International Journal of Research and Reports in Gynaecology

Knowledge and Attitudes toward Early Initiation of Breastfeeding among Postpartum Mothers in a Tertiary Hospital in Tamale, Ghana: A Cross-Sectional Study

Zariatu Yakubu — 2026-01-09

Background: Early breastfeeding initiation is a WHO recommendation aimed at improving neonatal health outcomes. The study was conducted to explore the knowledge and attitudes of early initiation of breastfeeding among puerperal mothers in a Tertiary Hospital in Tamale.

Methods: The study employed a descriptive cross-sectional design with a qualitative approach conducted within the hospital. The employed method was a systematic random sampling procedure. A total of 15 puerperal mothers were purposively selected from the labour and maternity wards of Tamale Teaching Hospital. In-depth face-to-face interviews were conducted using a semi-structured guide, and the data collected were analyzed through thematic analysis.

Results: The study found that 70% of mothers generally understand early initiation of breastfeeding (EIB) as beginning breastfeeding immediately after childbirth, aligning with international guidelines. Their knowledge about the importance of feeding colostrum within the first hour after birth exceeds findings in some developing countries, indicating a high level of awareness. They also showed positive attitudes toward early initiation of breastfeeding to foster an emotional bond with their babies and to provide nourishment to satisfy hunger.

Conclusion: Puerperal mothers displayed varying levels of understanding of what EIB entails. While some correctly associate EIB with starting breastfeeding immediately after birth, others have a less precise understanding. Mothers are willing to initiate breastfeeding early after giving birth, but some still have uncertainty about colostrum. There is compelling evidence that treatments like group prenatal care in Ghana can enhance exclusive breastfeeding knowledge and behaviours, including attitudes towards early initiation. Immediate breastfeeding assistance, skin-to-skin contact, and other Baby-Friendly Hospital Initiative procedures should be instituted at all birthing centres. This will facilitate both the consolidation of knowledge and the efficacy of early start. Community health systems can enhance post-discharge assistance for mothers and strengthen early initiation messages.

Knowledge, Attitude and Perception of Ectopic Pregnancy among Women of Reproductive Age in Abia State, Nigeria

Chyke I. Amah — 2026-01-13

Background: Ectopic pregnancy remains a significant cause of maternal morbidity and mortality in low- and middle-income countries. Understanding how women perceive this condition is essential for strengthening prevention, early detection and timely care. This study assessed the knowledge, attitude and perception of ectopic pregnancy among women of reproductive age in Abia State, Nigeria.

Methods: A hospital-based cross-sectional study was conducted at Abia State University Teaching Hospital, Aba, from July 2023 to June 2025. A total of 406 women aged 15 to 49 years were recruited using a systematic random sampling method. Data were collected with a structured interviewer-administered questionnaire that covered sociodemographic characteristics, reproductive history, knowledge, attitudes and perceptions. Descriptive statistics summarised key variables. Chi-square tests and t-tests examined bivariate associations, while multivariable logistic regression identified independent predictors of good knowledge and positive attitudes. Ethical approval and informed consent were obtained.

Results: Participants had a mean age of 29.74 years. Most had a tertiary education and were married. Overall, knowledge about ectopic pregnancy was modest, with 37.19% showing good knowledge. Fair and poor knowledge accounted for 35.22% and 27.59% respectively. Attitudes toward early care seeking and prevention were generally positive. Perception findings revealed that a considerable proportion attributed ectopic pregnancy to spiritual causes and curses, while some believed in herbal treatment. Hospitals were the preferred first point of care for most respondents. Correlation analysis showed weak relationships between knowledge, attitude and perception. Education and sociodemographic factors demonstrated limited predictive value for knowledge or attitude outcomes.

Conclusion: Women of reproductive age in Abia State demonstrated moderate awareness of ectopic pregnancy, though misconceptions and culturally influenced beliefs persist. Positive attitudes toward early detection and hospital care were encouraging, yet gaps in accurate understanding highlight the need for targeted community education and culturally sensitive counselling. Strengthening reproductive health awareness could promote earlier help-seeking and reduce preventable complications.

Antibacterial Activity of Hunteria umbellata (Madaci Seed) against Multidrug-Resistant Staphylococcus aureus Isolated from Patients in Dutsin-Ma, Katsina State, Nigeria

Zubaida Muhammad Yusuf — 2026-01-22

Background: Urinary tract infections (UTIs) caused by Staphylococcus aureus are increasingly reported in Nigerian healthcare settings, with multidrug resistance (MDR) posing a major therapeutic challenge. The search for alternative antibacterial agents from medicinal plants has therefore gained renewed attention. Hunteria umbellata (Madaci), widely used in traditional medicine in Northern Nigeria, is reputed for its antimicrobial properties, yet evidence against MDR uropathogenic S. aureus remains limited.

Objective: This study evaluated the in vitro antibacterial activity of Hunteria umbellata seed extracts against multidrug-resistant Staphylococcus aureus isolated from urine samples of patients attending General Hospital Dutsin-Ma, Katsina State, Nigeria.

Methods: Fifty urine samples were collected from patients with suspected UTIs. Staphylococcus aureus was isolated and identified using standard phenotypic and biochemical methods. Antimicrobial susceptibility testing was performed by the Kirby–Bauer disc diffusion method in accordance with CLSI guidelines. Multidrug resistance was defined as r resistance to ≥1 agent in ≥3 antimicrobial classes. Ethanol and aqueous seed extracts of H. umbellata were phytochemically screened and evaluated for antibacterial activity using agar well diffusion, minimum inhibitory concentration (MIC), and minimum bactericidal concentration (MBC) assays.

Results: Twenty-two (44.0%) urine samples yielded S. aureus, with a higher prevalence among females (63.6%). High resistance rates were observed to cefoxitin (81.8%), ciprofloxacin (77.3%), and ampicillin (72.7%), while all isolates were susceptible to vancomycin. Multidrug resistance was detected in 81.8% of isolates. The ethanol extract demonstrated strong, concentration-dependent antibacterial activity against MDR isolates (mean inhibition zone: 21.6 ± 2.1 mm at 100 mg/mL), with MIC values predominantly between 6.25 and 12.5 mg/mL. The aqueous extract showed moderate, largely bacteriostatic activity.

Conclusion: Hunteria umbellata seed extracts, particularly the ethanol extract, exhibit significant in vitro activity against MDR Staphylococcus aureus from UTIs, supporting their potential as sources of alternative antibacterial agents.

Quantifying Inequality, Volatility, and Stability in Early Postnatal Care Coverage by Multilevel Beta Regression

Francis Ayiah-Mensah — 2026-02-03

The early postnatal care in the first 48 hours of childbirth is crucial in preventing maternal morbidity and death. However, worldwide evidence remains dominated by mean-based and binary analyses that do not account for instability in service coverage. This research aims to measure the extent and consistency of early postnatal care coverage across nations and socioeconomic status. The three objectives include estimating changes in coverage over time, identifying socioeconomic and geographic disparities, and understanding the factors driving fluctuations in coverage. A multilevel beta regression was used with harmonised multi-country data from 73 countries covering 2010-2023, using 230 country-year-stratum observations to model bounded coverage percentages with country-random and survey-source random effects. The volatility was measured using a complementary instability model that relies on logarithmically transformed squared deviance residuals. Findings indicate a significant increase in temporal coverage (β = 0.058, p <.001), with coverage consistently lower in low-income contexts and in the poorest and rural populations (p <.001). The volatility of the poorest and richest groups was much greater than that of the nation groups, suggesting masked subgroup volatility. It is novel in that the coverage and instability of the models are jointly modelled in a distribution-consistent manner, thereby overcoming the significant statistical shortcomings of previous literature. The following recommendations should be considered: Stability metrics should be incorporated into SDG 3, resilience-based interventions should be prioritised for disadvantaged populations, and routine postnatal follow-up systems should be strengthened to ensure quality and consistency in maternal care.

Immunohaematological Signatures of Malaria in Pregnancy: Comparative Leukocyte Distribution in Infected and Uninfected Pregnant Women in Owerri, Imo State, Nigeria

Emmanuel Ifeanyi Obeagu — 2026-03-21

Background: Malaria during pregnancy remains a major public health challenge in sub-Saharan Africa and is associated with maternal anemia, adverse fetal outcomes, and immune alterations. Changes in leukocyte distribution reflect host immune responses and may provide insight into immunohaematological patterns associated with malaria infection.

Objective: The present study compared the differential leukocyte profiles among malaria-infected pregnant women (MP+), malaria-uninfected pregnant women (MP−), and non-pregnant women (controls) in Owerri, Imo State, Nigeria.

Methods: A comparative cross-sectional study was conducted among 150 participants comprising 50 malaria-infected pregnant women, 50 malaria-uninfected pregnant women, and 50 apparently healthy non-pregnant women recruited through convenience sampling from selected health facilities in Owerri. Malaria infection was confirmed using Giemsa-stained thick and thin blood film microscopy. Complete blood counts and differential leukocyte parameters were determined using an automated hematology analyzer. Statistical analyses were performed using analysis of variance (ANOVA) and independent t-tests, with p < 0.05 considered statistically significant.

Results: Malaria-infected pregnant women exhibited significantly lower lymphocyte percentages (22.70 ± 8.65%) compared with controls (41.12 ± 9.28%, p < 0.001), while the difference between MP+ and MP− groups (25.02 ± 7.11%) was not statistically significant (p = 0.146). Neutrophil percentages were significantly higher in both MP+ (73.46 ± 11.09%) and MP− (74.24 ± 7.69%) groups compared with controls (58.14 ± 9.51%, p < 0.001). Eosinophil percentages were significantly elevated in MP+ participants (1.94 ± 1.41%) relative to MP− (0.26 ± 0.44%) and controls (0.34 ± 0.48%) (p < 0.001). Monocyte and basophil levels showed no significant differences across groups.

Conclusion: Malaria infection during pregnancy is associated with alterations in leukocyte distribution, particularly reduced lymphocyte and elevated eosinophil levels, while pregnancy itself appears associated with increased neutrophil proportions. These findings suggest that leukocyte profiles may reflect immunological responses to malaria infection in pregnancy. However, interpretation should be cautious due to the cross-sectional design, convenience sampling, and absence of formal sample size calculation, which may limit causal inference and generalizability.

Socio-Demographic and Behavioral Determinants of Female Condom Utilization among Women of Reproductive Age, Sagamu LGA, Ogun State, Nigeria

Rhema Blossom Jay — 2026-03-31

Background: Female condoms prevent both unintended pregnancy and sexually transmitted infections (STIs). In Nigeria, usage remains extremely low with only 5.5-8.9% reported using Female condoms. It is on this note that this research aimed to assess the knowledge, attitude and factors inhibiting students towards the utilization of female condoms among students of South Western Nigeria College of Health Technology, Sagamu LGA, Ogun state.

Aim: This study employed a cross-sectional design to assess the level of knowledge, attitudes, and utilization of female condoms and to identify factors associated with their use among women of reproductive age.

Method: A cross-sectional study was conducted among 288 students from 3 departments selected through a proportionate stratified sampling technique. Data were collected using a self-administered, semi-structured questionnaire incorporating adapted Female Condom Knowledge Scale (FCKS), Condom Attitude Scale (CAS), Condom Use Behaviour Scale (CUBS) and Health Belief Model (HBM) scales. Analysis in IBM SPSS Statistics version 25 involved descriptive statistics, Mean score was used to categorise Knowledge, attitudes and utilization while factors inhibiting the use of female condom was descriptive. Inferential tests using chi-square and multiple linear regression were significant at p < 0.05.

Results: The mean age of respondents was 20.7 ± 3.9 years. On a 20 points knowledge scale, 176 (61.1%) had good knowledge, 112 (38.9%) had poor knowledge. On a 28-point attitude scale, 172 (59.7%) had positive attitudes toward female condom use, 116 (40.3%) had negative attitudes. On a 20-point utilisation scale, 172 (59.7%) had poor utilization. Factors influencing female condom use included accessibility, cost, partner influence, health worker/media guidance, self-efficacy, and fear of pregnancy or STIs, shaping utilization. Knowledge was significantly associated with female condom utilization (p = 0.025), whereas attitude showed no significant association (p = 0.505). Regression analysis indicated that knowledge and attitude jointly predicted female condom utilization (p = 0.003).

Conclusion: Findings indicate that knowledge was good and attitudes were positive among students, but utilization of female condoms remained low. Also, knowledge significantly predicted usage, yet, female condom use was hampered by accessibility, cost, partner reactions, health messaging, self-efficacy, and fear of pregnancy or STIs, with fear of adverse outcomes being a strong motivator. It is recommended that health education campaigns, improved distribution channels, and partner-inclusive interventions be implemented to promote positive attitudes, and increase consistent female condom use among students.

Awareness and Utilization of Pregnancy Related Mobile Applications among Pregnant Women Attending Antenatal Clinic at Federal Medical Centre, Umuahia, Abia State, Nigeria

Uka-Kalu, Ezinne Chioma — 2026-04-21

Background: Pregnancy apps are especially popular among expectant mothers due to their ease of access, user-centered designs, and ability to deliver personalized health information. Pregnancy mobile applications (apps) offer a promising avenue to enhance maternal health education and antenatal care engagement, yet their adoption in low-resource settings remains poorly understood.

Aim: This study assessed the awareness and utilization of these apps among pregnant women in a Nigerian tertiary hospital.

Methods: This is a descriptive cross-sectional study conducted among 410 pregnant women attending the antenatal clinic at Federal Medical Centre, Umuahia, Abia State. Data were collected using a structured interviewer-administered questionnaire. Analysis involved descriptive statistics and chi-square tests.

Results: A majority of respondents (61.0%) were aware of pregnancy apps, primarily through social media (32.3%). However, utilization was low: only 41.5% of informed women had ever used an app, and merely 12.2% were current users. Key perceived benefits included learning about pregnancy (25.5%) and remembering appointments (19.1%). Major barriers to use were high data cost (20.3%) and a preference for information from healthcare providers (20.3%). Socio-demographic factors showed no significant association with app awareness. Occupation was significantly associated with ever-use (p=0.014), but no factor predicted current use, indicating universal challenges with sustained engagement.

Conclusion: While awareness of pregnancy apps is relatively high, a significant gap exists between awareness and sustained utilization, driven by economic, trust-related, and design-related barriers. To realize their potential, interventions must move beyond awareness campaigns to address these specific barriers through provider integration, data cost mitigation, and the development of contextually relevant, low-cost applications.

Health-Information Seeking Behavior among Pregnant Women Attending Antenatal at Primary Health Centres in Umuahia South L.G.A., Abia State, Nigeria

Uka-Kalu, Ezinne Chioma — 2026-05-01

Background: Access to accurate health information is a critical determinant of positive maternal outcomes. In Nigeria, where maternal mortality remains high, understanding how pregnant women seek information within the primary healthcare system is essential for designing effective interventions.

Aim: This study assessed the health information-seeking behavior (HISB) among pregnant women attending antenatal care at Primary Health Care (PHC) centres in Umuahia South Local Government Area, Abia State.

Methods: A descriptive cross-sectional study design was employed. Using a multi-stage sampling technique, 305 pregnant women were recruited from selected PHC centres. Data were collected via a structured questionnaire, analyzing socio-demographic and obstetric profiles, information topics, sources, seeking patterns, and barriers. Analysis was performed using SPSS version 25, employing descriptive statistics and Chi-square tests at a significance level of p<0.05.

Results: The mean age of respondents was 27.4 (±5.8) years. Most had secondary education (39.7%) and were multiparous (70.8%). Nutrition (17.9% of topic mentions) and fetal development (15.2%) were the most sought-after information. Healthcare providers were the primary information source (46.9%), while the internet was a major supplementary source (17.0%). A majority (65.9%) were classified as active seekers, seeking information daily or weekly. The foremost barrier was the cost of internet data (20.4% of barrier mentions), followed by health workers being too busy (13.8%). No statistically significant association was found between the extent of seeking behavior and key socio-demographic or obstetric factors (p > 0.05).

Conclusion: Pregnant women in Umuahia South are proactive information seekers but face a syndemic of barriers dominated by economic constraints limiting digital access and health system challenges impeding clear communication. Recommendations include strengthening patient-centered communication in PHC, exploring subsidized data schemes for health information, and integrating targeted health literacy education into antenatal care.

Comparative Uterine Cavity Dimensions on Hysterosalpingography (HSG) in Women with and without Fibroids: Implications for Fair Pricing Policies in Sub Saharan Africa

I. Udobi Samuel — 2026-05-04

Background: Hysterosalpingography (HSG) is a radiologic modality widely used for investigations in infertility evaluation and preoperative planning for gynecologic surgeries. It is relatively cheap, making it more affordable in low- and middle-income countries (LMICs), like in Sub-Saharan Africa. Uterine fibroids are highly prevalent among women undergoing HSG. Recent astronomical rise in the cost of iodinated contrast agents used in HSG has led some radiology centres to differentially increase the price of the procedure based on the presumption (with no empirical evidence) that fibroids cause uterine cavity enlargement, requiring the use of more volume of contrast. This has raised concerns on both equity and access to surgical capacity in LMICs. This study compared uterine cavity dimensions (length, width, volume) as seen on HSG between fibroid and non-fibroid subjects.

Methodology: This is a prospective comparative study of women referred for HSG. Institutional ethical clearance and patients’ consent were duly obtained. Transabdominal ultrasound was performed to detect, characterize and measure fibroids. HSG was then used to demonstrate and measure the uterine cavity dimensions.

The data was analysed with Statistical package for Social Sciences version 23. Simple descriptive statistics, independent sample t-test, and Pearson’s correlation tests were done. In all the significance tests, p-values ≤0.05 were considered statistically significant at 95% confidence interval.

Results: A total of 185 were studied, consisting of 33 subjects (17.84%) in the fibroid subgroup and 152 subjects (82.16%) in the non-fibroid group. The mean uterine cavity dimensions were statistically greater among the fibroid group as follows: fibroid group vs non-fibroid groups; length [5.06cm vs 3.59cm (p˂0.001)], width [3.62cm vs 3.08cm (p=0.016)], volume [27.98cm³ vs 14.10cm³(p˂0.001).

Conclusion: The uterine cavity dimensions (length, width and volume) as measured on HSG of women with uterine fibroids are significantly larger than those without fibroids. However, fair pricing should also take into consideration equity, affordability and access.

Factors Influencing the Decision to Use in vitro Fertilisation among Infertile Couples Attending Public Tertiary Health Facilities in Abia State, Nigeria

Emmanuel M. Akwuruoha — 2026-05-06

Background: Infertility remains a major reproductive health concern in Nigeria, and in vitro fertilization (IVF) is increasingly considered by couples who have not achieved conception through conventional treatments. However, decisions to use IVF are shaped by multiple interacting factors.

Aim: This study assessed the socio-demographic, reproductive, knowledge-based, attitudinal, economic, and health system factors influencing the decision to use IVF among infertile couples attending Abia State University Teaching Hospital (ABSUTH), Aba, and Federal Medical Centre (FMC), Umuahia.

Methods: A multi-facility cross-sectional analytical study was conducted among 368 infertile couples attending the infertility clinic at ABSUTH and FMC, Umuahia. Systematic random sampling was used. Data were collected with a pretested structured interviewer-administered questionnaire covering socio-demographics, reproductive history, IVF knowledge, attitudes and beliefs, economic considerations, and health system factors. Data were analysed using SPSS version 25. Descriptive statistics were generated, Chi-square tests assessed associations, Pearson correlation examined relationships among key variables, and logistic regression identified independent predictors of the decision to use IVF. Statistical significance was set at p < 0.05.

Results: The mean age distribution showed that most respondents were 25–39 years. Overall, 57.9% of couples had decided to pursue IVF. Higher educational level, income, duration and type of infertility, religious support, and quality of counselling were significantly associated with IVF decision (p < 0.05). Knowledge and attitude toward IVF were positively correlated (r = 0.46, p < 0.001). Logistic regression revealed that tertiary education (AOR = 2.41; 95% CI: 1.38–4.21), high income (AOR = 3.17; 95% CI: 1.84–5.46), good IVF knowledge (AOR = 2.86; 95% CI: 1.67–4.89), positive religious belief (AOR = 1.98; 95% CI: 1.12–3.49), and adequate counseling (AOR = 3.42; 95% CI: 1.96–5.98) were independent predictors of the decision to use IVF.

Conclusion: The decision to use IVF among infertile couples in Abia State is strongly influenced by education, income, knowledge, religious beliefs, and quality of counseling. Strengthening patient education, improving access to affordable IVF services, and enhancing counseling quality may improve informed uptake of IVF among eligible couples.

Assessing the Effectiveness of Self-instructional Module on Knowledge Regarding Non-Pharmacological Management of Dysmenorrhea among Mothers of Adolescent Girls in Selected Rural Areas, Bengaluru, Karnataka, India

Noorjan K. S. — 2026-05-15

Background: Dysmenorrhea is a common concern among adolescent girls, often affecting daily activities and quality of life, with non-pharmacological management serving as a safe and accessible approach. (Ingham S A et al 2024) Assessing the effectiveness of a self-instructional module among mothers is essential to enhance their knowledge and support informed care practices in rural communities.

Aims: To assess the existing knowledge, to develop and administer self-instructional module, to evaluate the effectiveness of self-instructional module and to find out the association between pretest knowledge score and the selected demographic variables among mothers of adolescent girls regarding non- pharmacological management of dysmenorrhea.

Study Design: The research design is pre experimental one group pretest and post-test design.

Place and Duration of Study: The settings selected are rural areas of Bengaluru, Karnataka, India. The duration of the study was between March 2025 to Feb 2026.

Methodology: The sample of this study is 60 adolescent girls. Non probability convenient sampling technique was used to draw the sample for the study. The tool developed and used was structured knowledge questionnaire. Collected data was analyzed by using descriptive and inferential statistics.

Results: In the present study the posttest mean knowledge score was found higher (74.33%) when compared with pretest mean knowledge score (35.67%). The pretest mean knowledge score is 12.04, mean percentage is found to be 26.01, mean percentage is 35. 67% and standard deviation is 4.61. Enhancement is 41.4% and statistical paired ‘t’ test value is 24.83. Findings shows that there was a significant improvement in the knowledge on non-pharmacological management of dysmenorrhea at 0.005 levels. The statistical paired ‘t’ test indicates that in the mean knowledge score found to be significant at 5% level for all aspects under study.

Conclusion: Overall findings showed that the self – instructional module was significant in improving knowledge scores of mothers of adolescent girls regarding non – pharmacological management of dysmenorrhea, the results revealed that the self-instructional module will enable and empower mothers of adolescent girls with adequate knowledge which in turn contribute to improve the care of their daughter during dysmenorrhea.

Pregnancy-related Cultural Beliefs and Adherence among Pregnant Women Attending Primary Health Centres in Uturu, Nigeria: A Cross-Sectional Study

Uka-Kalu, Ezinne Chioma — 2026-05-19

Background: Pregnancy is often shaped by culturally transmitted superstitious beliefs that may influence maternal health behaviours and outcomes. In many communities, these beliefs persist alongside modern healthcare and may contribute to nutritional restrictions and delayed care-seeking. Although such practices have been documented in Nigeria, empirical data specific to Uturu, Isuikwuato LGA, Abia State, remain limited, thereby constraining the design of targeted local maternal health interventions.

Aim: This study aimed to investigate the types, sources, and extent of adherence to pregnancy-related superstitious beliefs among pregnant women in Uturu, Isuikwuato LGA, Abia State, Nigeria, and to examine their relationship with formal maternal healthcare utilization.

Methodology: A descriptive cross-sectional study was conducted among 424 pregnant women attending antenatal clinics at selected primary health centres in Uturu. Participants were recruited through a two-stage process involving purposive facility selection and convenience sampling. Data were collected using a structured questionnaire and analysed using descriptive statistics and Chi-square tests, with significance set at p < 0.05.

Results: Awareness of pregnancy-related superstitious beliefs was high, with the most commonly reported beliefs being non-disclosure of pregnancy until it becomes obvious (75.0%) and avoidance of pineapple/papaya to prevent miscarriage (73.1%). Adherence was lower than awareness across most beliefs, with 54.5% practising non-disclosure and 52.3% avoiding pineapple/papaya. Mothers (26.4%) and mothers-in-law (19.8%) were the primary sources of these beliefs. Overall, 50.0% of respondents demonstrated moderate adherence, while 49.3% showed low adherence. No socio-demographic or obstetric factor was significantly associated with adherence level. However, adherence level was significantly associated with the number of antenatal care visits attended (p = 0.014).

Conclusion: Pregnancy-related superstitious beliefs are widely known but selectively practised among pregnant women in Uturu. The findings suggest that cultural beliefs and biomedical healthcare utilization may coexist rather than operate in direct opposition. Maternal health interventions should therefore engage influential family members and address culturally rooted beliefs in a respectful manner while promoting evidence-based antenatal care.

Uric Acid in Severe Preeclampsia: A Narrative Review

Juan Gustavo Vázquez-Rodríguez — 2026-02-13

The diagnosis of preeclampsia is clinical, with systolic and diastolic blood pressure being the primary criteria. Clinical chemistry and urinalysis are the most essential tools the medical team has to assess the severity of preeclampsia. Uric acid is the first parameter of clinical biochemistry that is altered in the course of the disease.

For many years, blood uric acid concentration has been a useful tool for the early clinical diagnosis of preeclampsia, differential diagnosis with chronic hypertension, gestational hypertension, and other mimicking conditions, and for initiating drug therapy. New-onset hyperuricemia is an important maternal parameter for decision-making regarding termination of pregnancy, prediction of maternal-fetal complications during pregnancy, postpartum complications, and maternal-fetal outcome.

This narrative review addresses the most important data on uric acid biochemistry, its renal metabolism in normal subjects, and the physiological changes secondary to pregnancy. The main metabolic alterations identified in preeclampsia are reviewed. Normal blood uric acid concentration values are analyzed in healthy, non-pregnant women, values during normal pregnancy, and values in preeclampsia. The frequency of hyperuricemia and its correlation with preeclampsia severity are compared.

This article also compares uric acid levels with serum creatinine and proteinuria, their clinical interpretation in severe preeclampsia, and their clinical utility as markers of renal function. It proposes adding uric acid measurement to the clinical laboratory tests used to assess maternal renal function.

Research results support the triple role of Ua in preeclampsia: as an early biomarker of the disease, as a parameter of renal involvement, and as a potential therapeutic target in disease management.

The narrative is intended for the medical community and healthcare professionals interested in the topic, who are not necessarily experts.

A Forty years of in vitro Fertilization Techniques in Saudi Arabia: Historical Overview and Retrospective Insights

Hani Raka Karrar — 2026-05-18

IVF (in vitro fertilization) changed completely the landscape of reproductive medicine, including all of that completely, particularly in Saudi Arabia, for which it has been a scientific invention and a cultural sensation. This article describes the history of IVF techniques in Saudi Arabia from their appearance in the late 1980s. The development of the first test-tube baby in April 1986 marked a major advance for modern medical technology in the region. Assisted reproductive technologies, supported by the Islamic Fiqh Academy, provided couples struggling to get pregnant with a new means to start a family. It recounts some key events from when things were initially first done, including Dr Samir Abbas, who performed his first IVF surgery successfully in Jeddah. This extended the availability of assisted reproductive technology (ART) to couples in Saudi Arabia. Successful births are one of the many achievements that have occurred since IVF came into being in the Kingdom, such as quadruplets. In the late 1990s and early 2000s, as people increasingly accepted IVF, fertility clinics were opening in large urban centers and in a lot of big cities. This converted IVF from experimental technology to a standard medical procedure. The number of IVF cycles performed each year has shot up dramatically, from fewer than one thousand to over 20,000 now. That means patients are not only feeling more confident but also better informed. The group, the Saudi Society for Reproductive Medicine, has been quite useful for spreading the word about best practices and pushing research in this field. The application of preimplantation genetic screening (PGS) and less invasive embryo evaluation techniques like time-lapse microscopy and metabolomic analysis has improved the ease of embryo selection and, as a result, improved pregnancy outcomes. Ethical challenges in Saudi Arabia. Ethical considerations play a significant role in IVF treatments in Saudi Arabia, as religious and cultural beliefs influence its procedures. The paper reports the duties of healthcare personnel and guidelines created by the Saudi Ministry of Health for ensuring patients are protected and that reproductive technologies are used in a more ethical manner. But problems remain, such as the requirement to have national registries that collect research data and results and to consider ethical dilemmas that fall well outside that of doctors. This is why the people will have a better understanding of how IVF works. In conclusion, the more improved IVF methods in Saudi Arabia reflect the synergistic power of medical innovation with respect to knowledge of other cultural backgrounds. The transition from the first experiments to what things are doing at present shows that people are still committed to making reproductive health better. The Kingdom, still using these technologies and practices after so many years, is still spending funds for those with cultural and moral principles. This is encouraging news for couples who are struggling to get pregnant and want to have a family. It offers them hope; it provides them with good options in a healthcare system that’s changing.

Secondary Abdominal Ectopic Pregnancy after a Failed Attempt at Medical Termination: A Rare Case Report

Tanesha L. Harvey — 2026-02-09

Background and Aim: Ectopic pregnancy is the leading cause of maternal morbidity and mortality during the first trimester and the incidence increases dramatically with assisted-reproductive technology (ART). It occurs when a fertilized ovum is embedded outside of the endometrial cavity's lining. Aim of this study to demonstrate the diagnostic challenges encountered along with the surgical complications that can arise in patients diagnosed with an abdominal ectopic pregnancy.

Presentation of the case: A 26-year-old, para two, Afro-Guyanese woman was referred to the high-risk clinic at the Georgetown Public Hospital Corporation (GPHC) with an ultrasound finding of multiple foetal malformations, the patient had a failed medical termination of pregnancy and was taken for exploratory laparotomy, where she was diagnosed with an abdominal ectopic pregnancy with placental tissue adhered to the small and large bowel as well as the omentum along with a small defect noted in the right Fallopian tube.

Discussion: The abdominal location for an ectopic pregnancy is one of the rarest forms at 0.9–1.4% of all ectopic pregnancies and can present a challenge with diagnosis. Abdominal ectopic pregnancies carry a higher risk of mortality because of hemorrhaging and injury to surrounding organs. Diagnosis of an abdominal ectopic pregnancy can be difficult, with some cases requiring more advanced imaging techniques.

Conclusion: We report on a case of a patient who was undergoing medical termination of pregnancy for an intrauterine foetal demise along with foetal malformations. There was subsequently suspicion of a uterine rupture, and she was taken for an emergency exploratory laparotomy, which revealed a ruptured abdominal ectopic pregnancy. We aim to highlight the diagnostic challenges posed by these cases, which can lead to increased morbidity and mortality.

Postpartum Paraplegia a Tragic Event Caused by an Undiagnosed Spinal Schwannoma Following Cesarean Section: A Case Report with Literature Review

Hansa Dhar — 2026-03-27

Background and Aim: Undiagnosed spinal cord tumors may be underlying cause responsible for a fatal event of paraplegia post cesarean section following spinal anesthesia. Intradural extramedullary spinal cord tumors undergo expansion and acute cord compression due to hemorrhage, hypervolemia, pressure and hormonal changes of pregnancy. Commonly Schwannoma and Ependymoma have been accidentally diagnosed in postpartum women suffering with neurological complaints with no previous medical or surgical co-morbidity.

Aim of the presentation is to promote awareness among clinicians to expedite MRI and surgery in case of sudden paraplegia indicating acute compression by a space occupying spinal cord lesion unveiling in pregnancy.

Presentation of the Case: Presenting a case who suffered tragic paraplegia post cesarean section, underwent laminectomy with excision of the spinal tumor mass. Histopathology reported this lesion as ‘Schwannoma’. She was managed postoperatively with intense physiotherapy but continues to be paraplegic. A review of literature on spinal cord tumors and hematoma with management plan is described.

Discussion: Expansion or hemorrhage triggered by pregnancy changes or leak of cerebrospinal fluid impairs venous drainage to cause sudden acute spinal cord compression resulting in onset of paraplegia. Pregnancy compression of Inferior vena cava increases the venous engorgement in the spinal canal thereby further increasing the cord compression. Gold standard diagnostic modality is MRI. Urgent resort to surgical intervention of removing the mass has favorable prognostic outcome.

Conclusion: To avoid a permanent sequela of cord compression by the expanding spinal cord tumor adequate knowledge of this subject needs to be updated and disseminated among neurosurgeons, obstetricians and anesthesiologists for patient safety environment.

Spontaneous Rupture of an Unscarred Uterus during Induction of Labour after Failed Operative Vaginal Delivery: A Case Report

Dina Mohamed Abd El Fattah — 2026-05-22

Background: Uterine rupture is a rare but life-threatening obstetric emergency characterized by complete separation of the uterine wall, with risk factors including uterine scarring, trauma, multiparity, obstructed labour, and excessive use of uterotonic agents.

Aim: Uterine rupture in an unscarred uterus is a rare, life-threatening obstetric emergency with substantial maternal and neonatal morbidity and mortality.

Presentation of Case: We report a 32-year-old multiparous woman (G6P3A2) at 38 weeks undergoing induction of labour for pregnancy-induced hypertension. She had three previous normal vaginal deliveries, a BMI of 40 kg/m², and no prior uterine surgery. Baseline assessment was stable, with normal investigations, reassuring cardiotocography, and a singleton cephalic fetus with estimated fetal weight appropriate for gestational age.

Discussion: Induction of labour was initiated with a Foley catheter followed by prostaglandin gel. After spontaneous rupture of membranes, labour progressed rapidly, followed by sudden severe abdominal pain, continuous pushing, and acute fetal bradycardia. Vacuum-assisted delivery for fetal distress failed, and an emergency caesarean section was performed. Intraoperatively, hemoperitoneum and rupture of an unscarred uterus were found, with the fetal hand protruding through the tear and the fetus partially in the abdominal cavity. A live female infant with severe birth asphyxia required advanced resuscitation and neonatal intensive care unit (NICU) admission. The uterine tear was repaired, and the uterus was preserved.

Conclusion: This case highlights the importance of considering uterine rupture even in an unscarred uterus, particularly during induction of labour in multiparous women.

Acute Urinary Retention Secondary to a Large Uterine Fibroid in a Nulliparous Patient: A Case Report

Daniel Odongo — 2026-06-02

Background: Acute urinary retention in women is an uncommon urological emergency, and uterine fibroids are a rare but important obstructive cause. Large or impacted fibroids may compress the bladder neck and proximal urethra, leading to bladder outlet obstruction and urinary retention requiring prompt diagnosis and management.

Aim: To highlight the significance of comprehensive evaluation of a woman of reproductive age who presents with acute urinary retention.

Case Presentation: We present a 40-year-old nulliparous woman with a history of recurrent pregnancy losses who presented with acute urinary retention secondary to a large uterine fibroid.

Discussion: Uterine fibroids remain a rare cause of acute urinary retention, especially when impacted, causing anterior and superior displacement of the cervix with subsequent compression of the bladder neck and superior urethra, or when it causes compression of the pelvic nerve plexus leading to weak contraction of the detrusor muscle.

Urethral catheterisation provides immediate symptom relief, but definitive measures include myomectomy and hysterectomy depending on desire for future childbearing.

Conclusion: Physicians should therefore maintain a high index of suspicion in reproductive age women who present with a pelvic mass and urinary symptoms, especially in the absence of heavy menstrual bleeding.