Asian Research Journal of Gynaecology and Obstetrics

Navigating the Grey Area: Periviable Preterm Prelabour Rupture of Membrane Complicated by Subclinical Chorioamnionitis

2026-02-07T12:03:39+00:00

Periviable preterm prelabour rupture of membranes (PPROM), defined as rupture of membranes before 26 weeks of gestation, is an uncommon but serious obstetric complication that carries significant risks of perinatal mortality and maternal morbidity. Early recognition and timely management are critical, as decisions must balance the potential for fetal survival with the risk of maternal infection and other complications. Subclinical chorioamnionitis, in particular, can develop without overt clinical signs, making diagnosis challenging and often reliant on laboratory and imaging findings.This case highlights the complex course of a 31-year-old primigravida at 25 weeks and 2 days gestation diagnosed with subclinical chorioamnionitis complicating periviable (PPROM) with severe oligohydramnios, resulting in intrauterine fetal demise despite appropriate antibiotic course initiation. This case underscores the importance of early detection of subclinical chorioamnionitis, careful surveillance, and individualized, multidisciplinary decision-making in periviable PPROM. It highlights the need for sensitive counselling to support maternal safety while considering fetal prognosis, providing a practical example of the challenges in managing high-risk periviable pregnancies.

Intrauterine Fetal Demise in a Patient with HELLP Syndrome, Superimposed Preeclampsia, and Placental Calcification: A Case Report

2026-02-07T12:11:11+00:00

This case describes a 37-year-old gravida 3 para 1+1 woman at 31+3 weeks gestation who experienced intrauterine fetal death secondary to Hemolysis, Elevated Liver enzymes and Low Platelets (HELLP) syndrome and placental calcification, on a background of chronic hypertension with superimposed preeclampsia and gestational thrombocytopenia. Her obstetric history included previous preeclampsia, gestational diabetes managed with diet, obesity, and one prior miscarriage. She was managed with close monitoring and timely supportive care. This case highlights the diagnostic and management challenges of hypertensive disorders in high-risk pregnancies and underscores the importance of early detection, vigilant surveillance, and a coordinated multidisciplinary approach to optimize maternal outcomes.

Exploring New Risk Factors and Preventive Strategies for Premature Rupture of Fetal Membranes: A Systematic Review of Current Prevalence of Traditional, Lifestyle, Nutritional, Physiological and Haematological Factors

2026-04-03T10:36:41+00:00

Background: According to most recent hypotheses, premature rupture of fetal membranes (PROM) remains a leading cause of preterm birth and neonatal morbidity worldwide, affecting approximately 5–10% of all pregnancies. Harmful traditional practices, lifestyle choices, nutritional deficiencies, physiological factors, and haematological conditions have been implicated in the etiology of PROM, yet their collective and individual prevalence and impact are still poorly quantified and exploited.

Objective: To systematically review the current prevalence of harmful traditional practices, lifestyle, nutritional, physiological, and hematological risk factors among pregnant women that contribute to PROM, and to identify evidence‑based preventive measures.

Methodology: A comprehensive search was performed across ten databases and websites using defined search terms (e.g., “premature rupture of fetal membranes,” “PROM,” “risk factors,” “pregnant women”). Of 550 retrieved articles, 466 met the inclusion criteria after applying pre‑specified exclusion criteria. The review adhered to a registered systematic‑review protocol and followed PRISMA guidelines.

Results: The synthesis revealed that female genital mutilation, vaginal douching, smoking, alcohol use, low dietary intake of vitamins C and E, omega‑3 deficiency, prior PROM, cervical insufficiency, short cervical length, uterine anomalies, polyhydramnios, bacterial vaginosis, and chorioamnionitis are consistently associated with increased PROM risk. Haematological parameters showed that maternal anemia (hemoglobin < 11 g/dL) and thrombophilic disorders (e.g., factor V Leiden, antiphospholipid syndrome) also elevate risk. Prevalence varied widely across regions, with the highest burdens reported in sub‑Saharan Africa and South Asia. Interventions such as antenatal education, smoking‑cessation programs, micronutrient supplementation, progesterone therapy in high‑risk women, treatment of vaginal infections, correction of anemia, and thrombophilia management showed promise in reducing PROM incidence.

Conclusion: Addressing modifiable risk factors through targeted antenatal interventions and policy reforms could substantially lower PROM rates and improve maternal‑fetal outcomes. Future research should focus on longitudinal studies and randomized trials to strengthen causal inference and evaluate scalable preventive strategies.

Reconstructing Inequality in Maternal Health: Imputation-enhanced Machine Learning Models for Global ANC4 Performance

2026-01-02T10:54:26+00:00

The study develops a hybrid composite analysis model that combines imputation and machine learning techniques to predict 527 country-years of national antenatal care coverage with at least four visits (ANC4). The structured missingness of the wealth quintile indicators was addressed through imputations that preserved the distributional characteristics of disadvantaged groups. Five machine-learning algorithms were tested following the imputations. Gradient Boosting achieved the best predictive performance, followed by random forest and XGBoost. Elastic Net, which is more interpretable due to its coefficients, was less predictive but showed significant positive effects on the poorest quartile and rural populations. KNN Regression produced mediocre results and is sensitive to feature scaling. Based on the combined imputation and machine-learning pipeline, it can be concluded that social, economic, and regional disparities exist, with lower-income states and South Asian, Eastern and Southern African regions persistently associated with low ANC4 scores. This research represents a notable innovation, strengthening equity-based maternal health surveillance and providing actionable evidence to advance SDG 3 and SDG 10. It is recommended that global health agencies incorporate various imputation and machine-learning forecasting methods into their routine maternal health monitoring to identify injustices early and allocate resources more effectively.

Reproductive Determinants of Histopathological Variants of Cervical Cancer in Eastern Indonesia: A Retrospective Observational Study

2026-01-08T10:12:10+00:00

Aims: To examine the association between reproductive factors and the histopathological type of cervical cancer, specifically comparing squamous cell carcinoma and adenocarcinoma.

Methodology: The study was carried out at Abdoel Wahab Sjahranie General Hospital using medical record data from January 2023 to December 2024, and is a retrospective observational study. Secondary data were obtained from medical records of cervical cancer patients who underwent biopsy during the study period. A total of 97 patients were included through simple random sampling. Histopathological findings were grouped into squamous cell carcinoma (including keratinizing and non-keratinizing subtypes) and adenocarcinoma. Reproductive factors analyzed included number of marriages, age at menarche, age at marriage, parity, and history of abortion and fetal death. Bivariate analysis was performed using the Mann–Whitney U test. Variables with a P < .25 were included in multivariate binary logistic regression analysis. Statistical significance was set at P < .05

Results: The mean age of patients was 49.00 10.00 years. Bivariate analysis showed that parity was significantly associated with histopathological type (mean 3.21 1.91; P = .005), while other reproductive factors were not. In multivariate analysis, parity remained the only independent predictor of histopathological type, with higher parity associated with a lower likelihood of adenocarcinoma compared with squamous cell carcinoma (OR = 0.68; 95% CI: 0.50–0.92; P = .01). Age at menarche and age at marriage were not independently associated with histopathological type. The regression model explained 14.5% of the variability in histopathological type.

Conclusion: Parity is the only reproductive factor independently associated with the histopathological type of cervical cancer. Higher parity is more strongly linked to squamous cell carcinoma, while adenocarcinoma is more frequently observed among women with lower parity. These findings may support risk stratification and more targeted counseling and screening strategies in clinical and public health settings.

Accuracy of Intraoperative Gross Visual Assessment of Myometrial Invasion and Tumour Size to Guide Pelvic Lymphadenectomy in Early Stage Endometrial Cancer: A Retrospective Single Center Study in Sarawak, Malaysia

2026-01-10T12:38:01+00:00

Aims: To identify the accuracy of intra-operative gross visual assessment of myometrial invasion and tumour size in endometrial cancer as a tool for predictor of extent of surgical staging.

Study Design: A retrospective analysis of women diagnosed with endometrial cancer in Sarawak General Hospital.

Place and Duration of Study: Gynaecology-oncology Unit, Obstetric and Gynaecology Department, Sarawak General Hospital, Malaysia between January 2021 and December 2023.

Methodology: A total of 94 medical records of women diagnosed with endometrial cancer between January 2021 and December 2023 were reviewed. 39 out 94 women diagnosed with endometrial cancer had their uterus examined intraoperatively by the gynaecologic oncologist. Statistical analyses, including Kappa-Cohen statistic was used to compare whether there is an agreement between intra-operative findings by the gynaeoncologist and final histopathology report.

Results: Patients diagnosed with endometrial cancer were mainly between 26 to 72 years old, with mean age of 52 years. The mean body mass index (BMI) was 30.4. Majority of the patients were of Malay ethnicity, 37.2%. Most of the patients were diagnosed in the early stages 42.6% stage IA and 25.5% stage IB (FIGO 2009 staging). Endometrioid histology comprised of 90.4%. 26.5% of the patients had endometrial hyperplasia with or without atypia with a final histopathological report of endometrial cancer. There was a moderate agreement between intraoperative findings of myometrial invasion and final histopathology (kappa=0.59). For intraoperative tumour size estimation, there was only slight agreement (kappa=0.16).

Conclusion: Intraoperative gross assessment of myometrial invasion shows moderate agreement with the final histopathology compared to tumour size assessment. Therefore, intraoperative assessment done by a trained gynaecologic oncologist can be used as a cost effective tool to determine the need for pelvic lymphadenectomy in tumours confined to the uterus in places where more advanced techniques are not available.

Placenta Praevia in a Tertiary Hospital: Prevalence, Risk Factors and Fetomaternal Outcomes

2026-01-22T11:13:51+00:00

Background: Placenta praevia is a significant obstetric complication and remains an important cause of antepartum haemorrhage, contributing substantially to maternal and perinatal morbidity and mortality worldwide. The burden is particularly high in low- and middle-income countries, where delays in diagnosis, limited access to blood products, and suboptimal referral systems often worsen outcomes. Preventive strategies, early diagnosis through antenatal ultrasonography, and appropriate obstetric intervention are crucial in reducing adverse fetomaternal consequences.

Objective: This study aimed to determine the prevalence of placenta praevia, describe the sociodemographic characteristics of affected women, identify associated risk factors, and evaluate fetomaternal outcomes among women managed for placenta praevia in a tertiary health facility.

Study Design: A retrospective descriptive study of women managed for placenta praevia conducted at the Federal Medical Centre, Yenagoa, Bayelsa State, between 1st January 2018 and 31st December 2020.

Results: During the three-year study period, a total of 2,375 deliveries were recorded, of which 38 were complicated by placenta praevia, resulting in a prevalence of 1.6%. The mean maternal age was 32.7 years. The highest proportion of cases (42.1%) occurred among women aged 31–35 years. Placenta praevia was more common among primiparous women (42.1%), followed closely by multiparous women (39.4%). There was no difference in booking status, with equal proportions of booked and unbooked patients. Most women were married (89.5%) and employed (73.7%).

Previous caesarean section was the most frequently identified risk factor, present in 55.3% of cases. Other risk factors included previous dilatation and curettage, prior placenta praevia, previous myomectomy, and multiple pregnancy. Nearly all pregnancies resulted in live births, with only one stillbirth recorded. All women were delivered by caesarean section. Preterm delivery occurred in 52.5% of cases. Postpartum haemorrhage complicated 26.3% of deliveries, while 55.3% of women required blood transfusion. Forty percent of the neonates were admitted to the Special Care Baby Unit. No maternal deaths were recorded during the study period.

Conclusion: Placenta praevia accounted for 1.6% of deliveries in the study centre and was most common among primiparous women with a history of caesarean section. Prompt diagnosis and timely caesarean delivery resulted in favourable maternal and neonatal outcomes, with no recorded maternal mortality.

Prevalence and Antimicrobial Susceptibility of Klebsiella pneumoniae in Urinary Tract Infections among Outpatient Women in Rural Zambia

2026-01-27T13:46:41+00:00

Background: Urinary tract infections (UTIs) are among the most common bacterial infections affecting women worldwide. Klebsiella pneumoniae has emerged as an important uropathogen, particularly in settings with increasing antimicrobial resistance. Data from rural district hospitals in Zambia remain limited.

Objective: To determine the prevalence of Klebsiella pneumoniae among urinary tract infections in outpatient women at Kalindawalo General Hospital and to assess the antimicrobial susceptibility patterns of the isolates.

Methods: A retrospective cross-sectional descriptive study was conducted using laboratory records from January to December 2024. Urine culture and antimicrobial susceptibility data of female outpatients aged ≥15 years with culture-confirmed UTIs were reviewed. Bacterial identification and susceptibility testing were performed using standard microbiological techniques. Data were analyzed using SPSS version 26, with results summarized using frequencies and percentages.

Results: A total of 162 female outpatients with culture-confirmed UTIs were included. The majority were aged 25–34 years (41.1%). Escherichia coli was the most common uropathogen (60.5%), followed by Klebsiella pneumoniae (19.1%). K. pneumoniae isolates showed high resistance to ampicillin (100%), co-trimoxazole (83.9%), ceftriaxone (67.7%), and ciprofloxacin (61.3%). Moderate susceptibility was observed for gentamicin (64.5%) and nitrofurantoin (58.1%), while imipenem demonstrated the highest activity (93.5% susceptibility). A substantial proportion of isolates exhibited multidrug resistance.

Conclusion: Klebsiella pneumoniae is a significant cause of UTIs among outpatient women at Kalindawalo General Hospital and exhibits high levels of resistance to commonly used antibiotics. Routine urine culture and susceptibility testing, alongside strengthened antimicrobial stewardship, are essential to guide effective treatment and limit the spread of resistant strains in rural healthcare settings.

Clinical Profile and Outcomes of Obstetric ICU Admissions in a North Indian Tertiary Care Centre: A Retrospective Study

2026-01-28T10:19:50+00:00

Background: Obstetric ICU admissions come with unique challenges due to changes in maternal physiology, fetal health, and the potential for rapid complications. Fetal well-being is often compromised along with maternal health. There is high rates of preterm delivery, low birth weight, neonatal intensive care unit (NICU) admissions born to ICU obstetric patients.

Aim: This study aims to assess the clinical profiles and outcomes of obstetric patients who were admitted to intensive care.

Methodology: We conducted a retrospective observational study at St Stephen’s Hospital in New Delhi, covering the period from January 2022 to December 2023. The data collected included the demographic details like age, booked or unbooked, referral status, time of admission, obstetric history, medical history, mode of delivery, diagnosis at admission, interventions, and maternal outcome. The statistical analysis was divided into descriptive analysis which included mean/median age, percentage of referrals, and frequency of specific diagnoses.

Results: Out of 2010 deliveries, 37 patients (1.84%) required ICU admission, mainly due to hemorrhage and hemodynamic instability. A significant portion were unbooked (72.9%), and over half (54.05%) were referrals. Nearly 80% of these patients recovered, while the mortality rate stood at 8%. Hypertensive disorders were the second common cause for ICU admission (27.02%) with complications arising from preeclampsia, eclampsia and HELLP syndrome. This was followed by sepsis (21.6%), 8 patients requiring intensive management for septicaemia. Majority of the patients (81%) recovered in our study, 8 % improved with morbidity like dialysis dependent chronic kidney disease. This high rate of recovery is a testament of the ICU’s efficacy which demonstrates the aggressive multidisciplinary care involving the obstetricians, anesthesiologists and intensivists who successfully salvaged these patients even in the presence of severe organ failure.

Conclusion: To reduce maternal morbidity and mortality, it’s crucial to enhance antenatal care, promptly identify risk factors, and implement a multidisciplinary approach in ICU management. This study helped to identify the modifiable factors like regular antenatal care, early detection of hypertensive disorders, need for anemia correction and active management of third stage, which play a significant role in the maternal outcome and will reduce the ICU admissions in obstetric patients.

Disrespect, Abuse and Psychological Consequences of Facility-based Childbirth in Northern Ghana: Evidence from a Cross-Sectional Study

2026-01-30T06:33:53+00:00

Introduction: Disrespect and abuse while giving birth in health facilities undermines the basic maternal health care women deserve and builds distrust in health systems. Although access to skilled birth attendance has improved, many women report maltreatment and even abuse during child birth. This maltreatment includes care without consent, inadequate privacy, discriminatory, and neglectful treatment, and even detention in the facilities.

Purpose: The main purpose of the study was to assess the prevalence and forms of disrespect and abuse experienced by women during facility-based childbirth in Northern Ghana.

Method: This study took place in the Northern Region of Ghana. It focused on five hospitals in the area: The Northern Regional Hospital, Tamale West Hospital, Tamale Teaching Hospital, The Seventh-Day Adventist (SDA) Hospital and the Sevelugu Municipal Hospital. The research used a descriptive, cross-sectional design with a quantitative approach to collect data from mothers who had recently delivered and were receiving postnatal care from these hospitals. The target population for the study was mothers receiving postnatal care from of the five selected hospitals, with a total sample size of 1,347 participants from March 2024 to May, 2024. A probability sampling method was used to ensure each mother had an equal chance of being selected for the study. After data collection, all data was cleaned, coded and entered into the IBM Statistical Package For Social Science (SPSS) version 27, for the purpose of analysis.

Results: The extensive disrespect and abuse experienced by women during facility-based childbirth indicates the need for immediate improvement in maternity care. Around 48% of women reported having been physically abused during their labour or delivery, and approximately 52.3% stated they were verbally abused or humiliated. Almost 66.0% of the women reported being subjected to medical procedures without being given prior informed consent (i.e., serious violations of their autonomy and bodily integrity) and numerous women reported being detained or imprisoned in a health facility as a result of their inability to pay for health services. Additionally, these women frequently expressed feelings of helplessness and anger and fear of retaliation from healthcare providers, and most reported experiencing significant levels of psychological distress (including depression and anxiety) related to the aforementioned issues. When experiencing difficulty related to payment, many women also stated that they had been threatened with abandonment by healthcare providers. In sum, these findings demonstrate that the physical disrespect and abuse suffered during childbirth has had a significant negative impact on women's mental health, maternal identity and future healthcare-seeking behaviour, thereby necessitating large-scale reform of maternity care to ensure accountability and respect for women during childbirth.

Conclusion: Collectively, the results highlight the urgent need to reposition respectful maternity care as a central component of quality obstetric services in Northern Ghana. therefore, there is an urgent need for health system–level reforms to address disrespect and abuse during childbirth.

HELLP Syndrome: Predictive Factors and Benefits of a Standardized Treatment Protocol in a Cohort of 1,254 Cases of Preeclampsia

2026-02-19T08:34:47+00:00

Introduction: HELLP syndrome (Hemolysis, Elevated Liver Enzymes, Low Platelets) is one of the most severe complications of preeclampsia, posing a life-threatening risk to both mother and fetus. In middle-income countries, its management is complicated by delays in consultation and limited resources. This study aims to determine the incidence of the syndrome, its predictive factors, and to evaluate the impact of a standardized protocol on morbidity and mortality.

Methods: An analytical, comparative, prospective, and interventional study was conducted over four years at Annaba University Hospital, including 1,254 patients with preeclampsia. The study was designed to compare two consecutive periods: an initial observational phase (T1), conducted before the implementation of any standardized protocol, and an interventional phase (T2), following the introduction of a multidisciplinary management protocol incorporating antenatal corticosteroid therapy, conservative (expectant) management, and structured fluid management.

Results: Among 1,254 women with preeclampsia, 223 developed HELLP syndrome, corresponding to an incidence of 17.8%. The clinical presentation was dominated by hepatic cytolysis, observed in 197 cases (88.3%), and severe thrombocytopenia (<100,000/mm³) in 160 cases (71.8%). Acute renal failure complicated 153 cases (68.6%), reflecting delayed diagnosis and management. Implementation of the multidisciplinary management protocol during the interventional phase (T2) was associated with a significant reduction in neonatal mortality (35.6% vs. 44.4%; p = 0.0087), as well as a decrease in platelet transfusion requirements (p = 0.004) and a shorter maternal length of hospital stay (p < 0.0001). Importantly, this more conservative, expectant approach did not increase maternal morbidity.

Conclusion: Standards of care are changing the prognosis for HELLP syndrome. A conservative approach between 28 and 34 weeks of gestation is beneficial and safe in our setting, when strict monitoring is in place.

Comparison of IVF Outcomes in Natural and Programmed Menstrual Cycles Prior to Ovarian Stimulation in a Nigerian Tertiary Centre: A Randomized Clinical Trial

2026-02-20T08:05:42+00:00

Background: Controlled ovarian stimulation (COS) is essential in assisted reproductive technology to achieve synchronized follicular development and optimize oocyte yield for in-vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI). Combined oral contraceptive pills (OCPs) are widely used for cycle scheduling to facilitate patient batching and laboratory planning. Contemporary evidence from high-income settings suggests that short-term OCP pretreatment does not adversely affect ovarian response; however, concerns persist regarding excessive hormonal suppression, altered endocrine milieu, and potential impairment of follicular recruitment. Data from low- and middle-income countries, where patient characteristics and stimulation protocols may differ, remain limited.

Objective: The present study compared oocyte yield and reproductive outcomes following controlled ovarian stimulation initiated in natural menstrual cycles versus cycles scheduled with combined oral contraceptive pills among women undergoing IVF in a Nigerian tertiary centre.

Methods: This was a prospective, open-label randomized controlled trial conducted at the Federal Medical Centre, Abuja, Nigeria, between July and October 2022. Using consecutive sampling, 86 eligible and consenting women undergoing IVF were recruited and randomized in a 1:1 ratio (43 per group) using sealed opaque envelopes to either natural cycle initiation or OCP-programmed cycle initiation. Controlled ovarian stimulation was commenced on cycle day 2 or 3 in both groups using individualized follicle-stimulating hormone dosing based on age, body mass index, and baseline ovarian reserve. The primary outcome was mean oocyte yield. Secondary outcomes included duration of gonadotropin stimulation, embryo cleavage and blastocyst formation rates, biochemical and clinical pregnancy rates, ovarian hyperstimulation syndrome, and patient satisfaction. Analyses were conducted on an intention-to-treat basis using IBM SPSS version 23 with a 95% confidence level (p ≤ 0.05). Adjusted analyses were not performed; therefore, residual confounding was considered.

Results: Eighty-six women were analyzed (43 per group). Mean age was comparable between the OCP-programmed and natural cycle groups. Mean oocyte yield did not differ significantly between groups (natural cycle: 11.09 ± 2.86 vs OCP-programmed: 11.51 ± 1.62; p = 0.379). Clinical pregnancy rates were similar between groups (p = 0.659), indicating no statistically significant difference. The OCP-programmed group required a shorter duration of gonadotropin stimulation (p = 0.016). Embryo cleavage rates, blastocyst formation rates, and patient satisfaction scores were comparable. No significant difference was observed in the incidence of severe or critical ovarian hyperstimulation syndrome.

Conclusion: Combined oral contraceptive pretreatment for cycle scheduling before controlled ovarian stimulation does not adversely affect oocyte yield or pregnancy outcomes compared with natural cycle initiation. While transient hormonal suppression may occur, ovarian responsiveness and reproductive outcomes remain preserved. OCP-based scheduling offers logistical advantages without compromising IVF success in this Nigerian tertiary centre.

Feasibility and Pain Tolerance of 19Fr Mechanical Hysteroscopic Morcellation under Local Anesthesia: A Retrospective Case Series

2026-02-24T09:33:46+00:00

Objective: The paradigm shift from inpatient surgery to ambulatory settings represents a major trend in modern gynecology. However, the use of larger-diameter instruments like the 19Fr Bigatti Shaver (IBS®) under local anesthesia remains debated due to the need for cervical dilation. This study aims to evaluate the feasibility, pain tolerance, and safety of 19Fr mechanical morcellation performed under a standardized local anesthesia protocol.

Methods: We conducted a retrospective monocentric case series of 80 patients treated at the Centre Hospitalier des 4 Villes (France) between 2022 and 2024. All patients underwent operative hysteroscopy for benign pathologies (polyps, myomas <25mm, RPOC) using the 19Fr IBS system. The anesthetic protocol included oral multimodal premedication (NSAIDs, Paracetamol, Hydroxyzine) and a Paracervical Block (PCB), followed by mechanical dilation to Hegar 6. The primary outcome was pain tolerance assessed by the Visual Analog Scale (VAS, 0-10).

Results: The surgical success rate was 100% (defined as the complete removal of the pathology in a single session). The anesthetic feasibility rate was 97.5% (78/80); only two patients required conversion to sedation, both of whom were nulliparous. The mean operative time ranged from 5–15 minutes depending on pathology. The mean pain score was ≤ 3/10. No complications (perforation, infection, fluid overload) were recorded.

Conclusion: Operative hysteroscopy with a 19Fr shaver is feasible and well-tolerated under paracervical block, offering a safe and efficient alternative to general anesthesia. While highly effective for multiparous women, nulliparity was identified as a critical risk factor for pain intolerance, suggesting the need for tailored management in this subgroup.

Assessment of Pregnancy Outcomes and Pattern of Delivery among Pregnant Women Attending Healthcare Facilities in Port Harcourt Metropolis, Rivers State, Nigeria

2026-03-21T12:53:38+00:00

This study assessed pregnancy outcomes and patterns of delivery among pregnant women attending tertiary healthcare facilities in Port Harcourt metropolis, Rivers State. The research design was a health facility-based cross-sectional study. The study population consisted of all pregnant women admitted during the period under study. The sample size for this study of 339 was obtained using Cochrane formula. The proforma title was Pregnancy Outcomes and Pattern of Delivery (POPD). Data collected were analyzed using Statistical Product for Service Solution (SPSS) version 27.0. The result indicated a moderate positive correlation (R = 0.531) between instrumental delivery and delivery pattern. The result depicted a moderate positive correlation (R = 0.443) between cesarean section and delivery pattern, with cesarean section accounting for 20.8% of delivery patterns (R² = 0.208) among pregnant women. The result also illustrated that a strong, significant positive relationship exists between vaginal delivery and delivery pattern, indicating 41% of delivery patterns (R² = 0.410). The result indicated a strong positive correlation (R = 0.631) between maternal age and pregnancy outcomes, with maternal age indicating 39% of pregnancy outcomes (R² = 0.390). The outcome of the study also indicated that the delivery pattern was statistically significant with maternal complications (F = 110.30, p < 0.005). The findings show a strong, significant relationship between birth weight and pregnancy outcomes, with birth weight accounting for approximately 53.4% of pregnancy outcomes (R² = 0.534). The result indicated a moderate positive correlation (R = 0.531) between instrumental delivery and delivery pattern, with instrumental delivery depict 23% of delivery patterns (R² = 0.230). The result depicted a moderate positive correlation (R = 0.443) between cesarean section and delivery pattern, with cesarean section accounting for 20.8% of the variance in delivery patterns (R² = 0.208) among pregnant women. The result also illustrated that a strong positive correlation (R = 0.711) between vaginal delivery and delivery pattern, with vaginal delivery which indicated 41% of delivery patterns (R² = 0.410). It was concluded that pregnancy outcomes such as live birth, still birth, underweight birth and maternal age were determined by several maternal and infant-related factors which determine delivery patterns. Based on the findings of this study, the following recommendations were made among others pregnant women should prioritise their health by ensuring that they visit and receive healthcare services for at least four (4) times before delivery as determine by world health organization.

Comparative Evaluation of Platelet Indices among Malaria-infected Pregnant Women, Uninfected Pregnant Women and Non-pregnant Women in Owerri, Nigeria

2026-03-26T12:23:52+00:00

Background: Malaria in pregnancy is associated with haematological alterations that may compromise maternal and fetal health. Platelet indices, including platelet count (PLT), plateletcrit (PCT), mean platelet volume (MPV), and platelet distribution width (PDW), are potential markers of malaria-induced haematological changes, yet data in pregnant populations in southeastern Nigeria remain limited.

Objective: To compare platelet indices among malaria-infected pregnant women (MP+), uninfected pregnant women (MP−), and non-pregnant women (controls) in Owerri, Imo State, Nigeria.

Methods: A cross-sectional study was conducted involving 150 women divided into three groups: MP+ (n=50), MP− (n=50), and non-pregnant controls (n=50). Venous blood samples were analyzed for PLT, PCT, MPV, and PDW using standard haematology analyzers. Descriptive statistics were calculated, and group comparisons were performed using Student’s t-test and one-way ANOVA. A p-value <0.05 was considered statistically significant.

Results: There were no significant differences in platelet indices between MP+ and MP− women (PLT: 169.9 ± 52.5 vs 161.1 ± 47.8 ×10⁹/L, p=0.40; PCT: 0.12 ± 0.04 vs 0.13 ± 0.04%, p=0.47; MPV: 7.2 ± 0.7 vs 7.1 ± 0.7 fL, p=0.68; PDW: 8.3 ± 2.3 vs 8.6 ± 2.5%, p=0.54). However, MP+ and MP− women had significantly lower PLT and PCT compared to non-pregnant controls (PLT: 169.9 ± 52.5 vs 230.4 ± 84.5 ×10⁹/L, p<0.001; PCT: 0.12 ± 0.04 vs 0.18 ± 0.08%, p=0.022). MPV and PDW were also reduced in pregnant women relative to controls (MPV: 7.2 ± 0.7 vs 7.8 ± 1.3 fL, p=0.036; PDW: 8.3 ± 2.3 vs 9.9 ± 3.3%, p=0.004). One-way ANOVA confirmed significant differences among the three groups for all platelet indices (PLT: F=15.32, p<0.001; PCT: F=6.45, p=0.003; MPV: F=3.98, p=0.022; PDW: F=7.91, p=0.001).

Conclusion: Pregnancy, rather than malaria infection, significantly influences platelet indices, resulting in reduced PLT, PCT, and altered platelet morphology compared to non-pregnant women. Platelet indices may serve as simple, cost-effective haematological markers for monitoring maternal health in malaria-endemic regions.

The Distribution of the ABO and Rh ‘D’ Blood Groups among Pregnant Women in Rivers State, Nigeria: A Nine-Year Retrospective Study

2026-04-01T07:31:54+00:00

Introduction: The ABO and Rh blood groups are the most clinically relevant blood groups in transfusion medicine. Pregnancy could be associated with complications and may require blood transfusion.

Aims: This study aimed to determine the distribution of ABO and Rh D blood groups among pregnant women initiating antenatal care in Rivers State, Nigeria.

Method: This was a retrospective descriptive study of pregnant women attending antenatal clinic at the Rivers State University Teaching Hospital from 1^st January 2015 – 31^st December 2023. A total of 16,605 pregnant women seen during the study period were included in the study. The results were retrieved from the antenatal booking registers in our facility. The data were computed into Microsoft Excel 2016 spreadsheet and analyzed with the IBM SPSS Version 26. The result was presented in tables and figures.

Result: A total of 16605 pregnant women were seen at the antenatal clinic of RSUTH between 2015 and 2023. The mean age was 31.61 years, with age range of 15-58 years. The 26 to 35 years age group comprised 67.2% of the participants while participants aged more than 45 years comprised 0.4%. The majority of participants had an O blood group (n = 9789, 58.95%), followed by the A blood group (n = 3791, 22.83%) while the least was the AB blood group (n = 386, 2.32%). Regarding the Rh system, the prevalence of the Rh D negative type was (n = 774, 4.66%) while the Rh D Positive type was (n = 15,831, 95.3%). When both the ABO and the Rh blood groups are combined, the most prevalent was the blood group O Rh D Positive (n = 15,831, 95.3%) followed by Blood group A Rh positive (n = 3633, 21.9%) while the least was AB Rh negative (n = 10, 0.1 %).

Conclusion: Pregnancy is a physiologic condition that could be associated with complications requiring blood transfusion services. The most prevalent blood group in the ABO system was blood group O followed by group A, B and AB. In the Rh system, Rh D was the most prevalent.Determining the blood group of the pregnant woman is important in eliminating the critical consequences of ABO and Rh incompatibility. Our finding will be very useful in management of cases of obstetric haemorrhage and cases of feto-maternal incompatibility.

Clinical Characteristics and Associated Factors of Uterine Fibroids based on the FIGO 2018 Classification at the National Hospital of Obstetrics and Gynecology, Vietnam

2026-04-20T13:02:46+00:00

Background: Uterine fibroids are common benign tumors in reproductive-age women, with clinical presentation varying by location as defined by the FIGO 2018 classification. Evidence from Vietnam remains limited regarding their clinical characteristics and associated factors.

Aims: to describe the clinical characteristics of uterine fibroids and to identify factors associated with fibroid classification according to the FIGO 2018 system among patients treated at the National Hospital of Obstetrics and Gynecology, Vietnam.

Study Design: A retrospective cross-sectional study

Place and Duration of Study: This study was conducted at the National Hospital of Obstetrics and Gynecology between 01/2023 and 12/2024.

Methodology: We collected data among 292 patients who underwent uterine-preserving surgery for uterine fibroids. Fibroids were classified according to the FIGO 2018 system and grouped into submucosal (types 0–2) and intramural/other fibroids (types 3–8). Descriptive statistics, Chi-square tests, and multivariable logistic regression analyses were performed to identify factors associated with fibroid type.

Results: Among 292 patients, the most common fibroid types according to the FIGO classification were type L5 (28.4%), followed by type L3 (21.9%) and type L4 (20.5%). Submucosal fibroids were more frequently detected within one month and were associated with a higher proportion of severe or very severe anemia compared with intramural or other fibroids. They were also more commonly associated with smaller uterine size and smaller fibroid size. Multivariable analysis showed that heavy menstrual bleeding (HMB) (OR = 2.36, 95% CI: 1.29–4.30), severe anemia (OR = 3.08, 95% CI: 1.14–8.33), and very severe anemia (OR = 4.91, 95% CI: 1.11–21.64) were significantly associated with submucosal fibroids, while tumors detected after more than 12 months, larger uterine size, and larger fibroid size were negatively associated with this subtype (p<0.05).

Conclusion: Fibroid location according to the FIGO 2018 classification is strongly associated with clinical characteristics of uterine fibroids. Submucosal fibroids are more likely to present with heavy menstrual bleeding and severe anemia and tend to be detected earlier, highlighting the importance of early evaluation and appropriate management in patients with abnormal uterine bleeding.

Obstetric Characteristics and Anesthetic Satisfaction Following Neuraxial Blockade with 0.5% Hyperbaric Bupivacaine in Women Undergoing Cesarean Section in Southwest Mexico

2026-04-24T13:19:54+00:00

Background: Cesarean section is indicated in conditions that increase the risk of maternal and perinatal morbidity and mortality. The anesthetic technique of neuraxial block with 0.5% hyperbaric bupivacaine is widely used in Mexico. However, the level of perceived satisfaction with this technique has been little studied in the Southwest Region, despite the region's high population of women of childbearing age, frequency of risk factors, and birth rate. The findings of our research will indicate the demographic and obstetric conditions, hemodynamic behavior during the procedure, and level of anesthetic satisfaction, generating essential information to improve the quality of care and optimize institutional resources.

Aim: To know obstetric characteristics and anesthetic satisfaction following neuraxial blockade with 0.5% hyperbaric bupivacaine in women undergoing cesarean section in Southwest Mexico.

Methods: Prospective and descriptive study [ethical approval folio: R-2024-703-076] in women aged 18-39 years with a gestational age 37-40 weeks who underwent cesarean section at a Level II Public Hospital in Southwest Mexico during October–November 2024. Patients with serious complications or who were referred to other medical units were excluded. During pre-anesthetic evaluation, demographic data [maternal age, body mass index (BMI)], obstetric data [pregnancies, deliveries, cesarean sections, abortions, gestational age at delivery] and anesthetic risk [American Society of Anesthesiologists Physical Status Classification System (ASA)] were collected. Hemodynamic status was assessed at start procedure. The Iowa Satisfaction with Anesthesia Scale [ISAS] was administered in the post-anesthesia care unit 15 minutes after admission. Pain intensity [Visual Analogue Scale (VAS)] was assessed during hospitalization. Descriptive statistics were used with Statistical Package for Social Sciences (SPSS) version 25.

Results: The study included 289 women. The maternal age was 26.0±4.1 years and BMI was 34.9±5.9 kg/m². Patients with >3 pregnancies and >2 cesarean sections represented 10.4% and 5.5%. ASA classification II was recorded for all patients. The gestational age at delivery was 37.2±2.2 weeks. Significant hemodynamic changes were observed at beginning the procedure. The overall satisfaction level was 2.9 ± 0.1; 57.4% reporting very satisfaction and 42.2% moderate satisfaction. The VAS values at 2, 4 and 8 hours after procedure were 3.9±1.2; 5.6±1.8; and 5.3±1.2.

Conclusion: The women in southwestern Mexico who underwent cesarean section were primarily between 18-35 years old, obese, and had a gestational age ≥37 weeks. A history of high-risk obstetrics was common. Hemodynamic instability was observed at beginning the procedure. Anesthetic satisfaction was mainly reported as very satisfied or moderately satisfied. Moderate pain intensity was most prevalent. The effectiveness of 0.5% hyperbaric bupivacaine neuraxial blockade in cesarean section is noteworthy. However, it is essential to continue searching for safe and effective anesthetic alternatives for this priority group to provide higher quality care and optimize institutional resources.

Ectopic Pregnancy in a University Teaching Hospital in Southern Nigeria: A Four Year Retrospective Study

2026-05-02T13:23:47+00:00

Background: Ectopic pregnancy remains a major contributor to maternal morbidity and mortality in the first trimester, especially in middle- and low-income settings where it poses as a major gynaecological emergency with most patients presenting late.

Aim: This review highlights about Ectopic pregnancy at Rivers State University Teaching Hospital.

Methods: This is a retrospective descriptive study on women who had ectopic gestation over a period of four years from January 1^st, 2019 to 31^st December 2022 at RSUTH. A structured proforma was designed and used to extract data from gynaecology ward, operating theatre registers and the hospital medical records. Data was entered and analyzed using the statistical package for social sciences (SPSS) IBM version 25.0 (Armonk, NY). Continuous variables are expressed in means +standard deviations and categorical variables are recorded in frequencies and percentages.

Results: The prevalence of ectopic pregnancy was 1.1% of all deliveries and 3.9% of all gynaecological admission. Most of the patients who had ectopic pregnancy were amongst the age group 26-35 years, nulliparous, unemployed and single. The Mean age SD was 30.28 4.96 years. The history of pelvic inflammatory disease was the most common risk factor; 50.6%. Majority of the patients, 97.5% had ruptured ectopic pregnancy, 85% had estimated blood loss of at least 500mls and required blood transfusions. Only 2 deaths were recorded in the study.

Conclusion: The prevalence of ectopic pregnancy was relatively high with the ruptured cases in majority of the patients. There is need for increased enlightenment of the community on the disease and its risk factors.

Birthing Experiences among Multiparous Women in Urban Ghana: A Qualitative Descriptive Study in the Kumasi Metropolis

2026-05-07T04:37:21+00:00

Background: Childbirth is a significant physiological and psychosocial event with lasting implications for women’s physical, emotional, and social well-being, as well as for their future health-seeking behaviours and those of their families.

Aim: This study aimed to explore the childbirth experiences of multiparous women in the Kumasi Metropolis of Ghana, guided by the WHO framework for a positive childbirth experience.

Methods: A qualitative descriptive design was used. The study took place from July to September, 2021 at three health facilities (a tertiary and two secondary) within the Kumasi Metropolis. A purposive sample of twelve multiparous women aged 20–45 years, who had vaginal deliveries and were attending six-week postnatal clinics, was recruited. Data was collected using either a one-on-one face-to-face approach in a dedicated space within the health facilities or via a telephone based on the client’s preference with a semi-structured interview guide. Interviews were audio-recorded, transcribed verbatim, and analyzed manually using inductive content analysis.

Results: Three major themes emerged: clients’ expectations, emotional support, and informational needs. Some women reported positive support, while others encountered neglect and unresponsiveness. A strong desire for birth companionship was expressed, though it was often unmet due to institutional restrictions. Informational needs were frequently unmet, with many participants reporting inadequate orientation to the ward and a lack of explanation about procedures. If caregivers become supportive, clients find the hospital safe enough for future use. Irrespective of the treatment given to them, the care outcome was paramount, and that defined parturient experiences.

Conclusion: The quality of interpersonal care remains a decisive factor in shaping multiparous women’s childbirth experiences in urban Ghana. Persistent gaps between respectful maternity care policies and clinical practice continue to undermine positive birth experiences. Multiparity does not insulate women from negative care; instead, prior experiences heighten expectations of quality. Embedding respectful communication, emotional support, and birth companionship into routine intrapartum care, alongside addressing workforce and workload challenges, is essential for improving maternal satisfaction and promoting positive childbirth outcomes.

A Prospective Analysis Assessing Accuracy of Contrast-enhanced Computed Tomography (CECT) in Estimation of Peritoneal Carcinomatosis Index (PCI) Score and Its Correlation with Intraoperative Findings in Ovarian Cancer

2026-05-13T12:04:06+00:00

Background: Ovarian carcinoma, the third leading cancer affecting women worldwide, presents in advanced stages in nearly 75% of cases, where cytoreductive surgery (CRS) with platinum-based chemotherapy remains the standard treatment, and contrast-enhanced computed tomography (CECT) plays an important role in estimating the peritoneal carcinomatosis index (PCI) with correlation to intraoperative findings.

Objective: The present study assess the correlation between radiological PCI and intraoperative surgical PCI. Also, to estimate sensitivity, specificity, PPV and NPV, and accuracy of CECT in determining pre-operative disease burden.

Methods: This is a prospective, single-center observational cohort study that was done on 50 patients with advanced ovarian cancer (FIGO stage 2b and above) and recurrent ovarian tumors who underwent preoperative CECT followed by CRS +/- HIPEC at our center from August 2021 to July 2023. The total Radiological PCI and Surgical PCI were recorded and tabulated for comparison.

Results: The correlation between the total Radiological PCI and Surgical PCI using the Spearman rank correlation coefficient showed a positive correlation of 0.403 and a significant p-value of 0.004. The highest sensitivity has been found in the left upper quadrant (91.7%) and epigastrium (85.6%), while the lowest sensitivity in detecting deposits was in the left iliac fossa (30%) and distal ileum (33.3%). Similar trends in diagnostic accuracy have been observed, i.e., for the left upper quadrant (84%) and the distal ileum (48%). The overall sensitivity, specificity, PPV, NPV, and diagnostic accuracy were 53.11%, 76.13%, 61.7%, 69.16%, and 66.46 %, respectively, on taking all quadrant observations into account.

Conclusions: The correlation between the radiological PCI and surgical PCI is good. Thus, it is especially useful in patients with high-volume disease (PCI of more than 15) and help in predicting the resectability of the disease. However, certain areas, like the proximal and distal segments of the small bowel and left iliac fossa, do not show a good correlation.

A Retrospective Study of Polycystic Ovarian Syndrome (PCOS) among Women Screened at Madonna Hospital Umuahia from 2020 TO 2024

2026-06-10T13:34:42+00:00

Background: Polycystic Ovarian Syndrome (PCOS) is a widespread endocrine disease that affects females of reproductive age, causing considerable reproductive and metabolic complications. Although the syndrome affects women to a great extent, there is paucity of data concerning the prevalence of the disease locally in southeast Nigeria.

Methods: This study employed a retrospective approach, analyzing the medical records of 287 females who were assessed for PCOS in Madonna Hospital, Umuahia, from 2020 to 2024. Information was gathered utilizing a standardized form, while statistical analysis was performed.

Results: Out of 287 patients evaluated, PCOS was observed in 250 (87.1%), with cases rising during the study period and reaching their peak in 2023. The most prevalent symptoms included irregular menstruation (73.7%), ovarian cysts (63.2%), and abdominal pains (50.9%). There were no significant connections between PCOS and socio-demographic/clinical factors.

Conclusion: Polycystic Ovarian Syndrome is a reproductive and metabolic disorder that poses a significant health challenge among female patients undergoing screening in Madonna Hospital, Umuahia. The prevalence of PCOS indicates that screening, diagnosis, and management strategies should be strengthened in order to enhance reproductive health and prevent complications arising from PCOS.

Effectiveness of Swiss Ball and Pilates Exercises on Weight Management in Young Women with Polycystic Ovarian Disease

2026-01-17T12:15:48+00:00

Polycystic Ovary Disease is a hormonal disorder that develops due to abnormal secretion of androgens, resulting in functional ovarian hyperandrogenism. PCOD is one of the most frequently observed endocrine conditions affecting women in their reproductive years. Regular physical activity, particularly exercises such as Swiss ball and Pilates, can play a significant role in the management of PCOD. These exercises help regulate hormonal balance, improve insulin sensitivity, support weight control, and restore overall hormonal health. They also contribute to BMI reduction and improvement in waist–hip ratio, which is key of metabolic risk in PCOD. Along with this, they promote better strength, postural alignment, and muscle coordination, which enhances day-to-day activities. Consistent practice may further assist in achieving more regular menstrual cycles in women experiencing irregularities. The present research aims to investigate the effectiveness of Swiss ball and pilates exercises on weight management in young women with PCOD. The inclusion criteria cover students with diagnosed PCOD of age 18-24 years with BMI ranging from 25-30 kg/m.2 This Swiss ball and pilates exercise will include 15-20 repetitions, performed for 5 days a week for up to 8-12 weeks. The current study revealed that Swiss ball and Pilates exercises are effective in reducing BMI among young women with PCOD, though changes in waist-to-hip ratio were fluctuating. Individual differences in body composition may influence outcomes, but overall, these exercises can support lifestyle modification and improve both metabolic and reproductive health.

Post-Cesarean Abdominal Wall Endometriosis: A Case Report and Literature Review

2026-01-09T11:00:17+00:00

Background: Abdominal wall endometriosis (AWE) is a rare form of extrapelvic endometriosis, most commonly occurring in surgical scars following cesarean section. Due to its nonspecific presentation, it is frequently misdiagnosed, leading to delayed management. The purpose of our work is to raise clinical awareness about abdominal wall endometriosis and share our experience in managing this condition.

Case Presentation: We report the case of a 38-year-old woman, gravida 3 para 3, with a history of three cesarean sections, who presented with a painful parietal mass located at the right angle of her cesarean scar. The pain showed a clear cyclical pattern, worsening during menstruation. Physical examination revealed a firm; tender, erythematous mass measuring approximately 3 cm. Magnetic resonance imaging demonstrated a parietal lesion with a fistulous tract consistent with abdominal wall endometriosis. Initial medical management with a gonadotropin-releasing hormone agonist for three months resulted in partial regression of symptoms and lesion size. The patient subsequently underwent wide surgical excision with clear margins. Histopathological examination confirmed the diagnosis of abdominal wall endometriosis. Postoperative recovery was uneventful, with complete resolution of symptoms and no recurrence during follow-up.

Conclusion: Post-cesarean abdominal wall endometriosis should be considered in women presenting with a painful mass at a cesarean scar, particularly when symptoms are cyclical. Diagnosis is quite difficult to establish due to the nonspecific nature of its clinical presentation. Magnetic resonance imaging is valuable for diagnosis and surgical planning. Complete surgical excision remains the definitive treatment, offering excellent outcomes and low recurrence rates. Early recognition is essential to reduce diagnostic delay and improve patient prognosis.

Undiagnosed Advanced Abdominal Pregnancy Complicated by Fetal Death Following Failed Induction of Labour: A Case Report from Southwest Nigeria

2026-01-24T07:20:23+00:00

Abdominal ectopic pregnancy (AEP) is a rare and potentially life-threatening obstetric condition which complicates on average 1 in 10000 to 1 in 30000 pregnancies. Its diagnosis is challenging because the presenting symptoms are non-specific and some do not present with symptoms. AEP is associated with enormous complications, including perinatal and maternal morbidity and mortality. The purpose of this report is to highlight a clinically important but rare condition which can pose a diagnostic challenge, especially in regions with limited health resources and poor patient health-seeking behaviour, such as found in Nigeria and other sub-Saharan countries.

We present a 38-years old G7P3+3(3A) with post-dated pregnancy and incidental finding of intra-abdominal pregnancy complicated by fetal death during Caesarean section, following failed induction of labour. Intra-operative findings included a female macerated stillborn and a ball-shaped placenta found within the peritoneal cavity. The uterus was intact, about 20 weeks size, with grossly normal fallopian tubes and ovaries. Her post-operative recovery was unremarkable.

Despite multiple trans-abdominal scans done by this patient, the diagnosis of AEP was missed. This emphasises the need to have a high index of suspicion, coupled with the availability of high-frequency ultrasound and skilled sonologists. Following diagnosis, interventions should be prompt in order to avert complications that can ensue.

Rapid Progression of Mixed Adenocarcinoma with Large-cell Neuroendocrine Carcinoma of the Cervix

2026-02-02T13:40:55+00:00

Background: Large cell neuroendocrine carcinoma (LCNEC) is very rare and represents about 12.5% of neuroendocrine cervical tumors. These highly aggressive tumors may present as small lesions, but most are deeply invasive. They exhibit the usual features of neuroendocrine carcinoma, and high mitotic indices and necrosis are common. Following this, mixed adenocarcinoma with large cell neuroendocrine carcinoma (MALCNEC) is even very rare.

Aims: The case report raises awareness regarding diagnostic challenges associated with this rare and aggressive tumor.

Case presentation: A 37-year-old woman presented with a 2-month history of post-coital bleeding with abnormal vaginal discharge. Initial examination revealed a grossly normal cervix, but cervical screening indicated atypical squamous cells-cannot exclude high-grade squamous intra-epithelial lesion (ASC-H). Colposcopic assessment showed a small hyperemic area with thin aceto-white uptake, which was biopsied and later confirmed to be adenocarcinoma with clear cell differentiation. The management was delayed due to an active upper respiratory tract infection. During re-evaluation 2 weeks later, the previously grossly normal cervix had transformed into barrel- shaped cervix containing a hard mass, indicating rapid disease progression. It was clinically staged as FIGO stage 1B3 and the patient subsequently underwent radical hysterectomy. Final histopathology revealed a mixed tumor comprising both adenocarcinoma and large-cell neuroendocrine carcinoma with metastatic involvement of pelvic lymph nodes. The patient is then undergone adjuvant radiotherapy and recently completed chemotherapy with cisplatin and etoposide.

Discussion: Mixed neuroendocrine and non-neuroendocrine carcinomas of the cervix are exceedingly rare and tend to behave aggressively. They often present at advanced stages with metastases and carry a poor prognosis. Despite the initial presentation without an obvious cervical lesion and extra-pelvic spread, this case demonstrated rapid tumor progression, underscoring the tumor’s aggressive nature.

Conclusion: Diagnostic challenges associated with this pathology are well illustrated in this case. Heightened awareness may allow early recognition and prompt intervention in managing these aggressive tumors. This rarity poses significant challenges in accurate diagnosis and in developing more effective, optimal treatment strategies. To address these challenges, further research and increased collaboration among clinicians, radiologists, pathologists, and oncologists are essential.

Malignant Smooth Muscle Tumor of Broad Ligament: A Rare Diagnostic Challenge

2026-02-11T11:50:04+00:00

Leiomyosarcoma (LMS) represent a minority of uterine malignancies, comprising merely 1-2% of the total cases. Those of the broad ligament are very rare, rapidly progressive and highly malignant gynecological tumor.

Because of its rarity and atypical localization, we present a case of a young woman 38 years old which initially mimicked an ovarian malignancy and was complicated by multi-organ involvement at presentation. She underwent Total Abdominal Hysterectomy + Bilateral Salphingoophorectomy + Resection of left broad ligament tumor, in which histopathological diagnosis prove as myxoid type of leiomyosarcoma of the left broad ligament. She received total 6 cycle of adjuvant chemotherapy (Cisplatin + Doxorubicin) followed by adjuvant radiotherapy (45Gy/25 fraction) of external beam radiotherapy.

Postpartum Case Series of Abdominal/Pelvic Abscess in Nizwa Hospital: A Rare Event with Review of Literature

2026-02-17T09:57:38+00:00

Introduction: Intra-abdominal infection (IAI) is a pocket of pus or infected fluid located within the abdominal cavity. IAI is recognized as a major contributor to mortality worldwide if not well managed. Infections can occur within the pelvis, around the operation site, or in the organs. These infections lead to serious complications, lengthen hospital stays, increase medical costs, and can increase maternal morbidity and mortality.

Aims /Objectives of the Study: Mitigating complications from surgical site infection, medical cost containment, ameliorate patient’s outcome and highlight universal standards of care and management.

Study Design: Retrospective study of postpartum cases who suffered abdominal /pelvic abscess formation In Nizwa hospital, Oman. Data was collected from the Alshifa computerized electronic system.

Place and Duration: Department of Obstetrics and Gynecology and Department of Radiology, Nizwa Hospital -a two-year study.

Methodology: We included 6 cases of postpartum abdominal /pelvic infection during a two-year period from 2022 to 2024. Studied their unusual course of illness with diagnostic and treatment modalities duration their stay in Nizwa secondary care hospital, Oman.

Results: The total number of deliveries from 2022 to 2024 were 16,424 Caesarean deliveries accounted to 5045 accounting to 30.71%.

Abdominal/pelvic infections were noted in 6 cases in the postpartum period, with severe complications requiring various interventions resulting in intricate prolonged course in high dependency/intensive care units, ultrasound guided drainage of pus or surgical re-exploration and few had to be referred to higher center for management. The infection rate was 0.6/1000, in comparison with the worldwide which is 1/1000.

Conclusion: Although the rate of infection is less than the standard, measures to reduce the morbidity and mortality were taken like identifying the root cause, improving the aseptic technique, and a multidisciplinary approach.

Xanthogranulomatous Endometritis Mimicking Endometrial Carcinoma: A Case Report and Literature Review

2026-03-02T09:27:42+00:00

Introduction: Xanthogranulomatous endometritis (XGE) is a rare chronic inflammatory condition of the endometrium, belonging to the group of xanthogranulomatous inflammations more commonly reported in the kidney and gallbladder. Its clinical and radiological presentation can mimic endometrial carcinoma, making preoperative diagnosis challenging.

Case Presentation: We report the case of a 40-year-old woman with an 11-year history of infertility, presenting with intermittent metrorrhagia. Transvaginal ultrasound revealed a well-defined, heterogeneous, solid intrauterine mass measuring 110 × 80 × 62 mm, initially suggestive of a myoma or uterine sarcoma. Pelvic MRI confirmed an endometrial lesion of 110 × 80 × 40 mm with superficial myometrial invasion and a suspicious obturator lymph node classified, as FIGO IA. Hysteroscopy showed a hypertrophic, mamillated, highly vascularized endometrium. Endometrial biopsy confirmed xanthogranulomatous endometritis without evidence of malignancy. Infectious and immunological workup was unremarkable. The patient was treated with corticosteroids and monitored clinically and radiologically. After six months, PET-CT and follow-up hysteroscopy showed complete resolution of abnormalities.

Conclusion: Xanthogranulomatous endometritis is a rare condition that can mimic endometrial cancer, requiring histopathological confirmation for accurate diagnosis. Conservative management with corticosteroids can be effective and may preserve reproductive function. Early recognition of this entity helps avoid unnecessary surgical interventions and guides appropriate treatment.

Spontaneous Rupture of Ovarian Endometrioid Carcinoma in the First Trimester: A Case Report

2026-03-11T09:42:56+00:00

Aims: Ovarian malignancy in pregnancy is rare (1:10,000–50,000), and first-trimester spontaneous rupture is exceptional. It presents a diagnostic dilemma, often mimicking common obstetric emergencies.

Presentation of Case: A 32-year-old Malay primigravida at 9 weeks’ gestation presented with an acute abdomen. A previous ultrasound at 6 weeks’ gestation identified a left ovarian cyst with complex features measuring 11 × 6 cm. Diagnosis of torsion or ruptured ovarian cyst was entertained. Emergency laparotomy revealed a ruptured 10 × 8 cm left haemorrhagic ovarian cyst, with no other concerning intraoperative findings, and conservative cystectomy was performed. Histopathology confirmed endometrioid carcinoma of left ovary, stage IC2 (grade 2). The CT scan showed no distant metastases. After multidisciplinary counselling, adjuvant carboplatin chemotherapy was administered from 18 to 34 weeks’ gestation. At 34 weeks’ gestation, a caesarean section followed by definitive surgery was performed, delivering a healthy neonate. Both mother and infant recovered uneventfully.

Discussion: Torsion or ectopic pregnancy are typical diagnoses of acute abdomen in pregnancy. The rare histological subtype (endometrioid) and the exceptionally early timing of rupture are making this case unique. Management required a delicate balance between oncological safety and fetal viability. The successful use of platinum-based chemotherapy in the second trimester facilitated a favourable outcome.

Conclusion: Spontaneous rupture of ovarian malignancy is extremely rare; however, it should be considered a differential diagnosis for acute abdomen in pregnancy. Timely multidisciplinary management can optimise outcomes for both mother and neonate.

Mucinous Borderline Tumour with Microinvasion Arising from a Mature Teratoma

2026-03-25T10:29:57+00:00

A mucinous borderline tumour with microinvasion arising from a mature teratoma is typically detected incidentally and diagnosed postoperatively with histopathological confirmation. Due to the limited cases reported in literature; therefore, no established management recommendation is currently available. We reported a 25-year-old woman who presented with a painless, large ovarian mass, and was associated with elevated cancer-antigen 125 (CA125). Pre-operative contrast-enhanced computed tomography (CT) reported a large multiloculated ovarian tumour (solid-cystic) otherwise, other findings were normal. Patient underwent staging laparotomy with fertility sparing surgery, with no evidence of residual disease. Following surgery, histopathological examination revealed mucinous borderline tumour with microinvasion (2mm) arising from mature teratoma. Immunohistochemical stain showed diffuse and strong expression of cytokeratin 7 (CK7), but heterogeneous expression of cytokeratin 20 (CK20) and caudal-type homeobox transcription factor 2 (CDX2). This case report highlighted the importance of histopathological evaluation in patient management, selection of surgical approach, disease surveillance and monitoring of disease progression in this condition.

Hydrops Fetalis Caused by Fetal Structural Malformation in the Second Trimester of Pregnancy with Vaginal Bleeding: A Case Report

2026-05-26T08:08:44+00:00

Background: Hydrops fetalis is a severe fetal condition characterised by abnormal fluid accumulation in at least two fetal compartments, including the pleural, pericardial, or peritoneal spaces, with or without subcutaneous oedema. Non-immune hydrops fetalis accounts for most reported cases and is associated with poor perinatal outcomes, particularly when diagnosed early in gestation.

Aim: The case report presents the clinical presentation, antenatal findings, diagnostic evaluation, and obstetric management of a pregnant woman diagnosed with hydrops fetalis, and highlights the associated maternal and fetal outcomes.

Case Presentation: A 28-year-old gravida 2 woman at 19–20 weeks of gestation presented with recurrent abdominal tightening, decreased fetal movement, and vaginal bleeding. Obstetric ultrasonography demonstrated generalised fetal fluid accumulation consistent with hydrops fetalis. Maternal laboratory evaluation revealed mild anaemia. Due to worsening clinical condition and severe fetal compromise, emergency pregnancy termination by cesarean section was performed. A fetus with hydrops fetalis weighing 1400 grams was delivered with an Apgar score of 1, indicating profound fetal distress. The surgical procedure was completed without maternal complications, and placental delivery occurred spontaneously.

Conclusion: Early-onset hydrops fetalis before fetal viability carries a grave prognosis and a high risk of fetal death. Prompt recognition, maternal stabilisation, and systematic diagnostic evaluation are essential to guide management, identify potential underlying causes, and provide counselling regarding future pregnancy risks.

Antenatal Detection of Succenturiate Placenta with Uneventful Outcome: A Case Report

2026-05-26T10:43:16+00:00

Succenturiate placenta is a rare placental morphological variant characterized by one or more accessory lobes connected to the main placental disc by fetal blood vessels traversing the membranes. Although often asymptomatic, it is clinically significant due to its association with serious complications such as fetal distress, placental abruption, postpartum hemorrhage, and retained placental tissue, which may lead to significant maternal and fetal morbidity if not identified antenatally. Early recognition of this condition is therefore essential for appropriate intrapartum planning and timely obstetric decision-making.

We report the case of a 35-year-old multigravida at 38+6 weeks of gestation who was antenatally diagnosed with succenturiate placenta on ultrasonography. She underwent elective lower segment cesarean section for breech presentation and delivered a healthy male neonate with good Apgar scores. Intraoperatively, the accessory placental lobe with vascular connections to the main placental mass was confirmed, and the placenta was delivered completely without complications. The postpartum period was largely uneventful except for an episode of fever, which was managed appropriately. Both maternal and neonatal outcomes were satisfactory.

This case highlights the importance of meticulous antenatal ultrasonographic evaluation in identifying rare placental anomalies such as succenturiate placenta. Early diagnosis allows for careful obstetric planning and can contribute to favorable maternal and fetal outcomes despite the potential risks associated with this condition.

Intraocular Pressure across Pregnancy and Postpartum: Trimester-Resolved Physiology, Normative Ranges and Clinical Interpretation

2026-01-06T13:08:49+00:00

Pregnancy is characterized by changes in maternal hormone levels which are needed for proper development of fetus and normal delivery at term. The physiological effects of these hormones are not confined to the reproductive system and affect other organs including eye and its adnexae. Intraocular pressure and tear production are usually decreased in pregnancy. Pregnancy produces coordinated endocrine, cardiovascular, and connective-tissue adaptations that measurably influence intraocular pressure (IOP) and the reliability of common tonometry methods. For clinicians, the key challenge is not simply recognizing that IOP often falls in later gestation, but interpreting trimester-resolved values against shifting corneal biomechanics, physiologic changes in aqueous humor outflow, and the clinical context of pre-existing glaucoma or pregnancy-associated hypertensive and metabolic disorders. This review synthesizes contemporary evidence on IOP trajectories across pregnancy and postpartum, emphasizes mechanisms that plausibly underlie these patterns, and proposes practical “normative” interpretive bands that incorporate both population trends and measurement caveats. Across cohorts and meta-analytic evidence, IOP tends to be similar to non-pregnant baseline in the first trimester, declines modestly in the second trimester, and reaches its lowest levels in the third trimester. Postpartum, IOP generally rebounds toward pre-pregnancy values over weeks to months, though the time course varies by study design and measurement technique. Because central corneal thickness and corneal viscoelasticity may change during gestation, apparent IOP can be biased depending on the instrument used, the time of day, and the patient’s ocular surface status. These physiologic shifts have direct implications for monitoring pregnant and breastfeeding patients with glaucoma: a “reassuring” low IOP may partially reflect pregnancy physiology or altered biomechanics rather than true disease stability, while unexpectedly high or rising IOP warrants careful reassessment for secondary contributors (including corticosteroid exposure) and for pregnancy-related systemic disease. Future progress depends on larger longitudinal studies with standardized timing, device-consistent tonometry, and integrated corneal and systemic metrics to improve normative interpretation and strengthen guidance for higher-risk pregnancies and glaucoma management.

Advances in the Management of Polycystic Ovary Syndrome (PCOS): A Comprehensive Review

2026-03-12T13:00:03+00:00

Polycystic Ovary Syndrome (PCOS) is a complex endocrine–metabolic condition that clinicians encounter frequently in reproductive-age women. Far beyond a reproductive disorder, PCOS manifests across multiple physiological domains, including metabolic dysfunction, psychological stressors, dermatological symptoms, and long-term cardiometabolic risks. Over the past decade, clinical understanding and management of PCOS have undergone significant refinement, with a shift from uniform treatment strategies toward individualized, phenotype-driven care. This review synthesizes contemporary advances in PCOS management from a clinician’s perspective, integrating mechanistic insights, evidence-based therapeutic innovations, and practical considerations essential for day-to-day practice.

Lifestyle modification remains the foundational intervention; however, clinicians now appreciate the need for structured, achievable, and personalized dietary and exercise prescriptions rather than generic weight-loss advice. Pharmacologic therapy has expanded considerably, especially with the emergence of inositols, GLP-1 receptor agonists, SGLT2 inhibitors, newer hormonal formulations, androgen receptor antagonists, and updated ovulation induction protocols. The recognition of letrozole as the superior first-line agent for ovulation induction has significantly improved fertility outcomes, while refinements in assisted reproductive technologies have enhanced safety and efficacy for PCOS patients undergoing IVF.

Growing emphasis on mental health and quality-of-life outcomes has led clinicians to adopt more holistic care models addressing anxiety, depression, body-image concerns, and sexual dysfunction. Additionally, dermatologic complications—especially hirsutism, acne, and alopecia—now receive more targeted, integrated management. Emerging research on the gut microbiome, inflammation, vitamin D physiology, and oxidative stress has introduced novel adjunctive therapies and future therapeutic pathways.

Evolving Molecular Classifications and Personalized Therapeutics in Endometrial Cancer: A Narrative Review

2026-03-16T12:42:10+00:00

Endometrial cancer (EC) is the most common gynecological malignancy worldwide and an increasing public health concern. Although most cases are diagnosed at an early stage with favorable outcomes, advanced and high-risk disease remains associated with poor survival, highlighting the need for improved risk stratification. The traditional dualistic Type I/Type II classification inadequately reflects the molecular heterogeneity of EC. The Cancer Genome Atlas (TCGA) introduced a molecular classification defining four prognostically distinct subtypes: POLE ultramutated, microsatellite instability-high (MSI-H), copy-number low, and copy-number high. This framework has been translated into clinically applicable classifiers, including ProMisE and TransPORTEC, which stratify tumors into four clinically relevant molecular subgroups: POLE-mutated (POLEmut), mismatch repair-deficient (MMRd), no specific molecular profile (NSMP), and TP53-abnormal (p53abnormal). This classification has also been incorporated into the 2023 FIGO staging system. POLEmut tumors demonstrate favorable prognosis supporting treatment de-escalation; MSI-H/MMRd tumors show intermediate prognosis and derive benefit from immune checkpoint inhibitors; NSMP tumors are heterogeneous with variable outcomes requiring further molecular refinement; whereas p53abnormal tumors exhibit aggressive behavior and poor prognosis, often necessitating intensified multimodal and targeted therapies. This review highlights the clinical relevance of molecular classification, multiple-classifier tumors, and emerging diagnostic approaches including next-generation sequencing, underscoring a shift toward precision oncology in EC management.

Management Strategies and Surgical Interventions of Placenta Accreta Spectrum: A Comprehensive Review

2026-04-21T08:04:45+00:00

Placenta accreta spectrum (PAS) is an increasingly significant obstetric complication associated with rising cesarean delivery rates and advanced maternal age. It is characterized by abnormal placental adherence or invasion into the uterine wall and is associated with severe maternal morbidity and mortality, particularly in advanced forms such as placenta percreta.

This review was conducted to synthesize current evidence on the pathophysiology, diagnosis, and management of PAS. A comprehensive literature search was performed using PubMed, Scopus, and Web of Science databases for studies published between 2000 and 2025. Relevant articles, including original studies, systematic reviews, meta-analyses, and clinical guidelines, were selected based on predefined inclusion criteria and analyzed qualitatively.

The findings indicate that early antenatal diagnosis using ultrasound and magnetic resonance imaging (MRI) plays a critical role in improving maternal and fetal outcomes. While cesarean hysterectomy remains the standard treatment for PAS, conservative and fertility-preserving approaches such as one-step conservative surgery and leaving the placenta in situ are emerging as viable alternatives in selected cases. However, these approaches are associated with variable outcomes and require careful patient selection and multidisciplinary expertise. Advances in imaging techniques, perioperative management, and the integration of telemedicine in resource-limited settings have further contributed to improved clinical decision-making and outcomes.

In conclusion, effective management of PAS requires early diagnosis, standardized classification, and a multidisciplinary approach tailored to disease severity and patient needs. Although significant progress has been made, further research is needed to refine conservative strategies, improve diagnostic accuracy, and develop standardized management protocols to enhance maternal and neonatal outcomes globally.

Oocyte Developmental Competence and Its Role in Fertility and Reproductive Aging

2026-05-02T13:11:18+00:00

Oocyte developmental competence is a fundamental determinant of reproductive success, defined as the ability of an oocyte to complete meiotic maturation, undergo successful fertilization, and support embryonic development through implantation and fetal growth. The acquisition of this competence is a highly coordinated process that occurs during oogenesis and folliculogenesis and involves complex interactions between the oocyte and its surrounding somatic cells within the follicular microenvironment. These interactions regulate a network of molecular and cellular pathways, including nuclear and cytoplasmic maturation, mitochondrial metabolism, epigenetic programming, and the accumulation of maternal RNAs and proteins that sustain early embryogenesis prior to embryonic genome activation. Disruptions in these processes can compromise oocyte quality and significantly reduce fertility outcomes. A major factor influencing oocyte competence is reproductive ageing, which is associated with progressive mitochondrial dysfunction, increased oxidative stress, accumulation of DNA damage, and deterioration of chromosomal cohesion. These age-related alterations contribute to meiotic spindle instability and elevated rates of chromosomal segregation errors, leading to an increased incidence of aneuploidy, implantation failure, and miscarriage. In addition, changes in the follicular microenvironment, including altered endocrine signalling and impaired communication between the oocyte and surrounding granulosa and cumulus cells, further exacerbate the decline in oocyte quality with advancing maternal age. In assisted reproductive technologies (ART), the intrinsic quality of the oocyte remains a critical limiting factor despite advances in embryo culture and genetic screening. Consequently, significant research efforts are directed toward identifying reliable biomarkers that reflect the molecular determinants of oocyte competence. Emerging approaches include transcriptomic analysis of cumulus cells, metabolomic profiling of follicular fluid, and assessment of mitochondrial function and oxidative stress status. These strategies aim to improve the prediction of fertilization potential, embryo developmental capacity, and implantation success. This review synergises current knowledge regarding biological and molecular mechanisms regulating oocyte developmental competence and examines how these processes influence fertility outcomes and reproductive aging. Emphasis is placed on the roles of mitochondrial function, chromosomal stability, metabolic regulation, and follicular signalling in determining oocyte quality. Furthermore, the review discusses emerging biomarkers and clinical strategies aimed at improving oocyte assessment and optimising assisted reproductive treatments. Advancing our understanding of the mechanisms underlying oocyte competence will be essential for improving fertility management, enhancing the success of assisted reproduction, and addressing the challenges associated with reproductive ageing.