International Journal of Reproduction, Contraception, Obstetrics and Gynecology
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Study of changing trends and patterns in maternal mortality at a tertiary care hospital
Get PDFBackground: Maternal mortality continues to be a critical indicator of healthcare quality and socioeconomic development, particularly in developing nations. This study analyzes the evolving trends and patterns of maternal deaths at Karnataka institute of medical sciences (KIMS), Hubli, a major tertiary care center serving multiple districts in North Karnataka.
Methods: This cross-sectional observational study combined retrospective and prospective approaches to analyze maternal deaths at the department of obstetrics and gynecology, KIMS, Hubli, from 2019 to 2023. Medical records were reviewed for all maternal deaths occurring within 42 days of pregnancy termination, including complications from pregnancy, labor, puerperium, and related interventions. Data analysis encompassed maternal age, parity, antenatal registration, delivery characteristics, admission-to-death interval, and cause of death. Statistical analysis was performed using proportions and means to establish patterns and correlations in the collected data.
Results: A five-year analysis (2019-2023) at KIMS, Hubli documented 277 maternal deaths among 51,683 live births, yielding an average maternal mortality ratio (MMR) of 542.68 per 100,000 live births. The MMR peaked during 2021 (733.06) and subsequently declined to 437.46 in 2023. The majority of deaths occurred in women aged 20-25 years (53.79%) and primigravidas (57.03%), with hypertensive disorders (53.3%) being the leading direct cause of death. Notable trends included an increase in facility bookings (2.7% to 17.64%), a decrease in referred cases (100% to 70.5%), and a shift from vaginal deliveries (56.7% to 27.4%) to cesarean sections (32.4% to 52.9%). The COVID-19 pandemic's impact was evident through increased indirect causes of death during 2020-2021, with pneumonia/COVID accounting for 36.4% of indirect deaths across the study period.
Conclusions: The study revealed critical gaps in peripheral healthcare services and emphasized the need for strengthening antenatal care at primary healthcare centers. The high proportion of preventable causes highlights the importance of early detection, timely referral, and enhanced critical care capabilities in reducing maternal mortality
Comparision of pregnancy outcomes of history indicated and ultrasound indicated cervical cerclage: a prospective cohort study
Get PDFBackground: Cervical cerclage is a widely used intervention to prevent preterm birth in women at risk for cervical insufficiency. Indications for cervical cerclage may arise from clinical history or clinical finding of cervical shortening and or dilatation or ultrasound guided cervical length measurements in pregnancy. Despite its widespread use, there is ongoing debate about which indication yields better pregnancy and neonatal outcomes.
Methods: Prospective cohort study included pregnant women who underwent cervical cerclage due to either history of preterm birth or findings from cervical ultrasound. Key outcomes such as gestational age at delivery, incidence of preterm birth, neonatal birth weight, NICU admissions, and APGAR scores were analyzed. Statistical methods included chi-square tests for categorical data and independent t-tests for continuous data, with a significance threshold set at p<0.05.
Results: The study found that both history-indicated and ultrasound-indicated cervical cerclage were effective in prolonging pregnancy and preventing preterm birth. In our study, history indicated cerclage resulted in lower rate of preterm births and better neonatal outcomes compared to ultrasound indicated cerclage. Although there were differences in gestational age at delivery and neonatal outcomes between the two groups, these differences were not always statistically significant.
Conclusions: This study suggests that both history-indicated and ultrasound-indicated transvaginal cervical cerclage as an effective clinical treatment for cervical insufficiency
A rare presentation of non-cirrhotic portal fibrosis in pregnancy: a case report
Get PDFNon cirrhotic portal fibrosis (NCPF) in pregnancy is a rare occurrence with an in hospital incidence of 0.009%. Management in pregnancy is challenging due to lack of standard protocol and paucity of extensive research in current literature. NCPF if untreated can lead to catastrophic complications and lead to significant maternal morbidity and mortality. We present a case report of a 23-year-old G2A1 female presenting for the first time in pregnancy at 34 weeks’ gestation as a case of NCPF with prelabour rupture of membranes. She was managed with multidisciplinary approach and underwent normal vaginal delivery with satisfactory feto-maternal outcome. NCPF in pregnancy is uncommon and a thorough knowledge about the condition and systematic management at a tertiary care center with a multidisciplinary team is essential. Its prognosis in pregnancy is usually good if managed promptly and systematically
A comparative study between hysteroscopic findings and histopathology in cases of post-menopausal bleeding patients
Get PDFBackground: Postmenopausal bleeding (PMB) is most common cause of gynecological visits. All with unexpected uterine bleeding should be evaluated for endometrial carcinoma. Although most cases in developing countries is due to atrophy. Aim of the study was to evaluate endometrial causes of postmenopausal bleeding with its correlation with hysteroscopy findings and endometrial tissue histopathology.
Methods: A total 74 consecutive cases of PMB over a period of 1½ year fulfilling the inclusion and exclusion criteria and giving informed consent were selected. Each patient was subjected to transvaginal sonography (TVS) for assessment of uterus, adnexa and endometrial thickness. Then they were scheduled for hysteroscopy and dilation and curettage. Endometrial sample was sent for histopathological examination (HPE).
Results: In our study, 48.65% of patients with postmenopausal bleeding where in age group menopause is 51-55 years. The TVS, hysteroscopy and histopathological findings were correlated in this study. On HPE 43.24% showed atrophic endometrium out of which maximum 93.93% were identified in hysteroscopy.
Conclusions: In women with PMB, hysteroscopy is the basic tool that allows precise diagnosis of various endouterine pathologies. The average sensitivity of hysteroscopy was 98% in our study and the specificity was 96.4%. Hence, we can conclude that it is highly accurate for evaluating endometrial pathologies.
Study of ectopic pregnancy in a tertiary care hospital
Get PDFBackground: Ectopic pregnancy, occurring in 1.5-2% of pregnancies globally, is a serious, life-threatening complication and a leading cause of maternal morbidity and mortality in the first trimester. It poses risks to the mother’s life and future fertility by causing potential damage to the fallopian tubes and ovaries.
Methods: This retrospective study was conducted at a tertiary care hospital in Ahmedabad, India, from February 2023 to January 2025, involving 40 women diagnosed with ectopic pregnancies. Detailed computerized patient records, including complaints, vital signs, demographics, medical history, and risk factors such as amenorrhea duration, pelvic pathology, surgeries, and infertility treatments, were analyzed. Ultrasound findings, urine pregnancy tests (UPT), and intraoperative observations were also recorded. Data were entered into a pre-structured proforma and analyzed using percentage-based methods.
Results: The majority of patients were aged 26-30 years, with 60% in their second pregnancy. Common risk factors included previous ectopic pregnancy (17.5%) and pelvic inflammatory disease (12.5%). Symptoms included amenorrhea (57.5%) and abdominal pain (60%). Among cases, 45% were ruptured tubal pregnancies, and 10% received methotrexate treatment.
Conclusions: Ectopic pregnancy should be considered in women of reproductive age with lower abdominal pain, regardless of amenorrhea or sterilization history. Early diagnosis through ultrasound and beta hCG tests is crucial to prevent maternal morbidity and mortality. Timely intervention can reduce complications and significantly improve outcomes
A case report of peri-ovarian hematoma and hemoperitoneum following ovum pickup: a laparoscopic intervention
Get PDFA 29-year-old nulligravida woman with a seven-year history of primary infertility underwent transvaginal oocyte pick-up (TV-OPU) following controlled ovarian stimulation for in vitro fertilization (IVF) with intracytoplasmic sperm injection (ICSI). Post-procedure, she presented with abdominal pain and bilateral flank tenderness. There was significant haemoglobin drop and ultrasonography showed evidence of peri-ovarian hematoma. Initial conservative management, including close monitoring and intravenous antibiotics, was implemented; however, progressive haemodynamic compromise and hematoma expansion necessitated diagnostic laparoscopy. Intraoperatively, a right-sided peri-ovarian hematoma and active bleeding from the right ovarian puncture site were identified and surgically managed. The patient demonstrated an uneventful postoperative recovery and was discharged on day six. This case underscores the importance of vigilant monitoring, individualized management, and timely surgical intervention for post-TV-OPU complications.
Ruptured ectopic pregnancy with negative serum beta-human chorionic gonadotropin: a case report and literature review
Get PDFA negative urine pregnancy test is commonly used in emergency settings to exclude pregnancy; however, this assumption can be misleading and may delay critical diagnoses. We present a rare case of a ruptured ectopic pregnancy in a 30-year-old female with a serum beta-human chorionic gonadotropin (hCG) level of only 4 IU/l, falsely suggesting the absence of pregnancy. The patient presented with sudden-onset lower abdominal pain, presyncope, and hemodynamic instability. On arrival, she was hypotensive and tachycardic, with clinical and ultrasound findings consistent with massive hemoperitoneum of more than three litres of blood. Despite an initial negative pregnancy test, the patient required emergent laparotomy and right salpingectomy for a ruptured ectopic pregnancy. The patient was resuscitated with blood products and stabilised postoperatively in the intensive care unit before being discharged. This case highlights the limitations of beta-hCG testing in diagnosing ectopic pregnancy, emphasising that low or undetectable levels do not exclude the condition. A comprehensive literature review identified fourteen similar cases of ruptured ectopic pregnancy with negative or low serum beta-hCG levels, illustrating the diagnostic challenges associated with such presentations. Whilst serial beta-hCG monitoring remains a valuable tool, this case underscores the importance of clinical suspicion and point-of-care imaging, particularly transvaginal ultrasound (TVUS), as the primary modality for detecting ectopic pregnancies. Early recognition and intervention are crucial to reducing morbidity and mortality
Gender dynamics in IVF: uncovering male and female factors for IVF at a tertiary care hospital
Get PDFBackground: In spite of the global burden of subfertility affecting 8 to 12% of reproductive aged couples worldwide, not all sub fertile couples require in vitro fertilization (IVF). The decision to pursue IVF is typically based on a thorough assessment of the couple’s fertility challenges. Initially developed as a way to bypass irreparable tubal disease, IVF is now widely applied for treatment of infertility due to a variety of other causes. Latest achievements in the field of assisted reproduction have led to a rapid expansion in the indications of IVF. The objective of the study is to ascertain the various indications for which IVF was offered in the ART Centre of a public sector hospital, where such facilities are offered free of cost.
Methods: This cross-sectional retrospective study was carried out over a period of 3 years in a tertiary care public sector hospital. Medical records including the infertility data of 1934 couples who underwent IVF cycles during the study period was analysed.
Results: Of the 1934 couples taken up for IVF, 379 (19.6%) couples were for male factor only, 14.7% underwent IVF for chronic anovulation and 478 (24.7%) couples underwent IVF for combined male and female factors while 14.6% for idiopathic infertility.
Conclusions: Both male and female factors contribute vividly to the burden of infertility and result in IVF to attain a successful pregnancy. In our study combined factors was the commonest indication for IVF
Effect of yoga and probiotic intervention on hormonal parameters in pre-menopausal women with polycystic ovary syndrome
Get PDFBackground: Polycystic ovary syndrome (PCOS) affects reproductive and metabolic health in pre-menopausal women, necessitating innovative therapeutic approaches. This study investigated the combined effects of yoga and probiotic supplementation on hormonal parameters and fertility outcomes compared to yoga alone and control groups.
Methods: Forty pre-menopausal women (35-55 years) diagnosed with PCOS were allocated to three groups: control (n=10), yoga intervention (n=15), and yoga with probiotic supplementation (n=15). The yoga intervention consisted of standardized 30-minute sessions three times weekly for three months. The combined group practised yoga and consumed 5 gm dry-roasted powdered flaxseed in 100 ml of buttermilk twice daily. Primary outcomes included reproductive hormones (E2, FSH, LH, Prolactin), thyroid function (FT3, FT4, TSH), haemoglobin levels, and pregnancy outcomes.
Results: The control group showed no hormonal changes. The yoga-only group demonstrated modest improvements in thyroid function (FT3-12.1%, TSH-8.2%) with minimal reproductive hormone effects. The yoga with probiotics group showed substantial improvements: E2 increased 15.9%, while FSH (-15.0%), LH (-18.7%), and prolactin (-17.5%) decreased significantly. Significantly, 33.3% of participants in the yoga with probiotics group achieved pregnancy during the intervention period, while no pregnancies occurred in other groups.
Conclusions: Combining yoga with probiotic supplementation demonstrates superior efficacy in improving hormonal profiles and fertility outcomes in pre-menopausal women with PCOS compared to yoga alone, offering a promising integrative therapeutic approach
Intensive care unit admission of obstetrics cases in a tertiary care centre
Get PDFBackground: ICU admissions is on the rise in pregnant women. These must be handled by obstetricians and intensivist.
Methods: This retrospective observational study was conducted at the Gulbarga Institute of Medical Sciences to analyze obstetric outcomes and complications among patients admitted to the obstetric intensive care unit (ICU) from January to June 2024. The study included 69 women out of approximately 3651 deliveries, resulting in an ICU admission rate of 1.88%.
Results: Patient demographics revealed a predominance of younger women under 25 years, with the majority being in their first and second pregnancies. Antepartum admissions comprised 69.5% of cases, with hypertensive disorders of pregnancy and postpartum hemorrhage being the primary reasons for ICU admission. A range of interventions was administered, including anticonvulsants, blood transfusions, and mechanical ventilation. The study recorded 12 maternal deaths, primarily due to hemorrhage, hypertensive disorders, and sepsis, pointing to significant challenges within maternal healthcare management in critical settings.
Conclusions: The findings underscore the necessity for enhanced patient management strategies to address the identified complications and improve maternal outcomes in high-risk obstetric populations