International Journal of Reproduction, Contraception, Obstetrics and Gynecology
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Non-puerperal total uterine inversion: an unusual gynecological case managed with vaginal hysterectomy
Get PDFUterine inversion during puerperium is an obstetric emergency, and it is an even rarer complication posing a diagnostic challenge in gynaecology. Non puerperal uterine inversion is mostly associated with benign uterine pathology such as leimyomas. Treatment depends on the associated pathology and stage of inversion. A rare case of acute non-puerperal total uterine inversion caused by multiple fundal leiomyomas in a 47-year-old woman resulting in profuse vaginal bleeding is reported; it was successfully treated by vaginal hysterectomy. The postoperative period was uneventful, and the patient was discharged in good condition. Acute complete uterine inversion is rare in non-pregnant women, and there are only a few reported cases worldwide. It therefore poses a diagnostic dilemma to the unsuspecting gynaecologist, and therefore a high index of suspicion is needed to differentiate it from uterovaginal prolapse or a prolapsed fibroid, as the clinical presentations can be similar
Complications of nexplanon contraceptive implants and reasons for discontinuation, in Yenagoa, Nigeria
Get PDFBackground: Though nexplanon is a safe and effective contraceptive implant, the complications are often troublesome to warrant removal. This study intends to determine the complications of nexplanon contraceptive implant, and the reasons for removal.
Methods: It was a retrospective cross-sectional study of 258 women, who used nexplanon contraceptive implants for a while and discontinued. Data collected was: bio-data, the duration of contraceptive use, rank of the inserter (nurse or resident doctor), rank of the remover, the complications experienced, and the reasons for implant removal.
Results: The mean duration of nexplanon use was 30.95±14.34 months, majority (96.1%) were inserted, and (82.2%) removed by trained nurses. Insertion by resident doctor significantly resulted in more complications than by trained nurses, odds ratio=5.10 [1.06, 24.51], p=0.02. The complication rate was 50%, and vaginal bleeding (25.2%) was the most common. Others are: headache (8.9%), pain at the injection site (3.9%), Weight gain (3.1%), amenorrhoea (1.6%), mood swing (1.6%), and breast pain (1.2%). Regarding contraceptive failure, the pearl index was low (0.06). Women who inserted once significantly had more complications than those who inserted twice, odds ratio=0.46 [0.22, 0.77], p=0.03. Women who used it for a period of ≤36 months significantly had more complications than those who used it for a longer period, odds ratio=0.53 [0.30, 0.92], p=0.02. The commonest reasons for removal were: expired implant (41.9%), desire to get pregnant (31.8%), and heavy vaginal bleeding (21.3%). The removal rate (secondary to complications) was 26.4%.
Conclusions: Nexplanon is an effective contraceptive implant with a very low failure rate. Irregular vaginal bleeding is the commonest complication, and the most common reason for discontinuation
Insulin resistance by homeostatic model assessment in patients of polycystic ovarian syndrome
Get PDFPolycystic ovarian syndrome (PCOS) is one of the common endocrine disorders of reproductive age and affects approximately 6-16% of general population. Considering high incidence (70-95%) of insulin resistance in women with high BMI, 30-75% of population is found to have insulin resistance inspite of being lean. So, it is worth proving insulin resistance irrespective of BMI. Of amongst different tests to diagnose insulin resistance, homeostatic model assessment of insulin resistance (HOMA-IR) has been proved to be useful as a screening test for insulin resistance. This is a retrospective observational study of 4 months from April 2022 to July 2022 and included 18 patients diagnosed with PCOS. We studied their BMI, fasting glucose, fasting insulin and HOMA-IR. Out of total patients screened, the prevalence of insulin resistance was 72.22% as calculated by HOMA-IR test. No prevalence of HOMA-IR was observed in underweight cases. Out of normal weight cases, 83.33% cases were found to have Insulin resistance. Of the overweight and obese cases, 100% were found to have insulin resistance. Majority of women with PCOS have insulin resistance and consequent hyperinsulinemia. Insulin resistance is directly proportional to weight gain in PCOS patients. Lifestyle modification and administration of insulin sensitizers like Metformin is useful in reducing insulin resistance in overweight and obese patients. In patients with normal BMI who prove to have insulin resistance with raised HOMA-IR test are also benefited from medical therapy
Diagnostic efficacy of DIPSI criteria for diagnosis of gestational diabetes mellitus in comparison with WHO 2013 criteria
Get PDFBackground: Gestational diabetes mellitus (GDM) is a global health issue due to its increasing prevalence and negative effects on maternal and fetal health. The standard screening method is the 75 g glucose tolerance test (OGTT), which requires fasting. The Diabetes in Pregnancy Study Group of India (DIPSI) suggests a one-stage, non-fasting test as an alternative, which could be more patient-friendly and aligns with international recommendations. This study aimed to assess the diagnostic efficacy of the DIPSI method compared to the WHO criteria for GDM screening.
Methods: This cross-sectional study was conducted from October 2021 to September 2022 at the Department of Obstetrics and Gynecology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka. One hundred and thirty-three singleton pregnant women who provided informed consent were included.
Results: Among 133 participants, 34 (25.6%) were diagnosed with GDM according to WHO criteria, while 26 (19.5%) were diagnosed with DIPSI. The DIPSI method showed high specificity (96.97%) but lower sensitivity (67.65%) compared to the WHO criteria. The positive and negative likelihood ratios were 22.32 and 0.33, respectively, with an overall accuracy of 89.46%. Lowering the DIPSI cutoff to 7.3 mmol/L improved sensitivity to 82.4% and specificity to 92.9% and increased overall accuracy to 90.2%.
Conclusions: The non-fasting DIPSI method demonstrated reasonable diagnostic accuracy compared to the WHO criteria. It is recommended for use in low-resource settings but should not replace the gold standard OGTT for comprehensive GDM screening
Evaluation of triglyceride/glucose level index as a predictor of gestational diabetes mellitus: a comparative study with haemoglobin A1c
Get PDFBackground: Gestational diabetes mellitus (GDM) is a pregnancy complication characterized by chronic hyperglycaemia, which increases the risk of adverse outcomes for both the mother and foetus. Early identification and intervention are crucial for improving pregnancy outcomes. The triglyceride-glucose (TyG) index, calculated using fasting triglyceride and glucose levels, has shown promise as a predictor of insulin resistance and metabolic disturbances. This study aims to evaluate the potential of the TyG index, along with HbA1c, as early biomarkers for GDM prediction.
Methods: This prospective study was conducted at GS Medical College & Hospital, Pilkhuwa, Hapur, over 18 months (January 2022 to June 2024), involving 144 pregnant women aged 18-30 years. The study included fasting glucose, triglyceride, and HbA1c measurements, along with the oral glucose tolerance test (OGTT) to diagnose GDM. The TyG index was calculated as [fasting triglycerides (mg/dl) × fasting glucose (mg/dl)/2]. Statistical analysis was performed using SPSS version 26.0, with Chi-square, t-tests, and regression models.
Results: The study revealed that 11.8% of participants were diagnosed with GDM. The GDM group had significantly higher levels of HbA1c (6.34±0.59%) compared to the non-GDM group (4.32±1.26%) (p<0.0001). The TyG index was also significantly higher in the GDM group (150.4±25.2) compared to the non-GDM group (129.27±20.66) (p = 0.0002). Both markers showed strong associations with GDM, suggesting their utility for early prediction.
Conclusions: The study supports the use of HbA1c and the TyG index as effective early biomarkers for GDM. These markers can help identify high-risk women and enable timely intervention to reduce adverse maternal and fetal outcomes. Early screening using these biomarkers should be prioritized, particularly for high-risk populations. Further research is needed to validate their diagnostic utility and integrate them into routine clinical practice
Ruptured ovarian ectopic pregnancy: a rare and challenging diagnosis
Get PDFOvarian ectopic pregnancy is a rare and serious condition that can result in significant maternal morbidity and mortality. This report details the presentation, diagnosis, and surgical management of a 27-year-old woman with a ruptured ovarian ectopic pregnancy. Due to their nonspecific symptoms, ovarian ectopic pregnancies are often only diagnosed intraoperatively and confirmed through histopathological analysis. Prompt diagnosis and timely treatment are essential to prevent life-threatening complications. Whenever possible, fertility preservation should be prioritized through conservative surgical techniques or medical management for carefully selected patients. This case underscores the critical need for heightened awareness and prompt intervention in managing ovarian ectopic pregnancies.
A call for reminder before it’s too late atypical endometrial hyperplasia and concurrent cancer in reproductive age women
Get PDFEndometrial hyperplasia is a hyper proliferation of endometrial cells predominantly of stromal glandular components under estrogen influence. This is a premalignant lesion which concomitant with endometrial carcinoma in 40% of cases. Major risk factors are estrogen predominant states such as nulliparity, early menarche, late menopause, obesity, infertility, polycystic ovarian syndromes, estrogen producing tumours. Prolonged use of COCs, tamoxifen also plays a role in endometrial hyperplasia leading to concurrent endometrial carcinoma in reproductive age women. Pointing towards pathology endometrial carcinoma diagnosed at an earlier age are mostly of low grades with lower stage and good clinical outcomes. With this review we emphasize the need of endometrial sampling or fractional curettage in all young women with altered menstrual flow with suspicious of increased endometrial thickening before starting any medications.
Prevailing circumstances governing abortion in Africa
Get PDFA woman's worth is closely tied to childbirth in many African societies. The immense cultural emphasis that is placed on pregnancy means that women are also subject to stigmatization in the event of unintended pregnancies. In the patriarchal societies that commonly make up the region, a woman’s bodily autonomy is often subjugated to insensitive decisions taken by men based on social circumstances. Abortion remains a largely taboo topic with the resulting lack of informed awareness putting women at risk. The current review aims to change that discourse by examining the sociodemographic considerations, beliefs, and traditions across various regions that prevent the effective utilization of existing facilities. The risk factors that govern elective abortions are examined with attention being given to commonly found age-disparate relationships as well as vulnerable and marginalized sections of society. The impact of the pandemic is also discussed with recommendations on multi-level action plans that would allow for effective advocacy. There is a lack of access to safe abortion infrastructure. Strengthening healthcare delivery infrastructure will mitigate the national economic burden and ensure that female reproductive health receives the attention it deserves
Prevalence of asymptomatic bacteriuria among pregnant women in different trimesters
Get PDFBackground: Asymptomatic bacteriuria (ASB) occurs in individuals of all ages.
Methods: A cross-sectional study was conducted for a period of 6 months from February 2024 to August 2024 at Panimalar Medical College Hospital and Research Center that included 130 antenatal women presented for regular antenatal check-up in OG OPD. Graphpad Prism (vs. 9.2.0). was used for data analysis in which p≤0.05 was considered statistically significant.
Results: The overall prevalence of ASB was 33.1%.
Conclusions: The incidence of ASB was 33.1% which is still lower as reported in other Indian studies. Age, socioeconomic class and trimester were not found to be associated with ASB. The most common organism isolated was E. coli, followed by S. aureus, Klebsiella, Proteus, and equal incidence of Citrobacter spp. and Pseudomonas
Prevalence of sexually transmitted infections in symptomatic women of reproductive age group in a tertiary care centre
Get PDFBackground: Sexually transmitted infections (STIs) remain a significant global health challenge, affecting millions of individuals daily. This study aimed to investigate the prevalence and causative organisms of common STIs in women aged 18-49 years who presented with symptomatic vaginal discharge at a tertiary care hospital in India. The primary objective was to assess the prevalence of common STIs, including syphilis, gonorrhoea, chlamydia, trichomoniasis, human immunodeficiency virus (HIV), and candidiasis, through the use of specific diagnostic tests.
Methods: A total of 100 non-pregnant women aged 18-49 years with vaginal discharge (excluding physiological discharge) were enrolled in the study. The research was conducted in the Department of Obstetrics and Gynecology LLRM Medical College, Meerut. Each participant was subjected to a detailed medical history and clinical examination. Vaginal and cervical swabs were taken for laboratory testing, and specific tests were performed for the detection of syphilis, gonorrhea, chlamydia, trichomoniasis, HIV, and candida. Data were analyzed using Microsoft Excel and statistical software such as GraphPad Prism 8.4.2 and statistical package for the social sciences (SPSS) version 25.
Results: The study found that 15% of participants were diagnosed with an STI, with Candida infection being the most prevalent, affecting 66.67% of those with STIs. Chlamydia and Trichomonas infections each accounted for 13.33% of the cases, while one case of syphilis was reported. Significant correlations were observed between the type of vaginal discharge and the presence of STIs, with blood-stained and mucopurulent discharge being more common among STI-positive women.
Conclusions: The prevalence of STIs observed in this study was consistent with findings in the broader epidemiological literature. Candida infection was the most frequently diagnosed, underscoring the need for targeted interventions, early detection, and awareness among women of reproductive age in both urban and rural settings