International Journal of Reproduction, Contraception, Obstetrics and Gynecology
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The relationship between high risk factors for preeclampsia and the incidence of preeclampsia in pregnant women at The Medan City Community Health Center
Get PDFBackground: The maternal mortality rate (MMR) is a major issue in health development with total 305 per 100,000 live births in 2015. Preeclampsia (PE) affects about 3.4% of all pregnant women and is one of the leading causes of maternal and fetal morbidity.
Methods: This study is an observational analytical study with a cross-sectional design to assess the relationship between high-risk factors for preeclampsia present at <20 weeks of gestation and the incidence of preeclampsia based on blood pressure and proteinuria examinations at >20 weeks of gestation. This research was conducted at the Medan City Health Center. The research population consists of pregnant women receiving antenatal care services at the Medan City Health Center. Data were analyzed descriptively to see the frequency distribution. For bivariate analysis, the chi-square test is used. For multivariate analysis, logistic regression is used. The analysis results are considered significant if p<0.05.
Results: The majority of the research subjects are aged 31-35 years with a parity status of multigravida, an education level of high school, an employment status of unemployed, and a BMI classified as normoweight. Parity and education status were significantly related to preeclampsia (p<0.005). Bivariate analysis can be concluded that multipara status with preeclampsia, multiple pregnancies, gestational diabetes, chronic hypertension, and kidney disease are statistically significantly related to the occurrence of preeclampsia (p<0.05). There are five independent variables that significantly affect preeclampsia in this study, namely parity, multipara with preeclampsia, multiple pregnancies, diabetes in pregnancy, and chronic hypertension. Based on the regression equation, the probability is 27%.
Conclusions: There are five independent variables that significantly affect preeclampsia in this study, namely parity, multipara with preeclampsia, multiple pregnancies, diabetes in pregnancy, and chronic hypertension
A comparative study of the American Society for Reproductive Medicine and European Society of Human Reproduction and Embryology classification systems in the diagnosis and management of Müllerian anomalies: insights from a case series
Get PDFMullerian anomalies, congenital malformations of the female genital tract, arise from defective development, fusion, or resorption of Mullerian ducts and contribute to infertility, recurrent pregnancy loss, and primary amenorrhea. With a prevalence of 6.7% in the general population, accurate classification and diagnosis are crucial for effective management. This study compares the American Society for Reproductive Medicine (ASRM) and European Society of Human Reproduction and Embryology (ESHRE) classification systems using a prospective analysis of 12 cases. The ASRM’s simplicity contrasts with the ESHRE’s anatomical precision, but the latter struggles with complex anomalies. Findings reveal 41% of cases classified as hypoplastic uterus under ESHRE, with 25% remaining unclassifiable under ASRM. The study underscores the limitations of current systems in addressing complex anomalies involving vaginal and cervical deviations. It calls for a universal classification system integrating embryology, anatomy, and clinical insights for better diagnosis and treatment
Treatment modalities and clinical outcomes in patients with gestational trophoblastic disease
Get PDFBackground: Gestational trophoblastic disease (GTD) encompasses a diverse group of disorders characterized by abnormal trophoblastic tissue proliferation, including premalignant conditions like hydatidiform moles and malignant types such as choriocarcinoma and persistent trophoblastic disease, which carry significant malignant potential. The purpose of this study was to evaluate the effectiveness of various treatment modalities and the clinical outcomes in patients diagnosed with gestational trophoblastic disease. The aim of the study was to evaluate the effectiveness of various treatment modalities and the clinical outcomes in patients diagnosed with gestational trophoblastic disease.
Methods: This descriptive cross-sectional study, conducted at the Department of Obstetrics and Gynaecology, Sir Salimullah Medical College and Mitford Hospital, Dhaka (November 2012 - November 2013), included 50 cases of gestational trophoblastic disease (GTD). Inclusion criteria were fresh, incompletely treated, and recurrent GTD cases. Data were collected via a pretested questionnaire, analyzed using SPSS, and presented as descriptive statistics. Ethical approval and informed consent were obtained from all participants.
Results: Among 50 GTD cases, 60% were complete moles, with 94.44% of persistent disease linked to prior molar pregnancies. P/V bleeding was the most common symptom. Choriocarcinoma showed 50% metastasis, mainly to lungs, and 86% remission with EMACO therapy. Suction evacuation treated 56% of molar pregnancies, with 13.5% progressing to persistent mole and 4.5% to choriocarcinoma.
Conclusions: This study highlights the importance of early detection, timely treatment, and regular follow-up in improving outcomes for patients with gestational trophoblastic disease
Study of compliance of depot medroxy progesterone acetate in contraception in a tertiary care hospital
Get PDFBackground: This study aimed to evaluate the compliance and continuity of depot medroxyprogesterone acetate (DMPA) as a contraceptive method and assess its side effects among women at a tertiary care institution.
Methods: This prospective observational study was conducted in the obstetrics and gynecology department of a metropolitan teaching hospital, including 45 women aged 20-45 seeking temporary contraception with DMPA.
Results: The majority of participants were aged 25-30 years (40%) and had a parity of two (44.4%). All participants received at least one dose, with 75.5% receiving a second dose and 42.2% completing three doses. Side effects following the first dose were observed in 24.3% of women, mainly irregular bleeding (11.1%), along with amenorrhea, weight gain, and headaches (4.4% each). Adverse effects increased to 50% in the second dose, with irregular bleeding affecting 26.4%, and 47.4% reported side effects after the third dose, primarily weight gain (21.1%) and amenorrhea (15.7%). The timing of administration showed that 36% of participants received DMPA post-abortion, 31.1% post-menstrual, and 27% transitioned from other contraceptives. Side effects peaked with the second dose, while the continuity rate declined from 75.5% after the first dose to 39% after the third.
Conclusions: Despite side effects contributing to decreased continuity, DMPA remains a viable contraceptive option with proper counselling and follow-up. Further research is recommended to explore outcomes in women continuing beyond three doses for better insights into long-term compliance and side-effect management
A critical study to association between bleeding pattern and ultrasonographic findings in AUB patients in perimenopausal age in a tertiary care hospital
Get PDFBackground: Abnormal uterine bleeding (AUB) is a prevalent gynecological condition, particularly among perimenopausal women, which significantly affects their quality of life. The International Federation of Gynaecology and Obstetrics (FIGO) introduced the PALM-COEIN classification to categorize the causes of AUB into structural and non-structural factors. Ultrasonography (USG), particularly transvaginal sonography (TVS), plays a pivotal role in diagnosing AUB by assessing endometrial thickness and identifying structural abnormalities like fibroids, adenomyosis, and endometrial polyps. However, the correlation between bleeding patterns and USG findings remains complex, and further research is necessary to improve diagnostic accuracy and management.
Methods: This prospective observational study was conducted at GS Medical College and Hospital, Hapur, between November 2022 and February 2024. A total of 120 perimenopausal women, aged 40-50 years, presenting with various AUB patterns, were enrolled. Inclusion criteria included heavy menstrual bleeding, irregular cycles, intermenstrual bleeding, and continuous uterine bleeding. Exclusion criteria involved pregnancy, unstable hemodynamic, visible genital tract lesions, use of certain medications, and chronic systemic diseases. Data collection included clinical examinations, blood tests (haemoglobin, random blood sugar, thyroid-stimulating hormone), and transvaginal ultrasonography (TVS) for assessing uterine pathologies. Histopathological analysis was performed using endometrial biopsies. Data were analysed using SPSS version 26, with p-values <0.05 considered significant.
Results: Among the 120 women, the most common bleeding pattern was menorrhagia (48.3%), followed by menometrorrhagia (19.2%), metrorrhagia (18.3%), and polymenorrhagia (14.2%). The ultrasonographic findings revealed fibroid uterus in 55.8% of cases, adenomyosis in 41.8%, endometrial polyps in 1.6%, and malignancy in 0.8%. There was a significant association between fibroid uterus and menorrhagia, and adenomyosis was more commonly found in polymenorrhagia cases. The cross-tabulation of bleeding patterns and USG findings demonstrated a strong correlation, particularly between fibroids and heavy menstrual bleeding.
Conclusions: The study highlights a significant association between bleeding patterns and ultrasonographic findings in perimenopausal women with AUB. Menorrhagia was most commonly associated with fibroid uterus and adenomyosis. Transvaginal sonography plays a crucial role in identifying underlying structural uterine pathologies, facilitating accurate diagnosis, and enabling personalized treatment strategies. Future research should expand the sample size and incorporate advanced imaging techniques like MRI for comprehensive evaluation and better management of AUB in perimenopausal women
Fetomaternal outcomes beyond 40 weeks of gestation: a retrospective study
Get PDFBackground: Pregnancies extending beyond 40 weeks, categorized as late-term (40–41+6 weeks) or post-term (≥42 weeks), are associated with increased risks of adverse maternal and neonatal outcomes. This study aims to evaluate and compare fetomaternal outcomes in late-term and post-term pregnancies.
Methods: This retrospective observational study was conducted at the department of obstetrics and gynecology, Chettinad health and research institute. Medical records of 300 women aged 18-45 years, who delivered after 40 weeks of gestation between January 1, 2023, and December 31, 2023, were analyzed. Exclusion criteria included teenage pregnancies, elderly gravida (>45 years), past caesarean sections, and breech/transverse presentations. Data on demographic characteristics, induction methods, maternal and neonatal outcomes, and complications were collected and statistically analyzed using SPSS version 25.0.
Results: Out of 300 participants, 225 (75%) delivered at late-term, while 75 (25%) delivered post-term. Caesarean delivery rates were higher in post-term pregnancies (55%) compared to late-term (35%) (p<0.01). Maternal complications, including postpartum hemorrhage (PPH) (15%), perineal tears (10%), and uterine rupture (5%), were significantly more prevalent in post-term pregnancies (p<0.05). Neonatal complications were also higher in post-term deliveries, with increased rates of macrosomia (30% vs. 15%), NICU admissions (27% vs. 15%), and meconium-stained amniotic fluid (40% vs. 20%) (p<0.01). Stillbirths were exclusive to post-term pregnancies (7%).
Conclusions: Post-term pregnancies are associated with significantly higher maternal and neonatal risks compared to late-term pregnancies. Timely induction of labor and enhanced surveillance in pregnancies beyond 40 weeks are crucial to minimizing complications. These findings support the implementation of evidence-based management strategies to improve fetomaternal outcomes in prolonged pregnancies
A peri appendicular abscess presenting as tubo ovarian mass
Get PDFAn appendicular abscess represents the most prevalent complication associated with acute appendicitis, particularly occurring between the fifth and tenth day after an appendix has perforated. This abscess may manifest in either the retroperitoneal space or the peritoneal cavity. Approximately 8% of patients report epigastric pain, 15% experience generalized abdominal discomfort, while 70% present with localized pain in the periumbilical area. Furthermore, around 95% of individuals exhibit alterations in bowel habits, reduced appetite, nausea, and vomiting. A tubo-ovarian abscess (TOA) refers to an abscess that develops within the uterus, fallopian tubes, and ovaries, and it is a significant concern arising from pelvic inflammatory disease (PID). Not all instances of TOA are associated with PID; infections may also stem from gastrointestinal sources or an ascending vaginal infection. Between 15% and 35% of women treated for confirmed PID are subsequently diagnosed with a TOA. The majority of individuals affected by TOA are within the childbearing age group. Among sexually active women of reproductive age, the estimated lifetime prevalence of self-reported PID is approximately 4.4%. TOAs are generally polymicrobial, with common pathogens including Peptostreptococcus, Bacteroides fragilis, and Escherichia coli
Ectopic pregnancy: an analysis of risk factors, diagnosis and management
Get PDFBackground: Ectopic pregnancy (EP), implantation outside the uterine cavity, is a leading cause of first-trimester maternal morbidity and mortality. Tubal pregnancies constitute over 90% of cases, with risk factors including pelvic inflammatory disease (PID), assisted reproductive technologies (ART), and delayed childbearing. Advances in transvaginal ultrasonography and β-hCG assays have improved early detection, but challenges in diagnosis and management persist. This study examines trends, risk factors, and management outcomes of EP at Chettinad medical college, Kelambakkam.
Methods: A retrospective, non-interventional study of 50 EP cases (Jan 2023-June 2024) analyzed patient demographics, clinical presentations, and treatment outcomes. Descriptive and inferential statistics (Chi-square test, p<0.05) were used for analysis via SPSS.
Results: The mean age was 29.02 years (23-35). Abdominal pain (13 cases) was the most frequent symptom, followed by the classic triad (12 cases). Prior EP (13 cases), PID, and ART were primary risk factors. Unruptured EPs (17 right, 12 left) were more common. Medical management (19 cases) was initially used, but 15 required surgery post-failure. No significant correlation was found between risk factors and symptoms (Chi-square=57.64, p=0.85).
Conclusions: EP predominantly affects reproductive-age women, with abdominal pain as the primary symptom and prior EP as the main risk factor. Diagnostic advancements improve outcomes, but challenges remain in optimizing medical management and recurrence prevention. Future research should refine diagnostic markers and treatment strategies to reduce morbidity and mortality
Effect of inter-pregnancy interval on pregnancy outcome
Get PDFBackground: The inter-pregnancy interval (IPI) significantly impacts maternal and child health outcomes. Objective of the study was to determine the effect of inter-pregnancy interval on maternal and foetal outcome.
Methods: This prospective observational study was conducted at Sri Ramachandra Institute of Higher Education and Research Institute from September 2022 to April 2024. A total of 385 pregnant women in their second pregnancy were categorized into three groups based on the inter-pregnancy interval as short (<24 months), optimal (24-59 months), and long (>59 months). Data on maternal outcomes, intrapartum assessments, and foetal complications were collected and analysed using descriptive and comparative statistics.
Results: Out of 385 participants, 37.1% had an IPI of <24 months, 55.1% had an IPI of 24-59 months, and 7.8% had an IPI of >59 months. Shorter IPIs were associated with higher rates of anaemia (77%) and postpartum haemorrhage (45.8%). Longer IPIs were linked to increased gestational diabetes (50%) and hypertensive disorders (63.3%). Foetal complications such as macrosomia were more common in the longer IPIs group (16%).
Conclusions: Both short and long IPIs are linked with adverse maternal and foetal outcomes, emphasizing the need for optimal spacing between pregnancies to improve health outcomes
Correlation of mid-trimester cervical length in primigravida with preterm labour
Get PDFBackground: Preterm birth is the leading cause of neonatal morbidity and mortality that is not linked to congenital anomalies or chromosomal disorders. Studies have shown that a short cervix is a significant predictor of preterm birth in both singleton and twin pregnancies, with the risk of spontaneous preterm birth rising as cervical length decreases.
Methods: It is a prospective, observational, cross-sectional study conducted over a period of 18 months. The sample size was 500. The cervical length was measured using transvaginal ultrasound between 16 to 24 weeks period of gestation. These participants were followed up till delivery and the correlation of mid-trimester cervical length was done with preterm labour.
Results: The mean age of patients was 23.8±3.6 (range, 17-37 years). The mean body mass index (BMI) of patients was 22.6±2.7 (range, 17-33). The mean period of gestation at which trans-vaginal ultrasound was done was 19.6±8.34 weeks. The mean cervical length in patients with pre-term deliveries was 2.7±0.54 and in term deliveries was 3.2±0.43 cm, respectively. The difference in cervical length between the two groups was statistically significant (independent t-test, p<0.001).
Conclusions: There is an inverse relationship between cervical length measured by transvaginal ultrasound at 16 to 24 weeks of gestation and risk of preterm delivery