International Journal of Reproduction, Contraception, Obstetrics and Gynecology
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Laparoscopic approach of a spontaneous vesico-ovarian fistula in an infected endometriotic cyst: an atypical presentation
Get PDFSpontaneous vesico-ovarian fistula is a sporadic occurrence. It can either occur as a result of a large abscess draining into the bladder or due to spontaneous fistula secondary to deep infiltrative endometriosis which might get contaminated with urine. Impaired immunity and bloody content of the endometrioma may facilitate the formation of tubo-ovarian abscess in endometriosis. This case report deals with a case of tubo-ovarian abscess with spontaneous vesico-ovarian fistula managed by minimally invasive surgery. A 40-year-old, parous lady presented with an incidental finding of endometriotic cyst with no associated symptomatology at our outpatient department. Hence, patient was planned for ovarian suppression with GnRH analogues. While on her second dose, patient had complaints of lower abdominal pain, dysuria and pyuria. On further evaluation, MR imaging was suggestive of bilateral tubo-ovarian abscess. Patient was planned for laparoscopic management of tubo-ovarian abscess. Intra-operative findings were suggestive of a frozen pelvis with frank pus draining in the urobag. Cystoscopy was done, suggestive of vesico-ovarian fistula involving the dome of the bladder. Trans-mesenteric drainage of the ovarian abscess was done, and patient was started on broad spectrum antibiotics which was culture sensitive. TB-PCR was negative for this patient. Catheterization for 3 weeks aided in the spontaneous healing of the fistula. Her final histopathology was suggestive of infected endometriosis. After suppression, with 2 doses of GnRH analogues, patient was planned for definitive surgery. MR imaging in endometriosis yields more information when the ultrasound is unclear, in cases of deep infiltrative endometriosis and in cases where surgery is planned as it provides larger field of view and better contrast resolution. Asymptomatic endometriosis if untreated might increase the risk of tubo-ovarian abscess, hence timely management is mandatory. An atypical presentation of tubo-ovarian abscess is noted in this report unlike other abscesses. Here, in our case, laparoscopic hysterectomy was done after the primary surgery of TOA drainage due to residual tubo-ovarian abscess and persisting endometriosis. Tubo-ovarian abscess can have varying presentation. Endometriosis is considered to be a risk factor for the development of tubo-ovarian abscess, hence timely diagnosis and management is necessary. Pre-operative MR imaging and laparoscopic approach with a multidisciplinary team in such cases would aid in decreased post-operative morbidity and quick recovery
A prospective study of maternal complications as predictors of C-sections and their impact on neonatal outcomes
Get PDFBackground: Rising cesarean section (C-section) rates globally have emphasized the need to identify maternal complications that necessitate surgical intervention and their consequences for neonatal health.
Methods: This prospective observational study was conducted over six months at a government hospital in Dharashiv, involving 100 pregnant women undergoing C-sections due to complications such as oligohydramnios, hypertension and fetal distress. Data were collected using structured tools and analyzed using descriptive statistics and Fisher’s exact test to explore maternal and neonatal outcomes.
Results: Oligohydramnios (53%) emerged as the leading indication for C-sections, followed by previous cesarean delivery and breech presentation (14% each). Primigravida women accounted for the majority of cases (66%). Most deliveries occurred at term (81%) and while 58 neonates had normal birth weight, 41 were low birth weight. Postoperative maternal complications were primarily severe pain, back pain and headache. Neonatal complications included respiratory distress, jaundice and meconium aspiration, with APGAR scores significantly improving from 1 to 5 minutes.
Conclusions: The study underscores the critical role of early detection and management of maternal complications in reducing adverse neonatal outcomes and highlights the importance of individualized, evidence-based care to optimize C-section indications and improve maternal-neonatal health
Unveiling the hidden malignancy: primary vaginal squamous cell carcinoma in longstanding third-degree uterovaginal prolapse-a rare case report
Get PDFPrimary vaginal squamous cell carcinoma (SCC) is a rare malignancy, representing only 1–2% of all gynecologic cancers. Its occurrence in association with longstanding third-degree uterovaginal prolapse (UVP) is extremely uncommon, occurring in <1 % of cases. This overlap presents unique diagnostic challenges, as ulcerative lesions in prolapse may mimic benign decubitus ulcers, leading to delayed detection and treatment. A 70-year-old multiparous postmenopausal woman presented with a 25-years history of third-degree UVP, accompanied by foul-smelling vaginal discharge and difficulty in defecation for 6 months. Clinical examination revealed a 10 × 8 × 2 cm ulcerative, exophytic lesion involving the entire left lateral part of the vaginal wall with a small ulcer free area below the introitus. The cervix appeared hypertrophied with keratinization. The prolapsed portion was irreducible even under anesthesia. Histopathologic examination of a biopsy specimen confirmed moderately differentiated Vaginal Squamous Cell Carcinoma. Pelvic MRI demonstrated bilateral iliac lymphadenopathy without invasion of adjacent organs. In view of the patient’s advanced age and frailty, she was deemed unsuitable for surgical intervention. Definitive external beam radiotherapy was initiated and she continues to be monitored under oncologic care. This case highlights the importance of maintaining a high index of suspicion for malignancy in elderly patients with longstanding pelvic organ prolapse and atypical vaginal ulcerations. Early biopsy and imaging are critical for timely diagnosis. Clinicians should be vigilant for malignancy masquerading as decubitus ulcers in UVP, as early detection can significantly alter management strategies and improve outcomes
Seroprevalence of human immuno-deficiency virus infection in babies born to HIV positive women
Get PDFBackground: Parent to child transmission (PTCT) is a major route of human immuno-deficiency virus (HIV) infection in children. PTCT contributes to about 4% of HIV infections in India. Prevention of parent to child transmission (PPTCT) of HIV involved testing of all pregnant women for HIV status, administration of antiretroviral therapy (ART) to HIV positive pregnant women, antiretroviral (ARV) prophylaxis to their infants and safe obstetric and infant feeding practices. Purpose of the study was finding out the mother to child transmission rates in our institution and whether we have been able to achieve the World Health Organization (WHO) target.
Methods: This was a descriptive retrospective cohort study conducted in the Department of Obstetrics and Gynaecology, Government Medical College, Kozhikode, Kerala, India. Data of HIV positive mothers and infants born to them was collected using records.
Results: Out of the 60 pregnancies, we had 23 new cases (40.3%) and 34 mothers (59.6%) known HIV positives becoming pregnant. 39.5% had taken ART for <24 weeks and 60.4% had taken ART for >24 weeks. There were 48 live births. At 6 weeks, 3 babies had tested positive by HIV total nucleic acid (TNA) polymerase chain reaction (PCR). One out of these expired at 1 week of diagnosis.
Conclusions: Poor maternal adherence to ART, unsuppressed viral load, lack of ART during pregnancy, lack of ARV prophylaxis for the infant, poor antenatal visits were associated with HIV infections among children born to HIV positive mothers
Increase in number of healthy newborns breastfed within one hour of life after using quality improvement cycle at tertiary care centre in Goa
Get PDFBackground: It was evident from WHO Global Survey that, only 39.7% of newborns delivered via caesarean section were breastfed within 1 hour of life. By initiating breastfeeding within one hour of birth, over one million neonates can be saved each year globally. This study was conducted to analyse the retrospective secondary data to understand the reasons for delay in initiation of breastfeeding and to inculcate the methods used in quality improvement cycles for increasing the newborn babies breastfed within one hour of life.
Methods: Our study was retrospective secondary data analysis. Data of 3 months was analysed and reasons of delayed breast feeding was analysed and how use of PDCA cycles to increase the breast feeding was analysed.
Results: Our study showed that by using quality improvement tools, there was increase in the newborns breast fed within one hour of life from 73.75% to 94.95%.
Conclusions: To improve the rates of breastfeeding within one hour of life, quality improvement cycles need to be constantly carried out and any hindrances should be tackled timely so as to ensure good neonatal outcomes
The art of vaginal birth after caesarean section: a retrospective observational study
Get PDFBackground: There is an alarming rise in caesarean section rate worldwide. Our study aims to highlight the factors contributing to successful vaginal birth after caesarean section (VBAC) in our institution over a period of 4 years.
Methods: Our study is a retrospective observational study. 149 patients who underwent successful VBAC during the period of November 2022 to October 2024 were included in the study and their demographic characteristics, labor progress, maternal and neonatal outcomes studied.
Results: Out of the total 149 patients, 91% of patients were admitted with spontaneous onset of labor pains. Admission Bishop's score was >3 for 87% of patients. Majority of patients (95%) progressed in labour with low dose oxytocin. 7% of patients had gestation diabetes mellitus (GDM), 3% had gestational hypertension highlighting the fact that these are not contraindications for trial of labour after caesarean (TOLAC). There was no maternal and neonatal morbidity or mortality.
Conclusions: With proper case selection, antenatal counselling and adequate pain relief - TOLAC can result in successful VBAC. VBAC is a safe alternative to elective repeat caesarean section in patients with one previous caesarean section. Increasing VBAC deliveries can reduce the overall caesarean section rate and reduce the morbidities associated with repeated caesarean sections
Cervical cerclage for cervical insufficiency: methods and pregnancy outcomes at a tertiary hospital in South-Western Nigeria
Get PDFBackground: A ‘gold standard’ for the treatment of cervical insufficiency is by inserting cervical cerclage. This intervention may not be successful in all cases. Hence, there is a need to assess the methods and pregnancy outcomes of cervical cerclage, and draw conclusion from the findings. Objectives were to assess the methods and pregnancy outcome of cervical cerclage in women with cervical incompetence at the federal teaching hospital, Ido-Ekiti, Ekiti State.
Methods: This is a 5-year retrospective review of the records of women that had cervical cerclage between June 2019 and June 2024. The data were retrieved and analyzed for their socio-demographic factors, clinical characteristics, landmark past clinical events, number of past cerclage insertions, and the methods and pregnancy outcomes of index cerclage. The data obtained were analyzed using SPSS version 26.
Results: There were 27 cases of cerclage placement per 2,489 deliveries (1 in 92 births) during the period under review. The mean age was 33.6±4.8 years. Majority (74.1%) aged 31 to 40 years. Two-thirds of women (66.7%) had no prior births, 25.9% had one birth, and 7.4% had two or more births. The McDonald’s technique was the most commonly used method, accounting for 92.6% of cases. Favourable outcome was recorded in 85.2% of the women.
Conclusions: This study showed that majority of the women treated with cerclage had successful pregnancy outcome, further supporting this intervention as a “gold standard” for managing cervical incompetence
Association of serum ferritin with gestational diabetes mellitus: a longitudinal study
Get PDFBackground: Serum ferritin is an iron storage protein, also functions as an acute phase reactant and is elevated in inflammatory environments. Elevated serum ferritin is also associated with iron overload. Inflammation and iron overload are linked to occurrence of gestational diabetes mellitus (GDM). The purpose of this research was to determine whether serum Ferritin levels are associated with GDM.
Methods: A total of 150 non anemic females with singleton pregnancy were enrolled in the study. Serum ferritin was measured at 12-16 weeks of gestation. Oral glucose tolerance test OGTT was done at 24-28 weeks and repeated at 32-34 weeks. Patients were observed for development of GDM and association of serum ferritin and GDM was evaluated.
Results: Among the participants (mean age 25.46±4.0 years), 26.0% were diagnosed with GDM. Higher serum ferritin levels (61-90 ng/ml) showed the highest percentage (48.7%) compared to other groups. Significant differences across groups with a p value of less than 0.001 was noted establishing association of serum ferritin with GDM.
Conclusions: We can infer that higher serum ferritin is associated with GDM
Treatment for asymptomatic vaginal candidiasis to reduce preterm birth: a systematic review
Get PDFVaginal candidiasis, a prevalent fungal infection in women caused by the overgrowth of Candida species, primarily Candida albicans, often triggers a hyperimmune response. While it is rarely life-threatening, it can be uncomfortable, posing risks to both pregnant mothers and their unborn children, thus affecting quality of life. This systematic review aimed to determine whether treating asymptomatic vaginal candidiasis during pregnancy reduces the incidence of preterm birth. Literature search was conducted across four electronic databases finds randomised controlled trials (RCTs) comparing the treatment of vaginal candidiasis (clotrimazole) with usual care (no-treatment). The search was updated in August 2024, with no language restrictions. Participants were pregnant women between 12 and 20 weeks of gestation. The primary outcome measured was the rate of preterm birth, while secondary outcomes included adverse pregnancy events such as premature rupture of membranes, perinatal death, low birth weight, and stillbirth. Data analysis utilized review manager (RevMan) software. Three RCTs involving 3,868 pregnant women were included, with 1,942 in the clotrimazole group and 1,926 in the usual care group. The primary outcome revealed spontaneous preterm birth rates of 2% in the treatment group compared to 6.3% in the usual care group. Meta-analysis indicated a statistically significant effect favouring treatment, with a pooled effect size of -0.05 (95% CI -0.09, -0.01). Treating asymptomatic candidiasis in early pregnancy appears to reduce preterm birth risk. However, results should be interpreted cautiously due to the limited number of studies. Further well-designed trials are needed to optimise treatment strategies and assess their impact on neonatal outcomes
Perinatal depression and suicidal behaviour: the need for timely intervention
Get PDFThis review examines perinatal depression, including antenatal (pregnancy-related) and postnatal (after childbirth) depression. It highlights their prevalence, risk factors, symptoms, and impacts on women and families, such as premature birth and significant maternal mental health issues. Causes include environmental stressors, genetic predisposition, and hormonal changes. The review distinguishes between temporary "baby blues" and prolonged postnatal depression influenced by social, psychological, and biological factors. Risk factors include negative family dynamics, a history of mental health issues, and lack of social support. Emphasizing the need for timely intervention and comprehensive mental health care, this review used a comprehensive search strategy across databases like PubMed, Google Scholar, Scopus, and more. Keywords related to perinatal depression were used for screening abstracts and titles, with full-text articles assessed for eligibility. Quality was evaluated using tools like the Newcastle-Ottawa scale (NOS) and the critical appraisal skills programme (CASP). Findings highlight the importance of regular mental health screenings, psychotherapeutic approaches, pharmacological treatments, and robust support systems. Understanding the interactions between biological, psychological, and social factors in perinatal depression is crucial for improving maternal and fetal health outcomes