International Journal of Reproduction, Contraception, Obstetrics and Gynecology
Not a member yet
9909 research outputs found
Sort by
Isolated tubal ischemia secondary to small bowel volvulus: a rare case report
Get PDFTorsion of the fallopian tube is a rare cause of acute abdominal pain, often underrecognized in the context of intestinal pathology. We reported the case of a 30-year-old woman who developed isolated fallopian tube ischemia secondary to small bowel volvulus, a complication rarely described. She presented with acute hypogastric pain, vomiting, and mild left hydronephrosis. CT imaging revealed a small bowel obstruction with a whirlpool sign but no apparent tubal abnormalities. Laparotomy identified a twisted, ischemic fallopian tube with hydrosalpinx, attributed to adhesions from a recent appendectomy. Salpingectomy, small bowel resection, and anastomosis were performed, with histopathology confirming ischemic necrosis. This case underscores the diagnostic challenge posed by overlapping gastrointestinal and gynecological emergencies and suggests that vascular compromise in small bowel volvulus may extend to pelvic structures. Given the rarity of secondary tubal torsion, clinicians should consider this possibility in women with prior pelvic surgery and acute abdominal pain. Early CT imaging and interdisciplinary collaboration are essential for timely intervention and improved outcomes
Management of second trimester abortion beyond 20 weeks in a tertiary care setting
Get PDFBackground: Management of second-trimester abortion beyond 20 weeks is still unclear. To analyse the management of second-trimester abortions in a tertiary care setting.
Methods: A retrospective analysis was carried out over 1 year for the women undergoing 2nd trimester abortion after 20 weeks. The primary outcome was to find out the various regimens used for 2nd-trimester abortion. The secondary outcomes were the number of doses of drug required for completion of the abortion process, complications and side effects associated with the same. Other outcomes like the cause of abortion requirement beyond 20 weeks and the demographic profile of women have been noted. A review of literature was carried out on the management of 2nd trimester abortion beyond 20 weeks.
Results: A total of 57 medical termination of pregnancy (MTP) were carried out. Mifepristone followed by misoprostol was the method of choice in 93% of cases. Other methods adopted were foleys induction, mifepristone alone. The mean number of misoprostol doses used in termination between 20-24 weeks were 3-4 (400 mcg), While it was 4-5 doses (200mcg) beyond 24 weeks of gestation. Hysterotomy and hysterectomy were done as a result of complication arising out of the regimen followed in less than 1 % of cases.
Conclusions: The combination of 200 mg mifepristone and vaginally administered misoprostol is a safe, effective and non-invasive regimen for termination of pregnancy even beyond 20 weeks
Postmenopausal dysgerminoma: unveiling a rare ovarian tumour a case report and review of literature
Get PDFOvarian germ cell tumours (OGCTs) account for 2-5% of ovarian malignancies with an annual incidence of 1:100000 and typically occurs in young women and adolescents. A pure ovarian dysgerminoma in a postmenopausal female is a rare phenomenon. We report a case of 48-year-old female postmenopausal since 3 years presented to gynaecology opd with pain lower abdomen. On clinical examination an abdominopelvic mass enlarged to 18-20-week gravid uterus size. All tumour markers were normal except lactate dehydrogenase raised to 1375. On imaging a well-defined large solid cystic heterogenous mass arising from left adnexa, suggestive of neoplastic etiology. Staging laparotomy done. A final diagnosis of ovarian dysgerminoma was made on histopathological examination
A precarious outcome of incidentally diagnosed Krukenbergs tumor in antepartum eclampsia case: a rare case report and review of literature
Get PDFKruckenbergs tumors are the rare metastatic tumors of ovary with its incidence of 1-2%. It’s occurrence along with pregnancy is very rare with reported incidence of 0.4-0.5%. The occurrence of Krukenbergs tumors along with gestational hypertension is also very rare and it has poor prognosis. The most common primary origin is from gastric site. We report a case of 28‑year‑old pregnant female presented with Antepartum Eclampsia with incidental findings of bilateral enlarged ovaries during caesarean section. The diagnosis of Krukenbergs tumor was made with histopathology and it’s primary origin was rendered by postoperative gastroscopy guided biopsy. Our case is enthralling in view of its unusual presentation, young age, and the diagnostic dilemma it poses. Our case report highlights the fact that early diagnosis of Krukenbergs tumor in pregnancy may be difficult at times owing to the masquerading effects, implying widespread metastasis and a poor maternal survival. Tumor resection with concomitant Chemotherapy was given as treatment. The main aim of this paper is to evaluate whether earlier diagnosis can be made in such cases. A thorough literature review was also conducted, unfortunately no methods can be used for early detection. Furthermore, no consensus regarding diagnostics or treatment avail till date. Hence the need for more research regarding this rare condition to offer recommendations about early detection, diagnosis and therapeutic approaches can be prompted
Two true knots in the umbilical cord: a rare case report
Get PDFTrue knots of the umbilical cord are infrequent but significant complications in obstetrics, occurring in approximately 0.3% to 2% of pregnancies. Their formation is often associated with factors such as increased fetal mobility, excessive amniotic fluid, and maternal conditions like diabetes. These knots can lead to serious outcomes, including fetal distress and stillbirth, necessitating careful monitoring and management. We present the case of a 30-year-old woman Gravida 1 Para 1 Live birth 1 (G2P1L1) with a known case of type 2 diabetes mellitus who presented at 36 weeks and 6 days of gestation with mild labor pains. Upon evaluation, she exhibited persistent fetal tachycardia and non-progressing labor despite augmentation efforts. An emergency lower segment cesarean section (LSCS) was performed, revealing two true knots in a lengthy umbilical cord measuring approximately 70 cm, along with one loop wrapped around the neck. The timely intervention resulted in a favorable outcome for both mother and baby. This case highlights the importance of recognizing and managing true knots in pregnancies complicated by diabetes and other risk factors. As these noted are mostly obscured on ultrasound and diagnosis is made only post placental delivery, it underscores the need for vigilant prenatal monitoring and a low threshold for surgical intervention in cases of fetal distress
A case of haloperidol induced neuroleptic malignant syndrome in postpartum psychosis: a rare case report and review of literature
Get PDFNeuroleptic malignant syndrome (NMS) is a very rare and fatal complication which occurs due to use of Neuroleptic agents in the treatment of psychotic disorders. Neuroleptic drugs are assumed to be safe for both mother and foetus owing to its relative impact on untreated fulminant psychosis. NMS was observed mostly after the use of high potency first generation neuroleptic agents such as haloperidol, fluphenazine, chlorpromazine. NMS is characterised by triad of fever, muscle rigidity and altered mental status. We report a case of 26 years old G2P1L1 pregnant woman presented with abruptio placentae and intrauterine foetal demise at 35 weeks of gestation. During postpartum period, she developed NMS due to usage of haloperidol for postpartum psychosis. In this case we achieved a prompt recovery by using bromocriptine and lorazepam
A rare ovarian Leydig cell tumour masquerading as postmenopausal bleeding: a case report
Get PDFOvarian Sertoli-Leydig cell tumors (SLCTs) are rare ones, accounting for less than 0.2% of ovarian malignancies. While typically associated with virilization, they can present atypically with postmenopausal bleeding. We report a 72-year-old postmenopausal woman with post-menopausal bleeding. The diagnosis was endometrial hyperplasia. The patient, with a history of diabetes, hypertension, and dyslipidemia, had postmenopausal bleeding lasting five days without features of virilization. Ultrasonography showed a bulky uterus with a fibroid, adenomyoma, and thickened endometrium. Endometrial sampling revealed focal hyperplasia without atypia. Despite progestin therapy, she had recurrent vaginal bleeding. Hence decision for surgical management was sought. Histopathology confirmed a 1 cm Leydig cell tumour in the right ovary, with no significant findings in the left ovary or tubes
A case report of adult onset nephrotic syndrome in pregnancy
Get PDFProteinuria in pregnancy is one of the most common issues encountered on a routine basis, mostly thought due to preeclampsia. However, there are plethora of reasons for proteinuria other causes of the same should also be thought while diagnosing and managing proteinuria. One of the causes of massive proteinuria is nephrotic syndrome. Nephrotic syndrome is a clinical syndrome defined massive proteinuria responsible for hypoalbuminemia resulting in hyperlipidemia edema and various complications. It is caused by increased permeability through damaged basement membranes in renal glomeruli. Nephrotic range of proteinuria defined as urinary loss of 3 gm or more protein/ 24 hours or presence of 2 gm of protein per gram of creatinine in spot urinary samples. Here is a case report of nephrotic syndrome in pregnancy managed by a multidisciplinary approach with successful outcome.
Sensitivity and specificity of transvaginal ultrasonography in detecting endometrial pathology in women with postmenopausal bleeding
Get PDFBackground: Postmenopausal vaginal bleeding is a frequent reason for gynecological consultation. Transvaginal ultrasonography (TVS) is a key diagnostic tool for assessing endometrial pathology through the measurement of endometrial thickness in such patients. This study aimed to evaluate the sensitivity and specificity of TVS in detecting endometrial pathology in women with postmenopausal bleeding, using histopathological findings as the reference standard.
Methods: This cross-sectional study was carried out in department of obstetrics and gynaecology of DMCH, from June 2022 to May 2023. A total of 65 women with post-menopausal vaginal bleeding were included after taking informed written consent.
Results: The study included 65 women with postmenopausal bleeding, with a mean age of 55.5±7.6 years. Histopathological analysis revealed abnormal endometrial findings in 70.8% of cases: 47.8% had endometrial hyperplasia, 23.9% endometrial atrophy, 13.1% endometrial carcinoma and 15.2% endometrial polyp. On TVS, the mean endometrial thickness was 9.1±6.1 mm; 58.5% had a thickness>5 mm, while 41.5% had ≤5 mm. ROC curve analysis identified a cut-off value of ≥4.99 mm (AUC=0.880; 95% CI: 0.785–0.975; p<0.01) for detecting endometrial pathology, demonstrating 82.61% sensitivity, 73.68% specificity, 88.37% positive predictive value (PPV), 63.64% negative predictive value (NPV) and 80% overall accuracy. Another ROC analysis for detecting endometrial carcinoma revealed an optimal cut-off value of ≥13.5 mm (AUC=0.935; 95% CI: 0.875–0.995; p<0.01), with 100% sensitivity, 86.44% specificity, 42.86% PPV, 100% NPV and 87.69% accuracy.
Conclusions: Transvaginal ultrasonography has high sensitivity and specificity in detecting endometrial pathology in women with postmenopausal bleeding. However, further larger studies in different surgical units are warranted
Effect of metformin plus statin combination therapy compared to metformin alone in infertile woman with symptomatic endometrioma
Get PDFBackground: Endometriosis is an estrogen-dependent inflammatory condition characterized by endometrial tissue growth outside the uterus. Metformin suppresses estrogen production and has anti-inflammatory, anti-proliferative, and anti-angiogenic effects. Statins inhibit cholesterol synthesis and offer anti-inflammatory actions, reducing angiogenesis, invasion, adhesion, and lowering MCP-1 and MMP-3 levels. This study compares metformin plus statin versus metformin alone in infertile women with symptomatic endometrioma.
Methods: A randomized controlled trial was conducted in the department of reproductive endocrinology and infertility, BSMMU. Forty women with symptomatic endometrioma diagnosed via transvaginal ultrasound (TVS) were randomized into two groups. The experimental group received metformin 500 mg thrice daily plus atorvastatin 40 mg once daily; the control group received only metformin. Treatment lasted 3 months. Outcomes-endometrioma size (TVS), pain [visual analog scale (VAS)], and complement C3 level (Nephelometry)-were measured pre-and post-treatment. Data were analyzed using SPSS v.26.
Results: After treatment, the experimental group showed significant reductions in endometrioma size (3.50±0.82 vs 2.41±0.52 cm) and pain score (6.80±1.67 vs 3.13±2.32) from baseline (p<0.05). The control group showed significant reductions in endometrioma size (3.40±0.96 vs 2.92±0.80 cm) and pain score (6.65±2.10 vs 3.47±2.09) from baseline (p<0.05). Serum complements levels increased in both groups insignificantly. Endometrioma size reduction was significantly higher in the experimental group (1.06±0.53 vs 0.45±0.44 cm), but pain score and complement level reductions showed no significant difference between groups.
Conclusions: Metformin plus statin shows significantly better reduction in endometrioma size compared to Metformin alone in treating symptomatic endometrioma in infertile women