International Journal of Reproduction, Contraception, Obstetrics and Gynecology
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Psychosocial issues of newly diagnosed gynaecological cancer patients: a qualitative study
Get PDFBackground: The diagnosis of cancer generates significant anxiety and uncertainty. We aimed to identify the psychosocial needs and priorities of women newly diagnosed with gynaecological cancers.
Methods: The study employed a qualitative research design. In-depth interviews were conducted with patients and their attendants to explore their anxieties, information needs, expectations, and treatment priorities. After obtaining informed written consent, 16 patients were included. Data analysis was performed through conventional qualitative content analysis, following a descriptive-explorative approach. This process involved extracting codes, categories, and themes to better understand the patients' experiences.
Results: The content analysis of the transcripts brought forth five themes: 1) cause of cancer and its effects, 2) information needs and expectations, 3) concerns about prognosis and family, 4) dependence versus independence and 5) faith and hope in God. In our setting, patients with gynaecological cancer had low information needs regarding their disease stage and treatment options. They trusted their healthcare providers and preferred not to burden themselves with potentially distressing information. They sought information on prognosis and the chance of cure. Concerns about finances and daily living were prevalent, while worries about sexual activity were less common. Spiritual issues affected many and included despondency and faith in God.
Conclusions: Understanding patients' information needs and anxieties will enhance their care and treatment adherence
A rare case of maternal anti-m antibody causing autoimmune hemolytic anaemia in newborn
Get PDFMaternal antibodies against fetal red blood cells can cause hemolytic disease of the fetus and newborn (HDFN), leading to fetal anemia, fetal ascites (hydrops), and postnatal complications. While anti-D antibodies are the most common cause, other antibodies such as anti-M, anti-c, and anti-K1 can also be clinically significant. A 34-year-old woman (G2A1) with a prior second-trimester medical termination of pregnancy was found to have anti-M antibodies in her current pregnancy. Serial monitoring with blood tests and fetal Doppler scans indicated a risk of fetal anemia. Antenatal monitoring using ICT titers and MCA Doppler was performed for early detection of fetal complications. She delivered a preterm neonate (2.68 kg) who required NICU care, ventilation, phototherapy, and antigen-negative blood transfusions. Both mother and baby recovered well. Early detection of rare maternal antibodies, careful fetal surveillance, and planning for safe transfusions are essential for managing alloimmunized pregnancies. A multidisciplinary approach improves outcomes for both mother and newborn
A prospective cross-sectional observational study to compare the predictive performance of four types of risk malignancy index and computed tomography and magnetic resonance imaging findings in the triage of adnexal masses at a tertiary care centre in Mumbai, India
Get PDFBackground: Accurate pre-operative differentiation between benign and malignant adnexal masses is essential for appropriate referral and management.
Methods: A prospective cross-sectional observational study was conducted from August 2023 to July 2024 in the Department of Obstetrics and Gynaecology, Topiwala National Medical College and BYL Nair Charitable Hospital, Mumbai. Sixty women with adnexal masses were evaluated using clinical parameters, ultrasound, CA-125, and four types of risk of malignancy indices (RMI I-IV). Computed tomography and magnetic resonance imaging (CT/MRI) findings were compared wherever available. Histopathology served as the gold standard.
Results: Mean age 37.4±10.4 years. Of 60 cases, 45 (75%) benign, 15 (25%) malignant. RMI IV had highest diagnostic accuracy area under the curve (AUC=0.892). CT showed 100% sensitivity and 94.4% specificity.
Conclusions: RMI IV is the most reliable index for differentiating benign and malignant adnexal masses. CT provides additional diagnostic accuracy and is recommended for equivocal cases
Scar endometriosis: a rare complication of cesarean section
Get PDFScar endometriosis, also known as incisional endometriosis, is a rare condition characterized by the presence of functional endometrial tissue in surgical scars, most commonly after cesarean sections or gynecological procedures. We report a case of 34-year-old woman (P2L2) presented with a pain and swelling in the previous LSCS abdominal scar since 1year. Imaging revealed a hypoechoic lesion suggestive of endometriosis. Surgical excision was performed, and histopathology confirmed the diagnosis. Postoperative follow-up indicated complete symptom resolution and no recurrence on follow up. Wide local surgical excision is the definitive treatment for permanent cure
Telehealth in maternity care: benefits, barriers, and the future of digital maternity care: a narrative review
Get PDFTelehealth is emerging as a vital tool in maternity care, supporting pregnant women and their families through remote healthcare services, it creates new opportunities to provide continuous, patient-centered, and accessible care. This review examines the applications, benefits, and challenges of telehealth in maternity care with a focus on its implications. A structured search strategy was conducted across PubMed Medline, Google Scholar, Research Gate, Scopus, and Science Direct. Keywords included telehealth, telemedicine, nursing, and maternity care. Relevant studies were screened and references cross-checked to capture additional evidence. Telehealth interventions in maternity care demonstrate significant benefits such as reduced travel costs, decreased waiting time, and improved access in rural or underserved areas. For health care workers, telehealth supports timely antenatal education, early detection of complications through remote monitoring (e.g., blood pressure and weight), and enhanced patient engagement via mobile applications. The COVID-19 pandemic has accelerated the use of virtual antenatal consultations, creating opportunities for nursing professionals to extend their role in health promotion, psychosocial support, and counseling. However, challenges persist technological barriers, inequitable access, patient trust issues, and limitations in replacing physical examinations with virtual care raise concerns about patient safety. Telehealth in maternity care holds promise for advancing practices through innovations like tele-ultrasound, remote blood pressure surveillance, self-monitoring of fundal height, and digital maternal health education platforms. Yet, barriers related to equity, nurse preparedness, provider adoption, and regulatory frameworks must be addressed. Collaborative, research and policy support are essential to harness the full potential of telehealth, ensuring safe, equitable, and holistic care for pregnant women and their families
Association of physical metabolic markers with perinatal outcomes in low-risk pregnant women: a prospective cohort study
Get PDFBackground: This prospective study was planned to study the correlation of all physical metabolic markers (BMI, WC, WHR, and WHtR) in the antenatal period with perinatal outcomes.
Methods: All pregnant women who had first antenatal visit before 20 weeks were recruited into the study for period of 1 year. Detailed history was taken followed by a thorough general physical examination (including BMI, WC, WHR, and WHtR as per Indian standards).
Results: In multivariate logistic regression model none of parameters actually predicted the onset of GDM. Incidence of LSCS showed significant association with WC and WHtR. BW>3.5 kgs and NICU admission had a significant statistical association with WHtR.
Conclusions: BMI, WC, WHR and WHtR should be measured in all pregnant women at the first antenatal visit. WC predicts caesarean delivery, BMI predicts large for gestational age baby, and WHtR is a novel marker which predicts both
Outcome of septic abortion in a tertiary care hospital
Get PDFBackground: Septic abortion is a significant cause of maternal morbidity and mortality, particularly in resource-limited settings. This study aimed to evaluate the outcomes of septic abortion and identify associated risk factors and complications.
Methods: A descriptive cross-sectional study was conducted at the Department of Gynaecology and Obstetrics, Dhaka Medical College Hospital, from January to June 2013. Fifty patients with septic abortion were purposively sampled based on defined inclusion criteria. Data were collected through interviews and clinical records and analysed using SPSS version 16.
Results: The mean age of patients was 30.62±6.34 years, with 34% aged 31-35 years. Most were multiparous (82%) and illiterate (52%). Induced abortions accounted for 66% of cases, with 58% performed by untrained individuals. Abdominal tenderness (94%), abdominal pain (70%) and per-vaginal bleeding (64%) were the most common clinical presentations. Complications included pelvic abscess (24%), uterine perforation (22%) and disseminated intravascular coagulation (18%). Maternal mortality was 6%.
Conclusions: Unsafe abortions induced by untrained personnel remain a major contributor to maternal morbidity and mortality. Improved access to family planning, education and safe abortion services is essential to mitigate these outcomes. Comprehensive post-abortion care, including contraceptive counselling, is crucial
Fetomaternal outcome of newly detected thyroid disorders among pregnant women in tertiary care hospital: a cross sectional study
Get PDFBackground: Thyroid hormones are vital for fetal development and maternal health. Both overt and subclinical thyroid disorders can lead to complications like miscarriage, preterm labor, and neonatal issues. Identifying newly detected thyroid disorders in pregnancy is crucial for improving outcomes for both mothers and babies.
Methods: This cross-sectional study evaluated pregnant women newly diagnosed with thyroid disorders at a tertiary care hospital. Data on thyroid function, pregnancy complications, and neonatal health were collected and analyzed to assess the impact of these disorders. The findings aimed to enhance diagnostic methods and patient care.
Results: In our study, out of 150 cases, 148 were subclinical hypothyroidism, and 2 were subclinical hyperthyroidism. Subclinical hypothyroidism in pregnancy was associated with PPH (0.7%), preeclampsia (21.3%), preterm labor (9.3%), GDM (6.7%), IUD (3.3%), neonatal death (2.7%), prematurity (12.7%), LBW (21.3%), NICU admission (28%), congenital anomalies (2%), and neonatal hypothyroidism (11.3%). These findings were consistent with other studies; however, the number of hyperthyroid cases in our study was insufficient for a thorough outcome analysis.
Conclusions: Thyroid disorders during pregnancy can negatively impact both maternal and fetal outcomes, underscoring the need for routine antenatal thyroid screening
Lizard on the wall appearance-total laparoscopic hysterectomy on a ventrofixed uterus
Get PDFHysterectomy is one of the most performed procedures for gynecological conditions worldwide. Ventrofixation of the uterus, a surgical technique where the uterus is fixed to the anterior abdominal wall, can complicate routine gynecological procedures, including hysterectomy. Performing a total laparoscopic hysterectomy (TLH) on a ventrofixed uterus presents unique challenges due to altered anatomy and the presence of adhesive tissues. Adhesions during surgery are associated with increased morbidity due to prolonged operating time and organs injuries. A ventrofixed uterus can often be suspected in patients with a history of CS, based on specific clinical symptoms and ultrasonographic findings described by Sheth et al. Surgeons should be aware of the altered anatomy and the potential for adhesions when performing laparoscopic hysterectomy in such cases. Appropriate preoperative workup and planning of surgery reduces complications and improves the outcome. Some of techniques for dissection of ventrofixed uterus is discussed in this paper
A retrospective analysis on progressive ectopic pregnancy: incidence, clinical features, diagnosis, and treatment approaches
Get PDFBackground: Progressive ectopic pregnancy is a pregnancy that develops outside the uterus which progresses if not treated promptly.
Methods: A retrospective analysis of 51 patients was done in the gynecology department of Grodno State Medical university, first aid hospital.
Results: According to the analysis of the obtained data, the article shows the comparison and differences of these ectopic pregnancies in different age categories, with the parity and the complications followed due to this. The percentages are as follows; women with ectopic pregnancy of <30 years=52.9%, >30 years=47%, women with ectopic pregnancy in their 1st pregnancy =13.7%, 2nd pregnancy = 45.09%, 3rd pregnancy = 33.33%, recurrence rate = 13.72%, abortion = 15.68%, miscarriage due to ectopic pregnancy= 1.96%. Prominent complaints were pain together with the presence of spotting. Among patients undergoing culdocentesis, 25.49% presented with hemorrhagic fluid, while 43.13% showed a mixed-type fluid. Within 5 days of admission, beta-hCG levels increased in 83.34% of patients and decreased in 16.66%. All patients in our retrospective study underwent tubotubal anastomosis. Out of them, 17.64% of women had a previous history of tubectomy.
Conclusions: Women below 30 years with ectopic pregnancy had a higher incidence. Early diagnosis is the key to reduce the morbidity, mortality, to reduce the complications and to estimate the progression. Beta HCG level with transvaginal ultrasound (TVUS) is a preferred combination used nowadays for early diagnosis of the disease and complications such as rupture of a tubal pregnancy. To preserve fertility tubotubal anastomosis was the preferred mode of treatment (especially in patients with previous tubectomy surgery)