International Journal of Reproduction, Contraception, Obstetrics and Gynecology
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Serous cystadenofibroma of ovary mimicking malignancy: a case report and review of diagnostic challenges
Get PDFOvarian cystadenofibroma is a rare benign epithelial tumour composed of both glandular and fibrous stromal elements. Although benign, its imaging features mimic those of malignant neoplasms, posing diagnostic and therapeutic challenges. We report a case of 31-year-old nulliparous woman who presented with heavy menstrual bleeding. Clinical examination revealed right adnexal fullness and imaging studies demonstrated a complex multiloculated right ovarian cyst measuring approximately 5cm. a provisional diagnosis of complex ovarian neoplasm was made. Patient underwent right ovarian cystectomy. Histopathological examination confirmed the diagnosis of benign serous cystadenofibroma
Comparison of low level of pregnancy-associated plasma protein - A between first and early second trimester of pregnancy in intrauterine growth restriction
Get PDFBackground: Intrauterine growth restriction (IUGR) is the failure of the fetus to reach its growth potential due to pathological factors, most commonly placental dysfunction and is a major contributor to perinatal morbidity and mortality worldwide. This study compares low maternal serum PAPP-A levels in the first and early second trimesters to predict IUGR risk. The aim of the study was to compare low levels of Pregnancy-Associated Plasma Protein-A (PAPP-A) between the first and early second trimesters of pregnancy in relation IUGR.
Methods: This prospective cohort study was conducted at the Department of Obstetrics and Gynecology, Dhaka Medical College Hospital in 2020, including 186 pregnant women (6–12 and 13–20 weeks gestation) to assess PAPP-A’s predictive value for IUGR. Eligible healthy singleton pregnancies underwent blood PAPP-A testing and serial ultrasounds with Doppler. IUGR was diagnosed by fetal measurements and Doppler, with low PAPP-A defined as <0.5 MoM. Data analysis used SPSS with ROC curves.
Results: Most participants were aged 26–29 years. IUGR occurred in 17 (Group A) and 19 (Group B), with low PAPP-A in 12 and 13 cases, respectively. Low PAPP-A significantly predicted IUGR (RR: 10.73 and 9.03, p<0.001). Diagnostic performance was high in both trimesters (AUC>0.85, sensitivity>89%, specificity>69%). Serum PAPP-A is a reliable early predictor of IUGR.
Conclusions: Low maternal serum PAPP-A levels in early pregnancy moderately predict IUGR, with comparable accuracy in both first and early second trimesters
Effect of the umbilical cord length on mode of delivery and perinatal outcome
Get PDFBackground: The umbilical cord is a vital anatomical structure connecting the fetus to the placenta, and its length along with the presence of nuchal loops may influence labor progression and neonatal outcomes. This study aimed to evaluate the relationship between umbilical cord length and mode of delivery, duration of labor, neonatal APGAR scores, NICU admissions, and incidence of fetal distress.
Methods: A prospective observational study was conducted at Al-Ameen medical college hospital from July 2023 to January 2025, involving 200 pregnant women. Umbilical cord length and the presence and number of nuchal loops were documented at delivery. Maternal and neonatal outcomes, including mode of delivery, labor duration, fetal distress, and neonatal parameters, were recorded and analysed statistically.
Results: The mean umbilical cord length was 50.68±11.75 cm. Although the incidence of caesarean delivery was higher in both short and long cord groups, the difference was not statistically significant (p=0.217). Labor duration was significantly prolonged in cases with nuchal cord, particularly among primigravida (17.62±1.38 h vs. 11.95±1.49 h). Neonates with nuchal loops had lower APGAR scores at 1 and 5 minutes (p=0.003), and NICU admission rates were higher among those with multiple loops (p<0.001). Fetal distress increased significantly with number of nuchal loops (p<0.0001).
Conclusions: Abnormal cord length and multiple nuchal loops are significantly associated with prolonged labor, fetal distress, increased incidence of instrumental delivery, caesarean section due to cephalopelvic disproportion due to deflexed head, low APGAR score, NICU admission. Patients with 2-3 loop of cord around the neck can have normal vaginal delivery. There is increasing rate of caesarean section due to ultrasound diagnosis of cord around the neck at term, because of obstetrician distress and patients request rather than obstetric indication
Clinicopathological evaluation of abnormal uterine bleeding in peri menopausal women
Get PDFBackground: Abnormal uterine bleeding (AUB) is a frequently encountered gynaecological complaint in perimenopausal women and also the most common cause of hysterectomy in their age group. The current study was carried out to evaluate various presentations of perimenopausal Abnormal uterine bleeding and to correlate with histopathological examination of the dilation and curettage (D&C) sample of endometrium.
Methods: A cross-sectional study was conducted from 2022 to 2024 at a tertiary care hospital in Imphal, among 190 abnormal uterine bleeding cases. Data were collected in a predesigned proforma and analysed using SPSS Version 21.0. Descriptive statistics were used to express the findings. Ethical approval was obtained and informed consent was taken.
Results: The mean age of the study subjects or participants was 45.67±5.58 years. The majority of the cases were aged 41-50 years, Hinduism dominated, educated up to 12th class, self-employed, and living in a joint family. Heavy uterine bleeding was the common presentation. The USG findings were 80.5% sensitive and 100% specific to diagnose leiomyomas; in adenomyosis, USG is more sensitive (100%) and specific (100%). Clinically, leiomyoma was the most common suspected cause of AUB; radiologically, 50% of leiomyomas and post-hysterectomy histopathological findings showed that 62.1% were leiomyoma, among which 98.9% were proliferative. Only 21% were adenomyosis. The endometrial pattern was 63.7% proliferative, 21.6% secretory, 14.7% disordered proliferative.
Conclusions: The abnormal uterine bleeding was common in middle-aged women and heavy bleeding was the common presentation. The proliferative leiomyomas are the major causes for AUB followed by adenomyosis
Spontaneous hematuria after caesarean section: a case report and review of literature
Get PDFHematuria occurring postoperatively is typically associated with urinary tract infection, renal pathology, or surgical trauma. However, delayed-onset hematuria following caesarean section (CS) is uncommon and may point toward less frequently encountered etiologies directly or indirectly related to the surgical procedure. A patient presented with spontaneous gross hematuria on the 29th day after an uncomplicated CS. She had no fever, flank pain, or urinary symptoms. Preliminary investigations ruled out infection and renal pathology. Advanced imaging and cystoscopic evaluation were conducted to explore structural or vascular causes. Potential etiologies identified included retroperitoneal hematoma, vesicouterine fistula, and occult bladder injury. Diagnostic evaluation was challenged by the delayed timeline and non-specific presentation. Imaging techniques such as CT/MRI, cystoscopy, and dye tests proved critical in delineating the source. Spontaneous hematuria in the late postoperative period following CS is rare but warrants systematic evaluation to identify overlooked surgical or anatomical causes. Early diagnosis and targeted intervention are crucial to prevent long-term morbidity
A comparison of the effectiveness of Samarthram vacuum suction cannula with uterotonic drugs as primary management in cases of atonic PPH at tertiary care center: a randomized clinical trial
Get PDFBackground: Atonic PPH is a leading cause of maternal mortality. The SR cannula offers a low-cost, practical alternative by creating negative intrauterine pressure that mimics natural uterine retraction. To compare effectiveness of SR vacuum suction cannula and with uterotonic drugs in cases of Atonic PPH.
Methods: This prospective study at GMC Akola enrolled 100 women developing atonic PPH after AMTSL. Patients were randomized to SR cannula (n=50) or uterotonics (n=50). Group A: Cannula inserted up to fundus, negative suction at 650 mmHg for 10 min, repeated hourly 3 times. Group B: Uterotonics given as needed sequentially (Methergine → Carbetocin→Misoprostol→Carboprost) with 15-min interval. All patients were observed for bleeding, tone, vitals;
Results: In Group A (SR cannula), bleeding stopped in <4 min in 64%, 5-9 min in 26%, 10-14 min in 4% and >14 min in 6%. In Group B (uterotonics),in 6%, 52%, 30% and 12% respectively. Mean blood loss was 302.85±106.07ml in Group A vs 377.9±135.41ml in Group B.
Conclusions: SR cannula is as effective as uterotonics for atonic PPH, with faster bleeding control, lower cost, reusability and transport feasibility, yet larger studies are needed for validation
A retrospective observational study of maternal weight gain during pregnancy and correlation with fetomaternal outcome in women admitted to labour room in a tertiary care center of South Gujarat
Get PDFBackground: Gestational weight gain (GWG) is an important determinant of maternal and neonatal health. Both excessive and inadequate GWG are associated with adverse outcomes. This study evaluated the correlation of GWG, based on Institute of Medicine (IOM) guidelines, with pregnancy outcomes across different body mass index (BMI) categories.
Methods: A retrospective observational study was conducted in the Department of Obstetrics and Gynaecology at a tertiary care centre in South Gujarat over one year. A total of 300 pregnant women were analysed for age, parity, BMI, GWG, and fetomaternal outcomes.
Results: Most participants were aged 19–35 years (95%), with primipara comprising 40.67%. Poor GWG was observed in 56% and normal GWG in 35.67%. Preterm labour was more frequent in underweight women (11.13%), while post-term delivery was higher in obese women (17.47%). Vaginal delivery predominated in poor GWG (72.62%), whereas lower segment caesarean section (LSCS) rates were greater in high BMI groups (36%). Low birth weight (<2.5 kg) was common with poor GWG (41.07%), while birth weight >2.5 kg was more frequent in normal (76.63%) and excessive GWG (88%). Anaemia was the leading comorbidity (132 cases), particularly in underweight women. GDM, hypertensive disorders, big bay, induction failure, operative delivery, and postpartum complications were associated with higher BMI and excessive GWG.
Conclusions: GWG followed pre-pregnancy BMI trends. Excessive GWG was linked with metabolic and obstetric complications, while below-recommended GWG increased risks of low birth weight, preterm delivery, and anaemia
Acceptability, safety, and clinical outcomes of postpartum intrauterine contraceptive device insertion: a prospective study at a tertiary care hospital
Get PDFBackground: Contraception is vital in improving the quality of life of women and reducing the maternal mortality and morbidity, occurring due to unplanned pregnancy. During the immediate post-delivery period, women are highly motivated and need an effective method of contraception. The benefits of the postpartum intrauterine contraceptive device (PPIUCD) have to be emphasized to the women
Methods: The present study was conducted in the department of obstetrics and gynecology, JSS hospital, Mysore, from June 2021 to June 2024, spanning a period of 3 years. After counseling and consent, Copper T 380A was inserted after delivery. Acceptability, safety, and clinical outcome were studied.
Results: Among a total of 14196 deliveries at JSS hospital during the study period, 3107 PPIUCDs were inserted (21.88%). The 2522 among 6258 antenatally counselled women accepted PPIUCD insertion (40.3%), and 2450 (97.14%) got PPIUCD inserted. The 585 (11.68%) out of 5006 women counseled on admission for delivery had PPIUCD inserted. The most common reason for denial of PPIUCD was a family member's objection, followed by the concern about side effects. The 718 (23.10%) women reported complications like excessive bleeding, white discharge per vagina, abdominal pain, and only 2 (0.075%) had spontaneous expulsion of PPIUCD.
Conclusions: PPIUCD appears to be a safe and effective method of contraception. All the institutions providing health care to women need to be trained in the correct insertion technique of PPIUCD, counselling of women and family members, to propagate this novel method of contraception, and to motivate the women for continuation of IUCD by providing effective follow-up service
Sclerosing stromal tumor of the ovary: a rare case report
Get PDFSclerosing stromal tumors (SST) are rare benign tumors of the ovary, accounting for less than 5% of all sex cord-stromal neoplasms. We report the case of a 33-year-old woman who presented with pelvic pain and was found to have a 78×55 mm heterogeneous semisolid mass in the left adnexa on ultrasonography. Pelvic magnetic resonance imaging revealed a well-circumscribed adnexal lesion with both solid and cystic components, raising suspicion for a neoplastic process. The patient underwent laparoscopic left salpingo-oophorectomy. Final histopathological examination confirmed a diagnosis of SST, with an intact capsule and immunohistochemical staining positive for CD31 and CD34, and negative for cytokeratin AE1/AE3, inhibin A, and desmin. The Ki-67 proliferation index was 6%, and peritoneal cytology was benign. This case emphasizes the importance of including this rare tumor in the differential diagnosis of adnexal masses and highlights the value of minimally invasive surgery in their management
Homozygous SMN1 gene deletion as a cause of intrauterine and neonatal mortality
Get PDFDeoxyribonucleic acid is not only responsible for normal functioning and metabolism of body by the formation of essential proteins which are responsible for individuals growth and development but it is also responsible for transferring traits & genetic disorders from parents to their offspring, either these genetic traits make them carriers or major diseased individual, these conditions may arise because of any false nucleotide base insertion, or nucleotide deletion or any gene replacement due to radiations or mutations. SMA (survival motor atrophy) is a condition that arises because of less production or unavailability of the SMN protein, which is synthesized by the SMN-1 gene. A case of 29 years old married woman (cousin marriage- Consanguinity) has been discussed, she lost her 4 babies after birth (neonatal deaths) in between the duration of 2 to 8 months, with one intrauterine miscarriage (intra-uterine death), after CVS it was found that SMN-1 was absent in the genetic makeup of her all babies, and they were not able to survive because of muscular atrophy in pulmonary muscles causing pulmonary distress and reduced body movements with edematous condition and other body organ failures including kidney and liver. It was concluded that SMN-1 gene absence is not only responsible for causing intrauterine, neonatal deaths but also causes sudden deaths in adult age suddenly by causing paralysis. Gene replacement therapies with other oligonucleotides and splicing modifiers have been introduced with the advancement of biotechnology for the treatment of SMA disease