International Journal of Reproduction, Contraception, Obstetrics and Gynecology
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A two year review of indications and outcomes of obstetric admissions to ICU of a tertiary care hospital
Get PDFBackground: Managing critically ill obstetric patients presents a unique challenge. The outcomes of these cases not only serve as a measure of the quality of patient care but also aid in refining risk stratification for pregnant patients and evaluating new therapeutic approaches. This study aims to review a series of critically ill obstetric patients admitted to our ICU, examining the spectrum of diseases, necessary interventions and maternal outcomes, while identifying factors linked to maternal mortality.
Methods: This retrospective observational study was conducted in 7-bed obstetric ICU in a 300 bedded tertiary care hospital over 2-year period (August 2022-July 2024) at 1200 Bed Medicity Hospital, B. J. Medical College, Ahmedabad, Gujarat, India.
Results: Only obstetric patients were admitted to the ICU. The leading obstetric indication for ICU admission was hypertensive disorders (28.8%). Maternal mortality was 3.03%. The main cause of maternal death was due to medical disorders (32.7%). ICU interventions included mechanical ventilation, blood products transfusion, inotropes, anti-hypertensives and dialysis.
Conclusions: The demand for ICU management of obstetric conditions is increasing. Hypertensive disorders of pregnancy and hemorrhage have been the leading reasons for obstetric ICU admissions over the past two years. To improve outcomes for mothers and babies, it is essential to involve a multidisciplinary team early, including intensivists, obstetricians and physicians, to provide coordinated care. Obstetric teams should also develop basic skills in managing high-dependency unit (HDU) cases. This study highlights the importance of screening and preventing preeclampsia, providing antenatal education and encouraging early reporting and referral of complications
A case of rudimentary uterine horns with cervical agenesis with intramural fibroid and bilateral endometrioma
Get PDFThe objective of the study was to report a case of rudimentary horns of cervical agenesis with intramural fibroid and bilateral endometrioma. A 35-year-old nulligravida with a rare Mullerian anomaly of uterus, cervix and vagina with coexisting fibroid and endometrioma. A definite diagnosis and resection of Mullerian structure and endometrioma. This reports a rare case of occurrence of benign tumor of mesenchymal origin from a non-functioning uterine horn along with features of degeneration with cervical agenesis along with presence of bilateral ovarian endometrioma reinforcing the possibility of coelomic metaplasia theory of its origin
Role of nutrition on male fertility: a narrative review
Get PDFMale infertility is a significant public health concern in India, contributing to nearly half of all infertility cases among couples. While multiple factors can affect male reproductive health, growing attention has been placed on the role of nutrition. This review investigates the association between dietary habits and male fertility by analysing findings from observational studies and clinical trials. Improved sperm concentration, motility, morphology, and overall semen quality have been linked to a balanced diet full of fruits, vegetables, whole grains, legumes, lean meats, and foods high in antioxidants, including vitamins C and E, folate, selenium, and zinc. Conversely, diets high in saturated and trans fats, processed meats, refined sugars, and sugary beverages have been linked to reduced sperm quality and hormonal imbalances. Environmental toxins, pesticide residues in food, obesity, smoking, alcohol use, and physical inactivity further contribute to oxidative stress and hormonal disruption, compounding the problem. In regions of India where dietary patterns are changing due to urbanization and increased consumption of processed foods, these issues are particularly pronounced. The review highlights the importance of improving nutritional awareness and adopting healthier lifestyles as potential strategies to support male reproductive health. Addressing these modifiable factors can significantly enhance fertility outcomes and reduce the burden of infertility in the Indian context
Evaluation of clinical outcomes of primary postpartum haemorrhage cases referred to an Upazila health complex
Get PDFBackground: Primary postpartum haemorrhage (PPH) is a leading cause of maternal mortality and morbidity, especially in low-resource settings. In Bangladesh, the burden of PPH is exacerbated by limited emergency obstetric care and delayed referral. Understanding the clinical profiles and outcomes of PPH at the primary care level is essential for improving maternal health. This study aimed to evaluate the clinical outcomes and associated risk factors of primary PPH cases referred to a rural Upazila Health Complex in Bangladesh.
Methods: A prospective observational study was conducted at the Department of Obstetrics and Gynaecology, Nasirnagar Upazila Health Complex, Brahmanbaria, from July 2022 to June 2024. A total of 75 women with primary PPH were enrolled in this study. Data on sociodemographic characteristics, obstetric history, clinical presentation, and pregnancy-specific risk factors were collected using structured forms. Statistical analyses were performed using statistical package for the social sciences (SPSS) version 25.0, with a significance threshold of p≤0.05.
Results: Most participants were aged 21–30 years (48%) and resided in rural areas (86.7%). Uterine atony (78.6%), prolonged labour (60%), and induction of labour (52%) were predominant risk factors. The most common complications were maternal anaemia (84%), hypotension (80%), and birth asphyxia (36%). The clinical presentations were dominated by per-vaginal bleeding (92%) and abdominal pain (40%).
Conclusions: Primary PPH in rural settings leads to significant maternal and neonatal complications. Early identification, prompt referral, and improved emergency care infrastructure are important for reducing its impact
Accessory cavitated uterine malformation: a diagnostic challenge of an unclassified rare presentation
Get PDFMullerian anomalies are rare anomalies of female genital tract with prevalence of around 5%. Accessory cavitated uterine malformation (ACUM) is a cavitated lesion surrounded by a rim of myometrium, located below the insertion of round ligament and fallopian tubes. A normal uterine cavity with visualisation of both ostia is must to differentiate with non-communicating uterine horn. ACUM presents as severe dysmenorrhoea in females below 30 years of age. It is not included in revised ASRM or ESHRE classification. Diagnostic modalities include 3D ultrasonography and MRI. Medical management including estrogen/progesterone oral contraceptives, nonsteroidal anti-inflammatory drugs (NSAIDs), the progesterone-only pill proves to be ineffective in most of the patients. Most articles mentioned laparoscopic excision of ACUM as the main management. Some papers also mentioned cornual excision or hysterectomy as the treatment modality. Sclerotherapy has also been tried as a conservative management. Fertility has also improved post-surgery of ACUM
A clinical study on maternal and fetal outcomes of obstructed labour
Get PDFBackground: Obstructed labour is the failure of the fetal presenting part to descend in the birth canal despite adequate uterine contractions. This study aims to identify risk factors for obstructed labour and highlight strategies to reduce maternal and fetal morbidity and mortality.
Methods: This prospective cross-sectional study included all women with prolonged and obstructed labour at a tertiary hospital. Complete enumeration was used for sampling, and data were analysed using Microsoft excel.
Results: A total 48 patients were of the age of 18-25 years. 78 were primigravida. 32 patients needed operative vaginal delivery. In postpartum complications, 26 patients went into atonic PPH, 1 underwent laparotomy for rupture uterus,18 patients had extension of the uterine incision during LSCS and 8 patients suffered from vaginal lacerations. Postpartum complications such as anemia found in 34 cases, sepsis in 26 cases, paralytic ileus in 28 cases and surgical site infection in 12 patients. 21 patients had prolonged hospital stay. 8 babies died, 19 babies were still admitted in NICU and 75 were healthy.
Conclusions: Regular antenatal visits and pelvic evaluation beyond 37 weeks by an experienced gynaecologist are essential for diagnosing adequacy. Attendants at rural centres must be trained to monitor labour and identify prolonged labour using a partograph. Most obstructed labour cases are preventable if pregnant women receive proper antenatal care, births are attended by trained personnel, uterotonics are used appropriately, and instrumental vaginal deliveries are performed by expert gynaecologists when indicated
A rare case of vaginal vault prolapses after vaginal hysterectomy in North India: managed via sacrocolpopexy
Get PDFVaginal vault prolapse refers to the descent of the upper portion of the vagina (apex or dome) into the vaginal canal or beyond the vaginal introitus, typically following a hysterectomy. This condition is a rare but significant long-term complication, with an incidence ranging from 0.1% to 18.2% after vaginal or abdominal hysterectomy. It may present in isolation or in conjunction with other pelvic organ prolapse disorders, such as cystocele, rectocele, or enterocele. Risk factors include advancing age, multiparity, chronic increased intra-abdominal pressure, and poor pelvic support following surgery. Sacral colpopexy especially via the abdominal approach remains the gold-standard surgical treatment due to its superior anatomical and functional outcomes and lower recurrence rates when compared to vaginal repairs. The procedure involves attachment of the vaginal apex to the sacral promontory using a synthetic mesh, restoring normal vaginal axis and support. Despite its clinical relevance, vaginal vault prolapse with a large enterocele remains underreported in certain regions, particularly in North India. A lack of awareness and underdiagnosis often delay appropriate management, especially in rural populations. We present a case of a 63-year-old woman with a history of vaginal hysterectomy 13 years prior, who presented to our tertiary care center with a symptomatic vaginal vault prolapse associated with a large enterocele. She was successfully managed by open abdominal sacral colpopexy and discharged in stable condition
Knowledge, attitude and practice about human papilloma virus vaccination among medical students
Get PDFBackground: Human papilloma virus (HPV) is one of the most common sexually transmitted infections and a major etiological factor for cervical cancer, which remains a leading cause of morbidity and mortality among women worldwide. Although safe and effective vaccines are available, awareness and vaccination coverage remain suboptimal, especially among young adults. Medical students, as future healthcare providers, play a pivotal role in promoting HPV vaccination; therefore, understanding their knowledge, attitude, and practices (KAP) is essential.
Methods: A cross-sectional study was conducted among undergraduate medical students of JNU medical college, Jaipur. Data were collected using a structured, pretested questionnaire assessing participants’ knowledge about HPV infection and vaccination, their attitudes toward immunization, and their personal vaccination practices. The responses were analysed using descriptive statistics to determine awareness levels and the relationship between knowledge and vaccination behaviour.
Results: The study revealed that while a majority of students had heard about HPV and its association with cervical cancer, only a smaller proportion demonstrated adequate knowledge about the recommended age, dosage schedule, and target groups for vaccination. Attitude toward HPV vaccination was generally positive, but the actual practice of vaccination among students was low. A clear gap was observed between awareness and vaccine uptake.
Conclusions: Although medical students showed moderate awareness and positive attitudes toward HPV vaccination, poor vaccination practice highlights the need for targeted educational programs and inclusion of HPV-related content in the medical curriculum
Acute pulmonary edema secondary to severe preeclampsia in a 47-year old elderly gravida conceived via in vitro fertilization: a case report
Get PDFAdvanced maternal age and assisted reproductive technologies, such as in vitro fertilization (IVF) with oocyte donation, are recognized as risk factors for many disorders in pregnancy, including preeclampsia. Severe preeclampsia can, in rare instances, be complicated by acute pulmonary edema, posing significant risks to both the mother and the fetus. We report a rare case of a 47-year-old elderly primigravida with a BMI of 30 kg/m² (obese) who conceived via IVF and developed severe preeclampsia at 30+5 weeks of gestation with a hypertensive crisis that progressed to cause a life-threatening acute pulmonary edema. Immediate management included intravenous antihypertensives, diuretics, magnesium sulphate, and ventilatory support. Due to the deteriorating maternal and fetal status, an emergency lower segment caesarean section was performed in the intensive care unit. A 1.2 kg baby girl was delivered and admitted to the neonatal intensive care unit. The mother showed gradual postoperative improvement with stabilization of blood pressure and resolution of pulmonary symptoms. Her recovery period was aided by a multidisciplinary team involving obstetricians, anaesthesiologists, neonatologists, intervention specialists, and clinical psychologists. The case emphasizes the need for heightened vigilance and aggressive management in IVF pregnancies especially among women of advanced maternal age who are at increased risk of hypertensive disorders, fluid shifts, and cardiovascular stress. Risk assessment in elderly women undergoing IVF is crucial, along with vigilant monitoring and prompt multidisciplinary intervention to improve outcomes in high-risk pregnancies
Spontaneous rupture of leiomyosarcoma
Get PDFUterine sarcomas are rare, accounting for approximately 3-7% of uterine malignancies. Leiomyosarcoma (LMS), a particularly aggressive subtype, often presents diagnostic challenges due to overlapping features with benign fibroids. Spontaneous rupture of LMS is exceptionally rare and may lead to life-threatening complications. A 42-year-old woman presented with severe lower abdominal pain, distension, dyspnea, and hemodynamic instability. Imaging revealed a ruptured uterine mass with hemoperitoneum, bilateral pulmonary embolism (PE), and suspected metastatic disease. Initial stabilization required ICU support and multidisciplinary input. Uterine artery embolization was performed to control haemorrhage. The patient developed subsequent infections but stabilized and was repatriated to her home country, where she received six cycles of chemotherapy. Surgery is planned following completion of chemotherapy. This case underscores the diagnostic difficulty in differentiating LMS from benign fibroids, especially in the presence of large, rapidly growing uterine masses. Delayed diagnosis can result in catastrophic events such as spontaneous rupture. Imaging and histology remain essential, but molecular profiling is increasingly valuable for therapeutic planning. Spontaneous rupture of LMS, though rare, should be considered in patients with large symptomatic uterine masses. Early recognition, multidisciplinary management, and genetic profiling are vital for optimizing outcomes. Proactive surgical management of large tumours may help prevent such complications, even in presumed benign cases