International Journal of Gynecology & Obstetrics - Articles in Press

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.

A comparative study of the non-pneumatic anti-shock garment for the treatment of obstetric hemorrhage in Egypt - Corrected Proof

2010-01-25

Abstract: Objective: To assess the impact of the non-pneumatic anti-shock garment (NASG) on maternal outcome following severe obstetric hemorrhage.Methods: A non-randomized pre-intervention/intervention study was conducted in 2 tertiary hospitals in Egypt from June 2006 to May 2008. Women with obstetric hemorrhage (estimated blood loss ≥1000mL and/or ≥1 sign of shock [systolic blood pressure <100mm Hg or pulse >100 beats per minute]) were treated with either a standardized protocol (pre-intervention) or a standardized protocol plus the NASG (intervention). The primary outcome was extreme adverse outcome (EAO), combining maternal mortality and severe morbidity (cardiac, respiratory, renal, or cerebral dysfunction). Secondary outcomes were measured blood loss, urine output, emergency hysterectomy, and (individually) mortality or morbidity. Analyses were performed to examine independent association of the NASG with EAO.Results: Mean measured blood loss decreased from 379mL pre-intervention to 253mL in the intervention group (P<0.01). In a multiple logistic regression model, the NASG was associated with reduced odds of EAO (odds ratio 0.38; 95% confidence interval, 0.17–0.85).Conclusion: The NASG, in addition to standardized protocols at tertiary facilities for obstetric hemorrhage and shock, resulted in lower measured blood loss and reduced EAO.

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.

Social and therapeutic challenges of pelvic floor dysfunction - Corrected Proof

Bozo Kralj — 2010-01-20

Bozo Kralj, MD. School of Health Sciences, Novo Mesto, Slovenia Professor Bozo Kralj graduated from the Faculty of Medicine, University of Ljubljana, Slovenia, in 1956 and received a PhD degree from the same faculty in 1974. He became Full Professor of Obstetrics and Gynecology (1990) and Director of the University Department of Obstetrics and Gynecology, Ljubljana (1991–1999). Professor Kralj subsequently became the Dean of the High School of Health Sciences in Ljubljana and Novo Mesto, Slovenia. He was president of the Slovene Society of Obstetricians and Gynecologists (1994–2005), and vice president (1985–1988) and president (1988–1990) of the International Urogynecological Association (IUGA). He is an honorary member of the Italian, Slovak, Slovene, and Macedonian Society of Obstetricians and Gynecologists. Professor Kralj has published over 220 professional and scientific articles and acts on the editorial boards of several international medical journals. He has been awarded numerous decorations for his professional work, including the IUGA award for lifetime achievement in 2009. Professor Kralj was a member of the FIGO Scientific Board from 1997–2000, and a member of the FIGO Executive Board from 2003–2009.

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.

Community-based distribution of misoprostol for treatment or prevention of postpartum hemorrhage: Cost-effectiveness, mortality, and morbidity reduction analysis - Corrected Proof

Tori Sutherland, Carinne Meyer, David M. Bishai, Stacie Geller, Suellen Miller — 2010-01-15

Abstract: Objective: To compare the cost-effectiveness of community-based distribution of misoprostol for prevention with misoprostol for treatment of postpartum hemorrhage (PPH).Methods: A Monte Carlo simulation depicted mortality and anemia-related morbidity attributable to PPH among 3 scenarios of 10000 women delivering at home in rural India: (1) standard management; (2) standard management plus 800µg of sublingual misoprostol for PPH treatment; and (3) standard management plus 600µg of prophylactic oral misoprostol. The model included costs of drugs, birth attendant training, and transport for women who did not respond to misoprostol.Results: Misoprostol lowered mortality by 70% and 81% in scenarios 2 and 3, respectively. Scenarios 2 and 3 raise costs by 6% and 35%, respectively. Incremental cost per disability-adjusted life year (DALY) saved is estimated at $6 and $170, respectively.Conclusion: Both interventions were more effective at decreasing mortality and anemia than standard management. The most efficient scale-up plan would focus initially on increasing coverage with the treatment strategy ($6 per DALY).

Knowledge of correct dosages of misoprostol in reproductive health - Corrected Proof

Nishigandh Deole, Andrew Weeks — 2010-01-14

The prostaglandin E1 analog misoprostol is a powerful uterotonic that is effective for labor induction, uterine evacuation, and prevention and treatment of postpartum hemorrhage . Its low cost and ease of storage/administration make it ideally suited to use in low-resource settings. The patent holder has never applied to get a license for any of these indications and, consequently, misoprostol is used off-label in most countries. Furthermore, dosage regimens are complex because they vary by indication, gestation, and route of administration; there is therefore potential for the dangerous use of incorrect doses. To address this issue, a WHO-convened expert group met in Bellagio, Italy, in 2007 to create dosage guidelines (), which were adopted by FIGO in 2009.

Rectally administered misoprostol versus intravenous oxytocin infusion during cesarean delivery to reduce intraoperative and postoperative blood loss - Corrected Proof

Picklu Chaudhuri, Gita Basu Banerjee, Apurba Mandal — 2010-01-13

Abstract: Objective: To compare the efficacy of rectally administered misoprostol with intravenous oxytocin infusion in preventing uterine atony and blood loss during cesarean delivery.Methods: In this prospective, randomized, double-blind trial, 200 women undergoing cesarean delivery who did not have risk factors for postpartum hemorrhage were randomly allocated to receive either 800µg of rectal misoprostol at the time of peritoneal incision or an intravenous infusion of oxytocin after delivery of the neonate. Primary outcome measures were estimated amount of intraoperative and postoperative (8hours) blood loss and changes in hemoglobin levels 24hours after delivery.Results: A total of 96 and 94 women were analyzed in the misoprostol and oxytocin groups, respectively. Intraoperative and postoperative blood loss was significantly lower in the misoprostol group than in the oxytocin group (503 vs 592mL, P=0.003 and 74 vs 114mL, P=0.045, respectively). The incidence of shivering was higher in the misoprostol group (8.3% vs 1.1%, P=0.018; RR 7.83; 95% confidence interval, 0.99–61.42).Conclusion: Rectal misoprostol appears to be an effective alternative to intravenous oxytocin in preventing blood loss for routine use during cesarean delivery. Clinical Trials Registration: CTRI/2009/091/000075.

Granuloma gravidarum (pyogenic granuloma) treated with periodontal plastic surgery - Corrected Proof

Luis Eduardo R. da Nova Cruz, Josué Martos — 2010-01-13

Granuloma gravidarum (pyogenic granuloma) is a benign lesion that affects mainly the gingival mucosa, but also the skin and other mucosa. It is generally associated with periodontal disease, and inflammatory and hormonal factors such as pregnancy . The lesion is characterized by localized polypoid growth that is exophytic, sessile or pedicled, erythematous or brownish, and usually ulcerated—in addition to spontaneous bleeding. The surface color of oral pyogenic granuloma varies depending on the age of the lesion .

Fertility outcome following transvaginal cervicoisthmic cerclage using a polypropylene sling - Corrected Proof

2010-01-13

Abstract: Objective: To report fertility and pregnancy outcomes following transvaginal cervicoisthmic cerclage with a polypropylene sling during a previous pregnancy.Methods: A continuous series of 57 women who underwent prophylactic cervicoisthmic cerclage during a previous (reference) pregnancy were enrolled. Telephone interviews were carried out to evaluate each patient's subsequent fertility.Results: Among the 57 women interviewed, 8 had an inadequate follow-up, 13 women were lost to follow-up, 1 woman required a hemostatic hysterectomy, and 2 women required removal of the sling. Nineteen women did not desire a subsequent pregnancy. Of the 14 women who did desire a subsequent pregnancy, 1 woman had previously known tubal infertility. Of the 13 remaining women, 7 subsequently became pregnant. One woman had a spontaneous abortion (11weeks of pregnancy); 1 woman delivered at 22weeks of pregnancy, after a spontaneous premature membrane rupture; 1 woman had a cesarean delivery at 25weeks of pregnancy; and 4 patients had a cesarean delivery after 37weeks of pregnancy. Median duration of the 4 subsequent pregnancies at delivery was 37weeks (interquartile range [IQR], 37–38weeks). Median birth weight was 3040g (IQR, 2500–3250g).Conclusion: Subsequent pregnancy is possible after transvaginal cervicoisthmic cerclage using a synthetic sling.

Single access laparoscopy for adnexal pathologies using a novel reusable port and curved instruments - Corrected Proof

Liliana Mereu, Stefano Angioni, Gian Benedetto Melis, Luca Mencaglia — 2010-01-13

Abstract: Objective: To present our initial experience using single access laparoscopic surgery for the treatment of benign adnexal pathologies.Methods: Sixteen patients with benign adnexal pathologies underwent salpingoophorectomy (n=9), ovarian cyst enucleation (n=5), or salpingectomy (n=2) using a laparoendoscopic single site approach with a new multiport reusable trocar and flexible and curved—as well as standard—laparoscopic instruments.Results: Conversion to a multi-access standard laparoscopic technique was not required in any patient and no intraoperative complications were observed. Postoperatively, one umbilical scar infection was detected. Mean operative time was 42minutes.Conclusion: Laparoscopic single site enucleation for adnexal pathologies is feasible, safe, and effective, and has good results for cosmetic appearance and postoperative pain. Use of specialized instruments and standardization of the technique affect surgical ergonomy and operating time.

Cell-free placental mRNA in maternal plasma to predict placental invasion in patients with placenta accreta - Corrected Proof

Manal M. El Behery, Etewa Rasha L., Yehya El Alfy — 2010-01-13

Abstract: Objective: To evaluate whether measuring cell-free placental mRNA in maternal plasma improves the diagnostic accuracy of ultrasound and color Doppler in detecting placental invasion in patients at risk for placenta accreta.Methods: Thirty-five singleton pregnant women of more than 28weeks of gestation and at risk for placenta accreta underwent ultrasound and color Doppler assessment. Cell-free placental mRNA in maternal plasma was measured using real-time reverse-transcription polymerase chain reaction. Patients were classified into 2 groups based on the findings at cesarean delivery and histological examination: women with placenta accreta (n=7) and women without placenta accreta (n=28).Results: The median MoM (multiples of the median) value of cell-free placental mRNA was significantly higher in patients with placenta accreta than in those without placenta accreta (6.50 vs 2.60; P<0.001. Moreover, cell-free placental mRNA was significantly elevated in patients with placenta increta and percreta than in those with simple accreta. Six false-positive results were found on ultrasound, all from patients without placenta accreta and an insignificant rise in cell-free placental mRNA levels.Conclusion: Measuring cell-free placental mRNA in maternal plasma may increase the accuracy of ultrasound and color Doppler in prenatal prediction of placental invasion in patients with suspected placenta accreta.

The B-Lynch uterine brace suture, and a bit of this and a bit of that… - Corrected Proof

Mahantesh Karoshi — 2010-01-13

Abstract: The widespread application of the B-Lynch brace suture to control postpartum hemorrhage has sparked interest in a variety of adjunctive methods, used alone or in combination, to control uterine bleeding. Although the B-Lynch brace suture has been used with good results throughout the world, failures can and do occur in rare instances, especially when the suture is incorrectly placed for use for an inappropriate indication. Four reports of additional methods to control postpartum hemorrhage are published in this issue of IJGO. Three use the B-Lynch brace suture combined with other techniques. The need for additional techniques reminds the reader of the importance of proper suture application for proper indication. Potential reasons for failure of the B-Lynch suture are provided.

Tuberculosis in association with HIV/AIDS emerges as a major nonobstetric cause of maternal mortality in Sub-Saharan Africa - Corrected Proof

2010-01-13

Abstract: Every year, approximately 250000 African women die during pregnancy, delivery, or the puerperium. Maternal mortality rates due to infectious diseases in Sub-Saharan Africa now supersede mortality from obstetric causes. Evidence is accumulating that tuberculosis associated with HIV/AIDS, malaria, sepsis, and other opportunistic infections are the main infectious causes of maternal deaths. Screening for these killer infections within prenatal healthcare programs is essential at this stage to prevent and treat causes of maternal mortality. The combination of proven effective interventions that avert the greatest number of maternal deaths should be prioritized and expanded to cover the greatest number of women at risk, and incorporated into a “prophylaxis and treatment community package of care.” The effectiveness of these “packages of care” will need to be determined subsequently. Maternal deaths from tuberculosis are now on the increase in the UK, and due diligence and watchful surveillance are required in European prenatal services.

José Barzelatto lecture: Vision on unsafe abortion - Corrected Proof

Anibal Faúndes — 2010-01-12

Abstract: José Barzelatto first distinguished himself as a leader with a vision in his years as a medical student. Later, principally as Director of the Reproductive Health Program at the World Health Organization and of the Ford Foundation program for women's sexual and reproductive rights, he contributed immensely toward the recognition of women's sexual and reproductive rights as part of their basic human rights. José Barzelatto's vision on abortion reflects his drive to promote social justice and respect individual rights, respect diversity, and promote a social consensus for a peaceful society. He believed that the fetus has moral value and did not accept abortion as a method of fertility control, but understood that abortion is a social phenomenon that cannot be changed with legal or moral condemnation. He accepted that condemning women who abort does not prevent abortion, is unfair, and causes great human suffering at a high social cost. José proposed nine points to form the basis for an overlapping consensus on abortion, on which to base a practical consensus that would allow societies to reduce the number of abortions and minimize their consequences. If we can agree on all or most of those points we would achieve the common objectives of: fewer women confronting the dilemma of how to deal with an unwanted pregnancy; fewer induced abortions; and fewer women suffering the consequences of unsafe abortion.

Uterotonic use at home births in low-income countries: A literature review - Corrected Proof

Dawn Flandermeyer, Cynthia Stanton, Deborah Armbruster — 2010-01-06

Abstract: Objectives: This literature review compiles data on rates of use, indications, types of provider, mode of administration, and dose of uterotonics used for home births in low-income countries, and identifies gaps meriting further research.Methods: Published and unpublished English language articles from 1995 through 2008 pertaining to home use of uterotonics were identified via electronic searches of medical and social science databases. In addition, bibliographies of articles were examined for eligible studies. Data were abstracted and analyzed by the objectives outlined for this review.Results: Twenty-three articles met the inclusion/exclusion criteria. Use rates of uterotonics at home births ranged widely from 1% to 69%, with the large majority of observations from South Asia. Descriptive studies suggest that home use of uterotonics before delivery of the baby are predominantly administered by nonprofessionals to accelerate labor, and are not perceived as unsafe.Conclusions: To achieve maximum benefit and minimal harm, programs that increase access to uterotonics for postpartum hemorrhage prevention must take into account existing practices among pregnant women. Further research regarding access to uterotonics and intervention studies for provider behavior change regarding uterotonic use is warranted.

Editor's Comment - Corrected Proof

Judith A. Fortney — 2010-01-06

The use of uterotonics for home births is an idea whose time has come. When I first began to work in this field some 35years ago, wiser minds than mine had already been thinking along these lines. Yet despite the importance of postpartum hemorrhage (PPH) as the leading cause of maternal death, the idea didn't—couldn't—fly because the uteronics in question were oxytocin and ergometrine, neither of which is suitable for a variety of reasons. Very real concerns included the fear of misuse by traditional birth attendants, how the drugs should be administered, and the inability to store these substances under suitable conditions.

Prevention of postpartum hemorrhage at home birth in Afghanistan - Corrected Proof

2010-01-06

Abstract: Objective: To test the safety, acceptability, feasibility, and effectiveness of community-based education and distribution of misoprostol for prevention of postpartum hemorrhage at home birth in Afghanistan.Methods: A nonrandomized experimental control design in rural Afghanistan.Results: A total of 3187 women participated: 2039 in the intervention group and 1148 in the control group. Of the 1421 women in the intervention group who took misoprostol, 100% correctly took it after birth, including 20 women with twin pregnancies. Adverse effect rates were unexpectedly lower in the intervention group than in the comparison group. Among women in the intervention group, 92% said they would use misoprostol in their next pregnancy. In the intervention area where community-based distribution of misoprostol was introduced, near-universal uterotonic coverage (92%) was achieved compared with 25% coverage in the control areas.Conclusion: In Afghanistan, community-based education and distribution of misoprostol is safe, acceptable, feasible, and effective. This strategy should be considered for other countries where access to skilled attendance is limited.

Sublingual misoprostol for first trimester termination of pregnancy - Corrected Proof

2010-01-06

Abstract: Objectives: To compare blood loss, efficiency, and acceptability of repeated doses of sublingual misoprostol with the standard Tunisian regimen of mifepristone–misoprostol for first trimester medical abortion.Methods: A prospective randomized trial of 252 healthy pregnant women requesting medical abortion in the first trimester (up to 56days). Participants were randomized to receive 200mg of oral mifepristone followed by 400µg of oral misoprostol (group 1) or 800µg of sublingual misoprostol repeated every 4hours for up to a maximum of 3doses (group 2). Primary outcome was blood loss assessed by decrease in hematocrit.Results: Mean decrease in hematocrit at follow-up was significantly greater in group 1 than in group 2 (3.65%±1.18% vs 2.69%±1.89%, respectively; P=0.02). There was no difference in efficiency rates between groups 1 and 2 (94.5% vs 92.1%; P=0.7). Comparable proportions of women experiencing at least one adverse effect after misoprostol administration were reported in groups 1 and 2 (81.7% vs 79.4%; P=0.75).Conclusion: Compared with the most widely used regimen in Tunisia (mifepristone–misoprostol), sublingual misoprostol alone induces less blood loss (although not clinically significant); it is less expensive and offers reduced interval time to expulsion.

Hysterosalpingographic evaluation of 998 consecutive infertile women in Jos, Nigeria - Corrected Proof

Jonathan A. Karshima, Patrick H. Daru, John E. Ekedigwe — 2010-01-05

Infertility remains a major health problem in Nigeria—with distressing psychosocial implications for the couple, and emotional and physical repercussions for the woman . The World Health Organization study of the etiology of infertility and studies from southwestern Nigeria have shown the preponderance of infection-related tuboperitoneal disease, with resultant tubal occlusion, to be the major cause of infertility in women. Hysterosalpingography (HSG) has widely replaced Rubin's test for assessing tubal patency in infertile women, and is routinely performed on women evaluated for infertility at Jos University Teaching Hospital (JUTH), Jos, Nigeria. The aim of the present study was to determine the pattern of HSG findings among infertile women in central Nigeria.

Japanese single women have limited knowledge of age-related reproductive time limits - Corrected Proof

2009-12-30

In 2007, the total fertility rate in Japan decreased to 1.34, compared with 2.10 in the USA. This decline in fertility is partly due to increased age at marriage and delay in childbearing. Increased maternal age is associated with an increased risk of infertility, miscarriage, and poor pregnancy outcome . A 1986 study found that the percentage of women who did not use contraception and remained childless increased steadily according to age at marriage (6% among 20–24-year-old women compared with 64% among 40–44-year-old women) . The miscarriage rate rose from 14% among patients younger than 35years of age to 40% among those older than 40years of age . The average childbearing age in Japan has increased over the past 3decades as more women have postponed marriage to pursue higher education and careers.

Expanding uterotonic protection following childbirth through community-based distribution of misoprostol: Operations research study in Nepal - Corrected Proof

2009-12-25

Abstract: Objective: To determine feasibility of community-based distribution of misoprostol for preventing postpartum hemorrhage (PPH) to pregnant woman through community volunteers working under government health services.Methods: Implemented in one district in Nepal. The primary measure of performance was uterotonic protection after childbirth, measured using pre- and postintervention surveys (28 clusters, each with 30 households). Maternal deaths were ascertained through systematic health facility and community-based surveillance; causes of death were assigned based on verbal autopsy.Results: Of 840 postintervention survey respondents, 73.2% received misoprostol. The standardized proportion of vaginal deliveries protected by a uterotonic rose from 11.6% to 74.2%. Those experiencing the largest gains were the poor, the illiterate, and those living in remote areas.Conclusion: Community-based distribution of misoprostol for PPH prevention can be successfully implemented under government health services in a low-resource, geographically challenging setting, resulting in much increased population-level protection against PPH, with particularly large gains among the disadvantaged.

Use of intrauterine devices in women with uterine anatomic abnormalities - Corrected Proof

Naomi K. Tepper, Lauren B. Zapata, Denise J. Jamieson, Kathryn M. Curtis — 2009-12-25

Abstract: Objective: To examine the evidence regarding the safety and effectiveness of intrauterine devices (IUDs) in women with uterine abnormalities.Methods: We searched PubMed for all peer-reviewed articles in any language that had been published on the topic from database inception to September 2009. Primary research articles were included if they addressed the safety or effectiveness of any type of IUD among women with Müllerian anomalies or uterine synechiae.Results: In total, 19 case reports or case series met the inclusion criteria. Reported complications included expulsion, pregnancy, bleeding, perforation, and pain. In several case reports, no complications were reported.Conclusion: Evidence concerning the safety and effectiveness of IUD use among women with uterine abnormalities is very limited.

Consequences of delay in obstetric care for maternal and perinatal outcomes - Corrected Proof

Vinita Das, Smriti Agrawal, Anjoo Agarwal — 2009-12-23

The timing of medical interventions for obstetric emergencies is vital to prevent maternal and neonatal morbidity and mortality. A principal model of maternal mortality is the “3 delays model” – delay in seeking care; delay in identifying and reaching medical facilities; and delay in receiving adequate and appropriate treatment . Recognized causes of these delays in low-resource countries are transport availability, the costs involved, and accessibility to health facilities.

Pelvic hydatid (echinococcal) disease - Corrected Proof

2009-12-23

Abstract: Objective: To study epidemiologic and clinical features of pelvic hydatid disease and discuss its management.Method: A retrospective analysis of 11 cases of pelvic hydatid disease managed over 7years and 8months at the Maternity and Neonatalogy Unit, Tunisian Medical Center La Rabta, Tunis, Tunisia. All cases were identified from histopathologic reports.Results: The 11 affected patients had a mean age of 41.6years (range, 22–79years), 6 had a history of surgery for hydatid disease, 8 presented for chronic pelvic pain, and 1 was admitted for acute surgical abdomen. On physical examination, 6 had a pelvic mass. An ultrasound examination suggested the diagnosis preoperatively in 6. All were treated surgically. Primary laparoscopy was performed in 5 patients. Unroofing (or partial cystectomy) was performed in 6 patients and complete cystectomy in 4. The postoperative course was uneventful in all cases. Recurrence occurred only in 1 patient, 6months after initial surgery.Conclusion: Pelvic hydatid disease is rare and its diagnosis often difficult preoperatively. The treatment mainstay is surgery. The laparoscopic approach seems to be safe and effective, and may increasingly replace laparotomy.

A simple procedure to prevent chronic vaginal colpotomy wound bleeding after laparoscopically assisted vaginal hysterectomy - Corrected Proof

Kok-Min Seow, Yu-Hung Lin, Jiann-Loung Hwang, Lee-Wen Huang, Ching-Pin Pan — 2009-12-23

Abstract: Objective: To determine whether injecting the colpotomy wound with diluted vasopressin decreases vaginal bleeding after laparoscopically assisted vaginal hysterectomy (LAVH).Methods: In this prospective controlled study 100 patients who underwent LAVH from July 1, 2005 to June 30, 2007, were randomized to receive an injection of vasopressin (n=50) or normal saline (n=50) solution in the colpotomy wound.Results: In the vasopressin group, bleeding from the colpotomy wound occurred for more than 7days in 9 patients (18%), and none was bleeding after 1month; in the control group, the corresponding values were 29 (58%) and 2 (4%). Compared with the study group, the control group had a significantly higher rate of chronic bleeding from the colpotomy wound for more than 7days and for more than 14days after LAVH (P<0.001 for both).Conclusion: Infiltrating the colpotomy wound with diluted vasopressin was found to prevent chronic vaginal bleeding, which frequently occurs following LAVH.

“Top hat” versus conventional loop electrosurgical excision procedure in women with a type 3 transformation zone - Corrected Proof

2009-12-23

Abstract: Objective: To compare the “top-hat” and conventional loop electrosurgical excision procedures (LEEP) performed in women with a type 3 transformation zone to assess the rate of endocervical margin involvement.Methods: Women with a type 3 transformation zone randomly allocated into the conventional (n=94) and top-hat LEEP (n=86) groups were analyzed.Results: The rate of endocervical margin involvement in the top-hat group was lower than that in the conventional group (32.6% vs 53.2%; RR 0.36; 95% CI, 0.19–0.68; P=0.003). Among women with positive endocervical margins, women undergoing top-hat LEEP were less likely to have residual lesions compared with those in the conventional group (52.2% vs 84.1%, respectively, P=0.04). There was no significant difference in the complication rate between the top-hat and conventional groups (7.0% vs 10.6%, respectively, P=0.39).Conclusion: Top-hat LEEP performed in women with a type 3 transformation zone reduces the risks of endocervical margin involvement and residual diseases compared with conventional LEEP, with no significant difference in perioperative complications.

Epidemiology of mixed urinary incontinence in China - Corrected Proof

Lan Zhu, Lin Li, Jinghe Lang, Tao Xu, Felix Wong — 2009-12-21

Abstract: Objectives: To determine the prevalence and risk factors for mixed urinary incontinence (MUI) among Chinese women.Method: In this cross-sectional survey study we analyzed the answers to a modified Bristol Female Lower Urinary Tract Symptoms questionnaire provided by 19024 women older than 20years and from 6 regions in China.Results: The overall prevalence of MUI was 9.4%. The prevalence of MUI increased with age and reached 24.1% among women older than 70years. Multivariable logistic regression analysis revealed that age, vaginal delivery, chronic constipation, pelvic organ prolapse, chronic pelvic pain, respiratory system disease, menstrual disorder, urinary system disease, alcohol consumption, pelvic surgery, obesity, and a low educational level were independent risk factors for MUI.Conclusion: We found age, vaginal delivery, and chronic constipation to be the main risk factors for MUI among adult women in China.

Pentraxin 3 in amniotic fluid as a marker of intra-amniotic inflammation in women with preterm premature rupture of membranes - Corrected Proof

2009-12-21

Abstract: Objective: To determine whether amniotic fluid levels of pentraxin 3 (PTX3) are of value in the prenatal diagnosis of acute histological chorioamnionitis in preterm premature rupture of membranes (PPROM).Methods: Forty pregnant women with PPROM between 24 and 36weeks of pregnancy without (n=21) and with (n=19) histological chorioamnionitis (PPROM group) and 42 women between 16 and 20weeks of pregnancy (midtrimester group) were included in the study. We compared amniotic fluid PTX3 levels in the PPROM group with versus without histological chorioamnionitis, and between the PPROM and the midtrimester groups using nonparametric tests (Mann-Whitney test), given the non-normal distribution of the analyte.Results: Patients with histological chorioamnionitis had a significantly higher median amniotic fluid PTX3 concentration than patients without the histological signs of chorioamnionitis (3.69ng/mL [0.51–106.8] versus 0.8ng/mL [0.36–121.0]; P=0.015). Patients in the PPROM group reached a significantly higher median amniotic fluid concentration of PTX3 compared with those in the midtrimester group (1.0ng/mL [0.36–121.0] versus 0.67ng/mL [0.4–2.8]; P=0.007).Conclusion: Histological chorioamnionitis is associated with a significant increase of amniotic fluid pentraxin 3 levels. Amniotic fluid pentraxin 3 appears to be a marker of intra-amniotic inflammation.

Effectiveness of an instructional DVD on third- and fourth-degree laceration repair for obstetrics and gynecology postgraduate trainees - Corrected Proof

Tamara T. Chao, George D. Wendel, Donald D. McIntire, Marlene M. Corton — 2009-12-18

Abstract: Objective: To assess the effectiveness of an instructional DVD on the anatomy and repair of anal sphincter lacerations to improve postgraduate trainees’ understanding.Methods: A total of 71 obstetrics and gynecology trainees completed a pretest of third- and fourth-degree lacerations to assess baseline knowledge and perceptions. Question categories included anatomy, antibiotics, anesthesia, repair methods, complications, postoperative care, and risk factors. After 1year of clinical experience, 67 trainees (94%) were randomly assigned into DVD (intervention) and non-DVD (control) groups. A post-test was administered 4weeks later.Results: In the DVD group (n=34), mean scores on the pretest versus the post-test were 65% vs 74% for postgraduate year (PGY)-1 (P=0.09); 72% vs 83% for PGY-2 (P=0.06); 67% vs 83% for PGY-3 (P=0.01); and 75% vs 87% for PGY-4 (P<0.001). In the non-DVD group (n=33), mean scores did not change significantly for any year level. The increase in score from pretest to post-test was significantly different between the 2 groups, independent of year (P<0.001). DVD group scores improved significantly over non-DVD group scores in anatomy (P=0.005) and repair methods (P=0.042) subscales.Conclusion: An educational video is an effective tool for improving understanding of third- and fourth-degree lacerations for physicians-in-training.

Perioperative and long-term complications among obese women undergoing vaginal surgery - Corrected Proof

Ka-Hyun Nam, Myung-Jae Jeon, Hye-Won Hur, Sei-Kwang Kim, Sang-Wook Bai — 2009-12-18

Abstract: Objective: To determine whether obesity influenced the risk of perioperative and long-term complications in patients undergoing vaginal surgery.Methods: Women diagnosed with pelvic organ prolapse who underwent vaginal surgery between March 1999 and May 2007 were classified into 3 groups: normal weight (body mass index [BMI, calculated as weight in kilograms divided by the square of height in meters] 18.5–23.0); overweight (BMI 23.0–27.5); and obese (BMI ≥27.5). Complications were subdivided into perioperative (<1month) and long-term (≥1month). Statistical analysis was performed using analysis of variance, χ2 test, and logistic regression.Results: Demographic information showed no differences among the groups, except for the presence of comorbidity (P=0.03). Blood loss and transfusion as a perioperative complication and urinary retention as a long-term complication were significantly different among the groups: odds ratio (OR) 2.46 (95% confidence interval [CI], 1.38–4.39; P<0.01); and OR 2.20 (95% CI, 1.21–4.03; P=0.03), respectively.Conclusion: Major complications were rare, and most were not significantly different among the groups. However, obesity was a protective factor against blood loss and transfusion, and long-term urinary retention.

Prepregnancy body mass index, gestational weight gain, and pregnancy outcomes in China - Corrected Proof

Zhenyu Chen, Juan Du, Ling Shao, Liqiang Zheng, Meiyan Wu, Mo Ai, Yinling Zhang — 2009-12-17

Abstract: Objective: To look for associations between pregnancy outcomes and prepregnancy body mass index and gestational weight gain among Han women from Shenyang province, China.Method: A total of 2586 women were distributed across 4 prepregnancy categories according to the Chinese classification of body mass index, and to 4 end-of-pregnancy categories according to median weekly gestational weight gain.Results: The risks for gestational hypertension, pre-eclampsia, gestational diabetes, and preterm premature rupture of membranes were higher for those who were overweight or obese before becoming pregnant (P<0.05). Moreover, a gestational weight gain of 0.50kg per week or greater was associated with a higher risk for gestational hypertension, preterm premature rupture of membranes, and fetal macrosomia (P<0.05). Women in the highest quartile for weight gain (≥0.59kg per week) were at higher risk for pre-eclampsia (P<0.05).Conclusion: A high prepregnancy body mass index and excessive gestational weight gain were associated with increased risks for adverse pregnancy outcomes.

Transabdominal amnioinfusion in preterm premature rupture of membranes - Corrected Proof

Anshuja Singla, Poonam Yadav, Neelam B. Vaid, Amita Suneja, Mohammad M.A. Faridi — 2009-12-16

Abstract: Objective: To evaluate the effect of transabdominal amnioinfusion on prolongation of pregnancy, and maternal and neonatal outcomes in preterm premature rupture of membranes (pPROM).Methods: We conducted a prospective randomized controlled study of women with pPROM during singleton live pregnancy—between 26 and 33+6weeks—whose amniotic fluid index (AFI) was less than the 5th percentile. The study group underwent transabdominal amnioinfusion at admission and then weekly if their AFI fell below the 5th percentile again. The control group received expectant management.Results: The difference in the mean interval from pPROM to delivery between the groups was not statistically significant. Neonatal and maternal outcomes were significantly improved in the study group compared with the control group (fetal distress [10% vs 37%]; early neonatal sepsis [17% vs 63%]; neonatal mortality [17% vs 63%]; spontaneous delivery [83% vs 53%]; and postpartum sepsis [7% vs 33%]).Conclusion: Transabdominal amnioinfusion reduced fetal distress, early neonatal sepsis, and neonatal mortality. In the study group, more participants delivered spontaneously and there were fewer cases of postpartum sepsis, although the pPROM–delivery interval was not increased.

Urinary incontinence in hospital-based nurses working in Turkey - Corrected Proof

Yurdagül Yağmur, Neşe Ulukoca — 2009-12-16

Abstract: Objective: To determine the changes in quality of life due to urinary incontinence in female hospital-based nurses working in Turkey and whether professional help was sought by the nurses. Another aim was to determine the prevalence of urinary incontinence and its risk factors in working nurses.Methods: Data were collected through administration of a questionnaire and the Incontinence Quality-of-Life Instrument. The data were analyzed via χ2 test, t test, one-way analysis of variance, and binary logistic regression analysis.Results: The prevalence of urinary incontinence was 21.5%. Explanatory variables for developing urinary incontinence were age, parity, and recurrent urinary tract infections. Nurses with stress incontinence or urge incontinence had better quality of life than did those with mixed incontinence.Conclusion: In the present study, urinary incontinence was common in working nurses, and had a negative impact on their general quality of life.

Active management of the third stage of labour: Prevention and treatment of postpartum hemorrhage: No. 235 October 2009 (Replaces No. 88, April 2000) - Corrected Proof

2009-12-15

Abstract: Objective: To review the clinical aspects of postpartum hemorrhage (PPH) and provide guidelines to assist clinicians in the prevention and management of PPH. These guidelines are an update from the previous Society of Obstetricians and Gynaecologists of Canada (SOGC) clinical practice guideline on PPH, published in April 2000.Evidence: Medline, PubMed, the Cochrane Database of Systematic Reviews, ACP Journal Club, and BMJ Clinical Evidence were searched for relevant articles, with concentration on randomized controlled trials (RCTs), systematic reviews, and clinical practice guidelines published between 1995 and 2007. Each article was screened for relevance and the full text acquired if determined to be relevant. Each full-text article was critically appraised with use of the Jadad Scale and the levels of evidence definitions of the Canadian Task Force on Preventive Health Care.Values: The quality of evidence was rated with use of the criteria described by the Canadian Task Force on Preventive Health Care.Sponsor: The Society of Obstetricians and Gynaecologists of Canada.

Prevalence and characteristics of female sexual dysfunction in a sample of women from Upper Egypt - Corrected Proof

Ibrahim M.A. Hassanin, Yasser A. Helmy, Mohamed M.F. Fathalla, Ahmed Y. Shahin — 2009-12-15

Abstract: Objective: To study the prevalence and associated risk factors for female sexual dysfunction (FSD) in Upper Egypt.Methods: Married women attending the outpatient clinic of Sohag University Hospital between February 2008 and March 2009 were recruited. Through direct interviews, each woman completed a questionnaire that included questions on sexual dysfunction.Results: From 648 recruited patients, 47 declined to participate in the study. Of the 601 remaining participants, 462 women (76.9%) reported 1 or more sexual problems. Low sexual desire was the most common sexual problem (66.4%). Patients with FSD were significantly more likely to be older than 40years, have sexual intercourse fewer than 3 times a week, have been married for 10years or more, have 5 children or more, be circumcised, have a husband aged 40years or more, and be postmenopausal. Age of the women maintained a statistically significant positive relationship with FSD in the regression model (odds ratio 1.39; 95% CI, 1.26–1.53).Conclusions: There was a high prevalence of FSD in this sample of women from Upper Egypt. The prevalence of sexual problems increased with increasing age of the women.

Laparoendoscopic single-site surgery for total hysterectomy - Corrected Proof

Francesco Fanfani, Anna Fagotti, Giovanni Scambia — 2009-12-08

Single-access laparoscopic procedures, such as laparoendoscopic single-site surgery (LESS) and natural orifice transluminal endoscopic surgery (NOTES), are new techniques for less invasive surgical procedures.

Use of Chinese herbal medicine among menopausal women in Taiwan - Corrected Proof

Lih-Chi Chen, Bi-Ru Wang, I-Chin Chen, Chun-Hui Shao — 2009-12-08

Abstract: Objective: To assess the patterns of use of Chinese herbal medicine (CHM) used by women in Taiwan to treat menopausal symptoms.Methods: A retrospective review of the records of women who received CHM therapies for menopausal symptoms at the Traditional Medicine Center, Veterans General Hospital, Taipei, between January 2003 and December 2006. The average number of therapies per prescription, dosage, and duration of the prescription were recorded. The most commonly prescribed herbs and formulae were also recorded. Data were analyzed using descriptive statistics.Results: The records of 3432 women who were administered a total of 19370 CHMs to treat symptoms of the menopause were reviewed. The average number of drugs per prescription was 5.64. Most of the prescriptions (97.1%) were prescribed to be taken 3times a day. The most commonly prescribed Chinese herb was Leonurus heterophyllus. Jia-Wey-Shiau-Yau-San was the most commonly prescribed Chinese herbal formula.Conclusion: CHM is commonly used in Taiwan for the treatment of menopausal symptoms. The efficacy and safety of CHM drugs used for the management of menopausal symptoms require further study.

Reproductive health experiences among women with physical disabilities in the Northwest Region of Cameroon - Corrected Proof

Kimberly Bremer, Lynn Cockburn, Acheinegeh Ruth — 2009-12-02

Abstract: Objective: To investigate the reproductive health experiences among women with physical disabilities in the Northwest Region of Cameroon.Methods: Data were collected in the city of Bamenda through semi-structured interviews with women with mobility impairments, discussions with healthcare providers, hospital observations, and field notes. Interviews were transcribed verbatim, coded and analyzed for key themes.Results: The 8 participants included in the study had limited understanding of reproductive health and many had not received basic reproductive health education. Unplanned pregnancy was common and pregnancy was often feared. Respondents reported both positive and negative responses from family, community members, and healthcare workers regarding reproductive health. Most healthcare centers were physically and financially inaccessible.Conclusion: Women with disabilities need greater education on reproductive health and improved access to health care.

Trends in complicated illegally induced abortion in a low-resource Nigerian setting - Corrected Proof

Chukwuemeka A. Iyoke, Osaheni L. Lawani, Frank O. Ezeugwu — 2009-12-02

Restrictive abortion laws are, perhaps correctly, blamed for the high mortality and morbidity associated with unsafe abortion in low-income countries . Induced abortion is illegal in Nigeria, except for strict medical indications certified by at least 2 doctors. Legalization could enable women with unwanted pregnancies to procure safe induced abortions from health facilities; however, abortions performed by caregivers in private health facilities may not be entirely safe—consistent with clinical experience and previous studies from Nigeria in which physicians at private hospitals were implicated by patients in a significant proportion of complicated induced abortions .

Risk factors and management patterns for emergency obstetric hysterectomy over 2decades - Corrected Proof

Farah Lone, Abdul H. Sultan, Ranee Thakar, Andrew Beggs — 2009-12-02

Abstract: Objective: To review the demographic characteristics of patients, risk factors, indications, and complications of emergency obstetric hysterectomy (EOH), and to determine the changing trends in EOH over the last 2decades.Methods: A retrospective review of all consecutive cases of EOH over the last 20years at Mayday University Hospital, UK.Results: There were 84698 deliveries between January 1989 and January 2009. Fifty-two women had an EOH, with an incidence of 0.6 per 1000 deliveries. The underlying cause of EOH was uncontrolled primary hemorrhage in 50 (96.2%) women and severe sepsis leading to secondary hemorrhage in 2 (3.8%) women. A total of 38 (73%) EOHs were performed for intractable bleeding after cesarean delivery. Twenty-five EOHs were performed in the first decade, and 27 EOHs were performed in last decade.Conclusion: Despite the introduction of pharmacologic agents and new surgical techniques to control postpartum hemorrhage, there was no reduction in the prevalence of EOH. Previous cesarean delivery with associated placenta previa or placenta accreta was a major contributor toward EOH.

Prevalence of HPV and HIV among female drug addicts attending a drop-in center in Tehran, Iran - Corrected Proof

2009-12-02

Understanding the prevalence of HIV and HPV infection among drug-addicted women and detecting high-risk HPV types could lead to integration of prevention and treatment into public health planning.