International Journal of Reproduction, Contraception, Obstetrics and Gynecology
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Primary amenorrhea due to Asherman syndrome with dermoid cyst excision
Get PDFPrimary amenorrhea is less common than secondary amenorrhea. It can be caused by various anatomical, genetic, or hormonal factors during the development of the reproductive organs. Congenital absence of the endometrium or sclerotic endometrium is a very rare cause of primary amenorrhea. We describe a case of sclerotic or non-functional endometrium in the context of normal female karyotype 46 XX and recurrent dermoid cyst
Maternal near miss: as a tool for improving obstetric care: a 4.5-year audit from a tertiary referral centre in Sikkim
Get PDFBackground: Maternal near-miss (MNM) audits are valuable tools for evaluating obstetric care and identifying gaps in the health system. Limited data are available from Sikkim, where a single tertiary centre caters to all six districts. This study aimed to assess the incidence of maternal near-miss and maternal mortality over a four and a half year period, and to implement the results for better maternal health.
Methods: A retrospective observational study was conducted at a tertiary referral hospital in Sikkim, reviewing all deliveries between [2021-2025]. Maternal near-miss cases were identified. Indicators including MNM incidence ratio (NMIR), MNM to mortality ratio (MNM:MD), mortality index, and maternal mortality ratio (MMR) were calculated.
Results: A total of 5,401 deliveries and 5,330 live births were recorded. There were 44 maternal near-miss cases and 8 maternal deaths. The NMIR was 8.25 per 1,000 live births, MNM:MD ratio was 5.5, and the mortality index was 15.4%. The calculated MMR was 150 per 100,000 live births. Compared to national figures (MMR ~93 per 100,000; NMIR ranging 3-17/1,000), the centre recorded a higher MMR and a moderate NMIR.
Conclusions: The elevated MMR reflects referral nature of the institution, with most women presenting in moribund condition. The relatively lower NMIR suggests possible early recognition and prevention, but high mortality index underscores need for strengthening critical care, timely referral, and district-level facilities. Focused improvements in emergency obstetric management and referral systems are essential to reduce maternal morbidity and mortality.
Gangrenous torsion of a giant benign mucinous ovarian cystadenoma mimicking malignancy in a postmenopausal woman: a rare case report
Get PDFGiant mucinous cystadenomas are rare in postmenopausal women and may mimic ovarian malignancy, particularly when complicated by torsion or ischemic necrosis. Conventional tools such as the risk of malignancy index (RMI) and ovarian-adnexal reporting and data system (O-RADS) can be misleading in these situations. Although accurate distinction is desirable, when preoperative evaluation suggests high malignant potential, comprehensive staging surgery is justified to ensure oncologic safety, even if the lesion proves benign. A 75-year-old postmenopausal woman presented with 10 days of progressive abdominal distension, dull diffuse abdominal pain, anorexia, and weight loss. Examination revealed a large abdominopelvic mass corresponding to a 32-week gravid uterus. Tumor markers were normal (CA-125:32.1 U/ml< 35; CEA: 1.85 ng/ml<3). Ultrasonography and CT demonstrated a 20 cm multiloculated complex cystic adnexal mass with irregular mural nodules but no ascites or lymphadenopathy. Risk assessment suggested high malignant potential (elevated RMI score and O-RADS 4 category). A staging laparotomy was performed. Intraoperatively, a 30 cm torsed, gangrenous mucinous cystadenoma of the left ovary with intact capsule was identified. Surgical management included total abdominal hysterectomy, bilateral salpingo-oophorectomy, pelvic lymphadenectomy, and omentectomy. Frozen section and final histopathology confirmed a benign mucinous cystadenoma with extensive gangrenous changes. This case highlights the diagnostic dilemma of differentiating complicated benign adnexal tumors from malignancy in elderly women. It emphasizes the limitations of preoperative risk models when torsion or necrosis distorts imaging features and supports comprehensive surgical staging in high-risk profiles, even when pathology is benign, thereby ensuring oncologic safety
Understanding the burden of menstrual health issues in a health university setting: a study from Kerala
Get PDFBackground: Menstruation affects women, often leading to several health issues that impact academic and work performance. Menstrual health receives limited attention in institutional settings, despite its prevalence. Objective: To estimate the burden of menstrual health problems.
Methods: A cross-sectional online survey was conducted among female staff, students and faculty members of Kerala University of Health Sciences (KUHS). A structured, self-administered online-questionnaire assessed the burden of menstrual health problems. Quantitative data were expressed as mean (SD) or median (IQR), qualitative data as frequency and percentage. The outcome variables were dichotomised as problems present or absent.
Results: The prevalence of menstrual health problems was 96.4% (95% CI 95.6 to 96.8%). More than half of them reported that menstrual bleeding impacted their daily activities and 39.7% were prevented from going to their institution. However, only 15.2% reported that they would take menstrual leave if it were implemented as a policy. About 31.6% of participants reported a change in menstrual pattern after COVID-19 infection. The overall prevalence of premenstrual symptoms (PMS) was 77.2%, with mild PMS 37.3%, moderate PMS 30% and severe PMS 9.9%.
Conclusions: Menstrual health problems are common and significantly affect women’s academic and professional life. Gender-sensitive institutional measures are essential to support women's health and productivity
Impact of health education on women’s knowledge, attitude and practice regarding menopause in Karnataka
Get PDFBackground: Menopause represents an important change in a woman's life, frequently accompanied by various physical, emotional, and social alterations. In spite of its effects, numerous women, especially those in rural regions, do not have sufficient understanding and assistance. This study aimed to evaluate the impact of a health education program on knowledge, attitude, and practice (KAP) regarding menopause among women in Karnataka.
Method: A total of 340 women aged between 35 and 65 years were selected to participate in the study through systematic sampling methods. The study encompassed both pre-menopausal and post-menopausal women, while individuals who were unavailable or opted not to participate were excluded from the analysis. Initial data were collected regarding demographic information, health history, and reproductive status. Subsequently, an educational intervention was implemented, focusing on the symptoms of menopause, management techniques, and healthy lifestyle practices. The assessment of knowledge, attitudes, and practices (KAP) levels occurred before and after the intervention using structured interview schedule.
Results: At baseline, all participants exhibited inadequate knowledge regarding menopause. Following the intervention, only 7% retained a classification of poor knowledge, while 80% attained average knowledge and 13% achieved good knowledge. Positive attitudes increased from 22% to 74%, and negative attitudes declined from 78% to 26%. Instances of good practices improved from 7% to 36%, whereas instances of poor practices decreased from 93% to 64%. Notably, participation in yoga and meditation activities surged from 13% to 89%, alongside a significant enhancement in health-seeking behavior.
Conclusion: The health education program proved highly effective in enhancing KAP related to menopause. However, the initially low awareness emphasizes the need for sustained community-based educational initiatives and continued research to support women through menopausal transition
Estimation of shock index and need of blood transfusion in patients with post-partum hemorrhage: an observational study
Get PDFBackground: Postpartum hemorrhage (PPH) is a leading cause of maternal morbidity and mortality worldwide, especially in low-resource settings. Early detection of hemodynamic instability is critical for timely intervention. The Shock Index (SI), defined as the ratio of heart rate to systolic blood pressure, may serve as a rapid bedside indicator to predict transfusion requirements in PPH.
Methods: This prospective observational study included 120 women with PPH admitted to the Department of Obstetrics and Gynaecology, Government Medical College and Hospital, Akola, Maharashtra, from March 2023 to October 2024. Serial SI measurements at 30, 60 and 120 minutes postpartum were recorded and correlated with blood transfusion requirements, clinical interventions and outcomes. Data were analysed using SPSS version 16, with p<0.05 considered significant.
Results: The mean SI peaked at 60 minutes (1.09±0.25). SI≥0.9 predicted transfusion need with 95% sensitivity and 60% specificity, SI≥1.1 predicted transfusion with 100% sensitivity and 93% specificity and SI≥1.3 predicted massive transfusion (>4 units) with an AUC of 0.97 (sensitivity 94%, specificity 98%). Cesarean deliveries had higher SI (1.26 vs. 0.99) and transfusion rates (88% vs. 56%) than vaginal births (p<0.001).
Conclusions: Shock Index is a simple, non-invasive and reliable marker for early prediction of transfusion need in PPH. Incorporating SI thresholds (≥0.9 for vigilance, ≥1.1 for intervention, ≥1.3 for critical action) into PPH protocols can improve maternal outcomes.
Comparison of parenteral iron sucrose and oral iron preparations in the treatment of postpartum anemia at tertiary health care centre: randomised controlled trial study
Get PDFBackground: Postpartum anemia is a leading cause of maternal morbidity and delayed recovery after childbirth. Oral iron therapy, though widely used, is often limited by gastrointestinal side effects and poor absorption. This study compared the efficacy and safety of intravenous (i.v.) iron sucrose versus oral iron in treating postpartum anemia.
Methods: A randomized controlled trial was conducted in the department of obstetrics and gynecology, Government Medical College, Akola, Maharashtra. A total of 108 postpartum women with iron deficiency anemia were randomly assigned to two groups. Group A received i.v. iron sucrose (200 mg on alternate days, total 1000 mg) and group B received oral ferrous sulphate (325 mg thrice daily) for six weeks. Hemoglobin (Hb) and serum ferritin were measured at baseline, four, and six weeks. Adverse drug reactions (ADRs) and treatment efficacy (Hb rise >3.5 gm/dl) were analysed statistically.
Results: Both groups were comparable at baseline. Mean Hb rise was significantly higher with i.v. iron (3.8±0.6 gm/dl at 4 weeks; 4.2±0.7 gm/dl at 6 weeks) than with oral iron (2.9±0.7 and 3.3±0.6 gm/dl; p<0.001). Serum ferritin increased more with i.v. iron (95.4 ng/ml versus 71.1 ng/ml; p<0.001). ADRs were fewer in the i.v. group (14.8%) than in the oral group (40.7%; p<0.001).
Conclusions: Intravenous iron sucrose is a safe, well-tolerated, and more effective alternative to oral iron for rapid correction of postpartum anemia
Impact of premature rupture of membranes and preterm premature rupture of membrane on maternal and neonatal outcomes
Get PDFBackground: Premature rupture of membrane (PROM) and preterm premature rupture of membrane (PPROM) has significant adverse events in the prenatal, peripartum, and neonatal period. The objective of the present study is to understand the risk factors of PROM and PPROM and delivery outcomes in these subjects along with subgroup analysis on comparison of latent period less than 24 hours (group-1) and more than 24 hours (group-2).
Methods: The present data was retrospectively analysed in a private multispeciality birthing centre at Chennai which included a total of 61 cases of PROM and PPROM over a period of six months (January 2022–June 2022).
Results: Among 54% (n=33) of the study participants (n=61) were ranging from 30–35 years. Among n=49 PROM cases and n=12 PPROM, n=25 (51%) (including 8 vacuum assisted) and n=6 (50%) mothers had normal vaginal delivery respectively. Also, among study participants, n=13 (21%) subjects were in latent period more than 24 hours and n=49 (80%) subjects were in latent period of less than 24 hours. The maternal complications in both subgroups showed n=1 case of atonic postpartum hemorrhage (PPH) and puerperal pyrexia. Among the neonates, there were 2 incidences of hypoglycemia in both subgroups of LP. Two cases of sepsis in LP <24 hours and in LP >24 hours respectively. Among the 4 neonates with respiratory distress, 3 neonates were shifted to higher centre and were effectively managed.
Conclusion: Early diagnosis and prompt management of PROM and PPROM can reduce the risk of maternal and neonatal mortality
Association between body mass index in the first trimester of pregnancy and socioeconomic status with pregnancy outcomes
Get PDFBackground: Maternal body mass index (BMI) in early pregnancy and socioeconomic status are important determinants of maternal and fetal health. Their interaction influences pregnancy outcomes, including complications, birth weight, and neonatal health, highlighting the need for early assessment and targeted interventions. To compare pregnancy outcomes in relation to different BMI levels in the first trimester of pregnancy, and to determine whether BMI is related to socioeconomic status.
Methods: This cross-sectional study was carried out in the Department of Obstetrics and Gynaecology of Bangladesh Medical University, during the period of February 2012 to July 2012. A total of 180 women were admitted to the Department of Obstetrics and Gynaecology, Bangladesh Medical University, Dhaka. Participants who had fulfilled all inclusion criteria were enrolled in this study.
Results: Low BMI mothers were younger (p=0.002), from low-income groups (p<0.001), and had more preterm births (p<0.001). They and their husbands showed lower education (p=0.05, p<0.001). High BMI mothers were older, delivered earlier (p<0.001), and had higher risks of preeclampsia (37.8%), eclampsia (5.4%), gestational diabetes (29.7%), and wound infection (8.1%). Anemia was frequent in underweight individuals (87%). Caesarean delivery was higher in high BMI (81.8%) and underweight (65.2%). Asphyxia, sepsis, and neonatal death were significantly higher (p=0.001).
Conclusion: High BMI mothers were associated with low education status, low economic status, and adverse pregnancy outcomes, whereas low BMI mothers were associated with low education status and that of her husband, preterm delivery, and adverse pregnancy outcomes
Comparative analysis of sperm count, hormonal profile and testicular volume before and after intra-testicular PRP therapy in non-obstructive azoospermia
Get PDFBackground: Non-obstructive azoospermia (NOA) is a major cause of male infertility, with limited treatment options. Platelet-rich plasma (PRP), which is rich in growth factors, has been proposed as a regenerative therapy. This study conducted a comparative analysis of sperm count, hormonal profiles and testicular volume before and after intratesticular autologous PRP therapy in men with NOA.
Methods: This self-controlled clinical trial was conducted at the Department of Reproductive Endocrinology and Infertility, BSMMU, Dhaka, from January 2022 to July 2023. Thirty men with NOA underwent intratesticular injection of autologous PRP (2–3 ml per testis). Baseline and follow-up assessments at 1 and 3 months included semen analysis, clinical and ultrasound measurements of serum follicle-stimulating hormone (FSH), luteinizing hormone (LH), testosterone and testicular volume. Data were analyzed using SPSS v26.
Results: No spermatozoa were detected in semen samples at baseline, 1 month or 3 months post-treatment. Hormonal profiles showed mild fluctuations without significance (FSH: 33.1 to 24.3 mIU/ml, p=0.061, LH: 9.5 to 9.6 mIU/ml, p=0.562, testosterone: 392.0 to 435.1 ng/dl, p=0.062). Mean testicular volume increased from 9.5±2.3 ml to 11.2±2.4 ml (p=0.004) using the Prader orchidometer and from 10.0±2.4 ml to 11.3±2.4 ml (p=0.002) using ultrasound. Side effects included transient pain (20.0%) and hematoma (20.0%), with no infections reported.
Conclusions: Intratesticular PRP increased testicular volume but did not restore spermatogenesis or alter hormones significantly in NOA patients. Although safe and biologically plausible, its clinical utility requires validation through larger, long-term trials