International Journal of Reproduction, Contraception, Obstetrics and Gynecology
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Does use of mobile phone affect human semen profile?
Full text linkBackground: Mobile telephony is not very old technology. It functions based on electro-magnetic radiation (EMR). Mobile users are rapidly increasing every day and this technology is advancing rapidly. Scientists have demonstrated that EMR affects the human health and reproductive system too. Some other scientists revealed that mobile telephony does not affect human health. Our preliminary studies have shown that mobile telephony has some correlation with human semen profile in the exposure dependent manner. Therefore, this study was planned in male human volunteers to reassess the possible effects of mobile telephony on human semen profile in our infertility centre.
Methods: 74- human male volunteers consented and included in our research study. Their mobile phone placing, use hour/day was recorded and these volunteers were placed in three Groups- A, B and C (exposure of mobile telephony was 3-4 hrs, 5-6 hrs and 7-8 hrs respectively and approximately).
Results: Semen analysis was done using WHO method manual in our infertility research centre, Bangaluru, India. Semen analysis shows that decline in sperm density, motility (quantitatively and qualitatively) and enhanced percentage of abnormal sperm. It appears to be associated with duration exposure dependant as we found in our earlier study.
Conclusions: In conclusion, we may say that decline in sperm density, motility and enhanced percentage of sperm abnormalities may be associated with the use of mobile telephony along with other factors. Further research studies are needed to ascertain the possible effects of mobile telephony on human male reproductive health
Induction of labor versus expectant management for women with a prior caesarean delivery
Full text linkBackground: This study aimed to evaluate the feto-maternal outcomes in women with a previous caesarean section (CS) who underwent labor induction versus those managed expectantly. Vaginal birth after a caesarean (VBAC) has been associated with lower maternal morbidity, fewer fetal complications, shorter hospital stays, and fewer transfusions. While spontaneous labor may not always occur in these women, labor induction can be necessary for those attempting a trial of labor.
Methods: This prospective randomized controlled trial was conducted in the department of obstetrics and gynaecology at Pt. BD Sharma PGIMS Rohtak over one year. 140 women with a history of previous LSCS were randomly divided into two groups: Group 1 received induction at 39 weeks, with monitoring and augmentation, if necessary, while Group 2 was managed expectantly until 41 weeks. The study aimed to compare the outcomes of induced labor versus expectant management in these women.
Results: In our study, 37 women (52.8%) in the expectant management group went into spontaneous labor. Of these, 32 women (86.4%) delivered vaginally. In our study, the caesarean section rate was significantly higher (75.57%) when women were induced at 41 weeks compared to 39 weeks (40%). Fetal distress was the most common indication of caesarean section when the patient induced at 41 weeks.
Conclusions: The study found that induction of labor in women with a previous caesarean section led to similar vaginal delivery rates as expectant management. No significant maternal or perinatal complications were observed, but close monitoring for fetal distress and scar rupture is essential
Bilateral ovarian mature teratoma with unilateral torsion in a 42 years old female in a low-income country
Full text linkBilateral ovarian mature teratomas are rare. They occur mostly in the reproductive age group women. Serious complications such torsion required prompt surgical intervention. No case so far has been reported in the Haitian literature. We present a case of a 42-years-old female arrived at the Centre Medical Frere after a two-day delay due to limited healthcare access, experiencing acute abdominal pain and vomiting. After clinical and ultrasound examination, we concluded to the diagnosis of ovarian torsion with patient having bilateral ovarian mass which guided us considering different parameters to a total hysterectomy with salpingo-oophorectomy. Histopathology confirmed bilateral mature teratomas with torsion. This case helps bring awareness regarding the importance of regular gynecologic follow-up, along early detection and management especially in resource-limited settings where delayed care can lead to complications
Does the presence of blood on the catheter or the degree of difficulty in embryo transfer affect the outcome in ART
Full text linkBackground: Implantation may be impacted by the embryo transfer (ET) method. It's uncertain whether postprocedural blood at the transfer catheter tip is a true indicator of transfer difficulty because previous studies that examined its impact have produced conflicting findings. Our goal was to calculate the impact of blood at the moment of Embryo Transfer and the degree of difficulty associated with it on live birth rates (LBR).
Methods: This was a retrospective study conducted at Kamlesh Tandon test tube baby centre, Agra from July 2022 to April 2024. Patients underwent COS followed by Oocyte retrieval and fresh embryo transfers. Patients with high Serum Oestradiol levels and more than 15 oocytes were deferred for a fresh embryo transfer. A freeze-all policy was followed by a subsequent freeze thawed embryo transfer cycle. The Clinical Pregnancy Rates and the Live Birth Rates were calculated.
Results: Generalized estimating equations (GEE) for logistics regression with exchangeable correlation with robust variance was used to estimate the adjusted and unadjusted ORs in this retrospective cohort study. After conducting univariate modelling, all relevant confounders were taken into account in the final multivariate (adjusted) GEE model. At the moment of transfer, the ART specialist would subjectively assess embryo transfers as easy, medium or hard. Blood found at ET was linked to more challenging ETs, retained embryos in the catheter and mucus in the catheter. The degree of difficulty for ET had an adverse effect on the live birth rate (LBR), while ET with blood did not correlate with live birth in the univariate study. The only variables linked to an elevated LBR in the final multivariate GEE model, which took into account a patient's repeated cycles, were the blastocyst transfer, female age and the difficulty of the ET. The presence of blood in the transfer catheter was not linked to the chance of pregnancy and, therefore, was not an independent predictor of cycle outcome after correcting for confounding variables. This suggests that the transfer’s inherent complexity and its difficulties are factors that have a substantial negative predictive impact on pregnancy outcomes.
Conclusions: Optimizing ET will allow providers to maximize successful interaction of embryo and endometrium, leading to the establishment of a viable pregnancy. These data suggest that the presence of blood during a routine, easy ET is not detrimental to live birth
Optimizing delivery timing in selective fetal growth restricted dichorionic diamniotic twins: lessons from a case series
Full text linkAuthors aim to analyze the maternal and fetal outcomes in IVF -conceived dichorionic diamniotic (DCDA) twin pregnancies complicated by FGR in women of advanced maternal age, focusing on complications and management strategies. A retrospective analysis of five IVF-conceived DCDA twin pregnancies in women aged 30-49 years was conducted at our tertiary care center between August-October 2024. Establishment of presence of FGR in one or both twins, was done using Delphi criteria. Cases underwent systematic monitoring via serial ultrasound scans with Doppler and comprehensive maternal-fetal surveillance. The mean maternal age was 39.8 years, with a mean gestational age at delivery of 33+5 weeks. All deliveries were performed via cesarean section and the notable complications included a case of Edwards syndrome diagnosed postnatally, and one intrauterine fetal death at 34 weeks in a severely growth-restricted fetus. Maternal complications included pre-eclampsia, hypothyroidism, and obstetric cholestasis. The birth weight was in a range of 1.01-2.48 kg. The significant incidence of FGR and growth discordance in our cases emphasizes the need for regular fetal surveillance and Doppler studies in twin pregnancies. Our findings suggest that preventive cervical cerclage, timely antenatal corticosteroid administration, and appropriate timing of delivery are crucial elements in managing these pregnancies. The goals of management in these high-risk pregnancies are to optimize the time of delivery, minimize risks to both fetuses and balance risks of prematurity against risks of continued in-utero stay. Counselling the expecting couple is of paramount importance and due consideration should be given to maternal choice
Comparative analysis of dehydroepiandrosterone and transdermal testosterone pre-treatment in POSEIDON group 3 and 4 women undergoing in vitro fertilization: a retrospective cohort study
Full text linkBackground: Patients classified under patient-oriented strategies encompassing individualised oocyte number (POSEIDON) groups 3 and 4 typically demonstrate suboptimal response to controlled ovarian stimulation (COS) in in vitro fertilization (IVF) cycles. Androgen-based pre-treatments like dehydroepiandrosterone (DHEA) and transdermal testosterone have been studied for their role in enhancing ovarian response, although direct comparative data are limited. Objective of the study was to evaluate and compare the effects of DHEA versus transdermal testosterone gel administered before stimulation on ovarian and embryological outcomes in women within POSEIDON groups 3 and 4 undergoing IVF.
Methods: A retrospective cohort study was conducted at a tertiary fertility centre in India between January 2018 and January 2020. Eligible women received either DHEA (75 mg/day for 12 weeks) or testosterone gel (12.5 mg/day for 21 days) before controlled ovarian stimulation (COS). All patients underwent antagonist protocol with dual trigger followed by IVF. Primary outcomes included number of oocytes retrieved, metaphase II (MII) oocytes, and follicular output rate (FORT). Secondary outcomes included fertilization rate, good-quality embryos, and stimulation burden.
Results: Of 237 women analysed, 144 received DHEA and 93 received testosterone gel. The testosterone group showed significantly higher mean oocyte yield (7.2 versus 5.4; p<0.01), MII oocytes (5.6 versus 4.0; p<0.01), and FORT (58.2% versus 49.3%; p<0.01). While fertilization rate (63.5% versus 61.2%; p=0.37) and embryo quality (59.1% versus 57.6%; p=0.75) were similar, testosterone-treated patients required fewer days of stimulation (9.7 versus 10.3; p=0.04) and lower gonadotropin doses (2291 IU versus 2576 IU; p<0.01). No OHSS cases occurred in either group.
Conclusions: This study supports the use of short-course transdermal testosterone as a more practical and efficient adjuvant strategy in poor prognosis IVF cycles. It may be especially valuable in resource-constrained settings, where cost-effectiveness and cycle efficiency are critical to success. Further prospective trials are needed to evaluate long-term reproductive outcomes
Case series of rectovaginal fistula: clinical analysis and management strategies
Full text linkRectovaginal fistula (RVF) is a rare but serious obstetric complication with significant physical and emotional consequences. This retrospective review analyzed three cases of RVF that occurred between June 2023 and June 2024 to identify clinical patterns and propose improvements in management. All cases involved primigravid women who experienced either prolonged second-stage labor or rapid expulsive efforts; instrumental deliveries and episiotomies were performed in two instances. Primary repairs utilized vicryl and vicryl rapide sutures; however, two patients developed persistent fistulae necessitating colorectal referral and further surgical intervention, including temporary stoma formation. Delayed diagnosis and inconsistent post-operative care were identified as key issues. The findings highlight the importance of comprehensive perineal assessment, standardized repair techniques, and early multidisciplinary involvement. To prevent and manage RVF more effectively, the study recommends enhanced clinician training, updated local guidelines, and structured postnatal follow-up for early detection of complications
Asymptomatic bacteriuria in pregnancy and feto-meternal outcome
Full text linkBackground: Asymptomatic bacteriuria (ASB) is common in pregnancy; its prevalence varies between communities and different ethnicities and countries and has been implicated in adverse pregnancy outcomes. Thus, the present study determined the prevalence of ASB in pregnant women; to study the commonest causative pathogenic and antimicrobial susceptibility pattern, to assess the affliction of bacteriuria with age, parity, and socioeconomic status; and the effect of screening and treatment of ASB on maternal and fetal outcome.
Methods: This was a prospective case-control study involving pregnant women attending the department of obstetrics and gynecology, Jawaharlal Nehru hospital and research Center, Bhilai (C. G.) over a period of 18 months (June 2022 to December 2023). A total of 140 pregnant women were divided into two groups: cases (n=70 patients with ASB) and controls (n=70 patients without ASB). Cases received 7 days course of antimicrobial drugs. Repeat cultures were obtained at 2 weeks and 4 weeks interval to detect any relapses till delivery. At similar intervals, women without bacteriuria were followed up and assessed for bacteriuria throughout the pregnancy till delivery.
Results: The prevalence of ASB was 8.28%. On the first urine culture, E. coli (68.57%) was the most common organism grown and amikacin (30%) was the most sensitive antibiotic. The cases and controls did not differ significantly in any of the parameters, except significantly greater proportion of cases than controls had premature rupture of membranes (PROM) (p=0.003), underwent emergency lower segment caesarean section (LSCS) (p=0.049), a NICU stay of 6-10 days (p=0.001), and longer mean NICU stay (p<0.0001), while significantly greater proportion of controls than cases underwent normal vaginal delivery (p=0.007) and a NICU stay of 1-5 days (p=0.010).
Conclusions: The overall prevalence of ASB was 8.28%. Even with treatment, the patients with ASB had a significantly higher risk of PROM, underwent emergency LSCS, and longer NICU stay
Non-stress test, amniotic fluid index and color of liquor in term pregnancies in active labour and their association with labour and perinatal outcome
Full text linkBackground: The features of amniotic fluid, such as volume and color, are essential for evaluating fetal health and forecasting postnatal outcomes. Oligohydramnios and meconium-stained amniotic fluid correlate with a heightened risk of unfavorable newborn outcomes, such as diminished APGAR scores, increased NICU hospitalizations and cesarean sections. The non-stress test (NST) is an essential instrument for assessing fetal discomfort during childbirth. This research sought to evaluate the predictive significance of the amniotic fluid index (AFI), wine color and non-stress test (NST) in forecasting newborn outcomes in term pregnancies.
Methods: This comparative prospective cross-sectional research was performed at the Obstetrics and Gynaecology Department of teaching hospitals associated with J.J.M. Medical College, Davangere, from March 2021 to August 2022. A total of 100 term pregnant women in active labor were enrolled. Clinical and ultrasonographic evaluations were conducted to examine Amniotic Fluid Index (AFI), non-stress test (NST) reactivity and liquor properties. Neonatal outcomes, including APGAR scores, birth weight, NICU hospitalizations and delivery method, were documented. Data were evaluated using SPSS v22.0, with statistical significance established at p<0.05.
Results: Maternal age had a significant correlation with meconium-stained liquid (p=0.026), although other maternal factors, including parity, gestational age and BMI, shown no significant variations. The non-reactivity of NST was markedly elevated in the meconium-stained liquor groups (thin: 50%, thick: 33.33%) in contrast to the clear liquor group (16%) (p=0.011). A low amniotic fluid index (AFI) (<8 cm) was more common in the thin meconium-stained liquid group (75%) compared to the clear (54.67%) and thick meconium-stained groups (22.2%). The group with thick meconium staining had markedly lower mean APGAR scores at 1 minute (5.89±0.98) in comparison to the thin (6.47±2.05) and clear liquor groups (6.87±1.21) (p=0.007). NST, AFI and liquor color exhibited significant correlations with cesarean delivery, NICU hospitalization and infant morbidity. The predictive sensitivity of liquor volume, liquor hue and NST for neonatal problems was 77.78%, 80% and 81.82%, respectively.
Conclusions: NST, AFI and amniotic fluid color are significant indicators of fetal well-being in term pregnancies. The occurrence of oligohydramnios, abnormal NST and meconium-stained amniotic fluid markedly elevates the probability of negative outcomes, including as surgical delivery and diminished APGAR scores. These results highlight the need of ongoing intrapartum fetal surveillance and prompt management in high-risk pregnancies
A cross-sectional comparative study to assess the role of spot urinary calcium to creatinine ratio in prediction of preeclampsia
Full text linkBackground: Preeclampsia is a hypertensive disorder unique to pregnancy, associated with significant maternal and fetal morbidity and mortality. Early prediction and diagnosis are critical for better clinical outcomes. Biochemical markers such as the spot urinary calcium to creatinine ratio (UCa/Cr) have been proposed as a non-invasive, cost-effective tool for identifying preeclampsia. Objective of the study was to evaluate and compare the spot urinary calcium to creatinine ratio in pregnant women with and without preeclampsia and assess its diagnostic utility.
Methods: This cross-sectional comparative study was conducted on pregnant women in the third trimester attending antenatal clinics or admitted to the obstetric unit. Participants were divided into two groups: women diagnosed with preeclampsia (study group) and normotensive pregnant women (control group). A midstream urine sample was collected from each participant for calcium and creatinine estimation, and the UCa/Cr ratio was calculated. The two groups were statistically compared using appropriate tests.
Results: The mean UCa/Cr ratio was significantly lower in the preeclamptic group compared to the normotensive controls (p<0.001). A UCa/Cr cutoff value of <0.04 demonstrated good sensitivity and specificity in identifying preeclampsia.
Conclusions: The spot urinary calcium to creatinine ratio is a simple, non-invasive, and reliable test that may serve as an adjunct tool for the early detection and diagnosis of preeclampsia. Further large-scale studies are recommended to validate its clinical applicability