International Journal of Reproduction, Contraception, Obstetrics and Gynecology
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Prevalence of high-risk pregnancy and its association with adverse maternal and perinatal outcomes: a longitudinal study in 25 villages under Sarjapur primary health centre near Bangalore, India
Get PDFBackground: In India, about 20-30% pregnancies belong to the high-risk category. While an accurate estimate of maternal and neonatal mortality is available in India, there is a paucity of data on high-risk pregnancies in the rural population. Objectives were to estimate the prevalence of high-risk pregnancy among women residing in 25 villages of Sarjapur PHC area near Bangalore and to determine the association between high-risk pregnancy and adverse maternal and perinatal outcomes.
Methods: A longitudinal study was conducted among 180 pregnant women who completed 24 weeks of gestation. Subjects were visited once between 24-36 weeks of gestation and followed-up after 7 days of delivery. A pre-tested questionnaire was used to capture socio-demographic and obstetric details, risk factors and maternal outcomes. Regression analysis was performed to determine factors associated with adverse maternal outcomes.
Results: The mean age of study population was 24.7±4.2 years. The prevalence of high-risk pregnancy was 61.6%. High-risk factors found were previous LSCS (16.1%), hypothyroidism (11.6%), bad obstetric history (5.5%), Rh incompatibility (5.5%) and severe anaemia (5.5%). One-fifth of women had an adverse maternal outcome like postpartum haemorrhage (8.3%), puerperal sepsis (2.2%) and maternal death (0.6%). Factors significantly associated with adverse maternal outcome were presence of any one high risk condition in pregnancy [AOR=1.7 (95% CI:2.52-4.78), p=0.04], previous caesarean section [AOR=1.8 (95% CI:1.32-2.29), p=0.04] and bad obstetric history [AOR=17.3 (95% CI: 2.88-103.7), p=0.002].
Conclusions: Three out of every five pregnant women in the study area had high risk pregnancy and such pregnancies were associated with double the risk of adverse maternal outcomes. Routine ANC needs to be strengthened to screen for high-risk in pregnancy, with capacity building for management and referral
The use of RMI in triaging benign pelvic masses from malignant lesions and facilitating their management
Get PDFBackground: The most prevalent type of pelvic masses presenting to Gynec OPD are ovarian masses, which include cysts and tumors. Ovarian cancer is more common in older women, with highest incidence in seventies. Ultrasonography and surgically obtained tissue for diagnosis helps in optimising final plan. Good ethical practices suggest involvement of Gynec Oncosurgeon whenever necessary, after a correct preoperative diagnosis of pelvic masses is made. The basic diagnostic work-up of patients with a pelvic mass consists of a gynaecological examination, ultrasound and the analysis of serum tumour markers, especially CA 125. The objective of this study is to triage the patients and ensure optimum therapeutic approach for commonly encountered gynecological pelvic masses and to provide protocol-based treatment
Methods: Ours was a multicentric cross-sectional study in Navi Mumbai on “Patients presenting with abdominal masses” a combined, retrospective as well as prospective during the period of 6 months. 1st January 2023- 30th June 2023.
Results: The study group comprising of 140 patients in all, from 3 centres, were followed up from diagnosis till treatment comprising of namely: Gynec OPD at General hospital (10), a private MRI centre (30) and those admitted/attending Gynec OPD in Oncology hospital (100) with sonography findings of a pelvic mass greater than 6 cm size. Authors evaluated them on the basis of age, symptoms, and examination and tumor markers and managed as per RMI score to set a protocol.
Conclusions: With the help of ultrasonography findings and Ca125, the risk of malignancy index was calculated and helped us differentiate benign masses from cytology proven malignancy
A prospective study on possible clinical correlation between peripartum cardiomyopathy and hypertensive disorder in pregnancy
Get PDFBackground: Peripartum cardiomyopathy (PPCM) and hypertensive disorder in pregnancy (HDP) are often seen together. Though their correlation is a matter of research.
Methods: A prospective study of 76 patients of HDP in Apollo hospital Bilaspur (C. G.) over a period of one year February 2024 to February 2025 correlation with echocardiography.
Results: The maximum number of people with compromised left ventricular ejection fraction (LVEF) function is 28 years. Similarly in our study most of the patients are multigravida which is 22.37%. Maximum patients are of 3rd gravida.
Conclusions: Although the majority of HDP women were having normal LVEF function with no signs of PPCM but HDP was associated with markedly increased risks of PPCM that increased with HDP severity. HDP in association with increasing parity and age is also one of the contributing risk factors for PPCM. HDP, severe preeclampsia in particular, probably represents an additional cardiac stress during pregnancy
Fetomaternal outcome in gestational diabetes mellitus: a retrospective study
Get PDFBackground: Gestational diabetes mellitus (GDM) is a common pregnancy complication that can adversely affect both maternal and neonatal outcomes. This study aimed to retrospectively evaluate fetomaternal outcomes in GDM by comparing lower segment caesarean section (LSCS) and normal vaginal delivery groups.
Methods: A retrospective review of medical records from January 2018 to December 2020 was conducted at a tertiary care hospital. Fifty-one patients with GDM were included, with 29 undergoing LSCS and 22 having normal vaginal deliveries. Demographic, maternal, neonatal, lifestyle, and postpartum parameters were extracted and statistically analyzed using t-tests and Chi-square tests, with a significance threshold of p<0.05.
Results: No significant differences were observed in maternal age, height, weight, body mass index (BMI), or gestational age at diagnosis between groups. However, birth weight values showed significant variation (p=0.039), though data discrepancies were noted. Maternal complications were significantly higher in the LSCS group (p=0.024), particularly due to previous caesarean sections and complex comorbidities. Neonatal outcomes also differed, with the LSCS group requiring more specialized care (IDM care, NICU admissions) and showing lower Apgar scores (p=0.015). Lifestyle factors and postpartum recovery were comparable between groups.
Conclusions: The study highlighted that while baseline maternal characteristics were similar, significant differences in maternal complications and neonatal outcomes exist between LSCS and vaginal deliveries in GDM pregnancies. These findings underscore the need for individualized management and vigilant monitoring to optimize both maternal and neonatal health
Exploring the knowledge, awareness, and perceptions of reproductive-age women towards oocyte cryopreservation cross-sectional study in Saudi Arabia
Get PDFBackground: Egg freezing, or oocyte cryopreservation, is a reproductive technology that allows women to preserve eggs for future childbearing via in vitro fertilization (IVF). It is beneficial for those delaying pregnancy due to medical or non-medical reasons, though success rates vary with age and cultural factors. However, the procedure carries risks like ovarian hyperstimulation syndrome and raises ethical concerns, particularly in Arab countries such as Saudi Arabia, where religious views may limit its use. This study explores knowledge, awareness, and perceptions of oocyte cryopreservation among reproductive-age women in Saudi Arabia.
Methods: A cross-sectional, questionnaire-based study was conducted with 105 Saudi women aged 18-39 in the Eastern province. Data was collected via an online survey. The sample size was calculated using Cochran's formula with a 95% confidence level and 5% margin of error.
Results: A total of 129 women participated. Most, (75.2%) believed doctors should inform women about egg freezing as part of health education, (71.3%) felt healthcare should cover the costs for women with cancer, and (46.6%) were aware of IVF. However, only 30.2% understood egg freezing well, and (24%) believe cryopreserved eggs are safe and successful for pregnancy at older ages. Key barriers to fertility preservation were the procedure's cost (60.5%) and potential side effects (52.7%). Younger women and those with a university or medical education showed better knowledge.
Conclusions: The study highlights limited knowledge of oocyte cryopreservation among women in Saudi Arabia, with financial costs and potential risks being significant barriers to the procedure
Comparative evaluation of human papillomavirus DNA and liquid-based cytology in screening of cervical cancer
Get PDFBackground: Cervical cancer ranks as the fourth most prevalent cancer among women worldwide with approximately 604,127 new cases and 341,831 deaths reported in 2020. It takes around 10-20 years for progression from mild dysplasia to invasive cancer, allowing early detection through screening .
Methods: This was a cross-sectional study conducted at the department of obstetrics and gynaecology at GSVM medical college Kanpur between december 2022 to december 2023 involving 241 women aged 30-65 years attending the gynecology OPD. Liquid-based cytology (LBC) and human papillomavirus (HPV) DNA testing was conducted on each woman irrespective of complain of presentation.
Results: The mean age of patients in this study was 39.65 years. HPV DNA had a higher sensitivity (95.24%) than LBC (89.68%). Specificity of HPV DNA (72.16%) was slightly lesser than LBC (79.92%). Positive and negative predictive value for HPV DNA and LBC are (46.1%, 96.22%) and (49.68%, 94.68%) respectively. Area under curve for HPV DNA (0.79) was higher than LBC (0.74) proving its higher diagnosing accuracy. The cluster analysis showed HPV+ clusters covered more area and distribution than LBC proving its better performance.
Conclusions: HPV DNA testing showed superior sensitivity compared to LBC. HPV DNA's higher diagnostic accuracy and broader coverage make it a more reliable screening tool
The hidden pain of surgical scars: exploring scar endometriosis
Get PDFScar endometriosis is a rare disease and is difficult to diagnose. The symptoms are nonspecific, typically involving pain at the incision site at the time of menstruation. It commonly follows obstetrical and gynaecological surgeries. The diagnosis is frequently made only after excision of the diseases tissue. The case reports of the patients with a troublesome scar after a caesarean section are presented. Surgical excision led to the diagnosis of scar endometriosis. The Pathogenesis, diagnosis and treatment of this somewhat rare condition are discussed
Risk factors, phenotypic-pattern and feto-maternal outcomes of preeclampsia with severe features in a low-resource setting: a prospective study
Get PDFBackground: Preeclampsia is exclusive to pregnancy and one of the leading causes of maternal and perinatal morbidity and mortality globally. This study aims to assess the prevalence, risk factors, phenotypic pattern and feto-maternal outcomes among women managed for preeclampsia with severe features at the Federal Medical Center Asaba.
Methods: Women managed for preeclampsia with severe features between 1st June 2022 and, 31st January 2023 were recruited and relevant data extracted and entered into a standardized proforma which was subsequently analyzed using the SPSS version 26. Categorical variables were expressed in frequencies and percentages while continuous variables were expressed as mean and standard deviation. The association test between the categorical variables was via the chi-square and Fisher exact test where necessary with a p<0.05 considered significant.
Results: The prevalence of preeclampsia with severe features was 19.3% with the late-onset type (63.7%) being the commonest. Maternal and perinatal outcomes were comparable in both phenotypical patterns except for NICU admission which was higher and significant for early onset. Nulliparity, chronic hypertension, and previous history of preeclampsia were the most commonly identified risk factors. Neonatal intensive care unit admission (43.8%), perinatal mortality (17.8%), admission into the intensive care unit (1.4%), and development of eclampsia (0.7%) were the most frequent fetomaternal outcomes.
Conclusions: This study revealed a high burden of preeclampsia with severe features and some of its complications. Interventions such as early antenatal care booking and prompt identification of at-risk women will reduce its burden
Assessment of the benefit of cervical cerclage in mothers diagnosed with short cervix
Get PDFBackground: Cervical incompetence is the inability of the uterus to retain a pregnancy in the absence of signs and symptoms of clinical contractions or labour or both in the second trimester of pregnancy. Cervical cerclages could be better management for pregnancy outcome. In the present study, we evaluated the pregnancy outcome in mothers diagnosed with short cervix who underwent cervical cerclage during second trimester in tertiary care institute.
Methods: This research was conducted as prospective analytical study during the period of 25 months from January 2021 to April 2022. The cervical cerclage was performed as per McDonald’s technique under short anaesthesia among the mothers who presented with short cervix was posted for cervical cerclage operation as per the standard procedure.
Results: In the present study, among 10 mothers with previous one second trimester miscarriage 7 cases (70.0%) reached full term, among 5 patients with previous two second trimester miscarriages 3 cases (60.0%) reached full term and among 2 patients with previous three second trimester miscarriages and 2 cases (100%) reached full term. Overall, 12 cases (70.58%) out of 17 patients with previous second trimester miscarriages had reached full term. Moreover, among 19 mothers with previous one preterm delivery 15 cases (78.94%) reached full term and among 8 mothers with previous two preterm deliveries and 5 cases (62.50%) reached full term. Overall, 20 cases (74.07%) of 27 mothers with previous preterm deliveries had reached full term. The majority of mothers (45, 97.82%) had live births. Only 1 case (2.17%) had second trimester miscarriage.
Conclusions: this study observed the cervical cerclages an effective method in management of short cervix and cervical incompetence
Prenatal invasive diagnostic testing for hemoglobinopathies: a retrospective cohort study at a tertiary care public hospital in central India
Get PDFBackground: Transfusion-dependent hemoglobinopathies such as sickle cell disease, thalassemia, etc. have a huge impact on the Indian economy due to the need for lifelong care and treatment of associated morbidities. Primary prevention strategies focus on awareness generation and pre-marital and pre-conceptional counseling to prevent the conception of a child with a homozygous genotype. Aim was to study the prevalence of carrier status of hemoglobinopathies, the couples at risk of carrying a fetus with major hemoglobinopathies, and the prevalence of fetal affection with major hemoglobinopathies in prenatal invasive testing.
Methods: It was a retrospective cohort study conducted at AIIMS, Nagpur. Study conducted from 24 months (June 2021-June 2023). All antenatal women screened for hemoglobinopathies with HPLC and diagnosed to have hemoglobinopathies.
Results: The 5,432 antenatal women were screened for hemoglobinopathy using high-performance liquid chromatography (HPLC). Out of these, 214 women were carriers of hemoglobinopathies. 53 couples were found to be at risk of carrying a fetus with major hemoglobinopathy. The 52 women underwent prenatal diagnosis (PND), 11 (21.1%) were found to be affected with major hemoglobinopathies and underwent medical termination of pregnancy (MTP). 24 babies were found to be carriers while 17 had no mutation.
Conclusions: Owing to the high prevalence of hemoglobinopathies and the continually increasing impact on global health each year, the benefit of carrier screening programs to control incidence of new cases is recognized worldwide