International Journal of Reproduction, Contraception, Obstetrics and Gynecology
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A retrospective cohort study on optimal serum progesterone levels before FET cycles using vaginal and parenteral progesterone supplementation and its pregnancy outcomes
Full text linkBackground: Hormone replacement therapy (HRT) allows the day of embryo transfer to be scheduled and reduces the need for monitoring. We want to evaluate the relationship between serum progesterone (P) levels on the day of embryo transfer and pregnancy outcomes determining an ideal level could enable frozen-thawed embryo transfer (FET) personalization.
Methods: This study included 212 women who underwent FET-ICSI cycles. Women were grouped into two groups of administration (vaginal and parenteral) based on the route of progesterone administration. We investigated the correlations between route of progesterone administration and pregnancy outcomes, route of progesterone administration and serum P4 levels and route of progesterone administration and endometrial thickness.
Results: Pregnancy outcome in vaginal group was 67.65% and parenteral group was 60.53%.
p value was 0.2969, which is statistically insignificant. Median value for vaginal group was 11.60 and for parenteral group, it was 32.90. p value was <0.001, which is statistically significant of serum progesterone. Median value for vaginal group was 8.550 and for parenteral group, it was 8.660, p value was <0.001, which is statistically significant of endometrial thickness.
Conclusions: Higher clinical pregnancies are obtained from vaginal group when compared to parenteral group. There was a statistically significant difference while correlating serum P4 value with route of progesterone and there was no statistical difference in the endometrial thickness between the vaginal and parenteral groups
The effectiveness of hysteroscopic polypectomy in cases of female infertility
Full text linkBackground: The position of hysteroscopy in current fertility practice is under debate. There are many randomized controlled trials on technical feasibility and patient compliance demonstrating that the procedure is well tolerated and effective in the treatment of intrauterine pathologies. However, no consensus on the effectiveness of hysteroscopic surgery in improving the prognosis of sub fertile women is available. The aim of this study is to evaluate the effectiveness of hysteroscopic polypectomy in cases of female infertility.
Methods: This is a cross-sectional descriptive study. This study was carried out on 63 patients the find out about the population including female patients in the department of obstetrics and gynecology, Evercare Hospital, Dhaka, Bangladesh. The duration of the period from July 2020 to June 2023. The period from data was entered in MS Excel and statistical analysis was done using SPSS-24.
Results: The distribution of study patients according to indication of polypectomy and mode of anaesthesia where 37 (58.7%) patients had endometrial polyp and 26 (41.3%) patients had submucous fibroid and 52 (82.53%) patents were given spinal anaesthesia. Pregnancy after hysteroscopic polypectomy where 29 (46.03%) patients became pregnant with endometrium polyp and 34 (53.96%) patients became pregnant with submucous fibroid.
Conclusions: The efficacy of surgery in infertile women with intrauterine polyp suggests potential benefit. More randomized controlled trials are needed before the widespread use of hysteroscopic surgery in the general population
A prospective study on maternal near-miss and maternal mortality in a tertiary care hospital
Full text linkBackground: Maternal near-miss (MNM) has become a key indicator of healthcare quality, offering valuable insights into severe maternal morbidity. In developing countries, maternal morbidity remains a pressing issue, and understanding MNM cases is crucial for improving maternal health outcomes. The present study was carried out to evaluate the causes, interventions, and delays in managing maternal near-miss cases in a tertiary care hospital.
Methods: This observational study was conducted at Al-Ameen Medical College and Hospital, from September 2022 to September 2023. A total of 863 deliveries were analyzed, and 67 MNM cases were identified. The study included pregnant women who experienced severe maternal complications, and data on demographic, clinical, and intervention characteristics were collected. The incidence ratio, mortality index, and delay factors were also calculated.
Results: The MNM incidence ratio was 78.7 per 1000 live births. The most common risk factors were preeclampsia (29.9%), antepartum hemorrhage (APH) (16.4%), eclampsia, and surgical site infections (13.4%). A majority of MNM cases required high dependency unit (HDU) admission (55.2%), and 13.4% underwent hysterectomy. Delays were most prominent at the patient level (46.3%), followed by referral side delays (38.8%). The study also found that women with severe anemia had lower gestational ages and a higher incidence of transfusion interventions.
Conclusions: This study highlights the significant burden of MNM, particularly due to hypertensive disorders and hemorrhage. Delays in care, especially from the patient and referral sides, contribute to poor maternal outcomes. Early detection, effective interventions, and improved healthcare systems at all levels are crucial to reduce maternal morbidity
Vagal schwannoma in pregnancy: a case report
Full text linkCervical vagal schwannomas are rare, slow-growing, benign tumours that typically present in patients aged 30–50 years without neurological deficits. Magnetic resonance imaging (MRI) is the gold standard for preoperative diagnosis, while surgical resection remains the treatment of choice. A case report of a 25-year-old pregnant woman with a history of a right-sided neck swelling of 5×4×1 cm since childhood presented for antenatal care which was firm, immobile, and non-tender, with no significant neurological symptoms. Ultrasonography (USG) and computed tomography (CT) scan indicated a neurogenic tumour, most likely schwannoma. MRI in 2024 confirmed a 3.5×4.8×6.3 cm encapsulated, heterogeneously enhancing lesion in the right carotid triangle, consistent with a vagal nerve schwannoma. The tumour caused anterior displacement of the carotid artery and internal jugular vein without significant luminal narrowing. During her pregnancy, the patient remained asymptomatic but developed gestational hypertension postpartum. Neurology and neurosurgery consultations recommended tumour re-evaluation and follow-up after delivery. She underwent an emergency caesarean section at 38 weeks for obstetric indications, with intraoperative monitoring due to vagal nerve stimulation. Postoperative care included antihypertensive management, and the patient was discharged in stable condition with advice to follow up for definitive tumour management. Cervical vagal schwannomas are uncommon and often misdiagnosed due to their asymptomatic nature and resemblance to other neck masses. MRI is crucial for diagnosis, distinguishing vagal schwannomas from other neurogenic tumours based on vessel displacement patterns. Although surgical resection is the definitive treatment, management during pregnancy requires individualized, multidisciplinary care to balance maternal and fetal outcomes. Deferring surgery until postpartum is preferred unless urgent intervention is required. A collaborative approach ensures optimal outcomes for both mother and child
Caesarean myomectomy in case of anterior wall lower uterine segment myoma: a case report
Full text linkUterine fibroids are common benign tumor among women of the reproductive age group. Pregnancy with uterine myomas is considered high risk due to inherent fetal and maternal complications. Caesarean myomectomy is a safe and economical treatment, particularly when executed by a proficient surgeon in carefully chosen circumstances. We report the case of a 37-year-old G2P1L1 woman at 38+3 weeks of gestation. Ultrasound revealed a singleton live intrauterine pregnancy with an intramural fibroid measuring 5.4×4.7 cm located in the anterior wall, along the lower uterine segment, near the internal os. The patient underwent an elective cesarean section with concurrent myomectomy. A healthy baby was delivered, and the myomectomy was successfully performed. The patient was discharged on postoperative day nine without any complications. The case adds to growing evidence that performing myomectomy during cesarean section, particularly when the surgeon is experienced, is safe and economical for the patient
Stepwise approach to a large fibroid uterus in a nulliparous woman: a case report
Full text linkLeiomyomas are the most common benign pelvic tumour in the reproductive age women accounting for almost 20-25% incidence in general population. Leiomyomas are monoclonal tumours of the smooth muscle cells of the myometrium containing varying amount of fibrous tissue. A 45-year-old, unmarried, nulliparous woman presents with large distended abdominal swelling and heavy bleeding during her periods at a tertiary care hospital. This case report magnifies varying risk factors, diagnosis and management of large uterine fibroids and highlights joint diagnosis and decisions of gynaecologist, radiologist and pathologist. After putting forth various modes of treatment options, the definitive treatment was decided considering her age, severity of symptoms, that is fibroid impacting her quality of life and her future parity interest. This particular case showcases successful preoperative medical treatment, timely investigations and planned surgery for optimal patient outcome
Correlation of HDP gestosis score with severity of hypertensive disorder of pregnancy
Full text linkBackground: Hypertensive disorder of pregnancy (HDP) is the leading cause of maternal and perinatal mortality and morbidity. Among all maternal deaths, 19% deaths are due to hypertension in pregnancy. To calculate HDP gestosis score in women diagnosed with hypertensive disorder of pregnancy and find its correlation with severity of disease.
Methods: The study was conducted in the department of obstetrics and gynaecology, Pt. JNM Medical College Raipur. It is a hospital based prospective observational study. Women with hypertensive disorder of pregnancy admitted in hospital after 20 weeks of gestation were taken as study population. Previous ANC records and medical records were analysed and direct questions were asked to collect data and HDP gestosis score was calculated and its correlation with severity of hypertensive disorder was seen.
Results: The mean HDP gestosis score in patients of GHTN, Preeclampsia, Eclampsia, HELLP Syndrome was 4.28, 4.38, 4.36 and 3.5 respectively (p value 0.857- no significant association). Patients with BMI>30, excessive weight gain during pregnancy, obesity and patients with previous history of HDP have greater risk of developing severe form of disease.
Conclusions: HDP gestosis score is not a good indicator to detect severity of disease though it helps in identification of hypertensive disorder of pregnancy
Giant follicular cyst of ovary in an adolescent girl
Full text linkOvarian cystadenomas are rare neoplastic tumors arising from the ovarian surface epithelium. While commonly observed in adult women, their occurrence in adolescents is extremely uncommon. Now, those lesions diagnosed more frequently due to availability of better imaging modalities. Presentations as huge cysts have become rare as most of them are diagnosed and treated early. Adolescent girls presenting with huge benign abdominal cysts are uncommon, most of them due to serous cystadenomas of the ovary, but large follicular cysts are rare. We present a 13year old girl who presented with a large abdominal mass which was subsequently diagnosed as juvenile follicular cyst of the ovary. Urgent surgical intervention led to left salpingo-oophorectomy, confirming the benign nature of the tumor. This report highlights the importance of comprehensive approach to diagnosing and managing rare ovarian neoplasms in adolescents
An approach to reduce labor pain and increase vaginal birth rate
Full text linkBackground: Labor pain is considered one of the most intense pains experienced by women. Effective pain management is crucial in enhancing maternal satisfaction and ensuring a positive childbirth experience. The peri-pudendal block (PPB) is a promising alternative to conventional pain management strategies during the second stage of labor. This study evaluated the efficacy of the peri-pudendal block in reducing labor pain, episiotomy rates, and improving maternal and neonatal outcomes.
Methods: A prospective randomized controlled trial was conducted at BRD Medical College, Gorakhpur, involving 206 women with term pregnancies. Participants were divided into two groups: those receiving PPB (n=107) and those receiving standard care (n=99). Visual analogue scale (VAS) scores, duration of the second stage of labor, episiotomy rates, perineal injuries, and neonatal outcomes (APGAR scores) were assessed.
Results: PPB significantly reduced VAS scores in both primiparous and multiparous women (4.61±0.12 and 4.36±0.78, respectively). The second stage of labor was shorter in the PPB group for both primiparous (51.52±5.80 minutes) and multiparous women (24.49±4.23 minutes). Episiotomy rates were significantly lower in the PPB group (63% for primiparous and 26.4% for multiparous women). No significant differences in neonatal APGAR scores or maternal cardiovascular parameters were observed.
Conclusions: The peri-pudendal block is a safe and effective analgesic option during labor, improving maternal comfort and reducing surgical interventions without compromising neonatal outcomes
Maternal wellbeing: a concept analysis
Full text linkPregnancy and childbirth cause many physiological, psychological and social changes thus it is considered as critical period in every woman’s life. Wellbeing during perinatal period is influenced by many factors as it is a unique and complex process. Therefore, importance of conceptualizing concept of maternal wellbeing has recently gained attention. Objective of study is to provide more precise definition of concept maternal wellbeing. Walker and Avant method of concept analysis, was adapted to facilitate concept analysis on maternal wellbeing. Electronic bibliographic database was searched to identify the published paper related to the maternal wellbeing; which includes: (Google scholar, PubMed, Taylor and Francis, Ovid) and websites (WHO, Maternal and child health bureau (MCHB), NHM). By undertaking a detailed literature review attributes, antecedents, consequences and empirical referents of maternal wellbeing were identified. The attributes of maternal wellbeing during perinatal period includes: cognitive/affective self-evaluation of life, and multidimensional elements (physical, social, psychological, economical. This concept analysis will provide new insight into maternal wellbeing concept used for midwives and nurses in their practice. Also, findings can help expand or develop theories and models for improving maternal wellbeing during perinatal period