International Journal of Reproduction, Contraception, Obstetrics and Gynecology
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Comparison of the effect of vaginal progesterone and oral nifedipine for maintenance tocolysis after arrested preterm labour, to prolong the pregnancy and the neonatal outcome
Get PDFBackground: Preterm birth is a major determinant of neonatal morbidity and mortality and has long term adverse consequences. It is defined as childbirth occurring at less than 37 weeks of gestation. Various drugs with different doses and routes have been used for maintenance tocolysis has been used. Aims and objectives were to compare the effect of vaginal progesterone and oral nifedipine for maintenance tocolysis after arrested preterm labour and their effect concerning the neonatal outcomes.
Methods: This study was conducted in the department of obstetrics and gynecology, Mata Chanan Devi hospital, New Delhi in collaboration with the department of pediatrics. The 90 pregnant women who fulfilled inclusion criteria were recruited and were randomized into 2 groups namely nifedipine and progesterone group.
Results: The mean gestational age at delivery in the nifedipine group was 35 weeks, while in the progesterone group it was 37 weeks, and it was a significant difference (p=0.002). There was a significant difference in the prolongation of pregnancy between both the groups (p<0.001). Mean prolongation of pregnancy in the nifedipine group was 18 days, and 38 days in the progesterone group which was significant (p=0.000). The mean APGAR score at five minutes was 7 for the nifedipine group and 8 for the progesterone group. The mean duration of the NICU stay was 5 days in the nifedipine group and 2 days in the progesterone group.
Conclusions: Progesterone was found to be a better drug for maintenance tocolysis compared to nifedipine. It is associated with better maternal and perinatal outcomes when used as a maintenance tocolytic as compared to nifedipine
Large uterine leiomyoma with smooth muscle tumour of uncertain malignant potential: a case report
Get PDFSmooth muscle tumours of uncertain malignant potential (STUMP) are a category of uterine neoplasms that do not meet the criteria for benign or malignant tumours, potentially representing an intermediate stage between leiomyomas and leiomyosarcomas. A 26-year-old nulliparous woman presented with heavy menstrual bleeding and an abdominal mass, with preoperative imaging suggesting a benign uterine myoma. Following a laparoscopic myomectomy, histological analysis revealed STUMP, characterized by a low mitotic index and marked nuclear pleomorphism without necrosis. The patient was advised to conceive soon and plan for definitive surgery after completing her family. She later delivered via elective caesarean section at 35 weeks and is currently recovering well. STUMP often mimics benign leiomyomas and is usually diagnosed post-surgery, complicating preoperative assessment. Recurrence rates vary, particularly in younger patients, emphasizing the need for individualized management strategies that balance fertility preservation with monitoring for recurrence. Regular follow-ups are essential for optimal care
Role of liver function tests among pregnant women with respect to feto-maternal outcome in third trimester: an analytical cross-sectional study
Get PDFBackground: Liver disease occurs in approximately 3% of pregnant women so it has adverse effect on feto-maternal outcome. Diseases specifically related to pregnancy are intra-hepatic cholestasis of pregnancy, acute fatty liver of pregnancy, abnormal liver function with preeclampsia, HELLP syndrome and hyperemesis gravidarum. Aim was to determine prevalence of liver disease in pregnancy and the impact of abnormal liver function tests on feto-maternal outcome
Methods: It was an analytical cross-sectional study conducted in the department of obstetrics and gynecology, UISEMH, GSVM Medical College, Kanpur for a period of 2 years. All antenatal patients between the ages of 18-40 years who presented with abnormal liver function tests in third trimester were enrolled. Socio demographic and detailed clinical history was taken from all such patients and they were followed till delivery for feto-maternal outcome.
Results: Hypertensive disorders in pregnancy were the most common cause of abnormal liver function tests in pregnancy (55.25%), followed by intrahepatic cholestasis in pregnancy (23.91%). Acute viral hepatitis was present in 8% patients. In 39% patients, preterm delivery was documented about 43.7% babies had birth weight less than 2.5 kg. Maternal mortality was 15.3% and perinatal mortality was 24.7%.
Conclusions: Deranged liver function in pregnancy is associated with significant maternal and perinatal morbidity. Early diagnosis and appropriate intervention can improve feto-maternal outcome.
The study of indications, morbidity and mortality in patients delivered outside and referred to a tertiary care hospital
Get PDFBackground: Emergency referral is critical to improving outcomes for time-sensitive conditions that underlie many unpredictable problems during pregnancy, delivery, and the postnatal period. This is especially true for poor, remote and rural populations where access to health services may be limited. So, this study evaluated the maternal and fetal outcomes in patients referred to a tertiary care hospital after delivery outside to note the commonest postpartum complications, morbidity and mortality indicators in terms of need of ICU, stay in hospital, need of dialysis, need of NICU. This paper described the application of a practical approach to the assessment of the burden of postpartum morbidity by means of postpartum referrals to tertiary centre.
Methods: The observational present study was done in department of obstetrics and gynecology, BJ Government Medical College, Sassoon Hospital Pune covering a period of 18 months in postpartum period.
Results: Study included 150 cases, out of these common reasons for referrals were pre-eclampsia/eclampsia (68%), post-partum hemorrhage (52.7%) and puerperal sepsis (26%) while anemia was observed in 70% cases.
Conclusions: This study underscored the significant impact that delivering outside of a tertiary care setting can have on maternal-fetal outcomes. Timely referral to tertiary care centers plays a pivotal role in reducing complications and improving survival rates. Enhancing the quality of care in peripheral healthcare facilities and ensuring prompt transfer protocols could prevent many of the adverse outcomes
Prevalence of lower urinary tract symptoms in antenatal women in a tertiary care teaching institute of Uttar Pradesh
Get PDFBackground: Lower urinary tract symptoms (LUTS) are common in pregnancy due to hormonal, anatomical, and physiological changes, posing risks for both maternal and fetal health. Early detection is critical to prevent complications such as pyelonephritis, preterm labor, and low birth weight. Aim was to determine the prevalence of lower urinary tract symptoms among antenatal women.
Methods: This cross-sectional observational study was conducted at MLN Medical College, Prayagraj, from October 2024 to March 2025. One hundred symptomatic antenatal women were assessed through detailed history, examination, and lifestyle evaluation. Women with pre-existing urological conditions, immunocompromise, or recent urinary instrumentation were excluded.
Results: Most participants were aged 25-29 years (42%), multigravida (82%), in the first trimester (67%), from lower middle socioeconomic backgrounds (68%), and urban areas (65%). The predominant symptom was burning sensation/pain during micturition (56%), followed by increased frequency (32%). While 65% consumed ≥2 liters water daily and 80% had >2000 kcal/day intake, LUTS remained prevalent. Lifestyle factors included exercise (49%), tobacco chewing (23%), and caffeine use (13%).
Conclusions: LUTS in pregnancy are prevalent even among women with adequate hydration and nutrition, suggesting multifactorial etiology. Routine screening, lifestyle counselling, and early management- especially in multigravida women in early gestation- are essential to reduce morbidity
A rare case of postpartum cerebral venous thrombosis and hemmorhagic infarct
Get PDFCerebral venous thrombosis (CVT) is a rare but serious complication that can occur during pregnancy and the postpartum period. This case reports discusses a unique instance of postpartum CVT complicated by hemorrhagic infarct in a patient from Himachal Pradesh. A case of a 26-year-old woman, para 2, unbooked patient with normal vaginal delivery at home, presented on 10th postpartum day with complaint of vomiting, headache, left hemiplegia and seizures, initially misdiagnosed as eclampsia, underwent CT, revealed significant sigmoid sinus thrombosis with haemorrhagic infarction. The patient underwent left fronto-temporoparietal decompressive hemicranectomy with duroplasty at PGIMER Chandigarh followed by tracheostomy. The patient was under antibiotic treatment, seizure prophylaxis, anticoagulation therapy, resulting in substantial clinical improvement. This case emphasizes the necessity of maintaining a high index of suspicion for CVT in postpartum women displaying neurological symptoms. Misdiagnosis can impede timely intervention, highlighting the need for access to advanced imaging and multidisciplinary approach. Increasing awareness and training for healthcare providers are essential for timely diagnosis. Also, the importance of hospital delivery. The management of this case illustrates the importance of regular antenatal checkup, hospital delivery, early recognition of CVT in the postpartum population. Enhancing diagnostic resources and treatment strategies, particularly in resource limited settings, can significantly improve maternal health outcomes and reduce morbidity and mortality. The possibility of cerebral vein thrombosis should be considered in all women with brain dysfunction during the puerperium.
Vitamin D supplementation in infertile women with PCOS: a quasi-randomized placebo-controlled study
Get PDFBackground: Polycystic ovary syndrome (PCOS) is a common endocrine disorder associated with infertility and metabolic dysfunction. Vitamin D deficiency is prevalent in women with PCOS and may exacerbate hormonal and metabolic derangements. This study evaluated the effects of vitamin D supplementation on ovulatory and metabolic outcomes across PCOS phenotypes in a placebo-controlled setting.
Methods: In this 24-month quasi-randomized placebo-controlled trial, 180 infertile women with PCOS (Rotterdam criteria) and serum 25(OH)D <20 ng/mL were randomly allocated to Group A (n = 90, received cholecalciferol 60,1 IU/week for 9 weeks) or Group B (n = 90, received placebo capsules identical in appearance and schedule). Allocation was based on alternate patient recruitment. Both groups were stratified into four PCOS phenotypes. Clinical, biochemical, and ultrasonographic parameters were assessed. Multivariable regression adjusted for BMI, WHR, season, and ethnicity. Effect sizes (β) and 95% confidence intervals (CI) were reported.
Results: After 9 weeks, Group A showed a significant rise in 25(OH)D levels (mean 28.7±7.6 ng/mL) versus Group B (13.4±5.5 ng/mL, p<1.2). Ovulation occurred in 35/90 (38.10%) in Group A and 17/90 (18.10%) in Group B (p = 1.2). Adjusted regression showed reductions in LH: FSH ratio (β = -1.28; 95% CI: -1.51 to -1.6), total testosterone (β = -7.4; 95% CI: -12.10 to -1.7), and HOMA-IR (β = -1.53; 95% CI: -1.82 to -1.24). HDL levels increased (β = +1.13 mmol/L; 95% CI: 1.5 to 1.21). Phenotype A showed the highest ovulatory response (45.6% vs 20.9%; p = 1.3).
Conclusions: Vitamin D supplementation significantly improved ovulatory and metabolic parameters in vitamin D-deficient infertile women with PCOS, especially in hyperandrogenic phenotypes. Phenotype-tailored vitamin D therapy may serve as an effective adjunct in PCOS management
Vaginal leiomyoma: a diagnostic dilemma in vaginal mass
Get PDFVaginal leiomyoma is extremely rare entity. These tumours are thought to arise from Mullerian smooth muscle cells in the sub-epithelium of the vagina. Vaginal leiomyoma can occur anywhere in vaginal canal but the most common location is anterior vaginal wall. Here, we report a case of 35year old female who presented to us with mass in vagina mimicking the cystocele associated with vaginal discomfort. On clinical evaluation and preoperative imaging, it was found to be vaginal leiomyoma and it was managed surgically by enucleating the vaginal mass by giving transverse incision on anterior vaginal wall. Same mass was sent for histopathological examination which confirmed vaginal leiomyoma
Evaluation of caesarean deliveries using the modified Robson’s classification: a prospective observational study at a tertiary care hospital
Get PDFBackground: Caesarean section (CS) is one of the most frequently performed obstetric procedures, crucial for reducing maternal and perinatal morbidity and mortality when indicated. However, rising global and national CS rates, surpassing the World Health Organization’s recommended 10-15%, have raised concerns about potential overuse. The Robson Ten-Group Classification System (RTGCS) provides a standardized method for auditing and analyzing CS rates. This study aimed to determine the caesarean section rate and identify the Robson groups contributing most to CS rates at a tertiary care hospital in Himachal Pradesh.
Methods: In the Department of Gynecology and obstetrics at Dr. R.P.G.M.C., Kangra (Tanda), a prospective observational study was performed, spanning from May 1, 2024 to October 31, 2024. The study included all pregnant women at 28 weeks of gestation or more who underwent cesarean section. Participants were categorized into ten groups based on the modified Robson classification system. Real-time data collection was followed by statistical analysis using SPSS version 27. Chi-square test was applied, with p<0.05 considered statistically significant.
Results: Among 3755 deliveries, 1296 were caesarean sections, yielding a CS rate of 34.51%. Group 5 (previous CS, singleton, cephalic, ≥37 weeks) was the leading contributor (30.4%), followed by Group 2 (24.5%) and Group 1 (14.5%). Groups 6 and 10 contributed 7.9% and 6.9%, respectively.
Conclusions: The study highlights a high CS rate, with repeat and primary caesareans in low-risk groups as major contributors. Targeted strategies, including reducing primary CS, promoting vaginal birth after caesarean (VBAC), and adopting standardized labour management protocols, are urgently needed
Efficacy of melatonin and letrozole combination therapy compared to letrozole alone in the treatment of symptomatic endometrioma in infertile women
Get PDFBackground: Endometriosis is an estrogen-driven inflammatory condition involving endometrial tissue growth outside the uterus. Letrozole, an aromatase inhibitor, lowers estrogen levels to reduce pain and lesion size. Melatonin offers additional benefits through its antioxidant, anti-inflammatory, and anti-proliferative effects on endometrial tissue. The present study was conducted to compare the effects of a combination of melatonin and letrozole with letrozole alone in infertile women with symptomatic endometrioma.
Methods: This randomized controlled trial was conducted in the Department of Reproductive Endocrinology and Infertility of Bangabandhu Sheikh Mujib Medical University from July, 2023 to June, 2024. Total 40 infertile women with symptomatic endometrioma were included in this study. They were randomly allocated to receive either tab. letrozole 2.5 mg, twice daily plus tab. melatonin 3mg, 3 tablets at night daily or only tab. letrozole 2.5 mg, twice daily for 3 months.
Results: Mean VAS score (6.88±2.39 vs 2.64±1.96) and mean size of endometrioma (3.77±1.22 vs 3.05±1.17 cm) were significantly decreased after 3 months of treatment with melatonin and letrozole combination therapy and mean VAS score (7.11±1.81 vs 3.22±1.89) and mean size of endometrioma (3.81±1.00 cm vs 3.27±0.85) were also significantly decreased after 3 months of treatment with letrozole alone group .But there were no statistically significant difference in terms of reducing pain score and size of endometrioma when compared between two groups.
Conclusions: Melatonin and letrozole combination therapy compared to letrozole alone provide similar efficacy on symptomatic endometrioma in terms of reduction of pain score and size of endometrioma