International Journal of Gynecology & Obstetrics

Infertility treatment in patients with recurrent endometrioma

Horng-Der Tsai — 2010-07-12

Dr Horng-Der Tsai, Professor of Chang Jung Christian University, is the Chairman of the Obstetrics and Gynecology Department and the Director of the Division of Reproductive Medicine of Changhua Christian Hospital, Changhua City, Taiwan. He is the current President of the Taiwan Association of Obstetrics and Gynecology. Dr Tsai's field of expertise is assisted reproductive technology. He was President of the Taiwanese Society for Reproductive Medicine from 1998 to 2000 and became a member of FIGO's Executive Board in 2009.

CONTEMPORARY ISSUES IN WOMEN'S HEALTH

Richard M.K. Adanu — 2010-07-05

Implication of the RAGE–EN-RAGE axis in endometriosis

2010-06-01

Abstract: Objective: To investigate the involvement of the receptor gene for advanced glycation (RAGE), its ligand EN-RAGE, and COX-2 in endometriosis.Methods: The mRNA and protein expression of the corresponding genes were determined from endometriotic cells from 28 study patients and healthy endometrial stromal cells from 20 controls by semiquantitative RT-PCR and Western blot analysis, respectively, using β-actin as an invariant control.Results: The expression of COX-2, RAGE, and EN-RAGE was significantly increased, as evidenced by the significantly greater mRNA and protein expression in the cells of the study patients (P<0.001). Previous treatment for endometriosis did not lessen mRNA and protein expression (P<0.001).Conclusion: Our findings strengthen the hypothesis of an underlying inflammation in the pathophysiology of endometriosis and suggest exploring anti-inflammatory therapies as adjunct treatment.

Prevalence of newly diagnosed endometriosis in women attending the general practitioner

Simone Ferrero, Elisa Arena, Amatore Morando, Valentino Remorgida — 2010-05-26

Abstract: Objective: To investigate the prevalence of newly diagnosed endometriosis in premenopausal women who requested a consultation with their general practitioner because of non-gynecological problems.Method: Participants in the study were invited to complete a questionnaire investigating the presence of pain symptoms and infertility. On the basis of the characteristics of these symptoms, some patients underwent gynecological examination and transvaginal ultrasound. Radiological examinations were performed when bowel or bladder endometriosis were suspected.Results: A total of 1291 women without a previous diagnosis of endometriosis were included in the study. On the basis of the symptoms, 108 women were referred to a gynecologist. After gynecological examination and transvaginal ultrasound, endometriosis was suspected in 51 women (47.2%). The diagnosis of endometriosis was confirmed by radiological investigations and/or surgery in 46 patients; the diagnosis of endometriosis was presumed in 2 other women but it was not confirmed by radiological investigations and/or surgery. The prevalence of endometriosis diagnosed by magnetic resonance imaging and/or surgery was 3.6% (46/1291).Conclusion: The prevalence of newly diagnosed symptomatic endometriosis in this study was at least 3.6%. A simple evaluation of symptoms (pain and infertility) that can be performed by a general practitioner facilitates the diagnosis of endometriosis.

Increased basal FSH levels as predictors of low-quality follicles in infertile women with endometriosis

2010-05-31

Abstract: Objective: To determine whether basal levels of follicle-stimulating hormone (FSH) and anti-müllerian hormone (AMH), antral follicle count (AFC), and the numbers of dominant follicles, oocytes, and mature oocytes retrieved after ovarian stimulation differed between infertile women with endometriosis and healthy women undergoing assisted reproduction techniques (ART).Method: Of 77 consecutive ART candidates, 27 were infertile and had endometriosis. A male factor caused the infertility of the other 50, who acted as controls.Results: The AMH and AFC levels were similar in the 2 groups. The FSH levels were higher (8.28mIU/mL [range, 5.25–24.1mIU/mL] vs 5.91mIU/mL [range, 2.47–18.7mIU/mL]; P<0.01) in the study group. And the numbers of retrieved (n=5 [range, 0–12] vs n=9 [range, 0–27; P<0.05) and mature oocytes (n=4 [range, 0–11] vs n=5 [range, 0–16]; P<0.05) were less in the study group.Conclusion: Because AMH levels were unchanged, endometriosis seems not to damage the primordial pool of follicles and oocytes, but to lessen the quality of the ovarian response to the hCG injection. Basal FSH levels may be of value in predicting ART success in women with the disease.

Effects of transdermal estradiol gel and oral tibolone on health-related quality of life after surgical menopause

Sudhindra M. Bhattacharya, Ayan Jha — 2010-06-07

Abstract: Objective: To study the effects of 6months of treatment with transdermal estradiol gel versus oral tibolone on health-related quality of life (HRQOL) after surgical menopause.Methods: In a randomized single-blind trial, Indian women received either oral tibolone tablets (2.5mg) or transdermal estradiol gel (0.06%) daily. Each woman scored herself on the Menopause Rating Scale (MRS) II at the beginning of the study and after 6months. Independent t tests were used to determine the significance of changes in HRQOL.Results: In total, 31 (81.6%) women who received estradiol gel and 38 (100.0%) women who received tibolone completed treatment. Intent-to-treat analysis showed that, after 6months of treatment, the total MRS score was significantly reduced in the tibolone group compared with the transdermal estradiol gel group (−9.5±5.1 versus −4.9±5.7; 95% confidence interval, 2.0–7.0; P<0.01). Significant improvements were also noted in the tibolone group in terms of somatovegetative (P=0.04) and psychologic (P<0.01) domains.Conclusion: Oral tibolone treatment was more effective than transdermal estradiol gel at improving HRQOL in Indian women with surgical menopause.

Short-term type-specific HPV persistence and its predictors in an asymptomatic general female population in Zhejiang, China

Jing Ye, Xiaodong Cheng, Xiaojing Chen, Feng Ye, Weiguo Lu, Xing Xie — 2010-06-07

Abstract: Objective: To study short-term type-specific human papillomavirus (HPV) persistence and associated predictors in an asymptomatic general female population in Zhejiang, China.Methods: Persistence was evaluated in women who were HPV positive at enrollment and who returned within 6–14months. Liquid-based cytology screening was encouraged for returning women.Results: Persistence was evaluated in 548 women. Overall persistence was 49.1%, and established high-risk HPV persistence was 54.5%. The types associated with the highest level of persistence were HPV-52, HPV-58, HPV-56, and HPV-16—most of which belong to α9 species. In total, 252 women refused cytology screening. No differences were found regarding HPV persistence and other variables among women who returned for follow-up, women who accepted cytology screening, and women who refused cytology screening. Among women aged 35years or older, there were no differences between those with normal cytology and those with abnormal cytology in the short-term persistence of HPV types, except for HPV-58 (P<0.01) and HPV-81 (P=0.04). Established high-risk HPV persistence increased with age, low income, and early sexual experience.Conclusion: The data support close surveillance of older women with established high-risk HPV infections, and conservative management of women with non-α9 HPV and no risk factors.

Long-term vaginal administration of Lactobacillus rhamnosus as a complementary approach to management of bacterial vaginosis

Valentina Marcone, Giuseppe Rocca, Miriam Lichtner, Ettore Calzolari — 2010-06-24

Abstract: Objective: To investigate the advantages of long-term vaginal administration of Lactobacillus rhamnosus after oral treatment with metronidazole to prevent the recurrence of bacterial vaginosis (BV).Methods: A total of 49 women with a diagnosis of BV were randomized into 2 groups. Group A was treated with a twice daily dose of 500mg oral metronidazole for 7days. Group B was treated with the same schedule followed by a once-weekly vaginal application of 40mg of Lactobacillus rhamnosus for 6months. A non-parametric analysis of variance for repeated measures was used to test whether there were significant changes in the vaginal ecosystems in the 2 groups.Results: During the first 6months of follow-up, a constant percentage (96%) of patients in group B had a balanced vaginal ecosystem. Follow-up over 12months showed no statistically significant difference among vaginal ecosystems in patients in group B (P=0.40), whereas in group A there was a significant increase in the number of women with abnormal flora over time (P=0.01).Conclusion: The vaginal administration of the probiotic Lactobacillus rhamnosus allows stabilization of the vaginal ecosystem and reduces the recurrence of BV.

Isolation and genotyping of vaginal non-albicans Candida spp. in women from two different ethnic groups in Lanzhou, China

Yu-Ping Wei, Jie Feng, Zhi-Cheng Luo — 2010-06-14

Abstract: Objective: To investigate whether the vaginal flora of women from 2 different ethnic groups living in the same region of China harbored the same species of Candida in the same proportions.Methods: The ethnicity of the women was determined by conventional cultural identification, and the Candida spp. harbored by the women were determined by conventional methods and DNA genotyping.Results: Candida albicans accounted for 77.1% and 89.6%, respectively, of the Candida spp. isolated from the normal vaginal flora of Han Chinese and Tibetan women. This difference was statistically significant and may explain the differences in the rates of opportunistic infections in these 2 groups. Among the non-albicans Candida spp. isolated were C. glabrata and C. tropicalis.Conclusion: Different species of Candida were differently distributed in the normal vaginal flora of ethnic Han Chinese and Tibetan women living in the same geographic region.

Dating gestational age by last menstrual period, symphysis-fundal height, and ultrasound in urban Pakistan

2010-06-01

Abstract: Objective: To compare the accuracy of the reported date of the last menstrual period (LMP) with that of symphysis-fundal height (SFH) in the estimation of gestational age (GA), using an ultrasound (US) scan as reference.Methods: Gestational age was concurrently assessed by the 3 methods in this prospective, population-based, pregnancy-outcome study conducted in Hyderabad, Pakistan, from June 18, 2003, through August 31, 2005, with 1128 women between 20 and 26weeks of a singleton pregnancy.Results: The mean GA was less by ultrasound than by SFH measurement or the reported LMP, and the mean differences with the US result were statistically significant (P<0.001 for both). At delivery, about 75% of the GA values estimated by SFH measurement were within 7days and almost 91% were within 14days of the estimation by ultrasound, compared with 65% and 82% for the GA estimated by the reported LMP. Moreover, using the US as reference, the SFH correctly classified 84% of the term, 68% of the preterm, and 86% of the post-term deliveries (weighted κ=0.58) compared with the corresponding 79%, 61%, and 55% predicted by the reported LMP (weighted κ=0.44).Conclusion: The SFH measurement was found to be more accurate than the reported LMP as a tool to estimate GA and therefore date of delivery, but neither were as accurate as a US scan.

Perinatal risk for common mental disorders and suicidal ideation among women in Paraguay

Kanako Ishida, Paul Stupp, Florina Serbanescu, Edgar Tullo — 2010-05-18

Abstract: Objective: To examine the association between mental health problems among pregnant women and those in the postpartum period using a nationally representative sample of 6538 women aged 15–49years from the National Survey of Demography and Sexual and Reproductive Health in Paraguay.Methods: The predicted probabilities (PP) of common mental disorders (CMD) and suicidal ideation were assessed using the Self-Reporting Questionnaire (SRQ-20) and logistic regression models.Results: No evidence was found of an increased risk for mental health problems associated with being pregnant or in the postpartum period alone. The risk for CMD during pregnancy and the postpartum period and for suicidal ideation during pregnancy was significantly greater when the pregnancy was unintended. In addition, unintentionally pregnant women who had neither been in a union nor had a child were at a significantly higher risk for CMD and suicidal ideation compared with non-pregnant and non-postpartum women (PP: 0.54 versus 0.21 for CMD risk and 0.15 versus 0.02 for suicidal ideation). However, there were no significant differences by marital status among postpartum women.Conclusion: The significant effects of pregnancy intention and marital status highlight the importance of psychosocial, rather than physiological, contexts in which women experience pregnancy and childbirth.

Spontaneous preterm birth in women with chronic hepatitis B virus infection

2010-06-04

Abstract: Objective: To determine whether chronic hepatitis B virus (HBV) infection, as evidenced by serum levels of HBsAg and HBV DNA, is a risk factor for spontaneous preterm birth (SPB).Method: The prevalence of HBV infection and the SPB rate were prospectively investigated among 1826 pregnant women, 30.89% Albanian and the remainder of other European origins.Results: Overall, 70 (3.8%) of the women were chronically infected with HBV. HBsAg status was strongly linked to SPB, which incurred to 5 (7.3%) of 64 women with circulating HBsAg compared with 28 (1.6%) of 1703 without current HBV infection (odds ratio, 5.2; P=0.007). SPB, however, was linked neither to HBsAg levels, nor to HBV DNA levels, nor to the presence or absence of viremia.Conclusion: Pregnant women were found to be at higher risk for SPB if they had circulating HBsAg, and the risk did not seem to be influenced by the levels of HBsAg or HBV DNA.

Ultrasound cervical length measurement for prediction of delivery before 32weeks in women with emergency cerclage for cervical insufficiency

2010-06-07

Abstract: Objective: To assess the accuracy of ultrasound cervical length for predicting delivery before 32weeks among women with a threatened second trimester fetal loss treated by emergency cervical cerclage, and to compare it with prediction based on clinically-assessed cervical dilation.Methods: Retrospective study (1997–2006) of 70 women with singleton pregnancies who underwent emergency cervical cerclage and ultrasound cervical length measurement between 15 and 26weeks. The associations between cervical length and delivery before 32weeks were studied with univariate and multivariate regression. ROC curves were used to determine the most discriminating cut-off value.Results: Although ultrasound cervical length measurement was significantly associated with early preterm delivery, its predictive accuracy was moderate with an area under the ROC curve (AUC) of 0.68 (95% CI, 0.54–0.82), which was similar (P=0.43) to the AUC of cervical dilation of 0.73 (95% CI, 0.61–0.85). The best cut-off value was 7mm, corresponding to a doubled risk of delivery before 32weeks. Its sensitivity was 52%, specificity 82%, PPV 62%, and NPV 76%. It was no more informative than cervical dilation of 3cm.Conclusion: Ultrasound cervical length measurement does not predict early preterm birth better than clinically-assessed cervical dilation in women with an emergency cerclage.

The impact of pregnancy and vaginal delivery on urinary incontinence

Markus Huebner, Andrea Antolic, Ralf Tunn — 2010-06-07

Abstract: Objective: To identify women who had urinary incontinence (UI) before, during, and after pregnancy, and to determine whether women with symptoms of UI during pregnancy were the same women who had urinary incontinence postpartum.Methods: All primigravid women who delivered within 1year (1999) at the Charité Hospital in Berlin received a questionnaire about UI at 5 different time points during pregnancy and the postpartum period.Results: Of 610 eligible women, 411 (67.4%) completed the questionnaire. The prevalence of urinary incontinence increased significantly in the second half of pregnancy (26.3%, P<0.001). Although the overall number of women who reported UI within 6weeks after delivery (28.5%) was almost the same as the number reporting UI in the second half of pregnancy, approximately every second women changed from being continent to incontinent and vice versa.Conclusion: The group of women who experienced UI postpartum was different from the group that experienced UI before delivery and vice versa. Pregnancy itself may influence pelvic floor function in a different way compared with vaginal delivery.

Classification and management of extensive obstetric perineal injuries in the Czech and Slovak Republics

2010-06-01

Abstract: Objective: To assess the classification, repair, and follow up of extensive obstetric perineal injuries in the Czech and Slovak Republics.Methods: A survey conducted in 2009 using questionnaires distributed to obstetric departments regarding classification and management of obstetric perineal injuries.Results: Although 15 centers in the Czech Republic and 2 in the Slovak Republic indicated use of a 4-degree classification system, none of these centers reported using the classification accepted by the Royal College of Obstetricians and Gynaecologists. Use of a 3-degree classification system in accordance with definitions in Czech textbooks was reported by 14 Czech and 3 Slovak maternity hospitals. There was significant heterogeneity in clinical practice regarding techniques to repair extensive obstetric perineal injuries, antibiotic prophylaxis, early postpartum care, and follow up.Conclusions: There is great inconsistency in the classification and management of extensive obstetric perineal injuries. Uniform recommendations should be created and accepted, not only in the Czech and Slovak Republics, but worldwide.

Assessing changes in flow velocimetry and clinical outcome following use of an external aortic compression device in women with postpartum hemorrhage

Mohamed H. Soltan, Hisham H. Imam, Khalid A. Zahran, Suad M. Atallah — 2010-06-04

Abstract: Objective: To monitor femoral artery blood flow by Doppler velocimetry in women treated for postpartum hemorrhage (PPH) with and without the adjunction of the External Aortic Compression Device (EACD), and to assess the possible adverse effects of the device.Methods: Blood flow velocity in the femoral artery, as well as skin color and sensory or motor changes in the lower limbs, were assessed in 120 women with primary PHH of any cause, quasi randomized to either treatment group. Pulse rate, oxygen saturation, respiratory rate, urinary output, and gastrointestinal symptoms were checked in the study group.Results: While blood flow velocity was significantly less in the study group than control group (P<0.001), the lowest flow volume velocity of 310.40mL/sec exceeded the acceptable minimum after device application. The intensity of abdominal discomfort correlated with body mass index. No device complications were observed.Conclusion: The EACD contributed safely and effectively to the treatment of 60 women with PPH of different causes.

Transvaginal ultrasound and sonohysterography for assessment of postpartum residual trophoblastic tissue

2010-05-20

Abstract: Objective: To compare the accuracy of transvaginal ultrasound and sonohysterography (SHG) in diagnosing residual trophoblastic tissue in postpartum women and to assess the adverse effects and complications of the SHG procedure.Methods: A prospective study of patients with postpartum bleeding enrolled for clinical symptoms and signs of residual trophoblastic tissue. All women underwent transvaginal ultrasound and SHG. Uterine cavity curettage was performed in all women and the material collected was sent for pathologic examination.Results: Among 84 patients, transvaginal ultrasound revealed residual trophoblastic tissue in 60 women, whereas SHG detected residual trophoblastic tissue in 48 and blood clots in 12. Pathologic examination confirmed trophoblastic tissue in 48 patients and blood clots in 12. Fifteen (17.9%) patients experienced adverse effects after SHG. Thirteen (15.5%) experienced postprocedural fever that resolved with antibiotics. Two women (2.4%) had severe complications of infection: 1 required surgery for peritonitis, which revealed salpingitis and a pelvic abscess; 1 experienced fever and mild abdominal pain that resolved with antibiotics after 10days of hospitalization.Conclusions: Although SHG showed greater accuracy than transvaginal ultrasound in detecting residual trophoblastic tissue, a high proportion of patients experienced adverse effects.

Cable ties as tourniquets at open myomectomy

2010-06-21

The major risk of open myomectomy is intraoperative hemorrhage, and several strategies have been suggested to reduce bleeding . While injections of dilute vasopressin or its derivatives are the most widely used, tourniquets that render the uterus avascular during surgery are the most effective. The classic technique involves placing a clamp, catheter, or suture around the cervix (single tourniquet technique) and the infundibulopelvic ligaments (triple tourniquet technique) to occlude the uterine and ovarian blood supplies respectively.

Trafficking experiences and violence victimization of sex-trafficked young women in Cambodia

Heather L. McCauley, Michele R. Decker, Jay G. Silverman — 2010-05-31

While evidence suggests that trafficking of women and girls for commercial sex work (CSW), or sex trafficking, is prevalent in Cambodia, studies to date have not identified the actors perpetrating this gender-based crime . Moreover, the vulnerabilities faced by trafficked women and girls—such as violence victimization or risk of sexually transmitted infections (STIs) and HIV—are unclear in this Cambodian context; this makes design of successful efforts to protect women at risk of being trafficked and provision of assistance to those already victimized less likely .

Transmigration of a vaginal foreign body to the fallopian tube

2010-06-10

A 27-year-old woman presented with discomfort in the left iliac fossa. Her past medical history was noncontributory. The patient's first menarche was at 13years of age and she experienced regular menstrual cycles. She had been married for 3years and had been diagnosed with primary infertility.

Cancer mortality among patients admitted to gynecological wards at Lagos University Teaching Hospital, Nigeria

Rose Ihuoma Anorlu, Kingsley Obodo, Christian Chigozie Makwe — 2010-06-01

In 2007, about 72% of all deaths from cancer occurred in low- and middle-income countries, and the incidence is increasing . In sub-Saharan Africa, communicable diseases such as malaria, tuberculosis, and HIV/AIDS are typically reported as the leading causes of death. In addition, most studies on the causes of death among women in sub-Saharan Africa, including Nigeria, have concentrated on pregnancy-related mortality, HIV/AIDS, injuries, and cardiovascular diseases. Studies investigating cancer mortality in sub-Saharan Africa are scarce. The aim of the present study was to determine the proportion of deaths attributable to cancer that occurred on the gynecological wards of Lagos University Teaching Hospital (LUTH), Nigeria.

Knowledge of emergency contraception among married women in Izmir, Turkey

Gul Ertem, Asli Kalkim, Sevcan Topçu — 2010-05-31

Unintended pregnancy is a worldwide problem that affects women, their families, and society. Each unintended pregnancy may put the woman at risk for significant morbidity and mortality . According to the Turkish Demographic and Health Survey (2003), the rate of use of modern contraceptive methods was 43%, whereas use of the withdrawal method during intercourse was 26.4% and dilation and curettage for termination of pregnancy was 24%. After termination of pregnancy, 26.4% of women continued to use the withdrawal method and 30.7% did not use any method of contraception. Despite these numbers, 16.1% of women were familiar with emergency contraception .

Maternal mortality due to hypertensive disorders of pregnancy in a tertiary care center in Southern India

Papa Dasari, Syed Habeebullah — 2010-06-07

The maternal mortality ratio in India declined from 398 per 100000 live births in 1997–1998 to 301 per 100000 in 2001–2003. Despite this, the pace of decline is insufficient to achieve the major development goals for maternal mortality . Hypertensive disorders of pregnancy are a major cause of maternal mortality. Although their incidence is similar in high- and low-income countries, the morbidity and mortality attributed to these disorders remains excessive in low-income countries.

Spontaneous hemoperitoneum and fetal demise in a nulliparous woman requiring hysterectomy with fetus in situ

Olivier M. Brouckaert, Esther Oostenveld, Hendrik Quartero — 2010-05-31

Spontaneous hemoperitoneum in pregnancy (SHiP) is a rare entity reported to occur in the second half of pregnancy, in labor, or in the early postpartum period . Dramatic maternal and fetal/neonatal mortality rates (0%–49.3% and 31%–36%, respectively) have been reported . The cause of SHiP is unknown. Several reports suggest endometriosis as a risk factor .

John J. Sciarra prize paper award for 2010

2010-09-01

Author Index

2010-09-01

Subject Index

2010-09-01

International Journal of Gynecology & Obstetrics

Infertility treatment in patients with recurrent endometrioma

CONTEMPORARY ISSUES IN WOMEN'S HEALTH

Implication of the RAGE–EN-RAGE axis in endometriosis

Prevalence of newly diagnosed endometriosis in women attending the general practitioner

Increased basal FSH levels as predictors of low-quality follicles in infertile women with endometriosis

Effects of transdermal estradiol gel and oral tibolone on health-related quality of life after surgical menopause

Short-term type-specific HPV persistence and its predictors in an asymptomatic general female population in Zhejiang, China

Long-term vaginal administration of Lactobacillus rhamnosus as a complementary approach to management of bacterial vaginosis

Isolation and genotyping of vaginal non-albicans Candida spp. in women from two different ethnic groups in Lanzhou, China

Dating gestational age by last menstrual period, symphysis-fundal height, and ultrasound in urban Pakistan

Perinatal risk for common mental disorders and suicidal ideation among women in Paraguay

Spontaneous preterm birth in women with chronic hepatitis B virus infection

Ultrasound cervical length measurement for prediction of delivery before 32weeks in women with emergency cerclage for cervical insufficiency

The impact of pregnancy and vaginal delivery on urinary incontinence

Classification and management of extensive obstetric perineal injuries in the Czech and Slovak Republics

Assessing changes in flow velocimetry and clinical outcome following use of an external aortic compression device in women with postpartum hemorrhage

Transvaginal ultrasound and sonohysterography for assessment of postpartum residual trophoblastic tissue

Cable ties as tourniquets at open myomectomy

Trafficking experiences and violence victimization of sex-trafficked young women in Cambodia

Transmigration of a vaginal foreign body to the fallopian tube

Cancer mortality among patients admitted to gynecological wards at Lagos University Teaching Hospital, Nigeria

Knowledge of emergency contraception among married women in Izmir, Turkey

Maternal mortality due to hypertensive disorders of pregnancy in a tertiary care center in Southern India

Spontaneous hemoperitoneum and fetal demise in a nulliparous woman requiring hysterectomy with fetus in situ

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John J. Sciarra prize paper award for 2010

Author Index

Subject Index