International Journal of Reproduction, Contraception, Obstetrics and Gynecology
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Maternal and fetal outcome in pregnancy with advanced maternal age- a prospective study
Get PDFBackground: Advanced maternal age defined as the age of mother ≥35 years at the time of delivery has become common in last two to three decades. It is considered to have more adverse obstetric and perinatal outcomes as compared to those in younger women. Therefore, it requires a proper understanding of the effect of age during her antepartum, intrapartum, and postpartum period that prevent a healthy outcome.
Methods: The primary objective was to study the maternal and foetal outcome of pregnancy in women aged ≥ 35 years. This was a prospective observational study conducted in 122 pregnant women over a duration of 18 months in the multispecialty hospital in an urban setting.
Results: In this study, pregnant women aged ≥35 years had a higher incidence of obesity (88.9%). Among antenatal complications, mothers aged ≥35 years had higher incidence of anaemia (21.3%), gestational diabetes mellitus (GDM) (37.7%), gestational hypertension (32.8%), fetal growth restriction (13.1%). There was no significant difference in the incidence of miscarriage, multiple pregnancy, malpresentation, preterm premature rupture of membranes (PPROM), intrauterine fetal demise between the two age groups. The incidence of preterm delivery (41%) and caesarean section (72.4%) were higher in advanced age group. Perinatal complications like low birth weight (29.3%), neonatal intensive care unit (NICU) admissions (32.8%) were higher in neonates of women aged ≥35 years.
Conclusions: Advanced maternal age was significantly associated with adverse obstetrical and fetal complications. Therefore, proper preconceptional counselling and intensive antenatal care assessment can individualize and potentially reduce the risks for women with advanced maternal age
Analysis of caesarean section rates in Malta using the Robson ten-group classification system
Get PDFBackground: Caesarean section (CS) rates continue to rise globally. In Malta, the rate of caesarean deliveries has increased by eight percentage points over the past two decades. The World Health Organization recommends the use of the Robson classification as a global standard for monitoring and auditing CS. This study aimed to examine CS rates in the Maltese Islands across two time periods using the Robson classification.
Methods: A retrospective, registry-based study was conducted covering all deliveries between 2009-2013 and 2019-2023. Women undergoing childbirth in Malta and Gozo were allocated to one of the 10 Robson groups. Changes in overall CS rates and contributions by Robson group between the two periods were analysed using significance tests. Indications for CS were analysed for 2019-2023.
Results: A total of 42,585 deliveries were analysed across both periods. Despite more advanced maternal age and a higher proportion of non-Maltese mothers over the time periods, the CS rate remained stable (31.9% in 2009-2013; 32.6% in 2019-2023). Contributions to the overall CS rate of Robson groups 5 (previous CS), 6 and 7 (breech) increased significantly, whilst contributions of groups 1 (nullipara, spontaneous labour), 2 (nullipara, induction/pre-labour CS), 8 (multiple pregnancies), and 10 (preterm) decreased significantly between study periods. The top contributors remained Robson groups 5 and 2, followed by 1.
Conclusions: The Robson classification allows identification of the obstetric populations driving CS use. Our study findings provide a starting point for auditing of obstetric practices with a view to reducing CS rates
Maternal mortality unveiled: insights from a tertiary care hospital in western India
Get PDFBackground: Maternal mortality remains a significant public health issue, especially in resource-constrained settings. Despite national and global efforts, India still contributes substantially to the global maternal death burden. Objectives were to evaluate patterns along with socio-demographic and clinical factors linked to maternal mortality, and to analyze types of delay that contribute to maternal deaths.
Methods: This cross-sectional study was conducted in the obstetrics and gynaecology department of tertiary care center, from March 2023 to August 2024. All maternal deaths during this period (n=47) were analyzed. Data were extracted from case records and analyzed using descriptive statistics. The maternal mortality ratio (MMR) was calculated per 100,000 live-births.
Results: Total 47 maternal deaths were reported among 12,356 live births, giving an MMR of 380.38. Most deaths occurred in the 20-30-year age group (74.46%), among illiterate (72.34%) and rural (59.57%) women. More than half of the maternal deaths (57.44%) were in multigravida and in unregistered cases (57.44%). 68.1% of women were referred from other centres, often critically ill. A significant number of women died [33 (70.21%)] during postnatal period of pregnancy. Hemorrhage (43.3%), sepsis (33.3%), and hypertensive disorders (23.3%) were the leading direct causes. Indirect causes included heart and nervous system disorders. Type 1 delays (59.6%) were the most common, followed by type 3 (27.7%).
Conclusions: Adequate and quality antenatal care, early identification of high-risk pregnancies, and strengthening referral systems are crucial. A multifaceted approach including health education, infrastructure improvement, and continuity of care is necessary to reduce maternal mortality
Foreign body granuloma mimicking malignancy: a diagnostic challenge post-caesarean section
Get PDFForeign body granulomas arising from haemostatic agents such as oxidized regenerated cellulose (Surgicel) are rare but can closely mimic malignancy on imaging, resulting in unnecessary investigations, delays in treatment, and significant patient anxiety. Authors report the case of a 33-year-old para 1 woman who presented with lower abdominal pain and urinary symptoms eight months after elective caesarean section in which Surgicel was used. Imaging studies suggested a malignant mass involving the cervix, bladder, and vagina, with suspicious lymphadenopathy. Cystoscopy and drainage procedures were inconclusive. Exploratory laparoscopy revealed a 7×5 cm organized mass containing gelatinous material in the uterovesical pouch. Histopathology confirmed a foreign body granuloma with giant cell reaction to suture material. The patient recovered uneventfully following excision. Postoperative suture granulomas should be considered in the differential diagnosis of pelvic masses following caesarean section or other gynecological surgeries where haemostatic agents have been used. Early recognition can prevent unwarranted investigations and improve patient outcomes
Master’s programs in midwifery education in South Asia: organizational frameworks, competency goals, and learning outcomes
Get PDFSouth Asia continues to experience a disproportionate burden of preventable maternal and neonatal morbidity and mortality, while countries in the region are simultaneously accelerating midwifery reforms through advanced education pathways. Over the past decade, several South Asian countries have introduced or proposed master’s-level midwifery programs, often aligned with international confederation of midwives (ICM) competencies and world health organization (WHO) quality standards. This review synthesizes the current landscape of master’s programs in midwifery education across South Asia (Afghanistan, Bangladesh, Bhutan, India, Maldives, Nepal, Pakistan, Sri Lanka), examining organizational frameworks, competency goals relative to global benchmarks, and evidence on learning outcomes, implementation challenges, and policy alignment. A systematic review of peer-reviewed literature, national regulations, policy documents, and program webpages (2010-August 2025) was conducted, prioritizing authoritative sources including ICM, WHO, UNFPA, national acts, council guidelines, and university curricula. Data extraction focused on program typology, credit requirements, theory-practice ratios, competency frameworks, assessment modalities, and documented outcomes. Findings indicate regional convergence around ICM global standards for midwifery education (2021) and ICM essential competencies (2024), including minimum program durations (36 months direct-entry; 18 months post-nursing) and recommended theory/clinical ratios (40%/≥50%). India’s midwifery reforms (Guidelines on midwifery services, NPM educator programs, NNMC act 2023) provide a scalable national framework; Nepal offers a dedicated M. Sc. in Midwifery at Kathmandu university; Bangladesh is developing in-country master’s provision; and Pakistan emphasizes MSN tracks with maternal-neonatal specialization. Establishing a regional master’s archetype anchored in ICM/WHO standards, supported by robust clinical partnerships, OSCE-based assessment, and research-to-policy integration, can accelerate safe, respectful, and evidence-based maternity care across South Asia
Determinants of the use of modern contraceptive methods among women of reproductive age in a health zone in southern Benin
Get PDFBackground: The prevention of unintended pregnancies is one of the essential pillars of reducing avoidable maternal deaths. However, contraceptive prevalence remains low in Benin in general, and particularly in the Allada-Toffo-Zè health zone. Objective was to identify the determinants of the use of modern contraceptive methods among women of reproductive age in the Allada-Toffo-Zè Health Zone.
Methods: This was a cross-sectional study with descriptive and analytical purposes, based on prospective data collection from March 6 to May 31, 2023, conducted in ten (10) health facilities within the Allada-Toffo-Zè health zone located in southern Benin. All women of reproductive age (15-49 years old) who attended consultations and provided informed consent were included and interviewed through a face-to-face structured questionnaire. Logistic regression analysis was performed to assess the association between explanatory variables and the outcome variable, which was the use of modern contraceptive methods, with a significance level set at 5%.
Results: A total of 402 women were surveyed. The prevalence of modern contraceptive use was 20.79%. The mean age was 28.25±7 years. The determinants of modern contraceptive use were parity (p=0.014), knowledge of the effectiveness of contraceptive methods (p<0.001), knowledge about birth spacing by the method (p<0.001), insurance for the prevention of sexually transmitted infections by the method (p=0.008).
Conclusions: Understanding the determinants of modern contraceptive use will help target relevant interventions to improve contraceptive prevalence and contribute to accelerating the reduction of maternal mortality in the health zone
Awareness and preventive practices for anaemia among urban school going adolescent girls
Get PDFBackground: Anaemia is a significant public health concern in India, particularly among adolescent girls. The objective was to assess awareness and dietary practices related to anaemia among urban adolescent school-going girls and indirectly evaluate the effectiveness of the weekly iron and folic acid supplementation WIFS Program.
Methods: A prospective questionnaire-based survey was conducted among urban adolescent school-going girls in India. The data so obtained was analysed.
Results: High awareness levels regarding anaemia were observed (98.9%). Additionally, 96.7% of the respondents were aware that anaemia was a health problem, 71.3% of respondents could satisfactorily talk about anaemia, and 28.7% had insufficient knowledge. Awareness about anaemia symptoms was lower, with only 56.2% giving satisfactory responses. Most girls adopted good practices to prevent anaemia. 85.7% took iron supplements, which the government provides under the WIFAS scheme, and 78.7% consumed green leafy vegetables. The hygiene practices are well maintained, with 98.9% washing hands before meals and 100% washing hands after defecation. 85.6% had taken deworming tablets, which helped in preventing anaemia caused by parasitic infections 60.3% reported experiencing stress or worry, which may indirectly affect anaemia management, as stress can impact nutritional intake and overall health.
Conclusion: Targeted educational initiatives are necessary to enhance knowledge about anaemia symptoms and promote consistent dietary habits. Continuous monitoring and supportive health interventions are crucial to ensure better anaemia prevention and management
Four years, single surgeon, 114 robotic gynecological surgeries: an institutional audit from India with the Cambridge medical robotics Versius robot
Get PDFBackground: Robotic-assisted surgery is transforming minimally invasive gynecology by offering enhanced precision, superior visualization, and ergonomic advantages over conventional laparoscopy. The Versius surgical system is a newer, modular alternative with lower infrastructure needs. However, published evidence on Versius use in gynecological surgery, particularly from India, is limited. This study evaluates a single-centre, single-surgeon experience with the Versius system over four years. Objectives were to assess the safety, feasibility, and effectiveness of robotic gynecological surgeries performed using the Versius system at a tertiary hospital in Delhi, India, over a 4-year period.
Methods: A retrospective review covered 114 consecutive benign gynecological procedures performed using Versius between July 2021 and July 2025 at PSRI hospital, Delhi. Data on patient demographics, surgical types, operative times, blood loss, complications, and hospital stay were analyzed.
Results: Robotic hysterectomy was the most common procedure (61.4%), followed by myomectomy (15%) and endometriosis surgery (12%). The mean operative time for hysterectomy was 174 minutes. Blood loss was ≤100 mL in 78% of cases. Intraoperative complications occurred in 7.9%, primarily hemorrhage, with two conversions to open or laparoscopic surgery. Postoperative recovery was uneventful in 97.5%, with a mean hospital stay of 1.08 days; most (91%) were discharged within 24 hours.
Conclusions: Versius robotic gynecological surgery is safe, feasible, and effective in an Indian tertiary setting, highlighting its promise as a cost-effective platform with low complications, minimal blood loss, and short hospital stays
An epidemiological study on complications of total laparoscopic hysterectomy in obese vs. non-obese patients at tertiary care centre
Get PDFBackground: Total Laparoscopic Hysterectomy (TLH) is now the preferred approach for benign gynecological conditions due to reduced morbidity and faster recovery. However, obesity remains a challenge influencing surgical outcomes and complication rates. This study aimed to compare intraoperative and postoperative complications of TLH in obese versus non-obese women.
Methods: A comparative observational study was conducted at the Department of Obstetrics and Gynaecology, Government Medical College, Akola, Maharashtra, a tertiary care centre, including 146 women undergoing TLH. Participants were divided into obese (BMI ≥30 kg/m²; n=82) and non-obese (BMI <30 kg/m²; n=64) groups. Intraoperative and postoperative parameters, including blood loss, complications, operative time, and hospital stay, were recorded and analysed using the chi-square test and t-tests.
Results: The mean age of participants was 49.8±11.7 years. Obese patients had significantly higher intraoperative blood loss (306.0±20.4 mL vs 270.8±45.4 mL; p<0.001). Mean operative duration (117.8 vs 113.3 minutes; p=0.167) and hospital stay (2.6 vs 2.5 days; p=0.477) did not differ significantly. Most surgeries (83%) were completed without complications. Bleeding (8%) and conversion to laparotomy (5%) were the common intraoperative events. Postoperative vault infections (9% vs 2%; p=0.032) and port-site infections (4% vs 0%; p=0.022) were more frequent among obese women.
Conclusions: TLH can be safely performed in obese women with outcomes comparable to non-obese patients. Although obese women had higher minor wound-related complications, major intraoperative events were not significantly different
Against all odds: successful maternal outcome after massive abruption with intrauterine fetal demise and severe coagulopathy
Get PDFA 31-year-old multiparous woman presented with antepartum hemorrhage and intrauterine fetal demise (IUFD), who developed severe DIC (INR 6.0) and acute kidney injury (AKI). Despite multi-organ involvement, the patient made a complete recovery. Early multidisciplinary intervention and aggressive supportive management were the key to survival