International Journal of Reproduction, Contraception, Obstetrics and Gynecology
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A study on risk factors and proportion of emergency peripartum hysterectomy in a tertiary care centre
Full text linkBackground: Peripartum hysterectomy, though rare, is a high-risk procedure performed during or immediately after delivery. It is linked to increased morbidity, mortality, and significant healthcare costs, particularly affecting women wishing to preserve fertility. Major complications include transfusion requirements, re-exploration for persistent bleeding, febrile morbidity, severe surgical complications, and maternal death.
Methods: This prospective study was conducted over 18 months (September 2022 to May 2024) at Vilasrao Deshmukh Government Medical College and Hospital, Latur. It included patients requiring emergency peripartum hysterectomy, both those presenting directly and those referred after undergoing the procedure elsewhere.
Results: In this study, the majority of cases (12) occurred in individuals aged 35 and above, followed by 11 cases in the 26-34 age group and 7 cases in the 18-25 age group. Most patients had only primary education (43.32%), with 33.34% completing secondary education and 23.34% graduating from secondary education. A higher prevalence was observed in rural areas (56.66%) compared to urban locations (43.34%). Socioeconomically, most cases (73.34%) belonged to lower socioeconomic classes (III, IV, V), while 26.66% were from upper socioeconomic classes (I, II).
Conclusions: Emergency peripartum hysterectomy is a critical, life-saving intervention, where timely execution and a multidisciplinary approach are essential for improving patient outcomes. Assessing its prevalence in society aids in identifying key risk factors, enabling early detection and a comprehensive strategy to safeguard maternal health
Predicting mode of delivery using mid‑pregnancy ultrasonographic measurement of cervical length among nulliparous women
Full text linkBackground: Numerous studies have demonstrated that measuring the cervical length using transvaginal ultrasonography in singleton pregnancies at 20-24 weeks gestation can be a valuable technique for predicting the likelihood of a severe preterm birth. The association between cervical length at 20-24 weeks and the likelihood of a term cesarean section birth has, however, not been well researched. The purpose of this research is to ascertain if mid-pregnancy ultrasonography cervical length measurements are effective in anticipating term cesarean sections. Our hypothesis in this study is that there is no correlation between mid-pregnancy cervical length and the chance of a cesarean section during term labor.
Methods: One hundred pregnant women, ranging in gestation from twenty to twenty-four weeks, were enrolled in the study. Individuals were chosen from the prenatal outpatient clinic. The gestational age varied from 36 to 40 (38.7±2.2 weeks). Of the cases, 53 women (53%) had a normal birth, and 47 women (47%) had a cesarean section. Four sets of data were identified based on the cervical length quartile: first quartile (15-24 mm), second quartile (25-29 mm), third quartile (30-39 mm), and fourth quartile (40-50 mm).
Results: Patients with cervical lengths in the second quartile (18.2%) had the lowest rate of cesarean sections (18.6%), whereas patients with cervical lengths in the fourth quartile (96.6%) had considerably higher rates (p<0.00). Patients in the fourth quartile had a substantially higher (p<0.00) frequency of cesarean sections due to labor failure (6.38%). Logistic regression analysis revealed that the odds ratio (OR) for cesarean section in labor was lowest among patients in the first quartile (OR=1.94) and highest among patients in the fourth quartile (OR=2.95). The cervical length quartile did not significantly differ in terms of neonatal outcomes, with exception of birth weight, which did significantly differ.
Conclusions: For patients who are nulliparous, the cervical length measured by transvaginal ultrasonography at mid-gestation can be used to predict the chance of a cesarean delivery at term
Uterine carcinosarcoma: a rare and aggressive neoplasm
Full text linkUterine carcinosarcoma (UCS) is a rare highly aggressive tumor accounting for 2-3% of all uterine malignancies. It’s characterized by postmenopausal bleeding and often presents with a palpable pelvic mass. The tumors usually contain both malignant epithelial carcinomatous and sarcomatous mesenchymal components. Herewith presenting a case report of a patient with postmenopausal bleeding with a 16 weeks size lump in the abdomen
Mucous membrane ulcerations secondary to methotrexate in a patient with unruptured tubal ectopic pregnancy: a case report
Full text linkEctopic pregnancy remains a significant contributor to first trimester maternal mortality, though early diagnosis now allows for successful medical management in hemodynamically stable unruptured ectopic patients. Methotrexate is the drug of choice in such scenarios, with known side effects including gastrointestinal discomfort and myelosuppression. We present a rare case of a 29-year-old primigravida with a right tubal unruptured ectopic pregnancy managed with multiple dose methotrexate regimen. Despite stable blood counts and normal organ function, the patient developed severe oral and vulvar mucositis by day 6 of the treatment. Examination revealed multiple painful aphthous ulcers and erythema affecting the buccal mucosa and labia minora. The mucositis resolved completely by day 25 with symptomatic treatment including antihistamines, topical agents and delayed vitamin supplementation. This case highlights an uncommon presentation of methotrexate toxicity with isolated orogenital ulceration occurring in the absence of pancytopenia or systemic toxicity. Early recognition of mucosal lesions is critical for prompt management and may prevent progression to more severe toxicity
The case series of Eisenmenger syndrome and its pregnancy outcome in tertiary care centres of South India
Full text linkThe incidence of the Eisenmenger syndrome (ES) is very rare in the pregnant women, but it has significant association with materno-fetal morbidity and mortality. The prognosis of ES in terms of materno fetal outcomes and neonatal outcomes in the pregnant women is unclear. The main aim of this study is to evaluate the materno-foetal outcome of pregnancy with ES in a tertiary care centre. The case series had been observed in retrospective aspect at 2 tertiary care centres of South India, Government Thiruvarur Medical College and Hospital, Government Villupuram Medical College and Hospital, Tamil Nadu, India over a period of 1 year from 2023-2024. This study analysed the occurrence of ES in the pregnant women with cardiac disease and their materno-foetal outcomes in tertiary care centres of South India. In our study period, 41,718 cases were delivered, in which 6515 cases had cardiac disease, 1105 cases had congenital heart disease. Of these, 6 cases had ES during pregnancy. In our study, ES was noted in 1: 6953 pregnant women, 1:1086 pregnant women with cardiac disease, 1:184 pregnant women with congenital cardiac disease. The mean age was 23.4±0.52 and mean gestational age at delivery was 34±1.25 weeks. The mean pulmonary arterial pressure was 73 mmHg. In our study, 3 cases had preterm deliveries and 1 case had term delivery, 2 cases delivered vaginally, 2 cases had caesarean section and 2 cases had abortions. As per our study, nil maternal mortality reported. For achieving optimum outcomes in the pregnant women with ES, the well-equipped obstetric critical care unit with multidisciplinary approach must be ensured in a tertiary care centre
Awareness about cervical cancer screening and prevention among women attending tertiary care centre
Full text linkBackground: Cervical cancer is the fourth leading cause of cancer-related deaths worldwide, with India accounting for the highest number of deaths. Cervical cancer screening is crucial for detecting abnormal cervical cells at the pre-invasive stage, also known as cervical pre-cancer. Early detection enables timely treatment, preventing the progression to cervical cancer. Two primary screening methods are employed: high-risk human papillomavirus (HR HPV) DNA testing and the Papanicolaou (Pap) smear. To assess awareness about cervical cancer screening and prevention among women attending outpatient departments at the tertiary care centre, Bhopal.
Methods: This present study employed a cross-sectional design to investigate cervical cancer awareness among 100 female patients aged 20 years and above attending G-OPD at People Medical College Hospitals and Research Centre from January 2024 to June 2024. Participants were selected using a multistage sampling technique to ensure representation and a pre-tested, self-administered questionnaire was employed.
Results: The majority of participants (61%) were aged 20-40 years. Awareness about PAP smear testing was low, with 53% unaware in the 20-40 age group. Knowledge about cervical cancer risk factors was alarmingly low, with 57% unaware in the 20-40 age group. HPV vaccine awareness was also limited, with 57% unaware in the 20-40 age group. Conclusions: The study reveals a concerning lack of awareness about cervical cancer screening, risk factors and HPV vaccination. Targeted education and awareness campaigns are necessary to promote cervical cancer prevention and early detection
Current patterns of menstrual health and hygiene among adolescent and young women of 15-24 years from rural northern India: a community based cross sectional study
Full text linkBackground: Menstrual health has an impact on physical, mental and social well-being of young women. Young women in rural areas may face peculiar challenges related to menstrual health and hygiene management (MHHM). In view of evolving lifestyle and behavioural changes in transitional world, there is a need for latest community-based study among young women in rural India. Therefore, we aimed to estimate the magnitude of problems associated with MHHM, and to identify the factors associated with menstrual problems and menstrual hygiene.
Methods: House visits were made in the selected villages of Ballabgarh block of Haryana, and 483 non-pregnant women aged 15-24 years were interviewed regarding socio-demographic characteristics and menstrual history (on age of menarche, irregular menstrual bleeding, sanitary pad usage, heavy menstrual bleeding, dysmenorrhea, period fatigue). Dietary diversity was assessed using women dietary diversity (WDD) scale. Multivariable logistic regression analyses were done to identify factors associated with different menstrual problems and strict sanitary pad usage.
Results: The prevalences of heavy menstrual bleeding, dysmenorrhea and period fatigue were 20.9%, 26.3%, and 32.0% respectively. Age and marital status were associated with dysmenorrhea. Low dietary diversity was associated with period fatigue. Menarche was delayed among 26.9% and early by 20.8% of the participants. More than nine out of ten participants (92.8%) strictly use sanitary pads. Heavy menstrual bleeding was associated with lesser strict use of sanitary pads.
Conclusions: Menstrual problems were common among young women in rural India, and heavy menstrual bleeding was associated with lesser strict use of sanitary pads
A rare case report of twin reversed arterial perfusion sequence in monochorionic diamniotic twin and outcome of Dr. Pump and Mr. Acardiac acephalus in a tertiary care centre
Full text linkTwin reversed arterial perfusion (TRAP) sequence or Acardiac twinning is a rare complication seen in monozygotic gestation. The reported incidence of Acardiac twin is 1 in 35000 births and 1 in 100 monozygotic twin gestation. In monochorionic twin pregnancies, a twin with poorly developed heart and upper torso (the “Acardiac”) is perfused by its co-twin (the “pump”) via superficial arterio-arterial or veno-venous anastomoses located on the placental surface, through which blood pumped backwards. Due to poor prognosis of TRAP sequence in monochorionic pregnancies, 100% mortality was reported in Acardiac twin due to its severe malformations and also due to heart failure and prematurity in pump twin 50-55% mortality was reported. We hereby report a case of 22-year-old primigravida, monochorionic diamniotic (MCDA) twins presented with abruption at 24 weeks of gestation, resulted fetal demise of pump twin. Our study also reviewed necessity of thorough sonological evaluation and therapeutic opportunities in monochorionic multifetal pregnancies.
Placenta accreta syndrome: an obstetrician’s nightmare
Full text linkPlacenta accreta syndrome (PAS) poses significant clinical challenges during pregnancy and delivery, often resulting in severe maternal morbidity and mortality. This case series aims to present the varied presentations, management strategies, and clinical, and maternal outcomes associated with five patients diagnosed with PAS at our tertiary care center. A prospective analysis was conducted on five patients diagnosed with PAS who presented during the six months of study period. Demographics, clinical presentations, imaging findings, surgical interventions, and outcomes were systematically documented and analyzed. The case series included women aged 28 to 34 years, each with a history of caesarean deliveries. Common presentations included vaginal bleeding associated with placenta previa and varying degrees of placental invasion, namely accreta and percreta. All patients underwent planned caesarean deliveries, revealing severe placental adherence to surrounding structures, necessitating aggressive management. Significant postpartum hemorrhage occurred in all cases, with blood transfusions ranging from 3 to 6 units. Two patients required caesarean hysterectomy due to uncontrolled bleeding. All patients were admitted to the intensive care unit (ICU), with two cases resulting in mortality. Notable complications included post op infection, sepsis and bladder adhesion in individual cases, resulting in prolonged hospital stay for two patients. Histopathological confirmation supported the clinical diagnosis in all cases. PAS presents critical challenges in obstetric management, as demonstrated by the substantial morbidity and the requirement of multidisciplinary interventions in our case series. These findings underscore the importance of early diagnosis, thorough preoperative planning, and a collaborative approach to improve maternal outcomes in patients with PAS. Enhanced awareness and preparedness among healthcare providers are crucial to mitigate risks associated with this life-threatening condition. Further studies are warranted to refine management protocols and optimize patient outcomes in PAS
Efficacy of ormeloxifene versus norethisterone in the management of abnormal uterine bleeding
Full text linkBackground: Abnormal uterine bleeding (AUB) is a common gynecological issue that significantly affects the quality of life of women, particularly those in the reproductive and perimenopausal age groups. Ormeloxifene, a selective estrogen receptor modulator, and norethisterone, a synthetic progestogen, are commonly used in its medical management. Objective of this study was to evaluate and compare the efficacy and safety of ormeloxifene and norethisterone in the management of AUB.
Methods: A prospective comparative study was conducted on 100 women aged 35 years and above diagnosed with AUB at D. Y. Patil Hospital, Navi Mumbai between July 2023 to December 2024. Participants were randomly assigned to two treatment groups. Group A received ormeloxifene (60 mg twice a week for 12 weeks, then once weekly for four weeks), while Group B received norethisterone (5 mg twice daily from day 5 to 25 of the menstrual cycle for 4 cycles). The primary outcome was the change in PBAC score. Secondary outcomes included hemoglobin levels, endometrial thickness, and incidence of side effects, evaluated at baseline, 2 months, and 4 months.
Results: Group A showed a 76.15% reduction in PBAC score, a 2.91 g/dl increase in hemoglobin, and a 4.09 mm decrease in endometrial thickness. In contrast, Group B demonstrated a 45.97% reduction in PBAC score, a 1.31 g/dl increase in hemoglobin, and a 3.50 mm decrease in endometrial thickness. Acne and gastrointestinal side effects were more common in the norethisterone group.
Conclusions: Ormeloxifene was more effective and better tolerated than norethisterone for the treatment of AUB. Its weekly dosing schedule, superior hematological improvement, and lower side-effect profile make it a preferable first-line therapy