International Journal of Gynecology & Obstetrics

Announcing the winner of the John J. Sciarra IJGO Prize Paper Award for 2011

Timothy R.B. Johnson — 2012-04-02

The editors of the International Journal of Gynecology and Obstetrics (IJGO) are pleased to announce the winner of the prize award for the best clinical research paper from a low/middle-income country published in the IJGO during 2011. The winning paper is by A. Movafegh, L. Eslamian, and A. Dorabadi, from Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran. The paper is “Effect of intravenous tranexamic acid administration on blood loss during and after cesarean delivery” Int J Gynecol Obstet 2011; 115(3): 224–226. It was published in the December 2011 issue of the IJGO.

Incidence of cervical intraepithelial neoplasia in a cohort of HIV-infected women

2012-03-23

Abstract: Objective: To assess cervical intraepithelial neoplasia (CIN) incidence in HIV-positive women and the risk factors for these lesions.Methods: A retrospective and longitudinal cohort study was conducted from June 13, 1997, to December 18, 2009. At the first visit, the 348 participants had a normal cytologic finding but a negative Schiller test result, or an abnormal cytologic finding but no histologic diagnosis of CIN. Infection with HPV was detected by polymerase chain reaction. The main outcome measure was CIN incidence.Results: During a mean follow-up of 40months, 47 women (13.5%) developed CIN, for an incidence of 4.1 cases per 100 person-years of follow-up. The HPV prevalence was 68.1%, 42 women (89.4%) developed CIN 1, and no invasive cervical cancers were identified. On multivariate analysis, women younger than 19years at first sexual intercourse (RR, 2.6; 95% CI, 1.24–5.35) and women who had never used antiretrovirals or used them only during pregnancy (RR, 2.3; 95% CI, 1.31–4.19) were at higher risk for CIN.Conclusion: The CIN incidence was low despite the high HPV prevalence. Being younger than 19years at first sexual intercourse and not using antiretroviral medications were found to be the main risk factors for CIN.

The use of TachoSil for the prevention of postoperative complications after groin dissection in cases of gynecologic malignancy

2012-03-19

Abstract: Objective: To evaluate the effect of TachoSil in preventing postoperative complications after groin dissection performed for primary or recurrent gynecologic malignancy.Methods: In a case–control analysis, the incidence of postoperative complications—including lymphocyst formation, wound breakdown and/or infection, and chronic lymphedema—was examined among 8 patients who received TachoSil and 16 controls (standard technique) treated for vulvar cancer or recurrent ovarian/breast cancer at San Gerardo Hospital, Monza, Italy, from 2008 to 2011.Results: Thirty-eight inguinal dissections were performed in the 24 patients. Bilateral groin dissection was performed in 14 patients (n=4 in the study group; n=10 in the control group). Patients in the study group had a lower mean daily drainage volume than those in the control group (133mL [range, 50–356mL] vs 320mL [range, 67–472mL]; P<0.001) and a lower incidence of lymphocyst requiring drainage (25.0% vs 62.5%), cellulitis (12.0% vs 25.0%), and wound infection (0.0% vs 25.0%).Conclusion: The use of TachoSil seems to be effective in reducing the rate of postoperative complications after inguinofemoral lymphadenectomy in cases of gynecologic malignancy.

A new type of absorbable barbed suture for use in laparoscopic myomectomy

2012-03-26

Abstract: Objective: To compare effectiveness, feasibility, and suturing time required between an absorbable barbed wire (V-Loc) uterine suture and a classic continuous suture with intracorporeal knots among women undergoing laparoscopic myomectomy.Methods: From January 2010 to February 2011, women with single symptomatic intramural myoma were prospectively enrolled in a single-center study at a university hospital in Rome, Italy. A control group with characteristics meeting the criteria for study inclusion was retrospectively identified from the hospital databases. In the prospective group uterine wall defects were closed with V-Loc suture, whereas in the control group they were closed by classical continuous suture with intracorporeal knots. Data were analyzed via Student t test, Mann–Whitney U test, and Fisher exact test.Results: The mean operative time was shorter in the V-Loc (51±18.1min) than in the control (58±17.8min) group. Suturing time was significantly lower in the V-Loc than in the control (9.9±4.3 versus 15.8±4.7min; P=0.0004) group. Both intraoperative bleeding and drop in hemoglobin were significantly lower in the V-Loc group (P=0.0076 and P=0.0176, respectively).Conclusion: Use of a barbed suture may aid surgeons during laparoscopic suturing by reducing operative time, suturing time, and blood loss.

Effects of transvaginal repair of symptomatic rectocele on symptom-specific distress and impact on quality of life

2012-03-26

Abstract: Objective: To determine symptom-specific distress and quality-of-life impact outcomes among women who had undergone transvaginal repair of symptomatic rectocele.Methods: Women who underwent transvaginal repair of symptomatic rectocele at the University of Alabama at Birmingham, USA, between April 2006 and June 2009 were included in a retrospective case series. Minimum follow-up was 1year post-surgery. Women who underwent concomitant surgery, other than perineoplasty and/or midurethral sling, were excluded. End points were assessed using the Pelvic Floor Distress Inventory (PFDI-20) and the Pelvic Floor Impact Questionnaire (PFIQ-7).Results: Overall, 113 women underwent repair of symptomatic rectocele, of whom 69 (61.1%) completed preoperative questionnaires and 66 (58.4%) responded to follow-up questionnaires. Mean time from surgery was 31.2±11.2months. PFDI-20 and PFIQ-7 scores were significantly improved following surgery, with a median pre- and post-surgery difference of 35.4 (P<0.001) and 31.0 (P=0.002), respectively.Conclusion: Patients who underwent transvaginal repair of symptomatic rectocele reported improvements in symptom-specific distress and impact on quality of life.

Detailed analysis of a randomized, multicenter, comparative trial of dienogest versus leuprolide acetate in endometriosis

2012-03-29

Abstract: Objective: To analyze the secondary efficacy and safety outcomes from a recent trial comparing dienogest (DNG) with leuprolide acetate (LA) in women with endometriosis.Methods: A 24-week, open-label, randomized, multicenter study of DNG versus LA in women with endometriosis-related pain was assessed for outcomes such as responder rates (using predefined thresholds of pain relief), changes in single symptoms/signs and sum scores from the Biberoglu and Behrman (B&B) scale, clinical laboratory parameters, and measures of quality of life.Results: Dienogest was non-inferior to LA for treatment response using all predefined thresholds of pain relief and provided equivalent improvements in B&B symptoms and signs. No clinically relevant changes in laboratory parameters were observed during DNG treatment, whereas estrogen levels decreased in the LA group. Compared with LA, DNG was associated with pronounced improvements in specific quality-of-life measures.Conclusion: The analyses provide supportive evidence that the efficacy of DNG is equivalent to that of LA for treating endometriosis symptoms, with specific quality-of-life benefits and a favorable safety profile.

Clinical, surgical, and histopathologic outcomes following failed medical abortion

2012-04-09

Abstract: Objective: To address the consequences of surgical curettage following failed medical abortion.Methods: A retrospective case–control study was performed in a tertiary gynecologic department. The case group comprised 104 women who underwent surgical curettage following failed medical abortion; the control group included 104 women who underwent early surgically induced abortion. Clinical characteristics and surgical findings were examined. The extent of inflammation was quantified following immunohistochemical staining for cell-surface markers characteristic of T lymphocytes, B lymphocytes, and macrophages. The extent of necrosis was evaluated morphologically.Results: Abnormal findings during surgical curettage were significantly more prevalent among women in the case group than in the control group (10.6% versus 1.9%; P=0.019). The most frequent abnormality in the case group was the presence of intimately adherent products of conception, necessitating sharp curettage. The extent of inflammation (represented by increased numbers of T and B lymphocytes) was greater in the case group than in the control group (P=0.046 and P=0.001, respectively), as was the extent of necrosis (P<0.05).Conclusion: Curettage following failed medical abortion harbors particular difficulties, which may be attributed to an inflammatory response. The long-term consequences of curettage following failed medical abortion warrant further investigation.

Effects of parity and mode of delivery on urinary incontinence among postmenopausal women in Taiwan

2012-03-29

Abstract: Objective: To investigate the association between the prevalence of urinary incontinence and parity or mode of delivery among Taiwanese women aged 60years or older.Methods: Between July 1999 and December 2000, a nationwide epidemiologic study was conducted in Taiwan among 2410 women selected by a multistage random sampling method. Face-to-face interviews with 1517 women were conducted. The relationship between the prevalence of urinary incontinence and the number of vaginal deliveries or number of cesarean deliveries was assessed by frequency and Pearson χ2 test using a significance level of less than 0.05. Logistic regression was used to investigate the significance of dichotomous dependent variables.Results: Decades ago, most Taiwanese women (1435 of 1511 respondents, 94.97%,) gave birth via vaginal delivery and the rate of cesarean delivery was low (20 of 1513 respondents, 1.32%). Parity (odds ratio [OR], 2.42; 95% confidence interval [CI], 0.87–6.71; P=0.091), vaginal delivery (OR, 0.76; 95% CI, 0.39–1.47; P=0.408), and cesarean delivery (OR, 1.47; 95% CI, 0.59–3.70; P=0.409) did not increase the risk of urinary incontinence.Conclusion: There was no association between urinary incontinence and parity or mode of delivery among Taiwanese postmenopausal women decades after their first delivery.

Feasibility of training Zambian nurse–midwives to perform postplacental and postpartum insertions of intrauterine devices

2012-03-27

Abstract: Objective: To explore the feasibility of competency-based training of Zambian nurse–midwives in postplacental and postpartum intrauterine device (PPIUD) insertion and to estimate learning curves for this procedure.Methods: A pilot service-delivery project was conducted, involving 9 nurse–midwives who participated in a 10-day PPIUD insertion training course at the University Teaching Hospital, Lusaka, Zambia. US and Zambian clinicians taught the didactic and practical curriculum. Checklists were used for standardization and a pelvic model was developed to achieve PPIUD insertion competency in the classroom before moving to clinical practice. Patients were recruited during prenatal visits, in early labor, and postpartum. Informed, voluntary consent was obtained. All clinical PPIUD insertions were supervised or performed by experienced trainers.Results: All 9 nurse–midwives achieved competency on the pelvic model after 3 attempts. During the training period, 38 PPIUDs were inserted in postpartum women; no complications occurred. By the end of training, 4 of the nurse–midwives were deemed competent to independently insert PPIUDs. On average, 4 PPIUD insertions were needed to achieve clinical competency.Conclusions: Concentrated, competency-based training in PPIUD insertion is feasible in an African setting. Replication of such training could increase the popularity and prevalence of PPIUD use among African women.

The association between pelvic girdle pain and urinary incontinence among pregnant women in the second trimester

Colleen M. Fitzgerald, Lynette R. Santos, Trudy Mallinson — 2012-03-30

Abstract: Objective: To examine the association among pelvic girdle pain (PGP), urinary incontinence (UI), and pelvic floor muscle (PFM) function in pregnant women in the second trimester.Methods: Fifty-five pregnant women (29 with PGP and 26 without) were enrolled. Urinary incontinence was measured via the International Consultation on Incontinence Questionnaire-Short Form. Vaginal examination assessed PFM contract–relax patterns and muscle strength.Results: Overall, 51 women (26 with PGP and 25 without) were included in the final analyses. After controlling for PFM muscle strength, women with PGP were significantly more likely to have UI (P=0.03). After controlling for pain status, having little or no PFM contraction was significantly associated with UI (P=0.03). There was no association between PGP and PFM weakness.Conclusion: There was an association between PGP and UI and between UI and PFM weakness among the study participants. Lack of PFM weakness in women with PGP during pregnancy may reflect acuity of pain or measurement error.

Reference values for Doppler velocimetry of the ophthalmic and central retinal arteries in low-risk pregnancy

2012-04-02

Abstract: Objective: To establish reference values for Doppler velocimetry of the ophthalmic artery (OA) and the central retinal artery (CRA) in low-risk pregnancy.Method: Between January 2008 and March 2009, 63 low-risk pregnant women underwent an ultrasound scan every 2weeks at the Women's Hospital, Campinas, Brazil, to determine the resistance index (RI), pulsatility index (PI), and peak systolic velocity of both arteries, in addition to the flow velocity of the second peak and peak ratio (PR) of the OA. For analysis, linear regression was used with mixed models for longitudinal data, coefficient of determination, and estimates of the 5th and 95th percentiles for each parameter at each gestational age. Intra- and inter-observer variability was evaluated via the intraclass correlation coefficient.Results: There was a trend of a reduction with gestational age in PI and RI of the OA, and PI of the CRA, but not in PR of the OA; and the respective reference values were established. Intra- and inter-observer variability was considered satisfactory.Conclusion: Unilateral assessment of the orbital Doppler velocimetry is feasible. Establishment of reference values showed a negative correlation between gestational age and PI and RI of the OA, and PI of the CRA. The method demonstrated satisfactory reproducibility.

Treatment of twin reversed arterial perfusion sequence with alcohol ablation or bipolar cord coagulation

Aytul Corbacioglu, Ahmet Gul, Isil T. Bakirci, Ali Gedikbasi, Gokhan Yildirim — 2012-03-26

Abstract: Objective: To evaluate perinatal outcome in pregnancies complicated by TRAP sequence.Methods: The perinatal outcomes of 15 TRAP sequence pregnancies referred to Kanuni Sultan Suleyman Research and Teaching Hospital, Turkey, were evaluated. Six cases were treated conservatively. Alcohol ablation and bipolar coagulation were performed in 5 and 4 cases, respectively.Results: In 12 cases, there were signs of fetal compromise and acardiac/pump twin abdominal circumference ratio of more than 50%. In 3 cases without intervention, the ratio was less than 50%. Three of the 6 pregnancies treated conservatively resulted in intrauterine death of the pump twin. Alcohol ablation was successful in 3 cases, with delivery of live fetuses at 36–38weeks, whereas intrauterine death occurred in 1 case and abortion occurred in 1 case. In 2 of the cases involving bipolar cord coagulation, live birth occurred at 39weeks; preterm premature rupture of membranes and abortion occurred at 18weeks in 1 case, and pregnancy was terminated in 1 case because of ventriculomegaly.Conclusion: Conservative therapy is suitable for mild cases of TRAP sequence in which the pump twin dominates. If there are signs of pump twin compromise, alcohol ablation and bipolar cord coagulation can be performed successfully.

Neonatal outcome following long-distance air travel for fetoscopic laser coagulation treatment of twin-to-twin transfusion syndrome

Michael Tchirikov, Viktor Oshovskyy, Joscha Steetskamp, Volker Thäle — 2012-03-26

Abstract: Objective: To investigate the impact of undertaking long-distance air travel to a specialized medical center while pregnant in order to undergo fetoscopic laser coagulation (FLC) for twin-to-twin transfusion syndrome (TTTS).Methods: A retrospective cohort study was conducted of women with TTTS who travelled by air (n=16) or land (n=61) to the Centre of Perinatal Diagnosis and Microinvasive Fetal Surgery, Mainz, Germany, between January 1, 2006, and December 31, 2010. All women underwent FLC on arrival at the study center. Neonatal outcome, postoperative neonatal survival rates, and rates of adverse effects were recorded.Results: The postoperative survival rate for a single twin was 100.0% (n=16) in the flight group and 98.3% in the land transportation group (n=60). The postoperative survival rate for both twins was 81.3% in the flight group (n=13) and 75.4% (n=46) in the land transportation group. No differences in neonatal outcome or the rate of adverse effects were observed between the 2 groups. No flight-related pregnancy complications were recorded.Conclusion: Long-distance air travel to a specialized tertiary care medical center is sufficiently safe to warrant recommendation to pregnant women with TTTS who require FLC.

Influence of early self-diagnosis and treatment of bacterial vaginosis on preterm birth rate

2012-03-26

Abstract: Objective: To assess whether early self-diagnosis and treatment of bacterial vaginosis (BV) could lower the preterm birth rate among a group of Indonesian women.Methods: A randomized controlled trial of 331 pregnant women (14–18weeks) was conducted. Participants were randomly assigned to either the active model group (n=176) or the control group (n=155). Women in the active model group were equipped with a kit to self-evaluate vaginal pH; those with a positive test result were treated with a twice daily dose of 500mg of metronidazole for 7days. The primary end point was preterm birth rate.Results: There were 6 (3.8%) and 8 (5.4%) preterm births in the active model and control groups, respectively (P=0.468). No spontaneous abortions were recorded in either group. When compared with the gold standard (Gram staining), the vaginal acidity test had low ability to detect BV, with 88.7% specificity and 36.9% sensitivity. The positive predictive value of the test was 35.0% PPV, while the negative predictive value was 89.4%.Conclusion: Early self-diagnosis and treatment of BV did not reduce the preterm birth rate of the study group.ClinicalTrial.gov number: NCT01232192.

Awareness of and attitudes toward congenital cytomegalovirus infection among pregnant women in Singapore

S.L. Lim, W.C. Tan, L.K. Tan — 2012-03-26

Abstract: Objective: To assess the level of awareness of congenital cytomegalovirus (CMV) infection and attitudes toward prenatal CMV serologic testing among pregnant women.Methods: A questionnaire was distributed to pregnant women who attended a specialist outpatient clinic at Singapore General Hospital, Singapore, between September and December 2010.Results: Among 200 respondents, 40 (20.0%) were aware of CMV. Healthcare workers were more likely to be aware of CMV (odds ratio 6.91, confidence interval 2.14–22.30; P=0.001). Most respondents found it “very” or “somewhat” easy to adhere to standard guidelines for primary prevention of CMV. Among the respondents, 62.0% (124/200) would like to be given the option of prenatal CMV screening and 72.0% (144/200) were keen to be screened. On multivariate analysis, respondents who were keen to undergo serologic screening for CMV were not more likely to consider invasive testing or termination of pregnancy should the test results demonstrate primary maternal CMV infection.Conclusion: Pregnant women who were keen to undergo CMV testing demonstrated attitudes toward invasive testing and termination of pregnancy that were not significantly different from those of women who would refuse testing. Patient choice and expectations should be considered in the implementation of preventive measures against congenital CMV.

Outcome of unintended pregnancy after ultrasound-guided high-intensity focused ultrasound ablation of uterine fibroids

Juan Qin, Jin-Yun Chen, Wen-Peng Zhao, Liang Hu, Wen-Zhi Chen, Zhi-Biao Wang — 2012-04-02

Abstract: Objective: To evaluate the safety of ultrasound-guided high-intensity focused ultrasound (USgHIFU) ablation of uterine fibroids among women with unintentional pregnancy within 1year of therapy.Methods: A retrospective analysis was conducted of 435 women who underwent USgHIFU therapy at Chongqing Medical University, China, between October 1, 2006, and October 1, 2009.Results: Unplanned pregnancy was reported by 24 women within 1year of USgHIFU ablation; 8 of these women had desired pregnancy before undergoing treatment. A total of 27 fibroids were detected, 24 of which were treated (mean volume 65.9±58.8cm3). Pregnancy was continued by 7 women without any complications. One pregnant woman who had desired pregnancy before therapy underwent an induced abortion owing to concerns about the effects of USgHIFU on the fetus. Fourteen women without pregnancy intention before USgHIFU therapy chose to undergo induced abortion; 2 women experienced spontaneous abortion. No adhesion occurred after USgHIFU therapy. Furthermore, USgHIFU, labor, and abortion had no effect on subsequent menstruation or sexual activities.Conclusion: Pregnancy within 1year after USgHIFU ablation of uterine fibroids appears safe; however, large scale studies are required to confirm these data.

Sustainable scale-up of active management of the third stage of labor for prevention of postpartum hemorrhage in Ecuador

Jorge Hermida, Bernarda Salas, Nancy L. Sloan — 2012-04-09

Abstract: Objective: To analyze the Ecuadorian experience regarding the adoption, scale-up, and institutionalization of active management of the third stage of labor (AMTSL) for prevention of postpartum hemorrhage via continuous quality improvement (CQI) processes.Methods: Average AMTSL implementation rates for women with vaginal deliveries were compared using unweighted provincial aggregate data from facilities participating in 3 phases of AMTSL programming. Months taken to implement AMTSL at 80% or more and 90% or more compliance were compared across phases.Results: Rate of oxytocin administration during the first 3months was 5.0% in phase 1, 9.8% in phase 2, and 72.2% in phase 3 (P≤0.001 vs phases 1 and 2). The average number of months provinces took to increase oxytocin administration to 80% or more and 90% or in more women with vaginal deliveries was, respectively, 21.6±18.7 and 30.6±16.4 in phase 1, 23.5±15.1 and 30.1±14.9 in phase 2, and 4.7±4.9 (P≤0.01 vs phase 1; P≤0.001 vs phase 2) and 4.0±3.4 (P≤0.001 vs phases 1 and 2) in phase 3. By December 2009, AMTSL implementation was sustained at 90% or more in all provinces.Conclusion: CQI processes identified resistance and operational barriers, and developed mechanisms to overcome them.

The impact of emergency obstetric care training in Somaliland, Somalia

2012-03-27

Abstract: Objective: To provide and evaluate in-service training in “Life Saving Skills – Emergency Obstetric and Newborn Care” in order to improve the availability of emergency obstetric care (EmOC) in Somaliland.Methods: In total, 222 healthcare providers (HCPs) were trained between January 2007 and December 2009. A before–after study was conducted using quantitative and qualitative methods to evaluate trainee reaction and change in knowledge, skills, and behavior, in addition to functionality of healthcare facilities, during and immediately after training, and at 3 and 6months post-training.Results: The HCPs reacted positively to the training, with a significant improvement in 50% of knowledge and 100% of skills modules assessed. The HCPs reported improved confidence in providing EmOC. Basic and comprehensive EmOC healthcare facilities provided 100% of expected signal functions—compared with 43% and 56%, respectively, at baseline—with trained midwives performing skills usually performed by medical doctors. Lack of drugs, supplies, medical equipment, and supportive policy were identified as barriers that could contribute to nonuse of new skills and knowledge acquired.Conclusion: The training impacted positively on the availability and quality of EmOC and resulted in “up-skilling” of midwives.

Evaluation of the new cervical cancer screening program in Georgia

Nino Mirzikashvili, Tina Beruchashvili, Louise-Anne McNutt — 2012-03-19

Cervical cancer remains the third most common cancer among women. In 2008, cervical cancer morbidity affected an estimated 530000 women, and claimed 275000 lives worldwide . Eighty-five percent of cervical cancer cases occur in low-income countries that are ill equipped to identify cancer at the early and most treatable stages. As in much of the world, no cervical cancer screening programs existed in the former Soviet Union. In Georgia, cervical cancer incidence was 13.5 per 100000 females in 2008; 49% of newly detected cases were classified as stage III or IV . According to the Statistical Yearbook of Georgia 2009 , mortality rate per 100000 females was 9.7 in 2002 and 9.9 in 2009.

Distribution of HPV genotypes and HPV-16 and HPV-18 E2 gene disruption in South Brazilian women with cervical abnormalities

Paula R.B. Nogara, Fabrícia Gimenes, Marcia E.L. Consolaro — 2012-03-19

Although most women are infected at some time with high-risk human papillomavirus (HPV), few will progress to invasive disease . Viral integration to high-risk HPV into the host cell often disrupts the E1 and/or E2 regions, leading to upregulation of the viral E6 and E7 oncogenes and to neoplasia . The aim of the present study was to determine the distribution of HPV genotypes and HPV-16 and HPV-18 E2 disruption in South Brazilian women with cervical abnormalities to assess whether pure viral integration might serve as a predictive biomarker for progression of different grades of cervical abnormalities.

“Quilting” sutures to prevent hysterectomy in patients with postpartum hemorrhage

Ludwig Spätling — 2012-03-19

Postpartum hemorrhage (PPH) is the primary cause of maternal mortality. All obstetricians should know a safe, easy to perform method of uterine suturing in patients with PPH. The methods of B-Lynch et al. and Pereira et al. are relatively complicated. Ligation of the uterine artery is not sufficient as the only method to stop bleeding. A back stitch “quilting” technique was therefore developed by obstetricians at Klinikum Fulda in Germany.

Differences in the perception of urgency of cesarean delivery between obstetricians and anesthetists

Abubakar Mohammed, Jackson Wu, Timothy Biggs, Shane Duffy — 2012-03-19

The most recent report of the Confidential Enquires into Maternal Deaths in the UK highlights the need to improve communication between professionals . Perioperative communication between obstetricians and anesthetists is vital for safe delivery by cesarean. The urgency of cesarean delivery is a key piece of information that is frequently poorly communicated. Grading of urgency of cesarean delivery is routine practice in the UK. Urgency can be categorized into 4 grades, from grade 4: elective cesarean timed to suit the woman or staff; to grade 1: emergency cesarean owing to immediate threat to the life of the woman or fetus .

Pregnancy and delivery after liver transplantation

Žana Žegarac, Željko Duić, Vesna Čolić Cvrlje — 2012-03-19

Pregnancy in liver transplant patients is associated with an increased risk of hypertension, pre-eclampsia, preterm delivery, and neonates of low birth weight due to immunosuppressive therapy . Pregnant liver transplant recipients experience a higher incidence of hypertension (34% vs 4%–10%) and pre-eclampsia (22% vs 6%–8%) compared with the general pregnant population . The most common fetal complications in pregnant transplant recipients compared with the general population include prematurity, low birth weight (less than 2500g), and intrauterine growth restriction . The incidence of fetal malformations does not appear to be increased in post-transplant pregnant women compared with the general population, and is approximately 3% . Pregnancies that occur within 12months of transplantation have a higher incidence of preterm delivery (58% vs 29%), acute rejection of the graft or transplanted liver (50% vs 29%), and cesarean delivery (50% vs 24%) compared with those that occur after 1year. Cesarean delivery is not indicated for women who have undergone a liver transplant .

Pregnancy during a sporotrichosis epidemic in Rio de Janeiro, Brazil

2012-03-26

Sporotrichosis is a subacute or chronic disease that affects animals and humans. It is caused by the dimorphic fungus Sporothrix schenckii and is the primary subcutaneous mycosis in Latin America . Zoonotic transmission of sporotrichosis appears to be rare worldwide. An epidemic of sporotrichosis occurred in Rio de Janeiro, Brazil, from 1998 onward. Cats were found to be the main link in the epidemiological chain .

Perinatal health in rural Burkina Faso

2012-04-04

Dori in Burkina Faso is the regional capital of the Sahel region. Most people in Dori live in mud-brick houses without electricity or tap water, and rely on subsidiary farming. The majority of the population is Muslim and the dominant ethnicity is Peulh. The aim of the present study was to estimate the prevalence rate of pregnancy complications and maternal mortality at the regional hospital in Dori, and to analyze their risk factors.

Corrigendum to “Physiological adaptation to maternal malaria and other adverse exposure: Low birth weight, functional capacity, and possible metabolic disease in adult life” [Int J Gynecol Obstet 115 (Suppl. 1):S16-S19]

Dirk L. Christensen, Anil Kapur, Ib C. Bygbjerg — 2012-04-19

The authors wish to state that the inclusion of reference [40] (Lillioja et al. J Clin Invest 1987) is incorrect, as is the sentence leading up to the reference. As a consequence, the authors regret to have to omit the sentence on page S17 that reads: “Furthermore, reduced capillary density has been suggested as a possible LBW-induced biological adaptation [40]…”

John J. Sciarra prize paper award for 2012

2012-06-01

Author Index

2012-06-01

Subject Index

2012-06-01

International Journal of Gynecology & Obstetrics

Announcing the winner of the John J. Sciarra IJGO Prize Paper Award for 2011

Incidence of cervical intraepithelial neoplasia in a cohort of HIV-infected women

The use of TachoSil for the prevention of postoperative complications after groin dissection in cases of gynecologic malignancy

A new type of absorbable barbed suture for use in laparoscopic myomectomy

Effects of transvaginal repair of symptomatic rectocele on symptom-specific distress and impact on quality of life

Detailed analysis of a randomized, multicenter, comparative trial of dienogest versus leuprolide acetate in endometriosis

Clinical, surgical, and histopathologic outcomes following failed medical abortion

Effects of parity and mode of delivery on urinary incontinence among postmenopausal women in Taiwan

Feasibility of training Zambian nurse–midwives to perform postplacental and postpartum insertions of intrauterine devices

The association between pelvic girdle pain and urinary incontinence among pregnant women in the second trimester

Reference values for Doppler velocimetry of the ophthalmic and central retinal arteries in low-risk pregnancy

Treatment of twin reversed arterial perfusion sequence with alcohol ablation or bipolar cord coagulation

Neonatal outcome following long-distance air travel for fetoscopic laser coagulation treatment of twin-to-twin transfusion syndrome

Influence of early self-diagnosis and treatment of bacterial vaginosis on preterm birth rate

Awareness of and attitudes toward congenital cytomegalovirus infection among pregnant women in Singapore

Outcome of unintended pregnancy after ultrasound-guided high-intensity focused ultrasound ablation of uterine fibroids

Sustainable scale-up of active management of the third stage of labor for prevention of postpartum hemorrhage in Ecuador

The impact of emergency obstetric care training in Somaliland, Somalia

Evaluation of the new cervical cancer screening program in Georgia

Distribution of HPV genotypes and HPV-16 and HPV-18 E2 gene disruption in South Brazilian women with cervical abnormalities

“Quilting” sutures to prevent hysterectomy in patients with postpartum hemorrhage

Differences in the perception of urgency of cesarean delivery between obstetricians and anesthetists

Pregnancy and delivery after liver transplantation

Pregnancy during a sporotrichosis epidemic in Rio de Janeiro, Brazil

Perinatal health in rural Burkina Faso

Corrigendum to “Physiological adaptation to maternal malaria and other adverse exposure: Low birth weight, functional capacity, and possible metabolic disease in adult life” [Int J Gynecol Obstet 115 (Suppl. 1):S16-S19]

Top Ten IJGO articles downloaded from SciVersce ScienceDirect February 2011 - February 2012

John J. Sciarra prize paper award for 2012

Author Index

Subject Index