International Journal of Reproduction, Contraception, Obstetrics and Gynecology
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Association of serum irisin with gestational diabetes mellitus
Get PDFBackground: Gestational diabetes mellitus (GDM) is a condition characterized by glucose intolerance with onset during pregnancy, increasing risks to both mother and child. Recent studies have focused on irisin, a hormone linked to energy metabolism and insulin sensitivity, to understand its role in GDM. This study aimed to explore the relationship between serum irisin levels and the incidence of GDM.
Methods: This prospective diagnostic accuracy study was conducted at the outpatient Department of Fetomaternal Medicine and the Department of Obstetrics and Gynecology at BSMMU in Dhaka from July 2021 to June 2022. According to the inclusion criteria, 65 pregnant women who were non-GDM at 11-14 weeks were selected purposively. Serum irisin levels were measured in these non-diabetic participants using an enzyme-linked immunosorbent assay (ELISA) kit. The participants were divided into two groups: those with reduced irisin levels and those with normal irisin levels. Data were then analyzed using statistical package for the social sciences (SPSS) version 23.0 software.
Results: Among the low irisin group, 36.4% were diagnosed with GDM, while 63.6% remained euglycemic. In the high irisin group, 97.7% remained euglycemic, and 2.3% developed GDM. Overall, 14% of respondents were with GDM across both groups. The ROC analysis for detecting GDM based on irisin levels showed statistically significant results with an AUC of 0.834. A cut-off value of ≤0.287 had 88.9% sensitivity and 75% specificity, leading to 76.9% accuracy. The PPV was 36.4%, and the NPV was 97.7%. The mean serum irisin level was significantly lower in mothers with GDM compared to non-GDM mothers (p=0.001).
Conclusions: The maternal serum irisin level is found to be lower in pregnant women with GDM compared to those without GDM. Therefore, in pregnancy, maternal serum irisin levels may be useful as a biomarker for detection of GDM
Use of progestogens in pregnancy and its maternal and fetal outcome
Get PDFBackground: Progesterone is a crucial hormone in the establishment and maintenance of pregnancy. In early pregnancy, progesterone is produced by the corpus luteum and suppresses the maternal immune system, enabling the embryo’s survival. Later in pregnancy, progesterone is produced by the placenta and plays a role in the relaxation of smooth muscle cells, ensuring myometrial quiescence until delivery.
Methods: A prospective randomized control trial was done on 100 pregnant women attending the OPD, after written informed consent from the patient, using SPSS software and satisfying the inclusion and exclusion criteria are taken and were grouped under A -Control group (50) in whom no treatment was given and B-Study group (50) in whom progesterone was given in the form of injection or tablet and followed up till delivery at Navodaya Medical College Research Centre, Raichur, India.
Results: There was statistically significant difference found between group A and B with respect to outcome of miscarriage and pre-term birth with p value 0.004 and 0.025 respectively. There was no statistically significant difference found between groups with respect to NICU admission/RDS.
Conclusions: The study concluded that progesterone is crucial for luteal phase support and maintaining pregnancy, reduces uterine contractility, thus preventing miscarriage, preterm birth and neonatal morbidity and mortality
A twist in the tale: a rare case report of asymptomatic uterine torsion in a term pregnant woman
Get PDFAn abnormal rotation of the uterus along its fixed longitudinal or vertical axis by a margin greater than 45 degrees is known as uterine torsion. Prenatal diagnosis is challenging, and it has multiple surgical and post-operative consequences that increase maternal and perinatal morbidity. A 33-year-old G2P1L1 with 38 weeks gestation, came with complaints of labor pains since, 2 hours was admitted in Cheluvamba Hospital, Dept of OBG, MMCRI on 7th January 2024. She was a booked case and her antenatal period was uneventful. She was taken to Emergency LSCS as she was Previous LSCS in labor. At surgery, the uterine surface was found to be covered with dilated tortuous vessels but the diagnosis of uterine torsion was unable to be made until extraction of the baby and exteriorisation of the uterus. Posterior wall uterine incision over the lower segment was performed as the uterus had rotated by 180° around its cervical junction. No uterine anomalies or fibroids were seen. Both the mother and the neonate were in good condition post operatively and were discharged from hospital 72 hours later. The degree of rotation and the stage of pregnancy determine the mother's prognosis in cases of uterine torsion. The period between 20 and 28 weeks of gestation is when the highest mortality rates occur (17%), and these rates decline with increasing gestational age. A 36% fatality rate has typically been associated with torsion of 180 to 360°. Both gestational age and the degree of torsion have an equal bearing on the fetal outcome. 71% of cases with torsion of 180 to 360° resulted in fetal death. When uterine torsion occurs unexpectedly, posterior uterine incision is a viable and time-saving procedure. A safe obstetric result is ensured by exteriorization, uterine detorsion, and careful examination of surrounding structures for injuries.
Clinical profile and lifestyle factors in women with different severities of hirsutism
Get PDFBackground: Hirsutism is excessive hair growth in androgen dependent areas in women. It is noted in 10% women in the reproductive age group. Aim of the study was to identify the clinical profile and cause for hirsutism and to assess the role of diet and lifestyle factors in hirsute women.
Methods: It is a hospital based observational study. A total of 300 women in reproductive age group were given a self-administered pictorial representation for scoring according to modified Ferriman-Gallway score.
Results: 95 participants gave a positive response of score more than 8. Examination confirmed 85 participants had hirsutism, out of which 63 had mild hirsutism, 22 had moderate hirsutism and none had severe hirsutism. Polycystic ovarian syndrome (54.5%) was the major cause in moderate hirsutism. Features of hyperandrogenism (53%) were more prevalent in moderate hirsutism. Most of participants (31.6%) with moderate hirsutism used multiple methods for removal of hair like waxing, shaving and threading. Women with moderate hirsutism had outside food more frequently and had more of meat, fried items, alcohol. Social impact was significantly more in women with moderate hirsutism.
Conclusions: Polycystic ovarian syndrome is a major cause for moderate hirsutism and they had more features of hyperandrogenism. The preferred method of hair removal is waxing and multiple methods were often used by those having moderate hirsutism. Consumption of more of non-vegetarian food, fired food and alcohol was significant in moderate hirsute women. The study underscores the importance of diet and lifestyle factors in women suffering with hirsutism
Importance of universal screening-DIPSI for ANC cases
Get PDFBackground: Gestational diabetes mellitus (GDM) is defined as carbohydrate intolerance with varying degree, onset or first recognition during pregnancy. The study was done to assess the feasibility of DIPSI for screening and diagnosis of gestational diabetes mellitus.
Methods: Pregnant women at 24-28weeks gestation were given 75 grams of glucose in 300 ml of water, irrespective of last meal. If 2 hours plasma glucose levels are >200mg/dl were diagnosed as GDM, if it was >140 mg/dl and <200 mg/dl these patients were subjected to OGTT according to WHO criteria (1999) (FBS>126 mg/dl, 2-hour PG>140 mg/dl, one should be positive). After 8-12 hours fasting, FBS measured, 7 5gm of glucose in 300-400 ml water was given orally, later 2-hour plasma glucose measured. Those diagnosed as GDM followed up throughout pregnancy till delivery.
Results: Among 100 pregnant women, 5 were DIPSI+ and out of 5, 3 were OGTT+, making DIPSI 100% sensitive, 97.9% specific and NPV of 100% PPV of 60%. Mean age of GDM positive women was 28.8 years, mean BMI 24 kg/m2. Out of 5 DIPSI+ 3(60%) of them had c-section, 2 (40%) had FTVD. 2 babies had birthweight between 2.5-3 kg, 2 of them 3-3.5 kg and 1 had 3.8 kg (no macrosomia). Out of 5 women with GDM, 1 managed with insulin and others MNT. There was statistically significant association between mean BMI, birth weight of neonate among GDM and non GDM group. No association between parity and mode of delivery.
Conclusions: The DIPSI test used in screening of GDM proved to be simple, less cumbersome, cost effective and easily acceptable to the patients. GDM can be present in patients without risk factors, hence the need for universal screening. Timely intervention with diet, insulin therapy, patient education is required to prevent maternal and neonatal complications
Hormonal therapy versus hysterectomy in the management of symptomatic adenomyosis
Get PDFBackground: Adenomyosis is a uterine disorder marked by symptoms such as pelvic pain, abnormal uterine bleeding (AUB), and infertility. The purpose of this study was to assess the effectiveness and patient outcomes of hormonal therapy versus hysterectomy in the management of symptomatic adenomyosis. The aim of this study was to evaluate the effectiveness and patient outcomes of hormonal therapy versus hysterectomy in the management of symptomatic adenomyosis.
Methods: This prospective observational study included 85 patients with symptomatic adenomyosis treated with hormonal therapy (n=45) or hysterectomy (n=40) at Bangabandhu Sheikh Mujib Medical University (BSMMU) from 2022 to 2023. Inclusion criteria were adult females aged 20 years and above, while those with other gynecological disorders or severe comorbidities were excluded. Data on demographic characteristics, symptom relief, and patient satisfaction were analyzed using statistical package for the social sciences (SPSS) version 22.0, employing both descriptive and inferential statistics.
Results: Most patients (n=85) were aged 40-49 years, with 55.6% receiving hormonal therapy. Hormonal therapy was used in 52.9% of cases, slightly surpassing hysterectomy at 47.1%. Treatment outcomes showed that 75.0% of hysterectomy patients experienced complete symptom relief, while only 44.4% in the hormonal therapy group reported the same, and 70.0% of hysterectomy patients were very satisfied compared to 33.3% in the hormonal therapy group. Hysterectomy patients had a shorter hospital stay, with 25.0% discharged within 2-3 days compared to 11.1% of hormonal therapy patients.
Conclusions: Hysterectomy provides superior symptom relief and patient satisfaction compared to hormonal therapy in the management of symptomatic adenomyosis
Ovarian mucinous cystadenofibroma: a case report
Get PDFOvarian adenofibroma is a rare benign tumour originating from the stroma and germinal lining of the ovary. We describe here the case of a 54-year-old female with an ovarian mucinous cystadenofibroma that was diagnosed as a cystic mass of the ovary with neoplastic etiology before surgery. The tumour was a large cystic mass of size 30×25×10 cm arising from left ovary. The patient successfully underwent exploratory laparotomy with excision of large ovarian mass f/b total abdominal hysterectomy with B/L salpingoopherectomy
Genital trauma due to coital injury in women at Pikine National Hospital: epidemiological, diagnostic, and therapeutic insights from 32 cases
Get PDFBackground: Sexual trauma involves very different situations in women, most of which are uncommon in clinical practice. These are, often minor lesions following “normal” sexual act, not requiring medical attention. In general, it is estimated at less than 1% of gynecological emergencies.
Methods: This is a retrospective, descriptive and analytical study which extends over a period from March 2019 to January 2023, i.e., a duration of 3 years and 10 months.
Results: During the study period, 32 cases of per coital trauma were collected out of a total of 18,924 gynecological and obstetrical emergencies, i.e., a frequency of 0.16%. The 20–40-year-old age group was the most represented with a rate of 72.7% and most of them were married (72.7%).
The trauma occurred during consensual sexual intercourse with a male, rate of 75.8% compared to 24.2% of non-consensual reports. It was the first sexual act in 69.7% of cases and mainly occurred at night (72.7%). Patients mainly consulted for vaginal bleeding. The relationship between the type of lesion and parity as well as that between the type of lesion and the circumstances of occurrence showed that complex lesions were more frequently encountered in nulliparous women during consensual sexual act.
Conclusions: Percoital genital trauma in women remains an under-reported condition despite the enormous risks to the vital, but also functional and psychological prognosis
Acute colonic pseudo-obstruction after emergency lower segment caesarian section: a case report
Get PDFAcute colonic pseudo-obstruction (ACPO) is rare condition due to acute dilation of large bowel without any mechanical obstruction. It is usually found in patients with severe illness, trauma and surgical procedures; of which caesarian section is most common operation associated with it. It creates a diagnostic dilemma and caries high mortality if not managed early and appropriately with multidisciplinary approach. Here, I present a case report of ACPO developed after emergency lower segment caesarian section (LSCS)
Association between polycystic ovary syndrome and endometrial cancer risk: a systematic review
Get PDFBackground: Objective of the study was to clarify the relationship between the risk of endometrial carcinoma (EC) and polycystic ovary syndrome (PCOS).
Methods: A thorough search across four databases identified 816 relevant publications. After removing duplicates using Rayyan Qatar Computing Research Institute (QCRI) and screening for relevance, 383 full-text articles were reviewed, with 6 studies ultimately meeting the criteria for inclusion.
Results: A total of 25,016 women with PCOS diagnoses were involved in six investigations. With a total incidence of 254 (1%), the prevalence of EC among PCOS patients varied from 0.13% to 52%. Patients with PCOS are more likely to get EC, according to many research. The underlying causes are linked to chronic endometrial estrogen stimulation, with contributing factors including hyperlipidemia, diabetes mellitus, and hypertension. These factors increase the chance of EC in women with PCOS.
Conclusions: These findings demonstrate the robust correlation between PCOS and a higher risk of EC, emphasizing the need for proactive monitoring and prevention in clinical practice. While the evidence points to significant risk factors such as metabolic disturbances, further research is needed to establish a direct causal link and address potential biases. Nevertheless, integrating cancer risk management into the care of women with PCOS is essential for reducing long-term complications