International Journal of Reproduction, Contraception, Obstetrics and Gynecology
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The role of levonorgestrel intrauterine device in managing abnormal uterine bleeding
Get PDFBackground: Abnormal uterine bleeding (AUB) is a prevalent gynecological condition affecting menstrual regularity and quality of life, with causes ranging from structural abnormalities to hormonal imbalances. Conventional treatments, including hormonal therapy and surgery, pose challenges such as side effects, non-compliance, and fertility loss. The levonorgestrel-releasing intrauterine device (LNG-IUD) offers a minimally invasive alternative, targeting the endometrium to reduce menstrual blood loss while minimizing systemic effects.
Methods: This study evaluated the efficacy, safety, and acceptability of LNG-IUD in 52 women with AUB over 24 months. Clinical outcomes, including bleeding patterns, USG findings, complications, and satisfaction, were assessed at baseline and follow-ups (1 week, 1 month, and 6 months). Statistical analysis was conducted using SPSS v25.0.
Results: The mean age was 42.8 years, with menorrhagia (55.8%) being the most common complaint. Adenomyosis (38.5%) and thickened endometrium (30.8%) were frequent sonographic findings. At 6 months, 48% achieved amenorrhea, and spotting decreased to 36.5%. LNG-IUD retention was 88.4%, with removal in 7.6% and expulsion in 3.8%. Treatment failures led to hysterectomy (7.6%) and hormonal therapy (3.8%). Patient satisfaction was high, with 63.5% reporting being satisfied.
Conclusions: LNG-IUD proved highly effective, safe, and well-accepted for AUB management, significantly reducing menstrual blood loss and improving patient outcomes. Its high retention and satisfaction rates make it a viable alternative to systemic hormonal therapy and surgery, particularly for those seeking uterine preservation. Further studies should explore its long-term efficacy across AUB subtypes
Clinical method of foetal weight estimation: a comparable alternative to ultrasound method in a low resource setting
Get PDFBackground: Foetal weight estimation is of utmost importance to obstetricians in the management of pregnant women during the antenatal and intrapartum period. This study aimed at determining reliable method of foetal weight estimation, (sonographic or clinical), that closely predicts the actual birth weight in booked pregnant women in Lafia, North Central, Nigeria.
Methods: It was a cross-sectional comparative study carried out among 259 pregnant women recruited by consecutive sampling from September 2019 to January 2020 in the antenatal and labour wards of the hospital. The Dare’s formula was used to estimate the clinical foetal weight of the participants while the ultrasound foetal weight was estimated using the Hadlock 3 formula (BPD, AC and FL). The actual birth weight of each neonate was measured using the standardized Waymaster digital weighing scale. Qualitative variables were presented in means, median and standard deviation. Categorical variables were presented in frequencies and percentages. The absolute errors were tested with Chi square, paired t test, Mann Whitney U and Spearman’s rank correlation. A p<0.05 considered statistically significant.
Results: The mean actual birth weight of neonates was 3074.5±398.4g. The results did not show any significant difference in the mean of estimated foetal weights using ultrasound and clinical methods when compared with the actual birth weights.
Conclusions: There was no significant difference between the mean weight obtained through clinical and ultrasound estimation and actual birth weight. Clinical foetal weight estimation is as reliable as ultrasound weight estimation
Case study on heterotopic pregnancy
Get PDFHeterotopic pregnancy (HP) is a rare, life–threatening condition due to the occurrence of pregnancies in at least two different implantation sites at the same time. The diagnostic dilemma often ends up in delayed treatment. This case report signifies the vitality in considering the possibility of heterotopic pregnancy, the need for precise ultrasound examinations, and timely intervention to reduce feto-maternal mortality.
Ovarian-ectopic pregnancy: a rare case report
Get PDFOvarian ectopic pregnancy (OEP), is one of the variants of the non-tubal ectopic pregnancy, which varies one in 7,000–16,000 deliveries, and its prevalence is 1-3% among ectopic pregnancy. OEP is a complication which occurs when implantation and embryo development happens outside of the uterus. Usually, 91% of OEP terminates with rupture before the end of 1st trimester and it can lead to pregnancy complications such as hemorrhage and hypovolemic shock. Clinical presentation of OEP is lower abdominal or pelvic pain, or both. In addition to this, other symptoms include nausea, vomiting, and constipation. It is one of the life-threatening conditions that cause maternal morbidity and mortality. In this case study we report a 20-year-old primigravida who presented to R. L. Jalappa hospitals emergency department with pain abdomen, with history of 2 months of amenorrhea, unaware of her last menstrual period, on examination her vitals were unstable and left iliac fossa tenderness noted on per abdomen examination, ultrasound showing ruptured ectopic pregnancy, patient was managed successfully through emergency exploratory laparotomy with unilateral oophorectomy
Prevalence and risk factors of polycystic ovary syndrome among reproductive-aged women
Get PDFBackground: PCOS is one of the most common reproductive and hormonal health issues that Bangladeshi women and young girls’ experience, yet many remain unaware of their condition until later in life. This study assessed the prevalence of and examined the factors of polycystic ovary syndrome (PCOS) among reproductive-aged women.
Methods: This study cross-sectional included 500 patients diagnosed with PCOS who visited the department of obstetrics and gynecology, BSMMU, Dhaka, Bangladesh. This 2-years-long study included reproductive-aged women who were suffering from PCOS. Data were collected using a structured questionnaire that was administered to participants. The prevalence percentage of physician-diagnosed PCOS was calculated. A multivariable logistic regression model was employed to determine the adjusted odds ratios (aOR) and the corresponding 95% confidence intervals (CI) for the factors significantly associated with PCOS status.
Results: Out of the 500 participants, the majority were single (85%), and the age group of 21 to 25 years comprised 56% of the participants. The prevalence of polycystic ovary syndrome (PCOS) was found to be 61% out of 500 participants affected. The risk factors that were significantly associated with PCOS included. Menstrual irregularities [adjusted odds ratio (aOR) =7.67; 95% confidence interval (CI): 3.72-15.83], family history of PCOS (aOR =5.11; 95% CI: 2.32-11.31), Hirsutism (aOR=3.55; 95% CI: 2.06-6.21) and Male pattern baldness (aOR=2.06; 95% CI: 1.19-3.58).
Conclusions: This study revealed a moderately high prevalence of PCOS. Menstrual irregularities, obesity, a family history of PCOS, hirsutism, and baldness were significantly associated with the status of PCOS in the study sample
Impact of thyroid dysfunction on recurrent pregnancy loss and maternal-fetal outcomes
Get PDFBackground: Thyroid dysfunction, including hypothyroidism and hyperthyroidism, is a recognized risk factor for pregnancy complications. Both maternal thyroid disorders can adversely affect pregnancy outcomes, including recurrent pregnancy loss and maternal-fetal complications. This study aimed to investigate the impact of thyroid dysfunction on recurrent pregnancy loss and maternal-fetal outcomes in a cohort of Bangladeshi women.
Methods: This cross-sectional study was conducted from January 2024 to July 2024 at the Department of Obstetrics and Gynecology, Sheikh Fazilatuunnessa Mujib Memorial KPJ Specialized Hospital & Nursing College. A total of 100 pregnant women with a history of recurrent pregnancy loss were included. Participants underwent thyroid function testing, and maternal and fetal outcomes were recorded. Data were analyzed using SPSS software, and results were presented as frequencies and percentages.
Results: Among 100 participants, 31% had hypothyroidism, 19% had hyperthyroidism, and 50% were euthyroid. Pregnancy loss was most common in hypothyroid (68%) and hyperthyroid (74%) women, compared to euthyroid women (52%). Maternal complications such as anemia (29% in hypothyroid, 32% in hyperthyroid), hypertension (23% in hypothyroid, 26% in hyperthyroid), and preeclampsia (16% in hypothyroid, 21% in hyperthyroid) were more frequent in thyroid-dysfunctional pregnancies. Fetal complications, including intrauterine growth restriction, low birth weight, and preterm birth, were also higher in thyroid dysfunction cases.
Conclusions: Thyroid dysfunction is strongly associated with recurrent pregnancy loss, maternal complications, and adverse fetal outcomes. Early detection and appropriate management of thyroid disorders are crucial to improving pregnancy outcomes
Menstrual problems among adolescent girls attending at a tertiary care hospital in Bangladesh
Get PDFBackground: Adolescents constitute almost 20% of our population and one-fifth of the world’s total population. However, menstrual disorders are a common concern among adolescent girls, often impacting their physical and emotional well-being. This study aimed to assess the prevalence and causes of menstrual problems among adolescent girls attending a tertiary care hospital (BSMMU) in Bangladesh.
Methods: This cross-sectional study was conducted in the Department of Obstetrics and Gynaecology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh, from January 2017 to December 2017. This study included 668 adolescent girls with various menstrual disorders aged 10-19 years who attended the outpatient department of obstetrics and gynecology of our institution.
Results: In this study, out of 668 adolescent girls, 418 (62.6%) had some form of menstrual disorder. The most common were menorrhagia (30.38%), oligomenorrhea (26.07%), and amenorrhea (21.76%). Among those with amenorrhea, 3.58% and 18.18% had primary and secondary amenorrhea respectively. Abnormal uterine bleeding (47.4%) and polycystic ovarian disease (PCOD) (44.29%) were the leading causes among 289 individuals with menstrual dysfunction. In cases of primary amenorrhea, the most frequent cause was Müllerian agenesis (60%), followed by imperforate hymen (20%). For secondary amenorrhea, PCOD (77.63%) was the dominant cause, with anemia, emotional disturbances, and premature ovarian failure.
Conclusions: The findings show that menorrhagia, oligomenorrhea, and amenorrhea are frequently common menstrual problems among adolescent girls mostly due to abnormal uterine bleeding and PCOD. The study highlights the need for early diagnosis, proper medical intervention, and specialized adolescent gynecology clinics to improve reproductive health outcomes
Barriers and motivators for postpartum intrauterine contraceptive devices uptake in a rural tertiary care hospital in Maharashtra
Get PDFBackground: Postpartum family planning is crucial for improving maternal and neonatal health, especially in rural areas with limited healthcare access. Postpartum intrauterine contraceptive devices (PPIUCD) offer a safe, effective, and long-acting contraceptive solution. However, its uptake remains low due to various barriers, including lack of awareness, cultural beliefs, and fear of complications. This study aimed to explore the barriers and motivators influencing PPIUCD uptake among postnatal women in a rural tertiary care center in Maharashtra, India.
Methods: A cross-sectional study was conducted from October 2024 to November 2024 at Pravara institute of medical sciences, Loni, Maharashtra. Seven hundred forty postnatal women were randomly selected and interviewed. Statistical analysis was performed using SPSS version 21.
Results: The overall acceptance rate of PPIUCD was 37.9%. Acceptance was significantly higher among women with prior knowledge of PPIUCD and those with primary/secondary education. The main reasons for refusal were opting for other contraceptive methods (38.2%), fear of complications (28.7%), and husband’s and relative’s disapproval (21.6%). Women who attended three antenatal care visits were more likely to accept PPIUCD.
Conclusions: The study highlights the need for targeted interventions focusing on awareness, partner involvement, and culturally sensitive counselling to enhance PPIUCD acceptance in rural settings. Effective antenatal counselling can address misconceptions and promote informed decision-making
Association between socioeconomic factors, adverse childhood experiences, and intimate partner violence among infertile women in South Nigeria
Get PDFBackground: Infertility is a global reproductive health issue with medical, psychological, and socio-economic consequences. In low- and middle-income countries, it is highly stigmatized, disproportionately affecting women. Socio-economic status, adverse childhood experiences, and intimate partner violence are emerging contributors to infertility and its psychosocial burden. This study examines the relationship between socio-economic factors, adverse childhood experiences, and intimate partner violence among infertile women in Nigeria, assessing prevalence and patterns of violence.
Methods: A cross-sectional study of 401 infertile women at the Rivers State University Teaching Hospital Port Harcourt, between November 2024 to February 2025 using structured questionnaires to collect data on socio-demographics, childhood adversity, and intimate partner violence. Multivariate analysis of variance and descriptive statistics were used for analysis.
Results: Intimate partner violence was highly prevalent, with emotional abuse (72.8%) and physical abuse (65.3%) most common. Socio-economic status did not significantly affect overall violence risk, but low-income women were more likely to experience physical abuse (p=0.001). Adverse childhood experiences were strongly linked to emotional (p=0.000) and physical abuse (p=0.000). The combined effect of socio-economic status and adverse childhood experiences significantly increased emotional abuse and harassment (p=0.023, p=0.002).
Conclusions: Infertile women in Nigeria experience a high burden of intimate partner violence, influenced by socio-economic disparities and childhood adversities. Addressing these factors through screening, trauma-informed care, and economic empowerment is essential for improving reproductive health outcomes
Evaluation of PALM - COEIN classification and management of abnormal uterine bleeding in peri-menopausal age group
Get PDFBackground: Abnormal uterine bleeding (AUB) is a prevalent condition affecting a significant portion of women, particularly in the perimenopausal age group. The FIGO PALM-COEIN classification system, introduced in 2011, categorizes AUB based on its etiology and is a useful tool in diagnosing and managing AUB. The aim of the study was to evaluate the clinical and histopathological outcomes of AUB diagnoses in women based on this classification.
Methods: A 6-month retrospective study was conducted in a tertiary care teaching hospital in western India, including 80 perimenopausal women, presenting with AUB between July and December 2024. Patients were assessed using clinical history, physical examination, and imaging. Additional diagnostic modalities like hysteroscopy and MRI were employed when necessary. Treatment outcomes were analyzed, focusing on medical and surgical interventions.
Results: The majority of patients were in the 40-45 years age group (60%), with heavy menstrual bleeding (77.50%) being the most common bleeding pattern. Ultrasonography identified leiomyoma (38.75%) and adenomyosis (28.75%) as the most frequent causes. Histopathological examination of hysterectomy specimens revealed leiomyoma (45.58%), adenomyosis (30.90%), and endometrial hyperplasia (14.70%). Hysterectomy was the most common final treatment modality (85%).
Conclusions: The PALM-COEIN classification system is a valuable, efficient tool for diagnosing AUB, facilitating targeted treatment strategies. Transvaginal ultrasonography remains the first-line imaging modality, but histopathological examination of all surgical specimens is essential to ensure comprehensive diagnosis and optimal management. Medical hormonal therapy is effective in most cases, but surgical options, including hysterectomy, remain crucial for definitive treatment