International Journal of Reproduction, Contraception, Obstetrics and Gynecology
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Study of prognostic significance of platelet count as a predictor of severity of preeclampsia
Get PDFBackground: Pre-eclampsia is a pregnancy-specific syndrome, recognised from antiquity as a leading cause of maternal and perinatal mortality, and it accounts for almost 15% of pregnancy associated death. Hence, the current study was planned to assess the role of platelet count as a predictor of the severity of preeclampsia and its prognosis.
Methods: In this retrospective analytical study, a total of 100 pregnant women with preeclampsia were included and divided into two groups of non-severe and severe. Demographic data, socio-economic status, period of gestation and platelet count were recorded and compared.
Results: The average age of patients was 27.07±5.14 years, with no significant difference between patients based on preeclampsia severity. Most of the patients were multigravida females (69%). The distribution based on the socio-economic status was similar, with no significant difference (p>0.05). The average period of gestation was 36.01±3.41 weeks in the study. The average platelet count of patients with severe preeclampsia at the time of admission was seen to be lower compared to the non-severe patients. A ROC curve analysis was done to assess the ability of platelet count to differentiate severe PWE from non-severe PE. The area under the curve was high at 0.879. The LSCS rate was 54% in the study, followed by Pre-term birth seen in 48% of patients. There was no significant difference between the two groups in terms of maternal outcome parameter-based distribution. The proportion of patients with APGAR score <7 at 5 minutes was significantly higher in the non-severe PE group. It was seen that preeclamptic patients were associated with a significantly higher prevalence of pre-term birth and Ante partum haemorrhage (APH).
Conclusions: Platelet count is an accurate predictor of severe preeclampsia in pregnant females. The patients with low platelet counts were associated with significantly higher adverse pregnancy outcomes, as suggested by a significantly higher prevalence of pre-term birth, APH and rate of LSCS
Preventing ureteric injury in total laparoscopic hysterectomy: a focus on surgical technique
Get PDFHysterectomy is a frequently performed procedure in gynaecology. Laparoscopic hysterectomy offers the added advantages of reduced postoperative pain, minimal blood loss, shorter hospital stays, and lower incidence of surgical site infections. However, it does carry an elevated risk of injury to the urinary bladder and ureters. Recent technological advancements can help identify the ureters during laparoscopic hysterectomy, thereby decreasing the occurrence of lower urinary tract injuries. However, these advanced techniques are often not easily accessible in developing countries and can be expensive. We described a step-by-step approach to total laparoscopic hysterectomy that aims at minimising the risk of lower urinary tract injuries, and recent advances along with other methods to avoid urinary tract injuries are also discussed
Harnessing artificial intelligence in understanding endometriosis
Get PDFArtificial intelligence (AI) models, such as neural networks and machine or language learning algorithms like ChatGPT, Microsoft Bing/Copilot, Deepseek AI, Google Gemini are emerging as new tools that can change the world. As technology grows, the opportunity of diagnosing, treating, and especially identifying early signs of any disease becomes wider. In the era of AI, this tool that is supported by machine learning and big data analytics is already demonstrating its potential in advancing the outcomes in healthcare
A prospective open label randomized controlled trial comparing the effect of letrozole and mifepristone pre-treatment in medical termination of pregnancy up to 9 weeks
Get PDFBackground: Mifepristone for medical termination of pregnancy (MTP) has been shown to increase the success rate. mifepristone followed by misoprostol for the medical management of first trimester pregnancy in previous clinical trials has ranged from 79% to 87%. As access to mifepristone is restricted in some countries, and some patients may have contraindications to the use of mifepristone, we propose that letrozole may be a good alternative.
Methods: This was a hospital based open label randomized controlled trial study carried out year 2023 to 2024 in the department of obstetrics and gynecology at CIMS Bilaspur, total sample was 100.
Results: In present study both groups received a single dose of their respective drug, with a slightly higher proportion of mifepristone users receiving two doses (14%) compared to letrozole users (6%) and in gestational sac expulsion 84% of participants from both groups expelled the sac in 2 days, mifepristone users had a slightly higher rate of incomplete expulsion (6%) compared to letrozole users (4%) (p=0.041).
Conclusions: The comparison between letrozole and mifepristone users highlights several key differences. Mifepristone users experienced a higher frequency of irregular menstrual cycles, incomplete expulsion of the gestational sac, and a greater need for dilation and curettage (D and C) procedures compared to those using letrozole
Emergency twin births in ambulances: a qualitative case study from Sindh, Pakistan
Get PDFEmergency childbirth, particularly twin deliveries, poses profound challenges in pre-hospital contexts, where health professionals must often act swiftly under conditions of uncertainty. In rural Pakistan, where access to healthcare facilities is limited, ambulance-based deliveries have become increasingly common. This qualitative study draws on semi-structured interviews with emergency medical technicians, emergency vehicle operators, and a skilled birth attendant in Khairpur and Naushero Feroz districts of Sindh to explore the realities of managing such emergencies. The analysis revealed that variations in training, adherence to protocols, and inter-professional coordination shaped both the process and outcomes of care. Participants described the difficulties of working within constrained environments, confronting clinical complexities, and navigating cultural and gender dynamics, all while making critical decisions under pressure. Their accounts also reflected the emotional weight of these experiences, underscoring how professional background and preparedness influence responses in moments of crisis. The study points to the urgent need for structured obstetric training, strengthened infrastructure, wider integration of telemedicine, and improved collaboration among emergency personnel to safeguard maternal and neonatal health in resource-limited rural settings.
The prevalence and awareness of menopausal symptoms among perimenopausal and postmenopausal women visiting a tertiary care hospital
Get PDFBackground: The growing number of postmenopausal women has important implications for healthcare systems, as these women may face specific health concerns associated with menopause and ageing. The study aimed to know the prevalence and awareness of menopausal symptoms among perimenopausal and postmenopausal women visiting tertiary hospitals.
Methods: A cross-sectional design was used for data collection and analysis. Women aged 45 years and above in the perimenopausal and postmenopausal age groups were included. We utilised the menopausal rating scale questionnaire as a tool.
Results: A maximum percentage of women (73%) reported physical and mental exhaustion, bladder problems (66%), joint and muscular discomfort (61%), and irritability (59.66%). Additionally, 46.6% of women reported having hot flushes. Dryness of the vagina in 41.33%. Among the 45 to 55 years age maximum women had hot flushes (60.71%), the sexual problem (54.83%), irritability (54.74%), and depressive mood (32%). Among 56 to 65 years age the most common complaints were sleep disturbance (58.62%), bladder problems (45.96%), Anxiety (44.58%), physical and mental discomfort (40.63%), joint and muscular discomfort (39.89%), and vaginal dryness (36.29%). Among the 66 to 75 the heart discomfort was highest (45.67%). Among women aged 76 years and above, age depressive symptoms (16%) and sleep problems (13.79%) were present.
Conclusions: There is a high prevalence of menopausal symptoms and a lack of awareness among women, implying a need for healthcare initiatives in India, where this issue receives little attention. We strongly advocate a governmental policy for menopausal women to support their specific health needs
Postpartum kidney crisis: hidden burden of postpartum acute kidney injury
Get PDFPostpartum acute kidney injury (PPAKI) is a serious complication of pregnancy. This case series analyses seven patients aged 25-35 years, predominantly with hypertensive disorders such as preeclampsia, HELLP syndrome and eclampsia, with few complicated by sepsis and hemorrhagic shock. Dialysis was necessary in the majority of cases, with one mortality. The severity and multifactorial etiology of PPAKI are highlighted by diagnostic and treatment challenges. Results were greatly impacted by prompt intensive care unit treatment, renal support, and a multidisciplinary approach. In order to prevent irreversible renal damage, this series emphasizes the importance of early detection, aggressive management, and customized postpartum surveillance in high-risk obstetric populations
Utilization without equity: investigating gendered and structural inequities in antenatal care use in rural Kebbi State, Nigeria
Get PDFBackground: Antenatal care (ANC) is a proven strategy for reducing maternal and neonatal morbidity and mortality. Yet in many low- and middle-income countries (LMICs), including Nigeria, systemic and gendered barriers continue to undermine equitable utilization, particularly in rural settings. This study investigates structural and gender-based inequities influencing ANC utilization among women in rural Kebbi State, Nigeria.
Methods: A cross-sectional study was conducted with 420 women in Kebbi State. Data were collected using structured questionnaires and analysed using descriptive statistics, chi-square tests, means, and standard deviations via SPSS v20.
Results: Although 95.2% of respondents reported the presence of primary health centres (PHCs), service consistency was limited. Only 59% and 52.9% reported access to iron supplementation and deworming medications, respectively. Major barriers included long distances (48.8%), transport costs (41.0%), and absence of female providers (28.3%). Higher educational attainment and decision-making autonomy were significantly associated with increased ANC attendance (p<0.05). The mean number of ANC visits was 3.7 (SD±1.6), falling short of WHO recommendations, particularly among women with no formal education (mean=2.9, SD±1.4).
Conclusions: The availability of ANC services does not equate to equitable access and utilization. Deep-rooted structural and gendered inequities constrain maternal healthcare utilization in rural Nigeria. Interventions must prioritize equity, gender responsiveness, and community empowerment to ensure inclusive maternal health outcomes
Correlation of combined B-mode and uterine artery Doppler with the endometrial pathology in perimenopausal women with abnormal uterine bleeding
Get PDFIntroduction: Heavy menstrual bleeding in perimenopausal women is defined as excessive blood loss that interferes with the woman's physical, emotional, social, and material quality of life. In India, the reported prevalence of abnormal uterine bleeding is around 17.9%.
Background: This study was conducted at AIIMS, Nagpur, where 80 perimenopausal women were recruited with complaints of HMB in our cross-sectional study. We obtained samples of uterine artery PI and RI, endometrial thickness, and performed an endometrial biopsy on the same day. The mean and standard deviation for PBAC, haemoglobin, endometrial thickness, PI, and RI are calculated.
Result: The cohort comprised women with a mean age of 46.06 years (±5.8 years). The mean PBAC score was 342 (±117.2), ranging from 145 to 590. Haemoglobin levels were at a mean of 8.8 g/dl (±1.14), with a range from 6.2 gm/dl to 10.3 gm/dl. A mean endometrial thickness of 11.65 mm (±4.05) with mean values for pulsatility index (PI) and resistance index (RI) were 1.72 (±0.065) and 0.75 (±0.035), respectively. Endometrial pathology distribution in biopsy samples included disordered proliferation endometrium in 29 out of 80 cases (36.25%), proliferative endometrium in 21 out of 80 cases (26.3%), secretory endometrium in 14 out of 80 cases (17.5%), and endometrial hyperplasia without atypia in 9 out of 80 cases (11.2%). Additionally, three cases of endometrial malignancy were identified within the cohort.
Conclusion: The combination of uterine artery doppler to B-mode ultrasound doesn’t add much information in detecting endometrial pathologies like malignancy and atypia
Association of amniotic fluid index with feto-maternal outcomes: a prospective observational study
Get PDFBackground: Amniotic fluid index (AFI) serves as a critical marker for foetal wellbeing. Abnormal AFI values such as oligohydramnios and polyhydramnios have been associated with adverse pregnancy outcomes. Objective was to assess the association between AFI and feto-maternal outcomes amongst pregnant women between 32 and 40 weeks of gestation.
Methods: This prospective observational study was conducted at Holy Family Hospital, New Delhi, from July 2022 to March 2024. A total of 150 women with singleton pregnancies were evaluated and categorized into four groups based on AFI: oligohydramnios (<5 cm), borderline low (5.1-8 cm), normal (8.1-18 cm), and polyhydramnios (>18 cm). Clinical, intrapartum, and neonatal outcomes were analysed.
Results: Of the 150 participants, 14% had oligohydramnios, 23.3% borderline low, 39.3% normal, and 23.3% polyhydramnios. Oligohydramnios was significantly associated with preterm birth (47.6%, p<0.0001), low birth weight (57.1%, p<0.0001), emergency caesarean (61.9%, p<0.0001), NICU admissions (71.4%, p=0.004), and low APGAR scores at 1 and 5 minutes (61.9%; p=0.001 and 23.8%; p=0.0009, respectively). Polyhydramnios was strongly associated with gestational diabetes mellitus (51.4%, p<0.0001) and increased birth weight.
Conclusions: Abnormal AFI, particularly oligohydramnios, is significantly associated with adverse feto-maternal outcomes. Routine assessment of AFI should be emphasized in late pregnancy to enable timely intervention