International Journal of Reproduction, Contraception, Obstetrics and Gynecology
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A case of Dili-drug induced liver injury by norethisterone combined with mifepristone
Get PDFDILI related to female sex hormones like estrogen and progesterone generally occur with estrogen component. Progesterone related DILI are not commonly reported. We are reporting a case of DILI by norethisterone combined with mifepristone in a 37-year-old woman. Oral contraceptives have been shown to be associated with variety of liver injuries. Various manifestations include hepatitis, cholestatisis, hepatic adenoma, peliosis hepatitis, sinusoidal obstruction syndrome and increase in size of pre-existing hemangiomas. It is important to create awareness about norethisterone-induced liver injury among clinicians, especially gynaecologists and also use combination drugs after studying the mechanism of action, agonistic and antagonistic actions
Pilot study on ferritin and vitamin D3 levels in early pregnancy and it’s correlation with fetal wellbeing
Get PDFBackground: Overall fetal growth and development is influenced by the maternal nutrition status preconceptionally and in pregnancy. Very few studies have explored the roles of serum ferritin and vitamin D in fetal growth effectively. This pilot study aims to assess the serum Ferritin and vitamin D3 levels in early pregnancy and it’s correlation with fetal wellbeing.
Methods: This observational study was conducted at the OBGYN department of tertiary care hospital from Dec 2022 to Dec 2023.A total of 295 pregnant women who satisfied the criteria were recruited. Primary outcome was to assess baseline maternal serum ferritin and Vitamin D3 levels in early pregnancy and secondary outcome to assess it's effects on fetal wellbeing.
Results: Vitamin D deficiency was detected in 21 percent (42) of the study participants and low serum ferritin levels in 20 percent (40) of the patients. Vit D deficiency was more common in primigravidas (15%) as compared to low serum ferritin seen in multigravidas (12.5%). Low Serum ferritin was seen in 15 patients with anaemia and even in 10 patients with Vit D deficiency. Preterm labour, Preeclampsia was seen in three patients. Low birth weight was seen only in 2 patients and the majority of these patients underwent uneventful normal vaginal delivery.
Conclusions: Currently limited evidence is available to explore the association of serum ferritin, vitamin D with fetal wellbeing. The present study emphasizes the need for bigger study to elucidate the causal relationship between low maternal serum ferritin and Vitamin D3 and adverse pregnancy outcomes
Navigating dual challenges-breast cancer and pregnancy: a case report
Get PDFPregnancy-associated breast cancer (PABC) is a rare but challenging condition, affecting approximately 1 in 3000 pregnancies. It often presents with symptoms that overlap with common pregnancy changes, leading to delayed diagnosis. PABC is typically more aggressive, with higher rates of hormone receptor negativity and Her2 positivity. The mortality rate for PABC is 50% higher than for non-pregnancy-related breast cancer, making early detection and management crucial for both maternal and fetal outcomes. This case report aims to highlight the management complexities of PABC, emphasizing the importance of early diagnosis, prompt treatment, and coordinated multidisciplinary care to optimize outcomes. A 30-year-old woman, in her first pregnancy, presented with a palpable breast mass, initially believed to be a benign pregnancy-related change. However, further diagnostic evaluation revealed an advanced-stage invasive ductal carcinoma (IDC). Due to the aggressive nature of the tumor, neoadjuvant chemotherapy was promptly initiated. During treatment, the patient experienced spontaneous preterm labor. Despite this complication, both the mother and infant achieved favorable outcomes. The mother responded well to the chemotherapy, and the infant showed no significant complications, highlighting the critical importance of meticulous management in such complex cases. PABC requires prompt clinical evaluation and a multidisciplinary approach to treatment, balancing the needs of both mother and child. Neoadjuvant chemotherapy can be an effective option in managing advanced-stage disease, but careful monitoring is essential. This case underscores the importance of early detection and individualised treatment strategies in optimising outcomes for patients with PABC
Fetomaternal outcome of thrombocytopenia in pregnancy
Get PDFBackground: Thrombocytopenia in pregnancy can result from multiple etiologies, some specific to pregnancy and others in non-pregnant settings. Platelet count below 1.5 lakh/cumm is called thrombocytopenia. It is the second most common haematological disorder in pregnancy. It affects nearly 6 to 15% of all pregnancies. To determine the causative factors of thrombocytopenia in pregnancy and to study maternal and fetal outcome of thrombocytopenia in pregnancy.
Method: This prospective observational study was conducted on 87 patients with platelet counts below the thrombocytopenic range at the tertiary care centre, ESIC MC AND PGIMSR Medical College and Hospital, from October 2023 to October 2024 and informed consent was obtained from all patients.
Results: Gestational thrombocytopenia is the most common cause of thrombocytopenia during pregnancy (50.5%) hypertensive disorder of pregnancy (20%) and intrahepatic cholestasis of pregnancy (8%). Most of the women were primigravida (37.9%) with term pregnancies (78%) and less than 30 years old (66.6%) with high incidence of mild thrombocytopenia (72.4%). Approximately, 5.7% patients required steroid therapy. In this study, the incidence of intrauterine death is 5.7%, neonatal mortality is 1.1% fetal growth restriction (20.6%) and neonatal thrombocytopenia is 4.5%.
Conclusion: Careful blood pressure monitoring and a complete hemogram would suffice for the early detection of the disease. Proper antenatal care and institutional deliveries enable obstetricians to diagnose thrombocytopenia and its complications at an early stage. Careful surveillance is required for these women in high-risk units for early detection and treatment to reduce adverse maternal and neonatal outcomes. Platelet count to be monitored periodically
Prevalence of periodontal disease in pregnant women
Get PDFBackground: Periodontitis is inflammation of the periodontium that extends beyond the gingiva and produces destruction of the connective tissue attachment of the teeth. Maternal oral health is very important factor in determining pregnancy outcome not only for the mother but also for the health of fetus. Various forms of periodontal infections have been correlated to adverse pregnancy outcomes as miscarriage, preterm birth, preeclampsia, preterm birth, low birth weight, IUGR, still birth. Good maternal oral health may be key to childhood caries prevention.
Methods: Two hundred and sixty-three pregnant women were included as per inclusion criteria. Written informed consent of the eligible women was taken. Subjects were evaluated on the basis of predesigned and pretested study proforma with respect to history, clinical examination and ultrasonography. Oral health examination of the patients was conducted at the time of inclusion into study and re-examined in the postpartum period for maternal and perinatal outcomes.
Results: Prevalence of periodontal disease was seen in 77.18% of pregnant women. There was no statistically significant association between periodontal disease and maternal co-morbidities like GDM, Pre-eclampsia and gestation age of delivery. Significant correlation was found between periodontal disease and socio-economic status of the patients. There was significant correlation between birth weight and periodontal disease.
Conclusions: Periodontal disease is prevalent in pregnancy. Pregnant women were not aware regarding the role of periodontal disease in adverse pregnancy outcomes and the importance of regular dental check-up
An audit of respectful maternity care during pregnancy and childbirth in a tertiary healthcare facility
Get PDFBackground: Respectful maternity care (RMC) ensures dignity, autonomy, and positive birth experiences for women. Despite international efforts, mistreatment persists, particularly in low-resource settings. This study evaluated the quality of maternity care at a tertiary healthcare facility and assesses adherence to RMC principles.
Methods: A prospective observational study was conducted in the department of obstetrics and gynecology at Government Medical College Manjeri over two months (June-July 2024). All consenting women who delivered at the facility were included, except those with severe mental illness or critical health conditions. Data were collected using a pre-tested questionnaire adapted from the Birthplace Lab, incorporating the mother’s autonomy in decision-making (MADM) scale, the mothers on respect index (MOR), and the mistreatment index (MIST). The questionnaire was translated and back-translated for accuracy. Responses were gathered within 48 hours postpartum via self-administration or investigator-led interviews. Statistical analyses were performed using SPSS version 25.0.
Results: Among 149 participants, the mean age was 27.4 years; 59.7% were multiparous. The average gestational age at delivery was 38.5 weeks. Vaginal delivery occurred in 72.5%, and caesarean sections in 26.8%. High autonomy was reported by 70.5%, and high respect by 67.1%. Mistreatment, mainly privacy breaches, was reported by 6.7%.
Conclusions: While most women experienced high levels of RMC, privacy concerns remain. Strengthening awareness, staff training, and accountability mechanisms can enhance maternity care experiences and uphold women’s rights
Study on caesarean section rate using Robsons ten group classification system and its implications- a retrospective analysis from a medical college in the union territory of Puducherry
Get PDFBackground: Caesarean section is one of the major surgeries in obstetrics and it helps in preventing various complications and difficult labour ensuring the safety of both mother and baby. The aim of the study was to analyse the rate and various indication of caesarean section in our hospital and to analyse it using RTGCS.
Methods: Retrospective data collected from hospital records in the department of obstetrics and gynecology of SVMCH, Puducherry from January 2021 till January 2024 have been taken and analysed to study the various indications of caesarean section and to classify them according to RTGCS.
Results: Out of 2022 deliveries conducted during the study period, 984 (48.6%) were caesarean section. The most common indication of CS was previous LSCS (35.6%), belongs to group- 5 of RTGCS followed by fetal distress (20.5%). Other common indications were failed induction (7.4%), breech (4.3), IVF/twin (5.8%). 6% of women underwent preterm CS (group 10 of RTGCS). Around 1% of the women underwent CS for malposition/malpresentation and maternal request.
Conclusions: In our study, the rate of caesarean section is higher compared to WHO recommendation. Caesarean section if performed when needed utmost in case of obstetrics risks and emergencies may reduce the rate of CS. Trial of labour can be considered for women with previous CS who were the major contribution for repeat CS. Proper counselling and education to the mother may help in reducing the fear and anxiety about normal vaginal delivery, thus reduces the rate of other non-obstetrics indication like maternal request
A rare case report of post-partum ovarian vein thrombosis after manual removal of placenta
Get PDFPost-partum ovarian vein thrombosis (POVT) is an uncommon diagnosis that may lead to morbidity or mortality if unrecognized. This report discusses a single case of POVT in our hospital, along with the treatment and clinical course. The mechanism is believed to be right-sided clot formation provoked by anatomical and hormonal changes of gestation. Diagnosis is challenging as most patients are previously healthy and symptoms are often vague. Although the differential is broad, modern imaging is sensitive and specific for diagnosis. Prompt treatment with broad-spectrum antibiotics and anticoagulation may reduce morbidity, and prognosis following treatment is excellent
Evaluating combined therapy with myoinositol and D-chiro-inositol in infertility management across PCOS phenotypes: a comprehensive retrospective data analysis
Get PDFBackground: Polycystic Ovary Syndrome (PCOS) is a prevalent endocrine disorder affecting up to 20% of reproductive-aged women, often leading to infertility due to chronic anovulation. The condition has a multifactorial etiology involving genetic, hormonal, and metabolic factors, with insulin resistance being a key feature. The clinical presentation and therapeutic response can vary among different PCOS phenotypes. Myoinositol and D-chiro inositol has garnered attention as a potential insulin sensitizer with fertility-enhancing effects in women with PCOS. This study aimed to evaluate the impact of Myoinositol and D-chiro inositol treatment on fertility outcomes across different PCOS phenotypes, focusing on pregnancy rates and phenotype-specific responses.
Methods: A review of medical records from 200 women with PCOS treated at M2M Women’s Clinic between 2018 and 2020 was conducted. Each woman took a sachet twice daily containing 2 g of Myo-Inositol and 50 mg of D-Chiro-Inositol in a 40:1 ratio. They were grouped into four types (A, B, C, D) based on the Rotterdam criteria. Data on treatment specifics, fertility outcomes, and follow-up results were analysed, and Chi-square tests were employed to compare pregnancy rates across the phenotypes.
Results: Out of the 200 participants, 143 (71.5%) completed follow-up. The overall pregnancy rate was 70.6%, with rates of 70.4% in Phenotype A and 69.1% in Phenotype D. Phenotypes B and C achieved 100% conception rates; however, these findings were constrained by small sample sizes.
Conclusions: Myoinositol, in combination with D-Chiro-Inositol in the physiological 40:1 ratio, appears effective in improving fertility outcomes, particularly in Phenotypes A and D. Further research with larger sample sizes is warranted to validate these findings across all PCOS phenotypes and refine phenotype-specific treatment protocols
Impact of the Dakshata structured training module on healthcare professionals' knowledge and practices in intrapartum care: a study in a South Indian tertiary care institute
Get PDFBackground: Despite the high rate of institutional deliveries in India, maternal and neonatal mortality rates remain concerning. The Dakshata programme was introduced to enhance the quality of maternal and newborn care through structured training for healthcare professionals. This study evaluates the effectiveness of the Dakshata structured training module on knowledge and practices regarding intrapartum care among healthcare workers in a tertiary care institute.
Methods: A one-group pre test - post test design was used, involving 27 healthcare professionals. A self-developed 15-item multiple-choice questionnaire assessed knowledge, while Objective Structured Clinical Examination (OSCE) stations evaluated practical skills before and after the training intervention. Data were analyzed using IBM Software version 26, employing the Mann-Whitney U test and Spearman correlation for non-normally distributed data.
Results: The intervention significantly improved knowledge scores from a median of 14.00 pre-intervention to 17.00 post-intervention (p<0.001). OSCE scores also showed substantial increases across all stations. The correlation analysis revealed a significant positive relationship between pre-test knowledge and OSCE4 performance (r=0.490, p=0.009), but no significant correlation was found between post-test knowledge and OSCE scores.
Conclusions: The Dakshata structured training module effectively enhanced healthcare workers' knowledge and practical skills in intrapartum care. Continued investment in targeted training programs is essential to improve maternal and newborn care quality