International Journal of Reproduction, Contraception, Obstetrics and Gynecology

Clinical audit on period of gestation at induction of labor in singleton low risk women at a tertiary care centre in South India: M. O. S. C. Medical College, Kolenchery

Basil Mary Eldo — 2025-06-26

This audit evaluates the period of gestation at which labor induction was performed in singleton low-risk women at MOSC medical college, Kolenchery. The objective was to identify inadequacies in the process and indications for labor induction to ensure compliance with recognized guidelines, improve patient care, and raise the standard of labor induction practices. Over a two-month period, 376 deliveries were recorded, of which 137 were singleton uncomplicated pregnancies. Among these, 77 women (56%) were induced at or after 39 weeks, while 60 women (44%) were induced before 39 weeks. This report presents a statistical analysis of the induction practices and recommends modifications to enhance adherence to established criteria for labor induction.

Isolated tubal ischemia secondary to small bowel volvulus: a rare case report

Marouane Boukroute — 2025-06-26

Torsion of the fallopian tube is a rare cause of acute abdominal pain, often underrecognized in the context of intestinal pathology. We reported the case of a 30-year-old woman who developed isolated fallopian tube ischemia secondary to small bowel volvulus, a complication rarely described. She presented with acute hypogastric pain, vomiting, and mild left hydronephrosis. CT imaging revealed a small bowel obstruction with a whirlpool sign but no apparent tubal abnormalities. Laparotomy identified a twisted, ischemic fallopian tube with hydrosalpinx, attributed to adhesions from a recent appendectomy. Salpingectomy, small bowel resection, and anastomosis were performed, with histopathology confirming ischemic necrosis. This case underscores the diagnostic challenge posed by overlapping gastrointestinal and gynecological emergencies and suggests that vascular compromise in small bowel volvulus may extend to pelvic structures. Given the rarity of secondary tubal torsion, clinicians should consider this possibility in women with prior pelvic surgery and acute abdominal pain. Early CT imaging and interdisciplinary collaboration are essential for timely intervention and improved outcomes.

Endometrial polyp-induced fallopian tube obstruction

Abdirahman Omar Moallim — 2025-06-26

Endometrial polyps are common non-cancerous growths in the uterine lining, leading to unusual bleeding and fertility issues. These generally lack symptoms, but can cause heavy periods, bleeding between cycles, and fertility struggles. Diagnostic methods include hysterosalpingography, hysteroscopy, and histopathological examination. This report covers a 30-year-old woman with irregular cycles and infertility for seven years, diagnosed with an endometrial polyp blocking the fallopian tubes. After a hysteroscopic polypectomy, she experienced symptom relief and her menstrual cycle normalized.

Successful management of a young patient with endometroid ovarian carcinoma with positive immuno-histochemistry

Chiranjeev Shetty — 2025-06-17

Ovarian cancer is overall a disease of postmenopausal women although, in about 12% of cases, it may develop during child bearing age. This estimate includes numerous women with borderline and non-epithelial tumours typically presenting during child bearing age group. Although there are several case reports of Endometriosis-associated ovarian cancer (EAOC) at a young age, the exact age distribution of EAOC diagnosis is still not well- expounded. Presenting here with a young patient with ovarian malignancy with positive immuno-histochemistry for both oestrogen and progesterone receptor.

Unmasking the uncommon: a rare case of vulval leiomyoma mimicking a Bartholin cyst

Medarametla Hasitha — 2025-06-10

Vulval leiomyomas are rare benign smooth muscle tumors, often misdiagnosed due to their nonspecific presentation. They constitute approximately 3.8% of all benign soft tissue tumors in the vulvar region. We report the case of 30-year-old multiparous women, with a history of caesarean section five years’ prior, presenting with a three-month history of right-sided vulvar pain and swelling. Physical examination revealed a tender, cystic mass measuring 3×4 cm in the right labia, extending to the right lateral vaginal wall. A provisional diagnosis of a paraurethral mass was made. Surgical excision was performed under appropriate anesthesia. Histopathological examination confirmed the diagnosis of vulval leiomyoma. The patient’s postoperative course was uneventful, with no recurrence observed during follow-up. This case underscores the importance of considering vulvar leiomyoma in the differential diagnosis of vulvar masses. Accurate diagnosis relies on histopathological evaluation, and complete surgical excision remains the choice.

Cervical heterotopic pregnancy: a rare occurrence

Vinutha M. Sharma — 2025-06-17

Ectopic pregnancy is one of the leading causes of first-trimester gestation-related mortality. Cervical ectopic is a rare entity (less than 1% of all ectopic cases), heterotopic cervical pregnancy is a much rarer occurrence. Cervical pregnancy is highly dangerous and demands immediate termination of pregnancy as the chances of haemorrhage are too high, leading to maternal mortality. Although there are various approaches to terminate cervical pregnancy, it is challenging when accompanied by a live intrauterine pregnancy. Ultrasound-guided transcervical aspiration of the products of conception is the most suitable option in these cases. Here we describe a case of cervical heterotopic pregnancy, which we successfully and safely terminated using the above approach.

A successful pregnancy outcome in a known case of chronic kidney disease: a case report

Rituparna Ray — 2025-06-26

Chronic kidney disease (CKD) is defined as altered renal structure, function and morphology or glomerular filtration rate<60 ml/min for a minimum of 3 months. CKD affects approximately 6% women in reproductive age group in developed countries. The incidence is 0.03%-0.2% in pregnancy and if not diagnosed and treated on time, it may lead to poor prognosis. We are reporting a case of G2P1L1 at 24 weeks period of gestation with gestational hypertension, she was also a known case of CKD for 9 years not on treatment. She was followed up regularly with a multidisciplinary approach and successfully managed.

A case of haloperidol induced neuroleptic malignant syndrome in postpartum psychosis: a rare case report and review of literature

Jayalakshmi Meganathan — 2025-06-26

Neuroleptic malignant syndrome (NMS) is a very rare and fatal complication which occurs due to use of Neuroleptic agents in the treatment of psychotic disorders. Neuroleptic drugs are assumed to be safe for both mother and foetus owing to its relative impact on untreated fulminant psychosis. NMS was observed mostly after the use of high potency first generation neuroleptic agents such as haloperidol, fluphenazine, chlorpromazine. NMS is characterised by triad of fever, muscle rigidity and altered mental status. We report a case of 26 years old G2P1L1 pregnant woman presented with abruptio placentae and intrauterine foetal demise at 35 weeks of gestation. During postpartum period, she developed NMS due to usage of haloperidol for postpartum psychosis. In this case we achieved a prompt recovery by using bromocriptine and lorazepam.

A case report of adult onset nephrotic syndrome in pregnancy

Amita Budhewar — 2025-06-26

Proteinuria in pregnancy is one of the most common issues encountered on a routine basis, mostly thought due to preeclampsia. However, there are plethora of reasons for proteinuria other causes of the same should also be thought while diagnosing and managing proteinuria. One of the causes of massive proteinuria is nephrotic syndrome. Nephrotic syndrome is a clinical syndrome defined massive proteinuria responsible for hypoalbuminemia resulting in hyperlipidemia edema and various complications. It is caused by increased permeability through damaged basement membranes in renal glomeruli. Nephrotic range of proteinuria defined as urinary loss of 3 gm or more protein/ 24 hours or presence of 2 gm of protein per gram of creatinine in spot urinary samples. Here is a case report of nephrotic syndrome in pregnancy managed by a multidisciplinary approach with successful outcome.

Spontaneous hemoperitoneum in pregnancy: a rare case report

Anuradha Singh — 2025-06-26

Spontaneous hemoperitoneum in pregnancy (SHiP) is a rare but life-threatening condition with an estimated incidence rate of 0.04 per 1000 births. It is characterized by the accumulation of blood in the peritoneal cavity without trauma or obvious cause in pregnancy and up to 42 days postpartum that lead to significant maternal and perinatal complications. SHiP mostly occurs in third trimester of pregnancy with an incidence of 27% in the second trimester. A 40-year-old multigravida female at 30 weeks of gestation who presented with acute abdominal pain. Urgent imaging revealed a small amount of free fluid in perihepatic and perisplenic space with blood clots highly suggestive of hemoperitoneum. An emergency laparotomy was performed which confirmed the diagnosis and approximately 1-1.5 litres of hemoperitoneum with 1 litre of blood clot from pouch of douglas were evacuated. Caesarean section was performed at the same time placenta was delivered with intact membranes. There was atonic post-partum haemorrhage (PPH) which was not medically managed, so in view of doubt of rent in lower uterine segment with increased vascularity over the post surface, atonic PPH and general condition of the patient, total abdominal hysterectomy was done. Total blood loss was 3.5 litres. Both mother and baby recovered without further complications. This case highlights the importance of early recognition and prompt surgical intervention in SHiP to prevent maternal and fetal morbidity and mortality. Given its rarity and non-specific presentation, SHiP remains a diagnostic challenge and requires a high index of suspicion in pregnant women with acute abdomen and hemodynamic instability.

When endometriosis returns: managing vault involvement after hysterectomy: a case report

Anuvi Sinha — 2025-06-26

Vault endometriosis is a rare but quite challenging condition occurring in post-hysterectomy patients. Minimally invasive surgery remains the gold standard for the diagnosis and management of such cases. We hereby present a case report of a 41-year-old lady who had undergone total laparoscopic hysterectomy 12 years ago and came with irregular vaginal bleeding since 7 to 8 years. She was thoroughly evaluated for the same and underwent biopsy of the growth over the vault, which was suggestive of endometriosis. Magnetic resonance imaging (MRI) was done to rule out involvement of the bladder and rectum. She underwent elective laparoscopic excision of an endometriotic nodule over the vault and bladder serosal shaving. Postoperatively patient was relieved of her signs and symptoms.

A rare case report of septuple nuchal cord entanglement with favourable perinatal outcome

Saranya M. Krishnamoorthy — 2025-06-26

A nuchal cord refers to the umbilical cord being looped one or more times around the fetal neck. While often a common finding during pregnancy and labor without adverse effects, it can sometimes lead to complications, including variable decelerations in fetal heart rate, reduced fetal movement, signs of fetal distress, and, rarely, intrauterine fetal demise (IUD). This case describes a rare instance of seven loops of the umbilical cord encircling the fetal neck, identified during a cesarean section in a woman who presented with labor pains at 37 weeks and 1 day of gestation. The pregnancy was complicated by gestational diabetes and polyhydramnios. Intrapartum fetal surveillance revealed recurrent variable decelerations on cardiotocography and the presence of grade 2 meconium-stained liquor. Intraoperatively, seven tight loops of the umbilical cord were observed wrapped around the fetal neck, with a cord length of 115 cm. The fetal and maternal outcomes in cases of nuchal cord entanglement depend on various factors, including the number of loops, cord length, coiling tightness, and amniotic fluid index. Careful intrapartum monitoring and prompt interventions can improve perinatal outcomes, even when nuchal cord entanglement is not diagnosed prenatally. Managing nuchal cord entanglement remains challenging. Although multiple loops (more than five) are rare, we report an uncommon instance of seven loops of nuchal cord entanglement, which resulted in favorable maternal and fetal outcomes.

Successful pregnancy outcome in uncorrected tetralogy of Fallot with bidirectional shunt

Sheral Raina Tauro — 2025-06-26

Tetralogy of Fallot (TOF), a cyanotic congenital heart disease, is the most prevalent type, constituting 10% of all congenital heart conditions. During pregnancy and childbirth, patients with uncorrected TOF can experience deterioration, posing a significant risk to maternal health and even mortality. A 30 year old patient was referred from a private clinic in view of uncorrected TOF in the third trimester of pregnancy. She was G3P1A1 who reported at 37 weeks 2 days period of gestation to the emergency room with history of breathlessness on routine activities for 10 days (NYHA III) and easy fatigability for 4-5 months and pain abdomen. Her previous antenatal and pre pregnancy period was uneventful with no history of cyanotic spells, dyspnea or palpitations. Electrocardiography showed sinus rhythm, right atrial enlargement, right ventricular hypertrophy with sudden transition of QRS in V2. Her echocardiography confirmed the findings of TOF. It revealed a large peri membranous VSD with bidirectional shunt with 50% overriding of aorta. There was non dysplastic severe pulmonary stenosis, right ventricular outflow tract narrowing with right ventricular hypertrophy, severe pulmonary hypertension, with a left ventricular ejection fraction of 56%. She underwent emergency cesarean section under general anesthesia in joint consultation of the obstetrics unit along with anesthesiologist, cardiologist, intensivist and neonatologist. Her cardiovascular status was never compromised. She was started on torsemide and was discharged on 6^th post-operative day. She followed up with cardiologist after 4 weeks postpartum for further management.

Clinical management and successful pregnancy outcomes in women with empty Sella syndrome undergoing assisted reproductive technology: a case-based approach

Scindiya Mariyappan — 2025-06-26

Empty Sella syndrome (ESS) is a radiological condition characterized by a partially or completely flattened pituitary gland within the sella turcica, which may impact reproductive function. This case report presents two women with ESS undergoing in vitro fertilization (IVF). Despite having ESS, patient A had a normal ovarian reserve and conceived after frozen embryo transfer (FET) and regulated ovarian stimulation. Patient B needed an oocyte donation program in order to achieve pregnancy because of their significantly reduced ovarian reserve (AMH=0.01 ng/ml). The fact that both patients were able to conceive shows how important it is to use customized assisted reproductive technology (ART) plans depending on ovarian function. ESS presents a heterogeneous impact on fertility, necessitating tailored treatment plans, including optimized ovarian stimulation, embryo transfer protocols, and donor oocyte utilization. A multidisciplinary approach involving reproductive endocrinologists and fertility specialists is crucial in managing ESS-related infertility to maximize pregnancy success.

Harnessing artificial intelligence in understanding endometriosis

Dhwani K. Patel — 2025-06-26

Artificial intelligence (AI) models, such as neural networks and machine or language learning algorithms like ChatGPT, Microsoft Bing/Copilot, Deepseek AI, Google Gemini are emerging as new tools that can change the world. As technology grows, the opportunity of diagnosing, treating, and especially identifying early signs of any disease becomes wider. In the era of AI, this tool that is supported by machine learning and big data analytics is already demonstrating its potential in advancing the outcomes in healthcare.

Non-communicating rudimentary horn of a unicornuate uterus: clinical spectrum and diagnostic challenges: a case series

Karubaki Utkalika — 2025-06-26

Pregnancy or hematometra in a non-communicating rudimentary horn of a unicornuate uterus is a rare and potentially life-threatening condition, often misdiagnosed due to its atypical presentation and resemblance to other pelvic pathologies. We report three cases highlighting the varied presentations and diagnostic challenges associated with rudimentary horn anomalies: a 28-year-old woman presented with persistent lower abdominal pain and bleeding following a failed medical termination of pregnancy. Imaging revealed a 12-week live gestation in a non-communicating rudimentary horn; a 36-year-old woman with chronic dysmenorrhea and a suspected subserosal fibroid was intraoperatively diagnosed with a rudimentary horn; and a 45-year-old perimenopausal woman with irregular menstrual cycle and an adnexal mass was found to have hematometra within a non-communicating rudimentary horn. Early diagnosis of rudimentary horn anomalies remains challenging. A high index of suspicion and appropriate imaging (MRI/3D ultrasound) are essential for accurate diagnosis and timely surgical intervention to prevent complications.

Placenta accreta syndrome: an obstetrician’s nightmare

Sheetal B. — 2025-06-05

Placenta accreta syndrome (PAS) poses significant clinical challenges during pregnancy and delivery, often resulting in severe maternal morbidity and mortality. This case series aims to present the varied presentations, management strategies, and clinical, and maternal outcomes associated with five patients diagnosed with PAS at our tertiary care center. A prospective analysis was conducted on five patients diagnosed with PAS who presented during the six months of study period. Demographics, clinical presentations, imaging findings, surgical interventions, and outcomes were systematically documented and analyzed. The case series included women aged 28 to 34 years, each with a history of caesarean deliveries. Common presentations included vaginal bleeding associated with placenta previa and varying degrees of placental invasion, namely accreta and percreta. All patients underwent planned caesarean deliveries, revealing severe placental adherence to surrounding structures, necessitating aggressive management. Significant postpartum hemorrhage occurred in all cases, with blood transfusions ranging from 3 to 6 units. Two patients required caesarean hysterectomy due to uncontrolled bleeding. All patients were admitted to the intensive care unit (ICU), with two cases resulting in mortality. Notable complications included post op infection, sepsis and bladder adhesion in individual cases, resulting in prolonged hospital stay for two patients. Histopathological confirmation supported the clinical diagnosis in all cases. PAS presents critical challenges in obstetric management, as demonstrated by the substantial morbidity and the requirement of multidisciplinary interventions in our case series. These findings underscore the importance of early diagnosis, thorough preoperative planning, and a collaborative approach to improve maternal outcomes in patients with PAS. Enhanced awareness and preparedness among healthcare providers are crucial to mitigate risks associated with this life-threatening condition. Further studies are warranted to refine management protocols and optimize patient outcomes in PAS.

Pregnancy outcomes in women with uterine anomalies: a South Indian case series

Rakshana S. — 2025-06-13

Congenital uterine anomalies (CUAs) are important causes of adverse pregnancy outcomes, including miscarriage, malpresentation, and preterm delivery. This case series evaluates obstetric and neonatal outcomes among women with CUAs managed at a tertiary care center in South India. This case series includes seven pregnant women with confirmed uterine anomalies managed at a tertiary care center in South India between January 2023 and December 2024. The anomalies included three cases of unicornuate uterus, three bicornuate uterus, and one complete septate uterus. Six women conceived spontaneously, while one required ovulation induction. Five underwent cesarean section, one had a successful vaginal delivery, and one required emergency laparotomy for a ruptured rudimentary horn. The breech presentation was observed in two cases. Neonatal outcomes were favorable in six cases; one case resulted in neonatal loss due to uterine rupture and maternal hemorrhagic shock. CUAs are associated with increased risks of malpresentation and surgical delivery. Early diagnosis and individualized antenatal care are crucial for optimizing maternal and fetal outcomes.

Overcoming poor ovarian reserve: a case report series of spontaneous conception after failed intracytoplasmic sperm injection

Scindiya Mariyappan — 2025-06-26

This case report addresses the possibility of spontaneous conception in women with diminished poor ovarian reserve (POR) after multiple failure of assisted reproductive technology (ART) cycles, including intrauterine insemination (IUI) and intracytoplasmic sperm injection (ICSI). Four cases were analyzed, including patients aged 31 to 41 years, each with a unique clinical profile for POR. These patients were infertile for durations of 5 to 12 years, as well as with other conditions like hypothyroidism and raised BMI. Recombinant FSH was used in all cases for ovarian stimulation, but the outcome was suboptimal with poor oocyte retrieval rates and fertilization failure. The cumulative follicle-stimulating hormone (FSH) dose used in patients ranged from 1875 IU to 3000 IU. This strategy produced a low yield of oocytes, most of which were immature or failed to fertilize. Remarkably, all four patients subsequently conceived spontaneously and gave birth to healthy babies without additional ART treatments, despite the difficulty encountered in the ART cycles. The observation that spontaneous conception was successful in these complicated cases underscores the need for further studies into the mechanisms underlying such events to occur, especially in patients who have had multiple failure with ART. This case report underscores the merit of individualized treatment strategies and continued investigation into the determinants influencing fertility in women with POR.

Conservative laparoscopic approach to paratubal cyst torsion in young girls: three cases of preserved fertility

Khushbu Dubey — 2025-06-26

Paraovarian and paratubal cysts, constituting approximately 10% of all adnexal masses, are typically benign and originate from the mesothelial lining or remnants of the Müllerian and Wolffian ducts. Although the incidence of torsion is lower in paraovarian cysts compared to ovarian cysts, it presents notable challenges, particularly in young women where fertility preservation is crucial. This report discusses three cases of torsed paratubal cysts successfully managed through laparoscopic techniques designed to prioritize fertility preservation. The surgical approach emphasized careful detorsion, aspiration of cyst contents for ease of manipulation, and the avoidance of energy devices during dissection to maintain vascular integrity in the ovaries and fallopian tubes. A strategic incision placed away from the fallopian tube further minimized the risk of injury, thereby safeguarding reproductive potential. Postoperative outcomes demonstrated effective pain relief, with histopathological findings of serous cystadenoma underscoring the importance of meticulous surgical techniques in preserving reproductive function in young patients.

Breast cancer screening: a narrative review

Asmita Kaundal — 2025-06-26

Breast cancer (BC) is the most commonly diagnosed cancer and a leading cause of cancer-related mortality among women worldwide, accounting for over 2.5 million cases and 670,000 deaths annually. The burden is disproportionately higher in low- and middle-income countries (LMICs) due to limited access to screening, poor infrastructure, low awareness, and socio-cultural barriers. Early detection through screening plays a critical role in improving survival and reducing morbidity. This review outlines the epidemiology of breast cancer (BC), stratification of risk, and current international and national screening guidelines. Various screening modalities are discussed, including mammography, ultrasound, MRI, clinical breast examination (CBE), and emerging technologies such as artificial intelligence and liquid biopsy. The role of innovative tools such as the iBreastExam and, community-based strategies in resource-limited settings is emphasized. Despite advances, key challenges remain regarding accessibility, affordability, and awareness.

Preventing ureteric injury in total laparoscopic hysterectomy: a focus on surgical technique

Saeed Sarwar — 2025-06-26

Hysterectomy is a frequently performed procedure in gynaecology. Laparoscopic hysterectomy offers the added advantages of reduced postoperative pain, minimal blood loss, shorter hospital stays, and lower incidence of surgical site infections. However, it does carry an elevated risk of injury to the urinary bladder and ureters. Recent technological advancements can help identify the ureters during laparoscopic hysterectomy, thereby decreasing the occurrence of lower urinary tract injuries. However, these advanced techniques are often not easily accessible in developing countries and can be expensive. We described a step-by-step approach to total laparoscopic hysterectomy that aims at minimising the risk of lower urinary tract injuries, and recent advances along with other methods to avoid urinary tract injuries are also discussed.

Breast cancer in reproductive-age women: oncofertility perspectives, treatment impact, and fertility preservation strategies

Saloni Chadha — 2025-06-26

Breast cancer remains the most prevalent malignancy among females globally, comprising 12.5% of all cancer cases. While the median age of diagnosis in Western populations is 62 years, India reports a significantly younger median age of approximately 49 years, correlating with its youthful demographic profile. The incidence of breast cancer in women of reproductive age- approximately 19.3 per 100,000- has been rising steadily, necessitating urgent attention to fertility preservation in this population. Cancer treatments such as gonadotoxic chemotherapy, endocrine therapy, and radiation can adversely affect ovarian reserve, delay childbearing, or induce premature ovarian insufficiency. Consequently, fertility preservation has emerged as a crucial component of cancer care for young survivors. Oncofertility, an evolving interdisciplinary field, integrates oncology and reproductive medicine to provide comprehensive fertility counselling and interventions for cancer patients. Despite the growing importance of fertility preservation, barriers such as inadequate referral, limited awareness, financial constraints, and concerns regarding delays in cancer treatment or hormonal stimulation in hormone-positive cases hinder access. The impact of treatment on fertility varies depending on age, ovarian reserve, and treatment modality. Options for fertility preservation include embryo cryopreservation, mature and immature oocyte freezing, ovarian tissue cryopreservation, and temporary ovarian suppression using GnRH agonists. The National Comprehensive Cancer Network (NCCN) recommends early fertility discussions for all premenopausal breast cancer patients. In addition, pregnancy-associated breast cancer (PABC), though rare, presents a clinical challenge due to diagnostic delays and treatment limitations during gestation. As survival rates improve, safeguarding reproductive potential becomes vital to the quality of life of young survivors. Individualized, timely fertility preservation strategies supported by national and international guidelines are key to improving outcomes in reproductive-age women with breast cancer.

Determinants of risk factors for the development of obstetric fistula in a national fistula centre of a tertiary care medical college hospital

Sukla Nath — 2025-06-26

Background: Obstetric fistula is a debilitating condition caused by prolonged, obstructed labor without timely medical care, creating an abnormal opening between the birth canal and bladder or rectum. It remains prevalent in developing regions, particularly South Asia and Africa, due to early marriage, poor maternal healthcare, and lack of skilled birth attendants. In Bangladesh, obstetric fistula is both a medical and social burden, demanding targeted public health interventions. Objectives were to identify the risk factors and patient profile associated with obstetric fistula among women attending the national fistula centre, Dhaka medical college hospital (DMCH), Dhaka, Bangladesh.

Methods: This case-control study was conducted in the department of obstetrics and gynaecology at DMCH from July to December 2010. A total of 50 confirmed obstetric fistula cases were selected using purposive sampling. Data were collected via structured questionnaires and clinical examination. Inclusion and exclusion criteria were strictly followed. Data analysis was done using SPSS software. Ethical approval and informed consent obtained before initiating study.

Results: Among respondents, 34% were aged 31-35 years. In control group, 82% were aged 21-30. Inhabitants: 66% urban in control, 76% rural in case group. Education: 64% control crossed SSC; 42% case were illiterate. Labour pain >24 h in 94% cases. Home trial >24 h in 92% cases. Delivery by Dai: 87.5% in cases. Caesarean section: 58% in cases vs 6% in control. Assisted deliveries: 84.62% in cases.

Conclusions: Early marriage, poor health behavior, malnutrition, and lack of ANC contribute to obstetric fistula, with delayed hospital visits.

Risk factors for recurrence of invasive breast cancer after primary surgery in patients followed at the medical oncology and palliative care department of Soavinandriana Hospital Center

Dorland Tafitarilova Ranjandriarison — 2025-06-26

Background: Breast cancer mortality is often linked to recurrence or progression. This study aims to identify and describe the risk factors for recurrence in invasive breast cancers after primary surgery.

Methods: A case-control study was conducted from January 1, 2017, to December 31, 2023.

Results: The study included 55 cases and 55 controls. Identified risk factors for recurrence include age under 50 (OR 3.21; p=0.005), partial mastectomy (OR 7.7; p=0.001), vascular emboli or perineural invasion (OR 2.85; p=0.019), poor resection margin (R+) (OR 16.36; p=0.00), >25% lymph node invasion (OR 5.33; p=0.002), capsular rupture (OR 8.78; p=0.000), CA 15-3 >30 U/ml (OR 6.66; p=0.01), and lack of radiotherapy (OR 3.39; p=0.002) or chemotherapy (OR 4.07; p=0.001) as adjuvant treatments.

Conclusions: The identified risk factors align with those in existing literature and should be considered to enhance breast cancer treatment.

Management options of uterine leiomyoma patients admitted to a tertiary care hospital

Toma Aktar — 2025-06-26

Background: Uterine fibroids (UFs), or uterine leiomyomas (UL), are the most common benign tumors of the female reproductive system, affecting a significant proportion of women of reproductive age. This study aims to evaluate the management strategies of UFs to optimize treatment approaches and patient outcomes.

Methods: This cross-sectional study observational study was conducted department of obstetrics and gynecology, Shaheed Suhrawardy medical college hospital, Dhaka, from January 2022 to July 2022. A total of 100 women with fibroid were considered as study subjects by purposive sampling technique. Data analysis was done by statistical package of social sciences (SPSS) version 20.0.

Results: The study highlights that UFs affect 20% to 80% of women by the age of 50, with an estimated global prevalence of 171 million cases. The incidence is 2 to 3 times higher among Black women than White women and first-degree relatives have a 2.2 times greater risk of developing fibroids. Imaging studies suggest that 3% to 7% of untreated fibroids in premenopausal women regress over 6 months to 3 years. Hysterectomy, the definitive treatment, accounts for 40% to 60% of all hysterectomies performed due to fibroids.

Conclusions: In this study, it is observed that women with leiomyoma present with variable signs and symptoms. Menstrual disturbance, dysmenorrhea, pain in the lower abdomen, and anemia were the common clinical features. Almost half of the patients were managed by medical treatment whereas the rest of the portion was managed by either medical or surgical management and a few cases were managed by both medical and surgical treatment.

Ripe banana peel extract: a natural protector of testicular health in experimental models

Darlington Kenechukwu Ezeagu — 2025-06-26

Background: Spermatogenesis is highly vulnerable to oxidative stress, which can be intensified by environmental toxins like paraquat (PQ), an herbicide known for its potent toxicity, particularly in inducing reactive oxygen species (ROS). Musa sapientum (banana), has garnered attention for its antioxidant properties, particularly in its peel, which contains bioactive compounds such as flavonoids and phenols. This study investigated the protective effects of the ethanolic extract of ripe banana peel on male reproductive health in Wistar rats exposed to paraquat-induced testicular dysfunction.

Methods: After acclimatization and toxicity tests, 25 rats were divided into 5 groups. Group A served as the control, receiving rat feed and distilled water. Group B received 20mg/kg of paraquat. Group C received 1000mg/kg of ethanolic banana peel extract. Groups D and E both received 20mg/kg of paraquat followed by 500mg/kg and 1000mg/kg of banana peel extract respectively for three weeks. Sperm quality and testicular histoarchitecture were assessed, with semen samples collected from the epididymis and testes processed for histological evaluation.

Results: Paraquat exposure significantly reduced sperm motility, count, and testicular weight, while increasing sperm abnormalities and histological damage. These effects were likely due to ROS-induced lipid peroxidation and DNA fragmentation. Treatment with banana peel extract significantly improved sperm motility, count, and testicular histoarchitecture, indicating its antioxidant properties.

Conclusions: This study suggests that banana peel extract has potent antioxidant effects and could alleviate paraquat-induced male infertility.

Knowledge, attitudes, and practices regarding emergency contraception pills among adult students within the college of medical sciences, University of Guyana, from August to September 2024

Nickalus Howard — 2025-06-26

Background: Emergency contraceptive pills (ECPs), commonly known as the morning-after pill, are used to prevent unplanned pregnancy after unprotected intercourse, sexual assault, or failure of regular contraception. This study aimed to assess the knowledge, attitudes, and practices of ECPs among adult students from the College of Medical Sciences (CoMS).

Methods: A cross-sectional descriptive study was conducted at the University of Guyana, Turkeyen Campus, between August and September 2024. Data was collected through a structured electronic questionnaire and analyzed using descriptive methods, and the chi-square test for statistical significance.

Results: Out of 321 respondents, 76.1% were females and 23.6% were males, with a mean age of 23 years. 57% were from region 4, and 69.8% were Christians. The study found that the majority of students (86.6%) had adequate overall knowledge about ECPs, but there were notable gaps in understanding specific aspects, including mechanisms of action, side effects, and optimal timeframe for use. The study also found that attitudes toward ECPs were mixed, with a significant proportion of students holding negative attitudes (51.7%). However, the majority of students (95.5%) reported that ECPs were easy/very easy to obtain, and most students reported that they were somewhat effective (68.8%).

Conclusions: This study highlights the importance of targeted educational interventions to address knowledge gaps and misconceptions regarding ECPs. The findings have implications for the development of comprehensive sexual health education programs and policies aimed at promoting safe sexual practices and reproductive health among university students in Guyana.

Maternal and neonatal outcome in gestational and pregestational diabetes

Nasrin Sultana — 2025-06-26

Background: Diabetes during pregnancy increases risks for both mother and baby, despite medical advances. This study evaluates and compares maternal and fetal outcomes in pre-gestational and gestational diabetes. The aim of the study was to evaluate the maternal and perinatal outcomes in patients with gestational and pre-gestational diabetes.

Methods: This prospective cross-sectional study was conducted at the department of obstetrics and gynecology, BSMMU, and BIRDEM, Dhaka, Bangladesh, from January 2004 to December 2005, involving 150 pregnant women divided into three groups: 50 non-diabetics, 50 with pre-existing diabetes (PDM), and 50 with gestational diabetes (GDM). Data were collected using a structured questionnaire and analysed with SPSS, applying Chi-square and t-tests.

Results: Maternal age and weight were similar across groups (p>0.10). Diabetic patients had significantly more pregnancy complications (66-68%) than non-diabetics (28%) (p<0.05), with higher insulin use in pre-gestational diabetes (90%) (p<0.01). Operative deliveries and post-partum issues were more common in diabetics, though not statistically significant. Pregnancy losses were higher in diabetic groups (14% and 6%) vs. none in non-diabetics (p<0.05). Neonatal resuscitation (65.1%, 59.6%) and morbidities (50%, 38%) were also more frequent in diabetics than in non-diabetics (42% and 20%) (p<0.05).

Conclusions: Well-controlled diabetes, whether pre-gestational or gestational, still poses increased maternal and perinatal risks compared to non-diabetic pregnancies, but with proper preconception management, favourable outcomes are achievable.

Bayesian logistic regression of stillbirth cases in the Bolgatanga Municipality of Ghana, West Africa

Ernest Zamanah — 2025-06-26

Background: Stillbirth, as an adverse outcome of pregnancy, represents a growing worldwide public health challenge. The risks of stillbirth have been reported to exhibit considerable variation across different factors due to variability in socio-economic and geographical settings. Thus, this study was aimed at modelling the risk of stillbirth in the Bolgatanga Municipality of the Upper East region of Ghana and identifying some possible risk factors.

Methods: A retrospective cohort study design was utilized in this work. Thus, all the data were obtained from the medical recorded histories of all single birth outcomes at Bolgatanga Regional hospital in Ghana from September 2023 to December 2024. Bayesian logistic regression was applied in fitting the data on stillbirth in this study. R studio was the statistical software that was utilized in analysing the data.

Results: Based on the results of the posterior estimation of the Bayesian logistic regression, maternal age, educational level and hypertension status were established as significant risk factors of stillbirth in the Bolgatanga Municipality. Overall, women with low maternal age (<20 years) and those with advanced maternal age (≥35 years), women with no formal education, and women with hypertension during pregnancy were established to have a higher risk of stillbirth in the Bolgatanga Municipality.

Conclusions: The study concluded by indicating the need for various agencies of healthcare in the Bolgatanga Municipality to institute targeted interventions that will help control the effects of the risk factors and enhance improved overall pregnancy outcomes.

Frequency of endometriosis among infertile women and association of clinical presentations with laparoscopic findings in center for assisted reproduction, BIRDEM

Sayeeda Pervin — 2025-06-26

Background: Endometriosis is a significant cause of infertility, particularly among women of reproductive age. It often presents with symptoms such as pelvic pain, dysmenorrhoea, and dyspareunia. Laparoscopy is still the gold standard for diagnosing and staging endometriosis. This study aimed to determine the frequency of endometriosis among infertile women undergoing diagnostic laparoscopy and to assess the association of clinical symptoms with disease severity.

Methods: A cross-sectional descriptive study was conducted at the Center for Assisted Reproduction (CARE), BIRDEM General Hospital, Dhaka, Bangladesh, from July 2013 to June 2015. A total of 127 infertile women, both primary and secondary, undergoing diagnostic laparoscopy and dye test were enrolled. Data were analyzed using SPSS version 20, with a p-value <0.05 considered statistically significant.

Results: Endometriosis was detected in 18.9% of participants. The mean age was 29.31±4.08 years. Most women had normal (36.22%) or overweight (34.65%) BMI. Secondary infertility was more common (71.65%), but endometriosis was significantly associated with primary infertility (p=0.004). Clinical symptoms, including severe dysmenorrhoea, chronic pelvic pain, and dyspareunia, were significantly associated with endometriosis (p<0.05). Stage II endometriosis was significantly linked with chronic pelvic pain and moderate to severe dysmenorrhoea (p=0.002, 0.004), while stage IV was associated with severe dysmenorrhoea, menorrhagia, and dyspareunia (p=0.016, 0.004, 0.010, respectively). Menorrhagia had an inverse association with endometriosis overall.

Conclusions: Endometriosis is more frequently associated with primary infertility and specific pelvic symptoms, particularly at advanced stages. Laparoscopy remains essential for accurate diagnosis and staging.

Measurement of serum vitamin D levels among the pregnant women

Shah Noor Sharmin — 2025-06-26

ABSTRACT

Background: Vitamin D deficiency during pregnancy has been implicated in adverse maternal and neonatal outcomes, including preterm labor. However, study on serum vitamin D status among pregnant women remains limited in the local context. This study aimed to assess the serum vitamin D levels among pregnant women presenting in labor and to explore associations with sociodemographic, behavioral, and obstetric factors.

Methods: A descriptive type of cross-sectional study was conducted at the Department of Obstetrics and Gynaecology, Bangladesh Medical University (BMU), Dhaka, from July 2023 to June 2024. A total of 64 pregnant women aged 18-40 years in labor were enrolled, Data were collected using a semi-structured questionnaire. Serum 25(OH) vitamin D levels were measured using the Atellica IM assay. Statistical analysis was performed using SPSS version 26 with significance set at p≤0.05.

Results: The mean age of participants was 34.86±9.64 years. Most women were housewives (40.6%) and had completed primary, secondary, or higher secondary education (each 28.1%). Approximately 65.6% were primiparous, 45.3% were at 37-38 weeks of gestation, and 25.0% reported pregnancy complications. While 71.9% received vitamin D supplements, 34.4% had low intake of dairy/fish, and 89.1% had ≤30 minutes of daily sun exposure. The BMI assessment showed 29.7% were overweight and 20.3% obese. Vitamin D insufficiency was observed in 90.6% of participants. Significant associations were found between serum vitamin D levels and parity (p =0.000) as well as gestational age (p =0.000).

Conclusions: Vitamin D insufficiency is highly prevalent among pregnant women in labor, particularly in primiparas and those with preterm labor. Findings highlight the need for targeted nutritional interventions and routine vitamin D screening during antenatal care.

Effect of cabergoline and metformin combination therapy in the treatment of infertile women with symptomatic endometrioma: comparison with cabergoline alone

Asma Akter — 2025-06-26

Background: Endometrioma is a prevalent manifestation of endometriosis and a common cause of infertility in women of reproductive age. This study aimed to evaluate the effectiveness of cabergoline alone versus in combination with metformin in infertile women with symptomatic endometrioma.

Methods: This randomized controlled trial was conducted in the Department of Reproductive Endocrinology and Infertility, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh, from July 2022 to June 2023. This study included 50 women with clinically and sonologically diagnosed cases of endometrioma and dysmenorrhea attending the Reproductive Endocrinology and Infertility outpatient Department. Participants were assigned to two treatment groups: Group A (Cabergoline with metformin) and Group B (Cabergoline alone).

Results: Baseline demographic and clinical characteristics were comparable between the groups. At 3 months, both groups showed significant reductions in pain scores (Group A: 5.38±2.52; Group B: 4.86±1.52) and endometrioma size (Group A: 1.11±0.75 cm; Group B: 0.72±1.10 cm), with slightly higher reductions in Group A. However, the differences were not statistically significant (p>0.05). Endometrioma size reduction was more pronounced in Group A (mean difference: 1.11 cm vs. 0.72 cm; effect size 1.26 vs. 0.75). Side effects were mild and comparable in both groups, with no statistically significant differences.

Conclusions: This study showed that both treatment regimens significantly improved pain and reduced endometrioma size, with no significant difference in outcomes between the groups. The combination of cabergoline and metformin may offer a slight advantage in reducing endometrioma size and improving fertility outcomes.

Knowledge and attitudes of patients with gynaecologic cancer on palliative care in a low-middle income region

Berlyn Demot — 2025-06-26

Background: Palliative care improves the symptom burden of women with gynecologic malignancies either when they are admitted or treated in an outpatient. This study aims to evaluate the knowledge and attitudes of gynecologic cancer patients regarding palliative care, with the potential to identify barriers to delivering high-quality palliative care services. The results may be used by policymakers in developing strategies for the delivery of effective palliative care services.

Methods: This is a cross-sectional study design using a validated, self-administered questionnaire. Level of knowledge of the respondents was determined based on the number of correct responses. Attitude of the respondents was assessed using a 5-item Likert scale with its corresponding descriptive equivalent and computation of weighted means. The association between patients’ knowledge and attitude were determined using Pearson’s moment correlation coefficient.

Results: Between July and December 2020, a total of 67 patients participated in this study. The mean score of the participants’ knowledge was 8.78 (67%) which is of adequate knowledge. The majority of the participants’ computed weighted mean for attitude ranges from 3.31 to 3.52 which indicates appropriate attitude. Most participants responded correctly about the goals of palliative care that it would address any psychological issues (83.58 %) and stress (77.61%) brought up by serious illness and it can help the patients in dealing with the side effects of their medical treatments (82.09%). Unfortunately, more than half of the participants (62.69%) believed that palliative care is specifically for cancer patients and half of them (50.75%) responded that patients must be in the hospital to receive palliative care. The study also showed that the knowledge of the respondents is not correlated with appropriate attitude (p-value>0.05).

Conclusions: This study shows that gynecologic cancer patients have a good level of knowledge of palliative care and have a generally positive attitude toward accepting palliative care. No significant correlation between knowledge and attitudes was established in this study.

Sensitivity and specificity of transvaginal ultrasonography in detecting endometrial pathology in women with postmenopausal bleeding

Sanjana Rahman — 2025-06-26

Background: Postmenopausal vaginal bleeding is a frequent reason for gynecological consultation. Transvaginal ultrasonography (TVS) is a key diagnostic tool for assessing endometrial pathology through the measurement of endometrial thickness in such patients. This study aimed to evaluate the sensitivity and specificity of TVS in detecting endometrial pathology in women with postmenopausal bleeding, using histopathological findings as the reference standard.

Methods: This cross-sectional study was carried out in department of obstetrics and gynaecology of DMCH, from June 2022 to May 2023. A total of 65 women with post-menopausal vaginal bleeding were included after taking informed written consent.

Results: The study included 65 women with postmenopausal bleeding, with a mean age of 55.5±7.6 years. Histopathological analysis revealed abnormal endometrial findings in 70.8% of cases: 47.8% had endometrial hyperplasia, 23.9% endometrial atrophy, 13.1% endometrial carcinoma and 15.2% endometrial polyp. On TVS, the mean endometrial thickness was 9.1±6.1 mm; 58.5% had a thickness>5 mm, while 41.5% had ≤5 mm. ROC curve analysis identified a cut-off value of ≥4.99 mm (AUC=0.880; 95% CI: 0.785–0.975; p<0.01) for detecting endometrial pathology, demonstrating 82.61% sensitivity, 73.68% specificity, 88.37% positive predictive value (PPV), 63.64% negative predictive value (NPV) and 80% overall accuracy. Another ROC analysis for detecting endometrial carcinoma revealed an optimal cut-off value of ≥13.5 mm (AUC=0.935; 95% CI: 0.875–0.995; p<0.01), with 100% sensitivity, 86.44% specificity, 42.86% PPV, 100% NPV and 87.69% accuracy.

Conclusions: Transvaginal ultrasonography has high sensitivity and specificity in detecting endometrial pathology in women with postmenopausal bleeding. However, further larger studies in different surgical units are warranted.

Application of Robson's classification in clinical practice: a tool for quality improvement in obstetrics

Nafeesa Farheen S. K. — 2025-06-05

Background: The global rise in caesarean section (CS) rates has raised concerns regarding the overuse of the procedure in low-risk pregnancies, leading to potential maternal and neonatal risks. Robson’s classification offers a standardized method to assess CS rates and identify the groups contributing most to these high rates, facilitating targeted quality improvement interventions.

Methods: A retrospective observational study was conducted at Vydehi Institute of Medical Sciences, Bengaluru, from June 2024 to December 2024, including 265 deliveries. Data were collected from the hospital's obstetric registry, and studies under Robson’s classification.

Results: The overall CS rate was 54.7%, with 145 out of 265 deliveries being caesarean sections. The highest CS rates were observed in two groups, group 5 (multiparous women with a previous CS, 80%) and group 8 (all multiple pregnancies, including previous CS, 80%). Group 6 showed a 66.7% CS rate (nulliparous breech presentations). Groups 2 and 4 (induced labour) also exhibited elevated CS rates, with 62.5% and 50.0%, respectively. Lower CS rates were noted in multiparous women with spontaneous labour (group 3), which had a rate of 30%. The data revealed that induction of labour and previous caesarean sections were significant contributors to higher CS rates.

Conclusions: The study highlights the specific high-risk groups to the overall CS rate. The findings emphasize the need for targeted interventions to reduce unnecessary CS while maintaining maternal and neonatal safety. Future efforts should focus on promoting vaginal birth after caesarean (VBAC).

Predicting the success of intrauterine insemination using a clinically based scoring system

Sowbarnika Rajaraman — 2025-06-05

Background: Aim of the study was to predict the success of intrauterine insemination (IUI) using a clinically based scoring system. Retrospective cohort study in the institute of reproductive medicine, the Madras medical mission, Chennai

Methods: The 240 patients meeting the inclusion criteria and exclusion criteria who underwent IUI with husband/ donor sperms were retrospectively assessed. 10 parameters each influencing the success of IUI were taken and a total score was derived for each patient and their predictive cut off for success of IUI was determined. Each factor was also analysed individually for the success of IUI. All the patients were followed up till their serum beta human chorionic gonadotropin (hCG) test done 16 days post insemination.

Results: On evaluating, ROC curve was obtained and it showed that a cut off of 13.5 had a success prediction post IUI with a sensitivity of 82.9 and specificity of 68.2 on individually analyzing the 10 factors, serum anti-Müllerian hormone (AMH) was found to be influence the success of IUI.

Conclusions: The proposed scoring system integrates the parameters to provide an individualized pregnancy probability estimate. This tool can support clinicians in counselling patients more effectively, aiding in decision making and setting realistic expectations.

A prospective open label randomized controlled trial comparing the effect of letrozole and mifepristone pre-treatment in medical termination of pregnancy up to 9 weeks

Sangeeta Raman Jogi — 2025-06-05

Background: Mifepristone for medical termination of pregnancy (MTP) has been shown to increase the success rate. mifepristone followed by misoprostol for the medical management of first trimester pregnancy in previous clinical trials has ranged from 79% to 87%. As access to mifepristone is restricted in some countries, and some patients may have contraindications to the use of mifepristone, we propose that letrozole may be a good alternative.

Methods: This was a hospital based open label randomized controlled trial study carried out year 2023 to 2024 in the department of obstetrics and gynecology at CIMS Bilaspur, total sample was 100.

Results: In present study both groups received a single dose of their respective drug, with a slightly higher proportion of mifepristone users receiving two doses (14%) compared to letrozole users (6%) and in gestational sac expulsion 84% of participants from both groups expelled the sac in 2 days, mifepristone users had a slightly higher rate of incomplete expulsion (6%) compared to letrozole users (4%) (p=0.041).

Conclusions: The comparison between letrozole and mifepristone users highlights several key differences. Mifepristone users experienced a higher frequency of irregular menstrual cycles, incomplete expulsion of the gestational sac, and a greater need for dilation and curettage (D and C) procedures compared to those using letrozole.

A comparative assessment of decision to delivery interval for emergency and urgent lower segment caesarean section following maternal and foetal outcomes

Madhu Shishodiya — 2025-06-26

Background: Background: Timely decision-to-delivery interval (DDI) in lower segment caesarean section (LSCS) is critical for safeguarding maternal and foetal health. This study aimed to measure the DDI and assess its relationship with maternal and foetal outcomes.

Methods: A prospective observational study was conducted among 361 deliveries at a tertiary care hospital in Bhilai, Chhattisgarh. Pregnant women undergoing emergency (Category 1, n=283) and urgent (Category 2, n=78) LSCS were enrolled. Maternal and foetal outcomes were evaluated.

Results: A statistically significant difference was observed between mean DDI values in Category 1 and Category 2 (p<0.02). Maternal outcomes, including postpartum haemorrhage (PPH), post-operative fever, and blood transfusion, were significantly associated with increasing DDI (p<0.0001). A significant difference in neonatal intensive care unit (NICU) admission rates between the two categories was noted (p=0.03). APGAR score comparisons showed significant variations at different DDI intervals: 31–40 vs 51–60 min (p<0.0002), 41–50 min (p<0.00021) for 1-minute scores, and 21–30 min (p<0.028) for 5-minute scores.

Conclusions: While increased DDI correlated with certain adverse maternal and neonatal outcomes (NICU admission and low APGAR scores), no critical maternal or foetal mortality was attributed directly to prolonged DDI.

Placental location and fetomaternal outcome: a prospective study

Prachi Aggarwal — 2025-06-26

Background: The placental position within the uterus can significantly influence pregnancy outcomes, impacting maternal and fetal well-being. It has been associated with complications such as preeclampsia, intrauterine growth restriction (IUGR), and premature rupture of membranes (PROM). Understanding how different placental locations affect pregnancy outcomes is essential for optimizing clinical management and improving maternal and neonatal health. Objective of this study was to assess the effect of placental location on maternal and fetal outcomes.

Methods: This prospective study was conducted in the Department of Obstetrics and Gynaecology, Himalayan Institute of Medical Sciences, Dehradun, over 12 months from June 2023 to May 2024. 120 pregnant women with singleton pregnancies over 18 weeks of gestation were recruited. After determining placental location via ultrasonography, the participants were divided into three groups: anterior (n=53), posterior (n=46), and lateral (n=21). Maternal and fetal outcomes were assessed and analysed using SPSS software (version 23), with a p-value of less than 0.05, considered statistically significant.

Results: The most common placental location was anterior (44.1%), followed by posterior (38.3%) and lateral (17.5%). A significant association was observed between lateral placental location and hypertensive disorders including per-eclampsia (p=0.01), while anterior placental location was significantly associated with a higher incidence of PPROM/PROM (p=0.002). Regarding fetal outcomes, lateral placentation was significantly associated with IUGR (p=0.01). Although NICU admission rates were higher in the anterior placental group (35.8%), no significant correlation was found between placental location and neonatal outcomes.

Conclusions: Placental location, particularly lateral positioning, is significantly associated with adverse maternal and fetal outcomes, including hypertensive disorders and IUGR. Anterior placental location showed a strong association with PPROM/PROM. Further research is necessary to confirm these findings and refine clinical management strategies for pregnancies with abnormal placental locations.

Induction of labor versus expectant management for women with a prior caesarean delivery

Shaveta Jain — 2025-06-26

Background: This study aimed to evaluate the feto-maternal outcomes in women with a previous caesarean section (CS) who underwent labor induction versus those managed expectantly. Vaginal birth after a caesarean (VBAC) has been associated with lower maternal morbidity, fewer fetal complications, shorter hospital stays, and fewer transfusions. While spontaneous labor may not always occur in these women, labor induction can be necessary for those attempting a trial of labor.

Methods: This prospective randomized controlled trial was conducted in the department of obstetrics and gynaecology at Pt. BD Sharma PGIMS Rohtak over one year. 140 women with a history of previous LSCS were randomly divided into two groups: Group 1 received induction at 39 weeks, with monitoring and augmentation, if necessary, while Group 2 was managed expectantly until 41 weeks. The study aimed to compare the outcomes of induced labor versus expectant management in these women.

Results: In our study, 37 women (52.8%) in the expectant management group went into spontaneous labor. Of these, 32 women (86.4%) delivered vaginally. In our study, the caesarean section rate was significantly higher (75.57%) when women were induced at 41 weeks compared to 39 weeks (40%). Fetal distress was the most common indication of caesarean section when the patient induced at 41 weeks.

Conclusions: The study found that induction of labor in women with a previous caesarean section led to similar vaginal delivery rates as expectant management. No significant maternal or perinatal complications were observed, but close monitoring for fetal distress and scar rupture is essential.

Efficacy of levonorgestrel intrauterine system in conservative management of abnormal uterine bleeding: an emerging tool

Amrita Chaurasia — 2025-06-26

Background: Intrauterine LNG IUS, introduced in 1990, reduces hysterectomies for abnormal uterine bleeding, reducing the need for costly and incapacitating surgical treatments.

Methods: Heavy menstrual bleeding patients were prescribed oral progesterone therapy with norethisterone or medroxyprogesterone in doses of 20-60 mg daily for a maximum of 6 months. 80 patients chose oral progesterone and 40 chose LNG IUS insertion. The follow-up period for patients who chose LNG IUS was conducted at a rate of one year.

Results: Reduction in PBAC score pre and post treatment was statistically significant in both oral progesterone (p value <0.001) and LNG IUS group (p value <0.001). We found statistically significant reduction in endometrial thickness after 6 months of treatment with oral progesterone (p value <0.001) and LNG IUS group (p value <0.001). The most common complaint at 6 months follow-up was spotting per vaginum, which was comparable in both groups. Infrequent cycle and secondary amenorrhea were significantly more in LNG IUS group (p value <0.05) whereas heavy flow persistence and need for hysterectomy were more in oral progesterone group (p value <0.05). LNG IUS got spontaneously expelled in one patient (2.5%) after first menstrual cycle. Mean duration from insertion to amenorrhea was 8 months. After insertion, the mean Hb% showed a significant rise of 8% form baseline. Satisfaction level was more (70%) in LNG IUS users in comparison to oral progesterone (15%).

Conclusions: LNG-IUS is a superior nonsurgical option for managing HMB and uterine pathologies, with lower net costs compared to medical treatment and hysterectomy. It can be improved with counselling about self-remission of spotting per vaginum and fertility preservation.

Evaluating the effects of platelet-rich plasmas plus dehydroepiandrosterone and dehydroepiandrosterone alone in infertile women with diminished ovarian reserve

Sohely Akter — 2025-06-26

Background: Diminished ovarian reserve (DOR) is a significant cause of female infertility, often associated with poor response to ovarian stimulation during assisted reproductive techniques. This study aimed to evaluate the effects of a combination therapy using platelet-rich plasma (PRP) and dehydroepiandrosterone (DHEA) compared to DHEA alone in infertile women with DOR.

Methods: This Quasi-experimental study was conducted in the Department of Reproductive Endocrinology and Infertility, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh, from July 2022 to June 2023. In this study, we included 36 women aged 20 to 39 years diagnosed with diminished ovarian reserve (DOR) attending the outpatient Department of Reproductive Endocrinology and Infertility at BSMMU. Participants were assigned to two treatment groups: group A received DHEA plus PRP, and group B received only DHEA.

Results: The mean age in group A was 31.5±5.5 years (range: 25–39), and in group B, it was 31.4±5.2 years (range: 25–39). Baseline characteristics, including age, body mass index (BMI), infertility duration, and hormonal levels, were similar between the groups. Over the 3-month follow-up, both groups showed improvements in ovarian reserve markers. Group A demonstrated slightly greater improvements in AMH (0.36±0.2 ng/ml versus 0.30±0.1 ng/ml), AFC (1.2±1.4 versus 0.82±1.5), and a greater reduction in FSH (-3.1±1.9 mIU/ml versus -2.82±1.7 mIU/ml) compared to group B. However, these differences were not statistically significant.

Conclusions: This study showed that both DHEA alone and in combination with PRP resulted in improved ovarian reserve markers in women with DOR. Although the combination therapy of PRP and DHEA showed slightly better outcomes compared to DHEA alone, the differences were not significant.

Fetomaternal outcomes in patients undergoing cesarean after previous 1 or more cesarean section at Government Medical College, Saharanpur

Rashmi Singh — 2025-06-26

Background: There is an increase in trend of caesarean section in most countries worldwide, resulting in the rise of multiple repeat cesarean sections which is known to be associated with increase in maternal and perinatal morbidity and mortality rates. We decided to study the various fetomaternal outcomes in patients undergoing caesarean section at our institution.

Methods: This prospective study was carried out in department of obstetrics and gynecology, Government Medical College, Saharanpur (UP) over a period of 14 months. All patients undergoing caesarean section for various indications at Government Medical College, Saharanpur with previous one or more caesarean section were included. History taking and examination was done. Maternal and fetal outcomes were noted.

Results: Over a span of 14 months (September 2023 - December 2024), out of total 240 cesarean deliveries, 139 patients had at least 1 prior LSCS. Of these, 62.58% were emergency cases, and 37.43% were elective. 42.44% were aged 26-30 years, with only one patient over 40 years. 38.13% were gravida 2. Most common indication was short interpregnancy interval in 15.10%. Most frequent intra operative complication was adhesions in 31.65%. 8 cases with previous 1 LSCS needed NICU admission.

Conclusions: With rise in repeat cesarean section there lies increase in maternal and fetal risks. Hospitals should conduct cesarean audits to reduce primary cesarean section rates, promote trial of labor after cesarean (TOLAC) for successful vaginal birth after cesarean (VBAC), and counsel patients on vaginal birth after cesarean (VBAC) risks and benefits to reduce repeat c-sections and complications.

Metallothionein gene polymorphism associated with Cd and Hg levels in non-obstructive azoospermia patients: a hospital-based observational study

Nisha Sharma — 2025-06-26

Background: Heavy metals, such as Cadmium (Cd), Arsenic (As), Mercury (Hg) and Lead (Pb) might potentially induce reproductive toxicity in male infertility patients, regardless of the varying concentrations of these heavy metals in the blood. Genetic polymorphism is one of the least studied internal contributing factors in male infertility cases associated with high level of heavy metal in blood. Therefore, this study aims at identifying the difference in the serum levels of heavy metals in non-obstructive azoospermia (NOA) patients associated with genetic variants.

Methods: It’s a hospital based observational study where patients reporting with azoospermia due to hypospermatogenesis (HS) were recruited prospectively. Comprehensive clinical history, and blood samples were collected. Whole exome sequencing (WES) and was performed for 50 HS patients to identify variants. Inductively coupled plasma mass spectrometry (ICP-MS) was performed to assess levels of Cd, As, Hg and Pb levels in serum samples of 50 HS patients. Statistical analysis was performed to determine difference in heavy metal concentration of HS patients with and without the presence of metallothionein gene associated single nucleotide polymorphism (SNP).

Results: Genomic analysis for SNPs identified deleterious candidate variants in MT1A (rs11640851 and rs8052394) associated with 18/50, MT1E (rs138690474) associated with 4/50 and MT4 (rs11643815) associated with 5/50 HS patients. A statistically significant difference in the blood concentration of Cd and Hg was observed in HS patients associated with metallothionein gene SNPs.

Conclusions: This exploratory genomic analysis conducted on HS patients shows prevalence of deleterious candidate SNPs in metallothionein gene. The HS patients with candidate SNPs showed higher levels of Cd and Hg which indicate the genomic susceptibly towards heavy metal-induced reproductive toxicity.

Current patterns of menstrual health and hygiene among adolescent and young women of 15-24 years from rural northern India: a community based cross sectional study

Kathirvel Srinath — 2025-06-26

Background: Menstrual health has an impact on physical, mental and social well-being of young women. Young women in rural areas may face peculiar challenges related to menstrual health and hygiene management (MHHM). In view of evolving lifestyle and behavioural changes in transitional world, there is a need for latest community-based study among young women in rural India. Therefore, we aimed to estimate the magnitude of problems associated with MHHM, and to identify the factors associated with menstrual problems and menstrual hygiene.

Methods: House visits were made in the selected villages of Ballabgarh block of Haryana, and 483 non-pregnant women aged 15-24 years were interviewed regarding socio-demographic characteristics and menstrual history (on age of menarche, irregular menstrual bleeding, sanitary pad usage, heavy menstrual bleeding, dysmenorrhea, period fatigue). Dietary diversity was assessed using women dietary diversity (WDD) scale. Multivariable logistic regression analyses were done to identify factors associated with different menstrual problems and strict sanitary pad usage.

Results: The prevalences of heavy menstrual bleeding, dysmenorrhea and period fatigue were 20.9%, 26.3%, and 32.0% respectively. Age and marital status were associated with dysmenorrhea. Low dietary diversity was associated with period fatigue. Menarche was delayed among 26.9% and early by 20.8% of the participants. More than nine out of ten participants (92.8%) strictly use sanitary pads. Heavy menstrual bleeding was associated with lesser strict use of sanitary pads.

Conclusions: Menstrual problems were common among young women in rural India, and heavy menstrual bleeding was associated with lesser strict use of sanitary pads.

Correlation between endometrial thickness and histopathological report in patients with abnormal uterine bleeding: a prospective study

Preeti F. Lewis — 2025-06-26

Background: Abnormal uterine bleeding (AUB) refers to any bleeding from the uterus that is irregular in volume, duration, or frequency and does not fall within the normal menstrual cycle pattern. The objective of this study was to find the correlation between endometrial thickness on transvaginal or transabdominal ultrasound with histopathological assessment of the endometrial assessment on Dilatation and curettage in patients with AUB.

Methods: It was a prospective Cohort study. A total of 102 women in reproductive and peri-menopausal age (taking inclusion and exclusion criteria into account) who underwent dilatation and curettage for abnormal uterine bleeding during the period March 2023- March 2024 were taken and analysed and correlated their HPR reports with their endometrial thickness measured with ultrasound.

Results: Mean age of patients was 37.83±9.43. Mean endometrial thickness (mm) was 9.15±3.474. For pathological abnormalities in ultrasonography the cutoff point that delineates the abnormal histology and normal histology for endometrial thickness was 14.50 mm area under the curve (AUC) was 0.783 and sensitivity, specificity of 100%, 70% respectively.

Conclusions: A positive correlation between endometrial thickness and histopathological findings was observed, underscoring the importance of endometrial evaluation in patients presenting with abnormal uterine bleeding.

Survey to assess knowledge about polycystic ovarian syndrome in females of reproductive age group: a hospital-based study

Taranpreet Rehal — 2025-06-26

Background: Polycystic Ovarian Syndrome (PCOS) is the most common endocrine disorder affecting women of reproductive age. Many women remain undiagnosed due to lack of awareness about its signs, symptoms, and complications and associated risk factors. Educating women about PCOS is key for early diagnosis and effective management. This study aims to asses knowledge about PCOS in females of reproductive age group.

Methods: A cross-sectional observational study was conducted from June to August 2023 at the gynaecology OPD of Punjab Institute of Medical Sciences, Jalandhar. A total of 150 women aged 18–45 years participated by filling a structured and validated questionnaire designed in English and Punjabi. Data were analysed using MS excel.

Results: The majority of respondents (54.7%) were aged 21–30 years and from urban areas (64.7%). Most were students (50%) with education up to 10+2 (49.3%). Awareness of PCOS symptoms varied, with obesity (66%), hair loss (63.3%), and acne/oily skin (59.3%) being the most recognized. Only 38% identified junk food as a risk factor, while 52.7% believed obesity leads to PCOS. Complications like ovarian cancer (29.3%) and diabetes mellitus (24.7%) were less recognized. Awareness about lifestyle modifications such as healthy diet (83.3%) and regular exercise (79.3%) was high. Health workers (76.7%) were the primary source of information.

Conclusions: There is a significant gap in knowledge about PCOS among reproductive-age females. Increased awareness through education, seminars, and counselling is essential for early detection and prevention. Health seeking behaviour should be encouraged.

Thyroid stimulating hormone and thyroid peroxidase antibodies assessment in screening of hypothyroidism in pregnancy

Ashwini Vasant Patle — 2025-06-26

Background: Thyroid dysfunction in pregnancy is often underdiagnosed due to overlapping physiological changes, yet it poses significant risks to maternal and foetal outcomes. This study aimed to evaluate role of anti-thyroid peroxidase (TPO) antibodies alongside thyroid stimulating hormone (TSH) in diagnosing and guiding treatment for hypothyroidism in pregnant women.

Methods: A prospective cohort study was conducted from September 2019 to June 2021 at a tertiary hospital in Mumbai among antenatal women at booking visit. TSH, free T4, and anti-TPO antibodies were measured using chemiluminescent immunoassay. Follow-up and treatment were based on trimester-specific reference ranges and standard guidelines. Statistical analysis was done with significance set at p<0.05.

Results: Hypothyroidism was found in 11.46% pregnant women (n=253) using TSH cutoff level of 4.0 µIU/ml. The prevalence of anti-TPO antibodies was 5.1%. Among anti-TPO antibody-positive cases, 23.08% had history of miscarriage. Out of 13 participants who tested positive for anti-TPO antibodies, 6 had TSH levels above upper reference limit (4 mIU/l). Participants with borderline TSH levels were followed up; at the second follow-up, 1 out of 72 participants had TSH >4 mIU/l and was started on treatment. At third follow-up, 5 out of 69 participants had TSH >4 mIU/l and were also treated accordingly.

Conclusions: A significant association was observed between elevated TSH levels and presence of anti-TPO antibodies. A notable decrease in mean TSH levels was observed in second and third visits compared to baseline values among pregnant women with borderline TSH, without thyroid hormone supplementation.

Effect of omega-3 and D-chiro inositol compared to D-chiro inositol alone on hormonal parameters in women with insulin resistant polycystic ovary syndrome

Amitun Nessa — 2025-06-26

Background: Polycystic ovary syndrome (PCOS) is a common endocrine-metabolic disorder marked by high androgen levels, irregular ovulation, and ovarian cysts. Recommended treatments include lifestyle and nutrition changes alongside medication. Omega-3 fatty acids support immune function, insulin sensitivity, cell health, and ovulation. D-chiro Inositol helps lower blood pressure, triglycerides, and glucose, enhances ovarian function, and reduces harmful oxidative stress in the ovaries. This study was designed to evaluate and compare the effect of omega-3 and D-chiro inositol and effect of D-chiro inositol alone on hormonal parameters in women with insulin resistant PCOS.

Methods: This randomized controlled trail study was conducted in the departments of reproductive endocrinology and infertility, Bangbandhu Sheikh Mujib medical university, Dhaka from January 2023 to June 2024. Total 60 individuals with PCOS were observed in this study.

Results: The mean age was 24.88 (±4.81) years and mean BMI was 28.83 (±2.72) kg/m². In group A, omega-3 plus D-chiro-inositol therapy is found more effective than D-chiro-inositol alone in reducing serum luteinizing hormone (LH), (follicle stimulating hormone) FSH, free testosterone and fasting glucose, fasting insulin and homeostasis model assessment for insulin resistance (HOMA-IR) after 12 weeks of treatment. But there was no statistically significant difference in post treatment LH, FSH, free testosterone, fasting glucose, fasting insulin and HOMA-IR between 2 groups.

Conclusions: Combining D-chiro inositol and omega-3 fatty acids can significantly improve insulin sensitivity and reduce the levels of LH, FSH and free testosterone in women with PCOS. But there is no significant difference in this post treatment hormonal and biochemical parameters between the two groups.

Association of low pregnancy-associated plasma protein A with the timing of delivery in babies with intrauterine growth restriction, babies showing suboptimal growth on serial scans, and well-grown babies

Ayesha Fatima — 2025-06-26

Background: The ideal timing for delivering babies with pre-eclampsia or small for gestational age is clear. There is agreement on delivering babies with pre-eclampsia and small for gestational age, but not for normally growing babies with low pregnancy-associated plasma protein A (PAPP-A). The study aimed to investigate the association of low PAPP-A with adverse pregnancy outcomes and ideal delivery timing in a well-grown baby with low PAPP-A as a risk factor.

Methods: A retrospective study analyzed 3240 singleton pregnancies with first-trimester Down syndrome screening at local hospitals from January 2022 to April 2023. Among these, 130 singleton pregnancies had PAPP-A levels at the 5^th centile, along with risk estimations and documentation.

Results: In NCIC trust births, 3280 women were assessed for low PAPP-A. Of these, 130 had low PAPP-A levels. It revealed that 46.9% used Aspirin, with a high down screen risk found in 11.5%. In this study, 13.1% experienced pregnancy induced hypertension (PIH). 2 resulted in intrauterine fetal death (1.5%). 9 women (6.9%) experienced pre-term births. The study identified 8 newborns (6.25%) with birth weights below the 10th centile after >39+6 weeks, and 6 (4.6%) <3^rd centile after 37+6 weeks.

Conclusions: The study linked low PAPP-A to poor APGAR scores, stillbirth, growth issues, and special care unit admissions. Babies with low PAPP-A showed higher morbidity and mortality after 41 weeks. The findings indicate that delivery should occur between 40+0 and 40+6 weeks. Further research is needed to create an antenatal protocol for optimal delivery timing for babies with low PAPP-A.

Maternal near miss and maternal mortality in a tertiary care centre of North Karnataka: a retrospective study

Jyoti G. Lokapur — 2025-06-26

Background: Maternal near-miss cases and maternal deaths serve as crucial indicators of obstetric care quality. Analysis of these cases in tertiary care settings provides valuable insights for improving maternal healthcare services.

Objective of this study was to analyze the prevalence, causes, and outcomes of maternal near-miss cases and maternal deaths in a tertiary care center in North Karnataka.

Methods: This retrospective observational study was conducted at Karnataka Medical College and Research Institute, Hubli, during 2023. The study population comprised all pregnant women who were admitted to the Department of Obstetrics and Gynecology at KMCRI during 2023. The identification and classification of maternal near-miss cases were conducted in accordance with the Ministry of Health and Family Welfare (MoHFW), Government of India guidelines. Data was collected from multiple hospital records and analyzed using SPSS version 22.

Results: Among 11,658 live births, 113 maternal near-miss cases and 51 maternal deaths were recorded (maternal mortality ratio: 437.46 per 100,000 live births). The majority of cases occurred in the 20-25 years age group (near-miss: 43.4%, deaths: 54.9%). Primigravidae constituted 48.7% of near-miss cases and 43.1% of deaths. Most cases were referrals (near-miss: 76.1%, deaths: 70.6%) and booked outside the institution (near-miss: 94.7%, deaths: 82.4%). Hypertensive disorders were the leading cause of near-miss events (65.5%), and maternal deaths were also primarily attributed to hypertensive complications (31.4%), acute kidney injury (23.5%), and sepsis (19.6%). Mechanical ventilation was required in 90.2% of maternal deaths and 53.1% of near-miss cases.

Conclusions: The high proportion of referred cases and unstable presentations emphasizes the need to strengthen peripheral healthcare facilities and referral systems. Early recognition of complications, timely referral, and improved antenatal care at primary healthcare levels are crucial for reducing maternal morbidity and mortality.

Study of primary caesarean section among multiparous women in tertiary care centre of Bastar region: a prospective study

Sonam Kunjam — 2025-06-26

Background: In this study was to know the incidence of primary Caesarean section in multigravidas, its indications among these patients.

Methods: Prospective observational study. All deliveries at Late Baliram Kashyap Memorial Hospital and Govt Medical college Jagdalpur, Bastar, Chhattisgarh, India. 8729 deliveries during the period of 2 year from January 2022 to December 2023. Multigravida women admitted to hospital with pregnancy of >28 weeks gestation (gravida 2 and above), each of whom has had a previous vaginal delivery of >28 weeks gestation were included. Women with previous abortions and previous section were excluded. Indication of caesarean section, obstetric history, antenatal history.

Results: A total of 8729 deliveries were conducted in the institute Lt shri BRKM Govt Medical College Jagdalpur Chhattisgarh among which 2709 (31%) were caesarean sections and 6015 (68.9%) were conducted vaginally. Total number of primary CS in multiparous women were 642 about 23.6% of the total CS rate. The mean age is 26±4 years ranged from 18 – 40 years. Most of the patients were in the age group of 26-30 years (45.01%) followed by 21-25 years (26.01%) Out of 642 primary cs in multipara, 316 (50.6%) cases underwent emergency CS whereas rest 326 went elective CS. Maternal and fetal indications contributed 21% and 79%.

Conclusions: Many unforeseen complications occur in women who previously had a normal vaginal delivery. With this study we came to the conclusion that fetal distress is the major contributor of primary CS in multigravida. Thus, preventive measures should be taken to decrease the fetal distress and non-progress of labour.

Determination of caesarean section rate and its trend analysis in a tertiary care tribal preponderant state using Robson’s classification

Atima Bharti — 2025-06-26

Background: There are certain conditions during delivery where vaginal delivery becomes unsafe. To overcome this situation, caesarean section (CS) is necessary for the safety of the mother and baby. The incidence of CS is rising to improve the outcome of mother and baby; it is a life-saving surgical tool in the process of delivering the baby. Efforts are being made to decrease the rate of CS without adversely affecting the outcome of the mother and baby. Robson’s classification for the indication of CS is an excellent method to audit for the indication of the surgery. However, this classification does not include some important indications like placenta previa, which is on the rise in the present day.

Methods: This study was a hospital-based prospective observational study that enrolled 2066 pregnant females, conducted from October 2023 to September 2024 in a tertiary health centre.

Results: Delivery by vaginal route and CS was 4561 during one year period, 2066 women was delivered by CS accounting an incidence of 45.29%. The majority of patients were in the age group of 20-30 years (75.9%), 82.1% were from rural areas, and the majority of women were unbooked (70%), 57.4% were multiparous, and 51.3% of the patients belonged to the tribal community.

Conclusions: Standardisation of CS indication parameters, regular CS audits, and application of Robson classification for every woman undergoing a CS will be helpful to keep a check on rising CS rates.

Does use of mobile phone affect human semen profile?

Jayram — 2025-06-26

Background: Mobile telephony is not very old technology. It functions based on electro-magnetic radiation (EMR). Mobile users are rapidly increasing every day and this technology is advancing rapidly. Scientists have demonstrated that EMR affects the human health and reproductive system too. Some other scientists revealed that mobile telephony does not affect human health. Our preliminary studies have shown that mobile telephony has some correlation with human semen profile in the exposure dependent manner. Therefore, this study was planned in male human volunteers to reassess the possible effects of mobile telephony on human semen profile in our infertility centre.

Methods: 74- human male volunteers consented and included in our research study. Their mobile phone placing, use hour/day was recorded and these volunteers were placed in three Groups- A, B and C (exposure of mobile telephony was 3-4 hrs, 5-6 hrs and 7-8 hrs respectively and approximately).

Results: Semen analysis was done using WHO method manual in our infertility research centre, Bangaluru, India. Semen analysis shows that decline in sperm density, motility (quantitatively and qualitatively) and enhanced percentage of abnormal sperm. It appears to be associated with duration exposure dependant as we found in our earlier study.

Conclusions: In conclusion, we may say that decline in sperm density, motility and enhanced percentage of sperm abnormalities may be associated with the use of mobile telephony along with other factors. Further research studies are needed to ascertain the possible effects of mobile telephony on human male reproductive health.

Effect of Elagolix in comparison to Dienogest in the treatment of symptomatic adenomyosis

Umme Jubaida — 2025-06-26

Background: Adenomyosis, a benign gynecological disorder, is diagnosed with increasing frequency in infertile patients since women delay their first pregnancy. Common symptoms of adenomyosis are dysmenorrhea and heavy menstrual bleeding (HMB), resulting in poor quality of life. Elagolix, the oral GnRH antagonist, acts by reducing the occurrence of ectopic endometrial implants in the myometrium. It diminishes uterine volume, reduces dysmenorrhea and heavy bleeding, and improves fertility outcomes. Dienogest, a synthetic oral progestin highly selective for progesterone receptors, reduces the painful symptoms in women with adenomyosis. The aim or this study was to compare the effect of Elagolix with Dienogest in the treatment of symptomatic adenomyosis.

Methods: This randomized controlled trial was conducted in the department of reproductive endocrinology and infertility, Bangabandhu Sheikh Mujib medical university (BSMMU), Dhaka, from January 2024 to December 2024. A total of 58 participants with symptomatic adenomyosis were randomly assigned to 2 groups (n=29). Each group received either Elagolix (200 mg) or Dienogest (2 mg) once daily for 3 months.

Results: Compared between the two groups, post-treatment mean changes of VAS score (6.25±1.83 vs 4.84±1.56), hemoglobin (-1.21±0.97 vs-0.20±0.56), and median uterine volume (5.1 vs 1.2) were significantly higher in the Elagolix group than the Dienogest group. HMB was also significantly reduced (3.7% vs 23.1%) in the Elagolix than the Dienogest group after 3 months of treatment.

Conclusion: Elagolix significantly reduced VAS score, HMB, and uterine volume in symptomatic adenomyosis compared to Dienogest.

Bacteriological assessment on urinary tract infection in preterm premature rupture of the membranes and preterm labour related to fetomaternal outcomes

Ganesh M. Bargaje — 2025-06-26

Background: Urinary tract infection (UTI) is a health hazards risk during pregnancy of mothers, which leads to preterm premature rupture of the membranes (PPROM) following preterm labour (PTL). The objective was to investigate the most common bacteria causing UTI in cases presenting with PPROM following PTL and also their sensitivity profile to antibiotics and fetomaternal outcome in such cases at tertiary care hospital, Central India.

Methods: This research was conducted a hospital-based prospective and observational study among 60 pregnant women for the period of 01 July 2020 to 30 June 2021 in the tertiary care hospital at Bhilai, Chhattisgarh. Also studied urine for culture and sensitivity test for antibiotics related to fetomaternal outcomes.

Results: Among the marker of infection of total studied patients, a maximum for UCS positive (21.7%) and WBC count >15000 cumm (15.0%) while minimum for CRP (10.0%). Among the various microorganisms isolated in urine culture of participants, a higher value was observed on E. coli (11.67%) followed by Klebsiella sp. and Proteus sp. (3.33%) while lower value was observed for Pseudomonas sp. and CoNS (1.67%) among total studied patients. The association between urine culture and maternal complications, type of delivery, did not show significant association. No significant association was observed between urine culture and different parameters of neonatal complications and neonatal death. Only two deaths of babies were recorded.

Conclusions: UTI is significant causative factors of PTL and PPROM. It is always suggested to screen and monitor the antenatal mothers for the presence of asymptomatic or symptomatic UTI.

Efficacy of ormeloxifene versus norethisterone in the management of abnormal uterine bleeding

Aishwarya Mainani — 2025-06-26

Background: Abnormal uterine bleeding (AUB) is a common gynecological issue that significantly affects the quality of life of women, particularly those in the reproductive and perimenopausal age groups. Ormeloxifene, a selective estrogen receptor modulator, and norethisterone, a synthetic progestogen, are commonly used in its medical management. Objective of this study was to evaluate and compare the efficacy and safety of ormeloxifene and norethisterone in the management of AUB.

Methods: A prospective comparative study was conducted on 100 women aged 35 years and above diagnosed with AUB at D. Y. Patil Hospital, Navi Mumbai between July 2023 to December 2024. Participants were randomly assigned to two treatment groups. Group A received ormeloxifene (60 mg twice a week for 12 weeks, then once weekly for four weeks), while Group B received norethisterone (5 mg twice daily from day 5 to 25 of the menstrual cycle for 4 cycles). The primary outcome was the change in PBAC score. Secondary outcomes included hemoglobin levels, endometrial thickness, and incidence of side effects, evaluated at baseline, 2 months, and 4 months.

Results: Group A showed a 76.15% reduction in PBAC score, a 2.91 g/dl increase in hemoglobin, and a 4.09 mm decrease in endometrial thickness. In contrast, Group B demonstrated a 45.97% reduction in PBAC score, a 1.31 g/dl increase in hemoglobin, and a 3.50 mm decrease in endometrial thickness. Acne and gastrointestinal side effects were more common in the norethisterone group.

Conclusions: Ormeloxifene was more effective and better tolerated than norethisterone for the treatment of AUB. Its weekly dosing schedule, superior hematological improvement, and lower side-effect profile make it a preferable first-line therapy.

Qualitative assessment of barriers perceived by women using perception scale of barriers in contraceptive use as measurement tool

Sreesubhageetha D. — 2025-06-26

Background: This study was conducted to determine the barriers and obstacles perceived by women with regard to contraceptive use by using perception scale barriers in contraceptive use (PSBCU) as the measurement tool in women utilizing the family planning services.

Methods: It was a cross-sectional study conducted amongst 300 reproductive age group of women. Perception scale of barriers to contraceptive use was designed as 5-point Likert scale and the scale contains three dimensions. The domains were emotional dimension (10 items), social dimension (8 items) and cognitive dimension (9 items). The scale was administered using face to face interview. Each perceived obstacle was assessed by women using 5-point Likert scale ranging from strongly agree (score 5) to strongly disagree (score 1). The lowest score obtainable from the scale was 27 whereas the highest score was 135. Highest score indicates maximum barriers.

Results: By administering PSBCU scale, a maximum score was obtained for intra uterine contraceptive devices and a minimum score obtained for DMPA. Therefore, this study showed that intra uterine contraception devices have the highest barriers and long acting injectable-DMPA has lowest barriers.

Conclusions: A scale like PSBCU will be useful to know about the experience of current contraception and obstacles perceived and thereby addressing the issues to improve the uptake of contraception services and as well as to reduce the discontinuation rates.

A comparative study to determine the effectiveness of oral mifepristone and vaginal isosorbide mononitrate as cervical ripening agents for induction of labor in pregnant women with gestational age 28 to 34 weeks

Meeta Pandit — 2025-06-26

Background: The process of inducing labor is definitely one of the most commonly done obstetric procedures worldwide. An unfavourable cervix is a major reason for unsuccessful induction. Cervix must be softened. IOL should only be performed when there is an obvious medical need and advantages are greater than risks.

Methods: The present study was conducted at the Department of Obstetrics and Gynaecology, MGM Medical College, Indore from February 2023 to January 2024.One hundred pregnant women of gestational age 28 to 34 weeks, who had a valid indication for termination of pregnancy, were included in the study after valid consent and randomised into two groups. Oral Mifepristone was used in one group and vaginal isosorbide mononitrate IMN in the other. Modified Bishops Score was subsequently assessed and compared.

Results: In the study, indications for termination were hypertensive disorders of pregnancy, IUFD, anhydramnios, severe oligohydramnios and PPROM. Mean±SD of Bishop score before and after IMN were 1.84±1.23 and 4.40±1.34, whereas for Mifepristone 1.42±1.42 and 4.92±1.68, respectively. Mean cervical ripening to delivery time in IMN group was 30.04±3.37 hours; while in mifepristone group, it was 28.50±3.48 hours. Most patients delivered vaginally in both the groups (IMN group 88%; mifepristone group 94%). Both Mifepristone and IMN were generally well-tolerated by participants.

Conclusions: This study provides evidence supporting the effectiveness of both drugs as cervical ripening agents.

Effect of metformin plus statin combination therapy compared to metformin alone in infertile woman with symptomatic endometrioma

Hritu Shah — 2025-06-26

Background: Endometriosis is an estrogen-dependent inflammatory condition characterized by endometrial tissue growth outside the uterus. Metformin suppresses estrogen production and has anti-inflammatory, anti-proliferative, and anti-angiogenic effects. Statins inhibit cholesterol synthesis and offer anti-inflammatory actions, reducing angiogenesis, invasion, adhesion, and lowering MCP-1 and MMP-3 levels. This study compares metformin plus statin versus metformin alone in infertile women with symptomatic endometrioma.

Methods: A randomized controlled trial was conducted in the department of reproductive endocrinology and infertility, BSMMU. Forty women with symptomatic endometrioma diagnosed via transvaginal ultrasound (TVS) were randomized into two groups. The experimental group received metformin 500 mg thrice daily plus atorvastatin 40 mg once daily; the control group received only metformin. Treatment lasted 3 months. Outcomes-endometrioma size (TVS), pain [visual analog scale (VAS)], and complement C3 level (Nephelometry)-were measured pre-and post-treatment. Data were analyzed using SPSS v.26.

Results: After treatment, the experimental group showed significant reductions in endometrioma size (3.50±0.82 vs 2.41±0.52 cm) and pain score (6.80±1.67 vs 3.13±2.32) from baseline (p<0.05). The control group showed significant reductions in endometrioma size (3.40±0.96 vs 2.92±0.80 cm) and pain score (6.65±2.10 vs 3.47±2.09) from baseline (p<0.05). Serum complements levels increased in both groups insignificantly. Endometrioma size reduction was significantly higher in the experimental group (1.06±0.53 vs 0.45±0.44 cm), but pain score and complement level reductions showed no significant difference between groups.

Conclusions: Metformin plus statin shows significantly better reduction in endometrioma size compared to Metformin alone in treating symptomatic endometrioma in infertile women.

Study of prognostic significance of platelet count as a predictor of severity of preeclampsia

Saba Khan — 2025-06-26

Background: Pre-eclampsia is a pregnancy-specific syndrome, recognised from antiquity as a leading cause of maternal and perinatal mortality, and it accounts for almost 15% of pregnancy associated death. Hence, the current study was planned to assess the role of platelet count as a predictor of the severity of preeclampsia and its prognosis.

Methods: In this retrospective analytical study, a total of 100 pregnant women with preeclampsia were included and divided into two groups of non-severe and severe. Demographic data, socio-economic status, period of gestation and platelet count were recorded and compared.

Results: The average age of patients was 27.07±5.14 years, with no significant difference between patients based on preeclampsia severity. Most of the patients were multigravida females (69%). The distribution based on the socio-economic status was similar, with no significant difference (p>0.05). The average period of gestation was 36.01±3.41 weeks in the study. The average platelet count of patients with severe preeclampsia at the time of admission was seen to be lower compared to the non-severe patients. A ROC curve analysis was done to assess the ability of platelet count to differentiate severe PWE from non-severe PE. The area under the curve was high at 0.879. The LSCS rate was 54% in the study, followed by Pre-term birth seen in 48% of patients. There was no significant difference between the two groups in terms of maternal outcome parameter-based distribution. The proportion of patients with APGAR score <7 at 5 minutes was significantly higher in the non-severe PE group. It was seen that preeclamptic patients were associated with a significantly higher prevalence of pre-term birth and Ante partum haemorrhage (APH).

Conclusions: Platelet count is an accurate predictor of severe preeclampsia in pregnant females. The patients with low platelet counts were associated with significantly higher adverse pregnancy outcomes, as suggested by a significantly higher prevalence of pre-term birth, APH and rate of LSCS.

Emergency obstetric hysterectomy in a tertiary referral centre: 10 years retrospective cross-sectional study

Nalini Sharma — 2025-06-26

Background: Emergency obstetric hysterectomy (OH) is the last resort opted to save life of a mother in critical obstetric conditions compromising her future reproductive potential but is a considered a lifesaving procedure in an emergency obstetric situation. We sought to study the socio-demographic factors, incidence, clinical risk factors, indications, complications and feto-maternal outcomes associated with emergency obstetric hysterectomy.

Methods: This was a retrospective study. All cases of emergency hysterectomy were reviewed from various medical record section for a period of 10 years conducted at North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, Meghalaya, India.

Results: There were 23 cases of emergency obstetric hysterectomy. The incidence of the study was 0.18%. 43.4% were grand-multiparous. Most common associated risk factor was previous caesarean section and grand-multiparous patient. The most common indication associated with OH was found to be postpartum hemorrhage. Majority (91%) of the patient received one or more blood product. The most common maternal outcome was need of ICU care. Maternal mortality was noted to be 8.7%.

Conclusions: Adequate antenatal care, screening and counselling of high-risk pregnancies, avoidance of un-indicated caesarean section, counselling for family planning methods, anticipation and timely intervention are the key to prevent and reduce maternal/neonatal mortality and morbidity.

Postpartum hemorrhage prevention through audit and review of literature

Bibi Zainab — 2025-06-26

Background: Postpartum haemorrhage (PPH), particularly significant cases with blood loss >1000 ml, is a critical obstetric emergency. This audit evaluated PPH management at Khaja Banda Nawaz Teaching and General Hospital, addressing a high incidence of PPH (29.5%).

Methods: A retrospective audit, at Khaja Banda Nawaz Teaching and General Hospital, Kalburgi, Karnataka, India conducted between period of February and May 2024, reviewed 1786 vaginal births from 2022 to 2023, identifying 526 PPH cases (>500 ml), including 71 cases of PPH>1000 ml (4%) and 20 cases ≥2000 ml (1.1%). Compliance with NICE guideline NG235 standards was assessed. Recommendations were implemented from June 2024 to February 2025, followed by a reaudit of 500 vaginal births from February to May 2025, focusing on 14 cases of PPH >1000 ml (2.8%).

Results: The initial audit revealed deficiencies in 56% of PPH records, including inadequate monitoring (35%), delayed uterotonic administration (15%), and delayed transfer from the postpartum ward to the emergency operating unit (59%). Post-intervention, documentation of informed choice improved (78% versus 49%), and significant PPH incidence decreased (2.8% versus 4%). Active third stage management increased (73% versus 27% physiological).

Conclusions: The audit cycle reduced significant PPH through standardized protocols and team engagement, underscoring the value of continuous auditing in midwifery-led units.

Assessment of maternal and foetal outcome in elderly primigravida: a prospective observational study

Pothula Sudheshna Devi — 2025-06-26

Background: An elderly primigravida means age more than 35 years. Several maternal and foetal risk factors are well-established in elderly primigravida mothers. The study aimed to evaluate the maternal and foetal outcome in elderly primigravida mothers of central part of India and also to identify risks associated with advanced maternal age for mother.

Methods: The study was conducted as an observational prospective study in Jawaharlal Nehru Hospital and Research Centre, Bhilai, Chhattisgarh. In this study, the 82 mothers presenting primigravida aged ≥35 years and attending antenatal clinic for the period of January 2019 to December 2020. All primigravida aged 35 years and above, attending antenatal clinic, all primigravida aged 35 years and above admitted in emergency. We used data for demographic and socioeconomic status of the subjects, various obstetrics parameters related to gestational period and other relevant data were collected at the time of registration and the subjects were followed up till delivery and discharge. Detailed maternal and foetal outcomes were recorded.

Results: In the present study, the mean age was of about 36.52±2.41 years among the studied mothers. Higher education and socioeconomic status revealed the conception for pregnancy was found to be delayed. This concept is leading to more LSCS following antenatal complications of mothers that may be causative factors for neonatal complications. In the present study, no mortality was observed among newborns.

Conclusions: It was concluded that vaginal deliveries were significantly less and there was an increase in caesarean section rate in this study. Management will largely depend on attempts at improving perinatal outcome without compromise to health and well-being of the mother.

Predictors of optimal ovarian response in GnRH antagonist ovarian stimulation protocol

Pavithra Baskaran — 2025-06-26

Background: The outcome of assisted reproductive technology (ART) is significantly influenced by the ovarian response to controlled ovarian stimulation (COS). Identifying robust and reliable predictors of ovarian response is essential for tailoring individualized treatment strategies and optimizing reproductive success. This study aims to investigate clinical, hormonal, and stimulation-related variables that influence ovarian response among women undergoing ART and to identify significant predictors for both hyper-response and hypo-response patterns.

Methods: A retrospective cohort analysis was conducted involving 278 women who underwent COS under a gonadotropin-releasing hormone (GnRH) antagonist protocol. Based on ovarian responsiveness, participants were categorized into three groups: high responders (n=56), normal responders (n=151), and low responders (n=71). Demographic data, hormonal markers (including Anti-Müllerian hormone [AMH], antral follicle count [AFC], follicle-stimulating hormone [FSH], and luteinizing hormone [LH]), stimulation characteristics, and infertility etiologies were systematically analyzed. Statistical comparisons utilized t-tests and chi-square tests, while logistic regression identified independent predictive parameters. A p-value of less than 0.05 was considered statistically significant.

Results: Higher AFC and AMH levels, younger age, and lower baseline FSH levels were significantly correlated with high ovarian response. In contrast, women with low AMH, high FSH, reduced AFC, and prolonged stimulation duration tended to demonstrate poor ovarian responsiveness. Notably, polycystic ovary syndrome (PCOS) was more frequent in high responders, while diminished ovarian reserve (DOR) predominated in low responders. Multivariate logistic regression identified AMH and AFC as the most significant independent predictors of ovarian response.

Conclusions: Age, AMH, AFC, and baseline FSH are critical determinants of ovarian response in ART cycles. Incorporating these biomarkers into pre-treatment evaluation facilitates the customization of stimulation protocols, thereby enhancing oocyte yield and improving overall clinical outcomes. Personalized treatment planning grounded in these predictors holds promise for advancing ART success.

Perinatal outcomes and hematologic parameters of neonates born to Rh-negative mothers with and without isoimmunization

Nazia Miraz Shejuti — 2025-06-26

Background: Rh isoimmunization remains a significant cause of neonatal morbidity and mortality in Rh-negative pregnancies. It causes hemolytic disease of the fetus and newborn (HDFN), leading to anemia, hyperbilirubinemia, and perinatal complications. This study compares hematologic parameters and perinatal outcomes of neonates born to Rh-negative mothers with and without isoimmunization.

Methods: This cross-sectional study was conducted at the Department of Obstetrics and Gynecology, Mymensingh Medical College Hospital, Bangladesh, from July 2019 to December 2019. Eighty Rh-negative pregnant women were enrolled, comprising five isoimmunised and seventy-five non-isoimmunised mothers. Data on neonatal haemoglobin, serum bilirubin, direct Coombs test results, Apgar scores, and treatment requirements were collected. Maternal factors were documented, including gravidity, antenatal care, and anti-D prophylaxis. Statistical analyses used SPSS version 25.0, with p-values <0.05 considered significant.

Results: Neonates of isoimmunised mothers had lower haemoglobin levels (mean <12 g/dl in 60% vs. 0%, p<0.001), elevated bilirubin ≥4 mg/dl (80% vs. 20%, p<0.001), and 100% direct Coombs test positivity compared to none in non-isoimmunised neonates. Phototherapy and exchange transfusion were required in 80% and 60% of isoimmunised neonates, significantly higher than the non-isoimmunised group. Poor Apgar scores (<6 at 5 minutes) were more frequent in isoimmunised neonates (40% vs. 12%). High gravidity, inadequate antenatal care, and absent anti-D prophylaxis were prevalent among isoimmunised mothers.

Conclusion: Rh isoimmunization markedly worsens neonatal hematologic and perinatal outcomes. Strengthened antenatal screening, universal anti-D prophylaxis, and enhanced neonatal care are critical to reducing HDFN burden in at-risk populations.