International Journal of Reproduction, Contraception, Obstetrics and Gynecology
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Effect of borderline amniotic fluid index in last trimester on perinatal outcome in eastern India: a prospective observational study
Get PDFBackground: This study was done to evaluate the impact of borderline amniotic fluid index (AFI) on perinatal outcomes in term pregnancies.
Methods: This prospective observational study was conducted between January and June 2024. A total of 120 pregnant women at term (37-40 weeks) were divided into two groups: group A (n=60) with normal AFI (8-24 cm) and group B (n=60) with borderline AFI (5-8 cm). Participants were followed until delivery and up to 7 days postpartum with assessment of maternal and neonatal outcomes.
Results: Baseline maternal characteristics were comparable between groups. The borderline AFI group had significantly higher rates of fetal distress requiring caesarean delivery (30.0% versus 13.3%, p=0.026), meconium-stained amniotic fluid (36.7% versus 16.7%, p=0.013), and NICU admissions (23.3% versus 10.0%, p=0.048). Neonates in the borderline AFI group had lower birth weights (3042±384g versus 3186±352g, p=0.034), lower umbilical cord pH (7.24±0.08 versus 7.28±0.07, p=0.004), and more early neonatal complications (18.3% versus 6.7%, p=0.045). Subgroup analysis revealed poorer outcomes in pregnancies with AFI 5-6.5 cm compared to AFI 6.6-8 cm.
Conclusions: Borderline AFI at term is associated with adverse perinatal outcomes and should be considered a risk factor requiring closer antenatal monitoring and modified intrapartum management. The risk appears to increase with decreasing AFI values, even within the borderline range
Preservation of fertility in men with cancer
Get PDFFertility preservation in males is acknowledging a developing recognition as essential in treatment planning for cancer. Many currently available cancer therapies including chemotherapy, radiation and novel immunotherapy can affect sperm production, testicular function and reproductive potential. Although sperm cryopreservation is the gold standard for patients, considering post pubertal patients, experimental approaches to preserve fertility including cryopreservation of testicular tissue as an option for prepubertal boys, are in development. Whilst we do not currently lack options, several barriers prevent patients from timely access to fertility counselling, primarily a lack of awareness at their diagnosis or timely education of specific services. Early access to fertility preservation services as part of oncology health care can improve reproductive outcome and enhance long-term quality of life for survivors. Changes in our current practices will require better communication, collaboration, and a focus on improving patient access to fertility preservation options.
Spontaneous uterine rupture in early pregnancy: a systematic review of case reports and clinical outcomes
Get PDFSpontaneous uterine rupture in early pregnancy is rare but life-threatening complication. First-trimester ruptures often present atypically and are under-represented in literature. This review aims to analyze reported cases of uterine rupture occurring before 16 weeks of gestation to identify clinical features, diagnostic challenges, management strategies and maternal outcomes. A comprehensive search was conducted using PubMed, Scopus, Embase, Cochrane Library and Google Scholar databases including articles published up to March 2025. Data on patient demographics, prior uterine surgeries, presenting complaints, imaging findings, surgical intervention, histopathology and clinical outcomes were extracted. Original case reports or case series in English language reporting spontaneous uterine rupture occurring before or at 16 weeks with adequate details were included in the study. Data was extracted independently by two reviewers using a standardized Excel spreadsheet. Descriptive statistics including means, frequencies and percentages were calculated. Eleven studies comprising 12 patients were included. Mean age was 31 years, with most patients being multiparous. Prior caesarean section or uterine surgery was identified in four patients and eight cases had unscarred uteri. Fundal rupture was most common site. Hemoperitoneum on ultrasonography and acute abdominal pain were common presenting features. Eight patients underwent uterine repair and four required hysterectomy. No maternal deaths were reported. This review emphasizes need for high clinical suspicion and prompt surgical intervention in early pregnancy rupture, even in absence of traditional risk factors
Effect of probiotic and metformin combination therapy on insulin resistance in polycystic ovary syndrome compared with metformin alone
Get PDFBackground: Insulin resistance in PCOS can be aggravated by gut microbiota dysbiosis. Probiotics may improve microbial balance and insulin sensitivity and, in combination with metformin, improve glycemic control while reducing side effects. This study aimed to compare the effects of probiotic–metformin combination therapy versus metformin alone on insulin resistance in PCOS patients.
Methods: This randomized controlled trial at BSMMU included 60 infertile women with PCOS and insulin resistance. Participants were randomized into two groups: one received probiotics (Lactobacillus and Bifidobacterium, 4 billion CFU twice daily for 12 weeks) plus metformin and the control group received metformin alone. Fasting blood sugar and insulin were measured pre- and post-treatment to assess insulin resistance.
Results: In the experimental group (probiotics+metformin), FBS, fasting insulin and HOMA-IR decreased significantly after 12 weeks (5.1±0.6 vs 5.5±0.9 mmol/l; 10.2±3.8 vs 17.5±5.5 µIU/ml; 2.3±0.9 vs 4.3±1.5). Similar significant reductions were observed in the control group (metformin alone) for FBS (5.3±0.6 vs 5.4±0.5 mmol/l), fasting insulin (10.8±4.3 vs 17.6±7.4 µIU/ml) and HOMA-IR (2.6±1.4 vs 4.2±1.6). However, the mean changes between groups were not statistically significant.
Conclusions: Probiotic–metformin therapy improved insulin resistance, but not significantly more than metformin alone and had fewer, non-significant side effects
A comparative analysis of qSOFA and SOFA scores for outcome prediction among obstetric patients admitted to intensive care unit at a tertiary care centre
Get PDFBackground: Sepsis in obstetric patients remains a leading cause of maternal morbidity and mortality, requiring timely recognition and management. The sequential organ failure assessment (SOFA) score is widely used for organ dysfunction assessment, while the Quick SOFA (qSOFA) provides a rapid bedside tool. Their utility in obstetric sepsis, however, is challenged by pregnancy-related physiological changes.
Methods: This prospective observational study was conducted over 18 months (June 2023-November 2024) at L.L.R.M. Medical College, Meerut. Fifty women pregnant, postnatal (≤6 weeks), or postabortal (≤2 weeks) with sepsis diagnosed by SIRS criteria were included. Patients with ectopic pregnancy, malignancy, trauma, or chronic systemic disease were excluded. Clinical examination, laboratory investigations, and SOFA/qSOFA scoring were performed. Statistical analysis was done using SPSS v22 with Chi-square, Fisher’s exact test, independent t-test, and ROC analysis.
Results: SOFA scores showed significant correlation with maternal outcomes: 70% recovered, 20% developed complications, and 10% died (p=0.015). ICU admission was associated with higher qSOFA scores in 80% of patients (p=0.007). SOFA demonstrated superior sensitivity (85%) and specificity (90%) for mortality prediction compared to qSOFA (70% and 75%, respectively; p=0.013).
Conclusion: qSOFA is a useful triage tool for rapid assessment, while SOFA provides greater prognostic accuracy. A combined approach may improve management of obstetric sepsis
Association of prothrombin gene mutation (G20210A) with recurrent pregnancy loss
Get PDFBackground: Recurrent pregnancy loss (RPL) is a significant reproductive health concern, often with multifactorial etiologies. Among the possible causes, thrombophilic gene mutations, such as the Prothrombin G20210A mutation, has the most potential role. This study aimed to investigate the association between Prothrombin G20210A gene mutation and RPL in a selected group of Bangladeshi women.
Methods: This case-control study was carried out in the outpatient Department of Fetomaternal Medicine, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh, from December 2020 to May 2021. Total 35 women with history of recurrent pregnancy losses were selected as cases. The control group consisted of 35 women with at least one successful pregnancy and no history of recurrent pregnancy loss.
Results: Out of 35 cases two patients have Prothrombin gene mutation, one in 1st trimester and another in 2nd trimester. One was primary RPL and another one was secondary RPL. Normal homozygous (GG) were 94.3% and mutant heterozygous (GA) were 5.7%, mutant homozygous (AA) were 0.0% in case group. In control group there were no mutation of prothrombin gene (G20210A). The difference was statistically not significant (p=0.421) between two groups. Fisher exact test was done. This test was done to see the results were statistically significant or not. It is usually employed when sample sizes are small but it is valid for all sample sizes.
Conclusions: This study found no statistically significant association between the Prothrombin G20210A gene mutation and recurrent pregnancy loss. Although 5.7% of cases had heterozygous mutations, none were observed in controls
Assessment of breastfeeding knowledge, attitudes and practices among postpartum women at a tertiary healthcare setting in Ahmedabad, Gujarat: implications for maternal and child health
Get PDFBackground: Breastfeeding is essential for a child’s overall health and development. Breast milk provides all the vital nutrients needed for growth and well- being while offering immunity against various infectious and non-infectious diseases. Ideal breastfeeding practices include early initiation, exclusive breastfeeding for the first six months and continued breastfeeding for up to two years alongside complementary foods.
Methods: Women getting delivered at a tertiary care teaching hospital were surveyed and their responses were recorded on a detailed questionnaire. Appropriate analysis was performed to assess the awareness of breastfeeding.
Results: The sample of this study comprised of 150 mothers out of which maximum (60.67%) were in the age group of 18-26 years with mean age 26.2 years and standard deviation of 5.68. This study found that 85.33% of the mothers were aware of the importance of breastfeeding while only 56% of mothers were aware of the benefits of colostrum. A small proportion of mothers, specifically 6.67%, expressed fear that breastfeeding might alter their body image. Only 56.6% mothers initiated breastfeeding within 1 hour of delivery while 92.66% mothers fed colostrum to their newborns.
Conclusions: This study revealed a general awareness of breastfeeding among participants but limited knowledge regarding benefits of colostrum. Early weaning is still being practiced and timely initiation of breastfeeding within the first hour after birth was not universally adhered to
The wandering fibroid: a case report and an approach in reducing its incidence of future cases
Get PDFUterine fibroids are one of the most common tumours found in women of reproductive age group. parasitic or wondering fibroid are rare extra uterine benign tumours. Due to its atypical presentations and locations, these tumours cause dilemma to reach to a correct diagnosis pre operatively. Here is a case report where a 44-year-old female presenting with lower abdominal pain with a prior history of laparoscopic myomectomy with a diagnosis of leiomyoma on MRI turned out to be parasitic fibroid intra operatively
A case series on uterine inversion: diagnostic and surgical considerations
Get PDFUterine inversion defined as descent of fundus of uterus to or through the cervix, so uterus is turned inside out. It may be puerperal and non-puerperal/gynecological, the latter being extremely rare. This rarity, delayed presentation and atypical presentation contribute to the clinical challenges. We present a case series four cases of uterine inversion including three cases of gynecological inversion and one case of puerperal inversion, managed at a tertiary care hospital in India. Clinical presentation, diagnostic methods, surgical techniques, and outcomes were documented. Non-puerperal cases were associated with submucosal fibroids and presented with mass protrusion, bleeding, and urinary complaints. Diagnosis was confirmed using clinical examination and magnetic resonance imaging (MRI). Surgical management included Huntington’s and Haultain’s techniques followed by hysterectomy. The puerperal case presented with acute hemorrhage postpartum and was managed successfully with Johnson’s maneuver and uterine balloon tamponade. It could be concluded from series that non-puerperal uterine inversion requires individualized surgical management based on underlying pathology. Acute puerperal inversion demands rapid resuscitation and repositioning to reduce maternal morbidity. MRI plays a pivotal role in diagnosis and planning. This series delineates the challenges involved in the diagnosis and operative management of the condition
Effects of modified Elkin’s procedure along with specific breech exercises in breech repositioning and to determine the feasibility of normal delivery: an experimental study
Get PDFBackground: Breech presentation is observed in 3-4% of pregnancies at term and is one of the leading causes of caesarean section. Babies with breech presentation are at increased risk of complications during birth. An experimental study was conducted to demonstrate the effects of the Modified Elkin’s procedure and specific breech exercises. However, there is a lack of evidence suggesting which technique is superior in reducing the risk associated with vaginal delivery in breech presentation.
Methods: This experimental study enrolled 123 subjects diagnosed with breech presentation by ultrasonography during the third trimester. Participants in the experimental group were instructed to perform the Modified Elkin’s procedure along with specific breech exercises. These interventions were designed to be safe and simple and were found to significantly aid in breech repositioning, thereby increasing the feasibility of normal delivery. The study duration was 8 months. Treatment consisted of three sessions per week on alternate days for 4 weeks, including rest periods. Exercises were advised for women with fetuses in breech presentation.
Results: The results of the study showed a marked difference between the pre- and post-test values. After completing the full set of exercise sessions, there was a significant improvement in breech repositioning and an increased likelihood of normal delivery.
Conclusions: This trial revealed that 4 weeks of treatment using the Modified Elkin’s procedure along with specific breech exercises is effective for breech repositioning. Based on the results, this technique appears to be a simple, less painful, and safe option for managing breech presentation in the third trimester of pregnancy. It may also influence the mode of delivery