Perinatal depression and suicidal behaviour: the need for timely intervention

This review examines perinatal depression, including antenatal (pregnancy-related) and postnatal (after childbirth) depression. It highlights their prevalence, risk factors, symptoms, and impacts on women and families, such as premature birth and significant maternal mental health issues. Causes include environmental stressors, genetic predisposition, and hormonal changes. The review distinguishes between temporary "baby blues" and prolonged postnatal depression influenced by social, psychological, and biological factors. Risk factors include negative family dynamics, a history of mental health issues, and lack of social support. Emphasizing the need for timely intervention and comprehensive mental health care, this review used a comprehensive search strategy across databases like PubMed, Google Scholar, Scopus, and more. Keywords related to perinatal depression were used for screening abstracts and titles, with full-text articles assessed for eligibility. Quality was evaluated using tools like the Newcastle-Ottawa scale (NOS) and the critical appraisal skills programme (CASP). Findings highlight the importance of regular mental health screenings, psychotherapeutic approaches, pharmacological treatments, and robust support systems. Understanding the interactions between biological, psychological, and social factors in perinatal depression is crucial for improving maternal and fetal health outcomes

A rare case of ectopic pregnancy: cornual pregnancy following salpingectomy

The implantation of a fertilized egg outside the uterine cavity is known as an ectopic pregnancy, and usually occurs in the fallopian tubes. Few cases, have been reported where implantation has occurred in atypical sites. We report the case of an ectopic pregnancy that occurred in the residual stump after salpingectomy. It seems that a pregnancy implanted in this location is very uncommon, making correct diagnosis difficult. This paper includes a brief description of the case, a review of the different diagnostic and therapeutic methods available to this day, and a brief review of the literature.

A study of 44 cases of pure dysgerminoma of the ovary: a single institutional experience

Background: The extent of surgery and additional therapy required in patients with dysgerminoma is debated. This study evaluated the clinicopathologic characteristics, treatment modalities, long-term survival, and menstrual and fertility outcomes of women with ovarian dysgerminoma managed at our institute. Methods: A total 44 histologically proven pure ovarian dysgerminoma cases were identified in this retrospective study. Patients who received treatment between 2006 and 2017 at Gujarat Cancer and Research Institute, either surgery or chemotherapy, or both were included. Results: About 60.6% of patients presented with stage I, 9.09% with stage II, 27.27% with stage III, and 3.03% with stage IV disease. Initial management was surgery followed by observation in 9 (20.45%), surgery followed by adjuvant chemotherapy in 25 (56.81%), and neoadjuvant chemotherapy (NACT) followed by interval debulking surgery (IDS) and adjuvant chemotherapy in 9 (20.45%) patients. Recurrence occurred in 1 (2.32%) patient with stage III disease after 1 year and 5 months (17 months) post-chemotherapy successfully salvaged with platinum-containing chemotherapy. The 3-year disease-free survival (DFS) and overall survival (OS) were 93.18% and 95.45%, respectively. Thirteen patients attempted conception and 6 (46.15%) delivered after treatment completion. Thirty-five patients underwent fertility-sparing surgery. Out of these, thirty patients (85.7%) got regular menstrual cycles. All three prepubertal girls attained menarche. Conclusions: Regardless of the stage, fertility-sparing surgery can be offered to the patient with good reproductive outcomes expected after fertility-sparing surgery followed by chemotherapy. Adjuvant chemotherapy is associated with significant improvement in DFS. NACT followed by surgery is a reasonable option for patients with advanced-stage dysgerminoma

Diagnostic accuracy of office based endometrial biopsy when compared with subsequent findings of dilatation and curettage in patients with abnormal uterine bleeding in age group of 25 to 45 years

Background: Endometrial sampling is considered the gold standard method for assessing Abnormal uterine bleeding (AUB). The primary objective of this study was to assess the diagnostic accuracy of office based endometrial biopsy using Pipelle method when compared with subsequent findings of Dilatation and Curettage (D&C) which is an inpatient procedure and to make a comparative analysis between these two approaches. Methods: This was a prospective study carried out in the Department of Obstetrics and Gynaecology of Dr. Babasaheb Ambedkar Memorial Hospital, Central Railway, Mumbai over a period of one year on 100 gynaecological patients with one or more than one episode of abnormal uterine bleeding. Pipelle endometrial biopsy was taken on OPD basis and patients were subjected to D&C subsequently. Endometrial samples obtained using both methods then sent to the Department of Pathology for adequacy of sample and for histopathological analysis. Results: In my study, I got adequate sample in 100% of cases of D&C whereas with pipelle, one sample was inadequate. Sensitivity, specificity, positive and negative predictive value of pipelle for diagnosing atrophic endometrium, secretory phase endometrium, simple endometrial hyperplasia was 100% and for proliferative phase endometrium it was 99% when compared with that of D&C. Conclusions: Endometrial sampling by suction curette device is an inexpensive, safe OPD procedure that appears to be a feasible alternative to more invasive procedure like D&C for evaluation of patients with abnormal uterine bleeding in reproductive and premenopausal patients

Vaginal delivery through an intrapartum bucket handle cervical tear: a rare case report

Cervical tears, though rare, pose serious risks to maternal health, especially postpartum haemorrhage. During labour, these injuries can include cervical avulsion, annular detachment, bucket-handle tears, and lateral tears. Our case report presents a rare instance of spontaneous vaginal birth through a posterior bucket-handle cervical tear in a primiparous woman. This occurred despite the external cervical os being partially dilated without known risk factors. This situation serves as a warning that strong uterine contractions accompanied by a failure of the external cervical os to dilate may indicate an imminent cervical tear. In cases of excessive postpartum blood loss, it is essential to maintain a high level of suspicion for cervical tears. This emphasizes the importance of thoroughly inspecting the genital canal after a vaginal birth. Prompt diagnosis, repair, anatomical restoration, and haemostasis are essential for achieving the best outcomes

Efficacy of levonorgestrel releasing intrauterine system in the treatment of symptomatic adenomyosis: comparison with dienogest

Background: 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

Predicting mode of delivery using mid‑pregnancy ultrasonographic measurement of cervical length among nulliparous women

Background: Numerous studies have demonstrated that measuring the cervical length using transvaginal ultrasonography in singleton pregnancies at 20-24 weeks gestation can be a valuable technique for predicting the likelihood of a severe preterm birth. The association between cervical length at 20-24 weeks and the likelihood of a term cesarean section birth has, however, not been well researched. The purpose of this research is to ascertain if mid-pregnancy ultrasonography cervical length measurements are effective in anticipating term cesarean sections. Our hypothesis in this study is that there is no correlation between mid-pregnancy cervical length and the chance of a cesarean section during term labor. Methods: One hundred pregnant women, ranging in gestation from twenty to twenty-four weeks, were enrolled in the study. Individuals were chosen from the prenatal outpatient clinic. The gestational age varied from 36 to 40 (38.7±2.2 weeks). Of the cases, 53 women (53%) had a normal birth, and 47 women (47%) had a cesarean section. Four sets of data were identified based on the cervical length quartile: first quartile (15-24 mm), second quartile (25-29 mm), third quartile (30-39 mm), and fourth quartile (40-50 mm). Results: Patients with cervical lengths in the second quartile (18.2%) had the lowest rate of cesarean sections (18.6%), whereas patients with cervical lengths in the fourth quartile (96.6%) had considerably higher rates (p<0.00). Patients in the fourth quartile had a substantially higher (p<0.00) frequency of cesarean sections due to labor failure (6.38%). Logistic regression analysis revealed that the odds ratio (OR) for cesarean section in labor was lowest among patients in the first quartile (OR=1.94) and highest among patients in the fourth quartile (OR=2.95). The cervical length quartile did not significantly differ in terms of neonatal outcomes, with exception of birth weight, which did significantly differ. Conclusions: For patients who are nulliparous, the cervical length measured by transvaginal ultrasonography at mid-gestation can be used to predict the chance of a cesarean delivery at term

Risk factors for recurrence of invasive breast cancer after primary surgery in patients followed at the medical oncology and palliative care department of Soavinandriana Hospital Center

Background: Breast cancer mortality is often linked to recurrence or progression. This study aims to identify and describe the risk factors for recurrence in invasive breast cancers after primary surgery. Methods: A case-control study was conducted from January 1, 2017, to December 31, 2023. Results: The study included 55 cases and 55 controls. Identified risk factors for recurrence include age under 50 (OR 3.21; p=0.005), partial mastectomy (OR 7.7; p=0.001), vascular emboli or perineural invasion (OR 2.85; p=0.019), poor resection margin (R+) (OR 16.36; p=0.00), >25% lymph node invasion (OR 5.33; p=0.002), capsular rupture (OR 8.78; p=0.000), CA 15-3 >30 U/ml (OR 6.66; p=0.01), and lack of radiotherapy (OR 3.39; p=0.002) or chemotherapy (OR 4.07; p=0.001) as adjuvant treatments. Conclusions: The identified risk factors align with those in existing literature and should be considered to enhance breast cancer treatment

Successful management of a young patient with endometroid ovarian carcinoma with positive immuno-histochemistry

Ovarian cancer is overall a disease of postmenopausal women although, in about 12% of cases, it may develop during child bearing age. This estimate includes numerous women with borderline and non-epithelial tumours typically presenting during child bearing age group. Although there are several case reports of Endometriosis-associated ovarian cancer (EAOC) at a young age, the exact age distribution of EAOC diagnosis is still not well- expounded. Presenting here with a young patient with ovarian malignancy with positive immuno-histochemistry for both oestrogen and progesterone receptor

Placenta accreta syndrome: an obstetrician’s nightmare

Placenta accreta syndrome (PAS) poses significant clinical challenges during pregnancy and delivery, often resulting in severe maternal morbidity and mortality. This case series aims to present the varied presentations, management strategies, and clinical, and maternal outcomes associated with five patients diagnosed with PAS at our tertiary care center. A prospective analysis was conducted on five patients diagnosed with PAS who presented during the six months of study period. Demographics, clinical presentations, imaging findings, surgical interventions, and outcomes were systematically documented and analyzed. The case series included women aged 28 to 34 years, each with a history of caesarean deliveries. Common presentations included vaginal bleeding associated with placenta previa and varying degrees of placental invasion, namely accreta and percreta. All patients underwent planned caesarean deliveries, revealing severe placental adherence to surrounding structures, necessitating aggressive management. Significant postpartum hemorrhage occurred in all cases, with blood transfusions ranging from 3 to 6 units. Two patients required caesarean hysterectomy due to uncontrolled bleeding. All patients were admitted to the intensive care unit (ICU), with two cases resulting in mortality. Notable complications included post op infection, sepsis and bladder adhesion in individual cases, resulting in prolonged hospital stay for two patients. Histopathological confirmation supported the clinical diagnosis in all cases. PAS presents critical challenges in obstetric management, as demonstrated by the substantial morbidity and the requirement of multidisciplinary interventions in our case series. These findings underscore the importance of early diagnosis, thorough preoperative planning, and a collaborative approach to improve maternal outcomes in patients with PAS. Enhanced awareness and preparedness among healthcare providers are crucial to mitigate risks associated with this life-threatening condition. Further studies are warranted to refine management protocols and optimize patient outcomes in PAS