International Journal of Reproduction, Contraception, Obstetrics and Gynecology

Endocrine interventions and live birth outcomes in women with recurrent pregnancy loss: a meta-analysis

Kiny-Binyumbe Doukaga, Shan Wang — Mon, 28 Sep 2026 00:00:00 +0530

Recurrent pregnancy loss (RPL) is a multifactorial reproductive disorder for which endocrine therapies are frequently considered, although their effects on live birth remain uncertain. This meta-analysis assessed the effectiveness of progesterone and levothyroxine on pregnancy outcomes in women with RPL. Following PRISMA 2020 guidance, PubMed, the Cochrane Central Register of Controlled Trials, and Web of Science were searched from January 2015 to the final search date without language restrictions. Eight studies involving 7,749 participants were included in the systematic review; quantitative synthesis was restricted to randomized controlled trials with comparable data. Mantel-Haenszel fixed-effect meta-analyses generated pooled risk ratios (RRs) with 95% confidence intervals (CIs), heterogeneity was assessed using I², and risk of bias was evaluated with Cochrane RoB 2. For progesterone versus placebo, two large trials (PROMISE and PRISM; n=4,864) showed no statistically significant improvement in live birth (RR=1.03, 95% CI=1.00-1.07; I²=0%; p=0.08). For levothyroxine, pooled analysis suggested a non-significant trend toward improved live birth (RR 1.25, 95% CI 0.90-1.73; I²=74%), but substantial heterogeneity limited confidence in the estimate. Differences in thyroid status and study populations may explain part of this variability. Current evidence does not support routine empirical progesterone or levothyroxine use in unselected women with RPL. Progesterone may offer modest benefit in selected higher-risk subgroups, particularly women with multiple previous miscarriages; treatment should therefore be individualized according to clinical characteristics and endocrine profiles.

Ruptured tubal ectopic pregnancy with a giant paratubal cyst successfully managed by emergency laparoscopy

Taqwa Ferdous, Shwe Lwin Moe Myint, Slavyana Maydanovych — Mon, 28 Sep 2026 00:00:00 +0530

A ruptured ectopic pregnancy is a life-threatening gynaecological emergency requiring prompt surgical intervention. The presence of a giant adnexal cyst can significantly complicate the surgical approach by limiting access and visualisation. We present the case of a 21-year-old primigravida with a ruptured left tubal ectopic pregnancy associated with a giant right paratubal cyst measuring 18×17×23 cm. Despite the technical challenges, the patient was successfully managed laparoscopically with multidisciplinary input, avoiding laparotomy and preserving future fertility.

Cervical ectopic pregnancy: a rare case report and review of literature

Mon, 28 Sep 2026 00:00:00 +0530

Cervical pregnancy is a gyneacological emergency which is rear and life threaten, the ectopic pregnancy implant in the endocervical canal and the trophoblast can penetrate through the cervical wall and into the uterine blood supply resulting in catastrophic haemorrhage. The incidence of cervical ectopic is less than 1%. Historically, the treatment had been hysterectomy because of the considerable risk of life-threatening haemorrhage, but in the recent past various conservative management modalities have been applied to preserve fertility. We report a case of cervical ectopic pregnancy in a young Nigerian woman who was managed conservatively. She was a 34 years old Gravida 4, Para2⁺¹ lady with living child and one previous caesarean section. She presented to our facility with painless vaginal bleeding of 6 hours duration following amenorrhoea of 8 weeks and 3 days. She had a serum positive pregnancy before presentation and Transvaginal scan done revealed gestational sac at the cervical region. She subsequently had evacuation of retained product and balloon catheter insertion at the cervix. She did well post operatively.

Recurrent hematometra in a young woman taking depot medroxyprogesterone: a case report

Kavya Kshatriya, Harshita Ramamurthy, Sharmila Nagendran, Neekita Pradhan — Tue, 08 Sep 2026 00:00:00 +0530

Hematometra is defined as the pathologic collection of blood within uterine cavity typically resulting from lower genital tract obstruction. Depot medroxyprogesterone acetate (DMPA) is an injectable progestin contraceptive possibly linked to spontaneous hematometra. This case report describes a young female receiving DMPA who presented with recurrent hematometra. A 31year old, non-pregnant woman, presented with continuous lower abdominal pain and severe dysmenorrhoea with history of receiving two doses of DMPA three months apart. She had undergone cervical dilatation with hematometra drainage twice before she presented to us. MRI abdomen and pelvis revealed adenomyotic bulky uterus with hematometra. Diagnostic hystero-laparoscopy was performed. Cervical stenosis was noted. Mechanical cervical dilatation with hematometra evacuation was done. She was advised to discontinue DMPA and take Dienogest post-operatively for 3 months. This case illustrates a rare presentation of recurrent hematometra which may possibly be linked to DMPA use. Long term DMPA use results in hypoestrogenic state, which can cause significant atrophy of endometrial and endocervical lining and this atrophy might lead to stenosis of cervical os leading to hematometra. Mechanical dilatation of cervix and evacuation of hematometra is considered as gold standard, but may be insufficient. In the patients receiving DMPA, a high index of suspicion for hematometra should be maintained. This case report contributes to emerging evidence of potential association between DMPA usage and occurrence of hematometra. It is observed that these cases can be effectively managed by contraceptive modification.

Laparoscopic management of an unruptured interstitial ectopic pregnancy following tubal recanalization: a case report emphasizing haemostatic and uterine reconstruction techniques

Rachitha M. Prasad, Sharmila Nagendran, Neekita Pradhan — Sat, 19 Sep 2026 00:00:00 +0530

Interstitial ectopic pregnancy is a rare and potentially life-threatening form of ectopic pregnancy because of the rich vascularity of the interstitial portion of the fallopian tube. Pregnancy following tubal recanalization carries a risk of ectopic implantation. We report a case of an unruptured interstitial ectopic pregnancy following bilateral tubal recanalization, managed successfully by laparoscopy. A 40-year-old G3P2L1 woman at 9 weeks of gestation presented with acute lower abdominal pain. Ultrasonography showed a left adnexal mass containing a live fetus with good cardiac activity. Laparoscopy revealed a 5×4 cm unruptured, highly vascular left interstitial pregnancy. Cornual wedge resection with left salpingectomy and uterine reconstruction was performed. Haemostatic control was achieved using dilute vasopressin and electrocautery, followed by multilayer closure of the myometrium and serosa. Estimated blood loss was 50 mL. Histopathology confirmed ectopic pregnancy and follow-up β-hCG was negative. Interstitial pregnancy requires early diagnosis because rupture can result in catastrophic haemorrhage. Careful laparoscopic surgery with effective haemostatic control and anatomical uterine reconstruction can provide definitive treatment in appropriately selected haemodynamically stable patients. A high index of suspicion is essential when pregnancy occurs following tubal recanalization. Prompt recognition and meticulous laparoscopic management can achieve effective haemostasis and preserve uterine integrity while avoiding major blood loss.

Story of recurrent bilateral ovarian dermoid cyst in a young woman: a case discussion

Kalyani Saidhandapani, Banmathi — Mon, 28 Sep 2026 00:00:00 +0530

Mature cystic teratomas (MCTs), also known as dermoid cysts, are the most common benign ovarian germ cell tumors, typically affecting women of reproductive age. Although usually unilateral and slow-growing, MCTs can be bilateral and carry a risk of recurrence, particularly in younger patients with large tumors. We report the case of a 29-year-old second gravida woman, known case of right ovarian dermoid cyst complicated by torsion at 18 weeks of gestation, managed by right salpingo-oophorectomy. Histopathology revealed a collision tumor comprising a mature cystic teratoma and mucinous cystadenoma. Two years later, the patient presented with intermittent left lower abdominal pain. Imaging suggested a left ovarian dermoid cyst. Laparoscopic cystectomy was performed, and histopathology confirmed a mature cystic teratoma. The postoperative course was uneventful. The patient exhibited multiple risk factors for recurrence, including young age at diagnosis, initial tumor size >11 cm, and subsequent bilateral involvement. This case highlights the importance of identifying key risk factors for MCT recurrence-namely, young age, large tumor size, and bilateral presentation. While imaging and tumor markers such as CA 19-9 aid in diagnosis, surgical excision remains the definitive treatment. In reproductive-age women, laparoscopy offers a fertility-sparing approach. Long-term follow-up is essential in high-risk patients to monitor for recurrence.

Failed dilatation and evacuation due to false passage in a case of retained products of conception following self-medication abortion: a case report

Aastha H. Patel, Aniket Nayak — Mon, 28 Sep 2026 00:00:00 +0530

Self-medication with medical termination of pregnancy (MTP) pills without supervision is a common practice in developing countries specially in India and can lead to significant complications. We report a case of a 28-year-old female who presented with prolonged vaginal bleeding following unsupervised intake of MTP pills at approximately six weeks of gestation. Despite undergoing two attempts of dilatation and evacuation (D&E) at a tertiary care center, retained products of conception persisted. On evaluation, transvaginal ultrasonography revealed a persistent intrauterine mass with calcification. A suspicion of false passage during the previous procedure was raised. Subsequent D&E under ultrasound guidance confirmed the presence of a false passage in the anterior uterine wall. The true uterine cavity was identified, and adherent calcified products were successfully removed using ovum forceps. The patient recovered well post-procedure. This case highlights the importance of ultrasound guidance during uterine evacuation especially in cases of suspected false passage and emphasizes the risks associated with unsupervised abortion practices.

Incarcerated incisional hernia containing a gravid uterus with overlying skin necrosis: a case report from a rural secondary hospital, Silchar, Assam, India

Veino Kuveio Dumai, Sathiafrey Devaraj Anjela, Sharlotte Jones — Mon, 28 Sep 2026 00:00:00 +0530

Incarcerated incisional hernia containing a gravid uterus with overlying skin necrosis is a rare obstetric complication. Delay in diagnosis and management may result in serious maternal and fetal complications, including uterine rupture, intrauterine fetal demise, infection and sepsis. We report the case of a 25 year old gravida 2 para 1 woman with a previous lower-segment caesarean section who presented in labour with an incarcerated incisional hernia and overlying skin necrosis. Emergency lower-segment caesarean section was performed along with excision of the necrotic skin and herniorrhaphy. Both maternal and fetal outcome were favourable following multidisciplinary management. Early diagnosis and timely surgical intervention are essential to prevent severe maternal and fetal morbidity in such cases.

Episiotomy scar endometriosis misdiagnosed as a stitch granuloma eight years after vaginal delivery: a case report

Chetan Anand Raghunandan, Kaushik Naik V., Shripad Hebbar — Mon, 28 Sep 2026 00:00:00 +0530

Endometriosis of an episiotomy scar is an uncommon form of extrapelvic endometriosis in which endometrial-like tissue implants within a perineal obstetric scar and undergoes cyclical hormonal change. It is often misdiagnosed, because the classical triad of previous episiotomy, a tender perineal nodule, and cyclical pain is complete in only about half of cases, and because the swelling mimics common perineal conditions such as suture granuloma, abscess, or Bartholin cyst. We report a 32-year-old woman, para 2, with an eight-year history of a painful swelling at her left episiotomy site. The cyclical nature of the pain had been overlooked at several earlier consultations, and she had been treated empirically with antibiotics for a presumed antibioma without benefit. Pelvic ultrasound was normal, and a working diagnosis of stitch granuloma was made. At operation a firm mass of 4 by 3 cm was found over the left labia minora; on incision it released thick chocolate-brown fluid, an appearance typical of an endometriotic cyst. The lesion was excised completely with a 1 cm margin of healthy tissue, and histopathology confirmed endometriosis. Recovery was uneventful and she remained free of recurrence at 12 months. Scar endometriosis should be considered in any reproductive-age woman with a long-standing painful perineal lump at an episiotomy site, even when cyclical symptoms are not reported spontaneously. A directed menstrual history and complete surgical excision with a healthy tissue margin are the keys to diagnosis and cure.

Challenges in pregnancy of a patient with cardiac sarcoidosis on implantable cardioverter defibrillator: a case report

Kalyani Saidhandapani, Banmathi — Mon, 28 Sep 2026 00:00:00 +0530

Cardiac sarcoidosis (CS) can present as ventricular tachycardia (VT) and cardiac arrest. Management of VT in CS is difficult and includes disease-specific agents, such as steroids, antiarrhythmic drugs (AADs), and implantation of an implantable cardioverter-defibrillator (ICD). With the advent of ICD technology in recent decades, patients with inherited or congenital cardiomyopathy have a greater chance of survival into adulthood. Women with ICDs in this group are now more likely to reach reproductive age. We report a case of a 24-year-old Primi, known case of CS with recurrent VT managed with ICD, immunosuppressants and steroids. Five months later, the patient became pregnant. A multidisciplinary approach was sought throughout her pregnancy with contribution from a cardiologist and rheumatologist. Along with cardiologist team and anaesthetist team our patient delivered an alive female baby at 36 weeks. Regular follow-up and timely delivery made this high-risk pregnancy successful.

Unusual presentation of a spontaneous broad ligament hematoma during pregnancy unmasking endometriosis in a primigravida inadvertently: a rare case report

Deeksha Sharma, Ravi Mannan, Ritesh Sharma — Mon, 28 Sep 2026 00:00:00 +0530

Spontaneous broad ligament hematoma during pregnancy is an extremely rare obstetric emergency that can present with acute abdomen and hemodynamic instability. It is usually associated with trauma, uterine rupture, or vascular abnormalities. Association with endometriosis is uncommon, particularly in women with spontaneous conception. We present a rare case series of spontaneous broad ligament hematoma in a primigravida and another patient with previous vaginal delivery, both having spontaneous conception, having no presenting complaints other than obstetric indication for which lower segment caesarean section was done. Spontaneous hematomas were an incidental finding in both cases, where in previously undiagnosed endometriosis was identified intra-operatively with unusual spontaneous hematomas extending to the posterior surface of uterus. Every lower segment caesarean section should be complemented with thorough exploration of posterior surface and adnexa including the peritoneal surfaces to look for any endometriotic spot, hematoma or any other unusual finding before final closure to prevent any adversity of materno-fetal outcome.

Mature cystic teratoma simulating caesarean scar pregnancy: a rare case report

Alisha Goyal, Tuhina Gupta, Manju Puri — Mon, 28 Sep 2026 00:00:00 +0530

Mature cystic teratomas (dermoid cysts) are common benign ovarian germ cell tumours that usually demonstrate characteristic radiological features. However, coexisting pelvic pathology and altered postoperative anatomy may occasionally result in misleading imaging appearances, posing a significant diagnostic challenge. Caesarean scar pregnancy (CSP) is a rare but potentially life-threatening form of ectopic pregnancy that requires prompt recognition and appropriate management. We report the case of a 30-year-old multiparous woman with a previous lower segment caesarean section who presented with heavy prolonged menstrual bleeding and foul-smelling vaginal discharge. Initial ultrasonography suggested a left ovarian dermoid cyst with bilateral hydrosalpinx. However, magnetic resonance imaging (MRI) performed at a tertiary centre demonstrated an extrauterine gestational sac containing fetal skeletal structures communicating with the uterine cavity through a previous caesarean scar, raising suspicion of CSP. The absence of pregnancy-related symptoms and a negative serum β-human chorionic gonadotropin level prompted further clinical evaluation. Exploratory laparotomy revealed a left ovarian mature cystic teratoma densely adherent to the previous caesarean scar, bilateral pyosalpinx, extensive pelvic adhesions, and a uterine scar defect with scar endometriosis. Histopathological examination confirmed the diagnosis. This case illustrates an unusual diagnostic pitfall in which the combined presence of calcified components within the dermoid cyst, a previous caesarean scar defect, dense pelvic adhesions, bilateral pyosalpinx, and scar endometriosis created an MRI appearance closely resembling a CSP. Careful clinicoradiological correlation and integration of laboratory findings remain essential to avoid misdiagnosis and guide appropriate surgical management.

From labour room to rehabilitation: foot drop following vaginal delivery — a case report of two cases

Auxeelia Packia Devi R. Rathinasamy, Kanmani Parivallal — Mon, 28 Sep 2026 00:00:00 +0530

Postpartum peripheral nerve injuries are uncommon neurological complications that may result in significant functional impairment. They can occur following vaginal delivery due to compression, traction, or prolonged positioning during labour, and may present as lower-limb weakness or foot drop. The common peroneal nerve is particularly vulnerable because of its superficial course around the fibular neck. We report two cases of postpartum foot drop following vaginal delivery in the absence of regional anaesthesia. The cases highlight the importance of recognizing obstetric peripheral nerve injuries, performing careful neurological assessment, localizing the site of nerve involvement, and excluding alternative neurological causes. Both patients were managed conservatively with neurological evaluation and rehabilitation, with subsequent clinical improvement. Awareness of postpartum nerve injuries and early initiation of appropriate rehabilitation may facilitate functional recovery and improve maternal outcomes.

Surgical excision of frontal meningioma in pregnancy

Sumanjot Kaur, Manisha Meena, Pooja Sikka, Sushanta K. Sahoo — Mon, 28 Sep 2026 00:00:00 +0530

We report a case of a pregnant woman at 33+3 weeks period of gestation presenting with recurrent seizure episodes without a background of hypertension. Neuroimaging revealed a well-defined extra-axial meningioma along the anterior falx in right frontal paramedian location. The patient underwent right frontal craniotomy with Simpson grade II excision with Caesarean delivery in same setting. A multidisciplinary team approach involving obstetricians, neurosurgery, and anesthesiology was employed to optimize maternal and fetal outcomes. Gross total resection of the tumour was achieved without intraoperative or postoperative complications. The patient showed resolution of neurological improvement postoperatively. Timely intervention and coordinated multidisciplinary care are essential to achieving favourable maternal and fetal outcomes.

A case report on leiomyoma associated with uterine anomaly

Shailaja K. Dave, Mahima Jain — Mon, 28 Sep 2026 00:00:00 +0530

Uterine leiomyomas are common benign smooth-muscle tumors of the uterus, whereas uterine didelphys is an uncommon Müllerian duct anomaly characterized by duplication of the uterine cavities and cervices. The coexistence of a large symptomatic leiomyoma with uterine didelphys may create diagnostic and surgical challenges because the abnormal anatomy can be difficult to recognize on routine clinical examination and ultrasonography. We report a 43-year-old multiparous woman who presented with heavy menstrual bleeding and lower abdominal pain for 9 months. On examination, the uterus was approximately 24 weeks in size and a vaginal septum was noted. Ultrasonography demonstrated a bulky uterus with multiple heterogeneous lesions suggestive of multiple fibroids. Her hemoglobin was 7.4 g/dl and she received three units of packed red blood cells preoperatively. A hysterectomy was planned because of the large symptomatic fibroid burden and completed family. Intraoperatively, a 15×15 cm leiomyoma with two additional approximately 6×6 cm leiomyomas was identified. Two separate uteri with attached cornual structures and two cervices were unexpectedly recognized during surgery. The uteri and multiple leiomyomas were removed in toto, and histopathology confirmed leiomyoma. This case highlights the importance of considering Müllerian anomalies when pelvic examination and imaging findings do not completely explain the anatomy. Careful preoperative assessment and anticipation of altered pelvic anatomy are important for safe surgical management of large leiomyomas associated with uterine anomalies.

When a wart blocks the way: urethral condyloma presenting as acute urinary retention in pregnancy

Mon, 28 Sep 2026 00:00:00 +0530

Urethral wart (condyloma acuminatum) is a rare cause of acute urinary retention (AUR) in pregnancy. We report a 29-year-old gravida 2 who presented at 32 weeks' gestation with AUR. Examination revealed a 2×1 cm friable, vascular growth just at the urethral meatus obstructing the lumen. There were no associated other sexually transmitted infections nor she had any pelvic pain or foul-smelling discharge and fetal surveillance was reassuring. There was immediate relief in urinary retention following excision under local anaesthesia. Histopathology confirmed condyloma acuminatum with koilocytosis. She subsequently had a spontaneous preterm vaginal delivery of a healthy 2.2 kg female infant, with no repeat episode of urinary retention. This case highlights urethral wart as a rare mechanical cause of bladder outlet obstruction in pregnancy and shows that prompt local excision safely restores voiding without adverse maternal or fetal outcome.

Chorioangioma of placenta: a rare placental cause for adverse fetal outcome

Mon, 28 Sep 2026 00:00:00 +0530

Chorioangioma is a benign angioma of placenta arising from chorionic tissue. Large chorioangiomas are usually associated with adverse fetal or maternal outcome such as fetal growth restriction, polyhydramnios, fetal anemia, intrauterine fetal distress, intrauterine fetal demise, preterm delivery, premature rupture of membrane and sometimes association with pre-eclampsia in the mother. Here we are reporting a case of 35 years old primigravida who was diagnosed with large chorioangioma of 7.1×4.8×5.0 cm on her 28-32 weeks growth scan with estimated fetal weight of 2.259 kgs. She was having regular antenatal checkups previously. Her previous ultrasounds were reported normal. There were no abnormal findings like fetal growth restriction, polyhydramnios, signs of fetal anemia and all doppler parameters were normal. Usually, large Chorioangiomas are associated with complications. This placental growth seen only at 32 weeks it did not lead to any complications and patient had an uneventful delivery. However large Chorioangiomas require strict monitoring by ultrasound and doppler studies for fetal and maternal well being.

A catastrophic posterior wall rupture in a non-scarred uterus: a life-saving obstetric hysterectomy

Rashmi Singh, Aisha Rahman, Aastha Gupta — Mon, 28 Sep 2026 00:00:00 +0530

Uterine rupture is a rare but life-threatening obstetric emergency associated with significant maternal and perinatal morbidity and mortality. Although uterine rupture is more common in women with a previous uterine scar, it can also occur in an unscarred uterus and is often unpredictable. This report aims to highlight the clinical presentation, management, and outcome of such a case. We describe a case of a 32 year old multiparous woman at 40 weeks and 3 days of gestation who was referred in a state of shock following a prolonged trial of labor. Clinical examination and intraoperative findings confirmed uterine rupture with intrauterine fetal demise. Emergency laparotomy was performed after initial resuscitation. Intraoperative findings revealed approximately 2 liters of hemoperitoneum and a complete rupture of the posterior wall of uterus vertically extending into the cervix and laterally extending to left pelvic wall, with the fetus lying in the peritoneal cavity. A total obstetric hysterectomy with left salpingo-oophorectomy was performed due to extensive rupture. The patient received blood transfusion and intensive postoperative care, resulting in gradual recovery and stabilization. Rupture of an unscarred uterus, though rare, can lead to catastrophic outcomes if not recognized promptly. Early diagnosis, timely referral, aggressive resuscitation, and prompt surgical intervention are critical for maternal survival. Strengthening intrapartum monitoring and ensuring appropriate labor management can help prevent such complications.

Ovarian torsion mimicking subacute intestinal obstruction: a rare case report

Gargi Anand, Tanvi Sharma, Zara Ibtesham, Srishti Amarnath — Mon, 28 Sep 2026 00:00:00 +0530

Ovarian torsion is a time-sensitive gynaecological emergency resulting from rotation of the ovary, with or without the fallopian tube, around its vascular pedicle. Delayed diagnosis may lead to ischemia, necrosis and loss of ovarian function. Although the condition typically presents with acute unilateral pelvic pain, atypical manifestations may resemble gastrointestinal disorders, creating diagnostic uncertainty and delaying appropriate management. A 29-year-old multiparous woman presented with sudden-onset left iliac fossa pain, progressive abdominal distension, obstipation for four days and recurrent episodes of non-bilious vomiting, suggestive of subacute intestinal obstruction. Her medical history was significant for ovulation induction complicated by ovarian hyperstimulation syndrome and previous pelvic surgeries, including right salpingo-oophorectomy. Initial radiological evaluation demonstrated features of intestinal obstruction with a large left adnexal lesion. Magnetic resonance imaging revealed an enlarged oedematous left ovary with a twisted vascular pedicle demonstrating the characteristic whirlpool sign, consistent with ovarian torsion. Emergency surgical exploration identified a gangrenous left Tubo-ovarian complex twisted approximately 2.5 turns with associated hemoperitoneum and dense pelvic adhesions. Left salpingo-oophorectomy was performed. Histopathological examination confirmed haemorrhagic infarction with extensive congestion, oedema and coagulative necrosis. The postoperative recovery was uneventful. Ovarian torsion presenting as intestinal obstruction is an uncommon clinical entity. Gastrointestinal symptoms may predominate due to bowel compression, reactive ileus, or adhesion-related obstruction, masking the underlying gynaecological pathology. In such cases, MRI findings, particularly identification of the whirlpool sign, play an important role in establishing the diagnosis and facilitating timely surgical intervention. Ovarian torsion should remain an important differential diagnosis in reproductive-age women presenting with unexplained gastrointestinal symptoms accompanied by an adnexal mass. Early recognition, appropriate imaging and prompt surgical management are essential to reduce morbidity and maximize the possibility of ovarian preservation.

Accidentally diagnosed placenta accreta managed conservatively with methotrexate

Megha B. Patil, Modhusmita Chetia, Payal Modi — Mon, 28 Sep 2026 00:00:00 +0530

Placenta accreta is a life-threatening obstetrical emergency that requires multidisciplinary approach. The incidence of placenta accreta is increasing over years. In some cases, its diagnosis is occasionally discovered at the time of delivery when there occurs difficulty to deliver placenta. In general, the recommended management of suspected placenta accreta is planned preterm caesarean hysterectomy with the placenta left in situ because attempts at removal of the placenta are associated with significant hemorrhage. Recently, adjuvant therapy with methotrexate has been tried in the treatment of morbidly adherent placenta in patients desiring further child bearing. This case is presented to highlight the conservative management of accidently diagnosed placenta accreta with inj. Methotrexate in hemodynamically stable patient and it a safe alternative than extirpative management. A 28-year-old, G4P1L1A2 with a previous normal vaginal delivery, with GDM (on medical nutritional therapy) with hypothyroidism presented at 38 weeks 1 day of gestation with raised blood pressure. Patient was induced for labour and patient delivered vaginally. Placenta could not be delivered out and accidental morbidly adherent placenta accreta was diagnosed. Patient was hemodynamically stable. After discussing the treatment option with her family, she was being managed with Inj. Methotrexate and followed up regularly with ultrasound scan and antibiotic cover. Placental tissue reabsorbed gradually and patient expelled out retained placental tissue completely after 14 weeks of her delivery. One of the potentially catastrophic obstetric complications, placenta accreta is alarmingly on the rise due to repeated D and C and increasing caesarean section rate. It can be diagnosed accidently during third stage of labor. Methotrexate being a cytotoxic drug can be considered to promote placental tissue resorption in hemodynamically stable patient with regular follow up desiring uterus preservation.

Pregnancy in a woman with Henoch-Schönlein purpura: a case report

Sonal Tyagi, Juhi Srivastava, Dimpy Gomber — Mon, 28 Sep 2026 00:00:00 +0530

Henoch-Schonlein purpura (HSP), is an IgA-mediated small-vessel vasculitis that is uncommon in adults and rarely encountered in pregnancy. We report the pregnancy outcome of a 28-year-old woman with biopsy- and direct immunofluorescence-confirmed HSP. An unbooked patient presented at 38+4 weeks with fever, vomiting and decreased fetal movements. She underwent close maternal and fetal surveillance and supportive treatment. After spontaneous onset of labour, emergency lower-segment caesarean section was performed for non-progression of labour, resulting in delivery of a 3.360-kg live male infant. The postoperative course was complicated by lower respiratory tract infection with acute respiratory distress syndrome, requiring 5 days of intensive care and non-invasive ventilation; she subsequently recovered and was discharged on oral antibiotics. This case highlights the importance of multidisciplinary surveillance of renal function, blood pressure, maternal status and fetal wellbeing in pregnancies complicated by a history of HSP.

Vulval melanoma: a case report on an uncommon malignancy with poor prognosis

Rohith S. Raju, Nazia Ishrat, Nishat Akhtar — Mon, 28 Sep 2026 00:00:00 +0530

Vulvar melanoma is a rare and aggressive malignancy of the female genital tract. It predominantly affects older women and is frequently diagnosed late because lesions may be clinically subtle or mistaken for benign vulvar disease. This case report represents a 66 year old postmenopausal woman who with a six-year history of non-foul-smelling, non-blood-stained vaginal discharge and persistent perineal pruritus. Examination revealed a 2×3 cm leukoplakic plaque over the right labium minus. An initial excision biopsy showed mild dysplasia, while repeat biopsy six months later demonstrated focal severe dysplasia. Magnetic resonance imaging subsequently demonstrated suspicious bilateral inguinal lymphadenopathy. Following multidisciplinary counselling, the patient underwent bilateral radical vulvectomy with bilateral inguinal and femoral lymph-node dissection. Histopathology revealed malignant melanoma with a Breslow thickness of 2 mm and Clark level IV invasion; the lesion was non-ulcerated and margins were free of tumour. Immunohistochemistry was positive for HMB-45 and S100. The reported final pathological stage was pT2aN3aMx. The postoperative course was complicated by wound dehiscence, followed by acute pulmonary embolism and death despite resuscitative measures. The case highlights the diagnostic difficulty of vulvar melanoma, the prognostic importance of tumour thickness and nodal disease, and the need to integrate oncological treatment with meticulous postoperative venous-thromboembolism prevention and surveillance.

A case report: placental abruption complicated by disseminated intravascular coagulation, atonic postpartum hemorrhage, massive transfusion and obstetric hysterectomy

Pratiksha A. Vansdadiya — Mon, 28 Sep 2026 00:00:00 +0530

Placental abruption is a potentially life-threatening obstetric emergency caused by premature separation of the placenta from the uterine wall. Severe abruption may be associated with intrauterine fetal death, disseminated intravascular coagulation (DIC), major hemorrhage and renal or other organ dysfunction. The case represents a 25-year-old G6P5L5 woman at 35 weeks and 6 days of pregnancy who presented with severe abdominal pain and absent fetal movements. Clinical assessment and ultrasonography were consistent with placental abruption with intrauterine fetal death and a large retroplacental clot. Laboratory evaluation showed severe anemia and features of coagulopathy. Emergency lower-segment cesarean section was undertaken. A male baby was delivered by vertex presentation but did not cry after birth. Approximately 1500 ml of retroplacental clots were removed, and the uterus was found to be floppy and atonic. Obstetric hysterectomy was performed for definitive control of hemorrhage. The patient required extensive transfusion of blood and blood products, was managed for DIC, remained vitally stable after resuscitation, and was discharged on postoperative day 11. This case emphasizes rapid recognition, prompt operative management, aggressive correction of coagulopathy, and timely definitive control of severe obstetric hemorrhage.

Bladder endometriosis masquerading as recurrent urinary tract infection: successful fertility-preserving laparoscopic management

Raksha Gaikar, ⁠Niteen Ghorpade, Krunal Yerne — Mon, 28 Sep 2026 00:00:00 +0530

Urinary tract endometriosis is an uncommon manifestation of deep infiltrating endometriosis, accounting for approximately 1% of all endometriosis cases, with the bladder being the most frequently involved urinary organ. Because its symptoms often mimic recurrent urinary tract infection or bladder pain syndrome, diagnosis is frequently delayed. A 38-year-old woman presented with recurrent dysuria, severe dysmenorrhea and urinary frequency for one year despite repeated medical treatment. Pelvic MRI demonstrated deep infiltrating endometriosis involving the posterior bladder wall with associated bilateral ovarian endometriomas, adenomyosis and rectosigmoid serosal involvement. Cystoscopy revealed a bluish submucosal lesion over the posterior bladder wall with sparing of the trigone. The patient underwent laparoscopic bilateral ovarian cystectomy, excision of deep infiltrating endometriosis, bilateral ureterolysis, adenomyomectomy and laparoscopic partial cystectomy with two-layer bladder repair. Histopathology confirmed bladder endometriosis. The postoperative course was uneventful, and urinary symptoms resolved following catheter removal and hormonal suppression with dienogest. Bladder endometriosis should be considered in women with persistent lower urinary tract symptoms refractory to conventional treatment, particularly when associated with pelvic pain or dysmenorrhea. Early MRI evaluation and multidisciplinary laparoscopic surgery allow complete excision while preserving fertility.

Beyond the ectopic – pregnancy luteoma as a rare case of acute abdomen in pregnancy

Krishma Thakur, Shubhi Bandlish, Radhika Gupta, Madhu Chaudhary — Mon, 28 Sep 2026 00:00:00 +0530

Luteoma of pregnancy is a rare benign tumor attributed to the nodular hyperplasia of theca interna cells in the ovaries. Although the exact pathophysiology is still unknown, it is mainly implicated to the elevated levels of beta human chorionic gonadotrophin in pregnancy and pre-existing endocrinopathy. Here we are presenting the case of a female with an unlocalized pregnancy who presented in the emergency with symptoms of acute pain abdomen and presence of free fluid in the abdomen and was taken up for laparotomy in view of acute abdomen and possibility of ruptured ectopic pregnancy but the intraoperative picture to our surprise was entirely different. Intraoperatively, large solid cystic mass of 6 cm was found and salpingo-oophorectomy was done which was later confirmed as pregnancy luteoma on histopathology.

Determinants of postpartum family planning uptake among women in the Union of the Comores: the role of socio-demographic characteristics, partner support and contraceptive awareness

Naima I. Abbas, Youssouf Djabir, Ahamada A. Kamal, Akinyinka O. Omigbodun — Sat, 05 Sep 2026 00:00:00 +0530

Background: The postpartum period is an important opportunity to prevent unintended pregnancies through family planning (FP). Despite high contraceptive awareness, postpartum FP (PPFP) uptake remains low in many low- and middle-income countries (LMICs), including Comoros. This study assessed factors associated with postpartum contraceptive uptake among women in the Union of the Comoros.

Methods: A cross-sectional study was conducted among 251 pregnant and postpartum women aged 15 -49 years attending health facilities across the three islands of Comoros from July to December 2024. Data were collected using a structured questionnaire, and associations with PPFP uptake were assessed using chi-square tests. Ethical approval was obtained (UI/EC/24/0302 and N°24002/CNESS/PR).

Results: Among the participants, 78.9% had knowledge of FP, while 65.0% reported current contraceptive use. Injectable contraceptives were the most commonly used method (43%), followed by implants (23%) and oral contraceptive pills (12%). PPFP uptake was significantly associated with island of residence (p=0.0005), educational level (p=0.042), and number of living children (p=0.013). Women from Anjouan had the highest proportion of contraceptive use (25.0%), followed by Ngazidja (23.0%) and Mohéli (16.0%). Higher contraceptive uptake was observed among women with secondary and tertiary education compared with those without formal education. Women with three or more living children had the highest proportion of contraceptive use (46.1%). Age, marital status, employment status, income sufficiency, and desire for another child were not significantly associated with PPFP uptake.

Conclusions: PPFP uptake in Comoros is influenced by geographic location, education, and parity. Improving access to quality PPFP services and targeted interventions may enhance contraceptive use and maternal health outcomes.

Impact of elevated maternal bile acid levels on fetomaternal outcomes in intrahepatic cholestasis of pregnancy: a retrospective observational study

Jijisha Ali, Aisha Saifi, Janaki Gopalan, George Alexander — Mon, 28 Sep 2026 00:00:00 +0530

Background: Intrahepatic cholestasis of pregnancy (ICP) is a reversible liver disorder associated with elevated maternal bile acids and adverse perinatal outcomes. The degree of bile acid elevation is considered a key prognostic marker. To evaluate the impact of elevated maternal bile acid levels on maternal and neonatal outcomes and to identify bile acid thresholds associated with adverse pregnancy outcomes.

Methods: A retrospective study was conducted at Mediclinic Welcare Hospital, Dubai, from January 2023 to December 2024. Sixty pregnant women diagnosed with ICP were included after exclusion of incomplete records. Patients were categorized based on bile acid levels into gestational pruritus (<19 µmol/l), mild (19–39 µmol/l), moderate (40–99 µmol/l), and severe (≥100 µmol/l). Maternal and neonatal outcomes were analyzed.

Results: Most patients had gestational pruritus (65%) followed by mild (26.7%), moderate (6.7%), and severe ICP (1.7%). The majority were South Asian (73.3%) and multigravida (61.7%). No significant association was found between bile acid levels and maternal complications. Term delivery occurred in 83.3% of cases. Neonatal outcomes were favorable in 71.7%, with NICU admissions (26.7%) primarily due to respiratory distress rather than bile acid severity. Ursodeoxycholic acid therapy improved bile acid levels in nearly half of the cases.

Conclusions: Intrahepatic cholestasis of pregnancy was associated with favourable maternal and neonatal outcomes in this cohort when managed with close antenatal surveillance, bile acid monitoring, and individualized timing of delivery.

Reproductive outcomes after laparoscopic surgery in women with tubal infertility – a retrospective study of 136 cases at Pikine National Hospital, Senegal, 2018-2023

Mon, 28 Sep 2026 00:00:00 +0530

Background: Evidence on reproductive outcomes after laparoscopic management of tubal infertility remains limited in West Africa. This study described reproductive outcomes after laparoscopic surgery for tubal infertility at Pikine National Hospital, Senegal.

Methods: A retrospective descriptive and analytical study were conducted from January 2018 to December 2023. Women with documented tubal infertility who underwent laparoscopic management and had assessable reproductive follow-up were included. Women treated for ectopic pregnancy and those with incomplete clinical or follow-up data were excluded. Data were obtained from medical records and standardized telephone interviews. The primary outcome was pregnancy after surgery.

Results: The study included 136 women with a mean age of 38.1±6.1 years. Primary and secondary infertility each accounted for 50.0% of cases. Chromotubation results were available for 99 women: bilateral tubal patency was observed in 41.4%, unilateral patency in 24.2%, and bilateral proximal obstruction in 33.3%. During follow-up, 37 women became pregnant, giving an overall pregnancy rate of 27.2%. Of these pregnancies, 26 (70.3%) were carried to term, six (16.2%) ended in spontaneous abortion, and five (13.5%) were ongoing at study closure. No ectopic pregnancy was recorded. Age was not significantly associated with pregnancy (p=0.384).

Conclusions: More than one-quarter of women treated laparoscopically for tubal infertility subsequently achieved pregnancy. Prospective multicentre studies using standardized lesion grading and clearly defined reproductive follow-up are needed.

Follicle-stimulating hormone versus anti-Müllerian hormone: age related relevance to intracytoplasmic sperm injection results

Rana M. Ibrahim, Fadia J. Alizzi, Qais A. Alkhafaji — Mon, 28 Sep 2026 00:00:00 +0530

Background: Maternal age significantly impacts ovarian reserve and intracytoplasmic sperm injection (ICSI) outcomes. This study evaluated the influence of maternal age on ovarian reserve parameters and ICSI treatment results.

Methods: This prospective observational cohort study enrolled 100 infertile women (aged 20-43) undergoing ICSI in Baghdad (March 2025-February 2026), stratified by age: Group A (<35 years, n=65) and group B (≥35 years, n=35). Baseline anti-Müllerian hormone (AMH), follicle-stimulating hormone (FSH), estradiol (E2), and AFC were evaluated on cycle day 2-3. All patients received a standardized fixed antagonist protocol.

Results: Women aged <35 years had significantly higher baseline AMH levels than those ≥35 years (2.06±0.94 vs. 1.51±0.82 ng/ml, p=0.004). No significant differences were found in basal FSH (p=0.876), AFC (p=0.070), or E2 (p=0.326). Women aged ≥35 required significantly higher gonadotropin doses (41.0±5.05 vs. 29.3±6.72 ampoules, p<0.001) and longer stimulation (10.4±1.09 vs. 9.63±1.32 days, p=0.003). Retrieved oocytes (6.86±3.59 vs. 7.57±3.09, p=0.302), MII oocytes (p=0.097), and fertilized oocytes (p=0.136) were lower in older women but these differences did not reach statistical significance.

Conclusions: Ovarian responsiveness declines with maternal age, requiring higher gonadotropin doses and prolonged stimulation. Serum AMH is a more sensitive marker than basal FSH for detecting early age-related ovarian decline in ICSI candidates.

Per-operative anesthetic complications during lower segment caesarean section and their management

Sabrin Farhad, Tahmina Akter, M. Ridwanul Ferdous — Mon, 28 Sep 2026 00:00:00 +0530

Background: Lower uterine segment caesarean section (LUCS) is one of the most frequently performed surgical procedures worldwide. Both spinal anesthesia (SA) and general anesthesia (GA) are commonly employed, each carrying a distinct profile of per-operative complications. Prompt recognition and management of these complications, including rare but serious events, are critical for maternal safety. Objective was to determine the frequency, types, and management outcomes of per-operative anesthetic complications during LUCS under spinal and general anesthesia.

Methods: A prospective cohort study was conducted at the department of gynecology and obstetrics, Uttara Adhunik Medicak College Hospital, Dhaka, Bangladesh, from January 2025 to December 2025. A total of 163 pregnant women undergoing LUCS were enrolled using purposive sampling. Data on intraoperative complications under SA (n=112) and GA (n=51) were recorded. Management strategies and immediate outcomes were analyzed using SPSS version 23.0.

Results: Complications occurred in 48 patients (29.4%). Under SA, hypotension (32.1%), bradycardia (12.5%), and rare complications, including high spinal (1.8%) and transient radicular irritation (0.9%), were observed. Under GA, desaturation (7.8%), failed intubation (3.9%), and one case of anaphylaxis to rocuronium (2.0%) occurred. All complications were managed successfully without maternal mortality.

Conclusions: Per-operative anesthetic complications during LUCS are not uncommon. While hypotension under spinal anesthesia predominates, rare complications such as high spinal and anaphylaxis require high vigilance. Protocol-driven management ensures favorable outcomes.

Role of transvaginal ultrasound in diagnosis of adenomyosis, leiomyoma, or both in comparison with histopathological findings

Mon, 28 Sep 2026 00:00:00 +0530

Background: Adenomyosis and leiomyoma are common benign uterine disorders associated with abnormal uterine bleeding, dysmenorrhea, pelvic pain, infertility, and reduced quality of life. As treatment strategies differ between these conditions, accurate preoperative diagnosis is essential. Transvaginal ultrasonography (TVS) is a widely available, cost-effective imaging modality, while histopathology remains the gold standard for diagnosis.

Methods: This analytical cross-sectional study was conducted in the Department of Obstetrics and Gynecology, BIRDEM General Hospital, Dhaka, from January 2023 to June 2024. A total of 150 women aged 30–55 years with a TVS diagnosis of adenomyosis, leiomyoma, or both who subsequently underwent hysterectomy, myomectomy, or adenomyomectomy were included. TVS findings were compared with histopathological examination. Data were analyzed using SPSS version 26.0.

Results: The mean age was comparable among the three groups (p=0.523). Women with adenomyosis more frequently had regular menstrual cycles and average menstrual flow, whereas heavy menstrual bleeding was more common in women with leiomyoma and combined disease (p<0.0001). Severe dysmenorrhea was significantly associated with adenomyosis and combined disease (p<0.0001). Histopathology confirmed 15 of 19 TVS-diagnosed adenomyosis cases, 78 of 92 leiomyoma cases, and 34 of 39 combined cases (all p<0.0001). For the diagnosis of combined adenomyosis and leiomyoma, TVS demonstrated a sensitivity of 70.8%, specificity of 95.0%, positive predictive value of 87.1%, negative predictive value of 87.3%, and overall accuracy of 87.3%.

Conclusion: Transvaginal ultrasonography is a reliable, accurate, and cost-effective diagnostic tool for identifying adenomyosis, leiomyoma, and their coexistence, showing excellent agreement with histopathological findings.

Myometrial disease extent on standardized morphological uterus sonographic assessment transvaginal ultrasound is associated with severe dysmenorrhea in women with adenomyosis: a prospective observational study

Essa M. Arafa — Mon, 28 Sep 2026 00:00:00 +0530

Background: Aim was to evaluate associations between standardized morphological uterus sonographic assessment (MUSA) transvaginal ultrasound features and dysmenorrhea severity in women with adenomyosis.

Methods: This prospective observational study included 42 consecutive premenopausal women with secondary dysmenorrhea and sonographically diagnosed adenomyosis between March 2025 and March 2026. Standardized transvaginal ultrasound was performed using a GE Voluson E8 system with an 8-MHz transvaginal transducer. MUSA features, disease type, and myometrial disease extent were recorded. Dysmenorrhea was assessed using a 0-10 numerical rating scale. Group comparisons and diagnostic performance measures were evaluated.

Results: Participants had mild (n=16), moderate (n=10), or severe (n=16) dysmenorrhea. Heavy menstrual bleeding, dyspareunia, chronic pelvic pain, several direct MUSA features, and the presence of at least two direct MUSA features increased across symptom groups. Myometrial involvement >50% occurred in 56.3% of women with severe dysmenorrhea versus 6.3% with mild symptoms. For severe dysmenorrhea, disease extent >50% had 56.3% sensitivity, 88.5% specificity, 75.0% positive predictive value, 76.7% negative predictive value, and 76.2% accuracy.

Conclusions: Greater myometrial disease extent was strongly associated with dysmenorrhea severity in this cohort. Standardized reporting of disease extent may add clinically useful information to MUSA-based ultrasound assessment, but larger patient-level studies are required to determine independent predictive value.

Knowledge of caesarean section and its complications among women attending antenatal clinic in a tertiary facility

Weyinmi E. Kubeyinje, Sarah O. Ikonomwan, Jessica E. Kubeyinje, Reuben O. Iweka — Mon, 28 Sep 2026 00:00:00 +0530

Background: Caesarean section is a common surgical procedure performed to deliver a baby when a vaginal birth poses risks to the mother or child. Understanding the procedure among pregnant women could influence their perception of the procedure. This study therefore aimed to assess the knowledge of Caesarean sections among pregnant women attending antenatal care at the University of Benin Teaching Hospital (UBTH).

Methods: This was a descriptive cross-sectional study, involving 131 consenting pregnant women attending antenatal care at UBTH. Ethical approval was obtained from the Ethics Committee of the University of Benin Teaching Hospital. Data were collected through structured questionnaires. Quantitative data were analyzed using descriptive and inferential statistics using statistical package for the social sciences (SPSS) 26.0, and p values of less than 0.05 were considered statistically significant.

Results: The findings reveal that while 91.6% of respondents understood the meaning of caesarean section. There are gaps in knowledge regarding specific issues, such as the safety of the procedure and its implications for future pregnancies. The study highlights that fear of surgery (67.9%), financial constraints (64.9%), and cultural influences (55.0%) are major barriers to accepting the procedure. Infection, bleeding and anaesthetic injuries were recognized as possible complications of caesarean section in 65.6% of respondents.

Conclusions: The study underscores the need for targeted educational interventions and supportive counseling that involve both women and their families to address misconceptions regarding caesarean section.

Incidence, indication and complications of primary caesarean section in primigravida and multigravida at secondary care centre

Harshita Verma, Sangeeta Singhal, Zeel Dakshay Shah — Mon, 28 Sep 2026 00:00:00 +0530

Background: Caesarean section (CS) is one of the most common obstetric surgeries, with rates rising globally beyond the World Health Organization’s recommended 10–15%. Its overuse increases maternal risks like hemorrhage and abnormal placentation and neonatal issues such as respiratory distress. Understanding the incidence and causes of primary CS, especially in primigravida and multigravida, is essential. This study aimed to compare their incidence, indications and maternal-fetal complications at a secondary care hospital.

Methods: This prospective observational included a total of 1200 women were enrolled 600 primigravida (Group A) and 600 multigravidas with previous vaginal deliveries (Group B). Women with prior CS or non-viable pregnancies were excluded. Data on demographics, obstetric history and outcomes were recorded. Mode of delivery, CS indications and complications were analyzed. Statistical analysis was done using SPSS v26; p<0.05 was significant.

Results: Of 1200 women, 315 (26.25%) underwent CS, more in primigravida (30.33%) than multigravida (22.17%). Elective CS was higher in Group A (15.0% vs 8.5%), most often for oligohydramnios. Emergency CS was mainly for fetal distress in primigravida (32.61%) and meconium-stained liquor in multigravida (24.39%). PPH was more frequent in multigravida (9.02%). Neonatal outcomes showed no significant differences.

Conclusions: Primary CS was more common in primigravida, especially elective cases. Fetal distress and meconium-stained liquor were leading emergency indications. PPH was higher in multigravida, while neonatal outcomes were comparable. Improved antenatal care and counselling may reduce unnecessary CS, with parity-based interventions enhancing outcomes.

Incidence and determinants of surgical site infection following cesarean section: a one-year retrospective cohort study from a tertiary care centre in North India

Kanika Burman, Manmeet Kaur, Seema — Mon, 28 Sep 2026 00:00:00 +0530

Background: Surgical site infection (SSI) remains a significant postoperative complication following lower segment cesarean section (LSCS) and contributes to maternal morbidity and prolonged hospitalization.

Methods: A retrospective cohort study was conducted at ESIC Medical College and Hospital, Ludhiana, from 1 February 2025 to 31 January 2026. All women undergoing LSCS during the study period (n=544) were included. SSI was defined according to Centers for Disease Control and Prevention criteria. Statistical analysis was performed using chi-square test and independent t test. A p<0.05 was considered statistically significant.

Results: Among 544 women undergoing LSCS, 44 developed SSI, resulting in an incidence of 8.08%. Obesity (BMI ≥30 kg/m²), emergency CS, and repeat CS were significantly associated with SSI (p<0.05). Patients with SSI had significantly longer postoperative hospital stay than those without SSI (8.2±2.3 vs 4.1±1.2 days; p<0.001).

Conclusions: The incidence of SSI was 8.08%. Maternal obesity, emergency surgery, and repeat CS were significant determinants. Strengthening perioperative infection-prevention protocols is essential to reduce postoperative morbidity.

Uterine artery embolization versus total abdominal hysterectomy as a treatment modality: a comparative study of clinical outcomes and patient satisfaction in women with uterine fibroids ≤10 cm

Chuni Sangmu Bhutia, Pratibha Garg, Manohar Singh Rathore — Mon, 28 Sep 2026 00:00:00 +0530

Background: Uterine fibroids are the most common benign tumours affecting women of reproductive age. Total abdominal hysterectomy (TAH) is the definitive treatment, while uterine artery embolization (UAE) is a minimally invasive alternative. This study compares clinical outcomes and patient satisfaction between UAE and TAH.

Methods: A prospective observational study including 30 women with symptomatic uterine fibroids ≤10cm. Patients were divided into two groups: UAE(n=15) and TAH (n=15). Follow-up was done at 3 months, 6 months and 1 year.

Results: UAE showed shorter operative time, reduced blood loss, less postoperative pain and shorter hospital stay compared with TAH. Fibroid reduction up to 60% at one year was observed in the UAE group. Psychological well-being improved in 80% of UAE patients and 75% of TAH patients.

Conclusions: UAE is a safe and effective minimally invasive alternative to hysterectomy for symptomatic fibroids ≤ 10cm with high patient satisfaction and faster recovery.

Pap smear screening in mid-trimester pregnant women: a prospective observational study in a tertiary care centre

Alaka Banerjee, Ankita Dey, Priyadarshini V. Patil — Mon, 28 Sep 2026 00:00:00 +0530

Background: Cervical cancer is preventable if detected early, yet it remains a leading cause of mortality among women in India. While routine cervical screening is often underutilized during gestation due to safety and precision concerns, there is growing clinical interest in evaluating its relevance during the mid-trimester of pregnancy (14–28 weeks) to optimize maternal health monitoring. The study aims to evaluate the baseline prevalence and associated risk factors of abnormal Pap smears in pregnant individuals, while monitoring the subsequent progression or regression of identified cellular dysplasia throughout the postnatal period.

Methods: This hospital-based, single-site, prospective cross-sectional observational study systematically sampled and enrolled antenatal patients attending the outpatient department of Obstetrics and Gynecology at Silchar Medical College and Hospital during their mid-trimester (14–28 weeks).

Results: Cytological results from 200 participants revealed 47.4% normal smears, 28.65% inflammatory smears, 14.58% candidiasis, 4.69% bacterial infections and 3.65% Trichomonas vaginalis. Smear findings varied significantly across gestational age groups (p=0.001%)), with normal cytologies peaking at 19–23 weeks (57.6%) and candidiasis staging higher at 14–18 weeks.

Conclusions: Mid-trimester Pap smears are a safe, practical tool for opportunistic prenatal screening. Younger age groups (21–25 years) correlate with normal findings, whereas older cohorts trend toward inflammatory updates.

Neonatal outcomes in gestational diabetes mellitus: metformin alone versus metformin with insulin: a retrospective cohort study in India

Mon, 28 Sep 2026 00:00:00 +0530

Background: Gestational diabetes mellitus (GDM) is associated with adverse neonatal outcomes, including increased neonatal intensive care unit (NICU) admissions and differences in birth weight. Although metformin is commonly used for glycemic control in GDM, some patients require adjunctive insulin therapy. Comparative data on neonatal outcomes between these regimens remain inadequate.

Methods: This retrospective cohort study was conducted at a tertiary care center in Bengaluru, India. Medical records of women with singleton GDM pregnancies were analyzed and categorized into two groups: metformin monotherapy and metformin plus insulin. Primary outcomes were NICU admission and neonatal birth weight. Logistic regression was utilized to determine predictors of NICU admission, and linear regression estimated determinants of birth weight.

Results: Among 123 GDM pregnancies, 52.8% received metformin alone and 47.2% received combination therapy. NICU admissions were significantly lower in the metformin group compared to the combination group (46.2% versus. 74.1%, p=0.002). After adjusting for gestational age, metformin monotherapy was associated with reduced odds of NICU admission (OR=0.41, p=0.032), though maternal HbA1C emerged as the strongest predictor (AUC=0.751). When both HbA1C and birth weight were included in the model, treatment regimen lost statistical significance (p=0.056). Neonatal birth weight was significantly lower in the combination group (mean difference -0.30 kg), with gestational age showing a stronger association (0.151 kg/week, p<0.001).

Conclusions: Although NICU admissions were lower in the metformin monotherapy group, maternal glycemic control particularly HbA1C appears to be the principal determinant of neonatal outcomes in GDM pregnancies.

Glycemic control, maternal and neonatal outcomes in gestational diabetes mellitus treated with regular aspart insulin in comparison with regular human insulin

Mon, 28 Sep 2026 00:00:00 +0530

Background: Gestational diabetes mellitus (GDM) is associated with adverse maternal and neonatal outcomes, making optimal glycemic control essential during pregnancy. Rapid-acting insulin analogues may provide better postprandial glucose control than regular human insulin. This study aimed to compare glycemic control and maternal and neonatal outcomes among women with GDM treated with regular aspart insulin versus regular human insulin.

Methods: This randomized controlled trial was conducted at the outpatient Department of Obstetrics and Gynaecology, BIRDEM General Hospital, Dhaka, from October 2023 to January 2025. A total of 102 women diagnosed with GDM after 24 weeks' gestation were randomly assigned to receive regular aspart insulin (Group I, n=54) or regular human insulin (Group II, n=48). Follow-up was performed at 28-, 32- and 36-weeks’ gestation and after delivery. Ninety-five participants completed follow-up (49 and 46, respectively). Fasting blood sugar (FBS), HbA1c, birth weight and maternal and neonatal outcomes were compared. Statistical significance was set at p<0.05.

Results: Group I achieved significantly lower FBS than Group II at 28, 32 and 36 weeks' gestation and postpartum (all p<0.0001). HbA1c and birth weight were comparable between groups. Maternal complications did not differ significantly. Neonatal hypoglycaemia occurred less frequently in Group I than Group II (6.1% vs 19.6%, p=0.048).

Conclusion: Regular aspart insulin provided superior fasting glycemic control and reduced neonatal hypoglycaemia compared with regular human insulin, without increasing maternal complications, supporting its use as an effective treatment option for GDM.

An audit of the contemporaneous practice of cervical cerclage in a tertiary care hospital in Mumbai

Vandana Bansal, Pooja S., Meera Agalawe, Aishwarya Kadrekar, Ashwini Patel — Mon, 28 Sep 2026 00:00:00 +0530

Background: Cervical incompetence refers to the inability of the cervix to support a full-term pregnancy due to functional or structural defect of the cervix.

Methods: Prospective observational study conducted at a tertiary hospital of all consecutive patients who underwent cerclage during 18 months period. The pregnant women were followed-up through their antenatal and immediate postnatal period and perinatal outcomes were assessed.

Results: Of the total 60 patients in the study, 25 patients continued till full term (41.6%). 27 patients (45%) delivered preterm and 8 (13.3%) aborted after cerclage. 40% had conceived with assisted reproductive techniques, 41.6% were primigravida and 35% had history of previous cervical incompetence. 35% patients had multifetal gestations. Mean gestational age at cerclage was 17.4±3.6 weeks. Mean cervical length was 2.8±0.79 cm. Most common reason for opting cerclage was ultrasound indicated. 96% underwent Macdonald’s cerclage. The difference in outcomes with use of either Polyester fibre tape and black braided silk was not statistically significant. Ultrasonographic surveillance of cervical length post-cerclage placement did not impact clinical practice. 81% babies went home alive, mean birth weight was 2027±828 gram, 51% required NICU admission. Incompetence related preterm deliveries happened in 46.6% patients in spite of a cerclage. The mean gestational age at delivery in singleton was 34.4±4.6 weeks, while it was much less (30.5±6.5 weeks) in multifetal pregnancies

Conclusions: Cervical cerclage improves pregnancy outcome in carefully selected patients. Outcomes following cerclage could be unfruitful in few, while others may have a complicated antenatal period.

A study on the effect of exogenous thyroxine on known hypothyroid and the newly diagnosed hypothyroid patients during first trimester of pregnancy

Ajiti Tiwari, Nirmala Jaget, S. Sethupathy — Mon, 28 Sep 2026 00:00:00 +0530

Background: Hypothyroidism complicates pregnancy and is associated with adverse maternal and fetal outcomes if inadequately treated. This study evaluated the effect of levothyroxine on thyroid function and pregnancy outcomes among women with known and newly diagnosed hypothyroidism during the first trimester.

Methods: A prospective observational study was conducted in an Obstetrics and Gynaecology department from September 2024 to October 2025. Fifty pregnant women diagnosed with hypothyroidism in the first trimester (25 known, 25 newly diagnosed) were enrolled via consecutive sampling. Thyroid function tests (TSH, free T3, free T4) were assessed at baseline, six weeks post-intervention, and during the second and third trimesters. Maternal complications, delivery mode, neonatal outcomes, and NICU admissions were recorded.

Results: Participants' mean age was 24.30±3.04 years. Subclinical hypothyroidism was present in 54% (n=27) and overt hypothyroidism in 46% (n=23). Women with overt hypothyroidism had significantly higher TSH and lower free T3 and free T4 levels throughout pregnancy compared to those with subclinical hypothyroidism (p=0.001). Dose adjustments were required in 92% of women at baseline, decreasing to 68% by the third trimester. Term normal vaginal deliveries occurred in 90% of women, while 10% underwent caesarean section. Complications included miscarriage (18%), gestational diabetes (12%), gestational hypertension (10%), postpartum haemorrhage (10%), and abruptio placentae (4%). NICU admission was required for 19.5% of live births. Mean birth weight was 2.67±0.23 kg, and mean APGAR score was 8.62±1.12.

Conclusions: Early diagnosis, regular monitoring, and timely levothyroxine adjustments improve thyroid control and foster favorable maternal and neonatal outcomes. Continuous surveillance remains essential, particularly for overt cases.

A study to assess the knowledge, perceived roles and training needs of school teachers regarding human papillomavirus vaccination programs in selected schools of Dehradun, Uttarakhand, India

Neha Ali, Sheeba Philip, Rajni, Vandana, Naveen — Mon, 28 Sep 2026 00:00:00 +0530

Background: Cervical cancer is a critical global health challenge, with India bearing over 22% of worldwide mortality. School teachers are vital, trusted stakeholders who can mitigate vaccine hesitancy and champion adolescent human papillomavirus (HPV) immunization. However, institutional frameworks rarely address teachers' internal educational deficits. This study evaluated the baseline health literacy, perceived roles, and training needs of school teachers in Dehradun, India.

Methods: A descriptive cross-sectional study was conducted among 110 school teachers across selected government and private schools named shri guru ram rai (SGRR) public school, Government Primary School, Charan Haly Child School, Floridale School, Government Girls Inter College (GGIC), Prabhanand Children Academy, Government Inter College, and Shivalik Hills Academy in Dehradun, Uttarakhand, India from Jan to June 2026 using convenience sampling. Data were gathered via self-structured, validated instruments capturing socio-demographics, knowledge, perceived roles, and training needs. An evidence-based HPV awareness pamphlet was distributed immediately following baseline assessments.

Results: The cohort was predominantly female (90.9%) and lacked prior exposure to school health programs (96.4%) or HPV training (100.0%). Severe health literacy deficits were observed, with 77.3% of teachers demonstrating poor baseline knowledge. Institutional disconnect was high; 63.6% exhibited poor commitment regarding active responsibilities in vaccine promotion. Conversely, 81.8% indicated high training demands, with an exceptional overall scale mean of 4.68 out of 5.0. Notably, the highest demand (µ=4.80) was for structured educational materials (like pamphlets) to distribute during parent-teacher meetings.

Conclusions: While educators possess critically low baseline clinical awareness and professional involvement regarding HPV, they demonstrate immense, proactive motivation for capacity building. Distributing targeted, evidence-based awareness pamphlets represents an affordable, highly scalable intervention to bridge institutional gaps, empower educators, and foster supportive school environments for adolescent immunization.

A prospective observational study on maternal and perinatal outcomes in patients with placenta previa at a tertiary care centre

Prajakta Sunil Gulhane, Sandeep Suhas Pophale — Mon, 28 Sep 2026 00:00:00 +0530

Background: Placenta previa is a leading cause of antepartum hemorrhage associated with significant maternal and perinatal morbidity. Rising rates of cesarean sections have contributed to increasing prevalence. This study evaluates maternal and perinatal outcomes in placenta previa patients managed at a tertiary care centre. This study aimed to assess maternal complications (hemorrhage, anemia, blood transfusion, surgical interventions) and perinatal outcomes (preterm birth, low birth weight, NICU admission, neonatal mortality) in patients with placenta previa.

Methods: A prospective observational study of 90 pregnant women diagnosed with placenta previa at GGMC and Sir JJ Hospital, Mumbai over a 14-month period (January 2022 to February 2023). Data on demographics, risk factors, comorbidities, maternal interventions, and neonatal outcomes were systematically collected and analyzed using descriptive statistics and chi-square tests.

Results: The mean maternal age was 30.44±6.25 years. Previous uterine surgery was the predominant risk factor, present in 88.9% of patients. Antenatal hemorrhage occurred in 37.8% of cases. Maternal morbidity was substantial: 75.6% required blood transfusion, 48.9% required ICU admission, and 11.1% underwent obstetric hysterectomy. Placenta accreta spectrum (PAS) was identified in 13.3% of patients. Perinatal outcomes were significantly compromised: 53.3% of neonates were delivered early preterm (<34 weeks), 63.3% had low birth weight (<2.5 kg), 32.2% required NICU admission, and neonatal mortality was 11.1%. A statistically significant association was found between antenatal registration status and gestational age at delivery (χ²=19.437, p<0.001), with unregistered patients demonstrating markedly higher rates of early preterm delivery.

Conclusions: Placenta previa remains a high-risk obstetric condition with considerable maternal and perinatal morbidity. Previous cesarean delivery is the most important risk factor. Early antenatal registration significantly improves gestational age at delivery and is associated with better perinatal outcomes. Multidisciplinary management in well-equipped tertiary centres, including blood bank preparedness, skilled surgical interventions, and NICU support, is essential for improving outcomes.

A multimodal diagnostic matrix for emergency gynaecological triage: retrospective correlation of patient age, clinical features, serum tumour markers and O-RADS risk stratification in adnexal mass management

Anjali Gitte, Reena Wani, Pooja Champanerkar, Vaishnavi Dange — Mon, 28 Sep 2026 00:00:00 +0530

Background: Evaluating adnexal masses in the emergency setting requires rapid clinical decision-making to differentiate surgical emergencies from benign or self-limiting conditions. While ultrasound using the ovarian-adnexal reporting and data system (O-RADS) framework serves as the primary diagnostic tool, acute pelvic infections and inflammatory masses frequently display acoustic features mimicking malignancy. This study evaluates the diagnostic performance of an integrated matrix combining patient demographics, clinical presentation, serum tumour markers [CA-125, human epididymis protein 4 (HE4), and the risk of ovarian malignancy algorithm (ROMA) index], and multimodal O-RADS imaging (US and MRI) in guiding clinical triage.

Methods: A retrospective observational study was conducted analysing 200 women admitted with adnexal lesions between July 2025 and June 2026. Clinical characteristics, initial ultrasound findings, selective serum biomarkers, and secondary O-RADS MRI findings were correlated with final histopathological diagnoses or documented clinical resolution. Statistical analysis utilized Chi-square tests, student's t tests, and receiver operating characteristic (ROC) curves with 95% confidence intervals (CI).

Results: The cohort comprised ectopic gestation (n=72, 36.0%), acute inflammatory mass/ tubo-ovarian abscesses (TOA) (n=52, 26.0%), endometrioma (n=32, 16.0%), simple/benign cysts (n=28, 14.0%), and ovarian malignancy (n=16, 8.0%). Marker evaluation was selectively performed in 128 non-ectopic cases and omitted in ectopic pregnancies (n=72). Initial O-RADS ultrasound alone demonstrated high sensitivity (93.8%) but lower specificity (71.9%) due to complex inflammatory collections mimicking ovarian cancer. Incorporating HE4, ROMA index, and secondary O-RADS MRI significantly improved diagnostic specificity to 95.1% (95% CI: 90.2%-98.0%) and positive predictive value (PPV) to 92.6% (p<0.001), accurately reclassifying TOA and endometriomas as benign and preventing unnecessary emergency surgery.

Conclusions: Integrating clinical parameters and selective serum biomarkers with multimodal O-RADS imaging provides a robust diagnostic matrix in emergency OBGY admissions, facilitating conservative or elective management for benign conditions while expediting oncological referral pathways.

Assessment of the prescription pattern of dydrogesterone in obstetrics and gynaecological disorders in adult women in an outpatient setting across India

Mon, 28 Sep 2026 00:00:00 +0530

Background: Dydrogesterone is a prescribed progestogen used in infertility, threatened abortion, recurrent pregnancy loss, endometriosis, and menstrual disorders. However, large-scale real-world evidence describing its utilisation patterns in clinical practice in India remains limited.

Methods: This multicentric, cross-sectional, observational study included adult women receiving dydrogesterone therapy across India. Data on demographic and reproductive characteristics, clinical indications, comorbidities, treatment regimens, and duration of therapy were collected from routine clinical records and analysed using descriptive and inferential statistics.

Results: A total of 7,160 women were included. Infertility was the most common indication for dydrogesterone therapy (45.0%; n=3219), followed by threatened abortion (27.2%; n=1946) and recurrent pregnancy loss (13.6%; n=972). Dydrogesterone 10 mg twice daily was the most frequently prescribed regimen (49.8%; n=3564), followed by Dydrogesterone 10 mg once daily (30.9%; n=2211) and sustained-release 20 mg once daily (12.4%; n=886). Most patients were aged 18-30 years (73.4%; n=5256), had a normal body mass index (58.9%; n=4218), and were nulligravida (89.3%; n=6394). Significant associations were observed between treatment regimen and clinical indication, age category, body mass index, gravida status, parity status, comorbidity status, and duration of therapy (all p<0.05).

Conclusions: This large multicentric real-world study demonstrates extensive utilisation of dydrogesterone in Indian obstetric and gynaecological practice, with 10 mg twice-daily and once-daily regimens representing the predominant treatment approaches. The findings provide valuable real-world evidence on patient profiles and contemporary prescribing patterns associated with dydrogesterone use in routine clinical care.

Indication of blood components transfusion in obstetrics

Mon, 28 Sep 2026 00:00:00 +0530

Background: Blood and blood component utilization is an integral part of patient management in obstetrics and is often a life saving measure. Various pregnancy complications including 1^st trimester complications and disorders of labor show up as conditions needing transfusion in the day-to-day practice of obstetrics.

Methods: This prospective study was carried out at the department of obstetrics of tertiary care teaching hospital from April 2021 over a period of 18 months and data was collected from all patients (140) who had received transfusion of blood products for any obstetric cause.

Results: Out of a total 3102 obstetric admissions, 140 (4.51%) participants received blood product transfusion. Anemia (42.1%) followed by postpartum hemorrhage (20%) followed by antepartum hemorrhage (16.4%) and 1^st trimester complications (16.4%) were the major cause for blood product transfusion. 33.6% of participants gave no history of antenatal care (ANC) visits while 25.7% had only 1 to 3 ANC visits. 44.3% gave no history of hematinic intake while 31.4% had irregular hematinic intake. The department utilized maximum number of packed red blood cells (PRBC) followed by fresh frozen plasma (FFPs) and platelet concentrates.

Conclusions: Three most common indications for transfusion were nutritional anemia, obstetric hemorrhage and first trimester complications. Majority of patients had inadequate or no antenatal care. Early and regular antenatal care, early diagnosis and management of high-risk pregnancies and obstetric complications, institutional delivery can reduce the rate of transfusion of blood products.

Variation of pregnancy-associated plasma protein-A: a level in the first trimester of pregnancy and its clinical outcome

Simran Virdi, Aditi, Satwant Kaur — Mon, 28 Sep 2026 00:00:00 +0530

Background: Pregnancy-associated plasma protein-A (PAPP-A) is a placental glycoprotein used in first-trimester screening and is involved in placental development through the insulin-like growth factor pathway. Low PAPP-A has been associated with placental dysfunction and adverse pregnancy outcomes. This study evaluated the association between first-trimester maternal serum PAPP-A and subsequent maternal and fetal outcomes in singleton pregnancies.

Methods: This hospital-based prospective study was conducted in the Department of Obstetrics and Gynaecology, Adesh Medical College and Hospital, Shahabad, Kurukshetra, from March 2024 to February 2025. A total of 134 low-risk singleton pregnant women aged 18–35 years, attending antenatal care and undergoing first-trimester screening at 11-13 weeks, were enrolled. Serum PAPP-A was measured by chemiluminescence and expressed as multiples of the median (MoM). Participants were followed until delivery, and outcomes were analysed using a <0.4 MoM cut-off.

Results: Mean maternal age was 28.46±3.33 years. Mean PAPP-A was 0.695±0.324 mIU/ml and 0.278±0.130 MoM. Gestational hypertension occurred in 26.9%, preterm labour in 35.8%, PROM in 11.9%, and oligohydramnios in 5.2%. Fetal growth restriction occurred in 24.6% and stillbirth in 2.2%. PAPP-A<0.4 MoM was significantly associated with gestational hypertension (p=0.002), preterm labour (p=0.013), and FGR (p=0.002). Mean PAPP-A was significantly lower in gestational hypertension and oligohydramnios.

Conclusions: Low first-trimester PAPP-A was associated with selected adverse maternal and fetal outcomes, particularly gestational hypertension and FGR. PAPP-A may support early risk stratification and closer antenatal surveillance, but should not be used as a stand-alone diagnostic or predictive test. in routine practice.

Impact of fever in pregnancy on maternal and fetal outcomes: a prospective observational study of 171 cases

Shruthi B. Ranjanagi, Sandeep Suhas Pophale — Mon, 28 Sep 2026 00:00:00 +0530

Background: Fever during pregnancy is a high-risk condition associated with adverse fetomaternal outcomes; however, region-specific data from Indian tertiary care government hospitals remain limited. This study evaluated fetomaternal outcomes and etiological spectrum of fever in pregnancy.

Methods: This prospective observational study was conducted over 18 months in the Department of Obstetrics and Gynaecology of a tertiary care government hospital. Total 171 pregnant women with oral/axillary temperature ≥38°C were enrolled after informed consent. Demographic, obstetric, fever-related variables were recorded, maternal and neonatal outcomes were followed until 6weeks postpartum. Data were analysed using SPSS with chi-square/Fisher exact test; p<0.05 was considered statistically significant.

Results: Most women were aged 21-35 years (91.2%) and multigravida (52.0%). Fever occurred predominantly in second trimester (43.3%) and was low-to-moderate grade (94.7%). Urinary tract infection (23.4%), typhoid fever (14.6%), upper respiratory tract infection (13.4%) were commonest causes. Vaginal delivery occurred in 49.1%, caesarean section in 43.9%, abortion in 7.0%. Maternal complications occurred in 51.5%, mainly anaemia (19.9%), preterm labour (15.2%); one maternal death. Among neonates, 23.97% required NICU admission, 21% had coexisting adverse outcomes, two intrauterine and two neonatal deaths occurred. Typhoid, dengue, malaria, acute febrile illness of unknown cause, primigravidity, first-trimester fever onset, moderate-grade fever was significantly associated with adverse fetomaternal outcomes(p<0.05).

Conclusions: Fever in pregnancy is associated with substantial maternal and neonatal morbidity. Early diagnosis, prompt treatment, close antenatal surveillance may improve fetomaternal outcomes.

Assessment of antenatal mothers’ knowledge regarding birth preparedness and complication readiness in selected areas of Aizawl, Mizoram

L. P. Lalnunpuii, Nongmeikapam Monika, Laldinpuii Sailo — Mon, 28 Sep 2026 00:00:00 +0530

Background: Birth Preparedness and Complication Readiness (BPCR) promotes timely planning for skilled maternal care and recognition of pregnancy-related complications. Adequate knowledge can help reduce delays in seeking and receiving care. Although India has made progress in reducing maternal mortality, achieving further reductions requires continued emphasis on timely skilled care. BPCR supports preparedness for childbirth and emergencies by encouraging recognition of danger signs, planning for transport, and timely decision-making. This study assessed knowledge of antenatal mothers regarding BPCR in selected areas of Aizawl, Mizoram.

Methods: A quantitative descriptive design was used among 150 antenatal mothers attending the Maternity and Child Health Clinic, Civil Hospital Aizawl. Participants were selected through non-probability convenience sampling. Data were collected using a validated self-structured questionnaire covering socio-demographic characteristics, birth preparedness, and complication readiness. Descriptive and inferential statistics were used for analysis.

Results: Among the participants, 32.6% were aged 26–30 years, 52% were homemakers, and 42.6% had completed high school education. For birth preparedness, 69.3% demonstrated moderately adequate knowledge, 26.7% inadequate knowledge, and 4.0% adequate knowledge. Regarding complication readiness, 71.3% had moderately adequate knowledge, 27.3% inadequate knowledge, and 1.3% adequate knowledge. No statistically significant association was observed between knowledge levels and the selected demographic variables.

Conclusions: Most antenatal mothers demonstrated moderately adequate knowledge of BPCR, while only a small proportion had adequate knowledge. Strengthening BPCR-focused health education during antenatal care, particularly on danger signs, skilled care, and emergency planning, may improve preparedness and promote safer maternal and neonatal outcomes.

Impact of SPIKES -protocol on knowledge, attitude and practice on breaking bad news in obstetrics practice among obstetrics and gynecology postgraduate residents

Sara Khan, Saima Shreen, Uma Gupta, S. P. Jaiswar — Mon, 28 Sep 2026 00:00:00 +0530

Background: Breaking bad news (BBN) is a critical communication skill in Obstetrics and Gynaecology, particularly when dealing with adverse pregnancy outcomes such as stillbirth, congenital anomalies, and miscarriage. Despite its importance, formal communication training is often inadequately addressed during postgraduate medical education.

Methods: A prospective interventional study was conducted in the Department of Obstetrics and Gynaecology at Era's Lucknow Medical College and Hospital, Lucknow, over a period of 24 months from January 2024 to December 2025. Twenty-five postgraduate residents participated in the study. Baseline assessment of knowledge, attitude and practice was performed using a validated questionnaire. Participants subsequently underwent structured training based on the SPIKES protocol, including interactive lectures, role-play sessions and simulation exercises. Communication skills were evaluated using Objective Structured Clinical Examination (OSCE) and SPIKES-based assessment before and after training. Participant feedback regarding the training programme was also obtained.

Results: Only 12% of residents reported prior formal training in breaking bad news. Baseline assessment demonstrated positive attitudes but inconsistent communication practices and limited familiarity with structured communication protocols. Significant improvements were observed following training across all OSCE domains (p<0.001). Participants reported increased confidence, preparedness and satisfaction following the training programme.

Conclusions: Structured SPIKES-based communication training significantly improves knowledge, communication skills and confidence among postgraduate residents. Incorporation of formal communication training into postgraduate obstetrics and gynaecology curricula may enhance patient-centred care and improve management of adverse pregnancy outcomes.

Prevalence of bacterial vaginosis in antenatal women and its correlation with maternal outcomes: a tertiary hospital based prospective study

Aditi Singh, Nishi Makhija, Reema Jain, Juhi Srivastava, Yukti Sharma — Mon, 28 Sep 2026 00:00:00 +0530

Background: Bacterial vaginosis (BV) is the most common vaginal infection in reproductive-aged women, with heightened risks during pregnancy, including preterm labor and low birth weight. Despite its association with poor outcomes, routine screening in pregnancy is not universally implemented, particularly in India, where regional data on BV and pregnancy outcomes are limited. Present study aimed to evaluate the prevalence of BV in antenatal women and assess its impact on maternal outcomes.

Methods: This prospective cohort study was conducted at Tirath Ram Shah Trust Hospital, Delhi, over one year (April 2025 to March 2026). Two hundred pregnant women (singleton pregnancies, <20 weeks gestation) were enrolled. BV was diagnosed using Nugent’s criteria via Gram-stained vaginal smears. Maternal outcomes (abortions, preterm labor, PROM, IUD, chorioamnionitis) were tracked until delivery.

Results: Of the 200 women, 18% were BV-positive. No significant association was found between age, gravida, or mode of delivery and BV. However, BV was significantly linked with PROM (11.1% versus 0.6%) and PPROM (19.4% versus 2.4%). Preterm birth was also higher in BV-positive women (22.2% versus 2.4%).

Conclusions: BV in pregnancy was associated with higher risks of PROM, PPROM, and preterm birth. These findings suggest that routine screening and management of BV in antenatal care could help mitigate adverse maternal and neonatal outcomes.

Influence of mode of delivery on maternal and neonatal outcomes in singleton term breech presentation: a prospective observational study from a tertiary care centre

Shivani Samaiya, Vidya Chaudhary, Hema J. Shobhane, Divya Jain — Mon, 28 Sep 2026 00:00:00 +0530

Background: The optimal mode of delivery for singleton term breech presentation remains one of the most debated issues in modern obstetrics. While planned caesarean section has been associated with improved neonatal outcomes, it is also accompanied by increased maternal morbidity and implications for future pregnancies. Conversely, carefully selected women may achieve favorable outcomes with planned vaginal breech delivery when strict selection criteria and skilled obstetric care are available. Objective of the study was to compare maternal and neonatal outcomes between planned vaginal delivery and caesarean section in singleton term breech pregnancies managed according to predefined clinical selection criteria.

Methods: A prospective observational study was conducted in the Department of Obstetrics and Gynaecology at M. L. B. Medical College, Jhansi, India, between July 2023 and September 2024. 160 women with singleton breech pregnancies at ≥37 weeks of gestation were included. Women with multifetal gestation or intrauterine fetal demise were excluded. The mode of delivery was determined according to institutional protocols based on fetal presentation, estimated fetal weight, pelvic adequacy, fetal wellbeing, and obstetric indications. Maternal outcomes, including postpartum hemorrhage, infection, operative complications, prolonged recovery, and duration of hospital stay, were compared with neonatal outcomes, including NICU admission and neonatal mortality.

Results: Among 3,956 term deliveries, 188 (4.75%) presented with breech presentation, of whom 160 were randomly selected for the study. Caesarean section was performed in 109 women (68.1%), while 51 (31.9%) underwent vaginal delivery. Maternal morbidity was significantly higher following caesarean section, with increased rates of postoperative infection, prolonged hospital stays, postpartum hemorrhage, and delayed recovery. In contrast, neonatal morbidity was significantly higher following vaginal delivery, with increased NICU admissions and all neonatal deaths occurring in this group. No maternal mortality was observed in either group.

Conclusions: Caesarean section was associated with improved short-term neonatal outcomes, whereas vaginal delivery resulted in lower maternal morbidity in carefully selected women. These findings support an individualized approach to the management of singleton term breech presentation, emphasizing rigorous patient selection, adherence to standardized delivery protocols, and the availability of experienced obstetricians to optimize both maternal and neonatal outcomes.

Comparison of effects of metformin and inositol on AMH levels in PCOS patients

Anurag Chaudhary, Manju Khemani, Bela Makhija, Kiranjeet Kaur — Mon, 28 Sep 2026 00:00:00 +0530

Background: PCOS is very common problem. Insulin resistance is an integral part of PCOS. AMH level in women with PCOS are 2-3 times higher than in healthy women. In PCOS patients, there is excess amount of AMH and its physiological effect lasts longer than it should in larger follicles, leads to arrest of dominant follicle selection.

Methods: It was a prospective, interventional randomized clinical trial, a single tertiary center study over a period of 8 months. Cases with the documented PCOS were taken into account and divided into 2 groups, group A and group B randomly by alternate assigning of patients. Group A was given metformin and group B was given inositol. Group A was given metformin 850 mg twice daily orally and group B was given myo-inositol 1100 mg +D chiro inositol 27.6 mg plus 100 pg folic acid once daily for 12 weeks.

Results: AMH levels were reassessed after 12 weeks of period and changes in the levels of AMH were compared. In metformin group total number of patients were 86 of which 84 patients (97.7%) showed decrease in AMH levels while 2 patients (2.33%) did not show any changes. In inositol group total number of patients were 87 of which 53 patients (60.91%) showed decrease in AMH levels while 34 patients (39.1%) did not show any changes. There was a significant difference between the groups in terms of distribution of decrease in AMH (χ²=35.454, p<0.001).

Conclusions: As compared to Inositol group there were more patients who had decrease in AMH levels in metformin group. Hence, metformin is better than inositol in decreasing AMH levels in PCOS patients.

Impact of pharmacist-monitored patient education in pregnant women with anemia: a knowledge, attitude and practice study

Mon, 28 Sep 2026 00:00:00 +0530

Background: Anemia during pregnancy, defined as hemoglobin levels below 11 g/dL, affects nearly 37% of pregnant women globally and 52.2% in India. Pharmacists are well positioned to provide education, though evidence for the impact of pharmacist-led interventions on knowledge, attitudes, and practices (KAP) regarding anemia is limited. This study evaluated the impact of pharmacist-monitored patient education on KAP in pregnant women with anemia.

Methods: This six-month prospective interventional study (Jan-2025 to June-2025) was conducted among 130 pregnant women at a tertiary care hospital in Mangaluru, Karnataka. Data were collected during routine antenatal visits using a validated structured questionnaire in English and Kannada. Following initial KAP assessment, participants received pharmacist-led counselling and educational informational leaflet. KAP was reassessed after 1.5 months using the same questionnaire. Data were analysed using SPSS, with one-way ANOVA and paired t-tests. A p value <0.05 was considered statistically significant.

Results: Most participants were aged 26-35 years (65.38%), rural residents (62.30%) with high school education (61.54%) and no prior anemia history (80%); most were unemployed (83.84%), multigravida (59.24%), in their third trimester (63.14%), and continued their usual diet (84.62%). Knowledge (1.92±2.70 to 5.16±3.61) and attitude (14.67±2.53 to 15.91±2.48) scores increased significantly (p<0.00001, p=0.00096), while practice scores changed minimally (2.72±0.59 to 2.76±0.58; p=0.08326) post intervention. Knowledge was associated with education (p=0.0406); attitude with age, residence, and parity (p<0.05); and practice with age (p=0.0199). Anemia Mukt Bharat awareness rose from 10% to 60%.

Conclusions: Pharmacist-monitored education significantly improved knowledge and attitude towards anemia in pregnancy, though practice change was limited. Integrating pharmacist-led counselling into antenatal care may support sustained behavioural change and anemia prevention.

Knowledge, attitude and experience of menstrual cup usage among medical students at a tertiary care teaching hospital in central Kerala: a cross-sectional study

Janaki Menon C. M., Sreekala C., Aryashree A. — Mon, 28 Sep 2026 00:00:00 +0530

Background: Sanitary napkins contribute substantially to solid waste generation, and their disposal poses significant environmental challenges. Menstrual cups offer an eco-friendly and cost-effective alternative to disposable sanitary pads; however, their adoption remains limited among Indian women. The objectives of this study were to assess the knowledge, attitude and experience of the women medical students in a college in central Kerala, India regarding the use of menstrual cups.

Methods: The study was a prospective cross-sectional study carried out in 183 female medical students. It was done over a period of 6 months (from February 2025 to July 2025) in tertiary care centre of central Kerala. A self-administered online questionnaire was used to gather data, which was created with Google Forms. A questionnaire was used to evaluate the demographic, knowledge, attitude and experience of using the menstrual cup.

Results: The findings were that 97.8% of the respondents knew about menstrual cups while 8.2% of them used. The majority of the participants (64.5%) believed that the use of menstrual cups is a better alternative than sanitary pads and 86.3% were interested to receive formal training on the use of menstrual cups. Discomfort, fear of insertion, and lack of knowledge were the main obstacles to adoption. The main source of information was social media (51.9%). Even though the cups were not being used, 59% of the non-users said they would like to use them in the future.

Conclusions: The awareness rate of the menstrual cup was high amongst medical students, but the use of the menstrual cup was still low. Educational programs, organised demonstration activities, and specific awareness raising campaigns can help close the knowledge-action gap and encourage the use of sustainable menstrual hygiene products.

Combination of foley catheter and vaginal misoprostol compared with vaginal misoprostol alone for cervical ripening and induction of labour

Karingula Sushmitha, M. Swarnalatha, T. Sahitiroyal — Mon, 28 Sep 2026 00:00:00 +0530

Background: Induction of labour in women with an unfavourable cervix remains a common obstetric challenge. The addition of a transcervical Foley catheter may enhance cervical ripening through mechanical dilatation and endogenous prostaglandin release, thereby improving labour outcomes. This study compared the effectiveness and safety of Foley catheter combined with vaginal misoprostol versus vaginal misoprostol alone for cervical ripening and induction of labour in term pregnancies.

Methods: This prospective, comparative, hospital-based interventional study included 50 women with singleton term pregnancies, vertex presentation, intact membranes, and Bishop score ≤5. Participants were randomly allocated to vaginal misoprostol alone (n=25) or Foley catheter combined with vaginal misoprostol (n=25). Induction outcomes, mode of delivery, and neonatal outcomes were compared.

Results: The combination group had a significantly shorter induction-to-delivery interval (15.3±6.5 vs. 18.3±8.7 hours; p=0.03) and time to complete cervical dilatation (13.7±5.9 vs. 17.1±8.7 hours; p=0.03). Delivery within 24 hours was higher with combination therapy (80% vs. 64%). Birth weight, Apgar scores, and neonatal intensive care unit admissions showed no significant differences.

Conclusions: Foley catheter combined with vaginal misoprostol effectively shortens labour induction without increasing maternal or neonatal complications and is a safe alternative to vaginal misoprostol alone.

Sociodemographic and menstrual profile of infertile women with endometriosis: a comparative cross-sectional analysis from a tertiary centre in Rajasthan

Shivangi Yadav, Nupur Lauria, Anchal, Manisha Kumari — Mon, 28 Sep 2026 00:00:00 +0530

Background: Endometriosis disproportionately affects women during their reproductive years and has been associated with various sociodemographic and menstrual factors. Understanding these associations is critical for early identification and improved public health strategies, particularly in resource-constrained settings. Data on the sociodemographic profile of endometriosis from North India remain sparse.

Methods: A hospital-based cross-sectional comparative observational study of 60 infertile women (30 with laparoscopically confirmed endometriosis and 30 controls) was conducted at a tertiary care centre in Jaipur, between July 2023 and July 2025. Demographic, anthropometric, and menstrual data were collected. Chi-square, Fisher exact test, and unpaired t-test were used for analysis.

Results: No significant age difference was found between cases (mean 28.01±4.78 yrs) and controls (28.73±5.13 yrs; p=0.604). Women with endometriosis were significantly more likely to belong to higher socioeconomic status (53.33% upper class vs. 26.66% in controls; p=0.043) and had significantly lower BMI (21.26±2.91 vs. 23.26±3.26 kg/m²; p=0.0147). Shorter menstrual cycle length was significantly associated with endometriosis (mean 26.97±3.91 vs. 30.13±4.66 days; p=0.0013). No significant differences in religion, literacy, or parity were observed.

Conclusions: Higher socioeconomic status, lower BMI, and shorter menstrual cycle length are significantly associated with endometriosis in infertile women. These factors may serve as clinical flags to prompt earlier investigation in appropriate patient populations.

A prospective observational study comparing two embryo-transfer catheters and techniques to evaluate their impact on pregnancy outcomes

Sowmya Mahesh, Rita Bakshi — Mon, 28 Sep 2026 00:00:00 +0530

Background: The procedure of embryo transfer (ET) is a critical determinant of success in the field of assisted reproductive technology (ART), and the choice of transfer catheter may influence pregnancy outcomes. Although soft ET catheters are generally preferred because of their atraumatic design, metallic catheters may offer technical advantages in selected cases with challenging cervical anatomy. This prospective observational study compared pregnancy outcomes between the Edwards-Wallace soft catheter and the Easy Flex metal catheter.

Methods: Thirty-two women undergoing intracytoplasmic sperm injection (ICSI)/ in vitro fertilization (IVF) treatment at Risaa IVF Centre, New Delhi, between November 2025 and May 2026 were enrolled. Patients were allocated into two equal groups (n=16 each) based on the ET catheter selected according to findings from a mock ET. Baseline demographic characteristics, ovarian reserve parameters, stimulation characteristics, embryological outcomes, and β-hCG confirmed pregnancy rates were compared. The primary outcome was a positive pregnancy test measured by serum β-hCG test performed 14 days after ET.

Results: Baseline clinical characteristics, ovarian reserve markers (AFC and AMH), gonadotropin requirements, oocyte yield, fertilization rates, blastocyst formation and development, and the number of embryos transferred were same among the two groups and was statistically insignificant (p>0.05). Positive serum β-hCG test was observed in 8 of 16 patients (50.0%) in the Easy Flex metal catheter group and 7 of 16 patients (43.8%) in the Edwards-Wallace group. No statistically significant difference in pregnancy outcomes was identified between the groups (OR=1.29, p=1.000).

Conclusions: The Easy Flex metal catheter and the Edwards-Wallace soft catheter demonstrated comparable clinical performance with respect to positive pregnancy outcomes following IVF/ICSI. These findings suggest that catheter selection may be guided by procedural considerations and operator preference rather than expected differences in pregnancy rates. Large scale randomized controlled trials and studies are required to validate these findings.

Diagnostic and therapeutic yield of combined hysterolaparoscopy in female infertility: a prospective observational study from Central India

Anshu Ghosh, Anushaya Kuchekar, Razia Sultana — Mon, 28 Sep 2026 00:00:00 +0530

Background: Combined diagnostic hysterolaparoscopy (DHL) permits evaluation of intra uterine and extrauterine causes of infertility and selected corrective procedures during the same sitting. This study evaluated its diagnostic and therapeutic yield in relation to preoperative transvaginal sonography (TVS) and hysterosalpingography (HSG).

Methods: This prospective observational study included 250 consecutive consenting women with infertility who underwent hysteroscopy, laparoscopy, and chromopertubation at a tertiary-care hospital in Central India from 1 March 2024 to 28 February 2025. Direct endoscopic findings were compared with TVS and HSG findings. Appropriate paired and between-group statistical tests were applied.

Results: Primary infertility was present in 159 women (63.6%) and secondary infertility in 91 (36.4%). Combined DHL detected at least one abnormality in 213 women (85.2%), compared with 138 (55.2%) on TVS and 112 (44.8%) on HSG (both p<0.001). Hysteroscopy detected intrauterine abnormalities sin 129 women (51.6%) versus 45 (18.0%) on TVS, while laparoscopy detected tubo-pelvic abnormalities in 110 (44.0%) versus 86 (34.4%) on HSG (both p<0.001). In unadjusted comparisons, polycystic ovarian morphology and endometriosis/endometrioma were more frequent in primary infertility, while synechiae, hydrosalpinx, tubal pathology, and bilateral tubal block were more frequent in secondary infertility. Same-sitting procedures were performed in 135 women (54.0%).

Conclusions: Combined DHL had a high abnormality-detection yield and led to a same-sitting procedure in 54.0% of selected women. It is best used selectively after non-invasive evaluation, as a complementary, lesion-directed procedure at her than a replacement for first-line imaging.

Effectiveness of lukewarm water compress in reduction of breast engorgement and breast pain among postnatal mothers in selected hospital in Aizawl, Mizoram

Vanlalremi, Sujana Yambem, Lalhriatpuii — Mon, 28 Sep 2026 00:00:00 +0530

Background: Breastfeeding is the optimal method of infant feeding, providing essential nutrition and health benefits for mother and child. However, breast engorgement is a common early postpartum complication that causes swollen, tight, hard, and painful breasts and often leads to premature cessation of breastfeeding. Both pharmacological and non-pharmacological methods are used for relief. This study evaluated the effectiveness of lukewarm water compress in reduction of breast engorgement and breast pain among postnatal mothers in a selected hospital in Aizawl, Mizoram.

Methods: A pre-experimental one-group pretest-posttest design was used with a non-probability sample of 30 postnatal mothers. Lukewarm water compresses were applied to the breasts for 15-20 minutes twice daily for two consecutive days. Demographic data were collected using a structured interview schedule. Breast engorgement was assessed with the six-point engorgement scale (SPES) and breast pain with the visual analogue scale (VAS). Data were analysed using SPSS version 22.0.

Results: Mean breast pain scores decreased from 2.73±0.69 to 1.73±0.58 (t=12.04, p=0.001). Mean breast engorgement scores decreased from 4.87±0.63 to 3.60±0.62 (t=15.42, p=0.001). Most demographic variables showed no statistically significant association with pretest breast engorgement and breast pain scores; occupation and postpartum day were significantly associated with breast pain levels.

Conclusions: Lukewarm water compresses serve as a simple, safe, and cost-effective non-pharmacological method for alleviating breast engorgement and pain. Incorporating this intervention into routine postnatal nursing care may improve maternal comfort and support successful, sustained breastfeeding practices.

Oocyte count at retrieval as predictor of pregnancy rate in different age groups in the Indian population

Aneesha M. Grover, Vandana Bhatia, Sonia Malik — Mon, 28 Sep 2026 00:00:00 +0530

Background: An important consideration while planning in vitro fertilization (IVF) is whether an age-specific oocyte number can predict treatment success. Identifying such thresholds may aid counselling regarding embryo pooling and the need for donor oocytes.

Methods: This retrospective, multicentric, cross-sectional study was conducted at Nova Fertility and IVF Clinics across India. Women aged 21-50 years undergoing IVF between August 2019 and July 2024 who met the inclusion and exclusion criteria were included. A total of 1994 patients were enrolled: 149 aged 21-25 years, 580 aged 26-30 years, 813 aged 31-35 years, 381 aged 36-40 years, and 71 aged >40 years. Clinical pregnancy rates were evaluated across age groups and varying mature oocyte (MII) yields using appropriate statistical methods.

Results: Total oocyte retrieved declined with advancing age, whereas the median number of mature oocytes remained relatively stable. The minimum MII oocyte number associated with successful outcomes decreased with increasing age: 9.5 at 21-25 years age, 7.5 at 31-35 years, and 4.5 at 36-40 years, increasing to 5.5 in women >40 years. There was a non -linear relation between age, oocyte yield and clinical pregnancy outcomes, with most favourable outcomes in women aged 26-35 years and low success rates at the extremes of reproductive age (<25 years and >36 years).

Conclusions: Although the mature oocyte number associated with successful IVF outcomes varies with age, oocyte number alone does not determine success. Thus, individualized counselling remains essential.

Large-for-gestational-age births: maternal characteristics, risk factors and perinatal outcomes from a decade-long cohort

Pallavi Chandra Ravula, Vaishnavi Veloori — Mon, 28 Sep 2026 00:00:00 +0530

Background: Objectives were to describe the clinical profile and identify risk factors for large-for-gestational-age (LGA) births, defined by GROW customized birth-weight centile, comparing LGA with appropriately grown (AGA) births at a tertiary perinatal referral network in India.

Methods: This retrospective hospital-based study analysed 80,630 singleton births, live and stillborn, at 28 weeks gestation or more, to booked mothers between January 2013-December 2023, comprising 10,391 LGA and 70,239 AGA births. Multifetal pregnancies were excluded. Small-for-gestational-age births (<10^th centile; n=9,842) were excluded and LGA were compared with AGA. Univariable and multivariable logistic regression identified independent risk factors.

Results: In this analysis 1 in 9 babies were LGA, and they were delivered by caesarean section far more often (62.7% vs 43.7%). LGA proportion was higher in diabetics than non-diabetic mothers (17.5% vs 11.2%). In the adjusted model (n=80,630; 10,391 events), independent risk factors for LGA were diabetes (adjusted odds ratio [aOR] 1.60), preterm birth (1.50), short stature (1.30), multiparity (1.16), assisted conception (1.12), obesity (1.09), advanced maternal age (1.08) and male baby (1.06). LGA birth was associated with higher odds of shoulder dystocia (aOR 4.54), birth injury (3.29), caesarean (2.07), neonatal hypoglycemia (1.46) and postpartum haemorrhage (1.29).

Conclusions: When contrasted with AGA, LGA was driven chiefly by maternal diabetes, with an association with preterm birth. The inverse association with hypertensive/placental disease persisted but was attenuated, indicating that part of the apparent “protective” effect seen against a non-LGA comparator is contributed by small-for-gestational-age births. LGA carries substantially higher caesarean rate and warrants anticipatory intrapartum planning.

Impact of a standardized labour room management protocol on labour processes and World Health Organization Robson classification – a quality dashboard-based study

Rudrika Chandra, Sarita Kumari, Abhinav Tiwari — Mon, 28 Sep 2026 00:00:00 +0530

Background: Crude caesarean section (CS) rates inadequately capture labour room quality because they are confounded by case mix. We evaluated a standardized labour room management protocol using a multidimensional labour room quality dashboard incorporating the World Health Organization (WHO) Robson ten-group classification system (TGCS).

Methods: This retrospective before-and-after quality improvement study compared all deliveries during two identical one-month periods-July 2024 (pre-intervention, n=58) and July 2025 (post-intervention, n=76)-at a tertiary care teaching hospital in India. Labour process, delivery outcome, workflow, case-mix, and Robson-group indicators were compared using chi-square or Fisher’s exact test. Multivariable logistic regression identified independent predictors of CS.

Results: Spontaneous onset of labour increased from 29.3% (17/58) to 60.5% (46/76), while induction decreased from 44.8% (26/58) to 13.2% (10/76) (χ²=19.10, p<0.001). Overall CS rates remained unchanged (39.7% versus 40.8%; p=1.000), as did daytime versus night-time delivery (84.5% versus 86.8%; p=0.890). Robson group 1 increased from 1.7% to 25.0%, while induction-related group 4a decreased from 22.4% to 1.3% (χ²=41.08, df=9, p<0.001). No individual Robson group showed a significant change in internal CS rates. On adjusted regression, the post-intervention period was not independently associated with CS (aOR 1.55, 95% CI 0.70-3.41, p=0.281); induction showed a non-significant trend toward higher CS odds (aOR 2.41, 95% CI 0.99-5.88, p=0.053).

Conclusions: The standardized protocol reduced induction and increased spontaneous labour without changing CS rates or birth timing. A multidimensional dashboard may provide a more informative assessment of labour ward performance than CS rate alone.

Serum creatine kinase in ectopic pregnancy and its association with tubal rupture: a hospital-based case control study

Yukti Ajmera, Sangeeta Sen, Riya Srivastava, Komal Laddha, Khushi Sen — Mon, 28 Sep 2026 00:00:00 +0530

Background: Ectopic pregnancy (EP) remains an important cause of morbidity in pregnancy and diagnosis may be difficult when clinical findings and ultrasonography are inconclusive. This study evaluated serum creatine kinase (CK) in EP and its relationship with tubal rupture.

Methods: This hospital-based case-control study included 50 women with EP and 50 women with confirmed intrauterine pregnancy (IUP), all at ≤14 weeks of gestation, at Pannadhaya Rajkiya Mahila Chikitsalaya, RNT Medical College, Udaipur. Clinical, risk-factor and ultrasonographic data were recorded and serum CK and β-hCG were measured. Continuous variables were compared using the independent-samples t-test and categorical variables using chi-square/Fisher's exact test, as appropriate.

Results: Mean serum CK was significantly higher in EP than in IUP (112.4±24.6 vs 54.8±16.2 IU/l; p<0.001). CK >100 IU/L occurred in 76% of cases versus 12% of controls. Among EP cases, 32 (64%) were ruptured and 18 (36%) were unruptured. Mean CK was higher in ruptured than unruptured EP (130±18 vs 95±15 IU/l; p<0.001). Mean β-hCG was lower in ruptured than unruptured EP (2800±700 vs 3500±900 mIU/ml; p<0.01). Pelvic inflammatory disease was associated with EP (OR 3.63; p=0.03).

Conclusions: Serum CK was significantly elevated in EP and was higher in ruptured disease. CK may provide adjunctive information regarding ectopic pregnancy and tubal injury, but should be interpreted with clinical assessment, ultrasonography and β-hCG rather than used as a standalone diagnostic test.

Association of third trimester cerebroplacental ratio with obstetric and neonatal outcomes in uncomplicated singleton pregnancies: a prospective observational study

Riya Srivastava, Sangeeta Sen, Yukti Ajmera, Komal Laddha — Mon, 28 Sep 2026 00:00:00 +0530

Background: The cerebroplacental ratio (CPR) integrates information from the middle cerebral and umbilical artery circulations and may reflect fetal haemodynamic adaptation. This study evaluated the association between third-trimester CPR and obstetric and neonatal outcomes in uncomplicated singleton pregnancies.

Methods: This prospective observational study included 90 uncomplicated singleton pregnancies in the third trimester. Middle cerebral artery pulsatility index and umbilical artery pulsatility index were assessed by colour Doppler, and CPR was calculated as MCA PI/UA PI. The last CPR measurement before delivery was used for analysis. CPR values were compared between pregnancies with and without selected obstetric and neonatal outcomes. A secondary analysis used the study-derived CPR cut-off of ≤0.85.

Results: Mean CPR was significantly lower with non-reactive NST than reactive NST (0.72±0.19 vs 1.05±0.20; p=0.001). Lower CPR was also associated with Apgar score <7 at 5 minutes, NICU admission, meconium-stained liquor, respiratory distress syndrome, neonatal death, sepsis, assisted and extensive respiratory support, and birth weight <10th centile (p≤0.002). CPR was lower among cesarean than vaginal deliveries (0.81±0.22 vs 1.03±0.20; p=0.002). Overall, 72 (80.0%) had an adverse perinatal outcome; 52/54 (96.3%) with CPR ≤0.85 had an adverse outcome versus 20/36 (55.6%) with CPR >0.85 (p<0.001).

Conclusions: Lower third-trimester CPR was associated with several adverse obstetric and neonatal outcomes. The study-derived cut-off of ≤0.85 was also associated with adverse perinatal outcome. CPR may provide adjunctive information for perinatal risk assessment, while the study-derived threshold requires external validation.

Diagnostic accuracy of magnetic resonance imaging in the preoperative characterization of ovarian neoplasms: a retrospective study with histopathological correlation

Meghna Nair, Akkamahadevi Hiremath, Aishwarya Shukla — Mon, 28 Sep 2026 00:00:00 +0530

Background: To evaluate the diagnostic accuracy of magnetic resonance imaging (MRI) in the preoperative characterization of ovarian neoplasms using histopathological examination (HPE) as the reference standard.

Methods: This retrospective observational study included 105 women with indeterminate or suspicious adnexal masses who underwent preoperative MRI followed by surgical management and histopathological examination at a tertiary care centre. MRI findings were categorized as benign or borderline/malignant based on morphological and tissue-specific imaging characteristics. Histopathological examination served as the reference standard. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), overall diagnostic accuracy, and Cohen's kappa coefficient were calculated.

Results: Histopathological examination identified 73 (69.5%) benign and 32 (30.5%) borderline/malignant ovarian neoplasms. MRI correctly classified all 73 benign lesions and 27 of the 32 borderline/malignant lesions, while five borderline/malignant lesions were incorrectly classified as benign. MRI demonstrated a sensitivity of 84.4%, specificity of 100%, PPV of 100%, NPV of 93.6%, and overall diagnostic accuracy of 95.2%. Agreement between MRI and histopathological classification was excellent (κ=0.88).

Conclusion: MRI demonstrated high diagnostic accuracy and excellent agreement with histopathological examination in differentiating benign from borderline/malignant ovarian neoplasms. Its high specificity supports its role as a valuable problem-solving modality in the preoperative characterization of ovarian masses. However, histopathological examination remains essential for definitive diagnosis.

A prospective study to determine the relationship of serum uric acid level to maternal and perinatal outcomes in patients with hypertensive disorders of pregnancy

Jhelum Saurabh, Kirti Anima Kerketta, Shama Parween, Farhat Mazhari — Mon, 28 Sep 2026 00:00:00 +0530

Background: To study maternal and fetal outcomes in patients with hypertensive disorders of pregnancy (According to American College of Obstetrician and Gynaecologists) by the estimation of serum uric acid levels.

Methods: This is a prospective observational study conducted at tertiary hospital in Bokaro Steel city, Jharkhand over a period of 18 months. During this period women diagnosed with hypertensive disorders of pregnancy after 20 weeks (ACOG) were included. Their serum uric acid level was estimated and were divided into two groups, Group A with 60 patients with uric acid ≥6 mg/dl and Group B with 60 patients with uric acid ≥6 mg/dl. Maternal and fetal outcomes were analysed to detect differences between the two groups.

Results: In Group A, 20% had gestational hypertension, 18.3% had mild preeclampsia, 41.67% had severe preeclampsia, 10% had preeclampsia superimposed on chronic hypertension and 16.7% had eclampsia. In Group B 5% had gestational hypertension, 70% had mild preeclampsia,18.3% had severe preeclampsia,5 % had preeclampsia superimposed on chronic hypertension and 1.67% had eclampsia. In group A, the mean serum uric acid (Mean±SD) of the patients were 7.3733±1.4087 mg/dl. In group B, the mean serum uric acid (Mean±SD) of the patients was 4.6633±0.6428 mg/dl. LSCS was the most common mode of delivery in group A whereas in group B majority had spontaneous onset of labour and delivered vaginally (p<0.05). Group A had adverse perinatal outcome as compared to Group B (p<0.05). Overall, Group A had adverse overall outcome as compared to Group B.

Conclusion: Maternal hyperuricemia was associated with adverse maternal and perinatal outcomes in women with hypertensive disorders of pregnancy.

Morphokinetic trajectory analysis for conservative embryo deselection in two-embryo transfer cycle: A pilot time-lapse imaging study

G. A. Ramaraju, Pranati, P. Kavitha, Girish, Siva Narayana — Mon, 28 Sep 2026 00:00:00 +0530

Background: Time-lapse imaging enhances conventional morphological assessment by providing continuous developmental monitoring and novel morphokinetic parameters; however, its potential application as a conservative embryo deselection strategy remains inadequately explored. Therefore, this pilot study aimed to evaluate the feasibility of time-lapse morphokinetic analysis for identifying embryos with the lowest developmental viability in the in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) cycle.

Methods: A retrospective, observational, single-center, case-control, pilot study was conducted over a 3-month period at a tertiary care center in India. Morphokinetic parameters were compared between embryos associated with successful twin live births and failed pregnancies using generalized estimating equation models with a Gaussian distribution. A reference morphokinetic trajectory was derived from successful embryos using empirical 5th and 95th percentile limits for each developmental parameter.

Results: Twenty-nine IVF/ICSI cycles contributed 58 embryos, including 32 embryos from 16 cycles resulting in successful twin live birth and 26 embryos from 13 cycles resulting in pregnancy failure. Women in the successful outcome group were younger and had higher anti-Mullerian hormone concentrations than those with failed pregnancies. Embryos from successful cycles exhibited significantly greater morphokinetic progression and a more consistent developmental trajectory than embryos from failed cycles. About 81.3% of embryos from successful cycles remained within the reference developmental window, compared with only 34.6%of embryos from failed cycles.

Conclusions: The study suggests that time-lapse morphokinetic trajectory analysis may provide a feasible framework for a conservative embryo deselection by identifying embryos with markedly deviant developmental kinetics. These findings are hypothesis-generating and require validation in larger, independent cohorts before clinical implementation.

Co-relation of abnormal DIPSI values to feto-maternal outcome: an observational study

Nisarga Thammanna, Gayatri Devi Sivasambu, Urvashi — Mon, 28 Sep 2026 00:00:00 +0530

Background: Gestational diabetes mellitus (GDM) is linked to adverse feto-maternal outcomes. This study evaluates the effectiveness of the Diabetes in Pregnancy Study Group India (DIPSI) guidelines as an affordable, one-step universal screening and diagnostic tool.

Methods: This prospective study evaluated 107 pregnant women aged 18–40. The data was collected from November 2022 to April 2024. Participants with abnormal DIPSI results underwent a confirmatory 75g WHO OGTT (2013). Third-trimester ultrasound findings and labor outcomes were analyzed.

Results: At 24–28 weeks, 51.4% of subjects were diagnosed with GDM via DIPSI and confirmed by WHO OGTT. Major maternal-fetal complications included preeclampsia (42%), fetal AC >90th centile (33.3%), preterm labor (23%), and polyhydramnios (22%). The primary delivery mode was Caesarean section (60%), driven by ERCD (34.3%) and fetal distress (18.7%). Mean neonatal birth weight was 2.94 kg. Significant neonatal morbidities included hypoglycemia (43%), phototherapy (43%), NICU admission (42%), shoulder dystocia (5.5%), and IUFD (2%). DIPSI values significantly correlated with neonatal hypoglycemia (p<0.05), but not with fetal AC centiles or polyhydramnios.

Conclusion: All patients with abnormal DIPSI values had at least one abnormal WHO OGTT value, demonstrating DIPSI's strong sensitivity and specificity. DIPSI serves as a cost- and time-effective single-step tool to identify GDM and enable timely intervention to improve feto-maternal outcomes.

Understanding pregnancy outcome decision-making among pregnant adolescents in Vietnam: a qualitative study guided by the social ecological model

Pham Thi Minh Quyen, Le Thanh Tung, Ta Dinh De, Mai Thi Hien — Mon, 28 Sep 2026 00:00:00 +0530

Adolescent pregnancy remains a significant public health concern in Vietnam, yet little is known about how pregnant adolescents make decisions regarding pregnancy continuation or termination. This qualitative descriptive study aimed to explore the decision-making processes of pregnant adolescents and identify the multilevel factors influencing pregnancy outcomes using the social ecological model. Purposive sampling was employed to recruit adolescents aged 15-19 years with unintended pregnancies attending a provincial referral maternal and child health hospital in Central Vietnam. Semi-structured, in-depth interviews were conducted until thematic saturation was achieved. Interviews were audio-recorded, transcribed verbatim, and analyzed using Braun and Clarke’s six-phase thematic analysis. Twelve adolescents participated, including seven who continued their pregnancies and five who chose pregnancy termination. Seven interconnected themes were identified across four ecological levels. At the individual level, pregnancy recognition was commonly accompanied by emotional shock, uncertainty, and evolving pregnancy intentions. Interpersonal influences included both supportive and coercive roles of family members and partner commitment or rejection. At the community level, religious and moral beliefs, financial insecurity, and limited access to reliable reproductive health information and services substantially shaped decision-making. At the societal level, social stigma and cultural expectations regarding marriage, motherhood, and family reputation further influenced pregnancy outcomes. These findings demonstrate that pregnancy outcome decision-making among Vietnamese adolescents is a dynamic process shaped by interacting influences across multiple ecological levels. Interventions should extend beyond individual counseling to include family engagement, adolescent-friendly reproductive health services, improved access to accurate reproductive health information, and community-based strategies to reduce stigma and support informed, person-centered reproductive decision-making.

Impact of consumption of different tastes on the liver biomarkers in pregnant women: an observational pilot study

Sanika S. Aphale, Aarati Chitnis, Aishwarya Joglekar, Swati V. Gaikwad — Mon, 28 Sep 2026 00:00:00 +0530

Derangement of liver enzymes during pregnancy may represent a physiological adaptation or reflect underlying hepatic dysfunction that is pre-existing or coincidental. Multiple etiologies contribute to altered liver biomarkers in pregnancy, and identification of modifiable factors remains clinically relevant. Dietary assessment offers a potential means to understand the underlying contributors to such biochemical alterations. From an Ayurvedic perspective, diet is evaluated based on Shad-rasa (where shad is six and rasa is tastes), each of which exerts specific effects on body physiology and metabolic balance. Assessing dietary patterns through Shad-rasa may therefore provide insight into liver enzyme derangements during pregnancy. Pregnant women with deranged liver function tests (LFT) in the antepartum period were assessed using a structured diet history questionnaire documenting frequency and quantity of commonly consumed food items, categorized according to dominant taste profiles. Liver function parameters were classified as normal or abnormal based on standard reference ranges. Statistical analysis was performed to examine associations between dietary taste patterns and deranged LFT parameters.

Maternal and perinatal outcomes in acute pancreatitis complicating pregnancy: a case series and review of literature

Neha Sharma, Muntaha — Mon, 28 Sep 2026 00:00:00 +0530

Acute pancreatitis in pregnancy (APIP) is uncommon but can be a serious maternal and obstetric emergency. Its symptoms may resemble common pregnancy-related complaints, making early diagnosis challenging, particularly in the third trimester. We report three cases of APIP presenting in the third trimester. Case 1 was a 23-year-old G2P1L0 at 31 weeks who presented with severe epigastric pain, vomiting, and preterm labour. Markedly elevated amylase and lipase, along with imaging findings of acute necrotizing pancreatitis with limited pancreatic necrosis, extensive peripancreatic inflammation, collections, mild ascites, ileus, and left pleural effusion, confirmed the diagnosis. Fetal distress subsequently developed, necessitating emergency caesarean delivery. She required postoperative intensive care and ventilatory support. Case 2, a multigravida at 33+5 weeks with recurrent pancreatitis, fetal growth restriction, and anemia, presented with abdominal pain and reduced fetal movements. She improved with conservative management and later underwent induction at 35+5 weeks, resulting in a live preterm vaginal delivery. Case 3, a primigravida at 31+5 weeks with gestational hypertension and intrahepatic cholestasis, presented with epigastric pain radiating to the back and shoulder. Elevated pancreatic enzymes confirmed pancreatitis. She responded well to conservative treatment and subsequently delivered vaginally. All patients received bowel rest, intravenous fluids, electrolyte correction, analgesia, antibiotics, and close maternal-fetal monitoring. Maternal survival was 100%, and all pregnancies resulted in live preterm births. Early recognition and multidisciplinary management are crucial for favourable outcomes in APIP.

Reproductive outcome in congenital hypogonadotropic hypogonadism: our experience in a tertiary care centre

Mon, 28 Sep 2026 00:00:00 +0530

Congenital hypogonadotropic hypogonadism (CHH) is a clinical syndrome characterised by low levels of gonadotropins due to impaired secretion of GnRH. It is a rare cause of infertility in females and managing such cases becomes a challenge at times. We present 4 cases of CHH cases who were managed in our centre and had successful pregnancy outcome. All the cases were initially given hormone replacement therapy (HRT) for 3-4 cycles as the uterus and endometrium were infantile due to hormone deficiency. Post HRT ovarian stimulation with gonadotropins and IUI cycles were attempted. 2 cases conceived with ovulation induction and IUI on the second attempt. The third and fourth case had to undergo IVF cycle with prolonged stimulation with gonadotropins for 15 days and 17 days respectively and they finally conceived after frozen embryo transfer. First three patients carried their singleton pregnancies till term and delivered healthy newborns. The fourth patient underwent early preterm emergency cesarean of the twins due to obstetrical indications.

No two uteri are alike: clinical variability and management of uterine fibroids in pregnancy – a case series

Pooja Bhat, Rashiqua Khalid — Mon, 28 Sep 2026 00:00:00 +0530

Uterine fibroids present with unpredictable clinical behavior during pregnancy depending on their size, number, and anatomical location, as gestational hormonal shifts and altered uteroplacental dynamics influence tumor growth, placentation, and labor mechanics. This prospective case series evaluated four singleton pregnancies (mean maternal age: 29.5 years; 3 primigravidae, 1 multigravida) complicated by subserosal and intramural fibroids ranging from 1.9 to 7.0 cm. One patient exhibited transient second-trimester uterine artery Doppler notch resistance without fetal growth restriction. Intrapartum, three patients required emergency caesarean delivery secondary to failed labor induction or labor dystocia, while one underwent elective caesarean section for cephalopelvic disproportion. Selective caesarean myomectomy was successfully performed in two cases (50%) where fibroids directly obstructed the lower uterine segment incision line. Conversely, myomectomy was intentionally deferred in the remaining two cases due to deep intramural placement or transient intraoperative uterine atony. All four neonates were delivered at term with favorable birth weights (mean: 3.03 kg) and robust Apgar scores, requiring no NICU admissions. Uterine fibroids exhibit marked clinical heterogeneity; however, vigilant antenatal surveillance, selective Doppler application, and individualized intrapartum decision-making performing myomectomy specifically when fibroids impede surgical access ensure optimal maternal and neonatal outcomes.

A mysterious case series of scar endometriosis

Varsha R. Gowda, Vishwas M. K. — Mon, 28 Sep 2026 00:00:00 +0530

Scar endometriosis is an uncommon form of extrapelvic endometriosis that most frequently develops following obstetric or gynaecological surgery, particularly caesarean section. Because its clinical presentation may mimic other scar-related lesions, diagnosis is frequently delayed. A painful scar-associated mass with cyclical variation in symptoms should raise suspicion of scar endometriosis. We present a retrospective case series of 3 women diagnosed with scar endometriosis at MCH Holenarasipura between January 2026 and June 2026. Clinical presentation, previous surgical history, imaging findings, operative findings, treatment and histopathological confirmation were reviewed. The three patients were aged 24, 26 and 27 years. All had a previous history of caesarean section. The interval between the preceding surgery and presentation was 18 months, 24 months and 16 months. The predominant clinical presentation was a painful scar-associated swelling, with all three patients reporting cyclical exacerbation of pain during menstruation. Ultrasonography was performed in all patients; MRI was not performed in any patient. All three patients underwent wide local excision of the endometriotic lesion. Histopathological examination demonstrated endometrial glands and stroma within fibrous and/or skeletal muscle tissue, confirming scar endometriosis. Scar endometriosis should be considered in the differential diagnosis of a painful abdominal or pelvic surgical scar, particularly in women with a previous caesarean section. A high index of suspicion, appropriate ultrasonography and complete surgical excision with histopathological confirmation are important for definitive treatment and prevention of recurrence.

Activities of traditional birth attendants in a local council in Nigeria, menace and corrective measures

Eric O. Ojajuni, John O. Dirisu — Mon, 28 Sep 2026 00:00:00 +0530

Pregnancy and child-bearing remain key aspects of a woman’s life and adequate health access is needed by the expectant mother to birth each child safely. Given the prevailing circumstances in certain localities in Nigeria, adequate health access for proper maternal care is lacking and absent in some cases. The result of this lack is the thriving presence of unskilled and untrained traditional birth attendants (TBAs) who in most cases reside locally and are easily assessable by expectant mothers. In particular, Ilaje a local council in Ondo state has a preponderance of unskilled and untrained TBAs which is increasing the scale of the problem and culminating in increased maternal and infant mortality. A number of other factors such as poverty, poor educational exposure, and primitive religious and cultural indoctrination have also been identified as causal factors in this regard. While steps have been taken to address this challenge by a previous state government, successive governments have not mounted similar interventionist responses. The ‘Abiye’ and ‘Agbebiye’ initiatives were home grown models to reduce the incessant proliferation of unskilled TBAs, reduce infant and maternal mortality, and to strengthen the coordination of referrals from the community health centres to the well-equipped hospitals, which led to Ondo State becoming the only state in Nigeria to achieve the millennium development goals (MDGs) of reducing maternal death, surpassing the 75% reduction goal. It is hoped that such initiatives will be sustained to continue to savour the gains.

Medical negligence in assisted reproductive technology: a comparative legislative analysis of India and selected jurisdictions

Abhinav Kuchipudi, Aditi Jani — Mon, 28 Sep 2026 00:00:00 +0530

Assisted reproductive technology (ART) has rapidly advanced treatment of infertility and created new forms of medical malpractice that strain existing legal structures. This study investigates the treatment of medical malpractice with ART and analyzes the cases of India, Australia, Switzerland, Sweden, and New Zealand. This examination is both doctrinal and comparative. It studies primary legal documents, such as statutes, regulation, and case law, and focuses on recent publications. Common themes of negligence include failure to obtain informed consent, confused identity of embryos, false representation regarding success rates, violation of medical confidentiality, and insufficient regulatory oversight of fertility clinics. Based on comparisons, states with systems of independent accreditation and ethics - driven oversight have stronger protections. The ART Regulation Act, 2021 is a major improvement for India, but has significant shortcomings concerning negligence and compensation issues in ART. Clearer definitions and thresholds of negligence and stronger regulations and oversight of ART with mandatory periodic inspections and grievance redress mechanisms are needed to protect the rights of ART clients in India.

Endometriosis – the new approach and homoeopathic therapeutics

Tridibesh Tripathy, Anjali Tripathy, Sanskriti Tripathy — Mon, 28 Sep 2026 00:00:00 +0530

An integral part of public health and especially the reproductive health since decades is the condition of endometriosis. The reproductive and child health (RCH) is a large chunk of the entire national health mission (NHM) where primarily the target is maternal and child health (MCH). As part of MCH and RCH, this article discusses the issue of endometriosis in the domain of reproductive life of a woman. It traverses through the fact that endometriosis in reproductive health is not only under the umbrella of hormonal domain but also it is a part of the cellular and metabolic functions in the body. The term cellular is aimed at the power house of the cell located in the cytoplasm, the mitochondria. The mitochondrial lens will help the medical fraternity to see the clinical condition of endometriosis in the perspective of new and emerging research. Simultaneously, it will help in comprehending the issues of pain, inflammation and cellular energy in endometriosis. With the new approach, missions, programs, strategies, objectives, activities and policies will have to be tuned with the issue of endometriosis. A holistic approach is the need of the hour amidst the current approaches that were primarily hormonal and surgical. Medical and clinicians need to adopt a therapeutic that is preventive, resilient, cost effective, clinical effective and has no side effects. Homoeopathy of ayurveda, yoga and naturopathy, unani, siddha, and homoeopathy (AYUSH) ministry of India has all these qualities to face the future challenges in the interventions to deal with endometriosis.

Premature rupture of membranes: current concepts in diagnosis, management and prevention

Mon, 28 Sep 2026 00:00:00 +0530

Premature rupture of membranes (PROM) is an obstetric complication associated with adverse maternal and neonatal outcomes. Preterm PROM (PPROM) contributes substantially to preterm birth and unfavorable perinatal outcomes. This narrative review summarizes current evidence regarding the risk factors, diagnosis, management, and prevention of PROM and PPROM. A literature search was conducted using PubMed, Scopus, and Google Scholar for relevant publications from 2000 to 2026. Relevant clinical trials, systematic reviews, and clinical guidelines were included. Diagnosis of PROM requires clinical evaluation with the help of biochemical markers such as placental alpha microglobulin-1 (PAMG-1) and insulin-like growth factor binding protein-1 (IGFBP-1). The management strategies are based on gestational age and include antibiotic therapy, antenatal corticosteroids, magnesium sulfate for fetal neuroprotection, and careful assessment of maternal and fetal well-being. Early recognition, accurate diagnosis, and evidence-based management are essential for improving maternal and neonatal outcomes associated with PROM and PPROM. Management should be individualized according to gestational age and maternal and fetal clinical status, with appropriate use of antibiotics, antenatal corticosteroids, magnesium sulfate for fetal neuroprotection, and close monitoring when indicated. Preventive strategies addressing modifiable risk factors may further contribute to reducing the burden of PROM and PPROM.

Molecular techniques used in non-invasive pre-implantation genetic testing: current approaches, applications and challenges

Mon, 28 Sep 2026 00:00:00 +0530

Preimplantation genetic testing (PGT) represents an important diagnostic method in assisted reproductive technology (ART) for the screening of chromosomal and genetic aberrations prior to embryo transfer. Non-invasive PGT (niPGT) is a new technology that analyzes cell-free embryonic DNA (cfDNA) released into spent culture media. This is a safer method than conventional PGT that uses invasive biopsies of embryos that can damage their viability. Advanced molecular techniques support the diagnostic accuracy of NiPGT: array comparative genomic hybridization (aCGH) allows genome-wide detection of whole-chromosome aneuploidies and copy number variations through comparative hybridization. Next-generation sequencing (NGS) allows high-throughput deep-coverage analysis with extended dynamic range and allows detection of whole-chromosome aneuploidies, segmental defects and intermediate mosaic thresholds on all 24 chromosomes. Because embryonic cfDNA is so fragmented and present only in trace picogram quantities, whole genome amplification (WGA) is needed to amplify the genetic material for downstream analysis, and other targeted approaches such as quantitative PCR (qPCR) and high-density single nucleotide polymorphism (SNP) arrays are also important, as they enable copy count calculation and provide vital haplotype-specific information on parental inheritance patterns. niPGT has high embryo concordance rates, ranging from 76% to 91%, when compared to conventional biopsies, but it presents significant technical challenges, including maternal DNA contamination from cumulus cells or maternal shedding, which can mask true embryonic aneuploidies and lead to false-negative results, as well as unequal amplification biases and artifacts generated during WGA. Continued refinement of sequencing and amplification protocols, together with more robust clinical validation, will be needed before niPGT can be widely adopted in routine practice.

Postpartum haemorrhage – current perspectives on prevention and management

Sri Aakash Kumar — Mon, 28 Sep 2026 00:00:00 +0530

Postpartum hemorrhage (PPH) remains the leading cause of maternal mortality worldwide, disproportionately affecting women in low- and middle-income countries, including India. Despite measurable advances in obstetric care over the past decade, delayed recognition, inconsistent application of the management ladder, and fragmented guidance across professional bodies have continued to contribute to deaths that are, in the overwhelming majority of cases, preventable. This review draws on the October 2025 consolidated guidelines issued jointly by the World Health Organization (WHO), the International Federation of Gynecology and Obstetrics (FIGO), and the International Confederation of Midwives (ICM) - the first time these three bodies have produced a single unified framework on the subject - together with landmark trial evidence accumulated over the last decade, to synthesize current understanding of the prevention, diagnosis, and treatment of PPH. It examines risk factors and their limited predictive value, the increasingly central role of antenatal anemia correction alongside active management of the third stage of labor, the stepwise escalation of treatment from uterotonics and tranexamic acid through uterine balloon tamponade to surgical intervention, and the particular relevance of low-cost tamponade devices developed for and validated in resource-limited Indian settings. A comparative summary table is included to consolidate the escalation pathway into a single visual reference. The review is intended as an accessible, India-contextualized reference for postgraduate trainees and practicing obstetricians.

Standardized patients in antenatal history taking: bridging simulation and clinical practice: a narrative review

Gayathri Sabapathy, Eswar B Balakrishnan, Dhivya S Sabapathy — Mon, 28 Sep 2026 00:00:00 +0530

Antenatal history taking is a main competency in obstetric education, requiring integration of communication skills, clinical reasoning, professionalism and patient centred care. Traditional bedside teaching alone may not provide required opportunities for repetitive practice because of limited patient availability, ethical considerations and variability in clinical exposure. Simulation based education using standardized patients (SPs) has emerged as effective strategy to address these challenges by providing realistic, standardized and safe learning environments. To examine the evidence for the role of SPs in teaching antenatal history taking and also review their educational use, benefits, challenges of implementation and future prospects in competency based obstetric education. A narrative review of recent open access literature (2023-2026) was performed. A critical review and synthesis of relevant articles on SPs, simulation based learning, competency based medical education, communication skills and obstetric education were performed to give an evidence based overview of the educational role of SPs in antenatal history taking training. Available evidence consistently indicates that using SPs improves communication skills, history taking ability, learner confidence, professionalism and clinical competence. SP based learning offers opportunities for deliberate practice, immediate feedback, reflective learning, and standardized competency assessment. Recent innovations such as teacher SPs and virtual patient technologies add to the further improvement of simulation based education and are complementary to conventional clinical teaching. SPs can be a valuable educational approach to teach antenatal history taking within Competency Based Medical Education. The inclusion of this teaching strategy within the curriculum of undergraduate and postgraduate education in obstetrics will facilitate the development of communication skills, competency-based evaluation and preparation for the practical situations.

Closing the first 1,000 days gap: midwife-and nurse-led interventions for maternal, neonatal and child health-a narrative review

Mon, 28 Sep 2026 00:00:00 +0530

The first 1,000 days, from conception to a child's second birthday, shape maternal survival, newborn health and the course of early child development. Nurses and midwives deliver most of the care received in this period, yet evidence on their contribution is usually reported one stage at a time. This narrative review brings that evidence together across the whole continuum. PubMed/MEDLINE, Scopus, Web of Science, CINAHL, Embase, the Cochrane Library, WHO IRIS and UNICEF repositories were searched for English-language publications from January 2019 to June 2026, and current WHO guidance was consulted. Eighteen key studies were charted and synthesised thematically. Midwife continuity of care increased spontaneous vaginal birth and reduced caesarean and instrumental birth, although its effect on preterm birth was small or uncertain. Midwife-delivered bundles for postpartum haemorrhage, basic newborn resuscitation training, deferred cord clamping and immediate kangaroo mother care reduced severe morbidity or mortality in trials from low- and middle-income countries. Kangaroo mother care also lowered maternal depressive symptoms, and breastfeeding support reduced early cessation of exclusive breastfeeding. Parenting programmes improved early child development, whereas intensive nurse home visiting in one large trial did not change birth outcomes. Two-way mobile health communication increased antenatal attendance and skilled birth attendance. Three gaps remain: in coverage, in quality and in continuity between facility and community, with the second year of life the least studied. Closing them requires adequate nursing and midwifery staffing, competency-based education and services that follow the mother–child pair through all 1,000 days.

Physiotherapeutic interventions for overactive bladder

Ashudeep Kaur, Supreet Bindra, Pankajpreet Singh, Shavez Mansoori — Mon, 28 Sep 2026 00:00:00 +0530

Overactive bladder (OAB) is a common urinary disorder characterized by urgency, frequency, nocturia, and urge urinary incontinence (UUI), which can significantly impair quality of life (QoL). This study aimed to review the effectiveness of physiotherapeutic interventions in the management of OAB. Relevant studies published between 2013-2026 were collected from PubMed, Google Scholar, ResearchGate, and Cochrane Library. Outcome measures commonly used across the studies included OAB symptom score (OABSS), OAB questionnaire (OAB-q), international consultation on incontinence questionnaire OAB (ICIQ-OAB), dysfunctional voiding scoring system (DVSS), visual analogue scale (VAS), bladder diaries, uroflowmetry parameters, QoL questionnaires, pad tests, and frequency-volume charts. A total of 22 studies were included based on predefined eligibility criteria, including 10 studies on electrotherapeutic modalities, 5 studies on therapeutic exercises, and 7 studies examined the combined effects. Regarding the study population, 5 studies were conducted on children, 11 studies on women, and 6 studies included both men and women, while no study exclusively investigated only men. Findings demonstrated electrotherapeutic modalities such as transcutaneous tibial nerve stimulation (TTNS), transcutaneous electrical nerve stimulation (TENS), interferential current (IFC) and biofeedback significantly reduced urinary urgency, frequency, nocturia, and UUI while improving QoL. This study concludes that therapeutic exercises, including pelvic floor muscle training (PFMT), bladder training, urge suppression techniques and bladder training (BT), showed significant improvements in OAB symptoms and bladder control. Studies investigating combined interventions, particularly behavioral advice and PFMT (BA-PFMT), TTNS with behavioral therapy, and PFMT combined with tibial nerve stimulation, reported greater clinical benefits compared with single interventions. The existing studies indicate both electrotherapeutic modalities and therapeutic exercises are effective, safe, and non-invasive treatments for OAB. However, the combination of these approaches results in superior outcomes, leading to greater reductions in symptoms, enhanced bladder control and improved QoL.

Caesarean scar ectopic pregnancy: current concepts in diagnosis, classification and management – a comprehensive narrative review

Deychen D. Myes, Bhavana, Asmita Kaundal, Anita Choudhary — Mon, 28 Sep 2026 00:00:00 +0530

Caesarean scar ectopic pregnancy (CSEP) is defined as one in which implantation occurs within the myometrial scar of a previous caesarean section. Although uncommon, CSEP is associated with significant maternal morbidity and potentially life-threatening complications. Its incidence has increased substantially over the past two decades because of rising caesarean section rates and improvements in early pregnancy ultrasonography. Presentation of CSEP varies from asymptomatic cases to shock. The condition is associated with severe maternal morbidity, including massive haemorrhage, uterine rupture, placenta accreta spectrum disorders, disseminated intravascular coagulation, hysterectomy, and even maternal mortality if not diagnosed early. The main diagnostic modality for CSEP is transvaginal ultrasonography (TVS) with colour doppler imaging. Early recognition is crucial for timely intervention. Caesarean scar ectopic pregnancy is classified based on implantation pattern, direction of gestational growth, and myometrial thickness. Management remains controversial as there is no universally accepted treatment protocol. Treatment selection depends on hemodynamic status, gestational age, fetal viability, serum beta-human chorionic gonadotropin levels, myometrial thickness, and future fertility desires. This comprehensive narrative review summarizes the current literature on the epidemiology, etiopathogenesis, risk factors, classification, diagnosis, imaging findings, management options, complications, reproductive outcomes, and preventive strategies for caesarean scar ectopic pregnancy. Advances in early imaging and minimally invasive treatment strategies have improved outcomes substantially; however, standardized management guidelines remain lacking.