International Journal of Reproduction, Contraception, Obstetrics and Gynecology

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ISSN / EISSN : 2320-1770 / 2320-1789
Published by: Medip Academy (10.18203)
Total articles ≅ 7,273
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Shalini Vasudeva, Dhaval A. Baxi, Ambarish Mishra
International Journal of Reproduction, Contraception, Obstetrics and Gynecology; https://doi.org/10.18203/2320-1770.ijrcog20222078

Abstract:
Background: Postmenopausal bleeding (PMB) is considered a red flag symptom and warrants further examination and evaluation. Trans-vaginalsonography (TVS) can be used reliably to diagnose fibroids, polyps and thickened endometrium. Hysteroscopy is considered “gold standard” for evaluating endometrial cavity. It provides direct visualization of endometrial cavity. It can have both diagnostic as well as operative purpose however, it is not cost effective, an invasive procedure and requires anesthesia and expertise. Present study was designed and carried out to study aetiology and prevalence of PMB in Central India as well as to evaluate the efficacy of TVS and hysteroscopy in diagnosis of different endometrial pathologies in patients with PMB. Methods: This prospective study included 82 post-menopausal women with PMB who attended the gynaecological clinic from December, 2019 to December, 2020 at Motherhood hospital, Indore, India after ethical clearance. A detailed history, examination followed by transvaginal sonography was made. Hysteroscopy was then performed, and biopsy was obtained in all patients. Hysteroscopic and sonographic images were then analyzed and conformed with the histopathologic diagnosis. Results: Most common endometrial pathology was atrophic endometrium followed by endometrial polyp and hyperplasia. Endometrial carcinoma was observed in (3.66%) females. Other findings in cases of secretory, proliferative endometrium and endometritis accounted for 6.09%. The diagnostic accuracy of ET by TVS at a cut-off point of 5 mm was 94% with sensitivity 89.3%, specificity 100%, PPV 100% and NPV 88%. The diagnostic accuracy of hysteroscopy was 98% with sensitivity 96.4%, specificity 100%, PPV 100% and NPV 95.7%. Conclusions: TVS with ET measurement should first line investigation in the evaluation of women with PMB with suspected endometrial pathology because of cost effectiveness, easy accessibility and non-invasive method of diagnosis. Although hysteroscopy is more specific and sensitive, in poor resource settings it should be limited to cases with illdefined endometrial lining, recurrent/ persistent bleeding and cases with endometrial thickness greater than 5 mm irrespective of endometrial echotexture.
Sayeda Niger Sultana, Afrin Akter Sony, Moriam Pervin, M. A. Hamid
International Journal of Reproduction, Contraception, Obstetrics and Gynecology; https://doi.org/10.18203/2320-1770.ijrcog20222055

Abstract:
 Background: Hysterectomy is the most common gynaecological procedure performed. Abdominal hysterectomy remains the most common approach though recently there has been preference towards laparoscopic hysterectomy. It is still considered as the treatment of choice for benign lesion such as leiomyoma, adenomyosis, extensive pelvic infection or adhesions, dysfunctional uterine bleeding and obstetric complications. Objectives were to correlate the indications of abdominal hysterectomy to histopathological findings thus, determining histologically confirmed preoperative clinical diagnosis.Methods: This study was conducted at the department of obstetrics and gynaecology, Bangabandhu Sheikh Mujib medical university, Dhaka from August 2010 to January 2011. This is a descriptive analysis of the patients who had undergone abdominal hysterectomy during the study period.Results: One hundred patients undergoing abdominal hysterectomy were studied. Data were recorded on structured proforma, including demographic characteristics, clinical features and indications of the procedure. In. our study, it was observed that the most common clinical diagnosis was leiomyoma of uterus 52 (52%). Other clinical diagnosis was DUB in 30 cases (30%), adenomyosis in 7 cases (7%), endometriosis in 6 cases (6%). Pelvic inflammatory disease in 3 cases (3%), endometrial polyp (2%). Abdominal hysterectomy was the single approach done in these cases. Clinical, radiological as well as histopathology report correlated uterine leiomyoma very well and it was about 94.23%, while DUB was a disease of exclusion. In 53 cases combined pathology was found.Conclusions: Hysterectomy is currently the most widely performed major operation in gynaecology and histopathology is mandatory for ensuring diagnosis and management. With the improvement in the different organ preserving options, hysterectomy in benign disease should only be opted when all the other conservative options failure.
Esraa B. Elsadany, Shereef L. Elshwaikh, Hesham M. Borg, Nagwa M. Alghorab
International Journal of Reproduction, Contraception, Obstetrics and Gynecology; https://doi.org/10.18203/2320-1770.ijrcog20222080

Abstract:
Background: Vitamin D3 (VD3), a seco-steroid that is synthesized in skin and sequentially metabolized in liver and kidneys in humans, has been well-known for its function in maintaining calcium and phosphorus homeostasis and promoting bone mineralization. Polycystic ovary syndrome (PCOS) is a common cause of ovarian dysfunction in women with anovulation. Aim of this study is to show and evaluate VD3 level in women who are suffering from polycystic ovarian syndrome. Methods: This study was conducted on 200 women; group A: (study group) 100 infertile women who were suffering from PCOS and group B: (control group) 100 patients were selected with other cause of infertility than PCOS. US examination, hormonal profile (FSH, LH, AMH, TSH and prolactin level) and laboratory assay of serum VD3 level (postmenstrual) were done for every patient to evaluate relationship between VD3 deficiency and PCOS patients. Results: There was a significant relationship between group A compared to group B as regards irregular menstrual cycle, clinical hyperandrogenism, LH/FSH ratio and AMH. There was no significant difference between both groups as regards TSH, prolactin and VD3 level. VD was deficient in both groups as it was lower than normal level. There was a negative significant correlation between VD3 level and both hyperandrogenism and AMH. Conclusions: There was VD3 deficiency in PCO patients and infertile cases due to another factor, and negative significant correlation between VD3 level and clinical hyperandrogenism, LH/FSH ratio, menstrual cycle and AMH.
Adhi Pribadi
International Journal of Reproduction, Contraception, Obstetrics and Gynecology, Volume 11, pp 2301-2305; https://doi.org/10.18203/2320-1770.ijrcog20221960

Abstract:
Congenital abnormalities are a nightmare for a pregnant woman. However, congenital abnormalities are divided into several conditions. The state of major disability is the worst situation, with the possibility of disability and even postpartum death. The disability is still a pregnancy that can cause complications that have a bad effect on the mother, so the pregnancy is often induced labor for fear of endangering the mother even though the complications have not yet appeared. In addition, it often happens because the family refuses the presence of a child with a disability. Criteria and references for intrauterine anomalies have been made by various countries and organizations, with the treatment taking into account clinical, psychosocial, religious, and legal aspects. However, this reference is not always easy to implement due to various factors, so that the decision to induced labor or induced abortion is always based on the advice of the medical team and family approval without leaving the legal aspect. Parental consent is important because not all pregnant women agree to induced labor of pregnancy even though it is a major disability and threatens postpartum death. On the other hand, if the defect can be corrected, then a clinician must be able to maintain the pregnancy and refuse unnecessary attempts to terminate the pregnancy.
International Journal of Reproduction, Contraception, Obstetrics and Gynecology, Volume 11, pp 2306-2314; https://doi.org/10.18203/2320-1770.ijrcog20221961

Abstract:
Same-sex civil union, marriage, adoption and access to assisted reproduction have progressively been more accepted worldwide. However, many differences exist in national legislation regarding the matter. This work is a review of current national policies of 31 European countries, including all the European Union, Iceland, Norway, Switzerland and the United Kingdom. At the moment, many European countries recognize same-sex civil unions, marriage and adoption, as well as the access of single women and lesbian couples to assisted reproduction, specially the northern and western countries. However, there is still an important number of countries where there is no official recognition of gay partnerships and adoption, and fertility treatments are exclusive to heterosexual couples. In addition, given the need to surrogacy, male couples have quite limited options concerning assisted reproduction in Europe. Europe is progressively allowing same-sex couples to legalize their relationship and to open adoption and assisted reproduction to everyone, regardless of gender, sexual orientation or marital status.
Zeba H. Pathan, Niranjan N. Chavan, Shreya Kampoowale, Akanksha Barkase, Deepali S. Kapote, Ashwini S. Sakhalkar
International Journal of Reproduction, Contraception, Obstetrics and Gynecology, Volume 11, pp 2297-2300; https://doi.org/10.18203/2320-1770.ijrcog20221959

Abstract:
Mullerian duct anomalies (MDAs) are congenital defects of the female genital system that arise from abnormal embryological development of the Mullerian ducts. A didelphys uterus, also known as a double uterus, is one of the least common amongst the MDAs. This report discussed a case of pregnancy with uterus didelphys. This patient was a 27-year-old primigravida with 34.2-week gestation with spontaneous conception who presented with decreased fetal movements. On examination patient had a non-communicating, thick vaginal septum extending from the introitus to the cervix was seen and two cervices one on each side of the septum were located. The patient underwent emergency lower segment caesarean section in view of foetal distress and doppler changes. Intra-operatively, evidence of didelphys uteri was seen. Intraoperative and post-operative period was uneventful. A fetus of 1790 gram was delivered, with APGAR 9/10. There were no renal anomalies on subsequent ultrasonography.
Abhilasha N. Tomar, Vaibhav N. Nadkarni, Jigna S. Garasia, Purnima K. Nadkarni
International Journal of Reproduction, Contraception, Obstetrics and Gynecology, Volume 11, pp 2122-2126; https://doi.org/10.18203/2320-1770.ijrcog20221922

Abstract:
Background: The role of late follicular serum estradiol monitoring in artificial FET cycles remain unclear. The purpose of this study was to evaluate the correlation between serum estradiol levels on the day of starting progesterone supplementation with clinical pregnancy rates in FET cycle. Methods: This was a non-interventional observational cohort study of patients undergoing ICSI followed by FET at Nadkarni hospital and test tube baby center, Killa-Pardi, Gujarat during the period of January 2021 to May 2021. Total 64 cycles were studied and serum estradiol levels were analyzed on the day of starting progesterone supplementation. They were divided into 3 groups based on serum E2 levels (0-25th centile, 25th-75th centile and >75th centile). Chi square/Fisher exact test were used to compare the clinical pregnancy and implantation rates between these groups. Results: Clinical pregnancy and implantation rates in group A, B and C were 68.8%, 78.1%, 75% and 36.98±9.06, 32.03±4.48 and 29.69±5.69 respectively. Conclusions: Serum estradiol levels before progesterone supplementation in FET cycles do not predict the outcome of FET cycle therefore making routine monitoring of serum estradiol in FET cycle of questionable value.
Showri R., Rajini T.
International Journal of Reproduction, Contraception, Obstetrics and Gynecology, Volume 11, pp 2106-2111; https://doi.org/10.18203/2320-1770.ijrcog20221919

Abstract:
Background: Polycystic ovary syndrome (PCOS) is a multifactorial endocrine disorder with metabolic and reproductive consequences. Genomic damage and susceptibility to cancer are noteworthy concerns in PCOS. Relationship between PCOS and endometrial and ovarian cancer has already been established. The presence of high body mass index, excess triglycerides, oxidative stress and occurrence of metabolic syndrome is a frequent occurrence in PCOS. This may succeed into genetic damage and susceptibility to cervical cancer as they are also known risk factors of the same. The aim of the study was to estimate the frequency of micronuclei in cervical smear and to determine if it can be used as a biomarker of genomic instability and susceptibility to cervical changes in the future in PCOS. Methods: This observational case control study included 38 subjects diagnosed with PCOS by Rotterdam’s criteria and 38 controls and was conducted between September 2018 to March 2020 in VIMS and RC. Data regarding age and anthropometric details and cervical smear samples was collected from all the subjects. The frequency of micronuclei in cervical smears was expressed as mean±standard deviation (SD). Differences between the PCOS group and the control group were examined for statistical significance using two-sample independent t-test. A p value of ≤0.05 denoted statistically signifi­cant difference. Results: The mean±SD of micronuclei frequencies in cervical smears was observed to be 1.69±0.69 and 0.33±0.18 (p value <0.0001) in the subjects with PCOS and control group, respectively. Conclusions: Micronuclei frequency was found to be elevated in cervical smears of women with PCOS when compared to controls indicating genetic instability and probable susceptibility to cervical cancer in the future in women with PCOS.
Mouhamadou Wade, Mamour Gueye, Aissatou Mbodji, Mame Diarra Ndiaye, Ababacar Niakhana Fall, Mouhamet Sene, Pahté Sow, Daouda Adama Diallo, Mouhamadou Nazir Sylla, Magatte Mbaye
International Journal of Reproduction, Contraception, Obstetrics and Gynecology, Volume 11, pp 2076-2082; https://doi.org/10.18203/2320-1770.ijrcog20221916

Abstract:
Background: For a lot of women, childbirth is still a feared moment. Despite considerable progress in the management of childbirth and its complications, maternal and neonatal morbidity and mortality are still a major problem even in developed countries. To evaluate the influence of day of delivery on obstetrical and perinatal outcome. Methods: Retrospective cohort study conducted at the Philippe Maguilen SENGHOR health center maternity ward from January 1, 2011 to June 30, 2019, on patients with a pregnancy of more than 22 weeks of amenorrhea who were received for delivery management. The deliveries periods were divided according to whether they occurred on a working day (deliveries from Monday to Friday, excluding public holidays) or on weekends and public holidays (deliveries on Saturdays, Sundays and days declared as public holidays according to the Gregorian and Senegalese event calendars). The data were extracted from our E-perinatal database and analysed in the Statistical Package for Social Science (SPSS 24, Mac version). Results: Over 102 months, we recorded 42 870 deliveries. The average age of the patients was 27 years with extremes of 13 and 50 years. Nearly one in three deliveries took place on a holiday or weekend (n=13566-31.6%). The rate of caesarean delivery on weekends/holidays (18.8%) was lower than that on weekdays (21%). The odds ratio of having/benefiting from a weekend/holiday caesarean section was 0.87 (CI 0.83-0.92, p<0.0001). Our results suggest that patients who deliver on weekdays are more likely to receive a caesarean section than those who deliver on weekends or holidays. Perineal injury, World Health Organization obstetric complications, and neonatal outcome showed no significant difference by day of delivery. Conclusions: Our results contradict the idea that deliveries on weekends and holidays are more risky for patients and their children.
Smriti Rekha Saikia
International Journal of Reproduction, Contraception, Obstetrics and Gynecology, Volume 11, pp 2285-2286; https://doi.org/10.18203/2320-1770.ijrcog20221956

Abstract:
Reproductive outcome and pregnancy rates are relatively challenging in women with uterine anomalies. Pregnancies in bicornuate uterus are considered as high-risk pregnancies which requires adequate antenatal screening and early diagnosis to prevent complications. Many cases remain asymptomatic but in later age during pregnancy it leads to severe complications.
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