International Journal of Reproduction, Contraception, Obstetrics and Gynecology
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Successful pregnancy outcome in uncorrected tetralogy of Fallot with bidirectional shunt
Full text linkTetralogy of Fallot (TOF), a cyanotic congenital heart disease, is the most prevalent type, constituting 10% of all congenital heart conditions. During pregnancy and childbirth, patients with uncorrected TOF can experience deterioration, posing a significant risk to maternal health and even mortality. A 30 year old patient was referred from a private clinic in view of uncorrected TOF in the third trimester of pregnancy. She was G3P1A1 who reported at 37 weeks 2 days period of gestation to the emergency room with history of breathlessness on routine activities for 10 days (NYHA III) and easy fatigability for 4-5 months and pain abdomen. Her previous antenatal and pre pregnancy period was uneventful with no history of cyanotic spells, dyspnea or palpitations. Electrocardiography showed sinus rhythm, right atrial enlargement, right ventricular hypertrophy with sudden transition of QRS in V2. Her echocardiography confirmed the findings of TOF. It revealed a large peri membranous VSD with bidirectional shunt with 50% overriding of aorta. There was non dysplastic severe pulmonary stenosis, right ventricular outflow tract narrowing with right ventricular hypertrophy, severe pulmonary hypertension, with a left ventricular ejection fraction of 56%. She underwent emergency cesarean section under general anesthesia in joint consultation of the obstetrics unit along with anesthesiologist, cardiologist, intensivist and neonatologist. Her cardiovascular status was never compromised. She was started on torsemide and was discharged on 6th post-operative day. She followed up with cardiologist after 4 weeks postpartum for further management
Perinatal outcomes and hematologic parameters of neonates born to Rh-negative mothers with and without isoimmunization
Full text linkBackground: Rh isoimmunization remains a significant cause of neonatal morbidity and mortality in Rh-negative pregnancies. It causes hemolytic disease of the fetus and newborn (HDFN), leading to anemia, hyperbilirubinemia, and perinatal complications. This study compares hematologic parameters and perinatal outcomes of neonates born to Rh-negative mothers with and without isoimmunization.
Methods: This cross-sectional study was conducted at the Department of Obstetrics and Gynecology, Mymensingh Medical College Hospital, Bangladesh, from July 2019 to December 2019. Eighty Rh-negative pregnant women were enrolled, comprising five isoimmunised and seventy-five non-isoimmunised mothers. Data on neonatal haemoglobin, serum bilirubin, direct Coombs test results, Apgar scores, and treatment requirements were collected. Maternal factors were documented, including gravidity, antenatal care, and anti-D prophylaxis. Statistical analyses used SPSS version 25.0, with p-values <0.05 considered significant.
Results: Neonates of isoimmunised mothers had lower haemoglobin levels (mean <12 g/dl in 60% vs. 0%, p<0.001), elevated bilirubin ≥4 mg/dl (80% vs. 20%, p<0.001), and 100% direct Coombs test positivity compared to none in non-isoimmunised neonates. Phototherapy and exchange transfusion were required in 80% and 60% of isoimmunised neonates, significantly higher than the non-isoimmunised group. Poor Apgar scores (<6 at 5 minutes) were more frequent in isoimmunised neonates (40% vs. 12%). High gravidity, inadequate antenatal care, and absent anti-D prophylaxis were prevalent among isoimmunised mothers.
Conclusion: Rh isoimmunization markedly worsens neonatal hematologic and perinatal outcomes. Strengthened antenatal screening, universal anti-D prophylaxis, and enhanced neonatal care are critical to reducing HDFN burden in at-risk populations
Efficacy of levonorgestrel releasing intrauterine system in the treatment of symptomatic adenomyosis: comparison with dienogest
Full text linkBackground: Adenomyosis is a common, estrogen-dependent, chronic gynecological condition that often presents with dysmenorrhea, menorrhagia, and an enlarged uterus. This study aimed to evaluate and compare the effectiveness of the levonorgestrel-releasing intrauterine system (LNG-IUS) and oral dienogest in the management of symptomatic adenomyosis.
Methods: This randomized controlled trial was conducted in the department of reproductive endocrinology and infertility, Bangabandhu Sheikh Mujib medical university (BSMMU), Dhaka, Bangladesh, from April 2022 to March 2023. In this study, we included 32 women aged 25-45 years diagnosed with symptomatic adenomyosis (menorrhagia and dysmenorrhea) attending the outpatient department of reproductive endocrinology and infertility at BSMMU. Participants were assigned to two treatment groups: One group received LNG-IUS and other group received dienogest.
Results: Baseline demographic and clinical characteristics were similar between the groups. The LNG-IUS group showed a significantly greater reduction in menstrual pain at both 3 months (VAS 1.7±2.9 vs. 4.1±2.8) and 6 months (VAS 0.9±2.5 vs. 3.9±3.0) compared to the dienogest group (p<0.05). Uterine volume decreased more in the LNG-IUS group over time, but the differences were not statistically significant. Regular menstrual flow was significantly more common in the LNG-IUS group at both follow-ups, while heavy bleeding persisted in a notable portion of the dienogest group (p=0.004 and p=0.002, respectively). Hemoglobin levels improved significantly more in the LNG-IUS group by 6 months (100% vs. 57.14%; p=0.017). Although adverse effects were more frequently reported in the dienogest group, the difference was not statistically significant.
Conclusions: This study showed that LNG-IUS was more effective than oral dienogest in reducing pain, improving menstrual bleeding patterns, and increasing hemoglobin levels in women with symptomatic adenomyosis, with a lower incidence of side effects
Fetal outcomes of cord milking in term babies with meconium-stained amniotic fluid in a tertiary care centre: interventional type of study
Full text linkBackground: Umbilical cord milking (UCM) is proposed for increasing placental transfusion when immediate care for the newborn is needed enables blood to be directed into the baby more quickly than delayed cord clamping (DCC) at birth than waiting for this to happen physiologically. Any form of stress on the fetus and to mother can induce passage of meconium.6 Meconium-stained amniotic fluid results in increase the need of neonatal assistance, due to adverse outcomes such as respiratory distress, lower Apgar score, meconium aspiration syndrome and neonatal sepsis. From studies, it was observed that there was a gap in study of cord milking in term babies with MSAF. It was hypothesized that umbilical cord milking to be more beneficial that delayed as it can be performed more quickly, to babies with meconium-stained liquor requiring resuscitatory efforts. Therefore, a study was conducted to evaluate the maternal and fetal profile of term babies with meconium-stained liquor and their outcome on umbilical cord milking at the time of delivery.
Methods: A interventional type of study was conducted with a sample size of 200 labouring patients admitted in labour ward with gestational age between 37 to 42 weeks with meconium-stained amniotic fluid in Tertiary Care Centre. Details regarding patient’s demographics, detailed history of period of gestation, high risk factors, past history, patient’s entire obstetric history was noted. During delivery, if cord milking and clamping done was noted. Fetal wellbeing through APGAR score of baby, resuscitation required, hematocrit at 48 hours, DSPT required and their septic screening results; was evaluated.
Results: The present study was carried out on 200 labouring patients with meconium-stained amniotic fluid, admitted in labour ward in a tertiary health care centre. Baseline characteristics were comparable in both the groups. When we compared fetal profile in babies whose cord milking was done and in whom cord milking was not done, we observed that babies under UCM group, had better Apgar scores (at 1 min: 6.23 vs 5.77, p=0.0082) (at 5 min: 8.17 vs 7.36, p<0.0001), required less NICU admission, more hematocrit (53.58 vs 48.70, p<0.0001) and lower mortality (25% vs 75%) than non-milking group.
Conclusions: Meconium-stained amniotic fluid is worrisome as it is associated with increased frequency of operative delivery, neonatal sepsis and neonatal intensive care unit admissions which requires appropriate intrapartum care. UCM can be a used as a placental transfusion strategy in neonates with meconium-stained amniotic fluid, requiring resuscitation with some benefits and minimum adverse effects. It could be considered as an alternative for the current practice of delayed cord clamping
Pneumoperitoneum with peritonitis: an unseen, rare complication of postpartum caesarean uterine wound dehiscence
Full text linkPneumoperitoneum with peritonitis is very rare and life-threatening complication of post LSCS in postpartum period. Pneumoperitoneum is defined as presence of free air within the peritoneal cavity which can be associated with uterine scar dehiscence. We are presenting a case of pneumopyoperitoneum with uterine scar dehiscence on post operative day 6 of emergency LSCS which is successfully managed at our institution. A 22 years old female P1L1 with postoperative day 6 of emergency LSCS presented to labour room with chief complains of abdominal distension with pain abdomen since 1 day and on and off fever since 4 days with difficulty in breathing. On examination she was in septic shock. Her abdominal X-ray showed air under diaphragm. The abdominal CT scan showed moderate to gross pneumoperitoneum extending into endometrial cavity through full thickness defect involving anterior myometrium in lower uterine segment suggestive of uterine rupture and also endometrial and intraperitoneal collections with multiple air foci . Emergency laparotomy was done and air escaped out with hissing sound. All the pus with blood was drained. Margins of uterine caesarean site were freshened and sutured. Gut was explored, no perforation was present. Postoperative period was uneventful. Pneumoperitoneum associated with peritonitis is a grave cause of maternal morbidity and mortality. Hence high index of suspicion with proper investigation and treatment can reduce morbidity associated with this condition, leading to good future obstetric outcome of patient
Pregnancy outcomes in laterally implanted pregnancies: a case series
Full text linkLaterally implanted pregnancy refers to a pregnancy implanted in the upper lateral part of the uterine cavity medial to the uterotubal junction. It is a variation of a normal intrauterine pregnancy, requiring careful monitoring. This case series describes the clinical presentation, ultrasonographic features, and reproductive outcomes of eight patients diagnosed with laterally implanted pregnancy confirmed on 3D ultrasonography over two years from November 2021 to December 2023. Our findings highlight the importance of diligent follow-up due to the increased incidence of early pregnancy complications, including anembryonic pregnancy, missed abortion, and progression to partial interstitial pregnancy
Unmasking the hidden dangers in caesarean scar pregnancy: a case series
Full text linkCaesarean scar pregnancy (CSP) is a rare form of ectopic pregnancy with increasing incidence due to rising caesarean section rates. This case series aims to describe the clinical presentation, diagnostic approach, management, and outcomes of patients with caesarean scar pregnancies managed at our institution. This retrospective case series included eight patients diagnosed with caesarean scar pregnancy at Sri Ramachandra Institute of Higher Education and Research over a two-year period (January 2023–January 2025). Diagnosis was based on established ultrasonographic criteria. Clinical presentation, management strategies, and outcomes were analyzed. All patients had a history of prior caesarean deliveries. The majority presented with vaginal bleeding in early pregnancy, while one patient was diagnosed incidentally. Transvaginal ultrasound confirmed caesarean scar implantation in all cases. Management included systemic and intrasac methotrexate administration, ultrasound-guided suction evacuation, and uterine artery embolization in selected cases. Serial β-hCG monitoring guided treatment response. Fertility-preserving conservative management was successful in all patients without major complications. Early diagnosis and individualized conservative management can result in favourable outcomes in caesarean scar pregnancy. Increased awareness, early imaging, and careful monitoring are critical to prevent life-threatening complications and preserve reproductive potential. Further studies are needed to establish standardized treatment guidelines
Study the impact of short interpregnancy interval on pregnancy outcome: a case-control study
Full text linkBackground: The inter-pregnancy interval (IPI) refers to the period between the end of one pregnancy and the beginning of the next. It is a significant factor in maternal and neonatal health outcomes. It is typically defined as “the time span between a live birth and the conception/start of the next pregnancy”. The present study was undertaken to find an impact on the association of short interpregnancy intervals with adverse perinatal outcomes.
Methods: The present study was carried out as a case-control study. All pregnant females attending the department of obstetrics and gynecology, Era’s Lucknow Medical College and Hospital were enrolled in the study with short IPI versus normal IPI.
Results: Shorter interpregnancy gap was significantly associated with younger maternal age (15-25 years; RR 1.92), anemia in current pregnancy (RR=1.52), PROM (RR=15.33), birth weight <2.5 kg (RR=2.22). pregnancy complications like PROM, PIH and primary PPH were recorded in 13.8%, 1.7% and 1.7% women in current pregnancy.
Conclusions: Younger married women should be apprised of the need to maintain a reasonable interpregnancy gap as per national health mission guidelines in order to ensure a safe pregnancy and better pregnancy outcomes
Angioleiomyoma of uterine cervix – a common tumour at rare site
Full text linkAngioleiomyoma of the uterine cervix is a rare benign tumor of this site characterized by smooth muscle proliferation intermixed with prominent vascular structures. At cutaneous locations it presents as painful nodule however cervical angioleiomyoma clinically manifests with non-specific, mimicking other gynecological conditions such as fibroids or adenomyosis. No specific clinical or radiological features are noted hence histopathology remains the gold standard for diagnosis and sometimes immunohistochemistry is helpful in confirming smooth muscle origin. This case report details a case of uterine cervical angioleiomyoma in a 45-year-old woman presenting with abnormal excess uterine bleeding and pelvic pain. On radiology a diagnosis of cervical fibroid polyp was rendered. Following which surgical excision of the mass revealed the diagnosis, confirmed by histopathological and IHC evaluation. While angioleiomyoma is rare at this site may mimic benign or vascular tumors clinically or even microscopically. Hence correct and timely diagnosis is essential for appropriate clinical management
Knowledge of family planning among muslim women of reproductive age in Garissa County
Full text linkBackground: Kenya’s unmet need for family planning (FP) remains high, at 13.9%, despite government efforts to promote FP methods. Challenges persist, especially in rural areas like Garissa County, where contraceptive prevalence is low, at 12.7%. To determine the level of knowledge of FP among Muslim women of reproductive age in Garissa county.
Methods: A cross-sectional mixed methods research design focused on Muslim women aged 15-49 in Garissa County. The study involved 187 participants selected through stratified random sampling. A proportionate sample of women was calculated per subcounty. Data collection used semi-structured interviews with selected women and focus group discussions with community health volunteers from seven subcounties. Quantitative data were analyzed using the Statistical Package for Social Sciences through descriptive analysis. Qualitative data was analysed thematically.
Results: Eighty-two percent of women were aware of FP, mainly through community health workers (66%). Only 44% attended FP workshops, showing limited interest in education; additionally, only 39% practiced FP. Among those who used FP, 56% had husbands unaware of their usage.
Conclusions: There was knowledge of contraceptives and FP methods, largely due to information shared by community health workers and volunteers. Friends and media also spread FP awareness. However, attendance at FP workshops was low and actual use of FP methods was limited. About half of the women's partners were also aware of and supportive of FP