International Journal of Reproduction, Contraception, Obstetrics and Gynecology
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Maternal-fetal obstetric outcomes in mothers of advanced maternal age: a cross-sectional analytical study at Saint-Joseph Hospital and the University Clinics of Kinshasa in the Democratic Republic of Congo
Get PDFBackground: Pregnancy in advanced maternal age is any pregnancy occurring after the age of 35. Both late-term and early pregnancies carry a high risk of maternal and fetal morbidity and mortality and are a public health concern. The objective of this study is to identify obstetric outcomes associated with pregnancies in advanced maternal age at Saint-Joseph Hospital and the University Clinics of Kinshasa in the Democratic Republic of Congo.
Methods: This is a cross-sectional analytical study of the records of mothers aged 16 to 50 who gave birth in the maternity wards of Saint-Joseph Hospital and the University Clinics of Kinshasa from 01 January 2018, to 31 December 2022, using non-probability convenience sampling for case selection. Descriptive analyses, analysis of variance (ANOVA), Chi-square tests and logistic regression were used in statistical analyses.
Results: Pregnancies in women with advanced maternal age (AMA) are associated with the risk of pre-eclampsia (aOR: 2.5, p=0.02 for women aged 35-39 and aOR: 3.5, p=0.001 for those over 40) and gestational hypertension (aOR: 12.3, p=0.025 for those over 40), and fetal outcomes associated with pregnancies in women with AMA are prematurity (aOR: 2.7, p=0.001 for women aged 35-39 and aOR: 2.4, p=0.002 for women over 40), low birth weight (aOR: 2.5, p=0.0000 for women aged 35-39 and aOR: 2.4, p=0.002 for women over 40), and low birth weight (aOR: 2.5, p=0.0000 for women aged 35-39). women over 40 years of age) and admissions to neonatal intensive care units (aOR: 2.5, p=0.004 for women over 40 years of age).
Conclusions: Obstetric outcomes associated with pregnancy in older mothers are preeclampsia, prematurity, low birth weight, and admissions to neonatal intensive care units. Our results are useful for prevention through screening and other therapeutic measures of these obstetric and neonatal outcomes in women with AMA with a view to improving their care in our hospitals in Kinshasa
Adhesions in repeat caesarean sections: prevalence, predictive factors, and surgical outcomes
Get PDFBackground: Adhesion formation is a common sequela of repeat caesarean sections (CS), associated with increased surgical complexity and morbidity. This study aimed to identify maternal and surgical predictors of adhesion formation and to assess its intraoperative and postoperative consequences.
Methods: This cross-sectional cohort study was conducted at Sawai Mansingh Medical College, Jaipur, from June to December 2024. A total of 100 women undergoing repeat CS were included. Data on maternal demographics, surgical history, intraoperative findings, and postoperative outcomes were collected. Adhesions were graded as mild, moderate, or dense. Statistical analysis was performed using statistical package for the social sciences (SPSS) version 26, with p value <0.05 considered statistically significant.
Results: Adhesions were present in 35% of cases 15% mild, 11% moderate, and 9% dense. Significant predictors of adhesion formation included higher body mass index (BMI) (p=0.003), greater number of previous CS (p=0.0212), and higher parity. Adhesions were significantly associated with increased operative time (mean 60.56±8.46 minutes for dense adhesions), greater hemoglobin drop (1.10±0.25 g/dl versus 0.65±0.26 g/dl, p<0.001), higher rates of intraoperative blood transfusion (66.7% versus 7.7%, p<0.001), and visceral injury (44.4% versus 0%, p<0.001). Duration of hospital stay did not differ significantly between groups.
Conclusions: Adhesion formation in repeat CS is significantly associated with maternal risk factors and adversely impacts surgical outcomes. Anticipating adhesions through risk assessment and applying meticulous surgical techniques are essential to minimize complications
Male contraception through womens eyes: trust, perceptions and challenges
Get PDFContraception has historically been considered a female responsibility, with most contraceptive methods designed for and marketed toward women. There is imbalance in contraceptive responsibility between men and women. Historically, contraception has largely been seen as a woman's responsibility, with a wide range of options available to them, while men have had only limited choices. This has led to a disproportionate burden on women to prevent unintended pregnancies. Traditional male contraceptive methods, such as condoms and vasectomy, either require consistent use or involve permanent sterilization, leaving men with fewer alternatives. However, advancements in reproductive health are paving the way for new male contraceptive options, including hormonal treatments, reversible vasectomy techniques and non-hormonal methods like sperm-blocking gels. The introduction of these alternatives presents an opportunity to distribute contraceptive responsibility more equally between genders. Women’s perceptions of male contraception play a crucial role in determining its success, as trust, reliability and shared responsibility are central concerns. Many women welcome these new options, seeing them as a way to ease their own contraceptive burden, but concerns over adherence, side effects and effectiveness remain. Society and healthcare providers have a significant role to play in ensuring male contraceptives are widely accepted, properly understood and integrated into reproductive healthcare frameworks. Shifting cultural norms and increasing education on male contraception can help normalize the idea that birth control is not solely a woman’s duty but a shared responsibility between partners. With ongoing research and growing awareness, male contraceptives have the potential to transform the picture of reproductive health, making contraception a more balanced aspect of family planning. As acceptance increases and reliable options become available, the responsibility of preventing unintended pregnancies will no longer rest disproportionately on women, but instead be a mutual commitment between partners, fostering greater equality and cooperation in reproductive decision-making. This article explores historical perspectives, current male contraceptive methods, emerging alternatives, women's attitudes toward these options, factors influencing trust and the role of society and healthcare providers
Prevalence of hypertension among females with infertility, and its association with demographics
Get PDFBackground: Hypertension (HTN) is a major health problem accelerating worldwide, particularly among reproductive-age females. It may impair fertility through hormonal and vascular mechanisms. This study assesses the prevalence of HTN among females with infertility and its association with demographic and lifestyle factors.
Methods: A cross-sectional study was conducted over 12 months in the obstetrics and gynaecology department at Hind institute of medical sciences, Sitapur. A total of 384 infertile females aged 18-49 years were included. A predesigned proforma was used to gather demographic, dietary, and anthropometric data, as well as blood pressure (BP) measurements. The 2017 ACC/AHA guidelines were used to classify HTN. SPSS version 22 was used for the statistical analysis.
Results: The mean age of infertile females was 27.87 (6.58) years. The prevalence of HTN among infertile females was 33.1%. Overweight and obesity were present in 40.9% and 20.8% of participants, respectively. HTN was significantly associated with obesity (p<0.0001) and higher socioeconomic status (p=0.016). No significant associations were found with age, religion, family type, livelihood, type of infertility, diet, or junk food intake.
Conclusions: A high burden of HTN was observed among infertile women, particularly those with obesity and higher socioeconomic backgrounds. Integration of cardiovascular screening and lifestyle interventions into infertility care is essential
Non-communicating rudimentary horn of a unicornuate uterus: clinical spectrum and diagnostic challenges: a case series
Get PDFPregnancy or hematometra in a non-communicating rudimentary horn of a unicornuate uterus is a rare and potentially life-threatening condition, often misdiagnosed due to its atypical presentation and resemblance to other pelvic pathologies. We report three cases highlighting the varied presentations and diagnostic challenges associated with rudimentary horn anomalies: a 28-year-old woman presented with persistent lower abdominal pain and bleeding following a failed medical termination of pregnancy. Imaging revealed a 12-week live gestation in a non-communicating rudimentary horn; a 36-year-old woman with chronic dysmenorrhea and a suspected subserosal fibroid was intraoperatively diagnosed with a rudimentary horn; and a 45-year-old perimenopausal woman with irregular menstrual cycle and an adnexal mass was found to have hematometra within a non-communicating rudimentary horn. Early diagnosis of rudimentary horn anomalies remains challenging. A high index of suspicion and appropriate imaging (MRI/3D ultrasound) are essential for accurate diagnosis and timely surgical intervention to prevent complications
Spontaneous hemoperitoneum in pregnancy: a rare case report
Get PDFSpontaneous hemoperitoneum in pregnancy (SHiP) is a rare but life-threatening condition with an estimated incidence rate of 0.04 per 1000 births. It is characterized by the accumulation of blood in the peritoneal cavity without trauma or obvious cause in pregnancy and up to 42 days postpartum that lead to significant maternal and perinatal complications. SHiP mostly occurs in third trimester of pregnancy with an incidence of 27% in the second trimester. A 40-year-old multigravida female at 30 weeks of gestation who presented with acute abdominal pain. Urgent imaging revealed a small amount of free fluid in perihepatic and perisplenic space with blood clots highly suggestive of hemoperitoneum. An emergency laparotomy was performed which confirmed the diagnosis and approximately 1-1.5 litres of hemoperitoneum with 1 litre of blood clot from pouch of douglas were evacuated. Caesarean section was performed at the same time placenta was delivered with intact membranes. There was atonic post-partum haemorrhage (PPH) which was not medically managed, so in view of doubt of rent in lower uterine segment with increased vascularity over the post surface, atonic PPH and general condition of the patient, total abdominal hysterectomy was done. Total blood loss was 3.5 litres. Both mother and baby recovered without further complications. This case highlights the importance of early recognition and prompt surgical intervention in SHiP to prevent maternal and fetal morbidity and mortality. Given its rarity and non-specific presentation, SHiP remains a diagnostic challenge and requires a high index of suspicion in pregnant women with acute abdomen and hemodynamic instability
Overcoming poor ovarian reserve: a case report series of spontaneous conception after failed intracytoplasmic sperm injection
Get PDFThis case report addresses the possibility of spontaneous conception in women with diminished poor ovarian reserve (POR) after multiple failure of assisted reproductive technology (ART) cycles, including intrauterine insemination (IUI) and intracytoplasmic sperm injection (ICSI). Four cases were analyzed, including patients aged 31 to 41 years, each with a unique clinical profile for POR. These patients were infertile for durations of 5 to 12 years, as well as with other conditions like hypothyroidism and raised BMI. Recombinant FSH was used in all cases for ovarian stimulation, but the outcome was suboptimal with poor oocyte retrieval rates and fertilization failure. The cumulative follicle-stimulating hormone (FSH) dose used in patients ranged from 1875 IU to 3000 IU. This strategy produced a low yield of oocytes, most of which were immature or failed to fertilize. Remarkably, all four patients subsequently conceived spontaneously and gave birth to healthy babies without additional ART treatments, despite the difficulty encountered in the ART cycles. The observation that spontaneous conception was successful in these complicated cases underscores the need for further studies into the mechanisms underlying such events to occur, especially in patients who have had multiple failure with ART. This case report underscores the merit of individualized treatment strategies and continued investigation into the determinants influencing fertility in women with POR
Conservative laparoscopic approach to paratubal cyst torsion in young girls: three cases of preserved fertility
Get PDFParaovarian and paratubal cysts, constituting approximately 10% of all adnexal masses, are typically benign and originate from the mesothelial lining or remnants of the Müllerian and Wolffian ducts. Although the incidence of torsion is lower in paraovarian cysts compared to ovarian cysts, it presents notable challenges, particularly in young women where fertility preservation is crucial. This report discusses three cases of torsed paratubal cysts successfully managed through laparoscopic techniques designed to prioritize fertility preservation. The surgical approach emphasized careful detorsion, aspiration of cyst contents for ease of manipulation, and the avoidance of energy devices during dissection to maintain vascular integrity in the ovaries and fallopian tubes. A strategic incision placed away from the fallopian tube further minimized the risk of injury, thereby safeguarding reproductive potential. Postoperative outcomes demonstrated effective pain relief, with histopathological findings of serous cystadenoma underscoring the importance of meticulous surgical techniques in preserving reproductive function in young patients
Feto-maternal outcome of placenta previa with or without placenta accreta spectrum in tertiary hospital Dhaka
Get PDFBackground: Placenta previa, with or without placenta accreta spectrum (PAS), is linked to significant maternal and fetal morbidity and mortality, primarily due to complications like cesarean delivery, severe antepartum/postpartum hemorrhage and preterm birth. The combined military hospital (CMH) Dhaka, with its advanced facilities and sufficient case volume, provides an ideal environment for this research. The main objective was to evaluate the feto-maternal outcomes of placenta previa with or without PAS and develop a management framework to improve these outcomes.
Methods: This retrospective study was conducted in the Department of Obstetrics and Gynecology at CMH Dhaka. The study population consisted of 99 pregnant women with placenta previa and PAS admitted between January 2023 and June 2024. Data were collected through a questionnaire, ultrasound reports, operative findings and histological reports.
Results: The mean age of participants was 29.59 years. Women with a previous cesarean section had a higher risk of placenta previa (71.71%). Planned cesarean sections were performed at 34-36 weeks of gestation in 70.7% of cases. Emergency LSCS was required in 9 cases due to antepartum hemorrhage (APH), while 88 were elective cesarean sections and 2 were incidental findings during elective LSCS. Intraoperative complications included bladder injury (47 cases) and peripartum hysterectomy (61.61%). Among the newborns, 25 (25.25%) had a birth weight of 1-2 kg and 77 (77.77%) were preterm, with 5 (5.05%) being very low birth weight. APGAR scores<6 at one minute were observed in 14 babies, while 85 babies had scores>6.
Conclusions: Placenta previa with or without PAS is strongly associated with serious maternal and fetal complications. Our study aims to formulate management guidelines to improve outcomes for both mother and baby
Epidemiological patterns and clinical presentations of ectopic pregnancy in a tertiary hospital: a prospective observational study
Get PDFBackground: Ectopic pregnancy is a potentially life-threatening condition where a fertilized egg implants outside the uterus, most commonly in the fallopian tubes. It poses significant risks to the health and well-being of women of reproductive age. This study aims to explore the epidemiological patterns, clinical presentations, and risk factors associated with ectopic pregnancy in a tertiary hospital setting.
Methods: This prospective observational study was conducted at the Department of Obstetrics and Gynaecology, Rajshahi Medical College Hospital, Rajshahi, from January 2014 to June 2014. A total of 45 patients were selected as study subjects by purposive sampling technique. Statistical analysis was carried out by using the statistical package for social sciences (SPSS) version 16.0 for Windows.
Results: The study found that most ectopic pregnancy patients were aged 21-25 years, with 93.3% having ruptured ectopic pregnancies. A majority (60.0%) had 6-8 weeks of amenorrhea, and 46.7% had one prior pregnancy. Common symptoms included abdominal pain, amenorrhea, shock, and per vaginal bleeding, with abdominal pain present in all cases. Acute presentations, such as massive hemorrhage and cardiovascular collapse, were seen in 57.78%, while 35.56% had acute-on-chronic symptoms. Clinical signs often included abdominal tenderness, distention, and a positive cervical excitation test.
Conclusions: The study highlights the significant burden of ectopic pregnancy among women of reproductive age, particularly those between 21 and 30 years. The majority of cases were ruptured (93.3%), often presenting as acute emergencies with massive intraperitoneal hemorrhage and cardiovascular collapse. Abdominal pain was a universal symptom, while vaginal bleeding was present in most ruptured cases. Clinical findings commonly included abdominal tenderness, cervical excitation, and abdominal distension