Determination of caesarean section rate and its trend analysis in a tertiary care tribal preponderant state using Robson’s classification

Background: There are certain conditions during delivery where vaginal delivery becomes unsafe. To overcome this situation, caesarean section (CS) is necessary for the safety of the mother and baby. The incidence of CS is rising to improve the outcome of mother and baby; it is a life-saving surgical tool in the process of delivering the baby. Efforts are being made to decrease the rate of CS without adversely affecting the outcome of the mother and baby. Robson’s classification for the indication of CS is an excellent method to audit for the indication of the surgery. However, this classification does not include some important indications like placenta previa, which is on the rise in the present day. Methods: This study was a hospital-based prospective observational study that enrolled 2066 pregnant females, conducted from October 2023 to September 2024 in a tertiary health centre. Results: Delivery by vaginal route and CS was 4561 during one year period, 2066 women was delivered by CS accounting an incidence of 45.29%. The majority of patients were in the age group of 20-30 years (75.9%), 82.1% were from rural areas, and the majority of women were unbooked (70%), 57.4% were multiparous, and 51.3% of the patients belonged to the tribal community. Conclusions: Standardisation of CS indication parameters, regular CS audits, and application of Robson classification for every woman undergoing a CS will be helpful to keep a check on rising CS rates

Human semen profile and mobile telephony: an original research study

Background: Mobile telephony is recent phenomenon; it functions based on electro-magnetic radiation (EMR). It has revolutionized the telephonic communication system. Major population of world is using mobile telephony with android mobile handsets. Mobile users are rapidly increasing every day. Researchers show that Electro- Magnetic Radiation affects the human health and causes tumour, cancer and other diseases. This has also been reported that mobile telephony affects the reproductive health too. But some researchers claimed that mobile telephony does not affect human health. Therefore, this study was planned in male human volunteers to assess the possible effects of mobile telephony on semen profile. Methods: Eighty-two human male volunteers consented for our research study.  Their mobile phone placing, using hour/day was recorded and these volunteers were placed in three Groups A, B and C (exposure of mobile telephony was 3-4 hours, 5-6 hours and 7-8 hours respectively and approximately). Results: Semen analysis was done using WHO method manual in our infertility research centre, Bengaluru, India. Semen analysis of these volunteers shows that decline in sperm density, motility (quantitatively and qualitatively) and enhanced percentage of abnormal sperm. It appears to be associated with duration exposure dependant. Conclusions: In conclusion, we may say that sub-fertility in human male may be associated with the use of mobile telephony along with other factors. Further research studies are needed to ascertain the possible effects of mobile telephony on human male reproductive health

Various birthing positions and their effects on fetomaternal outcome during labour: a comprehensive review

Labour and delivery are major challenges globally, especially in developing countries. Labouring women should be allowed to choose their preferred positions and avoid staying in supine position for prolong periods as per WHO recommendation. However, studies indicate that most of the women still give birth in a lying or semi-sitting position. This research focuses on determining the most effective birthing positions than the supine one and empowering women to select the most comfortable posture during labour. We have searched a thorough electronic database, including Google Scholar, PubMed, and the Cochrane Library, using key terms such as "labour positions", “alternate birthing positions” and "fetomaternal outcomes." After applying inclusion and exclusion criteria, we integrated total 41 studies into this review. Upright positions, birth stool, birth chair, squatting and peanut ball positions improve labour outcomes for both mother and fetus compared to supine or lithotomy positions, but may increase risk of perineal laceration, episiotomy rate and blood losses in mother. Birthing and Swiss balls have a positive effect on feto-maternal outcomes, although they may not be suitable for all women. Semi-sitting and lateral positions have mixed effects. Whereas Water birth benefits the mother but may result in lower fetal Apgar score. Many women still deliver in traditional lithotomy or semi-recumbent positions in developing countries despite the benefits of different alternative birthing positions. Health systems must adopt policies to support these positions and integrate them into midwifery education, with ongoing research to evaluate their effects and address barriers to implementation

Parturients' opinions on the quality of delivery care in the obstetrics and gynecology department: case of the municipal medical center of Coronthie-Conakry

Background: In Africa, childbirth care depends on routine practices to the detriment of quality. The aim of this study was to analyze parturients' opinions on the quality of childbirth care offered at the Coronthie Community Medical Center (CMC). Methods: The study was carried out at the CMC of Coronthie. It was a cross-sectional, descriptive study lasting 6 months from 01 July to 31 December 2021. The study included parturients with a term ≥28 SA, and excluded those with a term <28 SA, or who refused to participate. Results: The mean age of parturients was 28.60±5 years. Most parturients (89.76%) were married women with secondary education (35.08%). The majority of parturients (59.86%) had given birth by caesarean section. No maternal deaths were recorded, and the neonatal mortality rate was 20/1000. Parturients (43.36%) were referred to the service. Over 2/3 of patients (76.03%) said that staff were competent and available. Most patients (86.49%) felt their privacy had been respected, while 2.18% said the opposite. The majority were satisfied with the overall care provided. To improve the quality of care. 54.98% suggested improving the ownership of the premises and 21% the behaviour of the staff. Conclusions: Improving ownership of premises and staff behaviour would help to improve quality

Evaluation of stillbirths: an epidemiological study over a 10-year period in Senegal

Background: The main objective of this study was to analyse a series of foetal deaths from an epidemiological, clinical and aetiological point of view. Methods: This study was performed over a period of ten (10) years, from 1 January 2014 to 31 December 2023. Our study included all patients who had delivered a stillbirth in our department after twenty-eight (28) weeks of amenorrhoea. The CODAC (causes of death and associated conditions) classification was then used to identify the principal aetiological groups. All data were analysed first in Microsoft Excel 2016 and then using the Statistical Package for Social Science (SPSS 26, Mac version). Results: Over 10 years, we recorded 1812 cases of stillbirth out of a total of 60794 deliveries, representing a frequency of 2.9%. The average age of the patients was 28 years, with a mean gestite of 1.97. Artificial induction of labour was performed in 20.9% of cases. The most common maternal pathologies were, in order of frequency, retroplacental haematoma, maternal obesity and gestational diabetes. A caesarean section was performed in 26.7% of cases. The average birth weight was 1916 g. Using the CODAC classification, the most common causes were maternal, followed by placental anomalies. No cause was found in 35.4% of cases. Conclusions: Our results reveal several challenges for improving the management of foetal deaths. It is crucial to strengthen diagnostic capacities, particularly through foetal autopsies and histological examinations of the placenta, and to train healthcare professionals in post-mortem investigation techniques

Estimation of vitamin D levels in low risk and high risk pregnancy and to evaluate maternal and neonatal outcome

Background: Vitamin D is linked with various physiological processes involving multiple organ systems and its deficiency is associated with pregnancy complication like pre-eclampsia, gestational diabetes mellitus, preterm delivery and low birth weight babies. The objective of this study was to estimate vitamin D levels in both low risk and high risk pregnant women and to correlate with the maternal and neonatal outcome. Methods: This was a prospective case control study from December 2020 to June 2022 at M. S. Ramaiah Medical College and Hospital, Bengaluru. All pregnant women between 28 weeks and 40 weeks of gestation were included in the study. Enzyme-linked immunosorbent assay (ELISA) method was used for quantitative determination of 25 hydroxy vitamin D in serum of all pregnant women. Results: A total of 166 pregnant women were included in the study, of which 81 subjects were high risk and 85 pregnant women were low risk. The mean vitamin D levels was 19.96 ng/ml in high risk group and 26.8 ng/ml in low risk group and this was statistically significant. In high risk group 23.45% were deficient and in low risk group 12.94% were deficient which was significant. The neonatal birth weight and serum vitamin D levels showed a strong correlation in low risk group as compared to the high risk group. Conclusions: Vitamin D deficiency or insufficiency in pregnancy can lead to complications in both mother and fetus. Estimation of vitamin D levels in pregnancy and supplementation can lead to healthy baby and healthy mother

Evaluation of PALM - COEIN classification and management of abnormal uterine bleeding in peri-menopausal age group

Background: 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

Effect of Elagolix in comparison to Dienogest in the treatment of symptomatic adenomyosis

Background: Adenomyosis, a benign gynecological disorder, is diagnosed with increasing frequency in infertile patients since women delay their first pregnancy. Common symptoms of adenomyosis are dysmenorrhea and heavy menstrual bleeding (HMB), resulting in poor quality of life. Elagolix, the oral GnRH antagonist, acts by reducing the occurrence of ectopic endometrial implants in the myometrium. It diminishes uterine volume, reduces dysmenorrhea and heavy bleeding, and improves fertility outcomes. Dienogest, a synthetic oral progestin highly selective for progesterone receptors, reduces the painful symptoms in women with adenomyosis. The aim or this study was to compare the effect of Elagolix with Dienogest in the treatment 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, from January 2024 to December 2024. A total of 58 participants with symptomatic adenomyosis were randomly assigned to 2 groups (n=29). Each group received either Elagolix (200 mg) or Dienogest (2 mg) once daily for 3 months. Results: Compared between the two groups, post-treatment mean changes of VAS score (6.25±1.83 vs 4.84±1.56), hemoglobin (-1.21±0.97 vs-0.20±0.56), and median uterine volume (5.1 vs 1.2) were significantly higher in the Elagolix group than the Dienogest group. HMB was also significantly reduced (3.7% vs 23.1%) in the Elagolix than the Dienogest group after 3 months of treatment. Conclusion: Elagolix significantly reduced VAS score, HMB, and uterine volume in symptomatic adenomyosis compared to Dienogest

Mucous membrane ulcerations secondary to methotrexate in a patient with unruptured tubal ectopic pregnancy: a case report

Ectopic pregnancy remains a significant contributor to first trimester maternal mortality, though early diagnosis now allows for successful medical management in hemodynamically stable unruptured ectopic patients. Methotrexate is the drug of choice in such scenarios, with known side effects including gastrointestinal discomfort and myelosuppression. We present a rare case of a 29-year-old primigravida with a right tubal unruptured ectopic pregnancy managed with multiple dose methotrexate regimen. Despite stable blood counts and normal organ function, the patient developed severe oral and vulvar mucositis by day 6 of the treatment. Examination revealed multiple painful aphthous ulcers and erythema affecting the buccal mucosa and labia minora. The mucositis resolved completely by day 25 with symptomatic treatment including antihistamines, topical agents and delayed vitamin supplementation. This case highlights an uncommon presentation of methotrexate toxicity with isolated orogenital ulceration occurring in the absence of pancytopenia or systemic toxicity. Early recognition of mucosal lesions is critical for prompt management and may prevent progression to more severe toxicity

Elagolix - a novel drug for management of endometriosis and uterine fibroids

Endometriosis and uterine fibroids are two hormone-dependent gynecological disorders that significantly impact women’s health impairing their quality of life. Traditional medical therapies used to control symptoms have side effects such as initial symptom flare and hypoestrogenic complications which limit their use. Elagolix is an oral non-peptide gonadotropin releasing hormone receptor (GnRH) antagonist. It is a new therapeutic approach which acts by directly and reversibly suppressing pituitary gonadotropin secretion. It acts by binding competitively to GnRH receptors in pituitary gland which leads to a rapid dose dependent suppression of LH and FSH leading to reduction in production of ovarian sex hormones (estrogen and progesterone). Alternative medications like GnRH agonists cause a transient hormone flare which is complete and long lasting before down regulation. Elagolix immediately inhibits GnRH receptor signaling, avoiding this flare phenomenon. The degree of hormonal suppression can be adjusted by dosing, allowing partial or near-complete suppression of estradiol levels, which is beneficial for tailoring therapy to minimize hypoestrogenic side effects. Elagolix, offers a safe and effective approach in the management of uterine fibroids and endometriosis. Clinical trials have demonstrated that Elagolix significantly reduces fibroid-associated heavy menstrual bleeding and alleviates endometriosis-related pelvic pain. Its rapid onset of action and adjustable dosing regimen allow individualized therapy aimed at balancing efficacy and minimizing hypoestrogenic adverse effects such as bone mineral density loss and vasomotor symptoms