International Journal of Reproduction, Contraception, Obstetrics and Gynecology

Subjective cognitive complaints in premenopausal women: an overlooked clinical reality demanding recognition

Abdul Rehman Bajwa — Wed, 29 Jul 2026 00:00:00 +0530

Subjective cognitive complaints (SCC)—self-perceived declines in memory, attention, and executive function—are a frequently dismissed clinical reality for premenopausal women. While often occurring before detectable deficits appear on objective neuropsychological tests, these symptoms represent a significant neurobiological and occupational challenge. SCC is driven by genuine neurobiological changes resulting from fluctuating reproductive hormones, primarily estradiol. Estradiol serves as a critical neuroprotective agent that enhances synaptic plasticity, modulates neurotransmitters (acetylcholine, dopamine, and norepinephrine), and supports mitochondrial biogenesis. The premenopausal transition acts as a "neuroplasticity window" where hormonal variability disrupts synaptic scaffolding and alters functional connectivity within the executive control network. Research indicates a profound "invisible productivity crisis," with approximately 25% of working women underperforming due to these symptoms. Nearly 86% of women in this transition report "brain fog," leading to an estimated $1.8 billion in annual lost working time in the U.S. alone. Furthermore, SCC with preserved objective performance is now recognized as a potential Stage 1 risk marker for preclinical Alzheimer’s disease. SCC should be treated as a legitimate clinical entity rather than being reflexively attributed to psychological distress. Recommendations include routine clinical screening for women aged 35 and older, the development of SCC-specific assessment tools, and the implementation of menopause-inclusive workplace policies to mitigate career disruption and systemic gender inequity.

Non-invasive assessment of fetal lung maturity: the role of pulmonary artery Doppler and AT/ET ratio in predicting respiratory distress syndrome

Wed, 29 Jul 2026 00:00:00 +0530

Respiratory distress syndrome (RDS) remains a primary cause of neonatal morbidity and mortality. Traditional fetal lung maturity (FLM) assessment relies on invasive amniocentesis, which carries inherent risks. Fetal pulmonary artery Doppler, specifically evaluating the acceleration time to ejection time (AT/ET) ratio and peak systolic velocity (PSV), has emerged as a reliable non-invasive alternative to evaluate downstream pulmonary vascular resistance. A narrative review of current, peer-reviewed literature was conducted to evaluate the physiological basis, standardized ultrasonographic technique, and clinical applicability of the AT/ET ratio in predicting neonatal RDS, incorporating real-world clinical caveats. As fetal lungs mature, pulmonary vascular resistance decreases, significantly prolonging the pulmonary artery acceleration time and increasing the AT/ET ratio. Clinical evidence demonstrates that an AT/ET cut-off value near 0.30-0.31 provides optimal diagnostic accuracy in normally grown fetuses. However, values directly on the 0.30 threshold constitute a "gray zone" requiring integration with other biophysical markers, such as the PSV. Furthermore, conditions such as gestational diabetes mellitus and fetal growth restriction (FGR) independently alter these indices; notably, chronic hypoxia in FGR mandates significantly lower population-specific thresholds (e.g., AT/ET <0.19) to accurately predict neonatal respiratory complications. The fetal pulmonary artery AT/ET ratio is a highly reproducible and accessible bedside tool for assessing FLM. Integrating this parameter into routine obstetric ultrasound optimizes perinatal outcomes, safely guides the administration of antenatal corticosteroids, and reduces reliance on invasive diagnostic procedures, provided it is interpreted as an adjunct to primary maternal indications for delivery.

Regenerative approaches in ovarian rejuvenation: hope for fertility restoration

Wed, 29 Jul 2026 00:00:00 +0530

Ovarian aging is a progressive biological process marked by a decrease in the amount and quality of oocytes, resulting in decreased fertility, diminished ovarian reserve (DOR), premature ovarian insufficiency (POI), and menopause. Multiple molecular processes, including as oxidative stress, mitochondrial dysfunction, telomere shortening, DNA damage, apoptosis, and hormone imbalance, all contribute to poor ovarian function and follicular depletion. Conventional fertility therapies and assisted reproductive technologies focus on the effects of ovarian malfunction rather than improving ovarian activity itself, with little success in women with low ovarian reserve. Recently, ovarian rejuvenation has emerged as a viable regenerative method for enhancing the ovarian microenvironment, awakening dormant follicles, and restoring endocrine and reproductive function. This study looks at the biology of ovarian aging, the pathophysiology of ovarian dysfunction, and recent breakthroughs in ovarian rejuvenation treatments such as platelet-rich plasma (PRP) treatment, stem cell-based therapy, in vitro activation (IVA), and ovarian tissue transplantation (OTT). PRP therapy has the potential to improve ovarian reserve markers such as AMH, FSH, and AFC, whereas mesenchymal stem cell therapy may promote angiogenesis, reduce inflammation, and support follicular survival via paracrine mechanisms. IVA and OTT are also novel fertility preservation and restoration procedures for women with DOR and POI. Although first results are intriguing, existing evidence is limited due to small sample sizes, a lack of standardized techniques, and insufficient long-term safety data. More large-scale randomized clinical trials are needed to determine the efficacy, safety, and therapeutic application of ovarian rejuvenation therapy in reproductive medicine.

Polycystic ovary syndrome and quality of life: reproductive and psychological perspectives

Deepika Singh — Wed, 29 Jul 2026 00:00:00 +0530

Polycystic ovary syndrome (PCOS) is a hormonal condition marked by elevated androgen levels and the presence of ovarian cysts. Women diagnosed with PCOS often face irregular menstrual cycles, frequently resulting in missed ovulation, which complicates their chances of conceiving. This disorder has become one of the leading factors contributing to infertility in women. In addition to affecting reproductive health, PCOS also has ramifications for women’s mental and physical wellness. Various factors including environmental toxins, eating habits, lifestyle choices, genetic factors, obesity, and imbalances in gut microbiota, play a role in the development, frequency, and manifestation of the condition. The effects of PCOS significantly diminish the quality of life for the women who experience it, due to its intricate physical, psychological, and social implications. Furthermore, PCOS heightens the likelihood of complications such as miscarriage, gestational diabetes, preeclampsia, and premature delivery in women. Women with PCOS also have a significantly higher risk of developing type-2 diabetes, cardiovascular diseases and metabolic disorders. PCOS has no permanent cure but the condition can be managed through lifestyle modification and medical treatment. A combination of both can help improve the quality of life in women with PCOS. This review analyzes the profound effects of PCOS on women’s fertility and health while highlighting how it impairs quality of life and the role of lifestyle changes in mitigating these impacts.

Endocrine-disrupting chemicals and human infertility: a scoping review of daily-life exposures and clinical implications for clinical practice

Vinoth Gnana Chellaiyan Devanbu, Jennifer Britto John, Vijayalakshmi Sridharan — Wed, 29 Jul 2026 00:00:00 +0530

Infertility is a growing worldwide health issue that cannot be addressed only by hereditary or behavioural causes. Growing research suggests that endocrine-disrupting chemicals (EDCs), which are pervasive environmental pollutants, are substantial contributors to poor male and female reproductive health, particularly in fast industrialising nations like India. The objective was to comprehensively map and synthesise current knowledge on the origins, mechanisms, and clinical reproductive consequences of EDC exposure, with an emphasis on the implications for infertility practice and public health policy. A scoping review was conducted using the PRISMA-ScR framework. The PubMed/MEDLINE, Scopus, and Web of Science databases were searched for systematic reviews, meta-analyses, umbrella reviews, and significant human and animal research published between January 2014 and June 2025. The Endocrine Society, World Health Organisation, and United Nations Environment Programme provided authoritative position statements. Evidence was synthesised thematically based on exposure sources, molecular pathways, and clinical consequences. EDCs, which include bisphenols, phthalates, pesticides, PFAS, and heavy metals, have been linked to poor sperm quality, testosterone shortage, ovulatory dysfunction, decreased ovarian reserve, endometriosis, poor pregnancy outcomes, and possible transgenerational impacts. Disruption of the hypothalamic-pituitary-gonadal axis, interference with hormone receptors, poor steroidogenesis, oxidative stress, mitochondrial dysfunction, and epigenetic alteration were among the mechanisms implicated. Exposure reduction treatments showed short-term reversibility of biomarker load, indicating therapeutic significance. EDCs are controllable yet underappreciated risk factors for infertility. Integrating exposure assessment, preventative counselling, biomonitoring, and regulatory tightening, particularly in India, may improve reproductive outcomes and supplement assisted reproductive technology.

Tailored management for a diverse spectrum: lessons from seven Mullerian anomaly cases with varying clinical impact

Snehal Saurabh Thanekar, Tejaswini Prasad Kale — Wed, 29 Jul 2026 00:00:00 +0530

Defects in the embryological developmental pathway led to Mullerian duct anomaly. The presentation of such anomalies ranges from being asymptomatic and incidental findings to severe dysmenorrhoea and heavy menstrual bleeding further affecting quality of life and reproductive outcome. Here, we presented case series of cases with mullerian anomalies visited B. J. Government Medical College and Sassoon hospital, Pune over the period of one year. All the case had varied clinical presentations of mullerian anomalies which were managed timely with good outcome Hence highlighting the fact that proper history elicitation & good imaging modality in association with high index of suspicion can lead to timely treatment and good outcome in terms of fertility and quality of life.

Implementation of individualized nursing care plans among antenatal mothers with anemia in a tertiary care hospital: a case series

Madhubala A., Madhumitha R., Mariya James, Mekala Moorthy — Wed, 29 Jul 2026 00:00:00 +0530

Anemia during pregnancy remains one of the most common nutritional disorders affecting maternal and fetal health, particularly in developing countries. Nurses play an important role in identifying maternal problems, providing health education, improving dietary practices, and promoting adherence to iron supplementation. This case series describes the nursing management of ten antenatal mothers diagnosed with anemia (hemoglobin <11 g/dl) who were admitted to the antenatal ward of KMCH Hospital, Coimbatore, Tamil Nadu, during February and March 2026. Each mother underwent a comprehensive nursing assessment, and individualized nursing care plans were developed based on the identified nursing problems. The most common symptoms were fatigue (80%), generalized weakness (60%), breathlessness (50%), headache (50%), and poor appetite (50%). Imbalanced nutrition (90%), fatigue (80%), deficient knowledge regarding anemia management (80%), and activity intolerance (60%) were the major nursing problems identified. Nursing interventions included nutritional counselling, reinforcement of iron-folic acid supplementation, dietary advice to improve iron absorption, monitoring of maternal condition, and health education. Following implementation of the nursing care plans, seven mothers showed improvement in symptoms, dietary practices, and adherence to iron therapy, while three mothers showed partial improvement and required continued counselling and follow-up. This case series highlights the importance of individualized nursing care in improving maternal understanding, treatment adherence, and early management of anemia during pregnancy.

Laparoscopic vaginal vault lateral suspension: a promising alternative to laparoscopic sacrocolpopexy for post-hysterectomy vault prolapse management

Wed, 29 Jul 2026 00:00:00 +0530

Post-hysterectomy vaginal vault prolapse is a common complication. There is an impact on the quality of life of patients after undergoing different types of hysterectomies, due to associated urinary, anorectal and sexual dysfunction. A clear understanding of the supporting mechanisms for the uterus and vagina is important to minimize the risk of post hysterectomy occurrence of vault prolapse, and also to make the right choice of the corrective procedure for vaginal vault prolapse. The gold standard for surgical management of post-hysterectomy vaginal vault prolapse has been sacrocolpopexy. However, with the procedure there is risk of accidental trauma to the pre-sacral venous plexus. In this article we present our technique of laparoscopic vaginal vault lateral suspension (LVVLS) with fixation to anterior superior iliac spine (ASIS). This technique offers the same benefit as sacrocolpopexy but without the risk of haemorrhage from the pre-sacral venous plexus, potential nerve injury, ureteral injury, bladder injury and rectal injury.

Successful delivery of two Nigerian women with severe kyphoscoliosis: a case report

Wed, 29 Jul 2026 00:00:00 +0530

Severe kyphoscoliosis is rare in pregnancy and increases cardiopulmonary and obstetric risks, including malpresentation and operative delivery. With multidisciplinary care, good outcomes are possible. Two Nigerian women with severe kyphoscoliosis were managed early in pregnancy. The first, a 24-year-old with a Cobb angle of 52.8° and twin gestation, developed respiratory discomfort and delivered healthy twins by caesarean section under spinal anaesthesia at 36 weeks. The second, a 35-year-old with a 75° Cobb angle, remained stable and delivered a healthy term neonate by caesarean under general anaesthesia. Severe kyphoscoliosis is not an absolute contraindication to pregnancy; early multidisciplinary care enables safe outcomes.

Androgen-secreting borderline mucinous ovarian tumor in pregnancy: multidisciplinary management of gestational hyperandrogenism

Wed, 29 Jul 2026 00:00:00 +0530

Most adnexal masses diagnosed during pregnancy are benign, but a subset is malignant, borderline, or hormonally active. Androgen-secreting tumors are particularly rare and carry an added risk of fetal virilization. We report the case of a 38-year-old pregnant woman incidentally diagnosed with a complex adnexal mass at 13 weeks of gestation, which showed progressive growth and was associated with elevated androgen levels suggestive of a functional tumor. A multidisciplinary team initiated conservative management with spironolactone to reduce the risk of fetal virilization, and surgery was performed at 28 weeks due to tumor growth progression. Histopathology confirmed a borderline mucinous tumor with Leydig cell hyperplasia. The patient had an uneventful recovery, with normalization of testosterone levels and a term delivery of a healthy newborn with no signs of virilization. This case, compared with the only three previously reported cases of this tumor in pregnancy, illustrates that an individualized, multidisciplinary approach to gestational hyperandrogenism caused by adnexal masses, combining conservative management with timely surgical intervention when indicated, can achieve favorable maternal and fetal outcomes.

Unexpected uterine rupture in first trimester: a life-threatening occurrence

Ipsita Sahoo, Mahesh Behera — Wed, 29 Jul 2026 00:00:00 +0530

First trimester uterine rupture is a rare occurrence but does occur in a setting of previous surgeries on uterus and uterine anomalies. A high index of suspicion and timely management is paramount to avoid disastrous outcome. Here, we report the case of a 34-year-old female at 13 weeks of gestation, with history of previous two caesarean section, who presented to our emergency department with acute pain abdomen and in a state of hypovolemic shock. Immediate laparotomy was done which revealed uterine rupture at site of previous scar and hemoperitoneum of 2 litres. Uterine repair and bilateral tubectomy was done. She was transfused blood and blood products postoperatively and recovered well.

Pregnancy in a patient with myelofibrosis secondary to ileocecal tuberculosis: a case report

Sreelakshmi K., Sajala Vimalraj, Smitha Sreenivas K., Rameshan C. K. — Wed, 29 Jul 2026 00:00:00 +0530

Myelofibrosis (MF) is a chronic myeloproliferative neoplasm that may occur de novo or secondarily due to infections, autoimmune disorders, or malignancies. Tuberculosis (TB)-induced MF is uncommon but clinically relevant in TB-endemic regions, as it represents a reversible, non-clonal process that can mimic primary MF and lead to unnecessary cytotoxic therapy if not correctly identified. We report the case of a 24-year-old woman who initially presented with pancytopenia, splenomegaly, and constitutional symptoms. Bone marrow examination revealed grade 2 fibrosis, and further evaluation indicated ileocecal TB, leading to a diagnosis of secondary MF due to TB. She was initiated on anti-tubercular therapy (ATT), resulting in significant clinical and hematologic improvement. The patient subsequently conceived spontaneously and later presented at 36 weeks of gestation with mild anemia, severe thrombocytopenia, and a history of allergic reactions to platelet transfusions. When she was admitted at term with critically low platelet counts necessitating transfusion, perioperative management became particularly challenging and required a coordinated multidisciplinary approach involving hematology, transfusion medicine, obstetrics, neonatology, and critical care. Her pregnancy was managed with strict antenatal, intraoperative, and postpartum monitoring. She remained clinically stable and did not require cytotoxic or disease-modifying therapy, and both maternal and neonatal outcomes were favorable. This case highlights the importance of differentiating reactive MF from clonal myeloproliferative neoplasms, especially in TB-endemic settings. TB-induced MF is reversible with appropriate antimicrobial therapy, and successful pregnancy outcomes are achievable with individualized, coordinated obstetric and hematological care. Diagnostic vigilance is essential to avoid overtreatment and to ensure optimal outcomes for women of reproductive age presenting with marrow fibrosis secondary to TB.

Recurrent hydatidiform mole: a case report highlighting NLRP7 gene mutations and genetic imprinting

Riya Sudev, Jyoti Ramesh Chandran, Santhosh Kuriakose — Wed, 29 Jul 2026 00:00:00 +0530

Recurrent hydatidiform mole (RHM) is a rare form of gestational trophoblastic disease and is frequently associated with mutations in maternal-effect genes, particularly NLRP7, which play a critical role in early embryonic development and genomic imprinting. We report the case of a 26-year-old woman (G7P0) who presented at 9 weeks’ gestation with features suggestive of a complete molar pregnancy. Ultrasonography demonstrated a heteroechoic intrauterine mass, and serum β-human chorionic gonadotropin levels were markedly elevated at 272,600 IU/l. Her obstetric history was significant for 6 prior molar pregnancies, highlighting the recurrent nature of the condition; one of these pregnancies progressed to low-risk gestational trophoblastic neoplasia with pulmonary metastases, which was successfully managed with multiagent chemotherapy and close follow-up. In view of the recurrent disease, genetic evaluation was undertaken and revealed compound heterozygous pathogenic variants in the NLRP7 gene, including an exon 3 deletion and an exon 4 truncation. The patient received comprehensive counseling regarding the genetic etiology of her condition, its oncologic implications, and future reproductive options. Biallelic NLRP7 mutations result in abnormal oocyte development and impaired genomic imprinting, leading to recurrent molar gestations and a significantly reduced likelihood of achieving a viable pregnancy with autologous oocytes. Ovum donation remains the most viable reproductive option for affected women. This case underscores the importance of early genetic evaluation in women with recurrent molar pregnancies to guide individualized management, surveillance, and reproductive counseling.

When size deceives: a giant 23 kg ovarian tumor mimicking malignancy in a young woman

Moly Sam Kodiplackal, Emil Rose Johnson, C. M. Sidhiq — Wed, 29 Jul 2026 00:00:00 +0530

Mucinous borderline ovarian tumors are epithelial ovarian neoplasms characterized by epithelial proliferation and nuclear atypia in the absence of stromal invasion and commonly occur in women of reproductive age. We reported the case of a 25-year-old woman with progressive abdominal distension over two years. She had a height of 157 cm, weight of 115 kg, and a body mass index of 46.7 kg/m². Clinical examination revealed a massive abdominopelvic mass measuring approximately 40×40 cm occupying the entire abdomen. Magnetic resonance imaging demonstrated a 40×28×28 cm multiloculated cystic lesion extending to the epigastrium, containing enhancing solid components, papillary projections, and a large enhancing solid plaque measuring 15×6 cm. Loculated ascites with focal peritoneal thickening was also noted. Serum CA 19-9 was markedly elevated at 1950 U/ml, while other tumor markers remained within normal limits. Staging laparotomy revealed a giant 45×45 cm solid-cystic ovarian mass weighing 23 kg along with approximately 100 ml of straw-colored ascitic fluid, without evidence of gross peritoneal deposits. Histopathological examination confirmed the diagnosis of a mucinous borderline ovarian tumor. This case highlights the rare occurrence of giant mucinous borderline ovarian tumors in contemporary clinical practice and demonstrates the association of markedly elevated CA 19-9 levels with mucinous ovarian neoplasms. Complete surgical excision remains the cornerstone of management and is associated with an excellent prognosis when the disease is confined to the ovary.

Lipoleiomyoma of uterine cervix in a young woman: a rare case report

C. Durga Devi, Roopa, T. Preetha, Sridevibala L. — Wed, 29 Jul 2026 00:00:00 +0530

Lipoleiomyoma is a rare benign variant of leiomyoma characterized by the presence of mature adipose tissue mixed with smooth muscle cell. It most commonly occurs in the uterine corpus and is typically seen in postmenopausal women, while involvement of the cervix is extremely rare. We presented a case of a 29-year-old woman who presented with lower abdominal discomfort and a pelvic mass. On clinical examination, a bulging mass was noted in the anterior vaginal wall with displacement of the cervical os. Ultrasonography revealed a large subserosal fibroid arising from the anterior cervical wall measuring approximately 8.5×8.4 cm causing mass effect. MRI pelvis suggested anterior cervical leiomyoma with cystic degeneration. The patient subsequently underwent total abdominal hysterectomy with cervical mass removal. Intraoperatively, a well-defined cervical mass was identified. Histopathological examination showed interlacing bundles of smooth muscle cells admixed with mature adipocytes, confirming cervical lipoleiomyoma. This case highlights the rarity of cervical lipoleiomyoma and the importance of histopathology for definitive diagnosis.

A gastrointestinal malignancy presenting as an ovarian mass: a case report of Krukenberg tumours

Pratiksha Dattu Khamkar, Tushar Palve, Anusha Shetty — Wed, 29 Jul 2026 00:00:00 +0530

Krukenberg tumour is a rare metastatic ovarian malignancy, most commonly arising from gastric signet-ring cell carcinoma. We report two cases of histopathologically confirmed Krukenberg tumours presenting with abdominal pain, menstrual irregularities, weight loss, and ovarian masses. Imaging studies revealed ovarian lesions associated with gastric wall thickening, while endoscopic biopsy confirmed gastric adenocarcinoma in both patients. Surgical management was performed, and histopathological examination established the diagnosis of metastatic ovarian involvement. These cases highlight the importance of considering a gastrointestinal primary in women presenting with ovarian masses and emphasize the role of early diagnosis and multidisciplinary management in improving patient outcomes.

Giant uterine leiomyoma mimicking leiomyosarcoma: a diagnostic dilemma — a case report

Shubhdeep Kaur, Prema Kania — Wed, 29 Jul 2026 00:00:00 +0530

Uterine leiomyomas are common benign tumors; however, giant leiomyomas are rare and can mimic malignant uterine neoplasms. We report a case of a 41-year-old nulligravid woman presenting with a massive abdominopelvic mass of uncertain origin. Imaging findings were inconclusive and raised suspicion of leiomyosarcoma. The patient underwent exploratory laparotomy with total abdominal hysterectomy and bilateral salpingectomy. Histopathological and immunohistochemical examination confirmed a benign leiomyoma. This case highlights the diagnostic challenges posed by large uterine masses and emphasizes the importance of histopathology in establishing a definitive diagnosis.

Disseminated peritoneal leiomyomatosis presenting as port site hernial sac contents following laparoscopic myomectomy

Akshay Kumar K. K., Jyoti R. Chandran, Shamlath M. K. P. — Wed, 29 Jul 2026 00:00:00 +0530

Disseminated Peritoneal Leiomyomatosis (DPL) is a rare, benign condition characterized by the proliferation of multiple smooth muscle-like nodules on the peritoneal surfaces. It is strongly associated with iatrogenic seeding following uterine surgeries, particularly laparoscopic myomectomy with power morcellation. We report the case of a 37-year-old, para 2, live 2 (P2L2) females with a history of laparoscopic myomectomy 4 years back. She presented with an 8-month history of dull abdominal pain and a progressive abdominal swelling. Clinical examination and imaging revealed a large 5x5 cm left port site incisional hernia and fibroid uterus of 10 weeks size. Both magnetic resonance imaging (MRI) and contrast-enhanced computed tomography (CECT) confirmed the hernia, and surprisingly, identified multiple nodular, enhancing lesions within the hernia sac, as well as in the left iliac fossa, consistent with peritoneal fibroids. The patient underwent an elective exploratory laparotomy, which confirmed the findings. The hernia sac contained multiple firm nodules consistent with fibromatosis. A total abdominal hysterectomy, bilateral salpingectomy, and excision of all visible peritoneal lesions was performed, followed by an incisional hernia repair with onlay mesh. The intraoperative findings and histopathology were consistent with DPL. This case highlights an unusual presentation of DPL where the lesions were found as the primary contents of an incisional hernia. DPL should be considered in the differential diagnosis for new peritoneal masses or unusual hernia contents in female patients with a history of uterine surgery.

Successful term vaginal delivery following remission from ultra-high-risk metastatic choriocarcinoma: a rare case of preserved fertility and favourable obstetric outcome

Subasini Sankar, Viruthigaa Vairavan, Vijayalakshmi Kandasamy — Wed, 29 Jul 2026 00:00:00 +0530

Metastatic choriocarcinoma represents one of the most aggressive forms of gestational trophoblastic neoplasia (GTN), particularly when associated with distant spread such as pulmonary and central nervous system involvement. Advances in multi-agent chemotherapy have significantly improved survival; however, data regarding fertility and pregnancy outcomes following treatment for ultra-high-risk disease remain limited. We reported a young woman diagnosed with metastatic choriocarcinoma following a medical termination of pregnancy, who achieved complete remission after EP/EMA chemotherapy and subsequently conceived spontaneously. Serial β-hCG levels showed a rapid decline from 443,096 IU/l to normal values, confirming treatment response. The interval between completion of chemotherapy and conception was approximately two years. Her antenatal course was clinically stable. She presented in labour at term and progressed to vaginal delivery despite meconium-stained liquor, with reassuring fetal status throughout. Both mother and neonate had an uncomplicated postpartum course. This case highlights the possibility of preserved reproductive function and favourable obstetric outcomes even after treatment for ultra-high-risk metastatic GTN.

Therapeutic phlebotomy in antenatal and postnatal period of pregnancy

Kavinkumar G. — Wed, 29 Jul 2026 00:00:00 +0530

Polycythemia during pregnancy is an uncommon but a high-risk condition that requires careful monitoring and individualized management to prevent maternal and fetal complications. This case report describes a pregnant woman diagnosed with polycythemia in the first trimester, managed successfully with therapeutic venesection under close monitoring. The procedure was well tolerated with no adverse effects on maternal or fetal health, and the pregnancy ended in the delivery of a healthy infant at term. A second venesection was performed postpartum due to persistent elevation of hematocrit. This case illustrates the safety and efficacy of venesection in pregnant patients with polycythemia, emphasizing the importance of multidisciplinary care and regular hematological evaluation throughout the antenatal and postpartum period.

Descend of the womb: a case report and review of literature of pregnancy with uterine prolapse, delivered vaginally using Duhrssen’s incision

Aarti Sharma, Reeta Mahey, Neha Varun, J. B. Sharma — Wed, 29 Jul 2026 00:00:00 +0530

Pregnancy with prolapse is a rare condition associated with high risk of obstructed labour leading to significant maternal and perinatal comorbidities. Duhrssen’s incision is a simple procedure which can be used for immediate delivery of the fetus when there is an entrapped head and it can reduce the need for caesarean section in such cases, thus decreasing the complications of a major surgery. We report a case of a multigravida in her 30’s with stage 3 pelvic organ prolapse successfully delivered vaginally using the Duhrssen’s incision. In this case, the patient presented in labor room with threatened preterm labor at 33 weeks of gestation. Conservative management was done. However, she went into spontaneous preterm labor at 35 weeks. As per patient's preference and after clinical evaluation the decision for vaginal delivery was taken. At cervical dilatation of 6 cm and 50% effacement, cervix was lying outside the vulva with fetal head entrapped. Duhrssen’s incision was given at 2 o’clock and 10 o’clock position. A vigorous, 2705 grams, male baby was delivered. The incision was sutured using 2-o vicryl. Patient resumed the use of ring pessary at 6 weeks post-partum. It emphasizes on the practicality of a simple procedure which can decrease the need of cesearean section in such a high-risk case where the mother is keen and willing for a vaginal delivery.

Amniotic fluid embolism during cesarean section: a rare and catastrophic obstetric: a case report

Yoshitha Reddy, Dilip Kumar — Wed, 29 Jul 2026 00:00:00 +0530

Amniotic fluid embolism (AFE) is a rare but catastrophic obstetric emergency characterized by sudden cardiovascular collapse, respiratory failure, and disseminated intravascular coagulation. It most commonly occurs during labour, cesarean section, or the immediate postpartum period and remains an important cause of maternal mortality worldwide. We report the case of a 28-year-old primigravida who developed sudden respiratory distress, hypoxemia, profound hypotension, and coagulopathy immediately following placental delivery during an emergency cesarean section under spinal anesthesia. The patient rapidly deteriorated and required endotracheal intubation, mechanical ventilation, aggressive fluid resuscitation, vasopressor support, and massive transfusion of blood products. Intraoperative chest radiography demonstrated diffuse bilateral pulmonary infiltrates consistent with acute pulmonary edema, supporting the clinical diagnosis of amniotic fluid embolism. Following multidisciplinary management in the intensive care unit, including ventilatory support and correction of disseminated intravascular coagulation, the patient recovered progressively, was successfully extubated after 48 hours, and was discharged without neurological sequelae. This case highlights the importance of early recognition, prompt multidisciplinary intervention, and aggressive supportive management in improving maternal outcomes in amniotic fluid embolism.

A parturient with congenital methemoglobinemia: navigating the oxygen saturation gap

Wed, 29 Jul 2026 00:00:00 +0530

Congenital methemoglobinemia (CMH) presents unique anesthetic challenges due to oxidative stress risks. We report a primigravida with type 1 CMH presenting with a profound oxygen saturation gap. Labor analgesia was successfully managed using a continuous epidural infusion of ultra-low dose bupivacaine (0.0625%) and fentanyl. The protocol strictly mandated avoiding oxidizing agents, notably substituting lidocaine with epidural bupivacaine for perineal repair. The patient was hemodynamically stable and delivered a healthy neonate. This case validates ultra-low dose epidural bupivacaine as a safe, effective strategy for labor analgesia in CMH, minimizing systemic drug load and oxidative risks.

Avoiding the knife: individualized management of cesarean scar pregnancy – insights from two cases

Parth H. Khunadia, Kausha K. Shah, Pranita V. Bankar, Nanda M. Katole — Wed, 29 Jul 2026 00:00:00 +0530

Caesarean scar pregnancy (CSP) is a rare form of ectopic pregnancy implanted within a previous caesarean section scar. Early diagnosis is crucial due to risk of uterine rupture and severe hemorrhage. We report two cases of CSP diagnosed in the first trimester and successfully managed with conservative medical therapy. Both patients were hemodynamically stable and treated with methotrexate-based protocols and mifepristone-misoprostol with close follow-up and serial β-hCG monitoring. One case required dilatation and curettage while other case did not require it. But more importantly, neither of them required any major surgery. Early diagnosis using transvaginal ultrasonography allows successful conservative management in selected cases, avoiding major surgical intervention and preserving fertility.

Uterine rupture following previous cornual ectopic pregnancy: a rare obstetric emergency

Wed, 29 Jul 2026 00:00:00 +0530

Uterine rupture in pregnancy following previous cornual ectopic pregnancy surgery is an uncommon but potentially catastrophic obstetric emergency. Prior cornual surgery may result in localized myometrial weakness, predisposing to rupture during a subsequent pregnancy. A 25-year-old gravida 2 abortion 1 woman at 30+2 weeks of gestation presented with sudden onset abdominal pain, vaginal bleeding, and absent fetal movements. She had undergone laparoscopic salpingectomy for a cornual ectopic pregnancy one year earlier. Clinical examination revealed absent fetal heart sounds and features suggestive of intra-abdominal bleeding. Emergency laparotomy demonstrated hemoperitoneum and rupture at the previous cornual surgery site with extrusion of the fetus into the peritoneal cavity. Uterine repair was performed successfully. Previous cornual ectopic pregnancy surgery should be recognized as a significant risk factor for uterine rupture in subsequent pregnancies. Early diagnosis and prompt surgical intervention are essential to improve maternal outcomes.

A classic case of caesarean scar endometriosis in 39-year-old women presenting with cyclical abdominal pain: a case report

Hanswahini Garg, Anup Pradhan — Wed, 29 Jul 2026 00:00:00 +0530

Scar or incisional scar endometriosis is a rare but increasingly recognised complication following obstetric and gynaecological surgeries, particularly caesarean section and others, including hysterectomy and myomectomy. It is frequently misdiagnosed due to its nonspecific presentation, which often mimics abscesses, hernias, hematomas, granulomas or neoplasms. This case report outlines a case of a female aged 39 years who reported with complaints of abdominal pain related to the menstrual cycles and a palpable infra-umbilical mass years after caesarean delivery. Ultrasonography revealed a hypoechoic solid lesion with internal vascularity, and fine needle aspiration cytology was suggestive of scar endometriosis. The patient underwent complete surgical excision, and histopathology confirmed the diagnosis. The case highlights the importance of clinical suspicion when a patient presents with the classical triad, appropriate imaging, and histopathological confirmation in diagnosing scar endometriosis. Surgical excision remains the definitive treatment.

Beyond the immediate postpartum - scar niche associated placenta accreta spectrum presenting as chronic AUB

Prachi Gedam, Ajay Halder, Shweta Patel, Bharati Singh Sengar — Wed, 29 Jul 2026 00:00:00 +0530

Placenta accreta spectrum (PAS) is typically diagnosed during pregnancy or in the immediate postpartum period. Delayed presentation years after delivery is exceedingly rare and may mimic chronic abnormal uterine bleeding (AUB), resulting in diagnostic difficulty. We report the case of a multiparous woman with three previous caesarean deliveries who presented with persistent abnormal uterine bleeding (AUB) for two years following her last childbirth. She had been repeatedly managed as a case of unexplained AUB with limited response to medical therapy. Transvaginal ultrasonography revealed a heterogenous lesion within a caesarean scar niche associated with myometrial thinning, scar dehiscence, and focal vascularity, raising suspicion for chronic retained products of conception with invasive placental tissue. Diagnostic hysterolaparoscopy revealed dense bladder adhesions and a hypervascular lower uterine segment lesion with significant intraoperative bleeding, necessitating conversion to total laparoscopic hysterectomy. Histopathological examination confirmed placenta accreta and placenta percreta associated with retained products of conception within a caesarean scar niche. This case highlights that chronic AUB in women with multiple prior caesarean deliveries may rarely be associated with retained invasive placental tissue within a caesarean scar niche.

Pemphigoid gestationis in a primigravida: autoimmune dermatosis of pregnancy — a rare case report

Ruby Bhatia, Simran Kamal, Mahak Singaal, Komal Bansal, Vidushi Tiwari — Wed, 29 Jul 2026 00:00:00 +0530

Pemphigoid gestationis (previously termed pemphigus gestationis) is a rare autoimmune vesiculobullous dermatosis unique to pregnancy, with an estimated incidence of approximately 1 in 50,000 pregnancies. It is mediated by maternal IgG autoantibodies directed against BP180 (collagen XVII), resulting in complement activation and subepidermal blister formation. The disease typically presents during the second or third trimester with severe pruritus followed by erythematous urticarial plaques and tense bullous lesions. We report the case of a 22-year-old primigravida at 34 weeks and 3 days of gestation who presented with generalized pruritus and multiple vesiculobullous skin lesions involving the abdomen, trunk, upper limbs, thighs, and face. Histopathology and direct immunofluorescence confirmed the diagnosis of pemphigoid gestationis. The condition was complicated by fetal growth restriction and abnormal Doppler findings, necessitating preterm emergency caesarean delivery. The patient was managed with systemic corticosteroids and multidisciplinary care, resulting in favorable maternal and neonatal outcomes. Although uncommon in primigravida women, pemphigoid gestationis should be considered in the differential diagnosis of pregnancy-associated pruritic dermatoses. Early diagnosis using histopathology and direct immunofluorescence, along with prompt treatment and close fetal surveillance, is essential to improve fetomaternal outcomes.

A silent growing mass: case report of large vulvar lipoma in a 50-year old woman

Abhyudai Ravooru, Sukanya Nagsen Thorat, Madhuri Alla — Wed, 29 Jul 2026 00:00:00 +0530

Vulvar lipomas are rare entities, accounting for a very small proportion of benign soft tissue tumors, with fewer than 100 cases reported globally. Most lesions are small (<5 cm) at diagnosis, whereas tumors exceeding 10 cm are classified as giant vulvar lipomas and are exceptionally uncommon. The present case, measuring 11×6 cm, falls within this “giant” category. Although larger lesions up to 20–26 cm and weighing several kilograms have been described, such extreme sizes are exceedingly rare. Therefore, this case represents a moderately large vulvar lipoma with significant functional impact, highlighting the tendency for delayed presentation in this anatomically sensitive region and the importance of surgical excision for definitive management.

Open sacrohysteropexy with polypropylene mesh for stage III uterovaginal prolapse in a young premenopausal woman with concurrent recurrent pregnancy loss: a case report

Vaishnavi Verma, Yeso Ashwini, Simmanjit Kaur, Himanshi Pareek, Priyanka Bansal — Wed, 29 Jul 2026 00:00:00 +0530

Uterovaginal prolapse (UVP) occurring in premenopausal women demands uterus-preserving surgical strategies that offer durable anatomical correction without compromising future reproductive potential. Open sacrohysteropexy (OSH) using type-I polypropylene mesh achieves reliable apical support while retaining the uterus. When accompanied by recurrent pregnancy loss (RPL), the clinical picture warrants a concurrent systematic aetiological evaluation.A 39-year-old woman (P1L1A3) presented with a five-to-six-year history of a vaginal mass prolapsing through the introitus, lower abdominal discomfort, and dysuria. Examination demonstrated the cervix lying 2 cm beyond the hymenal ring, consistent with Pelvic Organ Prolapse Quantification (POP-Q) Stage III uterocervical descent, a Stage I anterior compartment defect (cystocele), and the absence of posterior compartment prolapse on reduction. She additionally carried an evolving diagnosis of RPL following three consecutive first-trimester pregnancy losses. Open sacrohysteropexy with polypropylene mesh was performed under general anaesthesia on 19 February 2026 and was completed without intraoperative complications. The postoperative course was uneventful, and the patient was discharged in stable condition on postoperative day six.Open sacrohysteropexy with polypropylene mesh is a safe and reproducible uterus-preserving procedure for advanced pelvic organ prolapse in young women. Its concurrent use with structured RPL investigation represents an opportunity to address both anatomical and reproductive morbidity within the same admission episode.

Ruptured uterus with bladder injury in a scarred uterus: a near miss

Ruby Bhatia, Saizal Jain, Anand Thawait, Vidushi Tiwari, Himanshi Pareek — Wed, 29 Jul 2026 00:00:00 +0530

Uterine rupture in a previously scarred uterus is a life-threatening obstetric emergency associated with significant maternal and fetal morbidity and mortality. We report a case of a 27-year-old G5P2L1A2 at 36+5 weeks of gestation with two prior caesarean sections who presented with acute abdominal pain, vaginal bleeding, and decreased fetal movements. Clinical findings and USG suggested uterine rupture with intrauterine fetal demise. This case signifies the importance of early diagnosis and referral, prompt surgical intervention by multidisciplinary approach in a tertiary care centre.

Beyond the vaginal route: successful oocyte retrieval using a transabdominally adapted transvaginal ultrasound probe in a frozen pelvis: a case report

Wed, 29 Jul 2026 00:00:00 +0530

Transvaginal ultrasound-guided follicular aspiration constitutes the gold standard for oocyte retrieval in assisted reproductive technology (ART). However, complex pelvic pathology including severe adhesive disease, adenomyosis, and sequelae of prior pelvic surgery may profoundly distort adnexal anatomy, rendering conventional transvaginal access technically hazardous or anatomically precluded. We present a 38-year-old woman with primary infertility of 12 years’ duration, diminished ovarian reserve (DOR), diffuse uterine adenomyosis, and a complex surgical history encompassing open myomectomy and adenomyomectomy, referred for in vitro fertilization (IVF). Baseline ultrasonography disclosed markedly distorted adnexal anatomy with bilateral ovarian adhesion to adjacent pelvic structures. Following controlled ovarian stimulation (COS) via a clomiphene citrate–GnRH antagonist protocol, bilateral ovarian inaccessibility via the transvaginal route was confirmed intraoperatively. Transabdominal ultrasound-guided oocyte retrieval was therefore performed using a high-frequency transvaginal transducer repositioned and applied abdominally. Five dominant follicles were successfully aspirated without procedural morbidity, yielding five oocytes. Transabdominal oocyte retrieval employing an abdominally applied transvaginal ultrasound transducer is a technically feasible, safe, and clinically effective alternative in patients in whom conventional transvaginal retrieval is anatomically precluded. This approach may avert cycle cancellation and optimise cumulative oocyte yield in poor ovarian responders with complex adnexal anatomy.

Idiopathic massive vulvar edema in late pregnancy: a rare case report

Juhi Kumari, Fayaz H. Khan, Bhuvneshwari Upadhayay, Anushka Gupta — Wed, 29 Jul 2026 00:00:00 +0530

Massive vulvar edema during pregnancy is a rare clinical condition usually associated with preeclampsia, severe anaemia, infection, trauma, or systemic disorders. Idiopathic vulvar edema without any identifiable cause is uncommon and poorly documented in the literature. We report a rare case of idiopathic massive vulvar edema occurring during late pregnancy. A 22-year-old gravida 2 para 1 live 1 woman presented at 33 weeks and 4 days of gestation with progressively increasing vulvar swelling for six months. Clinical examination revealed massive bilateral vulvar edema involving both labia majora and minora. Laboratory investigations, including urine protein, renal and liver function tests, and urine culture, were within normal limits. Systemic and local causes of vulvar edema were excluded. The patient was managed conservatively with bed rest, pelvic elevation, local ice packs, and supportive medications. Significant reduction in edema was observed within two days, with near complete resolution after five days of conservative management. At 35 weeks of gestation, the patient presented again with spontaneous preterm labor and recurrent vulvar edema. She subsequently delivered vaginally a healthy 2.4 kg male neonate with good Apgar scores. Complete spontaneous resolution of vulvar edema occurred during the early puerperium. Idiopathic massive vulvar edema in pregnancy is a rare but generally benign condition. Careful evaluation is necessary to exclude secondary causes. Most cases can be managed successfully with conservative treatment, and spontaneous postpartum resolution is commonly observed.

A giant ovarian cyst in pregnancy managed by controlled decompression and cystectomy: a case report

Deepika Ravi, Niranjan Chavan — Wed, 29 Jul 2026 00:00:00 +0530

Adnexal masses complicate about 1-5% pregnancies. Timely evaluation and individualized management are crucial for an optimum maternal and fetal outcome. This case report deals with one such giant ovarian cyst detected in the second trimester of pregnancy during routine scan and further discusses the comprehensive clinical and radiographical evaluation to assess the condition and formulate an appropriate management plan. It underscores the need for balancing the risks of expectant management against those associated with surgical intervention, with decisions guided by gestational age, cyst characteristics, and patient-specific factors.

Early onset imminent eclampsia with antiphospholipid antibody syndrome and recurrent epilepsy with HELLP syndrome

Ruby Bhatia, Yeso Ashwini, Mahak Singaal — Wed, 29 Jul 2026 00:00:00 +0530

Early-onset pre-eclampsia and eclampsia superimposed on antiphospholipid antibody syndrome (APLA) and a pre-existing seizure disorder represent one of the most challenging constellations in contemporary obstetric practice. The convergence of these conditions demands coordinated multidisciplinary expertise and carries very high maternal and foetal morbidity and mortality with known case of epilepsy on treatment.We report a 28-year-old woman (G6P1L1A4) at 18–23 weeks of gestation who presented across three sequential hospital admissions between 18-23 weeks with recurrent eclamptic seizures, severe hypertension (180/100 mmHg), moderate-to-severe anaemia, bilateral uterine artery diastolic notching indicating uteroplacental insufficiency, and a prior caesarean scar. Despite optimisation of antihypertensive and antiepileptic therapy including intravenous levetiracetam loading, eclampsia remained refractory. Multidisciplinary evaluation encompassing obstetrics, neurology, nephrology, haematology, psychiatry, ophthalmology, and neonatology ultimately concluded that continuation of the pregnancy posed imminent and extreme risk to maternal life. Medical termination of pregnancy (MTP) was performed at 23 weeks.This case underscores the catastrophic potential of untreated APLA syndrome in a patient with recurrent pregnancy loss, the diagnostic challenge of eclampsia superimposed on known epilepsy, and the critical importance of multidisciplinary management, proactive social support, and comprehensive pre-conception counselling in high-risk obstetric populations.

Diagnostic challenges in chronic pelvic pain: delayed diagnosis of a functional non-communicating rudimentary horn mimicking benign gynaecologic disease: a case report and literature review

Hema J. Shobhane, Mimansa Bharti, Puneet Kumar — Wed, 29 Jul 2026 00:00:00 +0530

Functional non-communicating rudimentary horn is a rare Müllerian anomaly that may remain undiagnosed until adulthood because its presentation often mimics common gynecological conditions. Delayed diagnosis can result in chronic pelvic pain, severe dysmenorrhea, and prolonged ineffective treatment. A 32-year-old multiparous woman with two previous caesarean deliveries presented with chronic pelvic pain and severe dysmenorrhea for two years, refractory to medical therapy. Previous evaluations suggested fibroid uterus, endometrioma, adnexal mass, and ectopic pregnancy. Three-dimensional transvaginal ultrasonography identified a left-sided functional non-communicating rudimentary horn with hematometra. Surgical excision was performed, and histopathological examination confirmed the diagnosis. The postoperative course was uneventful, with complete resolution of pelvic pain and dysmenorrhea. A focused literature review of reported cases with delayed diagnosis or misdiagnosis demonstrated that chronic pelvic pain and dysmenorrhea were the most common presenting symptoms, while endometriosis, fibroids, and pelvic masses were frequent alternative diagnoses. Surgical excision resulted in symptom improvement in all reviewed cases. This case highlights the diagnostic challenges associated with functional non-communicating rudimentary horns, particularly in adult women with previous successful pregnancies. Müllerian anomalies should be considered in patients with refractory dysmenorrhea and chronic pelvic pain despite conventional treatment. Early use of advanced imaging modalities, especially three-dimensional ultrasonography, can facilitate timely diagnosis and definitive management, thereby reducing diagnostic delays and associated morbidity.

Gestational gigantomastia with severe bilateral breast enlargement and ulceration successfully managed with conservative therapy: a case report

Sarika, Archana Bamniya — Wed, 29 Jul 2026 00:00:00 +0530

Gestational gigantomastia is an extremely rare disorder characterized by rapid and excessive enlargement of the breasts during pregnancy, often resulting in pain, skin ulceration, functional disability, and psychological distress. Early diagnosis and multidisciplinary management are essential to prevent serious complications. A 29-year-old multiparous woman (P3L3) presented in the postpartum period with massive bilateral breast enlargement that began during the fourth month of pregnancy and progressed rapidly until delivery. She developed severe breast pain, erythema, neck and back discomfort, and a 4×6 cm ulcer over the right breast. Clinical examination revealed diffuse bilateral enlargement without palpable masses or axillary lymphadenopathy. Laboratory investigations, including serum prolactin, were within normal limits. Ultrasonography and MRI excluded malignancy and abscess formation, while FNAC suggested a benign breast condition. Gestational gigantomastia remains a rare but potentially debilitating condition. Conservative medical management can provide substantial clinical improvement and may delay or avoid surgical intervention in selected patients.

Successful term pregnancy in an unrecognized complete septate uterus with double cervix and longitudinal vaginal septum diagnosed during caesarean delivery

Byna Prasanna, M. Abhigna, K. B. Sudeep Reddy, Pulagam Sindhura — Wed, 29 Jul 2026 00:00:00 +0530

Congenital Müllerian anomalies are uncommon developmental defects of the female genital tract and may remain undetected until pregnancy. Complete uterine septum associated with double cervix and longitudinal vaginal septum is an unusual anomaly with significant obstetric implications. We report the case of a 19-year-old primigravida at 39 weeks gestation with cephalic presentation, in whom vaginal examination revealed a complete longitudinal vaginal septum with two cervices. Elective caesarean section was performed in view of the obstructive vaginal anatomy. Intraoperatively, a thick complete uterine septum extending from the uterine fundus to the vagina with two distinct cervices was identified. A healthy live baby was delivered uneventfully. This case highlights the importance of meticulous pelvic examination and awareness of rare Müllerian anomalies during antenatal care and delivery planning.

Collision tumor of ovary: an uncommon entity

Aprajita Garg, Pooja Sharma — Wed, 29 Jul 2026 00:00:00 +0530

Collision tumors are a rare group of neoplasms characterized by coexistence of histologically distant type of tumors in the same organ without any evidence of histological intermixing. We present a case of 35 years old female presenting with irregular menstrual cycle and was found to have collision of tumor of ovary composed of serous cystadenoma and mature cystic teratoma on histopathological evaluation. No histological admixture was found between the two lesions. These tumors are exceptionally uncommon entities and may present with diagnostic dilemma due to their complex morphology. This case, thus, highlights the importance of histopathological evaluation in diagnosing this entity. Awareness of this rare entity is also essential as early recognition influences prognosis, therapeutic decisions and patient follow up.

Struma ovarii in a euthyroid patient: a histopathological diagnosis

Purnima Upreti, Anjali Kaushik — Wed, 29 Jul 2026 00:00:00 +0530

Struma ovarii is a rare monodermal variant of ovarian teratoma composed predominantly of thyroid tissue, accounting for approximately 0.3–1% of all ovarian neoplasms. It is rarely associated with thyroid dysfunction. Due to the absence of distinctive clinical and radiological features, establishing a preoperative diagnosis is often challenging, particularly in euthyroid patients. We report a case of benign struma ovarii in a euthyroid patient, diagnosed exclusively by histopathological examination. A 40-year-old woman presented with lower abdominal pain. Clinical examination revealed bilateral adnexal masses. Imaging studies, including ultrasonography (USG) and contrast-enhanced computed tomography (CECT) of the abdomen and pelvis, were suggestive of bilateral ovarian teratomas. Thyroid function tests were within normal limits, confirming her euthyroid status. The patient subsequently underwent total hysterectomy with bilateral salpingo-oophorectomy. Gross examination revealed cystic masses in both ovaries. Histopathological evaluation demonstrated struma ovari in the right ovary, characterized by the presence of predominant thyroid tissue. The left ovary showed features consistent with a mature cystic teratoma. The postoperative period was uneventful, and the patient remained clinically and biochemically euthyroid on follow-up. Struma ovarii is an uncommon ovarian neoplasm that lacks specific clinical and radiological characteristics, rendering preoperative diagnosis difficult, especially in euthyroid individuals. Histopathological examination remains the gold standard for definitive diagnosis.

Systemic inflammatory markers neutrophil-lymphocyte, platelet-lymphocyte and monocyte-lymphocyte ratios as therapy response markers of epithelial ovarian cancer in Adam Malik Hospital Medan

Wed, 29 Jul 2026 00:00:00 +0530

Background: Ovarian cancer has a complex pathological type, high recurrence rate, poor therapy response and prognosis. In recent years, examination of inflammatory markers of ovarian cancer therapy response has been developed. Systemic inflammatory response is closely related to cancer initiation, development and metastasis so that it can be used as a therapy response of ovarian cancer. This study aims to determine the systemic inflammatory markers NLR, PLR and MLR as a therapy response of epithelial ovarian cancer patients stage III after optimal debulking and complete adjuvant chemotherapy.

Methods: This study is an observational analytical study with a diagnostic test design on systemic blood inflammatory markers NLR, PLR, and MLR as marker of therapy response of epithelial ovarian cancer patients at Adam Malik Hospital Medan using retrospective data. This study involved a total of 135 patients with stage III epithelial ovarian cancer patients who had undergone optimal debulking and complete adjuvant chemotherapy from January 1 2018 to December 31 2022 with complete follow-up for 1 year.

Results: Based on the results of ROC curve analysis, the optimal cut off value for NLR was 2.4 (AUC: 73.2%, 95% CI: 64.1-82.4%, p<0.001) with a sensitivity of 69.9% and a specificity of 66.67%. The optimal cut off value for PLR was 173 (AUC: 82%, 95% CI: 74.4-89.5%, p<0.001) with a sensitivity of 77.4% and a specificity of 73.8%. The optimal cut off value for MLR was 0.5 (AUC: 66.2%, 95% CI: 54.9-77.6%, p<0.001) with a sensitivity of 71% and a specificity of 69%. There was a significant association between the NLR, PLR, and MLR values with the response to therapy in stage III epithelial ovarian cancer patients who had undergone debulking laparotomy and complete adjuvant chemotherapy (p<0.001). The result of multivariate analysis showed that the most dominant variable in predicting therapy response of epithelial ovarian cancer patients was PLR with the largest OR value of 7.823 (95% CI 7.268-187.947).

Conclusions: The optimal cut-off values of NLR, PLR, MLR statistically significant with therapy response of stage III epithelial ovarian cancer who had undergone optimal debulking and complete adjuvant chemotherapy. Increased levels of NLR, PLR, and MLR were more likely to be associated with a non-complete therapy response.

Comparison of ultrasound scan fetal weight estimation and the combination of Dare and Johnson fetal weight estimation

Abel Jinyemiema, Atochi Prince Woruka, Dagogo Semenitari Abam, Terhemen Kasso — Wed, 29 Jul 2026 00:00:00 +0530

Background: Accurate estimation of fetal weight in pregnancy is key in decision making and determining when, where and how a delivery will occur, thereby contributing to the reduction of adverse pregnancy outcomes. Clinical and imaging methods have some degree of inaccuracy in estimating the fetal weight. This study aimed to evaluate the accuracy of fetal weight estimation by combination of the Dare and Johnson formulae compared with the Hadlock 2 ultrasound method in term pregnancies.

Methods: The study was a comparative cross-sectional study of 144 randomly selected pregnant women at the department of obstetrics and gynecology of the University of Port Harcourt Teaching Hospital from 1^st June to 30^th November, 2024. The degree of accuracy of fetal weight estimation using a combination of Dare and the Johnson formula and the Hadlock 2 ultrasound method was calculated using the mean absolute error, mean absolute percentage error, and the proportion of estimates within 10% of actual weight.

Results: The combination of the Dare and Johnson formulae overestimated fetal weight by 859.15±418.23 gm with a mean absolute percentage error of 25.13±15.18%. In comparison, the Hadlock 2 ultrasound scan method, underestimated the fetal weight by 163.01±253.19 gm with a lower mean absolute percentage error of 4.45±7.27%. The proportion of the combination of the Dare and the Johnson formulae, which is within 10% of the actual weight, was only 6.94%, while that of the Hadlock 2 ultrasound scan method had 76.39%.

Conclusions: The Hadlock 2 ultrasound scan method of fetal weight estimation has higher accuracy and should be preferred approach when available. However, in low-resource settings where ultrasound technology may not be available, the combination of the Dare and the Johnson formulae may be used, but with caution since it is less accurate.

Robotic assisted hysterectomy in a teaching hospital over ten years: trends, outcomes and service evolution

Wed, 29 Jul 2026 00:00:00 +0530

Background: Robotic hysterectomy is increasingly utilised in gynaecology, particularly for patients with obesity, significant comorbidities, or oncological indications. Castle Hill Hospital established a robotic hysterectomy service in 2016. This study evaluates perioperative outcomes and trends in operative efficiency over a ten-year period in a high-risk, complex cohort.

Methods: Authors conducted a retrospective review of 374 patients who underwent robotic hysterectomy between 2016 and 2025. Collected data included patient age, BMI, comorbidities, prior abdominal surgery, surgical indication, intra- and postoperative complications, conversion to laparotomy, hospital stay and mean operating times.

Results: Patient ages ranged from 29 to 87 years. Obesity was common, with 81% having a BMI≥30, and 71% had multiple comorbidities, most frequently cardiovascular or metabolic. One-quarter had a history of open abdominal surgery. Endometrial cancer was the primary indication in 65%, mostly early-stage. Additional procedures included pelvic lymph node sampling (84 cases), adhesiolysis, omental biopsy, omentectomy, and appendectomy. Forty-one women (10.96%) had intraoperative complications, out of which 23 (6.15%) had conversion to laparotomy, mostly due to surgical difficulty, bleeding, adhesion or for specimen retrieval. Postoperative complications were seen in 10.4%, with two returns to theatre. Intraoperative complications occurred in 6.4%, most commonly vaginal tears and bleeding. Postoperative complications, including readmissions, were seen in 10.4%, with two returns to theatre. Length of stay was brief, with 76% discharged within 48 hours. Mean operating time improved from 193–195 minutes in 2016–2017 to 140 minutes.

Conclusion: Robotic hysterectomy is safe and effective in complex, high-risk patients. Low complication and conversion rates, short hospital stays, and improved operative efficiency reflect increasing service maturity, reduced resource use, and potential cost-effectiveness.

Vaginal Candida colonization, species distribution, associated factors and antifungal susceptibility patterns among women attending Bowen University Teaching Hospital, Ogbomoso

Wed, 29 Jul 2026 00:00:00 +0530

Background: Vaginal colonization by Candida species is prevalent among women and may serve as risk factor to vulvovaginal candidiasis (VVC), especially when the vaginal microbiota is disrupted. However, the prevalence of vaginal Candida colonization (VCC), associated risk factors, and antifungal patterns remain limited in Nigerian settings. This study aimed to determine the prevalence, associated factors, and antifungal patterns of vaginal Candida isolated among women attending Bowen University Teaching Hospital, Ogbomoso, Nigeria.

Methods: This hospital-based cross-sectional study enrolled 176 consenting symptomatic and asymptomatic women between June and November, 2025. Data were collected using a semi-structured questionnaire and High vaginal swabs (HVS) were collected from participants. The HVS samples were examined using microscopy, culture on Sabouraud Dextrose Agar, CHROMagar, and Internal Transcribed Spacer-Polymerase Chain Reaction (ITS-PCR) for confirmation of Candida. Antifungal profiling was assessed by disk diffusion on Mueller-Hinton agar supplemented with glucose and methylene blue. Data were analyzed using SPSS version 26, with statistical significance set at p≤0.05.

Results: Among the 176 participants, 48(27.3%) participants were positive for VCC. Candida parapsilosis was the most frequent isolate, 25/48 (52.1%). In multivariate analysis, vaginal discharge (AOR=4.971, 95% CI: 1.485-16.646, p=0.009) and pregnancy (AOR=5.584, 95% CI: 1.344-23.209, p=0.018) were a strong significant predictor of Candida colonization. C. parapsilosis significantly emerged to be the most resistant to fluconazole (25(54.3%) (p=0.008).

Conclusions: VCC was common in this population, with predominance of C. parapsilosis. These findings provide local evidence supporting routine laboratory identification of Candida and antifungal testing, particularly in suspected, recurrent, persistent, or complicated VVC.

Comparative study of the efficacy and safety of dinoprostone vaginal insert versus low dose intravaginal misoprostol for induction of labour at term: a retrospective cohort study

Nisiya K. S., Uma Devi K., Susan S. Varghese, Farzana M. Ahmed — Wed, 22 Jul 2026 00:00:00 +0530

Background: Induction of labour is one of the most commonly performed obstetric procedures worldwide. Prostaglandins are among the most effective agents used for cervical ripening and labour induction. Various prostaglandin formulations are available, and their comparative efficacy and safety continue to be evaluated. This study aimed to compare the efficacy, safety, and patient acceptability of dinoprostone vaginal insert and intravaginal misoprostol for induction of labour.

Methods: This retrospective cohort study was conducted at a tertiary care centre over a six-month period. Medical records of 40 pregnant women who underwent induction of labour were reviewed. Participants were randomly allocated into two groups: 20 women received a single 10 mg dinoprostone vaginal insert for a maximum duration of 24 hours, while 20 women received 25 µg intravaginal misoprostol placed in the posterior fornix every 4 hours for a maximum of 24 hours. Maternal and fetal outcomes, induction-to-delivery interval, oxytocin requirement, mode of delivery, adverse effects, and patient acceptability were compared between the two groups.

Results: The induction-to-delivery interval was significantly shorter in the dinoprostone vaginal insert group compared with the misoprostol group. The requirement for oxytocin augmentation was lower in the dinoprostone group. Caesarean section rates were comparable between the groups. Uterine hyperstimulation was more frequent in the dinoprostone group, whereas there were no significant differences in the incidence of meconium-stained liquor or postpartum haemorrhage. Patient acceptability was higher with dinoprostone, attributed to reduced first-stage labour pain and fewer per-vaginal examinations. Neonatal outcomes, assessed using Apgar scores at 1 and 5 minutes, were comparable between the two groups.

Conclusions: Both intravaginal misoprostol and dinoprostone vaginal insert are safe and effective methods for induction of labour. Dinoprostone vaginal insert was associated with a shorter induction-to-delivery interval, reduced oxytocin requirement, and better patient acceptability. The choice of induction agent should be individualised based on clinical indication, patient preference, and cost considerations.

Intrapartum category II cardiotocography and its association with mode of delivery and perinatal outcomes in term pregnancy: a prospective observational study

Kasthuri Chinnasamy, Saradha Jagannathan — Fri, 10 Jul 2026 00:00:00 +0530

Background: Intrapartum cardiotocography (CTG) is widely used for foetal surveillance. However, Category II CTG has variable patterns and uncertain significance, often leading to operative delivery in pregnant women. This study aimed to assess the association between intrapartum Category II CTG, mode of delivery, and perinatal outcomes in term pregnancies.

Methods: This prospective observational study was conducted at the Department of Obstetrics and Gynaecology, Sri Ramakrishna Hospital, Coimbatore, between December 2019 and August 2020. A total of 103 consecutive term pregnant women with intrapartum Category II CTG were included. The mode of delivery and perinatal outcomes were analysed in relation to parity, modified Bishop score, CTG duration, and CTG pattern type.

Results: Among the study population, 55.3% underwent emergency caesarean section, while 44.7% delivered vaginally, including 31.1% by operative vaginal delivery and 13.6% by normal vaginal delivery. All women with unfavourable modified Bishop scores underwent emergency caesarean section (100%). With favourable Bishop scores, operative vaginal delivery was common in both primigravida (42.6%) and multigravida (40.9%) groups. The duration of category II CTG differed according to parity (p=0.041) but was not associated with neonatal outcomes. NICU admission occurred in 37.9% of neonates, most frequently with reduced variability (66.7%) and foetal tachycardia (55.6%) (p=0.027). Most NICU stays were less than 24 h (60.5%).

Conclusions: Intrapartum Category II CTG is associated with higher operative delivery rates; however, perinatal outcomes are generally favourable and depend more on CTG pattern type than on duration. Careful intrapartum reassessment may help reduce unnecessary caesarean sections.

Acceptance and outcomes of postpartum intrauterine contraceptive device insertion in a tertiary care hospital: a prospective observational study

Sweta S. Shrivastava, Tithi Patel, Khushi Sharma — Thu, 16 Jul 2026 00:00:00 +0530

Background: The postpartum period is an ideal time to address the unmet need for contraception. The postpartum intrauterine contraceptive device (PPIUCD) is a safe, effective, long-acting, reversible, and non-hormonal contraceptive that can be inserted immediately after delivery or within 48 hours. Objectives were to evaluate acceptance, demographic profile, reasons for acceptance and refusal, and clinical outcomes of PPIUCD insertion among postpartum women.

Methods: This prospective observational study was conducted at Dhiraj Hospital, Sumandeep Vidyapeeth, Vadodara, Gujarat, from January 2024 to January 2025. A total of 1,500 antenatal and postpartum women were counselled regarding PPIUCD. Of these, 300 women accepted copper T (Cu-T) 380A insertion and were followed up at 6 weeks and 6 months. Data on acceptance, demographic characteristics, reasons for acceptance/refusal, complications, expulsions, and removals were analysed.

Results: The acceptance rate was 22.2%. Most acceptors were 20-24 years old, second gravida (60%), and educated (82%). Intra-caesarean insertion was performed in 70% of cases. Convenience, long-term contraception, avoidance of an additional hospital visit, and absence of hormonal side effects were the main reasons for acceptance, while inability to make an independent decision without partner involvement was the commonest reason for refusal. At 6 weeks, 66% of women were asymptomatic, increasing to 94.7% at 6 months. No uterine perforation or pelvic infection occurred. Six expulsions and 14 removals were recorded during follow-up.

Conclusions: PPIUCD is a safe, effective, and well-tolerated postpartum contraceptive with high continuation and low complication rates. Strengthening antenatal counselling and partner involvement may improve acceptance.

Modified biophysical profile in antepartum fetal surveillance of high-risk pregnancy

Neethika Raghuwanshi, Sneha Gedam — Mon, 06 Jul 2026 00:00:00 +0530

Background: Antepartum fetal surveillance is essential for reducing perinatal morbidity and mortality in high-risk pregnancies. The modified biophysical profile (MBPP), combining the non-stress test (NST) with amniotic fluid index (AFI) assessment, offers a time-efficient, cost-effective alternative to the complete Biophysical Profile (BPP). This study evaluated MBPP as a surveillance tool in high-risk pregnancies.

Methods: A hospital-based observational study was conducted at Government Medical College, Akola, Maharashtra, India (January 2024-December 2025). Three hundred high-risk pregnant women at ≥30 weeks gestation were enrolled by universal sampling. MBPP comprised a 20-minute NST and ultrasonographic AFI measurement. Outcomes included mode of delivery, neonatal Apgar scores, neonatal intensive care unit (NICU) admissions, and neonatal mortality. Data were analyzed using SPSS version 20.0 (p <0.05).

Results: Most participants (51.00%) were aged 21-25 years (mean 24.75±4.56 years). Hypertensive disorders were the commonest risk factor (42.33%), followed by anaemia (28.00%) and intrauterine growth restriction (IUGR) (15.67%). NST was reactive in 78.33%; normal AFI in 81.33%; both normal in 66.67%. Full-term vaginal delivery occurred in 47.33%; emergency lower segment caesarean section (LSCS) in 34.00%. Apgar ≥7 was achieved in 83.33% neonates; 25.67% required NICU admission; neonatal mortality was 1.00%.

Conclusions: MBPP is a practical, non-invasive, cost-effective antepartum surveillance tool. Abnormal MBPP findings were significantly associated with operative delivery and adverse neonatal outcomes. MBPP is recommended as a routine first-line modality for high-risk pregnancy surveillance, especially in resource-limited settings.

Assessment of awareness regarding preconceptional care among women aged 18-25 years

Divya Panwar, Annesha Ganguly, Hemlata Parashar, Anjali Kanhere — Wed, 22 Jul 2026 00:00:00 +0530

Background: Preconception care (PCC) is a vital component of preventive reproductive healthcare that aims to optimize maternal and neonatal outcomes, yet awareness remains inadequate among young women in developing countries. This study aimed to assess awareness regarding preconception care among women aged 18–25 years and to identify socio-demographic factors influencing awareness.

Methods: This hospital-based cross-sectional study was conducted among 300 women aged 18–25 years attending the Department of Obstetrics and Gynaecology, Chirayu Medical College and Hospital, Bhopal. A predesigned, structured, and pretested questionnaire was administered to assess knowledge, awareness, and practices regarding preconception care. Awareness was scored and categorized as good, moderate, or poor. Data were analyzed using descriptive statistics and the Chi-square test, with p<0.05 considered statistically significant.

Results: Only 38% of participants had heard of preconception care. Overall, 26% demonstrated good awareness, 42% moderate awareness, and 32% poor awareness. Awareness regarding folic acid supplementation (45%), vaccination (39%), and chronic disease control (48%) was suboptimal. Higher education, urban residence, and prior healthcare exposure were significantly associated with better awareness (p<0.05).

Conclusions: Awareness regarding preconception care among young women remains inadequate. Strengthening targeted education and integrating preconception counseling into routine healthcare services are essential to improve maternal and neonatal health outcomes.

Maternal and neonatal outcomes of gestational diabetes mellitus: a retrospective study at a tertiary care centre

Vijaymala Sherkhane, Tushar Palve — Wed, 29 Jul 2026 00:00:00 +0530

Background: Gestational diabetes mellitus (GDM) is a prevalent metabolic disorder during pregnancy associated with adverse maternal and neonatal outcomes. This study aimed to assess neonatal complications associated with GDM and compare outcomes between modes of delivery.

Methods: This retrospective study was conducted at Cama and Albless Hospital, Mumbai, over one year (June 2024 to May 2025). Sixty-eight pregnant women diagnosed with GDM were included. Demographic, maternal, and neonatal data were analyzed.

Results: Mean maternal age was 29.6±4.5 years; 61.8% were multigravida. Of 68 patients, 48 (70.5%) underwent lower segment caesarean section and 20 (29.5%) had normal vaginal delivery. Neonatal complications included hypoglycemia (26.5%), macrosomia (22%), and NICU admission (32.4%). Complications were more frequent in the cesarean group.

Conclusions: GDM remains a significant risk factor for neonatal morbidity. Early screening, consistent antenatal monitoring, and adherence to standardized management protocols can help mitigate these risks.

Evaluation of maternal serum vitamin D levels and their correlation with adverse perinatal outcomes: a prospective study

Meenakshi Thakur, Deepti Rana, Meenakshi Verma — Wed, 29 Jul 2026 00:00:00 +0530

Background: Vitamin D, a fat-soluble prohormone, is critical for calcium absorption, immune regulation, and placental development. In pregnancy, its role extends beyond skeletal health to vascular regulation and fetal growth. Increasing evidence links hypovitaminosis D with complications such as preeclampsia, gestational diabetes, and adverse neonatal outcomes. This study aimed to evaluate maternal serum vitamin D levels during the third trimester of pregnancy and assess their correlation with maternal and neonatal outcomes.

Methods: A prospective observational study was conducted on 150 antenatal women beyond 28 weeks of gestation at a tertiary care centre in Himachal Pradesh, India, between January and December 2023. Maternal serum 25-hydroxyvitamin D [25(OH)D] levels were measured and women were classified as deficient (<20 ng/ml), insufficient (20–29 ng/ml), or sufficient (≥30 ng/ml). Maternal outcomes studied included preeclampsia, gestational diabetes mellitus (GDM), and preterm delivery. Neonatal outcomes studied were low birth weight (LBW) and NICU admissions. Statistical analysis was performed using statistical package for the social sciences (SPSS) version 25 with a significance level set at p<0.05.

Results: Vitamin D deficiency was found in 68% of women. Deficient women had significantly higher rates of preeclampsia (21.5% versus 6.3%, p=0.01), GDM (18.6% versus 4.2%, p=0.008), and LBW babies (27.4% versus 10.4%, p=0.01). NICU admission rates were also higher among deficient women (23.5% versus 8.3%, p=0.02). Preterm birth did not show a significant association.

Conclusions: Vitamin D deficiency is highly prevalent among Indian pregnant women and is significantly correlated with maternal complications and adverse perinatal outcomes. Routine screening and supplementation may improve pregnancy outcomes.

Vitamin B12 and folate: key predictors of HPV persistence in ASCUS patients

Kakoli Nikhil Banerjee, Poonam Rani, Mukul Chandra, Fayaz H. Khan, Saroj Singh — Wed, 29 Jul 2026 00:00:00 +0530

Background: Persistent infection with high-risk human papillomavirus (HPV) is the key driver of cervical carcinogenesis. Atypical squamous cells of undetermined significance (ASCUS) represent an equivocal cytology category in which optimal triage is crucial. Disturbances in one-carbon metabolism, particularly low vitamin B12 and folate, may impair DNA repair and immune responses, favouring HPV persistence. This study aimed to evaluate serum vitamin B12 and folate levels in women with ASCUS compared with cytologically normal controls and to explore their association with HPV positivity in ASCUS.

Methods: This comparative cross-sectional study was conducted in the Department of Obstetrics and Gynaecology, FH Medical College, Agra. Fifty women were enrolled: 25 with ASCUS cytology and 25 age-matched controls with normal Pap smears. Socio-demographic and clinical data were recorded. Fasting serum vitamin B12 and folate were measured using an automated immunoassay. High-risk HPV status in the ASCUS group was determined by PCR. Group comparisons were performed using appropriate statistical tests and the association between micronutrient levels and HPV positivity was assessed.

Results: Women with ASCUS had significantly lower vitamin B12 (265.17±54.25 vs 315.26±65.62 pg/ml, p<0.01) and folate (9.53±1.76 vs 11.91±2.62 ng/ml, p<0.01) than controls. Within the ASCUS group, HPV-positive women showed markedly reduced vitamin B12 (200.14±12.47 vs 295.53±40.25 pg/ml, p<0.01) and folate (7.86±0.61 vs 10.23±1.59 ng/ml; p<0.01) compared with HPV-negative ASCUS patients. Lower micronutrient levels showed a clear inverse association with HPV positivity.

Conclusions: Women with ASCUS, particularly those who are HPV-positive, exhibit significant subclinical deficiencies of vitamin B12 and folate. These findings suggest that impaired one-carbon metabolism may contribute to HPV persistence at an early stage and that vitamin B12 and folate could serve as simple, adjunctive biomarkers to refine risk stratification and follow-up strategies in ASCUS patients.

Prospective study on success rate and outcomes of trial of labour after caesarean at a tertiary hospital

A. Shanti Sri, Shravya — Wed, 29 Jul 2026 00:00:00 +0530

Background: The increasing prevalence of pregnancies with a scarred uterus has led to a rise in repeat caesarean sections (CS), which are associated with significant maternal morbidity. Trial of labour after caesarean (TOLAC) offers an alternative to reduce CS rates and associated complications. This study aimed to determine the success rate of TOLAC and evaluate maternal and fetal outcomes in a tertiary care hospital.

Methods: This prospective observational study was conducted over one year (April 2023 to February 2024) at Fernandez Hospital a tertiary maternity centre. A total of 206 women with singleton term pregnancies and one previous lower segment caesarean section (LSCS), eligible and consenting for TOLAC, were included. Women with contraindications to vaginal birth or significant comorbidities were excluded. Maternal and neonatal outcomes were recorded and analyzed using appropriate statistical tests, with p<0.05 considered significant.

Results: The success rate of TOLAC was 21.8% (45/206). Factors significantly associated with successful vaginal birth after caesarean (VBAC) included younger maternal age (p=0.019), shorter inter-delivery interval (p=0.048), previous VBAC (p<0.001) and spontaneous onset of labour (p=0.001). Induced labour was associated with higher CS rates. Postpartum haemorrhage (PPH) was significantly higher in the VBAC group (20% vs 6.2%, p=0.009). There were no cases of maternal mortality or major surgical injuries. Neonatal outcomes, including NICU admission and morbidity, were comparable between groups, with no neonatal deaths reported. Cord arterial pH was slightly lower in the VBAC group (p=0.023), though clinically acceptable.

Conclusions: The success rate of TOLAC in this study was relatively low, likely due to high induction rates. However, with careful selection and monitoring, TOLAC remains a safe option without significant adverse maternal or neonatal outcomes. Reducing unnecessary inductions and primary caesarean sections may improve VBAC success rates.

The indications, intraoperative complications, maternal and fetal outcomes in second-stage cesarean section at full dilation

Sreelakshmi K., Mohammad Siddhique, Smitha Sreenivas K. — Wed, 29 Jul 2026 00:00:00 +0530

Background: Second-stage caesarean section (SSCS), performed at full cervical dilatation, is associated with increased maternal and neonatal morbidity owing to technical difficulties d9uring fetal extraction. This study aimed to evaluate the indications, intraoperative complications and maternal and neonatal outcomes of SSCS.

Methods: A prospective observational study was conducted among 73 term pregnant women who underwent second-stage caesarean section at a tertiary care teaching hospital over one year. Maternal demographic characteristics, indications for surgery, intraoperative and postoperative complications and neonatal outcomes were recorded and analysed. Associations were evaluated using the Chi-square test with p<0.05 considered significant.

Results: The commonest indication for SSCS was arrest of descent/cephalopelvic disproportion (67.1%). Intraoperative complications occurred in 49.3% of women, with uterine angle extension being the most frequent (32.9%). Postoperative complications occurred in 50.7%, predominantly postoperative infection (38.4%). Neonatal complications were observed in 52.1%, with respiratory distress syndrome being the commonest (39.7%). The Patwardhan technique was significantly associated with increased intraoperative complications (p=0.013), while operative duration exceeding one hour was significantly associated with postoperative complications and infections (p=0.001).

Conclusions: Second-stage caesarean section is associated with substantial maternal and neonatal morbidity. Early recognition of labour abnormalities, timely intervention and appropriate surgical techniques may reduce adverse outcomes.

Comparison of immediate versus late induction in premature rupture of membranes with oral prostaglandins in term patients

Emil Rose Johnson, Smitha Sreenivas Kolasseri — Wed, 29 Jul 2026 00:00:00 +0530

Background: Immediate induction involves initiating labor as soon as prelabor rupture of membranes (PROM) is confirmed to minimize infection risk and complications associated with prolonged membrane rupture, including chorioamnionitis. This study aimed to compare maternal and neonatal outcomes in terms of PROM-delivery interval, mode of delivery, maternal and neonatal morbidity following immediate and delayed induction in PROM.

Methods: This prospective cohort study included 200 patients. Group A (100 patients) underwent immediate induction following PROM with oral PGE1, while group B (100 patients) underwent induction 6 hours after PROM with oral PGE1. A maximum of three doses of PGE1 (50 mcg) were administered over 24 hours. Intermittent fetal heart monitoring using CTG was performed, maternal and fetal complications were recorded and managed accordingly. Results were compared between groups.

Results: The efficacy of oral PGE1 as an induction agent at 2 hours and 6 hours post-PROM was assessed based on PROM - delivery interval, duration of first stage of labor, and vaginal delivery within 24 hours. In the early induction group, 80% delivered within 24 hours compared to 56% in the delayed group. Only 3.5% in the early group required three doses versus 9% in the delayed group. Normal vaginal delivery occurred in 96% of early induction cases and 91% of delayed cases. Maternal pyrexia and sepsis were carefully monitored.

Conclusions: Early induction at 2 hours after PROM reduces PROM-delivery interval and improved the outcome of delivery, maternal satisfaction rates including lesser maternal and neonatal morbidity.

Seroprevalence of HBsAg, HCV and HIV among antenatal women at a tertiary care centre in Northern India: a cross-sectional study from SNMC Agra

Itishree Jena, Urvashi Verma, Ruchika Garg, Meenal Jain — Wed, 29 Jul 2026 00:00:00 +0530

Background: Blood-borne viral infections such as hepatitis B (HBV), hepatitis C (HCV) and human immunodeficiency virus (HIV) significantly affect maternal health and pose a risk of vertical transmission. Antenatal screening is crucial for early detection and prevention. To determine the seroprevalence of HBsAg, anti-HCV and HIV among antenatal women attending a tertiary care centre.

Methods: A cross-sectional study was conducted from September 2023 to August 2024 among 314 antenatal women at SNMC Agra. Blood samples were tested using standard rapid immunochromatographic methods as per NACO guidelines.

Results: Among 314 women, 104 (33.1%) were reactive for at least one viral marker. HBsAg prevalence was 14.3%, HCV 10.5% and HIV 8.3%.

Conclusions: A high prevalence of viral infections highlights the need for universal antenatal screening and strengthened preventive strategies.

Study of C-reactive protein and procalcitonin in detecting subclinical intrauterine infections in preterm prelabour rupture of membrane

Wed, 29 Jul 2026 00:00:00 +0530

Background: Chorioamnionitis or intrauterine infection contributes to approximately 40–50% of preterm deliveries. Clinical signs appear late and are subjective, while conventional investigations such as leukocyte count and cultures are either unreliable or time consuming. Histopathological examination of the placenta confirms the diagnosis only after delivery. This study assessed C-reactive protein (CRP) and procalcitonin (PCT) in detecting subclinical intrauterine infection in women with preterm prelabour rupture of membranes (PPROM).

Methods: This cross-sectional study included 40 women with singleton pregnancies complicated by PPROM between 28 and 36+6 weeks of gestation at Hindu Rao Hospital over one year. Women with leaking per vaginum for more than12 hours were enrolled. CRP and PCT levels were measured at admission and delivery. Their association with clinical and histopathological chorioamnionitis was analyzed using SPSS version 25.0, and ROC curves determining optimal cut-off values.

Results: The mean age was 25.12±3.7 years, and mean gestational age was 34.98±1.38 weeks. Clinical chorioamnionitis occurred in 80% and histopathological chorioamnionitis in 55% of cases, with risk increasing significantly as leaking duration per vaginum prolonged. CRP was found to be a better predictor than PCT. CRP at termination predicted clinical chorioamnionitis at a cut-off >15.6 mg/l (AUC 0.805), whereas CRP on admission predicted histopathological chorioamnionitis at a cut-off >12 mg/l (AUC 0.941).

Conclusions: CRP and PCT are valuable biomarkers for early intrauterine infection detection in PPROM, enabling timely treatment and improving maternal-neonatal outcomes.

A retrospective analysis of emergency obstetric hysterectomy in a rural tertiary care centre in Northern India: incidence, indications, fetomaternal outcomes and challenges

Shilpi Srivastava, Pragati Divedi, Sarika Pandey, Vaibhav Kanti, Chandan Sharma — Wed, 29 Jul 2026 00:00:00 +0530

Background: Emergency obstetric hysterectomy (EOH) is a life-saving procedure performed in cases of uncontrolled obstetric hemorrhage when conservative measures fail. Despite advances in obstetric care, it remains associated with significant maternal and perinatal morbidity. To evaluate the incidence, indications, risk factors and maternal–neonatal outcomes associated with emergency obstetric hysterectomy.

Methods: This retrospective analytical study included all patients undergoing EOH between January 2020 and December 2024 at a tertiary care center. Data were analyzed for demographic variables, indications, surgical details, transfusion requirements, complications and outcomes.

Results: The incidence of EOH was 0.212% (52/24,441 deliveries). Most patients were aged 25–34 years (63.5%) and multiparous (88.5%). The leading indications were uterine rupture (30.8%), atonic postpartum hemorrhage (25%) and placenta accreta spectrum (19.2%). Cesarean hysterectomy constituted 65% of cases. ICU admission was required in 80.76% of patients. Maternal mortality was 11.5%. Neonatal survival rate was 61.5%, with poor outcomes mainly in rupture uterus cases.

Conclusions: EOH remains a critical intervention in obstetric emergencies. Uterine rupture and hemorrhage are still predominant indications in developing settings. Strengthening early referral systems and improving obstetric care can reduce associated morbidity and mortality.

Comparison of continuation rate, safety and acceptability of intra-caesarean insertion of CuT 380A versus CuT 375: a randomized controlled study

Pragati Gupta, Shivani Agarwal, Vaishali Yadav — Wed, 29 Jul 2026 00:00:00 +0530

Background: The immediate postpartum period represents an important opportunity to initiate long-acting reversible contraception. Intracesarean insertion of PPIUCD is a convenient and effective method for preventing unintended pregnancies. CuT 380A and CuT 375 are widely used devices; however, comparative evidence regarding continuation and safety following intra-caesarean insertion is limited.

To compare continuation rate, safety profile and acceptability of intra-caesarean insertion of CuT 380A and CuT 375.

Methods: This prospective randomized controlled study was conducted in the Department of Obstetrics and Gynaecology, Kasturba Hospital, Delhi from August 2023 to October 2024. Total of 144 women undergoing caesarean section and consented for IUCD insertion were randomized into two groups: CuT 380A (n=72) and CuT 375 (n=72). Participants were followed at 6 weeks, 3 months, 6 months and 9 months postpartum. Primary outcome was continuation rate. Secondary outcomes included expulsion, removal and complication

Results: Mean age of participants was comparable between CuT 380A and CuT 375 groups (23.83±4.31 vs 23.33±4.00 years; p>0.05). Overall follow-up rate was 97.9%. Expulsion occurred in 5.5% women in CuT 380A group and 4.1% women in CuT 375 group (p>0.05). Removal rates were 6.9% and 2.7% respectively. Continuation rates at 9 months were 84.7% and 91.7% respectively.

Conclusions: Both CuT 380A and CuT 375 are safe and effective for intra-caesarean insertion with comparable continuation and complication rates. CuT 375 demonstrated slightly higher continuation rates though differences were not statistically significant.

Nutritional status as an independent determinant of structural disease severity and functional disability in female knee osteoarthritis: a comparative cross-sectional study integrating Kellgren-Lawrence grading, WOMAC index and the mini nutritional assessment

Aavrati Rastogi, Roop B. Kaila, Om Kumari — Wed, 29 Jul 2026 00:00:00 +0530

Background: Knee osteoarthritis (OA) is a leading cause of chronic pain and disability worldwide, particularly among women, with emerging evidence suggesting that nutritional status may act as a modifiable determinant of disease severity and functional impairment. Objective was to evaluate nutritional status as an independent determinant of structural severity and functional disability in female patients with knee osteoarthritis.

Methods: A cross-sectional study was conducted among 108 female patients aged 45-70 years with knee OA, graded using the Kellgren-Lawrence system. Nutritional status was assessed using the mini nutritional assessment, and functional disability was evaluated using the WOMAC index. Multivariate linear regression analysis was performed to identify independent predictors of functional disability.

Results: Poor nutritional status was significantly associated with higher WOMAC scores and greater radiological severity. A moderate inverse correlation was observed between nutritional status and functional disability (r=-0.52, p<0.001). Multivariate regression analysis confirmed nutritional status as an independent predictor of functional disability (β=-0.48, p<0.001).

Conclusions: Nutritional status is an independent and clinically significant determinant of both structural severity and functional disability in female knee osteoarthritis. Nutritional optimization may represent a novel, modifiable therapeutic target in the comprehensive management of knee osteoarthritis.

Correlation of abnormal liver function tests in pregnancy with fetomaternal outcome at a tertiary care centre

Kajal Mandal, Shakun Singh — Wed, 29 Jul 2026 00:00:00 +0530

Background: Liver dysfunction during pregnancy is an important cause of maternal and perinatal morbidity. Abnormal liver function tests may indicate pregnancy-specific liver disorders, viral hepatitis, or hepatic involvement in systemic obstetric complications. Early identification is essential for risk stratification and timely management. This study aimed to evaluate the correlation between abnormal liver function tests during pregnancy and fetal-maternal outcomes.

Methods: This prospective observational study was conducted in the Department of Obstetrics and Gynaecology, LLRM Medical College, Meerut, over 18 months. A total of 150 pregnant women with abnormal liver function tests were enrolled after informed consent. Demographic details, obstetric profile, clinical presentation, liver function parameters, viral markers, maternal outcomes, and neonatal outcomes were recorded and analysed.

Results: The mean age of participants was 28.99±3.91 years. Most women were multigravida (88.0%) and unbooked (70.0%). Pruritus was the most common presenting symptom (66.66%), followed by nausea and vomiting (30.66%) and jaundice (18.66%). Mean serum bilirubin was 1.92±3.12 mg/dl, mean aspartate aminotransferase was 196.48±223.96 U/l, and mean alanine aminotransferase was 212.40±249.79 U/l. Cesarean delivery was performed in 41.33% of cases. Postpartum haemorrhage occurred in 43.3%, intensive care unit admission was required in 19.33%, and maternal mortality was 0.66%. Low birth weight occurred in 24.66%, neonatal intensive care unit admission in 40.66%, neonatal jaundice in 26.66%, respiratory distress in 24.66%, and perinatal mortality in 5.33%.

Conclusions: Abnormal liver function tests in pregnancy were associated with significant maternal and neonatal morbidity. Early diagnosis, regular antenatal monitoring, timely referral, and multidisciplinary management are essential for improving feto-maternal outcomes.

Comparative study of mifepristone plus vaginal misoprostol versus vaginal misoprostol alone for second-trimester medical abortion

Priyanka Patel K. S., L. H. Rathod — Wed, 29 Jul 2026 00:00:00 +0530

Background: Misoprostol is widely used for cervical ripening and uterine contractions, while mifepristone priming improves uterine sensitivity to prostaglandins and may enhance treatment efficiency. The present study compared the efficacy and safety of mifepristone plus vaginal misoprostol versus vaginal misoprostol alone for second-trimester termination of pregnancy (14-20 weeks).

Methods: This prospective comparative study included 150 women with singleton pregnancies between 14 and 20 weeks, allocated into two equal groups (n=75 each). Group 1 (Mife+Miso) received mifepristone 200 mg orally, followed after 36 hours by vaginal misoprostol 800 µg, then 400 µg vaginally every 3 hours up to four doses or until expulsion. Group 2 (Miso alone) received vaginal misoprostol 800 µg, followed by 400 µg every 3 hours up to four doses or until abortion occurred. Participants were monitored for expulsion, adverse effects, and complications; incomplete/failed abortions were managed with appropriate additional interventions.

Results: Baseline characteristics were comparable (mean age 24.43±5.13 vs 24.12±5.00 years; p=0.711). Complete abortion occurred in 90.7% of group 1 versus 65.3% of group 2 (p=0.0005), and overall success (complete abortion) remained significantly higher in group 1 (p=0.0004). The mean induction–abortion interval was significantly shorter with the combination regimen (7.38±2.60 vs 9.97±3.67 hours; p<0.001), with more women aborting within ≤8 hours (66.7% vs. 41.3%; p=0.003). The mean total misoprostol dose was lower in Group 1 (1413.33±368.10 vs. 1850.67±370.67 µg; p<0.001), and dose-category distribution differed significantly (p<0.001).

Conclusions: Mifepristone priming followed by vaginal misoprostol was more effective and faster than vaginal misoprostol alone for second-trimester medical abortion.

Maternal and neonatal outcomes of elective cesarean section before and after 39 weeks

Saumya Shandilya, Neerja Mistry, Darshana Chavhan — Wed, 29 Jul 2026 00:00:00 +0530

Background: Elective cesarean section rates are rising globally, including in India, due to medical and non-medical factors such as patient preference, fear of labor and scheduling convenience. Timing is crucial, as delivery before 39 weeks increases neonatal morbidity, while delaying beyond 39 weeks raises the risk of spontaneous labor and emergency cesarean section.

Methods: This retrospective observational study included 50 women with singleton pregnancies undergoing elective lower segment cesarean section (LSCS) at K. B. B. H Hospital, Mumbai. Participants were divided into <39 weeks (n=25) and ≥39 weeks (n=25), with 10 cases of spontaneous labor analyzed separately. Maternal outcomes included postpartum hemorrhage (PPH), wound complications, lower uterine segment formation and instrumental assistance. Neonatal outcomes included APGAR scores, respiratory complications, hypoglycemia and NICU admissions.

Results: Maternal complications, particularly PPH and need for instrumental assistance, were higher in the <39-week group. A well-formed lower uterine segment was more frequently observed in the ≥39-week group, resulting in improved surgical conditions. Neonatal outcomes were comparatively poorer in early-term deliveries, with increased respiratory morbidity and higher NICU admission rates. Women who experienced spontaneous labor before the scheduled date required emergency cesarean section and had increased perioperative risks.

Conclusions: Elective LSCS performed at or beyond 39 weeks is associated with improved maternal surgical outcomes and better neonatal health indicators. However, spontaneous labor before the planned date emphasizes the need for individualized, evidence-based scheduling to balance risks of early-term delivery against emergency interventions in accordance with established obstetric guidelines.

A prospective observational study of clinical profile, management modalities and outcomes in women undergoing second trimester induced abortions at a tertiary care centre in South Gujarat

Anjali Daglia, Anjani Shrivastava, Meet Sabuwala, Bindiya Postiwala — Wed, 29 Jul 2026 00:00:00 +0530

Background: Second trimester abortion is associated with significantly higher maternal morbidity compared to first trimester termination despite accounting for a smaller proportion of induced abortions. Delayed diagnosis of fetal anomalies, limited access to healthcare services, and socioeconomic barriers continue to contribute to second trimester terminations in developing countries. Aim was to evaluate the clinical profile, management modalities, and outcomes of women undergoing second trimester induced abortion at a tertiary care centre.

Methods: This prospective observational study was conducted in the department of obstetrics and gynecology at a tertiary care teaching hospital in South Gujarat over a period of 12 months. Fifty women undergoing second trimester medical termination of pregnancy between 13 and 24 weeks of gestation were enrolled. All participants received mifepristone 200 mg orally followed by vaginal misoprostol 400 µg every 6 hours after 24-48 hours. Clinical profile, indications for termination, induction-abortion interval, success rates, and complications were analysed.

Results: Most participants were multigravida women belonging to rural and lower socioeconomic backgrounds. Fetal anomalies were the most common indication for termination (46%), followed by maternal medical indications (42%). The majority of patients required two to three doses of misoprostol, and 78% achieved abortion within 24 hours of induction. Complete abortion was achieved in 88% of cases. Retained products of conception were observed in 10% of patients, while major complications such as haemorrhage, uterine rupture, or infection were not encountered.

Conclusions: Medical termination using the mifepristone-misoprostol regimen is a safe, effective, and reliable method for second trimester induced abortions when performed under appropriate clinical supervision.

A study of management and outcomes of postpartum haemorrhage in singleton pregnancy at a tertiary care hospital: an observational study

Vijaymala Sherkhane, Tushar Palve — Wed, 29 Jul 2026 00:00:00 +0530

Background: Postpartum haemorrhage (PPH) remains a leading cause of maternal morbidity and mortality worldwide, particularly in low- and middle-income countries. Early recognition and prompt management are crucial for improving outcomes.

Methods: This prospective observational study included 60 women with singleton pregnancies who developed PPH at Cama and Albless Hospital, Mumbai from August 2024 to May 2025. Data on demographics, risk factors, etiology, management modalities, and maternal outcomes were collected and analyzed.

Results: Uterine atony was the most common cause (91.7%), followed by genital tract trauma. Anemia was the predominant risk factor (71.7%). Medical management with uterotonics was first-line therapy; oxytocin was used in all cases (100%), carboprost in 91.7%, and misoprostol in 70.0%. Surgical interventions were required in refractory cases. Blood transfusion was needed in 50% of patients. Most patients (96.6%) recovered; maternal death occurred in 2 cases (3.4%).

Conclusions: PPH remains a significant obstetric emergency with substantial morbidity. Early risk factor identification, standardized management protocols, and prompt interventions are essential. Addressing antenatal anemia and ensuring blood product availability are critical for improving outcomes.

Quality of life improvement following trans-obturator tape procedure in stress urinary incontinence: a prospective observational study

Aruna Verma, Abhilasha Gupta — Wed, 29 Jul 2026 00:00:00 +0530

Background: Stress urinary incontinence (SUI) is a common but under reported condition in women that adversely affects day to day activity and overall well-being. The transobturator tape (TOT) procedure has emerged as a minimally invasive surgical option with favorable outcomes. This study aimed to assess improvement in quality of life (QoL) following TOT using a validated questionnaire.

Methods: A prospective observational study was conducted in the department of obstetrics and gynecology, on 68 women diagnosed with SUI at a tertiary care institution. All participants underwent TOT surgery. Quality of life was evaluated using the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) before surgery and at 6 months follow-up. Surgical success and complications were also analyzed.

Results: The average age of participants was 46.2±8.5 years. The mean ICIQ-SF score showed a significant reduction from 16.8±2.3 preoperatively to 3.2±1.6 postoperatively (p<0.001). Successful outcomes were observed in 66 patients (97.1%), with 2 cases categorized as failures. Most women (95.6%) reported marked improvement in QoL. Minor complications included transient groin discomfort (8.8%) and short-term urinary retention (2.9%).

Conclusions: TOT is an effective and safe surgical modality for SUI, resulting in substantial improvement in quality of life with a high success rate and low complication profile.

Prevalence of bacterial vaginosis among pregnant women and its perinatal outcome: a descriptive, observational and prospective study

Sruthi Srinivasan, Somenath Ghosh, Anindita Roy, Somdatta B. Datta — Wed, 29 Jul 2026 00:00:00 +0530

Background: Pregnancy is commonly associated with increased vaginal discharge which is often non-pathological while bacterial vaginosis, candidiasis and trichomoniasis are associated with abnormal vaginal discharge. However, most cases of abnormal vaginal discharge in pregnant women are treated inappropriately as candidiasis as a result of inadequate investigation of other causes. Bacterial vaginosis is a polymicrobial syndrome characterized by loss of normal vaginal flora and increase in other species like Gardenella vaginalis, Ureaplasma urealyticum, Mobiluncus, Mycoplasma, Bacteriodes, Peptostreptococcus and Prevotella. It has severe adverse outcomes in pregnancy which include preterm labour, preterm premature rupture of membranes (PPROM), spontaneous abortion, increased risk of peripartum infections. Current study aims to evaluate the prevalence of bacterial vaginosis in pregnant women using easily available, rapid, inexpensive, diagnostic tests and its adverse maternal and fetal outcome in pregnancy.

Methods: 150 antenatal women attending the outpatient clinic as well as the admitted patients in the Department of Obstetrics and Gynaecology satisfying the inclusion criteria and who had given well written and informed consent were enrolled for the study. We studied the prevalence of bacterial vaginosis in these women using Amsel’s criteria and Nugent scoring and correlated it with adverse pregnancy outcomes.

Results: Out of the 150 pregnant women screened, 35 women were tested positive as per Amsel’s criteria (23.3%). According to Nugent scoring, 16 out 150 pregnant women screened had a score of more than 7(10.6%). Out of the 16 women tested positive, 12 of them had preterm delivery and PPROM (75%), 7 of them delivered small for gestational age (SGA) babies (43.75%), and 15 of the delivered babies required NICU admission (93.75%).

Conclusions: The above results suggest that universal screening for all antenatal patients for bacterial vaginosis should be done during antenatal visits as they are rapid and inexpensive along with effective treatment of the same to avoid perinatal complications. More focus needs to be done on prevention of preterm labour and PPROM, rather than treatment of the same, once it occurs.

A clinical study of maternal outcome in women with heart disease in pregnancy at tertiary care centre

Dixitaben B. Rampariya, Falguni Patel — Wed, 29 Jul 2026 00:00:00 +0530

Background: Cardiac disease in pregnancy is a high-risk pregnancy and it complicates 2% of all pregnancies and contributes to about one fifth of all maternal deaths.

Methods: This was a prospective observational study conducted in Department of Obstetrics and Gynaecology, enrolling 50 consecutive subjects fulfilling inclusion criteria of pregnancy with heart disease admitted in OBICU, labour room, antenatal and postnatal wards of a tertiary health care centre, New Civil Hospital, Surat, Gujarat over a period of around 1 year.

Results: Majority of our patients belonged to age group of 25-35 years (56%) and urban residence (70%). 50% of our subjects were already booked case and 56% were multiparous. 78% were enrolled in last trimester. Majority of our patients, 70% had undergone LSCS. 42% were presented with dyspnoea. 68% had acquired heart disease. RHD is the most common cardiac disease. Heart failure is the most common cardiac complications. Hypertension is most common non-cardiac complications associated with pregnancy with cardiac disease.

Conclusions: The management of pregnancy with cardiac disease requires to strengthen preconception counselling and early registration at tertiary health care center for risk assessment, optimizing cardiac status and planning appropriate care and multidisciplinary approach to reduce maternal morbidity and mortality.

Borderline amniotic fluid index at term: does it independently predict adverse maternal and perinatal outcomes? A prospective comparative study

Anu Pathak, Anshu Jurel, Mohita Agrawal, Hari Singh, Madhu Nayak — Wed, 29 Jul 2026 00:00:00 +0530

Background: Borderline amniotic fluid index (AFI 5.1-8.0 cm) represents a gray zone in obstetrics, with uncertain association with adverse maternal and perinatal outcomes. Objective was to compare outcomes in term pregnancies with borderline and normal AFI and assess whether borderline AFI independently predicts adverse outcomes.

Methods: This prospective observational study included 160 singleton term pregnancies (≥37 weeks), divided into borderline AFI (n=80) and normal AFI (n=80) groups. After loss to follow-up, 74 and 72 women were analyzed. Maternal and perinatal outcomes were compared, and multivariate logistic regression was performed.

Results: Borderline AFI was associated with higher induction of labor (59.4% versus 32.4%, p=0.001) and failed induction (22.9% versus 5.6%, p=0.002). Caesarean delivery was significantly higher among induced women (44.7% versus 18.2%, p=0.037), though overall rates were comparable. Non-progression of labor, fetal distress, and meconium-stained liquor were more frequent in the borderline AFI group. Borderline AFI independently predicted low birth weight (AOR: 2.76, p=0.006) but not caesarean delivery.

Conclusions: Borderline AFI is associated with increased intrapartum interventions and low birth weight. However, it does not independently predict caesarean delivery, emphasizing the role of labor-related factors in clinical outcomes.

Assessing impact of BMI on menstrual patterns in adolescent girls in an urban area of Amravati district, Maharashtra, India

Janhvi Mahalle, Sonal Bhuyar, Manjusha Deotale — Wed, 29 Jul 2026 00:00:00 +0530

Background: Adolescence marks a critical transitional phase characterized by significant physical, mental, emotional, and hormonal changes, including the onset of the menstrual cycle. The nature of the menstrual cycle established during this time can profoundly influence reproductive health later in life. Regular menstruation is a sign of good health and normal development of an adolescent. A paradigm shift is noted in the pattern of lifestyle, habits, diet, sleep and physical activity since childhood and is known to affect menstrual health in young girls. Body mass index (BMI) has got a great impact on menstrual functions. However, this part of women’s health is mostly neglected or not talked about.

Methods: An observational, prospective study was conducted for a period of six months in four schools in an urban area in Maharashtra. This study enrolled 276 school girls in the age group of 12-16 years. Using structured questionnaires and anthropometric measurements, their BMI and menstrual patterns were assessed and statistically analysed.

Results: Adolescent girls who had higher BMI experienced earlier onset of menstruation, irregular cycles and heavy menstrual bleeding as compared to the normal BMI participants and the difference was statistically highly significant. However, the duration of menstrual flow or the severity of dysmenorrhoea had no significant association with BMI in our study population.

Conclusions: Maintaining a normal BMI through healthy lifestyle practices since early adolescence is crucial for promoting reproductive well-being among young girls. It also plays a vital role in preventing complications such as infertility and endocrine and gynaecological disorders in future.

Maternal and neonatal outcomes in induced versus spontaneous preterm labour: an observational study from a tertiary care centre in South Gujarat

Wed, 29 Jul 2026 00:00:00 +0530

Background: Preterm birth remains a leading cause of neonatal morbidity and mortality worldwide, particularly in developing countries like India. The clinical course and outcomes differ between spontaneous and induced preterm labour, making comparative evaluation essential for optimizing management.

Methods: This observational study was conducted at a tertiary care centre in South Gujarat and included 300 women delivering before 37 weeks of gestation. Participants were categorized into spontaneous preterm labour (SPL) and induced preterm labour (IPL). Maternal characteristics, intrapartum variables and neonatal outcomes were analysed. Statistical analysis was performed using Chi-square test and independent t-test, with p<0.05 considered significant.

Results: Induced preterm labour accounted for 56% of cases, while spontaneous labour constituted 44%. Higher maternal age was significantly associated with induced labour (p<0.001). Duration of labour was longer in IPL, whereas augmentation was more common in SPL (p<0.001). Caesarean section rates were higher in IPL. Maternal complications were comparable between the groups. Neonates born following SPL had lower Apgar scores, indicating poorer immediate condition, while respiratory morbidity was observed in both groups. Birth weight distribution did not differ significantly (p=0.324).

Conclusions: Induced preterm labour is associated with higher operative delivery rates but allows better perinatal preparedness. Spontaneous preterm labour is associated with poorer immediate neonatal outcomes. Strengthening antenatal care and timely interventions are essential to improve outcomes.

Assessment and evaluation of knowledge pertaining to PCOS among MBBS students in Western Maharashtra

Bhargavi Joshi, Shounak Subhedar, Sushma Sharma, Shreya Sambharam — Wed, 29 Jul 2026 00:00:00 +0530

Background: Polycystic ovary syndrome (PCOS) is a common endocrine-metabolic disorder among reproductive-age women. Despite its inclusion in undergraduate medical curricula, gaps persist in knowledge regarding its diagnosis, screening, and management. This study assessed PCOS awareness among MBBS students in Western Maharashtra.

Methods: A cross-sectional questionnaire-based study was conducted among 200 MBBS students using a pre-validated online survey. Data were analyzed using descriptive statistics and chi-square test, with p<0.05 considered significant.

Results: Most participants demonstrated knowledge regarding the etiology, risk factors, and management of PCOS, particularly hormonal imbalance, obesity, lifestyle factors, and use of lifestyle modification in management.68.8% identified ultrasonography as an important diagnostic modality. No association was observed between academic year and knowledge of most risk factors, whereas perception regarding the importance of screening showed a association with year of study (p=0.0063).

Conclusions: MBBS students demonstrated satisfactory baseline awareness regarding PCOS; however, deficiencies remain in diagnostic and screening-related knowledge. Strengthening longitudinal and clinically integrated PCOS teaching within the medical curriculum may improve competency and awareness.

An observational study to evaluate the clinical outcomes and complications among women presenting with unsupervised MTP pill intake at a tertiary healthcare centre in South Gujarat

Wed, 29 Jul 2026 00:00:00 +0530

Background: Unsupervised use of medical termination of pregnancy (MTP) pills is increasingly common in developing countries like India due to easy over-the-counter availability. Although safe under medical supervision, inappropriate use may lead to serious complications. Objectives of this study was to evaluate clinical outcomes and complications among women presenting with unsupervised MTP pill intake at a tertiary healthcare centre.

Methods: This prospective observational study included 200 women who came with a history of unsupervised MTP pill intake at our hospital for one year, from March 2025 to March 2026, after obtaining official approval from the Institutional Ethical Committee. Data regarding demographic profile, gestational age, source of pills, clinical presentation, outcomes, complications, and treatment modalities were collected and analysed. Statistical associations were evaluated using appropriate tests, with p < 0.05 considered significant.

Results: The majority of subjects were aged 21–25 years (38%), with a predominance of multigravida, rural (73%), and lower socioeconomic status (67%). Only 29% had prior ultrasound, while most obtained MTP pills from medical stores (60%). Half of the subjects (50%) consumed pills at 7–9 weeks, and most presented within 8–14 days (38%). The most common complaint was bleeding with passage of clots (48.5%). Incomplete abortion (63%) was the predominant outcome, followed by missed abortion (17%). Anaemia (55%) was the most common complication, with 17% requiring blood transfusion. Most subjects required intervention, with 62% undergoing dilatation and evacuation. Adverse outcomes were significantly associated with lack of prior ultrasound and higher gestational age.

Conclusions: Unsupervised use of MTP pills is a significant public health concern leading to preventable complications. Easy over-the-counter availability promotes misuse without proper medical evaluation. Therefore, strict regulation of MTP pill distribution and dispensing only through authorized centers under medical supervision is essential.

Fetomaternal outcomes in liver disorders of pregnancy: a retrospective study from South India

Uthra K. G., Meenakshi R., Saranya K. — Wed, 29 Jul 2026 00:00:00 +0530

Background: Liver disorders in pregnancy are rare but can cause life-threatening maternal and fetal complications. They arise from physiological, pregnancy-specific, or coincidental systemic diseases. This study aimed to analyze the etiological spectrum, biochemical profile, and fetomaternal outcomes among pregnant women with hepatic dysfunction at a tertiary-care center in Tamil Nadu.

Methods: A retrospective observational study was conducted between June 2024 and May 2025 in the department of obstetrics and gynecology, Government Medical College, Tiruvannamalai. All pregnant women with clinical or biochemical evidence of liver dysfunction were included. Data on symptomatology, etiology, biochemical parameters, complications, and fetomaternal outcomes were recorded. Statistical analyses included χ² tests and ROC curve analysis of serum bilirubin, transaminases, and LDH as predictors of maternal complications.

Results: Among 12,542 deliveries, 65 (0.5 %) women had liver disorders. Mean age was 25 years; 73.8% presented in the third trimester. The commonest causes were viral hepatitis (52.3%), HELLP syndrome (16.9%), and hyperemesis gravidarum (13.8%). Maternal complications included postpartum hemorrhage (23%), DIC (9%), and hepatorenal syndrome (15%). There were no maternal deaths. Of 57 live births, 12% were preterm and three fetuses had intra-uterine death. ROC analysis showed LDH (AUC 0.82) as the best predictor of adverse maternal outcomes.

Conclusions: Liver disease in pregnancy remains a significant threat to fetomaternal health. Elevated LDH serves as a reliable biochemical marker of severity. Early diagnosis and multidisciplinary management are key to preventing mortality.

An obstetric outcomes in women with and without one previous spontaneous abortion: a comparative study

Lakshmi Rachakonda, Valluri Lalitha Pavani, Savita Khiste, Supriya Lokhande — Wed, 29 Jul 2026 00:00:00 +0530

Background: Spontaneous abortion is defined as the spontaneous loss of pregnancy before the foetus reaches viability. Two key factors associated with an increased risk of miscarriage are a woman's age and a history of previous miscarriages Studies suggest that a history of miscarriage may raise the risk of PIH, FGR, PROM, threatened abortion, preterm labour, low birth weight, etc. in subsequent pregnancies. Hence, pregnancies with prior history of spontaneous abortions should be considered as high-risk pregnancies and effective precautions are to be taken.

Methods: A case-control study was undertaken on 52 cases and 52 controls to evaluate and compare the adverse outcomes in women who had a single previous spontaneous abortion immediately preceding the present pregnancy (cases) and those who haven’t(controls).

Results: 86.54% of cases were booked and only 65.38% from controls were booked. Antenatal factors strongly associated with previous spontaneous abortion are FGR, threatened abortion and PROM. LSCS was the most common mode of delivery in both groups suggesting that previous abortion did not become an indication of LSCS in case group. 65.12% of patients who received progesterone support reached full-term.

Conclusions: Women with a history of previous one spontaneous abortion are at an increased risk of developing complications in the next pregnancy. Adverse complications and foetal loss can be reduced by giving proper antenatal care in terms of increased awareness, early antenatal care initiation and effective timely intervention, like in this scenario, use of progesterone support and its usage was observed to be a boon.

Through the lens: a retrospective observational study of hysteroscopic findings in women attending a rural tertiary care centre

Wed, 29 Jul 2026 00:00:00 +0530

Background: Hysteroscopy is considered the gold standard modality for direct visualization of the uterine cavity and evaluation of intrauterine pathology. It serves both diagnostic and therapeutic purposes in gynaecological practice. With increasing use of minimally invasive techniques, hysteroscopy has become an essential tool in the evaluation of abnormal uterine bleeding, infertility, recurrent pregnancy loss, and postmenopausal bleeding.

Methods: This retrospective observational study was conducted in the Department of Obstetrics and Gynaecology at a rural tertiary care centre. Medical records of women who underwent hysteroscopy during the study period were reviewed. Demographic details, indications for hysteroscopy, hysteroscopic findings and histopathological reports were collected from registers and digital hospital records. Data was analysed after entering into Google forms and Microsoft Excel.

Results: Among the 157 patients studied, most were perimenopausal women aged 40–49 years, followed closely by those aged 30–39 years. Polyps were the commonest indication for hysteroscopy, followed by infertility and leiomyoma. Hysteroscopic findings most frequently revealed endocervical polyps and normal uterine cavities, while polypectomy was a common procedure performed. Histopathological examination predominantly showed proliferative endometrium, with smaller proportions demonstrating endometrial hyperplasia and malignancy.

Conclusion: Hysteroscopy is a minimally invasive procedure which has proven to be valuable for evaluation of intrauterine pathology and provides accurate assessment of uterine cavity abnormalities. It plays a significant role in diagnosis and management planning in gynaecological practice.

Observational study of effect of body mass index on fetomaternal outcome in pregnancy

Shalini, Mamta Anand, Twinkle Ashar, Prajakta More, J. B. Senapati — Wed, 29 Jul 2026 00:00:00 +0530

Background: Maternal body mass index (BMI), is a key predictor of pregnancy-related outcomes. Pre-pregnancy BMI and gestational weight gain are closely linked to both maternal and neonatal health. The study was conducted to evaluate the impact of maternal BMI on pregnancy, labour and neonatal outcome.

Methods: This was a cross-sectional observational study. This study was conducted in the Department of Obstetrics and Gynecology at Tertiary Care Institute (Chhatrapati Shivaji Maharaj Hospital, Kalwa) between July 2025 and December 2025. About 400 antenatal women registered in our hospital during the first trimester were enrolled in the study. Their BMI was calculated and each of them were allotted into 4 separate groups based on their BMI. Women are asked for routine antenatal visits in the OPD. At the end obstetric outcomes, perinatal outcome and neonatal outcomes were observed. Data entry was done in Microsoft excel and analysis was done using a software Epi Info 7.

Results: The present study demonstrates that increasing BMI is significantly associated with hypertensive disorders, GDM, postdatism, induction of labour, LSCS, and wound complications. Underweight status is associated with anaemia, preterm labour and IUGR.

Conclusions: Our study points out the numerous maternal and perinatal risks are associated with overweight, obese and underweight pregnant women. Hence these groups of women need to be regarded as ‘high risk’ when counselling and risk assessment is done in the antenatal clinic.

Urinary incontinence: prevalence and general awareness across genders

Shreya Luthra, Retasha Soni, Supreet Bindra — Wed, 29 Jul 2026 00:00:00 +0530

Background: Urinary incontinence (UI) is a common condition affecting individuals across the genders and can significantly impact their quality of life (QoL). Although it is highly prevalent, awareness regarding UI still remains limited. Therefore, this study aimed to evaluate the prevalence of UI and assess its general level of awareness among both male and female participants.

Methods: This cross-sectional study was conducted using a Google form-based questionnaire, distributed via email and social media. The questionnaire included sections on demographic information, medical history and evaluation of the presence and severity of UI was done by using International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF). It also contained questions related to general awareness about UI. A total of 171 participants responded to the survey.

Results: Among the reported participants, 57.3% were females and 42.6% were males. The overall prevalence of UI found to be 18.7%, with a higher occurrence in females (15.2%) as compared to males (3.5%). Although some participants demonstrated basic awareness, the overall general level of awareness regarding UI was moderate to low. A considerable number of respondents were unaware of available treatment options and commonly perceived UI as a normal consequence of aging rather than a treatable medical condition.

Conclusions: The study found that UI is prevalent among the general population, particularly among females, along with a significant gap in general awareness regarding UI. These findings highlight that there is a need for targeted educational interventions and promotion of public awareness programs so that timely healthcare-seeking behaviours can be facilitated.

Polycystic ovary syndrome in Indian women: clinical spectrum and determinants from a regional multicenter study in Vidarbha region, Maharashtra, India

Wed, 29 Jul 2026 00:00:00 +0530

Background: Polycystic ovary syndrome (PCOS) is a heterogeneous endocrine disorder with reproductive, metabolic, and psychological implications. Despite its high prevalence in Indian women, region-specific data on its clinical and metabolic spectrum remain limited. This study aims to evaluate the clinical presentation, anthropometric markers, metabolic profile, and phenotypic distribution of PCOS among adolescents and infertile women.

Methods: This cross-sectional retrospective, multicenter study was conducted across five centers between January 2022 and January 2023. A total of 309 women aged 14-32 years, diagnosed with PCOS, were enrolled. Data on demographic, reproductive, anthropometric, hormonal, biochemical, and ultrasonographic parameters were collated and analysed.

Results: The mean age of participants was 23.1±5.3 years, with mean menarche at 13.2±1.6 years. Among 153 married women, infertility duration averaged 3.2±2.5 years, with 90% reporting primary infertility. Ovulatory dysfunction was observed in 75.1%, hyperandrogenism in 46.3%, and polycystic ovarian morphology (PCOM) in 50.5%. Acne (46.3%) and acanthosis nigricans (36.2%) were frequent findings. The mean BMI was 25.4±5.3 kg/m², with 73.8% classified as overweight/obese. Neck circumference (33.6±4.0 cm) and wrist circumference (16.7±2.2 cm) showed correlation with insulin resistance. Among adolescents (n=156), hyperandrogenism was present in 55.8%, ovulatory dysfunction in 78%, and 20.5% showed PCOM.

Conclusions: PCOS in Vidarbha women shows early onset, high ovulatory dysfunction, obesity, insulin resistance, and adverse metabolic risks. Age-specific phenotypic variability underscores its evolving nature, necessitating early diagnosis, lifestyle changes, and comprehensive management to reduce reproductive and cardiometabolic complications.

Assessment of blood transfusion practices in antenatal women and their adherence to standard transfusion guidelines

Afifa Naushad, Tushar Palve, Rajashree Thatikonda, Dipika Khillare — Wed, 29 Jul 2026 00:00:00 +0530

Background: Blood transfusion is an important component of obstetric care and is frequently required in antenatal women with severe anemia, obstetric complications, and conditions associated with increased maternal and fetal risk. Appropriate utilization of blood and blood products according to established transfusion guidelines is essential to ensure patient safety and optimal use of blood resources. To assess blood transfusion practices among antenatal women and evaluate their adherence to standard transfusion guidelines.

Methods: A hospital-based observational study was conducted among 133 antenatal women who received blood transfusions during the study period. Demographic characteristics, obstetric profile, blood group distribution, hematological parameters, and transfusion-related variables were recorded using a structured proforma. Data were obtained from patient records, laboratory reports, and blood bank registers. Statistical analysis was performed using SPSS version 25.0. Continuous variables were expressed as mean ± standard deviation, while categorical variables were presented as frequencies and percentages. Pearson correlation analysis was used to assess associations between selected variables.

Results: The mean age of the participants was 26.87±5.19 years. The majority were Muslims (67.7%) and belonged to the B positive blood group (34.6%). The most common parity status was G2P1L1 (23.3%), followed by primigravida women (21.8%). All blood transfusions (100%) were issued through the institutional blood bank. The mean hemoglobin level was 8.84±2.96 g/dl, indicating that anemia was a major indication for transfusion. Correlation analysis demonstrated a strong positive association between BD and BS parameters (r=0.831, p<0.001) and a weak positive correlation between BD and hemoglobin levels (r=0.286, p=0.004).

Conclusion: Blood transfusions in antenatal women were predominantly administered for moderate to severe anemia. Standardized blood bank services facilitated uniform transfusion practices. Regular transfusion audits, adherence to evidence-based guidelines, and early management of antenatal anemia are essential for optimizing maternal outcomes and ensuring rational utilization of blood products.

A comparative study on one-step versus two-step screening methods for gestational diabetes mellitus and their impact on maternal and fetal outcome

Sunanda Ghosh, Erum Ali, Avijit Pan, Injamam ul Hoque — Wed, 29 Jul 2026 00:00:00 +0530

Background: Gestational diabetes mellitus (GDM) is a common pregnancy complication associated with adverse maternal and fetal outcomes. The one-step IADPSG and two-step ACOG screening methods are widely used for diagnosis. The one-step approach detects more cases of GDM, potentially enabling earlier treatment, but concerns regarding overdiagnosis and increased healthcare costs remain. Aim and objectives were to compare the one-step and two-step screening methods for gestational diabetes mellitus (GDM) in terms of prevalence, maternal and fetal outcomes, and to determine which method correlates better with adverse fetomaternal outcomes.

Methods: This prospective comparative study was conducted at Midnapore Medical College and Hospital from January to December 2024 and included 1,720 pregnant women with gestational age ≤24 weeks. Participants were randomly assigned to either group A (one-step IADPSG screening, n=860) or group B (two-step ACOG screening, n=860) for GDM screening. Women diagnosed with GDM were managed according to standard protocols and followed until delivery. Maternal and fetal outcomes were assessed and compared between the two groups using statistical analysis.

Results: Among 860 pregnant women screened by each method, GDM was diagnosed in 92 (10.69%) women using the one-step method and 66 (7.67%) women using the two-step method. During follow-up, 88 and 62 women remained in groups A and B, respectively. Maternal complications such as preeclampsia and polyhydramnios were comparable between the groups (p=0.964). The caesarean section rate was significantly higher in the one-step group than in the two-step group (68.18% versus 41.93%; p=0.024). Mean APGAR scores were similar in both groups (8.41±0.92 versus 8.71±0.82; p=0.151). Fetal outcomes, including preterm birth, low birth weight, neonatal hypoglycemia, large-for-gestational-age, hyperbilirubinemia, and NICU admission, were comparable between the groups (p=0.938).

Conclusions: One-step method detected more GDM cases than the two-step method, but maternal and fetal outcomes were similar. The one-step approach is simpler, more economical, and has better patient compliance.

Y chromosome microdeletions in male infertility: prevalence, molecular characteristics and clinical correlates in infertile men

Wed, 29 Jul 2026 00:00:00 +0530

Background: Y chromosome microdeletions within the azoospermia factor (AZF) regions are among the most common genetic causes of male infertility after Klinefelter syndrome. Screening for AZF microdeletions together with karyotyping plays an important role in evaluating men with impaired spermatogenesis before assisted reproductive techniques.

Methods: A total of 242 infertile men attending the andrology and reproductive genetics clinic were evaluated. Clinical assessment, semen analysis, hormonal profiling, karyotyping, and multiplex PCR-based screening of AZFa, AZFb, and AZFc regions using sequence-tagged site markers were performed.

Results: Among 242 infertile men, 80 (33.05%) had azoospermia, 44 (18.18%) severe oligozoospermia, 107 (44.21%) oligoasthenoteratozoospermia, and 8 (3.30%) asthenozoospermia. Y chromosome microdeletions were identified in 32 (13.22%) patients. AZFc deletions were the most common (96.9%), followed by combined AZFb+AZFc deletions and one isolated AZFb deletion. No AZFa deletions were detected. Most affected individuals had azoospermia or oligoasthenoteratozoospermia. One individual with Y chromosome microdeletion also exhibited mosaicism (mos45,X[80]/46,XY[20]). Ten individuals (4.13%) had varicocele with AZFc microdeletions.

Conclusions: Y chromosome microdeletions, particularly AZFc, are highly prevalent among infertile men with azoospermia and OAT. Routine evaluation of karyotype and AZF regions is essential before assisted reproductive techniques (ART) to assess prognosis and prevent transmission of genetic defects.

Peripartum cardiomyopathy in preeclampsia with severe features and eclampsia: a prospective observational study from a tertiary care center

Ruby Bhatia, Dimple Shekhawat, Mahak Singaal, Vaishnavi Verma, Himanshi Pareek — Wed, 29 Jul 2026 00:00:00 +0530

Background: Hypertensive disorders of pregnancy remain a major cause of maternal morbidity and mortality worldwide. Cardiovascular involvement is increasingly recognized as an important determinant of disease severity and maternal outcome. The present study evaluated the clinical presentation, echocardiographic characteristics, management strategies, and maternal outcomes of peripartum cardiomyopathy in patients with preeclampsia with severe features and eclampsia.

Methods: A prospective observational study was conducted at a tertiary care center from January 2025 to December 2025. Pregnant and postpartum women with preeclampsia with severe features or eclampsia presenting with newly detected left ventricular systolic dysfunction suggestive of peripartum cardiomyopathy were included. Clinical, echocardiographic, management, and outcome data were analyzed.

Results: The mean age was 27.3±5.8 years. The overall incidence of peripartum cardiomyopathy was 0.24% among total deliveries. Cardiac dysfunction occurred in 5% of patients with preeclampsia with severe features and 20% of patients with eclampsia. No mortality was observed among patients with LVEF ≥30%, whereas mortality occurred in patients with very severe systolic dysfunction (LVEF <30%). A progressive increase in case detection was observed over time.

Conclusions: Peripartum cardiomyopathy associated with preeclampsia with severe features and eclampsia represents a serious complication with significant prognostic implications. Very severe left ventricular systolic dysfunction (LVEF <30%) is a strong predictor of maternal mortality. Early echocardiographic evaluation and multidisciplinary management are essential for improving maternal outcomes.

Impact of premenstrual syndrome on daily activities and quality of life: a survey analysis

Titli Bhattacharjee, Prayushi Patel, Priti Rajbhar, Aesha Variya — Wed, 29 Jul 2026 00:00:00 +0530

Background: PMS affects a surprisingly large share of women in their reproductive years; prevalence estimates range from 30–40%, climbing to 80% when mild and moderate cases are counted. This study looked at how common PMS symptoms are in women aged 18–40, and whether lifestyle factors like diet, exercise, and stress have any bearing on their frequency or severity.

Methods: An online survey via Google Forms captured data on demographics, menstrual history, PMS awareness, emotional and physical symptoms, diet, exercise, and stress levels. Of 684 responses received, 650 met inclusion criteria women aged 18-40 with regular cycles. Excluded were participants who were pregnant, lactating, chronically ill, had psychiatric diagnoses, recently used hormonal medications, or submitted incomplete/duplicate forms.

Results: Most participants (71.23%) had heard of PMS. Of those surveyed, 82% reported emotional symptoms like mood swings and irritability being the most common before their periods. Fatigue was nearly as widespread at 76%, while food cravings affected 59.54%. Medium menstrual flow was typical (75.08%), with 36% reporting blood clots. On the lifestyle side, 72.31% didn't exercise regularly, and just over half (53.69%) reported dealing with stress.

Conclusions: PMS awareness is reasonably high, but emotional and physical symptoms remain common and undertreated. The low exercise rates and elevated stress levels among participants point to lifestyle factors as potential targets both for further research and practical management strategies.

Role of prophylactic add on tranexamic acid in active management of third stage of labour: a prospective randomised study

Shubhra Aggarwal, Tanushree Jain, Akash Jain, Ratna T. Papola — Wed, 29 Jul 2026 00:00:00 +0530

Background: Postpartum haemorrhage (PPH) remains the leading cause of maternal mortality worldwide. Tranexamic acid (TXA) is a synthetic antifibrinolytic agent, and its established efficacy in reducing haemorrhage in trauma and surgical contexts. Its prophylactic use in the obstetric setting is of growing interest. This study aims to evaluate the efficacy and safety of prophylactic TXA (1 g intravenous) as an adjunct to oxytocin (10 IU intramuscular) in reducing postpartum blood loss and the incidence of PPH for active management of third stage of labour in women undergoing vaginal delivery.

Methods: A prospective, double-blind, randomized controlled trial was conducted at a tertiary care teaching hospital, over 18 months. Eligible women with singleton pregnancies at ≥37 weeks of gestation expecting vaginal delivery were randomized 1:1 to group A (TXA 1 g IV slow infusion + oxytocin 10 IU IM; n=78) or Group B (normal saline 10 ml IV + oxytocin 10 IU IM; n=78). Primary endpoints were total measured postpartum blood loss (ml) and incidence of PPH (≥500 ml). Secondary endpoints included reduction in level of haemoglobin at 24 hours, requirement for additional uterotonics, blood transfusion requirement, duration of third stage, adverse maternal effects, and neonatal outcomes.

Results: Mean postpartum blood loss was significantly lower in group T than group O (72.56±30.94 ml versus 72.82±25.73 ml; p<0.05). PPH incidence was significantly reduced in the TXA group (8.97% versus 28.20%; OR: [0.25], RR: [0.32], 95% CI [0.14–0.70]; NNT=[6]; p<0.05). Mean haemoglobin fall, need for additional uterotonics, and blood transfusion rate were all significantly lower in group T. No significant difference in adverse effects, thromboembolic events, or neonatal outcomes was observed between groups.

Conclusions: Prophylactic TXA 1 g iv as an adjunct to standard therapy significantly reduces postpartum blood loss and PPH incidence without increasing adverse maternal or neonatal outcomes.

Frequency and clinical profile of polycystic ovary syndrome among young Indian women presenting with menstrual irregularities: a hospital-based cross-sectional study

Chandni Kalarikkal, Suneetha Kalam, Mini Chenicheri — Wed, 29 Jul 2026 00:00:00 +0530

Background: Polycystic ovary syndrome (PCOS) is a highly prevalent reproductive endocrinopathy. Diagnosing PCOS in adolescents and young adults presents major challenges due to physiological overlaps with normal pubertal development. This study aimed to determine the clinical frequency of PCOS among young women (15–24 years) presenting with menstrual irregularities at a tertiary care hospital in South India, and to characterize their anthropometric, clinical, and biochemical profiles.

Methods: This hospital-based cross-sectional study evaluated 180 young women (15–24 years) presenting with menstrual irregularities over a 12-month period. Participants were stratified into adolescents (15–19 years; diagnosed via international evidence-based guidelines) and young adults (20–24 years; diagnosed via modified Rotterdam criteria). Clinical parameters, hormone profiles, and transabdominal pelvic ultrasound metrics were recorded.

Results: Among 180 symptomatic participants, 114 met age-specific criteria for PCOS, yielding a clinical frequency of 63.3% within this cohort. Within the PCOS arm, 40.4% (n =46) were adolescents and 59.6% (n=68) were young adults. Clinical hyperandrogenism was highly prominent (hirsutism: 48.9%; acne: 36.7%), starkly outstripping biochemical hyperandrogenaemia (5.0%). Statistically significant differences were identified between the PCOS and non-PCOS cohorts regarding mean age ( 20.66±1.82 vs.19.91±2.02 years, p=0.014)), mean BMI (24.17±5.67 vs. 22.20±3.58kg/m2, p=0.020), mean luteinizing hormone (9.38±4.21 vs 8.24±3.11IU/l, p = 0.041), and mean thyroid stimulating hormone levels (2.78±2.51 vs. 2.23±1.41mIU/l, p=0.040 ).

Conclusions: PCOS is the primary driver of menstrual irregularities in young seeking-care populations in this demographic. The divergence between prominent clinical hyperandrogenism and low biochemical hyperandrogenaemia emphasizes the clinical reliance on standardized physical evaluations over routine biochemical assays for effective early screening.

Comparison of high dose calcium and vitamin D3 versus low dose aspirin combined with high dose calcium and vitamin D3 in prevention of preeclampsia: a prospective comparative study

Ashwini Pawar, B. H. Narayani, Surekha S. M. — Wed, 29 Jul 2026 00:00:00 +0530

Background: It is hypothesized that, vitamin D supplementation with or without calcium in pregnancy has important role in reducing risk of preeclampsia. This study was designed to compare the efficacy of high dose calcium, vitamin D3 supplementation with high dose calcium, vitamin D3 combined with low dose aspirin, in prevention of pre-eclampsia.

Methods: This hospital based prospective comparative study was conducted in the Department of Obstetrics and Gynaecology, Koppal Institute of Medical Sciences, Koppal, Karnataka State, India. A total of 210 females with gestational age of 12 weeks attending antenatal check-up divided into three groups of 70 each as group A (calcium and vitamin D3), group B (calcium and vitamin D and aspirin) and group C (routine antenatal medications) were enrolled.

Results: Most of the women in all the three groups were aged between 21 to 25 years (p=0.913). Gestational age of 12 weeks at the start of supplementation was noted in 58.57%, 64.29% and 41.43% of the women in group A, B and C had respectively (p=0.031). Majority of the women (88.33%) of the women in group C had pedal oedema (p<0.001) with presence of urine albumin (52.86%) (p<0.001). Majority of the women in group C (67.14%) had pre-eclampsia and complications compared to 32.86% in group A and 18.57% of in group B (p<0.001). The median gestational age at delivery was statistically similar in all the three groups (p=0.981). Most of the women (37.14%) of the women in group C delivered before 38 weeks of gestational compared to 18.57% in group B and 21.43% of in group A (p=0.032). In group C, 21.43% of the babies required NICU admission compared to 11.43% in group A and 8.57% of in group B (p=0.065). The common indication being preterm birth and low birth weight. Statistically significant difference was observed with respect to NICU stay (p=0.029).

Conclusions: High dose calcium, vitamin D3 combined with low dose aspirin, has significant benefit in preventing the pedal oedema and presence of urine albumin, regulating blood pressure at the time of delivery thereby PE with its associated complications and neonatal morbidity in terms of shorter duration of NICU stay.