International Journal of Gynecology & Obstetrics - Articles in Press

A 10-year experience in removing Chinese intrauterine devices - Corrected Proof

Vincent Y.T. Cheung — 2010-03-11

Abstract: Objective: To review 10years of experience in removal of Chinese intrauterine devices (IUD) attained by a single gynecologist practicing in Canada.Methods: Office records from women who presented requesting IUD removal between January 1999 and December 2008 were reviewed. Specific data including the time of IUD insertion, the country where the IUD was inserted, menstrual and obstetric histories, success of the IUD removal in an office setting, and the type of IUD removed were recorded.Results: Of 314 women using a Chinese IUD, 227 (72.3%) had successful removal of the device in an office setting. Most women (86.6%) fitted with a Chinese IUD had no thread seen outside the cervix. A total of 279 Chinese IUDs were removed (from both the office setting and operating room), consisting of 11 different types; the most common type was the stainless steel ring (63.4%). Difficult removal was associated with absence of a visible thread outside the cervix, postmenopausal status, and no previous vaginal birth. The type of IUD and duration of placement did not affect the ease of removal.Conclusion: Knowledge about the different types of Chinese IUDs in use will enable gynecologists to provide optimal care to their patients.

Prevalence of obstetric fistula in Malawi - Corrected Proof

2010-03-11

Abstract: Objective: To estimate the prevalence of obstetric fistula in Malawi and explore the potential risk factors for developing the condition.Methods: A community survey was conducted in 9 districts in Malawi, recruiting 3282 women aged at least 12years using the sibling based method to identify cases of obstetric fistula. Hospital records from 9 district hospitals involved in the community survey and all hospitals offering fistula repair services in Malawi were reviewed.Results: A total of 1107 women with obstetric fistula were identified: 575 from the community survey and 532 from hospital records. Median age was 29years (range, 12–89years). The prevalence of obstetric fistula was 1.6 per 1000 women. Women endured the condition for a median duration of 3years. Comparison of women with and without obstetric fistula revealed significant differences in age (P=0.02), occupation (P<0.01), and tribal origin (P=0.02), but no differences in education level (P=0.73) or religion (P=0.08).Conclusion: Obstetric fistula remains a major problem in Malawi. Increased awareness of the condition, improvement of maternal care services, and an increase in skilled personnel to perform fistula repair are needed to reduce the burden of this condition.

Efficacy of mifepristone in reducing intermenstrual vaginal bleeding in users of the levonorgestrel intrauterine system - Corrected Proof

Suman Lal, Alka Kriplani, Vidushi Kulshrestha, Meenakshi Sharma, Nutan Agarwal — 2010-03-11

Abstract: Objective: To evaluate the efficacy of mifepristone to reduce intermenstrual bleeding in levonorgestrel intrauterine system (LNG-IUS) users.Method: In this prospective, open-label, comparative study, 36 women using the LNG-IUS for menorrhagia received 100mg of mifepristone every 30days for 3months (group 1). Fifty age-matched LNG-IUS users who did not receive any drugs were used as the comparison group (group 2). Menstrual bleeding days, pictorial blood loss assessment chart (PBAC) score, and intermenstrual bleeding/spotting days were compared between the 2 groups at 3months (during treatment) and at 6months (3months post treatment).Results: Baseline characteristics were comparable between the groups. At 3months, median duration and episodes of intermenstrual bleeding/spotting were significantly lower in group 1 compared with group 2 (6 vs 12.5days, P=0.01; 2.5 vs 3, P=0.05, respectively). More women were satisfied with the LNG-IUS in the mifepristone group compared with the control group (75% vs 44%; P=0.004). At 6months, the median duration of intermenstrual bleeding/spotting was significantly lower in group 1 compared with group 2 (6 vs 15days; P=0.008).Conclusion: Mifepristone was effective in reducing the number of episodes and duration of intermenstrual bleeding/spotting in LNG-IUS users.

Implementing safe motherhood: Free resources for training in maternal and neonatal care - Corrected Proof

Luc R.C.W. van Lonkhuijzen, Jos van Roosmalen, Gerda Zeeman — 2010-03-11

Characterization of pelvic floor symptoms in community-dwelling women of northeastern Liberia - Corrected Proof

2010-03-08

Urinary incontinence (UI), fecal incontinence (FI), and pelvic organ prolapse (POP) are common conditions among women in the United States. Prevalence rates have been characterized by large diverse population-based studies ; however, there is little robust data characterizing the prevalence and quality of life (QoL) impact of pelvic floor disorders in women of West Africa, where parity is, on average, higher than in the United States . Some studies have reported that pelvic floor symptoms such as UI and POP may not be as prevalent in African American women compared with white women . This has been attributed to factors such as physiologic or anatomic differences or simple lack of reporting of these symptoms. The aim of the present study was to survey a large number of community-dwelling West African women without vesicovaginal fistulae to provide some insight regarding these reports.

Anthropometric characteristics and success rates of oral or vaginal misoprostol for pregnancy termination in the first and second trimesters - Corrected Proof

Louis-Jacques van Bogaert, Asha Misra — 2010-03-08

Abstract: Objective: To assess the effect of anthropometric characteristics related to weight on medical pregnancy termination with misoprostol.Methods: In this prospective cohort study, 454 women admitted for medical pregnancy termination in the first or second trimester took 400µg of misoprostol sublingually plus 800µg of misoprostol vaginally or orally. The regimen was readministered after 24hours if there was no response or the abortion was incomplete, and surgical evacuation was done when needed. Linear regression was performed for possible correlations between the studied characteristics and treatment process and outcome.Results: There was no correlation between the number of misoprostol administrations and any of the studied anthropometric characteristics. The numbers of both misoprostol administrations and surgical interventions were associated with oral administration.Conclusion: The route of misoprostol administration, but not anthropometric characteristics related to weight, were found to be associated with the success of pregnancy termination with misoprostol.

Increased complication rates associated with laparoscopic surgery among patients with genital tuberculosis - Corrected Proof

Jai Bhagwan Sharma, Pushparaj Mohanraj, Kallol K. Roy, Sunesh K. Jain — 2010-03-08

Abstract: Objective: To compare the complications and surgical difficulties encountered during laparoscopy between women diagnosed with and without genital tuberculosis (TB).Methods: Retrospective review of the records of women diagnosed with and without genital TB who underwent laparoscopy primarily for infertility and chronic pelvic pain from January 2006 through July 2009. Genital TB was diagnosed by laboratory studies and endoscopic findings.Results: A total of 313 women were included in the study: 87 (27.8%) with genital TB and 226 (72.2%) without. Laparoscopy was performed in 48 (55.2%) patients with genital TB and 19 (8.4%) without; laparoscopy with hysteroscopy was performed in 39 (44.8%) with the disease and 132 (58.4%) without. Although individual complication rates were all higher in the genital TB group, significant differences were seen for inability to see the pelvis (10.3% vs 1.3%, P=0.027), excessive bleeding requiring transfusion (2.3% vs 0%, P=0.045), and peritonitis (8.0% vs 1.8%, P=0.037). Other complications encountered were inability to create pneumoperitoneum, bladder injury, trocar site discharge, and need for laparotomy.Conclusion: Laparoscopic surgery may be associated with increased complication rates in patients with genital TB compared with those without the disease.

Feasibility, efficacy, safety, and acceptability of mifepristone–misoprostol for medical abortion in the Democratic People's Republic of Korea - Corrected Proof

2010-03-08

Abstract: Objective: To examine the feasibility, efficacy, safety, and acceptability of medical abortion among rural and urban women up to 56days of pregnancy in the Democratic People's Republic of Korea.Method: A total of 199 women (rural n=95, urban n=104) recruited from 2 rural and 2 urban reproductive health clinics received 200mg of oral mifepristone followed 2days later by 400μg of sublingual misoprostol. The women's abortion status and satisfaction level were determined 2weeks later.Results: Overall complete abortion occurred in 96.0% of the women; there was no statistically significant difference between the groups (rural 95.8%, 95% confidence interval [CI], 89.6–98.8; urban 96.2%, 95% CI, 90.4–98.9). The 2 groups reported similar adverse effects. In total, 90.5% of rural and 88.5% of urban participants were satisfied or very satisfied with the method.Conclusion: The high efficacy and acceptability of medical abortion among rural and urban women suggest that medical abortion is a safe alternative to surgical abortion and can be scaled up to other reproductive health clinics in both rural and urban areas of the Democratic People's Republic of Korea, provided that there is appropriate training and supervision.

Four-dimensional sonographic assessment of fetal movement in the late first trimester - Corrected Proof

Toshiyuki Hata, Kenji Kanenishi, Mutsuko Sasaki — 2010-03-08

Abstract: Objective: To evaluate, using four-dimensional (4D) sonography, the frequency of fetal movements during the late first trimester of normal singleton pregnancies.Methods: Singleton pregnancies were studied—using transvaginal 4D sonography—for 10minutes at 10–11 and 12–13weeks of gestation. The frequencies of 5 fetal movements (isolated arm, isolated leg, short trunk, long trunk, and jumping movements) were evaluated.Results: In the 17 pregnancies studied, the most frequent fetal movements were isolated arm movement at 10–11weeks and jumping movement at 12–13weeks. There was a significant difference in the frequency of jumping movement between 10–11 and 12–13weeks (P<0.05).Conclusion: The difference in frequency of 5 fetal movements at 10–11 and 12–13weeks of gestation may be caused by early neuromuscular development and differentiation of the neuromuscular system.

Report of the FIGO Working Group on Sexual Violence/HIV: Guidelines for the management of female survivors of sexual assault - Corrected Proof

2010-03-08

Abstract: Objective: To review the evidence and provide guidelines on the management of sexual violence against women, specifically, rape.Outcomes: Outcomes evaluated include effectiveness of post-rape care provision.Evidence: The MEDLINE database was searched for articles published up to December 2008 on the topic of post-rape care and expert opinion was sought from the Sexual Violence Research Initiative membership. In addition, a search was performed for English-language protocols on Google. One Spanish language protocol was considered in the development of the guidelines.Values: The evidence was evaluated by authors and reviewers of the South African Department of Health’s sexual assault curriculum, and by members of the FIGO Working Group and recommendations were made according to the guidelines developed by the Canadian Task Force on Preventive Health Care.Benefits, Harms, and Costs: Implementation of the recommendations in this Guideline should result in more appropriate management of survivors of sexual violence and better physical and psychological outcomes.

Unethical female stereotyping in reproductive health - Corrected Proof

Rebecca J. Cook, Simone Cusack, Bernard M. Dickens — 2010-03-08

Abstract: Stereotypes are generalized preconceptions defining individuals by group categories into which they are placed. Women have become stereotyped as homemakers and mothers, with the negative effect of precluding them from other roles and functions. Legislation and judicial constructions show a history, and often a continuing practice, of confining women to these stereotypical functions. In access to reproductive and sexual health care, for instance, women's requests have been professionally subject to approval of their husbands, fathers or comparable males. Choice of abortion is particularly significant, because it embeds moral values. Women's capacity to act as responsible moral agents is denied by stereotypical attitudes shown by legislators, judges, heads of religious denominations, and healthcare providers who consider women incapable of exercising responsible moral choice. These attitudes violate ethical requirements of treating patients with respect and equal justice. They can also result in violations of human rights laws that prohibit discrimination against women.

Care seeking for postpartum morbidities in Murshidabad, rural India - Corrected Proof

2010-03-08

Worldwide, an estimated 536000 maternal deaths occur each year . Of these, approximately 25% occur in India alone . Postpartum maternal morbidity, defined by the WHO as morbidity occurring in the first 6weeks after delivery, is a serious problem in resource-poor settings that contributes to maternal death . Despite the high prevalence of postpartum morbidity and the danger of maternal mortality, women in low-resource settings such as rural India frequently fail to seek care from formal health providers . Understanding the factors that influence care-seeking behavior for postpartum health problems in India is vital to setting program priorities and designing appropriate interventions. Our study sought to elucidate these factors in the rural district of Murshidabad, India.

Bone mineral density in women using the subdermal contraceptive implant Implanon for at least 2years - Corrected Proof

2010-03-08

Abstract: Objective: To compare the effect of the long-term use of a subdermal single-rod contraceptive implant on bone mineral density (BMD) between users and a control group.Methods: In this cross-sectional study, BMD was measured at the lumbar spine, femur, and distal radius and ulna in 100 Thai women of reproductive age, 50 who had used the Implanon implant for contraception for at least 2years and 50 controls.Results: Ethnicity, age, age at menarche, parity, menstrual pattern, and body mass index were similar in the 2 groups. The mean duration of Implanon use was 32.8±6.3months. Although the prevalence of osteoporosis was rare at all sites in both groups, the Implanon users had a significantly lower BMD at the distal radius and ulna than the controls.Conclusion: The long-term use of Implanon seemed to have a negative impact on the mineral density of the distal radius and ulna.

Uterine diverticulum complicating pregnancy diagnosed by ultrasound and uteroscopy - Corrected Proof

Xin Sun, Min Xue, Songshu Xiao, Yajun Wan, Binbin Wang — 2010-03-03

A 26-year-old patient (G2, P0, A2) presented at the gynecology clinic with amenorrhea of 50days’ duration and expressed her intention to terminate the pregnancy. The patient's urine sample tested positive for pregnancy. Ultrasound was performed as per our routine preoperative diagnostic procedure for patients requesting pregnancy termination. The ultrasound image revealed an early pregnancy complicated by incomplete septate uterus (approx. 6mm wide). Because we suspected that the pregnancy was complicated by a uterine deformity, we decided to perform the termination under uteroscopic surveillance.

Insulin resistance, dyslipidemia, and metabolic syndrome in women with polycystic ovary syndrome - Corrected Proof

Akmal El-Mazny, Nermeen Abou-Salem, Walid El-Sherbiny, Ahmed El-Mazny — 2010-03-03

Abstract: Objective: To investigate the association of insulin resistance with dyslipidemia and metabolic syndrome (MBS) in women with polycystic ovary syndrome (PCOS).Methods: Fasting glucose (G), insulin (I), and lipid levels were measured in 50 infertile women with PCOS. A fasting G/I ratio of 4.5 or less (n=29) defined insulin resistance (IR).Results: The mean levels of total cholesterol (P<0.001), low-density lipoprotein (P=0.02), and triglycerides (P<0.001) were significantly higher and the mean levels of high-density lipoprotein were significantly lower (P<0.001) in the IR group. The prevalence of MBS (P=0.02) and obesity (P=0.04), hypertension (P=0.02), fasting hyperglycemia (P=0.03), low high-density lipoprotein levels (P=0.02), and hypertriglyceridemia (P=0.02) were also significantly higher in the IR group.Conclusion: Insulin resistance is associated with dyslipidemia and MBS in women with PCOS. Lifestyle modification and insulin-sensitizing agents should be part of the management plan.

Rimonabant during early pregnancy - Corrected Proof

Guillaume Ducarme, Pierre-François Ceccaldi, Hélène Pejoan, Dominique Luton — 2010-03-03

Rimonabant (Sanofi-Aventis, Paris, France) was the first cannabinoid receptor antagonist to show high potency and selectivity for the central cannabinoid (CB1) receptor. It is indicated for the treatment of obesity, in conjunction with diet and exercise, for patients with a body mass index (BMI, calculated as weight in kilograms divided by the square of height in meters) greater than 30kg/m2 . There is no clinical evidence regarding the safety of fetal exposure to rimonabant during early pregnancy, but animal studies have indicated a particularly high risk of profound consequences for brain maturation .

A survey of Russian women regarding the presence of a companion during labor - Corrected Proof

Yekaterina Bakhta, Richard H. Lee — 2010-03-03

Abstract: Objective: To assess qualitatively the attitudes of Russian women toward the presence of a support person during labor.Methods: Pregnant and postpartum women were surveyed at the Omsk County Maternity and Delivery Hospital, Omsk, Russia. Demographic information was obtained, and each woman was asked about her opinions regarding the presence of a companion during labor.Results: Of the 70 women interviewed, 68.6% declined to have a partner present during labor. The most common reasons were that they: felt afraid for their husband (15.7%); felt personally embarrassed (17.1%); wanted to have a private experience (22.9%); and thought it would adversely affect their sex life (8.6%). Only 17.1% of the women agreed and were able to have a companion present during labor. In total, 31.4% of women were unable to have a companion present, for the following reasons: family matters; husband declined; husband did not undergo necessary laboratory tests; or spontaneous labor.Conclusion: Many Russian women viewed childbirth as a medical process that should not involve social interaction. It is important for physicians to understand that there is a wide range of cultural differences in childbirth practice.

Special commentary on the issue of reinfibulation - Corrected Proof

Rebecca J. Cook, Bernard M. Dickens — 2010-02-24

Abstract: Policy on reinfibulation exposes the interface between individual or micro-ethics and population-wide or macro-ethics. If, following childbirth, an infibulated woman requests reinfibulation, a gynecologist may respectfully advise her of its negative implications, but would not act in breach of ethical or usually legal requirements in undertaking the procedure. However, as a matter of health policy and professional responsibility, physicians should refuse to initiate infibulation, and advise their patients and communities that the procedure is harmful, not required by religious or other ordinance, and frequently if not always unlawful. Reinfibulation is not genital cutting (or “mutilation”) in itself, but when undertaken by a physician may appear to condone infibulation. This is contrary to medical professional ethics, which condemn medicalization of infibulation and generally of reinfibulation, even as a harm-reduction strategy to spare women the risks of injury and infection from unskilled interventions.

Fechtner syndrome—a myosin heavy chain 9 disorder—and pregnancy - Corrected Proof

Uwe Pelzer, Ute Braig-Scherer, Hanno Riess — 2010-02-24

Myosin heavy chain 9 (MYH9) related platelet disorders belong to the class of inherited thrombocytopenias. The MYH9 gene encodes the non-muscle myosin heavy chain IIA, a cytoskeletal contractile protein. First details were published in 1985 . Manifestations of autosomal dominant point mutations in the MYH9 gene are the May-Hegglin anomaly, and Sebastian, Fechtner, and Epstein syndromes. Clinical differentiation is based on different phenotypic characteristics, such as premature release of giant platelets from bone marrow, thrombocytopenia, basophilic granulocyte inclusions, deafness, cataracts, and renal failure. Varying degrees of thrombocytopenia may be associated with recurrent epistaxis, gingival bleeding, menorrhagia, and excessive bleeding associated with surgical procedures.

Cervical clamping following ultrasound-guided uterocervical packing to control postpartum uterine hemorrhage - Corrected Proof

Ramkrishna Purohit, Jaygopal Sharma — 2010-02-23

The use of conventional uterovaginal gauze packing to control intractable postpartum uterine hemorrhage—which is responsible for many maternal deaths and hysterectomies —has been advocated in low-income countries . Packing is an option in emergencies when balloon tamponades and foley catheters are unavailable , and packing each area of the uterine cavity tightly might be facilitated by the use of transabdominal ultrasound, compared with blind conventional packing. Cervical clamping after uterine packing prevents slippage.

Physicians' approaches to post-abortion care in Manila, Philippines - Corrected Proof

Catherine Cansino, Junice Lirza Melgar, Anne Burke — 2010-02-23

Abstract: Objective: To assess the knowledge and practice of health professionals in Manila, Philippines, regarding methods used for uterine evacuation in post-abortion care (PAC), including the use of misoprostol.Methods: A purposive sample of physicians providing PAC services completed questionnaires anonymously about PAC practices.Results: Among 45 survey respondents, the primary methods used for first-trimester uterine evacuation in PAC included sharp curettage (n=45, 100%) and manual vacuum aspiration (MVA; n=38, 84.4%), which was consistent with their preferences. Misoprostol was prescribed for first-trimester post-abortion uterine evacuation by 55.6% (n=25) of respondents; dosing regimens ranged from 50 to 200µg as a single dose or repeated every 4–24hours. Of the respondents, 91.1% (n=41) prescribed misoprostol for obstetric indications, including labor induction and postpartum hemorrhage.Conclusions: Most respondents used sharp curettage and MVA for first-trimester post-abortion uterine evacuation, and did not express a clear preference for either method. Despite the unregistered status of misoprostol, it was used in obstetrics and PAC by a majority of study respondents. The doses of misoprostol used for post-abortion uterine evacuation are lower than those recommended by evidence-based studies. The results indicate the need to disseminate evidence-based information about safe and effective use of MVA and misoprostol for PAC to physicians in Manila, Philippines.

Prevalence of HPV infection by cytologic diagnosis and HPV DNA extraction and prevalence of the HPV genotypes detected in urban Turkish women - Corrected Proof

Funda Eren, Mithat Erenus, Emine Bas, Rengin Ahiskali, Tevfik Yoldemir — 2010-02-23

Abstract: Objective: To evaluate the prevalence of the different human papillomavirus (HPV) genotypes in women seen at 2 Marmara University Hospital gynecologic outpatient clinics in Istanbul, Turkey.Methods: From May 1 through August 31, 2008, specimens were obtained from 500 women for cytologic evaluation by the split-sample method. HPV types were identified by PCR and hybridization using a microarray that identifies 35 types.Results: The overall prevalence of HPV was 16.5%, multiple genotypes were found in 35.8% of the infected women, and 75% of the types were high risk; 79% of the infected women had negative cytologic results, 3.7% had ASCUS, 10% had LSIL, and 6% had HSIL; the highest infection rates were 36% for women aged 20 to 30years and 35% for those aged 31 to 40years; 65.2% of the infected women were university graduates; and 34% were single.Conclusion: HPV infection involved numerous types, most of them high risk, even in women with negative cytology results. Further studies with larger groups will provide more information on HPV distribution in Turkey, which may guide the development of local vaccination programs.

Management of hepatic echinococcosis in pregnancy - Corrected Proof

2010-02-23

A 29-year-old woman presented with left flank pain at 20weeks of pregnancy. She had lived in Turkey during her childhood. Ultrasound and magnetic resonance imaging revealed 3 partially calcified hepatic cysts with a maximum diameter of 9.6cm and echinococcus multilocularis was confirmed serologically. Pharmacological treatment with albendazole (Eskazole; GlaxoSmithKline, Vienna, Austria) was started, but the cysts continued to enlarge.

Translational research in women's health: From bedside to bench and from bench to bedside - Corrected Proof

Takeshi Maruo — 2010-02-22

Takeshi Maruo, MD

Peritoneal VEGF burden as a predictor of cytoreductive surgery outcome in women with epithelial ovarian cancer - Corrected Proof

2010-02-18

Abstract: Objective: To determine whether peripheral plasma concentration, peritoneal fluid concentration, and/or peritoneal vascular endothelial growth factor (VEGF) burden can predict the possibility of optimal cytoreduction in women with epithelial ovarian carcinoma (EOC); and if so, to determine cutoff values below which optimal cytoreduction is likely to occur.Methods: We measured plasma VEGF concentration, peritoneal VEGF concentration, and VEGF burden in 46 women undergoing cytoreductive surgery. Univariate analysis, bivariate analysis, correlation tests, and stepwise regression were performed with cytoreduction as the outcome.Results: The VEGF burden best predicted the outcome. The area under the curve was 0.84 and the log-transformed cutoff value was 15.52 log pg. Overall, the chance of optimal cytoreduction was 11 times greater when the VEGF burden was less than 15.52 log pg. For women with advanced disease, the chance was 6 times greater below this value.Conclusion: The VEGF burden may quantify tumor activity, and it could be used when selecting patients likely to benefit from induction chemotherapy before undergoing cytoreductive surgery.

High-intensity focused ultrasound treatment for non-neoplastic epithelial disorders of the vulva - Corrected Proof

Liming Ruan, Zhenwei Xie, Huiyun Wang, Jingyi Jiang, Haiyan Shi, Jian Xu — 2010-02-16

Abstract: Objective: To assess the efficacy of high-intensity focused ultrasound (HIFU) treatment in patients with non-neoplastic epithelial disorders of the vulva.Method: We reviewed 41 cases of lichen sclerosus, 38 cases of squamous cell hyperplasia, and 17 mixed cases treated by HIFU from April 2004 to July 2008 at the Women's Hospital of Zhejiang University School of Medicine. Biopsy specimens were assessed with light microscopy before and after treatment.Results: Pruritus and signs of vulvar lesions were dramatically improved following HIFU treatment, without severe complications, and 90.23% of the patients were cured or had their symptoms improved 6months after treatment. On light microscopy, pigmentation and epithelial structures were recovered and dermal lymphocytic infiltration was reduced. The response rates were lower and complication rates higher among lichen sclerosus than among squamous cell hyperplasia cases (P<0.05 for both).Conclusion: Treatment with HIFU may be safe and effective in cases of vulvar dystrophy.

Fertility and obstetric outcome after conservative management of placenta accreta - Corrected Proof

2010-02-15

Abstract: Objective: To determine the fertility and obstetric outcomes after conservative management of placenta accreta.Methods: A retrospective observational cohort study of all identified cases of placenta accreta from 1993 to 2007 in 2 tertiary university hospitals in France. For patients treated conservatively, maternal and fetal morbidity, reproductive function, fertility, and subsequent pregnancies were recorded.Results: During the study period, 46 patients were treated by conservative management; 6 patients underwent a secondary hysterectomy. Of the remaining 40 patients, 35 were followed up for a median of 65months (range 18–156months). Patients resumed their menstrual cycles after a median of 130days (range 48–176days). Menses were irregular in 11 patients (31%), but none had amenorrhea. Twelve of the 14 patients desiring another pregnancy achieved a total of 15 pregnancies; 2 patients had recurrent placenta accreta. Five spontaneous abortions and 1 termination of pregnancy occurred during the first trimester. The median term at delivery was 37weeks (range, 35–40weeks). Four patients delivered prematurely.Conclusion: Conservative management of placenta accreta can preserve fertility, although the risk of recurrent placenta accreta appears to be high.

Anal dilation during labor - Corrected Proof

2010-02-15

Abstract: Objective: To determine the incidence and range of anal dilation during the final phase of the second stage of labor and shortly after delivery; determine whether parity affects anal dilation; and obtain anthropometric data for future projects.Methods: The anal diameter was measured on admission, when the fetal head crowned, and after suturing perineal injury in 142 women delivered between August 2008 and May 2009 at University Hospital Pilsen and District Hospital Klatovy, in the Czech Republic.Results: The anus was dilated during the second stage of labor in all women, and differences between primiparas and multiparas were not significant. The medians for both the anteroposterior and transverse diameters were 25mm. No measured variable was statistically associated with anal sphincter dilation.Conclusion: Anal dilation during the second stage of labor causes anthropometric changes to the perineum. This ought to be considered when designing anthropometric studies and in studies aiming at minimizing anal sphincter trauma during delivery.

Evaluation of cervical visual inspection screening in Dar es Salaam, Tanzania - Corrected Proof

2010-02-15

Abstract: Objective: To evaluate the feasibility and performance of screening for cervical cancer using visual inspection with acetic acid (VIA) or with Lugol's iodine (VILI) in Dar es Salaam, Tanzania.Methods: The accuracy of tests for detecting cervical intraepithelial neoplasia (CIN) was assessed in a cross-sectional study of 10378 women. All women who were screened underwent colposcopy, and biopsies were offered to those with abnormal colposcopy results.Results: The positivity rates were 3.8% for VIA and 4.8% for VILI. The peak positivity rates for both visual tests were observed just after training or re-training and gradually declined thereafter. CIN 1 was diagnosed in 41 women, CIN 2–3 in 33 women, and invasive cancer in 200 women, showing high detection rates of invasive cancer. The sensitivity and specificity for the detection of CIN 2–3 lesions were 60.6% (95% confidence interval [CI], 42.1–77.1) and 98.2% (95% CI, 97.9–98.4), respectively, for VIA; and 93.9% (95% CI, 79.8–99.3) and 97.3% (95% CI, 97.0–97.6), respectively, for VILI. Two-thirds of the women detected with CIN 2–3 lesions were treated.Conclusion: Both visual screening tests are useful and accurate, especially in low-income settings. Standardization of assessment of the visual inspection techniques, continual training and supervision, and quality control measures are important for successful visual screening programs.

Maternal gout associated with increased risk of low birth weight and preterm birth - Corrected Proof

Yi-Kuang Chen, Fang-Jen Wu, Herng-Ching Lin — 2010-02-15

Gout is a common medical condition, the incidence of which is 1.6 cases per 10000 patient-years during women's childbearing years . The relationship between maternal gout and pregnancy outcome is unknown and limits the ability of clinicians to provide effective strategies when advising pregnant women with gout.

Seroprevalence of hepatitis B surface antigen among pregnant women in Jiangsu, China, 17years after introduction of hepatitis B vaccine - Corrected Proof

Shu Zhang, Ruo-Tian Li, Yangyang Wang, Qilan Liu, Yi-Hua Zhou, Yali Hu — 2010-02-15

Abstract: Objective: To estimate the prevalence of hepatitis B surface antigen (HBsAg) among pregnant women in Jiangsu Province, eastern China, 17years after vaccination against hepatitis B virus (HBV) was introduced.Methods: From August 2002 to July 2004, serum samples from 6398 women between 15 and 20weeks of pregnancy and from 6 urban and 8 rural areas across Jiangsu Province were tested for markers of HBV. The results were then compared with the rates before 1980.Results: The overall rates of 6.71% for HBsAg and 36.84% for anti-HBs were significantly lower and higher, respectively, than the prevaccination rates. The rate for HBsAg was lower in urban areas than in rural areas (5.75% vs 7.14%, P=0.04). Although the rate used to be much higher in the northern part of Jiangsu Province, which is less prosperous than the southern part, the rates are now similar in both parts (6.60% vs 6.97%).Conclusion: These findings demonstrate a drop in the prevalence of HBsAg among pregnant women in Jiangsu Province since the introduction of vaccination programs in 1980, and indicate that HBV infection can also be controlled in less prosperous areas.

Effect of continuous support during labor on duration of labor and rate of cesarean delivery - Corrected Proof

Maryam Kashanian, Farahroos Javadi, Malektaj Moshkhbid Haghighi — 2010-02-15

Abstract: Objective: To evaluate the effect of continuous support provided by midwives during labor on the duration of the different stages of labor and the rate of cesarean delivery.Method: A randomized trial of 100 eligible nulliparous women who had not received education classes on childbirth. In the intervention group (n=50), continuous support during labor was provided; the control group (n=50) did not receive continuous support.Results: The two groups did not differ by age, employment, educational level, gestational age, economic status, and neonatal weight. Mean duration of the active phase of labor (167.9±76.3 vs 247.7±101min, P<0.001), second stage of labor (34.9±25.4 vs 55.3±33.7min, P=0.003), and the number of cesarean deliveries (4 vs 12, P=0.026) were significantly lower in the intervention group compared with the control group. The rates of oxytocin use and Apgar scores of less than 7 at 5 minutes were similar between the two groups.Conclusion: Continuous support provided by midwives during labor may reduce the duration of labor and the number of cesarean deliveries; this model of support should be available to all women.

Array-CGH detection of UGT2B28 gene deletion in a girl with primary amenorrhea and hyperandrogenism - Corrected Proof

Yanliang Zhang, Yong Dai, Zhiguang Tu, Qiyun Li, Linqian Wang, Li Zhang — 2010-02-12

Primary amenorrhea is defined as delayed menarche by 14years of age in the absence of secondary sexual characteristics, or absence of menses by 16years of age in the presence of normal growth and secondary sexual characteristics . The etiology of primary amenorrhea is complicated. Although some molecular basis for primary amenorrhea has been uncovered, the reasons have not been elucidated completely. The present paper reports on a new gene, UGT2B28, deletion of which appears to be associated with primary amenorrhea and hyperandrogenism.

Intrauterine device or estrogen treatment after hysteroscopic uterine septum resection - Corrected Proof

Esra Ayşin Tonguc, Turgut Var, Nafiye Yilmaz, Sertac Batioglu — 2010-02-12

Abstract: Objective: To investigate the effects on adhesion formation and pregnancy maintenance of an intrauterine device (IUD) and/or estrogen treatment after hysteroscopic septum resection.Methods: After septum resection 100 women received either no treatment, or estrogens, or an IUD, or an IUD plus estrogens (n=25 per group). Most were later checked hysteroscopically for uterine cavity adhesions. All pregnancies occurring during the study period were recorded.Results: Adhesions developed in 1 of 19 (5.3%) of the untreated women, 3 of 25 (12%) of the women treated with an IUD plus estrogens, 2 of 19 (10.5%) of the women treated with an IUD only, and none of the women treated with estrogens only. None of the differences, however, were significant. Regarding pregnancy, the differences between groups were also not significant.Conclusion: Neither IUD placement, nor estrogen treatment, nor both were found to prevent intrauterine adhesions or facilitate pregnancy after hysteroscopic uterine septum resection.

A qualitative study of the information needs of premenopausal women with breast cancer in terms of contraception, sexuality, early menopause, and fertility - Corrected Proof

Banu Karaöz, Hilmiye Aksu, Mert Küçük — 2010-02-12

Abstract: Objectives: To evaluate the information needed and received by premenopausal Turkish women with breast cancer regarding contraception, early menopause, infertility, fertility preservation, and sexuality.Methods: A qualitative exploratory methodology was used whereby an interviewer met on 2 occasions with women with breast cancer. The participants—who were recruited from the oncology clinic of Adnan Menderes University Hospital, Aydın, Turkey—were premenopausal, younger than 50years of age, and had been diagnosed with breast cancer within the past year. Raw data were sorted under themes.Results: Premenopausal women with breast cancer received insufficient counseling on contraception, early menopause, infertility, fertility preservation, and sexuality, despite their willingness to receive information.Conclusion: In Turkey, premenopausal women with breast cancer should receive comprehensive information and counseling from oncology staff on the issues studied. The present study may guide future research on this topic.

Pregnancy complications and obstetric outcomes among women with congenital uterine malformations - Corrected Proof

Fengbing Liang, Wensheng Hu — 2010-02-08

Uterine malformations are one of the major congenital anomalies of the female genital system. They are the result of abnormal development of the Müllerian ducts during fetal life . The presence of a malformed uterus adversely affects normal reproductive performance by increasing the incidence of abortion, preterm delivery, abnormal fetal positioning, and fetal growth restriction . According to Buttram and Gibbons , there are 4 types of uterine malformation: double uterus (uterus didelphys); bicornuate uterus; septate uterus; and unicornuate uterus. This excludes primordial uterus and rudimentary uterine horn.

The issue of reinfibulation - Corrected Proof

Gamal I. Serour — 2010-02-08

Abstract: Reinfibulation is resuturing after delivery or gynecological procedures of the incised scar tissue resulting from infibulation. Despite the global fight against female genital mutilation/cutting (FGM/C), reinfibulation of previously mutilated or circumcised women is still performed in various countries around the world. A good estimate of the prevalence of reinfibulation is difficult to obtain, but it can be inferred that 6.5–10.4million women are likely to have been reinfibulated worldwide. Women who undergo reinfibulation have little influence on the decision-making and are usually persuaded by the midwife or birth attendant to undergo the procedure immediately following labor or gynecological operation. Although medicalization of reinfibulation may reduce its immediate risks, it has no effect on the incidence of long-term risks. Reinfibulation is performed mainly for the financial benefit of the operator, and cultural values that have been perpetuated for generations. Reinfibulation has no benefits and is associated with complications for the woman and the unborn child. Its medicalization violates the medical code of ethics and should be abandoned. International and national efforts should be combined to eradicate this practice.

Characteristics of HPV prevalence among women in Liaoning province, China - Corrected Proof

2010-02-08

Abstract: Objectives: To investigate the prevalence rates of specific human papillomavirus (HPV) types infecting women in Liaoning Province, China.Methods: Specimens from 4780 patients with cervical disease and 165 age-matched controls were tested for HPV genotypes using a chip hybridization assay.Results: The infection rates were 35.66% for patients with cervicitis, 54.61% for those with ASCUS, 64.14% for those with CIN, 83.76% for those with cervical cancer in situ, and 83.12% for those with invasive cervical cancer. The most common HPV genotype was HPV-16, followed by HPV-58, HPV-52, HPV-33, HPV-53, and HPV-31. There were 1529 single and 731 multiple infections among the 4780 patients. Single infections with high-risk genotypes were associated with various cervical diseases. HPV-16 was present in 399 of the patients with multiple infections.Conclusion: Compared with prevalence rates for other populations, the rates of specific HPV types infecting women are different in Liaoning Province of China.

Improved quality of life is partly explained by fewer symptoms after treatment of fibroids with mifepristone - Corrected Proof

Changyong Feng, Sean Meldrum, Kevin Fiscella — 2010-02-04

Abstract: Objective: To examine mediators of mifepristone treatment on improvements in health-related quality of life (HRQOL) among women with symptomatic fibroids.Methods: The study sample included women with symptomatic uterine fibroids who were treated with 5mg or 2.5mg of mifepristone or placebo. Assessments of uterine size (ultrasound), pain (McGill pain questionnaire), bleeding (diary), anemia (gm/dL), and HRQOL measured using the uterine fibroid symptom quality of life scale were done at baseline, 3months, and 6months. The improvements in HRQOL that could be explained by changes in these clinical factors were assessed.Results: The final sample included 62 women. Treatment with mifepristone was associated with significant improvement in HRQOL, which was explained in part by reduction in pain (28%, P<0.001) and bleeding (18%, P<0.001). Reduction in uterine volume was of marginal significance (P=0.05) and was associated with a decrease in HRQOL (7%). Much of the impact of treatment on HRQOL (61%) remained unexplained in this model.Conclusions: Improvements in HRQOL after treatment with mifepristone are partly explained by improvements in pain and bleeding, but not uterine size. However, most of the improvement in HRQOL is not explained by improvements in these clinical parameters.

Inadequate identification of small-for-gestational-age fetuses at an urban teaching hospital - Corrected Proof

Kathleen Powell Mattioli, Maureen Sanderson, Suneet P. Chauhan — 2010-02-03

Abstract: Objective: To ascertain the likelihood of identifying small for gestational age (SGA) neonates prenatally (below the 10th percentile for gestational age).Methods: On admission for delivery, the charts of singletons with reliable gestational age (GA) were reviewed to determine whether intrauterine growth restriction (IUGR) was suspected, clinically or sonographically. Multiple logistic regression analysis was used with the accurate identification of SGA as the dependent variable and 13 independent variables.Results: Over 10months, 1502 pregnant women met the inclusion criteria and 16% of neonates were born SGA. Before delivery, only 10% (95% confidence interval 6%–14%) of newborns identified as SGA were detected, and 7% weighed below the 5th percentile. Multiple logistic regression analysis identified 4 factors that made a significant independent contribution to the detection of SGA: younger maternal age, size less than date, sonographic examination within 4weeks of delivery, and a history of substance abuse.Conclusions: Because we failed to identify 90% of SGA with fundal height measurements, the likelihood of detecting most growth-restricted fetuses clinically is low. If other investigators confirm these findings, a paradigm shift is warranted to improve the detection of IUGR.

Viability and functional capacity after thawing of hematopoietic progenitor cells cryopreserved at a cord blood stem cell bank in Colombia - Corrected Proof

2010-01-25

Abstract: Objective: To evaluate the viability and functional capacity of hematopoietic progenitor cells from cord blood samples cryopreserved at the Banco de Células Stem de Colombia.Methods: After thawing and centrifugation of 20 samples, viable white blood cells were numbered by the trypan blue method and CD34+CD45+dim hematopoietic progenitor cells were numbered by flow cytometry. Clonogenic assays also tested the functional capacity of viable CD34+CD45+dim cells.Results: The median rates of viable CD34+CD45+dim cells were 99.6% before freezing and 73.0% after thawing (P<0.001). The 20 cultures yielded a median of 12 cells with a lineage of red cells, 17.5 cells with a lineage of white cells, and 10 cells with a mixed lineage.Conclusion: Although the rate of viable CD34+CD45+dim cells was decreased by 26.6% after thawing by the method we used, the numbers of CD34+CD45+dim cells that formed colonies were similar to those obtained by other published methods.

Conservative management of stage IA1 squamous cell carcinoma of the cervix with positive resection margins after conization - Corrected Proof

Woo Young Kim, Suk-Joon Chang, Ki-Hong Chang, Seung-Chul Yoo, Hee-Sug Ryu — 2010-01-25

Abstract: Objective: To evaluate the efficacy of cold knife conization with electrocauterization and the feasibility of conservative management in patients with stage IA1 carcinoma of the cervix according to margin status after conization.Methods: Medical and histopathological records of 108 patients with stage IA1 cervical carcinoma were reviewed retrospectively. Patients underwent cold knife conization with electrocauterization or conization followed by hysterectomy. Disease recurrence was defined as a histologic diagnosis of cervical intraepithelial neoplasia (CIN) 2 or higher grade lesion.Results: Forty patients underwent conization followed by hysterectomy; of 27 women with positive margins, 14 (35%) had a residual lesion. Sixty-eight patients underwent conization without further surgical intervention. Forty patients had a negative resection margin without recurrence, while 28 had a positive resection margin: positive exocervical (n=11), positive endocervical (n=17). Among these, there were 7 cases of recurrence: positive exocervical (n=1); positive endocervical (n=6).Conclusion: Cold knife conization with electrocauterization appears to be a safe treatment option for patients with stage IA1 cervical carcinoma if careful follow-up is guaranteed for patients with CIN 3 exocervical resection margins. However, patients with CIN 3 endocervical resection margins should be managed surgically with repeat conization or hysterectomy.

Factors associated with operative hysteroscopy outcome in patients with uterine adhesions or submucosal myomas - Corrected Proof

2010-01-25

Abstract: Objective: To determine the factors associated with hysteroscopic surgery long-term outcome in patients with intrauterine adhesions or submucosal myomas.Methods: Factors thought to be associated with outcome were retrospectively evaluated from the records of 591 patients who were followed up for at least 5years after undergoing hysteroscopic adhesiolysis (n=203) or myomectomy (n=388).Results: The major factors affecting outcome were degree of adhesion (OR, 1.91; P=0.03) in the former group and parity (OR, 0.55; P=0.005) and depth of intramural penetration of the myoma (OR, 30.74; P<0.001) in the latter. Severe intrauterine adhesion, low parity, and deep intramural penetration of submucosal myoma had an associated increase risk of poor outcome. The overall complication rate was 1.35% and, respectively, 12.8% and 9.3% of the patients who underwent hysteroscopic adhesiolysis or myomectomy needed a second intervention.Conclusion: Hysteroscopic surgery is a safe and effective procedure. Degree of adhesion or parity and depth of intramural penetration of myomas are the major factors affecting outcome in patients with these lesions.

Perioperative course and medium-term outcome of the transobturator and infracoccygeal hammock for posthysterectomy vaginal vault prolapse - Corrected Proof

2010-01-25

Abstract: Objective: To describe the perioperative course and medium-term anatomic and functional outcomes of the transobturator–infracoccygeal hammock for posthysterectomy vaginal vault prolapse repair.Methods: A prospective consecutive series of 52 women with a stage 2 vaginal vault prolapse or higher that occurred after total hysterectomy who underwent surgery between 2003 and 2007. Principal outcome measures were anatomic cure (stage 1 or lower) and impact on quality of life measured using the pelvic floor distress inventory (PFDI) and pelvic floor impact self-reported questionnaire (PFIQ). Anatomical results were analyzed using χ2 and Fisher exact tests, and PFDI and PFIQ scores were analyzed using the Wilcoxon test.Results: With a median follow-up of 36months, the anatomic cure rate was 96%. Significant improvements were noted in POPQ-S scores after surgery (P<0.05). Stress urinary incontinence was cured in 73% of patients and improved in 15% of patients. The PFDI and PFIQ scores were improved (P<0.05). One mesh extrusion was observed. The rates of mesh contraction and new cases of dyspareunia were 31% and 13%, respectively.Conclusion: The transvaginal mesh hammock represents a useful treatment for recurrent and major vaginal vault prolapse, and has few complications.

Malaria and stillbirth in Omdurman Maternity Hospital, Sudan - Corrected Proof

Elshiekh Bader, Amel M. Alhaj, Ahmed A. Hussan, Ishag Adam — 2010-01-25

Abstract: Objective: The study was conducted in the labor ward of Omdurman Maternity Hospital, Sudan, from November 2007 to February 2008 to investigate the prevalence and risks factors for stillbirth.Methods: A case-control study. Cases were women who delivered stillbirths; 2 consecutive women who delivered a live-born singleton neonate at term (37–42weeks) per case were used as controls. Sociodemographic, clinical (including malaria infections), and obstetric histories were gathered using standard questionnaires. Maternal body mass index and hemoglobin levels were measured. Maternal, placental, and cord blood smears were investigated for malaria parasites.Results: Among 4760 singleton deliveries, there were 103 stillbirths, yielding a stillbirth rate of 22 per 1000 deliveries. Over half (52.4%) of these stillbirths were macerated stillbirths. Maternal sociodemographic characteristics were not associated with stillbirth, while a history of maternal malaria in the index pregnancy was the main risk factor for stillbirth (odds ratio, 3.0; 95% confidence interval, 1.0–8.9; P=0.04).Conclusion: Measures to prevent malaria infection should help to prevent stillbirth in this part of Sudan.

Inadequate prenatal care and the risk of stillbirth in the Peruvian Amazon - Corrected Proof

2010-01-20

Major risk factors for stillbirth include lack of skilled birth attendants, low socioeconomic status, poor nutrition, prior stillbirth, advanced maternal age, and the lack of prenatal care . The World Health Organization has published a prenatal care model that includes 4 routine visits for women with no specific risk condition or risk factor, and additional visits for women with health problems or risk factors . During these visits, risk factors should be ascertained (e.g., syphilis screening, measurement of blood pressure) and treatments administered (e.g., iron supplementation). In Peru, the Ministry of Health recommends a schedule of 6 routine prenatal care visits with a series of assessments or interventions to be performed at specific visits . However, for various reasons, the availability, accessibility, and utilization of prenatal care services may be less than optimal. In order to best inform prenatal care services in the Amazon region of Peru, where poverty remains high, we sought to identify risk factors associated with stillbirth in women delivering at the Hospital Iquitos “César Garayar Garcia” in Iquitos, the capital city of Loreto.

WITHDRAWN: Spontaneous rupture of pyometra causing peritonitis - Corrected Proof

R.S. Jhobta, R. Kaushik, A. Jhobta — 2006-06-28

This article has been withdrawn consistent with Elsevier Policy on Article Withdrawal (http://www.elsevier.com/locate/withdrawalpolicy). The Publisher apologizes for any inconvenience this may cause.