International Journal of Reproduction, Contraception, Obstetrics and Gynecology
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Abnormal uterine bleeding as first symptom of acute promyelocytic leukaemia: a case report and literature review
Get PDFAbnormal uterine bleeding is common within gynaecology practice. It affects up to one-third of women during their lifetime. Hematological cancer is a rare form of coagulopathy leading to abnormal uterine bleeding. Uterine bleeding caused by coagulopathy as a complication of acute promyelocytic leukaemia can be fatal. The aim was to document a rare case of acute severe abnormal uterine bleeding as first symptom of haematological cancer (Acute Promyelocytic Leukaemia). She was a 45-year-old Para 2 woman who presented at the emergency room with chief complaint of uterine bleeding of six days duration. She also developed a throbbing headache that suddenly intensified, initially on the left side of her head, radiating to the periorbital area. Assessment of Acute promyelocytic Leukaemia complicated by Subarachnoid haemorrhage was made. She was referred to National Hospital Abuja for further management. Uterine bleeding caused by coagulopathy as a complication of acute promyelocytic leukaemia can be life threatening, hence early diagnosis and treatment is imperative
Quadricuspid aortic valve in pregnancy: a case discussion
Get PDFA quadricuspid aortic valve (QAV) is an exceptionally rare congenital heart anomaly first time identified in 1862. This condition involves the presence of four cusps in the aortic valve instead of three, leading to potential complication such as aortic regurgitation. In the reported case 29-year-old pregnant women at 29 weeks gestation presented in OPD for further follow up with no dyspnea on exertion. Electrocardiogram findings were normal and transthoracic echocardiography (TTE) revealed a QAV with three equal sized cusps and one smaller cusp accompanied with mild aortic regurgitation with no other additional anomalies observed. The patient underwent a normal vaginal delivery without any peripartum cardiac complications. While QAV is a rare congenital anomaly it is not uncommon to be associated with aortopathies. This condition makes pregnancy is in high-risk state. Close monitoring especially in second and third trimesters remains of utmost importance. Due to its rarity, the characteristics, natural history, and long-term outcomes of QAV are poorly defined. In general, aortic valve disease during pregnancy can be associated with higher maternal and fetal risks. Pre conceptional counselling is essential to assess and manage high these risks appropriately. For instance patient with significant AVD should be assessed and followed up by multidisciplinary team including cardiologists, obstetricians, cardiothoracic surgeons and anasthesiae both before and throughout pregnancy. In summary, while QAV is a rare congenital anomaly its association with pregnancy necessitates careful monitoring and management to ensure favorable outcomes for both mother and child
Huge serous cystadenoma in a postmenopausal woman: a case report
Get PDFOvarian tumors have been classified into three main groups: epithelial, stromal and germ cells tumors on the basis of their origin. Epithelial tumors are the most common type accounting for about 60% of all the ovarian tumors in adult. Serous and mucinous tumors are the most common epithelial tumors occurring in women at age group 60-70 years. Giant ovarian tumors have become rare because of the early detection of adnexal pathology with the advent of routine imaging modalities in the recent era of medical practice. In previous studies, large or giant ovarian cysts were described as cysts measuring more than 10 cm in diameter in a radiological scan or those cysts reaching above the umbilicus
The influence of cultural practices and socioeconomic factors on teenage pregnancy across selected primary health care centers in Akinyele local government area, Ibadan, Nigeria
Get PDFBackground: Teenage pregnancy is a significant contributor to maternal and child mortality and a driver of the cycle of ill health and poverty, particularly in low- and middle-income countries (LMICs). Globally, around 21 million girls aged 15-19 and 2 million under 14 give birth annually, with 95% of these births occurring in developing countries. In Nigeria, the burden of teenage pregnancy is exacerbated by cultural practices, socioeconomic challenges, and limited access to education and reproductive health services.
Methods: A cross-sectional study was conducted across selected primary health care (PHC) centers in Akinyele local government area (LGA), Ibadan, Nigeria. Twelve PHCs were randomly selected, one from each ward. A multi-stage sampling method was used to select teenage antenatal attendees. A sampling frame was developed from antenatal records, and eligible participants were chosen using computer-generated random numbers. Data were collected using a validated questionnaire with both open- and close-ended questions from July to August 2024. Statistical analysis was done using IBM SPSS version 27.0, with significance set at p≤0.05.
Results: Peer pressure (58.5%) and family pressure (46.5%) were the most reported causes of teenage pregnancy. Cultural barriers around sex education and contraception were reported by 80.3% of participants, with only 9.4% affirming open dialogue. Financial hardship and lack of educational opportunities were also cited by 78.7% as key contributing factors. The mean age of respondents was 17.5 years (SD±1.57).
Conclusions: Cultural and socioeconomic factors significantly influence teenage pregnancy, highlighting the urgent need for targeted interventions in education, family engagement, and reproductive health communication
Average gonadotropin dosage per follicle as a predictor of ovarian response
Get PDFBackground: In ovarian stimulation, oocytes retrieved are commonly used to assess response to gonadotropins. Markers like FORT, FOI, and OSI have been proposed but show poor prediction of IVF outcomes. Each is limited by various clinical and technical factors. A novel index, average gonadotropin dosage per preovulatory follicle offers better prediction of ovarian response and clinical pregnancy rate, aiding in personalized stimulation and helping anticipate OHSS risk and cycle cancellations
Methods: This retrospective cohort study included 238 sub fertile women who underwent IVF at the Institute of Reproductive Medicine, Madras Medical Mission Hospital, from January 2019 to December 2023. It aimed to evaluate a new marker, average gonadotropin dosage per preovulatory follicle as a predictor of ovarian response and pregnancy outcomes. The index was calculated by dividing the total gonadotropin dose by the number of 16–22 mm follicles on trigger day. Patients were grouped by the 50th percentile, and stimulation parameters, MII oocyte ratio, clinical pregnancy rate, and live birth rate were compared between groups.
Results: Group A showed significantly higher oocyte yield, MII oocyte ratio, and fertilization rate (p<0.001). Clinical pregnancy and live birth rates were higher in Group A with statistical significance compared to Group B
Conclusion: Average gonadotropin dose per follicle proved to an ovarian response predictor in our study
Blinding clues: unveiling the ocular manifestations of preeclampsia
Get PDFPreeclampsia is a hypertensive disorder of pregnancy that significantly contributes to maternal and fetal morbidity and mortality. Although its hallmark manifestations include hypertension and proteinuria, systemic complications affecting various organs, including the ocular system, are often under-recognized. Ocular manifestations range from mild visual disturbances to severe complications such as cortical blindness and retinal detachment. These complications reflect the systemic endothelial dysfunction and vascular permeability characteristic of preeclampsia. Early recognition of ocular symptoms can serve as a valuable indicator of disease severity and progression, prompting timely intervention. In this case, a 37-year-old gravida 2, para 1, at 30+6 weeks of gestation presented with severe hypertension (200/110 mm Hg), headache, and loss of vision. A diagnosis of posterior reversible encephalopathy syndrome (PRES) was suggested, likely secondary to cerebral edema associated with preeclampsia. The patient underwent emergency lower-segment caesarean section (LSCS) after stabilization with intravenous Labetalol and magnesium sulphate (MgSO4). Postoperatively, her visual symptoms resolved within six hours, and an ophthalmological evaluation revealed a normal fundus examination. This case shows the importance of recognizing preeclampsia-induced ocular changes, as timely intervention can prevent irreversible complications such as optic neuropathy and permanent vision loss. Multidisciplinary management, including obstetric and ophthalmologic care, is critical to achieving favorable maternal and fetal outcomes. Routine monitoring and ophthalmological evaluations in high-risk pregnancies are essential to early detection and effective management. This case highlights the reversible nature of preeclampsia-induced ocular complications and emphasizes the role of expedited delivery in mitigating severe outcomes
Association of low pregnancy-associated plasma protein A with the timing of delivery in babies with intrauterine growth restriction, babies showing suboptimal growth on serial scans, and well-grown babies
Get PDFBackground: The ideal timing for delivering babies with pre-eclampsia or small for gestational age is clear. There is agreement on delivering babies with pre-eclampsia and small for gestational age, but not for normally growing babies with low pregnancy-associated plasma protein A (PAPP-A). The study aimed to investigate the association of low PAPP-A with adverse pregnancy outcomes and ideal delivery timing in a well-grown baby with low PAPP-A as a risk factor.
Methods: A retrospective study analyzed 3240 singleton pregnancies with first-trimester Down syndrome screening at local hospitals from January 2022 to April 2023. Among these, 130 singleton pregnancies had PAPP-A levels at the 5th centile, along with risk estimations and documentation.
Results: In NCIC trust births, 3280 women were assessed for low PAPP-A. Of these, 130 had low PAPP-A levels. It revealed that 46.9% used Aspirin, with a high down screen risk found in 11.5%. In this study, 13.1% experienced pregnancy induced hypertension (PIH). 2 resulted in intrauterine fetal death (1.5%). 9 women (6.9%) experienced pre-term births. The study identified 8 newborns (6.25%) with birth weights below the 10th centile after >39+6 weeks, and 6 (4.6%) <3rd centile after 37+6 weeks.
Conclusions: The study linked low PAPP-A to poor APGAR scores, stillbirth, growth issues, and special care unit admissions. Babies with low PAPP-A showed higher morbidity and mortality after 41 weeks. The findings indicate that delivery should occur between 40+0 and 40+6 weeks. Further research is needed to create an antenatal protocol for optimal delivery timing for babies with low PAPP-A
Thoracic segmental spinal anaesthesia over general anaesthesia for gynaecologic laparoscopy surgeries
Get PDFBackground: Gynaecologic laparoscopic procedures have traditionally relied on general anesthesia (GA), but thoracic segmental spinal anesthesia (TSSA) has emerged as a promising alternative. This research evaluates the efficacy, safety and patient outcomes when comparing TSSA to GA for gynaecologic laparoscopic surgeries.
Methods: A prospective randomized controlled trial (RCT) was done involving 126 patients scheduled for gynaecologic laparoscopy. Patients were allocated at random to the TSSA group (group.) (n=63) or the GA group. (n=63). Primary outcomes were hemodynamic stability, recovery profiles, post-operative pain scores and complications related to anesthesia. Secondary outcomes were patient satisfaction, cost evaluation and quality of surgical field visualization.
Results: TSSA provided superior hemodynamic stability with lower fluctuations in blood pressure along with heart rate (HR) (p<0.001). TSSA was associated with greatly lessened post-operative pain (p<0.001), faster recovery times (p<0.001), earlier ambulation (p<0.001) and lessened postoperative nausea and vomiting (PONV) (p<0.002). Patient satisfaction scores were higher in the TSSA group. (p<0.001), while cost analysis revealed a 66.18% drop in anesthesia-related expenses. Surgeon satisfaction regarding surgical field quality showed no noteworthy difference between techniques (p=0.34).
Conclusions: TSSA appears to be a secure and efficient alternative to GA for gynaecologic laparoscopic surgeries. It offers superior recovery profiles, enhanced patient comfort and economic benefits without compromising surgical conditions
Effect of cabergoline and metformin combination therapy in the treatment of infertile women with symptomatic endometrioma: comparison with cabergoline alone
Get PDFBackground: Endometrioma is a prevalent manifestation of endometriosis and a common cause of infertility in women of reproductive age. This study aimed to evaluate the effectiveness of cabergoline alone versus in combination with metformin in infertile women with symptomatic endometrioma.
Methods: This randomized controlled trial was conducted in the Department of Reproductive Endocrinology and Infertility, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh, from July 2022 to June 2023. This study included 50 women with clinically and sonologically diagnosed cases of endometrioma and dysmenorrhea attending the Reproductive Endocrinology and Infertility outpatient Department. Participants were assigned to two treatment groups: Group A (Cabergoline with metformin) and Group B (Cabergoline alone).
Results: Baseline demographic and clinical characteristics were comparable between the groups. At 3 months, both groups showed significant reductions in pain scores (Group A: 5.38±2.52; Group B: 4.86±1.52) and endometrioma size (Group A: 1.11±0.75 cm; Group B: 0.72±1.10 cm), with slightly higher reductions in Group A. However, the differences were not statistically significant (p>0.05). Endometrioma size reduction was more pronounced in Group A (mean difference: 1.11 cm vs. 0.72 cm; effect size 1.26 vs. 0.75). Side effects were mild and comparable in both groups, with no statistically significant differences.
Conclusions: This study showed that both treatment regimens significantly improved pain and reduced endometrioma size, with no significant difference in outcomes between the groups. The combination of cabergoline and metformin may offer a slight advantage in reducing endometrioma size and improving fertility outcomes
Analysis of trial of labour in previous one LSCS and its correlation with maternal and fetal outcome
Get PDFBackground: A rise in caesarean rate worldwide is one of the causes of maternal and perinatal mortality as well as morbidity. The goal of present study was to assess maternal and fetal outcome of patients with previous one LSCS who were given trial of labour. This research aimed to study the incidence of VBAC and repeat CS in cases with previous one LSCS. And to compare the fetomaternal outcome between vaginal and repeat caesarean delivery. Also, to discover factors predicting outcome of trial of labour after previous one caesarean delivery.
Methods: In this prospective observational study in the Department of Obstetrics and Gynaecology of Grant Govt medical college and JJ group of hospital Mumbai,100 patients with previous one LSCS were evaluated over period of one and half years.
Results: During the above period, out of 100 patients of previous 1 LSCS who were given trial of scar, 47 patients delivered vaginally and 53 required repeat LSCS. VBAC rate was higher in patient with history of previous vaginal delivery. Out of 53 cases who required repeat LSCS, scar tenderness was the most common indication followed by fetal distress. Complication rate were higher in LSCS group. NICU admission rate was higher in LSCS group.
Conclusions: After careful selection of cases, trial of scar after previous one LSCS is safe and often successful. A prior vaginal delivery, Bishop Score > 6, estimated fetal birth weight <2.5 kg, spontaneous onset of labour, interconceptional period >3 years are associated with higher VBAC rate