International Journal of Reproduction, Contraception, Obstetrics and Gynecology
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Tail gut cyst: laparoscopic removal - a case report
Get PDFA tailgut cyst, also known as a retro rectal cystic hamartoma, is a rare, congenital cyst arising from remnants of the embryonic hindgut. We hereby presented a case report of a 53 years old lady who had undergone hysterectomy in 2010 and laparoscopic tailgut cyst removal in 2023 and came with backache and constipation since 1.5 years. She was thoroughly evaluated for the same and underwent magnetic resonance imaging (MRI) showing a well-defined multiloculated cystic lesion with no involvement of adjacent pelvic organs and sacral nerve roots. She underwent laparoscopic tailgut cystectomy. Postoperatively patient was relieved of her signs and symptoms.
From participation to transformation: adolescents’ narratives of health and nutrition behavior change in a community-based project
Get PDFBackground: Adolescent girls are vulnerable to malnutrition, anaemia, and infections due to a lack of awareness and availability of services, putting them at a high risk of poor health, nutrition, and hygiene status. Hence, community-based interventions need to be implemented to spread awareness using different behavior change models. This study aimed to assess participants’ awareness, perceptions, and experiences with health, nutrition, hygiene, and environmental initiatives implemented under the Jagriti program in rural and urban areas.
Methods: Focus group discussions were conducted with adolescent girls. We performed thematic analysis to explore participants’ knowledge, practices, and feedback related to awareness campaigns, kitchen gardens, community-based events, digital interventions, and stakeholder meetings.
Results: Participants showed awareness of anemia, menstrual hygiene, nutrition, sanitation, and early marriage. The establishment of kitchen gardens improved dietary diversity and supported livelihood. Traditional and culturally accepted methods such as nukkad natak, rangoli making, and folk-art improved community engagement and knowledge retention. The digital interventions provided health education, but with limitations such as shared phone access and gender disparities. In addition, village and stakeholder meetings discussed waste segregation, cleanliness and hygiene, and air pollution for disease prevention; however, attendance remained a challenge.
Conclusions: The results emphasized the significance of multi-faceted, participatory strategies to increase awareness of health through cultural performances, digital interventions, and community involvement. Addressing barriers such as gender disparities, digital access limitations, and time constraints remains crucial to increasing the effectiveness of the program and its sustainability
Obese and non-obese polycystic ovarian syndrome: comparison of clinical, metabolic, hormonal parameter and their differential response to oral ovulation induction drugs
Get PDFBackground: Polycystic ovarian syndrome (PCOS) is a complex disorder characterized by hyperandrogenism, menstrual irregularities, and polycystic ovaries. The present study compared obese and non-obese PCOS patients in terms of clinical, metabolic, and hormonal parameters, as well as their response to oral ovulation induction drugs.
Methods: This study was conducted in the Department of Obstetrics and Gynaecology, AIMSR Bathinda, over one year after approval from the Institutional Ethics Committee. Women with PCOS presenting with infertility were enrolled. Patients were categorized into obese and non-obese groups, and their clinical, metabolic, and hormonal profiles were compared. Data were recorded in Microsoft Excel and analysed using SPSS software.
Results: The mean age was 25.3 years in the obese group and 26.1 years in the non-obese group. Mean fasting insulin levels were higher in obese patients (25.1 µIU/ml) compared to non-obese (15.9 µIU/ml). Similarly, insulin resistance and HOMA-IR values were significantly greater in the obese group. Mean testosterone levels were slightly higher in obese patients (58.3 ng/dl vs. 55.4 ng/dl). Conception rates following oral ovulation induction were significantly lower in obese women (30.6%) than in non-obese women (76.3%).
Conclusions: Obese women with PCOS are at higher risk of metabolic derangements and exhibit poorer responsiveness to ovulation induction therapy. Early identification and targeted weight management strategies may not only prevent adverse outcomes but also improve fertility outcomes in this population
Evaluation of safety, efficacy and continuation rates of post-partum intrauterine contraceptive device
Get PDFBackground: Postpartum intrauterine contraceptive device (PPIUCD) is a proven, safe, reversible, and long-acting method of contraception. Despite availability, its acceptance remains low. This study aimed to evaluate the safety, efficacy, and continuation rates of PPIUCD in a tertiary care hospital in Himachal Pradesh.
Methods: A prospective study was conducted from June 2023 to May 2024 among women >34 weeks gestation attending antenatal outpatient department (OPD), admitted in the labor room, and postpartum ward. PPIUCD insertion was performed either post-placental or intra-caesarean after counselling. Women were followed up at 6 weeks, 12 weeks, and 6 months to assess safety, efficacy and continuation rates.
Results: Of 500 women, the acceptance rate was 40%, significantly influenced by antenatal counselling. The main reasons for acceptance were long-term contraception (91.5%), safety (88%), and reduced clinic visits (62.5%). Refusals were attributed to poor knowledge (55.67%), partner/family disapproval (41.33%), preference for another method (35.33%), and fear of complications (33.67%). Most participants were 26–30 years (36.5%), multiparous (66%), graduates (48.5%), from rural areas (62%), and upper middle class (32.7%). Vaginal delivery accounted for 67.5% of insertions. The expulsion rate was 6.84%, with no significant association with type of insertion (p=0.24). At follow-up, 76.31% reported no complaints. Removal rate was 1.58%. Continuation was 91.58% and efficacy 100%, with no failures recorded.
Conclusion: PPIUCD is a safe, effective, and highly acceptable contraceptive option with excellent continuation and satisfaction rates. It is particularly advantageous in rural settings where access to follow-up and contraceptive services is limited
Comparison of clinical pregnancy rates and miscarriage rates in frozen vs selective fresh embryo transfers: a multicentric retrospective analysis
Get PDFBackground: IVF initially involved making of embryos and transferring in same cycle. However, with advanced freezing techniques, most of the clinics now have shifted to freeze all strategy claiming better pregnancy rates. Our study aims to compare clinical outcomes in frozen vs. selective fresh transfers. We also compared clinical outcomes in these groups in subgroups of PCOS, Poor reserve, tubal factor, endometriosis and male factor.
Methods: Multicentric, retrospective study conducted across 65 centers. The IVF cycles were included for a period of 5 years from 1st January 2019 to 31st December 2023. Sub fertile couples between 23 to 43 years of age undergoing self-cycles in antagonist protocol, undergoing embryo transfer with one or two blastocysts. Patients with severe uterine factor infertility (multiple fibroids, unicornuate uterus, Asherman’s syndrome, and severe adenomyosis), patient who had history of previous three or more IVF failure (recurrent implantation failure), patients with bad obstetric history (three or more pregnancy losses) were excluded.
Results: Total number of embryo transfers were 38,789. Frozen transfers were 34,407 and 4382 were fresh embryo transfer. Only those patients which had clinically low risk of OHSS and good endometrial thickness with trilaminar appearance were considered for fresh embryo transfers. Clinical pregnancy rates and miscarriage rates were calculated in both the groups. Further, the clinical pregnancy rates and miscarriage rates were also calculated in subgroups like PCOS group (n=3341), tubal factor (n=1929) endometriosis (n=693), low ovarian reserve (n=863) and male factor infertility (n=31963).
Conclusions: Our study showed better pregnancy rates with frozen embryo transfers over fresh embryo transfers, more so in endometriosis and male factor infertility. However, even miscarriage rates are higher in frozen embryo transfer except in endometriosis patients
Coexistence of acute fatty liver of pregnancy, gestational diabetes insipidus, and preeclampsia leading to severe hypernatremia and perinatal mortality: a case report
Get PDFAcute fatty liver of pregnancy (AFLP) and gestational diabetes insipidus (GDI) are rare but life-threatening obstetric complications. AFLP is linked to hepatic dysfunction, which can impair the breakdown of placental vasopressinase, leading to GDI and eventually hypernatremia. The coexistence of AFLP with GDI can be further worsened by placental dysfunction associated with preeclampsia, due to the disruption of the placental barrier that allows fetal vasopressin to enter the maternal circulation. This rare confluence of AFLP, GDI, and preeclampsia is scarcely reported and presents significant diagnostic and management challenges. We report a 25-year-old G2P1 woman, at 36 weeks of pregnancy, presenting with fever, jaundice, altered mentation, and hypertension. Laboratory tests showed hypernatremia (195 mEq/l), low urine osmolality, and abnormal kidney and liver function tests. Swansea criteria confirmed AFLP. Sodium was gradually corrected at a rate of 6-8 mEq/l per day, and vaginal delivery was planned. A live baby weighing 2.08 kg was delivered but died from respiratory failure on day two. Maternal recovery was complete by day 11 postpartum. This case highlights the interaction between AFLP, preeclampsia, and GDI. It emphasizes the importance of careful sodium correction and increased suspicion of vasopressinase dysfunction in cases of unexplained hypernatremia.
Association of gestational hypertension with hypothyroidism in pregnancy
Get PDFBackground: In recent years, the prevalence of hypothyroidism during pregnancy has been steadily increasing, a trend that is contributing to growing concerns about maternal and fetal health. Alongside the rising prevalence of hypothyroidism in pregnancy, gestational hypertension has emerged as an increasingly common and concerning complication.
Methods: The primary objective was to study the association of gestational hypertension with hypothyroidism in pregnancy and secondary was to assess perinatal outcomes in pregnancies complicated by hypothyroidism. This was a case–control study conducted in 102 cases and 102 controls over a duration of one year in a multispecialty Credence hospital in a urban setting.
Results: In our study, the distribution of age, parity, socioeconomic status, BMI, pre-existing complications- both medical and obstetric problems were comparable between groups . The odds of gestational hypertension were 2.15 times higher in cases compared to controls (OR: 2.15, 95% CI: 1.048–4.411) and this association was statistically significant (p=0.034). The incidence of preterm delivery was higher in hypothyroid women when compared to euthyroid women and was statistically significant OR=4.4 (95% CI: 1.203–16.096) (p=0.016). There was no statistically significant difference in the incidence of preeclampsia, FGR, anaemia, GDM, mode of delivery between the two study groups.
Conclusions: The results of this study provided evidence for an association between hypothyroidism and the development of gestational hypertension offering an understanding of how thyroid dysfunction influences the course of pregnancy, which is consistent with previous studies. Early detection and management of hypothyroidism may help to reduce gestational hypertension and improve overall pregnancy outcomes
Mode of delivery preferences, knowledge, and intention to practice exclusive breastfeeding among female undergraduates at Ladoke Akintola University of Technology, Ogbomoso, Oyo State
Get PDFBackground: Exclusive breastfeeding and preferred delivery modes are crucial for promoting maternal and child health. Understanding these factors among young women is important for improving future breastfeeding and delivery decisions. This study aimed to assess knowledge and intentions regarding exclusive breastfeeding and delivery mode preferences among female undergraduates of Ladoke Akintola University of Technology, Ogbomoso, Oyo State.
Methods: A descriptive cross-sectional study design was employed. A total of 1,000 respondents were selected through simple random sampling. Data were collected using a semi-structured, interviewer-administered questionnaire covering sociodemographic characteristics, knowledge of exclusive breastfeeding and delivery modes, and intentions related to breastfeeding and childbirth. Data were analyzed using the Statistical Product and Service Solutions (SPSS) version 20.0, employing descriptive statistics and chi-square tests to determine associations, with significance set at p<0.05.
Results: Most respondents (75.5%) had heard of exclusive breastfeeding, and 51.9% correctly defined it. A high proportion (75.7%) intended to practice exclusive breastfeeding, while 77.7% preferred vaginal delivery over caesarean section. Overall, 66.8% demonstrated good knowledge of exclusive breastfeeding, although 27.9% believed infant formula and breast milk contain equal nutrients. Significant associations (p<0.05) were found between sociodemographic characteristics, knowledge, and intentions regarding exclusive breastfeeding and delivery preferences.
Conclusions: Although awareness and intention to practice exclusive breastfeeding were high, misconceptions persist. Strengthening university-based maternal health education and practical learning initiatives is recommended to enhance accurate knowledge and improve reproductive health decisions among young women
Maternal outcomes in morbidly adherent placenta: a prospective cohort study
Get PDFBackground: Morbidly Adherent Placenta (MAP), encompassing placenta accreta, increta, and percreta, is a life-threatening obstetric condition associated with high maternal morbidity and mortality. This study aimed to evaluate maternal outcomes in women diagnosed with MAP and to identify risk factors influencing morbidity and mortality.
Methods: A prospective cohort study was conducted at a Government Medical College and Hospital, Akola, Maharashtra from Oct 2022 to Feb 2024, involving 50 women diagnosed with MAP. Data were collected regarding obstetric history, gestational age at delivery, estimated blood loss, need for hysterectomy, intensive care unit (ICU) stay, duration of hospitalization, and maternal mortality. Statistical analysis was performed to identify associations between previous Caesarean scars, emergency versus planned deliveries, and adverse outcomes.
Results: The majority of patients (62%) had placenta accreta, followed by increta (26%) and percreta (12%). MAP incidence and severity increased with the number of prior caesarean scas. The mean estimated blood loss was 1950±450 mL, and 80% of patients required blood transfusion. Caesarean hysterectomy was performed in 38% of cases. ICU admission was required in 56%, and the average hospital stay was 8.4±2.7 days. Planned deliveries were associated with significantly lower blood loss and fewer complications compared to emergency deliveries.
Conclusions: MAP remains a major cause of maternal morbidity, strongly associated with prior caesarean deliveries. Early antenatal diagnosis, and elective delivery in specialized centres significantly reduce blood loss, operative complications, and mortality
Evaluating the outcomes of sublingual and vaginal misoprostol for labor induction
Get PDFBackground: To evaluate and compare the effectiveness, safety, and outcomes of 25 µg sublingual versus 25 µg vaginal misoprostol used for induction of labor at term.
Methods: This retrospective observational study was conducted from May 2021 to October 2022. To analysed the records of 200 antenatal patients who were in their third trimester, specifically beyond 37 weeks of gestation. The study identified case files of patients who received induction of labor through sublingual versus vaginal misoprostol for various indications. The data collection process involved a thorough examination of the case record form, capturing essential details such as patients age, parity, clinical presentations, examination findings, and results from clinical assessments and ultrasonography. Additionally, it included pre-induction CTG readings, Bishop scores, the method of administering tablet misoprostol, the quantity of tablets utilized, modes of delivery, fetal and maternal outcomes, any complications encountered, and NICU admissions.
Results: Vaginal delivery occurred in 90% of the vaginal group and 88% of the sublingual group. The mean induction-to-delivery interval was slightly shorter in the vaginal group. Oxytocin augmentation was more frequently required with sublingual misoprostol. Adverse effects such as fever, nausea, and diarrhea were occurring slightly more in the sublingual group without statistical significance. Non-reassuring cardiotocography was the leading indication for caesarean section. Neonatal outcomes showed no significant difference.
Conclusions: Both sublingual and vaginal misoprostol are equally effective and safe for term induction. The route may be individualized according to patient preference and clinical suitability