International Journal of Reproduction, Contraception, Obstetrics and Gynecology
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Urticaria after intracervical dinoprostone gel: challenges of allergy testing in pregnancy
Full text linkHypersensitivity reactions to prostaglandins are rare but can pose significant risks during pregnancy. True type 1 hypersensitivity reactions are IgE-mediated, while pseudo-allergic reactions mimic these responses without involving immune pathways, making clinical differentiation challenging. Dinoprostone is commonly used for cervical ripening, with well-documented side effects; however, severe allergic reactions remain rare. We report a case of a 25-year-old primigravida induced at 39 weeks of gestation with 0.5 mg intracervical dinoprostone gel for oligohydramnios. Three hours post-administration, she developed widespread maculopapular rashes over her arms, legs, and abdomen, accompanied by itching. There were no signs of facial swelling, respiratory distress, or gastrointestinal symptoms, though mild hypotension and tachycardia were noted. The reaction was managed with intravenous chlorpheniramine, leading to partial resolution. An emergency caesarean section was later performed due to non-reassuring fetal heart rate and thick meconium. Urticaria completely resolved within 3 days with oral levocetirizine. This presentation suggested a possible pseudo-allergic reaction to dinoprostone, as patient lacked systemic features typical of IgE-mediated anaphylaxis. Although skin testing could confirm hypersensitivity, it carries considerable risk in pregnancy, including potential anaphylaxis, infection, and diagnostic uncertainties due to altered immune responses and test variability. This case highlights the importance of clinical vigilance in diagnosing and managing hypersensitivity reactions in pregnancy, where confirmatory testing may not be feasible. Close monitoring after dinoprostone administration is essential to ensure prompt identification and management of adverse reactions for maternal and fetal safety
A study of the changes in pelvic floor biometry in pregnancy by trans labial ultrasonography: cross sectional observational analytical study
Full text linkBackground: The pelvic floor, a crucial structure for urinary and anal continence, sexual function, and pelvic organ support, undergoes significant changes during pregnancy and childbirth. Damage to this area can lead to female pelvic floor disorders (FPFDs) such as urinary incontinence, fecal incontinence, and pelvic organ prolapse. This study aimed to evaluate the changes in pelvic floor biometry during pregnancy using translabial ultrasonography (USG) in Indian women.
Methods: This cross-sectional observational analytical study recruited 112 women from December 2022 to July 2023 at Sparsh Hospital. The participants included nulliparous women (n=12) and pregnant women in their second and third trimesters, divided into primigravida (n=50) and second gravida (n=50) groups. Translabial 2D and 4D USG was performed in the study.
Results: The study found statistically significant changes in bladder neck mobility and hiatal area in primigravida patients compared to nulliparous women. Bladder neck mobility increased with parity, especially during the Valsalva maneuver, suggesting a greater descent in multiparous women. The thickness of the levator ani muscle also increased during pregnancy, showing a significant change during contraction in primigravida patients. While hiatal area did not significantly change with increasing parity, bladder neck mobility was notably higher in second gravida patients compared to primigravida patients, particularly during contraction.
Conclusions: Translabial USG is a valuable, non-invasive tool for assessing these changes, which can help clinicians and patients anticipate potential PFDs and implement preventative post-delivery care
Study of dietary pattern in women who develop hypertensive disorders of pregnancy
Full text linkBackground: The upcoming evidence regarding role of diet in various disorders is compelling. This study was conducted to study the role of diet in hypertensive disorders of pregnancy apart from the already established role of genetics and biomarkers. Objectives were to study the dietary pattern in antenatal women, to study the association of dietary factors in development of hypertensive disorder of pregnancy in antenatal women.
Methods: This was a prospective study conducted in a tertiary care hospital from January 2021 to November 2021 in North India. A total of 50 pregnant women were included in their first trimester. Detailed dietary history was taken as per 24 hour recall method by a qualified dietician. The amount and proportion of various food nutrients i.e. carbohydrate, fats, proteins, fruits and vegetables, milk and milk products were calculated. These women were followed till delivery and studied for the development of hypertensive disorders of pregnancy.
Results: It was observed that there was lesser mean intake of fruits (235.71 vs 241.11 gm) and vegetables (257.14 vs 277.78 gm) in women who developed hypertensive disorder than among those who did not. However, the intake of fat was similar in both groups.
Conclusions: Our study shows that intake of more fruits and vegetables has a protective role in development of hypertensive disorders of pregnancy
A hospital-based case-control study to find out the association between prenatal exposure of household air pollutants and low birth weight among postnatal mothers attending a tertiary care centre in Chennai
Full text linkBackground: Indoor air quality is the air quality within and around buildings and structures. It is vital in determining the health status of a person. Indoor air pollution can predispose to development of several non-communicable diseases, especially among women and children. This study was undertaken to determine the patterns of indoor air quality in the houses of selected mothers and investigate the association between exposure to indoor air pollution and birth weight.
Methods: A case control study was conducted among 117 postnatal women, admitted in a tertiary hospital using a semi structured questionnaire. The participants were divided into groups of cases and controls in the ratio of 1:2, resulting in 39 cases and 78 controls. The study period spanned from July 2023 to December 2023.
Results: Among the cases, 48.71% were found to have been exposed to at least one household air pollutant against 38.46% among the controls. Factors which were found to have significant causative association towards birth of low-birth-weight babies included exposure to fungal moulds in consumed food items (8.33% among cases against 0% among controls with a p value of 0.009) and presence of water leakage in houses (8.33% among cases against 0% among controls with a p value of 0.016).
Conclusions: Antenatal exposure to fungal mold and water leakage were identified as major risk factors for low-birth-weight infants. Education and awareness regarding air pollutants and their management should be created among the general public
Fetomaternal outcomes in term pregnancies with artificial versus spontaneous rupture of membranes
Full text linkBackground: Artificial rupture of membranes (ARM) is a commonly used intervention in active labor management. Although effective in accelerating labor, its impact on maternal and fetal outcomes remains debated. This study was conducted to compare the feto-maternal outcomes associated with ARM versus spontaneous rupture of membranes (SRM).
Methods: This prospective comparative study was conducted on 160 term pregnant women admitted in labor, divided equally into two groups: Group I underwent ARM, and Group II progressed with SRM. Primary outcomes studied included labor duration, mode of delivery, maternal complications (such as postpartum hemorrhage and fever), and fetal outcomes (Apgar score, NICU admission, meconium-stained liquor.
Results: The mean duration of labor was significantly shorter in the ARM group (5.63±1.63 hours) compared to the SRM group (6.83±1.27 hours) (p<0.0001). There was no statistically significant difference in cesarean delivery rate, Apgar scores, NICU admissions, or maternal complications between the two groups.
Conclusions: Artificial rupture of membranes is a safe and effective method to reduce the duration of labor without increasing maternal or neonatal complications. When performed under aseptic conditions, it can be used reliably in active labor management
Povidone iodine- antiseptic wound irrigation prior to skin closure at caesarean section to prevent surgical site infection: a randomised study
Full text linkBackground: Surgical site infection (SSI) is seen frequently in women undergoing caesarean sections for various indications leading to increase in morbidity amongst the patients in the postpartum period. Irrigation of the subcutaneous tissue before the skin closure with topical antibiotics, povidone iodine or saline has been shown to reduce the risk of SSI. This study was aimed to determine the efficacy of povidone iodine for irrigation of subcutaneous tissue in prevention of SSI.
Methods: This study was performed on 200 subjects undergoing caesarean section who were randomised into two groups- one in which intervention in the form of povidone iodine irrigation was performed and the other in which it was not. The incidence of SSI was calculated in both the groups.
Results: The overall incidence of wound infection in this study was 8.5%. In povidone iodine and no povidone iodine group, the incidence was found to be 9% and 8% respectively.
Conclusions: There was no significant difference between wound infection rates between the povidone iodine and the no povidone iodine group (p value =0.799 by chi square test, chi square value =0.06)
Maternal indications, trends, and fetal outcomes of instrument-assisted vaginal deliveries in the United Arab Emirates
Full text linkBackground: Instrument-assisted vaginal deliveries (IAVDs), using vacuum or forceps, are vital for expediting childbirth in cases such as fetal distress or prolonged labor. While effective in preventing cesarean sections and reducing maternal-fetal morbidity, they carry risks including perineal trauma and neonatal injury. This study assessed the clinical indications and outcomes of IAVDs in a UAE tertiary hospital.
Methods: A retrospective review was conducted at Thumbay University Hospital, Ajman, including women who underwent IAVDs between January 2022 and January 2025. Data on maternal demographics, instrument type, clinical indications, and maternal-neonatal outcomes were collected using a validated form. Cesarean deliveries and incomplete records were excluded. Data were analyzed with SPSS v29 using descriptive statistics and Chi-square tests, with significance at p<0.05.
Results: Among 116 IAVD cases, most women were primigravida, aged 21-34, and delivered at full term. Indications included poor maternal effort (60.3%), prolonged second stage (39.7%), and fetal distress (37.9%). Vacuum was the predominant instrument. Neonatal outcomes were favorable, with 93.1% of newborns having normal birth weight. Common complications included respiratory distress (19.8%), NICU admission (14.7%), and cephalohematoma (12.9%). Maternal outcomes included episiotomy (82.8%) and vaginal tears (8.6%), with minimal serious complications.
Conclusions: IAVDs remain a safe and effective option for managing prolonged labor or fetal compromise. When guided by appropriate clinical judgment and technique, they yield favorable maternal and neonatal outcomes. Emphasis on early recognition of indications, ongoing operator training, and vigilant monitoring can further optimize safety
Gestational trophoblastic neoplasia: management and outcomes with EMACO regimen
Full text linkGestational trophoblastic neoplasia (GTN) is a rare and malignant condition arising from the maternal placental tissue. It is a highly chemo sensitive tumor, EMACO (etoposide/methotrexate/dactinomycin alternating with cyclophosphamide and vincristine) is the most common multiagent chemotherapy used for patients with high risk. An audit was conducted for patients with gestational trophoblastic disease (GTN) receiving EMACO regimen during the past five years at a tertiary care referral centre. Records were analysed for efficacy, toxicity and outcomes with EMACO regimen. Total of eight patients received EMACO during the study period. Median age at presentation was 25 years. All patients, except one gave a history of an antecedental molar pregnancy. The mean duration of development of GTN from the index pregnancy was 3.4 months. FIGO stage I, II and III were seen in one, three and four patients respectively. The average quantitative human chorionic gonadotrophin (hCG) prior to starting EMACO was 157,705 IU/L (6149-629,442 IU/L). The mean number of EMACO cycles for achieving normal hCG levels was 4 (2-6). All but one patient also received two additional cycles of consolidation chemotherapy. Grade 3/4 neutropenia was seen in seven patients. Hepatotoxicity was seen in one patient. At a median follow up of 36 months (18-50 months), all but one patient was alive, and four patients have successfully conceived, while three delivered healthy babies after receiving EMACO regimen. EMACO is a highly effective regimen with manageable toxicity, good patient compliance and fertility preservation. EMACO administration requires experienced multidisciplinary team approach which can help to adequately monitor response, manage toxicity, provide supportive care and detect early relapses
Placenta accreta with uterine rupture: a rare case report
Full text linkPlacenta accreta spectrum is a rare complication of pregnancy, associated with significant postpartum hemorrhage often requiring emergency postpartum hysterectomy. These cases are usually seen in patients having anterior low-lying placenta with history of previous LSCS. Here we present the case report of a patient who was 24year old, unbooked case, Gravida 2, Para 1 Live 1, who presented to our tertiary care center at 37 weeks of gestation with history of previous lower segment caesarean section with short inter-conception period of one year, with MRI showing complete placenta previa with PAS (Placenta Accreta Spectrum) with bladder involvement in the current pregnancy. Intraoperatively, silent uterine rupture and Placenta accreta noted, caesarean hysterectomy performed successfully. Post operative period was uneventful
Predictive value of cerebroplacental ratio measured by Doppler ultrasound for neonatal outcomes in hypertensive disorders of pregnancy: a prospective observational study
Full text linkBackground: Hypertensive disorders of pregnancy (HDP) are among the most significant contributors to maternal and perinatal morbidity and mortality. Inadequate placental perfusion and foetal hypoxia are key mechanisms affecting fetal growth. The cerebroplacental ratio (CPR), derived from Doppler ultrasound of the middle cerebral artery (MCA) and umbilical artery (UA), is a non-invasive method to assess foetal well-being. This study evaluated the CPR as a predictive tool for adverse neonatal outcomes in HDP.
Methods: A prospective observational study was conducted at Saraswathi Institute of Medical Sciences, including 160 singleton pregnancies complicated by HDP beyond 32 weeks of gestation. All participants underwent Doppler velocimetry to assess CPR and were divided into group A (CPR≥1.0) and group B (CPR<1.0). Outcomes assessed included birth weight, Apgar score, NICU admission, and mode of delivery. Statistical analysis involved chi-square tests and sensitivity/specificity calculations.
Results: CPR<1.0 was significantly associated with higher caesarean section rates (80% versus 40%), low birth weight (<2500 gm in 67.5% versus 28.8%), low Apgar scores (<7 in 68.8% versus 25%), and increased NICU admissions (72.5% versus 28.8%). CPR showed high specificity but moderate sensitivity for predicting poor outcomes.
Conclusions: CPR is a valuable Doppler parameter that can aid in identifying foetuses at risk in hypertensive pregnancies, enabling timely intervention to improve perinatal outcomes