International Journal of Reproduction, Contraception, Obstetrics and Gynecology
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Diagnostic accuracy of office based endometrial biopsy when compared with subsequent findings of dilatation and curettage in patients with abnormal uterine bleeding in age group of 25 to 45 years
Get PDFBackground: Endometrial sampling is considered the gold standard method for assessing Abnormal uterine bleeding (AUB). The primary objective of this study was to assess the diagnostic accuracy of office based endometrial biopsy using Pipelle method when compared with subsequent findings of Dilatation and Curettage (D&C) which is an inpatient procedure and to make a comparative analysis between these two approaches.
Methods: This was a prospective study carried out in the Department of Obstetrics and Gynaecology of Dr. Babasaheb Ambedkar Memorial Hospital, Central Railway, Mumbai over a period of one year on 100 gynaecological patients with one or more than one episode of abnormal uterine bleeding. Pipelle endometrial biopsy was taken on OPD basis and patients were subjected to D&C subsequently. Endometrial samples obtained using both methods then sent to the Department of Pathology for adequacy of sample and for histopathological analysis.
Results: In my study, I got adequate sample in 100% of cases of D&C whereas with pipelle, one sample was inadequate. Sensitivity, specificity, positive and negative predictive value of pipelle for diagnosing atrophic endometrium, secretory phase endometrium, simple endometrial hyperplasia was 100% and for proliferative phase endometrium it was 99% when compared with that of D&C.
Conclusions: Endometrial sampling by suction curette device is an inexpensive, safe OPD procedure that appears to be a feasible alternative to more invasive procedure like D&C for evaluation of patients with abnormal uterine bleeding in reproductive and premenopausal patients
Efficacy and safety of intravenous iron sucrose, ferric carboxymaltose and iron isomaltoside in gynaecological patients: a comparative study
Get PDFBackground: Anaemia is a serious global public health problem that particularly affects young children, menstruating adolescent girls, pregnant and postpartum women. Parental iron therapy with iron sucrose or ferric carboxy maltose or iron isomaltoside results in faster and higher replenishment of iron stores with correction of Hb and ferritin levels and better patient compliance compared to oral drugs.
Methods: This was a prospective, randomized comparative study conducted over 18 months in Department of Obstetrics & Gynaecology, Hind Institute of Medical Science, Barabanki, Uttar Pradesh. Total of 87 female patients of age group 18-50 years with haemoglobin level of <10gm/dl and serum ferritin <100ng/dl in Gynaecology OPD and IPD were assigned to 3 groups of Iron Sucrose (IS) group, Ferric Carboxymaltose (FCM) group and Iron Isomaltoside (IIM) group. Each group included 29 women with a ratio of 1:1:1. Iron requirement was calculated by Ganzoni formula and parenteral iron was given intravenously. Baseline values of haemoglobin and serum ferritin was noted and repeated at the end of 4 weeks of therapy. The observed values were compared and analysed.
Results: The rise in haemoglobin and ferritin was higher with iron isomaltoside and ferric carboxymaltose (p value 0.000, statistically significant) when compared with iron sucrose group. However, rise was statistically not significant when compared between FCM and IIM group (for hemoglobin, p=0.32 and ferritin, p=8.18). The occurrence of adverse reactions was seen more commonly in iron sucrose but it was not found to be statistically significant.
Conclusions: The ability to deliver a high dose of iron within a short time, with single prick and less adverse effects make FCM and iron isomaltoside suitable for patients requiring quicker restoration of iron stores
Mystery of a missing Cu-T: a case report
Get PDFThe Cu-T intrauterine device (IUD) is a popular contraceptive method. However, a "missing" Cu-T IUD poses a clinical challenge. This situation arises when the IUD cannot be visualized on ultrasound or X-ray, raising concerns about potential complications. This review discusses the etiology, diagnosis, and management of a missing Cu-T IUD, including the role of imaging modalities, surgical interventions, and patient counseling. This case report aims to discuss the complications and consequences of a "missing Cu-T" IUD, including perforation, migration, and infertility. We examine the causes, diagnosis, and management of this condition, highlighting the importance of timely detection and appropriate intervention to prevent long-term consequences.
Combination of metformin and myoinositol: a powerful weapon to combat polycystic ovary syndrome
Get PDFPolycystic ovary syndrome (PCOS) affects up to 13% of women of reproductive age, causing symptoms like menstrual irregularities, insulin resistance, and infertility. Insulin resistance is the root cause of PCOS. Metformin, an insulin-sensitizing drug, and Myo-inositol, a natural compound that enhances ovarian function and also an insulin sensitising agent, have both shown benefits in PCOS management. When combined, these agents act synergistically, that results in improved menstrual cycle regularity, reduction in hyperandrogenic symptoms, and enhancement in fertility outcomes. Recent clinical evidence supports this dual approach, and its approval for PCOS-related infertility treatment in India, along with endorsement by FOGSI, underscores its effectiveness as a promising therapeutic option for women with PCOS
Accessory cavitated uterine malformation: an underdiagnosed Mullerian anomaly
Get PDFBackground: Accessory cavitated uterine malformation (ACUM) is an extremely rare Mullerian anomaly that is not yet classified by the international societies as a type of uterine malformations. Due to its rarity, it is usually misdiagnosed as adenomyoma. Objective was to provide specific sonographic features of ACUM and differentiate it from the more common adenomyoma.
Methods: Our study is a comparative retrospective study. We presented the sonographic features of 3 cases of ACUM and compared these features with the sonographic features of 10 cases of adenomyoma. All cases had scanned by 2D and 3D luteal TVUS at Habashy 4D scan centre (Alexandria; Egypt) between June 2019 and June 2024. All the 13 cases in our study were had chronic pelvic pain and dyspareunia with a lesion in the myometrium that was not matched with the whorly echotexture of myoma. We had described the sonographic characteristics of the lesion and matched them with the final diagnosis after histopathology.
Results: TVUS features of the 3 cases who had ACUM were cystic lesion within the lateral myometrial wall. Its content has ground glass echotexture. TVUS features of the 10 cases of adenomyoma were heterogeneous ill-defined solid myometrial lesion with translesional minimal flow.
Conclusions: ACUM is a rare uterine malformation that is usually misdiagnosed as adenomyoma. Distinction between these two pathologies is important as the treatment of both differ. ACUM is suggested in patients with pelvic pain when there is a myometrial cystic lesion separable from a normal uterine cavity and contained a ground-glass material
Primary ovarian leiomyoma: a diagnostic dilemma
Get PDFPrimary ovarian leiomyoma is an uncommon entity accounting for 0.5-1%of all tumors and 4% of all the ovarian neoplasms. Ovarian leiomyoma is a benign, smooth muscle, solid tumors that occur in women aged 20-56 years. Because of its benign nature the prognosis for patient is good. A case of primary ovarian leiomyoma in a pre-menopausal female is to be presented here. A 49 years old female, married for 24 years came to gynaecology out-patient department with complaints of lower abdominal pain and abnormal uterine bleeding without dysmenorrhea and soakage of 4-5 pads per day since 1 month. On per abdomen examination non-tender firm to hard mass of 16 weeks gravid uterus size with regular margins, per speculum examination revealed cervicitis, per vaginal examination revealed the same mobile mass in left fornix and the uterus found to be normal size and to be deviated toward right side. CA-125 level found to be 10.71 and ultrasonically an ovarian mass of size 10×8×4 cm was revealed. The decision of total abdominal hysterectomy with bilateral salpingo-oophorectomy was taken. The histopathology of ovarian mass confirmed to be the diagnosis of primary ovarian leiomyoma. This report highlights a case of primary ovarian leiomyoma in a pre-menopausal woman with a postoperative pathology report as a definitive diagnosis
Parturients' opinions on the quality of delivery care in the obstetrics and gynecology department: case of the municipal medical center of Coronthie-Conakry
Get PDFBackground: In Africa, childbirth care depends on routine practices to the detriment of quality. The aim of this study was to analyze parturients' opinions on the quality of childbirth care offered at the Coronthie Community Medical Center (CMC).
Methods: The study was carried out at the CMC of Coronthie. It was a cross-sectional, descriptive study lasting 6 months from 01 July to 31 December 2021. The study included parturients with a term ≥28 SA, and excluded those with a term <28 SA, or who refused to participate.
Results: The mean age of parturients was 28.60±5 years. Most parturients (89.76%) were married women with secondary education (35.08%). The majority of parturients (59.86%) had given birth by caesarean section. No maternal deaths were recorded, and the neonatal mortality rate was 20/1000. Parturients (43.36%) were referred to the service. Over 2/3 of patients (76.03%) said that staff were competent and available. Most patients (86.49%) felt their privacy had been respected, while 2.18% said the opposite. The majority were satisfied with the overall care provided. To improve the quality of care. 54.98% suggested improving the ownership of the premises and 21% the behaviour of the staff.
Conclusions: Improving ownership of premises and staff behaviour would help to improve quality
Primary extragastrointestinal stromal tumor of greater omentum misdiagnosed as an adnexal tumor: a case report
Get PDFGastrointestinal stromal tumors (GISTs) are the most frequently occurring mesenchymal tumors in the gastrointestinal system. These tumors are believed to arise from interstitial cells of Cajal, the gastrointestinal pacemaker cells, due to the presence of tyrosine kinase receptors in their tissue. When tumors with similar morphological and immunohistochemical properties are found outside the gastrointestinal tract such as the mesentery, retroperitoneum, and every now and then the omentum, they are classified as extragastrointestinal stromal tumors (EGISTs). We report a case of a primary epithelioid (EGIST) of the greater omentum, the tumor was diagnosed in women with non-specific symptoms who presented for abdominal pain initially misdiagnosed as an adnexal tumor. This report highlights the need to consider EGIST in the differential diagnosis of abdominal and pelvic tumors and underscores the importance of EGIST-specific studies to evaluate treatment modalities for improved oncological outcomes and quality of life
Various birthing positions and their effects on fetomaternal outcome during labour: a comprehensive review
Get PDFLabour and delivery are major challenges globally, especially in developing countries. Labouring women should be allowed to choose their preferred positions and avoid staying in supine position for prolong periods as per WHO recommendation. However, studies indicate that most of the women still give birth in a lying or semi-sitting position. This research focuses on determining the most effective birthing positions than the supine one and empowering women to select the most comfortable posture during labour. We have searched a thorough electronic database, including Google Scholar, PubMed, and the Cochrane Library, using key terms such as "labour positions", “alternate birthing positions” and "fetomaternal outcomes." After applying inclusion and exclusion criteria, we integrated total 41 studies into this review. Upright positions, birth stool, birth chair, squatting and peanut ball positions improve labour outcomes for both mother and fetus compared to supine or lithotomy positions, but may increase risk of perineal laceration, episiotomy rate and blood losses in mother. Birthing and Swiss balls have a positive effect on feto-maternal outcomes, although they may not be suitable for all women. Semi-sitting and lateral positions have mixed effects. Whereas Water birth benefits the mother but may result in lower fetal Apgar score. Many women still deliver in traditional lithotomy or semi-recumbent positions in developing countries despite the benefits of different alternative birthing positions. Health systems must adopt policies to support these positions and integrate them into midwifery education, with ongoing research to evaluate their effects and address barriers to implementation
Evaluation of stillbirths: an epidemiological study over a 10-year period in Senegal
Get PDFBackground: The main objective of this study was to analyse a series of foetal deaths from an epidemiological, clinical and aetiological point of view.
Methods: This study was performed over a period of ten (10) years, from 1 January 2014 to 31 December 2023. Our study included all patients who had delivered a stillbirth in our department after twenty-eight (28) weeks of amenorrhoea. The CODAC (causes of death and associated conditions) classification was then used to identify the principal aetiological groups. All data were analysed first in Microsoft Excel 2016 and then using the Statistical Package for Social Science (SPSS 26, Mac version).
Results: Over 10 years, we recorded 1812 cases of stillbirth out of a total of 60794 deliveries, representing a frequency of 2.9%. The average age of the patients was 28 years, with a mean gestite of 1.97. Artificial induction of labour was performed in 20.9% of cases. The most common maternal pathologies were, in order of frequency, retroplacental haematoma, maternal obesity and gestational diabetes. A caesarean section was performed in 26.7% of cases. The average birth weight was 1916 g. Using the CODAC classification, the most common causes were maternal, followed by placental anomalies. No cause was found in 35.4% of cases.
Conclusions: Our results reveal several challenges for improving the management of foetal deaths. It is crucial to strengthen diagnostic capacities, particularly through foetal autopsies and histological examinations of the placenta, and to train healthcare professionals in post-mortem investigation techniques