International Journal of Reproduction, Contraception, Obstetrics and Gynecology
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Correlation between endometrial thickness and histopathological report in patients with abnormal uterine bleeding: a prospective study
Get PDFBackground: Abnormal uterine bleeding (AUB) refers to any bleeding from the uterus that is irregular in volume, duration, or frequency and does not fall within the normal menstrual cycle pattern. The objective of this study was to find the correlation between endometrial thickness on transvaginal or transabdominal ultrasound with histopathological assessment of the endometrial assessment on Dilatation and curettage in patients with AUB.
Methods: It was a prospective Cohort study. A total of 102 women in reproductive and peri-menopausal age (taking inclusion and exclusion criteria into account) who underwent dilatation and curettage for abnormal uterine bleeding during the period March 2023- March 2024 were taken and analysed and correlated their HPR reports with their endometrial thickness measured with ultrasound.
Results: Mean age of patients was 37.83±9.43. Mean endometrial thickness (mm) was 9.15±3.474. For pathological abnormalities in ultrasonography the cutoff point that delineates the abnormal histology and normal histology for endometrial thickness was 14.50 mm area under the curve (AUC) was 0.783 and sensitivity, specificity of 100%, 70% respectively.
Conclusions: A positive correlation between endometrial thickness and histopathological findings was observed, underscoring the importance of endometrial evaluation in patients presenting with abnormal uterine bleeding
Endometrial polyp-induced fallopian tube obstruction
Get PDFEndometrial polyps are common non-cancerous growths in the uterine lining, leading to unusual bleeding and fertility issues. These generally lack symptoms, but can cause heavy periods, bleeding between cycles, and fertility struggles. Diagnostic methods include hysterosalpingography, hysteroscopy, and histopathological examination. This report covers a 30-year-old woman with irregular cycles and infertility for seven years, diagnosed with an endometrial polyp blocking the fallopian tubes. After a hysteroscopic polypectomy, she experienced symptom relief and her menstrual cycle normalized
The prevalence, types, indications, and common complications associated with gynecological hysterectomy at Lautech teaching hospital, Ogbomoso, southwest Nigeria a five-year review
Get PDFBackground: Hysterectomy is a common major gynecological procedure performed on women.
Methods: This study was a retrospective study including all the gynecological hysterectomies done over a 5-year period in LAUTECH Teaching Hospital between 1st January 2020 and 31st December 2024. A total of 215 case files were retrieved out of 224 procedures done. Data were collected into proforma, cleaned, and analyzed using SPSS version 25. The results were expressed in frequencies, percentages, means, and standard deviation.
Results: The prevalence of the gynecological hysterectomy in Ogbomoso was 25.9%. The mean age in this study was 60.9±9 years. The most common indication for hysterectomy in this environment is symptomatic uterine fibroids. The preferred approach to the procedure was the transabdominal route, constituting 91.6%. Most of the patients (88.4%) who were offered hysterectomy had salpingo-oophorectomy. About 83.7% of patients stayed within five days in the hospital following the procedure. The mean blood loss in this study was 548±352.2. Slightly below one-fourth of the total number of patients who had hysterectomies suffered one form of complication or the other. These complications include hemorrhage (31.8%), surgical site infection (18.3%), anemia (22.7%), ureteral injury (13.6%), cuff cellulitis (9%), and bladder injury (4.6%). Most (72.6%) of the histological diagnoses were benign, and the rest were malignant in nature. The most common histological diagnosis was leiomyoma (27.9%).
Conclusions: Transabdominal hysterectomy is a common gynecological procedure in Ogbomoso, with symptomatic uterine fibroids being the leading indication for gynecological hysterectomy. Efforts should be made in the acquisition of skills for minimal access approaches, such as laparoscopic hysterectomy, in order to reduce complications associated with the procedure and further reduce the hospital stay
Association of maternal serum ferritin level with preterm labor
Get PDFBackground: Preterm labor is a significant contributor to neonatal morbidity and mortality worldwide. Identifying reliable biomarkers for predicting preterm birth can improve maternal and neonatal outcomes. Serum ferritin, an acute-phase reactant and iron storage protein, may play a role in the pathophysiology of preterm labor. This study aimed to evaluate the association between maternal serum ferritin levels and preterm labor.
Methods: A case-control study was conducted in the Department of Obstetrics and Gynaecology at Dhaka Medical College Hospital from June 2022 to May 2023. A total of 88 pregnant women were enrolled using purposive sampling, including 44 with preterm labor (cases) and 44 with term labor (controls). Sociodemographic, obstetric, and biochemical data were collected, and maternal serum ferritin levels were measured. Data were analyzed using statistical package for the social sciences (SPSS) version 25, and comparisons between groups were made using the Mann-Whitney U test and Chi-square test where appropriate.
Results: There was no significant difference in maternal age between the two groups. However, serum ferritin levels were significantly higher in the preterm group (89.09±106.07 ng/ml) compared to the term group (32.13±31.40 ng/ml) (p=0.004). A weak but statistically significant negative correlation was observed between serum ferritin levels and gestational age (r=-0.313, p<0.05).
Conclusions: Elevated maternal serum ferritin levels are significantly associated with preterm labor. Serum ferritin may serve as a useful biomarker for identifying women at risk of preterm delivery, allowing for timely interventions to prevent adverse pregnancy outcomes
Predicting the success of intrauterine insemination using a clinically based scoring system
Get PDFBackground: Aim of the study was to predict the success of intrauterine insemination (IUI) using a clinically based scoring system. Retrospective cohort study in the institute of reproductive medicine, the Madras medical mission, Chennai
Methods: The 240 patients meeting the inclusion criteria and exclusion criteria who underwent IUI with husband/ donor sperms were retrospectively assessed. 10 parameters each influencing the success of IUI were taken and a total score was derived for each patient and their predictive cut off for success of IUI was determined. Each factor was also analysed individually for the success of IUI. All the patients were followed up till their serum beta human chorionic gonadotropin (hCG) test done 16 days post insemination.
Results: On evaluating, ROC curve was obtained and it showed that a cut off of 13.5 had a success prediction post IUI with a sensitivity of 82.9 and specificity of 68.2 on individually analyzing the 10 factors, serum anti-Müllerian hormone (AMH) was found to be influence the success of IUI.
Conclusions: The proposed scoring system integrates the parameters to provide an individualized pregnancy probability estimate. This tool can support clinicians in counselling patients more effectively, aiding in decision making and setting realistic expectations
Predictors of optimal ovarian response in GnRH antagonist ovarian stimulation protocol
Get PDFBackground: The outcome of assisted reproductive technology (ART) is significantly influenced by the ovarian response to controlled ovarian stimulation (COS). Identifying robust and reliable predictors of ovarian response is essential for tailoring individualized treatment strategies and optimizing reproductive success. This study aims to investigate clinical, hormonal, and stimulation-related variables that influence ovarian response among women undergoing ART and to identify significant predictors for both hyper-response and hypo-response patterns.
Methods: A retrospective cohort analysis was conducted involving 278 women who underwent COS under a gonadotropin-releasing hormone (GnRH) antagonist protocol. Based on ovarian responsiveness, participants were categorized into three groups: high responders (n=56), normal responders (n=151), and low responders (n=71). Demographic data, hormonal markers (including Anti-Müllerian hormone [AMH], antral follicle count [AFC], follicle-stimulating hormone [FSH], and luteinizing hormone [LH]), stimulation characteristics, and infertility etiologies were systematically analyzed. Statistical comparisons utilized t-tests and chi-square tests, while logistic regression identified independent predictive parameters. A p-value of less than 0.05 was considered statistically significant.
Results: Higher AFC and AMH levels, younger age, and lower baseline FSH levels were significantly correlated with high ovarian response. In contrast, women with low AMH, high FSH, reduced AFC, and prolonged stimulation duration tended to demonstrate poor ovarian responsiveness. Notably, polycystic ovary syndrome (PCOS) was more frequent in high responders, while diminished ovarian reserve (DOR) predominated in low responders. Multivariate logistic regression identified AMH and AFC as the most significant independent predictors of ovarian response.
Conclusions: Age, AMH, AFC, and baseline FSH are critical determinants of ovarian response in ART cycles. Incorporating these biomarkers into pre-treatment evaluation facilitates the customization of stimulation protocols, thereby enhancing oocyte yield and improving overall clinical outcomes. Personalized treatment planning grounded in these predictors holds promise for advancing ART success.
Effect of Elagolix in comparison to Dienogest in the treatment of symptomatic adenomyosis
Get PDFBackground: Adenomyosis, a benign gynecological disorder, is diagnosed with increasing frequency in infertile patients since women delay their first pregnancy. Common symptoms of adenomyosis are dysmenorrhea and heavy menstrual bleeding (HMB), resulting in poor quality of life. Elagolix, the oral GnRH antagonist, acts by reducing the occurrence of ectopic endometrial implants in the myometrium. It diminishes uterine volume, reduces dysmenorrhea and heavy bleeding, and improves fertility outcomes. Dienogest, a synthetic oral progestin highly selective for progesterone receptors, reduces the painful symptoms in women with adenomyosis. The aim or this study was to compare the effect of Elagolix with Dienogest in the treatment of symptomatic adenomyosis.
Methods: This randomized controlled trial was conducted in the department of reproductive endocrinology and infertility, Bangabandhu Sheikh Mujib medical university (BSMMU), Dhaka, from January 2024 to December 2024. A total of 58 participants with symptomatic adenomyosis were randomly assigned to 2 groups (n=29). Each group received either Elagolix (200 mg) or Dienogest (2 mg) once daily for 3 months.
Results: Compared between the two groups, post-treatment mean changes of VAS score (6.25±1.83 vs 4.84±1.56), hemoglobin (-1.21±0.97 vs-0.20±0.56), and median uterine volume (5.1 vs 1.2) were significantly higher in the Elagolix group than the Dienogest group. HMB was also significantly reduced (3.7% vs 23.1%) in the Elagolix than the Dienogest group after 3 months of treatment.
Conclusion: Elagolix significantly reduced VAS score, HMB, and uterine volume in symptomatic adenomyosis compared to Dienogest
Diagnostic dilemma in a case of jaundice complicating pregnancy with successful maternal outcome in a tertiary care centre
Get PDFApproximately 3% of all pregnancies are complicated by liver biochemical test abnormalities, the most life-threatening of which is acute fatty liver of pregnancy (AFLP). We report a case of 32 years G2A1 patient, with IVF conceived DCDA twin pregnancy at 30+3 weeks gestation with intra-uterine death of one fetus with preterm prelabour rupture of membrane with meconium-stained liquor along with a history of jaundice from her 5th month of gestation. Her biochemical parameters were suggestive of early signs of disseminated intravascular coagulation. Acute fatty liver of pregnancy was suspected while keeping in mind other differentials and the patient was managed by prompt delivery and a multi-disciplinary team approach. High index of suspicion of the condition in women presenting with jaundice in pregnancy, can prevent maternal mortality and morbidity
Peripartum cardiomyopathy: a case report and review of current diagnostic and therapeutic strategies
Get PDFPeripartum cardiomyopathy (PPCM) is a rare but serious cause of heart failure in late pregnancy or the postpartum period. We report a unique case of PPCM with delayed onset and predominant right-sided heart failure in a 41-year-old woman, presenting on postpartum day 14 with peripheral edema and fatigue. Initial findings, including severe anemia and hypoalbuminemia, obscured the diagnosis. Echocardiography revealed biventricular dysfunction and biatrial enlargement. Treatment with beta-blockers and diuretics led to significant recovery. This case highlights the diagnostic challenge of atypical PPCM and underscores the need for vigilance and cardiac evaluation in postpartum patients with heart failure signs
Abdominal tuberculosis masquerading as ovarian tumor: a case series
Get PDFTuberculosis (TB) is a major health problem in developing countries. Abdominal TB accounts for 6%-13% cases of extra pulmonary TB. The diagnosis of abdominal TB poses a major diagnostic challenge due to its non-specific presenting symptoms. Abdominal TB mimics ovarian cancers in terms of clinical presentation, laboratory and radiological findings such as abdominal distension, ascites and raised CA 125 levels. Hence, in such cases a thorough and planned diagnostic approach becomes essential so that timely diagnosis can be made and unnecessary surgical or oncological intervention burden is avoided