While maternal age has long been recognized as a key determinant of reproductive outcomes, the impact of advancing paternal age on semen quality remains less clearly defined. With the global trend toward delayed fatherhood, understanding age-related changes in male reproductive parameters has become increasingly important. This study aims to evaluate the relationship between paternal age and key semen parameters, including semen volume, sperm concentration, progressive motility, and normal sperm morphology. This retrospective observational study included 94 males whose partners underwent intrauterine insemination in our tertiary care center over one-year period. Semen samples were analyzed according to the 6th edition WHO criteria. Paternal age was considered a continuous variable. The association between paternal age and semen parameters was assessed using Spearman’s correlation coefficient and linear regression model. A p value < 0.05 was considered statistically significant. The mean paternal age was 37.8 years. A statistically significant negative correlation was observed between paternal age and semen volume (r = − 0.33, p = 0.0008) and between paternal age and progressive motility (r = − 0.21, p = 0.046). No significant correlation was found between paternal age and sperm concentration (r = 0.021, p = 0.85) or normal morphology (r = − 0.15, p = 0.166). Linear regression model showed that paternal age accounted for 11.0
Mullerian duct anomalies (MDAs) refer to defects arising during the embryological development of the female reproductive system. Women with Mullerian duct anomalies seem to have an increased rate of unexplained infertility, endometriosis, spontaneous abortion, breech presentation, and premature delivery. Aim and primary objectives of the study are restoration of menstrual function in transverse vaginal septum imperforate hymen, other uterine and cervical anomalies (within 6 months of surgery), restoration of reproductive function in septate uterus, restoration of sexual function in vaginal agenesis (between 3 and 6 months of surgery) by doing surgical management. Secondary objective of the study is study of immediate and late complications related to surgery and postoperative study of patients satisfaction. A retrospective analysis of 37 patients with mullerian anomalies treated in a tertiary care hospital in 2016 to 2020 was done. The presenting symptoms, radiological findings, management and outcomes were evaluated. In the defined time, we managed total of 37 cases with different mullerian anomalies.Main presenting symptoms were cyclical pain abdomen, primary amenorrhoea, Infertility and recurrent miscarriage. Most of the patients were in the adolescent age group. With optimal surgical management we reported good patient outcome for all the cases. In our study restoration of menstrual function was achived in patients with transverse vaginal septum imperforate hymen, other uterine anomalies.Restoration of reproductive function was achived in septate uterus, Restoration of sexual function was achived in vaginal agenesis (between 3 to6 months of surgery) in our study without any complications with good patients satisfaction. In the defined time, we managed total of 37 cases with different Mullerian anomalies. Main presenting symptoms were cyclical pain abdomen, primary amenorrhoea, infertility and recurrent miscarriage. Most of the patients were in the adolescent age group. With optimal surgical management, we reported good patient outcome for all the cases.
Midwife‑led care is increasingly promoted to improve maternal and neonatal outcomes and reduce unnecessary interventions, particularly for low‑risk pregnancies in high‑volume settings in India. To describe trends, characteristics, and outcomes of midwife‑led births at the Fernandez Foundation from 2013 to 2023 and compare with doctor‑led births. A retrospective analysis was conducted of 36,204 vaginal births at a tertiary maternity centre between 1 January 2013 and 31 December 2023. Births were categorized by provider (doctor or midwife). Maternal and neonatal variables were compared between the providers using descriptive statistics. Of 36,204 vaginal births, 44.6
Giant condyloma acuminatum (GCA), also known as Buschke–Löwenstein tumor, is a rare but locally aggressive manifestation of human papillomavirus infection that may progress rapidly during pregnancy due to hormonal and immunological alterations. We report a case of a 28-year-old primigravida at 17 weeks gestation presenting with a rapidly enlarging giant vulvoperineal mass associated with severe pruritus, foul-smelling discharge, and difficulty ambulating. Clinical examination demonstrated a large cauliflower-like lesion involving the vulva, perineum, and perianal region measuring approximately 15 × 7 × 4 cm. Pelvic magnetic resonance imaging revealed diffusion restriction and irregular margins, raising suspicion for malignancy. Following multidisciplinary evaluation, the patient underwent successful second-trimester surgical excision under spinal anaesthesia with preservation of the urethra and anal sphincter complex. Histopathological examination confirmed condyloma acuminatum with acanthosis, parakeratosis,and koilocytic changes, while p16 immunohistochemistry was negative for high-risk HPV. Residual lesions were treated with topical trichloroacetic acid. The postoperative course was uneventful, and the patient subsequently delivered a healthy neonate at term without evidence of maternal recurrence or neonatal HPV transmission. This case highlights the diagnostic challenges and favourable maternal–fetal outcomes achievable with timely multidisciplinary management of giant condyloma acuminatum during pregnancy.
Labial fusion, or labial adhesion, is a condition characterised by partial or complete adherence of the labia minora, most commonly seen in prepubertal girls and postmenopausal women due to hypoestrogenic states. It is rare in reproductive-aged women and is often associated with trauma or chronic irritation. We report a case of a 21-year-old unmarried woman presenting with long-standing urinary symptoms, including decreased urinary stream and recurrent urinary tract infections. Despite multiple treatments, the underlying cause remained undiagnosed. Detailed history revealed prior genital trauma at 13 years of age. Examination showed dense, complete labial fusion with a pinhole opening. Surgical adhesiolysis was performed successfully, followed by appropriate suturing and post-operative care. The patient showed complete symptomatic relief with good healing on follow-up. This case highlights the importance of thorough local examination in patients with persistent urinary complaints, as early diagnosis and intervention can prevent prolonged morbidity and future complications.
OHVIRA syndrome: Uterus didelphys with an oblique vaginal septum that causes partial genital tract outflow obstruction and a urinary tract anomaly. Malignancies are rare, with early literature documenting only a handful of cases—historically categorized almost exclusively as cervical cancers. Recent reviews highlight a slightly broader spectrum of lower genital tract involvement. To our knowledge, aggressive histologies such as carcinosarcoma (mixed Mullerian tumor) in an OHVIRA patient have never been previously reported in the global literature. Our patient—42 yr old, divorced, nulligravida, with a history of drainage of hematocolpos + marsupialization of hemivagina at the age of 28 years. The patient was diagnosed with Uterus didelphys with a non-communicating horn with hematosalpinx along with ipsilateral renal agenesis and managed surgically. She presented with persistent mid-menstrual blackish vaginal bleeding. Initial pelvic examination revealed foul-smelling discharge and a mass arising from the cervix. MRI pelvis showed a distended vaginal cavity with a large polypoidal mass extending toward the left cervical cavity. PET scan showed a hypermetabolic polypoidal mass arising from the uterine cervix extending into the vagina. Excision of mass was done, which involved the anterior and lateral walls of the cervix. Histopathology report was suggestive of carcinosarcoma of the vagina (syn—mixed Mullerian tumor). A radical hysterectomy with sos pelvic lymph node dissection was planned. On the table, the tumor was inoperable with no discernible plane of dissection extending up to the introitus. The patient is now undergoing chemotherapy with taxanes. Our case is unique, being a vaginal carcinosarcoma in a Mullerian anomaly with an aggressive course.
Recurrent pregnancy loss (RPL), defined as the spontaneous loss of two or more pregnancies before 20 weeks of gestation, remains a complex clinical challenge with multifactorial etiology. Genetic abnormalities, uterine anomalies, endocrine disorders, antiphospholipid antibody syndrome, infections, environmental influences, and male factors contribute to its occurrence. Evaluation involves comprehensive history, endocrine and genetic testing, uterine imaging, and screening for thrombophilia and infections. Management strategies include surgical correction of uterine anomalies, pharmacological interventions (levothyroxine, metformin, cabergoline, progesterone, low-dose aspirin, LMWH), and supportive care. Emerging therapies such as preimplantation genetic testing, stem cell-derived exosome therapy, lymphocyte immunotherapy, and pharmacogenomics offer promising avenues but require further validation. Psychological support and multidisciplinary care are essential to improve outcomes. Despite advances, unexplained RPL remains prevalent, underscoring the need for precision medicine and integrative approaches to optimize reproductive success.
The medical classification of fetal health is critical for timely intervention. However, the variation in fetal heart rate patterns and other physiological parameters still poses a challenging task for medical practice. The current study aims to develop an accurate prediction model to classify fetal health using cardiotocography (CTG) data. This study evaluates the performance of various machine learning algorithms in classifying fetal health conditions. The analysis is based on a dataset that includes distinct differences in key features across three health categories. Specifically, features such as baseline fetal heart rate, accelerations, fetal movements, uterine contractions, and variability were examined, as they displayed unique patterns corresponding to each health condition. The best models were the Random Forest and Gradient Boosting, which each reached an accuracy of 94.84
Doppler ultrasonography of the Ophthalmic Artery (OA), due to its embryological and physiological relationship to the cerebral vasculature, offers a non-invasive method for assessing vascular alterations in PE. This study aimed to compare OA Doppler parameters between normotensive and pre-eclamptic pregnant women. A cross-sectional study was conducted involving 102 pregnant women (72 normotensive, 30 with pre-eclampsia). OA Doppler sonography was performed using a Samsung DC N3 USG machine. Parameters evaluated included first peak systolic velocity (PSV1), second peak systolic velocity (PSV2), end-diastolic velocity (EDV), pulsatility index (PI), and the PSV2/PSV1 ratio. Statistical analysis was performed using independent sample t-tests. Significant hemodynamic differences were observed between the groups. Women with pre-eclampsia demonstrated significantly lower mean PSV1 (p = 0.016) and PI values (p < 0.001), while mean PSV2 (p = 0.010), EDV, and the PSV2/PSV1 ratio (p < 0.001) were significantly higher compared with normotensive controls. These findings indicate altered Ophthalmic Artery hemodynamics in pre-eclamptic pregnancies. Pre-eclampsia is associated with characteristic alterations in Ophthalmic Artery Doppler indices, particularly reduced PI and increased PSV2/PSV1 ratio, reflecting changes in vascular resistance and orbital blood flow. OA Doppler sonography may serve as a useful non-invasive adjunct for the assessment and monitoring of vascular changes in pre-eclampsia.
Uterine necrosis is a rare but potentially life-threatening complication of conservative surgical management for postpartum hemorrhage (PPH). Early diagnosis is challenging because the clinical presentation may mimic postpartum infection or endometritis. A 38-year-old multiparous woman underwent cesarean delivery complicated by severe atonic PPH. Following failure of medical management, bilateral uterine artery ligation and uterine compression sutures were performed to control hemorrhage. Two weeks later, she presented with severe abdominal pain, fever, abdominal distension, foul-smelling lochia, and septic shock. Ultrasonography demonstrated a markedly enlarged uterus with multiple hyperechoic intramyometrial foci suggestive of intramyometrial gas. Emergency laparotomy revealed extensive gangrenous necrosis of the uterine corpus with preservation of cervical viability. Based on intraoperative confirmation of an intact cervical blood supply, supracervical hysterectomy was performed. Histopathological examination confirmed extensive transmural ischemic uterine necrosis with acute inflammation. The patient recovered uneventfully following surgery and broad-spectrum antibiotic therapy. Uterine necrosis should be considered in postpartum women presenting with sepsis and abdominal pain after uterine-sparing surgical procedures for PPH. Prompt recognition, appropriate imaging, and early surgical intervention are critical to reduce morbidity and mortality. Careful intraoperative assessment of cervical viability may permit supracervical hysterectomy in selected patients, preserving the cervix when its vascular supply remains intact.
Perimenopause represents a critical transitional stage in a woman’s life and is frequently accompanied by psychological disturbances, including depressive symptoms. Conventional depression screening instruments may not sufficiently address menopause-specific emotional and somatic experiences, underscoring the importance of context-specific evaluation in this population. To determine the prevalence and severity of depression among perimenopausal women in India and to identify associated demographic, biological, and psychosocial factors to inform targeted screening and intervention strategies. This pan-India, multicentric cross-sectional study enrolled 13,049 women from urban, rural, and semi-urban settings. Depression was assessed using the Meno-D Scale, a validated instrument specifically designed for perimenopausal women. Data on sociodemographic characteristics, reproductive history, medical comorbidities, and psychosocial variables were also collected to explore potential correlates. The overall prevalence of depression was 22.8
Ovarian steroid cell tumors (SCTs), not otherwise specified (NOS), are rare, with few large studies. A 58 year old menopausal para 3 female who presented with increased facial hair growth and deepening of voice for 3 years. Her serum testosterone was 410 ng/dl and free testosterone 18.90 pg/ml. MRI pelvis showed the presence of a solid left ovarian tumour 2*1.5*1.9 cm with minimal peritoneal fluid. The provisional diagnosis of a hormone-secreting tumour of the ovary was kept and abdominal hysterectomy with bilateral salpingooophorectomy with infracolic omentectomy was done. The histopathology report showed a steroid cell tumour not otherwise specified. Steroid cell tumour not otherwise specified though are rare but not exceedingly uncommon. Accurate diagnosis can be achieved through biochemical and radiological suspicion, with confirmation by histopathology and immunohistochemistry.
Granulosa cell tumors (GCTs) of the ovary are rare sex cord–stromal neoplasms characterized by indolent growth and a propensity for late recurrence. Identification of reliable clinicopathological predictors of recurrence remains challenging. This retrospective cohort study included 93 patients with ovarian granulosa cell tumors, with 137 histopathological specimens reviewed. Clinical, histomorphological, and treatment-related parameters were analyzed. Disease-free survival (DFS) was assessed using the Kaplan–Meier method and compared using the log-rank test. Recurrence was observed in 22
To report a rare case of complex pelvic mass from retained foreign body following cesarean section, highlighting long-term surgical complications. Gossypiboma, an accidentally retained surgical sponge or gauze within the body, represents a serious yet underreported surgical complication. Presentations vary from asymptomatic to obstruction, peritonitis, adhesions, fistula, abscess formations. It can cause exudative or fibrinous response. Exudative pattern presents early in postoperative period due to local inflammation. Fibrinous response occurs later through encapsulation of retained foreign object within scar tissue. A 44-year-old woman (Para 1, Living 1) with previous cesarean section 15 years prior presented with complex clinical picture. Her symptoms included abdominal lump for 6 months, chronic abdominal pain, dyspareunia, and heavy menstrual bleeding spanning five years. Clinical examination revealed pulled up and effaced cervix with 22-week-sized pelvic mass. Imaging studies (MRI with CT correlation) demonstrated a 12 × 14 × 15 cm cystic lesion, adherent to anterior uterine wall and abutting bladder dome. A linear hyperdense coiled structure with metallic streak artifacts was suggestive of retained foreign body. Additional findings included bilateral mild hydroureteronephrosis. Surgical intervention was performed which involved laparoscopic pus drainage and removal of sponge presumably left during initial cesarean section 15 years earlier. Retained foreign objects is one of the most dreadful complications of surgery. This case underscores the critical importance of meticulous surgical practices and thorough diagnostic evaluation of persistent gynecological symptoms. Preventing retained foreign objects remains paramount, with accurate surgical item counting serving as primary safeguard against such complications.
Vaginal vault closure is a crucial step in minimally invasive hysterectomy, and the choice of suture material can influence operative efficiency and postoperative outcomes. Barbed sutures, with their knotless self-anchoring design, may overcome technical limitations of conventional polyglactin sutures. This study compares barbed and non-barbed sutures for vault closure with respect to operative time, postoperative complications, and suture absorption. This retrospective cohort study included 204 women who underwent laparoscopic or robotic hysterectomy for benign gynecological indications between July’2016 – April’2024. Vaginal vault closure was performed using either vicryl-1 (non-barbed; n=100) or V-Loc 1-0 (barbed; n=104). Data on demographic variables, comorbidities, suturing time, postoperative complications, and suture absorption were collected. Follow-up was at 48 hours, 1 week, and at 6, 10, and 12 weeks. Statistical analysis used Chi-square and Student’s t-tests; p<0.05 was considered significant. Baseline demographic and clinical characteristics were comparable between groups. Mean suturing time was significantly shorter with barbed sutures (10.28 ± 1.94 vs 12.69 ± 3.31 minutes; p < 0.0001). Secondary hemorrhage (2.88
Cardiac disease in pregnancy presents complex clinical challenges and remains a leading cause of non-obstetric maternal mortality worldwide. Most available data on the prevalence and outcomes of heart disease in pregnancy come from high-income Western countries, limiting their applicability to low- and middle-income countries (LMICs). This study, conducted at a tertiary perinatal center in an LMIC setting, aims to describe the spectrum of cardiovascular disease in pregnancy and to evaluate maternal and perinatal outcomes, contributing context-specific evidence to the evolving field of cardio-obstetrics. We conducted a retrospective cohort study of pregnant women with pre-existing cardiac disease or heart disease first diagnosed during pregnancy, managed at our institute over an eleven-year period (January 2013 to December 2023). Major adverse cardiac events (MACE), along with obstetric and neonatal outcomes, were recorded. Receiver operating characteristic (ROC) analysis was performed to assess the predictive accuracy of Modified World Health Organization (mWHO) classification and CARPREG-II scores for MACE. The cohort included 606 pregnancies in 521 women. Congenital heart disease was the most common diagnosis (41.1
Interventional radiology (IR) has emerged as an important minimally invasive modality in the management of obstetric and gynaecological conditions. Its advantages include reduced morbidity, shorter hospital stays, faster recovery, and preservation of fertility. Uterine artery embolization (UAE) is increasingly utilized for the management of obstetric haemorrhage and selected gynaecological conditions. To evaluate the clinical outcomes, effectiveness, and limitations of uterine artery embolization in obstetric and gynaecological cases managed at a quaternary care centre. This retrospective observational study was conducted at a quaternary care facility in Belagavi and included 38 cases that underwent UAE over an eight-year period (2017–2024). Obstetric indications included placenta accrete spectrum (PAS), placenta previa, and postpartum haemorrhage (PPH), while gynaecological indications included uterine arteriovenous malformations (AVMs) and uterine fibroids. Clinical success, need for blood transfusion, complications, and fertility preservation were assessed. The overall clinical success rate for obstetric cases was 72
Cervical cancer remains a major public health burden in India, and Human papillomavirus (HPV) vaccination is an effective strategy to prevent this. Healthcare workers and medical students play a pivotal role in vaccine advocacy in the general population. The objective of this study is to assess knowledge, attitudes, and perceived barriers and to identify strategies to improve HPV vaccination uptake among medical students and healthcare workers. A cross-sectional study was conducted at AIIMS Deoghar, Jharkhand, over a six-month period, following institutional ethical approval. A structured questionnaire was administered to medical students (MBBS), residents, nursing officers, and faculty members. Data were analysed using SPSS software, and categorical variables were expressed as frequencies and percentages. A total of 335 participants were included in this study, with a mean age predominantly below 25 years (74
Nutrition during pregnancy plays a pivotal role in fetal growth, preserving the mother’s health, and fostering long-term health for both mother and child. This study aims to explore the dietary patterns, nutritional risks at conception and prescribed diet interventions in prenatal condition among pregnant women. Current retrospective study was carried on 3294 pregnant women, who presented to nutrition clinic with comprehensive nutritional assessments and dietary prescriptions at a tertiary care center for a five-year period. Overall mean age of pregnant women was 27.3 ± 3.9 years. At presentation to nutrition outpatient clinic, only 26
Endometrial polyps (EP) are a common cause of heavy menstrual bleeding (HMB). While Levonorgestrel-releasing intrauterine devices (LNG-IUDs) are effective for HMB control, their impact on EP recurrence and subsequent patient-reported outcomes, such as quality of life, remains a subject of investigation. To evaluate the effect of LNG-IUD on symptom control, health-related quality of life (QoL), and EP recurrence in patients with HMB who were diagnosed with EP following dilatation and curettage (D C). This retrospective cohort study included 69 women who presented with HMB and were diagnosed with EP on histopathology after D C. Following D C, all patients received an LNG-IUD. Symptoms and QoL were assessed using the Menorrhagia Multi-Attribute Scale (MMAS) and the Medical Outcomes Study 36-Item Short Form Health Survey (MOS SF-36) at baseline and at 6 and 12 months. Patients were stratified into groups with and without polyp recurrence, as determined by follow-up ultrasonography. Over the 12-month follow-up period, the polyp recurrence rate was 14.5
