International Journal of Reproduction, Contraception, Obstetrics and Gynecology
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Spontaneous rupture of an unscarred uterus during second trimester: a rare occurrence
Full text linkThe rupture of the uterus is one of the most serious obstetric complications a pregnant uterus can experience. Most ruptured uteri are associated with one or more risk factors and occur more frequently during the third trimester. As an obstetric emergency, it requires a high level of suspicion for prompt diagnosis and urgent intervention due to its life-threatening nature. We reported a 29-year-old primigravida without any known risk factors presenting with abdominal pain and vomiting at 20 weeks of pregnancy. Ultrasonography (USG) revealed free fluid in the paracolic gutter and Morrison’s pouch with a live intrauterine fetus. An exploratory laparotomy was planned in view of tachycardia and anemia. During laparotomy, hemoperitoneum was observed, and there was a 5 cm transverse fundal rent with placenta popping out from it. Emergency surgical management, including removal of the placenta and fetus along with fundal repair, was performed, and the patient recovered well. Symptoms such as acute abdominal pain during pregnancy should alert the surgeon to the possibility of uterine rupture, even in the absence of known risk factors. A prompt diagnosis and immediate intervention are crucial for achieving a good outcome in such cases
Family planning knowledge and practices in displacement: exploring barriers among Somali refugee women in Ali Addeh camp
Full text linkBackground: The use of modern contraceptives is a key strategy for improving maternal health and enabling informed reproductive choices. This study aimed to assess modern contraceptive use, knowledge, and attitudes among Somali refugee women in Ali Addeh camp, and to explore the factors influencing uptake.
Methods: A cross-sectional study was conducted at Ali Addeh camp including 360 Somali refugee women aged 18-49. Data were collected through structured questionnaires and statistical analysis were performed to examine key patterns and influencing factors.
Results: Although 83.06% of women had heard of at least one modern method, 89.44% were classified as having low knowledge. Poor contraceptive attitudes were scored by 80.83% of respondents, with 56.39% believing contraceptive use is inherently wrong, and 85.83% viewing it as solely the woman’s responsibility. While 96.67% expressed a desire for five or more children, 85% also preferred birth spacing of 2-3 years. Only 31.11% had discussed contraception with their husbands, and just 8.06% scored high spousal engagement. Regression analysis revealed that partner support, education level and income level was significantly associated with favorable contraceptive attitudes (p<0.01). Structural barriers were prevalent, with 94.44% scoring poorly on access.
Conclusion: Contraceptive use in Ali Addeh camp is limited by knowledge gaps, social norms, and access issues, highlighting the need for culturally tailored strategies that involve men
The silent signal of widened pulse pressure-aortic dissection in pregnancy
Full text linkAortic dissection in pregnancy is a rare but potentially life-threatening condition, often presenting with non-specific symptoms that can hinder timely diagnosis. Stanford type A dissections are especially perilous, with high risks of maternal and fetal mortality if not promptly treated with surgical intervention. A 35-year-old woman, G3P2 at 39 weeks’ gestation, presented with sudden-onset epigastric pain. Her blood pressure was 103/43 mmHg, with a widened pulse pressure of 60 mmHg - a subtle yet significant indicator. The initial examination was unremarkable however an urgent echocardiography and CT aortography confirmed a Stanford type A aortic dissection, extending from the aortic root to the infrarenal abdominal aorta. An urgent interdisciplinary discussion (MDT) was convened. Given the complexity of the case, which required the expertise of a highly experienced cardiothoracic surgeon, a surgeon was flown in from Peninsular Malaysia. She was transferred to the Sarawak Heart Centre, where she underwent an emergency caesarean section, delivering a baby boy weighing 2.7 kg. This was followed by a 13-hour Bentall procedure and coronary artery bypass grafting. Although the surgery was technically successful, she sadly succumbed to postoperative heart failure seven hours later. This case highlights the importance of early recognition and timely intervention in aortic dissection during pregnancy. Although rare, pregnancy associated aortic dissection carries significant risks for both mother and fetus. Despite the tragic outcome, the swift and coordinated response by the multidisciplinary team is commendable and reflects their commitment in providing high-risk care in a challenging and resource-limited setting
Gigantic clitoridal cyst: a rare presentation
Full text linkEpidermal inclusion cyst of the clitoris is a rare, benign lesion that is formed when surface epithelial cells become trapped beneath the skin in the clitoral area. It is usually acquired, and commonly after female genital mutilation. This case highlights the presentation, diagnosis and its surgical management. We report a 25-year-old patient with a vulvar swelling of 9 years duration. There was a positive history of female genital mutilation in childhood. She presented on self-referral to the gynaecology clinic for evaluation, diagnosis and treatment. Preoperative assessment was done with physical examination and investigations. Following surgical enucleation, the histological assessment of the excised tissue revealed a cystic lesion lined by stratified squamous epithelium with a granular layer. The cyst contained keratin flakes. A histologic diagnosis of epidermal inclusion cyst/ clitoridal cyst was made. Clitoridal cyst usually follows female genital circumcision. It is a rarity in this part of the world as female genital mutilation is widely condemned. A high incidence of suspicious and a thorough history and physical examination is needed to make a clinical diagnosis. However, histopathological assessment remains the cornerstone for its diagnosis. Its treatment is by complete enucleation to avoid a reoccurrence.
Endometrial preparation with stimulated versus artificial cycle: a comparative study on frozen embryo transfer outcomes
Full text linkBackground: Successful frozen–thawed embryo transfer (FET) depends on adequate endometrial preparation. Stimulated cycles (SC) may provide a more physiological hormonal milieu by supporting corpus luteum function, whereas artificial cycles (AC) offer flexible scheduling but rely entirely on exogenous hormones. Existing evidence comparing these two approaches remains inconsistent. This study aimed to evaluate reproductive outcomes following FET using stimulated versus artificial cycles.
Methods: This prospective comparative study included 89 women undergoing their first FET between January 2024 and April 2025. Participants were prepared using either a stimulated cycle (n=31) involving letrozole with low-dose gonadotropins or an artificial cycle (n=58) using estrogen–progesterone replacement. Endometrial thickness was monitored and two good-quality day-3 embryos were transferred after adequate progesterone exposure. Outcomes assessed were positive pregnancy test, clinical pregnancy, ongoing pregnancy at 12 weeks and early pregnancy loss. Statistical analysis was performed using Student’s t-test, Chi-square test or Fisher’s exact test, with p<0.05 considered significant.
Results: Baseline characteristics including age, BMI, infertility duration and ovarian reserve were comparable between groups. Pregnancy outcomes were higher in the SC group but did not reach statistical significance: positive pregnancy rate (41.9% vs. 31.0%, p=0.32), clinical pregnancy rate (32.3% vs. 24.1%, p=0.41) and ongoing pregnancy rate (29.0% vs. 19.0%, p=0.27). Early pregnancy loss remained low in both groups (3.2% vs. 5.2%, p=1.00).
Conclusions: Stimulated cycles showed a trend toward improved pregnancy outcomes compared with artificial cycles; however, differences were not statistically significant. Both protocols yielded acceptable clinical results, supporting individualized selection of endometrial preparation based on patient characteristics and clinical judgment.
Agreement between cytology, colposcopy and histopathology in assessment of precancerous cervical lesions
Full text linkBackground: Cervical cancer ranks as the third most common gynaecologic cancer in the world. The incidence rate for cervical cancer in Australia is 7.1 cases per 100,000 females as per 2022 data. Reduction in cervical cancer morbidity and mortality is based on the early detection of premalignant lesions. The aim of this clinical audit was to evaluate the agreement between the histology findings and CST LBC results/colposcopy impression in assessment of precancerous cervical lesions in all patients referred for colposcopy in view of abnormal cervical cytology.
Methods: This retrospective study included 108 participants. The study was conducted from June 2022 to May 2023 at blinded for review method. Cervical biopsy was performed on 48 cases out of the total 108 women based on colposcopy findings. The significance of the association between CST LBC result and colposcopy impression with histology of biopsy specimen was performed using the Chi-square test or Fisher’s exact.
Results: More than two-thirds of the colposcopy impressions (n=22/32, 68.75%) indicated LSIL matched the results of the biopsy findings. More than 80% of the CST results indicating HSIL (n=14/16, 87.50%) matched biopsy findings. Two-thirds of the CST results (n=14) indicated LSIL matched the results of the biopsy findings. The weighted Kappa measure for agreement between CST LBC result and biopsy findings was 0.464, 95% CI: 0.20-0.73.
Conclusions: Correlation of CST LBC result and colposcopy with histopathology, as the diagnostic tool in this study, was significant (p<0.001) Combination of cytology and colposcopy helped in the successful identification of pre-malignant lesions
Comparative study between vaginal isosorbide mononitrate and misoprostol for induction of cervical ripening prior to first trimester surgical abortion
Full text linkBackground: To evaluate the efficacy of the tab. isosorbide mononitrate 80 mg and tab. misoprostol 400 µg given transvaginal for cervical ripening before surgical evacuation in early embryonic demise upto 12 weeks of gestation (missed abortion).
Methods: The present randomized controlled trial was conducted in Bebe Nanaki mother and child care centre, attached to govt. medical college, Amritsar, from August 2011 to September 2013 after approval of institutional research committee. All the 50 women were included after obtaining a written consent, and after proper history taking and examinations and were allocated randomly into two groups. In group A patients, tab. isosorbide mononitrate 80 mg was given and in group B patients, Tab. Misoprostol 400ug was given up to maximum of four doses until cervical dilatation of >8 mm has been achieved. Lack of cervical dilatation >8 mm after the 4th dose of medication was considered as a failure of treatment.
Results: In this study, the success rate was more with tab. misoprostol group (96%) as compared to tab. isosorbide mononitrate group (80%), whereas the failure rate with tab. misoprostol group was 4% and with tab. isosorbide mononitrate group was 20%. Cervical ripening with tab. misoprostol was rapid with less frequency of dosage and less induction to ripening interval. Specific side effects are there for both the groups.
Conclusions: In our study we observed that, tab. misoprostol appeared to be more effective than tab. isosorbide mononitrate
The influence of lifestyle of obstetrics and gynecology female residents on gynecological and obstetrical outcomes in Saudi Arabia
Full text linkBackground: Obstetrics and gynecology (OB/residency is characterized by long working hours, high clinical demands, and significant psychological stress. These factors may adversely affect the lifestyle and reproductive health of female residents. The aim of the study was to investigates the impact of OB/GYN residency on physical well-being, mental health, and gynecological and obstetric outcomes compared to women from the general population.
Methods: A cross-sectional study was conducted between January and August 2024 using a culturally adapted, pilot-tested online questionnaire distributed to Saudi married women with children. Participants included 119 OB/GYN female residents and 91 age-matched controls. Data collected included demographic information, lifestyle characteristics, work-related stress indicators, menstrual and reproductive history, and obstetric outcomes. Statistical analyses were performed using SPSS version 25, with Chi-square and Mann-Whitney U tests applied for group comparisons (p<0.05).
Results: OB/GYN residents reported significantly higher rates of sleep disturbances (72.3% vs. 29.7%), concentration difficulties (71.4% verses 45.1%), and perceived work-related stress (>8/10: 44.5% verses 5.5%) compared to controls (p<0.001). They also reported significantly less sleep (<6 hours: 60% verses 30.8%). Despite similar BMI, dietary habits, and exercise routines between groups, pregnancy complications were more frequent among residents (51.3% verss 35.2%, p=0.02), and they had significantly lower pregnancy rates (p=0.0001). No significant differences were found in abortion rates, cesarean deliveries, or labor augmentation.
Conclusions: OB/GYN residency is associated with increased psychological and lifestyle stressors that may negatively impact reproductive health. Although residents reported comparable happiness levels, their higher stress, reduced sleep, and lower pregnancy rates with increased complications underscore the need for supportive policies to enhance well-being. Future research should focus on targeted interventions to mitigate stress and improve health outcomes among female medical residents
From symptoms to surgery: clinicopathological correlation in women undergoing hysterectomy for abnormal uterine bleeding
Full text linkBackground: Abnormal uterine bleeding (AUB) is one of the most frequently encountered conditions in women which is defined as any variation from the normal menstrual cycle which includes changes in regularity, frequency of menses, duration of flow, or amount of blood loss. The PALM-COEIN system classifies different causes of AUB and is composed of nine basic categories arranged according to the acronym PALM-COEIN as polyp, adenomyosis, leiomyoma, malignancy and hyperplasia, coagulopathy, ovulatory disorders, endometrial, iatrogenic, and not yet classified. Definitive treatment of AUB is hysterectomy even though less invasive options are also available. This study explored clinicopathological correlation in women undergoing hysterectomy, analysing the diagnostic criteria, clinical presentations, histopathological findings with an aim of establishing better therapeutic strategies and improving patient management and in further research for comparative and epidemiological studies in diagnostic approaches for AUB in various population.
Methods: This was prospective observational type of study which included 126 women with abnormal uterine bleeding (AUB) planned for hysterectomy at SNR district hospital, Kolar during the study period. Detailed history, required investigations were done. Study material was from hysterectomy specimens of the patients who underwent total abdominal hysterectomy (TAH) or vaginal hysterectomy for abnormal uterine bleeding (AUB). Data of clinically diagnosed cases, USG report and histopathological reports (of endometrial tissue) was collected and compared to find the correlation.
Results: A total of 126 women underwent hysterectomy in the study period. Heavy menstrual bleeding (HMB) was commonest presentation (60%) followed by dysmenorrhoea (55%) and irregular menstrual bleeding (52%). AUB-L was commonest cause for AUB clinically (51.58%), sonologically (51.58%) and histopathologically (49.20%), followed by adenomyosis on USG (17.46%) and histologically (16.66%) and clinically followed by the cases without any organic pathology (AUB-O) (42.85%).
Conclusions: The present study confirms a good correlation between clinical findings and histopathology especially in benign conditions
The rare Ogilvie's syndrome during pregnancy with scrub typhus and dengue co-infection
Full text linkOgilvie’s syndrome is a syndrome characterized by symptoms suggestive of intestinal obstruction without any mechanical cause. Otherwise known as acute colonic pseudo-obstruction (ACPO). This condition is very uncommon, however it is very important to recognize it at the earliest, as it increases the risk of mortality and morbidity if left untreated. It is mostly seen post traumatic or post operative. Though commonly seen associated with post caesarean section, rarely seen during the period of pregnancy. The treatment is fundamentally conservative, but the need of surgical management has also been reported in severe cases. Here, we describe the rare Ogilvie’s syndrome in young pregnant term female that continued to progress despite appropriate treatment