International Journal of Reproduction, Contraception, Obstetrics and Gynecology
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A rare case of true broad ligament fibroid in postmenopausal women: a minimally invasive approach
Get PDFUterine leiomyomas are the most common benign tumors of the female reproductive tract, but broad ligament fibroids are rare, comprising less than 1% of cases. We report a case of a 62-year-old postmenopausal woman presenting with dull abdominal pain and backache. Clinical examination revealed a mobile pelvic mass consistent with a 12-week gravid uterus. Imaging suggested a right adnexal lesion, possibly a complex ovarian cyst or exophytic fibroid, with associated right-sided hydroureteronephrosis. Diagnostic laparoscopy identified a true broad ligament fibroid measuring approximately 6×6 cm. The patient underwent total laparoscopic hysterectomy with bilateral salpingo-oophorectomy and fibroid excision. Histopathology confirmed leiomyoma. Broad ligament fibroids can mimic adnexal masses and pose diagnostic challenges. Laparoscopic excision is a safe and effective treatment in experienced hands
Metallothionein gene polymorphism associated with Cd and Hg levels in non-obstructive azoospermia patients: a hospital-based observational study
Get PDFBackground: Heavy metals, such as Cadmium (Cd), Arsenic (As), Mercury (Hg) and Lead (Pb) might potentially induce reproductive toxicity in male infertility patients, regardless of the varying concentrations of these heavy metals in the blood. Genetic polymorphism is one of the least studied internal contributing factors in male infertility cases associated with high level of heavy metal in blood. Therefore, this study aims at identifying the difference in the serum levels of heavy metals in non-obstructive azoospermia (NOA) patients associated with genetic variants.
Methods: It’s a hospital based observational study where patients reporting with azoospermia due to hypospermatogenesis (HS) were recruited prospectively. Comprehensive clinical history, and blood samples were collected. Whole exome sequencing (WES) and was performed for 50 HS patients to identify variants. Inductively coupled plasma mass spectrometry (ICP-MS) was performed to assess levels of Cd, As, Hg and Pb levels in serum samples of 50 HS patients. Statistical analysis was performed to determine difference in heavy metal concentration of HS patients with and without the presence of metallothionein gene associated single nucleotide polymorphism (SNP).
Results: Genomic analysis for SNPs identified deleterious candidate variants in MT1A (rs11640851 and rs8052394) associated with 18/50, MT1E (rs138690474) associated with 4/50 and MT4 (rs11643815) associated with 5/50 HS patients. A statistically significant difference in the blood concentration of Cd and Hg was observed in HS patients associated with metallothionein gene SNPs.
Conclusions: This exploratory genomic analysis conducted on HS patients shows prevalence of deleterious candidate SNPs in metallothionein gene. The HS patients with candidate SNPs showed higher levels of Cd and Hg which indicate the genomic susceptibly towards heavy metal-induced reproductive toxicity
Spontaneous hemoperitoneum due to ruptured myoma vessels in a nulliparous woman
Get PDFSpontaneous hemoperitoneum due to ruptured myoma vessels is a rare but potentially life-threatening condition. A 37-year-old nulliparous black West-African woman presented in hypovolemic shock with a tender and distended abdomen. During exploratory laparotomy, a large fundal subserosal myoma with an actively bleeding vein was identified yielding 2.2 l of hemoperitoneum for which myomectomy and peritoneal lavage was done. This case underscores the importance of considering spontaneous rupture of myoma vessels as a differential diagnosis of acute abdomen in women with uterine fibroids. Rapid diagnosis and surgical management are essential to prevent morbidity and mortality
Role of gut microbiome in gestational diabetes mellitus, in South Indian population
Get PDFBackground: Gestational diabetes mellitus (GDM) is one of the most common metabolic complications of pregnancy, characterized by glucose intolerance first recognized during gestation. Emerging evidence suggests that the gut microbiome an intricate community of microorganisms residing in the gastrointestinal tract plays a crucial role in metabolic health, insulin resistance, and inflammation. Alterations in gut microbiota composition have been implicated in the development of metabolic disorders, including type 2 diabetes mellitus (T2DM) and obesity.
Methods: This study was conducted to investigate the association between gut microbiome composition and GDM among pregnant women. A total of 124 pregnant women were enrolled, comprising 53 diagnosed with GDM and 71 healthy controls.
Results: This study revealed significant gut microbiome dysbiosis in women with GDM, characterized by reduced microbial diversity (lower Shannon, Chaol, and Simpson indices; p<0.01) and distinct taxonomic shifts compared to healthy controls. Pro-inflammatory genera like Bacteroides and Parabacteroides were enriched in GDM (p<0.001), while beneficial taxa such as Akkermansia and Ruminococcaceae were depleted (p<0.001). These microbial alterations strongly correlated with elevated fasting glucose and CRP levels (r>0.39, p≤0.002), suggesting a link between dysbiosis, hyperglycemia, and inflammation. Longitudinal analysis further showed worsening dysbiosis in late gestation, with Bacteroides increasing and Akkermansia declining by 36 weeks (p<0.01). The findings highlight the gut microbiome’s potential role in GDM pathogenesis in this population and support future interventions targeting microbial restoration.
Conclusions: Evidence from the study findings underscores the significant role of gut microbiota in GDM pathogenesis
Ripe banana peel extract: a natural protector of testicular health in experimental models
Get PDFBackground: Spermatogenesis is highly vulnerable to oxidative stress, which can be intensified by environmental toxins like paraquat (PQ), an herbicide known for its potent toxicity, particularly in inducing reactive oxygen species (ROS). Musa sapientum (banana), has garnered attention for its antioxidant properties, particularly in its peel, which contains bioactive compounds such as flavonoids and phenols. This study investigated the protective effects of the ethanolic extract of ripe banana peel on male reproductive health in Wistar rats exposed to paraquat-induced testicular dysfunction.
Methods: After acclimatization and toxicity tests, 25 rats were divided into 5 groups. Group A served as the control, receiving rat feed and distilled water. Group B received 20mg/kg of paraquat. Group C received 1000mg/kg of ethanolic banana peel extract. Groups D and E both received 20mg/kg of paraquat followed by 500mg/kg and 1000mg/kg of banana peel extract respectively for three weeks. Sperm quality and testicular histoarchitecture were assessed, with semen samples collected from the epididymis and testes processed for histological evaluation.
Results: Paraquat exposure significantly reduced sperm motility, count, and testicular weight, while increasing sperm abnormalities and histological damage. These effects were likely due to ROS-induced lipid peroxidation and DNA fragmentation. Treatment with banana peel extract significantly improved sperm motility, count, and testicular histoarchitecture, indicating its antioxidant properties.
Conclusions: This study suggests that banana peel extract has potent antioxidant effects and could alleviate paraquat-induced male infertility
Knowledge, attitudes, and practices regarding emergency contraception pills among adult students within the college of medical sciences, University of Guyana, from August to September 2024
Get PDFBackground: Emergency contraceptive pills (ECPs), commonly known as the morning-after pill, are used to prevent unplanned pregnancy after unprotected intercourse, sexual assault, or failure of regular contraception. This study aimed to assess the knowledge, attitudes, and practices of ECPs among adult students from the College of Medical Sciences (CoMS).
Methods: A cross-sectional descriptive study was conducted at the University of Guyana, Turkeyen Campus, between August and September 2024. Data was collected through a structured electronic questionnaire and analyzed using descriptive methods, and the chi-square test for statistical significance.
Results: Out of 321 respondents, 76.1% were females and 23.6% were males, with a mean age of 23 years. 57% were from region 4, and 69.8% were Christians. The study found that the majority of students (86.6%) had adequate overall knowledge about ECPs, but there were notable gaps in understanding specific aspects, including mechanisms of action, side effects, and optimal timeframe for use. The study also found that attitudes toward ECPs were mixed, with a significant proportion of students holding negative attitudes (51.7%). However, the majority of students (95.5%) reported that ECPs were easy/very easy to obtain, and most students reported that they were somewhat effective (68.8%).
Conclusions: This study highlights the importance of targeted educational interventions to address knowledge gaps and misconceptions regarding ECPs. The findings have implications for the development of comprehensive sexual health education programs and policies aimed at promoting safe sexual practices and reproductive health among university students in Guyana
Exploring the efficacy of centchroman as a postpartum contraceptive: an observational study
Get PDFBackground: Centchroman, a non-hormonal contraceptive, offers a safer alternative for postpartum women, particularly in India, where the responsibility of contraception largely falls on females. Despite its benefits, including minimal side effects and efficacy in pregnancy prevention, its adoption remains low. This study examines Centchroman’s effectiveness as a postpartum contraceptive in eastern India
Methods: This prospective observational study (March 2017–February 2018) recruited postpartum women from SCB Medical College, Odisha, meeting inclusion criteria. Participants took Centchroman following a structured regimen, with follow-ups at 1, 3 and 6 months. The primary objective was to determine contraceptive efficacy. Secondary objectives were to assess compliance, satisfaction and adverse effects. Data were analysed using SPSS using Statistics (Version 23.0).
Results: During the study, 785 eligible participants were counselled and 247 consented to use Centchroman, resulting in an acceptance rate of 31.5%. Most were aged 25–29, Hindu (79.7%) and from rural areas (59.5%). Compliance was high, with 96.2% satisfaction by the third follow-up. Common adverse events included delayed periods and heavy bleeding, which decreased over time. Milk secretion reduction was minimal. The main reasons for discontinuation were living apart from their husband (4.8%) and fear of side effects (4.4%). Centchroman showed high adherence, safety and effectiveness as a postpartum contraceptive.
Conclusions: This study highlights Centchroman as a safe, effective, non-hormonal postpartum contraceptive with high acceptability. Minimal adverse effects make it suitable for lactating mothers
Lessons from a private urban health centre in South India on why private healthcare system must step up cervical cancer screening
Get PDFA 32-year-old frail mother of two children, 10 and two-year olds, presented to the urban health center in January 2025 with worsening white discharge per vaginum, significant weight loss, and back pain for three months. A vaginal examination revealed an ominous friable cervical lesion that bled profusely. Biopsy confirmed the diagnosis of poorly differentiated cervical cancer. Her only known risk factor was lower socioeconomic status. She was last seen by a health care professional three months ago for the same complaint and had the intrauterine device (IUCD) removed. A supportive husband and family decided to shift her care to a nearby cancer center in the government health system
A rare case report of septuple nuchal cord entanglement with favourable perinatal outcome
Get PDFA nuchal cord refers to the umbilical cord being looped one or more times around the fetal neck. While often a common finding during pregnancy and labor without adverse effects, it can sometimes lead to complications, including variable decelerations in fetal heart rate, reduced fetal movement, signs of fetal distress, and, rarely, intrauterine fetal demise (IUD). This case describes a rare instance of seven loops of the umbilical cord encircling the fetal neck, identified during a cesarean section in a woman who presented with labor pains at 37 weeks and 1 day of gestation. The pregnancy was complicated by gestational diabetes and polyhydramnios. Intrapartum fetal surveillance revealed recurrent variable decelerations on cardiotocography and the presence of grade 2 meconium-stained liquor. Intraoperatively, seven tight loops of the umbilical cord were observed wrapped around the fetal neck, with a cord length of 115 cm. The fetal and maternal outcomes in cases of nuchal cord entanglement depend on various factors, including the number of loops, cord length, coiling tightness, and amniotic fluid index. Careful intrapartum monitoring and prompt interventions can improve perinatal outcomes, even when nuchal cord entanglement is not diagnosed prenatally. Managing nuchal cord entanglement remains challenging. Although multiple loops (more than five) are rare, we report an uncommon instance of seven loops of nuchal cord entanglement, which resulted in favorable maternal and fetal outcomes
A comparative study to determine the effectiveness of oral mifepristone and vaginal isosorbide mononitrate as cervical ripening agents for induction of labor in pregnant women with gestational age 28 to 34 weeks
Get PDFBackground: The process of inducing labor is definitely one of the most commonly done obstetric procedures worldwide. An unfavourable cervix is a major reason for unsuccessful induction. Cervix must be softened. IOL should only be performed when there is an obvious medical need and advantages are greater than risks.
Methods: The present study was conducted at the Department of Obstetrics and Gynaecology, MGM Medical College, Indore from February 2023 to January 2024.One hundred pregnant women of gestational age 28 to 34 weeks, who had a valid indication for termination of pregnancy, were included in the study after valid consent and randomised into two groups. Oral Mifepristone was used in one group and vaginal isosorbide mononitrate IMN in the other. Modified Bishops Score was subsequently assessed and compared.
Results: In the study, indications for termination were hypertensive disorders of pregnancy, IUFD, anhydramnios, severe oligohydramnios and PPROM. Mean±SD of Bishop score before and after IMN were 1.84±1.23 and 4.40±1.34, whereas for Mifepristone 1.42±1.42 and 4.92±1.68, respectively. Mean cervical ripening to delivery time in IMN group was 30.04±3.37 hours; while in mifepristone group, it was 28.50±3.48 hours. Most patients delivered vaginally in both the groups (IMN group 88%; mifepristone group 94%). Both Mifepristone and IMN were generally well-tolerated by participants.
Conclusions: This study provides evidence supporting the effectiveness of both drugs as cervical ripening agents