International Journal of Reproduction, Contraception, Obstetrics and Gynecology
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The interrelationship between abnormal vaginal discharge, genital hygiene practices, and sexual behaviours among women of reproductive age in Ibadan, Nigeria
Get PDFBackground: Abnormal vaginal discharge (AVD) is a common condition in women, often linked to infections and reproductive health complications. This study investigates the prevalence of AVD among women in Ibadan, Nigeria, and assesses its relationship with genital hygiene practices, and sexual behaviors.
Methods: A cross-sectional study was conducted among 366 women aged 18-49 using structured interviewer-administered questionnaires. Data were analyzed using Pearson correlation and linear regression models in statistical package for the social sciences (SPSS) 25.0.
Results: The prevalence of AVD was 42.1%, with 59.2% of affected women not seeking medical care due to financial constraints, stigma, or misconceptions. Poor genital hygiene (r=0.278, p=0.002) and risky sexual behaviours (r=-0.327, p=0.000) significantly increased AVD occurrence. Most women (90.2%) used water for genital cleaning, while 21.3% used soap and 16% relied on specialized hygiene products. Additionally, 41% of women used contraception, but only 27.1% used it consistently. Cultural influences such as: taboo, limited access to hygiene education, use of traditional herbs (OR=1.89, 95% CI: 1.02–3.51, p=0.042) also played a significant role in hygiene practices. Almost a quarter, 23.2%, of participants reported that AVD negatively affected their intimate relationships.
Conclusions: The findings underscore the necessity for public health initiatives that enhance genital hygiene education, promote safer sexual practices, and improve access to healthcare services. Addressing cultural and societal barriers such as stigma and religious norms is crucial to improving reproductive health outcomes and reducing complications associated with abnormal vaginal discharge among women in Ibadan
A case report on ovarian torsion after ovarian stimulation
Get PDFOvarian torsion is a rare but serious cause of acute abdominal and pelvic pain in women, accounting for 2.7% of gynecologic emergencies. The incidence of ovarian torsion has been reported to be increased due to ovarian hyper stimulation. The incidence increased to 6 % under stimulation for assisted reproductive technology (ART) and to 16 % with ovarian hyperstimulation syndrome (OHSS). Although the delay in diagnosis from symptom onset is common, rapid diagnosis of ovarian torsion is imperative to prevent morbidity. The gold standard to treat ovary torsion is surgery, and this is also the only way to confirm the torsion. Here is a case report of a 31-year-old lady with a history of infertility underwent two cycles of ovulation induction and intrauterine insemination (IUI), presented with acute pain abdomen as well as a history of a similar episode two months earlier. A preoperative diagnosis of an ovarian cyst with suspicion of torsion was made and laparoscopy was performed. Intraoperative diagnosis of left ovarian torsion due to dermoid cyst was done and ovary untwisted and fixed to the round ligament, cyst was removed, and ovarian tissue was conserved. Patient was followed up until pregnancy and delivery
Identification of risk factors of premature rupture of membrane at a tertiary care centre: a case-control study
Get PDFBackground: Premature rupture of membranes (PROM) is a critical issue in obstetrics, occurring in 3-4% of pregnancies and accounting for 40-50% of preterm births. This study aims to identify risk factors associated with premature rupture of membranes in women who deliver at tertiary care centre.
Methods: This research is a case-control study conducted with 240 women at the Department of Obstetrics and Gynaecology, People's College of Medical Sciences and Research Institute, Bhopal. The study comprised 80 cases and 160 controls in a 1:2 ratio.
Results: There were no significant demographic differences between cases and controls. However, significant differences were found in past obstetric and gynecological histories. PROM was strongly associated with previous PROM (Adjusted OR: 4.62, 95% CI: 2.06-10.52), previous lower segment cesarean section (LSCS) (Adjusted OR: 2.08, 95% CI: 1.14-6.74), abnormal vaginal discharge (AOR: 2.35, 95% CI: 2.53-22.46) and urinary tract infections (UTI) (AOR: 3.40, 95% CI: 6.56-13.04).
Conclusions: Key risk factors for premature rupture of membranes include previous PROM, LSCS, abnormal vaginal discharge and UTIs. Addressing these factors is crucial for preventing PROM and enhancing maternal and fetal health outcomes
Impact of multidisciplinary team simulation-based training of residents to improve the outcome of operative vaginal deliveries and obstetric emergencies
Get PDFBackground: Obstetric emergencies such as eclampsia, atonic postpartum hemorrhage and maternal collapse, use of vacuum or forceps for operative vaginal deliveries are high pressure situations where residents don’t feel very confident due to lack of practice. Use of high-fidelity simulation to improve the skill-set and confidence level was the main objective of this study.
Methods: This study was done in the D. Y. Patil University simulation lab over a period of 1 month. 42 postgraduate junior residents of the Department of Obstetrics and Gynaecology were included in the study. A pre and post workshop questionnaire on the subject and a confidence questionnaire were used to assess the residents. Three case-based scenarios were constructed on the high-fidelity simulator for the residents in the workshop followed by a debriefing of each case.
Results: The improvement in the knowledge and confidence for managing postpartum hemorrhage and eclampsia was from a mean value of 3.5±1.0 (2-6) and 4.7±1.0 (3-6) respectively in the pretest and a mean value of 8.2±0.8 (7-9) and 8.5±1.1 (6-10) respectively in the post test. The response time to postpartum hemorrhage and setup of eclampsia kit also had statistically significant p value of less than 0.0001.
Conclusions: Practice of obstetric emergencies, improving team building, communication and techniques of operative vaginal deliveries are all within the confines of a simulation laboratory. They are helpful in improving the proficiency of the junior residents and would eventually improve maternal and fetal outcomes
Silent uterine perforation and omental embedding of a Mirena® intrauterine device in a postpartum patient with undiagnosed uterine anomaly: a case report
Get PDFLevonorgestrel-releasing intrauterine systems (LNG-IUS) are commonly used for long-acting reversible contraception. While generally safe and effective, they carry a rare but serious risk of uterine perforation, particularly in the presence of risk factors like recent childbirth, breastfeeding or congenital uterine anomalies. We present the case of a 35-year-old, gravida 5 para 3, female who presented with chronic abdominal pain and missing intrauterine device threads ten months after postpartum Mirena® insertion. Transvaginal ultrasound failed to visualise the device. A pelvic X-ray and computed tomography (CT) scan confirmed extrauterine migration, with the intrauterine device (IUD) embedded in the omentum. Laparoscopy revealed a scar on the posterior uterine wall suggestive of silent uterine perforation, and hysteroscopy demonstrated a subseptate uterus. The device was successfully removed laparoscopically. This case emphasises the importance of anatomical screening prior to IUD insertion, the need for post-insertion imaging, and timely investigation of symptoms. It highlights how silent uterine perforation and subsequent delayed diagnosis of IUD-related complications can be avoided through adherence to established clinical guidelines, such as those provided by the Royal College of Obstetricians and Gynaecologists (RCOG) and Faculty of Sexual and Reproductive Healthcare (FSRH) recommendations
Determination of caesarean section rate and its trend analysis in a tertiary care tribal preponderant state using Robson’s classification
Get PDFBackground: There are certain conditions during delivery where vaginal delivery becomes unsafe. To overcome this situation, caesarean section (CS) is necessary for the safety of the mother and baby. The incidence of CS is rising to improve the outcome of mother and baby; it is a life-saving surgical tool in the process of delivering the baby. Efforts are being made to decrease the rate of CS without adversely affecting the outcome of the mother and baby. Robson’s classification for the indication of CS is an excellent method to audit for the indication of the surgery. However, this classification does not include some important indications like placenta previa, which is on the rise in the present day.
Methods: This study was a hospital-based prospective observational study that enrolled 2066 pregnant females, conducted from October 2023 to September 2024 in a tertiary health centre.
Results: Delivery by vaginal route and CS was 4561 during one year period, 2066 women was delivered by CS accounting an incidence of 45.29%. The majority of patients were in the age group of 20-30 years (75.9%), 82.1% were from rural areas, and the majority of women were unbooked (70%), 57.4% were multiparous, and 51.3% of the patients belonged to the tribal community.
Conclusions: Standardisation of CS indication parameters, regular CS audits, and application of Robson classification for every woman undergoing a CS will be helpful to keep a check on rising CS rates
Clinical management and successful pregnancy outcomes in women with empty Sella syndrome undergoing assisted reproductive technology: a case-based approach
Get PDFEmpty Sella syndrome (ESS) is a radiological condition characterized by a partially or completely flattened pituitary gland within the sella turcica, which may impact reproductive function. This case report presents two women with ESS undergoing in vitro fertilization (IVF). Despite having ESS, patient A had a normal ovarian reserve and conceived after frozen embryo transfer (FET) and regulated ovarian stimulation. Patient B needed an oocyte donation program in order to achieve pregnancy because of their significantly reduced ovarian reserve (AMH=0.01 ng/ml). The fact that both patients were able to conceive shows how important it is to use customized assisted reproductive technology (ART) plans depending on ovarian function. ESS presents a heterogeneous impact on fertility, necessitating tailored treatment plans, including optimized ovarian stimulation, embryo transfer protocols, and donor oocyte utilization. A multidisciplinary approach involving reproductive endocrinologists and fertility specialists is crucial in managing ESS-related infertility to maximize pregnancy success
A prospective cohort study to determine effectiveness of cystoinflation to prevent bladder injury in women with previous caesarean section
Get PDFBackground: The rising rate of caesarean sections (C-sections) has led to an increase in associated surgical complications, particularly urinary bladder injuries in patients with dense pelvic adhesions. Repeat C-sections elevate the risk of such injuries due to adhesions between the bladder and uterus. Cystoinflation, or retrograde bladder filling with saline, has been proposed to improve visualization and reduce injury risk, but its application in C-sections is underexplored. The present study aimed to evaluate the effectiveness of intraoperative cystoinflation in reducing urinary bladder injury during C-sections in women with previous caesarean deliveries and dense pelvic adhesions.
Methods: This prospective cohort study was conducted at MGM medical college and MTH hospital, Indore, over 12 months (October 2022-October 2023). A total of 240 women undergoing C-sections with dense adhesions were divided into two groups: group 1 (n=120) with cystoinflation, and group 2 (n=120) without. Primary outcome was bladder injury; secondary outcomes included blood loss; duration of surgery, complications, and hospital stay.
Results: Bladder injuries occurred in 3.3% of patients in group 2 and none in group 1 (p<0.001). Urinary tract infections and micturition issues were also significantly lower in the cystoinflation group. Mean hospital stay was shorter in group 1 (4.10±0.42 days) than in group 2 (4.88±1.86 days, p<0.001). Blood loss and operative time showed non-significant trends favouring cystoinflation.
Conclusions: Cystoinflation is a safe, simple, and effective technique that significantly reduces bladder injury and postoperative complications during C-sections in high-risk women. Its routine use in such cases is recommended
Association between gestational diabetes mellitus and risk of preeclampsia: a prospective observational case-control study in a tertiary care setting in Central India
Get PDFBackground: Preeclampsia (PE) is a hypertensive disorder with significant maternal and fetal morbidity, often developing after 20 weeks of gestation. Gestational diabetes mellitus (GDM) is a common metabolic complication of pregnancy that shares pathophysiological mechanisms with PE, such as endothelial dysfunction and oxidative stress. This study aimed to assess the risk and correlation of preeclampsia in women diagnosed with GDM in a tertiary care setting in central India.
Methods: A prospective, observational, case-control study was conducted over two months in the Department of Obstetrics and Gynecology. A total of 248 pregnant women were enrolled and categorized into two equal groups: GDM and control. Data were collected on glycemic profiles, blood pressure, and incidence of preeclampsia at baseline and after eight weeks. Statistical analysis included unpaired t-tests and Pearson correlation coefficients.
Results: The incidence of preeclampsia was significantly higher in the GDM group (25.79%) compared to the control group (10.4%), with an odds ratio of 2.96 and a relative risk of 2.48. A positive correlation was observed between worsening glycemic parameters and the development of preeclampsia. The GDM group also required more pharmacological interventions, including insulin and antihypertensives.
Conclusions: GDM significantly increases the risk of preeclampsia. Early screening, close monitoring, and tailored management of GDM are essential in mitigating maternal and fetal complications associated with hypertensive disorders in pregnancy
Elagolix - a novel drug for management of endometriosis and uterine fibroids
Get PDFEndometriosis and uterine fibroids are two hormone-dependent gynecological disorders that significantly impact women’s health impairing their quality of life. Traditional medical therapies used to control symptoms have side effects such as initial symptom flare and hypoestrogenic complications which limit their use. Elagolix is an oral non-peptide gonadotropin releasing hormone receptor (GnRH) antagonist. It is a new therapeutic approach which acts by directly and reversibly suppressing pituitary gonadotropin secretion. It acts by binding competitively to GnRH receptors in pituitary gland which leads to a rapid dose dependent suppression of LH and FSH leading to reduction in production of ovarian sex hormones (estrogen and progesterone). Alternative medications like GnRH agonists cause a transient hormone flare which is complete and long lasting before down regulation. Elagolix immediately inhibits GnRH receptor signaling, avoiding this flare phenomenon. The degree of hormonal suppression can be adjusted by dosing, allowing partial or near-complete suppression of estradiol levels, which is beneficial for tailoring therapy to minimize hypoestrogenic side effects. Elagolix, offers a safe and effective approach in the management of uterine fibroids and endometriosis. Clinical trials have demonstrated that Elagolix significantly reduces fibroid-associated heavy menstrual bleeding and alleviates endometriosis-related pelvic pain. Its rapid onset of action and adjustable dosing regimen allow individualized therapy aimed at balancing efficacy and minimizing hypoestrogenic adverse effects such as bone mineral density loss and vasomotor symptoms