International Journal of Gynecology & Obstetrics

Intensive caring

Timothy R.B. Johnson — 2009-01-01

Timothy R.B. Johnson, MD

Postpartum hemorrhage: A cure that eludes us

Louis Keith — 2009-01-01

Louis Keith, MD, PhD, ScD (Hon)

A systematic review of randomized controlled trials of prenatal and postnatal vitamin A supplementation of HIV-infected women

Eugene Justine Kongnyuy, Charles Shey Wiysonge, Muki Shehu Shey — 2009-01-01

Abstract: We searched the Cochrane Library, MEDLINE, EMBASE, AIDSearch, and Gateway to assess the effect of prenatal and/or postnatal vitamin A supplementation on the risk of mother-to-child transmission (MTCT) of HIV and other pregnancy outcomes. We included 5 trials totaling 7528 women (4 trials of prenatal and 1 trial of postnatal supplementation). Overall, there was no evidence of an effect of prenatal and/or postnatal vitamin A supplementation on the risk of MTCT of HIV (Relative Risk [RR] 1.06, 95% Confidence Interval [CI] 0.89–1.26). However, prenatal vitamin A supplementation significantly improved birth weight (weighted mean difference 89.78; 95% CI, 84.73–94.83), but there was no evidence of an effect on stillbirths (RR 0.99; 95% CI, 0.68–1.43), preterm births (RR 0.88; 95% CI, 0.65–1.19), death before 24 months among live births (RR 1.08; 95% CI, 0.91–1.29), and maternal death (RR 0.83; 95% CI, 0.59–1.17). The available evidence does not support vitamin A supplementation of HIV-infected pregnant and lactating women, despite improvement in birth weight.

Controversies surrounding the causes of brachial plexus injury

Herbert F. Sandmire, Robert K. DeMott — 2009-01-01

Abstract: In the past decades, obstetric personnel have attempted to reduce the frequency of brachial plexus injury (BPI) by attempting to use less traction during the delivery of the fetal anterior shoulder. Clearly, these attempts have been unsuccessful in preventing or reducing the frequency of BPI. We conducted a nonsystematic literature review of the reported controversies regarding the mechanisms of BPI causation and why this complication is not decreasing in frequency. The review indicates that maternal labor forces are the most likely cause of BPI.

Cesarean delivery surveillance system at a maternity hospital in Kabul, Afghanistan

2009-01-01

Abstract: Objective: To use an active facility-based maternal and newborn surveillance system to describe cesarean delivery practices and outcomes in a resource-poor setting.Methods: Using data from operating room logbooks, 392 cesarean deliveries were evaluated between April 1 and June 30 2006 at a large public maternity hospital in Kabul, Afghanistan.Results: The perinatal mortality rate was 89 per 1000 births: 57% antepartum and 37% intrapartum stillbirths. Fetuses with normal birth weight comprised 85% of intrapartum stillbirths. Obstructed labor, uterine rupture, and malpresentation accounted for more than 50% of perinatal deaths. The cesarean delivery rate was 10.2% and there were 2 maternal deaths.Conclusion: The high percentage of intrapartum stillbirths among normal birth weight fetuses suggests a need for improved labor monitoring and surgical obstetric practices. The use of a facility-based perinatal surveillance system is critical in guiding such quality assurance initiatives.

Intrapartum stillbirth in a Nigerian tertiary hospital setting

Chibuike O. Chigbu, Obioma A. Okezie, Boniface U. Odugu — 2009-01-01

Abstract: Objective: To examine the nonmedical events contributing to intrapartum stillbirths in an African setting.Methods: Retrospective analysis of the records of women who had intrapartum stillbirths at the University of Nigeria Teaching Hospital, Enugu, from January 1999 to December 2007. The events surrounding the delivery of these women were critically analyzed and statistically compared with those who had live births to determine the nonmedical factors contributing to the stillbirths.Results: The overall stillbirth rate was 89 per 1000 births. The intrapartum stillbirth rate was 52.1 per 1000 births. Nonmedical factors contributing to stillbirths included delays in receiving appropriate management, inadequate intrapartum monitoring, inappropriate interventions, and wrong diagnosis. All 3 types of delay were significantly associated with intrapartum stillbirth (P=0.0001).Conclusion: Intrapartum stillbirth accounts for the majority of stillbirths in this setting. Avoidable delays, suboptimal intrapartum monitoring, and inappropriate interventions contribute to the majority of intrapartum stillbirths in Nigeria.

Color Doppler analysis of pelvic arteries following bilateral internal iliac artery ligation for severe postpartum hemorrhage

2009-01-01

Abstract: Objective: To compare Doppler blood flow characteristics of the uterine, arcuate, and ovarian arteries of women who underwent bilateral internal iliac artery ligation with those of controls.Methods: Thirteen women who underwent bilateral internal iliac artery ligation for severe postpartum hemorrhage (PPH) were matched with 15 healthy women of reproductive age. Transvaginal color and pulsed (duplex) Doppler modes were used to visualize the pelvic arteries. The pulsatility index, the resistance index, the systolic/diastolic blood flow ratio, the peak systolic velocity, and the end-diastolic velocity were measured.Results: The mean age was 26.1±5.2 years in the study group and 27.0±5.4 years in the control group. All participants had regular menstrual periods. There were no significant differences between the groups regarding each of the vascular indices for the uterine, arcuate, and ovarian arteries.Conclusion: These findings are consistent with published data demonstrating that pelvic circulation is not compromised after bilateral internal iliac artery ligation.

Shoulder dystocia in a Jamaican cohort

2009-01-01

Abstract: Objective: To assess the risk factors for shoulder dystocia in Jamaica.Methods: A retrospective cohort analysis of all cases of shoulder dystocia, and birth weight-matched controls identified from January 1, 2000 to December 31, 2004. Multiple factors were analyzed individually and in combination to identify risk factors.Results: The incidence of shoulder dystocia was 0.83%. Nulliparity, a first stage of labor greater than 7 hours, a second stage lasting more than 1 hour, and use of oxytocin augmentation were found to be statistically significant factors with unadjusted odds ratios (95% confidence interval) of 1.78 (0.86–3.34), 1.89 (0.91–3.94), 2.78 (0.24–31.47), and 1.56 (0.77–3.15), respectively. The incidence of shoulder dystocia decreased as parity increased when adjusted for age.Conclusion: Individual risk factors for shoulder dystocia remain obscure. The nulliparous pelvis, when controlled for neonatal weight, was associated with a statistically increased risk of shoulder dystocia; this risk decreased with increasing parity.

Intravenous salbutamol for external cephalic version

2009-01-01

Abstract: Objective: To evaluate the success of external cephalic version (ECV) using an adjusted bolus dose of intravenous salbutamol compared with no tocolysis.Methods: An open-label randomized study of 114 women with a term breech fetus randomized to receive either an intravenous bolus dose of 0.1 mg salbutamol with further boluses every 5 minutes, as required, before commencing ECV, or no tocolysis. Primary outcomes were successful ECV and rate of cesarean delivery.Results: Salbutamol tocolysis resulted in a higher rate of successful ECV compared with no tocolysis (70.2% [40/57] vs 36.8% [21/57]; RR 1.9, 95% CI 1.3–2.8; P<0.001). Cesarean delivery rate was lower in the salbutamol group compared with the control group (31.6% [18/57] vs 63.2% [36/57]; RR 0.5, 95% CI 0.3–0.8; P=0.001). Salbutamol dose ranged from 0.1–0.4 mg and outcome was not related to dose.Conclusion: Adjusted dose intravenous salbutamol tocolysis prior to ECV increases its success rate and reduces the cesarean delivery rate.

Calcium supplementation for the prevention of pre-eclampsia

2009-01-01

Abstract: Objective: To study the effect of calcium supplementation during pregnancy on blood pressure and maternal and neonatal outcomes.Method: A total of 524 healthy primigravidas with a blood pressure less than 140/90 mm Hg were randomly assigned between the 12th and 25th weeks to receive 2 g of elemental calcium or placebo and were followed-up until delivery.Results: The incidence of pre-eclampsia was significantly less in the calcium than in the placebo group (4.0% vs 12.0%; odds ratio [OR], 0.31; 95% confidence interval [CI], 0.15–0.63); the mean systolic and diastolic blood pressures at study completion were different in the calcium and placebo group (P=0.007 and P=0.02). The risk for preterm delivery was less in the calcium (7.0%) than in the placebo (12.7%) group (OR, 0.51; 95% CI, 0.28–0.93). The mean baseline calcium intake was 313.83±203.25 mg/day (range, 85.71–910.71 mg/day), which is lower than the recommended dietary intake of 1000 mg, and the 24-hour urinary calcium excretion was 130.82±67.44 mg/dL (range, 40.5–387 mg/dL).Conclusion: Calcium supplementation appears to reduce the occurrence of pre-eclampsia and preterm delivery in primigravidas who have a daily dietary calcium intake less than the recommended dietary allowances.

Intercellular adhesion molecule-1 K469E polymorphism in Korean patients with spontaneous preterm delivery

2009-01-01

Abstract: Objectives: To investigate the association between intercellular adhesion molecule-1 (ICAM-1) gene K469E polymorphism and spontaneous preterm delivery in a Korean population.Methods: Genomic DNA was extracted from whole blood from 55 women experiencing preterm labor and 153 multiparous women (control group) with a history of at least 2 term deliveries. DNA samples were analyzed by polymerase chain reaction–restriction fragment length polymorphism.Results: The spontaneous preterm delivery (SPD) group carried the 469E allele significantly more frequently than those in the control group (odds ratio [OR], 1.62; 95% CI, 1.04–2.53). The EE genotype was significantly associated with increased risk of SPD (OR, 2.84; 95% CI, 1.17–6.89; P=0.02). Allelic frequencies in women with abnormal C-reactive protein levels (K=0.48; E=0.52) were significantly different from frequencies in the controls (K=0.68; E=0.32) (P=0.006).Conclusions: ICAM-1 gene K469E polymorphism may be a candidate region and useful predictor of susceptibility to SPD in the Korean population.

Oral micronized progesterone for prevention of preterm birth

2009-01-01

Abstract: Objective: To evaluate oral micronized progesterone (OMP) to prevent preterm birth (PTB).Methods: A randomized, double-blind, placebo-controlled trial of 150 women with at least one PTB who received 100 mg of OMP or placebo twice a day from recruitment (18–24 weeks) until 36 weeks or delivery.Results: PTB occurred in 29 (39.2%) women in the OMP group (n=74) compared with 44 (59.5%) in the control group (n=74, P=0.002). Mean gestational age at delivery was higher in the OMP group (36.1 vs 34.0 weeks, P<0.001). Fewer preterm births occurred between 28 and 31 weeks plus 6 days in the OMP group (RR 0.20; 95% CI, 0.05–0.73, P<0.001). Neonatal age at delivery (34 vs 32 weeks, P<0.001), birth weight (2400 vs 1890 g, P<0.001), NICU stay (>24 h, P<0.001), and Apgar scores (P<0.001) were more favorable in the OMP group, and fewer neonatal deaths occurred (3 vs 7, P=0.190).Conclusion: OMP reduced the risk of PTB between 28 and 31 weeks plus 6 days, NICU admissions, and neonatal morbidity and mortality in high risk patients.

Effect of oral N-acetyl cysteine on recurrent preterm labor following treatment for bacterial vaginosis

2009-01-01

Abstract: Objective: To evaluate the effect of N-acetyl cysteine (NAC) on gestational age at delivery in women with previous preterm labor and bacterial vaginosis.Methods: A randomized, double-blind, placebo-controlled trial with 280 women between 16 and 18 weeks of pregnancy who had 1 previous preterm birth and had just been successfully treated for bacterial vaginosis with metronidazole for 1 week. The women were randomized to receive 0.6 g of NAC per day plus 17-hydroxyprogesterone caproate (17-OHPC) or placebo plus 17-OHPC until 36 completed weeks of pregnancy or active labor. A vaginal swab was taken during labor.Results: Reaching 36 weeks of pregnancy was more frequent (P<0.05) and gestational age at delivery was significantly higher in the NAC than in the placebo group (37.4 weeks±0.4 weeks vs 34.1 weeks±1.2 weeks, P<0.05). The discontinuation rate was 11.4% in the NAC group.Conclusions: Oral NAC was found to reduce the recurrence of preterm birth in patients with bacterial vaginosis.

Hysteroscopic findings in women with primary and secondary infertility due to genital tuberculosis

Jai Bhagwan Sharma, Kallol K. Roy, Mohanraj Pushparaj, Sunesh Kumar — 2009-01-01

Abstract: Objective: To evaluate hysteroscopic findings of infertile women with genital tuberculosis.Method: A retrospective study of the records of 94 women who underwent diagnostic hysteroscopy for infertility at All India Institute of Medical Sciences, New Delhi, India. Genital tuberculosis was diagnosed by laboratory studies of an endometrial biopsy and/or laparoscopic findings.Results: For women with primary or secondary infertility, respectively, the hysteroscopic findings were normal in 15 (20.5%) vs 4 (9%) cases; and adhesions were grade 2 in 11 (15.1%) vs 3 (14) cases, grade 2a in 0 vs 1 (1.4%) cases, grade 3 in 11 (15.1%) vs 9 (42.9%) cases, grade 3b in 6 (8.2%) vs 0 cases, and grade 4 in 28 (38.4%) vs 2 (9.5%) cases.Conclusion: Genital tuberculosis causes significant pelvic morbidity due to uterine adhesions and infertility.

The influence of body mass index on in vitro fertilization outcome

2009-01-01

Abstract: Objective: To examine whether body mass index (BMI) influences the outcome of in vitro fertilization (IVF).Methods: We studied 516 IVF cycles, 438 undergone by nonobese (BMI≤30) and 78 by obese (BMI>30) women who all had an a priori favorable prognosis (age<40 years and first, second, or third IVF cycle).Results: Pregnancy was achieved in 122 (27.9%) nonobese and 12 (15.4%) obese women. The obese women required significantly longer stimulation and more gonadotropin ampoules, and had lower peak estradiol levels and a significantly lower fertilization rate; obese poor responders had a significantly lower pregnancy rate than nonobese poor responders; and the prevalence of poor responders was significantly higher among obese than nonobese women (28.2% vs 16.9%, P<0.04).Conclusion: While the likelihood of poor responders was increased among obese women, reasonable conception rates were achieved in nonobese poor responders, and were comparable to the rates in nonobese and obese normal responders.

Infracoccygeal sacropexy for uterovaginal prolapse

2009-01-01

Abstract: Objective: To report on the efficacy and safety of infracoccygeal sacropexy for the treatment of uterovaginal prolapse.Method: A retrospective analysis of 87 women who underwent an infracoccygeal sacropexy procedure, 53 receiving a multifilament and 34 receiving a monofilament tape.Results: The mean follow-up was 27 months. Postoperative perineal pain was reported by 7 women (10%), and dyschesia and dyspareunia were observed de novo in 4 (5%) and 5 women (6%), respectively. There were 5 cases (9%) of vaginal extrusion and 9 cases (18%) of prolapse recurrence in the multifilament tape group, and in the monofilament tape group there were no cases of vaginal extrusion and 4 cases (14%) of prolapse recurrence (P=0.79 for prolapse recurrence). The recurrence-free survival curves of the 2 groups were similar. Univariate analysis revealed no independent factors of recurrence.Conclusion: Although infracoccygeal sacropexy was found to be associated with few prolapse recurrences, complications were not rare.

Care-seeking behavior of women with reproductive health problems from low-income areas of Beirut

Faysal El-Kak, Marwan Khawaja, Myelene Salem, Huda Zurayk — 2009-01-01

Abstract: Objective: To examine the patterns of care-seeking behavior and provider choice of women with self-reported reproductive health problems from 3 urban communities in Beirut.Methods: The study was based on a sample of 1869 completed questionnaires from 2051 eligible women (married or had been married, and between 15 and 59 years) obtained during the Urban Health Survey. Associations between community of residence, other background characteristics, and two outcome measures (health care usage and choice of provider) were assessed using logistic regression.Results: Of the 1869 women assessed, 439 (23.5%) reported reproductive health problems; of these, 273 (62%) women sought care for their problems, with the majority (52.5%) using private providers. Younger age, health insurance, and severity and duration of problems were associated with use. Women with higher parity and those with financial problems were significantly more likely to use public and subsidized services.Conclusion: The private health sector needs to be more involved in planning, implementing, and offering reproductive health care in low-income communities.

Child labor and sexual assault among girls in Maiduguri, Nigeria

Bala Audu, Ado Geidam, Hajara Jarma — 2009-01-01

Abstract: Objective: To determine the relationship between child labor and sexual assault among girls in Maiduguri, Nigeria.Methods: Face-to-face interview using a validated questionnaire of a randomly selected sample of employed girls.Results: Out of 350 girls, 316 were successfully interviewed for a response rate of 90.3%. Mean age of the girls was 14.9±2.3 years and mean workday was 8.5±3.8 hours/day. In 33.4% of cases the girls had no formal education, and 78.5% were not currently going to school. The sexual assault rate was 77.7%, and in 38.6% of cases the assailant was a customer. Sexual assault was more likely in girls who were younger than 12 years (OR 3.54; 95% CI, 1.38–9.14), had no formal education (OR 4.80; 95% CI, 1.63–14.16), worked for more than 8 hours/day (OR 4.43; 95% CI, 1.60–12.30), or had 2 or more jobs (OR 16.09; 95% CI, 1.20–61.70).Conclusion: To reduce the risk of sexual assault, if girls are employed they should be older, work for limited hours, and not have more than one job at a time.

Impact of a perinatal network medical practice improvement program on postpartum hemorrhage-related morbidity

Anne-Sophie Ducloy-Bouthors, Jean-Claude Ducloy, Jérôme Sicot — 2009-01-01

Postpartum hemorrhage (PPH) remains the leading cause of maternal morbidity and mortality in France and worldwide, and can occur in any pregnant woman. A perinatal care network is defined as an association of women's hospitals and practitioners responsible for organizing the management of pregnant women and their babies during the birth period. The aim of our medical practice improvement program (MPIP) was to standardize the management of PPH in every women's hospital in the network, according to French guidelines . The aim of the present study was to measure the impact of the MPIP on PPH-related morbidity .

Diagnosis of fetal femoral fracture by midtrimester three-dimensional ultrasound

Jong Yun Hwang, Ji Yeon Lee, Dong Heon Lee — 2009-01-01

A 36-year-old healthy woman (para 2, gravida 3) received targeted two-dimensional (2D) ultrasound (Accuvix XQ; Medison, Hongcheon, Korea) at 23 weeks of pregnancy, which suggested that the right femur of the fetus was shorter than expected with a sharply angulated mid-shaft. No other fractures or fetal abnormalities were observed. Three-dimensional (3D) ultrasound was performed to examine the fetus, which revealed an intrauterine femoral fracture (). There was no family history of skeletal dysplasia and no history of maternal trauma. Serial ultrasound showed continued growth in all bones, including the fractured femur, which grew approximately to the appropriate size for gestational age.

Lactiferous duct reconstruction for obstructive engorgement following traumatic nipple damage

Vinita Puri, Yogesh S. Nandanwar — 2009-01-01

A 25-year-old woman developed a tense, engorged right breast 3 days after delivery of her second child. A scar was present in place of the nipple-areola complex in the right breast. The patient had a history of breast abscesses during the postpartum period of her first pregnancy 3 years previously; this had resulted in destruction of the nipple-areola complex of the right breast with secondary intention healing. However, the patient had been able to continue breastfeeding from the unaffected left breast. After delivery of her second child the patient developed swelling and tenderness in her right breast on the third day post partum. Because the patient wanted to breastfeed her newborn, suppression of lactation was decided against and she was referred to the plastic surgery department for reconstruction of the lactiferous duct openings in the right breast.

Distension versus traction in laparoscopically assisted balloon vaginoplasty for management of vaginal aplasia

Ali M. El Saman, Mahmoud S. Zakherah, Ahmed M. Nasr, Mohamed M.F. Fathalla — 2009-01-01

Creation of a neovagina in women with vaginal aplasia using laparoscopically assisted balloon vaginoplasty (LAB-V) has been described previously . The creation of the neovagina depends on the traction and distension of the Foley catheter balloon. Alternative procedures such as sigmoid neovaginoplasty, McIndoe procedure, and peritoneoplasty are more technically demanding and have higher complication rates . Preliminary results attest to the safety and effectiveness of LAB-V .

Obstructive suburethral mass following injection of dextranomer/hyaluronic acid copolymer

Brigitte Fatton, Denis Savary, Luka Velemir — 2009-01-01

A dextranomer/hyaluronic acid copolymer injection (Zuidex; Q-Med, Uppsala, Sweden) has been suggested for the treatment of female stress urinary incontinence (SUI) . Adverse events such as suburethral masses have been reported previously, but to date there is no consensus on the management of such complications.

Comparison of clinical and laparoscopic diagnoses of pelvic inflammatory disease

2009-01-01

Pelvic inflammatory disease (PID) may severely affect women's reproductive health. In everyday practice the diagnosis of PID is based primarily on clinical findings; however, laparoscopy is considered the gold standard for diagnosis of the disease. The aim of the present study was to prospectively evaluate the risk factors, clinical diagnostic criteria, and laparoscopic findings in women with PID.

Collins test in patients with vulvar pruritus

Bashar Y. Fatoohi — 2009-01-01

Pruritus is the most common symptom of vulvar disorders. The prevalence of vulvar pruritus in the female population is unknown, as is the prevalence of most of the conditions responsible for the itching .

Global issues in women's health

John J. Sciarra — 2009-01-01

Abstract: World population growth in the past century has taxed the ability of healthcare systems in low-income countries to provide reproductive health care. Maternal mortality and morbidity, sexually transmitted diseases, and cervical cancer are major problems. Expansion of reproductive health services, training of appropriate medical personnel, and elevating the status of women in society are all necessary and appropriate solutions to improve the health of women in low-income countries.

Essential interventions for maternity care in low resource countries

2009-01-01

John J. Sciarra Prize Paper Award for 2009

2009-01-01

Instructions to Authors

2009-01-01

International Journal of Gynecology & Obstetrics

Intensive caring

Postpartum hemorrhage: A cure that eludes us

A systematic review of randomized controlled trials of prenatal and postnatal vitamin A supplementation of HIV-infected women

Controversies surrounding the causes of brachial plexus injury

Cesarean delivery surveillance system at a maternity hospital in Kabul, Afghanistan

Intrapartum stillbirth in a Nigerian tertiary hospital setting

Color Doppler analysis of pelvic arteries following bilateral internal iliac artery ligation for severe postpartum hemorrhage

Shoulder dystocia in a Jamaican cohort

Intravenous salbutamol for external cephalic version

Calcium supplementation for the prevention of pre-eclampsia

Intercellular adhesion molecule-1 K469E polymorphism in Korean patients with spontaneous preterm delivery

Oral micronized progesterone for prevention of preterm birth

Effect of oral N-acetyl cysteine on recurrent preterm labor following treatment for bacterial vaginosis

Hysteroscopic findings in women with primary and secondary infertility due to genital tuberculosis

The influence of body mass index on in vitro fertilization outcome

Infracoccygeal sacropexy for uterovaginal prolapse

Care-seeking behavior of women with reproductive health problems from low-income areas of Beirut

Child labor and sexual assault among girls in Maiduguri, Nigeria

Impact of a perinatal network medical practice improvement program on postpartum hemorrhage-related morbidity

Diagnosis of fetal femoral fracture by midtrimester three-dimensional ultrasound

Lactiferous duct reconstruction for obstructive engorgement following traumatic nipple damage

Distension versus traction in laparoscopically assisted balloon vaginoplasty for management of vaginal aplasia

Obstructive suburethral mass following injection of dextranomer/hyaluronic acid copolymer

Comparison of clinical and laparoscopic diagnoses of pelvic inflammatory disease

Collins test in patients with vulvar pruritus

Global issues in women's health

Essential interventions for maternity care in low resource countries

Top 10 IJGO articles downloaded from ScienceDirect September 2007 - September 2009

John J. Sciarra Prize Paper Award for 2009

Instructions to Authors