International Journal of Reproduction, Contraception, Obstetrics and Gynecology
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The effect of letrozole on liver function test in polycystic ovarian syndrome with subfertile patient with and without fatty liver disease
Full text linkBackground: Polycystic ovarian syndrome (PCOS) is a common endocrine disorder characterized by subfertility, insulin resistance and metabolic dysfunction, commonly associated with nonalcoholic fatty liver disease (NAFLD). Letrozole is a first line ovulation induction agent, superior to clomiphene citrate but liver effects in PCOS patients with and without fatty liver disease has not been sufficiently explored. This study aims to determine the effect of letrozole on liver function tests (LFTs) in subfertile PCOS patients stratified by the presence of fatty liver disease.
Methods: This cross-sectional observational study carried out at department of obstetrics and gynecology, Shaheed Syed Nazrul Islam Medical College Hospital, Kishoreganj, Bangladesh from 1st October 2023 to 31st of March 2024. The study included 150 subfertile women with PCOS who had been divided equally between groups with or without fatty liver disease. The baseline characteristics, metabolic profiles and LFT parameters were analyzed.
Results: Across both groups, letrozole improved ovulation and pregnancy rates, but the patients with fatty liver disease had markedly increased LFT parameters compared to those without, for example (ALT: 39±7.9 versus 25.5±6.4 U/l; p<0.001). Fatty liver group also had worse metabolic markers. In patients with fatty liver, 20% of patients developed adverse liver effects.
Conclusions: Letrozole is effective for ovulation induction in subfertile PCOS patients but is hepatotoxic particularly if the patient has associated fatty liver disease. In high risk groups, therapists should closely monitor liver function
Impact of personalized embryo transfer based on endometrial receptivity assay on pregnancy outcomes in women with recurrent implantation failure: a retrospective study
Full text linkBackground: Recurrent implantation failure (RIF) poses a persistent challenge in assisted reproductive technology (ART), characterized by the repeated inability to achieve pregnancy following multiple embryo transfers. This retrospective study aimed to assess the impact of personalized embryo transfer (PET) guided by the endometrial receptivity assay (ERA) on pregnancy outcomes in couples experiencing RIF.
Methods: The study included couples who had undergone two or more failed ICSI cycles despite transferring grade A blastocyst. Endometrial biopsies were obtained during standard HRT cycles and analyzed using the ERA, a genomic diagnostic tool that evaluates the transcriptomic signature of the endometrium to pinpoint the window of implantation (WOI). Subsequent PET cycles were tailored based on ERA results, categorizing patients into receptive, pre-receptive, or post-receptive phases.
Results: Our findings revealed that 69.81% of patients were receptive, while 22.64% were pre-receptive and 7.55% were post-receptive. Following ERA-guided PET, 93.94% of patients achieved pregnancy, with a live birth rate of 80.65%. These results underscore the potential of this personalized approach to enhance ART success in challenging cases of RIF.
Conclusions: These results contribute to advancing personalized medicine in reproductive health, emphasizing the importance of individualized treatment strategies based on the precise assessment of endometrial receptivity.
Bacteriological study of post-operative wound infection in DMCH
Full text linkBackground: Post-operative wound infection is leading cause of morbidity, prolonged hospital stays. Understanding the bacteriological profile and associated risk factors is essential for effective prevention and management. This study was aimed to determine the bacteriological profile and associated factors of post-operative wound infections in women treated at Dhaka Medical College Hospital (DMCH).
Methods: This cross-sectional study was conducted at department of gynecology and obstetrics, Dhaka Medical College Hospital, Dhaka, from October 2019 to September 2021. A total of 200 women diagnosed as post-operative wound infection were enrolled in the study by purposive sampling. A detailed history, thorough clinical examination and wound swab culture and sensitivity test were carried out in each patient. Separate case-record data were gathered, and SPSS 24 was used for analysis.
Results: Among the post-operative wound infected women maximum had culture positive bacteriological findings (67%), where gram-positive bacteria, primarily Staphylococcus aureus (33.6%) were the most common pathogens, followed by gram-negative bacteria, including Escherichia coli (20.9%), Pseudomonas (20.9%), Acetobacter (14.2%) and Klebsiella (10.4%). Gram positive infections were associated with anemia (91.1%) and gram-negative infections with diabetes mellitus (23.6%). There was no significant association between bacterial type and the type of surgery, duration of hospital stays or obstetric factors like prolonged rupture of membranes or preeclampsia.
Conclusions: Gram positive and gram-negative bacteria cause post-operative wound infections in DMCH, with anemia, diabetes, and other comorbidities being equally important. However, further larger studies in different surgical units are warranted
Fournier’s gangrene secondary to marsupialization of Bartholin’s gland: a case report
Full text linkWe present the case of a 38-year-old patient without risk factors, who presented with Fournier’s gangrene secondary to marsupialization of Bartholin´s gland. Fournier´s gangrene is an extremely rare complication after the instrumented management of Bartholin´s gland abscess. The case aims to explore further evidence regarding the clinical presentation, diagnosis, and timely management of these surgical complication, due to its rapid progression it can compromise the patient´s life.
A comparative study of pregnancy complications and birth outcomes in very advanced maternal age women: a retrospective cohort analysis
Full text linkBackground: There has been a noted increment in the number of women having children at a very advanced maternal age (VAMA), in the recent decades. This changing trend raises concerns regarding the risks involved and the associated complications with pregnancy occurring in both the mother and the newborn. The associated complications include stillbirths, placental problems, higher risks of cesarean sections and gestational diabetes. Existing research on the correlative aspects of pregnancy outcomes and VAMA, however have shown contradicting results. Hence, the findings of the same remain debatable.
Methods: This was a hospital-based retrospective cohort study, conducted on 100 women delivering between the years 2018 and 2023. The participants were classified into two different groups: group I- low-risk women, including 50 pregnant females of age less than 35 years and group II- VAMA females, 50 pregnant females of age up to 45 years.
Results: Women falling in the category of VAMA reported an increased rate of complications; most of these were gestational diabetes and hypertensive disorders. With this evidence, pregnancy results for advanced-aged women ought to be enhanced using targeted care and greater alertness in antenatal checkups.
Conclusions: More attention should be paid to women exposed to VAMA during pregnancy. Better education and timely intervention are critical in preventing complications and contributing to healthier pregnancies in this group
Association between serum albumin levels and the incidence of pedal edema in normotensive pregnant women
Full text linkBackground: Pedal edema is a common clinical condition during pregnancy, often associated with hypertensive disorders. However, its occurrence in normotensive pregnant women and its relationship with serum albumin levels remain underexplored. This study investigates the association between serum albumin levels and pedal edema while examining the potential influence of age, parity, and BMI in normotensive pregnancies.
Methods: A hospital-based observational study was conducted on 100 normotensive pregnant women aged 20–40 years. Data on demographic details, obstetric history, and clinical parameters were collected. Serum albumin levels were measured in the third trimester and classified as normal (>3.5 g/dl) or low (≤3.5 g/dl). Pedal edema was assessed clinically. Statistical analysis was performed using chi-square tests, with a p value <0.05 considered significant.
Results: Among the study population, 71.4% of participants with low serum albumin levels (≤3.5 g/dL) experienced pedal edema compared to 23.1% of those with normal levels (>3.5 g/dl) (p=0.012). Age, parity, and BMI were not significantly associated with the incidence of pedal edema (p>0.05). Underweight participants showed a higher prevalence of edema (50%) compared to those with normal (33.3%) and overweight BMI (33.3%).
Conclusion: Low serum albumin levels are significantly associated with pedal edema in normotensive pregnant women, highlighting the importance of albumin monitoring during antenatal care. Addressing hypoalbuminemia may improve maternal health outcomes, particularly in resource-limited settings
Delta hypertension as an emerging predictor of post-partum eclampsia in normotensive patients: a case study and implications for clinical practice
Full text linkDelta hypertension is defined as a significant late-pregnancy increase in mean arterial pressure (MAP) as compared to its mid-pregnancy value. This case report details a rare instance of post-partum eclampsia in a normotensive patient, emphasizing delta hypertension's role in predicting eclamptic events at blood pressure readings conventionally considered to fall within normotensive range. A 23-year-old primigravida, with a normal medical history and consistent prenatal care, experienced unexpected post-partum eclampsia. Her pregnancy was uneventful until delivery, despite thrombocytopenia noted during labour. Initially recording a blood pressure range of 90/60 mmHg to 100/60 mmHg, the patient's blood pressure rose to 130/80 mmHg at term. Post-delivery she suffered from an episode generalized tonic-clonic seizure, despite maintaining blood pressure within normotensive limits. Extensive investigations were done to evaluate the episode- CT and MRI brain were done to rule out brain parenchymal defects, additionally 2D echocardiography, blood biochemistry panels, USG abdomen and pelvis revealed no abnormalities, indicating no typical eclamptic pathologies. Treatment included emergency seizure management and subsequent monitoring showing a return to pre-existing ante-natal blood pressure values without further incident or need for anti-hypertensive medications. Delta hypertension, a significant yet often overlooked rise in blood pressure later in pregnancy, was pivotal in this patient's clinical course. This condition suggests underlying endothelial dysfunction leading to critical end-organ damage, exemplified by this patient's post-partum eclampsia. Delta hypertension underscores the necessity for close longitudinal blood pressure monitoring protocols in ante-natal period, advocating for more nuanced assessments that could better predict and manage eclampsia in patients
A case of rudimentory horn ectopic pregnancy
Full text linkEctopic pregnancy is emergency in obstetrics. Sometimes difficult to diagnose make it difficult to manage. There are various types of ectopic pregnancy and each possible a variety of challenges. This is a case of a 20-year-old who presented to R. L. Jalappa hospital, Kolar with history of 3 months of amenorrhea and complaints of pain abdomen. She was in state of shock and after evaluation taken up for emergency exploratory laparotomy where the diagnosis of ruptured horn ectopic of a uni-cornuate uterus was made and treated accordingly.
The enigma of painful scars: abdominal and perineal scar endometriosis
Full text linkScar endometriosis is a rare and often underdiagnosed form of extra-pelvic endometriosis, occurring in surgical scars following obstetric and gynaecologic procedures. It is most commonly associated with caesarean sections but has also been reported after hysterectomies, episiotomies, and laparoscopic surgeries. The condition arises due to the iatrogenic implantation of endometrial tissue into the surgical wound, where it subsequently proliferates under hormonal influence. It is often mistaken for other dermatological or surgical conditions, leading to a delayed diagnosis. We are reporting three cases of scar endometriosis. The patient required wide surgical excision of the lesion. The pathogenesis, diagnosis, and treatment of this rare condition are being discussed
A 40-weeks ovarian pregnancy: a case report
Full text linkOvarian pregnancy is a rare ectopic pregnancy, often misdiagnosed at advanced gestational age. We present a case of a 38-year-old woman at 40 weeks with ovarian pregnancy and fetal death, discovered during laparotomy at Mirebalais Teaching Hospital, Haiti. The patient presented with abdominal pain, light vaginal bleeding, and high blood pressure. Ultrasound suggested intrauterine fetal death and placenta previa, but the laparotomy revealed a non-gravid uterus and a large amniotic sac in the left ovary, suggesting a term ovarian pregnancy. A left adnexectomy was performed, and histopathology confirmed the diagnosis based on the Spiegelberg criteria. Despite complications, the patient had a good outcome. This case emphasizes the diagnostic challenges and the importance of early prenatal care to prevent complications life-threatening associated with advanced ovarian pregnancies