http://www.hindawi.com The latest articles from Hindawi Publishing Corporation © 2013 , Hindawi Publishing Corporation . All rights reserved. Tue, 21 May 2013 09:40:15 +0000 http://www.hindawi.com/isrn/obgyn/2013/249357/ Objective. To describe the route of hysterectomy in a county hospital and evaluate the shift towards a minimal invasive approach. Design. Retrospective cohort study. Setting. A county hospital in Norway. Population. All women were scheduled for hysterectomy. Methods. Audit the route of hysterectomy in the period 2004–2012. Analyze the outcome of total laparoscopic hysterectomies. Main Outcome Measures. Complications after total laparoscopic hysterectomy. Results. A shift towards a minimal invasive approach has been achieved during the study period. In 2012 only 17.4% of the hysterectomies were performed abdominally, compared to yearly percentages of above 50% in the period 2004–2009. Laparoscopic supracervical hysterectomy was introduced in 2003, but the percentage of abdominal hysterectomy remained above 50% until total laparoscopic hysterectomy was introduced in 2010. Since the introduction of total laparoscopic hysterectomy in April 2010, 58 procedures have been performed. There have been no major complications. Two vaginal vault hematomas and one case of urinary tract infection were reported. Conclusions. It is possible for a county hospital to alter their praxis and perform mini-invasive hysterectomies, but it requires dedicated gynecologists. This change to an advanced procedure like total laparoscopic hysterectomy could be achieved without patients suffering from major complications. Christian Hoyer-Sorensen, Sigurd Hortemo, and Marit Lieng Copyright © 2013 Christian Hoyer-Sorensen et al. All rights reserved. Tue, 14 May 2013 14:49:37 +0000 http://www.hindawi.com/isrn/obgyn/2013/269425/ This retrospective cohort study was designed in a selective group of 185 patients diagnosed with and treated for ectopic pregnancy. Intramuscular administration of a single dose of methotrexate (50 mg/m2) was performed to measure predictors of failure or resistance to treatment necessitating surgical intervention. During the time of treatment with a single dose of MTX, 20 patients (10.8%) failed to response, in which 6 of 20 (30%) indicated side effects to MTX and rupture of the ectopic pregnancy. Remaining cases () showed resistance to the drug; the level of β-hCG did not fall at least 15% during 7 days after treatment and necessitated laparotomy. In backward-step analysis by multiple logistic regressions of various types of predictor factors, size of gestational sac (coefficient = 1.91, OR = 6.78, 95% confidence interval = 3.18–8.22) and baseline level β-hCG (coefficient = 1.60, OR = 5.0, 95% confidence interval = 4.26–6.72) had significant correlation with leading EP patients failing to response to MTX. This study suggests that further investigation for finding relative contraindications of MTX treatment in EP women should be considered on the gestational sac size because other variables are in the causal pathway of this variable. Parichehr Kimiaei, Zahra Khani, Azadeh Marefian, Maryam Gholampour Ghavamabadi, and Maryam Salimnejad Copyright © 2013 Parichehr Kimiaei et al. All rights reserved. Mon, 15 Apr 2013 14:36:40 +0000 http://www.hindawi.com/isrn/obgyn/2013/463598/ Objectives. To develop fundal height (FH) growth curve from normal singleton pregnancy based on last menstrual period (LMP) and/or ultrasound dating for women in the northern part of Thailand. Methods. A retrospective time-series study was conducted at four hospitals in the upper northern part of Thailand between January 2009 and March 2011. FH from 20 to 40 weeks was measured in centimeters. The FH growth curve was presented as smoothed function of the 10th, 50th, and 90th percentiles, which were derived from a regression model fitted by a multilevel model for continuous data. Results. FH growth curve was derived from 7,523 measurements of 1,038 women. Gestational age was calculated from LMP in 648 women and ultrasound in 390 women. The FH increased from 19.1 cm at 20 weeks to 35.4 cm at 40 weeks. The maximum increase of 1.0 cm/wk was observed between 20 and 32 weeks, declining to 0.7 cm/wk between 33 and 36 weeks and 0.3 cm/wk between 37 and 40 weeks. A quadratic regression equation was FH GA2 (wk) (R-squared = 0.85). Conclusions. A demographically specific FH growth curve may be an appropriate tool for monitoring and screening abnormal intrauterine growth. Jirawan Deeluea, Supatra Sirichotiyakul, Sawaek Weerakiet, Renu Buntha, Chamaiporn Tawichasri, and Jayanton Patumanond Copyright © 2013 Jirawan Deeluea et al. All rights reserved. Thu, 04 Apr 2013 13:18:35 +0000 http://www.hindawi.com/isrn/obgyn/2013/763782/ Objective. To evaluate whether pelvic measurements have any association with operative vaginal deliveries and the duration of the second stage of the delivery. Study design. A retrospective study of pregnant women at an increased risk of fetal-pelvic disproportion during 2000–2008 in North-Carelian Central Hospital. The mode of the vaginal delivery was chosen to represent the reference standard. The target condition was spontaneous vaginal delivery. Patients were divided into subgroups according to the size of the fetus and also by the parity to evaluate the variability reflecting differences in patient groups. Receiver operating characteristic (ROC) curves were established. Results. A total of 226 participants with fetal cephalic presentation delivered vaginally; of these, 184 women delivered spontaneously, and 42 women required operative vaginal delivery with vacuum extraction. There were no clinically or statistically significant differences between the size of the maternal pelvic outlet and the different modes of delivery types within these subgroups. With respect to the pelvic inlet and outlet, the areas under the curve in ROC were 0.566 with the value of 0.18 and 95% confidence interval (CI) of 0.465–0.667 and 0.573 (95% CI: 0.484–0.622; ). Conclusions. The maternal bony pelvic dimensions exhibited virtually no correlation with the need for operative vaginal deliveries. Ulla Korhonen, Pekka Taipale, and Seppo Heinonen Copyright © 2013 Ulla Korhonen et al. All rights reserved. Sun, 31 Mar 2013 16:10:25 +0000 http://www.hindawi.com/isrn/obgyn/2013/930479/ Objective. The purpose of this study was to assess the knowledge level about HPV and screening of cervical cancer in women from the metropolitan region of Natal, Brazil. Materials and Methods. A descriptive cross-sectional study involving sexually active women was conducted. The participants were submitted to a face-to-face interview, using a structured questionnaire that permitted the quantification of data and opinions of the respondents. Results. Most participants (70.9%) had poor knowledge about HPV and also the Pap test (53.0%). The high level of knowledge about HPV was associated with age, education, marital status, household income, and pregnancy, while the high level of knowledge about the Pap test proved to be associated only with education and household income. Conclusion. The results highlight the need for performing educational campaigns emphasizing the role of HPV in the etiology of cervical lesions of different degrees, including cervical cancer, as well as the importance of having a Pap test regularly to prevent these diseases. Érika Galvão Lima, Diego Breno Soares de Lima, Cleine Aglacy Nunes Miranda, Valeska Santana de Sena Pereira, Jenner Chrystian Veríssimo de Azevedo, Josélio Maria Galvão de Araújo, Thales Allyrio Araújo de Medeiros Fernandes, Paulo Roberto Medeiros de Azevedo, and José Veríssimo Fernandes Copyright © 2013 Érika Galvão Lima et al. All rights reserved. Wed, 27 Mar 2013 08:53:02 +0000 http://www.hindawi.com/isrn/obgyn/2013/650532/ Objective. Drip infusion during long-term tocolysis causes mechanical and infectious vasculitis and increases the frequency of peripheral venous catheter exchange (PVC), thereby placing a burden on patients. Our study aim is to confirm whether heparin ameliorates pain due to vasculitis during long-term tocolysis and reduces the frequency of peripheral venous catheter exchange. Design. Prospective study. Setting and Sample. All the patients requiring admission because of the presence of uterine contraction or progressive cervical dilatation from August 2009 to June 2011 at Juntendo University in Japan. Methods. Heparin was used for patients at the time the total number of peripheral venous catheter exchanges exceeded 5 in two weeks, and we evaluated whether heparin reduced the frequency of peripheral venous catheter exchange and improved the visual analog scale (VAS) for patients. The main outcome measures frequency of PVC exchange and VAS. Results. This study demonstrated that heparin reduced the frequency of peripheral venous catheter exchange () and VAS (). No side effects were noted. Conclusion. Heparin could satisfy patients during long-term tocolysis in terms of ameliorating pain due to vasculitis and reducing the PVC exchange frequency. Tetsunori Inagaki, Shintaro Makino, Takashi Yorifuji, Motoi Sugimura, and Satoru Takeda Copyright © 2013 Tetsunori Inagaki et al. All rights reserved. Mon, 25 Mar 2013 13:27:09 +0000 http://www.hindawi.com/isrn/obgyn/2013/297921/ Objective. To define compartment based therapeutic pelvic and periaortic lymphadenectomy in cervical and endometrial cancer. Compartment based oncologic surgery appears to be favorable for patients in terms of radicality as well as complication rates, and the same appears to be true for robotic surgery. We describe a method of robotically assisted compartment based lymphadenectomy step by step in uterine cancer and demonstrate feasibility data from 35 patients. Methods. Patients with the diagnosis of endometrial or cervical cancer were included. Patients were treated by rTMMR (robotic total mesometrial resection) or rPMMR (robotic peritoneal mesometrial resection) and pelvic or pelvic/periaortic rtLNE (robotic therapeutic lymphadenectomy) with cervical cancer FIGO IB-IIA or endometrial cancer FIGO I-III. Results. No transition to open surgery was necessary. Complication rates were 13% for endometrial cancer and 21% for cervical cancer. Within follow-up time median (22/20) month we noted 1 recurrence of cervical cancer and 2 endometrial cancer recurrences. Conclusions. We conclude that compartment based rtLNE is a feasible and safe technique for the treatment of uterine cancers and is favorable in aspects of radicality and complication rates. It should be analyzed in multicenter studies with extended followup on the basis of the described technique. Rainer Kimmig, Antonella Iannaccone, Paul Buderath, Bahriye Aktas, Pauline Wimberger, and Martin Heubner Copyright © 2013 Rainer Kimmig et al. All rights reserved. Thu, 28 Feb 2013 18:56:12 +0000 http://www.hindawi.com/isrn/obgyn/2013/120735/ Aim. Antenatal glucocorticoid therapy (AGT) has been commonly used recently. However, this therapy has severe harmful effects such as maternal hyperglycemia. In Japan, ritodrine hydrochloride has been used as a tocolytic agent. In this study, we performed retrospective casecontrol study to clarify whether concomitant use of ritodrine and glucocorticoid was safe to pregnant women without diabetes mellitus. Methods. We reviewed the computerized records of pregnant women with pregestational diabetes and nondiabetes who gave birth at our hospital between 2002 and 2011. Cases and controls received AGT. Blood glucose after the therapy was analyzed, and additional volume of insulin was compared to that before the therapy. Results. From this study, 30 units of insulin were necessary when performing AGT in diabetic pregnant women. And also, an increase in blood glucose of 40 mg/dL was seen after the therapy even in nondiabetic pregnant women. Blood glucose increased significantly in the group that also received ritodrine, and it was shown that the number of pregnant women who might develop ketoacidosis might increase 11-fold. Conclusions. Ritodrine should be carefully administered during antenatal glucocorticoid therapy. It may be necessary to adequately monitor blood glucose, when performing the therapy, even in nondiabetic pregnant women. Masaki Ogawa, Yoshio Matsuda, Aiko Kobayashi, Etsuko Shimada, Yoshika Akizawa, Minoru Mitani, Yasuo Makino, and Hideo Matsui Copyright © 2013 Masaki Ogawa et al. All rights reserved. Mon, 25 Feb 2013 17:43:33 +0000 http://www.hindawi.com/isrn/obgyn/2013/975251/ Background. The objective of this study was to estimate trends in ectopic pregnancies (EP) in a tertiary care center of Eastern Saudi Arabia. Method. Information about patients with ectopic pregnancies who had been admitted to King Fahd Hospital of the University, AlKhobar, between January 2000 and 31 December 2011 was collected from a computerized hospital registry. Age-specific ectopic pregnancy incidence was calculated. The data was analyzed using SPSS (Statistical Package for the Social Sciences), version 14.0 (Chicago, IL, USA). Results. There were 274 EPs during the study period; the yearly incidence in terms of 24,098 deliveries was 1.19%. The average age was 28.99 Å 5.62 years. During a three-year period (2000–2002), the incidence was 0.92%; from 2003 to 2005, the incidence was 1.01%; from 2006 to 2008, the incidence was 1.51%; and from 2009 to 2011, the incidence was 1.35%. Age-adjusted ectopic pregnancy incidence rates steadily increased from 92.23 per 10,000 women years during the period 2000–2002 to 149.408 during the 2006–2008 period; since then, it has declined to 110.313 per 10,000 women years. Conclusions. Our study reveals that the incidence of EP has decreased from what it had been during the mid-2000s but has remained significantly elevated when compared to the early 2000s. Haifa Abdulaziz Al-Turki Copyright © 2013 Haifa Abdulaziz Al-Turki. All rights reserved. Thu, 21 Feb 2013 09:49:36 +0000 http://www.hindawi.com/isrn/obgyn/2013/369419/ We retrospectively evaluated a series of 18 monoamniotic and 7 pseudomonoamniotic (secondary to rupture in the membrane dividing monochorionic diamniotic twins) twin gestations managed after 20 weeks’ gestation. There were no significant differences in the incidence of neonatal death or umbilical cord entanglement between the monoamniotic and pseudomonoamniotic twin gestations (33 versus 21%, and 72 versus 43%, ). Therefore, the same serious management may be needed for pseudomonoamniotic twin gestations as for monoamniotic twin gestations. Shunji Suzuki Copyright © 2013 Shunji Suzuki. All rights reserved. Wed, 13 Feb 2013 16:51:43 +0000 http://www.hindawi.com/isrn/obgyn/2013/672540/ Aim. Genitourinary fistulas are bothersome clinical entities not only for the patient but also for the treating surgeon as well. A lot of surgical procedures have been proposed; however, most of the fistulas can be easily treated with plain surgical techniques, such as the simple surgical closure of the fistula tract. Material and Method. The study was carried out in the urogynecology department of Ankara Etlik Zübeyde Hanım Maternity Training and Research Hospital. The study included 12 cases with vesicovaginal fistulas and 15 cases with rectovaginal fistulas. Twenty-six patients underwent simple surgical closure technique. The age, the referral time to the hospital, the longest diameter of the fistula opening, the hospitalization time, the follow-up period and identifiable risk factors of the patients were evaluated. Results. Caeserean section was detected as primary risk factor for vesicovaginal fistulas and prolonged labor was detected as the most important risk factor for rectovaginal fistulas. In our study, we found that the simple closure technique cured 91% of vesicovaginal fistulas and 93% of rectovaginal fistulas. Conclusion. The simple closure technique has very high cure rates for both vesicovaginal and rectovaginal fistulas when the longest diameter of the fistula openings is  mm. Eylem Unlubilgin, Tolgay Tuyan İlhan, Ahmet Akin Sivaslioglu, and Ismail Dolen Copyright © 2013 Eylem Unlubilgin et al. All rights reserved. Wed, 13 Feb 2013 13:37:21 +0000 http://www.hindawi.com/isrn/obgyn/2013/979345/ Purpose. To assess if there is a significant difference in enhancement of high grade serous carcinoma of the ovary compared with other ovarian malignancies on clinically performed contrast enhanced MRI studies. Methods. In this institutional-review–board-approved study, two radiologists reviewed contrast enhanced MRI scans in 37 patients with ovarian cancer. Readers measured the signal intensity (SI) of ovarian mass and gluteal fat pre- and postcontrast administration. Percentage enhancement (PE) was calculated as [(post-pre)/precontrast SI] × 100. Results. Pathology revealed 19 patients with unilateral and 18 patients with bilateral malignancies for a total of 55 malignant ovaries-high grade serous carcinoma in 25/55 ovaries (45%), other epithelial carcinomas in 12 ovaries (22%), nonepithelial cancers in 8 ovaries (14%), and borderline tumors in 10 ovaries (18%). Enhancement of high grade serous carcinoma was not significantly different from other invasive ovarian malignancies (Reader 1 ; Reader 2 ). Enhancement of invasive ovarian malignancies was more than borderline tumors but did not reach statistical significance (Reader 1; Reader 2 ). Conclusion. On clinically performed contrast enhanced MRI studies, enhancement of high grade serous ovarian carcinoma is not significantly different from other ovarian malignancies. Harpreet K. Pannu, Weining Ma, Emily Craig Zabor, Chaya S. Moskowitz, Richard R. Barakat, and Hedvig Hricak Copyright © 2013 Harpreet K. Pannu et al. All rights reserved. Mon, 04 Feb 2013 16:06:59 +0000 http://www.hindawi.com/isrn/obgyn/2013/628717/ Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome is a pathological condition characterized by primary amenorrhea and infertility and by congenital aplasia of the uterus and of the upper vagina. The development of secondary sexual characters is normal as well as that the karyotype (46,XX). Etiologically, this syndrome may be caused by the lack of development of the Müllerian ducts between the fifth and the sixth weeks of gestation. To explain this condition, it has been suggested that in patients with MRKH syndrome, there is a very strong hyperincretion of Müllerian-inhibiting factor (MIF), which would provoke the lack of development of the Müllerian ducts from primitive structures (as what normally occurs in male phenotype). These alterations are commonly associated with renal agenesis or ectopia. Specific mutations of several genes such as WT1, PAX2, HOXA7-HOXA13, PBX1, and WNT4 involved in the earliest stages of embryonic development could play a key role in the etiopathogenesis of this syndrome. Besides, it seems that the other two genes, TCF2 (HNF1B) and LHX1, are involved in the determinism of this pathology. Currently, the most widely nonsurgical used techniques include the “Frank’s dilators method,” while the surgical ones most commonly used are those developed by McIndoe, Williams, Vecchietti, Davydov, and Baldwin. Alfonsa Pizzo, Antonio Simone Laganà, Emanuele Sturlese, Giovanni Retto, Annalisa Retto, Rosanna De Dominici, and Domenico Puzzolo Copyright © 2013 Alfonsa Pizzo et al. All rights reserved. Wed, 30 Jan 2013 16:15:15 +0000 http://www.hindawi.com/isrn/obgyn/2013/387452/ Multiple metrics to characterize air pollution are available for use in environmental health analyses in addition to the standard Air Quality System (AQS) pollution monitoring data. These metrics have complete spatial-temporal coverage across a domain and are therefore crucial in calculating pollution exposures in geographic areas where AQS monitors are not present. We investigate the impact that two of these metrics, output from a deterministic chemistry model (CMAQ) and from a spatial-temporal downscaler statistical model which combines information from AQS and CMAQ (DS), have on risk assessment. Using each metric, we analyze ambient ozone's effect on low birth weight utilizing a Bayesian temporal probit regression model. Weekly windows of susceptibility are identified and analyzed jointly for all births in a subdomain of Texas, 2001–2004, and results from the different pollution metrics are compared. Increased exposures during weeks 20–23 of the pregnancy are identified as being associated with low birth weight by the DS metric. Use of the CMAQ output alone results in increased variability of the final risk assessment estimates, while calibrating the CMAQ through use of the DS metric provides results more closely resembling those of the AQS. The AQS data are still preferred when available. Joshua L. Warren, Montserrat Fuentes, Amy H. Herring, and Peter H. Langlois Copyright © 2013 Joshua L. Warren et al. All rights reserved. Thu, 10 Jan 2013 10:52:48 +0000 http://www.hindawi.com/isrn/obgyn/2013/305175/ Renato Seracchioli, Mohamed Mabrouk, Serena Solfrini, Giulia Montanari, Giulia Ferrini, Giulia Giovanardi, Diego Raimondo, and Riccardo Schiavina Copyright © 2013 Renato Seracchioli et al. All rights reserved. Thu, 27 Dec 2012 12:47:49 +0000 http://www.hindawi.com/isrn/obgyn/2012/491595/ Objectives. Antenatal corticosteroids (ACS) are not routinely administered to patients at risk for delivery between 34 and 36 6/7 weeks. Our objective was to determine whether ACS are cost-effective for late-preterm infants at risk for imminent preterm delivery. We hypothesized that the preferred strategy <36 weeks would include ACS while the preferred strategy ≥36 weeks would not. Methods. We performed decision-analytic and cost-effectiveness analyses to determine whether ACS was cost-effective at 34, 35, and 36 weeks. We conducted a literature review to determine probability, utility, and cost estimates absent of patient-level data. Base-case cost-effectiveness analysis, univariable sensitivity analysis, and Monte Carlo simulation were performed. A threshold of $100,000/QALY was considered cost-effective. Results. The incremental cost-effectiveness ratio favored the administration of a full course of ACS at 34, 35, and 36 weeks ($62,888.25/QALY, $64,425.67/QALY, and $64,793.71/QALY, resp.). A partial course of ACS was not cost-effective. While ACS was the consistently dominant strategy for acute respiratory outcomes, all models were sensitive to changes in variables associated with chronic respiratory disease. Conclusions. Our findings suggest that the administration of ACS to patients at risk of imminent delivery 34-36 weeks could significantly reduce the cost and acute morbidity associated with late-preterm birth. Jamie A. Bastek, Holly Langmuir, Laxmi A. Kondapalli, Emmanuelle Paré, Joanna E. Adamczak, and Sindhu K. Srinivas Copyright © 2012 Jamie A. Bastek et al. All rights reserved. Thu, 20 Dec 2012 14:30:17 +0000 http://www.hindawi.com/isrn/obgyn/2012/939762/ Background. Confidential enquiries into maternal deaths in the UK have repeatedly highlighted increased maternal morbidity and mortality associated with maternal obesity. Objective. To determine the impact of increased body mass index (BMI) on intrapartum outcomes. Materials and Methods. A retrospective case-control analysis of intrapartum outcomes of the study group (100 women), with a BMI above 40 kg/m2 (class III Obesity) at booking and a control group (100 women) with a booking BMI between 20 and 25 kg/m2 was performed. Results. A statistically significant increase in delivery by caesarean section (OR 2.32, 95% CI 1.26–4.29), minor and major postpartum haemorrhage (OR 5.93, 95% CI 2.34–11.98, OR 16.11, 95% CI 2.08–125.09, resp.), perineal trauma (OR 2.59, 95% CI 1.44–4.69), and fetal macrosomia (OR 3.11, 95% CI 1.25–7.79) was noted in the study group. Babies also had an increased risk of having a lower APGAR scores in the study group as compared to the control group (OR 3.09, 95% CI 1.07–8.94). Conclusion. Women with a BMI > 40 kg/m2 experience increased incidence of intrapartum complications and hence, input of skilled birth attendants during labour is essential to improve intrapartum outcomes. Dimuthu Vinayagam and Edwin Chandraharan Copyright © 2012 Dimuthu Vinayagam and Edwin Chandraharan. All rights reserved. Mon, 17 Dec 2012 14:11:55 +0000 http://www.hindawi.com/isrn/obgyn/2012/430265/ Background. Prolonged obstructed labour is a major cause of maternal and perinatal morbidity and mortality especially in the developing countries of the world, where the incidence is high. These complications are partly attributed to the metabolic and electrolyte derangements that are often associated with this problem. It is, therefore, important to evaluate the metabolic and electrolyte changes of these patients in a rural community in a developing country. Objective. To compare the electrolyte changes, maternal, and perinatal outcomes in patients with prolonged obstructed labour with that of normal labour in General Hospital Ikot Ekpene, Akwa Ibom State, Nigeria. Patients and Methods. This is a prospective cross-sectional case control study conducted in the Labour Ward of the General Hospital Ikot Ekpene to compare the electrolyte levels and perinatal outcome of 95 pregnant women who had prolonged labour with 105 women who had normal labour within the same period. Main Outcome Measures. Electrolyte changes, ketonuria, maternal complications, and perinatal outcome. Results. The majority of women with prolonged labour (91.6%) had major surgical interventions requiring anaesthesia. Perinatal death occurred in 12.6%, and a major life-threatening maternal complications (including two deaths) occurred in 13.7% of those with prolonged labour compared to 2.9% (with no death) in those with normal labour. Significant abnormal electrolyte changes included hyperkalemia, high urea, and creatinine as well as low bicarbonate levels were recorded. Metabolic abnormality was shown by ketonuria in 91.1% of the patients compared to 1.9% in women with normal labour. Conclusion. Women with prolonged labour in Ikot Ekpene have significant electrolyte and metabolic changes which impact adversely on the maternal and perinatal outcomes of the pregnancy. Effort should be made to correct these electrolyte and metabolic abnormalities during resuscitation of the woman in order to reduce the complications associated with such derangements. E. I. Ekanem, A. Umoiyoho, and A. Inyang-Otu Copyright © 2012 E. I. Ekanem et al. All rights reserved. Thu, 13 Dec 2012 10:13:38 +0000 http://www.hindawi.com/isrn/obgyn/2012/616759/ There are various factors related to postpartum depression. In this study we have aimed to determine the effect of mode of delivery on the risk of postpartum depression. A total of 318 women who applied for delivery were included in the study. Previously diagnosed fetal anomalies, preterm deliveries, stillbirths, and patients with need of intensive care unit were excluded from the study. Data about the patients were obtained during hospital stay. During the postpartum sixth week visit Edinburgh postnatal depression scale (EPDS) was applied. There was no significant difference between EPDS scores when compared according to age, education, gravidity, wanting the pregnancy, fear about birth, gender, family type, and income level (). Those who had experienced emesis during their pregnancy, had a history of depression, and were housewives had significantly higher EPDS scores (). Delivering by spontaneous vaginal birth, elective Cesarean section, or emergency Cesarean section had no effect on EPDS scores. In conclusion healthcare providers should be aware of postpartum depression risk in nonworking women with a history of emesis and depression and apply the EPDS to them for early detection of postpartum depression. Asli Goker, Emre Yanikkerem, M. Murat Demet, Serife Dikayak, Yasemin Yildirim, and Faik M. Koyuncu Copyright © 2012 Asli Goker et al. All rights reserved. Wed, 12 Dec 2012 08:54:54 +0000 http://www.hindawi.com/isrn/obgyn/2012/524537/ Objectives. The aim of this study was to determine whether prospective parents, primarily referred for prenatal diagnosis to exclude Down syndrome, prefer to know the fetal sex as part of invasive testing. Methods. In this prospective study 400 pregnant women undergoing amniocentesis were invited to answer a questionnaire, including information about demographic factors, current pregnancy, and previous children. In two open-ended questions they were asked why they wanted to know the fetal sex after amniocentesis or ultrasound investigation. Scores were given for reasons that could have played a role in the wish whether or not to know the sex of their unborn child. Results. A total of 210 (52.5%) questionnaires were completed. Overall, 69.0% was interested to know the fetal sex as part of the diagnostic test result. The most important reasons were curiosity (77.8%), “just want to know” (68.0%), and “because it is possible” (66.8%). The overall knowledge of sex chromosomal disorders appeared low and did not seem to affect the parent’s wish to know the fetal sex. Almost all women (96.6%) planned to have a 20-week ultrasound scan and 96.2% thought the scan to be reliable in detecting the fetal sex. A minority (28%) was willing to learn the fetal sex by ultrasound examination, whereas 65% preferred to learn the fetal sex only after the amniocentesis. Conclusion. Personal values affect the parental desire to know or not to know the fetal sex. This does not appear to be affected by invasive prenatal testing and/or genetic knowledge of sex chromosomal disorders. Angelique J. A. Kooper, Jacqueline J. P. M. Pieters, Alex J. Eggink, Ton B. Feuth, Ilse Feenstra, Lia D. E. Wijnberger, Robbert J. P. Rijnders, Rik W. P. Quartero, Peter F. Boekkooi, John M. G. van Vugt, and Arie P. T. Smits Copyright © 2012 Angelique J. A. Kooper et al. All rights reserved. Thu, 06 Dec 2012 09:05:36 +0000 http://www.hindawi.com/isrn/obgyn/2012/593876/ Objective. To identify the risk factors to the development of Burnout Syndrome in Ob/Gyn Brazilian physicians in four dimensions: emotional exhaustion (EE), professional repression (PR), dehumanization (De), and emotional distancing (EmD). Methods. A prospective cross-sectional study was realized with 48 Ob/Gyn physicians (12 lecturers, 12 attending physicians, 12 medical residents, and 12 graduate students) from Department of Obstetrics, São Paulo Federal University (UNIFESP). We used a sociodemographic questionnaire focusing on the activities (administrative, educational, healthcare, and research). We applied a Burnout Syndrome Inventory (BSI) composed of two parts: triggering factors (ISB1) and the Burnout Syndrome (ISB2). The ISB1 is composed of two scales: positive organizational conditions (POC) and negative organizational conditions (NOC). The ISB2 is composed of four scales: EE, PR, De, and EmD. Results. We observed a rate below and above average to POC and NOC, respectively. The dimensions recorded a level above average to EE, an index at the upper limit of the average to De, a median index to EmD, and a median index to PR. Conclusions. The Ob/Gyn physicians are in an area of vulnerability for the development of Burnout Syndrome due to the high level of EE and De, associated with a median index of PR. The high rate of NOC contributes to the triggering of this scenery. Fátima Ferreira Bortoletti, Ana Maria Teresa Benevides-Pereira, Esdras Guerreiro Vasconcellos, José Oliveira Siqueira, Edward Araujo Júnior, Luciano Marcondes Machado Nardozza, Ricardo Werner Sebastiani, and Antonio Fernandes Moron Copyright © 2012 Fátima Ferreira Bortoletti et al. All rights reserved. Wed, 21 Nov 2012 11:57:07 +0000 http://www.hindawi.com/isrn/obgyn/2012/678201/ Objectives. The study was conducted to characterize the use of the laparoscopic surgery in elderly patients. Methods. The medical records of elderly patients aged ≥65 years who underwent laparoscopic surgery were retrospectively reviewed for diseases, surgical procedures, histological diagnosis, intraoperative and postoperative complications, and reasons for presentation. Results. Of the 405 patients who underwent laparoscopic surgery between January 2005 and March 2012, 41 (10.1%) were aged ≥65 years. The most common disease treated by surgery was ovarian tumor, followed by uterine prolapse. Histological diagnosis of ovarian tumor specimens obtained from 23 patients included serous cystadenoma (44.0%), mature cystic teratoma (20.0%), mucinous cystadenoma (20.0%), and endometrioma (4%). In contrast, in the non-elderly group, the most common histological diagnosis was endometrioma (42.9%), followed in order by mature cystic teratoma (28.3%), serous cystadenoma (18.0%), and mucinous cystadenoma (4.7%). While 23.7% of the non-elderly patients required emergency laparoscopic surgery, none of the elderly patients required emergency surgery. Only 1 of 27 patients who underwent surgery for an ovarian or adnexal mass presented with abdominal pain. No one developed serious intraoperative or postoperative complications. Conclusion. Laparoscopic surgery can be safely performed in elderly patients. It should be noted, however, that few elderly patients with benign pelvic mass manifest symptoms before undergoing surgery. Haruhiko Kanasaki, Aki Oride, and Kohji Miyazaki Copyright © 2012 Haruhiko Kanasaki et al. All rights reserved. Wed, 14 Nov 2012 17:48:49 +0000 http://www.hindawi.com/isrn/obgyn/2012/519321/ Introduction. Pyelonephritis is a common complication of pregnancy. It is also exacerbated by immunocompromised states and also the sickle cell gene. We reviewed this condition in Jamaican women. Method. We did a six year hospital database docket review. We found 102 confirmed cases. Results. Pyelonephritis was found in 0.7% of deliveries. The mean maternal age was years with 51% primiparity. Most (58.8%) occurred in the second trimester. The main symptoms were loin pain (96.2%) and abdominal pain (84.6%). It was more common on the right side in 67% of cases. On urinalysis, 81.4% had pyuria. The commonest organism was Escherichia coli, in 61% of cases. Patients given Antibiotics prior to admission had quicker resolution, . Haemoglobin S was found in 16% cases (general population 10%; . However diabetes was only found in 1.3% cases (1.5% expected). 61.3% had positive urine culture after treatment showed that 61.3% and 25% had recurrent pyelonephritis. Complications included 32% threatened preterm labour and 17% preterm delivery. About 6% of neonates had intrauterine growth restriction. There were no ICU admissions and no deaths. Conclusion. Early recognition and treatment of pyelonephritis result in good outcome. The condition is more prevalent in patients with the sickle cell gene and recurrence is high. J. C. Dawkins, H. M. Fletcher, C. A. Rattray, M. Reid, and G. Gordon-Strachan Copyright © 2012 J. C. Dawkins et al. All rights reserved. Wed, 14 Nov 2012 13:37:16 +0000 http://www.hindawi.com/isrn/obgyn/2012/975135/ The prevalence of HTLV1 virus antibodies was determined in pregnant women and their neonates in Mashhad, northeast of Iran, as shown in this prospective cross-sectional study. 407 women who were hospitalized for delivery participated in this study. Venous blood sampling of pregnant women and umbilical cord of their neonates was done. The first samples of all women were tested for HTLV1 seropositivity by ELISA test and confirmed by PCR method. Then, the presence of HTLV1 in samples of umbilical cords blood in neonates who were delivered to an HTLV1-positive mother was determined by PCR method. All HTLV1-positive infants were called again at the age of 9–12 months, and PCR test was done using HTLV1-specific primers for them. Of all the participating women, 6 persons were HTLV1 seropositive by ELIZA test which was confirmed by PCR test. HTLV1 antibodies were found in cord blood samples by PCR test in 6 newborns who were born to HTLV1-seropositive women. All the six infants at the age of 9–12 months showed positive PCR results by HTLV1 LTR-specific primers; however, only one of them was PCR positive using HTLV1 TAX-specific primers. The prevalence of HTLV1 antibodies in pregnant women was 1.5%, and the vertical transmission rate to their neonates was 16.6%. A. Hamedi, F. Akhlaghi, Z. Meshkat, M. Sezavar, H. Nomani, and M. Meshkat Copyright © 2012 A. Hamedi et al. All rights reserved. Wed, 14 Nov 2012 11:01:09 +0000 http://www.hindawi.com/isrn/obgyn/2012/353791/ Background. Macrosomia is defined as an infant’s birth weight of more than 4000 g at term which is to different maternal and neonatal complications. Several studies have been done on factors influencing risk of macrosomia, but there is lack of information and study in our country regarding macrosomia complications. Objective. The aim of this study was to determine the prevalence of macrosomia and its complications. Method. A cohort study was conducted from 2007 to 2011 at Obstetrics and Gynecology Department, Razi Hospital in Ahvaz city, Iran. All pregnant mothers who were referred to Obstetrics and Gynecology Department for delivery were included in this study. The total number of 201,102 pregnant mothers was recruited and divided into case and control groups after delivery (macrosomia (case) and normal weight infants (control) groups). Results. Out of total deliveries (201,102), there were 1800 macrosomia, (9%). Gestational diabetes, maternal obesity (BMI), maternal aged and positive history of previous macrosomia were the major risk factors for macrosomia which were compared with the normal weight infant groups ( for all parameters). Neonatal complications associated with macrosomia included humerus—clavicle fractures and arm—brachial plexus injury which were significant compared to the control group ( for all parameters). Conclusion. The macrosomia is potentially dangerous for the mother and the neonate. It is important to recognize the suspected fetal macrosomia to prevent its risk factors and complications. There is a need to provide all delivery facilities and care services to prevent and reduce the maternal and neonatal macrosomia complications. Mahin Najafian and Maria Cheraghi Copyright © 2012 Mahin Najafian and Maria Cheraghi. All rights reserved. Wed, 14 Nov 2012 10:59:36 +0000 http://www.hindawi.com/isrn/obgyn/2012/945486/ Introduction. Recurrent spontaneous abortion (RSA) is a significant obstetrical complication that may occur during pregnancy. Various studies in recent years have indicated that two common mutations (C677T and A1298C) of the methylenetetrahydrofolate reductase (MTHFR) gene are risk factor for RSA. This study was carried out to determine the influence of (C677T and A1298C) of the methylenetetrahydrofolate reductase (MTHFR) gene mutations with RSA. Materials and Methods. A total of 139 women were included in this study: 89 women with two or more consecutive miscarriages and 50 healthy controls. Total genomic DNA was isolated from blood leukocytes. To determine the frequency of the two common C677T and A1298C MTHFR gene mutations in the patients and controls, we used two methods, amplification refractory mutation system-PCR and PCR-restriction fragment length polymorphism. Results. There is no significant difference in the prevalence of 677T/T genotype among women with RSA and healthy controls (). Also no statistically significant difference in the frequency of A1298C MTHFR gene mutation was detected between the two groups ( ). Conclusion. In conclusion, the results indicate that the Amplification Refractory Mutation System-PCR method was in complete concordance with the results obtained by standard PCR-restriction fragment length polymorphism method. The results also show no significant difference in MTHFR C677T/A1298C genotype distribution among the two groups; therefore, further studies on larger population and other genetic variants to better understand the pathobiology of RSA are needed. Ahmad Poursadegh Zonouzi, Nader Chaparzadeh, Mehrdad Asghari Estiar, Mahzad Mehrzad Sadaghiani, Laya Farzadi, Alieh Ghasemzadeh, Masoud Sakhinia, and Ebrahim Sakhinia Copyright © 2012 Ahmad Poursadegh Zonouzi et al. All rights reserved. Wed, 14 Nov 2012 10:45:55 +0000 http://www.hindawi.com/isrn/obgyn/2012/325790/ Background. The aim was to evaluate predictive and prognostic factors in a large consecutive series of endometrial carcinomas and to discuss pre- and postoperative risk groups based on these factors. Material and Methods. In a consecutive series of 4,543 endometrial carcinomas predictive and prognostic factors were analyzed with regard to recurrence rate and survival. The patients were treated with primary surgery and adjuvant radiotherapy. Two preoperative and three postoperative risk groups were defined. DNA ploidy was included in the definitions. Eight predictive or prognostic factors were used in multivariate analyses. Results. The overall recurrence rate of the complete series was 11.4%. Median time to relapse was 19.7 months. In a multivariate logistic regression analysis, FIGO grade, myometrial infiltration, and DNA ploidy were independent and statistically predictive factors with regard to recurrence rate. The 5-year overall survival rate was 73%. Tumor stage was the single most important factor with FIGO grade on the second place. DNA ploidy was also a significant prognostic factor. In the preoperative risk group definitions three factors were used: histology, FIGO grade, and DNA ploidy. Conclusions. DNA ploidy was an important and significant predictive and prognostic factor and should be used both in preoperative and postoperative risk group definitions. Bengt Sorbe Copyright © 2012 Bengt Sorbe. All rights reserved. Wed, 14 Nov 2012 10:01:45 +0000 http://www.hindawi.com/isrn/obgyn/2012/286141/ To compare the fetal cerebellum and cisterna magna length measurements by means of two- (2DUS) and three-dimensional (3DUS) ultrasonography using the three-dimensional extended imaging (3D XI), a cross-sectional study with 69 healthy pregnant women between 18 and 24 weeks was performed. For the measurements by 2DUS, the axial planes were used and for the 3DUS a sequence of adjacent axial slices (multislice view). To evaluate the difference between the two techniques, we used the Wilcoxon test. To evaluate the correlation between the cerebellum and cisterna magna length measurements and the gestational age, we used the Spearman correlation coefficient (). For the calculation of reproducibility, we used the intraclass correlation coefficient (ICC). The mean of the transverse and anterior-posterior diameter of cerebellum and cisterna magna by 3DUS was 9.23 and 6.62 mm, respectively. It was observed that the average of the measurements obtained by 3DUS was significantly higher, 0.76 and 1.02 mm for the length of the cerebellum and cisterna magna, respectively (). There was a high correlation between the length measurement of the cerebellum 3D (, ), but low correlation of cisterna magna 3D (, ) with the gestational age. There was good intra- and interobserver reproducibility for the cerebellum and cisterna magna 3D with , 0.668, 0.691, and 0.287, respectively. The measurements of the fetal cerebellum and cisterna magna length by 3DUS using the software 3D XI were significantly higher than those obtained by 2DUS. Fernanda Silveira Bello de Barros, Luiz Cláudio de Silva Bussamra, Edward Araujo Júnior, Leonardo da Silva Valladão de Freitas, Luciano Marcondes Machado Nardozza, Antonio Fernandes Moron, and José Mendes Aldrighi Copyright © 2012 Fernanda Silveira Bello de Barros et al. All rights reserved. Sun, 04 Nov 2012 11:38:25 +0000 http://www.hindawi.com/isrn/obgyn/2012/481870/ Gastro-oesophageal reflux (GER) and the symptoms of heartburn and regurgitation are common in pregnancy. These symptoms are transient and mostly resolve postpartum but have a negative impact on quality of life. Here, we present a prospective clinical evaluation of the safety and efficacy of an alginate raft-forming oral suspension that is licensed for use in pregnancy. The study was a multicentre, prospective, open-label, and baseline-controlled study of Liquid Gaviscon (LG) in the treatment of heartburn in pregnant women with current symptoms of heartburn and/or reflux requiring treatment (recruited 144). The efficacy of the study medication was rated by the investigator (primary endpoint) and patient. Treatment was deemed to be a success in 91% of patients as judged by the investigator (95% CI 85.0–95.3) and 90% (95% CI 84.1–94.8) when assessed by the patient themselves. Very few adverse events or serious adverse events were reported that were considered to be related to the study medication, and these were consistent with the normal population incidences. Serum sodium levels remained unchanged. This prospective open-label study in a large number of pregnant women has shown that LG is both safe and highly efficacious in the treatment of heartburn and GER symptoms in pregnancy. Vicki Strugala, Julian Bassin, Valerie S. Swales, Stephen W. Lindow, Peter W. Dettmar, and Edward C. M. Thomas Copyright © 2012 Vicki Strugala et al. All rights reserved. Tue, 30 Oct 2012 11:28:05 +0000 http://www.hindawi.com/isrn/obgyn/2012/183403/ Two hundred and 91 patients showing signs and symptoms of bacterial vaginosis (BV) were randomized to receive topical treatment with Fitostimoline (vaginal cream and vaginal ovules + vaginal washing) or benzydamine hydrochloride (vaginal cream + vaginal washing) for 7 days. Signs (leucorrhoea, erythema, oedema, and erosion) and symptoms (burning, pain, itching, vaginal dryness, dyspareunia, and dysuria) (scored 0–3) were evaluated at baseline and at the end of treatment; the total symptoms score (TSS) was also calculated. In 125 patients, a bacterial vaginosis was confirmed by vaginal swab test. The primary efficacy variable analysis, that is, the percentage of patients with therapeutic success (almost complete disappearance of signs and symptoms), demonstrated that Fitostimoline ovules and vaginal cream were therapeutically equivalent and that pooled Fitostimoline treatment was not inferior to benzydamine hydrochloride. All the treatments were well tolerated, with only minor local adverse events infrequently reported. The results of this study confirmed that gynaecological Fitostimoline is a safe and effective topical treatment for BV. F. Boselli, E. Petrella, A. Campedelli, M. Muzi, V. Rullo, L. Ascione, R. Papa, and G. Saponati Copyright © 2012 F. Boselli et al. All rights reserved.