International Journal of Reproduction, Contraception, Obstetrics and Gynecology
Not a member yet
9909 research outputs found
Sort by
Clinicopathological characteristics and oncological outcomes in a case of primary ovarian adenosarcoma with sarcomatous differentiation: a case report and literature review
Full text linkMullerian adenosarcoma is a rare malignant tumor generally involving the uterine corpus but can uncommonly involve extrauterine organs. Ovarian adenosarcoma is extremely rare and often diagnosed in young women. Majority of them are low grade with a good prognosis except for adenosarcoma with sarcomatous overgrowth (SO). We report a case of a large sized ovarian adenosarcoma with SO with elevated levels Ca125 and Ca19.9 and having disease free interval of approximately 1.5 years
Maternal near miss events in a tertiary care teaching hospital: a prospective analysis of risk factors, clinical outcomes and healthcare system performance
Full text linkBackground: Maternal health is a critical indicator of a nation's overall health and development. Maternal near miss (MNM) cases, defined as women who nearly died but survived a life-threatening complication during pregnancy or childbirth, offer valuable insights into improving maternal healthcare systems.
Methods: A comprehensive analysis was conducted at a tertiary care teaching hospital to identify MNM cases using world health organization's (WHO) standardized criteria, which include clinical, laboratory, and management-based indicators. Data on the frequency, causes, and outcomes of MNM events were collected and analyzed to assess the quality of care provided. The study was a prospective design, conducted for 6 months from January 2024 to June 2024, involving 50 participants.
Results: The study found that hemorrhage, hypertensive disorders, and sepsis were the most common causes of MNM. Early identification and timely intervention were crucial in preventing progression to maternal death. The study also highlighted the impact of health system factors, such as accessibility to emergency obstetric care and the availability of skilled healthcare providers, on the incidence of MNM. Blood transfusion was the most common life-saving intervention (30%), and 64% of cases were pregnancy-related.
Conclusions: MNM cases occur more frequently than maternal deaths and provide a larger sample size for analysis, leading to improved maternal care and reduced maternal mortality. The findings underscore the importance of enhancing healthcare infrastructure, training healthcare providers, and implementing evidence-based interventions to improve maternal outcomes
Effectiveness of enhanced recovery after surgery protocol in major gynecological surgeries: a cross-sectional study
Full text linkBackground: Objectives of the study include: assessment of effectiveness of perioperative outcome of components of enhanced recovery after surgery protocol (ERAS-P) - pre-operative, intra-operative, post-operative and compliance of participants to ERAS-P.
Methods: A prospective cross sectional study was conducted at Sri Chamarajendra Government, Teaching MCH hospital in one year.80women fulfilling selection criteria were selected for elective major gynecological surgeries under ERAS-P. Components of ERAS-P include: pre-operative, intra-operative, and post-operative were practiced and the outcomes include the length of hospital stay, post-operative pain assessment, return of bowel function, admission to discharge interval, cost of treatment, complications, repeat hospitalization, and patient satisfaction rate were assessed.
Results: Among 80 participants, distribution of cases were- abnormal uterine bleeding (AUB-L) leiomyoma-37.5%, uterine prolapsed-32.5%, adnexal mass-8.8%, adenomyosis-in 7.5%, and others 5%. The average length of hospital stay was 24 hours for laparoscopic salpingectomy, 48 hours for laparoscopic surgery, 72 to 96 hours for vaginal hysterectomy and laparoscopic surgery and 96 hours for TAH±BSO. The visual analogue scores indicated pain levels among participants with the mean score at 6 hours’ post-surgery-5.51 for major surgeries and <4.00 for minimal invasive surgeries.
Conclusions: The implementation of ERAS-P is observed to be associated with reduction in duration of hospitalization, early mobilization, need based pain management, high satisfaction, lower complications, and repeat hospitalization
Septic shock with multiple organ dysfunction syndrome, disseminated intravascular coagulation and mucormycosis following unsafe abortion: a case of acute infectious purpura fulminans
Full text linkA woman in her early thirties presented to the emergency department in the 2nd week of her illness. She had a history of self-MTP kit intake at 12 weeks gestation followed by dilatation and curettage by the local practitioner for incomplete abortion. She started having a fever and developed blisters all over her body. On presentation, thorough history and examination confirmed sepsis and septic shock. Management continued with the sepsis campaign recommendation 2021 in the critical care unit. In the sixth week of her stay, she developed methicillin-resistant Staphylococcus aureus (MRSA) and mucormycosis further complicating her management. The patient succumbed to her illness after 6 weeks of aggressive treatment including daily wound debridement, amputation, and colostomy. This case emphasizes the importance of contraception use and the prevention of unwanted pregnancy. Further to reduce maternal morbidity and mortality, safe abortion practices should be opted for
Benign Brenner’s tumor of ovary: a case report with review of literature
Full text linkBrenner’s tumor of the ovary is a rare neoplasia with an incidence of 02-03% of all ovarian tumors. Its origin is controversial; the new hypothesis describes it as transitional cell metaplasia of Walthard cell nests embedded in the ovary. The world health organization has classified it into benign, borderline, and malignant varieties, with incidences of 95%, <5%, and <2%, respectively. Benign Brenner’s tumor (BBT) is usually <2 cm in size, unilateral, solid, grayish white, well-circumscribed, rubbery to firm nodule, arising from ovarian cortex and resembling fibroma or thecoma of ovary. The average age of patients is 50 years. Diagnosis of the pathology is challenging as it does not have a specific clinical presentation or investigatory findings, and is usually diagnosed incidentally on histological examination of the ovary resected with other genital organs. Microscopy of the tumor shows a fibro-epithelial solid mass consisting of transitional epithelial cell nests surrounded by dense fibrous tissue. No further treatment is required in benign cases, whereas chemotherapy with or without radiotherapy and follow-up is needed in borderline and malignant cases. A case of unilateral BBT of the ovary in a 42-year-old parous lady was diagnosed in this institution, who had undergone total abdominal hysterectomy with bilateral salpingo-oophorectomy for fibroid uterus with abnormal uterine bleeding (AUB) and severe anemia. The presentation aims to report this rare pathology of Brenner’s tumor without a specific clinical presentation, diagnosed incidentally on histopathological examination (HPE), and to add to the statistics
Postpartum depression among women: a systematic review of prevalence, risk factors, and maternal outcomes
Full text linkPostpartum depression (PPD) was the most common psychiatric complication that followed childbirth, but it often remained undiagnosed and untreated across many regions of the world. Its prevalence differed greatly, depending on the characteristics of the population studied, the screening tools used, and the influence of cultural context. This review, conducted under PRISMA guidelines, synthesized findings from 10 peer-reviewed studies released between 2012 and 2023. Searches were conducted in PubMed, Scopus, and Web of Science. Only original observational studies evaluating PPD prevalence, identifying risk factors, and reporting maternal outcomes with validated tools were included. Extracted information covered study aspects, prevalence values, and risk factors, and narrative synthesis was applied. In the 10 included studies, which had sample sizes between 350 and 12,198, the prevalence of PPD ranged from 7.3% to 30.3%. Recurrent risk factors identified were low education, unemployment, unmarried status, cesarean birth, unplanned pregnancy, preterm delivery, absence of breastfeeding plans, low Apgar scores, poor partner support, and past psychiatric conditions. Protective influences included higher education, partner support, and effective breastfeeding. PPD was recognized as a worldwide maternal health challenge, with prevalence rates reported up to 30%. The review stressed the need for routine screening programs, culturally responsive interventions, and policies aimed at social determinants of maternal well-being.
Contribution of anti-BHCG, CK18, hPL and Ki-67 antibodies in the diagnosis of choriocarcinoma in Senegal
Full text linkBackground: Gestational choriocarcinoma (GC) is a rare malignant tumour derived from the trophoblast of women of childbearing age. The aim of this study was to determine the contribution of immunohistochemistry in the diagnosis of choriocarcinoma and to evaluate its ability to specify whether or not it is gestational in nature in order to establish a diagnostic algorithm for trophoblastic diseases in general.
Methods: This is a retrospective, descriptive, bi-centric study spanning eight (8) years from 1 January 2013 to 31 December 2020. All cases diagnosed on hysterectomy specimens and with a formal conclusion of gestational choriocarcinoma were included. Immunohistochemical staining was performed on formalin-fixed, paraffin-embedded tissue sections using the manual method. We recorded the data collected in Excel 2007 software and the analysis was performed using Epi Info.
Results: We collected 25 cases of choriocarcinoma. The average annual frequency was 3.12. The average age of the patients was 38.1±9.7 years (standard deviation). Multiparous women were the most common, accounting for 57.14% of cases. Mixed-site tumours (intracavitary and intramural) were the most common, accounting for 48% of cases. Patients in FIGO stage I accounted for 88% of cases. Immunohistochemistry was performed on 14 samples, revealing 100% positive staining for anti-hCG, CK18 and hPL.
Conclusions: Gestational choriocarcinoma (GC) is a proliferation of trophoblasts (cytotrophoblasts and syncytiotrophoblasts). This study demonstrated the indispensability of immunohistochemistry in confirming the diagnosis and in assessing both the progression and therapeutic prognosis of the disease
The role of bilateral internal iliac artery ligation in obstetric practice
Full text linkBackground: Postpartum hemorrhage remains a leading cause of maternal mortality globally, accounting for a significant percentage of obstetric emergencies. Bilateral internal iliac artery ligation (IIAL) is a surgical technique that has been advocated for controlling severe pelvic hemorrhage for over a century. The main aim of this study was to evaluate the effectiveness of IIAL in controlling intractable obstetric hemorrhage and to assess its impact on hysterectomy rates and maternal outcomes.
Methods: A prospective observational study was conducted between June 2023 and June 2024 in a tertiary care center. Women presenting with massive PPH unresponsive to conservative management were considered for IIAL. All procedures were performed by a senior obstetrician and a urologist. Data on patient demographics, indications for IIAL, surgical details, and maternal outcomes were recorded and analyzed.
Results: A total of 30 patients underwent IIAL, primarily for morbidly adherent placenta and uterine atony. Of these, 62.5% avoided hysterectomy following successful ligation, thereby preserving the uterus. There were no major surgical complications, and the need for excessive blood transfusions was markedly reduced after IIAL.
Conclusions: IIAL is a valuable procedure in obstetric practice for managing life-threatening PPH, especially in resource-limited settings where advanced interventional radiology may not be readily available. By effectively reducing pelvic arterial pressure, IIAL can control hemorrhage and lower the need for hysterectomy, thereby preserving fertility. Familiarity with pelvic anatomy and prompt surgical intervention are essential for successful outcomes
Evaluation of fetal outcome by biophysical profile in term pregnancy in women with less fetal movement
Full text linkBackground: Reduced fetal movement at term may indicate fetal compromise. Biophysical profile (BPP) is widely used to assess fetal well-being, yet its predictive value for neonatal outcomes in such cases requires further evaluation. This study aimed to assess the relationship between BPP scores and fetal outcomes, including Apgar scores, need for immediate resuscitation, and NICU admission, in term pregnancies with reduced fetal movement.
Methods: An analytical cross-sectional study was conducted at the department of obstetrics and gynecology, Dhaka Medical College and Hospital, Bangladesh, from August 2019 to July 2020. A total of 100 term pregnant women with reduced fetal movement were enrolled. Participants were classified into normal (≥8/10) and abnormal (≤6/10) BPP groups. Neonatal outcomes were recorded and analyzed using chi-square tests with significance set at p<0.05.
Results: Poor Apgar scores at one minute occurred in 33.3% of neonates in the abnormal BPP group versus 1.72% in the normal group (p<0.001). At five minutes, all neonates in the normal group had good Apgar scores, compared to 81% in the abnormal group (p=0.001). Immediate resuscitation was required in 33.3% of neonates in the abnormal group versus 1.72% in the normal group (p<0.001). NICU admission was significantly higher in the abnormal group (16.67% versus 1.72%, p=0.007).
Conclusions: Abnormal BPP scores were strongly associated with adverse fetal outcomes, while normal scores were highly reassuring. BPP remains an effective tool for evaluating fetal well-being in term pregnancies with reduced fetal movement
Relationship between anti-Mullerian hormone and ovarian response after using letrozole in subfertile polycystic ovary syndrome patients
Full text linkBackground: Polycystic ovary syndrome (PCOS) is the most common cause of anovulation in reproductive-age women. Anti-Mullerian hormone (AMH) was higher in PCOS women due to increased antral follicles. This study examined the relationship between Anti-mullerian hormone and ovarian response after letrozole in sub-fertile PCOS patients.
Methods: This cross-sectional study was conducted in the Department of Obstetrics and Gynaecology, BIRDEM General Hospital, Dhaka, Bangladesh, from April 2022 to September 2023. 116 sub-fertile PCOS patients receiving Letrozole were purposively selected. Patients underwent transvaginal ultrasound (TVS) and were divided into two groups by follicle size: non-responder group (<16 mm) and responder group (≥16 mm). Data was analyzed using statistical package for the social sciences (SPSS) version 26.0.
Result: Most women were aged 21-30 years, with a mean age of group I at 30.2±3.7 and group II at 29.9±5.1. Most were primary subfertile; group I 35(65.5%) and group II 41(70.7%). Mean serum FSH was higher in group II, 9.28±5.6, than in group I, 7.19±3.64 (p<0.001). Mean AMH was higher in group II, 5.82±1.4, than in group I, 5.2±1.8 (p=0.054) but statistically non-significant. ROC curve showed AMH cut-off value of 5.12 with 62.1% sensitivity and 65.5% specificity. Patients with AMH <5.12 ng/ml had 3.1 times more chance of ovarian response versus those with AMH >5.1 ng/ml (OR=3.1; 95% CI (1.5-6.6), p=0.003).
Conclusion: Elevated serum AMH level is a risk factor for poor ovarian response in PCOS, which may require adjusting the letrozole dosage