Department Of Gynecology Research Articles

Impact of Physical Exercise to Reduce the Risk of Gestational Hypertension, A Role of Leptin and Adiponectin

Objective: To investigate the effect of exercise on the blood pressure of new-onset hypertension and non-hypertensive pregnant women and to determine the serum leptin and adiponectin levels and their response to exercise. Methodology: This quasi-experimental cross-over study was conducted at the Department of Gynaecology and Obstetrics, Hayatabad Medical Complex Peshawar. Samples were processed and analyzed at Khyber Girls Medical College Peshawar from January 2022 to April 2022. A total of 140 pregnant females were recruited for this study through convenience sampling. Out of this total, 70 were normotensive for the control group and 70 were hypertensive (gestational hypertensive). All participants were included after taking an informed consent. Results: In normotensive pregnant women, mean systolic and diastolic blood pressure remained normal, and no hypertension developed. In gestational hypertensive women, 70% responded significantly to physical exercise. Post-exercise, Group A saw decreases in systolic BP , diastolic BP , and leptin levels, with an increase in adiponectin. Group B exhibited more pronounced changes by decreased systolic BP, diastolic BP, leptin, and increased adiponectin. Conclusions: We observed that recommended physical exercise during pregnancy is safe and beneficial for maternal health in pregnancy. Physical exercise significantly reduced the progression of GH and brought the serum leptin and adiponectin levels toward normal range. Therefore, physical activity should be encouraged in every healthy woman after addressing potential barriers to exercise during pregnancy. Keywords: Gestational hypertension, Exercise, Leptin, Adiponectin

7. EVALUATION OF INPATIENT OBSTETRIC SERVICE QUALITY AT THE DEPARTMENT OF OBSTETRICS AND GYNECOLOGY, PHUONG DONG GENERAL HOSPITAL IN 2024

Objective: Describe the perceptions of inpatients about the quality of services at the Department of Obstetrics and Gynecology, Phuong Dong General Hospital in 2024. Methods: This cross-sectional descriptive study, employing both qualitative and quantitative methods, was conducted on 223 obstetric inpatients from March 2024 to September 2024. Results: 91.0% of the inpatients evaluated the service quality as satisfactory. The satisfaction rates for specific aspects were as follows: 96.0% for reliability, 96.9% for responsiveness, 99.1% for assurance, 95.5% for empathy, and 97.3% for tangibility. Conclusion: The high level of satisfaction with obstetric service quality suggests that further efforts are needed to enhance and sustain the quality of services in the future.

Facilitating workplace learning in clinical practice, an evaluation among medical specialists

Purpose Training of medical students, interns and residents (junior professionals, JP) happens predominantly through workplace learning. This is supported by medical specialists (MS) and varies by MS, workplace, medical specialty, and social context. This study aimed to gain insights into the facilitation of workplace learning in clinical practice by MS. Method Thirteen semi-structured interviews were conducted with MS at the gynaecology and paediatrics department in an academic and three non-academic hospitals in the Netherlands. Participants were purposively sampled to be involved in the training of JP. Transcribed interviews were thematically analysed to describe facilitators and barriers for workplace learning. Results Workplace learning was interpreted as a broad concept, with some MS acknowledging its occurrence beyond created opportunities. Four themes revealed facilitators and barriers related to (1) Connection and alignment, (2) Attitude, (3) Organizational and learning dynamics, and (4) Policy and Logistics. Our research suggests MS’ beliefs and awareness regarding workplace learning guide their ability to recognize and utilize learning moments. Conclusions Our findings underscore the importance of a work environment for MS that is founded on interpersonal relationships, supportive logistics of healthcare institutions and a culture of active involvement within the team, all of which are essential for recognizing and utilizing learning opportunities.

Intrauterine Fetal Death and the COVID-19 Pandemic: Looking beyond SARS- CoV-2 Infection

Background: COVID-19 pandemic has caused high numbers of deaths and complications since 2020. Though the risk is the same as in the general population, pregnant women with COVID-19 are especially susceptible to developing complications because of their altered physiology. The objective of this retrospective study is to investigate the relationship betweenthe COVID-19 pandemic period and intrauterine fetal death, which can help to take steps to reduce intrauterine fetal death during the pandemic. Materials and methods: This retrospective study compared the intrauterine fetal death rate during the pre-pandemic (March 01, 2019 to February 29, 2020) and the pandemic period (March 01, 2020, to February 28, 2021) in a tertiary referral hospital in Bangladesh. Patient data were collected from the record-keeping register of the Department of Obstetrics and Gynecology and analyzed by computer-based software presented in graph, chart and table. Results: Out of 21717 obstetric patients admitted patients,821 (3.78%) were documented as cases of intrauterine fetal death in the pre-pandemic period, whereas in the pandemic period, the number was 895 (4.86%) out of 18424. Due to inadequate data records and considering the exclusion criteria, a total of 790 IUFD patients of the pre-pandemic period and 860 IUFD patients of the pandemic period were included in this study. Conclusion: The percentage of IUFD on obstetric admission showed significantly (p<0.001) higher in the pandemic period compared to that in the pre-pandemic period. This result is important for providing insights to the policy makers for future planning, counseling of women wishing to become pregnant, and prioritizing their safety, including their vaccination. Chatt Maa Shi Hosp Med Coll J; Vol.22 (2); July 2023; Page 47-50

Perinatal Outcome and Preventable Causes of Morbidity and Mortality in Eclampsia: A Cross-Sectional Observational Study in a Tertiary Hospital in Bangladesh

Background: Eclampsia poses a substantial threat to perinatal health in developing countries, with Bangladesh experiencing a notable impact on infant well-being. This cross-sectional observational study, conducted at Enam Medical College Hospital, Savar, Dhaka, aimed to investigate perinatal outcomes in eclampsia patients and identify preventable causes of perinatal mortality and morbidity associated with this condition. The study period spanned from June 2015 to July 2017, with a focus on understanding the specific factors contributing to adverse perinatal events in this population. Methods: A total of 155 eclampsia patients were enrolled in the study, resulting in the delivery of 161 babies, including six sets of twins. The study employed a comprehensive observational approach, assessing maternal and fetal conditions to analyze their correlation with perinatal outcomes. Data collection and analysis were conducted in the Department of Obstetrics and Gynaecology at the tertiary hospital, employing standard protocols and statistical methods to derive meaningful insights. Results: The study revealed a perinatal death rate of 27.32%, with stillbirth accounting for 15.52% and early neonatal death for 11.80%. In contrast, 84.47% of babies were born healthy. Among live-born neonates, 27.94% experienced jaundice, while 30.88% had no complications. Prematurity emerged as a significant contributor to perinatal loss in eclampsia cases. The findings underscore the critical role of early referral of eclampsia patients, the implementation of timely resuscitative measures, and improved neonatal care as potential avenues to enhance perinatal outcomes. Conclusion: In conclusion, this study highlights the importance of addressing stillbirth as a predominant component of perinatal death in eclampsia cases. Prematurity was identified as a key factor contributing to adverse perinatal outcomes. Early referral of eclampsia patients and the implementation of resuscitative measures, coupled with enhanced neonatal care, are crucial interventions that can potentially mitigate perinatal morbidity and mortality associated with eclampsia in the context of a tertiary hospital setting in Bangladesh. These findings provide valuable insights for healthcare practitioners and policymakers to guide strategies aimed at improving perinatal outcomes in similar healthcare settings.

An Observation of Outcome in Association with Spontaneous Onset of Labor and Induced Labour of Primigravida at Term

Introduction: Labour is a usual physiological process considered by progressive rise in frequency, intensity and duration of uterine contractions resulting in effacement and dilatation of the cervix with descent of the fetus over the birth canal. Initiation of labour is defined as iatrogenic stimulation of uterine reductions to cause the delivery of fetus before the onset of spontaneous labour. Aim of the study: To observe the outcome in association with spontaneous onset of labor and induced labour of primigravida at term. Methods: This cross-sectional study was conducted in the Department of Obstetrics and Gynecology in Ashiyan Medical College Hospital, Barua Khilkhet, and Dhaka, Bangladesh during the period from January 2018 to December 2018. Initially, all pregnant mothers at term (410/7 – 416/7 Weeks) were enrolled by purposive sampling. Thereafter, they were scrutinized according to the eligibility criteria. Finally, 80 participants were grouped in each category; namely spontaneous labor group. Thereafter, they were explained regarding the study procedure and informed written consent was charted on the partograph. A structure data sheet was used to obtain socio-demographic profile, obstetric profile, maternal and neonatal outcome profile were recorded using a pre structured, peer reviewed, interview and observation-based data collection sheet. All data were recorded, managed and analyzed using software Statistical Package for Social Science (SPSS) version 20.

Using the Robson’s Classification System to Analyze the Trend of Cesarean Section in a Tertiary Care Hospital: An Observational Study from Bangladesh

Introduction: A caesarean section (CS) is an obstetric procedure often performed when it is determined that vaginal delivery could be harmful to either mother or the baby. There is a growing concern about the increasing percentage of CS globally and this is particularly dramatic in many middle- and high-income countries, but at a lower degree in low-income countries. Hence, this study aimed to analyze the trends in cesarean section rates at a tertiary care hospital in Bangladesh using the Robson’s classification system. Methods: This cross-sectional study was conducted in the Department of Obstetrics and Gynaecology, Islami Bank Hospital, Dhaka, Bangladesh from January 2023 to September 2024. Our study included 486 pregnant women who underwent a caesarean section under the Department of Obstetrics and Gynaecology of our hospital during the study period. Result: In this study, we found that group 5 (multiparous with previous CS, single cephalic, ≥37 weeks- with one previous CS and two or more CS) had the highest frequency with 220 cases (45.27%). Most of our patients (68.72%) were aged between 18-30 years and the majority (95.47%) of the deliveries occurred at gestational ages >37 weeks. Out of 229 caesarean sections, 67.08% were elective, and 32.92% were emergency cases. The most common indication for CS was PCS (45.27%), followed by poor progress in labour (21.60%) and foetal distress (13.37%). Conclusion: Our study found that the use of the Robson’s classification of CS is increasing, and Robson group 5 is the main contributor to the overall CS rate.

Application of problem-based learning and case-based learning in teaching ectopic pregnancy to fifth-year medical students

ObjectiveThis study explored the effectiveness of combining problem-based learning (PBL) and case-based learning (CBL) in the clinical teaching of ectopic pregnancy. Methods: Fifth-year students majoring in clinical medicine were recruited from the Department of Gynecology at the Hengyang Central Hospital and Hainan General Hospital between September 2023 and June 2024. The students were randomly assigned to either the combined PBL-CBL or the traditional group. At the end of the class, both groups of students were required to complete a post-class quiz and an anonymous questionnaire.ResultsThe basic knowledge score in the combined PBL-CBL group was significantly higher than that in the traditional group (42.6 ± 3.6 vs 35.0 ± 2.3, p = 0.000). Similarly, the case analysis score was higher in the combined PBL-CBL group than that in the traditional group (37.1 ± 6.2 versus 33.8 ± 5.7, p = 0.013). The scores for learning motivation, understanding, student–teacher interaction, communication skills, clinical thinking skills, self-learning skills, knowledge absorption, and satisfaction with the course in the combined PBL-CBL group were significantly higher than those in the traditional group (p < 0.05). However, the score for the amount of free time consumed by the combined PBL-CBL group was significantly higher than that of the traditional group (p < 0.05).ConclusionThe study suggests that the combined PBL-CBL teaching method might be a promising new mode of gynecological education.

Association of Serum Vitamin D Level with Symptomatic Urinary Tract Infection in Pregnant Women

Background: Urinary tract infections (UTIs) are the most common bacterial infections during pregnancy. Pregnant women in Bangladesh often suffer from UTIs due to a lack of knowledge regarding proper hygiene practices. Adequate vitamin D levels have the potential to enhance the innate immune response, thereby can reduce susceptibility to bacterial infections. Therefore, vitamin D deficiency in pregnant women could increase the risk of urinary tract infections. Aim: To determine the association between maternal serum vitamin D levels and urinary tract infection in pregnancy. Method: This was a case-control study among purposively selected pregnant women attending the inpatient and outpatient department of Obstetrics and Gynaecology, ICMH, Matuail, Dhaka. A total 80 pregnant women between 18-40 years of age were included in this study at their 6-28 weeks of gestation. Among them 40 women who had urinary tract infection, confirmed by presence of ≥105/HPF pus cell in urine routine microscopic examination and a positive urine culture report, were considered as the cases and the rest of the 40 age and gestational age-matched healthy pregnant women without UTI were enrolled as the controls. Aseptically, 5 mL of venous blood was drawn to measure maternal serum vitamin D levels. Statistical analysis was done using the latest version of analytic software SPSS, where required. Results: Among 40 case respondents, Escherichia coli was found to be the most prevalent (60.0%) cause of UTI, with an average maternal serum vitamin D level of 20.5±11.94 ng/ml among those cases. The overall mean (±SD) vitamin D level was much lower among the cases than the controls, 21.1±11.25 ng/mL and 27.9±9.58 ng/ml, respectively. This difference was found statistically significant p=0.004). Considering vitamin D level of 30 ng/mL as the cut-off value, odd’s ratio calculation showed the mother with serum vitamin D level &lt;30 ng/mL had 3.2 times more risk to develop UTI compared to those ...

Caesarean Section at a Selected Tertiary Hospital in Dhaka: Indications and Feto-Maternal Consequences

Background: Cesarean section (CS) delivery has substantially increased globally over the past few decades. Unnecessary C-sections can cause infections, excessive bleeding and various health complications for mothers and babies. In Bangladesh, more than 860,000 C-sections per year are medically unnecessary. Objectives: To determine the indications along with fetal and maternal consequences of CS deliveries. Methods: A cross-sectional study was conducted in paying wards in the Department of Gynaecology and Obstetrics of a selected tertiary level hospital in Bangladesh. A sum of 306 patients were recruited to be a part of this study. Medical documents were used as sources of data and face-to-face interviews were conducted. Descriptive analysis was performed. Results: Mean age was 26.35 ± 5.08 years; 58.5% were multiparous; mean duration of current pregnancy was 35.89 ± 4.23 weeks; 85% deliveries were performed by CS; indications revealed 26.3% cases for less fetal movement and 12.9% for history of previous caesarean section; 91.5% babies were live births; mean birth weight was 2.82 ± 0.53 kg, APGAR scoring at 5th minute was good for 95% fetuses; maternal condition during discharge was stable in 93.1% cases and mean length of hospital stay was 4.30 ± 1.83 days. Conclusion: It can be suggested that the health authorities should formulate specialized programs and spread awareness about the ill effects of caesarean deliveries. The authorities should provide awareness to pregnant women on every comprehensive checkup about the pros and cons of C-section delivery and how to maintain good physical health throughout their pregnancy period.

Maternal Plasma Lipid Concentration in Early Pregnancy and Risk of Preeclampsia

Objective: To determine the relationship between maternal plasma lipid concentration in early pregnancy and risk of preeclampsia. Study Design: Cross-sectional study. Place and Duration of Study: Gynecology and Obstetrics Department Pak Emirates Military Hospital, Rawalpindi Pakistan, Jan 2019 to Jan 2020. Methodology: A total of 500 pregnant women who came for routine antenatal checkup and underwent serum lipid profile testing at 13th week of pregnancy were included in our study. They were followed up till the end of pregnancy for any signs and symptoms of pre-eclampsia. Age and lipid profile parameters were correlated with the presence of preeclampsia in the study participants. Results: Out of 500 pregnant women studied, 443(88.6%) had no preeclampsia during the course of pregnancy while 53(11.4%) had preeclampsia. Mean age of participants was 33.72±6.731 years. With binary logistic regression analysis, it was found that raised levels of total cholesterol, triglycerides and low density lipoprotein cholesterol at 13 weeks of pregnancy had statistically significant relationship with presence of preeclampsia later among the target population. Conclusion: Deranged lipid profile emerged as strong predictor of preeclampsia in our target population. Raised total cholesterol level, triglyceride levels and low density lipoprotein levels were significantly more in patients who developed preeclampsia as compared to those who did not develop this condition.

Clinical assortment of preeclampsia in women with diabetes mellitus type 1 during early pregnancy: an investigative analysis

Objective: To determine the clinical predictors of preeclampsia in T1DM women during first trimester. Study Design: Cross-sectional study Place and Duration of Study: Gynaecology and Obstetrics Department of Pakistan Emirates Military Hospital, Rawalpindi, Pakistan, from Dec 2022 to Oct 2023. Methodology: A cross sectional study of 245 T1DM women was conducted in this group. Two categories of women were identified: normal (n=221) and PE (n=24). Clinical data were gathered in the first trimester, and the eGDR, (mg/kg/min) was used to quantify insulin resistance (IR) in the first trimester. Statistical analysis was done to look for variables linked to PE. Results: Preeclampsia was diagnosed in primiparae. The greatest predictor of PE was vasculopathy (OR 28.15 95% CI 8.0-98.6, p=&lt;0.0001), followed by the duration of diabetes (25 years). PE was linked to a higher gestational weight gain (GWG) of 14 kg. Blood pressure factors of PE included both diastolic and systolic readings. PE and glycated haemoglobin (HbA1c) levels (7.5; 6.2–8.6) were substantially correlated. eGDR and PE had a negative correlation (8.6(6.6–10.6)). Triglycerides (TG) (0.94(0.6– 1.2)) were the lipids that showed a positive correlation with PE, and this correlation was true regardless of HbA1c levels. Conclusion: In T1DM women, primiparity and vasculopathy were the most significant risk factors for PE. Higher GWG was also linked to PE. PE was linked to increased TG and HbA1c levels. More research is necessary to determine the relationship between IR and PE.

Association Between Serum Uric Acid and Pregnancy Outcomes: A Study in Chinese Women

ABSTRACT Objective The study aims to explore the relationship between serum uric acid (UA) levels in the first trimester and pregnancy outcomes. Methods The clinical data of 1381 pregnant women who delivered in the Department of Obstetrics and Gynecology of Beijing Chao-Yang Hospital from June 2021 to July 2022 were collected. All patients were categorized into four groups (Q1-Q4) according to quartiles of UA, using the first quartile of UA as the reference group. Logistic regression analysis was used to observe the correlation between UA and pregnancy outcomes. Restricted cubic spline (RCS) was drawn to observe the dose-response relationship between UA and pregnancy outcomes. Results The numbers of GDM patients in Q1-Q4 were 40 (11.70%), 46 (13.49%), 60 (17.29%) and 83 (23.65%), respectively (p < 0.001). Logistic regression analysis showed that higher quartiles of UA were significantly associated with an increased prevalence of gestational diabetes mellitus (GDM). After adjusting for confounding factors (maternal age, prepregnancy BMI, gestational weight gain, and gestational age), compared with the lowest quartile of UA, the highest quartile of UA had 2.06 times odds of GDM (OR, 2.06; 95% CI, 1.34, 3.18; p = 0.001) in Q4. RCS suggested that the risk of GDM increased slowly until UA levels reached 219.43 µmol/L and then began to increase rapidly afterward (overall p = 0.0037). Conclusions Increased uric acid concentrations in the first trimester are associated with an increased risk of GDM and gestational hypertension.

Evaluation of efficacy of mentzer index for screening of beta - Thalassemia trait in antenatal women

People with thalassemia trait should be distinguished from those who have anemia due to iron deficiency since they typically have mild microcytic hypochromic anemia and are mostly asymptomatic. : To evaluate efficacy of Mentzer index for screening Beta- Thalassemia trait in pregnant women.From January 2023 to October 2023, the observational study was carried out in the Department of Gynecology &amp; Obstetrics at Sri Guru Ram Das Charitable Hospital Amritsar. The study comprised 130 pregnant women with anemia. To assess microcytic hypochromic anemia, tests like complete blood count (CBC), peripheral blood smears, iron studies, and hemoglobin electrophoresis were performed. Mentzer Index (MI) was computed, and its specificity and sensitivity assessed. Of the 130 patients, 112 had Mentzer Index greater than 13 and 18 had Mentzer Index less than 13 but only 12 out of these18 had beta thal-trait according to HPLC. There were total 15 females having beta thal-trait as per HPLC, however 3 of the 15 had Mentzer &amp;#62;13. Conserding Beta thal-trait, the Mentzer Index's sensitivity and specificity were 80% and 95.65% in this study, and 95.33% and 86.96% for IDA. Mentzer Index (MI) is a helpful tool to distinguish iron deficiency from thalassemia trait as its specificity and sensitivity is high as electrophoresis in diagnosis. In situations with limited resources, this proves to be advantageous in terms of cost-effectiveness.

To evaluate the reliability of Urea and Creatinine values in vaginal wash fluid for the diagnosis of PROM

Background &amp; Methods: The aim of the study is to evaluate the reliability of urea and creatinine values in vaginal wash fluid for the diagnosis of PROM. Study performed on pregnant women in the third trimester between 28 and 37 weeks of gestation with history of possible leakage of amniotic fluid at tending in the department of Obstetrics and Gynaecology. Results: Total 50 subjects were recruited. Group 1 is PROM confirmed 25 subjects . Group 2 were controls and in each group 25 subjects were allotted. The comparison of co-morbidity between study groups in vaginal wash fluid to diagnosis the high rupture of membrane. Around 24% of subjects had co-morbidity in PROM confirmed category. Conclusion: In PROM confirmed subject urea level was 9.99 ± 4.16 and in controls it was around 4.12 ± 2.65. This shows that both PROM confirmed and suspected subjects had increased urea level than the control group. Thus urea and creatinine levels in vaginal wash fluid serves as an excellent diagnostic marker in diagnosing premature rupture of membrane. In conclusion, our study demonstrated that the measurement of vaginal fluid urea and creatinine is a simple and reliable test for diagnosis of PROM.

Enhanced recovery after surgery (ERAS) a multimodal perioperative care pathway in cesarean deliveries

Enhanced Recovery After Surgery (ERAS) is an evidence based perioperative program applied for early recovery of patients after surgery to reduce the postoperative surgical stress and hasten early physiological and functional recovery. The present study is focused on application of ERAS protocol in the branch of obstetrics following cesarean sections.The primary objective is to compare the efficacy between post-operative recommendations of ERAS protocols and traditional post-operative care in cesarean sections. A total of 300 patients were included in this study from November 2020 to October 2022 from the inpatient department of Obstetrics and Gynaecology of Pradyumna Bal Memorial hospital, KIMS, Bhubaneswar. Out of 300 patients, 150 were in ERAS group and 150 were in control (conventional) group. The median Length of stay (LOS) of ERAS and control group were 3 and 5 days respectively (p&amp;#60;0.01). The median patient satisfaction score on Likert scale was 4 and 3 for ERAS and control group respectively (p&amp;#60;0.01).The application of ERAS in post-operative period after cesarean has showed significant results in decreasing length of stay and better patient satisfaction score.

Menstrual challenges in puberty: Investigating menorrhagia in adolescent girls

Menorrhagia, defined as excessive or prolonged menstrual bleeding, poses a significant challenge during this developmental stage, potentially impacting the health and well-being of adolescent girls. Despite its prevalence, comprehensive studies on menorrhagia in this specific demographic are scarce. This study aims to address this gap by investigating the underlying causes and treatment outcomes of puberty menorrhagia.A six-month observational study involving 50 adolescent girls presenting with menorrhagia was conducted at the Department of Obstetrics and Gynecology in a tertiary care center. The study utilized consecutive enumerative sampling and included a thorough investigation of participants, collecting data on demographic profiles, symptom severity, anemia levels, diagnoses, therapy requirements, and responses to conservative management. Baseline investigations encompassed a range of tests, including pregnancy exclusion, complete blood count, coagulation profile, and hormonal assays.The study cohort of 50 participants revealed varying characteristics: 24% were under 14 years, 34% were between 14-16 years, and 42% were aged 17-19 years. BMI distribution showed 14% below 18.5, 76% between 18.5 and 25, and 10% exceeding 25. Symptom duration included 20% reporting less than 6 months, 34% between 6-12 months, and 46% over 12 months. Etiology analysis indicated 60% with ovulatory dysfunction. Hemoglobin level analysis illustrated the prevalence and severity of anemia. Diverse treatments, including hormonal and non-hormonal interventions, were administered.This study provides insights into the causes of puberty menorrhagia, emphasizing the need for a holistic treatment. Future research should delve deeper into identified associations and clinical variants to enhance our understanding and guide effective interventions. Management should be directed to the cause.

Rights-based reproductive services in medical schools in Rajasthan, Gujarat and Chandigarh, India: baseline findings of mixed-methods implementation research

IntroductionThere is a need to assess and strengthen reproductive rights-based family planning and abortion services in Indian medical schools that play a key role in medical education and service delivery. This study presents the findings of baseline assessment across nine schools in two states and one union territory with objective to assess, identify the gaps and improve the status of reproductive rights and evidence-based family planning and abortion services in Indian medical schools.MethodsA convergent parallel mixed methods study was conducted in nine medical schools in Rajasthan, Gujarat, and Chandigarh a Union territory in India from October 2018 to June 2019. In-depth interviews with 33 faculty from the Department of Obstetrics and Gynaecology were conducted. The COM-B (Capability, Opportunity, and Motivation) model of behaviours was used to qualitatively identify barriers and facilitators of reproductive rights-based family planning and abortion services. Reproductive health services provided to 104 women for family planning and abortion were observed quantitatively using a pre-tested checklist.FindingsProviders’ preference bias in recommending contraceptive methods to specific clients (wherein sterilisation was offered to women with two or more children and IUCD to women with one child) was observed as barrier to reproductive rights. The facilitators of rights based reproductive services included well-informed faculty regarding providing dignified and respectful care. Barriers included infrastructure gaps, high workload, insufficient human resources affecting privacy, and lower awareness and decision-making power of clients. Family planning counselling using the cafeteria approach was offered in 69.4% of cases, 31.6% of women seeking abortion services were offered counselling on both family planning and abortion. Sterilisation or IUD insertion was a pre-condition in 36.8% of women requesting an abortion.ConclusionsRight-based reproductive services around family planning counselling and abortion services were delivered partially despite the medical schools’ trained faculty, mainly due to provider bias, high workload, and less autonomy and lower awareness of reproductive rights among women.

Pain and Fertility Outcomes in Patients Undergoing Cyst Excision Versus Cyst Aspiration in Moderate to Severe Endometriosis: A Case Series

Background: Endometriosis and ovarian cysts are prevalent gynecological disorders characterized by the presence of abnormal tissue growth in the pelvic cavity. Objective: To document the pain and fertility outcomes in patients undergoing cyst excision versus cyst aspiration in moderate to severe endometriosis presenting to a tertiary healthcare facility. Methods: This was a case series conducted in the Department of Obstetrics and Gynecology, Vinayaka Missions Medical College &amp; Hospital, Vinayaka Missions Research Foundation (VMRF, Deemed to be University), Karaikal, Puducherry, India between June 2021 and May 2023 (n=14). Results: The study included 14 patients, divided evenly with 7 undergoing cyst excision and 7 undergoing cyst aspiration. Before surgery, both groups had comparable baseline characteristics in terms of age, symptom severity, and the nature of the ovarian cysts. After surgery, patients who underwent cyst excision showed a higher rate of pain relief compared to those who underwent cyst aspiration (61% versus 26%, respectively). In terms of fertility outcomes, 55% of patients in the cyst excision group achieved improved clinical pregnancy outcomes after surgery, whereas 35% of those in the cyst aspiration group had comparable results. Conclusion: Cyst excision appears to be associated with superior pain relief and faster recovery compared to cyst aspiration in patients with endometriosis or ovarian cysts.

Contributions Regarding the Study of Pulsatility and Resistivity Indices of Uterine Arteries in Term Pregnancies-A Prospective Study in Bucharest, Romania.

Pregnancy is a complex stage in a woman's life, considering the physical and psychological changes that occur. The introduction of Doppler studies of the pregnant woman's vessels and those of the fetus has proven to be a useful tool in evaluating the maternal-fetal relationship. Objective: The study aims to assess the correlations of PI and RI values in term pregnancies. Methods: This analysis is based on the prospective evaluation of medical data from 60 patients who were admitted to the Obstetrics and Gynecology department of Saint Pantelimon Hospital in Bucharest, Romania, from May to August 2024. Among the examined parameters are patient age, blood pressure, amniotic fluid quantity, placenta location, and pulsatility and resistivity indices of uterine arteries. Results: A higher diastolic blood pressure is associated with higher mean PI and RI values, indicating that diastolic blood pressure has a significant correlation to these values. The mean RI shows a moderately negative and significant correlation, suggesting that a lower level of amniotic fluid is associated with a higher mean RI. Regarding the PI value of the uterine arteries, the p-value suggests that the difference between the groups with and without associated diseases is statistically significant. Placental insertion on the anterior or posterior uterine wall does not have a significant impact on the PI and RI values of the uterine arteries, but the values are higher in the contralateral part of the placental insertion. Conclusions: These results strengthen the evidence previously demonstrated. Uterine artery Doppler ultrasonography is an extremely useful tool in monitoring and managing high-risk pregnancies.