International Journal of Reproduction, Contraception, Obstetrics and Gynecology
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Knowledge, attitudes and practices on human papilloma virus infection, screening and vaccination among reproductive-aged women
Get PDFBackground: Cervical cancer is the most common gynecological cancer and the most preventable cancer among women. 93% of cervical cancers had infection with HPV. This study aims to evaluate the factors towards practices and perceived barriers of reproductive aged women on HPV infection, vaccination and screening by looking into demographic variables, knowledge and attitudes of respondents towards HPV infection, vaccination and screening.
Methods: This research is a descriptive cross sectional study, approved by the Research Ethics Committee. A self-administered questionnaire created by the researchers and validated by three specialists was used in assessing the knowledge, attitudes, practices and barriers towards HPV infection, screening and prevention. Descriptive statistics were used to summarize the data sets. Chi square test of association was used to analyze the association of age, knowledge, attitude to the history of screening and vaccination and general practices of respondents regarding HPV infection, screening and prevention.
Results: Between August and November 2020, 81 women participated in the study. Results shows that respondents have poor knowledge (Mean: 8.74; Ref: ≥13) but with positive attitude (M: 3.13) towards HPV infection, screening and vaccination. Majority of respondents did not undergo any screening procedure (70.4%) nor received HPV vaccination (92.6%). Although, respondents had generally good practices that prevents HPV infection. Marital status and age were found to be associated with HPV infection prevention practices. However, knowledge on screening and vaccination was not associated with demographic variables.
Conclusions: This study shows that knowledge on HPV infection, screening and vaccination was generally poor. Majority of respondents have not undergone screening tests or vaccination. Major reasons identified for this are feelings of anxiety, inability to communicate desire to get screened, cost of vaccine and lack of information. Hence, information dissemination and counselling regarding the disease, its screening and vaccination should be strengthened
Evaluation of endometrial abnormalities in breast cancer patients on tamoxifen therapy
Get PDFBackground: Breast cancer is the most common malignancy in women. Tamoxifen, widely used as adjuvant therapy, has anti-estrogenic effects on breast tissue but may induce endometrial changes due to estrogenic stimulation. To evaluate endometrial abnormalities in postmenopausal breast cancer patients receiving tamoxifen therapy.
Methods: This cross-sectional study was conducted at the Department of Gynaecological Oncology, NICRH, Dhaka, over one year. Seventy-five postmenopausal breast cancer patients who had received tamoxifen for more than six months were enrolled. All underwent transvaginal ultrasound (TVS) and 32 patients subsequently had histopathological evaluation. Data were analyzed using SPSS v23.
Results: The mean age was 58.03±7.96 years. TVS revealed endometrial thickness of 4–7.9 mm in 58.6%, 8–11.9 mm in 8%, 12–15.9 mm in 12%, 16–19.9 mm in 6.7% and ≥20 mm in 14.6% of patients, with a mean thickness of 11.22±6.68 mm. Thickness ≥8 mm was significantly associated with longer tamoxifen use (p<0.05). Histopathology (n=32) showed 25% normal endometrium, while 75% had abnormalities: polyps (28.1%), hyperplasia without atypia (25%), hyperplasia with atypia (9.4%), atrophy (9.4%) and carcinoma (3.1%). A significant correlation was found between TVS findings and histopathology (p=0.044).
Conclusions: Nearly two-fifths of patients developed endometrial thickening >8 mm and three-quarters of those biopsied had abnormal histopathology, including hyperplasia with atypia and carcinoma. Long-term tamoxifen therapy in postmenopausal women may predispose to endometrial pathology, warranting regular surveillance with TVS and prompt biopsy for suspicious cases
Caesarean scar ectopic pregnancy: a rare case report
Get PDFCaesarean scar ectopic is one of the rarest among all ectopic pregnancies. It is defined as a blastocyst implantation on a previous caesarean scar. The incidence of caesarean scar ectopic has increased due to rise in number of caesarean deliveries. Early diagnosis by using ultrasonography and prompt management improves the outcome by allowing preservation of future fertility. It is very important because any delay can lead to increased maternal morbidity and mortality. We are reporting a rare case of gravida3 para1 live1 abortion1 with previous one caesarean delivery, diagnosed as caesarean scar ectopic pregnancy with the help of ultrasonography. Patient underwent uterine artery embolization (UAE) after failed medical management followed by hysteroscopy and ultrasound guided dilatation and evacuation, and on histopathology examination caesarean scar pregnancy was confirmed
Laparoscopic management of cervical fibroids: a case series
Get PDFCervical fibroids present unique challenges due to their proximity to the ureter and potential impact on fertility and pelvic anatomy. Laparoscopic techniques offer advantages such as reduced blood loss; shorter hospital stays and faster recovery times as compared to the traditional open methods. We report a case series of 10 cases of cervical fibroid management using laparoscopic methods (laparoscopic myomectomy and total laparoscopic hysterectomy with prophylactic uterine artery ligation in selected cases) performed at our institute Shreeji Hospital, Bhilad between February 2020-January 2024. Laparoscopic hysterectomy was the most common procedure performed (70%), followed by laparoscopic myomectomy (30%). The mean operative time was 96 minutes, with minimal intraoperative complications observed. Postoperatively, patients experienced significant improvement in symptoms such as pelvic pain, abnormal uterine bleeding, and urinary symptoms. Preservation of fertility was achieved in 30% candidates
Is cabergoline mystical in euprolactemic polycystic ovarian syndrome
Get PDFBackground: Polycystic ovarian syndrome (PCOS) is most common in reproductive age females. Cabergoline is a potent long-acting dopamine agonist play an important role in decreasing high prolactin secretion which is present in 30–40% of PCOS and induce ovulation in those with normal prolactin level also. This is attributed to reduction of an occult hyperprolactinemia in PCOS patients.
Methods: This is a randomized, prospective, controlled study includes 100 Euprolactinemic infertile PCOS, 50 in each group, Group A (letrozole cabergoline group) patients received tablet letrozole 5 mg/day in 2 divided doses 2.5 mg from cycle day 3 to day 7 plus cabergoline tablet 0.25 mg, half tablet twice weekly for 4 weeks starting from cycle day 3 with letrozole despite normal serum prolactin level. Group B (letrozole Group):patients received only letrozole same as group A. Primary outcomes-ovulation rate, number of dominant follicles and secondary outcomes-pregnancy, miscarriage, multiple pregnancies, OHSS, side-effects of cabergoline were studied. Statistical analysis was done.
Results: Study groups compared for the demographic characters, basic clinical data, duration and type of infertility which showed no significant difference. Statistically significant difference in group A ovulation rate 76% (p value 0.0124), number of dominant follicles (p value 0.029). Pregnancy rate 72% in group A and 48% in group B (p value 0.014). No statistical difference in miscarriage (p value 0.15), twin pregnancies (p value 0.86), OHSS (p value 1.0) and no side effects.
Conclusions: Addition of cabergoline to Letrozole in induction of ovulation in euprolactinemic infertile PCOS results in increased ovulation, high pregnancy rate compared to use of letrozole alone, with very few side-effects
Effectiveness of innovator dydrogesterone versus generic dydrogesterone in early pregnancy: a real-world analysis
Get PDFBackground: Miscarriage is the most common complication of early pregnancy. Dydrogesterone, a retro-steroid with high oral bioavailability and receptor selectivity, is widely prescribed to support and maintain pregnancy via its novel immunomodulation mechanism. There is a lack of comparative data on the miscarriage rate for pregnant females prescribed innovator, generic, and no dydrogesterone in early pregnancy. This study aimed to evaluate this comparative rate in real-world settings.
Methods: A real-world, retrospective, observational study was conducted using anonymized and aggregated medical records from January 2017 to October 2024. Early pregnancy females (18-45 years) who consulted gynecologists were included. These were categorized into three arms: innovator dydrogesterone (Arm 1), generic dydrogesterone (Arm 2), and no dydrogesterone (Arm 3). These arms were balanced by propensity score matching (PSM), and miscarriage rates were compared using the Chi-square test.
Results: The incidence of miscarriage was significantly lower in the innovator arm (4.10%) compared to Arm 2 (5.54%, p=0.040) and arm 3 (12.46%, p<0.001). No event of miscarriage was reported among women who switched from generic to innovator dydrogesterone. However, one of the females who shifted from innovator to generic experienced a loss of pregnancy.
Conclusions: Innovator dydrogesterone was associated with the lowest rate of miscarriage compared to generic and no dydrogesterone. This suggests its potential clinical benefits in early pregnancy
Prevalence and associated factors of preeclampsia in two national university hospitals in Cotonou in 2024
Get PDFBackground: Preeclampsia is one of the direct obstetric complications with a heavy burden, particularly in low- and middle-income countries such as Benin. The objective of this research was to identify the determinants of preeclampsia among pregnant women managed in two national university hospitals in Cotonou in 2024.
Methods: The study was conducted in two university hospitals in Cotonou. It was a matched case-control study (two controls for each case), with an analytical aim and prospective data collection from August to October 2024. The threshold for retaining variables in the bivariate analysis was 0.2. Multivariate analysis consisted of a stepwise descending binary logistic regression with a significance level of 0.05.
Results: A total of 120 cases of preeclampsia and 240 controls were surveyed. The hospital prevalence of preeclampsia was 11.11%. The mean age was 27.64±6.32 years versus 27.35±5.72 years. Most participants had secondary education (33.33% versus 42.50%) and were nulliparous (45.83% versus 35.42%). The majority of cases were referred (84.17%). Preeclampsia had several determinants: acceptance of the pregnancy by the partner (p=0.013), recent change of partner (p<0.001), existence of stress during pregnancy (p=0.006), nulliparity (p = 0.034), difficult living conditions (p=0.014), place of antenatal care (p<0.001), and multiple pregnancies (p=0.002).
Conclusions: Identifying the determinants of preeclampsia will make it possible to target appropriate interventions and preventive measures to reduce its incidence, tailor antenatal care, and improve the maternal and perinatal prognosis of this condition
Pregnancy with Wilson’s disease
Get PDFWilson’s disease is a rare, autosomal recessive disorder characterized by impaired liver metabolism of copper, leading to decreased biliary excretion and incorporation of ceruloplasmin levels mainly in the liver and brain. Untreated Wilson’s disease has been shown to cause subfertility and miscarriages. Pregnancy management in women with Wilson’s disease remains an important clinical problem. Early recognition and effective management can help prevent the disease progression and hence give eventful progress and perinatal outcomes. We hereby report the case of a 29-year-old pregnant multigravida with known case of Wilson’s disease since childhood, and on treatment with copper chelating agents and zinc sulphate. She was followed up from early pregnancy till delivery at our hospital. She was monitored in combined obstetric, medicine and neurology clinic. Her pregnancy and postpartum course remained uneventful. She had a spontaneous vaginal delivery at 38+5 weeks period of gestation and gave birth to healthy female baby of 2.66 kg in weight. The infant was genetically screened and was found to be carrier free. It is relatively safe for women with Wilsons disease to become pregnant. Patients with Wilson’s disease receiving regular treatment who remain asymptomatic are usually able to conceive and achieve successful outcomes. However, these pregnancies should be considered as high risk and merit regular surveillance.
Clinicopathological characteristics and oncological outcomes in a case of primary ovarian adenosarcoma with sarcomatous differentiation: a case report and literature review
Get PDFMullerian adenosarcoma is a rare malignant tumor generally involving the uterine corpus but can uncommonly involve extrauterine organs. Ovarian adenosarcoma is extremely rare and often diagnosed in young women. Majority of them are low grade with a good prognosis except for adenosarcoma with sarcomatous overgrowth (SO). We report a case of a large sized ovarian adenosarcoma with SO with elevated levels Ca125 and Ca19.9 and having disease free interval of approximately 1.5 years
Maternal near miss events in a tertiary care teaching hospital: a prospective analysis of risk factors, clinical outcomes and healthcare system performance
Get PDFBackground: Maternal health is a critical indicator of a nation's overall health and development. Maternal near miss (MNM) cases, defined as women who nearly died but survived a life-threatening complication during pregnancy or childbirth, offer valuable insights into improving maternal healthcare systems.
Methods: A comprehensive analysis was conducted at a tertiary care teaching hospital to identify MNM cases using world health organization's (WHO) standardized criteria, which include clinical, laboratory, and management-based indicators. Data on the frequency, causes, and outcomes of MNM events were collected and analyzed to assess the quality of care provided. The study was a prospective design, conducted for 6 months from January 2024 to June 2024, involving 50 participants.
Results: The study found that hemorrhage, hypertensive disorders, and sepsis were the most common causes of MNM. Early identification and timely intervention were crucial in preventing progression to maternal death. The study also highlighted the impact of health system factors, such as accessibility to emergency obstetric care and the availability of skilled healthcare providers, on the incidence of MNM. Blood transfusion was the most common life-saving intervention (30%), and 64% of cases were pregnancy-related.
Conclusions: MNM cases occur more frequently than maternal deaths and provide a larger sample size for analysis, leading to improved maternal care and reduced maternal mortality. The findings underscore the importance of enhancing healthcare infrastructure, training healthcare providers, and implementing evidence-based interventions to improve maternal outcomes