International Journal of Reproduction, Contraception, Obstetrics and Gynecology
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Frontiers in fertility: a review of breakthroughs in assisted reproductive technology
Get PDFAssisted reproductive technology (ART) is undergoing a transformation driven by emerging biomedical innovations. This review examines recent advances including modulation of the endometrial microbiome, non-invasive preimplantation genetic testing (niPGT) (usually referred as NIPT - non-invasive prenatal genetic testing), mitochondrial replacement therapy (MRT), and reproductive tissue engineering and evaluates their clinical efficacy, ethical implications, and impact on reproductive outcomes. For instance, niPGT has demonstrated up to 80% concordance with invasive testing and reducing biopsy-associated risks. Endometrial microbiota profiling is increasingly used to personalize embryo transfer timing, improving implantation up to 30% of previously unsuccessful in vitro fertilization (IVF) cycles. Innovations in ovarian tissue cryopreservation and 3D bioprinting of reproductive tissues offer fertility solutions for patients with cancer or congenital anomalies. However, these advancements in technology raise ethical concerns around embryo manipulation, germline modification, and equitable access. By synthesizing recent findings, this paper outlines the future trajectory of ART, emphasizing the need for evidence-based integration and regulatory oversight
Compare use of subcutaneous drain vs. no drain in obese women to reduce wound complications post caesarean section: a randomized control trial
Get PDFBackground: Wound complications such as infection, seroma and dehiscence are more common in obese women after caesarean section. The use of subcutaneous drains has been proposed to minimize postoperative complication. This study aimed to evaluate the effectiveness of subcutaneous drains in reducing wound complications among obese women undergoing caesarean section.
Methods: A randomized controlled trial was conducted at Government Medical College, Akola, over 18 months. A total of 150 obese women undergoing caesarean section were randomized into two groups: Group A (with subcutaneous drain) and Group B (without drain). Both groups were comparable in age, parity, BMI and haemoglobin levels. Postoperative complications were assessed, along with duration of hospital stay and time to suture removal.
Results: Women without drains experienced significantly higher wound complications: superficial infection (17.5% vs 7.14%, p<0.05), deep infection (12.5% vs 4.29%, p<0.05) and seroma formation (27.5% vs 7.14%, p<0.001). Wound gape (20% vs 10%) and postoperative fever (15% vs 5.71%) were also more common in the no-drain group. Mean hospital stay and suture removal time were significantly shorter in the drain group (p<0.001).
Conclusions: Subcutaneous drain placement after caesarean section in obese women significantly reduces wound infection, seroma formation and postoperative morbidity, leading to faster recovery and shorter hospital stays. Routine use of drains may be beneficial in this high-risk population.
Nuchal translucency in first trimester of pregnancy: a descriptive study
Get PDFBackground: American college of obstetricians and gynecologists’ (ACOG) committee recommends all women should be offered aneuploidy screening before 20 weeks of gestation. Nuchal translucency (NT) measurement is currently a routine first trimester ultrasound. There is a void in studies of NT measurement in the Nepali population. The objective of the study was to determine the normal value of NT in the Nepalese population.
Methods: This was a hospital based descriptive study done in the obstetrics and gynecology department in Nepal medical college and teaching hospital, Jorpati, for one year. All pregnant women attending the antenatal care clinic before 11 weeks of gestation with a singleton live fetus, within the study period were considered for the study. The fetal NT at 11-13 weeks was measured.
Results: A total of 305 women participated in the study. Twenty-one women were excluded for various reasons, and a total of 284 women were included. The median age of the women was 26 years (IQR, 23-30 years), with a minimum age of 16 years and a maximum age of 41 years. The mean NT was 1.27±0.30 mm with a minimum of 0.6 mm and a maximum of 2.7 mm. There were two women with raised NT. The median Crown Rump length (CRL) was 65 mm (IQR, 54.8-68.3 mm). The minimum CRL was 45 mm and maximum was 79 mm. There was a weak positive correlation of NT with CRL with r=0.15 and p=0.013. The NT of male fetuses was slightly higher as compared to female fetuses (1.30±0.34 mm Vs 1.22±0.24 mm).
Conclusions: The normal value of NT in Nepalese population is within 3 mm. There was a weak positive correlation of NT with CRL
Maternal and fetal outcomes in early-onset severe preeclampsia: a cross-sectional study from a tertiary care centre in Assam
Get PDFBackground: Early-onset severe preeclampsia is associated with significant maternal and fetal risks due to its aggressive progression, which necessitates immediate termination, for maternal safety. This study aimed to evaluate and compare maternal and fetal outcomes in early-onset versus late-onset severe preeclampsia.
Methods: A prospective, hospital-based, cross-sectional study was conducted over one year at a tertiary care centre in Assam. A total of 135 pregnant women with severe preeclampsia were enrolled, of whom 44 had early-onset and 91 had late-onset disease. Maternal outcomes (e.g., eclampsia, Hemolysis Elevated Liver Enzymes Low platelets (HELLP) syndrome, pulmonary edema, acute kidney injury, disseminated intravascular coagulation, abruptio placenta, death) and fetal outcomes (e.g., intrauterine fetal demise, fresh still birth, respiratory distress syndrome, Neonatal Intensive Care Unit (NICU) admission, intrauterine growth retardation, neonatal death) were compared. Data were analyzed by using appropriate statistical tests (SPSS 16 version); p<0.05 was considered significant.
Results: Maternal complications were significantly more common in early-onset cases (59.1%) compared to late-onset controls (20.87%) (OR=6.03, p<0.0001). Maternal deaths occurred in 4.5% of cases and 1.09% of controls (OR=4.14, p=0.258). Fetal/neonatal death was significantly higher in early-onset cases (18.2%) than in controls (3.29%) (OR=6.30, p=0.0065). NICU admission (54.5% vs. 12.08%) and preterm delivery before 34 weeks were more frequent in early-onset cases.
Conclusions: Early-onset severe preeclampsia is associated with markedly increased maternal and fetal morbidity and mortality compared to late-onset severe preeclampsia. Early screening and diagnosis, close monitoring, and judicious timing of delivery are essential to improve outcomes in this high-risk group
Challenging the surgical norm-medical management of cesarean scar ectopic pregnancy: a case report
Get PDFCesarean scar pregnancy (CSP) is a rare form of ectopic pregnancy in which implantation occurs within the myometrial defect of a previous cesarean section scar. Its incidence is rising in parallel with increasing cesarean delivery rates. Although surgical management is traditionally preferred to prevent complications such as uterine rupture and morbidly adherent placenta, selected cases may be effectively managed medically. We report the successful medical management of a 34-year-old G3P2L1 woman with two prior cesarean deliveries who presented with mild abdominal discomfort and bleeding per vaginum after a 14-day delayed menstrual cycle. Her serum β-hCG was >15,000 mIU/mL. Transvaginal ultrasonography revealed a gestational sac measuring ~11.6 mm located within the anterior myometrium at the previous cesarean scar, containing a yolk sac and fetal pole with cardiac activity, consistent with a live CSP. The patient wanted uterine-preserving medical management. This case demonstrates that even a live CSP can be successfully managed using a combined local-systemic medical approach, preserving menstrual function, uterine integrity and fertility. With cesarean rates rising globally, evidence supporting safe, effective, non-surgical alternatives is increasingly important. The patient was followed up with β-hCG levels.
Exploring the perspectives and identifying the challenges of postnatal mothers delivered at a not-for-profit tertiary care referral centre in Vellore, South India: a qualitative study
Get PDFBackground: Our study aimed to explore the perspectives of postnatal women and identify the emotional, psychological and physical challenges in the post-natal period.
Methods: Women who delivered in a not-for-profit tertiary referral centre in South India and had postnatal visits in the last quarter of 2022 were contacted for an in-depth interview after verbal informed consent. Snowball sampling was used to contact postnatal women who fulfilled the eligibility criteria till data saturation was reached.
Result: Overall, 27 interviews were recorded based on the inclusion criteria of the study. After the initial coding, five themes evolved namely: Emotional challenges and response to motherhood; physical pain and self-care; cultural practices and support; financial responsibilities and support; and postnatal care beyond maternal nutrition and breastfeeding. Women who accepted their new role as mothers found ways to manage their time between self-care and care of the newborn. Choosing to stay at home for child care was difficult for women who were working earlier. Mothers were apprehensive of the next pregnancy and sexual health was affected in women who decided not to get pregnant again.
Conclusion: Pain interfered with self-care, care of the newborn and daily routine. Nutrition of postnatal women and perineal and newborn care were influenced by local beliefs that interfered with the discharge advice given by health care professionals. Postnatal women decided to go to a closer health centre for minor illnesses of the newborn or postpartum complaints. Birth spacing, Contraception, urinary and bowel symptoms were not addressed regularly at the time of discharge
Lesson revisited: laparoscopic prowess in bowel endometriosis: a case report on management of endometriosis involving the sigmoid colon and appendix
Get PDFEndometriosis is a chronic inflammatory disorder affecting 10-12% of reproductive-age women. Although it primarily involves pelvic organs, bowel endometriosis accounts for approximately 10% of cases, predominantly affecting the rectosigmoid region. Symptoms may be nonspecific, and imaging findings can be misleading, often delaying diagnosis. Surgical intervention remains both diagnostic and therapeutic, with laparoscopy now favored for its precision and reduced morbidity. We present a case of a 26-year-old woman with acute lower abdominal pain radiating to the right shoulder, alongside a six-month history of dyschezia, dyspareunia, and vaginal dryness. Imaging suggested a left-sided endometriotic ovarian cyst adherent to the uterus with suspicion of sigmoid involvement. Laparoscopic exploration revealed endometriotic lesions involving the sigmoid colon, appendix, and left ovary. Surgical management included bilateral ureterolysis, left ovarian cystectomy, segmental sigmoid colectomy with nerve-sparing side-to-side anastomosis, and appendicectomy. Specimens were retrieved via colpotomy. The patient had an uneventful recovery and reported significant symptom improvement at follow-up. This case highlights the complex presentation of bowel endometriosis and the pivotal role of laparoscopy in diagnosis and management. Segmental colectomy with nerve-sparing techniques ensures complete resection while preserving autonomic function and optimizing outcomes. Appendectomy is advisable when appendiceal involvement is suspected. Vaginal specimen retrieval may further reduce postoperative morbidity. Multidisciplinary collaboration and patient-specific surgical planning are essential in managing extensive bowel endometriosis
Uterine calcifications identified and removed via hysteroscopy in two patients with prior dilatation and curettage
Get PDFUterine calcification is a rare finding that may result from prior uterine trauma such as dilatation and curettage (D and C). We report two cases of women with prior D and C presenting with menstrual disturbances-one with amenorrhoea and another with menorrhagia. Imaging revealed intrauterine calcifications, which were removed via hysteroscopy using a nephroscope and forceps. Postoperative follow-up indicated significant symptomatic improvement and restoration of menstrual regularity. Hysteroscopic removal of uterine calcifications offers an effective and minimally invasive treatment option, particularly in post-D and C patients
Non-tubal ectopic pregnancy–case reports on diagnosis and management of ruptured primary abdominal ectopic and caesarean scar ectopic pregnancy in low resource setting
Get PDFNon-tubal ectopic pregnancy is a rare form of ectopic pregnancy with high morbidity and mortality. The diagnosis of non-tubal ectopic pregnancy requires a high index of suspicion. Clinical history, physical examination, and laboratory and ultrasonographic features may all be non-specific. Fortunately, a low threshold for diagnosis, urine and serum beta-human chorionic gonadotrophin (β-hCG) assays and transvaginal sonography allow earlier diagnosis. Consequently, both maternal survival rates and conservation of reproductive capacity are improved. We present 2 cases of non-tubal ectopic pregnancy. The first is a case of a 17-year-old female para 0+0 with a period of amenorrhea, who presented with lower abdominal pain and moderate bleeding per vaginam. A suspicion of a ruptured ectopic gestation was made and an emergency exploratory laparotomy done which revealed a ruptured ectopic gestation implanted on the lower edge of the omentum with intact tubes and ovaries bilaterally was seen intra op. The second case is a 32-year-old female gravida 4 para 2 + 1ectopic (2 previous caesarean section) who presented with recurrent bleeding per vaginam and lower abdominal pain. Transvaginal ultrasound (USG) report showed a cervical ectopic gestation and patient was counselled accordingly and prepared for curettage or total abdominal hysterectomy. However, about 18weeks gestation uterus, a gestation implanted in an old caesarean section scar extending into the cervix was seen intra op. No obvious intrauterine gestation, tubes and ovaries were all normal and hence a total abdominal hysterectomy was done with conservation of both ovaries. Non-tubal ectopic pregnancy is a rare but potentially life-threatening and often misdiagnosed condition. Our case presents an opportunity to discuss 2 different cases of rare forms of ectopic pregnancy and the importance of having a high index of suspicion to make a diagnosis and prompt management to reduce maternal morbidity and mortality
MicroRNA biomarkers in human embryo-endometrial implantation
Get PDFEmbryo-endometrial implantation is a crucial process in establishing pregnancy, with microRNAs (miRNAs) playing a significant role in regulating gene expression related to this process. Identifying miRNAs as biomarkers can provide valuable insights into predicting implantation success and improving outcomes in assisted reproductive technologies (ART). This study aimed to identify and validate significant miRNAs as biomarkers associated with human embryo-endometrial implantation, providing a comprehensive analysis of their potential in predicting reproductive outcomes. A systematic review and meta-analysis were conducted, including data from 50 studies that investigated miRNAs related to embryo-endometrial implantation. The frequency of miRNA identification, correlation with implantation success and robustness of findings were analyzed using bar charts, forest plots and sensitivity analyses. The study identified miR-451 and miR-21 as the most frequently reported miRNAs, with strong associations with implantation success. miR-30b and miR-30d were highlighted as enhancers of endometrial receptivity, while the miR-200 family was linked to the regulation of epithelial-mesenchymal transition (EMT). The findings were validated using independent datasets and sensitivity analyses confirmed the robustness of the results. miR-451, miR-21, miR-30b, miR-30d and the miR-200 family are critical biomarkers for embryo-endometrial implantation. Their identification provides valuable tools for predicting reproductive outcomes and offers potential for therapeutic interventions in ART. Further research is needed to validate these findings in diverse populations and explore their therapeutic potential