International Journal of Reproduction, Contraception, Obstetrics and Gynecology
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Study of maternal near miss cases at a tertiary centre
Full text linkBackground: When evaluating the quality of a women's health care system, maternal mortality serves as a sentinel occurrence. Since death rates are steadily declining, attention is now being paid to maternal near misses, which characterize severe maternal morbidity and have a shared pathway with mortality.
Methods: This is a retrospective descriptive study carried out in department of obstetrics and gynaecology of Khaja Banda Nawaz University- Faculty of medical sciences, over six months. All women who fulfil the World Health Organisation (WHO) criteria of Maternal Near Miss (MNM) were included in the study. Relevant demographic and obstetric, further course and events leading to maternal near miss were studied. Finally, the indices like maternal near miss incidence ratio, maternal near miss: maternal mortality ratio and mortality index were calculated.
Results: Total 124 women were recognized as near-miss instances out of 812 deliveries that occurred at our institution throughout the 6 months research period. The prevalence of near-miss case was 2.56%. The maternal near-miss to death ratio was 124:2, and the maternal near-miss ratio was 155 per 1000 live births. The most frequent cause of maternal near misses was obstetric haemorrhage, which occurred in 44.1% of cases, while the most prevalent medical co-morbidity was hypertensive condition of pregnancy (60.1%). Referral cases made up the majority of the cases (79.2%).
Conclusions: Analysing maternal near-miss incidents provides valuable insight into our healthcare system. Peripheral emergency obstetric care training contributes to a decrease in maternal morbidity overall and lessens the strain on healthcare system
Hysterectomy with trans-cervical resection of a prolapsed submucosal fibroid: a challenging surgical approach
Full text linkUterine fibroids or leiomyomas, are the common benign tumors of female reproductive tract that affects women of almost all age groups, leading to various gynecological problems such as heavy menstrual bleeding, dysmenorrhea, subfertility, and anemia. The increasing prevalence of these fibroids, due to prolonged estrogen exposure, influenced by lifestyle factors such as obesity, alcoholism, nulliparity and medical conditions like hypertension, have made necessitate their timely management to reduce significant morbidity. Surgical interventions, particularly hysterectomy, are considered definitive for women of perimenopausal and postmenopausal age group with symptomatic fibroids, though challenging due to the altered uterine anatomy. Here we present a case of a 46-year-old woman, P2L2, who reported with a history of heavy menstrual bleeding, dysmenorrhea, and intermenstrual bleeding, along with anemia (Hb 8.4 g/dL). Ultrasonography revealed a bulky uterus with multiple intramural fibroids and a prolapsed submucosal fibroid protruding through the cervical OS which bled on touch. She underwent a successful abdominal hysterectomy, with a unique surgical approach to manage the prolapsed submucosal fibroid. A vertical incision on the anterior cervix facilitated the clamping and removal of the pedunculated fibroid through the vagina, followed by its removal with minimal blood loss. This case highlights the importance of accurate preoperative imaging and surgical planning and use of surgical strategies such like this to improve operative outcomes and reduce morbidity, especially in anemic patients.
Successful pregnancy and delivery in a rare case of pemphigus vulgaris
Full text linkPemphigus vulgaris (PV) is a rare autoimmune bullous dermatosis characterized by flaccid blisters and extensive erosions on the skin and mucous membranes. While in the active stage of PV lesions, it is reported to be linked to infertility, and its presence during pregnancy is exceedingly rare. Pregnancies complicated by pemphigus vulgaris often result in adverse obstetrical outcomes, including prematurity, neonatal skin lesions, and even fetal demise. Our patient, a chronic pemphigus vulgaris case, was being treated with rituximab, a pregnancy category C drug. Later upon conceiving, her medication was switched to oral steroids, which were later changed to intravenous steroids due to a flare-up in the third trimester. Her elective lower segment caesarean section was done with delivery of a female baby weighing 2.6 kg with APGAR scores of 8 and 9 at one minute and five minutes respectively, without any apparent skin lesions. During the postpartum period, her skin lesions resolved completely by the time of her routine postnatal follow-up
Comparative analysis of sperm DNA fragmentation index with sperm chromatin dispersion in varied infertility types: a retrospective study
Full text linkBackground: Infertility is a major modern concern amongst couples due to the change in their lifestyle and being carrier-oriented leading to late marriage/s. Out of all the couples suffering from infertility, approximately 30-40% cases are contributed to the male factor. As the age advances, the reduced sperm count magnifies the problem. However, in addition to that, the qualitative change along with quantity is of much more importance. Aims and objectives were to find the prevalence of sperm DNA fragmentation with sperm chromatin dispersion (SCD) test and its comparison with types of infertility
Methods: The present study was retrospective that collected data from the semen sample given for routine check-up during the period of August 2022 to August 2023. A total of 138 semen analysis and sperm DNA Fragmentation Index (DFI) were carried out during this period. All 138 couples were further divided into 2 groups- 62 couples having oligozoospermia as cases and 76 couples with normozoospermia as controls and the data was compared.
Results: Among 138 subjects, (62 cases and 76 control) a significant difference in the age was found. Smoking as a risk factor was found to be statistically significant. While the sperm count was not significantly different in cases and controls, a statistically significant difference was found in DFI (p=0.001) in both the groups. The highest value for DFI was 12.78 % in controls and 24.98% in cases. DFI and sperm count showed negative correlation both in DFI and sperm count with a Karl Pearson’s correlation coefficient being 0.213 (p value <0.01) and 0.754 (p value <0.005), respectively. A significant difference was observed in the median value of sperm DFI. When DFI was compared to semen analysis, it yielded 87% sensitivity and 83% specificity. Surprisingly, 13 controls out of 76 i.e. around 17.1% had poor DFI inspite of normal semen analysis parameters.
Conclusions: On comparing, significant difference was observed in the median value of sperm DFI. SCD method is simple, easiest and standard tool to assess DFI
Knowledge, practice and awareness of adolescent girls on human papillomavirus vaccine
Full text linkBackground: Human papillomavirus (HPV) is a significant public health concern, particularly among adolescents, as it is a leading cause of cervical cancer and other HPV-related diseases. Despite the availability of an effective vaccine, knowledge and awareness about HPV and its prevention remain limited, especially among young girls. This study aims to assess the knowledge, practice, and awareness of adolescent girls regarding the HPV vaccine.
Methods: The study was conducted at department of obstetrics and gynaecology, Anwer Khan modern medical college and hospital, Dhaka, Bangladesh from July, 2023 to June, 2024. A cross-sectional descriptive study design was employed, targeting adolescent girls aged 13 to 19 years. The study population consisted of students from five secondary schools within the urban and peri-urban areas of the district. A total of 300 participants were included in the study.
Results: The study of 300 participants reveals that the majority are aged 15-16 years (40%), followed by 17-18 years (30%). Most participants are in senior secondary (1-2) (50%), and 60% are aware of HPV, with school programs being the most common source of awareness. Knowledge of HPV transmission and the HPV vaccine is limited, with 40% having correct knowledge about transmission and 30% possessing adequate vaccine knowledge. Vaccination rates are low, with only 40% vaccinated, primarily due to a lack of awareness. Most participants recommend increasing awareness campaigns (50%) and reducing vaccine costs (25%).
Conclusions: This study concludes that a majority (60%) of the participants were aware of HPV, only 40% demonstrated correct knowledge of its transmission, and an even smaller proportion (30%) had adequate knowledge about the HPV vaccine itself. The low vaccination rate of 40% reflects the challenges in increasing uptake, with the primary barrier being a lack of awareness
Clinical usefulness of hysterolaparoscopy and chromopertubation in evaluation and management of female infertility in a tertiary care hospital
Full text linkBackground: Infertility is defined by the World Health Organization (WHO) as the inability to achieve pregnancy after 12 months of unprotected intercourse which affects 10–15% of couples globally. In India, prevalence ranges from 3.9% to 16.8%. Hysterolaparoscopy combined with chromopertubation (DHL + CPT) serves as a valuable diagnostic and therapeutic tool in case of female infertility. This study evaluates the effectiveness of DHL + CPT in managing primary and secondary infertility at a tertiary care hospital.
Methods: In this prospective study, 60 women with primary or secondary infertility underwent clinical evaluations, basic blood tests, and abdominopelvic ultrasonography during the study period. Participants underwent DHL + CPT during their preovulatory phase following a negative urine pregnancy test. Tubal patency was assessed using methylene blue dye, and therapeutic interventions like cystectomy, adhesiolysis, ovarian drilling, septal resection were performed as necessary. Reproductive outcomes were monitored through follow-up visits or telephone correspondence.
Results: Among the participants, 75% had primary infertility, and 25% had secondary infertility. Of the 32 primary infertility patients followed up, 24 (75%) conceived within six months. In the secondary infertility group, 10 out of 18 patients (55.5%) achieved pregnancy within six months. Therapeutic interventions were performed in 53% of cases, yielding promising reproductive outcomes.
Conclusions: DHL + CPT is an effective, cost-efficient, and accessible method for evaluating and managing reversible causes of infertility. Patients undergoing interventions demonstrated significant improvements in fertility outcomes. However further research is warranted to explore newer, less invasive, and more cost-effective interventions
Severe acute maternal morbidity: sociodemographic analysis of intensive care unit admission in pregnancy
Full text linkBackground: Severe acute maternal morbidity also known as “Near Miss”. SAMM occurs 5 times more frequently than maternal death. Therefore auditing women with SAMM allows rapid collection of data and this may create a rapid diagnostic tool for evaluating current standard of maternal care in an area.
Maternal NEAR MISS refers to a woman who nearly died but survived a complication that occurred during pregnancy, child birth or within 42 days of termination of pregnancy. To have a more accurate picture of life threatening obstetrical conditions. To analyze various socio demographic factors associated with SAMM.
Methods: Retrospective study over a period of one year (November 2014 to October 2015) conducted in Kamla Raja Hospital, Gwalior, department of obstetrics and gynaecology. Analysis of various socio demographic factors done.
Results: During the study period, a total of 159 near-miss cases were identified, with 43 of those patients ultimately succumbing to maternal mortality. The maternal mortality ratio was 561 per 100,000 live births and the Maternal Near-Miss Incidence Ratio was 20 per 1,000 live births. The Maternity Near-Miss to Maternal Death ratio was 3.69:1.
Conclusions: Average MNMIR in ICU was 20 per 1000 live births. Hypertensive disorders of pregnancy and postpartum haemorrhage were the main obstetric causes of MNM in ICU. These findings would guide to improve professional skills of primary health care providers and encourage vaginal birth in the absence of medical indications for caesarean birth.
Oral contraceptive use and awareness among patients in a tertiary level teaching hospital: a questionnaire based observational study
Full text linkBackground: Oral contraceptive pills (OCPs) are a widely used method of contraception, yet awareness, adherence, and perceptions surrounding their use vary among individuals. Understanding the knowledge, attitudes, and practices related to OCPs is essential for improving reproductive health education and reducing unintended pregnancies.
Methods: An observational study was conducted among participants to assess their awareness, usage patterns, and perceptions of OCPs. Data was collected on demographic factors, knowledge of contraceptive effectiveness, adherence to prescribed regimens, reasons for discontinuation, and sources of information. Participant’s responses were examined to identify trends and gaps in knowledge.
Results: The findings indicate that a significant proportion of participants had limited awareness of the different types of OCPs and their correct usage. Many participants lacked knowledge regarding the difference between ‘perfect use’ and ‘typical use,’ which impacts overall efficacy. Common reasons for discontinuation included perceived side effects, misinformation, and accessibility issues. While healthcare providers were a primary source of information, a considerable number of participants relied on non-medical sources, leading to misconceptions. Community perceptions and societal stigma were also identified as influencing factors in OCP acceptance.
Conclusions: The study highlights the need for improved educational interventions to bridge knowledge gaps regarding OCPs. Enhancing access to reliable information and addressing misconceptions can contribute to better adherence and acceptance of oral contraceptive use, ultimately improving reproductive health outcomes
Analysis of the status of spot urine albumin creatinine ratio in pregnancy
Full text linkIntroduction: Urinary albumin-to-creatinine ratio (UACR) has been widely studied as a non-invasive biomarker for detecting and predicting complications in pregnancy.
Methods: A prospective cohort of 170 pregnant women was evaluated for UACR levels in all three trimesters. UACR thresholds were derived using receiver operating characteristic (ROC) curve analysis, with clinical diagnoses as the gold standard. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated for each threshold.
Results: Mean UACR values increased progressively across trimesters, from 3.6 (±1.9) mg/g in the first trimester to 189.4 (±214.1) mg/g in the third. A UACR threshold of 316 mg/g in the third trimester achieved high diagnostic accuracy for preeclampsia (sensitivity 96.15%, specificity 97.22%, AUC 0.958). Second-trimester thresholds were predictive for preeclampsia (10.6 mg/g; AUC 0.851), GHTN (8 mg/g; AUC 0.5408), and GDM (8.2 mg/g; AUC 0.5409). Fetal complications (8.6 mg/g; AUC 0.6386) and C-sections (8.4 mg/g; AUC 0.5657) were also significantly associated with second-trimester UACR levels.
Conclusion: The study establishes trimester-specific UACR thresholds for identifying and predicting maternal and fetal complications, emphasizing its utility in antenatal care. Incorporating UACR into routine screening could enhance early detection and management of high-risk pregnancies
Heterotopic pregnancy: diagnostic challenges and management of ruptured ectopic pregnancies in the presence of a viable intrauterine pregnancy
Full text linkHeterotopic pregnancy (HP), the simultaneous occurrence of intrauterine and ectopic pregnancies, is a rare but potentially life-threatening condition. It poses diagnostic and management challenges, especially in natural conception cycles. We report two cases of heterotopic pregnancies, highlighting the clinical presentation, diagnostic approach, and therapeutic management. These cases underscore the importance of maintaining a high index of suspicion for HP in patients presenting with pelvic pain or abnormal bleeding, even with confirmed intrauterine pregnancy