International Journal of Reproduction, Contraception, Obstetrics and Gynecology
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A rare case of peripartum cardiomyopathy: a multidisciplinary approach
Get PDFCardio obstetrics has emerged as an important multidisciplinary field that requires a team approach to the management of cardiovascular disease during pregnancy. Maternal heart disease complicates approximately 1% and 4% of pregnancies and accounts for up to 15% of maternal deaths. Multidisciplinary care in the antenatal period and during labour with continued surveillance extended through the puerperium along with contraceptive advise has been shown to enhance the chances of favourable outcome in these high-risk patients. Although heart disease is rare among pregnant women, it needs to be carefully managed in tertiary case sitting by a team of obstetrician. cardiologist and anaesthesiologist to obtain good maternal and fetal outcome
Comparison of postoperative recovery in women undergoing open abdominal hysterectomies for benign conditions observing conventional protocol versus early recovery after surgery protocol
Get PDFBackground: Benign gynaecological conditions are a significant health burden, especially in India, where hysterectomy is one of the most common surgical procedures. Despite advances in minimally invasive techniques, open abdominal hysterectomy remains prevalent. Enhanced recovery after surgery (ERAS) protocols, initially developed for gastrointestinal surgeries, have shown promising results in improving postoperative outcomes. However, their effectiveness in open abdominal hysterectomies for benign conditions is not well-documented. This study aims to compare the postoperative recovery outcomes in women undergoing open abdominal hysterectomies for benign conditions, following either the conventional protocol or the ERAS protocol.
Methods: A prospective cohort study was conducted from June 2023 to May 2024 at Kamla Nehru State Hospital for Mother and Child, Shimla. Fifty women undergoing open abdominal hysterectomy for benign conditions were recruited and divided into two groups: ERAS (n=25) and conventional protocol (n=25). Key outcomes measured included hospital stay duration, time to resumption of oral intake and ambulation, postoperative pain, complications, and patient satisfaction.
Results: The ERAS group demonstrated significantly shorter hospital stays (mean 5 days versus 8 days; p<0.001), faster return to oral intake (mean 6 hours versus 22 hours; p<0.001), and earlier ambulation (100% within 6-10 hours versus 0% in the conventional group; p<0.001). Postoperative complications, including nausea, vomiting, and constipation, were significantly lower in the ERAS group (p<0.05). Additionally, 56% of ERAS patients resumed normal activities within three weeks, compared to 32% in the conventional group. Patient satisfaction was also notably higher in the ERAS group.
Conclusions: The ERAS protocol significantly enhances postoperative recovery in women undergoing open abdominal hysterectomy for benign conditions. It leads to shorter hospital stays, faster recovery, and higher patient satisfaction compared to conventional protocols. These findings support the broader adoption of ERAS in gynaecological surgeries
Prospective study of role of transvaginal sonography in postmenopausal bleeding and its histopathological correlation: a prospective study from a tertiary care hospital of Rajasthan
Get PDFPostmenopausal bleeding is vaginal bleeding that occurring after one years of menopause. When periods have stopped for more than one years in women who are generally over than 45 years old and it is common condition in postmenopausal women, it can be the presenting symptom of endometrial cancer. Aim of study is to assess endometrial thickness by vaginal sonography and correlate it with the cytological pattern evaluated by endometrial sampling and histopathological typing of the endometrium.
Methods: This is a prospective observational study conducted in department of obstetrics and gynaecology at R.N.T. Medical college Udaipur from January 2022 to October 2024. Total 100 women with postmenopausal bleeding who attended the Gynaecology outpatient department were screened for this study. Transvaginal ultrasound examination was carried out to calculate endometrial thickness.
Results: This study depicts atrophic and thickened endometria were considered normal findings which was 73 of 100 (73%). The following were considered abnormal seen in 27% (27/100).Endometrial hyperplasia was seen in 15 of 100 women (15%), endometrial carcinoma in 7 women (7%) and endometrial polyp in 5 women (5%). 3/4th (71%) patients had endometrium findings are non-malignant e.g., atrophic endometrium (46%), proliferative endometrium (19%), secretory endometrium (09%). While29% cases in endometrium findings e.g. hyperplasia (17%), polyp (6%), carcinoma (6%).
Conclusions: Transvaginal sonography is safe, simple, non-invasive and cost effective in the diagnosis of endometrial disease. Evaluation of PMB at the earliest is essential for diagnosing endometrial status for early intervention. Role of endometrial thickness cannot be undermined for detecting patients at high risk especially with co-morbid conditions. endometrial thickness of less than 5 mm, most of the reports were benign on HPR and those with endometrial thickness of 10mm or more had mostly malignant findings. So we conclude that with increasing endometrial thickness, the risk of malignancy increases
Study of outcomes of transobturator tape fixation in management of stress urinary incontinence
Get PDFBackground: Stress urinary incontinence (SUI) is one of the most chronic conditions significantly impacting the quality of daily life of 15-40% of female population because of the involuntary escape of urine on exertion due to sudden rise in intraabdominal pressure. Transobturator tape (TOT) fixation is the leading surgical intervention in managing SUI if the conservative management fails because of its lesser postoperative complications, shorter hospital stay, lesser recurrence rate and easy to perform compared to other surgical interventions available hence enhancing the quality of life with women with SUI. TOT fixation therefore has the full potential to be the gold standard in the management of SUI.
Methods: It is a prospective observational study conducted in the Gyanecology ward of SKNMCGH, Pune for 3 years with apparatus and material available in the institute on 32 patients based on the inclusion criteria; all females with stress urinary incontinence willing for surgical management. Women not willing for surgical intervention, also women with mixed urinary incontinence and patients who had previous corrective surgery for stress urinary incontinence were excluded. The TOT procedure was performed by outside in technique.
Results: Success rate of TOT fixation was 96.9%. A total of 31 patients (96.9%) were cured whereas 1 (3.1%) experienced surgical failure.
Conclusions: Transobturator tape fixation is an effective method of management for SUI as it is associated with low morbidity, lesser postoperative complications and therefore has full potential to be the new gold standard for treating SUI
Progesterone prescription in pregnancy: revisiting rationality
Get PDFBackground: Progesterone is widely used in pregnancy for conditions like luteal phase defects and preterm labor prevention. However, irrational use, especially prolonged or with multiple formulations, raises concerns about liver dysfunction and intrahepatic cholestasis of pregnancy (IHCP). This study aimed to assess the impact of progesterone use on liver function tests (LFTs) and IHCP incidence based on duration and type of therapy.
Methods: A prospective study of 150 antenatal women categorized into three groups: no progesterone (Group A), progesterone until 16 weeks (Group B), and until 32 weeks (Group C). Liver enzyme levels were measured at baseline, mid, and late pregnancy. IHCP was diagnosed with bile acid levels >20 mmol/l.
Results: IHCP incidence was significantly higher in Group C (28%) compared to Group A (4%) and Group B (12%) (p<0.001). There was significant reversible rise of liver enzymes in group B which normalised after the stoppage of progesterone while in group C, liver enzymes remain persistently elevated.
Conclusions: Prolonged and multiple progesterone formulations led to persistent liver enzyme elevation but these changes are transient and go away quickly when the dose is discontinued or modified. Rational prescribing based on clear indications and appropriate formulations is essential for safe outcomes. Choosing the right patients is the main factor that determines how effective progesterone supplements are
Ruptured endometrioma mimicking ovarian malignancy: a case report and literature review
Get PDFIn current practice endometriosis is a rising concern, involving all age groups and relatively less prevalent in perimenopausal age groups. It has a variety of presenting symptoms in perimenopausal age group including severe dysmenorrhoea, dyspareunia, infertility, chronic pelvic pain, abdominopelvic mass, acute abdomen with peritonitis and non-specific symptoms like gastritis, diarrhoea, rectal bleeding. High index of suspicion should be there to diagnose a ruptured endometrioma in a perimenopausal female with adnexal mass, peritonitis features and rising serum CA-125 and CA19.9 levels. Here we present a case of ruptured endometrioma mimicking ovarian malignancy in a perimenopausal female
Cervical cancer in Asian countries: epidemiology, risk factors and challenges
Get PDFCervical cancer is one of the leading causes for cancer mortality in women worldwide especially in Asian region where, preventive strategies are underdeveloped, particularly in low-and middle-income countries (LMICs). The global cervical cancer burden and characteristics vary significantly, particularly between high-income (HICs) and LMICs. To obtain a systematic review of 20 peer-reviewed newspaper articles published within the range from 2010 to 2023, accessed through PubMed, Scopus and Google Scholar. Studies related to incidence, mortality, preventive measures and healthcare disparity in Asian countries were included. Findings from the review demonstrate that cervical cancer is inordinate burdened in South-Central Asia, with nearly 48% of the region's estimated cases occurring between India and Bangladesh. The screening coverage is a cause for concern, with only 33% of women in India and 7.5% of women in Bangladesh getting screened regularly. In stark contrast, HPV vaccination coverage is below 30% in most LMICs with over 70% in Japan and South Korea. Low levels of healthcare infrastructure, late-stage diagnoses, and cultural barriers to vaccine uptake represent some of these key challenges. Effective HPV vaccination and screening programs can prevent cervical cancer (CC) cases and deaths, but the availability and coverage of these interventions in Asian LMICs are uncertain. Better prevention and treatment can be achieved through improved healthcare infrastructure, but first cultural barriers need to be overcome
Uterine lipoleiomyoma: rare presentation of postmenopausal bleeding
Get PDFUterine lipoleiomyomas are rare benign tumors composed of mature adipose tissue and smooth muscle cells. They account for less than 0.2% of all uterine neoplasms and are typically asymptomatic, often discovered incidentally. Symptomatic cases presenting with postmenopausal bleeding are exceedingly rare. A 63-year-old postmenopausal woman presented with intermittent vaginal bleeding for one month. Imaging revealed a well-defined hyperechoic mass in the posterior uterine wall. Magnetic resonance imaging (MRI) confirmed the fat-containing lesion suggestive of lipoleiomyoma. She underwent total abdominal hysterectomy. Histopathology confirmed uterine lipoleiomyoma with no evidence of malignancy. Although rare, uterine lipoleiomyoma should be considered in the differential diagnosis of postmenopausal bleeding. Radiological evaluation is key, but histopathological confirmation is essential
Comparison of the efficacy and safety of sublingual misoprostol (PGE1) versus intracervical dinoprostone (PGE2) for induction of labour: a prospective study
Get PDFBackground: Induction of labour is indicated when the benefits of induction to either mother or fetus outweigh those of pregnancy continuation. Various mechanical methods include use of extra amniotic saline infusion, artificial rupture of membranes, balloon tipped catheter, natural and synthetic laminaria or stretch sweep method. Pharmacological methods are mainly using prostaglandins either Dinoprostone (PGE2) or Misoprostol (PGE1). This study aimed to compare the efficacy and safety of sublingual Misoprostol (PGE1) versus intracervical Dinoprostone (PGE2) for induction of labour and to compare maternal and perinatal outcome in both groups.
Methods: In this study, 250 antenatal women with 35 weeks or more period of gestation with a single live fetus, cephalic presentation were included for induction of labour.125 women received 25mcg misoprostol sublingually (group A) and 125 women received 0.5mg of dinoprostone intracervically (group B).
Results: There was shorter induction to active phase interval (7.68±3.39 vs 11.42±5.43 hours), induction to delivery intervals (11.46±3.46 vs 16.23±5.61 hours) and less requirement of oxytocin augmentation (25.6% vs 73.6%) in misoprostol group than dinoprostone group. Mode of delivery, maternal and neonatal complications were similar in both groups.
Conclusions: Use of sublingual misoprostol in lower dose is a safe and cost-effective method for induction of labour
Evaluation of risk factors for intrauterine foetal death during third trimester of pregnancy: a hospital-based cross-sectional study
Get PDFBackground: In most cases of intrauterine foetal death (IUFD) in which the aetiology is known, a recurrence risk can be determined, and sometimes prenatal diagnosis and prevention are possible. In the present study, we evaluated the risk factors for intrauterine foetal death during 3rd trimester of pregnancy.
Methods: This was a hospital based cross sectional study, which was conducted in department of obstetrics and gynecology in tertiary Government Teaching Hospital in North Maharashtra for the period of 24 months. We enrolled 131 patients attending ANC OPD/labour room in their 3rd trimester of pregnancy who were diagnosed to have IUFD.
Results: There were 131 stillbirths out of 6402 live births hence incidence of IUFD was 20 per 1000 birth. IUFD was maximum seen in age group of 21 to 35 years (83.2%). Mortality was higher in un-booked cases (81.7%) and maximum (83.2%) mothers were from rural area. Most common presenting complaint was pain in abdomen (29.8%) followed by bleeding per vaginum in 16.8%. Only a small percentage i.e. 6.9% had no complaint. Hypertensive disorder of pregnancy (preeclampsia, eclampsia, chronic hypertension) was found to be an important comorbid factor among patients of IUFD which accounts for 31%. About 54.2% stillborn were males showing male preponderance. Post partum complications were relatively rare but most frequent was occurrence of severe anaemia due to APH. Maternal mortality occurred in 0.8% cases.
Conclusions: In conclusion, IUFD is closely associated with maternal health disorders and demo-socioeconomic factors are highlighting the need for improved antenatal care and management to mitigate risks