International Journal of Reproduction, Contraception, Obstetrics and Gynecology
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Correlation between maternal and cord blood haematocrit among term singleton deliveries at a tertiary hospital in Sub-Saharan Africa
Get PDFBackground: Anaemia in pregnancy is a major public health concern in sub-Saharan Africa as it contributes significantly to maternal and neonatal morbidity. Maternal haematocrit reflects the oxygen-carrying capacity of the red blood cells, and its relationship with cord blood haematocrit provides insight into fetoplacental oxygen transfer. The study aims to determine the correlation between maternal and cord blood haematocrit and to identify predictors of neonatal anaemia among term singleton deliveries at a tertiary hospital in sub-Saharan Africa.
Methods: This was an analytical cross-sectional study conducted at Benue State University Teaching Hospital, Makurdi, Nigeria. Ninety-five term pregnant women and their neonates were recruited consecutively. Maternal venous and umbilical cord blood samples were taken and analysed for haematocrit. Spearman’s correlation was used to assess the relationship between maternal and cord blood haematocrit, while binary logistic regression was used to identify the predictors of neonatal anaemia. A p value <0.05 was considered statistically significant.
Result: There was a significant positive correlation between maternal and cord blood haematocrit (ρ=0.299, p=0.003). Neonates of non-anaemic mothers had a higher median cord haematocrit [46.0 (44.8–48.0)%] than those of anaemic mothers [43.0 (39.5–47.5)%] (p=0.009). Logistic regression identified maternal anaemia as the only independent predictor of neonatal anaemia (AOR=0.19, 95% CI=0.07–0.50, p=0.001).
Conclusion: Maternal haematocrit showed a significant positive correlation with cord blood haematocrit, confirming maternal anaemia as a key determinant of neonatal anaemia among term singleton deliveries
Needle in fetal brain and its role in modern obstetrics: a case report
Get PDFFetal hydrocephalus at term can obstruct labour and increase maternal risk, and although rarely employed in modern practice, cephalocentesis may decompress the fetal head and facilitate vaginal delivery. We describe two intrapartum transvaginal cephalocentesis procedures and consider their obstetric and ethical implications. In case 1, a 30-year-old multigravida at 38 weeks with Dandy–Walker malformation and severe hydrocephalus underwent transvaginal cephalocentesis with drainage of approximately 400 ml of cerebrospinal fluid (CSF), resulting in reduced biparietal diameter and uncomplicated vaginal delivery of a live infant who later required shunt placement. In case 2, a 27-year-old gravida 2 in labour with cord prolapse declined caesarean delivery and underwent cephalocentesis with drainage of about 200 ml CSF, enabling vaginal delivery of a stillborn infant, with uneventful maternal recovery. Although cephalocentesis is considered a destructive and infrequently indicated procedure, these cases highlight its continuing relevance in selected situations where maternal morbidity from caesarean delivery can be avoided and fetal prognosis is already poor owing to severe hydrocephalus and associated anomalies.
Prospective study on comparison between the efficacy of ulipristal acetate and mifepristone in the management of fibroids in the reproductive age group
Get PDFBackground: Uterine fibroids are the most common benign tumours found in women of reproductive age. Women experience symptoms affecting their quality of life, which include menorrhagia, pelvic pain, and pressure symptoms. In severe cases, fibroid causes infertility and pregnancy complications. Surgical interventions such as hysterectomy and myomectomy are effective, but invasive. Recently, selective progesterone receptor modulators (SPRMs) have emerged for the medical management, which include mifepristone and ulipristal acetate.
Methods: This was a prospective, observational clinical cohort study that enrolled 132 women, 66 in each group of ulipristal and mifepristone, conducted over a period of 18 months. Eligible participants were identified from the Outpatient Department at RIMS.
Results: After treatment, Hb levels increased to 9.9 g/dl (13.8% increase) with Ulipristal acetate and 10.4 g/dl (14.3% increase) with Mifepristone (p<0.001). The findings indicate a significant improvement in Hb levels with both treatments, with Mifepristone showing a slightly greater increase. Before treatment, both groups had a similar mean endometrial thickness of 5.8 mm (p=0.5471). After treatment, thickness increased significantly to 7.2 mm in the Ulipristal acetate group and 8.7 mm in the Mifepristone group (p=0.001).
Conclusions: Mifepristone (25 mg) may be preferable for patients with larger-sized fibroids and anemia. Ulipristal Acetate (5 mg) is beneficial for women having menorrhagia. Endometrial thickness should be regularly assessed in patients. Liver function tests (LFTs) should be performed periodically, particularly for Ulipristal Acetate users.
A study to assess the effectiveness of prone position on afterpains among postnatal women admitted in postnatal wards in Government Doon Medical College and Hospital Dehradun, Uttarakhand
Get PDFBackground: Afterpains are the irregular, spasmodic pains experienced in the lower abdomen between two and four days after delivery. The uterus contracts after delivery as it returns approximately to its pre-pregnancy size and position, resulting in these abdominal cramps.
Methods: Quasi experimental, non-equivalent control group pre-test-post-test design was used to conduct the study at govt. Doon medical college and hospital, Dehradun. A total of 70 primi postnatal women were taken by using non-probability purposive sampling technique, following particular inclusion and exclusion criteria. The duration of the data collection was 4 weeks, from June 2023 to July 2023. Descriptive and inferential statistics was used to analyse the collected data.
Results: The study revealed that the mean±SD of level of pain was 3.00±1.572 in experimental group and 4.89±1.183 in control group. The mean difference was 1.886 and calculated t=5.672 and p=.00001 hence the results is significant at p<0.001 level.
Conclusions: It is concluded that after intervention there was significant difference between the pre-test level of afterpains and post-test level of afterpains in experimental group compared to control group
Study of effect of oligohydramnios on maternal and perinatal outcomes in tertiary care center-hospital based cross-sectional study
Get PDFBackground: Oligohydramnios is described as a condition with decreased amniotic fluid volume relative to gestational age. The amniotic fluid (AF) is a part of the fetal life support system. Oligohydramnios was defined as amniotic fluid index (AFI) ≤5 (or less than the 5th percentile) or single vertical pocket less than 1 cm. With the help of method of amniotic fluid volume estimation by Phelan AFI method, using four quadrant techniques during transabdominal USG, helps in detecting oligohydramnios and foetuses at high risk.
Methods: 45 pregnant women presented with oligohydramnios to our hospital, a tertiary care centre at Bagalkot, from April 2023 to October 2023. Maternal and perinatal characteristics were retrieved from case papers.
Results: Of 45 cases of oligohydramnios, more than 50% underwent caesarean section, due to various causes. 44 cases had live born and 1 was still born due to prematurity. 15 cases (33%) were preterm at the time of presentation, whereas 21 cases (67%) were term at presentation. Of 45 cases, 21 cases required NICU admission, among them 10 were due to prematurity and IUGR component.
Conclusions: With this study we can conclude that oligohydramnios predisposes to raising caesarean rates, preterm delivery and NICU admission. Further research on large scale with larger sample and multicentric approach, follow up is required to predict the perinatal outcome in future
Platelet rich plasma: a newer modality of cervical erosion treatment
Get PDFCervical erosion is a condition in which squamous epithelium of the vaginal aspect of cervix is replaced by columnar epithelium. Some of the common causes of cervical erosion are poor hygiene, trauma, excessive use of chemicals, infection, malnutrition, low immunity, multiple partners and early age of sexual activity. The common clinical symptoms are mucoid discharge per vaginum, post coital bleeding, lower abdominal pain, low backache and deep dyspareunia. Asymptomatic erosions usually heal on their own, but symptomatic erosions need to be treated. Antibiotics and anti-inflammatory agents are used as the first line of treatment. Cryotherapy is a commonly used treatment modality which causes controlled destruction of tissue by freezing. Another method which holds promise is Carbon dioxide Laser. It works by ablation or vaporisation of abnormal cells and has better precision as well as insignificant pain post procedure. Chemical cautery with silver nitrate stick is also an easy and cheap method of treatment. Platelet rich plasma is a newer modality in which platelet derived growth factors help in tissue healing and epithelisation. It does away with the troublesome side effect of watery discharge post treatment, which is known after all other treatment modalities.
A rare case of ectopic pregnancy: cornual pregnancy following salpingectomy
Get PDFThe implantation of a fertilized egg outside the uterine cavity is known as an ectopic pregnancy, and usually occurs in the fallopian tubes. Few cases, have been reported where implantation has occurred in atypical sites. We report the case of an ectopic pregnancy that occurred in the residual stump after salpingectomy. It seems that a pregnancy implanted in this location is very uncommon, making correct diagnosis difficult. This paper includes a brief description of the case, a review of the different diagnostic and therapeutic methods available to this day, and a brief review of the literature.
Postnatal depression among Libyan women in Derna
Get PDFBackground: Postnatal depression during postnatal period is a recurrence of pre-existing situation and one of the common types of mental health illness. Objectives were to explore the factors and prevalence of postnatal depression that influences on the women’s during postnatal period in Denra city and it surrounded suburbs.
Methods: Design A prospective study was carried out and survey of practice. We used Edinburgh postnatal depression scale (EPDS) to collect data between January 2021 to December 2021 in Derna city and its suburbs. Participances women who took part in the study, met specific criteria such as their baby being born within the previous twelve months.
Results: Overall, 100 women were included in this study. The mean age of women was 32.51±5.72 from 23 to 45 years. More than one third 36% of women were from Derna and 66% of women live in their own house. According to EPDS, found 47% of women were possible to expose to depression, 51% of women were complain from postnatal depression and 2% were attempted to suicide. The women delivered by caesarean section were at high risk of postnatal depression (p=0.001).
Conclusions: Untreated postnatal depression led to harmful effect on the relationship between mother and her baby, her partner and other family members. lead to negative impact on society screening and early diagnosis for postpartum depression is important, essential and a vital role for health care professionals such as (midwives, health visitors, nurses and GPs)
Ovarian hemangioma: rare case report and review of literature
Get PDFOvarian haemangiomas are vascular tumours arising from ovary of female genital tract, are very rare. Not more than 60 well-documented cases of ovarian haemangioma are noted. Authors reports 77-year-old woman presented with pain in lower abdomen and discomfort along with bloating sensation since 1 month in gynaecology outpatient department (OPD) at Nowrosjee Wadia Maternity Hospital on august 2023. Ultrasonography suggestive of large cystic mass is seen the left hemi pelvis measuring 7.0×5.4 cm with multiple calcifications. Multidetector computed tomography (MDCT) suggestive of about 8×7.5×6 cm well-defined cystic lesion with multiple thick septae with calcification within it seen in left adnexa likely to be teratoma. Patient was posted for exploratory laparotomy. Total abdominal hysterectomy with bilateral salphingoopherectomy with partial dissection of retroperitoneal mass was done. Histopathology report suggested microscopic examination as ovarian tissue is replaced by variably sized thick and thin vascular channels and blood vessels. These vascular channels have partially denuded endothelial lining. The vascular channels are filled with frank haemorrhage suggestive of ovarian haemangioma. Ovarian haemangiomas sometimes coexist with genital tract diseases or even malignancies and thus ovarian haemangioma can be clinically significant.
Uterine didelphys: an incidental finding during caesarean section
Get PDFMullerian duct anomalies are congenital defects of the female reproductive system resulting from abnormal embryological development. Uterine didelphys occurs due to the failure of embryonic fusion of the Mullerian ducts. This results in the presence of a double uterus with two separate cervices, and often a double vagina; it is extremely rare and can have unpredictable effects on reproductive health and gestation. We report a case of accidental finding of uterine didelphys in a 27-year-old gravida 5 para 4 live 3 with previous three term vaginal deliveries and one caesarean section with history of tubal sterilization, during caesarean section