Indian Journal of Obstetrics and Gynecology

Background: Perimenopause represents a critical transitional phase in a woman's life, characterized by profound hormonal, metabolic, and physiological changes that significantly impact health and well-being. Body Mass Index (BMI) is an important anthropometric indicator that may modulate the severity of menopausal symptoms and influence quality of life during this vulnerable period. Understanding the relationship between BMI, quality of life, and clinico-biochemical parameters in perimenopausal women is essential for developing targeted, evidence-based interventions. Objectives: To evaluate the association of BMI with quality of life using the MENQOL score and to describe the relationship of BMI with clinico-biochemical profile among perimenopausal women. Methods: A cross-sectional analytical study was conducted among 134 perimenopausal women aged 45–55 years attending the Gynaecology OPD at Bharati Vidyapeeth (Deemed to be University) Medical College and Hospital, Pune, from February 2024 to July 2025. Quality of life was assessed using the validated Menopause-Specific Quality of Life (MENQOL) questionnaire. Anthropometric, haematological, biochemical, lipid profile, ultrasonographic, and cervical cytology data were collected and analyzed across BMI categories. Results: The mean age was 50.17 ± 3.40 years and mean BMI was 26.68 ± 7.10 kg/ m². Of the participants, 58.2% were overweight or obese. The physical domain of MENQOL showed a statistically significant association with BMI (p<0.001), with scores rising progressively from underweight (2.25 ± 0.45) to obese women (3.15 ± 0.55). No significant differences were found in vasomotor (p=0.286), psychosocial (p=0.694), sexual (p=0.655), or total MENQOL scores (p=0.439) across BMI categories. Elevated lipid parameters, subclinical hypothyroidism, and hyperglycaemia were present across all BMI groups. Platelet count varied significantly across BMI categories (p=0.043). No significant BMI-related differences were found in endometrial thickness, uterine or ovarian pathology, Pap smear findings, or mammography classifications. Conclusion: BMI significantly impacts the physical symptom domain of quality of life in perimenopausal women. Metabolic derangements, however, appear to be universal across all BMI categories, underscoring the importance of comprehensive metabolic screening for all perimenopausal women regardless of weight status.

Context: Fetal pyelectasis is a commonly detected abnormality on antenatal ultrasonography. Although many cases resolve spontaneously, persistent or severe dilatation may be associated with significant postnatal urinary tract pathology. Identification of antenatal sonographic features associated with adverse neonatal outcomes may help in appropriate counselling and postnatal follow-up. Aims: To evaluate the relationship between antenatally detected fetal pyelectasis and neonatal outcomes and to assess whether the severity of pyelectasis in the third trimester predicts persistent postnatal pathology and the need for surgical intervention. Settings and Design: Prospective observational study conducted among pregnant women with fetuses diagnosed with renal pyelectasis on antenatal ultrasonography. Methods and Material: A total of 41 fetuses with antenatally detected renal pyelectasis were enrolled. Serial ultrasonographic assessments were performed during the second and third trimesters. The anteroposterior diameter of the renal pelvis and the severity of pyelectasis were assessed. Postnatal clinical and radiological follow-up was performed for all liveborn infants. Antenatal sonographic findings were compared with postnatal outcomes. Statistical analysis used: Descriptive and inferential statistical analyses were performed to assess the association between antenatal sonographic findings and postnatal outcomes. Categorical variables were compared using appropriate tests, and continuous variables were compared between outcome groups. A p value <0.05 was considered statistically significant. Results: Of the 41 enrolled fetuses, 40 liveborn infants were available for postnatal evaluation. Spontaneous normalization of pyelectasis during pregnancy occurred in 42.5% of cases, while postnatal resolution was observed in 72.5% of neonates. Persistent or progressive urinary tract dilatation was documented in 27.5% of infants, and surgical intervention was required in 7.5%. Third-trimester severity showed a significant association with postnatal persistence (p<0.001) and the need for surgical intervention (p=0.047). Fetuses with moderate-to-severe thirdtrimester pyelectasis had a 100% rate of persistent postnatal pathology. The mean third-trimester anteroposterior renal pelvic diameter was significantly higher in neonates with persistent disease than in those with spontaneous resolution (11.93 ± 1.74 mm vs. 5.99 ± 1.23 mm; p<0.001). Conclusions: Most cases of antenatally detected fetal pyelectasis resolved spontaneously. Persistent moderate-to-severe third-trimester pyelectasis and a larger third-trimester renal pelvic diameter were strongly associated with persistent postnatal pathology and the need for intervention. Third-trimester ultrasonography may therefore be useful for risk stratification and planning appropriate postnatal follow-up.

Background: Modern family planning through barrier contraception offers couples autonomy over reproductive timing, yet prolonged avoidance of maternal seminal exposure may influence immunological adaptation to paternal antigens during pregnancy. Case Presentation: A 30-year-old educated, career-focused woman, who had consistently used condoms with her spouse for five years prior to conception, experienced an uncomplicated early pregnancy until developing pre-eclampsia at seven months. Her clinical manifestation triggered psychological distress regarding maternal-fetal genetic compatibility and the biological mechanisms underlying pre-eclampsia. Discussion: Pre-eclampsia affects approximately 10% of pregnancies and involves immune maladaptation to paternal genes in the fetus. Seminal plasma contains 93 immune-modulating elements, such as transforming growth factor-beta (TGF-β), which naturally prime and induce maternal immune tolerance during unprotected intercourse. Regular condom use prevents vaginal absorption of these factors, potentially raising pre-eclampsia vulnerability. This clinical reality sits at the intersection of modern social autonomy and biological laws. Conclusion: Healthcare providers must offer balanced, evidence-based counseling that respects reproductive autonomy while informing couples of emerging findings on immune tolerance, reconciling biological imperatives with modern lifestyle choices.

Endometriosis and uterine leiomyoma are gynaecological conditions that are influenced by hormonal and genetic factors. Placenta previa has also been associated with abnormalities in endometrial function and implantation. Although the coexistence of endometriosis and fibroids has been reported previously, the presence of endometriosis, leiomyoma, and placenta previa in the same patient is uncommon. This case highlights the findings of a 32 year old primigravida with a posterior wall uterine fibroid and Type III placenta previa in whom pelvic endometriosis was identified incidentally during cesarean section. The patient had no previous symptoms suggestive of endometriosis and had conceived spontaneously. During elective lower segment cesarean section at 37 weeks of gestation, multiple bluish-black deposits suggestive of endometriosis were noted over the posterior uterine serosa and bilateral uterosacral ligaments. A healthy female infant was delivered, and the postoperative period was uneventful. This case highlights the possibility of a relationship between these estrogen dependent conditions.

Background: Serous cystadenofibroma is an uncommon benign ovarian tumour that may closely resemble a simple or even suspicious adnexal lesion on imaging because of its prominent fibrous component. Recognising this entity is important because it may influence surgical planning and counselling, especially in young women with a family history of ovarian cancer. Case information: A 29-year-old P2L2A2 woman presented with lower abdominal pain, irregular menstrual cycles for 3 months, and dysmenorrhoea. Pelvic imaging suggested a right simple ovarian cyst(9.3 x 6.3 x 7.5 cm). after complete evaluation laparoscopic cystectomy was planned. Intraoperatively, a thick-walled mass adjacent to right ovary measuring 8 × 6 cm was identified, with suspected extra ovarian tissue.right ovary was absolutetly healthy.Mass was excised . Histopathology demonstrated serous cystadenofibroma, with a cyst wall composed of fibrous stroma. Recovery was uneventful. Conclusion: This case illustrates how serous cystadenofibroma can present deceptively as a simple ovarian cyst on imaging yet reveal a more complex appearance at surgery. Histopathological examination remains essential for definitive diagnosis.