International Journal of Gynecology & Obstetrics - Articles in Press

Opinion and experience of Brazilian women regarding menstrual bleeding and use of combined oral contraceptives - Corrected Proof

2012-01-30

Abstract: Objective: To describe the opinion and experience of Brazilian women regarding menstruation and the use of combined oral contraceptives (COCs) to control monthly bleeding and induce amenorrhea.Methods: Women attending regional public healthcare clinics for non-gynecologic conditions, and female members of staff from university schools unrelated to the field of medicine completed a questionnaire.Results: Of the 1111 women interviewed, 64.3% reported disliking menstruation. The desired frequency of bleeding was never (65.3%), less than monthly (18.2%), and every month or more often (16.5%). More than 60% of the women reported that they would use COCs to control menstrual bleeding, 82.0% would use COCs to reduce the amount of bleeding experienced, and 86.1% would use COCs to induce amenorrhea. When compared with women who disliked menstruation, those who reported that they liked to experience monthly bleeding had fewer years of schooling (OR1.98; 95% CI, 1.30–2.97), low socioeconomic status (OR 1.66; 95%CI, 1.12–2.46), fewer days of menstruation each month (OR 1.62; 95%CI, 1.11–2.36), and 1 or more child (OR 1.13; 95%CI, 1.01–1.26).Conclusion: Many of the women surveyed disliked monthly menstruation and were interested in the use of COCs to control menstrual bleeding and induce amenorrhea.

Community-driven impact of a newborn-focused behavioral intervention on maternal health in Shivgarh, India - Corrected Proof

2012-01-27

Abstract: Objective: To assess the effect on maternal health outcomes of a community-based behavior change management intervention for essential newborn care leading to a reduction in neonatal mortality.Methods: A cluster-randomized controlled trial involving 1 control and 2 intervention arms was conducted in Shivgarh, India, between January 2004 and May 2005. Risk-enhancing domiciliary newborn care behaviors, including those posing a concomitant risk to maternal health, were targeted through home visits and community meetings. Secondary outcomes included knowledge of maternal danger signs, self-reported complications, maternal care practices, care-seeking from trained providers, and maternal mortality ratio (MMR). The intervention arms were combined for analysis, which was done by intention to treat.Results: Significant improvements were observed in maternal health equity and outcomes including knowledge of danger signs, care practices, self-reported complications, and timely care-seeking from trained providers. The difference in adjusted MMR was not significant (relative risk 0.44; 95% confidence interval, 0.14–1.43; P=0.11) owing to the inadequate sample size for this outcome, but may suggest a decline in MMR given improvements in other outcomes in the causal pathway to mortality.Conclusion: Community-based strategies focused on prevention and care-seeking effectively complemented facility-based strategies toward improving maternal health, while synergizing with newborn care interventions.

Clinical evaluation of neoadjuvant chemotherapy followed by radical surgery in the management of stage IB2–IIB cervical cancer - Corrected Proof

Lin Gong, Jian-Yan Lou, Ping Wang, Jia-Wen Zhang, Hui Liu, Zhi-Lan Peng — 2012-01-24

Abstract: Objective: To evaluate clinical efficacy, toxicity, and survival outcomes of neoadjuvant chemotherapy (NACT) followed by radical surgery (RS) among patients with cervical cancer stage IB2–IIB.Methods: In a retrospective clinical study at West China Second Hospital, Chengdu, data were analyzed from 414 patients who underwent NACT followed by radical surgery (NACT–RS) or RS alone between January 2008 and November 2009.Results: The clinical response for NACT was 90%. Lymph node metastasis (25% versus 48%, P<0.05) and deep cervical stromal invasion more than 0.5, (68% versus 91%, P<0.05) were significantly lower among responders than among non-responders, respectively, in the NACT–RS group. The 2-year progression-free survival and 2-year overall survival were 93.0% and 95.5% in the NACT–RS group, and 94.5% and 97.1% in the RS group (P>0.05). Parametric infiltration (hazard ratio [HR], 7.668; P<0.05) and lymph node metastasis (HR, 7.714; P<0.05) were independent risk factors for all study patients.Conclusion: Compared with RS, NACT–RS did not show a significant advantage for patients with locally advanced cervical cancer. However, the data provide the rationale for assessing NACT–RS in a multicenter randomized clinical trial setting. NACT may be considered as an alternative treatment when radiotherapy is not available.

Incidence of gestational diabetes mellitus in Bahrain from 2002 to 2010 - Corrected Proof

2012-01-20

Abstract: Objective: To determine the incidence and trends of gestational diabetes mellitus (GDM) in Bahrain from 2002 to 2010, and to investigate 2 possible risk factors within the affected population.Methods: In a retrospective survey, data on maternal body weight and age were collected from women who gave birth in government maternity units in Bahrain and who were screened for GDM during pregnancy using the 2-step approach and criteria of the US Expert Committee on the diagnosis and classification of diabetes.Results: Among 49552 pregnant women, 4982 (10.1%) were diagnosed with gestational diabetes. The Cox–Stuart test for trend analysis suggested that there was an increase in the incidence of gestational diabetes from 7.2% in 2002 to 12.5% in 2010 (P<0.01). For the period 2006–2010, maternal age, and weight at onset of pregnancy and at time of delivery were positively associated with risk of GDM with an odds ratio (95% confidence interval) of 1.094 (1.081–1.107), 1.081 (1.001–1.104), and 1.027 (1.013–1.040), respectively.Conclusion: A combination of increasing maternal weight, maternal age, and incidence of GDM among women in Bahrain indicates a significant future burden on health services.

Prenatal care and basic emergency obstetric care services provided at primary healthcare facilities in rural Nigeria - Corrected Proof

2012-01-20

Abstract: Objective: To assess the availability of prenatal care and basic emergency obstetric care services at primary healthcare (PHC) facilities in rural Nigeria.Methods: In total, 652 PHC facilities enrolled in the Midwives Service Scheme, a government-funded program designed to reduce the national shortage of skilled birth attendants, were surveyed.Results: In all, 44.0% of the PHC facilities evaluated did not provide all components of prenatal care, and only 39.0% of all pregnant women nationwide attended prenatal care clinics 4 or more times. In addition, 52.2% of the facilities were not distributing insecticide-treated nets to pregnant women, while only 36.8% of the PHC facilities provided services to prevent mother-to-child transmission of HIV. By contrast, 70.0% of the PHC facilities had access to antibiotics for the treatment of uncomplicated sepsis. Only 11.0% of clinics reported the use of vacuum extraction during labor and 36.8% provided post-abortion care services. Treatment for pre-eclampsia and eclampsia was initiated at 40.0% and 28.0% of PHC facilities, respectively, prior to referral.Conclusion: The present study provides useful information on the state of prenatal and basic emergency obstetric care in rural Nigeria. The data obtained indicate that changes are needed to achieve related Millennium Development Goals.

The role of genital pathogens in morbidity following diathermy loop excision of the transformation zone of the uterine cervix - Corrected Proof

Darja Arko, Andraž Dovnik, Nina Fokter, Iztok Takač — 2012-01-20

Abstract: Objective: To evaluate the role of genital pathogens in postoperative morbidity following diathermy loop excision of the transformation zone (LETZ) of the uterine cervix.Methods: Patients with cervical intraepithelial neoplasia (CIN) who underwent diathermy LETZ were included in a prospective study. Cervical swabs for genital pathogens were collected before the diathermy procedure. After surgery, women were followed-up regarding the occurrence and severity of postoperative pain, bleeding, and discharge.Results: Genital pathogens were present in 463 of 788 (58.8%) cases. The most frequently isolated groups of microorganisms were group B β-hemolytic Streptococcus, α-hemolytic Streptococcus, Enterococcus species, and coliforms. In patients with genital pathogens, postoperative pain was present in 298 (37.8%), discharge in 262 (33.2%), and bleeding in 236 (29.9%) cases. In patients without genital pathogens, 199 (25.3%) experienced pain, 181 (23.0%) discharge, and 143 (18.1%) bleeding. The differences between the 2 groups were not statistically significant (χ2 for pain=0.675; χ2 for discharge=0.031; χ2 for bleeding=3.444; P>0.05).Conclusion: Genital pathogens are very common among patients with CIN and do not affect the occurrence or severity of pain, discharge, or postoperative bleeding after diathermy LETZ.

The effect of tuberculosis on ovarian reserve among women undergoing IVF in India - Corrected Proof

2012-01-20

Abstract: Objective: To assess ovarian reserve in infertile women with genital tuberculosis planning to undergo in vitro fertilization and in women of proven fertility, and compare the findings.Methods: A cross-sectional study was conducted at an outpatient gynecology unit with 104 women with genital tuberculosis and 104 healthy controls. In each group, ovarian reserve tests consisted in estimating serum levels of follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol, and inhibin B on day 3 of a natural menstrual cycle. On the same day ovarian volume, number of antral follicles, and ovarian stromal blood flow were also estimated.Results: The mean FSH and LH levels were significantly higher, and the mean inhibin B levels were significantly lower, among the participants with genital tuberculosis than among the controls. Conversely, the mean ovarian volume and the mean number of antral follicles were significantly lower among the participants with genital tuberculosis, as were the mean peak systolic velocity and pulsatility index for each ovary.Conclusion: There is no single absolute predictor of ovarian reserve, but combining the current assessment methods provides a close estimation of a woman's reproductive capability. Values for the studied markers showed that ovarian reserve was compromised in women with genital tuberculosis.

Group B streptococcus and Escherichia coli colonization in pregnant women and neonates in Lithuania - Corrected Proof

2012-01-20

Abstract: Objective: To evaluate the prevalence of maternal and neonatal colonization with group B streptococcus (GBS) and Escherichia coli, and examine GBS serotypes and susceptibility to antibiotics.Methods: A prospective cross-sectional study was carried out in Lithuania between October 2006 and June 2007. Lower vaginal/rectal swabs were obtained from pregnant women (n=998) and ear canal/throat swabs were obtained from their newborns (n=827) for culture.Results: Overall, maternal and neonatal GBS colonization rates were 15.3% and 6.4%, respectively. Serotypes III (34.5%) and Ia (29.7%) were most common. All GBS isolates were susceptible to penicillin and 4.1% were resistant to erythromycin. Overall, maternal and neonatal E. coli colonization rates were 19.9% and 14.4%, respectively. In total, 71.4% of newborns with E. coli colonization were born to E. coli-negative mothers. E. coli was resistant to ampicillin and piperacillin in 25.9% and 16.6% of cases, respectively. The majority of E. coli-colonized newborns were contaminated with maternal fecal, but not vaginal, E. coli strains.Conclusion: Maternal and neonatal GBS colonization rates, serotypes, and susceptibility to antibiotics were comparable to those reported in previous studies. Population-based data regarding early-onset neonatal infection rates will enable the formulation of a prevention program for early-onset GBS disease in Lithuania.

Effect of concomitant oophorectomy on the perioperative outcomes of laparoscopic hysterectomy - Corrected Proof

2012-01-19

The dilemma concerning elective oophorectomy continues to resurface as hysterectomy remains the most common major gynecologic surgery performed in the USA . While the pendulum continues to swing, there remains a paucity of information about the surgical outcomes of this practice. The objective of the present study was to assess whether concomitant adnexal removal at the time of laparoscopic hysterectomy has an impact on perioperative outcomes.

Intimate partner violence and its association with women's reproductive health in Pakistan - Corrected Proof

Rubeena Zakar, Muhammad Z. Zakar, Rafael Mikolajczyk, Alexander Krämer — 2012-01-19

Abstract: Objective: To determine the prevalence of intimate partner violence in Pakistan and its association with reproductive health outcomes.Methods: A cross-sectional survey was conducted in 8 hospitals in Lahore and Sialkot between October 2008 and January 2009. Information from randomly selected ever-married women of reproductive age was collected via a structured interview. Psychologic, physical, and sexual violence was categorized as “no” or “severe” violence. Associations between reproductive health outcomes and violence were assessed by multivariate logistic regression.Results: Among 373 women interviewed, 75.9% reported severe psychologic, 34.6% reported severe sexual, and 31.9% reported severe physical violence at least once in marital life. Women who experienced severe physical violence were more likely to have their husband's noncooperation in using contraceptives (adjusted odds ratio [AOR], 3.31; 95% confidence interval [CI], 1.93–5.68), poor prenatal care (AOR, 2.11; 95% CI, 1.23–3.69), unplanned pregnancies (AOR, 2.29; 95% CI, 1.39–3.76), and poor self-reported reproductive health (AOR, 2.95; 95% CI, 1.71–4.91) as compared with non-abused women. Similar associations existed for other types of violence.Conclusion: The results highlight the magnitude of violence and its association with reproductive health of women. Urgent action is needed to mitigate the violence and its consequential damage to health.

Recurrent bladder rupture after cauda equina syndrome - Corrected Proof

Ritva Nissi, Anne Talvensaari-Mattila, Markku Santala — 2012-01-19

Cauda equina syndrome (CES) occurs most frequently after a large central disc herniation. The clinical presentation varies depending on the involved nerve roots, but includes altered perineal sensation and disturbance of bladder and bowel function; 50%–70% of patients have urinary retention .

A multicenter study of the clinical characteristics of usual-type vulvar intraepithelial neoplasia in China - Corrected Proof

Xiaochuan Li, Lan Zhu, Yu Gu, Hangmei Jin, Changyu Wang, Jinghe Lang — 2012-01-19

Abstract: Objective: To investigate clinical characteristics of usual-type vulvar intraepithelial neoplasia (uVIN) in China.Methods: A retrospective review of the records of 64 patients with uVIN was performed at 3 academic hospitals between 2004 and 2010. Patients were assigned to a younger (≤40years) or an older (>40years) group. Clinical characteristics of lesions were described and analyzed.Results: Mean patient age was 40.6years. There was a high proportion of incidental findings (34%), multifocal lesions (64%), variegated lesions (59%), and multiple neoplastic lesions in the lower genital tract (20%). As patient age increased, so did numbers of patients reporting pain (P<0.05). Longer time between symptom onset and uVIN diagnosis, and more multifocal lesions were noted in the older group (P<0.05). Whereas younger patients often presented with cervical intraepithelial neoplasia and uVIN, older patients often presented with intraepithelial neoplasia at uncommon locations (e.g. vagina, anus, and periurethral region) (P<0.05). No differences between the groups were found regarding gross appearance or anatomic location of uVIN lesions (P>0.05).Conclusion: Age-specific differences were noted in location of neoplastic lesions in the lower genital tract and time to diagnosis of uVIN. However, the clinical features of uVIN lesions were heterogeneous and non-age specific.

Risk factors for eclampsia in Japan between 2005 and 2009 - Corrected Proof

2012-01-19

Abstract: Objective: To determine risk factors for eclampsia among Japanese women with singleton pregnancies.Methods: A retrospective observational study was carried out among patients with and those without eclampsia who were registered on the Japan Society of Obstetrics and Gynecology registry system and who gave birth to singleton infants at 22weeks or more between 2005 and 2009. Multivariate logistic regression analyses were performed to determine independent risk factors for eclampsia.Results: One-third (75/225) of eclampsia patients developed the condition in the absence of hypertension. Maternal age, nulliparity, and pregnancy-induced hypertension (PIH) were all independent risk factors for eclampsia. The risk of eclampsia decreased by 3.0% per 1-year increase in maternal age, and increased 2.6-fold and 35.4-fold in nulliparous women and women with PIH, respectively. Among teenaged girls with hypertension, the prevalence of eclampsia was 1 case per 28 teenagers.Conclusion: Hypertension alone was not a reliable predictor of eclampsia. More intensified monitoring of nulliparous women and teenaged girls with hypertension is needed in order to prevent eclampsia.

Perinatal outcomes associated with subsequent pregnancy among adolescent mothers in Peru - Corrected Proof

Walter Ventura, Jessica Ventura-Laveriano, Conny Nazario-Redondo — 2012-01-19

Abstract: Objective: To assess the perinatal outcomes of a subsequent pregnancy among adolescent mothers living in Peru.Methods: A large hospital-based retrospective cohort study was conducted to evaluate singleton births during a 9-year period (2001–2009). The study population was divided into 3 groups: adolescents aged 15–19years who had 1 previous parturition (n=2074), nulliparous adolescents (n=20721), and multiparous adults aged 20–29years (n=23 129).Results: No significant differences were found between multiparous adolescents and the 2 control groups with regard to preterm delivery, perinatal death, and 5-minute Apgar score below 7. Logistic regression analysis showed no significant differences in the rates of cesarean delivery or preterm birth before 34 or 37weeks. After adjusting for confounding factors, low birth weight (LBW) and small for gestational age (SGA) were more likely to occur during a subsequent pregnancy among adolescent mothers than during the 1st pregnancy among nulliparous adolescents. The odds ratios were 1.38 (95% CI, 1.14–1.67) and 1.27 (95% CI, 1.02–1.56), respectively.Conclusion: Multiparous adolescents are more likely to experience LBW or SGA than are nulliparous adolescents. No significant differences in other perinatal outcomes were found among the 3 study groups.

Acute fatty liver of pregnancy over a 10-year period at a Tunisian tertiary care center - Corrected Proof

2012-01-19

Acute fatty liver of pregnancy (AFLP) is a rare life-threatening disease that occurs in the third trimester or early postpartum period. Its incidence ranges from 1 in 7000 to 1 in 20000 pregnancies . Early detection of AFLP combined with identification of milder cases, rapid termination of pregnancy, and advances in critical care have all helped improve the prognosis.

Effect of omega-3 fatty acids on intensity of primary dysmenorrhea - Corrected Proof

Nahid Rahbar, Neda Asgharzadeh, Raheb Ghorbani — 2012-01-19

Abstract: Objective: To examine whether dietary supplementation with omega-3 fatty acids relieved symptoms of primary dysmenorrhea.Methods: Women aged 18–22years with primary dysmenorrhea were enrolled in a double-blind crossover study. Women assigned to group 1 (n=47) received 1 omega-3 capsule daily for 3months, followed by placebo for 3months. Women in group 2 (n=48) received placebo for 3months, followed by omega-3 for 3months. A washout period was performed in both groups. Participants used 400mg of ibuprofen as a rescue dose if severe menstrual pains were experienced.Results: A marked reduction in pain intensity was observed after 3months of treatment with omega-3 fatty acids (P<0.05). Women who received omega-3 fatty acids required fewer rescue doses than women who received placebo (P<0.05). The mean numbers of ibuprofen tablets used after 3months with omega-3 fatty acids were 4.3±2.1 (group 1) and 3.2±2.5 (group 2); the mean numbers of tablets used after 3months of placebo were 5.3±2.2 (group 1) and 6.0±2.6 (group 2) (P=0.001 for both).Conclusion: Supplementation with omega-3 fatty acids reduced the symptom intensity of primary dysmenorrhea. Supplementation efficacy was sufficient to decrease the ibuprofen rescue dose.

Multiple-dose vaginal misoprostol and single-dose misoprostol plus oxytocin for termination of second-trimester pregnancy - Corrected Proof

2012-01-19

Abstract: Objective: To compare 2 different methods—multiple doses of misoprostol and a combination of misoprostol and oxytocin—for termination of pregnancy in the second trimester.Methods: Between 2006 and 2008, 120 women undergoing termination of second-trimester pregnancy in 2 hospitals in Kermanshah, Iran, were enrolled in a randomized trial comparing 2 treatments. In each treatment group, an initial vaginal dose of 600μg of misoprostol was placed in the posterior fornix. After 6hours, an intravenous infusion of concentrated oxytocin was given to women in group A, and 400μg of vaginal misoprostol was given every 6hours to women group B, up to a maximum of 4 doses. The outcomes were compared via χ2 and independent t tests.Results: Within 30hours, 96.7% of women in group A and 96.7% of women in group B delivered successfully. The average duration between induction and delivery time was 12.3±6.0hours in group A and 12.1±6.0hours in group B (P>0.05).Conclusion: The use of misoprostol with oxytocin, and multiple doses of misoprostol gave similar results for termination of pregnancy in the second trimester.

Single-incision total laparoscopic hysterectomy with conventional laparoscopy ports - Corrected Proof

2012-01-19

Abstract: Objective: To study the feasibility of performing single-incision total laparoscopic hysterectomy using conventional ports and instruments.Methods: Patients undergoing laparoscopic surgery at Galaxy Care Laparoscopic Institute, Pune, India, between January 2007 and December 2010 were selected for participation. All procedures were performed using conventional laparoscopic instruments and trocars. Operative data—including operative time (from incision to port closure), blood loss, additional ports used, energy sources used, and intraoperative complications—were recorded.Results: Twenty-three procedures were performed during the study period. All procedures were completed via single incision only. Operative time, blood loss, and hospital stay were comparable with those associated with conventional laparoscopy.Conclusion: It is debatable whether laparoscopic surgery via a single incision would threaten the position of the current gold standard of conventional laparoscopic procedures. The present study showed that single-incision laparoscopic surgery using conventional instruments is feasible and effective.

Cytological detection of trophoblasts for rapid diagnosis of pregnancy of unknown location - Corrected Proof

Masato Kinugasa, Tetsuya Sato, Maki Tamura — 2012-01-18

Diagnostic uterine curettage and pathological examination of the specimen can be used when a pregnancy's location is unknown. However, it may take a few days to confirm the histopathological diagnosis, and frozen section examination sometimes leads to false-negative results due to a limited specimen . The aim of the present study was to evaluate the utility of cytodiagnosis of uterine specimens to differentiate between ectopic pregnancy and spontaneous abortion.

Safety and efficacy of contraceptive implants for HIV-infected women in Porto Alegre, Brazil - Corrected Proof

Regis Kreitchmann, Agnes Peruzzo Innocente, Gisele Maria Inchauspe Preussler — 2012-01-17

The proportion of women with HIV continues to increase worldwide, with recent figures estimating that women comprise almost 50% of all HIV-infected adults. Most infected women are in their childbearing years and need safe and effective contraception.

Transvaginal laparoscopic surgery for ovarian cysts - Corrected Proof

Jaeman Bae, Sun-Joo Lee, Soo-Nyung Kim — 2012-01-17

Abstract: Objective: To evaluate the effectiveness and feasibility of transvaginal laparoscopic surgery (TLS) using endoscopic instruments for management of ovarian cysts.Methods: In a retrospective study, data from 140 patients with benign ovarian cysts who underwent TLS at Konkuk University Hospital between June 2007 and December 2008 were evaluated. The preoperative characteristics of patients, operative time, blood loss, complications, and postoperative outcomes were evaluated.Results: The mean age of patients was 38years (range, 16–82years). TLS was accomplished in 136 women (97.1%). The more common pathology findings included 35 dermoid cysts, 28 endometriotic cysts, 23 mucinous cysts, 21 serous cysts, and 13 functional ovarian cysts. The median operative time was 35minutes (range 15–110minutes). The maximum diameter of the ovarian cysts ranged from 3 to 20cm (mean 6cm). The median estimated blood loss was 38mL (range 10–80mL). No patients received a blood transfusion. All of the patients were discharged within 24hours of surgery. No major complications occurred.Conclusion: Transvaginal laparoscopic surgery was found to be a feasible and cosmetically beneficial surgical technique for managing selected patients with benign ovarian cysts.

Clinical and anatomic features of female genital tuberculosis in 28 patients - Corrected Proof

2012-01-12

Although female genital tuberculosis is generally rare, its incidence is stable despite the BCG vaccination. The fallopian tubes are affected most commonly (90%), followed by the endometrium (50%) . Genital tuberculosis in childbearing women may lead to infertility.

Ovarian pregnancy in a patient with a levonorgestrel intrauterine system in situ - Corrected Proof

Omar Kazal, Asem A. Ali — 2012-01-12

Ovarian pregnancy is extremely rare, with an incidence of approximately 1 in 25000–40000 pregnancies . In contrast to tubal pregnancy, a history of pelvic inflammatory disease or the use of an intrauterine contraceptive device does not increase the risk of ovarian pregnancy. Endometriosis and abdominal surgery are the most common risk factors for this extrauterine pregnancy .

Diagnosis and treatment of vaginal intraepithelial neoplasia - Corrected Proof

Wei-Wei Wee, Yin N. Chia, Philip K.-L. Yam — 2012-01-12

Abstract: Objective: To audit our experience of the diagnosis and treatment of vaginal intraepithelial neoplasia (VAIN) in Kandang Kerbau Women's Hospital, Singapore.Methods: The clinical records of the patients diagnosed as having VAIN at our institution in the calendar year 2009 were periodically reviewed until March 2011.Results: There were 21 cases of VAIN. The mean follow-up duration was 18.2months. The lesion grades were VAIN 1 in 9 patients (42.9%), VAIN 2 in 9 patients (42.9%), and VAIN 3 in 3 patients (14.3%). The mean patient age was 39.1years. Sixteen patients (76.2%) were referred to our institution because of abnormal results to cytology tests and 4 patients (21.9%) were referred because of vaginal warts. The remaining patient was diagnosed from a surgical specimen. The diagnosis involved a cytology test, a colposcopic examination, an acetowhite test, a Schiller test, and a colposcopy-directed biopsy. The treatments varied and included watchful waiting but carbon dioxide laser vaporization was used the most frequently.Conclusion: After 6months of follow-up 18 patients were considered cured, for an overall cure rate of 85.7%. Two patients wanted no treatment and disease remained persistent in 1 patient despite laser vaporization and intravaginal applications of imiquimod cream.

Laparoscopic management of abdominal ectopic pregnancy using FLOSEAL Hemostatic Matrix - Corrected Proof

2012-01-11

An abdominal pregnancy is a pregnancy that is confined to the peritoneum of the abdominal cavity and which occurs independently of the female reproductive tract. It is very rare and constitutes approximately 1% of all ectopic pregnancies. Mortality rates are 7.7 times higher than tubal ectopic pregnancy , and the overall laparoscopy rate for treatment of this type of pregnancy has been reported to be as low as 55% .

Advanced Reproductive Age and Fertility: No. 269, November 2011 - Corrected Proof

2011-12-23

Abstract: Objective: To improve awareness of the natural age-related decline in female and male fertility with respect to natural fertility and assisted reproductive technologies (ART) and provide recommendations for their management, and to review investigations in the assessment of ovarian aging.Options: This guideline reviews options for the assessment of ovarian reserve and fertility treatments using ART with women of advanced reproductive age presenting with infertility.Outcomes: The outcomes measured are the predictive value of ovarian reserve testing and pregnancy rates with natural and assisted fertility.Evidence: Published literature was retrieved through searches of PubMed or Medline, CINAHL, and The Cochrane Library in June 2010, using appropriate key words (ovarian aging, ovarian reserve, advanced maternal age, advanced paternal age, ART). Results were restricted to systematic reviews, randomized controlled trials/controlled clinical trials, and observational studies. There were no date or language restrictions. Searches were updated on a regular basis and incorporated into the guideline to December 2010.Values: The quality of evidence was rated using the criteria described in the Report of the Canadian Task Force on Preventive Health Care. Recommendations for practice were ranked according to the method described in that report (Table).Benefits, harms, and costs: Primary and specialist health care providers and women will be better informed about ovarian aging and the age-related decline in natural fertility and about options for assisted reproductive technology.

WITHDRAWN: Spontaneous rupture of pyometra causing peritonitis - Corrected Proof

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

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