International Journal of Reproduction, Contraception, Obstetrics and Gynecology
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A telltale of twin pregnancy
Get PDFIntrauterine fetal death (IUFD) of one twin occurs most commonly during the first trimester. This phenomenon is known as a “vanishing twin”. Single IUFD in the second or third trimesters is much less common. Single IUFD is observed more often in association with monochorionic than with dichorionic placentation. When it occurs in a monochorionic gestation it may be associated with a worse outcome for the surviving co-twin. The etiology of IUFD in a multiple pregnancy may be similar to singletons or unique to the twinning process. IUFD may be caused by genetic or anatomical anomalies, abruption, placental insufficiency, cord abnormalities such as a velamentous cord insertion, infection, and maternal disease including diabetes and hypertension. In monochorionic pregnancies, IUFD may result from complications of the twin-to-twin transfusion syndrome (TTTS). Most often, the smaller, donor twin dies, but IUFD can occur in the larger recipient twin. In addition, monoamniotic twins are at increased risk of cord entanglement and subsequent IUFD. Similar to singletons, the etiology of IUFD often remains elusive. Single IUFD in a multiple gestation can adversely affect the surviving fetus
Impact of placental histopathology and maternal risk factors on neonatal morbidity in late preterm infants
Get PDFBackground: Maternal and placental risk factors are critical determinants of neonatal outcomes in preterm infants. This study aims to evaluate the impact of placental histopathological findings and maternal risk factors on neonatal morbidity and mortality among late preterm infants.
Methods: This prospective study was conducted between January and July 2018 at Başkent University Faculty of Medicine. A total of 62 late preterm infants, born via cesarean section between 34^0⁄7 and 36^6⁄7 weeks of gestation, were included. Neonatal morbidities were assessed in relation to placental histopathological features and maternal risk factors. Placental examinations included both gross and microscopic evaluations, focusing on maternal vascular malperfusion, chronic inflammation, placentomegaly, placental hematomas, and fetal obliterative vasculopathy.
Results: Placental histopathological abnormalities and maternal risk factors were significantly associated with adverse neonatal outcomes. Maternal vascular malperfusion correlated with an increased risk of hyperbilirubinemia and intracranial hemorrhage. Chronic placental inflammation was linked to polycythemia and feeding intolerance. Placentomegaly was associated with early-onset neonatal sepsis and feeding difficulties. Additionally, maternal conditions such as preeclampsia, thrombophilia, oligohydramnios, and maternal infections were found to influence neonatal morbidity.
Conclusions: Placental histopathological findings particularly maternal malperfusion, chronic inflammation, and placentomegaly appear to contribute significantly to neonatal morbidity in late preterm infants. The combined assessment of placental pathology and maternal risk factors may enhance early prediction of neonatal complications and guide postnatal clinical management
A case report of retained placenta
Get PDFRetained placenta can occur in the setting of significant uterine atony, abnormally adherent placenta, as with placenta accreta spectrum (PAS), or closure of the cervix prior to placental expulsion. Risk factors for retained placenta parallel those for uterine atony and PAS and include prolonged oxytocin use, high parity, preterm delivery, history of uterine surgery, and IVF conceptions.
Levonorgestrel intrauterine system for heavy menstrual bleeding: a real-world experience from a tertiary centre in Northern India
Get PDFBackground: Heavy menstrual bleeding (HMB) affects quality of life and health in reproductive-age women. Levonorgestrel intrauterine system (LNG-IUS) offers a conservative treatment option. This study aimed to evaluate the clinical efficacy and acceptability of LNG-IUS in women with HMB.
Methods: Retrospective analysis of 63 women (32-50 years) with HMB at Dr. RPGMC, Kangra, over two years. Follow-up was conducted at 1, 3, 6, and 12 months. Data included demographics, clinical presentation, hematological investigations, ultrasonographic findings, follow-up outcomes, and patient satisfaction scores.
Results: Mean age was 44.28 years; 50.79% were 45-50 years. Majority (68.25%) were para 2; 96.82% were married. Socioeconomic status varied, with 25.39% in the upper-lower class. The most common diagnosis was dysfunctional uterine bleeding (57.14%), followed by fibroid uterus (25.39%), adenomyosis (11.11%), and endometriosis (6.34%). Comorbidities included hypertension (15.87%) and diabetes (11.11%). Hemoglobin analysis showed moderate anemia in 52.38% and severe anemia in 26.98%. Bleeding patterns improved significantly: at 1 month, 57.14% had scanty flow; by 3 months, 74.60% reported reduced bleeding; at 6 months, 86.27% had scanty or no bleeding. By 12 months, 41.17% developed amenorrhea. Expulsion occurred in 2 cases; 2 others requested removal. Overall, 82.35% were satisfied with bleeding pattern; 98.03% had no dysmenorrhea. Social, sexual life, and mobility improved notably. Satisfaction assessment showed 80.38% of patients were either satisfied or very satisfied.
Conclusions: LNG-IUS is effective, safe, and well accepted for treating HMB, particularly in resource-limited settings. Its impact on reducing blood loss, correcting anemia, and improving life quality supports its wider use
Comparative study between 25 µg vaginal misoprostol and PGE2 gel for induction of labour at term
Get PDFBackground: Labour induction is a critical aspect of obstetric care, significantly affecting maternal and neonatal outcomes. Prostaglandins such as PGE2 gel facilitate cervical ripening and uterine contractions. Misoprostol, a prostaglandin E1 analogue, has shown promising results in achieving vaginal delivery within 24 hours. This study aims to compare these agents to provide clearer guidance on the safer and more effective option for labour induction. To compare the effectiveness and safety of 25 μg vaginal misoprostol versus 0.5 mg PGE2 gel for induction of labour at or beyond 37 weeks of gestation in terms of efficacy, foeto-maternal outcomes, and complications.
Objectives include comparing induction-to-delivery intervals, caesarean rates, and foeto-maternal outcomes between the two drugs.
Methods: A single-centre, randomised, open-label clinical trial was conducted in a tertiary care centre’s Obstetrics and Gynaecology department. A total of 176 women were randomised: Group A received 25 μg misoprostol every 4 hours (up to five doses), and Group B received 0.5 mg PGE2 gel every 6 hours (up to three doses). Outcomes included induction-to-delivery time, labour onset, need for augmentation, and maternal and neonatal outcomes.
Results: Both groups were similar in age, parity, and Bishop scores. Misoprostol led to quicker labour onset (6.5 vs. 8.5 hours) and required less oxytocin (15.9% vs. 45.5%). Delivery mode and neonatal outcomes were comparable.
Conclusions: Misoprostol proved more effective, with shorter induction-to-delivery intervals and less need for augmentation. It is cost-effective, stable at room temperature and offers similar maternal and neonatal safety compared to PGE2 gel
Clinical implications of the second and fourth digit ratio in male infertility: associations with semen parameters and sex hormone levels - a cross-sectional study
Get PDFBackground: Oligospermia and hypogonadism are synonymous with infertility in males. Data regarding its correlation with hand digit length and ratio are inconsistent and scarce. The aim was to study the ratio of second (2D) and fourth (4D) fingers of both hands in 236 infertile oligospermic men and their comparison with various clinical and laboratory parameters related to infertility.
Methods: In this cross-sectional study, the 2D and 4D length and ratio of both hands of 236 infertile oligospermic men were measured. Semen analysis and hormonal assessment, including serum total testosterone (T), estradiol (E), luteinizing hormone, and follicle-stimulating hormone, were performed and correlated with the 2D: 4D ratio and severity of oligospermia. Participants were further subdivided into two groups according to serum T levels.
Results: A significant difference in the 2D: 4D ratio of the right hand was observed between both cohorts and in patients with low T levels. The mean serum T level was significantly lower in infertile oligospermeic males (349.76±115.4 ng/dl; p<0.001) than healthy controls (p<0.001). The testosterone-to-estradiol (T/E) ratio was also significantly lower in the patient group (8.36±4.84; p<0.001). A decline in semen quality, including reduced sperm counts and progressive motility, was observed in patients with low T levels.
Conclusion: The 2D: 4D ratio might directly correlate with testosterone levels and, thus, semen quality and fertility potential of a subject. Thus, providing a cost-effective and time-saving method for indirect estimation of androgenization in male patients
Beyond conduction defects: fetal myocarditis as a rare cardiac manifestation in anti-Ro/La positive lupus pregnancy
Get PDFFetal myocarditis is an uncommon yet potentially fatal complication of maternal systemic lupus erythematosus (SLE), in contrast to the more recognized congenital heart block (CHB). We report a case of a fetal myocarditis in young female with lupus and anti-Ro/SSA and anti-La/SSB antibodies positivity. This case emphasizes the importance of early fetal monitoring in lupus pregnancies and highlights the complex role of maternal auto antibodies in fetal cardiac inflammation
Constipation in obstetrics - an underrated sign
Get PDFAn interesting case of normotensive hemolysis, elevated liver function tests, and low platelet counts (HELLP) syndrome with only presenting symptom of severe constipation near term; an occult sign of liver disease. She presented in active labour with mild jaundice and early signs of disseminated intravascular coagulation (DIC). This was an obstetric near miss, as it was a fine balancing act combined with aggressive monitoring and nursing management by highly skilled team of trained obstetric nurse midwives. This was a humbling lesson which reminded us not to ignore aggravated commonly occurring symptom in all patients of obstetrics. Availability of fresh whole blood makes it easier to manage such cases as fresh components are extremely difficult to procure and process in remote obstetric units.
Comparison of radiological imaging techniques for placenta accreta spectrum to optimise feto-maternal outcome by antenatal detection and management plan at a tertiary care centre
Get PDFBackground: Placenta accreta spectrum remains one of the most dangerous obstetric conditions especially when antenatal suspicion amounts to nil, resulting in severe feto-maternal outcomes. Therefore, accurate and optimal prenatal imaging is mandatory to instigate necessary preparation and strategic management approach.
Methods: We conducted a prospective study in our tertiary care centre, Punjab in duration of 18 months enrolling 54 antenatal patients fulfilling the inclusion criteria, reporting to the labour room by non-probability convenient sampling technique. Patients were subjected to radiological imaging (both ultrasonography and MRI) which was then followed by surgery. The data was analysed using suitable statistical software.
Results: We observed that patients with previous history of some surgery, be it caesarean section or D and C, pose a greater threat of acquiring placenta accreta syndrome and may tend to cause preterm births. Thus, requisiting antenatal diagnosis with the intent to ameliorate feto-maternal outcomes.
Conclusions: MRI has better diagnostic accuracy in terms of sensitivity and overall accuracy than sonography. Although cost and accessibility may limit the use of MRI, both aid in prenatal assessment and multi-disciplinary approach to help improve maternal and fetal outcome
Broad ligament fibroid-a diagnostic and surgical challenge
Get PDFBroad ligament fibroids, a rare subset of uterine leiomyomas, present unique diagnostic and surgical challenges due to their extrauterine location and potential to mimic adnexal masses. We present two illustrative cases: a 37-year-old parous woman with early satiety and abdominal pain found to have a 25×20 cm pseudo-broad ligament fibroid extending to the right lumbar region, successfully managed with ureteric catheterization and open enucleation; and a 50-year-old parous woman with abdominal pain from a 27×15×5 cm fibroid, treated via TAH+BSO with preoperative stenting. These cases highlight the diagnostic dilemmas posed by broad ligament fibroids, the indispensable role of MRI in surgical planning, and the importance of tailored approaches ranging from fertility-sparing techniques to definitive surgery. Both instances underscore the necessity of meticulous preoperative preparation, including ureteral protection strategies, and demonstrate how individualized management based on patient age, symptoms, and reproductive goals can lead to successful outcomes despite the anatomical challenges inherent to these rare tumors