International Journal of Reproduction, Contraception, Obstetrics and Gynecology
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Knowledge, attitudes and perceptions towards utilization of bilateral tubal ligation among married women of reproductive age (15-49 years) in Kasgunga Ward, Homabay County, Kenya
Get PDFBackground: Approximately 20% of women of reproductive age in developing countries would prefer to ultimately stop bearing children after attaining their desired family size, however, they are faced with over 26% rate of unmet modern family planning methods such as bilateral tubal ligation (BTL). Objectives were to assess knowledge, attitude and perceptions on the utilization of BTL among the married women in Kasgunga ward and to measure the association between education level, income, number of children and the use of BTL.
Methods: A cross-sectional study design was used to collect data related to knowledge, attitude and perceptions among 399 married women in Kasgunga Ward, Homabay County, Kenya.
Results: Only 36 (35.1% of those who had reached the desired number of children said they would consider using BTL after discussing it with their husbands. Eighty-two (79.6%) of study participants cited not considering busing BTL as it was against their culture, and 137 (66%) that it was against their religious beliefs. Forty-nine (47.2%) of the women would go on to have BTL, whether or not their husbands approved of it. The cross-tabulation indicated that the use of BTL was most common among women with more than 5 children (80.0%) compared to 20.0% in women with 3-5 children and none in those with 0-2 children, with a statistically significant association, χ²(2)=107.75, p<0.001.
Conclusions: This study demonstrated that knowledge, attitudes, and perceptions influence the utilization of BTL among married women of reproductive age
A study on the role of endoscopic evaluation in subfertile couples undergoing treatment for infertility
Get PDFBackground: Infertility affects approximately 10-15% of couples globally, with increasing numbers seeking medical assistance. Endoscopic procedures such as laparoscopy and hysteroscopy play a pivotal role in identifying and managing anatomical causes of female subfertility. This study aimed to evaluate the diagnostic and therapeutic value of endoscopic evaluation in subfertile couples undergoing infertility treatment.
Methods: This prospective observational study was conducted in the Department of Obstetrics and Gynaecology, Government Medical College, Akola, from September 2023 to June 2025. A total of 116 subfertile women aged 18-35 years with primary or secondary infertility underwent combined laparoscopy and hysteroscopy. Demographic, clinical, and endoscopic findings were analysed, and patients were followed up for six months to assess conception outcomes.
Results: The majority of participants (87.93%) were aged 26-35 years, with primary infertility comprising 66.38% of cases. Laparoscopic abnormalities were found in 44.83% of patients tubal (27.58%), ovarian (17.24%), uterine (13.79%), and peritoneal (5.17%) factors. Hysteroscopy revealed abnormalities in 32.76% of women, the most common being endometrial polyps (12.94%) and submucous fibroids (6.90%). Therapeutic procedures such as adhesiolysis, septal resection, and polypectomy were performed in 41 patients. Within six months, 59.72% of women achieved conception.
Conclusions: Combined laparo-hysteroscopic evaluation serves as a safe, effective, and comprehensive modality for both diagnosis and treatment of female infertility. Early integration of endoscopy in infertility work-up enhances detection of correctable pathology and improves conception outcomes, particularly in unexplained or long-standing infertility
A comparative study between cerviprime gel and misoprostol for induction of labour in term pregnancy with unfavourable Bishop’s score: a randomised controlled clinical trial
Get PDFBackground: Induction of labor (IOL) is a common obstetric intervention performed when benefits outweigh risks of continuing pregnancy. Cervical ripening using prostaglandins like dinoprostone (cerviprime) and misoprostol improves induction outcomes. This study compared their efficacy in term pregnancies with unfavorable Bishop’s score, evaluating induction and need for augmentation.
Methods: This randomized controlled clinical study was conducted over 18 months in the department of obstetrics and gynecology at a tertiary care centre among 100 term pregnant women (≥37 weeks) with an unfavourable Bishop’s score requiring induction of labour. Participants were randomized into two groups: 50 received intravaginal misoprostol (25μg, repeated every 4 hours) and 50 received intracervical dinoprostone gel (0.5 mg, repeated every 6 hours).
Results: A total of 100 pregnant women were studied, divided between the cerviprime and misoprostol groups. The mean age was comparable (33.09±9.56 years vs. 32.54±9.57 years). The time from induction to initiation of labour was significantly shorter in the misoprostol group (≤6 hours in 82% versus 58%; p<0.05). Vaginal delivery occurred in 84% of misoprostol cases and 76% of cerviprime cases. Misoprostol significantly shortened the induction-delivery interval (p<0.02). Oxytocin augmentation was required less often with misoprostol (46% versus 60%; p=0.16).
Conclusions: Vaginal misoprostol demonstrated greater efficacy than intracervical dinoprostone gel (cerviprime) for labour induction in term pregnancies with unfavourable Bishop’s scores, achieving shorter induction-to-delivery intervals without increasing maternal or neonatal complications, making it a safe and effective alternative
Pregnancy outcome in a woman with congenital adrenal hyperplasia: a rare case report
Get PDFCongenital adrenal hyperplasia (CAH) refers to family of inherited disorders of adrenal steroidogenesis caused by mutations in genes encoding steroidogenic enzymes involved in glucocorticoid synthesis/in cofactor enzyme P450 oxidoreductase that serves as electron donor to CYP21A2 and CYP17A1 with autosomal recessive inheritance pattern. A 24-year-old primigravida with simple virilizing CAH who underwent reconstructive surgery in childhood. During pregnancy, she developed severe preeclampsia requiring preterm emergency caesarean delivery at 30+6 weeks period of gestation. Stress steroid supplementation was administered intrapartum. Both mother and neonate had a favourable outcome with close multidisciplinary management. Early diagnosis, timely reconstructive surgery, optimized steroid replacement, and multidisciplinary care are crucial for favourable maternal and neonatal outcomes in CAH pregnancies
Fertility preservation in a young female with rectal mucinous adenocarcinoma and tailgut cyst: a multidisciplinary case report
Get PDFColorectal cancer (CRC) in women of reproductive age is rare, and its coexistence with congenital lesions such as tailgut cysts is exceptionally uncommon. Moreover, fertility preservation during multimodal oncologic therapy remains an evolving domain in young rectal cancer patients. We report a 22-year-old female, gravida 2 para 1, who presented with altered bowel habits. Imaging revealed an irregular rectal mass with posterior fat plane loss and a presacral cystic lesion suggestive of a tailgut cyst. Biopsy confirmed moderately differentiated mucinous adenocarcinoma of the rectum. Given the need for pelvic radiotherapy, ovarian transposition was performed to preserve fertility. The patient subsequently received 28 sessions of radiotherapy followed by six cycles of neoadjuvant CAPOX chemotherapy (capecitabine and oxaliplatin). Abdominoperineal resection was later performed, during which the presacral lesion was excised and confirmed histologically as a benign tailgut cyst. Post-treatment monitoring showed normalization of carcinoembryonic antigen (CEA) levels and no evidence of recurrence. This case highlights the importance of a multidisciplinary approach incorporating early diagnosis, fertility-preserving surgical strategies, and contemporary chemoradiation protocols. While ovarian transposition demonstrated preserved ovarian function, long-term follow-up remains crucial. The coexistence of a tailgut cyst and rectal adenocarcinoma in such a young patient raises potential embryological and oncogenic associations that merit further investigation. Fertility preservation should be an integral component of CRC management in young women. This case underscores the feasibility of successful oncologic and reproductive outcomes through personalized, multidisciplinary care
Study of maternal and fetal outcomes in abruptio placenta at a tertiary care institute
Get PDFBackground: This study aimed to determine the maternal and fetal outcomes in cases of abruptio placentae at a tertiary care institute.
Methods: This prospective observational study was conducted from November 2022 to June 2024 at Lokmanya Tilak Municipal Medical College and Hospital, Sion, Mumbai. Out of 14,780 deliveries that occurred in this period, 143 were selected. The study included patients diagnosed with placental abruption, either clinically or radiologically, who presented to the ANC ward and consented to participate.
Results: The study found a 0.9% incidence of placental abruption, predominantly seen in multigravida (68.5%) and women aged 21-30 years (70%). More than two-thirds of babies were born prematurely. The most common symptoms were vaginal bleeding and abdominal pain (75.5%), and hypertensive disorders of pregnancy were the most common associated factor (55.9%). Around 91.6% required lower segment cesarean section. 58.7% required blood transfusion. Complications included shock (4.2%), DIC (14.7%), acute renal failure (4.9%), sepsis (2.1%), cesarean hysterectomy (0.7%), and maternal mortality (0.7%). Additionally, 28% of women required ICU admission. The study found that 74.8% of deliveries resulted in live births, while 25.2% were stillbirths. Among the live births, 67 babies required NICU admission, and 7 (6.54% of live births) resulted in neonatal mortality.
Conclusions: Abruptio placenta is a life-threatening complication of pregnancy and is associated with poor maternal and fetal outcomes if not managed appropriately. Hence, early diagnosis and prompt resuscitative measures would prevent both perinatal and maternal mortality and morbidity
Correlation between red cell indices and serum ferritin level in pregnant women with latent iron deficiency
Get PDFBackground: Latent iron deficiency (LID), defined as iron depletion without anemia, frequently precedes iron deficiency anemia in pregnancy and is associated with adverse maternal and fetal outcomes. Serum ferritin is the gold standard for assessing iron stores but is often unavailable in low-resource settings. Readily obtainable red cell indices may serve as practical alternatives for identifying early iron deficiency. This study aimed to evaluate the relationship between red cell indices and serum ferritin levels among pregnant women with latent iron deficiency.
Methods: This cross-sectional analytical study was conducted at Sir Salimullah Medical College Mitford Hospital, Dhaka, including 205 non-anemic pregnant women in their second trimester. Complete blood count and serum ferritin were assessed using automated analyzers. Participants were categorized as latent iron-deficient (ferritin <30 µg/L) or non-deficient (≥30 µg/l). Group differences were compared using independent t-tests, and correlations between red cell indices and ferritin levels were analyzed using Pearson’s test.
Results: Mean MCV and MCH were lower in the latent iron-deficient group, though not significantly (p>0.05). RDW-CV% was significantly higher in LID women (15.3±1.6 vs 14.1±1.6, p<0.001). A significant negative correlation was observed between RDW-CV% and serum ferritin (r = -0.347, p<0.001).
Conclusions: RDW-CV% demonstrates a strong negative correlation with serum ferritin and may be used as a sensitive hematologic marker for early detection of latent iron deficiency in pregnancy. Integrating RDW interpretation into routine antenatal blood count assessments can improve screening and management of iron deficiency in resource-limited settings
Double placenta in a singleton pregnancy: a case report
Get PDFTwo placentas in singleton pregnancy with fused umbilical cord which has its own placental insertion site forming 3-vessel cord at fetal end is an extremely rare case. We present a case which describes two placentas with fused umbilical cord. A 37-year-old woman, height of 152 cm, gravida 0, para 0, conceived by IVF with ovum donation in a FET cycle with two embryos transferred, visited our clinic regularly during the antenatal period. The 1st trimester scan at 6 weeks showed DCDA twin but at 11 weeks combined 1st trimester screening test, the scan showed single fetus with demise of the second twin. The 1st trimester scan and anomaly scan did not reveal any double placenta. Later the ultrasound showed the second twin to have become a re-absorbed vanishing twin with single placenta only. The last ultrasound scan done for estimating the growth of the fetus and doppler velocimetry suddenly started showing large for date fetus. The patient was normotensive, non proteinuric and without any medical comorbidities throughout her antenatal period. We did Oral glucose tolerance test at every trimester to rule out diabetes mellitus. Serial growth scans done at 28, 30, 32 and 34weeks all showed the fetus to be large for gestational age. At 37 weeks and 4 days, the patient delivered a viable female infant weighing 3100 g via caesarean section and postpartum examination of the placentas and membranes showed two placentas with fused umbilical cord. Two placentas were almost equal in size and there were 2 cord insertions, 1 into each placenta. The cord at each of the placental disc had marginal insertion site and main placental disc cord had 2 arteries with one vein (3 vessel-cord) whereas side placental disc cord had one artery with one vein (2 vessel-cord).
Navigating gallstones in pregnancy: a case of surgical precision and obstetric vigilance
Get PDFGallstone disease during pregnancy poses clinical challenges due to altered physiology and concerns over fetal safety. We present the case of a 28-year-old primigravida who had undergone endoscopic retrograde cholangiopancreatography (ERCP) with biliary stenting for choledocholithiasis prior to conception. She remained asymptomatic during early pregnancy, with normal liver function and no signs of cholecystitis on magnetic resonance cholangiopancreatography (MRCP). After multidisciplinary evaluation, laparoscopic cholecystectomy was performed during the second trimester using fetal-safe anaesthetic techniques and open abdominal access. The procedure was uneventful, and recovery was smooth. She later delivered a healthy term infant via spontaneous vaginal delivery at 37 weeks. This case supports the growing evidence that laparoscopic cholecystectomy, when carefully timed and executed, is a safe and effective treatment for gallstone disease in pregnancy
A randomized controlled trial comparing labor induction at 40 versus 41 weeks in low-risk post-date pregnant women
Get PDFBackground: To determine effect of expectant management till 41 weeks versus labor induction (IOL) at 40 weeks, on spontaneous labor onset (SOL), in low-risk post-date (>40 weeks) women.
Methods: A randomized controlled trial was conducted among low-risk post-date women. At enrolment two hundred women were randomized (group 1; IOL at 40 weeks versus group 2; expectant management till 41 weeks). Demographic and clinical data were collected at enrolment and delivery.
Results: Three-fourth of women (76%) in group 2 had SOL. Additionally, duration of labor (minutes) [median±IQR; 380 (325-417) versus 410 (380-482), p<0.001], delivery within 12 hours (n; 87 versus 45, p<0.001) and within 12-24 hours of admission (n; 1 versus 42, p<0.001) was statistically significantly better in group 2. There was no statistically significant difference regarding mode of delivery (n) [vaginal delivery; 87 vs. 88, or cesarean section (CS); 13 versus 12, p=0.887] and indications of CS (fetal distress; 12 versus 12, and failure of induction of labor 1 versus nil, p=1.000) and maternal and fetal/neonatal outcomes. With an absolute risk of 21% of SOL, five women should be offered expectant management till 41 weeks for one woman to have SOL.
Conclusions: In low- and middle-income countries, low-risk post-date pregnant women should be offered expectant management of pregnancy till 41 weeks awaiting spontaneous labor (76%), with maternal and fetal/neonatal outcomes comparable to routine IOL at 40 weeks