International Journal of Reproduction, Contraception, Obstetrics and Gynecology
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Vaginal delivery through an intrapartum bucket handle cervical tear: a rare case report
Get PDFCervical tears, though rare, pose serious risks to maternal health, especially postpartum haemorrhage. During labour, these injuries can include cervical avulsion, annular detachment, bucket-handle tears, and lateral tears. Our case report presents a rare instance of spontaneous vaginal birth through a posterior bucket-handle cervical tear in a primiparous woman. This occurred despite the external cervical os being partially dilated without known risk factors. This situation serves as a warning that strong uterine contractions accompanied by a failure of the external cervical os to dilate may indicate an imminent cervical tear. In cases of excessive postpartum blood loss, it is essential to maintain a high level of suspicion for cervical tears. This emphasizes the importance of thoroughly inspecting the genital canal after a vaginal birth. Prompt diagnosis, repair, anatomical restoration, and haemostasis are essential for achieving the best outcomes
Enhanced pregnancy outcomes with intrauterine platelet-rich plasma infusion in women following failed personalized embryo transfer guided by endometrial receptivity assay
Get PDFBackground: Altered endometrial receptivity is an important cause of implantation failure. The embryo-endometrial asynchrony due to ovarian stimulation in IVF cycles contributes to low success rates. Frozen embryo transfer (FET) has become popular a method to overcome this asynchrony. Endometrial receptivity array (ERA) is a molecular test that differentiates a receptive from a non-receptive endometrium. Studies suggest that a personalised embryo transfer (pET) guided by ERA in FET cycles, improves pregnancy rates in recurrent implantation failure (RIF) patients. Despite pET not all patients achieve implantation. Intrauterine infusion of platelet-rich plasma (IUPRP) is emerging as an innovative technique to enhance fertility outcomes in patients with impaired endometrial receptivity. Platelet rich plasma (PRP) contains an abundance of growth factors and cytokines thought to enhance endometrial growth and receptivity. Aim of the study was to evaluate the role of IUPRP in improving pregnancy rate in patients with failed pET.
Methods: 53 patients with two previous pET failures, having an endometrial thickness ≥7 mm were included in this observational cohort study. FET was planned in a hormone replacement cycle. 0.4 ml PRP prepared by double centrifugation technique was infused into the uterus on the day of starting progesterone.
Results: A pregnancy rate of 64.1% and Live birth rate of 49.06% was achieved at FET after IUPRP infusion. Miscarriage rate was 17.6%. These results are similar to pregnancy and live birth rates achieved in our non-RIF IVF patients.
Conclusions: Our study suggests an improved reproductive outcome with infusion of IUPRP in patients with who failed to implant after pET
The role of the multidisciplinary team in managing a challenging brittle bone disease with 18 fractures in the modern era: a case report and literature review
Get PDFOsteogenesis imperfecta (OI) is a rare autosomal dominant disorder due to collagen type I biosynthesis defects. It aggressively affects maternal and fetal outcomes in pregnancy. In this case report, we will be discussing the course of pregnancy in an OI patient who has already had 18 fractures since childhood and the challenges faced during the course. A 29-year-old primigravida who was diagnosed with OI since childhood had approximately 18 fractures up to the age of 29. She was under regular antenatal follow-up in our clinic. She was diagnosed with late-onset stage 1 fetal growth restriction at 36 weeks. She was planned for an elective caesarian under a multidisciplinary team at 37 weeks given her short stature, contracted pelvis, and stage 1 fetal growth restriction. She had an uneventful delivery course without any intraoperative and postoperative complications. There was no stress fracture post-delivery, and the newborn developed normally during a 1-year follow-up period. This case highlights the management of OI in pregnancy who had a history of multiple fractures and also emphasizes the need for a tertiary care center in the management of these high-risk patients. A close follow-up of these patients with prenatal genetic testing, regular ultrasound monitoring, and a multi-disciplinary team will aid in an early diagnosis of all the potential underlying complications, thereby leading to favorable maternal and fetal outcomes. A literature review on this topic is also presented
A prospective, open-label, randomized, comparative clinical trial to assess the efficacy of NASO B12 or oral B12 supplementation along with standard of care in the treatment of anemia in women of reproductive age
Get PDFBackground: Anemia is a prevalent health issue among women of reproductive age (WRA), often attributed to iron deficiency but also influenced by vitamin B12 deficiency. Despite widespread iron and folic acid (IFA) supplementation programs, anemia persists, necessitating comprehensive treatments. This study evaluated the efficacy of intranasal vitamin B12 supplementation (NASO B12 of Troikaa Pharmaceuticals Ltd.) with IFA compared to oral vitamin B12 with IFA and IFA alone, in WRA.
Methods: This open-label, randomized clinical trial enrolled 75 anemic WRA across three centers in Lucknow, India. Participants were randomized into three groups: NASO B12 + IFA, Oral B12 + IFA, and IFA alone. In the NASO B12 and oral B12 groups, B12 supplementation was administered on alternate days for two weeks, then weekly until day 42, while IFA was given daily in all groups for 84 days. Hemoglobin (Hb) and other hematological parameters were assessed at multiple intervals. Safety evaluations included vital signs and adverse events monitoring. ANOVA was used for statistical analysis, with p<0.05 indicating significance.
Results: Among 75 anemic women, NASO B12 demonstrated the fastest and most significant improvements in Hb and vitamin B12 levels, as well as a notably greater increase in RBC counts compared to both the Oral B12 and IFA groups. Hb levels increased significantly from baseline by 2.8 gm/dl at day 84. Vitamin B12 levels rose rapidly, exceeding 400 pg/mL by day 7 and sustaining through day 84. NASO B12 consistently improved RBC counts from day 7, reaching 4.53 mill/cmm by day 84. Changes in reticulocytes, ferritin, and folic acid supported hematopoietic normalization. The treatment was well-tolerated in all three groups, with no serious adverse events.
Conclusions: In conclusion, NASO B12, when combined with IFA, demonstrated superior and faster efficacy in improving hematological parameters compared to oral B12 + IFA and IFA alone, making it a promising treatment option for vitamin B12 deficiency and anemia in WRA
A case of partial androgen insensitivity syndrome: from diagnosis to management
Get PDFPartial androgen insensitivity syndrome (PAIS) is a rare 46XY disorder that results from mutations in androgen receptors leading to failure of normal masculinization of external genitalia in genetically male individuals. An 18-year-old female visited our OPD i/v/o not attainment of menarche, on examination minor virilization of voice, bilateral inguinal masses, poorly developed labia majora, clitoromegaly, blind vaginal pouch was noted. Imaging showed absent mullerian structures with bilateral ectopic testes with overall features of partial androgen insensitivity syndrome. Karyotyping showed 46XY. PAIS can be presented as ambiguous genitalia at birth or as predominant female to male phenotype with varying degrees of virilization. Early identification and multi-disciplinary management aiming at appropriate gender assignment, gonadectomy, reconstructive surgery, hormone replacement therapy and screening of other family members should be done
Study of genital tuberculosis among infertile women at tertiary care centre
Get PDFBackground: A hospital based descriptive clinical study to evaluate the incidence of genital tuberculosis among infertile women and to correlate presentational symptoms and methods of diagnosis.
Methods: A descriptive clinical study, after taking consent a total of 52 patients were enrolled in the study. After evaluation of the couple with the help of history and examination, semen analysis was performed for the male partner. The female partner underwent complete (CBC), erythrocyte sedimentation rate (ESR), chest X-ray, hysterosalpingogram (HSG), endometrial biopsy in pre-menstrual phase. After this basic work-up, if semen analysis showed abnormalities those patients were excluded from the study. Mantoux test is done for every patient.
Results: Total number of patients included was 52. Out of these 15.38% were diagnosed to have genital tuberculosis by the help of a set investigation including PCR which was gold standard and was taken in this study due to its accuracy.
Conclusions: tuberculosis is still a common disease and must be considered in the differential diagnosis of patients with infertility. So, every woman attending an outpatient basis for infertility should be investigated by different investigative modalities to rule out the chance of genital tuberculosis and if present should be treated as early as possible
Spectrum of presentation of pregnancy induced hypertension with maternal and perinatal outcomes at a tertiary care centre
Get PDFBackground: Hypertension poses a significant threat to a pregnant woman and many times leads to unfavourable perinatal outcomes with untoward complications. It can also lead to future cardiovascular risk for mothers. This retrospective study was undertaken to assess the different types of hypertensive disorders in pregnancy and the associated neonatal outcomes.
Methods: It was a retrospective study conducted for 3 years (January 2019-December 2021) in the department of Obstetrics and Gynaecology at Chirayu Medical College and hospital, Bhopal. A total of 149 women with hypertensive disorders of pregnancy were enrolled in this study as per inclusion-exclusion criteria. Study recorded the type of hypertensive disorder, clinical presentation, laboratory parameters, management with perinatal outcomes using preformed proforma. Data was entered and analyzed by MS excel sheet with the help of Epi Info (TM) 7.2.2.2.
Results: In this study, most patients were in the age group of 26-30 years (36.9%) and more patients were multiparous (55.7%). Edema was the predominant symptom (32.9%). Among the enrolled pregnancy induced hypertensive (PIH) patients, 9.3% developed complications with ante partum haemorrhage (APH) being the most common (4%). Severe hypertension seen in 26.8% patients. Also 28.2% patients received anticonvulsant while antihypertensives were given to 43% patients. The most common hypertensive disorder was gestational hypertension (55.7%) followed by preeclampsia (29.5%). Preterm delivery occurred in 39.6% patients while intra uterine growth restriction (IUGR) seen in 18.1% babies.
Conclusions: Hypertensive disorders in pregnancy lead to multiple adverse feto-maternal outcomes. In this study most mothers had gestational hypertension while prematurity and low birth weight were common foetal outcomes. Hence early recognition with suitable medical management and follow up of patients would lead to favourable outcomes in PIH
Successful pregnancy outcome following uterine artery embolization for cornual ectopic pregnancy: a case report
Get PDFCornual ectopic pregnancy is a rare but potentially life-threatening condition that often requires prompt intervention. Uterine artery embolization (UAE) has emerged as a valuable treatment modality for controlling haemorrhage and preserving the uterus. However, UAE can compromise endometrial and ovarian function, potentially leading to infertility. While extensive literature exists on the use of UAE for fibroid management and its impact on pregnancy outcomes, data on successful conception following UAE for cornual ectopic pregnancy remain limited. We present a unique case of a 35-year-old woman who conceived and delivered at term following UAE for the management of a ruptured cornual ectopic pregnancy. Despite concerns regarding compromised uterine perfusion and endometrial receptivity post-UAE, the patient achieved a successful pregnancy with the assistance of assisted reproductive techniques. This case underscores the challenges associated with post-UAE fertility and highlights the role of judicious and timely assisted reproductive interventions in achieving favourable reproductive outcomes. This report adds to the limited evidence supporting successful pregnancy following UAE for cornual ectopic pregnancy. It emphasizes the need for individualized fertility counseling and management strategies for women desiring conception after UAE
Healthcare providers knowledge and attitudes toward abortion care in Ibadan, Nigeria
Get PDFBackground: In settings with limited resources, abortion care plays a crucial role in reducing maternal mortality rates and ensuring comprehensive healthcare. In Sub-Saharan Africa, over 70% of abortions are classified as unsafe. In Nigeria, restrictive laws and social stigmas shape healthcare providers’ knowledge and attitudes toward abortion care.
Methods: This study employed a cross-sectional study design to assess healthcare providers’ knowledge, attitudes, and practices regarding abortion care at the University College Hospital, Ibadan-Nigeria’s first tertiary hospital. Data was analysed using IBM statistical package for the social sciences (SPSS) version 25. Descriptive statistics were generated and presented as frequency tables and pie charts. A p value of <0.05 was regarded as statistically significant.
Results: While 63% of providers demonstrated adequate knowledge of abortion care, significant gaps persisted, particularly regarding legal provisions and post-abortion care. Despite 86% supporting access to safe abortion under specific circumstances, personal and religious beliefs influenced their willingness to provide services.
Conclusions: Addressing knowledge gaps and mitigating personal biases through targeted training, policy advocacy, and community engagement is essential for improving abortion care, reducing unsafe procedures, and enhancing maternal health outcomes in Nigeria
An interesting case of amniotic fluid embolism
Get PDFAmniotic fluid embolism is a rare condition. It is one of the leading causes of maternal mortality, and the overall rate has been approximately 20%. However, even those who survive have a significant morbidity, including neurologic injury due to cerebral hypoxia. If it occurs before delivery, neonatal outcomes are poor. Prompt recognition facilitates rapid initiation of potentially lifesaving therapies. This case is presented to share awareness regarding early detection and treatment of this life-threatening condition, resulting in good outcomes of both mother and baby