International Journal of Reproduction, Contraception, Obstetrics and Gynecology
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Dual diagnostic complexity in ART: pituitary microadenoma and heterotopic pregnancy - a case-based insight
Get PDFPituitary microadenomas are benign adenohypophyseal tumors most commonly related to hormonal dysregulation, possibly affecting fertility and reproductive function. This case report presents a 24-year-old female with a pre-existing preclinical diagnosis of pituitary microadenoma presenting to assisted reproductive treatment for subfertility. In spite of regular menstrual cycles and lack of any of the features of hyperprolactinemia at treatment, her clinical history warranted meticulous hormonal assessment and customized stimulation protocol. After controlled ovarian stimulation, ICSI, and frozen embryo transfer of two blastocysts, she got pregnant. To her astonishment, she was diagnosed with a heterotopic pregnancy, as evidenced by the presence of intrauterine and tubal gestation. This case points towards the intricate interplay between pituitary pathology and ART outcome. It emphasizes the need for individualized fertility management in patients with pituitary disease, who could have atypical or unpredictable responses to stimulation and implantation. The successful diagnosis and management of this uncommon dual-gestation event emphasize the caution required in the evaluation and multidisciplinary management in ART cycles with underlying endocrine pathology
Placental location and fetomaternal outcome: a prospective study
Get PDFBackground: The placental position within the uterus can significantly influence pregnancy outcomes, impacting maternal and fetal well-being. It has been associated with complications such as preeclampsia, intrauterine growth restriction (IUGR), and premature rupture of membranes (PROM). Understanding how different placental locations affect pregnancy outcomes is essential for optimizing clinical management and improving maternal and neonatal health. Objective of this study was to assess the effect of placental location on maternal and fetal outcomes.
Methods: This prospective study was conducted in the Department of Obstetrics and Gynaecology, Himalayan Institute of Medical Sciences, Dehradun, over 12 months from June 2023 to May 2024. 120 pregnant women with singleton pregnancies over 18 weeks of gestation were recruited. After determining placental location via ultrasonography, the participants were divided into three groups: anterior (n=53), posterior (n=46), and lateral (n=21). Maternal and fetal outcomes were assessed and analysed using SPSS software (version 23), with a p-value of less than 0.05, considered statistically significant.
Results: The most common placental location was anterior (44.1%), followed by posterior (38.3%) and lateral (17.5%). A significant association was observed between lateral placental location and hypertensive disorders including per-eclampsia (p=0.01), while anterior placental location was significantly associated with a higher incidence of PPROM/PROM (p=0.002). Regarding fetal outcomes, lateral placentation was significantly associated with IUGR (p=0.01). Although NICU admission rates were higher in the anterior placental group (35.8%), no significant correlation was found between placental location and neonatal outcomes.
Conclusions: Placental location, particularly lateral positioning, is significantly associated with adverse maternal and fetal outcomes, including hypertensive disorders and IUGR. Anterior placental location showed a strong association with PPROM/PROM. Further research is necessary to confirm these findings and refine clinical management strategies for pregnancies with abnormal placental locations
An evaluation of feto-maternal outcome in oligohydramnios: a prospective study
Get PDFBackground: Oligohydramnios is defined as amniotic fluid index (AFI) below 5th centile for the gestational age. AFI is an index of foetal well-being. It is associated with increased pregnancy complications, perinatal morbidity and mortality. AFI assessment would help to identify women who need increased antepartum and intra-partum surveillance. It occurs in 1-5% of pregnancies at term. We intended to do a specific study at our centre IGMC, Shimla to compare the maternal and perinatal outcome in pregnant women having isolated oligohydramnios at term with those having normal AFI.
Methods: This was a prospective observational case control comparative study conducted in the department of Obstetrics and Gynecology at Indira Gandhi Medical College, Shimla between 1st July 2019 to 30th June 2020. 50 cases with AFI≤5cm and 50 controls with AFI 8-20cm at 37-42 weeks were enrolled. Maternal and neonatal outcomes were compared.
Results: There was more foetal growth retardation (FGR) in study group 28% as compared to 10% in control group, more induction of labour in study group 50% as compared to control group 38%. 46% of patients from study group while only 20% patients from control group underwent LSCS. Significant difference observed between 1- and 5-minute APGAR scores in both groups. Low birth weight <2.5 kg was seen in 24% of neonates from study group and 10% of neonates from the control group. 50% of neonates from the study group were admitted in NICU for complications.
Conclusions: AFI is a valuable screening test for predicting foetal distress in labour requiring caesarean section. Timely intervention is required to reduce perinatal morbidity and mortality
Unani contraceptives: a substitute for contemporary unmet
Get PDFThe means of preventing unintended pregnancies are birth control and contraception. Today's advancements had given hundreds of contraceptives, giving people options but the primary reason that is unfulfilled, with the related adverse effects being the main concern. None satisfy the people's needs to the required extent. Therefore, it is imperative that we investigate and identify fertility-regulating drugs that are less expensive, universally accepted, safer and more effective in order to meet the millennium development goal and improve maternal health, the World Health Organization put efforts on the promotion of family planning. effective contraception is thought to be able to prevent 90% of abortion-related morbidity and mortality as well as 20% of pregnancy related morbidity and mortality. Research on more advanced, totally reversible, self-administered, less toxic, less costly contraceptives is therefore necessary. Many of these characteristics are found in contraceptives, as the traditional Unani scripture mentions. Unani physician has discussed the many contraceptive methods and medications. The effectiveness of many herbal medicines such as Suddab (Ruta graveolans), Abhal (Juniperus communis), Filfil daraz (Piper longum), Pudina (Mentha arvensis), Neem (Azadirachta indica), Anar (Punica granatum), Piyaz (Alium cepa) and wild carrot (Daucus carota) has been supported by scientific studies. Therefore, this article aims to examine the traditional Unani System of Medicine's approach to contraception in the context of existing scientific research.
Eclampsia is still a nightmare for obstetrician-maternal and perinatal outcome in eclampsia patients at tertiary hospital and factors affecting the outcome
Get PDFBackground: Among the disorders that complicate pregnancy, pre-eclampsia and eclampsia are major causes of maternal and perinatal morbidity and mortality. Hypertensive disorders complicate 5% to 10% of all pregnancies and form a lethal trio with haemorrhage and infection. In India, the incidence of eclampsia ranges from 1 in 500 to 1 in 30 (0.5%-1.8%). Pre-eclampsia and eclampsia are a major cause of approximately 20% of all maternal deaths in USA and around half of them are associated with eclampsia. To study various factors associated with eclampsia and outcomes in eclampsia patients.
Methods: It is a prospective observational study conducted in the department of obstetrics and gynaecology in a tertiary care hospital in Central India. The study was conducted for duration of two years from November 2019 to October 2021.
Results: In our study we found that Maternal complications were present among 19.0% women with eclampsia. Among the patients with maternal complications, atonic PPH was present among 16.2% women, obstetric hysterectomy was required in 0.4%. Maternal mortality was present among 4.5% patients. Of maternal deaths, cerebrovascular accidents accounted for four maternal deaths followed by acute renal failure among three women. Pulmonary edema, HELLP syndrome and septicemia were the cause of maternal death among two, one and one women respectively. Among the newborns, 6.9% comprised of stillbirths and early neonatal death was observed among seven newborns 2.8%.
Conclusions: Improving the antenatal care by proper antenatal visits, early booking, meticulous BP records at each antenatal visit and special attention to high-risk groups such as primigravida, teenage pregnancy and pregnancy-induced hypertension and early referral and specialist care is important for the improvement in the maternal and perinatal outcomes
Awareness about breast cancer and breast self-examination among reproductive age group females attending outpatient department of tertiary health care hospital: a cross-sectional study
Get PDFBackground: Breast cancer (BC) is the most common type of cancer in Indian women. For every two women newly diagnosed with breast cancer, one woman died of it in India. Hence, this study was conducted to assess the awareness about breast cancer, and to assess knowledge regarding breast self-examination (BSE) among reproductive age group females.
Methods: A cross-sectional study was conducted in the out-patient department (OPD) at a tertiary health care hospital from April to September 2023 among 203 females of the reproductive age group (15-49 years) using a simple random sampling technique. A self-designed, pre-tested questionnaire was used to assess awareness about breast cancer and knowledge regarding BSE. Institutional Ethics Committee approved this study. Data was analyzed with statistical package for the social sciences (SPSS) version 20.0 and Microsoft excel.
Results: Study participants had a mean age of 28±8 years. Among the total participants of n=203, 93 (45.8%) were married, and 58 (28.6%) belonged to the upper socioeconomic class. A total of 175 (86.2%) women heard about BC. Among them (n=175), 133 (76.0%) women were aware of causes of BC, 89 (50.8%) knows about diagnosis, 77 (44%) had knowledge regarding treatment and 101 (57.7%) were known to preventive measures for BC. 86 (49.1%) women had knowledge about BSE, but among them only 52 (60.4%) knew proper technique and were practicing it monthly.
Conclusions: Overall awareness about BC and BSE was less and measures should be taken to improve BC awareness and BSE practices
Feasibility of laparoscopic sacrocolpopexy in pelvic organ prolapse: a single centre prospective observational study
Get PDFBackground: Pelvic organ prolapse (POP) is a prevalent gynaecological condition that significantly impacts women's quality of life across all age groups. Surgical treatment is often necessary, laparoscopic sacrocolpopexy (LSC), offers a minimally invasive option with promising results. This study done in a tertiary care laparoscopic and robotic centre (GEM Hospital, Coimbatore) aims to explore the advantages of laparoscopic sacrocolpopexy.
Methods: This is a prospective study conducted over a period of 5 years. The participants are women who attended the gynecology clinic and were detected to have prolapse symptoms with a grade 2 or more descent of anterior wall, apex or posterior wall of vagina. Participants were followed until the 6th month of post-operative period.
Results: A total of 54 women were included in the study, most of them being multiparous. 30 out of the 54 women were obese, that signifies the association of obesity with pelvic organ prolapse. 54 patients underwent laparoscopic sacrocolpopexy, of which 7 patients underwent concomitant total laparoscopic hysterectomy (TLH) with sacrocolpopexy. 4 patients underwent laparoscopic sacrocolpopexy along with paravaginal cystocoele repair. The average time calculated was 182 minutes. All the patients reviewed at 3 months and 6 months post-op, had no symptoms of descent and on examination, 2 patients had Bp point at the level of -1.
Conclusions: Laparoscopic sacrocolpopexy offers comparable objective and subjective cure rates to open surgery and is a safe and effective treatment for vaginal vault prolapse, providing long-term anatomical restoration and cure
A novel combined abdominal and vaginal approach for pelvic organ prolapse in young patients
Get PDFIn India, the incidence of genital prolapse is 1.5 –2 % in nulliparous women and 5–8 % in young multiparous women which is the highest in the world. Though pelvic organ prolapse (POP) is not a life-threatening condition, its impact on life-style and self- esteem of a woman is paramount. There is a gamut of conservative surgical treatment options for POP for patients where the uterus needs to be preserved. Surgical repair in young women is more challenging as anatomical correction and preservation of fertility and sexual functions have to be addressed with a durable solution. In our case series, all three patients had third degree uterocervical descent with elongated and hypertrophied cervices. Hence neither abdominal nor vaginal repair alone was expected to be sufficient for restoring patient's anatomy and sexual functions. Therefore, we came up with a novel combined abdominal and vaginal approach by carrying out cervical amputation vaginally and Virkud’s composite sling abdominally. The position and healing of the neo cervix was found to be excellent in all three cases during their post operative follow up. Through this case series, we highlight that the best surgical option for the treatment of POP should be tailored according to the patient’s need and expertise of the surgeon, as there are no clear guidelines for the choice of surgery for POP
A descriptive cross-sectional study of association between abnormal uterine bleeding and thyroid dysfunction
Get PDFBackground: Abnormal uterine bleeding (AUB) is one of the most common gynecological presentation, accounting for at least 20% of all outpatient visits. Thyroid dysfunction has profound effect on the female reproductive system. Both hypothyroidism and hyperthyroidism are associated with untoward menstrual changes. This study aims to find the prevalence of thyroid dysfunction among patients with diagnosed AUB.
Methods: A descriptive cross-sectional study was conducted in the Department of Obstetrics and Gynaecology at General Hospital Jayanagar, Bengaluru. After taking ethical clearance from the Institutional Review Committee, the study was conducted on 100 patients with AUB satisfying the inclusion and exclusion criteria from November 2020 to May 2022. Thyroid function test was done in all patients by radioimmunoassay on an automated analyzer. Data was collected using a questionnaire which includes patient’s profile, pattern of AUB, examination and thyroid profile.
Results: Out of 100 patients, it was found that 75% were euthyroid, 20% were hypothyroid, among which 15% had subclinical hypothyroidism and 5% had overt hypothyroidism and 5% were hyperthyroidism. The most common type of AUB was menorrhagia in 38%, followed by acyclical bleeding in 33%, polymenorrhoea in 11%, metrorrhagia in 8%, oligomenorrhoea in 7%, and hypomenorrhea in 3%. The maximum number of patients were between 30-40 years.
Conclusions: Thyroid dysfunction is one of the important causes of AUB with hypothyroidism being the most common type in patients with menorrhagia. It was reported that their symptoms improved with thyroid medication
Comparison of mattress and continuous suturing techniques using polyglactin 910 and chromic catgut for episiotomy repair: an observational study
Get PDFBackground: An episiotomy is an incision through the perineum to increase the vulvae outlet’s diameter and assist childbirth. Despite the fact that episiotomy is proven to benefit mothers, it is responsible for a significant percentage of both short-term and long-term postpartum morbidities. This study compares two different suture materials, namely polyglactin and chromic catgut, for episiotomy repair and short-term maternal morbidity.
Methods: This was a prospective observational study conducted in the Department of Obstetrics and Gynaecology, Government Medical College, Thrissur. The data was collected and analysed using SPSS software.
Results: A total of 400 participants who fulfilled the inclusion and exclusion criteria were studied. The majority of 214 women (53.5%) included in this study were between 20-25 years. 17(4.3%) women had edema (1 cm) at 24-48 hours after delivery. 43 (10.8%) women had more than 99-degree temperatures at 24-48 hours. 6 (1.5%) women had wound dehiscence at 6 weeks of them, 4 belonged to group 4. 98.3% had episiotomy wounds healed by primary intention.
Conclusions: There was a reduction in wound dehiscence and more healing by primary intention in the polyglactin group than in the chromic catgut group. There was no significant reduction in short-term pain, temperature, induration and oedema between these groups. Hence, this study recommends a more rapidly absorbable form of polyglactin than traditional chromic catgut for perineal repair