International Journal of Reproduction, Contraception, Obstetrics and Gynecology
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Misoprostol: history and clinical aspects
Full text linkMisoprostol, a synthetic prostaglandin E1 analog, was originally developed for NSAID-induced gastric ulcers and is now widely used in obstetric and gynaecologic procedures. It acts as a prodrug, rapidly converted in the liver to misoprostol acid, which binds EP-3 receptors to induce uterine contractions. Misoprostol is effective for medical abortion, postpartum hemorrhage prevention, labour induction, cervical preparation and reducing blood loss during gynaecologic surgeries. Administration routes include oral, sublingual, buccal, rectal and vaginal, with dosing tailored to indication and gestational age. Adverse effects are generally mild but may include diarrhoea, nausea, fever and rarely, uterine rupture or teratogenic effects. Contraindications include prostaglandin hypersensitivity and advanced pregnancy with prior uterine scars. Overall, misoprostol is a versatile, generally safe drug with significant clinical applications in reproductive health
A comparative study of antiphospholipid antibodies in preeclampsia and normotensive pregnant women
Full text linkBackground: Hypertensive disorders of pregnancy cause major portion of maternal morbidity, mortality and poor feto maternal outcome. Abnormal trophoblastic invasion changes are seen in placental development in preeclamptic mother. Preeclampsia harms mother and baby, causing complications like intrauterine fetal death (IUFD), fetal growth restriction (FGR), and preterm delivery. Antiphospholipid antibodies (APLA) trigger coagulation, complement activation, and impaired syncytiotrophoblast differentiation, contributing to preeclampsia development. The study compared Antiphospholipid antibodies (anti-β2GPI, anticardiolipin, lupus anticoagulant) in preeclampsia and normotensive pregnancies. Detecting APLA may help predict preeclampsia and guide timely, specific management for at-risk women.
Method: The present study was conducted in Hindu Rao Hospital, New Delhi from January 2021 to May 2022. It was an observational case-control study which involved 100 normotensive pregnant women and 100 preeclamptic women who met the inclusion criteria. Blood pressure was measured in sitting position, and women were classified as preeclamptic or normotensive. Antiphospholipid antibodies were tested by enzyme linked immunosorbent assay (ELISA) and analyzed in the Biochemistry department. The following tests, anticardiolipin antibodies (aCL)-IgM and IgG, anti-beta-2 glycoprotein-IgM and IgG B and dilute Russell's viper venom time (DRVVT) screened lupus anticoagulant were done; presence of any antibody was positive, outcomes compared.
Results: In this study, out of 100 preeclamptic patients, 20 were positive for APLA antibodies (9 were positive among non-severe preeclampsia and 11were positive among severe preeclampsia) and out of 100 normotensive pregnant women, 3 were positive for APLA antibodies. Receiver operating characteristic (ROC) analysis showed lupus anticoagulant had 93% sensitivity and 97% specificity. APLA positivity was linked to preeclampsia, FGR, preterm delivery, lower segment caesarean section (LSCS), and neonatal complications.
Conclusions: The study found APLA prevalence of 20% in preeclamptic (9% non-severe, 11% severe) and 3% in normotensive women. Anticardiolipin and lupus anticoagulant differed significantly (p<0.05), but anti-β2GPI showed no significant difference (p>0.05)
Pregnancy, parathyroids, and a crisis of calcium: unmasking hypercalcemic crises in pregnancy and beyond: a dual case report
Full text linkHypercalcemia is a rare complication during pregnancy, but when it occurs, it can lead to significant maternal and fetal morbidity. Primary hyperparathyroidism is the most frequent cause; however, other uncommon mechanisms such as parathyroid hormone-related protein (PTHrP) secretion by uterine fibroids have been described. We presented two cases. The first involved a 36-year-old primigravida at 34 weeks with severe hypercalcemia associated with a large uterine fibroid. Her condition required intensive care, urgent hemodialysis, and emergency cesarean section. Despite intraoperative complications, both mother and infant survived. The second case was a 37-year-old woman at 24 weeks who was found to have hypercalcemia with elevated parathyroid hormone (PTH) levels while hospitalized for pulmonary embolism. She was not a candidate for surgery and was successfully managed with hydration, calcitonin, vitamin D, and cinacalcet, achieving near-normal calcium levels before delivery. Both pregnancies resulted in live infants. Hypercalcemia in pregnancy requires a high index of suspicion and multidisciplinary management. These two cases highlight rare but important clinical scenarios: fibroid-associated humoral hypercalcemia and the use of cinacalcet for refractory primary hyperparathyroidism during pregnancy
Impact of gestational weight gain in diabetic mothers on maternal and fetal outcomes at delivery
Full text linkBackground: Adequate weight gain during pregnancy is crucial for healthy outcomes, while excessive weight gain is linked to adverse effects, including higher rates of cesarean sections, gestational diabetes, and complications during delivery. The aim of this study was to assess the impact of gestational weight gain on maternal and fetal outcomes in women with pregestational and gestational diabetes at delivery.
Methods: A cross-sectional study was conducted in the obstetrics and gynecology department of BIRDEM General Hospital-II, Dhaka during January 2023-June 2024. A total 102 pregnant women with pregestational diabetes and gestational diabetes mellitus (GDM) were consecutively selected from patients admitted after 37 weeks of gestation and divided in to GDM (n=51) and PGDM (n=51) groups.
Results: Among GDM patients, 49.0% had normal GWG, 31.4% excessive, and 19.6% inadequate, while in PGDM patients, 37.3% had normal, 37.3% inadequate, and 25.5% excessive GWG. Maternal complications occurred in 43.8% of GDM and 61.5% of PGDM mothers, with no significant difference. Fetal complications were comparable across GWG groups. Notably, newborns of PGDM mothers with normal GWG had higher rates of SGA and NICU admission compared to GDM, whereas normal birth weight was more common in GDM (p=0.014).
Conclusions: In GDM patients, excessive weight gain was linked to significantly higher cesarean section rates and while PGDM cases showed more fetal and maternal complications than GDM but not significant. However, most newborns had normal birth weights across all groups, and many outcomes did not differ significantly
Comparative effectiveness of mifepristone with misoprostol versus intracervical Foley’s catheter in mid-trimester missed abortion with scarred uterus
Full text linkBackground: Second-trimester pregnancy termination carries higher risks than first-trimester procedures, making pharmacologic methods preferable. Misoprostol is widely used, while intracervical Foley’s catheter aids cervical ripening and stimulates prostaglandin/oxytocin release. Combined mifepristone and misoprostol have been shown to shorten induction-to-abortion time compared to Foley’s catheter alone. This study aimed to evaluate the effectiveness of combined mifepristone and misoprostol versus intracervical Foley’s catheter for mid-trimester missed abortion in women with a scarred uterus.
Methods: This quasi-experimental study was conducted at the department of gynecology and obstetrics, Dhaka Medical College Hospital, including 72 women aged 18-35 years with missed abortion and prior cesarean section. Participants were divided into two groups: group I (n=36) received combined mifepristone and misoprostol, and group II (n=36) received Foley’s catheter alone.
Results: Group I had a lower mean gestational age (16.2±2.6 versus 23.1±2.0 weeks), higher abortion success rate (97.2% versus 94.4%), shorter induction-expulsion time (7-12 hours in 86.1% versus >18 hours in 58.3%), and fewer surgical interventions (2.8% versus 5.6%) compared to group II. Side effects were more frequent in group I (55.6% versus 27.8%). All differences were statistically significant (p<0.05).
Conclusions: Combined mifepristone and misoprostol is more effective than Foley’s catheter alone for mid-trimester missed abortion in scarred uterus, yielding higher success rates and shorter induction-expulsion times
Mucinous cystadenoma of ovary with third degree uterovaginal prolapse in postmenopausal woman: a rare case report
Full text linkMucinous tumours of the ovary represent a spectrum of neoplastic disorders, including benign mucinous cystadenoma, pseudomyxoma peritonei, mucinous tumors of low malignant potential (borderline), and invasive mucinous ovarian carcinoma. These tumors are related closely to each other and are distinct from other histologic subtypes of epithelial ovarian neoplasms from a clinical, histologic, and molecular standpoint. Mucinous cystadenoma of ovary presenting with 3rd degree uterovaginal prolapse is extremely rare. This case highlights the importance of choosing the appropriate route of approach and about maintaining the gynae oncological safety. In our case, total abdominal hysterectomy with bilateral salpingo oophorectomy with anterior colporrhaphy with McCalls Culdoplasty with Moschowitz repair and posterior perineorrhaphy was performed
A comparative study of the efficacy of letrozole versus clomiphene citrate for ovulation induction in anovulatory cycle in subfertile women
Full text linkBackground: Anovulation is a leading cause of female infertility, with clomiphene citrate (CC) and letrozole (LTZ) being commonly used agents for ovulation induction. While CC has been the first-line therapy, its anti-estrogenic effects may impair endometrial receptivity. LTZ, an aromatase inhibitor, offers a potentially superior alternative by enhancing follicular sensitivity without adverse endometrial effects.
Methods: This randomized controlled trial was conducted at the department of obstetrics and gynecology, Government Medical College and Hospital, Akola, Maharashtra, involving subfertile women with anovulatory cycles. Participants were allocated to receive either CC or LTZ. Outcomes assessed included ovulation rate, pregnancy rate, cycles to conception, single follicle formation, and endometrial thickness. Data were analyzed using appropriate statistical methods.
Results: Letrozole demonstrated higher ovulation and pregnancy rates compared to clomiphene citrate. LTZ was associated with improved endometrial thickness and a greater proportion of monofollicular development. Fewer side effects and complications were observed in the LTZ group. The number of cycles required for conception was lower with LTZ.
Conclusions: Letrozole is more efficacious than clomiphene citrate for ovulation induction in anovulatory subfertile women. It offers better endometrial receptivity, higher pregnancy rates, and fewer adverse effects, making it a preferable first-line agent in selected cases
Comparison of the effectiveness of Kegel exercise and biofeedback therapy on Wexner scores in postpartum fecal incontinence patients
Full text linkBackground: Fecal incontinence (FI) is a distressing postpartum condition affecting physical, psychological, and social well-being. Conservative treatments, including Kegel exercises and biofeedback therapy, are commonly employed, but comparative effectiveness remains uncertain. The Wexner score is a validated measure of FI severity.
Methods: This prospective randomized controlled trial enrolled 36 postpartum women with FI at Arifin Achmad General Hospital. Participants were randomized into Kegel exercise (n=18) or biofeedback therapy (n=18) groups. Wexner scores were recorded at baseline and after four weeks. Statistical analyses included paired and independent t-tests, with significance set at p<0.05.
Results: Baseline Wexner scores were comparable (Kegel 14.08±0.86 versus Biofeedback 14.94±0.86; p>0.05). After four weeks, the Kegel group showed a non-significant mean reduction of 0.8 (13.2±2.4; p=0.120), whereas the biofeedback group achieved a significant mean reduction of 5.3 (9.5±2.3; p<0.001). Between-group comparison confirmed biofeedback was significantly more effective than Kegel exercises in lowering Wexner scores (p<0.001). Sub-analysis indicated biofeedback significantly improved continence for liquid, solid, pad use, and lifestyle impact, but not for gas incontinence.
Conclusions: Biofeedback therapy significantly reduces Wexner scores in postpartum FI and should be considered the preferred conservative treatment for this population
Immediate breastfeeding and skin-to-skin contact as a physiological approach to third-stage labour management: an observational study
Full text linkBackground: The third stage of labour is critical for preventing postpartum haemorrhage and ensuring maternal and neonatal safety. Early initiation of breastfeeding combined with immediate skin-to-skin contact (SSC) may enhance physiological uterine contraction and improve neonatal outcomes. This study aimed to assess the effectiveness of breastfeeding initiation and SSC immediately following delivery during the third stage of labour in a tertiary care hospital in India.
Methods: This observational study was conducted in the Department of Obstetrics and Gynaecology at Shimoga Institute of Medical Sciences, Shivamogga, Karnataka, India, over a six-month period from January 2023 to June 2023. The study included term pregnant women who delivered singleton infants. Immediately after birth, newborns were placed in skin-to-skin contact on the mother’s bare chest, and breastfeeding was initiated during the third stage of labour. Maternal outcomes assessed included the duration of the third stage of labour, changes in haemoglobin levels, and the requirement for additional uterotonics. Neonatal outcomes focused on breastfeeding success and morbidity.
Results: The median duration of the third stage was significantly shortened, with 90% of placental separation occurring within 10 minutes. Participants exhibited minimal haemoglobin drop and a reduced need for additional uterotonics (12%). Breastfeeding initiation within the first hour was achieved in 98% of neonates, with no adverse neonatal outcomes reported.
Conclusions: Initiating breastfeeding with immediate SSC during the third stage of labour appears to be a safe and effective physiological intervention that enhances uterine contraction, reduces maternal blood loss, and promotes successful neonatal adaptation. This low-cost approach holds promise for improving maternal and neonatal health outcomes, particularly in resource-limited settings
Status of respectful maternity care among postnatal women availing delivery services at a tertiary care centre: a cross-sectional study
Full text linkBackground: There are numerous reports of disrespectful, abusive, or neglectful treatment during childbirth from health facilities. Although India has substantially increased the number of hospital deliveries, the quality of intrapartum and immediate postpartum care for delivering mothers has not given much importance. Therefore, assessing mistreatment and quality of care during childbirth is vital for promoting respectful maternity care (RMC). Aim and objectives were to assess the status of RMC in tertiary care centre and to assess and compare various domains of RMC.
Methods: The cross-sectional study was conducted in the division of obstetrics and gynaecology, with 170 patients were enrolled and standard set of validated questionnaires was given to assess the RMC and socio-demographic status with appropriate statistical evaluation
Results: Data was collected using a predesigned and pretested questionnaire based on seven major categories as per the RMC. Results showed that 100% experienced at least one form of disrespect during their labor, childbirth, or postnatal period at the hospital.
Conclusions: The study sheds important light on the current state of RMC wherein mothers are noticing and reporting positive changes in maternity care, RMC still has scope of optimization in certain domains