International Journal of Reproduction, Contraception, Obstetrics and Gynecology
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Frequency of endometriosis among infertile women and association of clinical presentations with laparoscopic findings in center for assisted reproduction, BIRDEM
Get PDFBackground: Endometriosis is a significant cause of infertility, particularly among women of reproductive age. It often presents with symptoms such as pelvic pain, dysmenorrhoea, and dyspareunia. Laparoscopy is still the gold standard for diagnosing and staging endometriosis. This study aimed to determine the frequency of endometriosis among infertile women undergoing diagnostic laparoscopy and to assess the association of clinical symptoms with disease severity.
Methods: A cross-sectional descriptive study was conducted at the Center for Assisted Reproduction (CARE), BIRDEM General Hospital, Dhaka, Bangladesh, from July 2013 to June 2015. A total of 127 infertile women, both primary and secondary, undergoing diagnostic laparoscopy and dye test were enrolled. Data were analyzed using SPSS version 20, with a p-value <0.05 considered statistically significant.
Results: Endometriosis was detected in 18.9% of participants. The mean age was 29.31±4.08 years. Most women had normal (36.22%) or overweight (34.65%) BMI. Secondary infertility was more common (71.65%), but endometriosis was significantly associated with primary infertility (p=0.004). Clinical symptoms, including severe dysmenorrhoea, chronic pelvic pain, and dyspareunia, were significantly associated with endometriosis (p<0.05). Stage II endometriosis was significantly linked with chronic pelvic pain and moderate to severe dysmenorrhoea (p=0.002, 0.004), while stage IV was associated with severe dysmenorrhoea, menorrhagia, and dyspareunia (p=0.016, 0.004, 0.010, respectively). Menorrhagia had an inverse association with endometriosis overall.
Conclusions: Endometriosis is more frequently associated with primary infertility and specific pelvic symptoms, particularly at advanced stages. Laparoscopy remains essential for accurate diagnosis and staging
Assessment of maternal and foetal outcome in elderly primigravida: a prospective observational study
Get PDFBackground: An elderly primigravida means age more than 35 years. Several maternal and foetal risk factors are well-established in elderly primigravida mothers. The study aimed to evaluate the maternal and foetal outcome in elderly primigravida mothers of central part of India and also to identify risks associated with advanced maternal age for mother.
Methods: The study was conducted as an observational prospective study in Jawaharlal Nehru Hospital and Research Centre, Bhilai, Chhattisgarh. In this study, the 82 mothers presenting primigravida aged ≥35 years and attending antenatal clinic for the period of January 2019 to December 2020. All primigravida aged 35 years and above, attending antenatal clinic, all primigravida aged 35 years and above admitted in emergency. We used data for demographic and socioeconomic status of the subjects, various obstetrics parameters related to gestational period and other relevant data were collected at the time of registration and the subjects were followed up till delivery and discharge. Detailed maternal and foetal outcomes were recorded.
Results: In the present study, the mean age was of about 36.52±2.41 years among the studied mothers. Higher education and socioeconomic status revealed the conception for pregnancy was found to be delayed. This concept is leading to more LSCS following antenatal complications of mothers that may be causative factors for neonatal complications. In the present study, no mortality was observed among newborns.
Conclusions: It was concluded that vaginal deliveries were significantly less and there was an increase in caesarean section rate in this study. Management will largely depend on attempts at improving perinatal outcome without compromise to health and well-being of the mother
Comorbidity patterns and predictive factors in polycystic ovary syndrome: a cross-sectional study
Get PDFBackground: Polycystic ovary syndrome (PCOS) is a common endocrine disorder in women of reproductive age and is often associated with multiple metabolic and medical co-morbidities. Understanding the influence of demographic and laboratory parameters can aid in early identification and management. study aimed to evaluate the prevalence of medical co-morbidities in women diagnosed with PCOS and assess the impact of demographic and laboratory findings on these co-morbidities.
Methods: A cross-sectional study was conducted on 393 women diagnosed with PCOS based on the Rotterdam criteria. Data on age, body mass index (BMI), menstrual history, and family history were collected. Laboratory evaluations included fasting glucose, insulin levels, lipid profile, and hormonal assays (LH, FSH, testosterone. Statistical analyses assessed associations between variables using chi-square and logistic regression.
Results: Among 94 participants comorbid conditions, metabolic syndrome was identified in 27.65% of participants, while type 2 diabetes mellitus (T2DM) and hypertension were present in 14.89% and19.14%respectively. Mental health co-morbidities were also notable, with depression affecting18.05% and anxiety seen in 17.02% of the cohort higher BMI and elevated testosterone levels were significantly associated with metabolic abnormalities (p<0.05). Younger age at diagnosis and higher LH/FSH ratio were predictive of certain co-morbidities.
Conclusions: Women with PCOS are at high risk for multiple medical co-morbidities, with demographic and laboratory parameters showing significant associations. Early identification of high-risk profiles can facilitate timely intervention and improve long-term outcomes
Non-communicable diseases in pregnancy in Uganda: a growing threat to maternal and neonatal outcomes
Get PDFIn Uganda, the number of non-communicable diseases (NCDs) that contribute to poor maternal and newborn outcomes is rising. These diseases include hypertension, diabetes mellitus, cardiovascular diseases, asthma and thyroid disorders. The burden of non-communicable diseases (NCDs) among pregnant women is increasing due to increased urbanization, changes in lifestyle and constraints in the health system. The epidemiology, pathophysiology, screening methods and accepted practices of the common NCDs affecting pregnant women in Uganda are examined in this review. The report also highlights significant shortcomings in the health system and contrasts national recommendations with international standard
Primary Ewing’s sarcoma of vulva: a rare entity and a review of literature
Get PDFEwing sarcoma family of tumour (ESFT) is a group of bone and soft-tissue neoplasm which has variable neuroectodermal differentiation. In one end Ewing sarcoma (ES) is poorly differentiated, on the other end primitive neuroectodermal tumour (PNET) shows a clear evidence of neural differentiation. Extraosseous Ewing sarcoma (EES) commonly arises in soft tissues of trunk or extremities with a few reported rare sites include oro-naso-laryngo pharynx, neck, pleura, retroperitoneal space, mediastinal space and genital tract. Till now 30 cases of EES of vulva and vagina have been reported in the literature. We report a case of ES vulva in a 35-year-old patient. Her all routine markers were found to be normal, and magnetic resonance imaging (MRI) showed a vulval mass with high vascularity without infiltration to the surrounding structures. Ultrasonography (USG) guided biopsy(histopathology) revealed to be a small round cell tumour with necrosis and clusters of cells around blood vessels. Immunohistochemical staining demonstrated that the cells were positive for membranous CD99 and vimentin with nuclear positivity for NKX2.2, and negative for synaptophysin, chromogranin A, CD 56, Ki 67-30%, whereas all other IHC markers to rule out differentials of small round cell tumour were negative. Based on histopathological examination (HPE) and immunohistochemistry (IHC) panel diagnosis of ES was confirmed. After ruling out for the metastatic lesions,3 cycles of neo adjuvant chemotherapy with VAC were given and planned for surgical resection. After that she is on regular follow up with adjuvant chemotherapy. EES is a rare very rapid growing aggressive tumour requiring IHC, HPE and molecular genetics for exact timely diagnosis and multimodality treatment for better prognosis and survival
Attrition in new obstetrics and gynaecology residency: can we identify risk factors at selection?
Get PDFBackground: Resident attrition is costly and stressful to both residents and healthcare systems. Singapore remodelled its specialty training system 10 years ago, adopting the Accreditation Council for Graduate Medical Education International (ACGME-I) framework. A greater understanding of risk factors and trends of attrition could better inform the resident selection process. We aimed to determine if risk factors for resident attrition can be identified through demographic data available at the time of resident selection, and secondly, if differences exist between attrition rates of OBGYN residents under the SingHealth ACGME-I programme and the earlier British-based specialty training (BST-AST) programme.
Methods: Anonymised demographic data of all SingHealth ACGME-I obstetrics and gynaecology residents between 2011 and 2018 were retrospectively obtained and compared according to “stay” and “attrition” groups. Attrition rates from the BST-AST programme were obtained from the hospital’s departmental database.
Results: From 2011 to 2018, 77 residents were enrolled. There were 5 premature departures, all voluntary. No significant differences were found in demographic parameters between “stay” and “attrition” groups. The annual attrition rate for this programme was 2.07%, versus 3.45% for BST-AST trainees between 2002 and 2011 (OR 0.556, 95% CI 0.140–2.207).
Conclusions: Demographic data alone cannot predict risk of resident attrition as decisions to leave specialty training are complex. Introduction of the ACGME-I accredited residency programme appears to reduce resident attrition rates
Gray zone: a case report on borderline mucinous tumor
Get PDFBorderline ovarian tumors (BOTs) represent an intermediate form between benign and malignant epithelial ovarian neoplasms, with mucinous subtype accounting for a significant proportion. These tumors often present in women of reproductive age and are frequently diagnosed at an early stage. We report the case of a 25-year-old unmarried woman with regular menstrual cycles who was incidentally found to have a complex left adnexal mass during routine imaging. Clinical examination revealed a firm, midline abdominopelvic mass corresponding to 20 weeks’ uterine size. Tumor markers, including CA-125, CEA, CA 19-9, AFP, and LDH, were within normal limits. MRI pelvis revealed a 15 cm mixed solid-cystic lesion in the left adnexa. Intraoperatively, a unilateral ovarian mass with no evidence of extraovarian spread was noted. Frozen section was suggestive of a borderline mucinous tumor. The patient underwent a fertility-sparing staging laparotomy including left salpingo-oophorectomy, infracolic omentectomy, appendicectomy, pelvic lymph node dissection, and peritoneal biopsies. Final histopathology confirmed a borderline mucinous tumor, FIGO Stage IA. This case highlights the importance of thorough preoperative evaluation and intraoperative decision-making in young women with adnexal masses. Fertility-sparing surgery with complete staging offers an excellent prognosis in early-stage borderline mucinous ovarian tumors, with the added benefit of preserving reproductive potential
A study to determine the correlation of insulin resistance in pregnancy with obstetric outcomes
Get PDFBackground: Insulin resistance (IR) is a physiological adaptation in pregnancy but can predispose to adverse maternal and fetal outcomes if dysregulated. Early identification and monitoring are essential to improve obstetric outcomes and reduce the risk of gestational diabetes mellitus (GDM).
Methods: This prospective observational study was conducted at MTH Hospital, Indore, over one year. A total of 200 pregnant women with gestational age up to 26 weeks attending the antenatal clinic were screened for clinical signs of insulin resistance. Those with fasting plasma glucose ≥140 mg/dl or diagnosed with GDM were excluded. Remaining participants were followed up till delivery for obstetric outcomes. Data were collected using a predesigned proforma and analyzed with standard statistical tools.
Results: Among the 200 participants, a significant proportion with clinical features of insulin resistance were found to have increased rates of obstetric complications such as preeclampsia, polyhydramnios, preterm labor, and neonatal hypoglycemia. A positive correlation was observed between maternal BMI and adverse perinatal outcomes. Insulin-resistant women had higher rates of labor induction and cesarean deliveries compared to their non-resistant counterparts.
Conclusion: Early screening for insulin resistance in pregnancy is crucial in peripheral setups. Timely diagnosis and appropriate management can significantly improve maternal and neonatal outcomes
First trimester diagnosis of fetal cardiac anomalies: a sonopathological correlation study
Get PDFBackground: Accurate diagnosis of structural cardiac anomalies in the first trimester is critical due to its impact on anxiety and pregnancy management. This study aims to evaluate the correlation between first-trimester ultrasound (USG) findings of cardiac anomalies and perinatal pathological evaluations.
Methods: This retrospective study was conducted at Mediscan systems, a tertiary care fetal medicine center in South India, analyzing first-trimester scans from January 2012 to December 2017. Singleton pregnancies with detected cardiac anomalies were identified from the sonocare database. Only those cases with subsequent perinatal autopsy were included in the study cohort.
Results: In the study cohort, the mean maternal age was 26.6 years (range 19-44), mean BMI was 26.1 (range 17.5-42.8), and mean crown-rump length was 65 mm (range 48-82 mm). Ultrasound findings and autopsy results were in complete agreement in 62% of cases. Autopsies provided additional information in 28% of cases, while 10% of cases had discordant findings. Notably, the accuracy improved in the second cohort, with complete agreement rising from 49% to 76% and mismatches reducing from 21% to zero.
Conclusions: The study highlights that a systematic checklist enhances the accuracy of first-trimester cardiac assessments, achieving correct diagnoses in 90% of cases. The improvement over time underscores the effectiveness of refined diagnostic protocols. Despite these advances, challenges in differentiating certain anomalies persist, but no prenatally diagnosed anomalies were found normal on autopsy, reinforcing the reliability of early diagnoses and the ability to provide confident counselling
Analysis of maternal and fetal outcome in twin pregnancy
Get PDFBackground: The use of fertility drugs, in-vitro fertilization, gestational age and other factors contribute to the rising incidence of multiple pregnancies. Multiple pregnancies are associated with increased risk of obstetric complications and perinatal mortality and morbidities. The present study analyzes maternal and perinatal outcomes in multiple pregnancies to identify associated complications and reduce risks.
Methods: A retrospective study was conducted in the OBG department of MMCRI, from January 2023 to December 2023. Data from 182 twin deliveries were analyzed. All women diagnosed with twin pregnancies via clinical or ultrasound examination were included.
Results: Of the 7598 deliveries recorded, 182 (3.72%) were twin deliveries. The mean maternal age was 27.32±4.5 years. Most twin pregnancies occurred in multigravida women (67.7%) and were conceived after ovulation induction (74.43%). Dichorionic twins (71.4%) were more common than monochorionic twins (19.54%). Spontaneous delivery occurred in 132 (71.4%) cases, while 28.6% were induced. The rate of LSCS was 34.67%, with the most common indication being first twin not being cephalic. Preterm labour (72.7%), anemia (42%) and hypertensive disorders (38%) and postpartum hemorrhage (14.33%) were the most common complications. Single fetal demise occurred in 10% cases 10%.
Conclusions: Twin pregnancies are more common in advanced maternal age and often result from fertility treatments. Early diagnosis, vigilant prenatal and postnatal care and timely intervention can significantly reduce maternal and perinatal risks