Indian Journal of Obstetrics and Gynecology

Background: Maternal anthropometric and hematological parameters are important determinants of fetal growth and neonatal anthropometric outcomes. Identification of simple maternal predictors may help in early detection of pregnancies at risk for adverse neonatal outcomes, particularly in resource-limited settings. Objectives: To evaluate the correlation between maternal anthropometric parameters and neonatal anthropometric measurements, and to assess the association between maternal hemoglobin levels and neonatal birth weight. Materials and Methods: This prospective longitudinal observational study was conducted at Sagar Hospitals from April 2019 to March 2020 among 150 pregnant women aged 18–35 years delivering singleton live neonates between 37–40 weeks of gestation. Maternal weight, height, body mass index (BMI), gestational weight gain, and hemoglobin levels were recorded. Neonatal anthropometric measurements including birth weight, crown–heel length, head circumference, chest circumference, and mid-arm circumference were measured within 24 hours of birth. Statistical analysis was performed using appropriate tests, with p<0.05 considered significant. Results: The mean maternal age was 28.03 years. Mild anemia was observed in 11.33% subjects, while 88.67% had normal hemoglobin levels. Mean neonatal birth weight was 2.70±0.28 kg. Low birth weight incidence was significantly higher among mildly anemic mothers compared to non-anemic mothers (29.41% vs 6.78%). Maternal anemia was significantly associated with lower neonatal birth weight, length, head circumference, chest circumference, and mid-arm circumference. Maternal BMI showed a significant positive correlation with neonatal birth weight (r=0.23, p=0.005). Maternal weight >50 kg and gestational weight gain >11 kg were associated with significantly higher neonatal birth weight, whereas maternal height showed no significant association with neonatal anthropometric measurements. Conclusion: Maternal hemoglobin status, BMI, maternal weight, and gestational weight gain significantly influence neonatal anthropometric outcomes, particularly birth weight. Routine maternal anthropometric assessment and hemoglobin estimation during antenatal care may serve as simple and cost-effective tools for identifying pregnancies at risk for adverse neonatal outcomes.

Introduction: Gestational diabetes mellitus is a major contributor of perinatal morbidity and mortality. Thyroid hormones play an important role in glucose metabolism and any derangement in its production may lead to development of gestational diabetes mellitus. Thus we aim to find out whether hypothyroidism detected first time in pregnancy is associated with development of gestational diabetes mellitus. Methodology: Antenatal women visiting our medical college hospital out patient department during first trimester satisfying the inclusion criteria, after informed consent were enrolled in the study and routine antenatal investigations that includes serum TSH was done. Between 24-28 weeks gestation oral glucose tolerance test (OGTT) was done. The incidence of GDM in hypothyroid and euthyroid was calculated, based on the International Association of Diabetes in Pregnancy Study Group (IADPSG) criteria for the diagnosis of gestational. Results: The incidence of gestational diabetes was found to be 46.9% in hypothyroid women when compared to 20.8% in euthyroid women. The chance of developing GDM in hypothyroid antenatal women were 3.35 times more than euthyroid antenatal women. Highest number of diagnosis was made with 1 hour blood sugar values both in hypothyroid and euthyroid women as per IADPSG criteria. Conclusion: Our study found a significant number of hypothyroid women developed GDM as compared with euthyroid women. Hence identification of Hypothyroidism in first trimester and screening of GDM subsequently in 2nd trimester using a standardised criteria are important in-order to predict and prevent the perinatal morbidity and mortality caused due to GDM.

Background: Non-puerperal uterine inversion (NPUI) is a rare gynecological condition, most commonly associated with benign fundal leiomyomas. Its occurrence secondary to endometrial carcinoma is exceptionally uncommon and poses significant diagnostic and management challenges due to its nonspecific clinical presentation. Case Presentation: A 75-year-old multiparous postmenopausal woman presented with excessive vaginal bleeding, a protruding vaginal mass, lower abdominal pain, fever, and urinary retention. She had previously undergone polypectomy for a prolapsing vaginal mass, the histopathological examination of which revealed Grade 1 endometrioid adenocarcinoma. Clinical examination demonstrated a longitudinal growth protruding through the cervical os with distortion of normal cervical anatomy. Ultrasonography and contrast-enhanced computed tomography suggested uterine inversion with a uterine mass occupying the vaginal canal. Following multidisciplinary evaluation and optimization, exploratory laparotomy was performed. Intraoperatively, a completely inverted uterus with inflamed cervix and enlarged pelvic lymph nodes was identified. Manual vaginal reduction was followed by radical hysterectomy with bilateral salpingo-oophorectomy, bilateral pelvic lymphadenectomy, omentectomy, and appendicectomy. Histopathological examination demonstrated well-differentiated endometrioid carcinoma (FIGO Grade 1) with greater than 50% myometrial invasion and involvement of the lower uterine segment. All lymph nodes, adnexal structures, omentum, appendix, and peritoneal cytology were negative for malignancy. The final diagnosis was FIGO Stage IB (pT1bN0) endometrioid carcinoma presenting as non-puerperal uterine inversion. Conclusion: Non-puerperal uterine inversion secondary to endometrial adenocarcinoma is an exceptionally rare clinical entity. The condition may mimic other gynecological pathologies and often presents with vaginal bleeding and a protruding vaginal mass. Early recognition through careful clinical assessment and appropriate imaging is essential for accurate diagnosis and surgical planning. This case highlights the importance of considering underlying uterine malignancy in patients presenting with atypical vaginal bleeding and uterine inversion and emphasizes the role of histopathology in guiding definitive oncologic management.

Introduction: Caesarean section is a life-saving obstetric intervention when appropriately indicated; however, its increasing use among multiparous women with previous successful vaginal deliveries has become a matter of clinical concern. Evaluating the factors contributing to primary caesarean section (CS) in this group is essential for optimizing maternal and neonatal outcomes and promoting evidence-based obstetric care. Objectives: To determine the incidence, indications, associated antenatal risk factors, maternal and neonatal outcomes, and Robson ten group distribution of primary caesarean sections in multiparous women. Methods: A prospective observational study was conducted in the Department of Obstetrics and Gynaecology, Government Medical College and Rajindra Hospital, Patiala, over a period of one year (2022–2023). Multiparous women with at least one previous vaginal delivery beyond 24 weeks of gestation who underwent their first caesarean section were included. Relevant demographic, clinical, obstetric, and neonatal data were collected and analysed. Caesarean sections were further categorized using Robson’s Ten-Group Classification System. Results: Among 3,759 deliveries, 241 women underwent primary caesarean section, yielding an incidence of 12.98%. Most participants were unbooked referrals and belonged to lower socioeconomic strata. Anaemia (46.47%) was the commonest antenatal risk factor. Emergency procedures accounted for 89.21% of surgeries. Foetal distress emerged as the leading indication for caesarean section (40.25%), followed by breech presentation (19.92%) and major placenta previa (19.09%). Maternal complications were infrequent, with postpartum haemorrhage and wound disruption being the most common. No maternal mortality was recorded. Robson Group 10 contributed the largest proportion of primary caesarean sections (45.23%). Conclusion: Foetal distress remains the predominant indication for primary caesarean section in multiparous women. Strengthening antenatal care, encouraging timely referrals, and applying Robson’s classification can facilitate targeted interventions, improve obstetric decision-making, and contribute to reducing avoidable caesarean deliveries.

Background: Fibromyoma, or uterine leiomyoma, is the most common benign tumor of the female reproductive tract, affecting 50-80% of women by age 50. Despite its benign nature, it poses a significant clinical dilemma due to its variable presentation, impact on quality of life, and complex management decisions. Aim: This article discusses the diagnostic and therapeutic dilemmas associated with fibromyoma, focusing on challenges in clinical decision-making for symptomatic women. Discussion: The dilemma arises from several factors. First, most fibroids are asymptomatic, yet 25-30% cause menorrhagia, pelvic pain, pressure symptoms, or reproductive issues. Second, treatment must balance symptom relief with fertility preservation. Options include expectant management, medical therapy with GnRH agonists or SPRMs, minimally invasive procedures like uterine artery embolization and HIFU, and surgical approaches such as myomectomy or hysterectomy. Each has distinct risks, benefits, and recurrence rates. Third, differentiating benign fibroids from the rare leiomyosarcoma (<1%) preoperatively remains challenging. Fourth, fibroids in pregnancy can lead to red degeneration, preterm labor, and postpartum hemorrhage, yet many women have uneventful outcomes. Conclusion: Managing fibromyoma requires individualized care based on age, symptoms, fertility desires, and fibroid characteristics. A multidisciplinary approach with thorough counseling is essential. Further research is needed for reliable biomarkers to rule out malignancy and long-term fertility data for newer modalities.