International Journal of Reproduction, Contraception, Obstetrics and Gynecology
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A comparative analysis of fetal outcomes in pre-eclampsia and eclampsia: insights from vaginal, cesarean, and forceps deliveries
Full text linkBackground: Pre-eclampsia and eclampsia are significant complications of pregnancy, characterized by hypertension and potential multi-organ dysfunction, which pose serious risks to both maternal and fetal health. This study aimed to analyze fetal outcomes in pre-eclampsia and eclampsia: insights from vaginal, cesarean, and forceps deliveries.
Methods: This observational cross-sectional study was carried out in the department of gynaecology and obstetrics at Dhaka medical college hospital, Dhaka, from July 2015 to December 2015. Patients of pre-eclampsia and/or eclampsia who attended the eclampsia ward in the department of gynaecology and obstetrics at Dhaka medical college and hospital, Dhaka were taken as the study population as per inclusion criteria. A total number of 100 patients presented with pre-eclampsia and/or eclampsia fulfilled the selection criteria and were taken as study subjects by purposive sampling method. Different statistical methods were adopted for data analysis. Statistical analysis was performed by using statistical packages for social sciences (SPSS-19).
Results: Regarding fetal outcomes, 81.0% of mothers had live births, with 49.0% normal, 19.0% asphyxiated, and 15.0% requiring NICU admission. Nine percent resulted in stillbirths; all linked to intrauterine devices (IUD). Delivery methods included 77.0% vaginal births, 22.0% cesarean sections, and one forceps delivery, indicating a predominant use of vaginal delivery among the patients.
Conclusions: The 81.0% of mothers experienced live births, and there were concerning rates of adverse outcomes, including asphyxia and NICU admissions. The high rate of vaginal deliveries (77.0%) raises questions about safety, especially given the stillbirths recorded
Asymptomatic bacteriuria in pregnancy and its effect on maternal and fetal outcomes
Full text linkBackground: Asymptomatic bacteriuria is the most common infection encountered in pregnancy and can lead to multiple complications both in mother like acute pyelonephritis, sepsis and in the fetus like LBW, preterm labour, PROM, if left untreated. The present study was done to determine the current prevalence of ASB and its maternal and perinatal outcome.
Methods: A prospective cohort study was conducted at a tertiary centre on 150 antenatal females. Urine culture and sensitivity was conducted for each participant and the fetomaternal outcome between affected and unaffected women were compared and p value <0.05 was considered significant.
Results: 27 females had ASB making the prevalence of 18% out of which 12 (44.4%) cultures yielded Klebsiella and 15 (55.5%) samples were sensitive to nitrofurantoin. There was no significant increase in antenatal complications, mode of delivery, post natal complications, neonatal outcomes.
Conclusions: There is no significant risk associated with ASB, therefore the next question opens regarding the need for treatment
Diagnostic value of semen analysis in male infertility
Full text linkBackground: Semen analysis is an indispensable diagnostic tool in the evaluation of the male partners of infertile couples. Aim was to analyze semen parameters according to WHO criteria (5th edition) in patients attending infertility OPD and compare it with 6th edition.
Methods: It was a retrospective descriptive cross sectional study that took place at the department of pathology, JMF ACPM medical college, Dhule, Maharashtra. This study included 103 subjects who were presented for semen analysis from June 2022 to June 2024. The data regarding ejaculate volume, count, motility and morphology were collected.
Results: Abnormal semen quality was a major factor of infertility in our rural setup with 39% of male partners of infertile couples having abnormal semen parameters.
Conclusions: Male contribution towards infertility is yet to be studied and requires more elaborate research
Study of association of serum bile acid levels with fetomaternal outcomes in cases of intrahepatic cholestasis of pregnancy: a case control study
Full text linkBackground: This study was done to find out the association of serum bile acid level with fetomaternal outcome in patients with intrahepatic cholestasis of pregnancy (IHCP) and to determine the level of bile acids at which immediate intervention will be required to obtain good fetomaternal outcome.
Methods: An observational case control study was conducted on 60 women with IHCP as cases and 60 women without IHCP as controls in the department of obstetrics and gynecology at Hindu Rao Hospital and NDMC Medical College from March 2023 to December 2023 and statistical analysis was done using SPSS version 21.0. Quantitative variables were compared using Mann-Whitney test. Qualitative variables were calculated from the receiver operating characteristic curve. The p value of <0.05 was considered statistically significant.
Results: The most common symptom of IHCP was itching over whole body seen in 50% cases. Most of the cases (90% cases) were diagnosed with IHCP at 32-37 weeks of gestation. Recurrence was seen in 36.7% cases. 48.3% cases versus 71.7% controls went into spontaneous onset of labour while induction of labour was done in 51.7% cases versus 28.3% controls and augmentation of labour was required in 32.7% cases versus 52.5% controls with statistically significant difference. Preterm delivery was seen in 16.7% cases versus 3.3% controls. 43.3% cases versus 16.7% controls were delivered by cesarean section (p value <0.5). The liquor was meconium stained in 53.3% cases versus 10% controls with a statistically significant difference. 20% cases versus 1.7% controls landed up into PPH at the time of delivery (p value <0.5). There was no statistically significant difference in the fetal outcome, need of NICU admission and birth weight of the babies. The cut-off of 33.7µmol/l bile acid level at the time of diagnosis of IHCP was predictive of MSL, 64.19 µmol/l was the cut off of bile acid for predicting IUD/perinatal death with optimum sensitivity and specificity. 32.85µmol/l was the cut off of bile acid for predicting NICU admissions. A positive correlation was found between the levels of serum bile acid and level of ALT (r value of 0.355 and p value of 0.005), AST levels (r value 0.383 and p value of 0.003), total bilirubin levels (r value 0.355, p value 0.005) and direct bilirubin (r value 0.145, p value 0.271).
Conclusions: Significantly higher number of adverse fetomaternal outcomes occurred in the cases of intrahepatic cholestasis of pregnancy as compared to the controls. Increase in the level serum bile acid was associated with increased incidence of adverse fetomaternal outcomes. Serum bile acid levels can be used to predict those adverse fetomaternal outcomes. The adverse fetomaternal outcomes need to be predicted well in time so as to prevent them. Management can be optimized by timely prediction of adverse fetomaternal outcomes with the help of monitoring serum bile acid levels among pregnant women with IHCP
Study of fetomaternal outcomes in maternal jaundice at term pregnancy
Full text linkBackground: Jaundice in pregnancy, although uncommon, is associated with significant fetomaternal morbidity and mortality. Etiologies include viral hepatitis, intrahepatic cholestasis of pregnancy (ICP) and acute fatty liver of pregnancy (AFLP), each carrying unique risks.
Methods: This prospective observational study included 30 term pregnant women with jaundice (serum bilirubin ≥2.5 mg/dl), conducted at F.H. Medical College, Agra (July 2023–June 2024). Demographic, clinical and laboratory data were collected and outcomes were analyzed.
Results: Viral hepatitis was the most common etiology (50%), followed by ICP (30%) and AFLP (20%). Hepatic encephalopathy and coagulopathy were noted in 13.3% and 23.3% respectively. Cesarean delivery occurred in 40% of cases. NICU admission was needed in 33.3% and perinatal mortality was 3.3%.
Conclusions: Maternal jaundice at term is a critical condition requiring early diagnosis and multidisciplinary care. The severe outcomes associated with AFLP and viral hepatitis underscore the need for timely intervention
Role of hystero-laparoscopy in evaluation of infertility: a retrospective observational study
Full text linkBackground: Infertility affects 8-10% of couples worldwide. Hystero-laparoscopy offers a dual diagnostic and therapeutic advantage in evaluating infertility, particularly where standard imaging falls short. Objective was to assess the diagnostic value of hystero-laparoscopy in female infertility and identify associated pelvic and intrauterine pathologies.
Methods: A retrospective observational study was conducted at AIIMS, Raipur from June 2021 to June 2023, including 140 infertile women (83 with primary and 57 with secondary infertility). Patient records were reviewed for clinical, sonographic, hysteroscopic, and laparoscopic findings, including interventions. Data were analysed using SPSS v22.
Results: Mean age was 28.6±4.3 years; mean infertility duration was 4.4±2.2 years. 73.57% of hysteroscopies were normal; uterine septum (15.71%) was the most frequent abnormality. Laparoscopy revealed adhesions (30%), ovarian pathologies (28.57%), and endometriosis (15.71%). Tubal block was noted in 57.85% by HSG. Interventions included adhesiolysis (28.57%), cystectomy (20.71%), and myomectomy (8.57%).
Conclusions: Hystero-laparoscopy provides a comprehensive approach to evaluate and treat underlying causes of infertility, especially those undetected by non-invasive imaging
A study on jaundice in pregnancy and its impact on maternal and perinatal outcomes in a tertiary care hospital, Bhavnagar
Full text linkBackground: Jaundice during pregnancy is a significant clinical condition that affects 3-5% of pregnancies and represents an important cause of maternal and perinatal morbidity and mortality. With viral hepatitis being the predominant cause in developing countries, comprehensive studies examining outcomes in tertiary care settings are essential for evidence-based management strategies.
Methods: A retrospective observational study was conducted at Government Medical College, Bhavnagar, Gujarat, and data taken from April 2022 to April 2023. Fifty antenatal patients with clinical and laboratory evidence of jaundice (serum bilirubin >1.2 mg/dl, liver transaminases >45 IU/l) were enrolled using purposive sampling. Detailed clinical assessment, laboratory investigations including liver function tests, viral serology, and coagulation profiles were performed. Maternal and perinatal outcomes were systematically recorded and analysed.
Results: The study population predominantly comprised women aged 21-29 years (72%) with 56% being primigravida. Viral hepatitis was the leading cause (60%), followed by preeclampsia with HELLP syndrome (32%). Maternal complications included preterm delivery in 54% of cases, with coagulopathy present in 24% and thrombocytopenia in 42%. Neonatal outcomes revealed concerning statistics with 62% low birth weight babies and 18% early neonatal mortality, primarily due to pneumonia (8%) and intrauterine growth restriction (4%).
Conclusions: Jaundice in pregnancy significantly impacts maternal and perinatal outcomes in our tertiary care setting. The high rates of preterm delivery, low birth weight, and neonatal mortality emphasize the critical need for enhanced antenatal surveillance, early detection protocols, and preventive strategies including hepatitis vaccination programs to reduce associated morbidity and mortality
Failed methotrexate therapy in a cesarean scar ectopic pregnancy: a case report
Full text linkCesarean scar ectopic pregnancy (CSEP) is a rare and potentially life-threatening early pregnancy complication associated with prior cesarean section scars, where early detection and treatment are critical to reducing maternal morbidity. Methotrexate (MTX) therapy is a standard conservative approach, but may fail in some instances. We report a case of a 29-year-old woman (gravida 5, para 4) who presented at seven weeks' gestation with mild vaginal bleeding. Transvaginal ultrasound (TVUS) confirmed a non-viable CSEP, and ultrasound-guided intra-sac MTX injection was attempted as conservative management. Despite treatment, the patient developed worsening haemorrhage requiring emergency surgical intervention. Intraoperative findings revealed significant vascularity at the implantation site, and surgical excision of the ectopic pregnancy was performed with preservation of the uterus. The postoperative course was uneventful. This case highlights the limitations of MTX in treating CSEP. It emphasizes the importance of early recognition of treatment failure and prompt surgical management to prevent severe maternal morbidity and preserve reproductive potential
Ovarian tumors: a case series from a tertiary care center
Full text linkOvarian cancer is the third most common malignancy among women in India and accounts for approximately 6% of cancer-related deaths, with late-stage presentation being frequent due to vague and nonspecific symptoms. This case series describes twelve patients with ovarian neoplasms diagnosed over six months at a tertiary care center, highlighting the clinical diversity and age-related distribution of these tumors. Most cases were observed in postmenopausal women above 50 years of age, with histopathological types ranging from high-grade serous carcinoma and mucinous carcinoma to mucinous cystadenoma, granulosa cell tumor, dysgerminoma, and metastatic malignant melanoma. Clinical manifestations included abdominal pain, distension, ascites, respiratory difficulty, and in one case, incidental detection during infertility evaluation. Risk factors such as nulliparity, delayed childbearing, and family history were noted. Management strategies varied from surgical excision for benign lesions to cytoreductive surgery with adjuvant chemotherapy for malignant cases. This study underscores the heterogeneity of ovarian tumors and the critical importance of early recognition, accurate histopathological classification, and individualized treatment planning. Despite advances in surgical and chemotherapeutic modalities, prognosis in advanced disease remains poor, emphasizing the need for improved screening strategies, molecular research, and targeted therapies to enhance survival and quality of life
Effect of oral feeding following elective caesarean section on paralytic ileus among participants in a tertiary institution in Southern Nigeria
Full text linkBackground: Studies suggest that early initiation of oral feeding after caesarean delivery is well-tolerated by patients, but it is not yet practiced in most institutions. Traditionally, patients are kept on nil per oral until bowel functions return. This practice is associated with complications including paralytic ileus. However, the time for commencing oral feeding after elective caesarean delivery is still controversial. The aim of this study was to compare the effect of 2-hour (early) and 24-hour (delayed) post-operative oral feeding on the outcome of elective caesarean delivery in Rivers State University Teaching Hospital Port Harcourt.
Methods: This was a randomised controlled trial done in Rivers State University Teaching Hospital, Port Harcourt, between May 2023 and September 2023. 166 participants were selected consecutively during the period of study and randomised into two groups with 83 participants in each group. Using a structured questionnaire, data were collected and analysed with SPSS version 25 software.
Results: The proportion of post-operative ileus symptoms was 6.0% vs. 3.6% in the early and delayed groups showing no statistical difference (ꭓ2=0.52; p–0.473). The time interval for return of bowel function (3.7±0.7 hours vs. 13.6±2.7 hours), passage of flatus (6.1±1.3 hours vs. 20.4±3.8 hours) and bowel movement (32.9±15.1 hour vs. 64.7±14.6 hours) were significantly higher (p<0.05) in the delayed group than the early group.
Conclusions: Early initiation of oral feeding after elective caesarean section is safe and is associated with earlier return of normal bowel function without fear of gastrointestinal symptoms or paralytic ileus