International Journal of Reproduction, Contraception, Obstetrics and Gynecology
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Postpartum hemorrhage prevention through audit and review of literature
Get PDFBackground: Postpartum haemorrhage (PPH), particularly significant cases with blood loss >1000 ml, is a critical obstetric emergency. This audit evaluated PPH management at Khaja Banda Nawaz Teaching and General Hospital, addressing a high incidence of PPH (29.5%).
Methods: A retrospective audit, at Khaja Banda Nawaz Teaching and General Hospital, Kalburgi, Karnataka, India conducted between period of February and May 2024, reviewed 1786 vaginal births from 2022 to 2023, identifying 526 PPH cases (>500 ml), including 71 cases of PPH>1000 ml (4%) and 20 cases ≥2000 ml (1.1%). Compliance with NICE guideline NG235 standards was assessed. Recommendations were implemented from June 2024 to February 2025, followed by a reaudit of 500 vaginal births from February to May 2025, focusing on 14 cases of PPH >1000 ml (2.8%).
Results: The initial audit revealed deficiencies in 56% of PPH records, including inadequate monitoring (35%), delayed uterotonic administration (15%), and delayed transfer from the postpartum ward to the emergency operating unit (59%). Post-intervention, documentation of informed choice improved (78% versus 49%), and significant PPH incidence decreased (2.8% versus 4%). Active third stage management increased (73% versus 27% physiological).
Conclusions: The audit cycle reduced significant PPH through standardized protocols and team engagement, underscoring the value of continuous auditing in midwifery-led units
Breast cancer in reproductive-age women: oncofertility perspectives, treatment impact, and fertility preservation strategies
Get PDFBreast cancer remains the most prevalent malignancy among females globally, comprising 12.5% of all cancer cases. While the median age of diagnosis in Western populations is 62 years, India reports a significantly younger median age of approximately 49 years, correlating with its youthful demographic profile. The incidence of breast cancer in women of reproductive age- approximately 19.3 per 100,000- has been rising steadily, necessitating urgent attention to fertility preservation in this population. Cancer treatments such as gonadotoxic chemotherapy, endocrine therapy, and radiation can adversely affect ovarian reserve, delay childbearing, or induce premature ovarian insufficiency. Consequently, fertility preservation has emerged as a crucial component of cancer care for young survivors. Oncofertility, an evolving interdisciplinary field, integrates oncology and reproductive medicine to provide comprehensive fertility counselling and interventions for cancer patients. Despite the growing importance of fertility preservation, barriers such as inadequate referral, limited awareness, financial constraints, and concerns regarding delays in cancer treatment or hormonal stimulation in hormone-positive cases hinder access. The impact of treatment on fertility varies depending on age, ovarian reserve, and treatment modality. Options for fertility preservation include embryo cryopreservation, mature and immature oocyte freezing, ovarian tissue cryopreservation, and temporary ovarian suppression using GnRH agonists. The National Comprehensive Cancer Network (NCCN) recommends early fertility discussions for all premenopausal breast cancer patients. In addition, pregnancy-associated breast cancer (PABC), though rare, presents a clinical challenge due to diagnostic delays and treatment limitations during gestation. As survival rates improve, safeguarding reproductive potential becomes vital to the quality of life of young survivors. Individualized, timely fertility preservation strategies supported by national and international guidelines are key to improving outcomes in reproductive-age women with breast cancer
Inversion of uterus with sub mucus fundal fibroid with secondary infection: a rare case report
Get PDFUterine inversion is a rare gynecological condition where the uterus turns inside out, typically starting with the fundus descending into the uterine cavity and potentially progressing to complete inversion with vaginal prolapse. It is classified as complete or partial based on the extent of inversion. While most cases (85.8%) are acute and associated with childbirth, non-puerperal uterine inversion—occurring outside the obstetric context—accounts for only 16.35% of cases and is seldom encountered in clinical practice. Non-puerperal inversions are usually linked to uterine pathology and affect women in their reproductive years. The most common cause is the prolapse or extrusion of submucosal fibroids, particularly those located at the fundus, responsible for 80–85% of cases. Less common causes include endometrial polyps, neoplasms, and increased intra-abdominal pressure. Diagnosis of non-puerperal uterine inversion before surgery is difficult and requires a high index of suspicion. Management is exclusively surgical, with the choice of approach based on the patient’s fertility preferences. Uterus-preserving surgeries are preferred when future fertility is desired. Surgical techniques include abdominal approaches (Huntington and Haultain procedures) and vaginal approaches (Kustner and Spinelli procedures). Although abdominal hysterectomy is commonly performed, vaginal hysterectomy can be safe and effective with proper technique. Complications such as superinfection, ulceration, and necrosis of the prolapsed mass are possible and should be managed promptly with broad-spectrum antibiotics and appropriate wound care. Successful outcomes depend on early recognition, accurate diagnosis, and skilled surgical intervention tailored to the individual patient
Evaluation of the relationship between thyroid hormones and endometriosis: a clinical investigation
Get PDFBackground: Endometriosis is a chronic gynecological condition that affects reproductive-aged women. This study evaluated the correlation between thyroid hormone levels and endometriosis severity.
Methods: A cross-sectional study was conducted at Shohada Tajrish Hospital and Atieh Hospital from September 2024 to April 2025. Participants diagnosed with endometriosis underwent clinical, ultrasound, and thyroid hormone assessments. Statistical analyses were used to explore correlations between hormone levels and endometriosis severity.
Results: Significant associations were found between anti-TPO levels and UBESS stage 2. Pain severity was higher in moderate disease. However, TSH, T3, and Free T4 levels showed no significant correlations with disease stage or pain severity. Adhesion levels were associated with nodule presence and uterosacral ligament thickness.
Conclusions: Elevated anti-TPO levels may indicate autoimmune involvement in moderate endometriosis. Structural markers on ultrasound, such as nodule count and USL thickness, may predict disease severity
Ovarian osseous metaplasia-a clinical mimicker of teratoma: a rare case report
Get PDFOssification in the ovary is an extremely rare occurrence, typically associated with mature cystic teratomas, osseous metaplasia in serous or mucinous neoplasms, or endometriotic (chocolate) cysts. Isolated osseous metaplasia in the absence of these conditions is exceptionally uncommon. We report a rare case of a 28-year-old female who underwent laparoscopic oophorectomy following clinical and radiological suspicion of a mature cystic teratoma. However, histopathological examination revealed osseous metaplasia occurring in the background of a polycystic ovary, with no evidence of teratomatous elements. The lesion, although benign, radiologically mimicked a malignant neoplasm, leading to surgical intervention. This case underscores the diagnostic challenge posed by ossified ovarian lesions, which may be indistinguishable from malignant tumors on imaging. Osseous metaplasia, particularly in the context of polycystic ovary, is a rare but benign condition. Recognition of this entity is crucial, as it may allow for conservative management with close follow-up, avoiding unnecessary surgical procedures, especially in young women where fertility preservation is a concern. Ossified ovarian lesions, though rare, should be considered in the differential diagnosis of calcified ovarian masses. Accurate histopathological diagnosis is essential to guide appropriate management and prevent overtreatment
The effect of vitamin D supplementation on glycemic control in diabetic vitamin D deficient pregnant women
Get PDFBackground: This study aimed to evaluate the effect of vitamin D supplementation on glycemic control in diabetic vitamin D-deficient pregnant women and assess the fetomaternal outcomes and compare the fetomaternal outcomes between vitamin D-supplemented and non-supplemented diabetic pregnant women.
Methods: A hospital-based case-control study was conducted at Kasturba Hospital, Delhi, involving 60 pregnant women diagnosed with gestational diabetes mellitus (GDM) or overt diabetes. Participants were randomized into two groups: one receiving weekly vitamin D3 supplementation (60,000 IU) until delivery and a control group receiving routine antenatal care without vitamin D supplementation. Glycemic parameters, oral hypoglycaemic agent and insulin requirements, and maternal-fetal outcomes were assessed. Maternal outcomes included pre-eclampsia, fetal growth restriction, liquor amount, mode of delivery and fetal outcomes included birth weight, neonatal intensive care unit (NICU) admissions, and neonatal hypoglycaemia. Statistical analysis was carried out using statistical packages for IBM statistical package for the social sciences (SPSS) versus 22 for Windows. Two sided p values was considered as statistically significant at p<0.05.
Results: With vitamin D supplementation, improved glycemic control was observed in pregnant women with diabetes with a mean change of fasting blood sugar 21.45 (SD=15.99) in the supplemented group compared to 8.37 (SD=9.88) in the controls with p value <0.001 and the mean change of post prandial blood sugar was 39.13 (SD=41.33) in the supplemented group while the control group had a mean change of 8.93 (SD=40.99) with a p value of 0.006. However, vitamin D supplementation does not change the maternal and fetal outcomes of pregnancy in diabetic mothers.
Conclusions: Vitamin D supplementation in diabetic vitamin D-deficient pregnant women improved glycemic control. Universal supplementation is recommended for all diabetic pregnant women along with adequate sun exposure and consumption of vitamin D rich foods
Association of thyroid dysfunction with menstrual irregularities among women attending a tertiary care hospital in western India: a cross-sectional study
Get PDFBackground: Thyroid dysfunction is a significant yet often underdiagnosed contributor to menstrual irregularities among women of reproductive age. Alterations in thyroid hormone levels can disrupt the hypothalamic-pituitary-ovarian axis, affecting the menstrual cycle in multiple ways. This study aimed to assess the prevalence and patterns of thyroid abnormalities among women presenting with menstrual irregularities in a tertiary care setting in Gujarat, India.
Methods: A hospital-based cross-sectional study was conducted at SSG Hospital, Vadodara, from March 2024 to February 2025. A total of 321 women aged 18-45 years presenting with menstrual irregularities were enrolled. Data were collected using a structured questionnaire covering menstrual history, symptoms of thyroid dysfunction, and clinical examination. Thyroid function tests (TSH, FT3, FT4) were conducted for all participants. Statistical analysis was performed using Chi-square and ANOVA to determine associations between menstrual patterns and thyroid function.
Results: Out of 321 participants, 99 (30.8%) had thyroid dysfunction. Among them, 65 (65.6%) had subclinical hypothyroidism, 21 (21.2%) had overt hypothyroidism, 9 (9.1%) had subclinical hyperthyroidism, and 4 (4%) had overt hyperthyroidism. Oligomenorrhea (36.3%) and menorrhagia (28.2%) were the most common menstrual disturbances associated with thyroid dysfunction. A significant association was observed between hypothyroidism and menorrhagia (p<0.05), while hyperthyroidism was more frequently linked with hypomenorrhea (p<0.05).
Conclusions: Thyroid abnormalities, particularly subclinical and overt hypothyroidism, are common among women with menstrual irregularities. Routine screening for thyroid dysfunction should be integrated into the evaluation of such cases to ensure early diagnosis and intervention
A case of late-onset twin-twin transfusion syndrome with severe fetal anemia and maternal acute kidney injury
Get PDFTwin-twin transfusion syndrome (TTTS) is a rare but serious complication of monochorionic twin gestation which forewarns obstetricians about the best management approach. The majority of cases are diagnosed early and managed with laser coagulation, resulting in reduced neonatal mortality. We have managed a late-diagnosis of TTTS Quintero stage 1, who was delivered due to suspicion of severe fetal anemia in the donor and cardiac overload in the recipient twin. The mother developed acute kidney injury in the early third trimester which worsened despite appropriate management. The cause of kidney injury in a mother carrying monochorionic diamniotic (MCDA) twins is unknown, yet restoration of renal function post-delivery suggests a connection. We are presenting this case as a rare presentation of severe fetal anemia in TTTS. This case demands additional research to identify the triggering factors, knowledge of which is expected to reformulate the management of MCDA twins
A scar that cycles: unmasking episiotomy site endometriosis: a case report
Get PDFEndometriosis is a condition characterised by occurrence of endometrial cells outside the uterine cavity and when it appears at the previous scar site like episiotomy scar, caesarean scar or laparoscopic port incision scar sites, it is called extrapelvic or cutaneous endometriosis. Here we present a case of 31-year-old lady who had vaginal delivery with episiotomy scar 6 years ago. She presented at our center with cyclical pain at the episiotomy scar site and a hard nodular mass of 3×4 cm was found at the episiotomy site. She underwent complete excision of mass after thorough examination and imaging. The hsitopathology report confirmed the diagnosis. Hence, we knew that the definitive treatment of episiotomy scar site endometriosis is surgical and medical management has no role
Sonographic assessment of uterine scar thickness and associated factors among pregnant women with previous caesarean sections at a tertiary hospital in Tanzania
Get PDFBackground: Uterine scar thickness has a practical application on the safe mode of delivery for pregnant woman with previous cesarean section (CS) lower uterine segment (LUS) scar. The study aimed to assess sonographic uterine scar thickness and associated factors among pregnant women with previous CS at a tertiary hospital in Mwanza, Tanzania.
Methods: An analytical cross-sectional analytical study was carried out at a tertiary hospital in Mwanza, Tanzania that included pregnant women with previous CS at term (≥ 36 weeks of gestation). Transabdominal obstetric ultrasound was performed. A uterine scar thickness was categorized as thin or thick using a cut off of 2.5 mm. Data were presented using descriptive statistics and analysed. A p value of less than 0.05 considered statistically significant.
Results: About 113 out of 400 women (28.3%) had thin uterine scars. Inter-pregnancy interval (p<0.001), history of wound infection (p=0.01) and placenta location (p=0.001) were significant factors associated with uterine scar thickness. On adjusted logistic regression analysis, inter-pregnancy interval [aOR (95% CI) =2.35 (1.38-3.99), p=0.002], estimated fetal weight [aOR (95% CI) =0.54 (0.34-0.87), p=0.01] and anterior placenta location [aOR (95% CI) =0.55 (0.34-0.90), p=0.02] were factors most likely to predict uterine scar thickness.
Conclusions: Uterine scar thickness assessment by sonography in pregnant women with previous cesarean sections can be easily integrated in an obstetric ultrasound. We recommend its routine application, and in combination with risk factors may guide decision on the mode of delivery and help prevent adverse maternal and fetal outcomes