International Journal of Reproduction, Contraception, Obstetrics and Gynecology
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The hidden face of ovarian cysts: a case of incidentally detected granulosa cell tumor
Get PDFAdult granulosa cell tumors (AGCTs) are rare ovarian sex cord–stromal neoplasms that constitute 1–2% of ovarian malignancies and are often diagnosed late due to their nonspecific clinical, radiological, and biochemical features. We describe the case of a 50-year-old perimenopausal woman who presented with abnormal uterine bleeding and was found on ultrasound to have an endometrial polyp and a benign-appearing ovarian cyst, with normal tumor markers. She underwent laparoscopy-assisted vaginal hysterectomy with bilateral salpingo-oophorectomy, after which histopathological examination unexpectedly revealed an adult granulosa cell tumor in the left ovary, characterized by classic Call-Exner bodies and grooved (“coffee-bean”) nuclei. Immunohistochemistry demonstrated strong positivity for SF1 and Calretinin with focal Inhibin expression, confirming the diagnosis. The patient was staged as FIGO IA and placed on surveillance. This case highlights the importance of routine histopathological evaluation of adnexal masses even when preoperative findings appear benign, and underscores the need for long-term follow-up because AGCTs carry a risk of late recurrence
Prediction of the maternal and perinatal outcomes in premature rupture of membranes at and after 37 weeks of gestation using maternal serum C reactive protein levels
Get PDFBackground: Premature rupture of membranes (PROM) complicates 5-10% of pregnancies, mostly at term, and increases the risk of maternal and neonatal morbidity due to intrauterine infection. Early prediction is crucial, and C-reactive protein (CRP), an acute-phase reactant, is frequently studied, though its diagnostic accuracy in PROM remains uncertain. This study was conducted to evaluate the role of maternal serum CRP in predicting chorioamnionitis and associated complications in term PROM.
Methods: This prospective observational study included 90 women with term PROM admitted to Swami Dayanand Hospital, New Delhi, between August 2022 and February 2024. Maternal serum CRP was measured at admission, and patients were followed for development of chorioamnionitis, mode of delivery, and maternal and neonatal outcomes. Diagnostic accuracy was calculated.
Results: Of 90 women, 72% were aged 21-30 years and 65.6% were primigravida; mean gestational age was 38.4 weeks. Adverse outcomes were significantly higher with leaking >24 hours (p=0.008). CRP ≥5 mg/L was associated with caesarean delivery (35.1% vs. 11.3%, p=0.02), postpartum febrile morbidity (32.4% vs. 7.5%, p=0.004), and neonatal antibiotic requirement (35.1% vs. 11.3%, p=0.006). No significant association was observed with chorioamnionitis, postpartum haemorrhage, low Apgar scores, neonatal intensive care unit (NICU) admission, or perinatal death. CRP predicted adverse outcomes with 64.7% sensitivity, 73.2% specificity, and 70% diagnostic accuracy.
Conclusions: Maternal CRP ≥5 mg/L is a useful predictor of adverse outcomes in term PROM, particularly postpartum infection and neonatal sepsis risk. Its high negative predictive value supports its role as a simple, cost-effective screening tool
Comparative study of oxytocic drugs versus negative pressure suction method in management of atonic postpartum hemorrhage in high-risk mothers
Get PDFBackground: Postpartum hemorrhage (PPH) is the most dreadful obstetric emergency and atonic PPH being most common cause of PPH accounting for 70-80% of cases leading to maternal mortality worldwide. The aim of the present study was to compare efficacy of oxytocic drugs and panicker PPH hemostatic suction cannula in management of postpartum haemorrhage in atonic PPH and to describe an effective, simple and minimally invasive method to avoid excess blood loss.
Methods: This study was carried out in Department of Obstetrics and Gynecology, Adesh Medical College and Hospital, Mohri, Kurukshetra. All the high-risk patients who delivered in Adesh Medical College by vaginal delivery and underwent PPH were included in this study. Patients requiring PPH management were admitted to the obstetrics ward and managed.
Results: This study included a total of 50 patients, divided equally into two groups. Group A consisted of 25 patients who were managed with medical therapy alone, while Group B included 25 patients who received both medical treatment and management with the Panicker PPH hemostatic suction cannula. In Group A, all patients required more than four minutes for the bleeding to stop. Of these, 15 patients experienced a blood loss between 250-500 ml, and 10 patients had a blood loss ranging from 501-1000 ml. Regarding transfusion requirements, 15 patients did not require any blood transfusion, whereas 6 patients received two units and 4 patients required three units. In contrast, all patients in Group B achieved cessation of bleeding within four minutes of cannula application. Among them, 20 patients had a blood loss of up to 250 ml, and 5 patients had a loss between 251-500 ml. Most patients (20) in Group B did not require any transfusion, and only 5 required a single unit of blood.
Conclusions: Management of atonic postpartum hemorrhage with the Panicker suction cannula proved to be highly effective and efficient. The study concludes that the Panicker suction cannula offers a simple, safe, and minimally invasive technique for the prompt control of atonic PPH. It serves as a cost-effective and practical alternative, particularly suited for use in rural or resource-limited settings, thereby contributing significantly to the reduction of maternal morbidity and mortality associated with postpartum hemorrhage
Glassy cell variant of human papillomavirus associated poorly differentiated adenosquamous carcinoma with concurrent adenocarcinoma in situ: a rare case report
Get PDFGlassy cell carcinoma (GCC) of the uterine cervix is a rare neoplasm, first described by Gluksman and Cherry in 1956. It is a poorly differentiated adenosquamous carcinoma, comprising about 1-2% of all cervical cancers. It is considered to originate from the subcylindrical reserve cells of the cervix and has been associated with human papillomavirus (HPV). Histologically glassy cell carcinoma is composed of nests of large cells with ground glass nucleoli. Nuclear pleomorphism and tumour giant cells are frequently seen. Mitotic activity is brisk. Infiltration by eosinophils and plasma cells with admixture of lymphocytes is a characteristic feature. we report a case of 44-year female who presented with per vaginal bleeding and white discharge which was diagnosed clinically as cervicitis. On pap smear it was reported as NILM- inflammation probably because of its rich inflammatory stroma. Ultrasonography (USG) abdomen and pelvis done which showed mild bulky cervix with changes of cervicitis. We performed P16 which was diffuse block like positivity along with p63 and CK 7 which confirms the adenosquamous presentation and highlights adenocarcinoma in situ arising from endocervical glands. Cervical GCC was recognized as a rare histological entity associated with poor prognosis since the report from Cherry and Glucksmann. We reported a rare case of GCC of cervix variant of poorly differentiated adenosquamous carcinoma associated with HPV and concurrent adenocarcinoma in situ, confirmed on immunohistochemistry.
From stigma to statute: unpacking the concept of menstrual leave in the Indian socio-policy landscape
Get PDFThe concept of menstrual leave has emerged as a pivotal intersection of gender equity, labour rights, and public health in India’s evolving socio-policy landscape. Despite its growing visibility in corporate and legislative spaces, the idea remains conceptually fragmented and socio-culturally contested. This concept analysis, conducted using Walker and Avant’s eight-step framework, critically deconstructs menstrual leave to identify its defining attributes, antecedents, consequences, and conceptual boundaries. Through a systematic review of scholarly articles, legal documents, corporate policies, and policy briefs sourced from PubMed, Scopus, and SSRN, the study elucidates menstrual leave as a rights-based, inclusive, and physiologically grounded policy construct. Key findings highlight menstrual leave’s defining features-its explicit linkage to menstruation, symbolic recognition of bodily integrity, and its dual nature as both a welfare provision and an equity instrument. Antecedents such as menstrual stigma, workplace absenteeism, and feminist advocacy were found to shape its emergence, while consequences include enhanced wellbeing, gender-sensitive workplaces, and risks of stereotype reinforcement. The analysis further delineates surrogate terms like “period leave” and “menstrual rest,” and constructs model and contrary cases to clarify conceptual limits. Ultimately, menstrual leave represents more than a health accommodation-it signifies a shift from silence to recognition, from stigma to statute. Anchored in sustainable development goals (SDG 3, 5, and 8), this paper advances the discourse on menstrual equity, inclusive labour policy, and gender-responsive governance in contemporary India
Association of maternal serum c-reactive protein with pre-eclampsia among patients attending in the outpatient department of a tertiary care hospital
Get PDFBackground: Preeclampsia is a pregnancy-specific hypertensive disorder associated with systemic inflammation and endothelial dysfunction. C-reactive protein (CRP), an acute-phase reactant, is a potential biomarker for detecting and assessing preeclampsia severity. This study aimed to evaluate the association between maternal serum c-reactive protein (CRP) levels and preeclampsia.
Methods: This case-control study was conducted in the department of obstetrics and gynecology, Institute of Child and Mother Health (ICMH), Dhaka, Bangladesh, from March 2023 to February 2024. This study included 70 pregnant women with a gestational age of 20-40 weeks. Among them, 35 women diagnosed with pre-eclampsia were assigned as cases, and 35 normotensive pregnant women were taken as controls.
Results: Mean age and height were similar between groups, but preeclamptic women had significantly higher weight compared to controls (67.46±9.85 kg versus 57.26±9.27 kg; p=0.001). Elevated serum CRP levels were observed in 94.3% of preeclamptic patients, whereas all controls (100%) had normal CRP levels (p<0.001). The mean CRP was significantly higher in cases (25.37±14.70 mg/dl) than controls (4.22±0.92 mg/dl; p<0.001). A strong positive correlation was found between CRP and systolic blood pressure (r=0.822, p<0.001) and diastolic blood pressure (r=0.792, p<0.001).
Conclusions: This study demonstrated a significant association between elevated maternal serum c-reactive protein (CRP) levels and preeclampsia, with a strong positive correlation to blood pressure. Elevated CRP may serve as a useful biomarker for early detection and monitoring of preeclampsia
Ultrasound guidance versus classical method for intrauterine insemination
Get PDFBackground: There are a wide range of treatment options available for unexplained infertility, such as expectant management, superovulation, intrauterine insemination (IUI) and In vitro fertilization (IVF). So, the objective was to compare clinical pregnancy rates in IUI with transabdominal ultrasound guidance (US-IUI) versus the “blind method” IUI.
Methods: This was a randomized controlled trial done at Basrah Maternity and Child Hospital/IVF Center during the period between 01 January 2020 till 01 March 2023. 130 couples with unexplained infertility were included. All couples underwent infertility assessment in day 2 or day 3 basal serum follicle-stimulating hormone (FSH) levels and serum luteinizing hormone (LH) levels. Patients were divided randomly into 2 groups; 1ST group (70 women) underwent IUI with transabdominal ultrasound guidance while the 2nd group (60 women) undergoing IUI without ultrasound guidance.
Results: The mean age of the patients was 30.6 ± 4.0 years (range 25-40). Of the 267 cycles, 145 were carried out as US-guided and 122 were performed using the blind procedure. The overall pregnancy rate was 17%; one pregnancy were multiple pregnancies and 1 ended in abortion. There was no significant difference between the US-guided and blinded IUI groups regarding the multiple-pregnancy rate, abortion rate. The pregnancy rates were 23.4% and 13.9% respectively and the difference was statistically significant (p=0.049). In the US-guided group, 9.7% of the cases were difficult. In the blinded group, 26.2% were difficult.
Conclusions: The conventional blind method for intrauterine catheter insemination is recommended for patients undergoing IUI treatment
Fusion vaginal wall in a pediatric patient with post hematopoietic stem cell transplantation
Get PDFAplastic anemia is a rare condition characterized by bone marrow failure and reduced blood cell production. Hematopoietic stem cell transplantation (HSCT) is the preferred treatment when a matched donor is available. This condition carries a graft-versus-host disease (GVHD) risk, affecting 30-70% of patients. GVHD can manifest in various areas, including the mouth, skin, and genitals, with vaginal symptoms present in 26% of cases. These may include dryness, itching, discharge, and labial fusion. A 14-year-old female treated with HSCT, developed skin and vaginal GVHD. She experienced amenorrhea and abdominal pain, a subsequent MRI revealed a normal uterus but a lobed vagina with multiple septa. The patient underwent vaginal exploration and laparoscopic surgery, revealing a fusion in labia minora and a significant vaginal cavity obstruction. Approximately 600 ml of blood was drained. Female genital GVHD in pediatric patients has a low incidence of 5.9%. Symptoms often include vulvar pain (37%), dysuria (37%), and pruritus (26%), with many patients remaining asymptomatic. A study found limited occurrences of vaginal stenosis, emphasizing the rarity of severe presentations. Routine gynecological evaluations are recommended for patients post-HSCT. In cases of colpohaematometra, draining and addressing stenosis may be necessary. Vaginal GVHD is a common complication of HSCT, ranging from vulvar pruritus to severe vaginal stenosis or fusion. Management may involve surgical liberation, vaginal molds, and treatment with estrogens and corticosteroids. Gynecological consultations are recommended for all patient’s post-transplant
Correlation of ovarian adnexal reporting and data system classification with histopathological examination in diagnosis of adnexal masses
Get PDFBackground: Adnexal masses are common and present significant clinical challenges related to diagnostic imaging, surgery and pathology. Ovarian adnexal reporting and data system (O-RADS) serves as both a lexicon and risk stratification tool, which is designed to accurately characterize adnexal lesions and facilitate optimal patient management. This study aimed to evaluate the diagnostic accuracy of O-RADS using histopathological examination as the gold standard.
Methods: This was a prospective observational study conducted in the department of Obstetrics and Gynaecology, Radio-diagnosis, Pathology in collaboration with the department of radio-diagnosis and pathology at Government Medical College and Hospital, Chandigarh from December 2022 to March 2024. A total of 35 women who were diagnosed with adnexal masses were included in the study.
Results: The age group of presentation of adnexal masses in our study was 14 to 62 years of age with a mean age of 31.69±11.25 years. O-RADS score 2 was 100% sensitive and 21.4% specific for detecting benign adnexal masses. ORADS score 3 was 100% sensitive and 24% specific for detecting benign masses. O-RADS score 4 was 25% sensitive and 89.47% specific for detecting malignant adnexal masses. Similarly, ORADS score 5 was 100% sensitive and 87.88% specific for detecting malignant masses using histopathology as the gold standard.
Conclusions: The ORADS classification system has a high sensitivity in differentiating between benign and malignant lesions when correlated with gold standard histopathology report
Assessment of knowledge and creating awareness for the use of menstrual cup and its related aspects during menstruation among young adults: an environment friendly approach
Get PDFBackground: An advancement in the field of menstrual management products is the menstrual cup that act by collecting the menstrual blood which needs to be emptied every 6 to 12 hours and can last for up to 5 to 10 years, thereby decreasing the environmental impact caused by one-time use products. Thus, this research was conducted to assess the knowledge among young adult females about the use of menstrual cup and to further spread awareness about its use as an environment friendly and cost-effective device.
Methods: The present study was a cross-sectional descriptive study conducted in Doon Hospital, Dehradun with 230 participants.
Results: 68.6% of the study participants knew about the use of menstrual cup as menstrual management device. 57.8% of the participants feel that the menstrual cup is cost effective alternative to sanitary pads and tampons and 66.5% feel that the menstrual cup is an environment friendly device. After an informative video was shown to the participants about menstrual cup, the knowledge of majority of the participants changed from “average” to “good”.
Conclusions: The study results show that although majority of the study population knew about the use of menstrual cup, yet they hesitate from using it. Thus, there is need to create awareness about the use of menstrual cup as an effective menstrual management product and make it more affordable and available to the public