International Journal of Reproduction, Contraception, Obstetrics and Gynecology
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Anterolateral vaginal cyst in an adult woman: a rare case of Mullerian cyst
Full text linkMullerian cysts are of embryological origin and are usually found incidentally during delivery or a routine gynaecological examination. They remain asymptomatic unless they become large enough to cause heaviness or pressure on the surrounding structures, here we are presenting case of 29-year-old multi para (P2L2 both NVD) with 4×3 cm mass arising from the anterior vaginal wall. Complete vaginal cyst excision done. The cyst was filled with grey brown solid homogenous material and histopathology of ciliated columnar epithelium with squamous epithelium later on confirmed the diagnosis.
Prevalence, risk factors, and bacterial pathogens responsible for surgical site infection after caesarean section: a retrospective study
Full text linkBackground: Surgical site infection (SSI) is one of the most common complications following caesarean section (CS), with a reported incidence of 3-20%. SSIs cause a significant burden on both the mother and the healthcare system and are associated with maternal morbidity and mortality rates of up to 3%.
Methods: A hospital-based retrospective study was conducted. Of 703 patient charts reviewed, 51 met the inclusion criteria. Data were extracted from medical records and analyzed using Statistical Package for the Social Sciences (SPSS).
Results: The prevalence of SSI was 7.3%. Most cases (96.1%) were classified as Class I SSI, while 3.9% were Class II; no cases of organ-space infection were identified. The mean age of affected patients was 27.5 years. Obesity was present in 68.8% of the cohort. The SSI rate was 17.6% among patients with rupture of membranes (ROM) before CS. Prolonged rupture of membranes (>18 hours) occurred in 13.7% of cases, while ROM <18 hours was noted in 3.9%. Anemia and postpartum hemorrhage each accounted for 2% of associated conditions.
Conclusions: At Georgetown Public Hospital, SSI following caesarean delivery remains a significant complication, with a prevalence of 7.5%. The most commonly isolated organisms were Staphylococcus aureus, followed by Escherichia coli, Klebsiella pneumoniae, and MRSA. Efforts to reduce preventable risk factors are essential to decreasing the overall burden of SSI after caesarean section
Navigating dual vulnerability: a rare case of esthesioneuroblastoma in pregnancy
Full text linkEsthesioneuroblastoma (ENB) is a rare malignancy of the sinonasal tract from the olfactory neuroepithelium. Our purpose is to highlight this scarcely described but aggressive tumor presenting in a unique setting where the patient is facing dual vulnerabilities: pregnancy and EBN. We report a case of a 29-year-old female (G2P1L1), 24 weeks pregnant, with a history of progressively increasing left side nasal mass with proptosis, diplopia, nasal discharge, and bleeding from the mass. MRI showed a polypoidal mass in the left nasal cavity with intraorbital and intracranial extensions. The biopsy revealed Hyams grade 2 ENB. Management included craniofacial resection of the lesion and chemoradiation. Caesarean section was performed at 32 weeks, and the patient delivered a baby with a birth weight of 1.463 kg. Early diagnosis and timely intervention, combined with a multidisciplinary approach, for craniofacial resection and chemoradiation, can yield favourable outcomes in this challenging condition
A rare gynaecological emergency: non-obstetric vulvar hematoma
Full text linkInjuries of female genital tract accounts for 0.8% of gynecological admissions. Non obstetric vulvar hematoma typically results from blunt trauma to the genitalia. Although they are small and pose little threat but at times become large to cause hemodynamic instability. Herein, we report a case of 32-year-old woman with complaint of swelling and severe pain at vulva due to injury by a cow. Examination revealed a hematoma on left labia majora of size 10×8 cm. Incision and drainage of swelling done at left mucocutaneous junction. Blood clots of approximately 500 cc were removed Postoperative follow-up indicated significant symptomatic improvement and restoration of normal vulval anatomy. Timely intervention is important in vulvar hematomas. In case of minor injuries conservative approach may work but in large hematoma surgery is required to drain the hematoma
Association of ovarian volume with insulin resistance in PCOS patients
Full text linkBackground: Polycystic ovary syndrome (PCOS) is a common endocrine disorder in women, characterized by hyperandrogenism, menstrual irregularities, polycystic ovarian morphology, and often associated with insulin resistance. The purpose of this study was to assess the association between insulin resistance and ovarian volume in PCOS patients, comparing women with ovarian volume >10 cc to those with ≤10 cc. The aim of the study was to evaluate the association between ovarian volume and insulin resistance among patients diagnosed with polycystic ovary syndrome (PCOS).
Methods: This comparative cross-sectional study at the department of obstetrics and gynecology, ICMH, Dhaka (October 2022-September 2023) included 66 women with PCOS (18-35 years), divided by ovarian volume into Group A (>10 cc, n=34) and Group B (≤10 cc, n=32). Fasting glucose, insulin, HOMA-IR, hirsutism, BMI, and waist-to-hip ratio were assessed, analyzed with SPSS v27 (p<0.05).
Results: In 66 PCOS patients, groups were similar in age, BMI, waist-to-hip ratio, menarche, parity, and Ferriman-Gallwey score (all p>0.05); HOMA-IR was higher in group A (4.83 versus 3.59; p=0.012), correlated with ovarian volume (r=0.685, p<0.001), and HOMA-IR ≥3.8 increased odds of ovarian volume >10 cc (67.6% versus 21.9%; OR=7.468; 95% CI=2.476-22.522; p<0.001).
Conclusions: Higher insulin resistance (HOMA-IR ≥3.8) is significantly associated with larger ovarian volume (>10 cc) in PCOS patients, suggesting ovarian volume as a potential indicator of insulin resistance
Relationship of maternal serum vitamin D level with preeclampsia
Full text linkBackground: Vitamin D deficiency has been increasingly implicated in adverse pregnancy outcomes, including preeclampsia; however, evidence from South Asian populations remains limited. This study aimed to evaluate the relationship between maternal serum vitamin D levels and preeclampsia in pregnant women in Bangladesh.
Methods: A hospital-based case-control study was conducted at Sir Salimullah Medical College Mitford Hospital in Dhaka from March 2019 to March 2020. A total of 106 pregnant women aged 18–35 years with gestational age 28-40 weeks were enrolled, 53 with preeclampsia and 53 normotensive controls. Data on sociodemographic and obstetric characteristics were collected through interviews. Serum 25(OH)D concentrations were measured using chemiluminescence immunoassay and categorized as deficient (≤20 ng/ml), insufficient (21-29 ng/ml), and sufficient (≥30 ng/ml). Statistical analyses were performed using SPSS version 23.0, and p<0.05 was considered significant.
Results: Mean serum vitamin D levels were significantly lower in preeclamptic women (13.41±6.83 ng/ml) than in controls (19.96±9.07 ng/ml, p<0.001). Women with vitamin D levels <30 ng/ml had 7.46 times greater odds of developing preeclampsia (95% CI 1.58-35.25). In the multivariate analysis, both deficient and insufficient vitamin D levels remained significant predictors (OR = 6.03 and 6.55, respectively).
Conclusions: Low maternal serum vitamin D levels were strongly associated with preeclampsia. Routine screening and adequate vitamin D supplementation during pregnancy may help reduce the risk of this potentially fatal disorder
Pregnancy outcomes in women with thalassemia major and minor: an observational cross-sectional study
Full text linkBackground: Recent advances in the management of thalassemia have significantly improved life. Expectancy and quality of life in patients with this hemoglobinopathy result in a consequent increase in their reproductive potential and desire to have children. This study aimed to assess the pregnancy outcome in thalassemia patients.
Methods: This observational cross-sectional study was conducted at the Department of Obstetrics and Gynaecology of Bangabandhu Sheikh Mujib Medical University and Dhaka Medical College, Dhaka, Bangladesh, from October 2014 to March 2015. A total of 50 admitted patients in the Obstetrics and Gynaecology wards of BSMMU in the set duration of 6 months; the pregnant patients with thalassemia were enrolled in this study purposively. Data were analyzed using Microsoft Office tools.
Results: The data analysis of 50 patients yielded the following results. The mean age of 50 mothers was 27.67 (±7.59) years. The maximum 36 (72%) patients were from the 21-30 years’ age group. Among the 50 mothers with thalassemia, 8 (16%) were diagnosed with thalassemia major, and the remaining 42 (84%) were diagnosed with thalassemia minor. Pregnancy was relatively less complicated in the mothers with thalassemia major, as they were under regular ANC and regular supervision of hematologists, so that they could avoid pregnancy-induced thalassemia-related complications. But most thalassemia minor cases were undiagnosed or less emphasized before they became pregnant. So, they faced more complications. A total of 48 (96%) mothers gave birth successfully. Every mother bore a singleton pregnancy. 7 (14%) were born with low birth weight. Among them, 2 (28.57%) were found as intra uterine devices (IUDs). APGAR scores of neonates at 1 min <7 were found in case of 8 cases (16%), and at 5 min were 3 (6%). 12 (24%) babies required ICU admission.
Conclusion: Pregnancy is possible, safe, and usually has a favourable outcome in patients with thalassemia, in the presence of a multidisciplinary team
Factors associated with the knowledge and attitudes of the population of Parakou towards law no. 2021-12 on abortion in Benin in 2024
Full text linkBackground: Law 2021-12 was passed in Benin to address unsafe abortions. This study aimed to study the knowledge and attitudes of the population of Parakou regarding Law No. 2021-12 in Benin.
Methods: This was a descriptive and analytical cross-sectional study with a prospective design. All individuals aged 18 years or older, residing in Parakou, who gave informed consent were included. Those who did not consent, those suffering from a psychological condition, those who did not complete the questionnaire, and those without consent were excluded. The data collected by Epi Data 3.1 and processed by Microsoft Word 2016 were analyzed by Epi Info 7.1.3.3. Central tendency and dispersion parameters, the chi-square test, and Fisher's exact test were used.
Results: There were 444 participants included and 10 excluded. The average age was 28.55±11.90 years, with extremes of 18 and 76 years. A total of 307 (70.74%) were aware of the law, 46.65% had a favourable opinion, and 29.7% had a favourable attitude. Age (p=0.011); level of education (p=0.0000); marital status (p=0.023), ethnicity (p=0.000), religion (p=0.0004); and profession (p=0.001) were significantly associated with poor knowledge of the new law. Ethnicity (p=0.0000), having been pregnant (p=0.001), and having had an abortion (p=0.000) were significantly associated with a negative attitude.
Conclusions: The knowledge and attitudes of the population of Parakou regarding Law No. 2021-12 in Benin in 2024 need to be improved through information and outreach
Application of Robson's classification in clinical practice: a tool for quality improvement in obstetrics
Full text linkBackground: The global rise in caesarean section (CS) rates has raised concerns regarding the overuse of the procedure in low-risk pregnancies, leading to potential maternal and neonatal risks. Robson’s classification offers a standardized method to assess CS rates and identify the groups contributing most to these high rates, facilitating targeted quality improvement interventions.
Methods: A retrospective observational study was conducted at Vydehi Institute of Medical Sciences, Bengaluru, from June 2024 to December 2024, including 265 deliveries. Data were collected from the hospital's obstetric registry, and studies under Robson’s classification.
Results: The overall CS rate was 54.7%, with 145 out of 265 deliveries being caesarean sections. The highest CS rates were observed in two groups, group 5 (multiparous women with a previous CS, 80%) and group 8 (all multiple pregnancies, including previous CS, 80%). Group 6 showed a 66.7% CS rate (nulliparous breech presentations). Groups 2 and 4 (induced labour) also exhibited elevated CS rates, with 62.5% and 50.0%, respectively. Lower CS rates were noted in multiparous women with spontaneous labour (group 3), which had a rate of 30%. The data revealed that induction of labour and previous caesarean sections were significant contributors to higher CS rates.
Conclusions: The study highlights the specific high-risk groups to the overall CS rate. The findings emphasize the need for targeted interventions to reduce unnecessary CS while maintaining maternal and neonatal safety. Future efforts should focus on promoting vaginal birth after caesarean (VBAC).
Determinants of risk factors for the development of obstetric fistula in a national fistula centre of a tertiary care medical college hospital
Full text linkBackground: Obstetric fistula is a debilitating condition caused by prolonged, obstructed labor without timely medical care, creating an abnormal opening between the birth canal and bladder or rectum. It remains prevalent in developing regions, particularly South Asia and Africa, due to early marriage, poor maternal healthcare, and lack of skilled birth attendants. In Bangladesh, obstetric fistula is both a medical and social burden, demanding targeted public health interventions. Objectives were to identify the risk factors and patient profile associated with obstetric fistula among women attending the national fistula centre, Dhaka medical college hospital (DMCH), Dhaka, Bangladesh.
Methods: This case-control study was conducted in the department of obstetrics and gynaecology at DMCH from July to December 2010. A total of 50 confirmed obstetric fistula cases were selected using purposive sampling. Data were collected via structured questionnaires and clinical examination. Inclusion and exclusion criteria were strictly followed. Data analysis was done using SPSS software. Ethical approval and informed consent obtained before initiating study.
Results: Among respondents, 34% were aged 31-35 years. In control group, 82% were aged 21-30. Inhabitants: 66% urban in control, 76% rural in case group. Education: 64% control crossed SSC; 42% case were illiterate. Labour pain >24 h in 94% cases. Home trial >24 h in 92% cases. Delivery by Dai: 87.5% in cases. Caesarean section: 58% in cases vs 6% in control. Assisted deliveries: 84.62% in cases.
Conclusions: Early marriage, poor health behavior, malnutrition, and lack of ANC contribute to obstetric fistula, with delayed hospital visits