Background: Missed abortion is a common complication (1-5% of pregnancies) involving the retention of a non-viable embryo or fetus within utero. Diagnosis relies on ultrasound, revealing halted development and absent fetal heartbeat. If untreated it poses emotional distress and infection risk. Treatment options are surgical evacuation or medical management with abortifacients. Vaginal misoprostol is preferred for higher efficacy and quicker results, while oral misoprostol is more convenient but slightly less effective with longer treatment times. Both the rotes offer non-invasive alternatives to surgery, in management option of missed abortion. Objective: To compare the effectiveness of vaginal misoprostol over oral misoprostol in the medical management of missed abortion during the first trimester of pregnancy. Methods: The randomized controlled trial (RCT) was carried in the Department of Obstetrics and Gynecology, Institute of Child and Mother Health (ICMH), Matuail, Dhaka. The sampling method was random selection according to the availability of the patients. Data were collected from women aged 18-35 years. Patients diagnosed with missed abortion through ultrasonography (USG) and received medical management with vaginal misoprostol were considered as group I (n=36), while those received oral misoprostol comprised as group II (n=36). The outcome of termination of pregnancy in between group I and II were measured. The descriptive and inferential analysis was carried out using SPSSv26. p-value < 0.05 was considered as statistically significant. Results: This study found that vaginal misoprostol was significantly more effective than oral misoprostol, with a success rate of 80.6% compared to 55.6% (p=0.042). Vaginal misoprostol also required fewer doses and shorter induction-expulsion times (p=0.028, p=0.004). Surgical intervention was needed less frequently in the vaginal group (19.4% vs. 44.4%, p=0.042). Adverse effects differed, with more nausea/vomiting and fever in the oral group and more severe cramps and diarrhea in the vaginal group. Hemoglobin levels decreased similarly in both groups. The duration of bleeding favored vaginal misoprostol, but patient satisfaction significantly favored it as well (75.0% vs. 44.5%, p=0.029). Conclusion: Vaginal misoprostol is more effective than oral misoprostol in the medical management of missed abortion during the first trimester of pregnancy.

Background: Niger remains one of the countries with the highest maternal mortality burden worldwide. Approximately one in 23 women is at risk of dying from complications related to pregnancy, childbirth, or the postpartum period. Despite the implementation of the Millennium Development Goals (MDGs), the Sustainable Development Goals (SDGs), and substantial investments in maternal health over the past 15 years, progress has remained modest. The maternal mortality ratio declined from 700 deaths per 100,000 live births in 2005 to 553 in 2015 and 509 in 2017. Methods: We conducted a retrospective descriptive and analytical study at Issaka Gazoby Maternity Hospital, a tertiary referral maternity hospital in Niamey, Niger. The study covered a 12-month period from 1 January to 31 December 2025 and included all maternal deaths that met the World Health Organization (WHO) definition of maternal death. Results: During the study period, 8,002 live births and 175 maternal deaths were recorded, corresponding to a maternal mortality ratio of 2,186.9 per 100,000 live births. Maternal mortality was significantly associated with hypertensive disorders of pregnancy, grand multiparity, and lack of formal education. Direct obstetric complications accounted for most maternal deaths, with eclampsia/severe pre-eclampsia being the leading cause. Conclusion: Maternal mortality in this tertiary referral hospital remains unacceptably high and is driven by the combined effects of socioeconomic, health system, cultural, and biological factors. Strengthening antenatal care, improving timely referral systems, and ensuring rapid management of obstetric emergencies are essential to reduce preventable maternal deaths in Niger and other low-resource settings.

Background: Carcinoma of the cervix remains a leading cause of cancer-related morbidity and mortality among women in developing countries, where organized screening coverage is limited and most patients present only after the disease becomes symptomatic. Objective: To describe the pattern of clinical presentation, disease stage and clinical findings among women with histologically confirmed carcinoma cervix attending a tertiary-level teaching hospital in Bangladesh. Methods: This cross-sectional, prospective study was conducted in the Department of Obstetrics and Gynaecology, Rangpur Medical College Hospital, over one year. Fifty consecutive patients diagnosed with carcinoma cervix who fulfilled the inclusion criteria were enrolled after informed consent and data on presenting symptoms, clinical stage, general and local examination findings and imaging correlates were recorded on a structured questionnaire and analyzed as frequencies and percentages. Results: Most patients (60%) were 41-50 years old. Blood-stained per-vaginal discharge (94%), foul-smelling discharge (50%) and post-coital bleeding (50%) were the commonest complaints. Forty-eight patients (96%) presented in stage IIB or beyond. Nearly all patients (100%) were anaemic, 80% had a cauliflower-like cervical growth and 92% had squamous cell carcinoma on histopathology. Ultrasonography showed cervical growth in 52%, hydronephrosis in 44% and pelvic lymphadenopathy in 22% of patients. Conclusion: Carcinoma cervix in this tertiary-hospital population presents predominantly with abnormal vaginal bleeding and discharge at an advanced clinical stage, underscoring the continued need for symptom awareness and organized early-detection services.

Background: Manual vacuum aspiration (MVA) is a valuable technique for uterine evacuation for early pregnancy loss and post-abortion care, especially in situations where portability, low equipment needs and the avoidance of general anaesthetic are beneficial. Objective: To describe the volume of MVA procedures, indications, patient characteristics and documented complications at Madonna University Teaching Hospital (MUTH), Elele, Rivers State, Nigeria. Methods: This was a descriptive retrospective study, where the records of women who had MVA in the Department of Obstetrics and Gynaecology were reviewed during the study period (2013-2023). Structured proforma was used for the extraction of sociodemographic, obstetric and procedural variables. Frequencies, percentages, means and standard deviations and medians and interquartile ranges were reported. The prevalence of MVA was determined by dividing the number of MVA procedures by the number of gynaecology visits in the same period, and then multiplying by 100. Results: 173 MVA procedures were documented in 983 gynaecology visits, resulting in a prevalence of 17.6% at the institution. Most patients were aged 20–34 years (71.1%), married (81.5%) and had secondary education (84.4%). The majority of procedures were carried out prior to 13 weeks' gestation (74.6%) and by medical officers (83.8%). The most common indication was incomplete miscarriage (161, 93.1%) followed by missed miscarriage (6, 3.5%), retained products of conception (4, 2.3%) and other indications (2, 1.2%). Five adverse outcomes were documented: uterine synechia in three patients (1.7%) and post procedure vaginal discharge in two patients (1.2%). The mean estimated blood loss was 133.3 ± 102.6 mL, with five patients (2.9%) receiving one unit of blood. The median length of hospital stay was 2 days (IQR 1–3) with 47.4% having a 1 day stay. Conclusion: MVA was used in the majority of cases of incomplete miscarriage accounting for 17.6% of gynaecology visits at MUTH. Blood loss, documented complications and hospital stay were minor, and most procedures were performed in the first trimester by medical officers.

Background: Adenomyosis and leiomyoma are common benign uterine disorders with overlapping clinical and imaging features, making accurate preoperative diagnosis challenging. This study evaluated the diagnostic value of individual transvaginal ultrasonography (TVS) criteria for adenomyosis and leiomyoma using histopathology as the reference standard. Methods: This analytical cross-sectional study was conducted among 150 women aged 30–55 years with TVS-diagnosed adenomyosis, leiomyoma, or both who subsequently underwent hysterectomy, myomectomy, or adenomyomectomy and had histopathological confirmation. Participants were enrolled using purposive sampling. Individual TVS criteria for adenomyosis and leiomyoma were compared with corresponding histopathological findings. Statistical analyses were performed using SPSS version 26.0, with p<0.05 considered statistically significant. Results: Leiomyoma was the most common diagnosis (61.33%), followed by combined adenomyosis and leiomyoma (26.00%) and adenomyosis alone (12.67%). For adenomyosis, no distinction of the endometrial-myometrial junction (78.9%), asymmetry of the anterior and posterior myometrium (83.3%), heterogeneous myometrial echotexture (80.3%) and myometrial cysts with fibrosis (62.5%) showed significant associations with histopathology (all p<0.0001). For leiomyoma, clear tumor margin demarcation (96.7%), peripheral vascularity on color Doppler (95.6%), irregular uterine surface (93.5%) and irregular endometrial surface (95.7%) were also significantly associated with histopathological confirmation (p≤0.005). Conclusion: Individual TVS criteria demonstrated significant diagnostic value for adenomyosis and leiomyoma. Recognition of these sonographic features may improve preoperative diagnostic accuracy and support appropriate clinical management.

Background: Early initiation of breastfeeding within the first hour of life is a critical intervention for reducing neonatal morbidity and mortality. However, timely initiation remains suboptimal in many settings. This study aimed to identify maternal and neonatal characteristics associated with early initiation of breastfeeding. Methods: This cross-sectional study was conducted in the Department of Obstetrics and Gynaecology at Dhaka Medical College Hospital from July 2012 to December 2012. A total of 100 postpartum mothers were enrolled using purposive sampling. Data were collected through direct interviews using a pre-designed data collection sheet and analyzed using SPSS software. Results: Among the 100 mothers, 57% were below 25 years of age, 62% had primary level education, 82% were housewives, 72% were Muslim and 68% resided in rural areas. The majority (58%) belonged to the lower socioeconomic group and 72% were primipara. Regarding neonatal characteristics, 74% of babies were born at term, 58% were male and 62% had low birth weight (< 2.5 kg). Statistically significant associations were observed for gestational age (P = 0.001) and birth weight (P = 0.001), while gender did not reach statistical significance (P = 0.060). Conclusion: Maternal characteristics such as younger age, lower education, primiparity, lower socioeconomic status, along with neonatal factors like preterm gestational age and low birth weight, were prominent among the study population. These findings highlight the need for targeted breastfeeding support and counseling, particularly for vulnerable groups, to promote early initiation and improve neonatal outcomes.

Background: A clinically unhealthy cervix may be associated with benign inflammatory conditions as well as cervical intraepithelial neoplasia (CIN) and invasive carcinoma. Colposcopy provides magnified assessment of cervical abnormalities and facilitates targeted biopsy, while histopathology remains the definitive diagnostic method. This study evaluated colposcopic findings and their correlation with histopathological diagnoses among women with a clinically unhealthy cervix. Methods: This prospective observational study was conducted in the Department of Obstetrics and Gynecology, Dhaka Medical College Hospital, Bangladesh, from January to June 2026. A total of 150 women with a clinically unhealthy cervix were enrolled. All participants underwent clinical examination, colposcopic evaluation, and colposcopy-directed cervical biopsy. Histopathological findings were considered the reference standard. The diagnostic performance of colposcopy for detecting CIN 2+ was assessed, and agreement between colposcopic impression and histopathological diagnosis was evaluated using Cohen’s kappa. Results: The mean age was 44.1±10.2 years, and 31.3% were aged 41–50 years. Abnormal vaginal discharge was the commonest complaint (60.7%), while acetowhite epithelium was the most frequent colposcopic finding (48.7%). Histopathology revealed chronic cervicitis/inflammatory lesions in 34.7%, CIN 1 in 19.3%, CIN 2 in 11.3%, CIN 3 in 9.3%, and invasive squamous cell carcinoma in 6.7%. Overall, CIN 2+ was identified in 27.3%. Colposcopy showed 85.4% sensitivity, 83.5% specificity, and 84.0% diagnostic accuracy for CIN 2+. Agreement with histopathology was fair (κ=0.37, p<0.001). Conclusion: Colposcopy is a useful diagnostic tool for evaluating clinically unhealthy cervices, but histopathological confirmation remains essential for definitive diagnosis.

Introduction: Preeclampsia constitutes a significant complication during pregnancy, contributing notably to maternal and perinatal morbidity and mortality on a global scale. Calcium is vital for the functioning of vascular smooth muscle and the regulation of blood pressure. However, the association between maternal serum calcium levels and the severity of preeclampsia remains insufficiently elucidated, particularly within the context of Bangladesh. Objective: To evaluate the association between maternal serum calcium levels and the severity of preeclampsia among pregnant women at Dhaka Medical College Hospital. Methods: This cross-sectional observational study was conducted in the Department of Obstetrics and Gynecology, Dhaka Medical College Hospital, Bangladesh, from January to June 2026. A total of 120 pregnant women diagnosed with preeclampsia, categorized into non-severe (n=70) and severe (n=50) groups. Serum calcium levels were measured, and demographic, obstetric, and clinical characteristics were recorded. Data were analyzed using appropriate statistical tests, with p<0.05 considered significant. Results: Women with severe preeclampsia had significantly lower mean serum calcium levels compared to those with non-severe disease (7.82 ± 0.61 mg/dL vs. 8.64 ± 0.52 mg/dL; p<0.001). Serum calcium <8.5 mg/dL was strongly associated with severe preeclampsia (OR=4.5, 95% CI: 1.96–10.15, p<0.001), and this association persisted after multivariable adjustment (AOR=3.92, 95% CI: 1.64–9.37, p=0.002). Significant negative correlations were observed between serum calcium and both systolic (r=-0.49) and diastolic (r=-0.43) blood pressures. Conclusion: Low maternal serum calcium is linked to severe preeclampsia, suggesting it could help identify women at risk. However, causality can't be confirmed due to the study's cross-sectional nature. Longitudinal research with ionized calcium, vitamin D, and diet assessment is needed to clarify mechanisms before clinical use.

Background: Insulin therapy is required in gestational diabetes mellitus (GDM) when glycaemic targets are not achieved through lifestyle modification and rapid acting insulin analogues such as regular aspart insulin have been developed to provide more physiological postprandial and fasting glucose control than regular human insulin. This study aimed to compare glycemic control, including fasting, postprandial and glycated haemoglobin parameters, between regular aspart insulin and regular human insulin in women with gestational diabetes mellitus. Methods: This randomized controlled trial was conducted in the outpatient department of Obstetrics and Gynaecology, BIRDEM General Hospital, Dhaka, from October 2023 to January 2025, among 102 pregnant women with GDM diagnosed after 24 weeks of gestation. Participants were randomly allocated to regular aspart insulin (Group I, n=54) or regular human insulin (Group II, n=48); 49 and 46 women respectively completed follow up at 28, 32 and 36 weeks of gestation and after delivery. Fasting blood sugar, postprandial glucose two hours after breakfast, lunch and dinner and HbA1c were compared using SPSS version 26, with p&lt;0.05 considered significant. Results: Mean age of participants was 29.2 ± 4.6 years and 63.16% were obese before pregnancy. Fasting glucose was significantly lower in Group I at every assessment point (p&lt;0.0001). Postprandial glucose values were also significantly higher in Group II at 28 weeks (p&lt;0.05 for all three postprandial readings), but these differences attenuated by 32 and 36 weeks and after delivery. HbA1c was comparable between groups at 28 weeks (6.1 ± 1.0 versus 6.4 ± 1.4, p=0.327) and 36 weeks (5.8 ± 1.0 versus 5.9 ± 1.4, p=0.697). Conclusion: Regular aspart insulin provided superior fasting glycaemic control throughout pregnancy and more favourable early postprandial control than regular human insulin, while overall glycated haemoglobin remained comparable, supporting its use as an effective glycaemic management option in gestational diabetes mellitus.