International Journal of Reproduction, Contraception, Obstetrics and Gynecology
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World’s first successful caesarean delivery performed at the lowest documented maternal platelet count (1,000/μl) with sustained maternal and neonatal outcomes
Get PDFSevere thrombocytopenia in pregnancy poses a major challenge for obstetric management, particularly when platelet counts fall below critical thresholds. Cesarean delivery under such conditions carries an exceptionally high risk of hemorrhage and maternal morbidity. Reports of successful maternal and neonatal outcomes at platelet counts around 1000/µL are not available in literature. We present this high-risk pregnancy case of a woman with rare O negative blood group, decreased fetal movements, severe oligohydramnios, fetal distress and an extremely low platelet count (1000/µL)-severe immune thrombocytopenia at 35 week 2 days gestational age (GA). Despite the unprecedented hematological risk, fetal distress mandated urgent intervention. The surgery was successful, resulting in the survival of both mother and neonate. Follow‑up over three years confirmed sustained maternal and neonatal health. This case represents a unique milestone in obstetric surgery worldwide-the first documented successful cesarean section performed during pregnancy at the lowest reported platelet count (1,000/µL) at the time of delivery, with long‑term survival of both mother and child. It highlights the importance of individualised management, timely intervention, meticulous preparation, and sound clinical judgment in achieving favourable outcomes despite extraordinary hematological risk
Effect of omega-3 and D-chiro inositol compared to D-chiro inositol alone on hormonal parameters in women with insulin resistant polycystic ovary syndrome
Get PDFBackground: Polycystic ovary syndrome (PCOS) is a common endocrine-metabolic disorder marked by high androgen levels, irregular ovulation, and ovarian cysts. Recommended treatments include lifestyle and nutrition changes alongside medication. Omega-3 fatty acids support immune function, insulin sensitivity, cell health, and ovulation. D-chiro Inositol helps lower blood pressure, triglycerides, and glucose, enhances ovarian function, and reduces harmful oxidative stress in the ovaries. This study was designed to evaluate and compare the effect of omega-3 and D-chiro inositol and effect of D-chiro inositol alone on hormonal parameters in women with insulin resistant PCOS.
Methods: This randomized controlled trail study was conducted in the departments of reproductive endocrinology and infertility, Bangbandhu Sheikh Mujib medical university, Dhaka from January 2023 to June 2024. Total 60 individuals with PCOS were observed in this study.
Results: The mean age was 24.88 (±4.81) years and mean BMI was 28.83 (±2.72) kg/m2. In group A, omega-3 plus D-chiro-inositol therapy is found more effective than D-chiro-inositol alone in reducing serum luteinizing hormone (LH), (follicle stimulating hormone) FSH, free testosterone and fasting glucose, fasting insulin and homeostasis model assessment for insulin resistance (HOMA-IR) after 12 weeks of treatment. But there was no statistically significant difference in post treatment LH, FSH, free testosterone, fasting glucose, fasting insulin and HOMA-IR between 2 groups.
Conclusions: Combining D-chiro inositol and omega-3 fatty acids can significantly improve insulin sensitivity and reduce the levels of LH, FSH and free testosterone in women with PCOS. But there is no significant difference in this post treatment hormonal and biochemical parameters between the two groups
Acute kidney injury secondary to bilateral tubo-ovarian abscess: a case report
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Tubo-ovarian abscess (TOA) is a severe sequela of pelvic inflammatory disease and is exceedingly rare in postmenopausal women. Acute kidney injury (AKI) is commonly encountered in hospitalized patients; however, AKI due to ureteral obstruction from TOA is exceptionally uncommon. We report a case of a 51-year-old postmenopausal woman with a 27-year retained intrauterine device (IUD) who presented with bilateral TOA and postrenal AKI caused by bilateral hydroureteronephrosis. Initial management included broad-spectrum antibiotics, bilateral nephrostomy, and antegrade double-J stenting. Due to ongoing sepsis and persistent fever, she underwent emergency laparotomy with bilateral abscess drainage and total abdominal hysterectomy with bilateral salpingo-oophorectomy. The patient’s renal function returned to normal following surgical decompression. This case underscores the importance of considering TOA in the differential diagnosis of postrenal AKI, particularly in women with pelvic masses and signs of infection. Early imaging and multidisciplinary management are essential for favourable outcomes. Retained IUDs in postmenopausal women may contribute to chronic pelvic infections and abscess formation
Letrozole plus metformin versus letrozole alone in the treatment of symptomatic endometrioma
Get PDFBackground: Endometriosis is a chronic, estrogen-dependent inflammatory disorder affecting up to 10% of reproductive-age women, with endometrioma present in 17-44% of cases and linked to pain and subfertility. This study aims to compare the efficacy of letrozole plus metformin versus letrozole alone in the treatment of women with symptomatic endometrioma. The aim of the study was to evaluate the efficacy of letrozole plus metformin versus letrozole alone in reducing endometrioma size, pain, and serum IL-6 levels, with comparable side effects.
Methods: This randomized controlled trial (RCT) was conducted at the department of reproductive endocrinology and infertility, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka (January 2022 to June 2023). Fifty women with endometrioma (<5 cm) received either letrozole (2.5 mg/day) plus metformin (1500 mg/day) or letrozole alone for 12 weeks. Outcomes (endometrioma size, visual analog scale (VAS) pain score, IL-6 levels) were analyzed using SPSSv23 (paired/unpaired t tests; p<0.05 significant).
Results: Letrozole plus metformin (Group A) and letrozole alone (Group B) were compared in 50 women with endometrioma, with no significant baseline differences (p>0.05). After 3 months, group A showed greater reduction in endometrioma size (p=0.003), pain scores, and IL-6 levels, though the latter two were not statistically different between groups (p>0.05). Side effects were mild and similar in both groups, indicating improved efficacy of the combination therapy with comparable safety.
Conclusions: Combined letrozole and metformin therapy significantly reduces endometrioma size, pain, and IL-6 levels more than letrozole alone, offering a promising treatment for endometriosis patients seeking fertility
Pregnancy outcomes in women with uterine anomalies: a South Indian case series
Get PDFCongenital uterine anomalies (CUAs) are important causes of adverse pregnancy outcomes, including miscarriage, malpresentation, and preterm delivery. This case series evaluates obstetric and neonatal outcomes among women with CUAs managed at a tertiary care center in South India. This case series includes seven pregnant women with confirmed uterine anomalies managed at a tertiary care center in South India between January 2023 and December 2024. The anomalies included three cases of unicornuate uterus, three bicornuate uterus, and one complete septate uterus. Six women conceived spontaneously, while one required ovulation induction. Five underwent cesarean section, one had a successful vaginal delivery, and one required emergency laparotomy for a ruptured rudimentary horn. The breech presentation was observed in two cases. Neonatal outcomes were favorable in six cases; one case resulted in neonatal loss due to uterine rupture and maternal hemorrhagic shock. CUAs are associated with increased risks of malpresentation and surgical delivery. Early diagnosis and individualized antenatal care are crucial for optimizing maternal and fetal outcomes
Silent suffering: a late presentation of obstetric fistula
Get PDFRectovaginal fistulas are uncommon and account for less than 5% of all anorectal fistulas. Obstetric causes include perineal laceration, episiotomy, assisted vaginal delivery, prolonged labour, and trauma to the genital tract. They usually present with fecal incontinence immediately or within 7-10 days. Other causes include inflammatory bowel disease, diverticulitis, gynaecological surgeries, malignancy, and post-irradiation changes
Posterior reversible encephalopathy syndrome: a diagnostic dilemma
Get PDFBackground: Incidence of eclampsia 1 in 2000 to 3250. Seizures can occur antepartum, intrapartum, postpartum. PRES characterised by features like visual disturbances, headache, vomiting, seizures and altered sensorium .Hypertension major cause of PRES. Study aims incidence of PRES, asses clinical presentation, neuroimaging in PRES patients and maternal outcome.
Methods: PRES is neurological disorder characterized by symptoms like visual disturbances, headache, vomiting, seizures and altered sensorium. Eclampsia by definition have seizures as part of clinical syndrome. In our study, all patients diagnosed with PRES admitted in obstetric ICU from January 2023 to June 2023 at Gulbarga institute of medical sciences are included. They underwent CT scan for diagnosis of PRES. Abnormal findings included brain hypodense areas in posterior parietal lobe and occipital areas, posterior temporal lobes. To avoid misdiagnosis, it requires careful attention to clinical and radiographic presentation. Main criteria for PRES are Presence of neurologic symptoms or findings, presence of risk factors for PRES, absence of other possible causes of encephalopathy, Reversible course on follow up.
Results: Out of 22 patients admitted in obstetric ICU, 14 cases revealed PRES on neuroimaging. Eclampsia occurred in 20 antepartum and in 2 postpartum patients. Headache being predominant symptom, followed by altered mental status, visual disturbances.
Conclusions: Our study revealed the common finding of PRES in patients with eclampsia which suggested that PRES is a core component of pathogenesis of eclampsia in pregnancy. Hence early diagnosis and treatment is essential to avoid irreversible neurological damage and maternal morbidity and mortality.
Observational comparative study in pregnant females between normal thyroid profile and subclinical hypothyroidism in first trimester and its effect on pregnancy and fetomaternal outcome
Get PDFBackground: Subclinical hypothyroidism (SH) by definition means there is increased in serum thyroid stimulating hormone (TSH) and normal free T4 and free T3. Normal range of serum TSH according to trimester is given below (as per American Thyroid Association and Endocrine Society Clinical Practice Guidelines recommendations): 1st trimester: 0.1 to 2.5 mIU/l; 2nd trimester: 0.2 to 3.0 mIU/l; 3rd trimester: 0.3 to 3.0 mIU/l. Numerous studies have demonstrated association of SH with adverse pregnancy related outcome while some studies found no association. This study was conducted to study about SH in pregnancy and its impact on fetomaternal outcomes.
Methods: This was a hospital based prospective case control study, conducted on 100 women taking routine antenatal care between year 2023 and 2024. The participants were divided into two groups - case: antenatal women in 1st trimester with SH, and control: antenatal women with 1st trimester with normal thyroid profile. These women were followed till their delivery and their maternal and neonatal outcomes were compared.
Results: Women with SH reported increased risk of complications (anaemia, preeclampsia, postdatism, oligohydramnios, more NICU admissions and low APGAR score).
Conclusions: Evaluation for altered thyroid profile in early pregnancy should be done routinely and timely intervention for treatment even for subclinical hypothyroidism to be done. It will lead to decrease in all complications and will improve the maternal and neonatal outcome
Evaluation of the efficacy and tolerability of 4 mg dienogest in women with adenomyosis and BMI >30
Get PDFBackground: To evaluate the efficacy and tolerability of 4mg dienogest in women with adenomyosis and BMI >30.
Methods: This prospective study, conducted at Lakshmi Madhavan Hospital Pvt Ltd, Tirunelveli, Tamil Nadu, between January and October 2023, included 110 women aged 30-40 years diagnosed with adenomyosis via ultrasonography and presenting with severe dysmenorrhea. These women, all with BMI >30, were administered 4mg Dienogest (2mg twice daily) for eight weeks, followed by a taper to 2mg once daily for 12 weeks. All participants received dietary counselling emphasizing reduced carbohydrate intake and lifestyle modifications. Data on symptom improvement, adverse effects, and adherence were collected and analyzed using STATA 11.0.
Results: A significant improvement in symptoms such as menorrhagia, dysmenorrhea, dyspareunia, and chronic pelvic pain was observed in 81% of participants. Adverse effects, including headache (15%), breast discomfort (10%), and mild weight gain (8%), were reported but were well-tolerated. Irregular bleeding led to discontinuation in 3% of cases. Women requiring the 4mg dose beyond eight weeks demonstrated poor adherence to dietary modifications. The overall success rate was 81% (n=89), with a failure rate of 19% (n=21).
Conclusion: The study suggests that a higher dosage of Dienogest (4mg) for a limited period is effective and well-tolerated in obese women with adenomyosis who do not respond to the standard 2 mg dose. However, individualized treatment and strict lifestyle adherence are essential for optimal outcomes
A successful pregnancy outcome in a known case of chronic kidney disease: a case report
Get PDFChronic kidney disease (CKD) is defined as altered renal structure, function and morphology or glomerular filtration rate<60 ml/min for a minimum of 3 months. CKD affects approximately 6% women in reproductive age group in developed countries. The incidence is 0.03%-0.2% in pregnancy and if not diagnosed and treated on time, it may lead to poor prognosis. We are reporting a case of G2P1L1 at 24 weeks period of gestation with gestational hypertension, she was also a known case of CKD for 9 years not on treatment. She was followed up regularly with a multidisciplinary approach and successfully managed