International Journal of Reproduction, Contraception, Obstetrics and Gynecology
Not a member yet
9909 research outputs found
Sort by
Evaluation of spot urine albumin creatinine ratio as a screening tool for prediction of preeclampsia
Get PDFBackground: Preeclampsia is the second leading cause of maternal mortality, accounting for approximately 12-18% of pregnancy-related deaths. Spot urine albumin creatinine ratio (UACR) underscores its significance as a practical tool for earlier detection and effective management thereby enhancing clinical outcomes for both mother and their infants.
Methods: Singleton pregnant women between 16 and 20 weeks of gestation attending the antenatal care (ANC) outpatient department (OPD) of GMC Akola were enrolled in this prospective study. The spot urinary albumin-to-creatinine ratio (UACR) was calculated for each case. All patients were placed under regular follow-up at 24 weeks, 28 weeks, 32 weeks, 34 weeks, 36 weeks, and subsequently on a weekly basis until delivery. Special attention was given to identifying the development of preeclampsia during the antenatal period and/or at the time of delivery.
Results: A UACR cutoff of 35.5 mg/mmol was identified as predictive of preeclampsia, with a significant association noted (p<0.0001). Diagnostic performance measures revealed a sensitivity of 85.1%, specificity of 91.4%, PPV of 82.6%, and NPV of 92.8%, suggesting high diagnostic accuracy.
Conclusions: The present study establishes that spot UACR, when measured between 16-20 weeks of gestation in asymptomatic pregnant women, serves as a highly sensitive and specific early screening tool for predicting the subsequent development of preeclampsia
Gestational trends in uterine artery pulsatility index and maternal blood pressure among pregnant women at 11-14 weeks to 34 weeks of gestation
Get PDFBackground: Pre-eclampsia (PE) and fetal growth restriction (FGR) are significant obstetric complications associated with impaired placental perfusion and adverse maternal and perinatal outcomes. Uterine artery pulsatility index (PI) and maternal mean arterial pressure (MAP) are established biophysical markers for predicting these conditions. However, longitudinal evaluation of these parameters in low-resource populations remains limited. This study aimed to assess gestational trends in uterine artery PI and MAP from 11–14 weeks to 34 weeks of gestation and their association with pregnancy outcomes.
Methods: This prospective observational study was conducted over 18 months at a private medical college in Kerala, India. Pregnant women with singleton pregnancies at 11–14 weeks undergoing routine nuchal translucency scans were enrolled (n=128). Uterine artery Doppler and MAP were measured at 11–14, 20–24 and 30–34 weeks of gestation. PI was obtained using standard Doppler techniques and MAP was calculated from four arm measurements. Data were analyzed using paired-samples t tests, with p<0.05 considered statistically significant.
Results: The mean uterine artery PI decreased progressively from 1.6±0.4 at 11–14 weeks to 1.1±0.4 at 20–24 weeks and further to 0.8±0.2 at 30–34 weeks (p<0.01). MAP remained relatively stable across gestation, within normal physiological ranges. The cohort was predominantly young (21–30 years, 60.9%) and primigravida (57.8%).
Conclusions: Uterine artery PI shows a significant progressive decline with advancing gestation, reflecting normal uteroplacental adaptation, while MAP remains stable, indicating adequate cardiovascular adjustment. These findings support the utility of uterine artery Doppler and MAP monitoring in predicting adverse pregnancy outcomes and highlight the need for population-specific reference ranges
Hormone receptors in gynecological cancers: focus on androgen receptor status
Get PDFBackground: Hormonal therapy and chemotherapy remain the primary treatment modalities for advanced and recurrent gynecologic malignancies. The presence or absence of hormone receptors has significant prognostic value in gynecological cancers. Previous studies have shown that high estrogen receptor (ER) and progesterone receptor (PR) levels in endometrial cancer predict favorable survival, while loss of PR expression in ovarian cancers correlates with recurrence. However, the role of androgen receptors (AR) in these cancers is not fully understood.
Methods: This observational study analyzed the immunohistochemical expression of AR, ER alpha (ERα), PR, and p53 in patients diagnosed with gynecologic cancers at a tertiary care center. Hormonal receptor expression was evaluated and correlated with tumor type and histopathological features.
Results: Prominent expression of ARs was observed across all categories of gynecological cancers included in the study. The expression profiles of ER, PR, and p53 varied among tumor subtypes, reflecting their potential prognostic and therapeutic significance.
Conclusions: Androgens appear to play a role in the pathogenesis of gynecological cancers. Hormonal expression profiling may guide future endocrine therapy strategies and could be considered as a potential salvage treatment option similar to that used in ovarian cancers. These findings underscore the importance of detecting hormone receptor expression in all gynecological malignancies
Guillain-Barré syndrome complicating pregnancy: a tragic dual loss
Get PDFGuillain-Barré syndrome (GBS) is a rare, immune-mediated neuropathy characterized by acute, progressive weakness and areflexia. Although its incidence in pregnancy parallels that of the general population, the third trimester and early postpartum period are particularly vulnerable due to immunological alterations. We report the case of a 24-year-old multigravida at 33 weeks gestation who presented with progressive quadriparesis and respiratory distress. Neurological evaluation revealed flaccid limb weakness with preserved sensation, and cerebrospinal fluid analysis demonstrated albuminocytological dissociation. Nerve conduction studies confirmed the acute motor axonal neuropathy (AMAN) variant of GBS. Despite timely administration of intravenous immunoglobulin, ventilatory support, and comprehensive multidisciplinary management, the patient experienced rapid deterioration, leading to maternal and fetal demise. This case underscores the aggressive nature and poor prognosis associated with the AMAN variant of GBS in pregnancy. Prompt recognition of neurological symptoms, early initiation of immunotherapy, and meticulous respiratory monitoring are critical for optimizing maternal and fetal outcomes. Awareness among clinicians regarding this rare but potentially fatal association is essential to facilitate early diagnosis and improve survival.
An ultrasound study of foetal head-perineum distance in term pregnant women to estimate successful vaginal delivery
Get PDFBackground: The aim of the study is to find the role of foetal head-perineum distance in term primiparous pregnant women being induced, in estimating successful vaginal delivery using transperineal ultrasound. And further to compare fetal head-perineum distance with cervical length and Bishop score. Cervical length and Bishop score were already established as good predictors of vaginal delivery.
Methods: An ultrasound machine with transabdominal and transvaginal probe was used in the study. In this study spanning from December 2023 to October 2024; 63 primiparous term pregnant women were recruited from Vijaya hospital, Chennai after getting approval from the Institutional Ethical Committee. 63 primiparous patients who underwent induction of labour for various reasons were selected for the study and examined. Patients undergoing elective induction of labour at term gestation were assessed for the fetal head-perineum distance (FHPD) by transperineal ultrasound and cervical length by transvaginal ultrasonography. Bishop score was assessed digitally. After induction of labour, patient undergoing vaginal delivery and caesarean sections were noted down.
Results: Forty-two patients delivered vaginally. Twenty-one patients delivered by LSCS. Fetal head-perineum distance cut-off in my study was 5.5 cm. Cervical length cut-off was 3cm. Patients having favorable bishop score of 5 and above delivered vaginally.
Conclusions: Trans perineal fetal-head perineum distance measured by ultrasound can be used as an important tool to predict vaginal delivery before induction of labour.
Effectiveness of combined use of mifepristone and misoprostol in comparison to misoprostol alone in induction of labor in intrauterine fetal death
Get PDFBackground: Intrauterine fetal death (IUFD) remains a significant obstetric challenge, with a global prevalence of 1-4% of pregnancies. Timely and effective induction of labor is critical to minimizing complications like coagulopathy and infection. Prostaglandins, especially misoprostol, are widely used for labor induction. This study compared the efficacy and safety of the combined regimen of mifepristone and misoprostol in comparison to misoprostol alone in IUFD management.
Methods: This randomized controlled trial was conducted in the department of obstetrics and gynecology, Institute of Child and Mother Health (ICMH), Matuail, Dhaka, from October 2023 to March 2025. A total of 68 patients with intrauterine fetal death (IUFD) requiring induction of labor were enrolled.
Results: The induction to labour interval was significantly shorter in group A (6.32±2.16 hours) compared to group B (16.06±5.59 hours) p=0.00. The induction-to-delivery interval was significantly shorter in group A (13.88±5.36 hours) compared to group B (26.62 ±11.86 hours, p=0.00). The mean dose of misoprostol was lower in group A (2.85±0.61) versus group B (3.97±0.30, p<0.001). Group A demonstrated fewer side effects like fever which was statistically significant (p-0.008). Other side effects like diarrhoea vomiting headache were not statistically significant. There were no statistically significant differences in the observed complication like PPH retained placenta hyperstimulation gastrointestinal symptoms in both groups. Group A also demonstrated shorter hospital stay (4.71±0.63 versus 5.21±0.77 days, p=0.005).
Conclusions: Combined mifepristone and misoprostol therapy is more effective and safer than misoprostol alone for labor induction in intrauterine fetal death
Association of insulin resistance with pre-eclampsia: a case-control study
Get PDFBackground: Preeclampsia, characterized by new-onset hypertension and proteinuria after 20 weeks of gestation, is a leading cause of maternal and perinatal death. Its etiology involves vascular endothelial dysfunction, oxidative stress, and metabolic dysregulation. Evidence suggests that insulin resistance may contribute to its development by promoting vasoconstriction and endothelial injuries. This study aimed to evaluate the association between insulin resistance and preeclampsia and its correlation with blood pressure in pregnant women.
Methods: A hospital-based case-control study was conducted at Department of Obstetrics and Gynaecology, Sir Salimullah Medical College Mitford Hospital, Dhaka, Bangladesh, from February 2022 to January 2023, including 50 preeclamptic and 50 normotensive pregnant women (gestational age, 20-40 weeks). Fasting plasma glucose and serum insulin were measured, and insulin resistance was calculated using the HOMA-IR index. Data were analyzed using SPSS version 24, and statistical significance was set at p<0.05.
Results: Preeclamptic women had significantly higher fasting glucose (4.48±0.51 mmol/l), serum insulin (29.0±5.97 µU/ml), and HOMA-IR (3.52±0.74) compared to controls (4.24±0.47 mmol/l, 13.94±3.61 µU/ml, 1.73±0.40; p<0.001). Women with HOMA-IR ≥1.7 had a 7.94-fold increased risk of preeclampsia (95% CI: 2.87–21.98). Insulin resistance was strongly correlated with systolic (r=0.755) and diastolic (r=0.774) blood pressure (p<0.001).
Conclusions: Elevated insulin resistance is significantly associated with preeclampsia and blood pressure elevation, indicating its potential utility as an early biomarker for the risk assessment and prevention of preeclampsia.
Accessory cavitated uterine mass: an underdiagnosed condition and a diagnostic challenge
Get PDFAccessory cavitated uterine mass (ACUM) is a rare Müllerian duct anomaly characterized by a non-communicating, cavitated lesion within the myometrium, lined by functional endometrium. ACUM often mimics other gynaecological disorders such as endometriosis, cystic adenomyoma, leiomyoma or cornual ectopic pregnancy, leading to diagnostic delays and significant morbidity. We present the case of a 28-year-old multiparous woman with a three-year history of severe, progressive dysmenorrhea and chronic pelvic pain refractory to standard medical management. Pelvic ultrasonography and MRI suggested possible endometriosis or chronic ectopic pregnancy. Definitive diagnosis achieved intraoperatively, a rudimentary horn–like, non-communicating cavity was identified, filled with fluid and surrounded by normal myometrium, consistent with ACUM. The patient underwent surgical resection of the accessory uterine cavity, resulting in complete resolution of her symptoms. This case underscores the importance of considering ACUM in the differential diagnosis of young nulliparous as well as multiparous women presenting with severe dysmenorrhea and chronic pelvic pain, especially when symptoms are refractory to initial treatment. Increased clinical awareness of ACUM's characteristic features is essential to reduce diagnostic delay and improve patient outcomes
Efficacy and safety of oral misoprostol solution compared to sublingual misoprostol for induction of labor at term pregnancy
Get PDFBackground: Induction of labor (IOL) is the artificial stimulation of uterine contractions at term to achieve vaginal delivery. This study aimed to compare the efficacy and safety of 25 μg oral versus sublingual misoprostol for labor induction at term pregnancy. The aim of the study was to compare the efficacy and safety of oral misoprostol solution versus sublingual misoprostol for induction of labor in term pregnancies.
Methods: This randomized controlled trial was conducted at the Department of Obstetrics and Gynecology, Institute of Child and Mother Health (ICMH), Matuail, Dhaka, Bangladesh, from July 2023 to June 2024, including 66 term pregnant women with a singleton cephalic fetus and unfavorable cervix (Bishop score <6). Participants were randomized to oral misoprostol solution (Group A, n=33) or sublingual misoprostol (Group B, n=33), with labor progress, maternal, and neonatal outcomes monitored. Data were analyzed using SPSS v26, with P<0.05 considered significant.
Results: Among 66 term women (33 oral, 33 sublingual), most were 20-30 years, housewives, with normal BMI and primigravida. Indications and gestational age were similar. Oral group required higher misoprostol doses (3.6±1.1 vs. 3±1.9, p=0.010), but labor times, oxytocin use, Bishop score improvement, delivery mode (vaginal 72.7% vs. 75.8%), neonatal outcomes, and adverse effects were comparable. Success rates were 84.8% vs. 90.9%.
Conclusions: Both oral and sublingual misoprostol are similarly effective for labor induction, with oral misoprostol showing a slightly safer profile
Duration of meconium-stained labor-prevalence and association with adverse maternal and neonatal outcomes
Get PDFBackground: Meconium-stained amniotic fluid (MSAF) is the result of the passage of fetal intestinal contents by normal intestinal peristalsis of the mature fetus or by vagal stimulation in utero. It affects up to 9-20% of deliveries. The incidence of MSAF increases with gestational age from 31 weeks to the end of pregnancy. MSAF is known to be associated with neonatal adverse effects. To provide insight on the correlation between secondary Meconium stained amniotic fluid and adverse pregnancy outcomes including maternal and neonatal morbidities, compared with Primary MSAF.
Methods: This was a prospective longitudinal observational study done at Fernandez Hospital, Hyderabad over a period of 1 year 5 months-Aug 2022 to Dec 2023. All women with Term gestation, singleton pregnancy, with spontaneous or induced labour, who were booked or referred delivering at Fernandez Hospitals and were included in this study Sample size received during study was 500.
Results: Secondary MSL was seen more to occur with Primigravida and Nulliparous women (p=0.045). Association of secondary MSL was found to be more with Induced labor whereas occurrence of Primary MSL was more seen in spontaneous labor (p=0.042). Complications such as PPH, Non-reassuring FHR were more in secondary MSL group and were statistically significant. Composite neonatal outcomes of Acidemia, low apgar at 1 min, Need for resuciation and Meconium aspiration were significant in secondary MSL Group.
Conclusions: MSAF remains a stigma. This study showed complications more with secondary MSL than Primary MSL. The findings would be useful in counselling couples in such case scenarios and make informed choices and help in decision making