International Journal of Reproduction, Contraception, Obstetrics and Gynecology
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Unexpected diagnosis of uterine perivascular epithelioid cell tumors: a case report
Get PDFUterine perivascular epithelioid cell tumor (PEComa) is a rare mesenchymal tumor. Most PEComas are benign and patients have good prognosis but sometimes they can have aggressive malignant and metastatic potential. Symptoms are nonspecific and similar to those of other uterine tumors. Correct preoperative diagnosis is rarely achieved due to the presence of nonspecific imaging features. At the present time, surgery is the main treatment and adjuvant chemotherapy is used in malignant cases, with different prognosis for each individual case. This case report describes a 42-year-old Caucasian woman presenting to us with a suspected intramural uterine fibroid, menometrorrhagia and iron deficiency anemia (IDA). At the last check-up, an increase in the volume of the known fibroid was observed on transvaginal ultrasound, which measured 72.6×46.8×70.8 mm. The patient underwent a laparotomic myomectomy for suspected enlarged uterine leiomyoma with elevated tumor markers (LDH and CA-125). Histological examination of the surgical specimen revealed a PEComa of uncertain malignant potential. Following this diagnosis, a total hysterectomy with bilateral adnexectomy was performed with histological examination that confirmed the radicalization of the previous surgery without residual tumor tissue. PEComas of the uterus are rare mesenchymal neoplasms that pose significant diagnostic challenges pre-operatively due to their nonspecific imaging features and no specific Blood Markers. This underscores the importance of including PEComa in the differential diagnosis of uterine tumors to ensure optimal surgical planning and patient outcomes
Birthing outcomes and experience of holistic approach in women undergoing trial of labor after cesarean: a retrospective analysis
Get PDFBackground: A person-centered holistic birth approach (HBA) includes preparation of mind and spirit along with physical body to help mothers attain their ideal birthing experience. There is paucity availability of research done to evaluate the integrity of HBA. The present study aims to evaluate the birthing experience and outcomes of women undergoing a person-centered naturopathic pregnancy care.
Methods: Women with at least one previous cesarean section with no significant comorbidity and spontaneous conception who opted to have holistic approach towards trial of labor after cesarean (TOLAC) (n=44) in a private birthing center with an exclusive birthing team located in Chennai were provided with evidence based holistic interventions under a naturopathic physician from 28 weeks of gestation till delivery. Data collected between November 2022 to September 2023 were analysed retrospectively for maternal and labor outcomes using descriptive statistics.
Results: Out of all eligible pregnant women who had holistic approach (n=44), 1 in 2 (n=27) (61%) had successful vaginal birth (VB), women who came in labor spontaneously were n=32 (73%). Among those who delivered vaginally (n=27), n=17 (63%) had natural birth with no medical interventions, n=25 (93%) had nonmedicated pain management, n=16 (59%) had natural tears ranging from intact perineum to 2nd degree perineal tear and n=17 (46%) chose various birthing positions. Majority of women rated their childbirth experience to be empowering and satisfactory n=35 (88%).
Conclusions: The study demonstrates, that a holistic approach involving a multidisciplinary team in a specialty birthing center delivered by qualified professionals could result in above mentioned birthing experience and outcomes which in turn empowers women through a person-centered care
Examining the association between body mass index and abnormal uterine bleeding: a cross-sectional study among women in a tertiary care gynaecology outpatient setting
Get PDFBackground: This study examines body mass index (BMI) and abnormal uterine bleeding (AUB) in tertiary care hospital gynaecology outpatients. The findings will improve resource-limited AUB management practices.
Methods: At Rajendra Institute of Medical Science in Ranchi, India, 100 women aged 18-60 attended the gynaecology outpatient department for this cross-sectional study. Clinical assessments, BMI measurements and PALM-COEIN-based diagnostic techniques classified abnormal uterine bleeding (AUB) categories in participants.
Results: Higher BMI categories were associated with more AUB, according to the study. Obese women had the greatest AUB rate (83.3%), followed by overweight (66.7%). Obese subjects had the highest AUB-related ovulatory dysfunction. Women with higher BMI had more frequent heavy menstrual flow (p<0.01).
Conclusions: Elevated BMI is strongly associated with an increased prevalence of abnormal uterine bleeding, particularly in overweight and obese women
A clinical study on trial of labor after caesarean at tertiary care centre
Get PDFBackground: The global rise in caesarean section (CS) rates has led to an increase in women eligible for Trial of Labor After Caesarean (TOLAC). TOLAC Offers an Opportunity for Vaginal birth After Caesarean (VBAC), thereby reducing complications of repeat caesarean sections.
Methods: This prospective Observational Study was conducted on 50 antenatal women with a history of one prior lower segment caesarean section (LSCS) at civil hospital, B J medical College, Ahmedabad from September 2023 to December 2023. The women were assessed based on eligibility and monitored during labor. The study analyzed outcomes based on prior caesarean indication, previous vaginal delivery, and intrapartum events.
Results: Out Of 50 women, 32 (64%) achieved successful VBAC, 18 (36%) underwent emergency LSCS for fatal distress (44.44%), scar tenderness (27.77%), non-progression of labor (22.22%), and uterine rupture (5.55%). Prior vaginal delivery had a strong association with successful VBAC (80%).
Conclusions: TOLAC is a viable and safe option for with a prior LSCS if they are carefully selected and monitored. The best predictors for success are prior vaginal delivery, and a non-recurrent indication in previous caesarean. Institutional delivery is essential for ensuring maternal and fetal safety
Artificial intelligence in assisted reproduction: the future for reproductive medicine
Get PDFAn important turning point in the development of assisted reproductive technologies has come with the use of artificial intelligence (AI). Because optimising results is such a constant struggle, AI is being used in assisted reproduction. This review presents a concise yet comprehensive overview of AI applications in ART, including its role in computer-assisted semen analysis (CASA), oocyte and embryo evaluation, personalized stimulation protocols, and treatment outcome prediction. AI augments objectivity, enhances prediction precision, and facilitates individualized therapy through the utilization of extensive, intricate datasets. Commercial AI platforms are increasingly integrated into routine IVF workflows, particularly in embryo grading and selection, showing promising preliminary outcomes. The need for openness and fairness in AI research, development, and implementation, as well as the identification of issues and moral quandaries surrounding AI support, are underscored by the lack of legislation addressing AI in healthcare. The goal of the regulatory framework is to strike a middle ground between worldwide innovation and patient safety. Highlighting possible benefits, limits, and ethical issues, this comprehensive research evaluates the advancement of AI in assisted reproduction
Stitch in time saves nine: a retrospective study of uterine rupture over two years at a tertiary care hospital, Jabalpur
Get PDFBackground: Uterine rupture remains a critical obstetric emergency with unpredictable presentations and significant maternal-fetal risks. While often associated with prior caesarean sections, recent evidence points to a rising trend in unscarred ruptures in developing regions. This study aims to assess the incidence, risk profile, and outcomes of uterine rupture over a two-year period at a high-volume referral centre, identifying preventable gaps in care.
Methods: A retrospective observational study was conducted at Netaji Subhash Chandra Bose Medical College, Jabalpur, from April 2022 to March 2024. All women with complete uterine rupture in the second or third trimester were included. Data on demographics, obstetric history, rupture site, surgical management, and maternal-fetal outcomes were analysed. Preventive factors such as antenatal care and referral delays were also examined.
Results: Among 20,064 deliveries, 39 cases of uterine rupture were identified (1.94/1000). Of these, 61.5% occurred in scarred uteri and 38.5% in unscarred. Key contributing factors included short inter-delivery intervals, prolonged labour, previous uterine evacuation, and delayed referrals. Primary repair was performed in 71.8% of cases; hysterectomy and bladder repair were required in others. Maternal complications included anaemia, infection, and wound issues. The stillbirth rate was 74.4%, often linked to delayed presentation.
Conclusions: In addition to known risk factors, poor spacing, unregulated uterotonic use, and systemic referral delays contribute significantly to uterine rupture. Strengthening antenatal counselling, timely referral mechanisms, and obstetric preparedness at peripheral levels is essential to reduce the burden of this preventable emergency
Observational study to analyse transfusion practices in obstetrics at tertiary care center in adult populations
Get PDFBackground: Blood transfusion is one of the eight essential components of comprehensive emergency obstetric care and plays a critical role in reducing maternal mortality. Obstetric hemorrhage, particularly postpartum hemorrhage (PPH), remains a leading cause of maternal morbidity and mortality worldwide. Anemia and coagulation disorders further increase the risk of severe bleeding during pregnancy and delivery. The study aims at improving transfusion practices and also to deal with reactions associated with it.
Methods: A prospective observational study was conducted to evaluate obstetric patients who received transfusions. Data were collected on the type and indication of transfusion, components used, transfusion protocols followed, adverse reactions encountered, and maternal outcomes.
Results: The most common indications for transfusion were anemia, PPH, and placental causes such as placenta previa and abruption. Blood components commonly used included packed red blood cells (PRBCs), fresh frozen plasma (FFP), platelet concentrates, and cryoprecipitate. The majority of antepartum transfusions were for anemia correction, while postpartum transfusions were primarily due to hemorrhage. Adverse reactions were minimal but documented. Outcomes varied based on the condition and the promptness of transfusion.
Conclusions: Timely and appropriate transfusion of blood and its components is vital in the management of obstetric complications. Identifying high-risk patients and ensuring adequate blood component availability can significantly improve maternal outcomes and reduce mortality related to obstetric hemorrhage
Recurrent ovarian dysgerminoma in pregnancy: a rare case of successful maternal and fetal outcome
Get PDFDysgerminoma is a rare malignant ovarian germ cell tumor that typically affects women younger than age 30 and is highly sensitive to chemotherapy. Its occurrence during pregnancy is uncommon and recurrence during an ongoing pregnancy is extremely rare. We report the case of a 24 years old gravida 3 para 2 woman, previously diagnosed with left ovarian dysgerminoma, who presented at 27 weeks of gestation with a recurrent left adnexal mass and splenomegaly. Imaging revealed a large, multilobulated, vascularized pelvic-abdominal mass displacing the gravid uterus, with laboratory results showing elevated tumor markers. After multidisciplinary evaluation, the pregnancy was managed conservatively until 34 weeks, when increasing maternal symptoms necessitated emergency caesarean section with staging laparotomy. A healthy infant was delivered and the mass was completely excised along with total abdominal hysterectomy and right salpingo-oophorectomy. Histopathological examination confirmed recurrent dysgerminoma and the patient was subsequently started on platinum-based chemotherapy. This case highlights the importance of individualized, multidisciplinary care and timely intervention in achieving favourable maternal and fetal outcomes in pregnancies complicated by recurrent ovarian malignancy
Disseminated intravascular coagulation in pregnancy: a case report
Get PDFDisseminated intravascular coagulation (DIC) is a life-threatening situation arising from a variety of obstetrical and non-obstetrical causes. Obstetrical causes include postpartum hemorrhage, placental abruption, preeclampsia, HELLP (hemolysis, elevated liver enzymes and low platelets) syndrome, retained stillbirth, septic abortion and intrauterine infection, amniotic fluid embolism and acute fatty liver of pregnancy. Prompt diagnosis and understanding of the underlying mechanism is essential for a favorable outcome. We report a successful pregnancy outcome in a multiparous woman with severe atonic postpartum hemorrhage following normal vaginal delivery managed by obstetric hysterectomy complicated with disseminated intravascular coagulation. Massive blood and blood products transfusion given. Serial monitoring of coagulation profile done- improved on postoperative day 3. Identification of risks and early diagnosis of DIC can prevent maternal morbidity and mortality. Team work and prompt treatment are essential for successful management
Scar endometriosis: a case report
Get PDFCaesarean scar endometriosis is most commonly reported type of abdominal wall endometriosis due to is pathophysiology where endometrial tissue from caesarean incision directly implanted to the scar. A case report of a patient with a troublesome scar after caesarean section is presented below. A 34-year-old multipara with history of caesarean section delivery presented with complain pain, mass and bloody discharge from mass which increases during menstruation since past 5 years with history of lumpectomy 18 months ago with recurrence of symptoms 6 months after lumpectomy. On examination there was a 4×5 cm size, bluish firm, immobile mass at left size of caesarean scar. MRI suggested lesion measures 37×42×45 mm at the paramedian aspect of anterior pelvic wall involving rectus abdominis muscle, subcutaneous tissue and skin at site of previous surgical scar. Patient was operated and histopathological examination confirms diagnosis of scar endometriosis. Scar endometriosis is a rare entity which can easily be misdiagnosed as lump but the cyclic nature of pain with or without discharge from lump in a female patient with history of caesarean section should raise the suspicion of scar endometriosis. Caesarean scar endometriosis has a reported incidence of 0.03 to 0.45%. Diagnosis is mainly clinical after ruling out other conditions and diagnosis can be confirmed with radiology imaging and histopathology. Caesarean scar endometriosis should be considered in a reproductive age group patient with previous caesarean delivery which present with complain of lower abdominal pain