International Journal of Reproduction, Contraception, Obstetrics and Gynecology
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Levormeloxifene - a non-hormonal woman-centric oral contraceptive under development: a comprehensive review
Get PDFThe drugs controller general of India (DCGI) has granted permission to Cipla Limited, an Indian pharmaceutical company, to conduct Phase-I clinical trial of levormeloxifene for development as oral contraceptive for women as joint collaboration with CSIR-Central Drug Research Institute, Lucknow, India (CSIR-CDRI). Levormeloxifene is laevorotatory enantiomer of ormeloxifene, a benzopyran Selective Estrogen Receptor Modulator (SERM). Ormeloxifene is racemic mixture in equal quantities of levo- and dextro-enantiomers (compounds having same chemical composition but mirror-image 3-dimensional structures). In rats, levormeloxifene [Minimum Effective Dose (MED): 0.15 mg/kg/day] prevented pregnancy at almost half the dose than ormeloxifene (MED: 0.25 mg/kg/day) when administered orally covering the entire pre-implantation period. Levormeloxifene is equally effective as single 1 mg/kg dose when administered within 24 hours of coitus. In accordance with its higher relative binding affinity (RBA: 15.7±3.1 percent of estradiol-17β), levormeloxifene exhibited more potent estrogenic and antiestrogenic activities than the d-ormeloxifene (RBA: 2.10±0.9) or dl-ormeloxifene (RBA: 5.24±1.45). Besides, it shows promise in prevention of increased bone turnover and destructive joint diseases, and beneficial effect on serum lipids. This is the first comprehensive review providing relevant published information on structure, pharmaceutical properties, preparation, safety, pharmacokinetics and pharmacodynamics of levormeloxifene
Study of the incidence of tubal ligation and long-acting reversible contraceptives in tertiary care centre: a population-based study
Get PDFBackground: Tubal ligation and long-acting reversible contraceptives (LARC) provide reliable long-term contraception; however, women’s choices are influenced by factors such as age, parity, previous deliveries, and counselling. This study aimed to assess and compare the acceptance of tubal ligation versus LARC among reproductive-aged women at a tertiary care centre, with the primary objective of identifying the demographic, obstetric, and socioeconomic factors affecting their choice of contraception.
Methods: A prospective cross-sectional study was conducted from April 2023 to December 2024 at a tertiary care obstetrics and gynecology centre. Sexually active women aged 19-49 years seeking post-partum family planning were recruited via purposive sampling if opting for tubal ligation or LARC. Sociodemographic, obstetric, and contraceptive data were collected and analysed using SPSS.
Results: Most participants were aged 26-32 years (79, 46.47%) and 18-25 years (75, 44.12%). FTND was the most common previous pregnancy (105, 61.76%). The uterus was anteverted in 165 (97.06%). Contraception choices included tubectomy (99, 58.23%), PPIUCD (28, 16.47%), and DMPA (34, 20%). LARC use was higher in P1L1 (28, 100%) and P1L1A2 (4, 100%), while tubectomy was associated with higher parity and previous LSCS (p<0.001). Delivery mode also influenced method (LSCS 37, 56.92%; FTND 62, 59.05%; p=0.0069).
Conclusions: Tubal ligation was the main contraceptive choice, especially among multiparous women and those with prior cesarean sections. LARC was preferred by younger or lower-parity women but remained underutilised. Choices were influenced by obstetric history and delivery mode, underscoring the need for better counselling, awareness, and access
A comparative study of placental abnormalities in normal and specific high-risk pregnancies by using Doppler, histology and their fetal outcome
Get PDFBackground: The placenta, a vital organ connecting mother and fetus, undergoes significant growth and facilitates essential exchange. Various placental pathologies, including issues with vascular processes, inflammation, and structural abnormalities, can impact pregnancy outcomes. Conditions like placenta accreta, placenta previa, and vasa previa pose significant risks. Diagnosis and evaluation of these abnormalities are primarily done through ultrasound imaging, doppler ultrasound for blood flow assessment, and histopathology after birth.
Methods: This two-year prospective observational study at Lt. Baliram Kashyap Memorial Govt. Medical College will investigate placental characteristics in 200 pregnant women (100 normal, 100 high-risk) over 28 weeks' gestation. It involves detailed examination of placentas and babies, with data analyzed using SPSS. The study has ethical approval and aims to identify associations between placental features and pregnancy outcomes.
Results: In this study of 200 pregnant women, high-risk pregnancies were associated with older maternal age (mean 26.5 vs 24.6 years, p<0.01) and a higher proportion of multiparous women (p<0.01). Key placental abnormalities (round shape, infarct, fibrosis) and umbilical cord abnormalities (edema, foul-smelling liquor) were significantly more prevalent in the high-risk group. Doppler findings showed that an abnormal Systolic/Diastolic ratio was significantly linked to adverse perinatal outcomes. Overall, various maternal and fetal factors contribute to high-risk pregnancies and their associated complications.
Conclusions: Placental abnormalities (infarcts, fibrosis, bleeding) and umbilical cord issues (edema, foul-smelling liquor, marginal insertion) are major indicators of high-risk pregnancies and poor neonatal outcomes. Conditions like pre-eclampsia and gestational hypertension also correlate with these placental issues. Early ultrasound and Doppler studies are crucial for detection, necessitating increased clinical caution in managing such pregnancies. Further research is vital to establish comprehensive guidelines for improved care
A case series on uterine anomalies and their obstetric outcomes
Get PDFCongenital uterine anomalies (CUAs) are structural malformations of the female reproductive tract resulting from disruptions in the embryological development of the Müllerian ducts. These anomalies may remain undetected due to their asymptomatic nature but can significantly affect reproductive outcomes, including infertility, recurrent pregnancy loss, and complications during gestation and delivery. This case series presents five patients diagnosed with different types of uterine anomalies unicornuate, bicornuate, didelphys and septate uterus—each demonstrating distinct antenatal and postnatal trajectories. The series highlights the importance of accurate diagnosis, individualized management strategies, and multidisciplinary care to optimize maternal and neonatal outcomes
Panicker’s vacuum suction hemostatic device- a novel innovation for the treatment of atonic postpartum hemorrhage
Get PDFBackground: The aim of this study was to evaluate the effectiveness of the Panicker’s vacuum suction hemostatic device in treating postpartum hemorrhage refractory to medical treatment.
Methods: A retrospective study including women with atonic postpartum hemorrhage in whom Panicker’s vacuum suction hemostatic device was used, since they did not respond to the medical management. The demographic factors, mode of delivery, volume of blood loss, blood transfusion and outcome of the procedure were studied.
Results: The study demonstrated that the device achieved effective hemostasis in both minor and major PPH, helping reduce maternal morbidity and mortality. Early recognition and timely preventive measures in at-risk women could have limited bleeding and reduced the need for transfusions.
Conclusions: Panicker’s vacuum suction hemostatic device which works on the principle of vacuum retraction of the uterus was found to be effective in the management of atonic postpartum hemorrhage
Uterine-preserving vaginal sacrospinous hysteropexy in pelvic organ prolapse: a case series
Get PDFPelvic organ prolapse (POP) is a major cause of morbidity among women worldwide and is commonly managed by hysterectomy. However, uterine-preserving procedures such as vaginal sacrospinous hysteropexy (SSH) are increasingly being adopted, particularly where cultural and psychological considerations make uterine conservation desirable. We report our experience with SSH in Northern Nigeria as a case series. This series involved 26 women with symptomatic POP who underwent SSH between 2015 and 2024 across different locations in Northern Nigeria. The mean age of the women was 40 years and the modal parity was 2, with most women presenting with advanced prolapse (POP-Q stage IV). All women reported protrusion per vaginam as their main complaint. The mean operating time was 31 minutes, mean blood loss was 171 mL, and mean duration of hospital stay was three days. Early complications were recorded in two patients (7.6%): one case each of postoperative bleeding and urinary retention. Recurrence was observed in two patients (7.6%) during follow-up. Outcomes were comparable to those reported in similar studies, with relatively short operative times, low blood loss, and acceptable recurrence rates. Our findings suggest that SSH is a safe, effective, and culturally acceptable option for uterine preservation in women with advanced POP in low-resource settings. Wider use of this technique could improve access to surgical care and enhance the quality of life of affected women, particularly where resources and surgical expertise are limited.
Prevalence, immediate neonatal outcomes, and factors associated with short birth intervals among mothers delivered at Mubende Regional Referral Hospital, Uganda
Get PDFBackground: Short birth intervals (SBIs) pose significant public health risks, particularly in low-resource settings like Uganda, where they are associated with adverse neonatal outcomes. Despite WHO recommendations for optimal birth spacing, high rates of SBIs persist, largely due to socio-economic, cultural, and healthcare access challenges. This study aimed to determine the prevalence, immediate neonatal outcomes, and associated factors of SBIs among mothers at Mubende Regional Referral Hospital.
Methods: A cross-sectional study was conducted from May to August 2024, involving 422 postpartum mothers. Data on sociodemographic, obstetric, and behavioral factors were collected, and logistic regression analysis was used to identify factors associated with SBIs and assess the impact on neonatal outcomes, including small for gestational age, preterm birth, early neonatal death, and External congenital defects.
Results: The study revealed an SBI prevalence of 40.3%. The most common adverse neonatal outcomes were Small for gestational age (31%), and preterm birth (26%). Key factors associated with SBIs included young maternal age (<20 years, aOR 2.18, 95% CI: 1.13-4.22), rural residence (aOR 2.84, 95% CI: 1.69-4.78), lack of antenatal care (aOR 4.64, 95% CI: 1.80-11.95), unplanned pregnancies (aOR 2.15, 95% CI: 1.35-3.41), and short breastfeeding duration (<12 months, aOR 3.26, 95% CI: 2.05-5.20).
Conclusions: The study identified a high prevalence of SBIs, with significant associations to adverse neonatal outcomes such as Small for gestational age, and preterm birth. Factors contributing to SBIs included young maternal age, rural residence, limited antenatal care, and unplanned pregnancies, are highlighting the need for targeted family planning and maternal health interventions.
Prevalence of dysmenorrhea and intention to seek care among in-school adolescents in Nigeria: a cross-sectional study
Get PDFBackground: Dysmenorrhea is a problem that girls face and often manage themselves with or without support from health professionals. The objective of this study was to assess the prevalence of dysmenorrhea and intentions to seek care among in-school adolescents.
Methods: Descriptive cross-sectional research design was utilized, and a two stage sampling technique was used in selecting 315 participants based on the required sample size. Data were analyzed using SPSS version 20, and results were summarized using descriptive and inferential statistics with level of significance set at p<0.05.
Results: The mean age of respondents was 15.49±1.44 years. Dysmenorrhea was prevalent among 80% of the respondents. Predictors of intention to seek care for dysmenorrhea among the respondents were awareness about health services for dysmenorrhea (AOR=2.15, 95%CI=1.19-3.86, p=0.012), cost of care for dysmenorrhea (AOR=0.29, 95%CI=0.12-0.62, p=0.002), and perception on dysmenorrhea (AOR=0.21, 95%CI=0.10-0.40, p=0.001).
Conclusions: Dysmenorrhoea is a common health problem among in-school adolescents in Nigeria. Health education campaigns should be organized to create awareness on availability of services for treatment of dysmenorrhea and correct the misconception that dysmenorrhea needs no care especially in situations where the pain is moderate to severe
Psychosomatic disorders with predominantly gynecological complaints: a clinical and demographic profile study at a tertiary care center
Get PDFBackground: Psychosomatic disorders, particularly somatic symptom disorders (SSD), represent a significant challenge in clinical practice due to their complex interplay of psychological and physical symptoms. Women frequently present with unexplained gynecological symptoms, often impacting their quality of life and leading to multiple healthcare consultations. This study aims to evaluate the prevalence and symptom profile of SSD in women attending a gynecology outpatient department (OPD).
Methods: A cross-sectional study was conducted over 12 months in the department of obstetrics and gynecology at the Himalayan institute of medical sciences, Dehradun. Seventy-two women aged ≥18 years with unexplained gynecological symptoms persisting for >6 months were recruited. Detailed history, clinical examination, and investigations were performed to exclude organic causes. The public health questionnaire-15 (PHQ-15) was used to assess symptom severity. Data were analyzed using SPSS version 20.
Results: Out of 6000 gynecology OPD attendees, 1.2% (72 patients) were diagnosed with SSD. The most common symptoms were chronic pelvic pain (56.94%), vaginal discharge (37.5%), and lower backache (26.38%). The majority (45.83%) of patients were aged 40-59 years, and 56.9% had a normal BMI. Parity of three was most common (44.44%), and 34.72% had a history of primary education. Psychiatric comorbidities were present in 34.72%, with depression being the most frequent (13.88%). Hypothyroidism (13.88%) was the most common comorbidity. PHQ-15 scores indicated that 38.88% had moderate severity of symptoms.
Conclusions: SSD is an underrecognized but significant concern among women with unexplained gynecological symptoms. Chronic pelvic pain and vaginal discharge were the most prevalent symptoms. A multidisciplinary approach, including psychiatric evaluation, is essential for effective management of these patients
Heterotopic pregnancy: a case report
Get PDFHeterotopic pregnancy is a potentially life-threatening condition if left undiagnosed. Early pregnancy ultrasound is a key diagnostic tool in all symptomatic cases or where there are risk factors and clinical suspicion. Multi-professional discussion is essential in decision making. As this patient miscarried the intrauterine pregnancy, and the ectopic pregnancy appeared to be resolving spontaneously, no further laparoscopic intervention was required. Only monitoring β-hCG levels till it reached the non-pregnant levels helped to confirm complete resolution.