Obstetric violence: a health system study

Background: Disrespect and abuse during facility-based childbirth is a global problem with differing driving factors in different contexts. Obstetric Violence (OV) refers to professional deficiencies in maternity care. The objective of this study was to assess knowledge and attitudes towards OV in a cohort of members of the obstetric healthcare team at a tertiary care, teaching hospital in Western India (Mumbai).Methods: A questionnaire-based study involving 80 participants comprising of trainee doctors and faculty, nursing students, staff and teachers from the department of Obstetrics and Gynaecology and hospital administration.Results: 57.97% of participants had heard the term ‘Obstetric violence’ earlier. 75.36% reported verbal abuse as a form of OV, others being physical abuse, non-consented care, discriminatory care, abandonment/neglect or refusal of care and imposition of interventions without scientific basis. 53% and 89.8% of the participants did not consider routine episiotomies and artificial rupture of membrane respectively as forms of OV. 84.06% and 59.4% of participants considered instrumental delivery without consent and Caesarean section citing safety/convenience respectively as forms of OV. 82.6% participants endorsed the need of birth companion. Improving the number and training of healthcare providers and better institutional policies on respectful maternity care were suggested as solutions.Conclusions: Majority of the participants had witnessed some form of OV. The need for practical training of healthcare personnel and better infrastructure in the healthcare system were emphasised, but there appeared to be a lack of consciousness of the paternalistic mindset and approach to women in labour. Soft skills training of healthcare providers with emphasis on key ethical principles like autonomy, respect and dignity is crucial to address the issue of OV.

A case of ovarian fibroma masquerading as a uterine fibroid

A case of a 37-year old patient who presented with a pelvic mass, recurrent urinary tract infection, urinary hesitancy and elevated serum CA-125 levels. A diagnosis of a large, posterior wall uterine fibroid was made on the basis of clinical examination and radiological imaging and abdominal myomectomy was planned. Intraoperative findings were a large left ovarian mass and multiple small uterine fibroids. The ovarian mass was removed and its histopathological examination findings were suggestive of an ovarian fibroma. This article highlights the unique clinical and radiological presentation of an adnexal mass as a fibroid and the non-specificity of CA-125 as a marker of ovarian malignancy

Fresh versus frozen embryo transfer: a retrospective cohort study

Background: Elective frozen embryo transfer (FET), has recently increased significantly with improvements in cryopreservation techniques. Observational studies and randomized controlled trials suggested that the endometrium in stimulated cycles is not optimally prepared for implantation; risk of ovarian hyperstimulation syndrome reduced and pregnancy rates increased following FET and perinatal outcomes are less affected after FET. However, the evidence is not unequivocal and recent randomised control trials challenge the use of elective FET for the general IVF population. Pregnancy rates were analysed in a cohort of patients undergoing embryo transfers.Methods: This was a retrospective cohort study of patients who underwent embryo transfers from April 2018 to March 2019 at study centre in Surat.175 cycles of embryo transfers (119 fresh and 56 frozen) were included in the study. Outcomes measured were positive pregnancy, clinical pregnancy and ongoing clinical pregnancy rates achieved in the IVF-ET cycles.Results: There were no statistically significant differences between positive pregnancy rate (54.6% versus 60.7%, Odds ratio (OR) 0.78; 95% Confidence Interval (CI) 0.41-1.49), clinical pregnancy rate (48.73% versus 57.14%, OR 0.52; 95% CI 0.1- 2.64) and ongoing clinical pregnancy rate  (45.38% versus 51.78% OR 1.4; 95% CI 0.29 - 6.67) in fresh ET and FET cycles, respectively, p < 0.05 was considered statistically significant for all measures.Conclusions: Despite the observed higher rates of positive biochemical, clinical and ongoing clinical pregnancy per transfer in the FET cohort, these did not reach statistical significance. Thus, both transfer strategies are reasonable options, although there is a trend favouring the freeze-all strategy

A case of ovarian fibroma masquerading as a uterine fibroid

A case of a 37-year old patient who presented with a pelvic mass, recurrent urinary tract infection, urinary hesitancy and elevated serum CA-125 levels. A diagnosis of a large, posterior wall uterine fibroid was made on the basis of clinical examination and radiological imaging and abdominal myomectomy was planned. Intraoperative findings were a large left ovarian mass and multiple small uterine fibroids. The ovarian mass was removed and its histopathological examination findings were suggestive of an ovarian fibroma. This article highlights the unique clinical and radiological presentation of an adnexal mass as a fibroid and the non-specificity of CA-125 as a marker of ovarian malignancy