International Journal of Reproduction, Contraception, Obstetrics and Gynecology
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Low grade serous ovarian carcinoma presenting with monoparesis due to deep vein thrombosis: a case report
Get PDFLow-grade serous ovarian carcinoma (LGSOC) is a rare and indolent form of ovarian cancer. While it commonly presents with abdominal symptoms, unusual manifestations such as neurological deficits are less frequent. This case report explores an atypical presentation of LGSOC associated with deep vein thrombosis (DVT) leading to monoparesis. A 45-year-old multiparous female, regular menstrual cycles presented with sudden onset of swelling and pain in her left lower limb. Physical examination revealed tender and swollen left lower limb with Homan’s sign, with imaging confirming DVT in multiple lower limb veins. Further investigation, including pelvic imaging, revealed an ovarian mass. DVT was managed conservatively and patient had total abdominal hysterectomy with bilateral salpingo oophorectomy. Biopsy revealed LGSOC with external iliac vein thrombosis. The tumor was initially asymptomatic, and the neurological symptoms were attributed to paraneoplastic syndrome secondary to the DVT rather than direct tumor invasion. This case highlights an atypical presentation of LGSOC where DVT complicated by monoparesis was the primary symptom. It underscores the importance of considering underlying malignancies in patients with unexplained neurological symptoms and venous thromboembolism (VTE). Early recognition and comprehensive evaluation are crucial for appropriate diagnosis and management. LGSOC can present with unusual neurological symptoms, particularly when complicated by DVT. Clinicians should be vigilant for potential malignancies in patients with unexplained monoparesis and thromboembolic events to ensure timely and effective treatment
A rare case of fundal rupture of uterus at term with placental blood supply from omental vessels in a tertiary care centre
Get PDFUterine rupture is one of the rare causes of obstetric hemorrhage with high incidence of fetal and maternal morbidity. The global prevalence of uterine rupture is 0.3-2.9%. The etiology for rupture in early decades was neglected labor, with passing years newer causes of uterine rupture have been added like previous cesarean delivery, uterine curettage, myomectomy, anomalies in uterus, etc. The most common site of uterine rupture is at the scar site of previous caesarean and the rupture may occur spontaneously or during labour, at the same time some unusual sites of rupture of uterus sparing the cesarean scar have also been documented in the world. We have incidentally detected a case of fundal rupture of uterus when we were performing emergency lower segment caesarean section for a term patient with previous lower segment caesarean delivery who came to us in labour without any imminent features of rupture. The rupture site was sealed by omentum and placenta was taking blood supply from omental vessels, there was no fresh bleeding from scar site. Omentum dissected from uterus, and rent was closed in two layers. Atonic PPH was encountered hence subtotal hysterectomy was done. The objective of this discussion is to raise awareness about the atypical appearance of uterine rupture and its consequences
Unmasking the uncommon: a rare case of vulval leiomyoma mimicking a Bartholin cyst
Get PDFVulval leiomyomas are rare benign smooth muscle tumors, often misdiagnosed due to their nonspecific presentation. They constitute approximately 3.8% of all benign soft tissue tumors in the vulvar region. We report the case of 30-year-old multiparous women, with a history of caesarean section five years’ prior, presenting with a three-month history of right-sided vulvar pain and swelling. Physical examination revealed a tender, cystic mass measuring 3×4 cm in the right labia, extending to the right lateral vaginal wall. A provisional diagnosis of a paraurethral mass was made. Surgical excision was performed under appropriate anesthesia. Histopathological examination confirmed the diagnosis of vulval leiomyoma. The patient’s postoperative course was uneventful, with no recurrence observed during follow-up. This case underscores the importance of considering vulvar leiomyoma in the differential diagnosis of vulvar masses. Accurate diagnosis relies on histopathological evaluation, and complete surgical excision remains the choice
Knowledge, perception and awareness associated with symptoms and complications of polycystic ovarian syndrome among college women
Get PDFBackground: This study aimed to assess the knowledge, perception, and awareness of polycystic ovarian syndrome (PCOS) symptoms and complications among college women’s in Chennai, India, to identify gaps in understanding and inform targeted educational interventions.
Methods: A cross-sectional survey was conducted among 292 female college students aged 18-25 years at Sri Ramachandra institute of higher education and research. A structured questionnaire evaluated participants' knowledge, perceptions, and awareness of PCOS symptoms, complications, and preventive measures. Data were analyzed using descriptive statistics.
Results: While 91.43% of participants had heard of PCOS, only 54.97% correctly identified androgen excess as a key factor. Awareness of symptoms like irregular menstrual cycles 82.19% and hirsutism 66.78% was relatively high, but knowledge of long-term complications such as diabetes 35.27% and heart disease 37.67% was low. Most participants recognized the importance of lifestyle interventions, with 77.05% endorsing regular exercise and 76.36% supporting dietary modifications. Allopathic medicine was the preferred treatment 70.89%, with minimal interest in alternative therapies.
Conclusions: The study reveals significant gaps in knowledge regarding the long-term complications of PCOS among college women’s. While awareness of common symptoms is relatively high, targeted educational programs are needed to improve understanding of the syndrome's broader health implications. Healthcare professionals should play a central role in disseminating accurate information to promote early detection and effective management of PCOS
Efficacy of levonorgestrel intrauterine system in conservative management of abnormal uterine bleeding: an emerging tool
Get PDFBackground: Intrauterine LNG IUS, introduced in 1990, reduces hysterectomies for abnormal uterine bleeding, reducing the need for costly and incapacitating surgical treatments.
Methods: Heavy menstrual bleeding patients were prescribed oral progesterone therapy with norethisterone or medroxyprogesterone in doses of 20-60 mg daily for a maximum of 6 months. 80 patients chose oral progesterone and 40 chose LNG IUS insertion. The follow-up period for patients who chose LNG IUS was conducted at a rate of one year.
Results: Reduction in PBAC score pre and post treatment was statistically significant in both oral progesterone (p value <0.001) and LNG IUS group (p value <0.001). We found statistically significant reduction in endometrial thickness after 6 months of treatment with oral progesterone (p value <0.001) and LNG IUS group (p value <0.001). The most common complaint at 6 months follow-up was spotting per vaginum, which was comparable in both groups. Infrequent cycle and secondary amenorrhea were significantly more in LNG IUS group (p value <0.05) whereas heavy flow persistence and need for hysterectomy were more in oral progesterone group (p value <0.05). LNG IUS got spontaneously expelled in one patient (2.5%) after first menstrual cycle. Mean duration from insertion to amenorrhea was 8 months. After insertion, the mean Hb% showed a significant rise of 8% form baseline. Satisfaction level was more (70%) in LNG IUS users in comparison to oral progesterone (15%).
Conclusions: LNG-IUS is a superior nonsurgical option for managing HMB and uterine pathologies, with lower net costs compared to medical treatment and hysterectomy. It can be improved with counselling about self-remission of spotting per vaginum and fertility preservation
Virilizing Leydig cell tumor of the ovary: from presentation to treatment - a case report
Get PDFLeydig cell ovarian tumor is a rare sex cord-gonadal stromal tumor which constitutes less than 0.2% of ovarian tumors. As they produce testosterone, virilization is the most common presenting feature. This case report discusses a multiparous, 55 years old, postmenopausal lady who presented with complaints of excessive scalp hair loss and increased facial hair growth since two years. On examination she had androgenic alopecia, increased facial and midline body hair and clitoromegaly. Blood investigations done showed elevated S. testosterone. CT abdomen done showed no pathological lesions in the adrenal glands. MRI done in view of suspicion of Androgen secreting ovarian tumour showed mildly enlarged left ovary measuring 2×1.8 cm with altered signal intensity. She underwent total laparoscopic hysterectomy with bilateral salpingo-oophorectomy. Post operatively, histopathological examination was reported as Benign Leydig cell tumour of left ovary.
Fetomaternal outcome in overweight and obese pregnant women in tertiary care hospital in Northeast India
Get PDFBackground: The global prevalence of overweight and obesity in 2014 was 39% and 13% respectively. Underweight is defined as BMI less than 18.5, normal weight as BMI from 18.5 to 24.9, overweight from 25 to 29.5 and obese as BMI of 30 or greater. Obesity is critically important to maternal and fetal health during the perinatal period. Obesity increases the risks of gestational diabetes mellitus, overt diabetes, pregnancy induced hypertension including gestational hypertension, pre-eclampsia, eclampsia, thrombo-embolic phenomena, infections, miscarriage.
Methods: A prospective cohort study was carried out in the Department of Obstetrics and Gynaecology, RIMS, Imphal, Manipur for duration of two years beginning from July, 2019 to August, 2021. Consecutive sampling method was followed to include 38 cases and 38 controls and analysis was done.
Results: Comparison of pre-eclampsia among the study groups showed 8 (21.1%) of exposed group and 1 (2.6%) of the non-exposed group developed preeclampsia. The association between overweight and obesity with GDM. 9 (23.7%) of overweight and obese women while 1 (2.6%) of non-obese women developed GDM. The distribution of neonates requiring neonatal resuscitation among the two study groups showed that 14 (36.84%) of neonates born by overweight and obese women required resuscitation as against 5 (13.16%) of neonates born by non-obese women.
Conclusions: It was evident from the study that maternal obesity has adverse maternal and fetal outcomes. Maternal obesity was strongly associated with antenatal complications like gestational diabetes mellitus, preeclampsia and increase in need for newborn resuscitation
Survey to assess knowledge about polycystic ovarian syndrome in females of reproductive age group: a hospital-based study
Get PDFBackground: Polycystic Ovarian Syndrome (PCOS) is the most common endocrine disorder affecting women of reproductive age. Many women remain undiagnosed due to lack of awareness about its signs, symptoms, and complications and associated risk factors. Educating women about PCOS is key for early diagnosis and effective management. This study aims to asses knowledge about PCOS in females of reproductive age group.
Methods: A cross-sectional observational study was conducted from June to August 2023 at the gynaecology OPD of Punjab Institute of Medical Sciences, Jalandhar. A total of 150 women aged 18–45 years participated by filling a structured and validated questionnaire designed in English and Punjabi. Data were analysed using MS excel.
Results: The majority of respondents (54.7%) were aged 21–30 years and from urban areas (64.7%). Most were students (50%) with education up to 10+2 (49.3%). Awareness of PCOS symptoms varied, with obesity (66%), hair loss (63.3%), and acne/oily skin (59.3%) being the most recognized. Only 38% identified junk food as a risk factor, while 52.7% believed obesity leads to PCOS. Complications like ovarian cancer (29.3%) and diabetes mellitus (24.7%) were less recognized. Awareness about lifestyle modifications such as healthy diet (83.3%) and regular exercise (79.3%) was high. Health workers (76.7%) were the primary source of information.
Conclusions: There is a significant gap in knowledge about PCOS among reproductive-age females. Increased awareness through education, seminars, and counselling is essential for early detection and prevention. Health seeking behaviour should be encouraged
Qualitative assessment of barriers perceived by women using perception scale of barriers in contraceptive use as measurement tool
Get PDFBackground: This study was conducted to determine the barriers and obstacles perceived by women with regard to contraceptive use by using perception scale barriers in contraceptive use (PSBCU) as the measurement tool in women utilizing the family planning services.
Methods: It was a cross-sectional study conducted amongst 300 reproductive age group of women. Perception scale of barriers to contraceptive use was designed as 5-point Likert scale and the scale contains three dimensions. The domains were emotional dimension (10 items), social dimension (8 items) and cognitive dimension (9 items). The scale was administered using face to face interview. Each perceived obstacle was assessed by women using 5-point Likert scale ranging from strongly agree (score 5) to strongly disagree (score 1). The lowest score obtainable from the scale was 27 whereas the highest score was 135. Highest score indicates maximum barriers.
Results: By administering PSBCU scale, a maximum score was obtained for intra uterine contraceptive devices and a minimum score obtained for DMPA. Therefore, this study showed that intra uterine contraception devices have the highest barriers and long acting injectable-DMPA has lowest barriers.
Conclusions: A scale like PSBCU will be useful to know about the experience of current contraception and obstacles perceived and thereby addressing the issues to improve the uptake of contraception services and as well as to reduce the discontinuation rates
Bayesian logistic regression of stillbirth cases in the Bolgatanga Municipality of Ghana, West Africa
Get PDFBackground: Stillbirth, as an adverse outcome of pregnancy, represents a growing worldwide public health challenge. The risks of stillbirth have been reported to exhibit considerable variation across different factors due to variability in socio-economic and geographical settings. Thus, this study was aimed at modelling the risk of stillbirth in the Bolgatanga Municipality of the Upper East region of Ghana and identifying some possible risk factors.
Methods: A retrospective cohort study design was utilized in this work. Thus, all the data were obtained from the medical recorded histories of all single birth outcomes at Bolgatanga Regional hospital in Ghana from September 2023 to December 2024. Bayesian logistic regression was applied in fitting the data on stillbirth in this study. R studio was the statistical software that was utilized in analysing the data.
Results: Based on the results of the posterior estimation of the Bayesian logistic regression, maternal age, educational level and hypertension status were established as significant risk factors of stillbirth in the Bolgatanga Municipality. Overall, women with low maternal age (<20 years) and those with advanced maternal age (≥35 years), women with no formal education, and women with hypertension during pregnancy were established to have a higher risk of stillbirth in the Bolgatanga Municipality.
Conclusions: The study concluded by indicating the need for various agencies of healthcare in the Bolgatanga Municipality to institute targeted interventions that will help control the effects of the risk factors and enhance improved overall pregnancy outcomes