International Journal of Gynecology & Obstetrics

Contemporary Issues in Women's Health

Richard M.K. Adanu, Vincent Boama — 2012-01-13

Comparison of laparoscopy and laparotomy for endometrial cancer

Hui Zhang, Jing Cui, Lin Jia, Shuhui Hong, Beihua Kong, Dadong Li — 2011-12-26

Abstract: Objective: To compare the safety and efficacy of laparoscopy and laparotomy on clinical outcomes among patients with endometrial cancer.Methods: Eligible randomized controlled trials (RCTs) conducted between 1966 and June 2010 were analyzed by meta-analysis.Results: Eight RCTs were included, with 3599 patients in total. No significant difference was observed between laparoscopy and laparotomy in overall (odds ratio [OR], 0.96; 95% confidence interval [CI], 0.50–1.82; P=0.892), disease-free (OR, 0.96; 95% CI, 0.50–1.82; P=0.892), or cancer-related (OR, 0.90; 95% CI, 0.27–3.08; P=0.871) survival. More intraoperative complications (OR, 1.33; 95% CI, 1.03–1.73; P=0.030), fewer postoperative complications (OR, 0.59; 95% CI, 0.46–0.75; P<0.001), longer operative time (standardized mean difference [SMD], 0.80; 95% CI, 0.46–1.15; P<0.001), lower blood loss (SMD, –2.29; 95% CI, –3.67 to −0.91; P=0.001), and shorter hospital stay (SMD, –2.60; 95% CI, –3.47 to −1.72; P<0.001) were associated with laparoscopy. There was no significant difference between the groups in pelvic (SMD, 0.22; 95% CI, –0.03 to 0.48; P=0.086) or para-aortic (SMD, 0.54; 95% CI, –0.04 to 1.11; P=0.067) lymph node yield.Conclusion: Laparoscopy has short-term advantages and seemingly equivalent long-term outcomes and, in experienced hands, might be a feasible alternative to laparotomy for endometrial cancer.

Availability and quality of emergency obstetric and neonatal care services in Afghanistan

2011-12-26

Abstract: Objective: To assess the availability and utilization of emergency obstetric and neonatal care (EmONC) facilities in Afghanistan, as defined by UN indicators.Methods: In a cross-sectional study of 78 first-line referral facilities located in secure areas of Afghanistan, EmONC service delivery was evaluated by using Averting Maternal Deaths and Disabilities (AMDD) Program assessment tools.Results: Forty-two percent of peripheral facilities did not perform all 9 signal functions required of comprehensive EmONC facilities. The study facilities delivered 17% of all neonates expected in their target populations and treated 20% of women expected to experience direct complications. The population-based rate of cesarean delivery was 1%. Most maternal deaths (96%) were due to direct causes. The direct and indirect obstetric case fatality rates were 0.8% and 0.2%, respectively.Conclusion: Notable progress has been made in Afghanistan over the past 8years in improving the quality, coverage, and utilization of EmONC services, but gaps remain. Re-examination of the criteria for selecting and positioning EmONC facilities is recommended, as is the provision of high-quality, essential maternal and neonatal health services at all levels of the healthcare system, linked by appropriate communication and functional referral systems.

Improving maternal mortality at a university teaching hospital in Nnewi, Nigeria

Anthony O. Igwegbe, George U. Eleje, Joseph O. Ugboaja, Robinson O. Ofiaeli — 2011-12-26

Abstract: Objective: To evaluate the impact of the introduction of the Service Compact with all Nigerians (SERVICOM) contract on maternal health at Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria.Methods: A retrospective and comparative study of maternal deaths between 2004 and 2010 was carried out. The main outcome measures were yearly maternal mortality ratio (MMR), relative risk (RR) of maternal mortality, and presentation–intervention interval. The yearly MMR and the RR of maternal mortality were compared with the figures from 2004, which represented the pre-SERVICOM era.Results: There were 4916 live births and 54 maternal deaths during the study period, giving an MMR of 1098 per 100 000 live births. Pre-eclampsia/eclampsia was the most common direct cause (25.0%), followed by hemorrhage (18.8%) and sepsis (8.3%). Anemia (12.5%) was the most common indirect cause. There was a progressive reduction in MMR and RR of maternal mortality, with a corresponding increase in live births. The presentation–intervention interval improved significantly from 2006.Conclusion: A positive change in the attitude of health workers and the elimination of fee-for-service in emergency obstetric care would reduce type 3 delays in public health facilities, and consequently reduce maternal mortality.

The value of adding a universal booking scan to an existing protocol of routine mid-gestation ultrasound scan

Elizabeth J. Poggenpoel, Lutgart T.G.M. Geerts, Gerhardus B. Theron — 2011-12-26

Abstract: Objective: To compare 2 routine obstetric ultrasound protocols regarding number of clinically relevant events detected and total ultrasound workload.Methods: An interventional before-and-after study comparing 2 groups of 750 consecutive low-risk pregnant women was conducted. The 1st group was routinely offered mid-trimester ultrasound and selective ultrasound examinations for specific indications; the 2nd group was, in addition to this, offered a scan at 1st prenatal visit.Results: The groups were comparable at baseline, and 78% underwent booking scan. The expanded protocol showed no improvement in detection of most clinically relevant findings but did detect twins slightly earlier (P=0.3) and significantly reduced the number of presumed post-term deliveries (8.4% vs 13.1%; OR 0.61 [95% CI, 0.41–0.90]). Although more women were scanned at any point or <24weeks (P<0.001), the increase in women receiving a properly timed fetal anomaly scan was small (60.7% vs 52.3%; P=0.003). Total ultrasound workload increased by 74%, mainly because of more follow-up scans (323 vs 122) and more women being scanned for the 1st time >24weeks (146 vs 51; P<0.001).Conclusion: The results do not support a policy of routine booking scans and revealed no significant benefit apart from a small reduction in presumed post-term pregnancies.

Vitamin B6 supplementation in pregnant women with nausea and vomiting

2011-12-22

Abstract: Objective: To determine whether supplementation with vitamin B6 improves nausea and/or vomiting in pregnancy.Methods: This experimental study was conducted with 60 pregnant women experiencing nausea and/or vomiting prior to the 12th gestational week. Of these women, 30 were treated daily with 10mg and the remaining 30 with 1.28mg of pyridoxine hydrochloride for 2weeks. The primary outcome was the Pregnancy-Unique Quantification of Emesis and Nausea (PUQE) score in each group at the end of treatment.Results: The women experiencing nausea and/or vomiting in pregnancy had significantly lower levels of circulating vitamin B6 (P=0.007) compared with those without this symptom. Vitamin B6 supplementation significantly increased plasma vitamin B6 concentration (P<0.05 in both groups). There were no significant differences in PUQE score or in plasma concentration levels of protein, dopamine, serotonin, unconjugated estriol, and ghrelin after supplementation between the 2 groups at baseline, but there was a significantly lesser decrease in PUQE score and a greater increase in vitamin B6 level and vitamin B6 concentration to plasma protein concentration ratios in group 1 than in group 2 after supplementation (P<0.05 for all).Conclusion: Although the high-supplementation group had a greater decrease in PUQE score in comparison to the low-supplementation group, the difference is unlikely to affect the severity of symptoms.

Prevalence of serum anti-rubella virus antibodies among pregnant women in southern Italy

2012-01-10

Abstract: Objective: To determine the prevalence of anti-rubella virus antibodies and the level of knowledge about congenital rubella syndrome (CRS) among pregnant women living in southern Italy.Methods: A seroepidemiologic study was conducted between July 1, 2006, and December 31, 2007. Five-hundred women resident in Messina were enrolled in the study; the participants were in the 4th to 39th week of pregnancy. Anti-rubella virus antibodies were assayed using a microparticle enzyme immunoassay. Demographic details, vaccination history, and participants’ knowledge of the potential risks of rubella infection during pregnancy were assessed via questionnaire.Results: On the basis of the questionnaire results, 70.4% of women were classed as immune to rubella virus infection; however, the prevalence of IgG anti-rubella virus antibodies measured in the participants’ serum was 85.8%. Although 55.2% of women had undergone pre-pregnancy rubella screening, only 81 participants reported that they had been vaccinated before becoming pregnant. The participants’ general knowledge about CRS was poor, as was their understanding of the importance of undergoing screening.Conclusion: The number of women at risk of rubella infection fell short of the national target set for elimination of CRS. Increased involvement and collaboration by all healthcare workers are, therefore, required to disseminate the information necessary to prevent CRS.

Obstetric, clinical, and perinatal implications of H1N1 viral infection during pregnancy

2011-12-26

Abstract: Objective: To determine perinatal outcome and epidemiologic, clinical, and obstetric characteristics among pregnant women infected with the H1N1 virus admitted to a Brazilian university hospital.Methods: A cross-sectional study was conducted of pregnant women infected with H1N1 who were admitted to the University Hospital at the School of Medicine, Federal University of Mato Grosso do Sul, Campo Grande, Brazil, during the 2009 pandemic. Data were obtained via a questionnaire, which was administered during the hospital evaluation of patients’ medical records.Results: Thirty-one patients were included in the study. Antiviral therapy was initiated within 48 hours of the onset of symptoms in 64.5% of cases. Infection with the H1N1 virus was associated with severe clinical complications in 22.6% of patients and adverse perinatal outcomes in 41.9% of cases. The rate of maternal and perinatal mortality was 9.7%. There was a statistically significant association between late treatment with oseltamivir and increase in systemic complications in pregnancy (odds ratio 22.80 [95% confidence interval, 2.20–235.65]; P=0.007).Conclusion: Early treatment with oseltamivir may prevent serious complications associated with H1N1 infection in pregnant women but it does not affect perinatal outcome.

Costs and benefits of multidrug, multidose antiretroviral therapy for prevention of mother-to-child transmission of HIV in the Dominican Republic

2011-12-26

Abstract: Objective: To investigate whether costs of multidose antiretroviral regimens (MD-ARVs), including highly active antiretroviral therapy (HAART), for prevention of mother-to-child transmission (PMTCT) of HIV might be offset by savings gained from treating fewer perinatally acquired infections.Methods: Rates of MTCT reported in the Dominican Republic among mother-infant pairs treated with single-dose nevirapine (SD-NVP; n=39) and MD-ARVs (n=91) for PMTCT were compared. Annual births to women infected with HIV were estimated from seroprevalence studies. Antiretroviral costs for both PMTCT and for HAART during the first 2years of life (in cases of perinatal infection) were based on 2008 low-income country price estimates.Results: Rates of MTCT were 3.3% and 15.4% for the MD-ARV and SD-NVP groups, respectively (P=0.02). Assuming that 5775 of 231 000 annual births (2.5%) were to HIV-positive women, it was estimated that 191 perinatally acquired infections would occur using MD-ARVs and 889 using SD-NVP. High costs of maternal MD-ARVs (HAART, US$914,760 versus SD-NVP, $1155) would be offset by lower 2-year HAART costs ($250,344 versus $1,168,272 for infants in the SD-NVP group) for the lower number of children with prenatally acquired infection (191 versus 889) associated with the use of MD-ARVs for PMTCT (net national saving $3168).Conclusion: Despite the high costs, use of MD-ARVs, such as HAART, for PMTCT offer societal savings because fewer perinatally acquired infections are anticipated to require treatment.

Nitric oxide metabolite levels and assessment of cervical length in the prediction of preterm delivery among women undergoing symptomatic preterm labor

2011-12-26

Abstract: Objective: To evaluate the diagnostic accuracy of measuring cervical length (CL) in combination with cervical and plasma nitric oxide metabolite (NOx) levels to identify women undergoing preterm labor (PTL) who will deliver preterm.Methods: A hospital-based prospective cohort study of 730 women undergoing spontaneous PTL between 24 and 33weeks+6days of pregnancy was conducted. Measurement of cervical and plasma NOx levels and ultrasonographic assessment of CL were performed to find the best model to predict preterm delivery (PTD). Optimal cut-off values were calculated by receiver operating characteristic (ROC) curve analysis. Logistic regression analysis and rank correlation tests were also performed.Results: CL of 15mm or less, cervical NOx levels greater than 87.6μmol/L, and plasma NOx levels greater than 123μmol/L (P<0.0001) were the only factors significantly associated with PTD within 7days of sampling. This combined model provided high diagnostic accuracy (sensitivity 80.0%; specificity 99.2%). Both cervical and plasma NOx levels were negatively correlated with CL (r=−0.453, P<0.0001 and r=−0.362, P<0.0001, respectively).Conclusion: Combined measurement of CL and levels of cervical and plasma NOx could help identify women undergoing symptomatic PTL who are at increased risk of PTD.

External cephalic version in East, Central, and Southern Africa

Abraham M. Mukaindo, Sikolia Z. Wanyonyi, William R. Stones — 2011-12-26

Abstract: Objective: To evaluate the views of maternity care providers in East, Central, and Southern Africa on external cephalic version (ECV), and its determinants, with the aim of drawing lessons for practice.Methods: In February 2009, a cross-sectional survey using self-administered semi-structured questionnaires was conducted among delegates attending a regional conference of obstetricians and gynecologists. Descriptive statistical analysis was undertaken, and comments were analyzed for themes.Results: Of the 70 questionnaires issued to eligible delegates, 64 were fully completed (response rate 91%). Seventy-nine percent of respondents did not offer ECV. Approximately a third (31%) of the practitioners offered elective vaginal breech delivery. Clinicians offering ECV did so at varying gestational ages. Clinicians not offering ECV gave various reasons including concerns about the procedure's safety and lack of training and experience with it, policy restrictions, medico-legal concerns, clinician or client reluctance, and poor results with the procedure.Conclusion: Overall, ECV is not widely practiced in East, Central, and Southern Africa, mainly owing to concerns related to safety and policy. Efforts aimed at reviving ECV in these regions should address these concerns. A conceptual framework of such efforts is proposed herein.

Management of eclampsia at Assiut University Hospital, Egypt

Diaa E.M. Abd El Aal, Ahmed Y. Shahin — 2011-12-22

Abstract: Objective: To evaluate the protocol used for management of eclampsia at Assiut University Hospital, Assiut, Egypt.Methods: In a prospective cross-sectional study, data were collected from 1998 women treated for eclampsia at Assiut University Hospital between January 1990 and January 2010, including 1594 cases of prepartum eclampsia, 75 of intrapartum eclampsia, 16 of intercurrent eclampsia, and 313 of postpartum eclampsia. The treatment regimen included use of nifedipine as an antihypertensive, magnesium sulfate as an anticonvulsant, rapid interruption of pregnancy, and admission to the ICU. Data were evaluated for control of blood pressure, prevention and control of convulsions, and maternal and perinatal outcomes.Results: Magnesium sulfate was effective in controlling convulsions in 98.1% of women. Nifedipine initiated a smooth decline in blood pressure (P>0.0001). There were 79 maternal deaths (3.95%). Maternal morbidity occurred in 439 (22%) women. Twenty-seven percent of women delivered vaginally (most of these women were admitted postpartum). Perinatal mortality occurred in 7.9% of cases.Conclusion: A combination of nifedipine as an antihypertensive drug, magnesium sulfate as an anticonvulsant, rapid interruption of pregnancy, and managing the patients in the ICU resulted in a marked improvement in the outcome for both mother and fetus at Assiut University Hospital.

A shortened postpartum magnesium sulfate prophylaxis regime in pre-eclamptic women at low risk of eclampsia

Lalthakimi Darngawn, Rubi Jose, Anni Regi, Ramandeep Bansal, Laxmanan Jeyaseelan — 2012-01-20

Abstract: Objective: To determine whether magnesium sulfate (MgSO4) prophylaxis is needed for up to 24hours postpartum in all patients with pre-eclampsia.Methods: In a randomized open clinical trial conducted in a tertiary health center in India between September 2008 and April 2010, 150 women with severe pre-eclampsia who received intrapartum MgSO4 and delivered at more than 20weeks gestation were enrolled. After 6hours postpartum, the participants were randomized to continue receiving (control group) or to discontinue (intervention group) MgSO4, and outcomes were compared.Results: Administration of MgSO4 had to be reinstituted for 1 woman in the intervention group. Under the current protocol in the institution, all 75 women in the intervention group would have received MgSO4 for 24hours postpartum. A significant reduction in time spent by the doctors (P<0.001) and nurses (P<0.001) was seen in the intervention group. The pain score in the intervention group was significantly less (P<0.001), and women in the intervention group were able to look after themselves better (P<0.001).Conclusion: For women at low risk for postpartum eclampsia, a shortened (6-hour) MgSO4 regime was as effective for seizure prophylaxis as the conventional 24-hour regime, with significant benefits in terms of cost and morbidity.

Effects of domperidone on augmentation of lactation following cesarean delivery at full term

Surasak Jantarasaengaram, Praweena Sreewapa — 2011-12-22

Abstract: Objective: To evaluate the effects of domperidone on breast milk production in women who underwent cesarean at full term.Methods: Women who underwent uncomplicated full-term cesarean were randomly assigned to receive domperidone or placebo for 4 consecutive days post partum. Breast milk was collected twice daily via electric breast pump. Baseline milk production was determined by measuring the volume of milk collected on the 1st postpartum day, before initiation of study medication (day 0). The daily volume of milk collected was compared between groups. Adverse treatment-related effects were recorded.Results: The study was completed by 22 women in the domperidone group and 23 in the placebo group. Compared with day 0, mean increases in milk volume per participant collected on days 1, 2, 3, and 4 were significantly higher in the domperidone (13.6±23.2mL, 68.5±71.9mL, 144.5±122.3mL, and 191.3±136.1mL) than in the placebo (2.5±4.6mL, 24.5±26.5mL, 72.1±55.6mL, and 91.4±60.3mL) group. Minor adverse effects were reported by 7 women in the domperidone group.Conclusion: Postpartum treatment with domperidone can augment breast milk production after full-term cesarean, with minimal adverse effects.

Women's decision making regarding choice of second trimester termination method for pregnancy complications

2011-12-14

Abstract: Objective: To describe how women terminating a pregnancy for fetal or maternal complications decide between surgical (dilation and evacuation [D&E]) and medical abortion.Methods: A qualitative study was conducted among women who underwent D&E or medical abortion before 24weeks of gestation for fetal anomalies or pregnancy complications at an academic medical center where both methods are offered. Women were interviewed by phone 1week after the procedure about their counseling experiences and reasons for choosing a particular method. Data were analyzed by 3 researchers using a grounded theory approach, and interviews were stopped upon thematic saturation.Results: Of the 21 women, 13 (62%) chose D&E and 8 (38%) chose medical abortion. Key themes that emerged from the interviews were valuing the ability to choose the method, and the importance of religious beliefs, abortion attitudes, and emotional coping style. Women's preferences for a method were largely based on their individual emotional coping styles.Conclusion: Decisions to undergo D&E or medical abortion are highly personal and could affect how women recover after ending a desired pregnancy. Women should be offered counseling about and access to both methods. Understanding these decision processes may help when counseling women faced with these diagnoses and decisions.

Critical care providers’ opinion on unsafe abortion in Argentina

2012-01-19

Abstract: Objective: To survey the opinion of critical care providers in Argentina about abortion.Methods: An anonymous questionnaire was distributed to critical care providers attending the 20th National Critical Care Conference in Argentina.Results: 149 of 1800 attendees completed the questionnaire, 69 (46.3%) of whom were members of the Argentine Society of Critical Care (ASCC). 122 (81.9%) supported abortion decriminalization in situations excluded from the current law; 142 (95.3%) in cases of congenital defects; 133 (89.3%) in cases of rape; 115 (77.2%) when women's mental health is at risk; 71 (47.7%) when pregnancy is unintended; and 61 (40.9%) for economic reasons. 126 (84.6%) supported abortion in public and private institutions, and 121 (81.2%) before 12weeks of pregnancy. Variables independently associated with abortion support among female versus male attendees were abortion to preserve women's mental health (OR 4.47; 95% CI, 1.61–12.42; P=0.004) and abortion before 12weeks of pregnancy (OR 3.93; 95% CI, 1.29–11.94; P=0.015). Abortion at request was independently associated with ASCC membership (OR 2.63; 95% CI, 1.07–6.45; P=0.034).Conclusion: Critical care providers would support abortion in situations excluded from the current abortion law and before 12weeks of pregnancy, in both public and private hospitals.

Balanced autosomal translocation and double Robertsonian translocation in cases of primary amenorrhea in an Indian population

Neeraja Kopakka, Rupa Dalvi, Dhanlaxmi L. Shetty, Bibhu R. Das, Swarna Mandava — 2011-12-09

Abstract: Objective: To assess the frequency of balanced autosomal translocations in patients with primary amenorrhea in an Indian population.Methods: Cytogenetic analysis was carried out among women referred from all parts of India for primary amenorrhea between 2002 and 2010. Clinical history and laboratory findings were taken into consideration to determine the diagnosis. G-banding with trypsin–Giemsa was performed to detect chromosome abnormalities.Results: There were 15 balanced autosomal translocations in 1100 patients. Two novel translocations were identified: 1 with mosaic pattern of X chromosome monosomy and male karyotype, together with balanced autosomal translocation of chromosomes 11 and 20 in both cell lines; and 1 with double Robertsonian translocation of chromosomes 14 and 21.Conclusion: Autosomal genes have a crucial role in reproductive development. More candidate genes need to be recognized for appropriate genetic counseling and clinical management.

Factor VIII:C levels in pregnancies complicated by pre-eclampsia and intrauterine growth restriction

2011-12-22

Although the pathophysiology of vascular complications in pregnancy remains unclear, placental vascular bed thrombotic lesions are frequently observed in pregnancies complicated by pre-eclampsia and intrauterine growth restriction (IUGR). A greater prevalence of inherited thrombophilia has also been widely reported in these conditions . Factor VIII:C coagulant is a major procoagulant protein, and while a high level of factor VIII:C is generally recognized as an independent risk factor for thromboembolic diseases, substantial controversy exists . The aim of the present study was to investigate plasma levels of factor VIII:C in women with pre-eclampsia or IUGR compared with levels in healthy pregnant women.

Admissions of women in the third trimester of pregnancy to an intensive care unit in Morocco over a 4-year period

Yassamine Bentata, Brahim Housni, Ahmed Mimouni, Redouane Abouqal — 2011-12-26

Recourse to the intensive care unit (ICU) for obstetric complications is relatively rare. However, in low-resource countries the technical and organizational capacities required for hospital management of serious complications of pregnancy are often limited. The aim of the present study was to determine the occurrence of third trimester obstetric admissions to an ICU in Morocco over a 4-year period, and to identify the associated obstetric pathologies.

A teamwork approach to obstetric fistula repair training in Uganda

John Kelly, Maura Lynch — 2011-12-14

Obstetric fistula is still common in low-resource countries . Training courses on the management of obstetric fistula began at the Kitovu Health Care Complex in Masaka, Uganda, in 2004. Teamwork forms the basis of treatment and therefore the trainees include nurses, doctors, and nondoctor anesthetists. Training comprises tutorials in small groups and hands-on experience. The patients are poor, have suffered much, and are in great need of compassion. There is no private practice.

Misoprostol for cervical ripening before diagnostic hysteroscopy in nulliparous women

2011-12-14

Misoprostol has been used for cervical preparation before diagnostic hysteroscopic procedures, but there is no agreement on the recommended dose, route, or time of administration . The aim of the present study was to compare the efficacy of 3 different misoprostol regimens for cervical ripening before diagnostic hysteroscopy in nulliparous women.

Laparoendoscopic single-site assisted vaginal hysterectomy

Marco Calcagno, Maria Pastore, Vincenzo Scotto di Palumbo — 2011-12-19

Laparoendoscopic single-site surgery (LESS) represents the last frontier of minimally invasive surgery. Varied and more complex gynecological procedures have been performed as surgeons become more familiar with the technique .

Muscle-derived stem cells and smooth muscle healing in a rat model of uterine injury

Chung Ra Jun, Ji Young Lee, Hyun Hee Cho — 2011-12-09

The uterus is a major female reproductive organ with fibromuscular characteristics. During pregnancy, its smooth muscles undergo marked hypertrophy, increasing from 70g to about 1100g. Such a dramatic increase suggests that these changes may not be attributable to hypertrophy and hyperplasia of existing myometrial cells alone.

Pelvic splenosis in an infertile patient

Antonio Mollo, Marcello Granata, Giuseppe De Placido — 2011-12-09

Splenosis is a benign, usually asymptomatic, condition involving autotransplantation of splenic tissue that occurs frequently after splenic rupture caused by trauma or surgery . When located in the pelvis it can mimic gynecologic pathologies and the diagnosis can be arduous . A case of pelvic splenosis in an infertile patient is presented.

The diagnosis and management of ovarian hyperstimulation syndrome: No. 268, November 2011

2011-12-23

Abstract: Objective: To review the clinical aspects of ovarian hyperstimulation syndrome and provide recommendations on its diagnosis and clinical management.Outcomes: These guidelines will assist in the early recognition and management of ovarian hyperstimulation. Early recognition and prompt systematic supportive care will help avert poor outcomes.Evidence: Medline, Embase, and the Cochrane database were searched for relevant articles, using the key words “ovarian hyperstimulation syndrome” and “gonadotropins,” and guidelines created by other professional societies were reviewed.Values: The quality of evidence was rated using the criteria described in the Report of the Canadian Task Force on Preventive Health Care. Recommendations for practice were ranked according to the method described in that report (Table 1).

John J. Sciarra Prize Paper Award for 2012

2012-03-01

Author Index

2012-03-01

Subject Index

2012-03-01

International Journal of Gynecology & Obstetrics

Contemporary Issues in Women's Health

Comparison of laparoscopy and laparotomy for endometrial cancer

Availability and quality of emergency obstetric and neonatal care services in Afghanistan

Improving maternal mortality at a university teaching hospital in Nnewi, Nigeria

The value of adding a universal booking scan to an existing protocol of routine mid-gestation ultrasound scan

Vitamin B6 supplementation in pregnant women with nausea and vomiting

Prevalence of serum anti-rubella virus antibodies among pregnant women in southern Italy

Obstetric, clinical, and perinatal implications of H1N1 viral infection during pregnancy

Costs and benefits of multidrug, multidose antiretroviral therapy for prevention of mother-to-child transmission of HIV in the Dominican Republic

Nitric oxide metabolite levels and assessment of cervical length in the prediction of preterm delivery among women undergoing symptomatic preterm labor

External cephalic version in East, Central, and Southern Africa

Management of eclampsia at Assiut University Hospital, Egypt

A shortened postpartum magnesium sulfate prophylaxis regime in pre-eclamptic women at low risk of eclampsia

Effects of domperidone on augmentation of lactation following cesarean delivery at full term

Women's decision making regarding choice of second trimester termination method for pregnancy complications

Critical care providers’ opinion on unsafe abortion in Argentina

Balanced autosomal translocation and double Robertsonian translocation in cases of primary amenorrhea in an Indian population

Factor VIII:C levels in pregnancies complicated by pre-eclampsia and intrauterine growth restriction

Admissions of women in the third trimester of pregnancy to an intensive care unit in Morocco over a 4-year period

A teamwork approach to obstetric fistula repair training in Uganda

Misoprostol for cervical ripening before diagnostic hysteroscopy in nulliparous women

Laparoendoscopic single-site assisted vaginal hysterectomy

Muscle-derived stem cells and smooth muscle healing in a rat model of uterine injury

Pelvic splenosis in an infertile patient

The diagnosis and management of ovarian hyperstimulation syndrome: No. 268, November 2011

Top 10 IJGO articles downloaded from SciVerse Science Direct November 2010 - November 2011

John J. Sciarra Prize Paper Award for 2012

Author Index

Subject Index