International Journal of Reproduction, Contraception, Obstetrics and Gynecology
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Broad ligament leiomyoma with cystic change mimicking as ovarian tumor
Full text linkUterine leiomyomas are common benign gynaecological tumours, occurring in 20-40% of cases in India. Broad ligament fibroids, though rare (less than 1%), are the most frequent extrauterine site and can be mistaken for ovarian carcinoma due to their unusual location. This report presents a nearly asymptomatic 50-year-old woman with irregular menstrual cycles who was found to have a non-tender, mobile cystic mass equivalent to an 18-week gravid uterus. Ultrasound detected a 540 CC complex solid-cystic right adnexal lesion with an un-visualized ovary; CECT showed a 780 CC solid-cystic right ovarian mass, and MRI revealed a suspicious 570 CC solid-cystic lesion, raising concerns for malignancy. IVP was omitted as ureters were normal. Laparotomy identified a sizable cystic mass located on the right side within the broad ligament, which exhibited minimal resemblance to leiomyoma and resulted in mild anatomical distortion. Both the uterus and ovaries appeared unremarkable. Histopathological analysis confirmed the lesion as a broad ligament fibroid exhibiting extensive cystic degeneration. Due to this atypical presentation, immunohistochemical studies were recommended to exclude malignancy. Broad ligament leiomyomas, particularly those with solid and cystic components, may mimic ovarian malignancies during clinical and radiological assessment, complicating differential diagnosis due to their atypical presentation. Histopathology plays a crucial role in establishing a definitive diagnosis. This case is presented due to its infrequency and the diagnostic uncertainty it created for both clinicians and the patient
Determinants of contraceptive choices among young females in northern Nigeria
Full text linkBackground: Reproductive health is vital to societal wellbeing, and in Nigeria, home to one of the largest youth populations, understanding the factors influencing contraceptive choices is crucial for improving access and uptake. This study assessed determinants of contraceptive choices and patterns of uptake among young female undergraduates in northwestern Nigeria.
Methods: It was a descriptive, cross-sectional survey. The study was conducted among 400 female undergraduates of Ahmadu Bello University, Zaria, selected through a multistage sampling technique. Data were collected using a structured, pretested questionnaire administered by trained assistants. Analysis was performed with SPSS version 25.0.
Results: Of 400 questionnaires, 360 were completed, yielding a 90% response rate. Most respondents were single and aged 21-25 years. The oral contraceptive pill (20.3%) and male condom (18.9%) were the most commonly used methods. Availability (32.2%) influenced method choice, while safety (34.7%) was the most important determinant of use. Although 70% reported easy access to contraceptives, primary sources were patent medicine stores (25.8%), partners (22.7%), and parents (17.2%). Barriers included inadequate knowledge of proper use (24.4%) and fear of side effects (28.3%). Broader impediments were personal reasons, limited information, health system gaps, and negative provider attitudes. Marital status significantly influenced contraceptive use (p<0.001), while both marital status (p=0.04) and residence (p<0.001) determined consistency of use.
Conclusions: Contraceptive choice remains a key issue for young women. Enhancing availability, safety, clarity of use, and confidence in efficacy could substantially improve uptake among this population
Correlation between respectful maternity care and childbirth experience in a tertiary care centre
Full text linkBackground: Respectful maternity care (RMC) is essential for a positive childbirth experience. Disrespectful maternity practices can lead to adverse maternal and neonatal outcomes. This study evaluates the correlation between RMC and childbirth experience among women delivering at a tertiary care centre. The objectives was to study the correlation between respectful maternity care and childbirth experience.
Methods: A cross-sectional study was conducted at the Department of Obstetrics and Gynaecology, Hind Institute of Medical Sciences, Safedabad, Barabanki, over 18 months (July 2023 to January 2025). A total of 150 postpartum women were enrolled using a consecutive sampling method. Data were collected using the Respectful Maternity Care (RMC) Questionnaire and the Childbirth Experience Questionnaire (CEQ). RMC was assessed across seven domains, while CEQ measured four dimensions of childbirth experience. Statistical analysis included correlation assessments between RMC and childbirth experience domains.
Results: The study found a significant correlation between RMC and childbirth experience (p<0.001). Domains of physical harm and ill-treatment (r=0.734), informed consent (r=0.725), and dereliction of care (r=0.711) showed strong associations with perceived safety and decision-making. Women who experienced greater autonomy, informed consent, and respectful care reported a better childbirth experience. The analysis also found that family structure influenced RMC, with joint family participants reporting significantly higher dignity scores (p=0.032). However, economic and educational status did not significantly impact RMC or childbirth experience.
Conclusions: The study highlights the critical role of respectful maternity care in shaping a positive childbirth experience. Improving patient autonomy, informed consent, and professional support can enhance maternal satisfaction and reduce negative childbirth experiences. Targeted interventions are needed to reinforce respectful maternity care practices in tertiary care settings
Egg-sploring the unusual: ICSI in Klippel-Trenaunay-Weber syndrome
Full text linkKlippel-Trenaunay-Weber syndrome (KTWS) is a rare congenital vascular disorder characterized by capillary malformations, venous and lymphatic anomalies, and soft tissue or bone overgrowth. Patients with KTWS face unique challenges in assisted reproductive technology (ART) due to their hypercoagulable state and the presence of extensive vascular malformations. Pregnancy can exacerbate these vascular complications, increasing maternal morbidity and mortality. In vitro fertilization (IVF) with gestational surrogacy offers a safer reproductive option. A 34-year-old woman with KTWS, a history of intermittent rectal bleeding, and extensive vascular malformations presented with primary infertility. Clinical and diagnostic evaluation revealed a reasonable ovarian reserve (AMH: 1.08 ng/ml) but significant vascular abnormalities in the mesenteric, splenic, hepatic, and colonic vasculature. A multidisciplinary approach was undertaken to minimize the risks associated with ovarian stimulation and oocyte retrieval. A GnRH antagonist protocol was chosen, with a dual trigger (Decapeptyl 200 mcg and hCG 10,000 IU) and careful anticoagulation management using low molecular weight heparin (LMWH). Nine mature oocytes were retrieved and cryopreserved without complications, and the patient was advised to proceed with gestational surrogacy. This case highlights the complexities of fertility management in patients with KTWS. The successful oocyte retrieval in a high-risk vascular patient demonstrates that, with meticulous planning and individualized care, ART can be safely performed. A multidisciplinary strategy, including anticoagulation adjustments and perioperative monitoring, is crucial in achieving favourable reproductive outcomes while minimizing risks. This case adds to the limited literature on ART in KTWS, reinforcing the feasibility of fertility preservation through a well-planned, multidisciplinary approach
Laparoscopic management of ectopic pregnancy: a 34-month retrospective study at Amath Dansokho Regional Hospital Center, Kédougou, Senegal
Full text linkBackground: Ectopic pregnancy (EP) is a major gynecological emergency with significant incidence in rural settings where access to care is limited. Laparoscopic surgery is now recognized as the reference technique for EP treatment. This study reports the experience of the Amath Dansokho Regional Hospital Center of Kédougou in the laparoscopic management of EP.
Methods: A retrospective descriptive study was conducted on 30 patients operated by laparoscopy for EP between September 2022 and July 2025 at Amath Dansokho Regional Hospital Center, a rural level II hospital located 800 km from Dakar. Sociodemographic, clinical, surgical data and postoperative outcomes were analyzed.
Results: The mean age of patients was 26.3 years. The majority of EPs were located on the left fallopian tube (53.3%) and ruptured in 70% of cases. The laparoscopic management rate for EP was 71.4%. Anterograde salpingectomy was the main procedure in 80% of interventions. Postoperative outcomes were favourable with no conversion to laparotomy and an average hospital stay of 2 days.
Conclusions: Laparoscopy is a safe and effective technique for managing EP in rural settings, reducing morbidity and hospital stay. Its development in resource-limited areas requires capacity building and adequate training of medical teams
An observational study to classify causes of abnormal uterine bleeding according to PALM-COEIN classification
Full text linkBackground: Abnormal uterine bleeding (AUB) is a frequent gynecological complaint affecting women of all ages, significantly impacting quality of life. To standardize its diagnosis and management, the International Federation of Gynecology and Obstetrics (FIGO) introduced the PALM-COEIN classification system, which categorizes AUB into structural and non-structural causes. To classify AUB according to PALM-COEIN classification, to know associated risk factors, to know their demography and modality of treatment required.
Methods: This observational cross-sectional study was conducted in the Department of Obstetrics and Gynaecology at New Civil Hospital, Surat, from May 2024 to April 2025. Approval was obtained from the Institutional Research Review Committee (Approval ID: GMCS/RRC-2/13433/24).
A total of 200 consenting women with AUB (non-pregnancy related) were included. Exclusion criteria: pregnancy-related bleeding or refusal to consent. Detailed clinical history, examination, investigations, imaging and biopsy when indicated were done. Classification was as per PALM-COEIN. Treatment included medical or surgical modalities. Response was assessed over a 3-month follow-up.
Results: The most common cause of AUB was adenomyosis (AUB-A, 33%), followed by leiomyoma (AUB-L, 30.5%) and ovulatory dysfunction (AUB-O, 14%). Among non-structural causes, AUB-O was predominant. In this study simple endometrial hyperplasia without atypia in 4 cases and half of those patients improved with medical treatment. Medical management was effective in 64.48% of treated patients, while 65.5% required surgical intervention. Obesity (26%) and thyroid disorders (17.5%) were the most common comorbid risk factors.
Conclusions: The PALM-COEIN classification system was a useful and thorough tool for understanding the causes of AUB, helping to standardize diagnoses, plan better treatments and achieve better results in patient care. It also facilitated effective communication and comparison across clinical and research settings
Caesarean delivery: rate, indications and pregnancy outcome at Suntreso government hospital; an analytical cross-sectional study
Full text linkIntroduction: Globally, caesarean section (CS) rates are increasing, revealing disparities across regions and socioeconomic groups, becoming a challenge due to its overuse or underuse with direct consequences on maternal and neonatal health. Despite this, the factors contributing to these trends and disparities remain insufficiently documented. This study determined the rate, associated indications and maternal and neonatal outcomes of caesarean section deliveries at the Suntreso Government Hospital, Ghana.
Methods: This retrospective study encompassed the entire number of women who gave birth within the study time period spanning from 1st January, 2021 to 31st December, 2021.
Results: Caesarean section rate over the study period was 33.1%. Previous caesarean section, fetal distress and severe oligohydramnios were the 3 commonest indications for CS. There were 13 adverse maternal outcomes. Maternal deaths after CS were 2 out of 1057 cases. About 91% of patients stayed in the hospital for longer than three days post-surgery. 41% of babies delivered were admitted to the Neonatal Intensive Care Unit (NICU) for various reasons. Pre-eclampsia/eclampsia, antepartum hemorrhage and fetal distress were some indications of caesarean section with significant association with adverse maternal and neonatal outcome.
Conclusion: Caesarean section rates were higher than the WHO standard. A repeat CS delivery was the commonest indication. CS should be performed when clinicians anticipate a better outcome for both mother and neonate
Evaluation of a therapeutic combination to prevent ovarian hyperstimulation syndrome
Full text linkBackground: Ovarian hyperstimulation syndrome (OHSS) remains a significant iatrogenic complication in assisted reproductive technology. Various strategies have been proposed to minimize its occurrence, particularly in high-risk patients. To evaluate the effectiveness of a combined preventive protocol including GnRH antagonist protocol, GnRH agonist trigger, dopamine agonist (cabergoline), calcium infusion, and a freeze-all strategy in reducing the incidence of OHSS without compromising IVF outcomes.
Methods: A comparative study was conducted on women undergoing IVF, divided into a study group receiving the combined protocol and a control group managed conventionally. Primary outcomes included stimulation parameters, incidence of OHSS, and biochemical pregnancy rates. Secondary outcomes assessed included the number of cumulus-oocyte complexes (COCs), mature oocytes (MII), and vitrified embryos.
Results: The study group showed significantly lower gonadotropin doses, with improved ovarian response reflected by higher numbers of COCs, MII oocytes, and vitrified embryos (p<0.05). Despite these improved biological outcomes, β-hCG positivity rates did not differ significantly between the two groups (24% vs. 26.5%; p=0.239). No cases of moderate or severe OHSS were observed in the study group.
Conclusions: The combined use of multiple evidence-based strategies appears effective in reducing the risk of OHSS while maintaining satisfactory IVF outcomes. This multifaceted approach may offer a safer stimulation pathway for high-risk patients without compromising pregnancy potential
Sperm selection techniques in assisted reproduction: a comprehensive review
Full text linkSperm selection plays a pivotal role in assisted reproductive technology (ART), directly influencing fertilization rates, embryo development and overall clinical outcomes. While conventional methods such as swim-up and density gradient centrifugation methods are in clinical practice, they offer limited precision in identifying spermatozoa with optimal functional ability and DNA integrity. In response to these limitations, a range of advanced sperm selection techniques has emerged, aiming to improve the selection of high-quality spermatozoa. This review explores the principle, methodologies and clinical evidence behind both established and emerging sperm selection methods. Techniques discussed include magnetic-activated cell sorting (MACS), microfluidic sperm sorting (MSS), hyaluronic acid binding assay/ physiological intracytoplasmic sperm injection (HBA/PICSI) and high-magnification selection methods like intracytoplasmic morphologically selected sperm injection (IMSI). Additionally, novel technologies such as Raman spectroscopy, polarized light microscopy and surface charge-based selection (Zeta potential) are examined for their potential applications in reproductive medicine. While early results suggest these advanced methods may enhance ART outcomes, particularly in cases of male factor infertility, further large-scale randomized controlled trials are needed to confirm their clinical utility and define their optimal use. This review aims to provide ART practitioners with a comprehensive overview of the evolving landscape of sperm selection in ART, highlighting both current practices and future directions
Leptin and LH/FSH ratio as independent predictors of polycystic ovary syndrome in normoglycemic women: a case-control study
Full text linkBackground: Polycystic ovary syndrome (PCOS) is a multifaceted disorder characterized by reproductive, metabolic, and endocrine disturbances. While insulin resistance (IR) is recognized as a central feature, the interplay of adipokines, lipid metabolism, gonadotropin imbalance, and inflammation in normoglycemic PCOS women remains underexplored.
Methods: A case-control study was conducted on 30 newly diagnosed normoglycemic women with PCOS (Rotterdam criteria, 2003) and 30 age-matched healthy controls. Anthropometric, hormonal (LH, FSH, LH/FSH ratio, prolactin, estrogen, progesterone, testosterone), metabolic (fasting glucose, HbA1c, insulin, HOMA-IR), lipid (cholesterol, triglycerides, HDL), adipokine (leptin), and hematological parameters were assessed. Group comparisons were performed using independent t-test/Mann-Whitney test as appropriate. Correlation analysis explored inter-relationships among variables, and multivariate logistic regression identified independent predictors of PCOS.
Results: Compared with controls, PCOS women had significantly higher BMI (26.3±5.3 versus 23.4±3.2 kg/m2; p=0.014), WHR (0.861±0.061 versus 0.799 ±0.060; p<0.001), LH (7.5±3.7 versus 5.3±2.2 mIU/ml; p=0.006), LH/FSH ratio (1.37±0.76 versus 0.76±0.32; p<0.001), estrogen (54.5±18.2 versus 38.0±11.1 pg/ml; p<0.001), testosterone (49.7±25.1 versus 34.5±14.0 ng/dl; p=0.001), fasting insulin (11.55±10.8 versus 5.63±2.6 uIU/ml; p=0.004), HOMA-IR (2.47±2.4 versus 1.17±0.54; p=0.007), and leptin (31.3±17.4 versus 16.4±10.5 ng/ml; p<0.001), with significantly lower FSH (5.6±1.7 versus 7.2±1.9 mIU/ml; p<0.001) and HDL (43.0±10.0 versus 54.3±15.3 mg/dl; p<0.001). Correlation analysis revealed positive associations between BMI and leptin, insulin, and HOMA-IR; WHR and testosterone; TLC and leptin/WHR; and LH/FSH ratio and estrogen, while HDL correlated negatively with HOMA-IR and TLC. Logistic regression identified leptin (OR=1.105, 95% CI 1.016-1.201, p=0.020) and LH/FSH ratio (OR=18.48, 95% CI 1.82-187.7, p=0.014) as independent predictors of PCOS.
Conclusions: Normoglycemic PCOS women show distinct hormonal, metabolic, and adipokine alterations, with leptin and LH/FSH emerging as robust independent predictors. These findings highlight the early convergence of adiposity, insulin resistance, inflammation, and gonadotropin imbalance in PCOS, underscoring the need for early biomarker-based risk stratification and intervention even before the onset of overt glycemic abnormalities