International Journal of Reproduction, Contraception, Obstetrics and Gynecology
Not a member yet
9909 research outputs found
Sort by
Gestational choriocarcinoma presenting with uterine rupture and shock: a case report
Get PDFThe aim of the study was to report an extremely rare case of gestational choriocarcinoma with a ruptured uterus, its early manifestations and management. With the patient's consent, her medical records were accessed, and older records, whichever were available, were retrieved from the hospital archives. A 24-year-old female presented with acute abdominal pain, distension and dyspnoea to the emergency department. The CT scan showed a massive haemoperitoneum of 1.5 l and a hyperechoic lesion in the fundus of the uterus. Given the previous history of complete molar pregnancy, gestational choriocarcinoma was suspected, and she was taken for an emergency laparotomy with hysterectomy. On opening the abdomen, a ruptured uterus with a dark brown exfoliative mass arising from the fundus of the uterus was found, and the whole specimen was sent for histopathologic examination. HPE confirmed that the tumour was choriocarcinoma, and based on the staging, the patient is being managed by gynaecology and medical oncology teams. Choriocarcinoma presenting as uterine rupture and shock is very rarely seen. Timely surgical intervention, transfusion of blood and blood products, followed by chemotherapy, can save a life
Fetomaternal outcome of rheumatic heart disease in pregnancy: an observational study
Get PDFBackground: Rheumatic heart disease (RHD) remains a significant global health burden, particularly among pregnant women in regions with limited access to healthcare. Pregnancy exacerbates the risks associated with RHD due to increased cardiac demand, potentially leading to adverse fetomaternal outcomes. This study aims to investigate the fetomaternal outcomes associated with RHD during pregnancy. Specific objectives include assessing the maternal outcome of patients with rheumatic heart disease in pregnancy and investigating the fetal outcome.
Methods: It was a retrospective observational study to assess the outcomes of pregnant women and neonatal outcomes.
Results: The findings reveal a significant burden of adverse fetomaternal outcomes associated with RHD during pregnancy. Maternal complications, such as maternal mortality (4%), mean gestational age 39.17 years, valvular disorder and mode of delivery, and fetal complications, including preterm birth, low birth weight, intrauterine growth restriction, and neonatal mortality, were also elevated in this population.
Conclusions: Moving forward, further research is essential to enhance our understanding and optimize care for pregnant women with RHD
Risk factor analysis of endometriosis in women of reproductive age: a tertiary care level hospital study in Bangladesh
Get PDFBackground: Endometriosis is a disease in which tissue near the lining of the uterus grows outside the uterus. It can originate severe pain in the pelvis and make it harder to get pregnant. In several studies, several factors have been identified as the risk factors of endometriosis. But in Bangladesh, we have very limited research-based information regarding this issue. This study aimed to assess the risk factors of endometriosis in women of reproductive age.
Methods: This case-control study was conducted in the department of obstetrics and gynecology, Anwer Khan modern medical college, Dhaka, Bangladesh from January 2019 to December 2019. As per the inclusion criteria, in total 24 women of reproductive age with endometriosis were enrolled in the case group (Group 1). On the other hand, 24 age-matched women without endometriosis were enrolled in the control group (Group 2). A purposive sampling technique was used in sample selection. All the demographic and clinical data were analyzed by using the SPSS version 23.0 program and disseminated by the MS office program.
Results: In this study, assessing the risk factors of endometriosis among various reproductive histories of the participants revealed statistically significant correlations between the groups for the age of 30-40 years, late marriage, late childbearing, dysmenorrhea, and family history of endometriosis, with p values less than 0.05. However, when comparing genital tract obstruction, frequent and prolonged menstrual cycles, and nulliparity, we observed noticeable differences between the groups, but these were not statistically significant.
Conclusions: Age of 30-40 years, late marriage, late childbearing, dysmenorrhea, and family history of endometriosis may be considered the potential risk factors for endometriosis in women of reproductive age
A combined efficacy of cervical cerclage and vaginal progesterone use in a pregnant woman with sonographic short cervix and its outcome- an observational study in a tertiary care centre
Get PDFBackground: Combined use of cervical cerclage procedure and vaginal progesterone administration in a women with sonographic short cervix as a treatment of cervical insufficiency is the most efficacious and safest intervention used to prevent preterm birth and neonatal morbidity/mortality.
Methods: This prospective observational study was conducted in Government Villupuram Medical College and Hospital, Villupuram over a period of June, 2022- July, 2024. This study includes a observational review of 133 patients in a tertiary care centre, who undergone transvaginal cervical cerclage procedures and vaginal progesterone administration over a period of 2 years.
Results: Out of 133 cases, only 100 cases were included in this study, remaining cases were dropped due to incomplete follow up and abortions. Overall efficacy of cervical cerclage and vaginal progesterone combination were expressed in terms of sensitivity as 86% which indicates the reduced incidence of preterm birth by improving latency period in terms of gestational age at the time of delivery as well as by decreasing the incidence of cervical dilatation prior to labour in our study group.
Conclusions: Combination of cervical cerclage and vaginal progesterone administration in a pregnant woman with a sonographic short cervix had a beneficial impact in reducing preterm birth and significant improvement in perinatal outcomes
Total laparoscopic hysterectomy in a super obese patient- a challenge to gynecologists
Get PDFLaparoscopic approach is preferred over laparotomy in almost all cases requiring hysterectomy because of reduced pain, postoperative complications, blood loss, hospital stay and faster recovery. Laparoscopic approach was traditionally considered to be difficult in morbidly obese patients but with advancement in laparoscopic techniques and accessibility of bariatric trocars this approach is gaining more importance. Here, we present a 51 years old multiparous lady with recurrent postmenopausal bleeding with multiple comorbidities for which total laparoscopic hysterectomy (TLH) was done and the patient recovered with no postoperative complications
Duration of labour and severity of postpartum haemorrhage: a case-control study
Get PDFBackground: Postpartum haemorrhage (PPH) remains one of the leading causes of maternal morbidity and mortality worldwide, contributing significantly to adverse maternal outcomes. Hence, this study aimed to compare the duration of labour in women with and without PPH and among women having PPH with and without risk factors. Also to determine the gradient effect of duration of labour on severe PPH and maternal consequences of PPH.
Methods: A case-control study was conducted in the department of obstetrics, Fernandez hospital, Hyderabad. The required sample size was 197 cases and 397 controls (1:2 ratio) within 8 months duration.
Results: The mean age of the cases and controls were 28±3.66 and 28±3.91 years, respectively. Anaemia was more prevalent among cases (10.15%) than controls (4.03%), with a p=0.001. Hypertension was more common in controls (16.1%) than in cases (9.1%), with a p=0.02. The mode of conception differed significantly, with assisted conception being more prevalent among cases (7.6%) compared to controls (3.8%) (p=0.04). The duration of various labour stages was significantly longer in cases than in controls. Intrapartum fever was significantly higher in cases (37.06%) compared to controls (15.37%), (p≤0.001).
Conclusions: The study results indicate that longer durations of labour, the need for oxytocin augmentation, and specific maternal characteristics such as anaemia and mode of conception are significant predictors of PPH. The gradient effect of labour duration on the risk of PPH suggests that monitoring labour progression and timely intervention are crucial in preventing severe haemorrhage.
Role of CD 138 for the diagnosis of chronic endometritis in unexplained infertility and recurrent pregnancy loss
Get PDFBackground: Chronic endometritis (CE) is persistent inflammation of the endometrium in response to bacterial infection, which may be mostly asymptomatic. However, patients may present with pain abdomen, abnormal uterine bleeding, pelvic discomfort, leukorrhea and dyspareunia. In this study, we have compared the role of hysteroscopy and CD 138 IHC for the diagnosis of CE in unexplained infertility and RPL. We have also studied the reproductive outcome following cure of CE with antibiotics.
Methods: A prospective study, recruiting 107 participants, was carried out in the department of reproductive medicine and surgery at Mahatma Gandhi hospital, Jaipur, India. The study duration was between September 2022 and April 2024, including 8 months follow up.
Results: The mean age of the patients in unexplained Infertility group was 34.4±4.9 years (range, 25-41 years) and in RPL group was 33.7±3.9 years (range, 20-40 years). Out of the total 107 patients, 75 patients presented with unexplained infertility and 32 presented with RPL.
Conclusions: It was found that both hysteroscopy and immunohistochemical analysis of CD138 cells are equally effective to diagnose CE. While hysteroscopy can be used to obtain a guided biopsy, from the most suspicious areas, it is an invasive procedure and diagnosis is observer dependent.
A case of scar endometriosis: rare entity
Get PDFScar endometriosis is a rare and challenging condition characterized by the presence of endometrial tissue outside the uterine cavity, commonly arising in post-surgical scars. This condition typically follows gynecological or obstetric procedures, such as caesarean sections, episiotomies, or hysterectomies, where endometrial cells become implanted and later proliferate within the scar tissue. Symptoms often include cyclic pain and swelling of the scar that correlates with the menstrual cycle, making clinical diagnosis challenging. The prevalence and pathophysiology of scar endometriosis remain under-researched, though it is recognized as an increasingly reported entity due to heightened awareness and diagnostic advances. This surgical condition is usually mistaken with other surgical conditions. The case here reported is a case of scar endometriosis involving rectus sheath after caesarean section. This patient required surgical excision of the scar lesion. The case report, conclusion and treatment of this rare condition are being discussed further
The mean postpartum drop in the hemoglobin levels in a patient after delivery in the population attending a tertiary hospital in south Kerala
Get PDFBackground: Post partum hemorrhage is still the major cause of maternal mortality and morbidity all around the world. Post partum anemia is a major outcome of postpartum hemorrhage and this affects the maternal health. Postpartum anemia is diagnosed when the adjusted Hb falls to <11 gm% in 24 hours, this impacts 80% of women in low- and middle-income countries. We hypothesize that more than anemia and blood loss it is the percentage drop in hemoglobin postnatally that affects the maternal health.
Methods: The prospective observational study for a period of 1 year from January 2018 among the antenatal patients attending Sree Gokulam Medical College and Research Foundation, Kerala. 544 women were included in the study after applying the inclusion and exclusion criteria. The hemoglobin levels were estimated at the time of admission for labor and 48 hours postnatally. Statistical analysis was done and the mean hemoglobin drop post-partum was calculated in cases of normal delivery and in Caesarean section.
Results: There is a mean drop of Hb of 0.237 (95% CI 0.091-0.383) with t value of 3.189 (p- value of 0.002) and the mean fall in Hb after CS is 0.604 with t value of 5.847 (95% CI 0.400-0.808) with percentage drop in Hb calculated as 5.09%.
Conclusions: There is significant blood-loss not amounting to postpartum hemorrhage by definition but can affect the maternal health detrimentally
A cross-sectional study on referred obstretric patients to a tertiary care centre
Get PDFBackground: Most of the obstetric patients can be managed at primary health center. Identifying high risk obstetric cases, severe maternal complications and timely referring them to a centre equipped with basic emergency obstetric and newborn care helps to reduce feto-maternal mortality and morbidity. This study was aimed to study the clinical profile of referred obstetric patients to SSIMS & RC and made to assess the feto- maternal outcome.
Methods: A prospective observational study was conducted from June 2023 to May 2024 in the department of Obstetrics and Gynecology at SS institute of medical sciences and Research Centre, Davanagere. The study included all women referred while pregnant (irrespective of gestational age) during labor and within immediate postpartum (1 week following delivery). Sociodemographic profile, cause for referral and maternal and perinatal outcome was studied.
Results: In the present study 276 obstetrics patients were included. The main causes for referral were previous LSCS 76 (27.5%), pre-eclampsia 20 (7.24%), Rh negative pregnancy 20 (7.24%), preterm labor 16 (5.79%) and postpartum referral 4 (1.44%). Among them 228 (91.9%) underwent emergency LSCS and 20 (8.06%) delivered vaginally. Main maternal complications observed were acute renal failure 8 (40%), wound sepsis 4 (20%), peripartum cardiomyopathy 2 (10%), postpartum psychosis 2(10%). Out of 248 deliveries;158 babies were healthy (63.7%) and 90 (36.2%) babies had NICU admission.
Conclusions: Ours being a tertiary care hospital, wide spectrum of complicated obstetric cases is referred to us. Referral system is an important part of health care system. Identification of high-risk women and timely referral to an equipped center will help in reducing feta-maternal morbidity and mortality.