International Journal of Reproduction, Contraception, Obstetrics and Gynecology
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Correlation between body mass index and serum anti-Mullerian hormone level in subfertile women at BIRDEM General Hospital, Dhaka
Get PDFBackground: Anti-Mullerian hormone (AMH) is a crucial marker for ovarian reserve, reflecting ovarian function due to its secretion by antral follicles. Obesity can adversely affect fertility, potentially altering AMH production. The aim of this study was to assess the correlation between body mass index (BMI) and serum anti-Mullerian hormone (AMH) level in subfertile women.
Methods: This cross-sectional analytical study was carried out in the department of obstetrics and gynecology, BIRDEM General Hospital, Dhaka, over a period of 18 months from January 2023 to June 2024.
Results: Between BMI≥25 kg/m2 and <25 kg/m2 groups there were no significant differences in age distribution (mean ages: 30.5 versus 30.4 years, p=0.912). There were no significant differences in education, occupation, or income distribution between two groups. Menstrual regularity and flow differed significantly, with more irregular cycles and heavier flow in the BMI≥25 group (p<0.0001 and p=0.049, respectively). Serum AMH levels were significantly lower in the BMI≥25 group (1.7 versus 3.1, p<0.0001). A negative correlation was found between serum AMH levels and BMI, indicated that serum AMH level decreases with increasing BMI (p<0.0001). Age and BMI were inversely significantly associated with serum AMH level adjusted for each other.
Conclusions: Higher BMI was associated with lower serum AMH levels in subfertile women, suggesting that elevated BMI may negatively impact serum AMH level which is a potential marker of ovarian reserve
Incidence of complications in gynaecological laparoscopic surgeries: a prospective study from a single tertiary care centre
Get PDFBackground: Laparoscopy is a widely utilized procedure in gynecology due to its minimally invasive nature, offering numerous benefits such as reduced postoperative pain, quicker recovery, and shorter hospital stays. However, as with all surgical procedures, complications may arise, particularly in more complex surgeries. This study aimed to evaluate the incidence of complications associated with gynecological laparoscopic surgeries performed at a single centre.
Methods: A total 248 patients undergoing laparoscopic gynecological procedures at the centre during the study period were included. Informed consent was obtained from each patient, outlining the risks and the possibility of conversion to laparotomy if necessary. The study evaluated patient demographics, surgical history, body mass index (BMI), types of procedures performed, hospital stay durations, and the incidence of major and minor complications.
Results: Mean age of 31.51±8.79 years. Diagnostic laparoscopy was performed in 39.51% of cases, while advanced procedures accounted for 27.01%. Complications occurred in 21 patients (8.47%), with major complications seen in 2 patients (0.80%) and minor complications in 12 patients (4.84%). Laparoscopic hysterectomy had the highest complication rate at 18.33%, and 6 patients required conversion to laparotomy. No complications were observed in diagnostic or minor surgeries.
Conclusions: Laparoscopic surgery in gynecology is generally safe, with an overall complication rate of 8.47%, which aligns with reported literature. Complications were more frequent in complex procedures and in patients with previous abdominal surgeries. Continued improvements in surgical techniques and patient selection are essential for further reducing complication rates and enhancing surgical outcomes
A rare occurrence of multiple vaginal fibroids: a case report from Yenagoa, Bayelsa, Nigeria
Get PDFVaginal leiomyomata are an unheard-of diagnosis in many climes. When a case is seen, especially if there are multiple vaginal fibroids, it becomes a reportable event. This case highlights the possibility of finding multiple leiomyoma at a very unusual site in the genital tract and its treatment. A 36-year-old patient with asymptomatic, multiple, lateral and posterior vaginal walls nodules, presented on self-referral to the gynaecology clinic for evaluation, diagnosis and treatment. Preoperative assessment was done with physical examination and investigations. Following surgical excision of the vaginal nodules, histological assessment revealed a differentiation of the mesenchyme of the tissues toward leiomyoma. Vaginal fibroid is a rarity. Multiple vaginal fibroids is a distant rarity. Thus, a high index of suspicion is necessary when examining women presenting with nodule(s) in the vagina. Such swellings or nodules should be subjected to histological assessment to clinch the diagnosis of vaginal leiomyomata
Association of maternal serum total homocysteine level with gestational diabetes mellitus
Get PDFBackground: Gestational diabetes mellitus (GDM) is diabetes first diagnosed during pregnancy, affecting a significant proportion of pregnancies worldwide. This study was conducted to determine the association between maternal serum total homocysteine levels and GDM. The aim of the study was to evaluate the association between maternal serum total homocysteine levels and the occurrence of gestational diabetes mellitus.
Methods: This case-control study was conducted in the Department of Obstetrics and Gynecology, Institute of Child and Mother Health (ICMH), Matuail, Dhaka, Bangladesh, from October 2023 to March 2025, including 36 pregnant women with GDM and 36 matched controls. Demographic, obstetric, and biochemical data, including serum total homocysteine (Hcy) levels measured by ELISA, were collected, and associations with blood glucose were analyzed using SPSS 27.0; GDM was diagnosed per WHO (2013) criteria and elevated Hcy defined as ≥6.38 µmol/l.
Results: Among 72 pregnant women, mean serum total homocysteine was higher in GDM cases than controls (9±3.5 vs. 6.7±3.7 µmol/l, p=0.008). Women with homocysteine ≥6.38 µmol/L had 4.55 times higher odds of GDM (95% CI: 1.69-12.25, p=0.003). Homocysteine levels correlated positively with fasting blood sugar (r=0.543, p<0.001) and 2-hour post-75g glucose (r=0.388, p=0.001).
Conclusions: This study establishes that elevated maternal serum total homocysteine levels are associated with gestational diabetes mellitus and may serve as a potential biomarker for GDM risk.
Serum β-hCG and neutrophil lymphocyte ratio in early second trimester of pregnancy and prediction of pre-eclampsia
Get PDFBackground: Hypertensive disorders, especially preeclampsia (PE), continues to challenge obstetric care, contributing substantially to maternal and perinatal morbidity and mortality. Reliable biomarkers for early prediction are needed. Biomarkers such as serum beta-human chorionic gonadotropin (β-hCG) and neutrophil-to-lymphocyte ratio (NLR) are emerging as potential tools for early risk stratification.
Methods: This prospective observational study included 86 pregnant women attending antenatal care at a tertiary care hospital. Serum β-hCG and NLR were measured between 13-20 weeks of gestation, and participants were followed until delivery. The development of PE was recorded, and associations with biochemical and clinical parameters were analysed using t tests, chi-square tests, and ROC curves.
Results: Of the 86 participants, 17.4% developed PE. Mean serum β-hCG was significantly higher in the PE group (60719 mIU/ml) vs. normotensive group (24952 mIU/ml, p=0.002)). MeanNLR was also elevated in PE (4.409) compared to normotensive women (3.010, p=0.002). A β-hCG cut-off of 57213 mIU/ml had a specificity of 93% for predicting PE. Higher BMI and multigravidity were significantly associated with PE (p=0.049 and p=0.029, respectively). PE was linked with earlier gestational age at delivery (35.13 vs. 37.56 weeks, p=0.013) and lower birth weight (2.53 kg vs. 2.93 kg, p=0.019).
Conclusions: Elevated second-trimester β-hCG and NLR, are significantly associated with an increased risk of PE. These accessible and cost-effective markers can aid in the early identification of high-risk pregnancies, allowing for timely interventions to improve maternal and foetal outcomes
Conservative management of unruptured ectopic pregnancy
Get PDFBackground: Ectopic pregnancy accounts for 0.5-2% of all first-trimester pregnancies and is one of the important, yet often misdiagnosed, causes of maternal death. This study aimed to determine the success rate of conservative management of unruptured ectopic pregnancy in terms of pregnancy resolution.
Methods: A prospective study was conducted over a period of two years from 2020 to 2022 at the Department of Obstetrics and Gynaecology, LD Hospital of Government Medical College, Srinagar. A total of 200 patients diagnosed with unruptured ectopic pregnancy were managed with expectant or medical management, after counseling about the need of surgical options in the advent of failed treatment or rupture.
Results: The cumulative success rate of conservative management of unruptured ectopic pregnancies was 70% while 30% cases had to resort to surgical intervention.
Conclusions: A significant number of patients with an unruptured ectopic pregnancy can be successfully identified and treated by conservative management, thereby reducing the operative interference, morbidity and economic burden, and preserving future fertility
Analysis of referred cases in a tertiary care center in Mysuru, Karnataka
Get PDFBackground: Pregnant women are at high risk for life threatening complications throughout the pregnancy and during delivery. Early detection of complications and prompt referral to higher level of care can reduce associated adverse maternal outcome. Improvement in quality of maternal child health care at primary health centre, community health centre level, regular training of healthcare provider in emergency obstetrics care is required to curb unnecessary referrals and consequently reducing feto maternal morbidity and mortality.
Methods: This is a observational study conducted in the department of obstetrics and gynaecology, at a tertiary care hospital attached to MMCRI mysuru. Patients are referred from nearby primary health centre, community health centre, district hospital and private hospitals. All referred antenatal and intra- natal patients to our center of>24 weeks of gestational age were studied.
Results: During this study period of 1 year, there were about 9234 admissions of obstetric cases out of which 6535 (70.7%) were referred cases. Maximum cases i.e.,4300 (65%) were in the age group of 20-30years age group. The most common indication for referral was PIH-2091 (32%), preterm labour (Lack of NICU facility)-1110 (17%), followed by fetal distress-718 (11%), lack of maternal ICU facility-8%, lack of cardiologists-4%. Out of the total referred cases, 2287 (35%) delivered vaginally, 3332 (51%) delivered by lower segment caesarean delivery but the remaining 916 obstetric cases did not have the follow up. Maternal morbidity was seen in 2854 (43%) of which requiring ICU admissions in 12%, PPH seen in 7%, requiring dialysis in 3%, puerperal sepsis in 1.8% , wound gaping in 2.1%, Total maternal death were-4.78% neonates were shifted to mother side, whereas 18% were admitted to NICU.
Conclusions: Referral helps healthcare seekers to reach a high level of care in the health system in a span of time. Identification of high risk factors by health personnel and timely decisions about intervention is important. Present study showed that timely referral is crucial for a satisfactory maternal and fetal outcome. In order to reduce unnecessary referral and burden on tertiary care hospitals, strengthening of existing first referral units (FRU) is necessary to provide better services and will help in achieving goal of ideal maternal mortality rate and neonatal mortality rate
Study the effect of lifestyle modifications on fetomaternal outcomes in gestational diabetes mellitus
Get PDFBackground: GDM leads to varied outcomes on both mother and foetus. However, most of the adverse effects are preventable. Timely diagnosis, proper counselling, adequate follow up plays a vital role. Lifestyle modifications include dietary interventions, weight management, adequate physical activity and stress management and prevention of any ill habits affecting health of the patient.
Methods: A study included pregnant women in their first trimester at their first antenatal visit. patients with DIPSI report >140 were taken into study. all of them were counselled regarding lifestyle interventions. Patients were followed and healthy lifestyle score was calculated. The patients who followed the advices were taken in group 1 and those that didn’t followed were taken in group 2. 100 participants of each group were followed. Follow ups were done to see the outcomes till postpartum period.
Results: The study found that Group 1 had better glycaemic control, more vaginal deliveries, and a shorter labor duration. The average baby weight was 97% in Group 1, slightly lower than in Group 2. NICU admissions were also lower in Group 1, and significant differences were observed in antepartum, intrapartum, and postpartum complications.
Conclusions: The study shows that lifestyle modifications are an important part of management of GDM. Adherence to these changes leads to better glycaemic control and thus better maternal and foetal outcomes
Caesarean section presenting an opportunity for myomectomy: a case report
Get PDFObstetricians, all over the world, frowned at the performance of myomectomy during pregnancy due to haemorrhage associated with such a procedure. This haemorrhage is even more severe in a gravid uterus undergoing caesarean section, making obstetric surgeons to avoid this risky adventure of performing the two surgeries (Caesarean section and myomectomy) at the same time. Sometimes, the fibroids are located in different parts of the uterus and they can be subserous/ pedunculated, intramural or submucous. The pedunculated fibroid has long stalk that may be thin making it very easy to “pluck” by suture ligating it. Again, uterine fibroid may be located in the lower uterine segment and bump into the incision line during cutting (uterine incision) to create access to the fetus. Caesarean sections done for different indications can therefore present an opportunity for obstetricians to remove these myomas in a harmless way that defiles the old obstetric dictum of “never a myomectomy during caesarean section”. The case in this report had caesarean section on account of severe preeclampsia with oligohydramnos but chance favoured the performance of unsolicited caesarean myomectomy safely for her
Misoprostol versus Dinoprostone for induction of labour in premature rupture of membranes
Get PDFBackground: To compare the efficacy of misoprostol (PG E1 analog) and Dinoprostone (PGE2) for induction of labour in patients with premature rupture of membranes (PROM).
Methods: This prospective study was conducted at the Department of Obstetrics and Gynaecology, Dr. BVP Rural medical college, Loni, Ahmednagar, Maharashtra. A total of 120 women (60 in each group) presenting with PROM (premature rupture of membranes) within 48 hours with gestational age between 34 weeks to 40 weeks were included. Group A women received tab misoprostol 25 mcg orally and Group B women received Dinoprostone gel vaginally kept in posterior vaginal fornix for induction of labour. Dose was repeated every 4th hourly in Group A with maximum of 4 doses and it was repeated 6th hourly In Group B with maximum of 3 doses.
Results: Among 60 patients in Group A, 47 (78.33%) delivered vaginally and 13 (21.66%) were delivered by caesarean section. In Group B, 39(65%) patients delivered vaginally and 21(35%) were delivered by LSCS.
Conclusions: Oral misoprostol 25 mcg 4 hourly is efficient and cost-effective alternative to PGE2 gel for cervical ripening and induction of labour in PROM patients