International Journal of Reproduction, Contraception, Obstetrics and Gynecology
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Cervico-isthmic compression suture: an effective method to manage PPH during caesarean-section for placenta previa
Get PDFBackground: Obstetric hemorrhage is the leading cause of maternal mortality, placenta previa and placenta accreta spectrum (PAS) are major causes of it. Most of time these bleeding don’t respond to uterotonics drugs in placenta previa. In failed first-line management of PPH, cervico-isthmic compression sutures are effective to control PPH from lower uterine segment in placenta previa. The objectives of this study were to determine effectiveness of Cervico-isthmic compression suture in management of PPH during caesarean section for placenta previa the primary outcome was assessed by the need of blood transfusion, caesarean hysterectomy, ICU care, total hospital stay and incidence of maternal mortality and the secondary outcome was to describe the complications of the procedure in peri-operative periods.
Methods: This retrospective study was carried out in the department of obstetrics and gynecology, ANMMCH, Gayajee, from April 2025 to March 2023. It included 36 patients of placenta previa in which cervico- isthmic compression suture was applied.
Results: In the study group the mean age was 27±4.18 years. The gestational age at the time of delivery ranges from 32.3 to 37.4 weeks. Postpartum hemorrhage was adeptly managed with the compression sutures in 34 patients (94.45%), while in 2 patients (5.5%), caesarean hysterectomy was needed. Notably, 66.66% of patients (n=24/36) necessitated blood transfusions during peri-operative periods. There was no any recorded maternal mortality.
Conclusions: Cervico-isthmic compression suture is a simple, quick and effective measure for intractable bleeding from placental bed or atonic lower uterine segment in cases of placenta previa
Effect of maternal blood transfusion versus maternal parenteral iron therapy on fetal vascular adaptation: an observational study in a tertiary care hospital in North India
Get PDFBackground: Maternal anemia, particularly with haemoglobin levels below 7g/dl, is associated with significant fetal hemodynamic adaptations that may impact perinatal outcomes. This study aimed to evaluate the effects of maternal anemia on fetal doppler indices and assess changes after treatment with blood transfusion versus parenteral iron therapy.
Methods: A prospective study was conducted over a period of 12 months at GMC Srinagar, including 80 pregnant women (32-36 weeks gestation) with severe anemia (Hb<7g/dl). Participants were divided into two groups: Group 1 (blood transfusion) and Group 2 (parenteral iron therapy). Hematological parameters and fetal doppler indices (umbilical artery resistive index [UA RI] and middle cerebral artery resistive index [MCA RI]) were measured at admission, two weeks, and four weeks post-treatment. Statistical analysis was performed using SPSS Version 20.0.
Results: At baseline, Group 1 had significantly lower hemoglobin (5.69±0.54g/dl) than Group 2 (6.46±0.29g/dl, p<0.001). Post-treatment, Hb levels improved to 8.18±0.33g/dl (Group 1) and 8.05±0.22g/dl (Group 2, p=0.116), with a greater increase in Group 1 (2.48±0.77g/dl vs. 1.59±0.18g/dl, p<0.001). Doppler indices showed a significant reduction in UA RI and an increase in MCA RI in both groups (p<0.001).
Conclusions: Both blood transfusion and parenteral iron therapy effectively improved maternal hematological status and fetal doppler parameters. However, blood transfusion led to a faster correction of anemia. Regular doppler monitoring allows for timely assessment of fetal adaptation and intervention, improving perinatal outcomes
A comparative study on MgSO₄ and nifedipine as acute tocolytic agents in preterm labour
Get PDFBackground: Preterm labour is a major cause of neonatal morbidity and mortality. Tocolysis helps delay delivery, allowing time for antenatal corticosteroids and in-utero transfer. Magnesium sulphate (MgSO4) and nifedipine are commonly used agents, but comparative evidence is limited. To compare the efficacy and safety of MgSO₄ and nifedipine as acute tocolytics in preterm labour.
Methods: This randomized controlled trial at a tertiary care centre - GMC Akola, enrolled 100 women between 28–34 weeks of gestation with preterm labour. Participants were randomly allocated to receive either MgSO₄ (loading dose 4 g IV, followed by 1 g/hr infusion) or oral nifedipine (10 mg every 20 min up to 3 doses, then 20 mg every 4-6 hrs for 24 hrs). Outcomes assessed were uterine quiescence, prolongation of pregnancy ≥48 hrs, maternal side effects, and neonatal outcomes.
Results: Labour was arrested in 92% of women treated with MgSO₄ and 90% with nifedipine. MgSO₄ achieved slightly higher rates of uterine quiescence and prolongation beyond 48 hrs. NICU admissions were lower with MgSO₄ (38% vs 44%), as was neonatal mortality (10% vs 14%). Side effects were mild and comparable: hot flushes/lethargy with MgSO₄ and tachycardia/headache with nifedipine. No serious adverse events occurred.
Conclusion: Both MgSO₄ and nifedipine are effective and safe tocolytic agents. MgSO₄ offers a marginal advantage in prolonging gestation and provides fetal neuroprotection, whereas nifedipine is simpler to administer and cost-effective in low-resource settings
Comparative study of maternal and perinatal outcomes between elective and emergency caesarean section in term pregnancy at a tertiary care centre
Get PDFBackground: One of the most common surgical procedures done worldwide is the Caesarean section. The goal of the current study is to ascertain the problems and outcomes for mothers and newborns in two groups of pregnant women who had elective and emergency caesarean sections. So that measures can be taken to reduce morbidity and mortality in near future.
Methods: A prospective comparative observational study carried out in department of Obstetrics and Gynecology, Jawaharlal Nehru Hospital and Research Centre, Bhilai, Chhattisgarh. All patients who underwent caesarean section are divided into two groups elective and emergency. Two groups were compared on the basis of different parameters like age, parity, booking status, indication, maternal and neonatal complications.
Results: The incidence of caesarean section was 51.15%. The proportion of elective and emergency CS was 39.55% and 60.44% respectively. Most of the complications were more common in emergency group.
Conclusions: The incidence of caesarean section is high in JLNH&RC, Bhilai and overall complication rate was more common in emergency group
Modern contraceptive method utilization among mothers of children aged 7 to 24 months at the Yalgado Ouédraogo University Hospital, Burkina Faso, West Africa
Get PDFBackground: This study aimed to examine the use of modern contraceptive methods among mothers of children aged 7 to 24 Months at Yalgado Ouédraogo University Hospital (CHU-YO) in Ouagadougou, Burkina Faso.
Methods: An analytical cross-sectional survey was conducted among 412 women who had delivered at CHU-YO and whose infants were between 7 and 24 months of age. A structured questionnaire was used to collect data on sociodemographic characteristics, obstetric history, and modern contraceptive use. Data analysis using R software identified associations between modern contraceptive use and various factors.
Results: The study found a 69.2% prevalence of modern contraceptive use among participants. The progestin implant and intrauterine device (IUDs) were the most commonly used methods. Factors associated with modern method use included age over 30 years, higher level of education, having at least two living children, having received family planning counseling, and having given birth by cesarean section. Factors associated with the use of long-acting methods in the multivariate analysis were being married, having received family planning counseling during pregnancy or in the postpartum period, having had a cesarean delivery, and being overweight (BMI ³ 24.5 kg/m2). Factors associated with the use of hormonal methods in multivariate analysis were having received family planning counseling during pregnancy or in the postpartum period and having had a vaginal delivery.
Conclusions: The use of modern contraceptive methods was higher among mothers of children aged 7 to 24 months than in the general population. However, factors such as age, level of education and having received family planning advice influenced women's contraceptive use. Health professionals need to explore ways to further improve the use of modern contraceptives
Asymptomatic bacteriuria in HIV positive and negative pregnant women at Federal University Teaching Hospital Lafia: a comparative study
Get PDFBackground: Pregnant women with asymptomatic bacteriuria (ASB) are at increased risk of complicated urinary tract infection. The prevalence and risk of progression may be higher with background human immunodeficiency viral (HIV) infection. The aim of the study was to compare the prevalent microbial isolates and antibiotic sensitivity pattern in asymptomatic bacteriuria among HIV positive and negative antenatal clients in Federal University Teaching Hospital (FUTH), Lafia.
Methods: A cross sectional comparative study carried out among 60 HIV positive and negative antenatal women respectively at the obstetric unit of FUTH, Lafia, Nasarawa state. Relevant Socio-demographic and clinical data were collected using structured proforma. ‘Clean catch’ midstream urine samples were collected from each subject and microbial culture and sensitivity test were carried out and analysis done using SPSS version 22. A p-value of less than 0.05 was accepted as statistically significant.
Results: The overall prevalence of ASB in both groups was 53.3% with a higher prevalence of 54.7% HIV positive compared to the prevalence of 45.3% in HIV negative pregnant women. Echerechia coli were the commonest organisms isolated and majority of the organism isolated were gram negative. Ciprofloxacin was the antibiotics with the best sensitivity. However, there is a marked resistance of greater than 50% of all the drugs.
Conclusions: Though there is high prevalence of ASB in HIV positive women than the HIV negative pregnant women, there was no statistically significant difference in prevalence, microbial isolates and antibiotic sensitivity in the two groups
Lateral cervical fibroid: a case report with review of literature
Get PDFCervical fibroid constitutes 1-2% of total fibroids and is usually solitary as the cervix is deficient in myometrium. It is classified into anterior, posterior, lateral, and central depending on its location. Being estrogen dependent, it is common in the reproductive age group. Lateral cervical fibroids constitute 10.26% of total cervical fibroids as reported by one retrospective observational cohort study. Symptoms of lateral cervical fibroid are vague and depend on its site and size. Chronic pelvic pain, dyspareunia, abnormal vaginal bleeding, and pressure effect on bowel in a left-sided lesion are the usual symptoms in a lateral cervical fibroid. As it grows into the broad ligament, compression of the ipsilateral ureter with renal affection is early. The patient’s obstetric outcome is likely to be affected. Pressure on pelvic vessels may cause hemorrhoids and edema in the legs. Growth and extension of this fibroid into the broad ligament distorts pelvic anatomy. Its definitive management is surgery, which is very challenging to the surgeon, with increased risk of ureteric damage and excessive hemorrhage. We report a case of lateral cervical fibroid of 08.5×05.0 cm with constipation, and menorrhagia; foul-smelling vaginal discharge and post-coital bleeding in a 38-year-old parous lady. Total abdominal hysterectomy with bilateral salpingectomy and right oophorectomy was done under regional anesthesia. Histopathological examination confirmed the diagnosis of right lateral cervical leiomyomas, sub-mucous fibroid polyp in the uterus, and excluded malignancy. The surgery was uneventful, and the patient remained asymptomatic and healthy during postoperative follow-up. Although the incidence is low, lateral cervical fibroids are more likely to distort the pelvic anatomy around important viscera, affecting other systems early, and surgery is challenging.
An unusual case of tubercular tubo-ovarian abscess in a sexually inactive female: a diagnostic dilemma
Get PDFTubo-ovarian abscess (TOA) is usually encountered in sexually active women as a complication of pelvic inflammatory disease (PID). Its occurrence in sexually inactive patients is extremely rare and suggests atypical etiologies, including genital tuberculosis (GTB). We report a rare case of a sexually naïve young woman with a giant TOA due to isolated ovarian tuberculosis. This case highlights the diagnostic dilemma when tuberculosis mimics adnexal malignancy or pyogenic abscess and underscores the importance of maintaining a high index of suspicion, particularly in tuberculosis-endemic regions
Association of thyroid dysfunction and hyperprolactinemia with subfertility in women at a tertiary care hospital
Get PDFBackground: Endocrine abnormalities, particularly thyroid dysfunction and hyperprolactinemia, are recognized contributors to female subfertility. Both disorders are potentially correctable causes of impaired reproductive function through their effects on the hypothalamic-pituitary-ovarian axis. This study aimed to investigate the association between thyroid dysfunction and hyperprolactinemia with subfertility in women attending a tertiary care hospital in Bangladesh.
Methods: This case-control study was conducted at the department of obstetrics and gynecology, BIRDEM General Hospital, from January 2022 to March 2024. A total of 100 women were enrolled in the study: 50 subfertile (cases) and 50 fertile (controls). The demographic and clinical characteristics were recorded. Serum TSH, FT3, FT4, and prolactin levels were measured using chemiluminescent magnetic microparticle assays. Thyroid status and prolactin levels were compared. The correlation between TSH and prolactin levels was assessed using Pearson’s test.
Results: Thyroid dysfunction was observed in 16% of subfertile women compared to 6% of controls. Hyperprolactinemia was significantly more frequent among cases (32% versus 10%, p=0.007). A moderate positive correlation was found between TSH and prolactin in the case group (r=+0.537, p<0.001) and a weak positive correlation in the control group (r=+0.263, p=0.065).
Conclusions: Thyroid dysfunction and hyperprolactinemia were more prevalent among subfertile women and were strongly associated. Routine screening for thyroid and prolactin abnormalities should be incorporated into infertility evaluations, as correction of these disorders may restore fertility
From infection to hypertension: exploring the association between urinary tract infection and development of preeclampsia
Get PDFBackground: Preeclampsia remains a major cause of maternal and perinatal morbidity, presenting with hypertension and proteinuria after 20 weeks of gestation. Although multifactorial in origin, maternal inflammatory and endothelial dysfunction play crucial roles in its pathogenesis. Urinary tract infection (UTI), a common condition in pregnancy, has been proposed as a potential trigger for systemic inflammation contributing to preeclampsia. This study aimed to evaluate the association between UTI and the subsequent development of preeclampsia among pregnant women attending a tertiary care hospital in Chennai.
Methods: A prospective cohort study was conducted from October 2023 to October 2024 at Madras Medical College, Chennai. A total of 116 pregnant women were enrolled and categorized into UTI (n=58) and non-UTI (n=58) groups based on urine routine and culture findings. Participants were followed throughout pregnancy with serial assessments of blood pressure, urine albumin, and clinical parameters each trimester. Statistical analysis was performed using Chi-square and Fisher’s exact tests, and relative risk was calculated to estimate the strength of association.
Results: UTI occurred most frequently in the first trimester, whereas preeclampsia was mainly observed in the third trimester. Among women with UTI, 60% developed preeclampsia compared to 18.7% without UTI, yielding a relative risk of 3.2, signifying a significant association.
Conclusions: UTI in pregnancy was associated with a 3.2-fold increased risk of preeclampsia. Early identification and prompt treatment of UTI may reduce preeclampsia-related complications. Further large-scale studies are needed to confirm this relationship