International Journal of Reproduction, Contraception, Obstetrics and Gynecology
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Incarcerated vaginal ring pessary: a case report
Get PDFWe report a rare case of a 75-year-old postmenopausal woman with a long-standing ring pessary for third-degree uterovaginal prolapse, managed conservatively due to significant cardiac comorbidities. She presented acutely with perineal pain, vaginal bleeding, and urinary difficulty. Examination revealed an incarcerated pessary embedded in the anterior cervical lip, encased by a fibrous band causing bladder compression. Prompt bedside surgical release under local anesthesia led to successful removal. This case underscores the importance of strict follow-up in elderly pessary users, as even well-tolerated long-term use can result in unexpected, serious complications
Hypertensive disorders in pregnancy gestosis score as a predictor of pre-eclampsia
Get PDFBackground: Pre-eclampsia (PE) significantly contributes to maternal and neonatal morbidity, particularly in low-resource settings. The hypertensive disorders in pregnancy (HDP) gestosis score integrates clinical risk factors to identify women at risk. This study aimed to assess the ability of the HDP gestosis score to predict PE, analyse associated risk factors, and highlight the importance of early risk stratification in primary care.
Methods: This analytical/observational prospective study was conducted on 280 patients at SRM Medical College Hospital, Trichy, between June 2024 and March 2025. Baseline data, including demographics, obstetric history, and medical conditions, were collected from records and interviews during the first visit. The HDP scoring system was applied, and all participants were prospectively followed up until delivery.
Results: Among 280 mothers, 46 (16.4%) developed PE. Mothers with PE had a significantly higher mean age (29.7±6.1 years) than those without PE (p<0.001). Obesity (p<0.001), age >35 years (p<0.001), ART use (p<0.001), hypothyroidism (p<0.001), and chronic hypertension (HTN) (p<0.001) were significantly associated. A Gestosis score ≥3 was present in 17.5% of mothers, with 71.7% of them developing PE (p<0.001). The score showed a sensitivity of 71.7%, specificity of 93.2%, negative predictive value of 94.4%, positive predictive value of 67.4%, and an accuracy of 89.7%, confirming its value for early risk stratification and PE prediction in primary care.
Conclusions: PE was associated with advanced age, obesity, ART use, hypothyroidism, family history, multiple pregnancies, diabetes, and HTN. An HDP Gestosis score ≥3 predicted PE with high specificity and moderate sensitivity, supporting its use in antenatal risk assessment
The study of length of umbilical cord and fetal outcome
Get PDFBackground: The umbilical cord is vital for fetal development, and its length can influence intrapartum complications, mode of delivery, and perinatal outcomes such as FGR, oligohydramnios, preterm delivery, operative delivery for fetal distress, fetal demise/stillbirth, meconium-stained liquor, cord accidents. This study investigated the impact of umbilical cord length on these factors in singleton pregnancies.
Methods: A retrospective study was conducted at SVP Hospital, Ahmedabad, from June 2024 to June 2025, involving 300 randomly selected singleton pregnancies. Inclusion criteria included primigravida and multigravida subjected to ultrasound, excluding malpresentations and multiple gestations. Data on cord length, nuchal loops, true knots, mode of delivery, and perinatal outcomes, including intrauterine fetal demise (IUFD), were analysed.
Results: Of the 300 cases, 58% were booked, and 68% were multigravida. Cord lengths of 66-75 cm were most common (32.33%), with short cords (<45 cm) and long cords (>90 cm) comprising 5.32% and 8.66%, respectively. Short cords were associated with a 31.25% IUFD rate, compared to 11.5% for long cords and 2.7% for medium cords (46-90 cm). Nuchal cords increased caesarean delivery rates (53.33% for one loop, 85.70% for three loops). True knots had a lower caesarean rate (42.86%). The overall IUFD rate was 5%.
Conclusions: Short and long umbilical cords are associated with increased IUFD and caesarean delivery rates, particularly with multiple nuchal loops. Antenatal ultrasound is crucial for identifying cord abnormalities to optimize outcomes
Sociodemographic and clinical characteristics associated with perinatal outcome in high and low cerebro-umbilical ratio groups
Get PDFBackground: Perinatal morbidity and mortality are largely driven by preterm birth, intrauterine asphyxia from placental insufficiency, and complications related to operative deliveries and medication use. Therefore, this study aimed to assess the association between sociodemographic and clinical characteristics and perinatal outcomes across high and low cerebro-umbilical ratio groups. The aim of the study was to assess the association between sociodemographic and clinical characteristics and perinatal outcomes across high and low cerebro-umbilical ratio groups.
Methods: This prospective cohort study at the department of obstetrics and gynecology, BIRDEM General Hospital, Dhaka (November 2022-February 2024) included 106 women at 29-38 weeks gestation undergoing third-trimester Doppler. Maternal (gestational age, delivery) and fetal outcomes (birth weight, APGAR, respiratory distress, FGR) were assessed in relation to C/U ratio (cutoff 1.01). Data were collected via questionnaire, examination, and ultrasound, analyzed in SPSS 26.0 (p<0.05).
Results: C/U<1.01 was associated with lower education (24.0% versus 57.1% higher secondary), lower income (79,800 versus 68,357 BDT), higher BMI (35.1 versus 33.1 kg/m2), earlier delivery (33.9 vs 36.6 weeks), lower birth weight (1.9 versus 2.6 kg; 96% versus 12.5% LBW), more complicated outcomes (84.0% versus 21.4%), APGAR<7 (68.0% versus 19.6%), NICU admission (74.0% versus 21.4%), respiratory distress (60.0% versus 12.5%), and FGR (18.0% versus 0%). Maternal age, parity, and occupation were similar between groups.
Conclusions: A low cerebro-umbilical ratio is strongly associated with adverse perinatal outcomes, including lower birth weight, earlier delivery, and increased neonatal complications.
Audit on gynaecological surgeries in Ramaiah medical college and hospital in year 2025
Get PDFBackground: Surgical audit is a peer-reviewed process to assess surgical quality and improve patient outcomes. In gynaecology, common surgeries include hysterectomy, dilatation and curettage, prolapse repair, laparoscopy, and myomectomy. This study aimed to evaluate the effectiveness, efficiency, and outcomes of gynaecological surgeries performed at Ramaiah Medical College and Hospital, Bengaluru, from January to March 2025, and to identify areas for improvement in surgical practice.
Methods: This retrospective observational study included all patients who underwent gynaecological surgeries during the study period at Ramaiah Memorial Hospital. Data on demographics, indications, type of surgery, complications, anaesthesia, and hospital stay were collected and analysed using SPSS version 26.0.
Results: A total of 52 gynaecological surgeries were conducted. The majority of patients were aged 50-55 years. Abnormal uterine bleeding (38%) was the most common indication. Hysterectomy was the predominant surgery (46%), performed mainly via the vaginal route (50%). Endoscopic procedures constituted 50% of surgeries, including hysteroscopies (32%) and laparoscopies (17%). Spinal anaesthesia was used in 62% of cases. The main complication was intraoperative blood loss requiring transfusion. The mean hospital stay was longest for abdominal hysterectomies (3-5 days).
Conclusions: Most surgeries adhered to ACOG and RCOG recommendations, prioritising minimally invasive approaches. Vaginal and laparoscopic hysterectomies were preferred where feasible, reflecting evidence-based and patient-centred surgical practice
A cross-sectional study to determine the challenges in minimally invasive gynaecological surgeries
Get PDFBackground: Minimally invasive gynaecological surgery is widely practiced, yet it is associated with specific surgical and non-surgical challenges. This cross-sectional study aimed to assess the challenges and complications encountered during minimally invasive gynaecological surgeries at a tertiary healthcare centre.
Methods: A cross-sectional study was conducted from May 2022 to April 2023 at a tertiary care centre. All women undergoing laparoscopic gynaecological surgeries were included, excluding laparoscopic tubectomy and malignancy cases. Data were obtained from medical records and included age, parity, indication for surgery, intraoperative difficulties, duration of surgery, and postoperative outcomes.
Results: Most patients were aged 21-40 years (57.5%), belonged to the middle socioeconomic class (70%), and were multiparous (para 2-3). Common indications included abnormal uterine bleeding (38.8%), uterine fibroids (26.3%), and ovarian cysts/endometrioma (25%). Total laparoscopic hysterectomy was the most frequently performed procedure (33.8%), followed by diagnostic hysterolaparoscopy (18.8%). The overall complication rate was 31.25%, with major complications in 11.25% and minor complications in 20% of cases. Intraoperative bleeding requiring blood transfusion occurred in 6.25% cases, organ injuries in 3.75%, and conversion to laparotomy in 5%. Technical difficulties such as equipment issues or staff unavailability were noted in 12.25% cases. Postoperative complications included fever (10%), ureteric injury (2.5%), urinary tract infection (3.75%), stress urinary incontinence (2.5%), and vaginal cuff dehiscence (1.25%). Most surgeries lasted 121-180 minutes (45%).
Conclusions: Minimally invasive gynaecological surgeries are generally safe but not without risk. Higher complication rates may be related to procedural complexity and surgeon experience. Individualized patient assessment, surgical expertise, and adequate resources are essential to reduce complications
Study on the occurrence of gestational diabetes mellitus in first trimester hypothyroid and euthyroid pregnant women
Get PDFBackground: Hypothyroidism and gestational diabetes mellitus are two common endocrine complications in pregnancy. Individually, contributing to adverse outcomes. With the increase in the prevalence of subclinical hypothyroidism, the risk of the occurrence of gestational diabetes mellitus among pregnant women has increased. Thus, the purpose of this study is to determine the association between hypothyroidism and the subsequent onset of gestational diabetes. Introducing universal thyroid screening in the early stages of pregnancy, along with timely intervention, may help reduce the impact of both conditions on expectant mothers, thereby promoting healthier pregnancies and overall maternal well-being. This study aimed to determine the proportion of pregnant women with gestational diabetes mellitus among first-trimester (0- 12 weeks) hypothyroid and euthyroid pregnant women.
Methods: This is a Prospective study conducted in the Department of OBG, ESIC-PGIMSR Bangalore between April 2023 to October 2024. Pregnant women who registered at the Antenatal OPD during their first visit, including both euthyroid and hypothyroid individuals, were followed up, and the prevalence of gestational diabetes mellitus among them, with maternal and fetal outcomes, has been evaluated.
Results: In our study, the prevalence of GDM in patients with hypothyroidism is found to be 80%, with adverse maternal and fetal outcomes. Thus, the association of GDM with hypothyroidism has an increased risk of preterm delivery (22.5%), severe preeclampsia (10%), gestational hypertension (7.5%), anaemia (30%), placental abruption (5%), and an increased number of caesarean sections (72.5%), with an increased neonatal morbidity.
Conclusions: Early universal screening and timely intervention for hypothyroidism in the first trimester can reduce the subsequent occurrence of gestational diabetes mellitus in later trimesters of pregnancy, with a reduction in the adverse maternal and fetal outcomes
Evaluation of uterine factors in patients with recurrent pregnancy loss by office hysteroscopy: a prospective and retrospective study
Get PDFBackground: Pregnancy loss or miscarriage, occurs before 20 weeks, often due to chromosomal issues. Recurrent pregnancy loss (RPL), defined as two or more consecutive losses, has various causes. Office hysteroscopy is the gold standard for diagnosing uterine anomalies, improving accuracy and patient comfort in RPL management. The study aims to evaluate uterine factors in patients of recurrent pregnancy loss by office hysteroscopy.
Methods: This prospective study was conducted over 18 months (June 2023 to December 2024) Department of Obstetrics and Gynaecology at Department of Obstetrics and Gynaecology at Government Medical College, Akola, Maharashtra. All patients with a history of recurrent pregnancy loss attending the outpatient department (OPD) during the study period were included using universal sampling method.
Results: Among 132 women with recurrent pregnancy loss (RPL), the mean age was 27.75±4.6 years and mean duration of marriage was 5±2.04 years. Overweight and obesity were common (78%) and acquired uterine anomalies (54.16%) slightly exceeded congenital ones (45.83%). Office hysteroscopy detected more uterine abnormalities than transvaginal sonography, confirming its superior diagnostic yield with minimal procedural complications.
Conclusions: Office hysteroscopy demonstrated high diagnostic accuracy and safety in evaluating uterine abnormalities among women with recurrent pregnancy loss. It effectively identified both congenital and acquired intrauterine pathologies, outperforming transvaginal sonography and proved valuable as both a diagnostic and therapeutic tool for improving reproductive outcomes in affected women
Primary broad ligament fibroid: a case report with review of the literature
Get PDFFibroids are benign tumors with minimal malignant potential arising from estrogen-sensitive smooth muscles, which can be uterine and extrauterine in origin. The broad ligament is the most common site for extrauterine fibroids, and it is differentiated into primary and secondary. A fibroid arising from smooth muscles in the broad ligament without attachment to the uterus or connected to it by a vascular pedicle is classified as a primary broad ligament fibroid. Its significance lies in the retroperitoneal location in the parametrium, which distorts the anatomy and affects the surrounding viscera, making diagnosis as well as surgical management challenging. Patient is usually asymptomatic or has vague pain abdomen and bloating unless it grows to a large size, putting pressure on the ipsilateral ureter and bladder, and an abdominal mass may be detected, pushing the uterus to the other side, and development of symptoms. Diagnosis is usually incidental during pelvic surgery for other pathology. Neither clinical nor imaging studies can differentiate it from an adnexal mass. Treatment is myomectomy by laparotomy or a minimally invasive approach. In both methods, the procedure is high risk for injury to the ipsilateral ureter and uterine vessel and blood loss due to more tissue dissection. Preoperative planning and preparation in suspicious cases, and an experienced surgeon with adequate knowledge of pelvic anatomy, is the solution to avoid complications. Our patient, a 47-year-old parous premenopausal lady, reported to this institution with dragging pain abdomen with bloating was found to have a fibroid uterus and underwent total laparoscopic hysterectomy, during which a primary broad ligament fibroid of 09×07 cm was detected incidentally, and myomectomy was done. The presentation aims to report the rare case and add to statistics, to highlight the asymptomatic nature of the tumor and the challenging diagnosis, and its management
Maternal and fetal outcomes in pregnancy beyond 40 weeks of gestation: an observational study
Get PDFBackground: Pregnancy beyond 40 weeks, or postdated pregnancy, is associated with increased maternal and perinatal morbidity. The present study aimed to evaluate maternal and fetal outcomes in pregnancies extending beyond 40 weeks of gestation.
Methods: This prospective observational study was conducted among 200 pregnant women with gestational age >40 weeks admitted to the department of obstetrics and gynaecology, government medical college and hospital, Akola, Maharashtra. Data were collected regarding maternal demographics, mode of delivery, onset of labor, complications, and neonatal outcomes. Statistical analysis was performed using descriptive methods.
Results: The mean maternal age was 26.7±3.2 years, with 64.5% being primigravida. Sixty percent of women delivered at term (40-40+6 weeks), 30% at late term (41-41+6 weeks), and 10% beyond 42 weeks. Vaginal delivery occurred in 63.3% and caesarean section in 36.7% of cases. Labor induction was required in 45%, predominantly using prostaglandins. Maternal complications included oligohydramnios (25%), prolonged labor (20.5%), and postpartum hemorrhage (19%). Fetal complications included fetal distress (29%) and meconium-stained liquor (23%). NICU admission was needed in 18% of neonates, mainly for respiratory distress, hypoglycemia, and perinatal asphyxia. Most neonates (81.6%) had normal birth weight (2.5-3.9 kg), with 12.2% macrosomic.
Conclusions: While most postdated pregnancies had favourable outcomes, maternal and neonatal risks increased with advancing gestation. Early identification, timely induction, and vigilant intrapartum monitoring are essential to optimize outcomes in pregnancies beyond 40 weeks