Background: The postpartum period is an important opportunity to prevent unintended pregnancies through family planning (FP). Despite high contraceptive awareness, postpartum FP (PPFP) uptake remains low in many low- and middle-income countries (LMICs), including Comoros. This study assessed factors associated with postpartum contraceptive uptake among women in the Union of the Comoros. Methods: A cross-sectional study was conducted among 251 pregnant and postpartum women aged 15 -49 years attending health facilities across the three islands of Comoros from July to December 2024. Data were collected using a structured questionnaire, and associations with PPFP uptake were assessed using chi-square tests. Ethical approval was obtained (UI/EC/24/0302 and N°24002/CNESS/PR). Results: Among the participants, 78.9% had knowledge of FP, while 65.0% reported current contraceptive use. Injectable contraceptives were the most commonly used method (43%), followed by implants (23%) and oral contraceptive pills (12%). PPFP uptake was significantly associated with island of residence (p=0.0005), educational level (p=0.042), and number of living children (p=0.013). Women from Anjouan had the highest proportion of contraceptive use (25.0%), followed by Ngazidja (23.0%) and Mohéli (16.0%). Higher contraceptive uptake was observed among women with secondary and tertiary education compared with those without formal education. Women with three or more living children had the highest proportion of contraceptive use (46.1%). Age, marital status, employment status, income sufficiency, and desire for another child were not significantly associated with PPFP uptake. Conclusions: PPFP uptake in Comoros is influenced by geographic location, education, and parity. Improving access to quality PPFP services and targeted interventions may enhance contraceptive use and maternal health outcomes.
Controlling obstetric haemorrhage has remained a major clinical challenge and continues to drive innovations and the sharing of effective techniques. Packing of the uterine cavity and other bleeding cavities is sometimes the only feasible temporary or definitive intervention when uterine-conserving procedures, specialised equipment, or surgical expertise are unavailable. This technique has been practiced for decades. Conventionally, the packing material consists of a tape prepared by rolling surgical gauze into a narrow strip. Although chitosan-based haemostatic packs are available, they are expensive, not readily accessible, and often associated with inventory constraints. Furthermore, the width of the packing tape must be tailored to the size of the bleeding cavity and should be wider when packing an atonic uterus with a widely dilated cervix. We developed an indigenous packing tape using a surgical cotton sheet that can be prepared instantly at the point of care. In our obstetric practice, this packing material effectively addressed these limitations and proved to be an efficient option for uterine packing in postpartum haemorrhage (PPH) and for packing other bleeding cavities, which we have described in this communication.
Background: Fetal growth restriction (FGR) poses significant risks of adverse perinatal outcomes. Accurate surveillance is essential to distinguish pathologically growth-restricted fetuses from constitutionally small infants and to optimize the timing of delivery. Methods: A comparative cross-sectional observational study was conducted at Rajiv Gandhi Medical College among 118 singleton pregnancies (≥32 weeks) with diagnosed FGR. Comprehensive doppler velocimetry of the umbilical artery (UA), middle cerebral artery (MCA), and ductus venosus (DV) was performed and categorized into doppler grades 0 to 5. Primary outcomes evaluated were perinatal morbidity, neonatal mortality, APGAR scores, and birth weight. Results: Normal doppler (grade 0) was present in 98 (83.1%) participants, while 20 (16.9%) exhibited abnormal doppler indices. Abnormalities in UA, MCA, and DV were strongly associated with adverse outcomes (p<0.001). Grade 0 doppler showed a high association with normal neonatal outcomes (odds ratio=24.14, p<0.001). Conversely, severe doppler deterioration (grade 4 and grade 5) was significantly associated with perinatal morbidity (p=0.037) and neonatal mortality (p=0.011), respectively. Infants with abnormal doppler had significantly lower gestational age at delivery (35.35±2.30 vs 37.22±0.58 weeks, p=0.001), lower APGAR scores at 5 minutes (6.10±3.09 vs 8.53±0.61, p<0.001), and reduced birth weights (1.67±0.44 kg vs 2.09±0.14 kg, p<0.001). Conclusions: Fetal doppler surveillance effectively stratifies risk in growth-restricted fetuses. Abnormal doppler indices correlate strongly with hemodynamic compromise and adverse perinatal outcomes, providing critical evidence to guide timely clinical intervention prior to irreversible fetal acidemia.
Background: Postpartum hemorrhage (PPH) remains a leading cause of maternal morbidity and mortality. Active management of the third stage of labor (AMTSL) using uterotonic agents significantly reduces the incidence of PPH. Oxytocin is the most commonly used uterotonic; however, its short duration of action may necessitate repeated dosing. Carbetocin, a long-acting oxytocin analogue, offers sustained uterine contraction with a single dose. Methods: A single-blind randomized controlled trial was conducted at a tertiary care center over 18 months. A total of 200 pregnant women with singleton or multiple pregnancies ≥32 weeks of gestation undergoing vaginal delivery or cesarean section were enrolled. Participants were randomly allocated into two groups: the carbetocin group (100 µg intravenous single dose) and the oxytocin group (10 IU intramuscular or 20 IU intravenous infusion). The primary outcomes assessed were blood loss within 24 hours postpartum, uterine tone, and requirement of additional uterotonics. Secondary outcomes included changes in hemoglobin levels, need for blood transfusion, hemodynamic changes, and drug-related adverse effects. Results: Mean blood loss in the 1st 24 hours postpartum was significantly lower in the carbetocin group compared to the oxytocin group (398±138.52 ml versus 467±189.65 ml; p=0.004). Fewer women in the carbetocin group required additional uterotonic agents. Post-delivery hemoglobin levels were significantly higher in the carbetocin group. No significant adverse effects were observed in either group. Conclusions: Carbetocin is more effective than oxytocin in reducing postpartum blood loss during active management of the third stage of labor, with the added advantage of single-dose administration and a comparable safety profile. Carbetocin can be considered a suitable alternative to oxytocin, particularly in tertiary care and high-risk obstetric settings.
Burn injuries during pregnancy are rare but represent a significant obstetric emergency with potential adverse maternal and fetal outcomes. Physiological changes of pregnancy, combined with the systemic inflammatory response to burns, complicate resuscitation, infection control, and obstetric decision-making, particularly in late gestation. Management becomes more complex in the third trimester due to fetal viability and the need to consider timing and mode of delivery. We report a case of a 21-year-old multigravida at 36 weeks of gestation with moderate-severity accidental flame burns involving 20–25% total body surface area (TBSA). The patient was managed at a tertiary care centre with prompt maternal stabilization, multidisciplinary coordination, and elective lower segment caesarean section (LSCS). Both maternal and neonatal outcomes were favourable. This case highlights the importance of early referral to tertiary care, individualized obstetric decision-making, and multidisciplinary management in achieving optimal outcomes in third-trimester burn injuries.
Background: Endometriosis is a common gynecological disorder affecting approximately 10–15% of reproductive-aged women and is strongly associated with infertility and pelvic pain. Laparoscopic surgery plays an important role in the diagnosis and management of endometriosis. This study aimed to evaluate fertility outcomes following laparoscopic management of endometriosis. Methods: This prospective study was conducted at Sudha Sundar Fertility Hospital, Tamil Nadu between January 2018 and August 2022. A total of 53 women diagnosed with endometriosis who underwent laparoscopic surgery were included. Procedures included laparoscopic cystectomy, adhesiolysis, and fulguration of endometriotic lesions. Patients were followed up for fertility outcomes. Results: Most patients belonged to the age group of 31–35 years (43.3%). Primary infertility was present in 86.7% of patients. Advanced disease (stage III–IV) was observed in the majority of cases. The overall pregnancy rate following laparoscopic treatment was 45.29%. Conclusions: Laparoscopic management of endometriosis improves fertility potential and assists in planning further assisted reproductive techniques when required.
Delayed childbearing has increased the number of women of advanced maternal age (AMA) seeking assisted reproductive technology (ART). AMA, defined as ≥35 years, is linked to reduced ovarian reserve, poor oocyte quality, and higher pregnancy risks. Despite advances in IVF, ICSI and frozen embryo transfer (FET), maternal age remains a key factor affecting success rates. This review summarizes the biological changes associated with reproductive aging and their impact on ART outcomes such as implantation, pregnancy rates, miscarriage and perinatal outcomes. Literature shows that aging leads to mitochondrial dysfunction, chromosomal abnormalities and reduced embryo quality, resulting in lower pregnancy and live birth rates and higher miscarriage rates in women ≥35 years. While FET may improve uterine conditions, it cannot fully overcome the decline in oocyte quality. AMA is also associated with increased risks such as hypertension, gestational diabetes and preterm birth. In conclusion, advanced maternal age significantly affects ART outcomes, and careful patient counselling and individualized treatment strategies are essential to improve success rates.
Preeclampsia is a major cause of maternal and fetal complications worldwide. Vitamin D has been suggested as a possible factor that may influence its development, but existing evidence is inconsistent. To evaluate the association between vitamin D and the risk of preeclampsia and to assess the effect of vitamin D supplementation during pregnancy. A systematic review was conducted following PRISMA 2020 guidelines. Studies published from 2012 to 2026 were searched in PubMed, Scopus, Web of Science, EMBASE, Cochrane Library and Google Scholar. Keywords included “vitamin D,” “preeclampsia,” “pregnancy-induced hypertension,” and “supplementation”. Eligible studies included randomized controlled trials, cohort studies and case-control studies involving pregnant women. Data on study design, vitamin D exposure and outcomes were extracted. Risk of bias was assessed using the Newcastle-Ottawa Scale and Cochrane tool. Fifteen studies were included. Most observational studies showed that low vitamin D levels were linked with a higher risk of preeclampsia. Several trials reported that high-dose or early supplementation reduced risk, especially in deficient or high-risk women. However, some studies found no clear benefit, particularly with low doses or late pregnancy supplementation. The findings were inconsistent due to differences in dose, timing and baseline vitamin D status. Low vitamin D levels may increase the risk of preeclampsia. Supplementation appears beneficial mainly when started early and in deficient women. However, evidence is not fully consistent. More large and well-designed trials are needed to establish clear clinical recommendations for vitamin D use in pregnancy.
Background: Preeclampsia (PE) is a disorder that happens during pregnancy. It is marked primarily by symptoms such as high blood pressure and problems with organs that develop after 20 weeks of gestation. Recently, biomarkers like pregnancy-associated plasma protein A (PAPP-A) and uterine artery Doppler pulsatility index (PI) have been identified as new predictors of PE because they reflect the condition and throughput of the placenta. Therefore, the goal of this research was to determine how accurate maternal serum PAPP-A levels and uterine artery PI predict PE when used not only separately but also together. Methods: This prospective cohort study was carried out in Department of Obstetrics and Gynecology and the Fetal-Maternal Medicine Department of Bangladesh Medical University (BMU) Dhaka during January 2024 to December 2024. The sample of the study consisted of 99 pregnant women who visited outpatient departments, their gestational age was between 12 and 20 weeks and they were normotensive. Statistical analysis was done through SPSS version 26.0. The association between PAPP-A levels and the development of PE, which was illustrated through odds ratios (ORs) with 95% confidence intervals (CIs), and a p-value less than 0.05 was regarded as statistically significant. Results: ROC analysis showed that PAPP-A has moderate predictive ability for preeclampsia, with an AUC of 0.742 (95% CI:0.638-0.846, p=0.03). A cut-off value of ≥0.55 yielded good sensitivity (72.73-81.82%) and moderate specificity (68.18%), with a high negative predictive value (95.24-95.28%) but low positive predictive value (22.22%) and overall accuracy of 68.69%. Most PE cases (8 of 11) occurred in participants with PAPP-A <0.55, supporting its role as a predictor. Similarly, elevated uterine artery PI (≥1.61) was observed in 7 of 11 PE cases and showed high specificity (93.18%), high negative predictive value (95.35%), moderate sensitivity (63.64%), and overall accuracy of 89.90%, indicating a strong association between increased PI and the development of preeclampsia. Conclusions: Low PAPP-A and high uterine artery PI show solid early signs of preeclampsia. Tracking these markers in first trimester pregnancies helps spot at-risk women. Early detection allows actions to be taken before complications arise. Interventions can reduce harm to mother and baby. The data supports real-time risk assessment without waiting for symptoms to appear.
Background: Premenstrual syndrome (PMS) is one of the most common gynaecological conditions among females which is characterised by a constellation of behavioural, physical and emotional symptoms occurring during the luteal phase of the menstrual cycle. In developing countries like India PMS remains unrecognised even today. There is very little data available regarding the burden of PMS and determinants among women in Jammu. Methods: A cross-sectional study among 500 females aged between 15–49 years in both urban and rural settings of Jammu was conducted. Convenience sampling was used to select respondents for the study. Data was collected using a structured pre-tested questionnaire which covered menstrual history, socio-demographic characteristics, lifestyle factors and PMS symptoms based on standardised criteria. Descriptive statistical analysis was conducted to estimate prevalence and chi-square test were applied to assess association. A p value <0.05 was considered statistically significant. Results: The overall prevalence of PMS was found to be 68.4 (n=342). Among the affected females 42.7% had moderate symptoms, 31.6% severe symptoms and 25.7 mild symptoms. Abdominal cramps were the most commonly reported symptoms among these females which were 72%, fatigue 61.8%, irritability 58.2% and mood swings 65.5%. Premenstrual syndrome prevalence was significantly higher among younger females aged between 15 to 24 years 72.8% (p<0.05). The lifestyle and factors like sedentary life style 76.9% and frequent consumption of junk food 78.5% were highly associated with PMS. A strong association was observed with levels of stress, with prevalence increasing from 51.7% in low stress individuals to 82.6% among females with high stress (p<0.05). Menstrual irregularity 75.8% and dysmenorrhea 81.3% where are also highly associated with premenstrual syndrome. Conclusion: PMS is highly prevalent among women of reproductive age in Jammu, with a large portion experiencing moderate to severe symptoms. Lifestyle and psychological factors especially physical inactivity, diet and stress play an important role in its occurrence. Targeted interventions focusing on modification of lifestyle, awareness for women and integration of PMS management into primary health care and education are recommended.
Assisted reproductive technologies (ART) have emerged as important medical interventions for infertility; however, their acceptance and utilization are strongly influenced by cultural and religious beliefs, particularly in a diverse country like India. This review explores the impact of cultural diversity and religious perspectives on the perception and practice of ART in the Indian context. Indian society places significant importance on marriage, parenthood, lineage continuation, and family honour, which contributes to the social stigma associated with infertility, especially for women. Regional cultural variations across North, South, East, West, and North-East India further shape attitudes toward infertility treatment, access to fertility services, and acceptance of procedures such as in vitro fertilization (IVF), gamete donation, and surrogacy. Religious beliefs also play a major role in reproductive decision-making. Hinduism generally demonstrates a permissive approach toward ART, whereas Islam restricts third-party reproduction to preserve lineage. Christian perspectives vary across denominations, with Roman Catholic teachings opposing most ART procedures, while protestant groups may permit selected interventions. Buddhism and Sikhism are comparatively flexible, whereas Jainism adopts a cautious ethical stance emphasizing non-violence. The review additionally discusses the ethical and socio-legal implications of surrogacy and highlights the influence of recent Indian legislation, including the surrogacy (Regulation) Act, 2021 and the Assisted reproductive technology (Regulation) Act, 2021. Understanding these cultural and religious dimensions is essential for promoting culturally competent fertility counselling, ethical reproductive healthcare, and equitable access to ART services in India.
Background: Uterine fibroids are the most common benign tumors of the female reproductive tract and are a major cause of menstrual disturbances and anemia. Conservative medical therapies are increasingly preferred over surgical options in women desiring uterine preservation. Mifepristone, a progesterone receptor antagonist, has shown promising results in reducing fibroid volume and associated symptoms. Objectives were to evaluate the clinical efficacy and safety of low-dose mifepristone (25 mg daily) in reducing fibroid size and improving clinical symptoms among perimenopausal women with symptomatic leiomyomas. Methods: This prospective observational study was conducted from June 2024 to July 2025 at the Department of Gynecology, Government Peripheral Hospital, Tondiarpet, Chennai. Ninety-three perimenopausal women aged 35-50 years with ultrasonographically confirmed symptomatic fibroids were treated with 25 mg mifepristone daily for three months. Clinical parameters, uterine and fibroid volumes, hemoglobin, and endometrial thickness were evaluated before and after therapy. Results: Amenorrhea was achieved in 92.7% of patients. Mean uterine and myoma volumes decreased to 63.7% and 53.6% of baseline, respectively. Mean hemoglobin levels increased by 2.8 g/dl (37%) post-treatment. Endometrial thickening was mild in most patients, with two cases of simple hyperplasia without atypia. Headache was the most frequent adverse effect (12%), with no major hepatic or renal complications reported. Hysterectomy was avoided in 87.8% of patients. Conclusions: Low-dose mifepristone (25 mg daily) is a safe, effective, and affordable therapeutic option for managing symptomatic uterine fibroids in perimenopausal women. It significantly reduces fibroid and uterine volume, controls bleeding, and improves hemoglobin levels, minimizing the need for surgical intervention.
Congenital complete heart block (CCHB) is a rare condition, most commonly associated with maternal autoimmune antibodies such as anti-Ro/SSA. We report a case of antenatally diagnosed immune-mediated CCHB at 27 weeks’ gestation in a 27-year-old gravida 2 woman with positive antinuclear and anti-Ro/SSA antibodies. Fetal echocardiography revealed complete heart block in a structurally normal heart with a ventricular rate of 55 bpm. The pregnancy was managed with maternal dexamethasone and hydroxychloroquine, with close fetal surveillance. A late preterm infant weighing 2.4 kg was delivered at 36 weeks and required permanent pacemaker implantation within 24 hours of life due to persistent bradycardia. The postnatal course was uneventful, and at 3-month follow-up, the infant demonstrated stable pacemaker function with appropriate growth and development. This case highlights the importance of early diagnosis, multidisciplinary perinatal management, and timely neonatal pacing in achieving favourable outcomes in immune-mediated CCHB.
Schwannoma (neurilemmoma) is a benign peripheral nerve sheath tumor that commonly occurs in the head, neck, and extremities. Pelvic and retroperitoneal schwannomas are rare and often pose a diagnostic challenge due to nonspecific clinical and radiological features, frequently mimicking common gynecological conditions such as broad ligament fibroids. Laparoscopic excision is a safe and effective treatment modality, offering excellent outcomes when performed with careful identification and preservation of surrounding neurovascular structures.
Posterior reversible encephalopathy syndrome (PRES) is an uncommon complication of pregnancy, whose rarity may lead to delayed diagnosis adverse outcomes, especially when seizures persist despite standard anti-seizure regime for eclampsia. A 25-year-old primiparous with sickle cell haemoglobinopathy was admitted about 48 hours into the puerperium with generalized tonic-clonic seizures, severe hypertension and altered mental state. She was managed for eclampsia and suspected sepsis with magnesium sulphate, antihypertensives and antibiotic therapy, with transient improvement. She however deteriorated rapidly and lapsed into unconsciousness, prompting further evaluation. After a period of delay due to financial difficulties, computerized tomography scan revealed widespread bilateral vasogenic edema that was characteristic of PRES. Following the initiation of corticosteroid therapy, the seizures ceased and she achieved full neurological recovery without any deficit. This case depicts the diagnostic dilemma of persistent pregnancy-associated seizures, especially in resource-constrained settings. Heightened suspicion, early imaging and multidisciplinary vigilance are recommended for such patients.
Background: Menopause is the cessation of menstruation for one year at the end of reproductive life. The average age of menopause differs in different regions. Early menopause is a high risk for cardiovascular diseases, osteoporosis, and late menopause for breast, and genital cancers. As the age of natural menopause is affected by many factors and early and late menopause cause life-threatening diseases, the determination of the age of menopause is important for different geographical regions. Methods: This prospective cross-sectional study was conducted in the outpatient department of Obstetrics and Gynecology, Mamata Medical College and General Hospital, Khammam, Telangana, India, over 09 months from 01 April 2024 to 31 December 2024. Women with natural menopause were asked pre-determined questions like name, age, occupation, education, etc. and answers were noted. Iatrogenic and premature menopause or unwilling women, were excluded. Descriptive statistical analysis and a p-value test were used to find the age of menopause and co-relation with determinants. Medcalc-24 was used for calculations. p-value< 0.05 was considered significant. The outcome was discussed critically and compared with other study reports. Results: The average age of menopause was 47.05 +/- 04.39 years. A strong co-relation of the age of menopause with occupation (p-0.0002) and marital status (p-0.0003) was observed. The same co-relation with body weight (p-0.0232) and parity (p-0.0114) was significant. No significant co-relation was detected between the age of menopause and menarche or with education. Conclusions: The age of natural menopause is an important indicator of health in postmenopausal women and varies in different geographical regions. It is required to formulate health strategies for a healthy postmenopausal life of women.
Background: Induction of labor (IOL) is a common obstetric intervention performed when continuation of pregnancy poses greater risk than delivery. Methods: A retrospective observational study was conducted among 120 women who underwent induction of labor over a 6-month period. Data regarding demographic profile, indications, methods, maternal and neonatal outcomes were analyzed. Results: Majority of women were aged 21-30 years (80.8%) and multiparous (55%). Most inductions were performed between 38-40 weeks. Vaginal delivery was achieved in 62.5%, while 30% required cesarean section. Maternal complications were minimal with 1.7% experiencing postpartum hemorrhage. Neonatal outcomes were favorable with 98.3% normal outcomes and minimal NICU admissions. Conclusions: Induction of labor is a safe and effective intervention with good maternal and neonatal outcomes when appropriately indicated and monitored.
We report two cases of pregnant women diagnosed with unruptured cerebral arteriovenous malformations (AVM), each with distinct clinical presentations. One had history of focal seizures since adolescence. The other woman had history of an unevaluated focal neurological deficit prior to conception. During pregnancy, assessment with neuroimaging revealed an unruptured AVM. In both cases, a multidisciplinary team involving obstetricians, neurologists, neurosurgeons, and anesthesiologists was engaged to formulate the management plan. Considering the stability of the patients, conservative management was chosen and the pregnancy was closely monitored. The patient remained neurologically stable throughout gestation. Delivery planning aimed to minimize maternal hemodynamic stress and the risk of AVM rupture. Both cases underwent Caesarean delivery delivery in controlled conditions. There were no intraoperative, postpartum or neonatal complications.
Background: Thrombocytopenia is defined as a platelet count below 1.5 lakh/mm3. After anaemia, it is the second most common haematological disorder encountered during pregnancy. It affects approximately 6-15% of pregnancies, with an average incidence of around 10%. Methods: This was a hospital-based retrospective observational study conducted in the Department of Obstetrics and Gynaecology at C. U. Shah Medical College and Hospital from 1 January 2024 to 31 August 2024. A total of 75 pregnant women with thrombocytopenia out of 700 delivered cases during the study period were included in the study. Results: Out of 700 delivered cases, 75 women were found to have thrombocytopenia, while 625 had normal platelet counts. The incidence of thrombocytopenia in the present study was 10.7%. Gestational thrombocytopenia was the most common cause. Postpartum hemorrhage was the most common maternal complication, while intrauterine growth restriction and prematurity were the most common neonatal complications. Conclusions: Thrombocytopenia in pregnancy is associated with significant maternal and neonatal morbidity. Routine antenatal platelet count monitoring facilitates early diagnosis and timely management, thereby improving fetomaternal outcomes.
Background: Preeclampsia remains a leading contributor to maternal morbidity and mortality worldwide, while fetal growth restriction is associated with an increased risk of adverse neonatal outcomes, including preterm birth, low birth weight, and long-term developmental challenges. Early prediction and prevention of these conditions are crucial for improving maternal and fetal outcomes. This study aims to estimate the incidence of preeclampsia and fetal growth restriction in antenatal women with normal uterine artery Doppler at 11-14 weeks. Methods: A prospective observational study for a period of one and a half year, clinical data and demographic data were collected, analysed and the p-value will be calculated by the Pearson Chi-square test. The significance level will be set a p<0.05. Results: Despite normal uterine artery Doppler indices at 11–14 weeks, the study population showed a 7.3% incidence of preeclampsia and 36% fetal growth restriction. These women also had higher risks of small-for-gestational-age neonates, gestational hypertension, and diabetes. Maternal age, body mass index (BMI), socioeconomic status, education, and parity were significantly associated with adverse outcomes, and fetal growth restriction was notably linked to preeclampsia. Conclusion: The study highlights that even with normal uterine artery Doppler PI at 11–14 weeks, women remain at risk for preeclampsia and fetal growth restriction. Early identification and monitoring, including aspirin therapy and attention to borderline PI values, may help prevent adverse outcomes. The findings support further research combining Doppler with biochemical markers for improved early prediction.
