International Journal of Gynecology & Obstetrics - Articles in Press

National maternal mortality ratio for Jordan, 2007–2008 - Corrected Proof

Zouhair Amarin, Yousef Khader, Abdelhakeem Okour, Hashim Jaddou, Raeda Al-Qutob — 2010-09-01

Abstract: Objective: To estimate the number of maternal deaths per 100000 live births during 2007–2008 among Jordanian women; to identify the causes of maternal mortality; and to compare the results with those of the last report for 1995–1996.Methods: Reproductive-age mortality study of maternal deaths among women aged 15–49years in Jordan in 2007–2008.Results: Among 1406 identified deaths of reproductive-aged women, 76 maternal deaths were identified out of 397588 live births, for a maternal mortality ratio of 19.1 deaths per 100000 live births. Forty-three (56.6%) deaths were attributable to hemorrhage, thrombosis and thromboembolism, and sepsis. Avoidable factors were present in 53.9% of women, 52.6% had substandard care, and 31.5% had 3 or fewer antenatal visits. Of those with available information on family planning, only 29.4% had ever used any form of contraception.Conclusions: Maternal deaths in Jordan are declining. The maternal mortality ratio of 19.1 deaths per 100000 live births reported for 2007–2008 showed a remarkable reduction of 53.9% achieved in the 12years since the 1995–1996 report (a 4.5% annual reduction), which is approaching the 75% reduction recommended by Millennium Development Goal 5.

A randomized controlled trial of 400-μg sublingual misoprostol versus manual vacuum aspiration for the treatment of incomplete abortion in two Egyptian hospitals - Corrected Proof

2010-09-01

Abstract: Objective: To compare the safety, efficacy, and acceptability of 400-μg sublingual misoprostol with that of manual vacuum aspiration (MVA) in 2 Egyptian hospitals.Methods: Participating women were randomized to either MVA or misoprostol treatment for incomplete abortion. The primary outcome, complete uterine evacuation, was determined 1week later, as were adverse effects, change in hemoglobin, acceptability, and satisfaction.Results: Complete uterine evacuation was achieved in 98.3% of women who received misoprostol and 99.7% who underwent MVA (relative risk [RR] 0.99; 95% confidence interval [CI], 0.97–1.00). A decrease in hemoglobin of 2g/dL or more was comparably rare in the 2 groups (0.3% misoprostol vs 0.9% MVA; RR 0.34 [95% CI, 0.04–3.21]). Mean change in hemoglobin was also clinically similar (–0.5g/dL misoprostol vs –0.4g/dL MVA; P<0.01). Heavy bleeding was rare (2.4% misoprostol vs 1.6% MVA; RR 1.55 [95% CI, 0.51–4.68]) following treatment. Nearly all women (96.8% misoprostol vs 98.3% MVA) were satisfied with their treatment but those who received misoprostol were significantly more likely to prefer that method in the future (81.9% vs 62.8%; RR 1.30 [95% CI, 1.19–1.43]).Conclusion: The high efficacy, safety, and acceptability of 400-μg sublingual misoprostol indicate that it is analogous to surgery as a first-line treatment for incomplete abortion. Misoprostol might improve post-abortion care when resources are limited and surgical treatment is unavailable.

Cytology versus visual inspection with acetic acid among women treated previously with cryotherapy in a low-resource setting - Corrected Proof

2010-09-01

Abstract: Objective: To compare visual inspection with acetic acid (VIA) with conventional cervical cytology as a follow-up cervical cancer screening method in women who had been treated previously with cryotherapy.Methods: Salvadoran women screened with VIA and treated with cryotherapy within 3years were eligible to participate. Study participants were rescreened with VIA, Pap smear, colposcopy, 4-quandrant biopsy, and endocervical curettage.Results: Of 147 women enrolled in the study, post-cryotherapy VIA was positive in 39 women (26.5%; 95% CI, 19.6%–34.4%). Of these 39, 1 woman had CIN 1 or higher on biopsy. Post-cryotherapy Pap smear was positive (ASCUS or higher) in 6 women (4.1%; 95% CI, 1.5%–8.7%). Of these 6, 2 women had CIN 1 or higher on biopsy. Post-cryotherapy specificity was significantly higher for Pap compared with VIA (95.8% [138/144]; 95% CI, 91.2%–98.5% vs 73.6% [106/144]; 95% CI, 65.6%–80.6%; P<0.001).Conclusion: As the single-visit approach for cervical cancer screening gains popularity, more women will have been treated with cryotherapy. Appropriate follow-up screening is therefore vital. Cytology may be a more suitable screening method than VIA in low-resource settings for women treated previously with cryotherapy.

Cross-border reproductive services - Corrected Proof

Bernard Dickens — 2010-09-01

The FIGO Committee for the Ethical Aspects of Human Reproduction and Women's Health considers the ethical aspects of issues that impact the discipline of obstetrics, gynecology, and women's health. The following document represents the result of that carefully researched and considered discussion. This material is intended to provide material for consideration and debate about these ethical aspects of our discipline for member organizations and their constituent membership.

Disclosing adverse outcomes in medical care: FIGO Committee for the Ethical Aspects of Human Reproduction and Women's Health - Corrected Proof

Bernard Dickens — 2010-09-01

Domestic violence during pregnancy reported by women attending a university teaching hospital in Nigeria for antenatal care - Corrected Proof

Ifeanyichukwu Uzoma Ezebialu, Obiechina Nwora, Eke Ahizechukwu Chigoziem — 2010-09-01

Domestic violence against women continues to be a serious public health issue and its occurrence during pregnancy may lead to adverse outcomes for both the mother and fetus. Research has shown that it occurs in every society, but with varying prevalence . In Nigeria, the prevalence of domestic violence during pregnancy varies across different regions and the highest figure has been reported for Lagos . The aim of the present study was to determine the prevalence of domestic violence during pregnancy as reported by women attending a university teaching hospital in Nigeria to book for antenatal care, and to assess the types of and risk factors for domestic violence.

Lactobacillus rhamnosus GR-1 and L. reuteri RC-14 to prevent or cure bacterial vaginosis among women with HIV - Corrected Proof

2010-09-01

Abstract: Objective: To assess, among women with HIV, whether long-term oral Lactobacillus rhamnosus GR-1 and Lactobacillus reuteri RC-14 supplementation can prevent bacterial vaginosis (BV) and enhance the cure rate of metronidazole among those with BV.Methods: A randomized, double-blind, placebo-controlled trial conducted among 65 HIV-infected women with an aberrant microbiota (Nugent score 4–10) who were randomized to receive daily probiotics or placebo for 6months. Those with BV (Nugent score 7–10) additionally received metronidazole for 10days (400mg twice daily).Results: We did not find an enhanced cure rate of BV among women with HIV treated with adjuvant probiotics to metronidazole treatment. Among women with an intermediate vaginal flora, probiotics tended to increase the probability of a normal vaginal flora (odds ratio 2.4; P=0.1) and significantly increased the probability of a beneficial vaginal pH (odds ratio 3.8; P=0.02) at follow-up.Conclusion: Supplementation of probiotic L. rhamnosus GR-1 and L. reuteri RC-14 did not enhance the cure of BV among women living with HIV, but may prevent the condition among this population. Trial registration: NCT00536848.

Outcomes for pregnant women infected with the influenza A (H1N1) virus during the 2009 pandemic in Porto Alegre, Brazil - Corrected Proof

2010-09-01

Abstract: Objective: To study the epidemiologic characteristics and underlying conditions that place pregnant women infected with H1N1 virus at increased risk for being admitted to the intensive care unit (ICU).Methods: In this cross-sectional study conducted in Porto Alegre, Brazil, with 57 pregnant women hospitalized with the H1N1 influenza during the 2009 pandemic, we collected epidemiologic characteristics and assessed the rates of ICU admission according to pregnancy duration and the presence or absence of comorbidities.Results: The median (range) of maternal age was 26years (15–41years), the pregnancy duration at the time of infection was 29weeks (8–41weeks), and the birth weight was 3180g (740–3900g). Five patients (8.8%) were in the first, 22 (38.6%) in the second, and 30 (52.6%) in the third trimester, and (22.8%) had comorbidities. Antiviral drugs were administered to all, and 46 (80.7%) patients received an early treatment. There were no maternal, fetal, or neonatal deaths. Eight patients (14%) required ICU admission and 15 (50%) of the patients who gave birth during their hospitalization underwent a cesarean delivery. The risk of being treated at the ICU did not increase for patients with comorbidities (P=0.22) or an advanced pregnancy (P=0.31). The study revealed a relationship between early initiation of an antiviral treatment and a lower mortality rate.Conclusion: Neither an advanced pregnancy nor comorbidities increased the risk of being admitted to the ICU but, compared with the results of other studies, a prompt treatment lowered mortality.

Effect of married women's beliefs about gender equity on their use of prenatal and delivery care in rural China - Corrected Proof

Ying Cui, Qiaoli Zhang, Li Yang, Jianli Ye, Mentao Lv — 2010-08-30

Abstract: Objective: To investigate the effect of married women's beliefs regarding gender equity on their use of prenatal and delivery care in China's rural Xinjiang and Anhui provinces.Methods: In this survey, 1029 women aged from 15 to 69years, living in rural Xinjiang and Anhui provinces, and married, answered a questionnaire designed to collect information on their demographic characteristics, reproductive history (number of pregnancies, level of prenatal care, and mode and place of delivery), and beliefs regarding gender equity. We quantified “belief in gender equity” based on responses to 7 specific statements and graded the responses according to a system scoring the strength of the overall belief (a total score ≥19, strong; 15–18, moderate; and ≤14, weak).Results: Only 34.3% of the women demonstrated strong convictions about gender equity. Even after adjusting for education and ethnicity, the percentage of women who received consistent prenatal care and were delivered at a maternity facility was highest among those scoring 19 or higher, and the reverse was true for women scoring 14 or less.Conclusion: Overall, women in China's rural Xinjiang and Anhui provinces do not hold strong convictions about gender equity. There was a positive correlation between belief in gender equity and use of prenatal and delivery care.

Long-term follow-up of a comprehensive HIV and sexually transmitted infection prevention program for female sex workers in Ningbo, China - Corrected Proof

Hang Hong, Guo-zhang Xu, Dan-dan Zhang — 2010-08-30

Growth of the commercial sex industry has been dramatic in China since the country adopted a free-market economy and an open-door policy in 1978. In 2004, Chinese Public Security estimated that there were 4–10million female sex workers (FSWs) in the country . UNAIDS estimated that there were 127000 FSWs and their clients living with HIV in China in 2005 . The HIV/AIDS epidemic in China has increased from an association with illegal plasma/blood-collecting practices and intravenous drug use to commercial sex work , with sexual transmission now the most common mode of HIV transmission. This has become an increasingly important public health problem in China .

Sexual dysfunction among women of low-income status in an urban setting - Corrected Proof

Brett Worly, Manish Gopal, Lily Arya — 2010-08-30

Abstract: Objective: To determine demographic and clinical conditions associated with sexual dysfunction among women of low-income status living in an urban setting.Methods: Cross-sectional study of 102 consecutive women attending an urban gynecology clinic. Women were given validated questionnaires to measure sexual function, depression, urinary incontinence, and erectile dysfunction in the partner. The association of sexual dysfunction with demographic variables, depression, urinary incontinence, and sexual function in the partner was assessed by the respondent.Results: The prevalence of sexual dysfunction was 37.3% (n=38). Women with sexual dysfunction reported significantly lower scores on all subscales of sexual function compared with women without sexual dysfunction. Women with sexual dysfunction were more likely to be older (33±11.2 vs 28.7±8.6; P<0.04), unemployed (68% vs 47%; P<0.03), and report depression (OR 4.4; 95% CI, 1.7–11.3), urinary urge incontinence (OR 2.7; 95% CI, 1.2–7.3), and intake of multiple medications (OR 5.4; 95% CI, 1.6–20.1). On multivariate analysis, depression and urge urinary incontinence were independently associated with sexual dysfunction.Conclusion: Female sexual dysfunction is associated with the presence of depression and urge urinary incontinence in women of low-income status living in an urban setting.

Adolescent pregnancy outcomes and risk factors in Malaysia - Corrected Proof

2010-08-30

Abstract: Objective: To assess the outcomes and risk factors of adolescent pregnancies in 2 major hospitals in Malaysia.Methods: We conducted a case-control study of pregnant girls aged 10 through 19years. The controls were women aged 20 through 35years who did not become pregnant in their adolescence. Cases and controls were matched for parity and place of delivery. Data were collected from questionnaires and the hospitals’ medical records.Results: The study included 102 cases and 102 controls. There were significant associations between adolescent pregnancy and low education level, low socioeconomic status, being raised by a single parent, not engaging in extracurricular school activities, engaging in unsupervised activities with peers after school, and substance abuse (P<0.05 for all); being anemic, being unsure of the expected delivery date, and having few antenatal visits and a late delivery booking; and low Apgar scores and perinatal complications.Conclusion: Adolescent pregnancies are high-risk pregnancies. Better sexual health strategies are required to address the associated complications.

Fetal growth restriction in Latvia - Corrected Proof

2010-08-19

Fetal growth restriction is defined as the inability of a fetus to maintain expected growth, with estimated fetal weight or actual birth weight below the 10th percentile for gestational age . Up to 70% of such fetuses are constitutionally small but healthy . True fetal growth restriction occurs in 5%–10% of all pregnancies and is associated with significant morbidity and mortality in the perinatal period and infancy .

Prenatal diagnosis of warfarin embryopathy using three-dimensional ultrasound - Corrected Proof

Prerna Gupta, Sunesh Kumar, Kallol K. Roy, Jai Bhagwan Sharma, Neeta Singh — 2010-08-18

The anticoagulant warfarin sodium—which readily crosses the placenta because of its low molecular weight—is responsible for a group of congenital anomalies known as warfarin embryopathy. Nasal hypoplasia and chondroplasia punctata (stippling of the epiphyses) are the 2 most common anomalies that occur following the use of warfarin during pregnancy . Other commonly reported anomalies include cleft lip and/or palate, choanal atresia, hydrocephalus, and intraventricular hemorrhage. Coarctation of the aorta, bilobed lung, and malformed ears have also been reported—albeit rarely . Prenatal diagnosis is difficult, and even high-detail ultrasonography may not detect the anomalies seen after warfarin use. We highlight the use of three-dimensional (3D) ultrasound in a case of suspected warfarin embryopathy.

Effects of method of uterine repair on surgical outcome of cesarean delivery - Corrected Proof

Melike Doğanay, Esra Ayşin Tonguc, Turgut Var — 2010-08-16

Abstract: Objective: To compare the rates of intraoperative and postoperative complications of uterine repair when performed in situ or extra-abdominally following cesarean delivery.Methods: In this prospective randomized study 4925 women who underwent cesarean delivery were randomly assigned to in situ (n=2462) or extra-abdominal (n=2463) uterine repair (group 1 and group 2, respectively). The study compares drop in hemoglobin concentration (as a measure of intraoperative blood loss). It also compares operating time, time to return of bowel sound, and duration of hospitalization as well as rates of uterine atony, blood transfusion, intraoperative complications, additional use postoperative analgesics, endometritis, and wound infection.Results: Uterine atony developed in 96 women (3.8%) in group 1 and 226 women (9.1%) in group 2 (P=0.001). Moreover, the operating time and the time to return of bowel sound were shorter and the rates of both additional use of postoperative analgesics and wound infection were lower in group 1 (P=0.001, P=0.002, P=0.001, and P=0.003, respectively).Conclusion: Fewer cases of uterine atony, a shorter operating time, a faster return of bowel function, a lesser need for postoperative analgesics, and lower rates of additional use of postoperative analgesics and wound infections suggest that in-situ uterine repair ought to be preferred to extra-abdominal uterine repair following cesarean delivery.

Adoption of HPV testing as an adjunct to conventional cytology in cervical cancer screening in Japan - Corrected Proof

Masaki Inoue, Makoto Okamura, Shigeru Hashimoto, Masahiro Tango, Toshihiko Ukita — 2010-08-13

Abstract: Objective: To assess the effectiveness of including HPV testing as an adjunct to conventional cytology in cervical cancer screening.Methods: Atypical epithelial cells (ATC) were classified according to the 2001 Bethesda classification system. The study ran for 6years from May 2004 to November 2009 in conjunction with public cervical cancer screening for Kanazawa City residents. Patients with ATC (ASC-US, ASC-H, and AGC) underwent parallel testing for high-risk HPV types with the Hybrid Capture II system; HPV positive and cytology-ATC cases were recalled for colposcopic examination and biopsied if necessary. Results were compared with those obtained before HPV screening was initiated.Results: A total of 62645 women underwent screening over the 6-year period; of these, 3622 (5.8%) were ATC positive, among whom 527 (14.5%) tested HPV-positive. These 527 women (0.8% of the screened population) were recalled for colposcopic examination. The resulting 426 biopsies were diagnosed as CIN 1 (n=187), CIN 2 (n=53), CIN 3 (n=11), and invasive cervical cancer (n=2).Conclusion: HPV testing as an adjunct to conventional cytology in cervical cancer screening seems to increase detection sensitivity with proven cost-effectiveness.

Urodynamic findings in women with pelvic organ prolapse and obstructive voiding symptoms - Corrected Proof

2010-08-13

Abstract: Objective: To determine whether obstructive voiding symptoms in women with advanced pelvic organ prolapse (POP) were associated with objective bladder outflow tract obstruction.Methods: We reviewed preoperative data from patients with advanced POP who underwent surgical correction at the Department of Obstetrics and Gynecology, Carmel Medical Center, Haifa, Israel, between December 1, 2005, and November 30, 2007. Obstructive voiding symptoms were recorded from Pelvic Floor Distress Inventory-20 questionnaires.Results: Of the 81 women aged 44–80years who were included in the study, 40 (49.4%) reported incomplete bladder emptying preoperatively. There was no significant difference between these women and asymptomatic women in terms of demographic and clinical parameters such as age, parity, and stage of prolapse. Furthermore, there was no significant difference with regard to postvoid residual bladder volume (52.8±65.8 vs 41.6±41.2mL), maximal (23.8±11 vs 21.9±9.6mL/second) and average (10.3±6.2 vs 9.3±4mL/second) urinary flow velocities, prevalence of increased postvoid residual volume (10.0% vs 4.8%), or obstructive urinary flow (17.5% vs 7.3%).Conclusion: Almost half of all women with advanced POP experienced incomplete bladder emptying; however, this symptom did not correlate with objective urodynamic bladder outflow tract obstruction.

Improving quality and safety of maternity care - Corrected Proof

Sir Sabaratnam Arulkumaran — 2010-08-13

Professor Sir Sabaratnam Arulkumaran St Georges Hospital, London, UK

Acute abdomen due to vaginal impalement - Corrected Proof

Philipp Lingohr, Thomas Galetin, Karl Peter Rheinwalt — 2010-08-13

Acute abdomen is a common and often complicated condition in the emergency department. Etiology may vary from harmless to extremely severe causes, any of which can present the same nonspecific symptoms. Impalement or penetrating injuries of the lower genital tract are rare and frequently related to unusual sexual habits . Evaluating the mechanism of trauma may be difficult as patients are often unwilling or unable to provide the necessary information.

Pattern of hepatitis virus infection among pregnant women and their newborns at the Women's Health Center of Assiut University, Upper Egypt - Corrected Proof

Kamal M. Zahran, Mohamad S. Badary, Michael N. Agban, Nafesa H.R. Abdel Aziz — 2010-08-13

Abstract: Objective: To determine the prevalence, risk factors, and rate of vertical transmission of HBV and/or HCV infection among pregnant women in Upper Egypt, and assess the preventive efficacy of administering hepatitis B immunoglobulin and vaccine to newborns on their carrier status at 8months.Methods: Five hundred pregnant women were screened for HCV and HBV serum markers by enzyme-linked immunoassay. Those testing positive had their status confirmed by polymerase chain reaction and their levels of liver enzymes and interferon gamma were evaluated. The newborns of HBV-positive women received hepatitis B immunoglobulin and vaccine and were followed up to assess the rates of vertical transmission and carrier status among the newborns.Results: Of the 500 pregnant women, 6.4% were HCV positive, 4.0% were HBV positive, and 1.0% were both. The vertical transmission rate was 3.1% for HCV, 30.0% for HBV, and 20.0% for a combined infection. The carrier rate of the infants at the end of their eighth month was 10.8% for those with HCV and 8% for those with HBV.Conclusion: Infection with HBV and/or HCV is highly prevalent among pregnant women in Upper Egypt. The rate of vertical transmission was also high. Administering hepatitis B vaccine and immunoglobulin resulted in a 92% reduction in carrier status among newborns.

Partner, workplace, and stranger abuse during pregnancy in Germany - Corrected Proof

Heidi Stöckl, Linda Hertlein, Klaus Friese, Doris Stöckl — 2010-08-13

Abstract: Objective: To investigate the prevalence, perpetrators, sociodemographic correlates, and health impacts of psychological, physical, and sexual abuse during pregnancy among women attending a maternity ward in Germany.Methods: A written questionnaire was given to pregnant women in a maternity ward of a university hospital in Munich. Abuse during pregnancy was assessed using the Abuse Assessment Screen.Results: Of 552 women, 401 completed the questionnaire for a response rate of 72.6%. The prevalence of psychological, physical, or sexual abuse during pregnancy by any perpetrator was 6.7% (n=27); the main perpetrators were women's partners and work colleagues. After controlling for the effect of age, psychological, physical, or sexual abuse during pregnancy was significantly associated with a history of abuse, low education level of the woman and the father of her child, short relationship duration, unintended pregnancy, financial problems caused by the pregnancy, having more than 3 children, and insufficient social support. Women who reported abuse during pregnancy were significantly more likely to smoke and to have adverse maternal health outcomes.Conclusion: Psychological, physical, or sexual abuse during pregnancy was experienced by 1 in 15 women who attended a maternity ward in Munich and adversely affected maternal health outcomes.

Leukocytosis as an initial sign of aggressive growth of granulocyte colony-stimulating factor-producing cervical cancer - Corrected Proof

Maki Yabuta, Kyousuke Takeuchi, Sohei Kitazawa, Hiroki Morita — 2010-08-13

Granulocyte colony-stimulating factor (G-CSF)-induced leukemoid reaction is a rare paraneoplastic syndrome in cervical carcinoma, with rapid tumor progression and poor prognosis . We report two cases of G-CSF-producing squamous cell carcinoma of the cervix, where leukocytosis led to diagnosis of the disease and its recurrence.

Frequency of asthma as the cause of dyspnea in pregnancy - Corrected Proof

2010-08-13

Abstract: Objective: To estimate the prevalence of asthma among pregnant women with dyspnea.Methods: Pregnant women referred for prenatal care visits who had complaints of dyspnea were included. All pregnant women were evaluated by a respiratory specialist. Spirometry was performed by a single trained physician.Results: Asthma was diagnosed in 38.8% of participants. Dyspnea was diagnosed as being physiologic in 36.4% of cases, but 24.8% of cases were of probable asthma (spirometric values were within normal range but symptoms and signs were suggestive of asthma). Cough, wheezing, and post-exercise symptoms were significantly more prevalent in asthmatic and probable-asthmatic women than in women without asthma.Conclusion: Dyspnea in pregnancy can be physiologic, but when it is accompanied by other symptoms such as cough or wheezing it is likely to be caused by asthma. Because of the high prevalence of asthma during pregnancy, it seems logical to evaluate dyspnea via physical examination and response to bronchodilators.

One- and two-day mifepristone–misoprostol intervals for second trimester termination of pregnancy between 13 and 16weeks of gestation - Corrected Proof

Shuping Hou, Lanrong Zhang, Qinfang Chen, Aihua Fang, Linan Cheng — 2010-08-12

Abstract: Objective: To compare the efficacy of 1-day and 2-day mifepristone and misoprostol intervals for second trimester termination of pregnancy between 13 and 16weeks.Methods: A prospective randomized cohort study of 100 women who underwent voluntary termination between 13 and 16weeks of gestation. Patients were randomly assigned to receive 200mg of oral mifepristone, followed 1day (group 1) or 2days (group 2) later by 600μg of vaginal misoprostol. All patients received 400μg of oral misoprostol every 6hours for a maximum of 2doses. Main outcome measure was successful abortion rate at 24hours after the start of misoprostol treatment. Secondary outcome measures were induction-to-abortion interval and frequency of adverse events.Results: The 24-hour successful abortion rate was similar between groups 1 and 2 (47 [94%] vs 50 [100%]; P=0.241). The mean misoprostol-to-abortion interval was also similar (7.0±3.0 vs 6.8±4.3hours; P=0.744). Among the 86 patients for whom histological examination of the products of conception was performed, retained chorionic villi rates were higher in the 1-day regimen group compared with the 2-day regimen group (46.2% [18/39] vs 29.8% [14/47]; P<0.001).Conclusion: A 2-day mifepristone–misoprostol interval resulted in fewer incomplete abortions than a 1-day interval for second trimester termination of pregnancy between 13 and 16weeks.

The legal status of in vitro embryos - Corrected Proof

Bernard M. Dickens, Rebecca J. Cook — 2010-08-12

Abstract: Judicial approaches to stored (cryopreserved) human embryos, in western jurisprudence, tend not to reflect approaches within systems of moral ordering or particular religious traditions, which differ among themselves. The emerging judicial approach is pragmatic, protecting individuals’ rights of control and their interests in parenthood. Embryos are approached instrumentally, not by reference to any inherent characteristics that may be attributed to them outside the law. Political legislatures may adopt religious approaches, such as by prohibiting embryo preservation and limiting how many may be created in an IVF treatment cycle. Legislatures may alternatively set time limits on embryo preservation, however, on expiry of which they must be left to natural degeneration. In treating human embryos as property, courts recognize owners’ powers of voluntary disposition, for instance by gift, but have held back from making financial assessments of their value, for instance on loss, consistently with legislation prohibiting their exchange for payment.

Relationship between umbilical artery Doppler waveform analysis and perinatal prognosis in women with intrahepatic cholestasis of pregnancy - Corrected Proof

Ke Zhang, Jing He, Minyue Dong — 2010-08-12

Intrahepatic cholestasis of pregnancy (ICP), characterized by generalized pruritus, elevation in serum bile acids, and abnormal liver function tests, occurs primarily during the second half of pregnancy and disappears a few days after delivery . ICP is associated with adverse obstetric outcomes, including preterm delivery, fetal distress, and sudden intrauterine fetal death . The role of fetal monitoring in predicting fetal well-being among patients with ICP remains controversial since fetal death may still occur within 24hours of a normal cardiotocograph, a few days or hours after normal antepartum testing, or even during fetal heart rate tracing . Reducing the occurrence of fetal death depends on active management, which may lead to high rates of iatrogenic preterm delivery and low birth weight.

Ovulation Induction in Polycystic Ovary Syndrome: No. 242, May 2010 - Corrected Proof

2010-08-09

Abstract: Objective: To review current non-pharmacologic and pharmacologic options for ovulation induction in women with polycystic ovary syndrome (PCOS).Options: This guideline reviews the evidence for the various options for ovulation induction in PCOS.Outcomes: Ovulation, pregnancy and live birth rates, risks, and side effects are the outcomes of interest.Evidence: Published literature was retrieved through searches of Medline using appropriate controlled vocabulary and key words. Results were restricted to systematic reviews, randomized control trials/controlled clinical trials, and observational studies. Grey (unpublished) literature was identified through searching the websites of health technology assessment and of health technology assessment-related agencies, clinical practice guideline collections, clinical trial registries, and national and international medical specialty societies.Values: The evidence gathered was reviewed and evaluated by the Reproductive Endocrinology and Infertility Committee of the Society of Obstetricians and Gynaecologists of Canada. The quality of evidence was quantified using the Canadian Task Force on Preventive Health Care.Benefits, Harms, and Costs: Benefits include weight reduction and improvements in ovulation, pregnancy, and live birth rates. Potential harms include medication side effects and multiple pregnancies.Validation: These guidelines have been reviewed and approved by the Reproductive Endocrinology and Infertility Committee of the SOGC.Sponsor: The Society of Obstetricians and Gynaecologists of Canada.

Term labor management and outcomes in treated HIV-infected women without contraindications to vaginal delivery and matched controls - Corrected Proof

2010-08-06

Abstract: Objective: To assess labor management and outcomes for treated HIV-infected pregnant women with no obstetric or virologic contraindications to vaginal delivery.Method: A retrospective case-control study was conducted at a single center with 146 treated HIV-infected pregnant women without obstetric or virologic contraindications to vaginal delivery and 146 controls. Cases and controls were matched for parity, previous cesarean delivery, and geographic origin.Results: The mode of delivery was similar in the 2 groups but the episiotomy rate was significantly lower among the HIV-infected women (29.6% vs 45.6%, P=0.01), with no difference in mean birth weight, simple or complex perineal laceration rates or neonatal outcome. Postpartum morbidity was also similar for controls and HIV-infected women with a CD4+ cell count of 200 cells/mL or higher. However, in the study group, postpartum morbidity was higher among those whose CD4+ cell count was lower than this threshold (3.2% vs 22.2%, P=0.007). No case of mother-to-child transmission of HIV occurred.Conclusion: HIV-infected women with no contraindication to vaginal delivery seem to have the same labor outcomes as uninfected women.

Effect of the interval between onset of sustained fetal bradycardia and cesarean delivery on long-term neonatal neurologic prognosis - Corrected Proof

2010-08-05

Abstract: Objective: To examine the effect of the interval between onset of sustained fetal bradycardia and cesarean delivery on long-term neonatal neurologic prognosis.Method: A retrospective observational case-series performed with patients who had sudden-onset and sustained (<100 beats per minute) fetal bradycardia during labor. Fetal heart rate was monitored closely until cesarean delivery. The effect of the interval between the onset of bradycardia and delivery on neonatal neurologic prognosis was examined.Results: Among 2267 deliveries in 2002–2003 at Kitasato University Hospital, 19 pregnancies met the inclusion criteria. Episodes of fetal bradycardia were due to umbilical cord prolapse (n=5), placental abruption (n=4), uterine rupture (n=3), maternal respiratory failure (n=1), and other causes (n=6). Mean onset of fetal bradycardia to delivery interval (BDI) was 20.5±8.9minutes. Mean decision-to-cesarean delivery interval was 11.4±3.9minutes. BDI was negatively correlated with umbilical arterial pH at delivery. There were 3 postnatal deaths. Neurologic assessment at the age of 2years revealed that 15 of 16 children were neurologically normal. When the BDI was less than 25minutes, all term pregnancies led to normal neonatal neurologic development.Conclusion: In the event of sustained intrapartum fetal bradycardia, delivery by emergency cesarean within 25minutes improved long-term neonatal neurologic outcome.

Fetal facial sonographic markers for second trimester Down syndrome screening in a Thai population - Corrected Proof

Ratchadawan Sooklim, Saknan Manotaya — 2010-08-03

Abstract: Objective: To assess the efficacy of using facial sonographic markers for screening fetuses in the second trimester for Down syndrome (DS) in a high-risk Thai population.Method: Frontomaxillary facial angle (FMF) and nasal bone length (NBL) were measured prospectively in pregnant women at high-risk for DS who were undergoing genetic amniocentesis from November 2008 to October 2009. The receiver operator characteristic (ROC) curves were constructed to assess the screening efficacy of FMF angle and NBL.Result: A total of 460 pregnant women were recruited, and a mid-sagittal facial profile was obtained for 403 fetuses. There were 386 fetuses with normal chromosomes, 10 fetuses with DS, 1 fetus with trisomy 13, and 1 fetus with trisomy 18. The remaining 5 fetuses had balanced translocation (n=2), deletion (n=1), and mosaic Turner (n=2). Two different combinations of FMF angle and biparietal diameter to nasal bone length (BPD:NBL) ratio for DS screening in the second trimester achieved 50% and 90% detection rates and 4.4% and 14.0% false positive rates, respectively.Conclusion: The combination of FMF angle and BPD:NBL ratio has a high sensitivity and specificity for screening for DS in the second trimester in a high-risk Thai population.

Postabortion care counseling practiced by health professionals in southeastern Nigeria - Corrected Proof

2010-08-02

Abstract: Objective: To determine the practice of postabortion care (PAC) counseling among healthcare professionals in southeastern Nigeria.Methods: A cross-sectional questionnaire-based survey conducted among healthcare professionals in Anambra State, southeastern Nigeria, in 2006. Participants were chosen using a multi-stage sampling technique. A pre-tested questionnaire assessing the practice of PAC counseling was administered.Results: A total of 431 health professionals were questioned: 270 (62.6%) medical doctors and 161 (37.4%) nurses. Of 302 (70.1%) respondents who reported practicing PAC counseling, only 173 (40.1%) had received formal training. PAC counseling was most commonly practiced by health professionals working in the University Teaching Hospital (90.5%). It was also more commonly practiced by nurses in rural areas compared with nurses working in urban areas (75 [67.6%] vs 24 [48.0%]; P=0.02).Conclusion: A high proportion of health professionals reported practicing PAC counseling. However, less than half had received formal training in PAC counseling. An increased PAC training activity program, with an emphasis on counseling, is recommended for health professionals to improve the overall quality of PAC service delivery.

Screening for cervical neoplasia in Bangladesh using visual inspection with acetic acid - Corrected Proof

2010-08-02

Abstract: Objective: To report the organization and early results of a visual inspection with acetic acid (VIA) screening program for cervical cancer prevention in Bangladesh.Methods: Opportunistic VIA screening was offered by trained medical personnel to healthy women attending healthcare facilities in 44 districts. Colposcopy and/or directed biopsies were performed on VIA-positive women at Bangabandhu Sheikh Mujib Medical University (BSMMU) or medical college hospitals. The numbers of screened and VIA-positive women as well as the results of colposcopy, biopsy, and treatment of those with cervical intraepithelial neoplasia (CIN) attending BSMMU are reported.Results: From January, 2005, to June, 2008, 104098 women underwent VIA screening. Among them, 5013 (4.8%) women were positive, of whom 4371 (87.2%) attended colposcopy clinics in different hospitals. Of the 2188 who underwent colposcopy at BSMMU, 157 were diagnosed with CIN 2–3 and 123 with invasive cancer. For 2065 women (excluding the cancer cases), results for sensitivity, specificity, and positive predictive value of VIA to detect CIN 2–3 lesions were 93.6%, 58.3%, and 15.6%, respectively. Almost half the women with CIN 2 or 3 lesions had treatment.Conclusion: A VIA-based program would facilitate the development of screening, diagnosis, and treatment of cervical neoplasia and improve awareness of cervical cancer prevention in Bangladesh.

Adhesion prevention in gynaecological surgery: No. 243, June 2010 - Corrected Proof

2010-08-02

Abstract: Objectives: To review the etiology and incidence of and associative factors in the formation of adhesions following gynaecological surgery. To review evidence for the use of available means of adhesion prevention following gynaecological surgery.Options: Women undergoing pelvic surgery are at risk of developing abdominal and/or pelvic adhesive disease postoperatively.Surgical technique and commercial adhesion prevention systems may decrease the risk of postoperative adhesion formation.Outcomes: The outcomes measured are the incidence of postoperative adhesions, complications related to the formation of adhesions, and further intervention relative to adhesive disease.Evidence: Medline, EMBASE, and The Cochrane Library were searched for articles published in English from 1990 to March 2009, using appropriate controlled vocabulary and key words. Results were restricted to systematic reviews, randomized control trials/controlled clinical trials, cohort studies, and meta-analyses specifically addressing postoperative adhesions, adhesion prevention, and adhesive barriers. Searches were updated on a regular basis and incorporated in the guideline to March 2009. Grey (unpublished) literature was identified through searching the websites of health technology assessment and health technology assessment-related agencies, clinical practice guideline collections, clinical trial registries, and national and international medical specialty societies.Values: The quality of evidence was rated using the criteria described in the Report of the Canadian Task Force on Preventive Health Care.

Tibolone as a hormone replacement in women with endometriosis after bilateral oophorectomy - Corrected Proof

Anna L. Roberts, Hany Lashen — 2010-07-26

A 40-year-old woman with a history of endometriosis underwent pelvic and abdominal ultrasound for investigation of a fibroid uterus. A right-sided pleural effusion was noted. Upon further questioning, it transpired that the woman had been experiencing right-sided chest pain with menstruation for approximately 18months. Histology of a pleural aspirate revealed scattered mesothelial cells and groups of epithelioid-looking cells forming glandular structures, which enabled a diagnosis of pleural endometriosis.

Bacillary angiomatosis in a pregnant woman - Corrected Proof

2010-07-22

A 32-year-old pregnant woman sought medical care for a skin lesion on her left thumb that had bled for 2months. The lesion appeared at 36weeks in an otherwise-normal pregnancy; it began as a violaceous macular lesion on her thumb, which gradually grew to measure 5mm and bled upon contact. There were no other symptoms. During prenatal care the patient had recorded normal glucose screening and negative serology for HIV, hepatitis B, hepatitis C, cytomegalovirus, toxoplasmosis, and rubella. Patient history included residing in a rural area where cats were ubiquitous, but she denied close contact with them.

Implications of cycle length immediately after discontinuation of combined oral contraceptives on use of the Standard Days Method - Corrected Proof

Marcos Arévalo, Irit Sinai, Bruna Olivotti, Luis Bahamondes — 2010-07-22

Abstract: Objective: To determine when after discontinuing the use of combined oral contraceptives (COC) women can start using the Standard Days Method (SDM)—a fertility awareness-based family-planning method that is appropriate only for women for whom most menstrual cycles last 26–32days.Methods: We reviewed data from the medical records of women who attended the Human Reproduction Unit at the University of Campinas, Brazil, between October 16, 1979, and May 5, 2006. The study population comprised women younger than 40years of age who had recently switched from COC to copper intrauterine devices and whose clinical records contained the information necessary for determining the length of the first menstrual cycle immediately after discontinuing COC.Results: In total, 47.2% of the 2845 women included in the study had a first post-COC cycle of 26–32days; 40.5% had a second cycle within that range.Conclusion: A first post-COC cycle within the 26–32-day range did not predict a second cycle within range. Women discontinuing COC should not start using the SDM in their first or second post-COC cycle, even if the first cycle falls within the stated range. Instead, they should use a backup method until they meet the necessary eligibility criteria.

Levator ani injury in primiparous women with forceps delivery for fetal distress, forceps for second stage arrest, and spontaneous delivery - Corrected Proof

2010-07-22

Abstract: Objective: To compare levator ani muscle injury rates in primiparous women who had a forceps delivery owing to fetal distress with women delivered by forceps for second stage arrest; and to compare these injury rates with a historical control group of women who delivered spontaneously.Methods: Primiparous women who delivered by forceps were recruited retrospectively into 2 groups: forceps for fetal distress with short second stage (25±11minutes; n=19); and forceps delivery for second stage arrest (137±26minutes; n=19). MR images of the levator ani muscles were compared with a historical control group of women from a previous study who had delivered spontaneously (n=129).Results: Major defect rates were: 42% for forceps and short second stage; 63% for forceps and second stage arrest; and 6% for spontaneous delivery. The odds ratios for major injury were: 11.0 for forceps and short second stage compared with spontaneous delivery; 25.9 for forceps and second stage arrest compared with spontaneous delivery; and 2.3 for forceps and second stage arrest compared with short second stage (P=0.07).Conclusion: Women delivered by forceps have a higher rate of levator ani injury compared with spontaneous delivery controls; the difference between the forceps groups did not reach significance.

Active management of the third stage of labor and eclampsia management as critical components of skilled care during birth in Cambodia - Corrected Proof

Jerker Liljestrand, Judith Moore, Maya Tholandi — 2010-07-22

For 10years, the level of maternal mortality in Cambodia has remained at approximately 470 maternal deaths per 100000 live births . The 2 primary causes of maternal death in Cambodia are postpartum hemorrhage and eclampsia, which together account for more than 50% of maternal deaths .

Safety of the loop electrosurgical excision procedure performed by clinical officers in an HIV primary care setting - Corrected Proof

Megan J. Huchko, May Maloba, Elizabeth A. Bukusi — 2010-07-14

The increasing availability of HIV clinics providing highly active antiretroviral therapy (HAART) has dramatically reduced AIDS-related morbidity and mortality in resource-limited settings. However, the impact of HAART on development and progression of cervical neoplasia and invasive cervical cancer remains uncertain . The longer life expectancy among HIV-infected women receiving HAART may actually increase the overall risk for cervical cancer, underscoring the need for prevention strategies for this high-risk population. A potentially cost-effective way of providing this “primary” care may be through HIV clinics, which are generally well staffed and have more resources than government or private clinics . In addition to utilizing the staffing and infrastructure in place to provide HIV care and HAART, incorporating cervical cancer screening into an HIV clinic visit may increase screening uptake and follow up.

Hysterotomy and evacuation of a deciduate placental hematoma following placental abruption - Corrected Proof

Grzegorz Raba, Jan Kotarski — 2010-07-12

Placental abruption occurs in about 1% of births and is a primary cause of perinatal mortality, especially of premature neonates . Mild forms of placental abruption can be self-limiting and treated safely using conservative methods . Severe cases require management, which is often premature delivery by cesarean . We describe two patients in whom hysterotomy and evacuation of a deciduate placental hematoma was carried out as an alternative to cesarean to allow further intrauterine development of the fetus.

Endometrial ablation as a treatment for postmenstrual bleeding due to cesarean scar defect - Corrected Proof

Yu-Hung Lin, Jiann-Loung Hwang, Kok-Min Seow — 2010-07-12

A less well-known complication of cesarean delivery is postmenstrual bleeding due to a defect of the cesarean scar. Successful use of endometrial ablation to treat this condition is reported.

Liver transplantation for spontaneous hepatic rupture associated with HELLP syndrome - Corrected Proof

Giovanni Varotti, Enzo Andorno, Umberto Valente — 2010-07-09

Hemolysis, elevated liver enzymes, and low platelet count, known collectively as HELLP syndrome, was first described by Weinstein in 1982 . This rare disease is defined by laboratory levels of aspartate transaminase (AST) and alanine transaminase (ALT) greater than 70U/L, platelet count less than 100000/μL, and lactate dehydrogenase (LDH) greater than 600U/L.

Clinical use of magnetic resonance imaging for the evaluation of abdominal pain during pregnancy - Corrected Proof

Gavin Low, Cinzia Crawley — 2010-07-09

A 35-year-old woman presented at 28weeks of pregnancy with acute right-lower-quadrant abdominal pain and tenderness. Ultrasound examination was inconclusive. Magnetic resonance imaging (MRI) showed a fat-containing mass on the right ovary (), with twisting and enlargement of its vascular pedicle, consistent with torsion of a dermoid cyst. Diagnosis was confirmed during emergency surgery.

Vaginal pH versus cervical length in the mid-trimester as screening predictors of preterm labor in a low-risk population - Corrected Proof

Ratko Matijevic, Ozren Grgic, Mario Knezevic — 2010-07-08

Abstract: Objective: To assess the accuracy of a sign of bacterial vaginosis and a sign of cervical insufficiency in predicting preterm labor (PTL, occurring in the 37th week or earlier) and early PTL (occurring in the 34th week or earlier) in a low-risk cohort of 316 pregnant women.Method: Vaginal pH was assessed using test gloves and cervical length (CL) was measured by transvaginal ultrasound. A pH value less than 5.0 (the 95th-percentile threshold) and a CL greater than 26mm (the 5th-percentile threshold) were considered normal.Results: There were 14 participants (4.4%) with an elevated vaginal pH and 15 (4.7%) with a shortened CL. The incidence of PTL (<37weeks) was 7.2%, while incidence of early PTL (≤34weeks) was 2.5%. A shortened CL was significantly correlated with PTL (likelihood ratio [LR] weighted by prevalence; 2.7; 95% CI, 1.1–6.7) but not with early PTL (LR, 0.8; 95% CI, 0.4–1.8). An elevated vaginal pH was a better predictor of PTL (LR, 3.7; 95% CI, 1.3–10.4) and early PTL (LR, 1.7; 95% CI, 1.1–3.1).Conclusion: An elevated vaginal pH was a better predictor of early PTL than a shortened CL in this cohort of pregnant women at low risk.

Influence of training in the use and generation of evidence on episiotomy practice and perineal trauma - Corrected Proof

2010-07-05

Abstract: Objective: To examine episiotomy practices before and after a multi-component intervention designed to support the use and generation of research evidence in maternal and neonatal health care.Methods: Set in 9 centers across 4 Southeast Asian countries, a retrospective survey was performed for 12 recommended pregnancy/childbirth practices and 13 outcomes of women in each center before and after intervention. Qualitative interviews were conducted to assess staff awareness and experience in evidence-based practice.Results: There were significant decreases in the rate of episiotomy, from 64.1% to 60.1% (risk difference [RD] –4.0; 95% confidence interval [CI], –5.8 to –2.2) for all women and from 92.2% to 80.7% (RD –11.5; 95% CI, –13.4 to –9.6) for nulliparous women. Severe trauma decreased from 3.9% to 1.9% (RD –2.0; 95% CI, –2.7 to –1.4) for all women and from 6.7% to 3.0% (RD –3.7; 95% CI, –4.9 to –2.5) for nulliparous women. The frequency of intact perineum increased from 12.4% to 15.6% (RD 3.2; 95% CI, 1.9–4.6) for all women and from 1.7% to 8.0% (RD 6.3; 95% CI, 5.0–7.5) for nulliparous women.Conclusion: An intervention based on understanding and using the best available evidence can result in significant improvements in care and health outcomes.

Uterine massage to reduce postpartum hemorrhage after vaginal delivery - Corrected Proof

2010-07-05

Abstract: Objective: To determine the effectiveness of sustained uterine massage started before delivery of the placenta in reducing postpartum hemorrhage.Methods: A randomized controlled trial conducted in Egypt and South Africa between September 2006 and February 2009. A total of 1964 pregnant women were randomly allocated to 1 of 3 treatment groups: intramuscular oxytocin, sustained uterine massage, or both treatments. Blood loss within 30minutes of delivery was recorded.Results: The incidence of blood loss of 300mL or more within 30minutes of delivery was significantly higher in the massage group than in the massage plus oxytocin (RR 1.88; 95% CI, 1.29–2.74 in Assiut, and RR 1.3; 95% CI, 1.00–1.68 in SA) and the oxytocin only group (RR 1.7; 95% CI, 1.11–2.61 in Assiut, and RR 2.24; 95% CI, 1.54–3.27 in SA). In both centers, use of additional uterotonics was significantly higher in the uterine massage group compared with the other 2 groups.Conclusion: Uterine massage was less effective than oxytocin for reducing blood loss after delivery. When oxytocin was used, there was no additional benefit from uterine massage. The effectiveness of uterine massage in the absence of oxytocin was not studied. ACTRN: 12609000372280.

Prevention of nausea and vomiting during termination of pregnancy - Corrected Proof

Yoshitaka Fujii — 2010-07-05

Abstract: Background: Postoperative nausea and vomiting (PONV) is common in women undergoing dilatation and curettage under general anesthesia for pregnancy termination, and many studies suggest treating these women prophylactically for PONV.Objectives: Reviewing the antiemetics used over the past 20years for this indication and comparing their efficacy.Search strategy: We performed MEDLINE and EMBASE searches for articles published from January 1980 through June 2009. The search terms were complications, nausea, vomiting, antiemetics, anesthetics, surgery, dilatation, curettage, pregnancy, and women.Selection criteria: We selected the studies of the antiemetics droperidol, metoclopramide, hydroxyzine, propofol, dexamethasone, ondansetron, and ramosetron when used for the stated indication. When assessing drug efficacy, we compared the antiemetics used at the time the article was written.Data collection and analysis: We reviewed the selected studies, presented the reported incidence rates of PONV for each drug, and presented and interpreted the P values reported for the different comparisons.Main results: Although all antiemetics assessed decreased the incidence of PONV, the combination of dexamethasone and droperidol seems to be the most effective in preventing PONV.Conclusions: All antiemetics used in the last 20years to prevent PONV are effective (some more than others) in women undergoing dilatation and curettage for pregnancy termination. However, there is a need for benefit and risk analyses of the different treatments.

Pregnancy outcomes among patients infected with pandemic H1N1 influenza virus in Shiraz, Iran - Corrected Proof

2010-07-05

The pandemic H1N1 2009 influenza virus caused a widespread outbreak of febrile respiratory infection with symptoms of mild to moderate severity in large proportions of infected patients . Pregnant women are at an increased risk of developing severe diseases owing to changes to the respiratory, cardiovascular, and immune systems . These women, especially in the second and third trimesters of pregnancy, and their fetuses/neonates should be managed carefully since they are susceptible to severe outcomes of the infection, including neural tube defects, spontaneous abortion, preterm delivery, intrauterine fetal death, severe pneumonia (primary viral or secondary bacterial), acute respiratory distress syndrome, respiratory failure, maternal mortality, and postpartum complications . Early diagnosis and treatment of suspected infection in pregnant women is vital . The aim of the present study was to describe the demographic, clinical, and laboratory characteristics of pregnant patients with laboratory-confirmed pandemic H1N1 influenza virus in Shiraz, Iran.

Performance of cryotherapy devices using nitrous oxide and carbon dioxide - Corrected Proof

2010-06-28

Abstract: Objective: To compare temperatures reached by 4 different cryotherapy devices commonly used to treat precancerous cervical lesions in low-resource countries using nitrous oxide (N2O) and carbon dioxide (CO2) as well as with and without a gas conditioner.Methods: Bench testing was conducted using 4 different cryotherapy devices and locally obtained N2O and medical- and industrial-grade CO2 refrigerant with and without a gas conditioner. A thermocouple was used to continuously measure the temperature of the cryotherapy tip. Comparison across the cryotherapy devices was based on the mean and lowest temperatures.Results: Without the gas conditioner, all of the devices tested reached mean temperatures colder than –50°C with N2O, although 2 devices reached warmer temperatures in a proportion of N2O tests. Only 2 of the devices reached mean temperatures colder than –50°C with CO2. One-way analysis of variance identified the device as the dominant factor for the temperature differences, while the gas was not a determinant of temperature variation. The gas conditioner hindered the performance of 2 of the devices, and only improved the performance of 1 device.Conclusion: Both N2O and CO2 reach appropriate freezing temperatures with some cryotherapy devices. Performance of some cryotherapy devices is suboptimal.

Variant anatomy of the uterine artery in a Kenyan population - Corrected Proof

Moses M. Obimbo, Julius A. Ogeng'o, Hassan Saidi — 2010-06-28

Abstract: Objective: To investigate the uterine artery's origin, branching patterns, and relation to the ureter in a Kenyan population.Method: The uterine arteries of the bodies of 53 girls and women were dissected at the University of Nairobi Department of Human Anatomy to study these patterns. Data were analyzed for frequency and the patterns are presented via digital macrographs.Results: The uterine artery consistently originated as a branch of the internal iliac artery. It formed the second or third branch of the anterior trunk in 70.8% of cases; it ascended as a single branch, or from a bifurcation, or from a trifurcation in 76.4%, 17.1%, and 6.7% of cases; and lay posterior to the ureter in 3.8% of cases. In all, 46.2% of the uterine arteries studied varied from the classic description.Conclusion: About half of the uterine arteries had a nonclassic origin, branching pattern, or relation to the ureter—as a posterior relation to the ureter had not been previously described. Surgeons operating in the pelvis should be aware of this variant anatomy to avoid injury to the ureter and other organs.