A case control study to elicit fetal outcome in high-risk pregnancies and to study the various maternal parameters associated with fetal outcomes

Background: High risk pregnancies (HRP) threaten the health or life of the mother or her fetus. Perinatal mortality varies widely in some developed countries and more than 10 times higher in developing countries. For most women, early and regular prenatal care promotes a healthy pregnancy and delivery without complication. Methods: It is a prospective study conducted in BMC, Sagar of duration one year, keeping in mind the inclusion and exclusion criteria with 216 (108 control and 108 cases) patients included in our study. Results: study shows that there is a significantly high incidence of IUGR delivery and preterm delivery in HRP as compared to control. Conclusions: In our study we conclude that there is a high correlation between HRP and poor perinatal outcome thus identifying HRP is important because it is the first step towards prevention perinatal mortality and morbidity

Pre-conception and pre-natal diagnostic techniques act-draconian or a considerate de jure tamer

Principles of gender equity are an integral part of constitution. The constitution confers equal rights and opportunities on women; bars discrimination on the basis of sex and denounces practices derogatory to the dignity of women. In spite of this, discrimination against women and girls is almost universal. Forced abortions of female foetuses and prenatal sex determination results in millions of girls not being allowed to be born just because they are girls. Pre-conception and pre-natal diagnostic techniques (PC and PNDT) act were enacted in 1994, amended and effectively implemented in 2003 and strictly amended in 2011, to curb this heinous crime of female foeticide that was taking place due to prenatal diagnostic techniques for determination of the sex of the foetus and thus, to balance the disturbed sex ratio of the country. To achieve the said purposes, the act imposes penalties for the offences committed under this Act, including clerical errors. However, according to the radiologists, the PC and PNDT act has become draconian for all practicing sonologists and radiologists instead of serving the purpose of saving the girl child. This article, explaining the provisions of PC and PNDT act, addresses the concerns of sonologists and radiologists in the light of the judgements passed by Hon’ble Supreme Court of India. It further discusses the hindrances occurring in the usage of evolved medical technology due to the provisions of the Act thereby paving way towards a much-needed legitimate decision to settle the ongoing country-wide debate

Menstrual product choice and the extent of period poverty among young adult females: findings from a cross-sectional study in Kerala, India

Background: In Kerala state, India, while there is higher coverage of hygienic methods for menstrual protection among young women, empirical evidence on menstrual hygiene management is limited. This study aims to present menstrual hygiene product choices and the extent of period poverty among young adult females in Kerala. Methods: A cross-sectional study was conducted in Kerala using a web-based Google form. Data were collected on menstrual product usage, perceptions and attitudes towards menstruation, awareness and use of government initiatives for menstrual hygiene management, perspectives on better management, period poverty, and associated factors. Results: The mean age of respondents was 21.7 years (SD±2.0). Cultural beliefs hindered the choice of menstrual products. Period poverty was reported by 25.5% of respondents, with higher rates among younger, lower social category, and unemployed individuals. Lower income and negative attitudes towards menstruation were significantly associated with higher period poverty. Conclusions: There is a need for free menstrual products for the financially disadvantaged. Further research is necessary to gain a comprehensive understanding of period poverty in this community

Proteinuria assessment in preeclampsia: a comparative study

Background: Preeclampsia, a severe pregnancy-related hypertensive disorder, presents substantial maternal and fetal health risks. Accurate proteinuria assessment is crucial but traditional methods are cumbersome and error-prone. This study compares the spot urinary protein/creatinine ratio with 24-hour urine collection for proteinuria estimation in preeclampsia at Kamla Nehru State Hospital for Mother and Child. Methods: A cross-sectional study with 90 eligible pregnant women collected comprehensive medical data. Both spot urinary protein/creatinine ratios and 24-hour urine collections were analyzed. Strong correlation (r=0.942, p<0.0001) was observed. Results: Spot urinary protein/creatinine ratio demonstrated moderate diagnostic accuracy (AUC=0.3). Sensitivity was 100%, specificity 87.9%, with PPV and NPV at 90.4% and 92%, confirming its clinical utility for proteinuria diagnosis. Conclusions: This study validates the spot urinary protein/creatinine ratio as an efficient method for proteinuria assessment in preeclampsia, with a strong correlation and high diagnostic value. Widespread adoption has the potential to expedite diagnosis, enhance outpatient care, and improve outcomes for preeclampsia patients, addressing a crucial healthcare challenge in maternal and fetal health

Dehydroepiandrosterone supplementation improves reproductive outcomes in women of the POSEIDON IV group

Background: The decrease in ovarian reserve has become one of the main causes of infertility. Recent studies have sought to improve the reproductive outcomes of these women through adjuvant treatments. In patients undergoing assisted reproduction treatments, exogenous Dehydroepiandrosterone (DHEA) or prasterone acts as a precursor to testosterone in the follicular fluid, which increases steroidogenesis and the number of primary and antral follicles. Methods: A quantitative, quasi-experimental case series study was carried out in the clinical area of assisted reproduction from August 2021 to March 2022. All women included were over 34 years and categorized as POSEIDON IV. They were supplemented with 100 mg of DHEA one month prior to the follicular capture. Data was collected from the records of the patients who met the inclusion criteria, including the antral follicle count on the first three days of the menstrual period before the supplementation and one month after. Finally, the number of metaphase II oocytes and blastocysts obtained were analyzed. Results: There were 22 women underwent controlled ovarian stimulation; there was a difference in antral follicle count from 5±2.1 SD to 8.23​±4.29 SD (p=0.004) and MII oocytes 3.25±2.31 to 4.53±3.27 (p=0.04) before DHEA and after DHEA, respectively. Conclusions: DHEA or prasterone supplementation can be used as an adjuvant treatment in women of the POSEIDON IV group one month before the ovarian stimulation to improve their reproductive outcome

Adult granulosa tumor of the ovary about a case

Granulosa tumors are rare tumors of the ovary (0.6 to 3%). They belong to the group of mesenchymal and sex cord tumors, and represent more than 70% of malignant tumors in this group and 5% of ovarian cancers. They present two histological forms: the juvenile form and the adult form, the most common, occurring mainly in women in the post-menopausal period. The solido-cystic appearance of these tumors is generally non-specific and the histological diagnosis can be confirmed by immunohistochemistry. Surgery remains the basis of treatment and must be extensive in elderly patients. The prognosis depends on the histological type and several parameters. We report the observation of a 53-year-old patient without known risk factors, who presented with a granulosa tumor of the left ovary diagnosed postoperatively. The epidemiological, clinical and therapeutic aspects are discussed

Evaluating the efficacy of Dfrag tablets on human sperm DNA fragmentation - insights from a prospective clinical study

Background: Infertility affects approximately 8-10% of couples worldwide. Sperm deoxyribonucleic acid (DNA) fragmentation index (DFI) has emerged as a significant factor in infertility research, highlighting its importance in understanding reproductive health. Methods: This prospective clinical study aimed to assess the impact of Dfrag® tablets, a unique nutraceutical combination containing vitamin D3 (600 IU), selenomethionine (40 mcg), coenzyme Q10 (100 mg), and astaxanthin (8 mg), on high sperm DFI over a 3-month period. The study utilized the sperm chromatin dispersion test (SCD) to measure DFI and examined semen parameters before and after the intervention. Results: Dfrag® tablets were found to significantly improve semen volume, total sperm count, sperm concentration, and progressive motility within the 3-month treatment period. The study reported an average reduction of 36% in DNA fragmentation levels post-treatment with Dfrag® tablets. However, no significant changes were observed in total motility or sperm morphology. Conclusions: This study demonstrates the potential of Dfrag® tablets in reducing sperm DNA fragmentation and improving key semen parameters associated with fertility.

A study of fetomaternal outcome in pregnancy beyond expected date of delivery in obstetrics and gynaecology department of a tertiary health care center of South Gujarat

Background:  Post-dated pregnancy is that extends beyond 40 weeks plus one or more days (anytime past the estimated due date). Mother and the foetus are at increased risk of adverse events when the pregnancy continues beyond the expected date of delivery (EDD). Method: This prospective observational study was conducted at obstetrics and gynaecology department of tertiary care centre of South Gujarat for 1 year period after official approval from human research ethical committee. Results: In our study total 200 postdated pregnant women included. Majority i.e. 134 (67%) patients had delivered as normal vaginally, whereas 68 (34%) patients required caesarean section. The most common indication for cesarean section was meconium-stained liquor (42.6%, n=68) follow by fetal distress, 2nd stage CPD, non-progress of labor, failure of induction etc. Altogether 19 newborn need NICU admission for different complication of which the most common neonate’s complication was perinatal asphyxia followed by meconium aspiration syndrome and RDS and only one neonate had early neonate death (END) due to RDS.   Conclusions: In pregnancies beyond 40 weeks, timely confirmed of postdated pregnancy, effective fetal monitoring and timely induction and with proper intervention could preclude the adverse feto-maternal outcome

Silent ovarian ectopic pregnancy: a case report

In clinical practice, an ovarian pregnancy is considered one of the most challenging diagnoses faced by an obstetrician/gynecologist. In this article, we report a 31-year-old Asian-Pakistani female, who presented to the ObsGynae clinic with 8 weeks of amenorrhea, a positive urine pregnancy test, and very high serum β-hCG levels. Transvaginal ultrasonography ruled out a tubal pregnancy, and the patient was sent for repeat β-hCG levels. The patient was hemodynamically stable and displayed no characteristic signs and symptoms of an ectopic pregnancy. Upon repeat scans and β-hCG levels, a diagnosis of ovarian ectopic pregnancy was made. The patient was managed on medication; a single dose of I/M 50 mg/m2 methotrexate was administered and the resultant decline in β-hCG levels proved the success of conservative treatment in this case. An ovarian ectopic can present as a life-threatening condition, and a high index of suspicion can prevent morbidity as well as mortality. Ovarian pregnancy, without any alarming signs despite very high β-hCG levels, as reported in this case, is one of the rarest clinical cases observed

The study of fetomaternal outcome in second stage caesarean section

Background: Caesarean section is commonly perceived as a simple alternative to difficult vaginal birth and in the recent years its prevalence during the second stage is increasing. Caesarean section in second stage of labor has additional associated risks for the mother such as obstetric hemorrhage, extended uterine tear, bladder injury and longer hospital stay. It is also associated with increased neonatal morbidity in terms of NICU admissions, fetal acidemia, hypoxemia and prolonged NICU stay. This study was conducted to know the indications of second stage caesarean section and to assess maternal and neonatal outcomes in second stage caesarean section. Methods: We conducted a prospective observational study conducted at a tertiary perinatal care center from August 2021 to August 2022. All second stage caesarean sections performed during this period were analyzed in terms of indication for caesarean section, intraoperative, postoperative complications and fetal outcomes. Results: During the study period there were a total of 10433 deliveries. Out of this, 5392 deliveries done by caesarean section, in which 67 were second stage caesarean section. Deep transverse arrest was the most common indication for caesarean section in second stage of labor. Most common intra operative complication was uterine atony, seen in 32.5% cases. 16 (24%) NICU admission were noted with respiratory distress being the most common indication. 15 (23%) had post operative complications like febrile illness. Conclusions: Second stage caesarean section is associated with significant maternal and neonatal morbidity. A skilled obstetrician and proper training are required to take appropriate decisions for caesarean section at full dilatation of cervix