International Journal of Reproduction, Contraception, Obstetrics and Gynecology
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Comparative analysis of maternal and neonatal outcomes in early versus late onset pre-eclampsia: a prospective study from northern India
Get PDFBackground: Pre-eclampsia, a leading hypertensive disorder in pregnancy, significantly contributes to maternal and neonatal morbidity and mortality. It is categorized into Early-Onset Pre-Eclampsia (EOPE, <34 weeks) and Late-Onset Pre-Eclampsia (LOPE, ≥34 weeks), differing in risk factors, clinical profiles, and outcomes. This study compared EOPE and LOPE regarding risk factors, laboratory findings, and maternal and neonatal outcomes.
Methods: A prospective study was carried out from April, 2021 to March, 2022 at Kamla Nehru State Hospital for Mother and Child, IGMC, Shimla, including 184 pre-eclamptic women diagnosed as per ACOG 2020 criteria. Participants were divided equally into EOPE (n=92) and LOPE (n=92) groups. Demographics, clinical history, complications and outcomes were analyzed using SPSS 25.0, with significance set at p<0.05.
Results: EOPE was associated with younger age (mean 24.79 vs. 26.95 years, p=0.001), primigravidity (62% vs. 37%, p=0.001), chronic hypertension and prior pre-eclampsia. Diabetes was more prevalent in LOPE (21.7% vs. 5.4%, p=0.001). EOPE had higher rates of severe maternal complications, including HELLP syndrome (9.8% vs. 2.2%), eclampsia (20.7% vs. 8.7%) and placental abruption (14.1% vs. 5.4%). Neonates in EOPE had poorer outcomes, with lower birth weight (1.84 kg vs. 2.45 kg, p<0.001), more NICU admissions (90.2% vs. 20.7%, p<0.001) and longer NICU stays (13.69 vs. 1.65 days, p<0.001).
Conclusions: EOPE is linked to younger maternal age, primigravidity and severe outcomes, whereas LOPE is associated with metabolic risk factors like diabetes and milder complications. Early identification and tailored management are crucial to improve maternal and neonatal outcomes
Impact of pregnancy on antibody response to COVID-19 vaccine
Get PDFBackground: Vaccination during pregnancy is a common and recommended practice to prevent maternal and infant morbidity from many infectious diseases. Likewise, pregnant women should be vaccinated against COVID-19 to protect themselves and their expectant children. The immune system is known to undergo alterations during pregnancy. Therefore, the present study was undertaken to determine the impact of pregnancy on antibody response in Bangladeshi pregnant women following two doses of the COVID-19 vaccine.
Methods: This cross-sectional study was conducted in the department of obstetrics and gynecology, Bangabandhu Sheikh Mujib medical university (BSMMU), Dhaka, Bangladesh from April 2022 to March 2023. This study included COVID-19-vaccinated 25 pregnant and 25 nonpregnant women attending the outpatient department (OPD) of obstetrics and gynecology, of BSMMU.
Results: The pregnant women were younger than the non-pregnant women. A few of the study subjects were hypertensive and/or diabetics and there was no difference between the study groups concerning hypertension and diabetes (p=0.500 and p=0.174 respectively). Over 20% of the study subjects were ever tested for COVID-19, but none were positive for COVID-19 infection. More than half of the subjects received Pfizer-BioNTech COVID-19 vaccination. In the majority of the pregnant and non-pregnant women, blood was collected after 6 weeks of the second dose of the vaccine. The IgG antibodies to SARS-CoV-2 were almost similar in both the study groups (15401.4 vs. 16575.6 AU/ml respectively) (p=0.742).
Conclusions: This study found that pregnancy did not significantly impact the antibody response to COVID-19 vaccination. The study also concluded that pregnant women respond well to the COVID-19 vaccines, mounting strong immune responses with final titers being fairly comparable to those in non-pregnant women of reproductive age
Labour epidural analgesia and maternal and neonatal outcome
Get PDFBackground: This study was done to determine the maternal and neonatal outcomes in parturient who were administered with labour epidural analgesia. Primary objectives include the comparison of time to deliver after insertion of the epidural catheter at less than 4 cm and more than 4 cm of cervical dilatation, to determine the requirement of assistance for normal vaginal delivery, and also to determine adverse maternal outcomes.
Methods: The study was conducted at Arokya Women’s Centre, Salem, Tamil Nadu, India. The data was collected from medical records department, between July 2023 and June 2024. After obtaining written and informed consent, 749 parturient, who were willing for receiving labour epidural analgesia, were included in our study.
Results: In our study, majority of the parturient received labour epidural analgesia during their first stage of labour, i.e. less than 4 cm of cervical dilatation. The time to deliver in this age group is found to be more 465.4±393.3 minutes, as compared to those who were provided with labour epidural analgesia during their second stage of labour, 130.4±184, which was statistically significant (p value- 0.000).
Conclusions: We conclude that labour epidural analgesia, when administered between 1 and 4 cm of cervical dilatation, was helpful for parturient to have a pain-free, quicker delivery. We also observed that labour epidural did not cause an increased occurrence of post-partum haemorrhage among parturient and NICU admission among neonates
Clinical outcome of colposcopy guided biopsy in women with abnormal Pap smear results
Get PDFBackground: Cervical cancer is the fourth most common cancer among women globally and remains a significant public health challenge despite being largely preventable. Persistent infection with high-risk human papillomavirus (HPV), particularly HPV-16 and HPV-18, is the primary cause. Early detection through effective screening methods, such as Pap smear and colposcopy, plays a critical role in reducing cervical cancer incidence. This study evaluates the clinical outcomes of colposcopy-guided biopsy in women with abnormal Pap smear results, highlighting the importance of integrated screening approaches.
Methods: This prospective observational study was conducted in the department of obstetrics and gynaecology, GS medical college and hospital, Hapur, over 15-18 months (November 2022-February 2024). A total of 150 women aged 25-65 years with abnormal Pap smear results and cervical symptoms (e.g., leukorrhea, postcoital bleeding, intermenstrual bleeding) were included. Colposcopy-guided biopsies were performed on these patients. Data were analysed using IBM SPSS version 27, applying statistical tests like the T-test and chi-square test, with p<0.05 considered significant. Descriptive statistics summarized the data, presented in charts and tables.
Results: Among the 150 participants, 10.6% had abnormal Pap smear findings, and 17.3% had abnormal colposcopy findings. Squamous metaplasia (46.15%) and high-grade lesions (34.61%) were the most frequently observed abnormalities during colposcopy, while Pap smears predominantly revealed ASC-US (56.25%) and HSIL (31.25%). Postcoital and postmenopausal bleeding had the highest rates of abnormal findings. Colposcopy demonstrated greater sensitivity compared to Pap smear in detecting cervical lesions, emphasizing its importance in early diagnosis.
Conclusions: Colposcopy is more sensitive than Pap smear in detecting cervical abnormalities, particularly high-grade lesions. Combining these methods enhances the accuracy and reliability of cervical cancer detection. Integrating molecular tests and visual inspection techniques into existing screening protocols could further improve outcomes. Raising public awareness about regular screening, HPV vaccination, and early detection is essential to reducing cervical cancer burden globally
A case report of uterine leiomyosarcoma
Get PDFThe most prevalent benign tumour in women is uterine leiomyoma. Smooth muscle cells give rise to the uncommon malignant tumour known as uterine leiomyosarcoma. It makes up 1% of all uterine cancers. One out of every 800 women who are thought to have leiomyoma actually has a sarcoma. Uterine leiomyosarcoma is usually diagnosed by histopathological examination and surgery is the only treatment. We describe a 48-year-old woman who had heavy menstrual flow and was initially diagnosed with uterine leiomyoma. Histological analysis revealed that she actually had uterine leiomyosarcoma.
A case report on disseminated peritoneal leiomyomatosis
Get PDFDisseminated peritoneal leiomyomatosis (DPL) is a rare benign Smooth muscle tumor proliferating along the sub peritoneal and peritoneal surface. The pathogenesis of the disease remains unknown, but iatrogenic implantation, hormonal effects, heredity, and peritoneal mesenchymal stem cell metaplasia has been implied. Approximately 200 cases have been reported worldwide. Owing to the rarity of the disease and the lack of typical clinical symptoms and signs, the misdiagnosis rate is extremely high. We present a case of DPL intervened in our centre.
Vitamin B12 deficiency in pregnancy and its association with maternal and fetal outcomes
Get PDFBackground: Pregnancy is a unique physiological state characterized by profound changes in a woman's body to support fetal growth and development. Adequate nutrition is vital during pregnancy to meet the increased demands of both the mother and the developing fetus. Among the various nutrients required during pregnancy, vitamin B12 stands out as a critical micronutrient. It plays a pivotal role in cellular replication, neurodevelopment, and the synthesis of DNA, making it essential for the proper growth and development of the fetus. This study was conducted to evaluate vitamin B12 deficiency in pregnancy and its association with maternal and fetal outcomes.
Methods: This was a cross-sectional study conducted among consecutively selected pregnant women who had just given birth to a single live baby admitted to the department of obstetrics and gynecology and also the department of feto-maternal medicine, Bangabandhu Sheikh Mujib medical university (BSMMU), Shahbagh, Dhaka from September 2022 to August 2023. A total of 90 women of 18-40 years of age at their 28-40 weeks of gestation were included in this study. Study subjects with vitamin B12 levels of <200 pg/ml were considered as the low level (group I), whereas level ≥200 pg/ml was considered as the normal (group II). Observations were undertaken on pregnancy complications and perinatal outcomes, which were compared between the two groups.
Results: The study revealed majority (57.8%) of the study participants age were within 26-34 years, a housewife was 74.4% and multigravida constituted 70.0% of the respondents. The 31 (34.4%) of the respondents had vitamin B12 level below 200 pg/mL and 59 (65.60%) women had normal serum vitamin B12 levels (≥200 pg/mL). Congenital hydrocephalus was observed in 16.1% of the group I mothers compared to only 1.7% in group II (p=0.017) and neural tube defect was present in 9.7% of group I but in none of group II mothers (p=0.038).
Conclusions: Mothers having vitamin B12 deficiency experience significantly higher rates of oligohydramnios, fetal hydrocephalus, and neural tube defects compared to those with normal vitamin B12 levels. However, there was no significant maternal complication
A case report of xanthogranulomatous inflammation of a tubo-ovarian mass
Get PDFAlthough uncommon, xanthogranulomatous inflammation of the female reproductive system frequently manifests in the endometrium. There have only been a few documented incidences affecting the ovary. It may resemble ovarian cancer in its clinical presentation, radiological characteristics, and other aspects. Clinicians and pathologists should be aware of the importance of pre-diagnosing this inflammatory lesion in order to avoid misdiagnosis and drastic surgical treatment. This case report elaborates how a 60-year-old female patient with a tubo-ovarian tumor was suspected of having cancer based on clinic-radiological symptoms, but histological confirmed the ultimate diagnosis of xanthogranulomatous inflammation of an tubo ovarian mass
Analysis of caesarean section at tertiary centre in North Karnataka
Get PDFBackground: There is increase in caesarean section (CS) rate worldwide. As per WHO CS are should be 10-15%. The present study is undertaken to know the incidence of CS at a tertiary centre and also to analyse the cases as per Robsons 10 group classification system.
Methods: A prospective observational study was conducted in department of obstetrics and gynaecology at GIMS Kalaburagi from January 2023 to December 2023. All pregnant women of gestational age 28 weeks or more admitted to labour room and delivered are taken into this study. Detailed history and clinical examination are done, labour details are recorded. Maternal and perinatal outcome is studied.
Results: Total deliveries in year 2023 were 8266, of which 4202 underwent CS incidence is 50.8%. Incidence of vaginal birth after CS (VBAC) is 1.1% group 5 followed by group 1 and group 10 were maximum contributors to overall CS 37.2%, 31% and 8.5% respectively. Perinatal mortality was 21.7/1000 birth.
Conclusions: The incidence of CS is very high in our study, because ours is a tertiary centre, cases are referred late, leading to increase in CS rate. CS has got more maternal morbidity when compared to vaginal delivery, therefore primary CS should be reduced by proper labour monitoring and early referral and CS should be done appropriately when indicated
Clinical study on risk factors, management pattern and outcome of patients with secondary post-partum hemorrhage admitted in BSMMU
Get PDFBackground: Secondary postpartum hemorrhage (PPH) is a life-threatening obstetric condition. The percentage of secondary PPH is thought to be higher in developing countries. This is an important cause of maternal morbidity and mortality. Most of the patients had no identifiable risk factors and PPH cannot always be preventable. The particular cause of the hemorrhage must be investigated and treated after basic resuscitation. This study aims to evaluate risk factors, management pattern and outcome of patients with secondary PPH.
Methods: This cross-sectional study was conducted in the department of obstetrics and gynaecology, BSMMU, total patients were 42 who fulfilled the selection criteria, from March 2012 to August 2012 and data were interpreted with statistical analysis.
Results: Among 42 patients, 54.77% presented with identifiable risk factors, with multiple pregnancy (14.2%) and prolonged rupture of membranes (9.52%) being the most common. The leading causes were infection (54.29%) and retained placental tissue (28.57%). Most patients (59.52%) were managed medically using uterotonic drugs and antibiotics, while 23.8% required surgical evacuation of retained tissue. Blood transfusion was needed in 80.95% of cases. Favorable outcomes were observed in 97.61% of patients, with only one case of complications and no maternal deaths.
Conclusions: Medical and surgical interventions for secondary PPH are effective. Prevention and early detection require strengthening of antenatal care, hygiene during childbirth and post-partum monitoring