International Journal of Reproduction, Contraception, Obstetrics and Gynecology
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A successful pregnancy outcome in a patient with cardiac permanent pacemaker
Get PDFWe present a case of 31 years old Gravida 2 Abortion 1 at 25 weeks of gestation with history of congenital heart disease- Left aorto-ventricular tunnel, for which she had intracardiac repair at 7 years of age. She had bradycardia, syncopal attacks, diagnosed as complete heart block at 26 yrs of age and had permanent pacemaker implantation had come for antenatal care. Echocardiogram showed ejection fraction of 30%, global hypokinesia of left ventricle and moderate aortic regurgitation. Patient was asymptomatic. As per cardiologist opinion, started on Tab. Amiodarone 100mg once daily on alternate days and pregnancy continued. Patient was admitted at 38wks, for elective lower segment caesarean section, in view of cardiac condition, pacemaker adjustment done before anaesthesia. Under general anaesthesia, delivered an alive boy baby of birth weight 3.2 kg with a good Apgar score. Intraoperative and postoperative period was uneventful. At postoperative follow-up, patient was asymptomatic. Hence, we report a successful pregnancy outcome despite critical ejection fraction in a pregnant patient with permanent pacemaker.
Incarcerated vaginal ring pessary in short duration: an uncommon complication
Get PDFIn pelvic organ prolapse (POP), vaginal pessaries are considered as most effective, safe and highly acceptable management. This is a case report of 78-year, multiparous postmenopausal women who had vaginal pessary insertion for POP and lost follow up came to hospital after 3 months. On speculum examination it revealed a right-side vaginal wall focal ulceration of size 0.5×0.5 cm noted which bled on touch, displaced left lateral part of pessary with a 1.5cm band of tissue overgrowing it. It was managed by surgical removal under general anaesthesia and local oestrogen cream application. It is concluded that to avoid this type of complication patient education and good compliance plays a major role
Placenta previa: maternal and fetal outcome in a tertiary care institute
Get PDFPlacenta previa (PP) is a serious health disorder, which leads to higher level of foetal-maternal morbidity and mortality. In this study, we evaluated maternal and fetal outcome due to PP in tertiary care institute. This research was a prospective and observational study. Among 8311 numbers of deliveries, 96 patients were presented PP admitted in Department of Obstetrics and Gynaecology, Shri Bhausaheb Hire Government Medical College, Dhule, Maharashtra, India. The study period was June 2021 to May 2022. All patients were informed and taken written informed consents. After the clinical assessment, the diagnosis was confirmed for PP. The parameters viz. age, parity, GA, previous delivery, PV bleeding, PP types, mode of delivery, intraoperative interventions, morbidity and mortality of mothers and neonatal outcomes were recorded. Our study found PP rate of about 1.15% and the prevalent age group was maximum 25-29 years. Maximum mothers were multigravida and GA was maximum>37 weeks recorded. 19 babies were observed early neonatal death. More the prevalence of PP lead to high resources utilization and risk of maternal and fetal morbidity and mortality. PP prevention can be achieved by better spacing in between pregnancies, antenatal registration of all pregnant women, routine check-up, routine use of USG in pregnancy and early referral of high-risk pregnant women to tertiary care centres
Reproductive outcome after surgical sperm retrieval and intracytoplasmic sperm injection in couples with male factor sub fertility: a 10-year retrospective observational study
Get PDFBackground: To evaluate surgical sperm retrieval (SSR) rate in men with obstructive azoospermia (OA) and non-obstructive azoospermia (NOA) and to compare clinical pregnancy rate (CPR) following ICSI. It was a retrospective observational study done at Dream Flower IVF Centre, Kasaragod, Kerala, India.
Methods: The 124 azoospermic men who underwent SSR along with intra cytoplasmic sperm injection (ICSI) between June 2013 to May 2024 were included in the study. OA and NOA were classified depending on the history, physical examination, ultrasonography and laboratory findings. Analysis of data on SSR rate and reproductive outcome following ICSI was done.
Results: A total of 124 male patients presented with azoospermia of which 52 patients (41.93%) had OA while 72 patients (58.06%) had NOA. The SSR rate was significantly higher in OA (100%) when compared to NOA (48.6%; p<0.05). The follicle stimulating hormone (FSH) level was significantly lower in participants with OA (5.2±2.0) when compare to NOA (25.1±15.2; p<0.05). ICSI using surgically retrieved spermatozoa was done in 90 couples. We failed to retrieve sperms in 34 (28.41%) patients, of which 27 couples opted for donor sperm (DS) for ICSI. The CPR was 55.8% and 39.5% in OA and NOA respectively. No significant difference in CPR (p=0.286), miscarriage rate (p=0.056) or live birth rate (p=0.904) were observed among the three groups.
Conclusions: Azoospermic men can be counselled about the probability of successful sperm retrieval as well as their likelihood to father their biological child following ICSI without the need of donor spermatozoa
Emaciation and immobility due to enormously growing degenerating subserosal fibroid up to mid-thorax during pregnancy and following childbirth-an unusual presentation managed by multidisciplinary approach
Get PDFUterine fibroids (leiomyomas) are common neoplasms in women of childbearing age, with prevalence of approximately 10.7% in pregnancy. Subserosal fibroids are typically less symptomatic but can lead to significant complications during pregnancy, such as degeneration and hemorrhage. Large, rapidly growing fibroids, particularly those causing compression and degeneration, present challenges in clinical management, requiring careful consideration of delivery routes, timing, and the preservation of fertility. This case report addresses the complex management of a patient with enormously growing degenerating subserosal fibroids during pregnancy and postpartum. A 32-year-old nulliparous woman presented at 8 weeks gestation with large subserosal fibroids. Despite adequate fetal growth, the fibroids grew substantially during pregnancy, resulting in cachexia, immobility, and dyspnoea by the third trimester. The patient required multiple blood transfusions and frequent monitoring. At 32 weeks, after delivery via category 3 cesarean section, complications arose including postpartum hemorrhage, which was managed with uterotonics. Postpartum, the patient experienced a significant increase in fibroid size, causing further complications such as respiratory distress and abdominal distension. This required a laparotomy followed by myomectomy. The patient underwent successful laparotomy for the removal of the degenerated fibroid cyst, with along with drainage of 38 litres of cystic fluid. Postoperative care involved intensive monitoring, including respiratory management and fluid replacement. Histopathological analysis confirmed the presence of a benign degenerated leiomyoma. The patient’s postoperative recovery was gradual, with significant improvement in her symptoms. This case highlights the rare and challenging scenario of rapidly growing subserosal fibroids in pregnancy and postpartum. The multidisciplinary approach was crucial for managing both phases of the patient’s care during pregnancy to ensure fetal well-being and manage complications, and postpartum to address the growing fibroids. Though uterine subserosal fibroids generally do not impact pregnancy significantly, in rare cases, such as this, they can lead to severe complications requiring surgical intervention.
Impact of adenomyosis on fertility and obstetric outcomes among women in tertiary care center
Get PDFBackground: Adenomyosis is a serious reproductive difficulty caused by aberrant endometrial tissue within the myometrium. It can induce infertility and predispose women to hypertensive problems, preeclampsia, and preterm birth. However, the influence of adenomyosis on fertility and obstetric outcomes has not been extensively explored, particularly in resource-limited settings. This study aimed to investigate the effect of adenomyosis on fertility and obstetric outcomes in women who visited a tertiary care hospital in Dhaka, Bangladesh.
Methods: A case control study was conducted in Shahabuddin Medical College Hospital and one IVF center from June 2023 to May 2024. The study included 100 women divided into two groups: A case group of 50 with adenomyosis and 50 in the control group without. Two groups were compared in terms of baseline characteristics, fertility outcomes, obstetric complications, and delivery outcomes. SPSS software statistical analysis was performed.
Results: Obstetric complications such as hypertensive disorders (32% versus 6%, p=0.001), preeclampsia (16% versus 2%, p=0.01) and preterm delivery (26% versus 8%, p=0.01) were more frequent in the adenomyosis group. The adenomyosis group also had a higher caesarean delivery rate (62% versus 34%), p<0.05. Outcomes in fertility, namely implantation rates and live birth rates were not different (p>0.05).
Conclusions: Early diagnosis and careful management of adenomyosis are important because adenomyosis is associated with increased obstetric complications and higher caesarean delivery
Management of iron deficiency anemia in Indian women using ferric carboxymaltose: a sub-group analysis from the PROMISE multi-center real-world study in India
Get PDFBackground: To evaluate the effectiveness of intravenous ferric carboxymaltose (FCM) in patients with iron deficiency anaemia (IDA) across 269 centres in India, we conducted a retrospective, observational, real-world investigation. The present analysis was done to evaluate FCM in Indian women with IDA in a real-world scenario.
Methods: Haematological parameters were examined for the study population's baseline and 4±1 week follow-up data on females with anaemia who regularly received FCM for anaemia management.
Results: 1666 females with IDA, the hematological parameters improved significantly at 4 weeks (p<0.001) Hb increased by 2.78 g/dl, serum ferritin increased by 35.26 µg/l, haematocrit, red blood cell (RBC) count, mean corpuscular haemoglobin (MCH) and mean corpuscular volume (MCV). Subjects with severe IDA (n=304), significant increase in Hb (by 3.32 g/dl), serum ferritin (by 34.96 µg/l) (p<0.001 for both), RBC count (p<0.001), haematocrit (p=0.004), MCH (p<0.001) at 4 weeks. Subjects with moderate IDA (n=1227), significant increase in Hb (by 2.66 g/dl), serum ferritin (by 35.42 µg/l), haematocrit, RBC count, MCH and MCV (p<0.001 for all) at 4 weeks. Subjects with mild IDA (n=26), significantly higher mean Hb values were seen at 4 weeks (by 1.99 g/dl) Hematological parameters improved compared to baseline at 4 weeks mean difference was statistically insignificant. Physicians rated efficacy and safety of FCM as very good to good in 97.4% and 97.1% of subjects, respectively.
Conclusions: FCM corrects anemia in all subsets of Indian women in short span of 4 weeks and thus supports evidence of efficacy and safety
A comparative study of hyperbaric bupivacaine with fentanyl and sequential administration of isobaric and hyperbaric bupivacaine with fentanyl in caesarean delivery
Get PDFBackground: To compare intrathecal sequential plain and hyperbaric Bupivacaine with fentanyl and hyperbaric Bupivacaine with fentanyl for hemodynamic stability, onset of block and duration of block in patients undergoing caesarean delivery under spinal anesthesia.
Methods: This observational, double-blind study, seventy full term parturient, randomly divided to receive either 10 mg 0.5% Hyperbaric Bupivacaine with 25µg Fentanyl or 5 mg each of 0.5% plain and hyperbaric bupivacaine with 25 µg of Fentanyl. Surgery was allowed to proceed when block height reaches T6. Hemodynamic parameters, ephedrine use, time to reach peak dermatomal level and duration of sensory and motor block were compared among two groups.
Results: Demographic data, quality of perioperative anesthesia, Apgar score were identical in both groups. Incidence of Hypotension in HB (77.14%) as compare to 25.71% in PHB. Nausea/Vomiting in both the groups, 68.57% for HB and 25.71% for PHB. For HB, 80% (10.3mg) of patients required Ephedrine while 17 % (4mg) in Group PHB. Peak dermatomal level in minutes was faster in HB (06±1.13) as compare to PHB. (9.06±0.76) Maximum Block level was achieved in HB was T4.94±0.76 and in PHB it was 5.71±0.86. Time to regression of sensory block in minutes for HB was 234.86±10.49 and PHB 258.14±12.37. Recovery from motor block is faster in HB (190.66±10.38) compared to PHB (205.71±11.95).
Conclusions: Sequential administration of low dose of hyperbaric and plain bupivacaine with fentanyl provides better hemodynamic stability, accomplish adequate level of sensory and motor block in obstetric population for caesarean delivery
Prevalence of sonographically detected fetal congenital malformations among cases of placenta accrete: a retrospective study
Get PDFBackground: Placenta accreta spectrum (PAS) is well known cause of maternal morbidity and mortality. Its incidence had been increased obviously during the last two decades. Almost all literature about placenta accreta is about maternal complications and paucity about fetal ones. Objectives were to assess the prevalence of fetal anomalies detected sonographically in cases placenta accreta diagnosed at the third trimester.
Methods: Our study is a retrospective study that had carried on at one tertiary center (Habashy 4D scan center; Alexandria; Egypt). We collected cases that diagnosed as placenta accreta prenatally by ultrasound in the third trimester from January 2020 till December 2024. We had excluded twin, ICSI pregnancies and maternal age ≥37 years. After enrollment of these cases we had searched for the prevalence of major fetal anomalies recorded in their reports.
Results: We included 133 PAS cases in our study. Maternal age window was: 24-36 years. Gestational age range at their third trimester scanning was: 28-36 weeks. 2 out of the 133 fetuses (1.995%) were had major fetal anomaly which were; transposition of the great arteries (TGA) and bladder exstrophy (BE).
Conclusions: The prevalence of major fetal anomalies among cases of placenta accreta is 1.995% which is lower than that in non-accreta pregnancies. Further large-scale studies are needed to confirm our observation
Serum progesterone level as a predictor of pregnancy in frozen embryo transfer
Get PDFBackground: Aim of the study was to know the effect of serum progesterone (P4) level on pregnancy rate in frozen embryo transfer. The retrospective observational study was conducted in Institute of Reproductive Medicine, Madras Medical Mission Hospital, Chennai.
Methods: 126 patients underwent frozen embryo transfer with hormone replacement treatment using oral estradiol valerate and intramuscular progesterone beyond 7 mm of endometrial thickness were started on IM micronized progesterone 100 mg once a day till p+4. Morula transfer was done with at least one good-quality embryo. Serum progesterone level was measured one day before embryo transfer at our institute by chemiluminescence immunoassay. Adequate luteal support was given.
Results: The receiver operating curve (ROC) cut off showed serum progesterone level of 20.6 ng/ml had a sensitivity of 71.7% and specificity of 56.5%. Overall pregnancy rate was 50.7%. Live birth rate was significantly more in P4 >20.6 ng/ml.
Conclusions: In conclusion, the results of our study conclude that Progesterone level before embryo transfer day is an important prognostic factor for pregnancy outcome. According to this study, serum progesterone level >20.6 ng/ml one day before embryo transfer can be a good predictor of pregnancy in morula transfer. Further studies on a large scale on morula transfer are needed to modulate individualized treatment for patients for a successful pregnancy outcome