International Journal of Reproduction, Contraception, Obstetrics and Gynecology

Surgical management of uterine prolapse by sacrohysteropexy: a case series

Manas R. Moharana — 2025-09-15

Abdominal sacrohysteropexy is a transabdominal procedure where the prolapsed uterus is suspended from the sacral promontory by the use of mesh to restore the normal anatomical position. The purpose of our study was to assess the safety of sacrohysteropexy surgery by determining intraoperative and post-operative complications and its effectiveness in management of UV prolapse by pelvic organ prolapse recurrence on follow up. A rospective study was carried out in the department of gynaecology and obstetrics, RIMS medical college, Raipur, Chhattisgarh from January 2023 to December 2023. Eight young patients <40 years of age with 2^nd degree or more uterovaginal prolapse, admitted through OPD were selected for abdominal sacrohysteropexy with polypropelene mesh. Variables of study including duration of surgery, any intra-operative and post operative complications, need of intra operative blood transfusion, post operative hospital stay; recurrence of POP in 06 months follow up were recorded. In these 8 patients, mean age was 33.5 years. All were married with parity 2 or more and all of them had only vaginal deliveries and had 3^rd degree pelvic organ prolapse (POP). Duration of surgery was around 90 mins. In our cases intra operative blood loss was around 250 ml. Post operatively no case developed any complications and all were discharged on 5^th post operative day. No recurrence was noticed in 06 months follow up. Abdominal sacrohysteropexy is a safe and an effective surgical treatment in terms of overall anatomical and functional outcome, intraoperative and postoperative complications, post operative recovery and length of hospital stay in women who desire uterine and hence fertility preservation.

A case series of scar endometriosis: a mysterious painful scar

Aswenee Bhavani — 2025-09-26

Endometriosis is the presence of endometrial tissue outside the uterine cavity. Scar endometriosis, one of its rare variants, is the study of interest since most of the patients present to the general surgeon rather than to a gynaecologist due to its quite often non-specific symptoms. In this case series of 5 patients, 2 of the patients had presented to the general surgery department, one presented with non-specific symptom. Prior history of any obstetric (caesarean section in particular) and gynaecological surgeries must be elicited which may help in clinching towards the diagnosis. This report is about a case series of 5 patients who had variable presentations and were offered wide local excision. Diagnosis was confirmed with post-operative histopathology. The pathogenesis, treatment and prevention have been discussed.

Evaluation of the synergistic application of bone marrow aspirate concentrate and platelet-rich plasma therapy in women experiencing premature ovarian failure and poor ovarian reserve: a case series

Srinivasan Vyjayanthi — 2025-09-26

Autologous bone marrow-derived stem cells (BMSCs) and platelet-rich plasma (PRP) separately were found to be effective in restoring ovarian function in infertile women. The present study aims to study the synergistic effect of bone marrow-derived aspirate concentrate (BMAC) and PRP in women diagnosed with poor ovarian response (POR) and premature ovarian failure (POF) undergoing in vitro fertilization (IVF). A total of 10 patients participated in the study. Eight patients were diagnosed with POR, while two patients had POF. Intraovarian BMAC-PRP injection was given to all the patients via the laparoscopic or transvaginal route. Group 1 before starting the IVF cycle, group 2-intracycle-post ovum pick-up and group 3-POF patients. Outcomes assessed include improvement in antral follicular count (AFC), Anti-Mullerian hormone (AMH), response to ovarian stimulation at subsequent IVF cycle and clinical pregnancy. In group I POR patients (n=4) post-instillation, an increase in AFC count was observed and subsequently, these patients underwent IVF, however, no clinical pregnancies were achieved. Group II POR patients (n=4), who received BMAC-PRP instillation intracycle post-OPU there was improvement in AFC and better response with more oocytes and embryos in the subsequent IVF cycle, leading to three pregnancies in this group. In group III-POF patients (n=2) who received BMAC-PRP instillation, one of them spontaneously conceived post 3 months of instillation. The synergistic application of BMAC-PRP was found to be effective in improving ovarian function in POR and POF patients.

A case series on uterine inversion: diagnostic and surgical considerations

Harsha M. Agrawal — 2025-09-26

Uterine inversion defined as descent of fundus of uterus to or through the cervix, so uterus is turned inside out. It may be puerperal and non-puerperal/gynecological, the latter being extremely rare. This rarity, delayed presentation and atypical presentation contribute to the clinical challenges. We present a case series four cases of uterine inversion including three cases of gynecological inversion and one case of puerperal inversion, managed at a tertiary care hospital in India. Clinical presentation, diagnostic methods, surgical techniques, and outcomes were documented. Non-puerperal cases were associated with submucosal fibroids and presented with mass protrusion, bleeding, and urinary complaints. Diagnosis was confirmed using clinical examination and magnetic resonance imaging (MRI). Surgical management included Huntington’s and Haultain’s techniques followed by hysterectomy. The puerperal case presented with acute hemorrhage postpartum and was managed successfully with Johnson’s maneuver and uterine balloon tamponade. It could be concluded from series that non-puerperal uterine inversion requires individualized surgical management based on underlying pathology. Acute puerperal inversion demands rapid resuscitation and repositioning to reduce maternal morbidity. MRI plays a pivotal role in diagnosis and planning. This series delineates the challenges involved in the diagnosis and operative management of the condition.

Laparoscopic management of cervical fibroids: a case series

Ritika Shrivastav — 2025-09-26

Cervical fibroids present unique challenges due to their proximity to the ureter and potential impact on fertility and pelvic anatomy. Laparoscopic techniques offer advantages such as reduced blood loss; shorter hospital stays and faster recovery times as compared to the traditional open methods. We report a case series of 10 cases of cervical fibroid management using laparoscopic methods (laparoscopic myomectomy and total laparoscopic hysterectomy with prophylactic uterine artery ligation in selected cases) performed at our institute Shreeji Hospital, Bhilad between February 2020-January 2024. Laparoscopic hysterectomy was the most common procedure performed (70%), followed by laparoscopic myomectomy (30%). The mean operative time was 96 minutes, with minimal intraoperative complications observed. Postoperatively, patients experienced significant improvement in symptoms such as pelvic pain, abnormal uterine bleeding, and urinary symptoms. Preservation of fertility was achieved in 30% candidates.

Foreign body granuloma mimicking malignancy: a diagnostic challenge post-caesarean section

Farheen Khan — 2025-09-15

Foreign body granulomas arising from haemostatic agents such as oxidized regenerated cellulose (Surgicel) are rare but can closely mimic malignancy on imaging, resulting in unnecessary investigations, delays in treatment, and significant patient anxiety. Authors report the case of a 33-year-old para 1 woman who presented with lower abdominal pain and urinary symptoms eight months after elective caesarean section in which Surgicel was used. Imaging studies suggested a malignant mass involving the cervix, bladder, and vagina, with suspicious lymphadenopathy. Cystoscopy and drainage procedures were inconclusive. Exploratory laparoscopy revealed a 7×5 cm organized mass containing gelatinous material in the uterovesical pouch. Histopathology confirmed a foreign body granuloma with giant cell reaction to suture material. The patient recovered uneventfully following excision. Postoperative suture granulomas should be considered in the differential diagnosis of pelvic masses following caesarean section or other gynecological surgeries where haemostatic agents have been used. Early recognition can prevent unwarranted investigations and improve patient outcomes.

Low-grade appendiceal mucinous adenocarcinoma with peritoneal and ovarian spread: a case report and literature review

Hanae Benchaou — 2025-09-26

Appendiceal mucinous neoplasms are rare and often present with nonspecific symptoms, leading to diagnostic challenges. This case report describes an atypical presentation of a low-grade mucinous appendiceal adenocarcinoma initially misdiagnosed as an ovarian mass, highlighting the importance of a multidisciplinary diagnostic approach. This case report involves a 57-year-old postmenopausal woman presented with persistent gastroesophageal reflux disease (GERD) and was found to have a large abdominopelvic cystic mass on imaging, suggestive of ovarian origin. Further evaluation, including computed tomography (CT), magnetic resonance imaging (MRI), and histopathological analysis after exploratory laparotomy, revealed a metastatic low-grade mucinous appendiceal adenocarcinoma with peritoneal dissemination (pseudomyxoma peritonei). The patient was referred for cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). This case illustrates the diagnostic complexity of appendiceal mucinous neoplasms, particularly when mimicking gynaecological pathology. A high index of suspicion, comprehensive imaging, and histopathological confirmation are crucial for accurate diagnosis. CRS and HIPEC remain the standard of care for advanced disease, emphasizing the need for early multidisciplinary involvement in management.

A case of late-onset twin-twin transfusion syndrome with severe fetal anemia and maternal acute kidney injury

Tasnim Z. Hussain — 2025-09-26

Twin-twin transfusion syndrome (TTTS) is a rare but serious complication of monochorionic twin gestation which forewarns obstetricians about the best management approach. The majority of cases are diagnosed early and managed with laser coagulation, resulting in reduced neonatal mortality. We have managed a late-diagnosis of TTTS Quintero stage 1, who was delivered due to suspicion of severe fetal anemia in the donor and cardiac overload in the recipient twin. The mother developed acute kidney injury in the early third trimester which worsened despite appropriate management. The cause of kidney injury in a mother carrying monochorionic diamniotic (MCDA) twins is unknown, yet restoration of renal function post-delivery suggests a connection. We are presenting this case as a rare presentation of severe fetal anemia in TTTS. This case demands additional research to identify the triggering factors, knowledge of which is expected to reformulate the management of MCDA twins.

Failed methotrexate therapy in a cesarean scar ectopic pregnancy: a case report

Rania E. Belal — 2025-09-26

Cesarean scar ectopic pregnancy (CSEP) is a rare and potentially life-threatening early pregnancy complication associated with prior cesarean section scars, where early detection and treatment are critical to reducing maternal morbidity. Methotrexate (MTX) therapy is a standard conservative approach, but may fail in some instances. We report a case of a 29-year-old woman (gravida 5, para 4) who presented at seven weeks' gestation with mild vaginal bleeding. Transvaginal ultrasound (TVUS) confirmed a non-viable CSEP, and ultrasound-guided intra-sac MTX injection was attempted as conservative management. Despite treatment, the patient developed worsening haemorrhage requiring emergency surgical intervention. Intraoperative findings revealed significant vascularity at the implantation site, and surgical excision of the ectopic pregnancy was performed with preservation of the uterus. The postoperative course was uneventful. This case highlights the limitations of MTX in treating CSEP. It emphasizes the importance of early recognition of treatment failure and prompt surgical management to prevent severe maternal morbidity and preserve reproductive potential.

Spontaneous rupture of leiomyosarcoma

Ni Ni Soe — 2025-09-26

Uterine sarcomas are rare, accounting for approximately 3-7% of uterine malignancies. Leiomyosarcoma (LMS), a particularly aggressive subtype, often presents diagnostic challenges due to overlapping features with benign fibroids. Spontaneous rupture of LMS is exceptionally rare and may lead to life-threatening complications. A 42-year-old woman presented with severe lower abdominal pain, distension, dyspnea, and hemodynamic instability. Imaging revealed a ruptured uterine mass with hemoperitoneum, bilateral pulmonary embolism (PE), and suspected metastatic disease. Initial stabilization required ICU support and multidisciplinary input. Uterine artery embolization was performed to control haemorrhage. The patient developed subsequent infections but stabilized and was repatriated to her home country, where she received six cycles of chemotherapy. Surgery is planned following completion of chemotherapy. This case underscores the diagnostic difficulty in differentiating LMS from benign fibroids, especially in the presence of large, rapidly growing uterine masses. Delayed diagnosis can result in catastrophic events such as spontaneous rupture. Imaging and histology remain essential, but molecular profiling is increasingly valuable for therapeutic planning. Spontaneous rupture of LMS, though rare, should be considered in patients with large symptomatic uterine masses. Early recognition, multidisciplinary management, and genetic profiling are vital for optimizing outcomes. Proactive surgical management of large tumours may help prevent such complications, even in presumed benign cases.

Pregnancy with Wilson’s disease

Nandeesha Thindlu Devraj — 2025-09-04

Wilson’s disease is a rare, autosomal recessive disorder characterized by impaired liver metabolism of copper, leading to decreased biliary excretion and incorporation of ceruloplasmin levels mainly in the liver and brain. Untreated Wilson’s disease has been shown to cause subfertility and miscarriages. Pregnancy management in women with Wilson’s disease remains an important clinical problem. Early recognition and effective management can help prevent the disease progression and hence give eventful progress and perinatal outcomes. We hereby report the case of a 29-year-old pregnant multigravida with known case of Wilson’s disease since childhood, and on treatment with copper chelating agents and zinc sulphate. She was followed up from early pregnancy till delivery at our hospital. She was monitored in combined obstetric, medicine and neurology clinic. Her pregnancy and postpartum course remained uneventful. She had a spontaneous vaginal delivery at 38+5 weeks period of gestation and gave birth to healthy female baby of 2.66 kg in weight. The infant was genetically screened and was found to be carrier free. It is relatively safe for women with Wilsons disease to become pregnant. Patients with Wilson’s disease receiving regular treatment who remain asymptomatic are usually able to conceive and achieve successful outcomes. However, these pregnancies should be considered as high risk and merit regular surveillance.

A rare case of double cervix with normal uterus and vagina: Müllerian anomaly in North India

Jasmine — 2025-09-26

Bifid cervix is a rare Müllerian duct anomaly. We present a case of a 38-year-old woman with secondary infertility, found to have a cervical duplication. To the best of our knowledge, only a few cases of bicervical normal uterus with normal vagina exist in the literature. This form of uterine abnormality is not explicable by the existing classical theory of Müllerian anomalies and suggests that a complex interplay of events beyond the classical postulate gives rise to the female genital tract.

A rare case of postpartum cerebral venous thrombosis and hemmorhagic infarct

Sonal Jamwal — 2025-09-26

Cerebral venous thrombosis (CVT) is a rare but serious complication that can occur during pregnancy and the postpartum period. This case reports discusses a unique instance of postpartum CVT complicated by hemorrhagic infarct in a patient from Himachal Pradesh. A case of a 26-year-old woman, para 2, unbooked patient with normal vaginal delivery at home, presented on 10th postpartum day with complaint of vomiting, headache, left hemiplegia and seizures, initially misdiagnosed as eclampsia, underwent CT, revealed significant sigmoid sinus thrombosis with haemorrhagic infarction. The patient underwent left fronto-temporoparietal decompressive hemicranectomy with duroplasty at PGIMER Chandigarh followed by tracheostomy. The patient was under antibiotic treatment, seizure prophylaxis, anticoagulation therapy, resulting in substantial clinical improvement. This case emphasizes the necessity of maintaining a high index of suspicion for CVT in postpartum women displaying neurological symptoms. Misdiagnosis can impede timely intervention, highlighting the need for access to advanced imaging and multidisciplinary approach. Increasing awareness and training for healthcare providers are essential for timely diagnosis. Also, the importance of hospital delivery. The management of this case illustrates the importance of regular antenatal checkup, hospital delivery, early recognition of CVT in the postpartum population. Enhancing diagnostic resources and treatment strategies, particularly in resource limited settings, can significantly improve maternal health outcomes and reduce morbidity and mortality. The possibility of cerebral vein thrombosis should be considered in all women with brain dysfunction during the puerperium.

A case report of retained placenta

Ameya Sunil Mulay — 2025-09-26

Retained placenta can occur in the setting of significant uterine atony, abnormally adherent placenta, as with placenta accreta spectrum (PAS), or closure of the cervix prior to placental expulsion. Risk factors for retained placenta parallel those for uterine atony and PAS and include prolonged oxytocin use, high parity, preterm delivery, history of uterine surgery, and IVF conceptions.

A scar that cycles: unmasking episiotomy site endometriosis: a case report

Niteen Ghorpade — 2025-09-26

Endometriosis is a condition characterised by occurrence of endometrial cells outside the uterine cavity and when it appears at the previous scar site like episiotomy scar, caesarean scar or laparoscopic port incision scar sites, it is called extrapelvic or cutaneous endometriosis. Here we present a case of 31-year-old lady who had vaginal delivery with episiotomy scar 6 years ago. She presented at our center with cyclical pain at the episiotomy scar site and a hard nodular mass of 3×4 cm was found at the episiotomy site. She underwent complete excision of mass after thorough examination and imaging. The hsitopathology report confirmed the diagnosis. Hence, we knew that the definitive treatment of episiotomy scar site endometriosis is surgical and medical management has no role.

A case report on large uterine fibroids in pregnancy with successful caesarean myomectomy

Usha Natarajan — 2025-09-26

Uterine fibroids are benign tumors that commonly affect the female reproductive system. They are observed in approximately 0.1% to 10.7% of pregnancies, with their frequency increasing as maternal age advances. Although many pregnancies with fibroids progress without issues, complications can occur in about 10% to 40% of cases. These may include pelvic or abdominal discomfort, pregnancy loss, intrauterine growth restriction, abnormal fetal positioning, premature birth, placental abruption, prelabour rupture of membranes, increased likelihood of caesarean section, postpartum hemorrhage. Here we present a case of 30 years old primigravida with fibroid complicating pregnancy who had preterm delivery at 34+3 weeks. She was on regular antenatal follow up. On early pregnancy scan she was found to have multiple fibroid uterus with largest in the left adnexa-subserosal pedunculated. She had multiple Inpatient admissions for pelvic pain during her second and third trimester. She was admitted in view of preterm labour and undergone emergency lower segment caesarean section in view of multiple fibroid complicating pregnancy with cervical dystocia. Intraoperatively-multiple fibroid uterus. Caesarean myomectomy done. Postoperative period uneventful.

Serous cystadenofibroma of ovary mimicking malignancy: a case report and review of diagnostic challenges

B. Kalpana — 2025-09-26

Ovarian cystadenofibroma is a rare benign epithelial tumour composed of both glandular and fibrous stromal elements. Although benign, its imaging features mimic those of malignant neoplasms, posing diagnostic and therapeutic challenges. We report a case of 31-year-old nulliparous woman who presented with heavy menstrual bleeding. Clinical examination revealed right adnexal fullness and imaging studies demonstrated a complex multiloculated right ovarian cyst measuring approximately 5cm. a provisional diagnosis of complex ovarian neoplasm was made. Patient underwent right ovarian cystectomy. Histopathological examination confirmed the diagnosis of benign serous cystadenofibroma.

Fallopian tube prolapses through uterine rent: a rare complication following dilation and curettage

Pushplata Kumari — 2025-09-26

Fallopian tube prolapse (FTP) presents with symptoms of pelvic pain and vaginal discharge and has been reported as a rare complication after hysterectomy without salpingectomy. On other hand, uterine perforation is common complication reported with dilation and curettage (D&C). Authors reported an unusual case of fallopian tube prolapse through the uterine rent as an unrecognised uterine perforation.

Invasive mole presenting as abnormal uterine bleeding: a case report and review of literature

Neetha Nandan — 2025-09-26

Invasive mole is a type of gestational trophoblastic neoplasia (GTN). It usually occurs after a molar or non-molar pregnancy. Here we would like to present a 47-year-old nulligravida lady who does not give any history of antecedent pregnancy. She had symptoms of abnormal uterine bleeding (AUB) and came to the causality with heavy flow. Beta hCG was very high and MRI showed uterine tumor. She underwent total abdominal hysterectomy with bilateral salpingoopherectomy which showed invasive mole FIGO stage II. Her WHO prognostic score was 9 and hence she received EMA-CO regimen of chemotherapy. GTN can present in different ways, even without a history of previous pregnancy. In such situations a high level of suspicion and a simple Beta hCG level can clinch the diagnosis.

The wandering fibroid: a case report and an approach in reducing its incidence of future cases

Yashika Kotla — 2025-09-26

Uterine fibroids are one of the most common tumours found in women of reproductive age group. parasitic or wondering fibroid are rare extra uterine benign tumours. Due to its atypical presentations and locations, these tumours cause dilemma to reach to a correct diagnosis pre operatively. Here is a case report where a 44-year-old female presenting with lower abdominal pain with a prior history of laparoscopic myomectomy with a diagnosis of leiomyoma on MRI turned out to be parasitic fibroid intra operatively.

Surgical management of uterine niche in a patient with secondary infertility and successful pregnancy outcome

T. Ramani Devi — 2025-09-26

Uterine niche or caesarean scar defect is a known cause of secondary infertility and implantation failure. Surgical repair can restore uterine anatomy and improve fertility outcomes in selected patients. This case report presents a 38-year-old woman with a history of one lower segment caesarean section and two failed in vitro fertilization (IVF) cycles presented with secondary infertility. Ultrasound showed a prominent uterine niche. She underwent DHL with niche repair followed by controlled ovarian stimulation and intracytoplasmic sperm injection (ICSI). Frozen embryo transfer of two day 3 embryos resulted in a viable pregnancy. An elective repeat caesarean section was performed at 36 weeks + 4 days, resulting in the birth of a healthy infant. Laparoscopic niche correction may improve fertility outcomes in patients with uterine scar defects contributing to infertility, particularly those with prior IVF failures.

Acute pulmonary edema secondary to severe preeclampsia in a 47-year old elderly gravida conceived via in vitro fertilization: a case report

Madhumitha Venkatesh — 2025-09-26

Advanced maternal age and assisted reproductive technologies, such as in vitro fertilization (IVF) with oocyte donation, are recognized as risk factors for many disorders in pregnancy, including preeclampsia. Severe preeclampsia can, in rare instances, be complicated by acute pulmonary edema, posing significant risks to both the mother and the fetus. We report a rare case of a 47-year-old elderly primigravida with a BMI of 30 kg/m² (obese) who conceived via IVF and developed severe preeclampsia at 30+5 weeks of gestation with a hypertensive crisis that progressed to cause a life-threatening acute pulmonary edema. Immediate management included intravenous antihypertensives, diuretics, magnesium sulphate, and ventilatory support. Due to the deteriorating maternal and fetal status, an emergency lower segment caesarean section was performed in the intensive care unit. A 1.2 kg baby girl was delivered and admitted to the neonatal intensive care unit. The mother showed gradual postoperative improvement with stabilization of blood pressure and resolution of pulmonary symptoms. Her recovery period was aided by a multidisciplinary team involving obstetricians, anaesthesiologists, neonatologists, intervention specialists, and clinical psychologists. The case emphasizes the need for heightened vigilance and aggressive management in IVF pregnancies especially among women of advanced maternal age who are at increased risk of hypertensive disorders, fluid shifts, and cardiovascular stress. Risk assessment in elderly women undergoing IVF is crucial, along with vigilant monitoring and prompt multidisciplinary intervention to improve outcomes in high-risk pregnancies.

A rare case of vaginal vault prolapses after vaginal hysterectomy in North India: managed via sacrocolpopexy

Ritu Kataria — 2025-09-26

Vaginal vault prolapse refers to the descent of the upper portion of the vagina (apex or dome) into the vaginal canal or beyond the vaginal introitus, typically following a hysterectomy. This condition is a rare but significant long-term complication, with an incidence ranging from 0.1% to 18.2% after vaginal or abdominal hysterectomy. It may present in isolation or in conjunction with other pelvic organ prolapse disorders, such as cystocele, rectocele, or enterocele. Risk factors include advancing age, multiparity, chronic increased intra-abdominal pressure, and poor pelvic support following surgery. Sacral colpopexy especially via the abdominal approach remains the gold-standard surgical treatment due to its superior anatomical and functional outcomes and lower recurrence rates when compared to vaginal repairs. The procedure involves attachment of the vaginal apex to the sacral promontory using a synthetic mesh, restoring normal vaginal axis and support. Despite its clinical relevance, vaginal vault prolapse with a large enterocele remains underreported in certain regions, particularly in North India. A lack of awareness and underdiagnosis often delay appropriate management, especially in rural populations. We present a case of a 63-year-old woman with a history of vaginal hysterectomy 13 years prior, who presented to our tertiary care center with a symptomatic vaginal vault prolapse associated with a large enterocele. She was successfully managed by open abdominal sacral colpopexy and discharged in stable condition.

Torsion of giant ovarian cyst in postmenopausal woman: a case report with review of literature

Basanta M. Hota — 2025-09-26

Torsion of ovarian cyst, an acute gynecological emergency, needs attention not only for pain relief but to prevent its serious complications and in certain cases, to preserve the ovary. Though many factors predispose to the pathology, an enlarged ovary is the primary factor in the pathophysiology of torsion. It is rare in postmenopausal women. The Clinical presentation may be variable depending on the extent of pathology, as well as the investigation reports. Ultrasonography, using both grayscale and doppler imaging, and both transabdominal and transvaginal approaches, is the primary diagnostic investigation for patients with clinical suspicion. Surgery is both diagnostic and the treatment of choice. The earlier the treatment, the better the outcome, as it helps prevent complications. In certain cases, the ovary may be preserved through cystectomy and oophoropexy. Torsion of a benign giant ovarian cyst of 24 cm and weighing 3.5 kg in a postmenopausal woman is rare. In our case, a 46 years old postmenopausal parous lady presented with moderate pain abdomen and was found to have a giant ovarian cyst with mild tenderness, diagnosed as 7200 torsions of the right ovarian cyst of 24×20 cm on exploratory laparotomy. Total abdominal hysterectomy with right salpingo-oophorectomy and left salpingectomy was executed considering her age, healthy looking left ovary, and the benign features of the right ovarian cyst. Histopathology revealed a benign mucinous cystadenoma. Her post-operative period was uneventful, and she was found asymptomatic and healthy on follow up.

Low recto-vaginal fistula cured by Kshar Sutra (a medicated seton) treatment: a case report

Prasad Bapat — 2025-09-26

Rectovaginal fistulas (RVFs) are challenging to treat, primarily due to their high recurrence rate and the risk of faecal incontinence following surgical intervention. A 30-year-old woman was suffering from low RVF. An herbal medicated seton, known as 'Kshar Sutra,' was used to treat the patient. The local anaesthesia was used in and around the fistula track. Weekly thread changes were done on an outpatient basis for four weeks. There were no complications such as severe bleeding, secondary infection, severe pain, and incontinence. The patient has been fistula-free for the last 5 years. Low RVF can be treated safely by an herbal Kshar Sutra seton without any complications.

Constipation in obstetrics - an underrated sign

L. Thulasi Devi — 2025-09-26

An interesting case of normotensive hemolysis, elevated liver function tests, and low platelet counts (HELLP) syndrome with only presenting symptom of severe constipation near term; an occult sign of liver disease. She presented in active labour with mild jaundice and early signs of disseminated intravascular coagulation (DIC). This was an obstetric near miss, as it was a fine balancing act combined with aggressive monitoring and nursing management by highly skilled team of trained obstetric nurse midwives. This was a humbling lesson which reminded us not to ignore aggravated commonly occurring symptom in all patients of obstetrics. Availability of fresh whole blood makes it easier to manage such cases as fresh components are extremely difficult to procure and process in remote obstetric units.

Clinicopathological characteristics and oncological outcomes in a case of primary ovarian adenosarcoma with sarcomatous differentiation: a case report and literature review

Sheereen Fatima — 2025-09-26

Mullerian adenosarcoma is a rare malignant tumor generally involving the uterine corpus but can uncommonly involve extrauterine organs. Ovarian adenosarcoma is extremely rare and often diagnosed in young women. Majority of them are low grade with a good prognosis except for adenosarcoma with sarcomatous overgrowth (SO). We report a case of a large sized ovarian adenosarcoma with SO with elevated levels Ca125 and Ca19.9 and having disease free interval of approximately 1.5 years.

Enhanced myometrial vascularity in hysteroscopy in the elderly: a case report

Deepika Theresa — 2025-09-26

Sildenafil citrate (Viagra), a selective cGMP specific PDE5 inhibitor, widely used in erectile dysfunction in males, acts on vascular smooth muscle, especially corpus cavernosum. Authors detail a rare case report here, elderly 80-year-old woman, on sildenafil for coronary artery disease and pulmonary hypertension, with a small long standing FIGO 2-5 uterine fibroid, presenting with acute post-menopausal bleeding after 40 years of menopause, hysteroscopy showing enhanced myometrial vascularity and benign histopathology thereafter.

Outcomes of amniocentesis at a tertiary maternal-fetal medicine unit in Malaysia: a five-year retrospective cohort study of cytogenetic yield and procedure-related complications

Shashi Indran Naidu — 2025-09-26

Background: Amniocentesis is the most widely performed invasive prenatal diagnostic procedure worldwide. While its diagnostic accuracy is well established, procedure-related risks such as miscarriage and preterm prelabour rupture of membranes (PPROM) remain central to patient counselling. Although international safety and diagnostic outcome data are robust, regional evidence from Southeast Asia is limited. This study aimed to evaluate the cytogenetic yield and short-term complications of amniocentesis performed in a Malaysian tertiary maternal-fetal medicine (MFM) training centre over a five-year period.

Methods: A retrospective cohort study was conducted, including all women who underwent amniocentesis at hospital Tuanku Jaafar (HTJ), Seremban, between January 2018 and December 2022. Maternal demographics, ethnicity, indications, cytogenetic outcomes, and procedure-related complications within 14 days were extracted from hospital records. Descriptive statistics were used to summarise baseline characteristics and outcomes. Associations were analysed using Fisher's exact test, and binary logistic regression was performed to identify independent predictors of miscarriage and PPROM.

Results: A total of 650 amniocentesis were included. Most women were <35 years (34.8%) or 38-40 years (31.1%); the majority were Malay (73.8%). Advanced maternal age was the leading indication (54.6%). Cytogenetic analysis revealed normal results in 90.9% of cases. Abnormal findings included trisomy 21 (1.7%), trisomy 18 (3.4%), trisomy 13 (0.8%), and other aneuploidies (3.1%), yielding an overall abnormal karyotype rate of 8.9%. Procedure-related complications were rare, with miscarriage in 0.3% (n=2) and PPROM in 0.6% (n=4). An abnormal karyotype was significantly associated with miscarriage and PPROM in univariate analysis (p<0.001) and remained an independent predictor of PPROM on logistic regression (OR=2.74, 95% CI=1.5-5.1, p=0.001). No independent predictors of miscarriage were identified.

Conclusions: Amniocentesis in this tertiary MFM training centre was associated with a high diagnostic yield and very low short-term complication rates, consistent with international benchmarks. The clustering of complications among abnormal karyotypes suggests that biological vulnerability contributes to adverse outcomes independent of procedural factors. These findings reinforce the safety of amniocentesis in the hands of experienced practitioners and provide important regional data for patient counselling and training.

Cross-sectional study comparing paracervical and combined paracervical-fundal block for outpatient Novasure

Farheen Khan — 2025-09-11

Background: This retrospective cross-sectional study aimed to evaluate whether the combination of paracervical and fundal block provides greater reductions in self-reported pain during NovaSure endometrial ablation compared with paracervical block alone.

Methods: Fifty women aged 45–60 years who underwent NovaSure endometrial ablation at hysteroscopy clinics were retrospectively analyzed.

Results: Participants who received the combined block reported significantly lower pain scores during the procedure (mean: 3) compared with those who received paracervical block alone (mean: 6). The overall procedural success rate was 76%. Complications occurred in 28% of cases, all of which were managed conservatively. Patient satisfaction was high, with 92% reporting satisfaction and 84% indicating they would recommend the procedure. Most participants experienced minimal pain and resumed normal activities within 1–3 days.

Conclusions: The combination of paracervical and fundal block provides superior pain relief compared to paracervical block alone during NovaSure endometrial ablation. This approach is associated with high patient satisfaction, rapid recovery and manageable complication rates.

Evaluation of endometrial abnormalities in breast cancer patients on tamoxifen therapy

Silvia Hossain — 2025-09-26

Background: Breast cancer is the most common malignancy in women. Tamoxifen, widely used as adjuvant therapy, has anti-estrogenic effects on breast tissue but may induce endometrial changes due to estrogenic stimulation. To evaluate endometrial abnormalities in postmenopausal breast cancer patients receiving tamoxifen therapy.

Methods: This cross-sectional study was conducted at the Department of Gynaecological Oncology, NICRH, Dhaka, over one year. Seventy-five postmenopausal breast cancer patients who had received tamoxifen for more than six months were enrolled. All underwent transvaginal ultrasound (TVS) and 32 patients subsequently had histopathological evaluation. Data were analyzed using SPSS v23.

Results: The mean age was 58.03±7.96 years. TVS revealed endometrial thickness of 4–7.9 mm in 58.6%, 8–11.9 mm in 8%, 12–15.9 mm in 12%, 16–19.9 mm in 6.7% and ≥20 mm in 14.6% of patients, with a mean thickness of 11.22±6.68 mm. Thickness ≥8 mm was significantly associated with longer tamoxifen use (p<0.05). Histopathology (n=32) showed 25% normal endometrium, while 75% had abnormalities: polyps (28.1%), hyperplasia without atypia (25%), hyperplasia with atypia (9.4%), atrophy (9.4%) and carcinoma (3.1%). A significant correlation was found between TVS findings and histopathology (p=0.044).

Conclusions: Nearly two-fifths of patients developed endometrial thickening >8 mm and three-quarters of those biopsied had abnormal histopathology, including hyperplasia with atypia and carcinoma. Long-term tamoxifen therapy in postmenopausal women may predispose to endometrial pathology, warranting regular surveillance with TVS and prompt biopsy for suspicious cases.

Association of prothrombin gene mutation (G20210A) with recurrent pregnancy loss

Surayea Bul Bul — 2025-09-26

Background: Recurrent pregnancy loss (RPL) is a significant reproductive health concern, often with multifactorial etiologies. Among the possible causes, thrombophilic gene mutations, such as the Prothrombin G20210A mutation, has the most potential role. This study aimed to investigate the association between Prothrombin G20210A gene mutation and RPL in a selected group of Bangladeshi women.

Methods: This case-control study was carried out in the outpatient Department of Fetomaternal Medicine, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh, from December 2020 to May 2021. Total 35 women with history of recurrent pregnancy losses were selected as cases. The control group consisted of 35 women with at least one successful pregnancy and no history of recurrent pregnancy loss.

Results: Out of 35 cases two patients have Prothrombin gene mutation, one in 1st trimester and another in 2nd trimester. One was primary RPL and another one was secondary RPL. Normal homozygous (GG) were 94.3% and mutant heterozygous (GA) were 5.7%, mutant homozygous (AA) were 0.0% in case group. In control group there were no mutation of prothrombin gene (G20210A). The difference was statistically not significant (p=0.421) between two groups. Fisher exact test was done. This test was done to see the results were statistically significant or not. It is usually employed when sample sizes are small but it is valid for all sample sizes.

Conclusions: This study found no statistically significant association between the Prothrombin G20210A gene mutation and recurrent pregnancy loss. Although 5.7% of cases had heterozygous mutations, none were observed in controls.

Knowledge of family planning among muslim women of reproductive age in Garissa County

Mumtaz Muhumed Ahmed — 2025-09-26

Background: Kenya’s unmet need for family planning (FP) remains high, at 13.9%, despite government efforts to promote FP methods. Challenges persist, especially in rural areas like Garissa County, where contraceptive prevalence is low, at 12.7%. To determine the level of knowledge of FP among Muslim women of reproductive age in Garissa county.

Methods: A cross-sectional mixed methods research design focused on Muslim women aged 15-49 in Garissa County. The study involved 187 participants selected through stratified random sampling. A proportionate sample of women was calculated per subcounty. Data collection used semi-structured interviews with selected women and focus group discussions with community health volunteers from seven subcounties. Quantitative data were analyzed using the Statistical Package for Social Sciences through descriptive analysis. Qualitative data was analysed thematically.

Results: Eighty-two percent of women were aware of FP, mainly through community health workers (66%). Only 44% attended FP workshops, showing limited interest in education; additionally, only 39% practiced FP. Among those who used FP, 56% had husbands unaware of their usage.

Conclusions: There was knowledge of contraceptives and FP methods, largely due to information shared by community health workers and volunteers. Friends and media also spread FP awareness. However, attendance at FP workshops was low and actual use of FP methods was limited. About half of the women's partners were also aware of and supportive of FP.

Impact of placental histopathology and maternal risk factors on neonatal morbidity in late preterm infants

Arife Sancaktar — 2025-09-26

Background: Maternal and placental risk factors are critical determinants of neonatal outcomes in preterm infants. This study aims to evaluate the impact of placental histopathological findings and maternal risk factors on neonatal morbidity and mortality among late preterm infants.

Methods: This prospective study was conducted between January and July 2018 at Başkent University Faculty of Medicine. A total of 62 late preterm infants, born via cesarean section between 34^0⁄7 and 36^6⁄7 weeks of gestation, were included. Neonatal morbidities were assessed in relation to placental histopathological features and maternal risk factors. Placental examinations included both gross and microscopic evaluations, focusing on maternal vascular malperfusion, chronic inflammation, placentomegaly, placental hematomas, and fetal obliterative vasculopathy.

Results: Placental histopathological abnormalities and maternal risk factors were significantly associated with adverse neonatal outcomes. Maternal vascular malperfusion correlated with an increased risk of hyperbilirubinemia and intracranial hemorrhage. Chronic placental inflammation was linked to polycythemia and feeding intolerance. Placentomegaly was associated with early-onset neonatal sepsis and feeding difficulties. Additionally, maternal conditions such as preeclampsia, thrombophilia, oligohydramnios, and maternal infections were found to influence neonatal morbidity.

Conclusions: Placental histopathological findings particularly maternal malperfusion, chronic inflammation, and placentomegaly appear to contribute significantly to neonatal morbidity in late preterm infants. The combined assessment of placental pathology and maternal risk factors may enhance early prediction of neonatal complications and guide postnatal clinical management.

Comparison of low level of pregnancy-associated plasma protein - A between first and early second trimester of pregnancy in intrauterine growth restriction

Zobaida Sultana Susan — 2025-09-26

Background: Intrauterine growth restriction (IUGR) is the failure of the fetus to reach its growth potential due to pathological factors, most commonly placental dysfunction and is a major contributor to perinatal morbidity and mortality worldwide. This study compares low maternal serum PAPP-A levels in the first and early second trimesters to predict IUGR risk. The aim of the study was to compare low levels of Pregnancy-Associated Plasma Protein-A (PAPP-A) between the first and early second trimesters of pregnancy in relation IUGR.

Methods: This prospective cohort study was conducted at the Department of Obstetrics and Gynecology, Dhaka Medical College Hospital in 2020, including 186 pregnant women (6–12 and 13–20 weeks gestation) to assess PAPP-A’s predictive value for IUGR. Eligible healthy singleton pregnancies underwent blood PAPP-A testing and serial ultrasounds with Doppler. IUGR was diagnosed by fetal measurements and Doppler, with low PAPP-A defined as <0.5 MoM. Data analysis used SPSS with ROC curves.

Results: Most participants were aged 26–29 years. IUGR occurred in 17 (Group A) and 19 (Group B), with low PAPP-A in 12 and 13 cases, respectively. Low PAPP-A significantly predicted IUGR (RR: 10.73 and 9.03, p<0.001). Diagnostic performance was high in both trimesters (AUC>0.85, sensitivity>89%, specificity>69%). Serum PAPP-A is a reliable early predictor of IUGR.

Conclusions: Low maternal serum PAPP-A levels in early pregnancy moderately predict IUGR, with comparable accuracy in both first and early second trimesters.

Effect of oral feeding following elective caesarean section on paralytic ileus among participants in a tertiary institution in Southern Nigeria

Kpoobari Bema — 2025-09-26

Background: Studies suggest that early initiation of oral feeding after caesarean delivery is well-tolerated by patients, but it is not yet practiced in most institutions. Traditionally, patients are kept on nil per oral until bowel functions return. This practice is associated with complications including paralytic ileus. However, the time for commencing oral feeding after elective caesarean delivery is still controversial. The aim of this study was to compare the effect of 2-hour (early) and 24-hour (delayed) post-operative oral feeding on the outcome of elective caesarean delivery in Rivers State University Teaching Hospital Port Harcourt.

Methods: This was a randomised controlled trial done in Rivers State University Teaching Hospital, Port Harcourt, between May 2023 and September 2023. 166 participants were selected consecutively during the period of study and randomised into two groups with 83 participants in each group. Using a structured questionnaire, data were collected and analysed with SPSS version 25 software.

Results: The proportion of post-operative ileus symptoms was 6.0% vs. 3.6% in the early and delayed groups showing no statistical difference (ꭓ2=0.52; p–0.473). The time interval for return of bowel function (3.7±0.7 hours vs. 13.6±2.7 hours), passage of flatus (6.1±1.3 hours vs. 20.4±3.8 hours) and bowel movement (32.9±15.1 hour vs. 64.7±14.6 hours) were significantly higher (p<0.05) in the delayed group than the early group.

Conclusions: Early initiation of oral feeding after elective caesarean section is safe and is associated with earlier return of normal bowel function without fear of gastrointestinal symptoms or paralytic ileus.

Effect of letrozole and dexamethasone combination therapy compared to letrozole alone for ovulation induction in infertile women with polycystic ovary syndrome: a randomized controlled trial

M. Ariful Islam — 2025-09-26

Background: Polycystic ovary syndrome (PCOS), a common cause of anovulatory infertility, affects 5–10% of reproductive-age women. Hyperandrogenemia disrupts follicular development. Dexamethasone may enhance folliculogenesis. This study compared letrozole plus dexamethasone versus letrozole alone for ovulation induction in infertile PCOS women.

Methods: This randomized controlled trial was conducted at the Department of Reproductive Endocrinology and Infertility, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh, from September 2023 to August 2024. 72 infertile PCOS women (18-35 years) were allocated into 2 groups. Group A (36 patients) received letrozole 7.5 mg/day for 5 days with dexamethasone 0.5 mg twice daily for 10 days from cycle day 2. Group B (36 patients) received letrozole 7.5 mg/day for 5 days from cycle day 2 for 3 cycles. TVS folliculometry assessed ovarian response on day 12-14. HCG injection was given for mature follicles. Ovulation was confirmed by mid-luteal progesterone and pregnancy by serum B-HCG.

Results: Group A showed more mature follicles than group B, notably in the 3rd cycle (76.7% vs 51.6%, p<0.05). Endometrial thickness was greater in Group A in both 2nd (7.7±1.4 vs 6.6±0.9 mm, p<0.05) and 3rd cycles (7.9±1.4 vs 6.7±1.0 mm, p<0.05). Ovulation rates were higher in Group A, reaching significance in the 3rd cycle (76.7% vs 51.6%, p<0.05). Cumulative pregnancy rates favored Group A (30.6% vs 19.4%), though not significantly.

Conclusions: Letrozole plus dexamethasone is more effective than letrozole alone in enhancing follicular development, endometrial thickness, ovulation, and pregnancy outcomes in women with PCOS.

A comparative study on MgSO₄ and nifedipine as acute tocolytic agents in preterm labour

Neethika Raghuwanshi — 2025-09-15

Background: Preterm labour is a major cause of neonatal morbidity and mortality. Tocolysis helps delay delivery, allowing time for antenatal corticosteroids and in-utero transfer. Magnesium sulphate (MgSO4) and nifedipine are commonly used agents, but comparative evidence is limited. To compare the efficacy and safety of MgSO₄ and nifedipine as acute tocolytics in preterm labour.

Methods: This randomized controlled trial at a tertiary care centre - GMC Akola, enrolled 100 women between 28–34 weeks of gestation with preterm labour. Participants were randomly allocated to receive either MgSO₄ (loading dose 4 g IV, followed by 1 g/hr infusion) or oral nifedipine (10 mg every 20 min up to 3 doses, then 20 mg every 4-6 hrs for 24 hrs). Outcomes assessed were uterine quiescence, prolongation of pregnancy ≥48 hrs, maternal side effects, and neonatal outcomes.

Results: Labour was arrested in 92% of women treated with MgSO₄ and 90% with nifedipine. MgSO₄ achieved slightly higher rates of uterine quiescence and prolongation beyond 48 hrs. NICU admissions were lower with MgSO₄ (38% vs 44%), as was neonatal mortality (10% vs 14%). Side effects were mild and comparable: hot flushes/lethargy with MgSO₄ and tachycardia/headache with nifedipine. No serious adverse events occurred.

Conclusion: Both MgSO₄ and nifedipine are effective and safe tocolytic agents. MgSO₄ offers a marginal advantage in prolonging gestation and provides fetal neuroprotection, whereas nifedipine is simpler to administer and cost-effective in low-resource settings.

An observational study to classify causes of abnormal uterine bleeding according to PALM-COEIN classification

Urmish Patel — 2025-09-09

Background: Abnormal uterine bleeding (AUB) is a frequent gynecological complaint affecting women of all ages, significantly impacting quality of life. To standardize its diagnosis and management, the International Federation of Gynecology and Obstetrics (FIGO) introduced the PALM-COEIN classification system, which categorizes AUB into structural and non-structural causes. To classify AUB according to PALM-COEIN classification, to know associated risk factors, to know their demography and modality of treatment required.

Methods: This observational cross-sectional study was conducted in the Department of Obstetrics and Gynaecology at New Civil Hospital, Surat, from May 2024 to April 2025. Approval was obtained from the Institutional Research Review Committee (Approval ID: GMCS/RRC-2/13433/24).

A total of 200 consenting women with AUB (non-pregnancy related) were included. Exclusion criteria: pregnancy-related bleeding or refusal to consent. Detailed clinical history, examination, investigations, imaging and biopsy when indicated were done. Classification was as per PALM-COEIN. Treatment included medical or surgical modalities. Response was assessed over a 3-month follow-up.

Results: The most common cause of AUB was adenomyosis (AUB-A, 33%), followed by leiomyoma (AUB-L, 30.5%) and ovulatory dysfunction (AUB-O, 14%). Among non-structural causes, AUB-O was predominant. In this study simple endometrial hyperplasia without atypia in 4 cases and half of those patients improved with medical treatment. Medical management was effective in 64.48% of treated patients, while 65.5% required surgical intervention. Obesity (26%) and thyroid disorders (17.5%) were the most common comorbid risk factors.

Conclusions: The PALM-COEIN classification system was a useful and thorough tool for understanding the causes of AUB, helping to standardize diagnoses, plan better treatments and achieve better results in patient care. It also facilitated effective communication and comparison across clinical and research settings.

Maternal near miss events in a tertiary care teaching hospital: a prospective analysis of risk factors, clinical outcomes and healthcare system performance

Pranav S. Nair — 2025-09-26

Background: Maternal health is a critical indicator of a nation's overall health and development. Maternal near miss (MNM) cases, defined as women who nearly died but survived a life-threatening complication during pregnancy or childbirth, offer valuable insights into improving maternal healthcare systems.

Methods: A comprehensive analysis was conducted at a tertiary care teaching hospital to identify MNM cases using world health organization's (WHO) standardized criteria, which include clinical, laboratory, and management-based indicators. Data on the frequency, causes, and outcomes of MNM events were collected and analyzed to assess the quality of care provided. The study was a prospective design, conducted for 6 months from January 2024 to June 2024, involving 50 participants.

Results: The study found that hemorrhage, hypertensive disorders, and sepsis were the most common causes of MNM. Early identification and timely intervention were crucial in preventing progression to maternal death. The study also highlighted the impact of health system factors, such as accessibility to emergency obstetric care and the availability of skilled healthcare providers, on the incidence of MNM. Blood transfusion was the most common life-saving intervention (30%), and 64% of cases were pregnancy-related.

Conclusions: MNM cases occur more frequently than maternal deaths and provide a larger sample size for analysis, leading to improved maternal care and reduced maternal mortality. The findings underscore the importance of enhancing healthcare infrastructure, training healthcare providers, and implementing evidence-based interventions to improve maternal outcomes.

Effectiveness of enhanced recovery after surgery protocol in major gynecological surgeries: a cross-sectional study

Sudha T. R. — 2025-09-26

Background: Objectives of the study include: assessment of effectiveness of perioperative outcome of components of enhanced recovery after surgery protocol (ERAS-P) - pre-operative, intra-operative, post-operative and compliance of participants to ERAS-P.

Methods: A prospective cross sectional study was conducted at Sri Chamarajendra Government, Teaching MCH hospital in one year.80women fulfilling selection criteria were selected for elective major gynecological surgeries under ERAS-P. Components of ERAS-P include: pre-operative, intra-operative, and post-operative were practiced and the outcomes include the length of hospital stay, post-operative pain assessment, return of bowel function, admission to discharge interval, cost of treatment, complications, repeat hospitalization, and patient satisfaction rate were assessed.

Results: Among 80 participants, distribution of cases were- abnormal uterine bleeding (AUB-L) leiomyoma-37.5%, uterine prolapsed-32.5%, adnexal mass-8.8%, adenomyosis-in 7.5%, and others 5%. The average length of hospital stay was 24 hours for laparoscopic salpingectomy, 48 hours for laparoscopic surgery, 72 to 96 hours for vaginal hysterectomy and laparoscopic surgery and 96 hours for TAH±BSO. The visual analogue scores indicated pain levels among participants with the mean score at 6 hours’ post-surgery-5.51 for major surgeries and <4.00 for minimal invasive surgeries.

Conclusions: The implementation of ERAS-P is observed to be associated with reduction in duration of hospitalization, early mobilization, need based pain management, high satisfaction, lower complications, and repeat hospitalization.

A study to assess the knowledge regarding expressed breast milk among working mothers attending outpatient departments in a selected hospital at Mangaluru, Karnataka, India

Akshata N. Naik — 2025-09-17

Background: Breastfeeding is the gold standard for infant feeding. Breastfeeding is essential for child survival and health. Employment is one of the most common barriers to discontinue breast feeding after childbirth. Expressed breast milk (EBM) serves as a practical solution for mothers who cannot be physically present to breastfeed due to work commitments. The aim of the study was to assess the knowledge regarding EBM and find the association between knowledge and their sociodemographic variables among working mothers attending outpatient departments in a selected hospital at Mangaluru, Karnataka, India.

Methods: A non-experimental descriptive study. Purposive sampling technique was used to select 30 working mothers. Data was collected using a structured knowledge questionnaire. Data was analysed using descriptive and inferential statistics.

Results: The study findings showed that the mean knowledge score with standard deviation was 12.76±3.58 and the mean knowledge score percentage was 42.5% regarding EBM. There was no significant association between mother’s knowledge level and sociodemographic variables.

Conclusions: The study highlights the urgent need for educational programs and support systems to empower working mothers with the right knowledge regarding EBM and ensuring better nutrition and growth for their infants.

Acceptability, safety, and clinical outcomes of postpartum intrauterine contraceptive device insertion: a prospective study at a tertiary care hospital

Shruthi K. R. — 2025-09-04

Background: Contraception is vital in improving the quality of life of women and reducing the maternal mortality and morbidity, occurring due to unplanned pregnancy. During the immediate post-delivery period, women are highly motivated and need an effective method of contraception. The benefits of the postpartum intrauterine contraceptive device (PPIUCD) have to be emphasized to the women

Methods: The present study was conducted in the department of obstetrics and gynecology, JSS hospital, Mysore, from June 2021 to June 2024, spanning a period of 3 years. After counseling and consent, Copper T 380A was inserted after delivery. Acceptability, safety, and clinical outcome were studied.

Results: Among a total of 14196 deliveries at JSS hospital during the study period, 3107 PPIUCDs were inserted (21.88%). The 2522 among 6258 antenatally counselled women accepted PPIUCD insertion (40.3%), and 2450 (97.14%) got PPIUCD inserted. The 585 (11.68%) out of 5006 women counseled on admission for delivery had PPIUCD inserted. The most common reason for denial of PPIUCD was a family member's objection, followed by the concern about side effects. The 718 (23.10%) women reported complications like excessive bleeding, white discharge per vagina, abdominal pain, and only 2 (0.075%) had spontaneous expulsion of PPIUCD.

Conclusions: PPIUCD appears to be a safe and effective method of contraception. All the institutions providing health care to women need to be trained in the correct insertion technique of PPIUCD, counselling of women and family members, to propagate this novel method of contraception, and to motivate the women for continuation of IUCD by providing effective follow-up service.

Non-stress test as an admission test to assess the outcome in all pregnant women attending tertiary care center

Rita D. — 2025-09-15

Background: Perinatal mortality remains high in developing countries, including India, where it is approximately 32 per 1000 live births. The non-stress test (NST) is a non-invasive, simple, and widely used method to assess fetal well-being after 30 weeks of gestation. A reactive NST usually indicates adequate fetal oxygenation, while a non-reactive result may suggest hypoxia or neurological depression.

Methods: This prospective study included 100 pregnant women (>30 weeks gestation) with singleton pregnancies admitted to the labour ward of Navodaya medical college, Raichur. NST was performed in the semi-recumbent or left lateral position for 20 minutes (extended to 40 minutes if non-reactive). Outcomes assessed included mode of delivery, birth weight, Apgar scores at 1 and 5 minutes, NICU admissions, maternal complications, and hospital stay duration.

Results: Reactive NST was recorded in 78% of participants, non-reactive in 16%, and suspicious in 6%. Non-reactive and suspicious NSTs were significantly associated with higher emergency caesarean section rates (50% vs 17.9%), increased NICU admissions (37.5% and 33.3% vs 5.1%), lower Apgar scores, and greater incidence of meconium-stained liquor and intrapartum fetal distress (p<0.05).

Conclusions: Admission NST is a reliable predictor of perinatal outcome. Reactive NSTs are associated with favorable outcomes, whereas non-reactive/suspicious results indicate higher perinatal risk, necessitating timely intervention.

Hypertensive disorders in pregnancy gestosis score as a predictor of pre-eclampsia

B. Dhivya — 2025-09-26

Background: Pre-eclampsia (PE) significantly contributes to maternal and neonatal morbidity, particularly in low-resource settings. The hypertensive disorders in pregnancy (HDP) gestosis score integrates clinical risk factors to identify women at risk. This study aimed to assess the ability of the HDP gestosis score to predict PE, analyse associated risk factors, and highlight the importance of early risk stratification in primary care.

Methods: This analytical/observational prospective study was conducted on 280 patients at SRM Medical College Hospital, Trichy, between June 2024 and March 2025. Baseline data, including demographics, obstetric history, and medical conditions, were collected from records and interviews during the first visit. The HDP scoring system was applied, and all participants were prospectively followed up until delivery.

Results: Among 280 mothers, 46 (16.4%) developed PE. Mothers with PE had a significantly higher mean age (29.7±6.1 years) than those without PE (p<0.001). Obesity (p<0.001), age >35 years (p<0.001), ART use (p<0.001), hypothyroidism (p<0.001), and chronic hypertension (HTN) (p<0.001) were significantly associated. A Gestosis score ≥3 was present in 17.5% of mothers, with 71.7% of them developing PE (p<0.001). The score showed a sensitivity of 71.7%, specificity of 93.2%, negative predictive value of 94.4%, positive predictive value of 67.4%, and an accuracy of 89.7%, confirming its value for early risk stratification and PE prediction in primary care.

Conclusions: PE was associated with advanced age, obesity, ART use, hypothyroidism, family history, multiple pregnancies, diabetes, and HTN. An HDP Gestosis score ≥3 predicted PE with high specificity and moderate sensitivity, supporting its use in antenatal risk assessment.

Birthing outcomes and experience of holistic approach in women undergoing trial of labor after cesarean: a retrospective analysis

Kavitha Gautham — 2025-09-09

Background: A person-centered holistic birth approach (HBA) includes preparation of mind and spirit along with physical body to help mothers attain their ideal birthing experience. There is paucity availability of research done to evaluate the integrity of HBA. The present study aims to evaluate the birthing experience and outcomes of women undergoing a person-centered naturopathic pregnancy care.

Methods: Women with at least one previous cesarean section with no significant comorbidity and spontaneous conception who opted to have holistic approach towards trial of labor after cesarean (TOLAC) (n=44) in a private birthing center with an exclusive birthing team located in Chennai were provided with evidence based holistic interventions under a naturopathic physician from 28 weeks of gestation till delivery. Data collected between November 2022 to September 2023 were analysed retrospectively for maternal and labor outcomes using descriptive statistics.

Results: Out of all eligible pregnant women who had holistic approach (n=44), 1 in 2 (n=27) (61%) had successful vaginal birth (VB), women who came in labor spontaneously were n=32 (73%). Among those who delivered vaginally (n=27), n=17 (63%) had natural birth with no medical interventions, n=25 (93%) had nonmedicated pain management, n=16 (59%) had natural tears ranging from intact perineum to 2^nd degree perineal tear and n=17 (46%) chose various birthing positions. Majority of women rated their childbirth experience to be empowering and satisfactory n=35 (88%).

Conclusions: The study demonstrates, that a holistic approach involving a multidisciplinary team in a specialty birthing center delivered by qualified professionals could result in above mentioned birthing experience and outcomes which in turn empowers women through a person-centered care.

A comparative analysis of qSOFA and SOFA scores for outcome prediction among obstetric patients admitted to intensive care unit at a tertiary care centre

Paridhi Agarwal — 2025-09-15

Background: Sepsis in obstetric patients remains a leading cause of maternal morbidity and mortality, requiring timely recognition and management. The sequential organ failure assessment (SOFA) score is widely used for organ dysfunction assessment, while the Quick SOFA (qSOFA) provides a rapid bedside tool. Their utility in obstetric sepsis, however, is challenged by pregnancy-related physiological changes.

Methods: This prospective observational study was conducted over 18 months (June 2023-November 2024) at L.L.R.M. Medical College, Meerut. Fifty women pregnant, postnatal (≤6 weeks), or postabortal (≤2 weeks) with sepsis diagnosed by SIRS criteria were included. Patients with ectopic pregnancy, malignancy, trauma, or chronic systemic disease were excluded. Clinical examination, laboratory investigations, and SOFA/qSOFA scoring were performed. Statistical analysis was done using SPSS v22 with Chi-square, Fisher’s exact test, independent t-test, and ROC analysis.

Results: SOFA scores showed significant correlation with maternal outcomes: 70% recovered, 20% developed complications, and 10% died (p=0.015). ICU admission was associated with higher qSOFA scores in 80% of patients (p=0.007). SOFA demonstrated superior sensitivity (85%) and specificity (90%) for mortality prediction compared to qSOFA (70% and 75%, respectively; p=0.013).

Conclusion: qSOFA is a useful triage tool for rapid assessment, while SOFA provides greater prognostic accuracy. A combined approach may improve management of obstetric sepsis.

A comparison of the effectiveness of Samarthram vacuum suction cannula with uterotonic drugs as primary management in cases of atonic PPH at tertiary care center: a randomized clinical trial

Neethika Raghuwanshi — 2025-09-04

Background: Atonic PPH is a leading cause of maternal mortality. The SR cannula offers a low-cost, practical alternative by creating negative intrauterine pressure that mimics natural uterine retraction. To compare effectiveness of SR vacuum suction cannula and with uterotonic drugs in cases of Atonic PPH.

Methods: This prospective study at GMC Akola enrolled 100 women developing atonic PPH after AMTSL. Patients were randomized to SR cannula (n=50) or uterotonics (n=50). Group A: Cannula inserted up to fundus, negative suction at 650 mmHg for 10 min, repeated hourly 3 times. Group B: Uterotonics given as needed sequentially (Methergine → Carbetocin→Misoprostol→Carboprost) with 15-min interval. All patients were observed for bleeding, tone, vitals;

Results: In Group A (SR cannula), bleeding stopped in <4 min in 64%, 5-9 min in 26%, 10-14 min in 4% and >14 min in 6%. In Group B (uterotonics),in 6%, 52%, 30% and 12% respectively. Mean blood loss was 302.85±106.07ml in Group A vs 377.9±135.41ml in Group B.

Conclusions: SR cannula is as effective as uterotonics for atonic PPH, with faster bleeding control, lower cost, reusability and transport feasibility, yet larger studies are needed for validation.

A retrospective observational study of maternal weight gain during pregnancy and correlation with fetomaternal outcome in women admitted to labour room in a tertiary care center of South Gujarat

Nitinkumar Hadiya — 2025-09-09

Background: Gestational weight gain (GWG) is an important determinant of maternal and neonatal health. Both excessive and inadequate GWG are associated with adverse outcomes. This study evaluated the correlation of GWG, based on Institute of Medicine (IOM) guidelines, with pregnancy outcomes across different body mass index (BMI) categories.

Methods: A retrospective observational study was conducted in the Department of Obstetrics and Gynaecology at a tertiary care centre in South Gujarat over one year. A total of 300 pregnant women were analysed for age, parity, BMI, GWG, and fetomaternal outcomes.

Results: Most participants were aged 19–35 years (95%), with primipara comprising 40.67%. Poor GWG was observed in 56% and normal GWG in 35.67%. Preterm labour was more frequent in underweight women (11.13%), while post-term delivery was higher in obese women (17.47%). Vaginal delivery predominated in poor GWG (72.62%), whereas lower segment caesarean section (LSCS) rates were greater in high BMI groups (36%). Low birth weight (<2.5 kg) was common with poor GWG (41.07%), while birth weight >2.5 kg was more frequent in normal (76.63%) and excessive GWG (88%). Anaemia was the leading comorbidity (132 cases), particularly in underweight women. GDM, hypertensive disorders, big bay, induction failure, operative delivery, and postpartum complications were associated with higher BMI and excessive GWG.

Conclusions: GWG followed pre-pregnancy BMI trends. Excessive GWG was linked with metabolic and obstetric complications, while below-recommended GWG increased risks of low birth weight, preterm delivery, and anaemia.

A study of the changes in pelvic floor biometry in pregnancy by trans labial ultrasonography: cross sectional observational analytical study

Mamta Singh — 2025-09-26

Background: The pelvic floor, a crucial structure for urinary and anal continence, sexual function, and pelvic organ support, undergoes significant changes during pregnancy and childbirth. Damage to this area can lead to female pelvic floor disorders (FPFDs) such as urinary incontinence, fecal incontinence, and pelvic organ prolapse. This study aimed to evaluate the changes in pelvic floor biometry during pregnancy using translabial ultrasonography (USG) in Indian women.

Methods: This cross-sectional observational analytical study recruited 112 women from December 2022 to July 2023 at Sparsh Hospital. The participants included nulliparous women (n=12) and pregnant women in their second and third trimesters, divided into primigravida (n=50) and second gravida (n=50) groups. Translabial 2D and 4D USG was performed in the study.

Results: The study found statistically significant changes in bladder neck mobility and hiatal area in primigravida patients compared to nulliparous women. Bladder neck mobility increased with parity, especially during the Valsalva maneuver, suggesting a greater descent in multiparous women. The thickness of the levator ani muscle also increased during pregnancy, showing a significant change during contraction in primigravida patients. While hiatal area did not significantly change with increasing parity, bladder neck mobility was notably higher in second gravida patients compared to primigravida patients, particularly during contraction.

Conclusions: Translabial USG is a valuable, non-invasive tool for assessing these changes, which can help clinicians and patients anticipate potential PFDs and implement preventative post-delivery care.

Vitamin D supplementation in infertile women with PCOS: a quasi-randomized placebo-controlled study

Nupur Rawat — 2025-09-26

Background: Polycystic ovary syndrome (PCOS) is a common endocrine disorder associated with infertility and metabolic dysfunction. Vitamin D deficiency is prevalent in women with PCOS and may exacerbate hormonal and metabolic derangements. This study evaluated the effects of vitamin D supplementation on ovulatory and metabolic outcomes across PCOS phenotypes in a placebo-controlled setting.

Methods: In this 24-month quasi-randomized placebo-controlled trial, 180 infertile women with PCOS (Rotterdam criteria) and serum 25(OH)D <20 ng/mL were randomly allocated to Group A (n = 90, received cholecalciferol 60,1 IU/week for 9 weeks) or Group B (n = 90, received placebo capsules identical in appearance and schedule). Allocation was based on alternate patient recruitment. Both groups were stratified into four PCOS phenotypes. Clinical, biochemical, and ultrasonographic parameters were assessed. Multivariable regression adjusted for BMI, WHR, season, and ethnicity. Effect sizes (β) and 95% confidence intervals (CI) were reported.

Results: After 9 weeks, Group A showed a significant rise in 25(OH)D levels (mean 28.7±7.6 ng/mL) versus Group B (13.4±5.5 ng/mL, p<1.2). Ovulation occurred in 35/90 (38.10%) in Group A and 17/90 (18.10%) in Group B (p = 1.2). Adjusted regression showed reductions in LH: FSH ratio (β = -1.28; 95% CI: -1.51 to -1.6), total testosterone (β = -7.4; 95% CI: -12.10 to -1.7), and HOMA-IR (β = -1.53; 95% CI: -1.82 to -1.24). HDL levels increased (β = +1.13 mmol/L; 95% CI: 1.5 to 1.21). Phenotype A showed the highest ovulatory response (45.6% vs 20.9%; p = 1.3).

Conclusions: Vitamin D supplementation significantly improved ovulatory and metabolic parameters in vitamin D-deficient infertile women with PCOS, especially in hyperandrogenic phenotypes. Phenotype-tailored vitamin D therapy may serve as an effective adjunct in PCOS management.

A two year review of indications and outcomes of obstetric admissions to ICU of a tertiary care hospital

Vishrut M. Mashruwala — 2025-09-26

Background: Managing critically ill obstetric patients presents a unique challenge. The outcomes of these cases not only serve as a measure of the quality of patient care but also aid in refining risk stratification for pregnant patients and evaluating new therapeutic approaches. This study aims to review a series of critically ill obstetric patients admitted to our ICU, examining the spectrum of diseases, necessary interventions and maternal outcomes, while identifying factors linked to maternal mortality.

Methods: This retrospective observational study was conducted in 7-bed obstetric ICU in a 300 bedded tertiary care hospital over 2-year period (August 2022-July 2024) at 1200 Bed Medicity Hospital, B. J. Medical College, Ahmedabad, Gujarat, India.

Results: Only obstetric patients were admitted to the ICU. The leading obstetric indication for ICU admission was hypertensive disorders (28.8%). Maternal mortality was 3.03%. The main cause of maternal death was due to medical disorders (32.7%). ICU interventions included mechanical ventilation, blood products transfusion, inotropes, anti-hypertensives and dialysis.

Conclusions: The demand for ICU management of obstetric conditions is increasing. Hypertensive disorders of pregnancy and hemorrhage have been the leading reasons for obstetric ICU admissions over the past two years. To improve outcomes for mothers and babies, it is essential to involve a multidisciplinary team early, including intensivists, obstetricians and physicians, to provide coordinated care. Obstetric teams should also develop basic skills in managing high-dependency unit (HDU) cases. This study highlights the importance of screening and preventing preeclampsia, providing antenatal education and encouraging early reporting and referral of complications.

Observational study to analyse transfusion practices in obstetrics at tertiary care center in adult populations

Jinal A. Tuklia — 2025-09-26

Background: Blood transfusion is one of the eight essential components of comprehensive emergency obstetric care and plays a critical role in reducing maternal mortality. Obstetric hemorrhage, particularly postpartum hemorrhage (PPH), remains a leading cause of maternal morbidity and mortality worldwide. Anemia and coagulation disorders further increase the risk of severe bleeding during pregnancy and delivery. The study aims at improving transfusion practices and also to deal with reactions associated with it.

Methods: A prospective observational study was conducted to evaluate obstetric patients who received transfusions. Data were collected on the type and indication of transfusion, components used, transfusion protocols followed, adverse reactions encountered, and maternal outcomes.

Results: The most common indications for transfusion were anemia, PPH, and placental causes such as placenta previa and abruption. Blood components commonly used included packed red blood cells (PRBCs), fresh frozen plasma (FFP), platelet concentrates, and cryoprecipitate. The majority of antepartum transfusions were for anemia correction, while postpartum transfusions were primarily due to hemorrhage. Adverse reactions were minimal but documented. Outcomes varied based on the condition and the promptness of transfusion.

Conclusions: Timely and appropriate transfusion of blood and its components is vital in the management of obstetric complications. Identifying high-risk patients and ensuring adequate blood component availability can significantly improve maternal outcomes and reduce mortality related to obstetric hemorrhage.

Correlation of combined B-mode and uterine artery Doppler with the endometrial pathology in perimenopausal women with abnormal uterine bleeding

Navjeet Kumar — 2025-09-26

Introduction: Heavy menstrual bleeding in perimenopausal women is defined as excessive blood loss that interferes with the woman's physical, emotional, social, and material quality of life. In India, the reported prevalence of abnormal uterine bleeding is around 17.9%.

Background: This study was conducted at AIIMS, Nagpur, where 80 perimenopausal women were recruited with complaints of HMB in our cross-sectional study. We obtained samples of uterine artery PI and RI, endometrial thickness, and performed an endometrial biopsy on the same day. The mean and standard deviation for PBAC, haemoglobin, endometrial thickness, PI, and RI are calculated.

Result: The cohort comprised women with a mean age of 46.06 years (±5.8 years). The mean PBAC score was 342 (±117.2), ranging from 145 to 590. Haemoglobin levels were at a mean of 8.8 g/dl (±1.14), with a range from 6.2 gm/dl to 10.3 gm/dl. A mean endometrial thickness of 11.65 mm (±4.05) with mean values for pulsatility index (PI) and resistance index (RI) were 1.72 (±0.065) and 0.75 (±0.035), respectively. Endometrial pathology distribution in biopsy samples included disordered proliferation endometrium in 29 out of 80 cases (36.25%), proliferative endometrium in 21 out of 80 cases (26.3%), secretory endometrium in 14 out of 80 cases (17.5%), and endometrial hyperplasia without atypia in 9 out of 80 cases (11.2%). Additionally, three cases of endometrial malignancy were identified within the cohort.

Conclusion: The combination of uterine artery doppler to B-mode ultrasound doesn’t add much information in detecting endometrial pathologies like malignancy and atypia.

Association of thyroid dysfunction with menstrual irregularities among women attending a tertiary care hospital in western India: a cross-sectional study

Payal Godria — 2025-09-26

Background: Thyroid dysfunction is a significant yet often underdiagnosed contributor to menstrual irregularities among women of reproductive age. Alterations in thyroid hormone levels can disrupt the hypothalamic-pituitary-ovarian axis, affecting the menstrual cycle in multiple ways. This study aimed to assess the prevalence and patterns of thyroid abnormalities among women presenting with menstrual irregularities in a tertiary care setting in Gujarat, India.

Methods: A hospital-based cross-sectional study was conducted at SSG Hospital, Vadodara, from March 2024 to February 2025. A total of 321 women aged 18-45 years presenting with menstrual irregularities were enrolled. Data were collected using a structured questionnaire covering menstrual history, symptoms of thyroid dysfunction, and clinical examination. Thyroid function tests (TSH, FT3, FT4) were conducted for all participants. Statistical analysis was performed using Chi-square and ANOVA to determine associations between menstrual patterns and thyroid function.

Results: Out of 321 participants, 99 (30.8%) had thyroid dysfunction. Among them, 65 (65.6%) had subclinical hypothyroidism, 21 (21.2%) had overt hypothyroidism, 9 (9.1%) had subclinical hyperthyroidism, and 4 (4%) had overt hyperthyroidism. Oligomenorrhea (36.3%) and menorrhagia (28.2%) were the most common menstrual disturbances associated with thyroid dysfunction. A significant association was observed between hypothyroidism and menorrhagia (p<0.05), while hyperthyroidism was more frequently linked with hypomenorrhea (p<0.05).

Conclusions: Thyroid abnormalities, particularly subclinical and overt hypothyroidism, are common among women with menstrual irregularities. Routine screening for thyroid dysfunction should be integrated into the evaluation of such cases to ensure early diagnosis and intervention.

A clinical study on maternal and fetal outcomes of obstructed labour

Shirish S. Dulewad — 2025-09-26

Background: Obstructed labour is the failure of the fetal presenting part to descend in the birth canal despite adequate uterine contractions. This study aims to identify risk factors for obstructed labour and highlight strategies to reduce maternal and fetal morbidity and mortality.

Methods: This prospective cross-sectional study included all women with prolonged and obstructed labour at a tertiary hospital. Complete enumeration was used for sampling, and data were analysed using Microsoft excel.

Results: A total 48 patients were of the age of 18-25 years. 78 were primigravida. 32 patients needed operative vaginal delivery. In postpartum complications, 26 patients went into atonic PPH, 1 underwent laparotomy for rupture uterus,18 patients had extension of the uterine incision during LSCS and 8 patients suffered from vaginal lacerations. Postpartum complications such as anemia found in 34 cases, sepsis in 26 cases, paralytic ileus in 28 cases and surgical site infection in 12 patients. 21 patients had prolonged hospital stay. 8 babies died, 19 babies were still admitted in NICU and 75 were healthy.

Conclusions: Regular antenatal visits and pelvic evaluation beyond 37 weeks by an experienced gynaecologist are essential for diagnosing adequacy. Attendants at rural centres must be trained to monitor labour and identify prolonged labour using a partograph. Most obstructed labour cases are preventable if pregnant women receive proper antenatal care, births are attended by trained personnel, uterotonics are used appropriately, and instrumental vaginal deliveries are performed by expert gynaecologists when indicated.

Cervical cancer screening in patients at a tertiary care centre with Pap smear and HPV DNA testing

Khushboo Suresh Shinde — 2025-09-26

Background: Cervical cancer ranks fourth among the most commonly diagnosed cancers as well as the fourth leading cause of cancer mortality in women globally. Of all new cases and deaths worldwide in 2020, India accounted nearly one-fourth of deaths due to cervical cancer. In India, cervical cancer is the second most common cancer in both incidence 18.3% and cancer mortality 18.7% among women in 2020, with a 5-year prevalence of 18.8%.

Methods: A hospital based cross sectional study was conducted in the Gynecology OPD of PBM Hospital, Bikaner. 118 women aged 19-60 years presenting with complaints such as unusual bleeding between periods/after menopause/after sexual intercourse; increased or foul-smelling vaginal discharge etc were included. A questionnaire was administered containing general information, clinical findings at pelvic evaluation. They then underwent Pap smear, HPV testing and histo-pathology. Appropriate statistical tests were used to compare the outcome between the sub-groups.

Results: Pap smear offered high specificity (~93.9%) and a strong NPV (99.1%), with a low positive predictive value (PPV~18%-25%) indicating a high false-positive rate, necessitating triage with confirmatory tests. HPV DNA testing emerged as the superior tool, with 100% sensitivity and NPV. Its specificity was over 95% and PPV was 37.5%.

Conclusions: HPV DNA testing is the most accurate screening test, reflecting its utility in early detection of high-risk cases.

Hysterectomy in practice: a cross-sectional insight into indications incidence and surgical approaches

Shreya H. Phafat — 2025-09-26

Background: Hysterectomy is the second most commonly performed surgical procedure among women, following cesarean section. It is indicated for a variety of benign and malignant gynecological conditions. The choice of indication, surgical route, and associated outcomes varies significantly across clinical and demographic contexts. This study aims to evaluate the clinical patterns of hysterectomy performed at a tertiary care center over six months, with a focus on patient age, common indications, surgical approach, and the requirement for blood transfusion.

Methods: A retrospective, observational study was conducted in the Department of Obstetrics and Gynecology at Cama and Albless Hospital, Mumbai, in which latest fifty patients who underwent elective hysterectomy were included, based on defined inclusion and exclusion criteria. Data regarding patient demographics, indications, surgical routes, and intraoperative details were collected and analyzed using descriptive statistics.

Results: Among 50 patients, the most common age group was 36-45 years (50%). Abnormal uterine bleeding was the leading indication (60%), followed by uterine fibroids (32%) and uterovaginal prolapse (14%). The abdominal route was used in 52% of cases, while 28% underwent vaginal hysterectomy and 20% underwent laparoscopic hysterectomy. Blood transfusion was required in only 12% of patients.

Conclusions: Hysterectomy remains a significant gynecological intervention, most commonly indicated for abnormal uterine bleeding. It should be approached judiciously, with an emphasis on conservative and fertility-preserving alternatives where appropriate. When surgical intervention is necessary, the vaginal or minimally invasive route should be preferred whenever feasible.

Comparative evaluation of maternal and neonatal outcomes using the WHO labour care guide versus the WHO-modified partograph: a prospective observational study

Kumari Anjali Singh — 2025-09-26

Background: Labour and childbirth remain critical phases in maternal care, with significant implications for maternal and neonatal outcomes. Despite declining global mortality rates, disparities persist, particularly in low-resource settings. Effective labour monitoring tools are essential for improving outcomes and reducing complications. This study aimed to compare maternal and neonatal outcomes using the WHO Labour Care Guide (LCG) versus the WHO-Modified Partograph (WHO-MP) for intrapartum monitoring.

Methods: This prospective observational study was conducted at GS Medical College & Hospital over 15-18 months. A total of 200 full-term pregnant women in active labour (≥4 cm cervical dilation) were randomly assigned to either the WHO-LCG group (n=100) or the WHO-MP group (n=100). Inclusion criteria encompassed singleton pregnancies with vertex presentation and no medical or obstetric complications. Labour progression, delivery mode, maternal complications, and neonatal outcomes were recorded and analysed using SPSS v27.

Results: Normal vaginal deliveries were higher in the LCG group (86%) compared to WHO-MP (78%), with lower maternal infection rates (6% vs. 18%, p=0.005) and postpartum hemorrhage (1% vs. 6%). The LCG group showed significantly shorter labour durations and NICU stays. Apgar scores and NICU admission rates were comparable, though early neonatal recovery was more favorable in the LCG group.

Conclusions: The WHO Labour Care Guide provides a structured, patient-centered approach to labour monitoring, potentially enhancing maternal and neonatal outcomes through timely and individualized care.

Thyroid dysfunction and hypertensive disorders in pregnancy: a retrospective study stratified by gestational age and maternal thyroid profile

Meenakshi Thakur — 2025-09-26

Background: Thyroid dysfunction has been increasingly implicated in the development of hypertensive disorders in pregnancy (HDP), though its influence on gestational age of onset, fetal outcomes, and disease severity remains underexplored. The roles of maternal parity, intrauterine growth restriction (IUGR), and antihypertensive management strategies in this context are also not well established.

Methods: A retrospective study was conducted at a tertiary care center in North India over 3 years (2022–2025), including pregnant women diagnosed with HDP after 20 weeks of gestation. Thyroid function tests (TSH, FT4) were correlated with HDP type, gestational age at onset, parity, presence of IUGR, and antihypertensive therapy used.

Results: Among 384 women with HDP, 114 (29.7%) had thyroid dysfunction 96 (25%) with subclinical and 18 (4.7%) with overt hypothyroidism. Thyroid abnormalities were more prevalent in women with early-onset HDP (<34 weeks) and in primigravidae. IUGR was observed in 41.2% of patients with thyroid dysfunction compared to 22.9% in euthyroid women (p<0.01). Subclinical hypothyroidism was strongly associated with preeclampsia and eclampsia. The most commonly prescribed antihypertensive agents were labetalol (74.1%) and nifedipine (62.5%), with higher use of dual therapy in patients with overt hypothyroidism.

Conclusions: Thyroid dysfunction, particularly subclinical hypothyroidism, is significantly associated with early-onset and severe hypertensive disorders, higher incidence of IUGR, and increased need for combination antihypertensive therapy. Routine thyroid screening in antenatal care, especially in primigravidae, may facilitate early risk identification and targeted management.

Assessment of breastfeeding knowledge, attitudes and practices among postpartum women at a tertiary healthcare setting in Ahmedabad, Gujarat: implications for maternal and child health

Om Shah — 2025-09-26

Background: Breastfeeding is essential for a child’s overall health and development. Breast milk provides all the vital nutrients needed for growth and well- being while offering immunity against various infectious and non-infectious diseases. Ideal breastfeeding practices include early initiation, exclusive breastfeeding for the first six months and continued breastfeeding for up to two years alongside complementary foods.

Methods: Women getting delivered at a tertiary care teaching hospital were surveyed and their responses were recorded on a detailed questionnaire. Appropriate analysis was performed to assess the awareness of breastfeeding.

Results: The sample of this study comprised of 150 mothers out of which maximum (60.67%) were in the age group of 18-26 years with mean age 26.2 years and standard deviation of 5.68. This study found that 85.33% of the mothers were aware of the importance of breastfeeding while only 56% of mothers were aware of the benefits of colostrum. A small proportion of mothers, specifically 6.67%, expressed fear that breastfeeding might alter their body image. Only 56.6% mothers initiated breastfeeding within 1 hour of delivery while 92.66% mothers fed colostrum to their newborns.

Conclusions: This study revealed a general awareness of breastfeeding among participants but limited knowledge regarding benefits of colostrum. Early weaning is still being practiced and timely initiation of breastfeeding within the first hour after birth was not universally adhered to.

Contraceptive conversations: an observational pilot study to understand, ‘what women prefer and why’

Hina Meraj — 2025-09-26

Background: Contraceptive use is a vital aspect of reproductive health and women's empowerment. Despite national progress in family planning, regional disparities persist, especially in Uttar Pradesh (UP), where contraceptive prevalence remains below the national average. This study explores the preferences and factors influencing contraceptive choices among women in Aligarh, UP. To identify the most commonly preferred contraceptive methods among women aged 18–60 years attending a government hospital in Aligarh and to examine the socio-demographic factors influencing their choices.

Methods: A retrospective cross-sectional study was conducted using hospital records from Mohan Lal Gautam Rajkiya Mahila Chikitsalaya, Aligarh, covering a six-month period (January–June 2024). A total of 3,776 women who sought contraceptive services were included. Data on age, socioeconomic status and contraceptive method used were collected and analyzed using descriptive statistics.

Results: The majority of women preferred short-term, non-invasive contraceptive methods. Nirodh (condoms) and Mala N (oral contraceptive pills) were the most commonly used, accounting for 40.88% and 39.43% of usage, respectively. Long-term methods such as IUDs and female sterilization were significantly less utilized (<10%). Preference was influenced by factors such as accessibility, cultural acceptability, ease of use and government promotion. Middle and lower-middle socioeconomic groups formed the largest segments of users and women aged 29–39 represented the highest age group seeking contraception.

Conclusions: The study highlights a clear preference for reversible, user-controlled contraceptives among women in UP, shaped by ease of access, affordability and minimal side effects. Government initiatives have played a pivotal role in promoting these methods. However, low uptake of long-term options indicates the need for enhanced education, counselling and culturally sensitive awareness programs to broaden contraceptive choices and support informed decision-making.

Effect of the umbilical cord length on mode of delivery and perinatal outcome

Syeda Mahin Saidani — 2025-09-26

Background: The umbilical cord is a vital anatomical structure connecting the fetus to the placenta, and its length along with the presence of nuchal loops may influence labor progression and neonatal outcomes. This study aimed to evaluate the relationship between umbilical cord length and mode of delivery, duration of labor, neonatal APGAR scores, NICU admissions, and incidence of fetal distress.

Methods: A prospective observational study was conducted at Al-Ameen medical college hospital from July 2023 to January 2025, involving 200 pregnant women. Umbilical cord length and the presence and number of nuchal loops were documented at delivery. Maternal and neonatal outcomes, including mode of delivery, labor duration, fetal distress, and neonatal parameters, were recorded and analysed statistically.

Results: The mean umbilical cord length was 50.68±11.75 cm. Although the incidence of caesarean delivery was higher in both short and long cord groups, the difference was not statistically significant (p=0.217). Labor duration was significantly prolonged in cases with nuchal cord, particularly among primigravida (17.62±1.38 h vs. 11.95±1.49 h). Neonates with nuchal loops had lower APGAR scores at 1 and 5 minutes (p=0.003), and NICU admission rates were higher among those with multiple loops (p<0.001). Fetal distress increased significantly with number of nuchal loops (p<0.0001).

Conclusions: Abnormal cord length and multiple nuchal loops are significantly associated with prolonged labor, fetal distress, increased incidence of instrumental delivery, caesarean section due to cephalopelvic disproportion due to deflexed head, low APGAR score, NICU admission. Patients with 2-3 loop of cord around the neck can have normal vaginal delivery. There is increasing rate of caesarean section due to ultrasound diagnosis of cord around the neck at term, because of obstetrician distress and patients request rather than obstetric indication.

A hospital-based study of hysteroscopic and laparoscopic findings in infertility cases among rural and urban female population of southern Rajasthan

Deepika Sharma — 2025-09-26

Background: Infertility affects millions worldwide and presents significant medical and psychological challenges. This study assesses the diagnostic role of hysteroscopy and laparoscopy in infertile women from rural and urban Southern Rajasthan.

Methods: A hospital-based descriptive study of 130 women aged 21-40 years with infertility (primary or secondary) was conducted. All patients underwent diagnostic hysteroscopy and laparoscopy with Chromopertubation. Data was analyzed using Jamovi software.

Results: 62.5% had primary infertility, 37.5% had secondary. Laparoscopy revealed ovarian pathology in 56.25%, tubal in 48.34%, uterine in 15.62%, and adhesions in 18.75%. Hysteroscopy revealed uterine abnormalities in 12.5%.

Conclusions: Combined hysteroscopy and laparoscopy enhance the diagnosis of female infertility and help guide treatment, “especially in underserved populations”.

Comparative study between 25 µg vaginal misoprostol and PGE2 gel for induction of labour at term

Ritika Mishra — 2025-09-26

Background: Labour induction is a critical aspect of obstetric care, significantly affecting maternal and neonatal outcomes. Prostaglandins such as PGE2 gel facilitate cervical ripening and uterine contractions. Misoprostol, a prostaglandin E1 analogue, has shown promising results in achieving vaginal delivery within 24 hours. This study aims to compare these agents to provide clearer guidance on the safer and more effective option for labour induction. To compare the effectiveness and safety of 25 μg vaginal misoprostol versus 0.5 mg PGE2 gel for induction of labour at or beyond 37 weeks of gestation in terms of efficacy, foeto-maternal outcomes, and complications.

Objectives include comparing induction-to-delivery intervals, caesarean rates, and foeto-maternal outcomes between the two drugs.

Methods: A single-centre, randomised, open-label clinical trial was conducted in a tertiary care centre’s Obstetrics and Gynaecology department. A total of 176 women were randomised: Group A received 25 μg misoprostol every 4 hours (up to five doses), and Group B received 0.5 mg PGE2 gel every 6 hours (up to three doses). Outcomes included induction-to-delivery time, labour onset, need for augmentation, and maternal and neonatal outcomes.

Results: Both groups were similar in age, parity, and Bishop scores. Misoprostol led to quicker labour onset (6.5 vs. 8.5 hours) and required less oxytocin (15.9% vs. 45.5%). Delivery mode and neonatal outcomes were comparable.

Conclusions: Misoprostol proved more effective, with shorter induction-to-delivery intervals and less need for augmentation. It is cost-effective, stable at room temperature and offers similar maternal and neonatal safety compared to PGE2 gel.

Effects of modified Elkin’s procedure along with specific breech exercises in breech repositioning and to determine the feasibility of normal delivery: an experimental study

Sumathi Govindan — 2025-09-26

Background: Breech presentation is observed in 3-4% of pregnancies at term and is one of the leading causes of caesarean section. Babies with breech presentation are at increased risk of complications during birth. An experimental study was conducted to demonstrate the effects of the Modified Elkin’s procedure and specific breech exercises. However, there is a lack of evidence suggesting which technique is superior in reducing the risk associated with vaginal delivery in breech presentation.

Methods: This experimental study enrolled 123 subjects diagnosed with breech presentation by ultrasonography during the third trimester. Participants in the experimental group were instructed to perform the Modified Elkin’s procedure along with specific breech exercises. These interventions were designed to be safe and simple and were found to significantly aid in breech repositioning, thereby increasing the feasibility of normal delivery. The study duration was 8 months. Treatment consisted of three sessions per week on alternate days for 4 weeks, including rest periods. Exercises were advised for women with fetuses in breech presentation.

Results: The results of the study showed a marked difference between the pre- and post-test values. After completing the full set of exercise sessions, there was a significant improvement in breech repositioning and an increased likelihood of normal delivery.

Conclusions: This trial revealed that 4 weeks of treatment using the Modified Elkin’s procedure along with specific breech exercises is effective for breech repositioning. Based on the results, this technique appears to be a simple, less painful, and safe option for managing breech presentation in the third trimester of pregnancy. It may also influence the mode of delivery.

Evaluation of sepsis in obstetric score: a novel scoring system for obstetric population, a tertiary care centre study

Shakuntla Kumari — 2025-09-26

Background: Sepsis remains the second leading cause of maternal mortality, affecting approximately 5.7 per 10,000 pregnancies. Delayed recognition and escalation of care contribute to preventable deaths. The Sepsis in Obstetrics Score (SOS), designed by Albright et al. to predict critical care needs in pregnant and postpartum women, has limited validation data. This study evaluates SOS in predicting maternal and neonatal outcomes in septic obstetric patients.

Methods: A prospective study was conducted on 50 pregnant, post-abortal, and postpartum women with sepsis at GSVM Medical College, Kanpur. Patients with pre-existing organ disease were excluded. SOS was calculated using clinical and laboratory parameters, with scores <6 classified as non-severe and ≥6 as severe sepsis. Outcomes assessed included ICU admission, organ dysfunction, maternal and neonatal mortality, and hospital stay. ROC analysis determined the optimal cutoff for predicting mortality.

Results: Mortality rose with higher SOS scores: 5.3% (0–2), 18.2% (3–5), 30% (6–8), and 71.4% (9–11). ICU admission and multi-organ failure were significantly more frequent in the ≥6 group. Neonatal outcomes were worse among high-score mothers, with more NICU admissions (5 vs. 1) and stillbirths (9 vs. 6). ROC analysis showed good predictive accuracy (AUROC 0.859, p<0.001). A cutoff ≥5 predicted mortality with 92.3% sensitivity, 62.2% specificity, and 70% diagnostic accuracy, outperforming the traditional ≥6 threshold by identifying high-risk women earlier.

Conclusions: SOS is a reliable triage tool for obstetric sepsis. A threshold ≥5 enables earlier ICU transfer, timely intervention, and improved maternal and perinatal outcomes, supporting its integration into routine obstetric care.

A comparative study of placental abnormalities in normal and specific high-risk pregnancies by using Doppler, histology and their fetal outcome

Dikshamani — 2025-09-26

Background: The placenta, a vital organ connecting mother and fetus, undergoes significant growth and facilitates essential exchange. Various placental pathologies, including issues with vascular processes, inflammation, and structural abnormalities, can impact pregnancy outcomes. Conditions like placenta accreta, placenta previa, and vasa previa pose significant risks. Diagnosis and evaluation of these abnormalities are primarily done through ultrasound imaging, doppler ultrasound for blood flow assessment, and histopathology after birth.

Methods: This two-year prospective observational study at Lt. Baliram Kashyap Memorial Govt. Medical College will investigate placental characteristics in 200 pregnant women (100 normal, 100 high-risk) over 28 weeks' gestation. It involves detailed examination of placentas and babies, with data analyzed using SPSS. The study has ethical approval and aims to identify associations between placental features and pregnancy outcomes.

Results: In this study of 200 pregnant women, high-risk pregnancies were associated with older maternal age (mean 26.5 vs 24.6 years, p<0.01) and a higher proportion of multiparous women (p<0.01). Key placental abnormalities (round shape, infarct, fibrosis) and umbilical cord abnormalities (edema, foul-smelling liquor) were significantly more prevalent in the high-risk group. Doppler findings showed that an abnormal Systolic/Diastolic ratio was significantly linked to adverse perinatal outcomes. Overall, various maternal and fetal factors contribute to high-risk pregnancies and their associated complications.

Conclusions: Placental abnormalities (infarcts, fibrosis, bleeding) and umbilical cord issues (edema, foul-smelling liquor, marginal insertion) are major indicators of high-risk pregnancies and poor neonatal outcomes. Conditions like pre-eclampsia and gestational hypertension also correlate with these placental issues. Early ultrasound and Doppler studies are crucial for detection, necessitating increased clinical caution in managing such pregnancies. Further research is vital to establish comprehensive guidelines for improved care.

Cervico-isthmic compression suture: an effective method to manage PPH during caesarean-section for placenta previa

Ruby Kumari — 2025-09-26

Background: Obstetric hemorrhage is the leading cause of maternal mortality, placenta previa and placenta accreta spectrum (PAS) are major causes of it. Most of time these bleeding don’t respond to uterotonics drugs in placenta previa. In failed first-line management of PPH, cervico-isthmic compression sutures are effective to control PPH from lower uterine segment in placenta previa. The objectives of this study were to determine effectiveness of Cervico-isthmic compression suture in management of PPH during caesarean section for placenta previa the primary outcome was assessed by the need of blood transfusion, caesarean hysterectomy, ICU care, total hospital stay and incidence of maternal mortality and the secondary outcome was to describe the complications of the procedure in peri-operative periods.

Methods: This retrospective study was carried out in the department of obstetrics and gynecology, ANMMCH, Gayajee, from April 2025 to March 2023. It included 36 patients of placenta previa in which cervico- isthmic compression suture was applied.

Results: In the study group the mean age was 27±4.18 years. The gestational age at the time of delivery ranges from 32.3 to 37.4 weeks. Postpartum hemorrhage was adeptly managed with the compression sutures in 34 patients (94.45%), while in 2 patients (5.5%), caesarean hysterectomy was needed. Notably, 66.66% of patients (n=24/36) necessitated blood transfusions during peri-operative periods. There was no any recorded maternal mortality.

Conclusions: Cervico-isthmic compression suture is a simple, quick and effective measure for intractable bleeding from placental bed or atonic lower uterine segment in cases of placenta previa.

Correlation between respectful maternity care and childbirth experience in a tertiary care centre

Malawika Anand — 2025-09-26

Background: Respectful maternity care (RMC) is essential for a positive childbirth experience. Disrespectful maternity practices can lead to adverse maternal and neonatal outcomes. This study evaluates the correlation between RMC and childbirth experience among women delivering at a tertiary care centre. The objectives was to study the correlation between respectful maternity care and childbirth experience.

Methods: A cross-sectional study was conducted at the Department of Obstetrics and Gynaecology, Hind Institute of Medical Sciences, Safedabad, Barabanki, over 18 months (July 2023 to January 2025). A total of 150 postpartum women were enrolled using a consecutive sampling method. Data were collected using the Respectful Maternity Care (RMC) Questionnaire and the Childbirth Experience Questionnaire (CEQ). RMC was assessed across seven domains, while CEQ measured four dimensions of childbirth experience. Statistical analysis included correlation assessments between RMC and childbirth experience domains.

Results: The study found a significant correlation between RMC and childbirth experience (p<0.001). Domains of physical harm and ill-treatment (r=0.734), informed consent (r=0.725), and dereliction of care (r=0.711) showed strong associations with perceived safety and decision-making. Women who experienced greater autonomy, informed consent, and respectful care reported a better childbirth experience. The analysis also found that family structure influenced RMC, with joint family participants reporting significantly higher dignity scores (p=0.032). However, economic and educational status did not significantly impact RMC or childbirth experience.

Conclusions: The study highlights the critical role of respectful maternity care in shaping a positive childbirth experience. Improving patient autonomy, informed consent, and professional support can enhance maternal satisfaction and reduce negative childbirth experiences. Targeted interventions are needed to reinforce respectful maternity care practices in tertiary care settings.

Effect of maternal blood transfusion versus maternal parenteral iron therapy on fetal vascular adaptation: an observational study in a tertiary care hospital in North India

Farheen Qureshi — 2025-09-26

Background: Maternal anemia, particularly with haemoglobin levels below 7g/dl, is associated with significant fetal hemodynamic adaptations that may impact perinatal outcomes. This study aimed to evaluate the effects of maternal anemia on fetal doppler indices and assess changes after treatment with blood transfusion versus parenteral iron therapy.

Methods: A prospective study was conducted over a period of 12 months at GMC Srinagar, including 80 pregnant women (32-36 weeks gestation) with severe anemia (Hb<7g/dl). Participants were divided into two groups: Group 1 (blood transfusion) and Group 2 (parenteral iron therapy). Hematological parameters and fetal doppler indices (umbilical artery resistive index [UA RI] and middle cerebral artery resistive index [MCA RI]) were measured at admission, two weeks, and four weeks post-treatment. Statistical analysis was performed using SPSS Version 20.0.

Results: At baseline, Group 1 had significantly lower hemoglobin (5.69±0.54g/dl) than Group 2 (6.46±0.29g/dl, p<0.001). Post-treatment, Hb levels improved to 8.18±0.33g/dl (Group 1) and 8.05±0.22g/dl (Group 2, p=0.116), with a greater increase in Group 1 (2.48±0.77g/dl vs. 1.59±0.18g/dl, p<0.001). Doppler indices showed a significant reduction in UA RI and an increase in MCA RI in both groups (p<0.001).

Conclusions: Both blood transfusion and parenteral iron therapy effectively improved maternal hematological status and fetal doppler parameters. However, blood transfusion led to a faster correction of anemia. Regular doppler monitoring allows for timely assessment of fetal adaptation and intervention, improving perinatal outcomes.

Clinicopathological evaluation of abnormal uterine bleeding in peri menopausal women

Saurabh Soni — 2025-09-26

Background: Abnormal uterine bleeding (AUB) is a frequently encountered gynaecological complaint in perimenopausal women and also the most common cause of hysterectomy in their age group. The current study was carried out to evaluate various presentations of perimenopausal Abnormal uterine bleeding and to correlate with histopathological examination of the dilation and curettage (D&C) sample of endometrium.

Methods: A cross-sectional study was conducted from 2022 to 2024 at a tertiary care hospital in Imphal, among 190 abnormal uterine bleeding cases. Data were collected in a predesigned proforma and analysed using SPSS Version 21.0. Descriptive statistics were used to express the findings. Ethical approval was obtained and informed consent was taken.

Results: The mean age of the study subjects or participants was 45.67±5.58 years. The majority of the cases were aged 41-50 years, Hinduism dominated, educated up to 12^th class, self-employed, and living in a joint family. Heavy uterine bleeding was the common presentation. The USG findings were 80.5% sensitive and 100% specific to diagnose leiomyomas; in adenomyosis, USG is more sensitive (100%) and specific (100%). Clinically, leiomyoma was the most common suspected cause of AUB; radiologically, 50% of leiomyomas and post-hysterectomy histopathological findings showed that 62.1% were leiomyoma, among which 98.9% were proliferative. Only 21% were adenomyosis. The endometrial pattern was 63.7% proliferative, 21.6% secretory, 14.7% disordered proliferative.

Conclusions: The abnormal uterine bleeding was common in middle-aged women and heavy bleeding was the common presentation. The proliferative leiomyomas are the major causes for AUB followed by adenomyosis.

Is cabergoline mystical in euprolactemic polycystic ovarian syndrome

Gazala Taiseen — 2025-09-26

Background: Polycystic ovarian syndrome (PCOS) is most common in reproductive age females. Cabergoline is a potent long-acting dopamine agonist play an important role in decreasing high prolactin secretion which is present in 30–40% of PCOS and induce ovulation in those with normal prolactin level also. This is attributed to reduction of an occult hyperprolactinemia in PCOS patients.

Methods: This is a randomized, prospective, controlled study includes 100 Euprolactinemic infertile PCOS, 50 in each group, Group A (letrozole cabergoline group) patients received tablet letrozole 5 mg/day in 2 divided doses 2.5 mg from cycle day 3 to day 7 plus cabergoline tablet 0.25 mg, half tablet twice weekly for 4 weeks starting from cycle day 3 with letrozole despite normal serum prolactin level. Group B (letrozole Group):patients received only letrozole same as group A. Primary outcomes-ovulation rate, number of dominant follicles and secondary outcomes-pregnancy, miscarriage, multiple pregnancies, OHSS, side-effects of cabergoline were studied. Statistical analysis was done.

Results: Study groups compared for the demographic characters, basic clinical data, duration and type of infertility which showed no significant difference. Statistically significant difference in group A ovulation rate 76% (p value 0.0124), number of dominant follicles (p value 0.029). Pregnancy rate 72% in group A and 48% in group B (p value 0.014). No statistical difference in miscarriage (p value 0.15), twin pregnancies (p value 0.86), OHSS (p value 1.0) and no side effects.

Conclusions: Addition of cabergoline to Letrozole in induction of ovulation in euprolactinemic infertile PCOS results in increased ovulation, high pregnancy rate compared to use of letrozole alone, with very few side-effects.

Clinical implications of the second and fourth digit ratio in male infertility: associations with semen parameters and sex hormone levels - a cross-sectional study

Saurabh Gupta — 2025-09-26

Background: Oligospermia and hypogonadism are synonymous with infertility in males. Data regarding its correlation with hand digit length and ratio are inconsistent and scarce. The aim was to study the ratio of second (2D) and fourth (4D) fingers of both hands in 236 infertile oligospermic men and their comparison with various clinical and laboratory parameters related to infertility.

Methods: In this cross-sectional study, the 2D and 4D length and ratio of both hands of 236 infertile oligospermic men were measured. Semen analysis and hormonal assessment, including serum total testosterone (T), estradiol (E), luteinizing hormone, and follicle-stimulating hormone, were performed and correlated with the 2D: 4D ratio and severity of oligospermia. Participants were further subdivided into two groups according to serum T levels.

Results: A significant difference in the 2D: 4D ratio of the right hand was observed between both cohorts and in patients with low T levels. The mean serum T level was significantly lower in infertile oligospermeic males (349.76±115.4 ng/dl; p<0.001) than healthy controls (p<0.001). The testosterone-to-estradiol (T/E) ratio was also significantly lower in the patient group (8.36±4.84; p<0.001). A decline in semen quality, including reduced sperm counts and progressive motility, was observed in patients with low T levels.

Conclusion: The 2D: 4D ratio might directly correlate with testosterone levels and, thus, semen quality and fertility potential of a subject. Thus, providing a cost-effective and time-saving method for indirect estimation of androgenization in male patients.

Maternal and fetal outcome in pregnancy with advanced maternal age- a prospective study

Neha A. Thayyil — 2025-09-26

Background: Advanced maternal age defined as the age of mother ≥35 years at the time of delivery has become common in last two to three decades. It is considered to have more adverse obstetric and perinatal outcomes as compared to those in younger women. Therefore, it requires a proper understanding of the effect of age during her antepartum, intrapartum, and postpartum period that prevent a healthy outcome.

Methods: The primary objective was to study the maternal and foetal outcome of pregnancy in women aged ≥ 35 years. This was a prospective observational study conducted in 122 pregnant women over a duration of 18 months in the multispecialty hospital in an urban setting.

Results: In this study, pregnant women aged ≥35 years had a higher incidence of obesity (88.9%). Among antenatal complications, mothers aged ≥35 years had higher incidence of anaemia (21.3%), gestational diabetes mellitus (GDM) (37.7%), gestational hypertension (32.8%), fetal growth restriction (13.1%). There was no significant difference in the incidence of miscarriage, multiple pregnancy, malpresentation, preterm premature rupture of membranes (PPROM), intrauterine fetal demise between the two age groups. The incidence of preterm delivery (41%) and caesarean section (72.4%) were higher in advanced age group. Perinatal complications like low birth weight (29.3%), neonatal intensive care unit (NICU) admissions (32.8%) were higher in neonates of women aged ≥35 years.

Conclusions: Advanced maternal age was significantly associated with adverse obstetrical and fetal complications. Therefore, proper preconceptional counselling and intensive antenatal care assessment can individualize and potentially reduce the risks for women with advanced maternal age.

Levonorgestrel intrauterine system for heavy menstrual bleeding: a real-world experience from a tertiary centre in Northern India

Meenakshi Thakur — 2025-09-26

Background: Heavy menstrual bleeding (HMB) affects quality of life and health in reproductive-age women. Levonorgestrel intrauterine system (LNG-IUS) offers a conservative treatment option. This study aimed to evaluate the clinical efficacy and acceptability of LNG-IUS in women with HMB.

Methods: Retrospective analysis of 63 women (32-50 years) with HMB at Dr. RPGMC, Kangra, over two years. Follow-up was conducted at 1, 3, 6, and 12 months. Data included demographics, clinical presentation, hematological investigations, ultrasonographic findings, follow-up outcomes, and patient satisfaction scores.

Results: Mean age was 44.28 years; 50.79% were 45-50 years. Majority (68.25%) were para 2; 96.82% were married. Socioeconomic status varied, with 25.39% in the upper-lower class. The most common diagnosis was dysfunctional uterine bleeding (57.14%), followed by fibroid uterus (25.39%), adenomyosis (11.11%), and endometriosis (6.34%). Comorbidities included hypertension (15.87%) and diabetes (11.11%). Hemoglobin analysis showed moderate anemia in 52.38% and severe anemia in 26.98%. Bleeding patterns improved significantly: at 1 month, 57.14% had scanty flow; by 3 months, 74.60% reported reduced bleeding; at 6 months, 86.27% had scanty or no bleeding. By 12 months, 41.17% developed amenorrhea. Expulsion occurred in 2 cases; 2 others requested removal. Overall, 82.35% were satisfied with bleeding pattern; 98.03% had no dysmenorrhea. Social, sexual life, and mobility improved notably. Satisfaction assessment showed 80.38% of patients were either satisfied or very satisfied.

Conclusions: LNG-IUS is effective, safe, and well accepted for treating HMB, particularly in resource-limited settings. Its impact on reducing blood loss, correcting anemia, and improving life quality supports its wider use.

Polycystic ovary syndrome: a comprehensive review of pathophysiology, diagnosis, and emerging management strategies

Mustafa Bashir — 2025-09-26

Polycystic ovary syndrome (PCOS) is a complex endocrine disorder affecting 6-20% of women of reproductive age, characterized by hyperandrogenism, ovulatory dysfunction, and polycystic ovarian morphology. Its pathophysiology involves intricate interactions among genetic, epigenetic, metabolic, and environmental factors, with insulin resistance, gut microbiota dysbiosis, and novel biomarkers like anti-Müllerian hormone (AMH) playing pivotal roles. This review provides an in-depth exploration of PCOS etiology, diagnostic challenges, and management strategies, including lifestyle interventions, pharmacological therapies, and emerging approaches like microbiota modulation and microRNA therapies. We also address long-term health risks, such as cardiovascular disease, type 2 diabetes mellitus (T2DM), and mental health challenges, emphasizing personalized and multidisciplinary treatment strategies.

Levormeloxifene - a non-hormonal woman-centric oral contraceptive under development: a comprehensive review

Man Mohan Singh — 2025-09-26

The drugs controller general of India (DCGI) has granted permission to Cipla Limited, an Indian pharmaceutical company, to conduct Phase-I clinical trial of levormeloxifene for development as oral contraceptive for women as joint collaboration with CSIR-Central Drug Research Institute, Lucknow, India (CSIR-CDRI). Levormeloxifene is laevorotatory enantiomer of ormeloxifene, a benzopyran Selective Estrogen Receptor Modulator (SERM). Ormeloxifene is racemic mixture in equal quantities of levo- and dextro-enantiomers (compounds having same chemical composition but mirror-image 3-dimensional structures). In rats, levormeloxifene [Minimum Effective Dose (MED): 0.15 mg/kg/day] prevented pregnancy at almost half the dose than ormeloxifene (MED: 0.25 mg/kg/day) when administered orally covering the entire pre-implantation period. Levormeloxifene is equally effective as single 1 mg/kg dose when administered within 24 hours of coitus. In accordance with its higher relative binding affinity (RBA: 15.7±3.1 percent of estradiol-17β), levormeloxifene exhibited more potent estrogenic and antiestrogenic activities than the d-ormeloxifene (RBA: 2.10±0.9) or dl-ormeloxifene (RBA: 5.24±1.45). Besides, it shows promise in prevention of increased bone turnover and destructive joint diseases, and beneficial effect on serum lipids. This is the first comprehensive review providing relevant published information on structure, pharmaceutical properties, preparation, safety, pharmacokinetics and pharmacodynamics of levormeloxifene.

Unveiling the role of pregnancy associated plasma protein-A in idiopathic preterm labour: a review

Asmita Kaundal — 2025-09-26

Idiopathic preterm birth (IPTB) is birth before 37 weeks in the absence of any identifiable cause for preterm labour. Prediction and prevention of preterm birth can significantly reduce the burden of morbidity and mortality associated with under-five mortality across the world. Pregnancy-associated plasma protein-A (PAPP-A), a glycoprotein secreted by the placenta, which plays an important role in early placenta development through regulation of the IGF system, has emerged as an excellent biomarker for the prediction of preterm birth. This narrative review aims to understand the possible mechanism by which it is linked to preterm birth and its potential as a predictive biomarker for idiopathic preterm birth.