International Journal of Reproduction, Contraception, Obstetrics and Gynecology
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Invasive mole presenting as abnormal uterine bleeding: a case report and review of literature
Full text linkInvasive mole is a type of gestational trophoblastic neoplasia (GTN). It usually occurs after a molar or non-molar pregnancy. Here we would like to present a 47-year-old nulligravida lady who does not give any history of antecedent pregnancy. She had symptoms of abnormal uterine bleeding (AUB) and came to the causality with heavy flow. Beta hCG was very high and MRI showed uterine tumor. She underwent total abdominal hysterectomy with bilateral salpingoopherectomy which showed invasive mole FIGO stage II. Her WHO prognostic score was 9 and hence she received EMA-CO regimen of chemotherapy. GTN can present in different ways, even without a history of previous pregnancy. In such situations a high level of suspicion and a simple Beta hCG level can clinch the diagnosis.
Surgical management of uterine niche in a patient with secondary infertility and successful pregnancy outcome
Full text linkUterine niche or caesarean scar defect is a known cause of secondary infertility and implantation failure. Surgical repair can restore uterine anatomy and improve fertility outcomes in selected patients. This case report presents a 38-year-old woman with a history of one lower segment caesarean section and two failed in vitro fertilization (IVF) cycles presented with secondary infertility. Ultrasound showed a prominent uterine niche. She underwent DHL with niche repair followed by controlled ovarian stimulation and intracytoplasmic sperm injection (ICSI). Frozen embryo transfer of two day 3 embryos resulted in a viable pregnancy. An elective repeat caesarean section was performed at 36 weeks + 4 days, resulting in the birth of a healthy infant. Laparoscopic niche correction may improve fertility outcomes in patients with uterine scar defects contributing to infertility, particularly those with prior IVF failures.
A case series of imperforate hymen
Full text linkImperforate hymen is an uncommon congenital anomaly of the female genital tract, which is caused by the persistence of the hymenal membrane to perforate during embryogenesis. Although it is benign, delayed diagnosis can cause marked morbidity and it typically occurs in adolescents with primary amenorrhea, cyclic abdominal pain, urinary retention, or pelvic mass. Their early recognition is essential to prevent patients from developing sequelae such as endometriosis, infection, infertility, or urinary tract injury. We report a series of three adolescent girls with imperforate hymen who presented with abdominal pain, urinary retention and primary amenorrhea. Diagnosis was based on physical examination, including ultrasonography and all patients were managed with hymenotomy or hymenectomy with good response and return of normal menstruation. This case series emphasizes the need for a high index of suspicion of imperforate hymen in adolescent girls with lower abdominal pain or delayed menarche and that timely diagnosis, correction, and surgical management are crucial to prevent long-term complications
Calcium ionophore A23187 versus progesterone: induction of acrosome reaction in thawed and prepared cryopreserved semen samples
Full text linkBackground: Acrosome reaction facilitates fertilization and it can be induced in-vitro using various stimuli like progesterone, calcium ionophore A23187, prostaglandins, etc. We investigated the efficacy of calcium ionophore and progesterone in inducing acrosome reaction in prepared semen samples following cryopreservation, using fluorescein isothiocyanate- labelled Arachis hypogaea (peanut) agglutinin (FITC-PNA) as a marker.
Methods: A prospective analysis was carried out on 10 normozoospermic semen samples collected between March and May 2025 at the department of reproductive medicine and andrology, Chettinad Super Speciality Hospital, Chettinad Academy of Research and Education. The collected semen samples were cryopreserved using rapid freezing method and subsequently after thawing, sperm preparation was carried out using direct swim-up method. The obtained post-wash was then subjected to capacitation and in-vitro induction of acrosome reaction using calcium ionophore A23187 and progesterone. The spermatozoa were stained with a fluorescent dye FITC-PNA and by examining under a fluorescent microscope, acrosome reacted and acrosome intact spermatozoa were scored. An independent t-test was performed to determine the statistical significance between the two groups. The statistical significance was set at p value <0.05.
Results: Our study revealed a significant difference between calcium ionophore and progesterone in inducing acrosome reaction in frozen thawed spermatozoa. Calcium ionophore demonstrated a higher acrosome reaction rate when compared to progesterone (p value <0.001).
Conclusions: The in-vitro induced acrosome reaction rate in frozen thawed spermatozoa is significantly higher with calcium ionophore when compared to progesterone
Outcomes of amniocentesis at a tertiary maternal-fetal medicine unit in Malaysia: a five-year retrospective cohort study of cytogenetic yield and procedure-related complications
Full text linkBackground: Amniocentesis is the most widely performed invasive prenatal diagnostic procedure worldwide. While its diagnostic accuracy is well established, procedure-related risks such as miscarriage and preterm prelabour rupture of membranes (PPROM) remain central to patient counselling. Although international safety and diagnostic outcome data are robust, regional evidence from Southeast Asia is limited. This study aimed to evaluate the cytogenetic yield and short-term complications of amniocentesis performed in a Malaysian tertiary maternal-fetal medicine (MFM) training centre over a five-year period.
Methods: A retrospective cohort study was conducted, including all women who underwent amniocentesis at hospital Tuanku Jaafar (HTJ), Seremban, between January 2018 and December 2022. Maternal demographics, ethnicity, indications, cytogenetic outcomes, and procedure-related complications within 14 days were extracted from hospital records. Descriptive statistics were used to summarise baseline characteristics and outcomes. Associations were analysed using Fisher's exact test, and binary logistic regression was performed to identify independent predictors of miscarriage and PPROM.
Results: A total of 650 amniocentesis were included. Most women were <35 years (34.8%) or 38-40 years (31.1%); the majority were Malay (73.8%). Advanced maternal age was the leading indication (54.6%). Cytogenetic analysis revealed normal results in 90.9% of cases. Abnormal findings included trisomy 21 (1.7%), trisomy 18 (3.4%), trisomy 13 (0.8%), and other aneuploidies (3.1%), yielding an overall abnormal karyotype rate of 8.9%. Procedure-related complications were rare, with miscarriage in 0.3% (n=2) and PPROM in 0.6% (n=4). An abnormal karyotype was significantly associated with miscarriage and PPROM in univariate analysis (p<0.001) and remained an independent predictor of PPROM on logistic regression (OR=2.74, 95% CI=1.5-5.1, p=0.001). No independent predictors of miscarriage were identified.
Conclusions: Amniocentesis in this tertiary MFM training centre was associated with a high diagnostic yield and very low short-term complication rates, consistent with international benchmarks. The clustering of complications among abnormal karyotypes suggests that biological vulnerability contributes to adverse outcomes independent of procedural factors. These findings reinforce the safety of amniocentesis in the hands of experienced practitioners and provide important regional data for patient counselling and training
Assessment of knowledge, enablers, and barriers to healthcare-seeking behaviours for urinary tract infections among pregnant women at Banadir Maternal and Child Hospital, Somalia
Full text linkBackground: Urinary tract infections (UTIs) are common during pregnancy causing serious issue to both maternal and infantile health. However, little research has been conducted regarding what women know and do about UTIs in Somalia.
Methods: A cross sectional mixed-methods approach was employed in this study to obtain both quantitative data and qualitative findings of women knowledge, experiences, and health-seeking behaviours related to UTIs. Between August and December 2024, 200 women participated in a quantitative survey, among which 21 were selected for qualitative interviews.
Results: The majority (55%) of women reported having symptoms related to UTI, with the most common symptoms being fever or chills (54%), lower abdominal pain (50%), and frequent urination (42%). Only 33.5% had tested positive for UTIs in their urine. Before seeking medical attention, a large percentage of women (51%) turned to traditional remedies, such as camel milk and herbal teas. The main obstacles to accessing healthcare were transportation concerns (20.5%) and financial limitations (49.5%). Some people believed that spiritual factors caused UTIs, while others believed that poor hygiene (43%) or sexual activity (41.5%) were the main causes. The qualitative analysis revealed that people's understanding of UTIs varied; many were aware of the symptoms but not the causes or complications. Cultural factors influenced healthcare-seeking, with women frequently avoiding medical care out of fear of judgment and stigma.
Conclusions: The study underscores the need of better UTI education; the integration of biomedical and traditional practices can help in early detection and seeking healthcare at the appropriate time
Family planning barriers and enablers among displaced Somali women in Ali Addeh Camp, Djibouti
Full text linkBackground: Sexual and reproductive health is essential to human rights, yet displaced populations, particularly women, face numerous barriers to accessing family planning services. This cross-sectional study aimed to explore the barriers and enablers of contraceptive use among Somali refugee women in the Ali Addeh Refugee Camp, Djibouti.
Methods: A qualitative, exploratory design was used, incorporating focus group discussions (FGDs) with Somali refugee women. A total of 49 women participated, organized into seven groups based on marital status and age. Thematic analysis was conducted, focusing on barriers, enablers, and social dynamics related to family planning.
Results: Major barriers cited were religious opposition, misinformation, and sociocultural resistance. Interestingly, 79.6% of the respondents desired large families, 67.3% of whom desired 18 to 35 months of birth spacing. While 40.8% of the women had 1-2 children, 34.7% of the women had five or more children. Contraception was viewed as foreign or religiously prohibited by most women, and 22 women cited religion. Male endorsement of family planning decisions was present, with 27 women reporting that spousal disapproval was a significant deterrent. Privacy concerns were common, with 18 women reporting stigma and fear of judgment among healthcare providers. Despite such barriers, trust in healthcare providers, religious endorsement, and community outreach were reported as facilitators of family planning.
Conclusions: The study underscores the need for men and religious leaders' involvement in family planning. Interventions for displaced women should also prioritize privacy in health facilities, accessible and culturally acceptable family planning services
Nephritic syndrome complicating placental site trophoblastic tumour: a case report and review of the literature
Full text linkPlacental site trophoblastic tumour (PSTT) is rarely associated with renal disorders and has been described only a few case reports so far. Authors report the case of a 27-year-old female who presented with abnormal uterine bleeding post vaginal delivery and developed nephritic syndrome, thereafter. Detailed evaluation revealed increased levels of human chorionic gonadotropin (beta subunit)-β-hCG, and imaging findings suggesting gestational trophoblastic disease. The patient underwent hysterectomy, which led to immediate remission of proteinuria, ascites and hypertension. Thus, the diagnosis was confirmed as PSTT and, following treatment, her β-hCG became normal and proteinuria gradually disappeared. This type of association of gestational trophoblastic disease with renal disorders is a rare entity. A thorough review of the literature was also performed by us, in order to explain the pathophysiology as well as the relation between these conditions so that these unusual findings can be interpreted appropriately to achieve the correct diagnosis.
Does the oocyte quality impact intracytoplasmic sperm injection outcomes in severe male factor infertility: a retrospective study
Full text linkBackground: ICSI has transformed the approach in treating severe male factor infertility, however the quality of oocyte plays a significant role in compensating for sperm abnormalities and enhancing the clinical outcomes. The study aims to evaluate the impact of oocyte quality on fertilization rates, embryo development and pregnancy outcomes in couples undergoing intracytoplasmic sperm injection (ICSI) in two distinct groups- cryptozoospermia and azoospermia.
Methods: A retrospective observational study was conducted at a fertility centre in a tertiary hospital. A total of 61 couples with male infertility were included in the study. Group 1 includes 42 patients diagnosed with cryptozoospermia and Group 2 includes 19 patients diagnosed with azoospermia. Controlled ovarian stimulation was done using gonadotrophins to induce follicular development followed by ICSI procedure. All the retrieved oocytes were categorized based on the morphology criteria outlined in the Istanbul consensus into two distinct groups: oocytes with normal morphology and oocytes with abnormal morphology. Clinical outcomes including fertilization rate, implantation rate, pregnancy rate and miscarriage rate were evaluated.
Results: The observed fertilization rate in oocytes with normal morphology and oocytes with abnormal morphology was 84.03% vs. 78.26% in the cryptozoospermia group and 80.76% vs. 78.57% in the azoospermia group. The overall pregnancy rate was 26.19% in group 1 and 31.58% in group 2 with no statistical significance. Oocytes with normal morphology exhibited higher pregnancy rates, while oocytes with abnormal morphology showed very low or no pregnancy in both groups.
Conclusions: The study concludes oocyte quality has a greater impact on the ICSI outcomes irrespective of the type of sperm used. Future studies with a large cohort size are needed to validate these findings
When anatomy mimics: broad ligament mimicry of neurofibroma
Full text linkSchawannoma aka neurilemmoma are encapsulated tumour which arise from the nerve sheaths. Pre sacral tumours are rare tumors which arise from the pre sacral space. It can be diagnosed with modality like magnetic resonance imaging (MRI). Sometime ultrasonography findings for broad ligament fibroid can mimic with neurofibroma. Patient with complaint of pain in abdomen should be evaluated. Surgical removal is treatment of choice for that