypertension (26.7%), GDM (26.7%), IHCP (16.7%), and preeclampsia (3.3%). PROM occurred in 15%, and preterm labor in 5%. LSCS rate was high (78.3%), with 87.5% of IVF pregnancies delivered by LSCS. Neonatal outcomes showed 31.8% low birth weight and 7.6% very low birth weight infants. Preterm delivery occurred in 23.3%.

Conclusions: Pregnancies conceived after infertility treatment especially those resulting from IVF, older maternal age, PCOS, obesity, and long-standing infertility were associated with higher risks of hypertensive disorders, GDM, PROM, preterm birth, LSCS, and low birth weight. Enhanced antenatal surveillance and multidisciplinary management are essential to optimize outcomes.

Study on acceptance of immediate postpartum intrauterine contraceptive device and their follow-up

Fathima Banu K. — 2026-02-25

Background: India faces a persistent challenge with a high unmet need for family planning, particularly in the immediate postpartum period, with 65% of women in the first-year postpartum requiring contraception. Immediate postpartum intrauterine contraceptive devices (PPIUCDs) offer a highly safe, effective, long-acting, and reversible method that does not interfere with breastfeeding. This study aimed to determine the acceptance rate of PPIUCD, identify key factors influencing acceptance, and analyse reasons for discontinuation among postpartum women in a tertiary care centre.

Methods: A study was conducted on 1,000 postpartum participants at Government Medical College, Kozhikode. Participants were counselled on PPIUCD (Cu T 380A), and acceptance, demographics, and follow-up data were collected at 6 weeks and 6 months postpartum.

Results: The overall acceptance rate was 18% (n=179). Acceptance was significantly higher among parity 2 women (23.5%). Key reasons for acceptance included long-term use (41%) and reversibility (23%). The main reasons for rejection were fear of pain and bleeding (33%) and partner refusal (29.7%). At the 6-week follow-up, the continuation rate was 87%. Discontinuation (13%) was due to removal or expulsion.

Conclusions: PPIUCD acceptance remains low but is significantly influenced by parity, age, and counselling location. Targeted, culturally sensitive counselling is essential to address common misconceptions and partner concerns to improve the uptake of this highly effective contraceptive method.

Is levonorgestrel intra-uterine system in menorrhagia: effective and acceptable? A retrospective study

Niranjana Rajan — 2026-02-25

Background: This study aimed to evaluate the effectiveness, acceptability, satisfaction and continuation rates of the levonorgestrel intrauterine system (LNG-IUS) in women with heavy menstrual bleeding (HMB) and to assess associated adverse effects.

Methods: This retrospective study was conducted in the Department of Obstetrics and Gynaecology, Vijaya Hospital, Chennai. Fifty-five women who underwent LNG-IUS insertion for HMB between January 2023 and January 2025 were identified from outpatient records. Demographic details, co-morbidities, menstrual patterns, ultrasound findings, and histopathology reports were reviewed. Follow-up assessments at 3 and 6 months included evaluation of menstrual blood loss, dysmenorrhea, side effects, and satisfaction scores. Continuation and acceptability rates were documented. Patient satisfaction was measured on a 1-5 scale.

Results: The mean age of participants was 42.3 years, and 78% were overweight or obese. A significant reduction in menstrual blood loss was observed, with 90% showing improvement by 6 months. Amenorrhea occurred in 44%, normal bleeding in 26%, and spotting in 20% of women. Dysmenorrhea decreased from 64% at beginning to 4% at 6 months. The continuation rate was 90% and the overall satisfaction score was 74.5%. The LNG-IUS expulsion rate was 10%. The most common adverse effects were spotting (25%) and simple ovarian cysts (20%).

Conclusions: LNG-IUS is an effective, acceptable, and minimally invasive therapeutic option for HMB, offering substantial improvement in symptoms, high continuation rates, and favourable tolerability. It serves as a safe and cost-effective alternative to conventional medical and surgical treatments.

Assessment of patient satisfaction in obstetric care under the LaQshya program

Archana Singh — 2026-02-25

Background: Patient satisfaction is a key indicator of healthcare quality, especially in maternity services. The LaQshya program, launched by the Government of India, aims to improve labour room and maternity OT services and ensure respectful maternity care. To assess the effectiveness of the program, study was done to know patient satisfaction with obstetric care among post-delivery women at Government General Hospital, Siddipet.

Methods: A prospective cross-sectional study was conducted over 3 months among 1000 postpartum women who stayed for at least 2 days after delivery. A structured questionnaire assessed socio-demographic profile, communication, birthing satisfaction, staff behaviour, hospital facilities, and overall satisfaction.

Results: Most patients reported satisfaction with communication (90%), intrapartum care (94%), and staff professionalism (94%). Birthing satisfaction was high, with 100% reporting privacy and permission for a birth companion. Hospital infrastructure satisfaction was 81%, cleanliness 85%, and bed availability 93%. Overall, 83% rated services as “good” and 17% as “excellent.” The mean satisfaction score was 92.5%.

Conclusions: Overall patient satisfaction with obstetric services was high, indicating effective implementation of the LaQshya program. Continuous monitoring and targeted interventions can further enhance quality of maternal care.

Are all day 6 blastocysts inferior to day 5 blastocysts? A retrospective study comparing reproductive outcomes between day 5 and day 6 good quality blastocysts in various clinical scenarios

Rubina Pandit — 2026-02-25

Background: Day 5 (D5) blastocysts have a better reproductive outcome than Day 6 (D6) blastocysts in fresh cycle transfer. However, conflicting results were observed in frozen embryo transfers (FET), primarily due to presence of multiple confounding factors. The aim of study was to compare reproductive outcomes between D5 and D6 good quality blastocysts in FET in different clinical scenarios causing infertility - female, male, unexplained and combined (male and female) factors.

Methods: This was a retrospective cohort study conducted at multiple chains of a private fertility center. A total of 16,996 D5 and 4,382 D6 good quality blastocysts were included. Clinical Pregnancy Rates (CPR), Implantation Rates (IR), Miscarriage Rates (MR) and Biochemical Pregnancy Rates (BPR) were compared in four different scenarios.

Results: In female factor, D5 blastocysts have better CPR (60.85% vs 47.95%) and IR (47.15% vs 36.13%) compared to D6 blastocysts. Similar outcomes were observed in unexplained factors where D5 blastocysts had better CPR (59.64% vs 45.83%) and IR (45.63% vs 33.08%) than D6 blastocysts. In male factor, CPR (53.61 % vs 49.79%) and IR (40.12% vs 39.96%) were comparable between D5 and D6 blastocysts. Similar comparable rates were found in combined causes - CPR (51.26% vs 48.97%) and IR (39.45% vs 37.78%).

Conclusions: Reproductive outcomes were better in D5 than D6 blastocysts in female and unexplained factors. The results were comparable in male and combined factors indicating that not all D6 blastocysts can be considered inferior to D5 blastocysts.

Effect of age on antral follicle count, AMH levels and pregnancy outcomes in ART

Suparna Bhattacharya — 2026-02-25

Background: The purpose of this study is to determine if baseline antral follicle assessment and serum AMH level may serve additional information in predicting pregnancy outcome in in-vitro fertilization outcome in women of different age groups.

Methods: A total of 680 cycles of in-vitro fertilization (IVF) in all clinics of Nova IVF fertility all over India from June 2023 to December 2024 were retrospectively analyzed in a cohort study. All the patients recruited in the study will be divided into 2 groups, based on age as-Group 1) Age<35 years (n=335) Group 2) Age>35 years (n=345). Each group will be further subdivided into 3 subgroups, depending upon their AMH (anti mullerian hormone) and AFC (antral follicle count). They were divided into very low AMH group, low-AMH group and high-AMH group. Similarly AFC groups were divided into <5, 5-9 and >10. Primary outcomes included the No of oocytes retrieved, No of mature oocytes, Biochemical Pregnancy rate, Clinical Pregnancy Rate. Secondary outcomes included fertilisation rate, blastulation rate, miscarriage rate.

Results: The pregnancy rates for women below 35 years and above 35 years were not significant in the AMH subgroups but was significant in the AFC subgroup of 5-9, where it was 53.12% and 27.91% respectively. The Area Under the Curve (AUC) for the logistic regression model 0.656, indicating moderate discriminative ability. The distribution of AFC and AMH values by age group illustrates that younger women more frequently fall into higher AFC and AMH categories, supporting their use as age-related biomarkers. However, pregnancy and miscarriage rates are stratified by AMH and AFC groups failed to reach statistical significance, implying limited predictive value for these markers in isolation when it comes to final pregnancy outcome.

Conclusions: Correlation analysis further affirmed that AFC has stronger associations with ovarian and embryological parameters compared to AMH. This aligns with prior research and clinical understanding, which recognizes AFC as a more dynamic and reliable predictor of ovarian reserve and treatment responsiveness. AMH, while useful, showed only moderate correlation with oocyte quantity and did not significantly predict fertilization, blastulation or pregnancy outcomes.

Study of fetomaternal outcome in first trimester bleeding per vaginum

Hemilkumar Hasmukhbhai Patel — 2026-02-25

Background: First trimester vaginal bleeding is a frequent obstetric problem affecting 20–25% of pregnancies and is associated with anxiety and adverse pregnancy outcomes. It may range from benign causes to life-threatening conditions and can significantly influence fetal and maternal prognosis.

Methods: This retrospective observational study was conducted at Sub district hospital Gandhidham Bhuj Kutch over 9 months and included 40 pregnant women presenting with vaginal bleeding in the first trimester. Data regarding age, parity, obstetric history, ultrasound findings, management and pregnancy outcomes were collected from hospital records and analyzed.

Results: Most women were aged 21–30 years and 62.5% were primigravida. Ultrasound findings included normal scans, incomplete and missed abortions, anembryonic gestation, ectopic pregnancy and subchorionic hematoma. Conservative and medical management was used in threatened cases, while surgical intervention was required in non-viable pregnancies. Eighteen women had viable outcomes, with 13 delivering live babies.

Conclusions: First trimester bleeding is a high-risk condition associated with increased miscarriage and adverse obstetric outcomes. Early diagnosis, close monitoring and proper counselling are essential to improve feto-maternal outcomes.

Association of disorders of coagulation profile with feto-maternal outcome in abruptio placentae

Shivangi — 2026-02-25

Background: Placental abruption is a significant cause of maternal morbidity and perinatal mortality. There is a paucity of literature on evaluation of coagulation profile in patients with placental abruption and their feto-maternal outcome. Therefore, the present study was designed to evaluate disorders of coagulation system and feto-maternal outcome in patients with placental abruption.

Methods: It was a prospective, observational study on 254 pregnant women diagnosed as abruption at >28 weeks gestation. Women were tested for prothrombin time, activated Partial Thromboplastin Time (aPTT), Internalised Normalised Ratio (INR), plasma fibrinogen, factor VIII, Von Willebrand Factor, factor IX, protein C, protein S and antiphospholipid antibodies. They were followed till discharge for feto-maternal outcome. Variables were compared using Unpaired t-test/Mann-Whitney Test/Chi-Square test/Fisher’s exact test.

Results: Prolonged prothrombin time was found in 251/254 (98.82%) women, factor VIII and factor IX deficiency was found in 248/254 (97.64%) and 247/254 (97.24%) women respectively. Of 254 women, 143 (56.30%) had prolonged aPTT, 134 (52.76%) had raised INR decreased serum fibrinogen was found in 111/ 254 (43.70%) women. Cases of abruption with any one coagulation defect had adverse maternal and fetal outcome. It was interesting to find that a proportion of women who had no coagulation defect were not associated with hypertensive disorders of pregnancy, delivered vaginally, and had no NICU admission or neonatal death.

Conclusions: Most of the abruption cases had factor VIII, factor IX deficiency and prolonged prothrombin time and had adverse feto-maternal outcome. However, women without any coagulation disorders had a favourable outcome.

Quality of life at initial presentation in patients with gynaecological malignancies: a cross-sectional study from a tertiary care centre in India

Saloni Chadha — 2026-02-25

Background: Gynaecological malignancies are associated with significant physical, psychological, social, and functional morbidity, often beginning at the time of diagnosis. Quality of life (QOL) assessment at baseline remains underexplored in the Indian setting. This study aimed to evaluate the quality of life of patients with gynaecological cancers at the time of initial presentation using the Functional Assessment of Cancer Therapy-General (FACT-G) questionnaire.

Methods: This cross-sectional observational study included 70 newly diagnosed, treatment-naïve patients with gynaecological malignancies presenting to a tertiary care hospital in North India. QOL was assessed using the interviewer-administered FACT-G questionnaire, comprising physical, social, emotional, and functional well-being domains. Descriptive statistical analysis was performed.

Results: Pain was the most frequently reported physical symptom, affecting 73% of patients. Emotional distress was highly prevalent, with 78% reporting sadness and fear of dying. Social well-being was compromised, with 88% reporting lack of closeness to friends and 70% dissatisfaction with sexual life. Overall, 76% of patients were dissatisfied with their current quality of life.

Conclusions: Quality of life was significantly impaired across multiple domains at the time of diagnosis of gynaecological cancers. Early identification of QOL deficits and integration of supportive and psychosocial care from the outset of cancer management are essential to improve patient-centered outcomes.

Failed induction of labor and associated factors among women undergoing induction of labor

Gayatri L. Patil — 2026-02-25

Background: Induction of labor (IOL) is increasingly employed in modern obstetric care, yet carries a significant risk of failure, contributing to higher caesarean rates and associated maternal-neonatal morbidity. Identifying factors that influence IOL success is essential for individualized labor management.

Methods: This prospective observational study was conducted over one year at a tertiary care center in Karnataka, India. A total of 504 women undergoing IOL at ≥37 weeks gestation were enrolled. The induction protocol included mifepristone followed by misoprostol and oxytocin augmentation. Primary outcome was failed induction, defined as failure to enter active labor or caesarean delivery for failed progress. Associations between maternal and obstetric variables and IOL failure were analyzed using chi-square tests.

Results: Out of 504 women, 181 (35.9%) experienced failed induction. PROM was the strongest predictor of failure (81.9%), followed by unfavorable Bishop score <5 (70.8%), maternal age <20 years (76.3%) or >35 years (67.5%), BMI >25 (58.3%), and post-term pregnancy (71.42%). Primigravidity and birth weight >4 kg were also significant contributors. Most caesareans due to failed induction resulted in favorable neonatal outcomes, though a small proportion required NICU admission.

Conclusions: Failed induction is prevalent in women with PROM, low Bishop scores, maternal age extremes, high BMI, and suspected macrosomia. Pre-induction risk stratification and cervical ripening optimization can enhance IOL success and reduce cesarean burden.

Awareness and acceptance of cervical cancer screening among women attending a tertiary care hospital: a cross-sectional study

Ramajyothi Sanavelli — 2026-02-25

Background: Cervical cancer remains a major public health challenge in India despite the availability of effective screening methods and HPV vaccination. Limited awareness and poor utilization of screening services contribute significantly to delayed diagnosis.

Methods: A hospital-based cross-sectional study was conducted among 334 married women aged 20–65 years attending the gynaecology outpatient department of a tertiary care hospital in Telangana from February-November 2025. Data were collected using a pretested structured questionnaire. Statistical analysis was performed using SPSS version 26. Chi-square test and multivariate logistic regression were applied. A p value <0.05 was considered statistically significant.

Results: Only one third (31.4%) of participants were aware of cervical cancer. Awareness regarding symptoms (13.5%), risk factors (8.9%), preventive measures (6.9%), and HPV vaccination (14.0%) was low. Awareness of screening tests was reported by 12.8%, and only 7.0% had ever undergone screening. Despite poor knowledge and minimal screening practice, willingness to undergo screening was high (82.0%). On multivariate analysis, employment status (Adjusted OR 2.31; 95% CI: 1.18-4.52), knowledge of screening tests (Adjusted OR 3.11; 95% CI: 1.49-6.48), and willingness to undergo screening (Adjusted OR 5.62; 95% CI: 2.71-11.64) were independent predictors of awareness.

Conclusions: Awareness and utilization of cervical cancer screening services were inadequate despite high willingness. Strengthening targeted health education and provider-initiated counseling is essential to improve screening uptake.

Routine vs no episiotomy in primigravida: a pilot RCT on perineal injury and pelvic floor dysfunction

Archana Kumari — 2026-02-25

Background: The present study compared the effect of ‘routine-episiotomy’ vs ‘no-episiotomy’ on perineal injury and pelvic floor function during normal vaginal delivery in primigravida.

Methods: This open-label RCT allocated women in the second stage of labour to routine mediolateral episiotomy or no-episiotomy (1:1) using concealed computer-generated randomisation. Episiotomy was avoided in the no-episiotomy group unless instrumental delivery was required for maternal or foetal reasons. Perineal trauma, suturing characteristics, pain, pelvic-floor function, urinary and anal incontinence were assessed at 24 hours, 36 hours, and 3 months postpartum. Pre and post-episiotomy biomarkers assessed the tissue-level injury. Analyses were conducted in STATA with significance at p<0.05.

Results: Out of 125 women screened initially, n=42 were randomised to episiotomy and no-episiotomy groups, while n=83 were excluded due to caesarean section or instrumental delivery. The episiotomy group had a shorter second stage of labour (p=0.034) and longer tears (p=0.047). More women in the no-episiotomy group used analgesics within 24 hours (p=0.048), but none after 36 hours. There was no significant difference in perineal pain, subjective tear grading, or pelvic-floor dysfunction, anal and urinary incontinence in both groups. Furthermore, biomarkers showed a significant increase in MDA (p=0.005) in the no-episiotomy group and increased TNF-α (p=0.042) in the episiotomy group, while CK and IL-6 changes were not significant.

Conclusions: Considering no additional clinical benefits of episiotomy compared to no-episiotomy in terms of perineal pain, pelvic-floor dysfunction, or most biomarkers, routine episiotomy should be discouraged in clinical practice.

A cross-sectional study on knowledge, attitude, and practices regarding cervical cancer screening among women aged 21-45 years attending a tertiary care hospital in Southern India

Saranya M. Krishnamoorthy — 2026-02-25

Background: Cervical cancer remains a leading yet preventable cause of cancer-related morbidity and mortality among women in India. Despite the availability of screening methods and human papillomavirus vaccination, utilisation remains low. Assessing gaps in knowledge, attitudes, and practices is essential to understand this discrepancy and to guide effective prevention strategies. This study assessed knowledge, attitudes, and practices related to cervical cancer screening and human papillomavirus vaccination among women aged 21-45 years.

Methods: A descriptive cross-sectional study was conducted among 250 women aged 21-45 years attending the outpatient department of a tertiary care hospital in Chennai. Data were collected using a structured questionnaire. Knowledge, attitude, and practice scores were categorized using predefined score-based criteria. Data were analysed using STATA version 11.0. Associations were assessed using the chi-square test, and relationships between knowledge, attitude, and practice were evaluated using Pearson’s correlation coefficient. A p-value less than 0.05 was considered statistically significant.

Results: Based on composite scoring, 52.0% of participants demonstrated poor knowledge regarding cervical cancer and its prevention, and only 31.6% were aware of screening methods. Although 46.8% had heard of the human papillomavirus vaccine, vaccination uptake was low at 2.8%. In contrast, 69.6% exhibited a positive attitude toward cervical cancer screening, while actual uptake of cervical cancer screening and HPV vaccination remained low. Knowledge showed significant positive correlations with attitude and practice, and attitude with practice, with all p-values below 0.001.

Conclusions: Targeted counselling, opportunistic screening, and community education are essential to convert positive attitudes into preventive action.

Demographic and clinical predictors of gestational diabetes mellitus in early pregnancy: a prospective observational study

Pooja Agarwal — 2026-02-25

Background: Gestational diabetes mellitus (GDM) poses significant health risks to both the mother and fetus. Identifying predictors of GDM early in pregnancy can facilitate timely intervention and reduce associated morbidity. To evaluate demographic and clinical parameters as predictors of GDM in pregnant women attending antenatal care before 20 weeks of gestation.

Methods: A prospective observational study was conducted on 200 pregnant women attending antenatal outpatient department at J.L.N. Hospital and Research Centre, Bhilai, Chhattisgarh. Relevant demographic and clinical data were recorded. DIPSI tests were conducted at <20 weeks, 24-28 weeks and 32-34 weeks of gestation. Associations between GDM and factors such as age, BMI, family history of diabetes, gravidity, haemoglobin and socioeconomic status were analysed using chi-square and t-tests.

Results: GDM was diagnosed in 34 participants (17%). Significant predictors of GDM included advanced maternal age (p<0.01), higher BMI (p=0.02) and positive family history of diabetes (p<0.001). Gravidity, hemoglobin and socioeconomic status did not show any associations.

Conclusions: Maternal age, BMI and family history of diabetes are strong predictors of GDM. Routine screening and early risk stratification based on these predictors can guide targeted interventions, particularly in resource-limited settings.

Injectable natural progesterone: a physiologic alternative following the withdrawal of 17α-hydroxyprogesterone caproate for preterm birth prevention

Venkata Kishan Pokuri — 2026-02-11

Following the withdrawal of 17-alpha hydroxyprogesterone caproate (17-OHPC; formerly marketed as MAKENA) there is a therapeutic gap in the prevention of recurrent spontaneous preterm birth (PTB) in women with singleton pregnancies and a history of prior PTB. Originally granted accelerated approval based on the Meis trial, 17-OHPC failed to demonstrate clinical benefit in the confirmatory PROLONG trial and raised long-term safety concerns regarding childhood cancer risk. In contrast, natural progesterone, an endogenous hormone essential for pregnancy maintenance, can provide strong biological plausibility for myometrial quiescence through evident genomic and non-genomic mechanisms. Although no head-to-head trials exist comparing intramuscular (IM) natural progesterone with 17-OHPC for PTB, physiological reasoning, pharmacokinetic advantages of the native molecule, and indirect evidence from historical and contemporary progestogen studies support its consideration as a viable alternative. In this short communication we highlight the mechanistic rationale for IM natural progesterone while acknowledging the need for dedicated clinical trials to establish efficacy and optimal dosing in modern obstetric practice.

Aspirin history and its clinical applications in pregnancy

Mukesh Kumar — 2026-02-25

Aspirin (acetylsalicylic acid), derived from salicylate-containing plants and refined through major chemical advances in the 19th century, remains one of the most widely used NSAIDs. Its irreversible inhibition of COX-1 reduces thromboxane A₂ production, producing sustained antiplatelet effects central to its therapeutic use. Hypertensive disorders of pregnancy are major contributors to maternal and perinatal illness and death globally, with preeclampsia posing a significant clinical challenge. Low-dose aspirin (LDA) is extensively studied in pregnancy and is recommended for preventing preeclampsia, with strong evidence demonstrating reduced maternal and perinatal morbidity, particularly when initiated before 16 weeks. Additional benefits include lower rates of preterm birth, improved foetal growth in selected cases of IUGR, and enhanced pregnancy outcomes in women with APS and SLE when used alone or in combination with heparin. Major guidelines from ACOG, NICE, RCOG, WHO, and FIGO support LDA use in high-risk pregnancies.

Integrating law and ethics through scenario-based learning in midwifery education: effects on moral sensitivity and reasoning

Suhashini — 2026-02-25

This scoping review examined the impact of integrating law and ethics through scenario-based learning (SBL) on moral sensitivity and moral reasoning in midwifery and related health-professional education. Midwives frequently navigate ethically complex and legally consequential decisions in maternity care, making ethical competence essential for safe and respectful practice. However, traditional didactic instruction often fails to prepare students for real-world ethical dilemmas. Using the Arksey and O’Malley framework and PRISMA-SR guidelines, seven major databases were searched from 2000 to 2025, yielding 35 eligible studies. These included midwifery, nursing, medical, and interprofessional education contexts. Findings showed that SBL delivered through written scenarios, high-fidelity simulation, standardized patients, virtual platforms, and problem-based learning consistently enhanced learners’ ability to identify ethical issues, understand legal obligations, and engage in principled moral reasoning. Interventions that incorporated structured debriefing, reflective dialogue, and explicit legal analysis produced the strongest improvements. Moral sensitivity improved in 26 of 31 studies measuring this outcome, particularly when scenarios reflected emotionally charged maternity care situations. Moral reasoning also improved across 18 of 24 studies, with the greatest gains observed when SBL was longitudinal and interactive. Barriers included limited faculty expertise, insufficient legal integration, and resource constraints. Overall, evidence demonstrates that SBL is a powerful pedagogical approach for strengthening ethical and legal competence in midwifery education. The review highlights the need for more midwifery-specific research, culturally adapted scenarios, and rigorous long-term evaluations.

Reducing preventable maternal and neonatal deaths: policy, practice and evidence-based pathways to achieve universal health targets

Usha Rani R. — 2026-02-25

Preventable maternal and neonatal deaths remain a major global health challenge despite decades of progress and the availability of effective, evidence-based interventions. This review synthesizes current knowledge on policies, clinical practices, and system-level strategies essential for achieving international targets under the sustainable development goals. Evidence from global analyses demonstrates that most maternal deaths arise from postpartum hemorrhage, hypertensive disorders, sepsis, and obstructed labor, while neonatal mortality is primarily driven by preterm birth complications, intrapartum asphyxia, and infections. High-impact interventions including antenatal corticosteroids, active management of the third stage of labor, magnesium sulfate therapy, essential newborn care, Kangaroo Mother Care, and neonatal resuscitation significantly reduce mortality when implemented with fidelity. However, gaps persist in coverage, workforce capacity, facility readiness, referral pathways, respectful maternity care, and community engagement. Health system constraints, including inadequate staffing, poor-quality intrapartum monitoring, limited equipment availability, and social barriers such as gender inequity, further impede progress. Successful country examples highlight the importance of integrated policies, universal health coverage, strong midwifery systems, maternal and perinatal death surveillance and response (MPDSR), and sustained quality-improvement cycles. Digital health innovations, when appropriately supported, improve risk detection, protocol adherence, and accountability. This review underscores that reducing preventable deaths requires not isolated interventions but coordinated, multisectoral strategies spanning clinical, community, and policy domains. Achieving global targets demands strengthening health systems, addressing sociocultural barriers, and ensuring every woman and newborn receives timely, respectful, high-quality care across the continuum.

Crossing the line: unprotected and unseen; vasa previa and the perils of fetal vessel rupture

Sanghamitra Padhy — 2026-02-25

Vasa previa is a rare but life-threatening obstetric condition in which unprotected fetal vessels traverse the fetal membranes near the cervical OS, predisposing them to rupture during labor or membrane rupture. We present the case of a 39-year-old gravida 3 para 2 woman at 39 weeks gestation with a history of assisted reproductive technology conception and a low-lying placenta. Following induction of labor and artificial rupture of membranes, she developed sudden vaginal bleeding with fetal bradycardia. Emergency cesarean section was performed under general anesthesia. The patient experienced massive peripartum hemorrhage requiring transfusion of multiple blood products, vasopressor support, and insertion of a bakri balloon. Placental examination revealed velamentous cord insertion with an accessory lobe consistent with vasa previa. The neonate, delivered with low APGAR scores, required intubation and NICU admission but recovered successfully. Both mother and infant were discharged in stable condition, with favorable outcomes on follow-up. This case underscores the critical importance of early recognition, timely intervention, and multidisciplinary management in vasa previa to prevent catastrophic maternal and fetal morbidity and mortality.

Unexpected placenta accreta spectrum in a primigravida with an unscarred uterus: life-threatening hemorrhage following vaginal delivery

Hassan Barakat — 2026-02-25

Placenta accreta spectrum disorders (PASD) are severe obstetric conditions associated with significant maternal and fetal morbidity. While the incidence of PASD has risen in correlation with increasing cesarean section rates, its occurrence in an unscarred uterus is exceptionally rare. We report a case of placenta increta in a 20-year-old primigravida with no identifiable risk factors. The diagnosis was made following a term vaginal delivery that was complicated by a retained placenta and subsequent life-threatening postpartum hemorrhage. This case is distinctive for its occurrence in a primigravida, contrasting with the few reported cases in unscarred uteri that are often described in multiparous women with a prior vaginal delivery. It underscores that PASD, while unlikely, can present in low-risk populations with no obstetric history. This report highlights the critical importance of maintaining a high index of suspicion and considering routine prenatal screening for radiological signs of PASD, even in low-risk populations.

Mature placental teratoma, fetiform type: a rare case report

Trishika Verma — 2026-02-09

A placental teratoma is a rare benign tumor of germ cell origin. Fewer than 50 cases have been reported worldwide. The fetiform variant poses a diagnostic challenge in distinguishing it from acardius amorphus, as it resembles fetal structures without true axial organization. Here we present a case of mature placental teratoma, fetiform type, in a 34-year-old G2P1L1 woman who delivered a healthy male infant at term via uncomplicated vaginal delivery. Post-delivery, a 7.0×6.5×3.5 cm hairy mass was identified on the fetal surface of placenta, supplied by placental vessels without Wharton's jelly or an umbilical cord. The tumor was not reported on antenatal scans. On Gross examination, a heterogeneous solid mass with yellowish areas and few bony components was identified; histopathology confirmed mature tissues from all three germ layers, including ectoderm, mesoderm, endoderm, without immature, malignant, or any organized fetal structures. Due to absent axial skeleton, polarity, and segmentation diagnosis favours teratoma over acardius amorphus. Etiology suggests aberrant migration of germ cells between amnion and chorion. There were no adverse neonatal or maternal outcomes in our case. This case report adds to the limited literature of placental teratoma.

A rare case of unicornuate uterus with non-communicating functional rudimentary horn associated with grade 3 endometriosis and a vascular anomaly

Shruthi Kelasur Rajashekara — 2026-02-25

Uterine anomalies result from either non-fusion or aberration in the fusion of the Müllerian ducts. An unicornuate uterus is one such anomaly that can present in different age groups due to its variation in relation to the presence or absence of a rudimentary horn. It can present as severe dysmenorrhea in young women if there is hematometra in the non-communicating functional rudimentary horn or if there is associated endometriosis. It can also present with infertility, recurrent pregnancy loss, or preterm delivery, and can be incidentally diagnosed during a cesarean section. One of the dreaded complications is pregnancy in the non-communicating horn and its rupture. It can pose a diagnostic and management challenge. Magnetic resonance imaging (MRI) is the gold standard for diagnosis, and surgical management is imperative in case of a functional non-communicating horn for relief of dysmenorrhea, prevention of endometriosis, and to prevent pregnancy complications. We report a case of a woman in her early 20s with severe dysmenorrhea and infertility diagnosed with a unicornuate uterus with a non-communicating functional rudimentary horn with grade 3 endometriosis with vascular anomaly who was managed surgically.

An eclamptic dilemma: a rare case of old cerebral venous thrombosis with antepartum eclampsia

Madhurya Nagesh — 2026-02-25

Pregnancy and puerperium are associated with an increased risk of venous thromboembolic events, including cerebral venous thrombosis (CVT), which accounts for a significant proportion of pregnancy-related strokes. Women with a previous history of CVT are at increased risk of recurrence and hypertensive disorders of pregnancy. We report a rare case of a primigravida presenting with antepartum eclampsia and recurrent seizures, later diagnosed as posterior reversible encephalopathy syndrome with radiological evidence of old CVT. The patient had discontinued prior anticoagulation and antiepileptic therapy and did not disclose her medical history during antenatal care. Prompt multidisciplinary management led to a favorable maternal outcome. This case highlights the diagnostic challenge of differentiating eclampsia from neurological sequelae of previous CVT and underscores the importance of detailed history-taking and thromboprophylaxis in high-risk pregnancies.

COVID-19 as a potential trigger for mirror syndrome: exploring an infectious etiology in a rare obstetric triad

Kavitha Narayanaswamy — 2026-02-25

Mirror syndrome (Ballantyne's syndrome)—the triad of maternal edema, fetal hydrops, and placental hydrops—is a sporadic, life-threatening condition. Its etiology is diverse, including infections, isoimmunization, and fetal anomalies. This case report aims to explore and highlight a possible correlation between COVID-19 infection and the precipitation of mirror syndrome in a primigravida. In this case, a 25-year-old primigravida (PCOS history) presented to OPD at 28 weeks 4 days gestation with dyspnea and grade IV edema/anasarca. Ultrasound and MRI confirmed fetal hydrops (ascites, pleural effusion), polyhydramnios (Liquor 25-26 cm), and placentomegaly, fulfilling the diagnostic criteria for mirror syndrome. Further evaluation revealed maternal bilateral pleural effusion and consolidation, confirmed as a new-onset COVID-19 infection by CT and RT-PCR. Due to PPROM, the pregnancy was terminated, resulting in a stillbirth. Mirror syndrome's pathogenesis is thought to involve trophoblastic damage and endothelial dysfunction, similar to preeclampsia. Given that COVID-19 infection is known to induce systemic inflammation, coagulopathy, and endothelial injury, the timing of the maternal infection in this case suggests a potential infectious etiology. While a direct causal link requires further study, this case supports the hypothesis that COVID-19 may act as a trigger, contributing to the angiogenic-antiangiogenic imbalance implicated in the syndrome. This case highlights an unusual presentation of mirror syndrome coinciding with acute maternal COVID-19 infection. Due to the high morbidity/mortality of mirror syndrome, we advise wider screening for this condition in COVID-19 positive pregnant patients, and vice versa, to ensure early detection and prompt, etiology-based management.

Accessory and cavitated uterine mass: a rare case

Anjali Chauhan — 2026-02-25

Accessory and cavitated uterine mass (ACUM) are a rare congenital Müllerian duct anomaly characterized by a non-communicating uterine mass containing functional endometrial tissue, typically located near the insertion of the round ligament. It predominantly affects adolescents and young women presenting with severe dysmenorrhea or cyclic pelvic pain unresponsive to medical therapy. Due to its similarity in presentation to adenomyosis, fibroids, and rudimentary uterine horn, ACUM is frequently misdiagnosed. We report a case of a reproductive-age woman with intractable dysmenorrhea since adolescence that did not improve with hormonal treatment. Preoperative magnetic resonance imaging (MRI) suggested ACUM, and the patient underwent laparoscopic ACUM removal. Intraoperative findings revealed an isolated cavitated mass at the left round ligament. Histopathological examination confirmed the presence of functional endometrial lining surrounded by hypertrophic myometrium, consistent with ACUM. Postoperatively, symptoms resolved completely. Early recognition of ACUM is essential in young women with unexplained dysmenorrhea, and surgery remains the definitive treatment.

A rare case of nulligravida with abnormal uterine bleeding, bicornuate uterus, iron-deficiency anaemia, thrombocytopenia and connective-tissue disorder features

Khateeb Farheen — 2026-02-25

Abnormal uterine bleeding (AUB) frequently causes iron deficiency anaemia; however, coexistence with thrombocytopenia and uterine anomaly is unusual. A 30-year-old nulligravida presented with severe AUB and marfanoid features. Laboratory evaluation showed iron-deficiency anaemia and thrombocytopenia refractory to transfusion. Imaging and intraoperative findings confirmed a bicornuate unicollis uterus with adenomyosis. Total abdominal hysterectomy resulted in normalization of platelet count postoperatively. Severe AUB out of proportion to typical presentation should raise suspicion of Mullerian anomaly. Definitive surgical management can reverse hematologic abnormalities in select cases.

Pregnancy diagnosed in a rudimentary horn of uterus: a rare case report

Jalpa K. Bhatt — 2026-02-25

Pregnancy in a rudimentary horn of the uterus is a quite rare clinical condition with a reported incidence of 1 in 100,000 to 140,000 pregnancies. The patient may get complicated if not diagnosed timely. The standard treatment is the surgical excision of the horn. A gravida 1, para 0 patient presented at 5 weeks gestation diagnosed as pregnancy in rudimentary horn. She underwent a laparotomy with right rudimentary horn excision. The final diagnosis of pregnancy in rudimentary horn was confirmed by histopathology. A unicornuate uterus with a rudimentary horn is a congenital uterine anomaly resulting from the incomplete development of one of the Müllerian ducts also incomplete fusion with the contralateral side. This case highlights the importance of an early detection by ultrasound and the need for high clinical diagnosis with suspicion.

Forensic insight into sudden maternal death from spontaneous uterine rupture in the third trimester: an autopsy-based case report

Munesh Kumar — 2026-02-25

Spontaneous rupture of the uterus remains a severe obstetric complication in many developing nations, posing a significant threat to both maternal and fetal outcomes. In India, it continues to contribute to approximately 5-10% of maternal deaths, primarily due to the high incidence of unregistered or emergency pregnancies, particularly among women from rural regions with limited access to antenatal care. While rupture of a previously scarred uterus is more commonly reported, spontaneous rupture of an unscarred uterus is an uncommon occurrence. Identified risk factors for such ruptures include grand multiparity, abnormal placentation, and congenital uterine malformations. We are reporting an autopsy-based case of sudden, unexplained death of a 40-year-old full-term pregnant lady, who was G7P6L6, with all previous normal deliveries, in which multiparity was the predisposing factor of spontaneous uterine rupture.

A case report of rupture uterus in an unscarred uterus

Rajalakshmi V. Jayakumar — 2026-02-25

Uterine rupture in an unscarred uterus is a rare occurrence. It is defined as A complete disruption of all layers of the uterine wall (endometrium, myometrium, and serosa), often associated with extrusion of the fetus, placenta, or both into the peritoneal cavity. A 26- year-old, P2L2 at 38 weeks + 3 days of gestation with an unscarred uterus who was induced with misoprostol and oxytocin and delivered from a local hospital was referred to this tertiary care centre with provisional diagnosis of severe postpartum haemorrhage. She was diagnosed to have posterior uterine wall rupture with huge haematoma extending to cervix, broad ligament and lower uterine segment. Active management with emergency laparotomy and obstetric hysterectomy with bilateral internal iliac artery ligation led to complete recovery of the mother with uneventful 1 month follow up. The report highlights the need to consider uterine rupture as differential diagnosis even in an unscarred uterus in case of postpartum haemorrhage and urgent referral to higher centre for timely management. Early diagnosis and immediate surgical intervention may significantly improve the prognosis.

The solid surprise: laparoscopic discovery of an ovarian fibroma – a case report

Sunanda N. — 2026-02-25

Ovarian fibromas are uncommon benign sex cord–stromal tumours arising from the ovarian cortex. Although they predominantly occur in peri- and postmenopausal women, they may also present in younger patients. Their solid nature and occasional association with ascites or elevated tumour markers can mimic ovarian malignancy, making preoperative diagnosis challenging. Herein, this case reports the case of a 35-year-old multiparous, tubectomised woman who presented with abdominal pain, distension, and vomiting. Clinical examination suggested a subserosal uterine fibroid. Ultrasonography revealed a solid left ovarian mass measuring 10×5 cm with preserved vascularity and no features of torsion. Serum CA-125 levels were within normal limits. Due to diagnostic uncertainty, diagnostic laparoscopy was performed, which revealed a solid ovarian mass arising from the left ovary. Left salpingo-oophorectomy was undertaken. Histopathological examination confirmed the diagnosis of ovarian fibroma. The postoperative course was uneventful. Ovarian fibroma should be considered in the differential diagnosis of solid adnexal masses, even in younger, premenopausal women. Preoperative distinction from malignant ovarian tumours remains difficult using clinical and ultrasonographic features alone. Surgical excision remains both diagnostic and therapeutic, with laparoscopy offering a safe and effective approach in carefully selected cases.

Uterine leiomyosarcoma in a postmenopausal woman: a case report

Samrat Kadam — 2026-02-25

Uterine leiomyosarcoma (ULMS) is a rare but highly aggressive smooth muscle malignancy that often masquerades as benign fibroids, delaying diagnosis until advanced stages. The disease carries a grim prognosis, especially when clinical suspicion is low. We present the case of a 56-year-old multiparous, postmenopausal woman with a 20 day history of dysuria with unexpected vaginal bleeding. With no abdominal pain, postcoital bleeding, or systemic symptoms, the presentation initially appeared benign. However, imaging revealed a bulky uterus with mixed fibroid pathology and a thickened endometrium. Cytology was inconclusive for malignancy. Definitive diagnosis came from histopathological examination of endometrial curettage and a malignant fibroid polyp, revealing ULMS. Pelvic MRI confirmed lobulated anterior uterine wall lesions, pelvic lymphadenopathy, and endometrial collection. The patient underwent total abdominal hysterectomy with bilateral salpingo-oophorectomy and lymphadenectomy. This case highlights the silent yet aggressive nature of ULMS and the importance of a high index of suspicion, even in seemingly routine gynecological presentations. Timely surgical management remains the cornerstone of care in achieving disease control.

Intravascular leiomyomatosis associated with uterine STUMP extending into the right atrium: a rare case report

Asmin Shaikha Badusha — 2026-02-25

Intravascular leiomyomatosis (IVL) is a rare benign smooth muscle tumor that originates from the uterus and proliferates within venous channels, occasionally extending into the heart. Smooth muscle tumour of uncertain malignant potential (STUMP) represents a borderline uterine neoplasm with unpredictable biological behavior. The coexistence of IVL and STUMP is exceptionally rare, posing diagnostic and therapeutic challenges. We report the case of a 52-year-old perimenopausal woman who presented with abdominal distension and bilateral lower limb pain for six months. Imaging revealed a large uterine mass with a thrombus extending from the pelvic and gonadal veins into the inferior vena cava (IVC) and right atrium. The patient underwent staging exploratory laparotomy with total abdominal hysterectomy, bilateral salpingo-oophorectomy, pelvic tumour excision, venotomy with thrombus extraction, and lymphadenectomy. Histopathology confirmed a spindle cell neoplasm consistent with a STUMP associated with intravascular leiomyomatosis. This case highlights the rare coexistence of STUMP and IVL with intracardiac extension. Comprehensive preoperative imaging, multidisciplinary surgical planning, and complete tumor resection are crucial to prevent recurrence and ensure favorable outcomes.

Spontaneous intrauterine pregnancy, post laparoscopic surgery for didelphys uterus with longitudinal vaginal septum, multiple leiomyomas and bilateral proximal tubal block

Prabha Agrawal — 2026-02-25

Mullerian duct anomalies (MDAs) are congenital developmental anomalies of the female reproductive tract. Uterine didelphys also known as a double uterus, with two uteri and cervices, and a single or double vagina, is one of the rarest MDA. Uterine leiomyomas are a common finding in the normal uterus but extremely rare in women with MDAs. We present the case and surgical management of a 28 year-old African woman with uterus didelphys with two separate cervix and vagina with multiple leiomyomas and bilateral proximal tubal block. She presented with inability to conceive and dyspareunia and was referred to us with a diagnosis of multiple fibroids uterus. She was managed successfully by a combined hysteroscopic, laparoscopic and vaginal approach with myomectomy and excision of longitudinal vaginal septum. Post procedure she conceived spontaneously after 6 months. Management of this case was a challenge owing to the coexistence of multiple complex malformations and the difficulty in preserving the reproductive potential. The aim of this case report is to expand the available knowledge about this group of females affected with a common diagnosis of leiomyomas, superimposed on an extremely rare MDA, uterine didelphys.

A rare case of spontaneous severe haemoperitoneum in a primigravida in the third trimester: a case report

Ravmeet Kaur Sareen — 2026-02-25

Spontaneous haemoperitoneum in pregnancy (SHIP) is a rare but potentially life-threatening obstetric emergency characterised by sudden, non-traumatic intraperitoneal bleeding, most commonly occurring in the third trimester and associated with significant maternal and perinatal morbidity and mortality. We report the case of a 23-year-old primigravid woman at 36+2 weeks’ gestation who presented with acute abdominal pain followed by fetal bradycardia and maternal haemodynamic instability. Emergency laparotomy revealed approximately 2 litres of haemoperitoneum with diffuse posterior uterine serosal bleeding in an intact uterus. Caesarean delivery was performed, and haemostasis was achieved using conservative surgical measures, including bilateral uterine artery ligation, allowing preservation of the uterus. Spontaneous haemoperitoneum should be suspected in pregnant women presenting with unexplained acute abdomen and fetal distress, as prompt diagnosis and early surgical intervention are critical for improving maternal and fetal outcomes.

Acute chemical peritonitis secondary to ovarian dermoid rupture: a rare complication

Noela T. Correia — 2026-02-25

A dermoid cyst is also known as a mature cystic teratoma and is one of the most common ovarian germ cell tumors of women, particularly in the premenopausal age group. This tumor is composed of skin, hair, teeth and sebum, enclosed in a fibrous tissue. A ruptured dermoid cyst can be missed and can have serious morbidity, and imaging modality can help in the diagnosis, as was done in this case. A 42-year-old parous woman presented with acute onset, vague, lower abdominal pain. The patient had a history of acute onset abdominal pain for two days, that worsened. An ultrasound followed by CT scan revealed a dermoid cyst that had ruptured following which an exploratory laparotomy was done, which confirmed the finding. Although a dermoid cyst is the most common ovarian germ cell tumor, a ruptured ovarian dermoid cyst is a very infrequent complication. The resulting peritonitis from the rupture often presents with acute or chronic peritonitis. A good clinico-radiological correlation can help us come to a diagnosis and lead us to the surgical intervention that is required. A ruptured dermoid cyst can present with vague symptoms. A high degree of suspicion is required to lead us to the timeliest surgical intervention.

A case report on gonadal dysgenesis caused by a rare NR5A1-associated contiguous gene deletion: a diagnostic challenge

Shiny Nivya G. — 2026-02-25

Disorders of sexual development (DSD) encompass a diverse group of congenital conditions characterised by atypical development of chromosomal, gonadal, or anatomical sex. Among these, NR5A1 mutations represent an important and heterogeneous cause of 46, XY DSD, often exhibiting wide phenotypic variability with limited genotype–phenotype correlation. Early incorporation of genetic testing is therefore pivotal, particularly when gonadal dysgenesis is suspected. We present a 19-year-old individual, raised as female, who presented with primary amenorrhoea and underdeveloped secondary sexual characteristics. Endocrine testing showed hypergonadotropic hypogonadism, and karyotyping identified a genotype of 46, XY. Genetic testing revealed a contiguous deletion involving the NR5A1 gene, consistent with severe gonadal dysgenesis. Pelvic magnetic resonance imaging showed the presence of an infantile uterus, but, on diagnostic laparoscopy, complete Müllerian agenesis was discovered. Bilateral gonadectomy showed dysgenetic testes without signs of malignancy. This case highlights the diagnostic complexity of NR5A1-related DSD, the potential discordance between imaging and operative findings, and the importance of a multidisciplinary approach to ensure accurate diagnosis and appropriate management.

Non-communicating rudimentary horn pregnancy managed at a community health center: a case report

Aastha H. Patel — 2026-02-25

Pregnancy in a non-communicating rudimentary horn is a rare and potentially life-threatening form of ectopic pregnancy. Early diagnosis is challenging, particularly in low-resource settings, and delayed management often leads to rupture and massive hemorrhage. A 22-year-old G3P2L1D1 woman with two previous normal vaginal deliveries presented with two months of amenorrhea and spotting per vaginum. Ultrasonography suggested a left non-communicating rudimentary horn ectopic pregnancy of approximately 9 weeks’ gestation. Considering the high risk of rupture and limited diagnostic facilities, emergency laparotomy was performed at a community health centre. Intraoperatively, a left non-communicating rudimentary horn pregnancy was confirmed. Excision of the rudimentary. This case highlights that timely diagnosis and definitive surgical management of rudimentary horn pregnancy can be successfully achieved even at a community health center with limited resources, emphasizing the importance of clinical suspicion and prompt intervention.

A rare case of cornual molar ectopic pregnancy

Ameya Sunil Mulay — 2026-02-25

Gestational trophoblastic disease (GTD) comprises a heterogeneous group of placental disorders characterized by abnormal trophoblastic proliferation. The reported incidence of GTD ranges from 0.2 to 5.8 per 1,000 pregnancies, while ectopic pregnancies account for approximately 0.64% of all pregnancies. The coexistence of ectopic pregnancy with molar pathology is exceptionally uncommon. Hydatidiform mole occurs in about 1 in 2,000 pregnancies, with most cases arising within the uterine cavity.

Ovarian hyperstimulation syndrome with a twist: a rare case of adnexal torsion complicating severe ovarian hyperstimulation syndrome

Zufishan L. Amin — 2026-02-25

Ovarian hyperstimulation syndrome (OHSS) is a serious complication of ovarian stimulation protocol. This rare case highlights a patient with severe OHSS complicated by adnexaltorsion. A 24-year-old married woman with history of oocyte donation presented in tertiary care centre with complaints of progressive abdominal pain, distension and shortness of breath. Clinical examination and investigations confirmed diagnosis of severe OHSS and right sided enlarged ovary (1190 cc) with torsion. Emergency laparotomy with right salpingo-oophorectomy was done. Adnexal torsion is common due to ovarian enlargement is common amongst patients undergoing ovulation induction. Doppler ultrasound aids the diagnosis, and surgical intervention is warranted. Early recognition of patient at risk of OHSS is essential for its prevention. Surgical management of adnexal torsion in OHSS is crucial to avoid complications.

Pelvic aggressive fibromatosis masquerading as a uterine fibroid: a diagnostic challenge

Asma A. K. — 2026-02-25

An invasive pelvic mass in a young female presents a diagnostic challenge, as a variety of benign and malignant conditions can contribute to such findings. One rare but significant cause of an invasive pelvic mass are desmoid tumours (also called aggressive fibromatosis) benign, slowly growing fibroblastic neoplasms with no metastatic potential but a propensity for local recurrence, even after complete surgical resection. We report a case of pelvic aggressive fibromatosis - a young woman who presented with gynaecological symptoms and was found to have a large invasive pelvic mass that closely mimicked a uterine fibroid or gynaecological malignancy on clinical examination and imaging. Surgical management was undertaken due to the extent of the lesion and diagnostic uncertainty. Definitive diagnosis was established only on histopathological examination, supported by immunohistochemistry, confirming desmoid fibromatosis. This case underscores the importance of including desmoid fibromatosis in the differential diagnosis of invasive pelvic masses in young females. It also highlights the limitations of imaging in distinguishing benign from malignant pelvic tumours and emphasises the pivotal role of histopathology and immunohistochemistry in establishing the diagnosis and guiding appropriate multidisciplinary management.

A rare cause of secondary amenorrhoea due to acquired cervical atresia: a case report and review of literature

Swarnima Shukla — 2026-02-25

Haematotrachelos, also known as haematocervix, is an extremely rare gynaecological condition characterised by accumulation of menstrual blood within the cervical canal due to obstruction of the cervical os. It represents one of the least common forms of genital outflow tract obstruction. We report a 41-year-old multiparous woman presenting with progressive hypomenorrhoea followed by secondary amenorrhoea and acute pelvic pain. Clinical examination revealed a ballooned cervix with a pinpoint external os. Ultrasonography and magnetic resonance imaging confirmed haematotrachelos with associated haematometrocolpos. The patient was successfully managed using a conservative uterus-preserving approach including cruciate cervical incision, serial dilatation, drainage of retained blood, Foley catheter placement intrauterine copper device insertion and adjunct hormonal therapy. Complete resolution of symptoms and restoration of regular menstrual cycles were achieved.