International Journal of Reproduction, Contraception, Obstetrics and Gynecology
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Effect of serum progesterone on the day of trigger administration to MII oocyte ratio on IVF/ICSI outcomes
Get PDFBackground: To evaluate the effect of serum progesterone on the day of trigger administration to MII oocyte ratio on IVF/ICSI outcomes. Retrospective observational study in Institute of Reproductive Medicine, The Madras Medical Mission, Chennai.
Methods: 211 patients meeting inclusion and exclusion criteria were subjected to controlled ovarian stimulation with antagonist protocol and were serially monitored by ultrasound and hormonal blood tests and when at least 3 follicles reach 18 mm size, ovulation is triggered with HCG or GnRH agonist. Serum progesterone levels on the day of trigger were noted and oocyte retrieval done 35 hours after trigger injection and the no. of MII oocytes retrieved were noted. Embryo transfer was done on day 3 of oocyte retrieval. Adequate luteal support was given, Pregnancy test was done 16 days after embryo transfer.
Results: On evaluating 211 fresh ICSI–ET cycles, Roc curve was obtained and it showed that when compared with patients with P-trigger/MII oocyte ratio≤0.29 group, patients with P-trigger/MII>0.29 group had a lower clinical pregnancy rate, implantation rate and live birth rate.
Conclusions: The present study reveals that an elevated of P-trigger/MII oocyte ratio is inversely correlated with the probability of pregnancy, indicating that this ratio may be a reliable predictor of IVF outcomes. P/MII ratio could also play a key role in selection of patients for cryopreservation of all embryos (elective freeze-all policy) and subsequent transfer of cryopreserved/thawed embryos
Maternal and fetal outcomes in overweight and obese pregnant women
Get PDFBackground: The prevalence of obesity among child bearing age women is rising in India and it has adverse implications on mother and fetus. The aim of this study is to assess impact of overweight and obese mothers on antenatal, intrapartum, postpartum and neonatal outcomes.
Methods: It is an observational hospital-based study. Pregnant women were categorized into three groups depending on their body mass index (BMI)–normal (BMI–18.5–24.9 kg/m2), overweight (BMI–25.0–29.9 kg/m2) or obese (BMI>40 kg/m2). Antepartum, intrapartum, postpartum and neonatal complications were noted.
Results: Out of 104 women, 36 each were in normal and overweight group and 32 were in obese group. Obese and overweight women had higher rate of caesarean section (68.8% and 44.4%) compared to normal group (30.6%, P-value – 0.006). Failed induction rate was more in obese and overweight women (12.5% and 11.1%) compared to normal group (2.8%) but not statistically significant. Postpartum hemorrhage (PPH) was high in normal group (36.1%, P-value–0.040). Neonatal hyperbilirubinemia requiring NICU admission was significantly high in overweight and normal group (P-value–0.000). Gestational diabetes and hypertension were comparatively more in obese and overweight group but not statistically significant.
Conclusions: Women who are obese and overweight pregnant women have increased risk for caesarean section and have higher rate of failed induction. They have higher tendency to develop gestational diabetes and hypertension in pregnancy. Postpartum hemorrhage was high in normal BMI women. Neonatal intensive care admissions for neonatal hyperbilirubinemia were high in overweight and normal BMI women
Liver function tests as an indicator of adverse maternal and fetal outcomes in patients with hypertensive disorders of pregnancy
Get PDFBackground: Hypertensive disorders of pregnancy (HDP) are significant contributors to maternal and fetal morbidity and mortality worldwide, with a prevalence in Southeast Asia ranging from 5-15% of pregnancies. In India, the incidence stands at 6.9%. Early detection and management of HDP are vital for improving outcomes. Liver function tests (LFTs) provide a cost-effective tool for assessing HDP severity and predicting complications. This study aims to evaluate the effectiveness of LFTs as a prognostic tool for adverse maternal and fetal outcomes, analyze altered LFT parameters across different HDP types and associated complications, and determine cutoff values for serum glutamic oxaloacetic transaminase (SGOT), serum glutamic pyruvate transaminase (SGPT), and lactate dehydrogenase (LDH) in predicting HDP.
Methods: This prospective study was conducted at a tertiary care referral hospital from January 2023 to January 2024. A total of 186 pregnant women diagnosed with HDP were included, excluding those with pre-existing liver disorders. LFTs were performed, and the results were analyzed using statistical package for the social sciences (SPSS) 20.0.
Results: Gestational hypertension was most common (48.9%), followed by severe preeclampsia (33.9%). Elevated LFTs (SGOT, SGPT, ALP, LDH) were significantly associated with adverse outcomes, with LDH showing high sensitivity (97.6%) and specificity (82.1%) at 150 U/l for maternal complications.
Conclusions: Abnormal LFTs, particularly SGOT, SGPT, and LDH, are key prognostic markers for adverse fetal and maternal outcomes in women with HDP, with LDH having the highest predictive significance. Timely intervention for cases with elevated LFTs can reduce maternal and fetal morbidity and mortality.
A knowledge, attitude and practice study on awareness and acceptance of contraceptives in postpartum women in a tertiary care hospital
Get PDFBackground: Postpartum family planning (PPFP) is crucial to prevent unintended pregnancies and promote maternal and child health. However, postpartum contraceptive awareness and acceptance remain low in many developing countries, including India, where high fertility rates contribute to rapid population growth and strain health care resources. This study aims to assess the knowledge, attitudes, and practices (KAP) regarding contraceptives among postpartum women in a tertiary care hospital in Pune, Maharashtra.
Methods: This cross-sectional study was conducted from May 2024 to August 2024 in the obstetrics and gynaecology department of a tertiary care hospital. A total of 211 postpartum women were recruited based on inclusion criteria, and a self-structured questionnaire was administered to gather data on contraceptive awareness, attitudes, and acceptance. The data was then analyzed further.
Results: Of the 211 participants, 87.2% were aware of contraceptive methods, with the highest awareness of barrier contraceptives, followed by oral contraceptive pills and intrauterine devices (IUDs). Despite this high awareness, only 39.8% of the participants chose to adopt contraceptives during the postpartum period. The most accepted method was IUDs (81%), while the primary reasons for non-acceptance included the desire for more children (44.9%) and fear of infertility (21.3%).
Conclusions: Although awareness of contraceptives among postpartum women in this study was high, the acceptance rate was significantly lower. Factors such as cultural beliefs, fear of infertility, and spousal refusal contribute to non-acceptance. Addressing these barriers through targeted education and counselling during the postpartum period may increase contraceptive uptake and ultimately improve maternal and child health outcomes
Total laparo-endoscopic single site surgery hysterectomy for endometrial cancer: a single-centre retrospective review
Get PDFBackground: LESS surgery is a novel technique for benign gynaecological conditions. It has advantages of shorter operative stay, less post-operative pain, better cosmesis, and improved patient satisfaction. However, similar data is limited in endometrial cancer. This study aims to analyse the peri- and post-operative outcomes of LESS surgery for endometrial cancer.
Methods: This was a retrospective, single-centre study. One gynae-oncologist trained in minimally invasive surgery performed 97 cases of LESS surgery for endometrial cancer at Singapore General Hospital, Singapore from January 2018 to December 2023.
Results: 97 patients were recruited for this study. At the time of pre-operative staging, 72 women were Stage IA, and 22 IIB. All underwent total hysterectomy bilateral salpingo-oophorectomy, with 90 and three patients undergoing pelvic and para-aortic lymphadenectomy respectively. A median of 18 pelvic lymph nodes (IQR 13-21) were retrieved. The median operative time and operative blood loss was 165 minutes (IQR 130-196.25) and 100mls (IQR 50-150) respectively. The median hospitalization stay was 2 days (range 1-7). Two women were readmitted for ileus (POD20) and post-op fever secondary to urinary tract infection (POD14), both of which were managed conservatively. The median duration of follow up was 24.5 months. There was 1 reported case of recurrence. There were three deaths in this study.
Conclusions: Women with early-stage endometrial cancer should be offered LESS surgery. It is a safe and effective surgical option for the management of endometrial carcinoma
Association of pregnancy induced hypertension with fetal gender
Get PDFBackground: Hypertension is a common complication during pregnancy, affecting up to 10% of pregnancies. Fetal gender has been suggested to influence the incidence and severity of pregnancy induced hypertension, though findings are inconsistent. This study aimed to investigate the relationship of pregnancy induced hypertension and its severity with fetal gender.
Methods: A total of 1500 pregnant women with singleton pregnancies diagnosed with gestational hypertension or preeclampsia were included in this prospective observational study conducted at Lal Ded Hospital, Srinagar, from November 2018 to March 2020.
Results: The fetal male/female sex ratio in the study group was 0.86 male/female, which was significantly lower than the overall hospital sex ratio of 1.07 male/female during this period. In other words pregnant women having PIH delivered more female babies. The study also found that pregnancy-induced hypertension was more common in primigravida women, with preeclampsia being more prevalent than gestational hypertension. Female fetuses had a higher incidence of intrauterine growth restriction (IUGR), while male fetuses had a higher rate of preterm deliveries. Overall, 4.1% of pregnancies resulted in intrauterine deaths, with a higher proportion of male fetuses.
Conclusions: The study highlights that female fetal gender increases the likelihood of mothers having PIH and are associated with higher IUGR rates than male fetuses while male fetal gender was associated with predominant preterm deliveries and intrauterine demise/still birth. Though many studies suggest controversial results, the study demands detailed evaluation at chromosomal level as to study the factors that predisposed the mother to pregnancy induced hypertension
Evaluation and management of Mullerian duct anomalies
Get PDFBackground: Development of the female genital tract is a complex embryogenesis including cell differentiation, migration, fusion, and canalization. Mullerian duct anomalies (MDA) are structural anomalies which occur due to defective embryogenesis of the Mullerian ducts, resulting in abnormalities of internal reproductive organs and ambiguity of the external genitalia. Other causes include deficiencies in steroidogenesis, signalling defects of WNT4 gene and TP63, receptor defects and genetic abnormalities.
Methods: A prospective observational study was performed at our institute to observe the congenital anomalies of the female genital tract in our population and their clinical implication.
Results: Most common anomaly observed was septate uterus followed by bicornuate uterus. Gynaecological complication: most common presenting symptom was primary amenorrhea followed by cyclical abdominal pain. Obstetric complication: women with Mullerian duct anomalies have a higher incidence of preterm labour, repeated first trimester spontaneous abortions, foetal malpresentations, and intrauterine foetal growth restriction. Hysterosalpingography (HSG) and ultrasonography (USG) are the primary tools to detect genital tract anomalies, Magnetic resonance imaging (MRI) being gold standard for detecting Mullerian duct anomalies.
Conclusions: Mullerian duct anomalies can present with various obstetric and gynaecological complications. MRI is superior to other diagnostic modalities (HSG or USG) in establishing an accurate diagnosis and deciding further management options. Surgical approach used for correction of these anomalies is specific to the type of malformation and may vary in a specific group
Non transfusion dependent thalassemia of pregnancy: a multifaceted approach to maternal and fetal health
Get PDFNon-transfusion dependent thalassemia (NTDT) patients typically remain asymptomatic until certain triggers, such as pregnancy, necessitate transfusions and increase the risk of pregnancy-related complications if not managed appropriately. We present the case of a 38-year-old female with NTDT, splenectomised at age six, who presented at 17 weeks of gestation with weakness and bipedal edema. She was advised to undergo regular blood transfusions and take aspirin, targeting a haemoglobin level of 9 g/dl. The patient was lost to follow-up and she returned later to underwent an emergency caesarean section at 32 weeks due to absent fetal movements and absence of end-diastolic flow. Postpartum, she experienced thromboembolism and was diagnosed with severe osteoporosis, treated with low molecular weight heparin, calcium, and vitamin D supplements. Pregnancy exacerbates anemia and thrombosis risk in thalassemia patients, leading to complications such as intrauterine fetal death, growth retardation, and spontaneous abortions. Aspirin or low molecular weight heparin, along with blood transfusions, are often required to prevent these complications. Iron chelating agents, contraindicated during pregnancy due to teratogenic risks, are typically recommended post-breastfeeding. Thalassemia also impacts other body systems, including cardiovascular, gastrointestinal, and skeletal systems. Therefore, a multidisciplinary approach with a well-planned treatment regimen and comprehensive family planning counselling is essential for NTDT patients
Effectiveness of goal oriented prenatal education on birth preparedness and complication readiness among antenatal mothers in selected community areas
Get PDFBackground: High maternal mortality has been associated with inadequate Birth Preparedness and Complication Readiness (BPACR) and non-institutional delivery in developing countries. Therefore, there is a need for proven interventions that will improve BPACR and institutional delivery to reduce maternal mortality. This study evaluated the effects of Goal-Oriented Prenatal Education (GOPE) on pregnant women's BPACR and institutional delivery. The objectives of the study were to assess and evaluate the effectiveness of GOPE regarding BPACR by comparing mean pre and post scores of experimental and control groups. Find out the association between post-test GOPE score regarding BPACR among antenatal mothers with selected demographic variables.
Methods: This was a community based pre-test and post-test interventional study (quasi-experimental research design) and was conducted in two randomly selected community areas. A total of 60 antenatal mothers were selected by using purposive sampling technique. Data was collected by socio demographic variables, self-structured questionnaire.
Results: In experimental group pre-test mean knowledge score was 14.23 and post-test was 20.70. Whereas in control group the pre-test mean knowledge score was 15.00 and post-test was 15.60. As result showed that ‘t’ value 8.21 p=0.00* level which indicates significance at <0.05 level. Hence research hypothesis was accepted that it was proclaimed that the GOPE had definite impact on increasing in the level of knowledge score regarding BPACR among antenatal mothers in both groups.
Conclusions: GOPE was effective to increase in knowledge score regarding BPACR
Gestational trophoblastic tumors: a case series of 18 cases at the university hospital center Mohammed VI of Oujda
Get PDFGestational trophoblastic tumors (GTTs) are rare but potentially life-threatening diseases arising from the abnormal proliferation of trophoblastic tissue following conception. Their clinical presentation, biological behavior, and metastatic potential vary significantly, complicating both diagnosis and management. We conducted a retrospective observational study over a 9-year period (July 2014 to June 2023) at the university hospital center Mohammed VI of Oujda. Eighteen patients diagnosed with GTTs, including invasive moles and choriocarcinomas, were analyzed in terms of epidemiological, clinical, therapeutic, and prognostic features. The mean age was 35.9 years (range: 19-52). All patients were married and unemployed. Most were referred from external healthcare centers and lived more than 60 km from the hospital. The predominant symptom was abnormal uterine bleeding. Diagnosis was based on abnormal β-hCG trends (89%) or histopathological confirmation (11%). Metastases were present in 43.75% of cases, most commonly in the vagina. Ten patients received chemotherapy: 8 with methotrexate monotherapy and 2 with EMA-CO. One patient underwent hysterectomy for hemorrhage. A favorable therapeutic response was observed, with β-hCG negativation achieved in 90% of patients after nine cycles. Fertility was preserved in most cases. No secondary malignancies were reported. Despite challenges in diagnosis and management, GTTs can be effectively treated with appropriate chemotherapy and close monitoring. Our experience underscores the need for early referral, standardized management protocols, and a national registry to improve patient outcomes.