ISRN Obstetrics and Gynecology The latest articles from Hindawi Publishing Corporation © 2014 , Hindawi Publishing Corporation . All rights reserved. Effect of Treatment with Ginger on the Severity of Premenstrual Syndrome Symptoms Sun, 04 May 2014 07:22:29 +0000 Premenstrual syndrome (PMS) is a common disorder. Although the etiology of PMS is not clear, to relieve from this syndrome different methods are recommended. One of them is use of medicinal herbs. This study was carried out to evaluate effects of ginger on severity of symptoms of PMS. This study was a clinical trial, double-blinded work, and participants were randomly allocated to intervention () and control () groups. To determine persons suffering from PMS, participants completed daily record scale questionnaire for two consecutive cycles. After identification, each participant received two ginger capsules daily from seven days before menstruation to three days after menstruation for three cycles and they recorded severity of the symptoms by daily record scale questionnaire. Data before intervention were compared with date 1, 2, and 3 months after intervention. Before intervention, there were no significant differences between the mean scores of PMS symptoms in the two groups, but after 1, 2, and 3 months of treatment, there was a significant difference between the two groups (). Based on the results of this study, maybe ginger is effective in the reduction of severity of mood and physical and behavioral symptoms of PMS and we suggest ginger as treatment for PMS. Samira Khayat, Masoomeh Kheirkhah, Zahra Behboodi Moghadam, Hamed Fanaei, Amir Kasaeian, and Mani Javadimehr Copyright © 2014 Samira Khayat et al. All rights reserved. Knowledge and Attitude of Nigerian Pregnant Women towards Antenatal Exercise: A Cross-Sectional Survey Mon, 14 Apr 2014 00:00:00 +0000 Background. Engagement in physical exercise in pregnancy is hamstrung by safety concerns, skepticism about usefulness, and limited individualized prescription guidelines. This study assessed knowledge and attitude of pregnant women towards antenatal exercises (ANEx). Methods. The cross-sectional study recruited 189 pregnant women from six selected antenatal clinics in Ile-Ife, South-West, Nigeria. Data were obtained on maternal characteristics, knowledge, and attitude towards ANEx. Results. Relaxation and breathing (59.8%), back care (51.3%), and muscle strengthening (51.3%) exercises were the most commonly known ANEx. Prevention of back pain risk (75.9%) and excess weight gain (69.1%) were perceived as benefits, while lower extremities swelling (31.8%) and extreme weight gain or loss (30.7%) were considered as contraindications to ANEx. 15.8% of the respondents had negative attitude towards ANEx resulting from insufficient information on exercise (83.3%) and tiredness (70.0%). Age significantly influences knowledge about contraindications to ANEx (), while attitude was influenced by age and occupation, respectively (). There was significant association between attitude and knowledge about benefits and contraindications to ANEx (). Conclusion. A majority of Nigerian pregnant women demonstrated inadequate knowledge but had positive attitude towards ANEx. Knowledge about benefits and contraindications to ANEx significantly influenced the attitude towards exercise in pregnancy. Chidozie E. Mbada, Olubukayomi E. Adebayo, Adebanjo B. Adeyemi, Olujide O. Arije, Olumide O. Dada, Olabisi A. Akinwande, Taofeek O. Awotidebe, and Ibidun A. Alonge Copyright © 2014 Chidozie E. Mbada et al. All rights reserved. The Role of Androgen Hormones in Early Follicular Development Thu, 10 Apr 2014 12:21:16 +0000 Background. Although chronic hyperandrogenism, a typical feature of polycystic ovary syndrome, is often associated with disturbed reproductive performance, androgens have been shown to promote ovarian follicle growth in shorter exposures. Here, we review the main effects of androgens on the regulation of early folliculogenesis and the potential of their application in improving follicular in vitro growth. Review. Androgens may affect folliculogenesis directly via androgen receptors (ARs) or indirectly through aromatization to estrogen. ARs are highly expressed in the granulosa and theca cells of early stage follicles and slightly expressed in mature follicles. Short-term androgen exposure augments FSH receptor expression in the granulosa cells of developing follicles and enhances the FSH-induced cAMP formation necessary for the transcription of genes involved in the control of follicular cell proliferation and differentiation. AR activation also increases insulin-like growth factor (IGF-1) and its receptor gene expression in the granulosa and theca cells of growing follicles and in the oocytes of primordial follicles, thus facilitating IGF-1 actions in both follicular recruitment and subsequent development. Conclusion. During the early and intermediate stages of follicular maturation, locally produced androgens facilitate the transition of follicles from the dormant to the growing pool as well as their further development. Catiele Garcia Gervásio, Marcelo Picinin Bernuci, Marcos Felipe Silva-de-Sá, and Ana Carolina Japur de Sá Rosa-e-Silva Copyright © 2014 Catiele Garcia Gervásio et al. All rights reserved. Labour Analgesia When Epidural Is Not a Choice: Tramadol versus Pentazocine Mon, 07 Apr 2014 08:01:06 +0000 Background. Parenteral opioids, thus, are still popular for pain relief in labor in many countries throughout the world. Aim. To evaluate and compare the efficacy of intramuscular tramadol and pentazocine in the first stage of labor. Method. Sixty-five patients were divided into pentazocine group and tramadol group. Subjects received either 30 mg pentazocine or 1 mg/kg tramadol intramuscularly. Pain was assessed using visual analog scale (VAS) before the administration of the drug, at 1 h, 2 h, 4 h, and at full dilatation. Maternal and neonatal side effects were determined. Results. Analgesic effect of the two drugs was not significantly different. Neither of these analgesics was effective towards the end of the first stage. However, in the tramadol group, the majority of women (55%) rated pain as severe, whereas in the pentazocine group, the majority of women (60%) rated pain as moderately severe. There were not many side effects with either of the drug in the given dosage. Mean injection to delivery interval was significantly shorter in the tramadol group as compared to the pentazocine group. Conclusion. Pentazocine or tramadol can be given for labor pain relief as an alternative to epidural analgesia in resource poor setting. Jyothi Shetty, Ashwini Vishalakshi, and Deeksha Pandey Copyright © 2014 Jyothi Shetty et al. All rights reserved. Major Congenital Malformations in Barbados: The Prevalence, the Pattern, and the Resulting Morbidity and Mortality Sun, 06 Apr 2014 07:10:03 +0000 Objectives. To study the prevalence and the pattern of major congenital malformations and its contribution to the overall perinatal morbidity and mortality. Methods. It is a retrospective population based study. It includes all major congenital malformations in newborns during 1993-2012. The data was collected from the birth register, the neonatal admission register and the individual patient records at the Queen Elizabeth Hospital where over 90% of deliveries take place and it is the only facility for the care of sick newborns in this country. Results. The overall prevalence of major congenital malformations among the live births was 59/10,000 live births and that among the stillbirths was 399/10,000 stillbirths. Circulatory system was the most commonly affected and accounted for 20% of all the major congenital malformations. Individually, Down syndrome (4.1/10, 000 live births) was the commonest major congenital malformation. There was a significant increase in the overall prevalence during the study period. Major congenital malformations were responsible for 14% of all neonatal death. Conclusions. Less than 1% of all live newborns have major congenital malformations with a preponderance of the malformations of the circulatory system. Major congenital malformations contribute significantly to the overall neonatal morbidity and mortality in this country. Keerti Singh, Kandamaran Krishnamurthy, Camille Greaves, Latha Kandamaran, Anders L. Nielsen, and Alok Kumar Copyright © 2014 Keerti Singh et al. All rights reserved. Perineal Distensibility Using Epi-no in Twin Pregnancies: Comparative Study with Singleton Pregnancies Thu, 27 Mar 2014 10:05:15 +0000 The aims of this study were to compare perineal distensibility between women with twin and singleton pregnancies and to correlate these women’s perineal distensibility with anthropometric data. This prospective cross-sectional case-control study was conducted among nulliparous women, of whom 20 were pregnant with twins and 23 with a single fetus. Perineal distensibility was evaluated in the third trimester by means of Epi-no, which was introduced into the vagina and inflated up to the maximum tolerable limit. It was then withdrawn while inflated and its circumference was measured. The unpaired Student’s -test was used to compare perineal distensibility in the two groups and Pearson’s correlation coefficient () was used to correlate the pregnant women’s perineal distensibility with their anthropometric data. There was no difference in perineal distensibility between the twin group (16.51 ± 2.05 cm) and singleton group (16.13 ± 1.67 cm) (). There was a positive correlation between perineal distensibility and abdominal circumference (; ). The greater the abdominal circumference was, the greater the perineal distensibility was, regardless of whether the pregnancy was twin or singleton. Juliana Sayuri Kubotani, Antonio Fernandes Moron, Edward Araujo Júnior, Miriam Raquel Diniz Zanetti, Vanessa Cardoso Marques Soares, and Julio Elito Júnior Copyright © 2014 Juliana Sayuri Kubotani et al. All rights reserved. Fetal Head Position during the First Stage of Labor: Comparison between Vaginal Examination and Transabdominal Ultrasound Thu, 27 Mar 2014 08:36:15 +0000 Introduction. Recent evidence indicates that clinical examination, for determination of fetal head position, is subjective and inaccurate. Present study was aimed to compare transabdominal ultrasound for fetal head position with vaginal examination during first stage of labor. Material and Methods. This prospective study was performed at a tertiary center during a two-year period. Before or after clinically indicated vaginal examinations, transverse suprapubic transabdominal real-time ultrasound fetal head position assessment was done. Frequencies of various ultrasound depicted fetal head positions were compared with position determined at vaginal examination. Results. In only 31.5% of patients, fetal head position determinations by vaginal examinations were consistent with those obtained by ultrasound. Cohen’s Kappa test of concordance indicated a poor concordance of 0.15. Accuracy of vaginal examination increased to 66% when fetal head position at vaginal examination was recorded correct if reported within +45° of the ultrasound assessment. Rate of agreement between the two assessment methods for consultants versus residents was 36% and 26%, respectively (). Conclusion. We found that vaginal examination was associated with a high error rate in fetal head position determination. Data supports the idea that intrapartum transabdominal ultrasound enhances correct determination of fetal head position during first stage of labor. Jyothi Shetty, Vinod Aahir, Deeksha Pandey, Prashanth Adiga, and Asha Kamath Copyright © 2014 Jyothi Shetty et al. All rights reserved. Can Platelet Indices Be New Biomarkers for Severe Endometriosis? Wed, 26 Mar 2014 09:41:27 +0000 Objective. The aim of this study was to investigate whether platelet indices-mean platelet volume (MPV), platelet distribution width (PDW), and plateletcrit (PCT) would be useful as noninvasive biomarkers for determining the severity of endometriosis. Methods. A retrospective review of the medical charts of 164 patients diagnosed with endometriosis and who were operated on between 2001 and 2013 was performed. The stage of endometriosis was determined according to revised American Society for Reproductive Medicine criteria. Results. In patients with advanced endometriosis (Stages 3-4), PLT, PCT levels were found to be significantly higher and MPV, PDW values to be significantly lower when compared to initial endometriosis (Stages 1-2). In addition, there was a significant positive correlation between PLT (r: 0.800, P: 0.001) and PCT (r: 0.727, P: 0.002) and the inflammatory marker white blood cell count (WBC). Conclusion. Our finding may not sufficient for employing platelet indices solely in this differential diagnosis, but our finding could provide a suggestion for clinical physicians so that attention is paid to the value of platelet indices and that these may be taken into account when making decisions about the initial or advanced stages of endometriosis. Sümeyra Nergiz Avcioğlu, Sündüz Özlem Altinkaya, Mert Küçük, Selda Demircan-Sezer, and Hasan Yüksel Copyright © 2014 Sümeyra Nergiz Avcioğlu et al. All rights reserved. Does Postevacuation β-Human Chorionic Gonadotropin Level Predict the Persistent Gestational Trophoblastic Neoplasia? Mon, 24 Mar 2014 11:25:18 +0000 β-human chorionic gonadotropin (HCG) level is not a reliable marker for early identification of persistent gestational trophoblastic neoplasia (GTN) after evacuation of hydatidiform mole. Thus, this study was conducted to evaluate β-HCG regression after evacuation as a predictive factor of malignant GTN in complete molar pregnancy. Methods. In this cross-sectional study, we evaluated a total of 260 patients with complete molar pregnancy. Sixteen of the 260 patients were excluded. Serum levels of HCG were measured in all patients before treatment and after evacuation. HCG level was measured weekly until it reached a level lower than 5 mIU/mL. Results. The only predictors of persistent GTN are HCG levels one and two weeks after evacuation. The cut-off point for the preevacuation HCG level was 6000 mIU/mL (area under the curve, AUC, 0.58; sensitivity, 38.53%; specificity, 77.4%), whereas cut-off points for HCG levels one and two weeks after evacuation were 6288 mIU/mL (AUC, 0.63; sensitivity, 50.46%; specificity, 77.0%) and 801 mIU/mL (AUC, 0.80; sensitivity, 79.82%; specificity, 71.64%), respectively. Conclusion. The rate of decrease of HCG level at two weeks after surgical evacuation is the most reliable and strongest predictive factor for the progression of molar pregnancies to persistent GTN. Azam Sadat Mousavi, Samieh Karimi, Mitra Modarres Gilani, Setareh Akhavan, and Elahe Rezayof Copyright © 2014 Azam Sadat Mousavi et al. All rights reserved. Molecular Patterns of Neurodevelopmental Preconditioning: A Study of the Effects of Antenatal Steroid Therapy in a Protein-Restriction Mouse Model Thu, 13 Mar 2014 15:32:35 +0000 Introduction. Prenatal programming secondary to maternal protein restriction renders an inherent susceptibility to neural compromise in neonates and any addition of glucocorticosteroids results in further damage. This is an investigation of consequent global gene activity due to effects of antenatal steroid therapy on a protein restriction mouse model. Methods. C57BL/6N pregnant mice were administered control or protein restricted diets and subjected to either 100 μg/Kg of dexamethasone sodium phosphate with normosaline or normosaline alone during late gestation (E10–E17). Nontreatment groups were also included. Brain samples were collected on embryonic day 17 and analyzed by mRNA microarray analysis. Results. Microarray analyses presented 332 significantly regulated genes. Overall, neurodevelopmental genes were overrepresented and a subset of 8 genes allowed treatment segregation through the hierarchical clustering method. The addition of stress or steroids greatly affected gene regulation through glucocorticoid receptor and stress signaling pathways. Furthermore, differences between dexamethasone-administered treatments implied a harmful effect during conditions of high stress. Microarray analysis was validated using qPCR. Conclusion. The effects of antenatal steroid therapy vary in fetuses according to maternal-fetal factors and environmental stimuli. Defining the key regulatory networks that signal either beneficial or damaging corticosteroid action would result in valuable adjustments to current treatment protocols. Clarissa Velayo, Takuya Ito, Yupeng Dong, Miyuki Endo, Rika Sugibayashi, Kiyoe Funamoto, Keita Iida, Nobuo Yaegashi, and Yoshitaka Kimura Copyright © 2014 Clarissa Velayo et al. All rights reserved. A Case-Control Study on Risk Factors for Preterm Deliveries in a Secondary Care Hospital, Southern India Thu, 13 Mar 2014 11:15:14 +0000 Introduction. Preterm birth is the leading cause of newborn deaths and the second leading cause of death in children under five years old. Three-quarters of them could be saved with current, cost-effective interventions. The aim of this study was to identify the risk factors of preterm birth in a secondary care hospital in Southern India. Methods. In the case-control study, records of 153 antenatal women with preterm birth were included as cases. Age matched controls were women who had a live birth after 37 weeks of gestational age. Gestational age at delivery and associated risk factors were analyzed. Results. The preterm birth rate was 5.8%. Common risk factors associated with preterm birth were hypertensive disorders of pregnancy (21.4%), height <1.50 m (16.8%), premature rupture of membranes (17.5%), and fetal distress (14.9%). Mean birth weight for preterm babies was 2452 grams while the birth weight for term babies was 2978 grams. Conclusion. The commonest obstetrical risk factor for preterm birth was hypertensive disorders of pregnancy and nonobstetrical risk factor was height <1.50 m. The percentage of preterm birth was low, comparable to developing countries. Chythra R. Rao, Lara E. E. de Ruiter, Parvati Bhat, Veena Kamath, Asha Kamath, and Vinod Bhat Copyright © 2014 Chythra R. Rao et al. All rights reserved. Environmental Tobacco Smoke Exposure during Intrauterine Period, Promotes Caspase Dependent and Independent DNA Fragmentation in Sertoli-Germ Cells Wed, 12 Mar 2014 08:21:36 +0000 Objectives. To investigate the effect of cigarette smoke exposure during intrauterine period on neonatal rat testis. Methods. Twenty-five rats were randomized to be exposed to cigarette smoke with the Walton Smoking Machine or to room air during their pregnancies. The newborn male rats () were grouped as group 1 () which were exposed to cigarette smoke during intrauterine life and group 2 () which were exposed to room air during intrauterine life. The orchiectomy materials were analyzed with TUNEL immunofluorescent staining for detection of DNA damage. To detect apoptosis, immunohistochemical analyses with caspase-3 were performed. Primary outcomes were apoptotic index and immunohistochemical scores (HSCORES); secondary outcomes were Sertoli-cell count and birth-weight of rats. Results. Sertoli cell apoptosis was increased in group 1 (HSCORE ) when compared to group 2 (HSCORE ) (). Sertoli cell count was decreased in group 1 (). The HSCORE for the germ cells was calculated as in group 1 and in group 2 () referring to an increased germ cell apoptosis in group 1. The apoptotic indexes for group 1 were and for group 2 (). The immunofluorescent technique demonstrated increased DNA damage in seminiferous epithelium in group 1. Conclusions. Intrauterine exposure to cigarette smoke adversely affects neonatal testicular structuring and diminishes testicular reserve. Beril Yüksel, Sevtap Kilic, Nese Lortlar, Nicel Tasdemir, Semra Sertyel, Yesim Bardakci, Tarik Aksu, and Sertaç Batioglu Copyright © 2014 Beril Yüksel et al. All rights reserved. Genital Infection with Herpes Simplex Virus Types 1 and 2 in Women from Natal, Brazil Tue, 11 Mar 2014 15:44:29 +0000 Objective. To evaluate the prevalence of HSV-1 and HSV-2 in pregnant and nonpregnant women, testing the correlation between DNA of the viruses with colposcopic and/or cytological changes, and evaluate association with sociodemographic characteristics and sexual activity. Methods. Included in this study were 106 pregnant and 130 nonpregnant women treated at primary health care units of Natal, Brazil, in the period 2010-2011. The patients were examined by colposcopy, and two cervical specimens were collected: one for cytology examination and another for analysis by PCR for detection of HSV-1 and HSV-2. Results. HSV-1 alone was detected in 16.0% of pregnant and 30.0% of nonpregnant women. For HSV-2, these rates were 12.3% and 15.5%, respectively. HSV-2 had a higher correlation with cytology and/or colposcopy changes than HSV-1 did. Genital HSV-1 infection was not associated with any of the variables tested, whereas HSV-2 infection was associated with ethnicity, marital status, and number of sexual partners. Conclusions. The prevalence of HSV-1 was higher than that observed for HSV-2 in both pregnant and nonpregnant women. The genital infection by HSV-2 was higher in women with changed colposcopy and/or cytology, and it was associated with ethnicity, marital status, and number of sexual partners. Cleine Aglacy Nunes Miranda, Érika Galvão Lima, Diego Breno Soares de Lima, Ricardo Ney Oliveira Cobucci, Maria da Conceição de Mesquita Cornetta, Thales Allyrio Araújo de Medeiros Fernandes, Paulo Roberto Medeiros de Azevedo, Jenner Chrystian Veríssimo de Azevedo, Josélio Maria Galvão de Araújo, and José Veríssimo Fernandes Copyright © 2014 Cleine Aglacy Nunes Miranda et al. All rights reserved. HPV Vaccination in India: Critical Appraisal Tue, 11 Mar 2014 10:51:57 +0000 Cervical cancer is the third most common cancer in women worldwide. The role of human papilloma virus (HPV) in the genesis of cervical carcinoma is well documented. The HPV 16 and 18 are found to be most commonly associated with invasive cervical carcinoma. The advent of cervical carcinoma vaccine has advanced the hopes that eradication of cervical carcinoma might be possible in future. The scenario of prevention of cervical carcinoma is completely different in developed and developing countries. The implementation of the vaccination as a routine in India is still controversial. Here we have tried to critically analyse these issues in Indian context. However it is clear that cervical cancer vaccine is not an immediate panacea and cannot replace the cervical cancer screening which is mandatory in Indian context. Aruna Nigam, Pikee Saxena, Anita S. Acharya, Archana Mishra, and Swaraj Batra Copyright © 2014 Aruna Nigam et al. All rights reserved. Postnatal Systemic Blood Flow in Neonates with Abnormal Fetal Umbilical Artery Doppler Wed, 05 Mar 2014 10:09:39 +0000 Objective. Abnormal umbilical artery Doppler (UAD) studies are associated with poor neonatal outcomes. We sought to determine if postnatal measures of systemic blood flow (SBF), as measured by functional echocardiography (fECHO), could identify which fetuses with abnormal UAD were at the highest risk of adverse outcomes. Study Design. This is a retrospective review of fetuses with abnormal UAD who received fECHO in the first 72 hours of life. Measures of SBF (right ventricular output (RVO) and superior vena cava (SVC) flow) were performed and compared with prenatal variables and postnatal outcomes. Result. 63 subjects had abnormal UAD, 20 of which also had fECHO. Six subjects had abnormal flow. Gestational age at delivery was similar between the two groups. Those with abnormal SBF had fewer days of abnormal UAD prior to delivery and developed RDS (). Conclusion. Postnatal measures of SBF were associated with poor postnatal outcomes in fetuses with abnormal UAD. Future studies incorporating antenatal measures of SBF may help obstetricians determine which pregnancies complicated by UAD are likely to have postnatal morbidity. Richelle N. Olsen, Jennifer Shepherd, and Anup Katheria Copyright © 2014 Richelle N. Olsen et al. All rights reserved. Evaluation of the Oncogenic Human Papillomavirus DNA Test with Liquid-Based Cytology in Primary Cervical Cancer Screening and the Importance of the ASC/SIL Ratio: A Belgian Study Tue, 18 Feb 2014 07:07:52 +0000 Objectives. In Belgium, very few studies have focused on cervical high-risk human papillomaviruses (hrHPV) prevalence and the relationship between HPV and cervical cytological abnormalities. The aim of this study was to investigate hrHPV prevalence and its relationship with cytological screening and histological results in the French-speaking community in Belgium (Brussels and Wallonia). Methods. A total of 58,265 liquid-based cytology tests were performed during this period. All cases of ASC-US, ASC-H, LSIL, and HSIL were tested by Hybrid Capture 2 for hrHPV screening. Results. The prevalence of cytological abnormalities was 3.1% for ASC-US, 0.3% for ASC-H, 1.5% for LSIL, and 0.3% for HSIL. The frequency of hrHPV infection was 47% in ASC-US, 90% in ASC-H, 86% in LSIL, and 98.4% in HSIL. CIN 2+ lesions were found in 12.2% of smears with an ASC-US result, in 54% of smears with an ASC-H result, in 12.5% of smears with a LSIL result, and in 89.3% of smears with a HSIL result. The ASC/SIL ratio was 1.9%. Conclusions. This study provides a good representation of cytological abnormalities and HPV status in patients living in Belgium’s French-speaking community. The prevalence in our study was similar to that derived from meta-analyses of European studies. Our ASC/SIL ratio was 1.9%, being within the lower and upper limits proposed in the literature, which tends to prove the good quality diagnosis of cervical smears in our laboratory. Xavier Catteau, Philippe Simon, and Jean-Christophe Noël Copyright © 2014 Xavier Catteau et al. All rights reserved. Review of Management and Outcomes in Women with Thrombophilia Risk during Pregnancy at a Single Institution Mon, 17 Feb 2014 13:30:05 +0000 Pregnancy is a hypercoagulable state associated with an increased risk of venous thromboembolic disease (VTE). We retrospectively studied 38 Caucasian pregnant women with thrombophilia risk and compared their obstetric outcomes with a matched cohort without known thrombophilia risk during the period between January 2007 and December 2010. There were (2) cases with factor V Leiden, (6) prothrombin gene mutation, (1) antithrombin III deficiency, (2) protein C deficiency, (3) protein S deficiency, (10) MTHFR mutation, (7) anti-cardiolipin antibodies, and (1) lupus anticoagulant. Patients without thrombophilia who presented with recurrent unprovoked VTE were considered as high risk (6 cases). Most patients received anticoagulation (34/38) with aspirin only (6), enoxaparin (27), and warfarin (1). Twenty-six out of thirty-eight pregnant women (68.4%) with an increased risk of thrombophilia experienced one or more obstetric complications defined as hypertension, preeclampsia, placenta abruptio, VTE, and oligohydramnios, compared with 15 out of 40 (37.5%) pregnant women in the control group (OR 3.6; 95% CI 1.42, 9.21, ). The incidence of obstetric complications was significantly higher in the thrombophilia group compared to the controls. However, these complications were the lowest among patients who received full-dose anticoagulation. Our study suggests that strict application of anticoagulation therapy for thrombophilia of pregnancy is associated with an improved pregnancy outcome. The study was registered in the Australian and New Zealand Clinical Trials Registry under ACTRN12612001094864. Alhossain A. Khalafallah, Abdul-Rauf O. Ibraheem, Qiong Yue Teo, Abdul-Majeed AlBarzan, Ramanathan Parameswaran, Emily Hooper, Toly Pavlov, Amanda E. Dennis, and Terry Hannan Copyright © 2014 Alhossain A. Khalafallah et al. All rights reserved. Occurrence of Pre- and Postoperative Stress Urinary Incontinence in 105 Patients Who Underwent Tension-Free Vaginal Mesh Surgery for Pelvic Organ Prolapse: A Retrospective Study Thu, 06 Feb 2014 06:11:40 +0000 Objective. To examine retrospectively the occurrence of stress urinary incontinence (SUI) in patients who underwent transvaginal mesh repair (TVM) for pelvic organ prolapse (POP). Methods. The presence of preoperative SUI and postoperative changes in SUI was retrospectively analyzed for 105 patients who underwent TVM for POP between September 2009 and September 2012. Results. Preoperative SUI was observed in almost half of the patients () who underwent TVM surgery. No significant differences were seen in patient age, pelvic organ prolapse quantification (POP-Q) stage, or primary POP complaint between those with and without preoperative SUI. Of the 50 patients with preoperative SUI, SUI was resolved in 14 (28%) following TVM surgery. Of the 55 patients without preoperative SUI, de novo postoperative SUI appeared in 26 (47.3%), of whom approximately half experienced resolution or improvement of SUI within 6 months postoperatively. There was no relationship between preoperative residual urine volume and occurrence of postoperative SUI. Conclusion. TVM surgery is a useful surgical method that can replace traditional methods for treating POP, but sufficient informed consent with regards to the onset of postoperative SUI is required. Haruhiko Kanasaki, Aki Oride, Tomomi Mitsuo, and Kohji Miyazaki Copyright © 2014 Haruhiko Kanasaki et al. All rights reserved. Fenestration Labioreduction of the Labium Minus: A New Surgical Intervention Concept Tue, 04 Feb 2014 00:00:00 +0000 Objectives. To test applicability of the new surgical concept for labioreduction of the labia minora. Study Design. The observational, prospective, case series study was designed. Subjects. Three consecutive subjects were included. Methods. The application of new surgical intervention was tested. Main Outcome Measures. A primary outcome measured applicability of the fenestration labioplasty and secondary measures was used to evaluate surgical resolution of medical, emotional, and social symptoms; aesthetic outcomes; and potential complications. Results. Symptomatic, asymmetrical, and enlarged labia minora were associated with aesthetic dissatisfaction from deformations of the labia minora. The new operation was applied easily and without complications. The procedure reduced height and length, accomplished symmetries, preserved natural color and contour, and accomplished the labium minus expected appearance. Postoperatively, physical, emotional, social symptoms and signs resolved, pleasing surgical outcomes exceeded subjects’ aesthetic expectations. Meaningfully, self-image and self-confidence improved in all subjects. No feelings of regrets were reported. Emotional tensions were reduced, social openness improved, intimate interaction increased, and their body image perception improved following the operation. Conclusion. In this study group, fenestration labioreduction with inferior flap transposition was easy to execute without complications and the method was reproducible; the new operation achieves pleasing aesthetic results and the procedure improves physical, emotional, and social wellbeing. Adam Ostrzenski Copyright © 2014 Adam Ostrzenski. All rights reserved. Posterior Deep Infiltrating Endometriotic Nodules: Operative Considerations according to Lesion Size, Location, and Geometry, during One’s Learning Curve Mon, 20 Jan 2014 14:12:17 +0000 We conducted this prospective cohort study to standardize our laparoscopic technique of excision of posterior deep infiltrating endometriosis (DIE) nodules, according to their size, location, and geometry, including 36 patients who were grouped, according to principal pelvic expansion of the nodule, into groups with central (group 1) and lateral (group 2) lesions, and according to nodule size, into ≤2 cm (group A) and >2 cm (group B) lesions, respectively. In cases of group 1 the following operative steps were more frequently performed compared to those of group 2: suspension of the rectosigmoid, colpectomy, and placement of bowel wall reinforcement sutures. The opposite was true regarding suspension of the adnexa, systematic ureteric dissection, and removal of the diseased pelvic peritoneum. When grouping patients according to nodule size, almost all of the examined parameters were more frequently applied to patients of group B: adnexal suspension, suspension of the rectosigmoid, systematic ureteric dissection, division of uterine vein, colpectomy, and placement of bowel wall reinforcement sutures. Nodule size was the single most important determinant of duration of surgery. In conclusion, during the building-up of one’s learning curve of laparoscopic excision of posterior DIE nodules, technique standardization is very important to avoid complications. Athanasios Protopapas, Georgios Giannoulis, Ioannis Chatzipapas, Stavros Athanasiou, Themistoklis Grigoriadis, Dimitrios Haidopoulos, Dimitrios Loutradis, and Aris Antsaklis Copyright © 2014 Athanasios Protopapas et al. All rights reserved. Fundal Height Growth Curve for Underweight and Overweight and Obese Pregnant Women in Thai Population Thu, 19 Dec 2013 11:29:33 +0000 Objectives. To develop fundal height growth curves for underweight and overweight and obese pregnant women based on gestational age from last menstrual period and/or ultrasound. Methods. A retrospective study was conducted at four hospitals in the northern part of Thailand between January 2009 and March 2011. Fundal height, gestational age, height, and prepregnancy weight were extracted from antenatal care and delivery records. Fundal height growth curves were presented as smoothed function of the 10th, 50th, and 90th percentiles between 20 and 40 weeks of gestation, derived from multilevel models. Results. Fundal height growth curve of the underweight was derived from 1,486 measurements (208 women) and the overweight and obese curve was derived from 1,281 measurements (169 women). The 50th percentile line of the underweight was 0.1–0.4 cm below the normal weight at weeks 23–31 and 0.5–0.8 cm at weeks 32–40. The overweight and obese line was 0.1–0.4 cm above the normal weight at weeks 22–29 and 0.6–0.8 cm at weeks 30–40. Conclusions. Fundal height growth curves of the underweight and overweight and obese pregnant women were different from the normal weight. In monitoring or screening for abnormal intrauterine growth in these women, fundal height growth curves specifically developed for such women should be applied. Jirawan Deeluea, Supatra Sirichotiyakul, Sawaek Weerakiet, Rajin Arora, and Jayanton Patumanond Copyright © 2013 Jirawan Deeluea et al. All rights reserved. A New Surgical Method of Suprapubic and Extraperitoneal Approach with Uterine Preservation for Pelvic Organ Prolapse: Kurt Extraperitoneal Ligamentopexy Tue, 17 Dec 2013 15:01:15 +0000 Objective. To introduce an alternative surgical approach for the optimal treatment of pelvic organ prolapse (POP). Methods. Twenty symptomatic women with grades 2–4 POP diagnosis who opted to choose this alternative surgery were retrospectively analyzed. Results. A total of 22 cases were included. The mean age of the patients was years (29–72 years) with a mean gravid and parity of and , respectively. The mean body-mass index of the patients was . Nine (45%) patients were premenopausal and 11 (55%) patients were postmenopausal. Uterine descensus was present in all patients, and additionally cystorectocele in 9 patients (45%), cystocele in 6 patients (30%), rectocele in 4 patients (20%), and elangatio colli in 6 patients (30%) were diagnosed. In addition to the alternative surgery, Manchester procedure and anteroposterior vaginal wall repair or Burch procedure was performed where necessary. Mean follow-up time was months (6–171 months). No recurrence of POP occurred. Conclusions. Suprapubic, extraperitoneal, and minimally invasive ligamentopexy of the round ligament to the anterior rectus fascia offers an alternative to conventional POP surgery with favorable outcomes without any recurrence. Sefa Kurt, Mehmet Tunc Canda, and Abdullah Tasyurt Copyright © 2013 Sefa Kurt et al. All rights reserved. The Intrauterine Device in Women with Diabetes Mellitus Type I and II: A Systematic Review Wed, 11 Dec 2013 15:03:20 +0000 Background. Women with diabetes mellitus type I and type II need effective contraception for personal and medical reasons. Long acting reversible contraceptive (LARC) methods are among the most efficient and cost-effective methods. Study Design. We searched the Popline, PubMed, and databases from 1961 to March 2013 for studies on the efficacy of the IUD in diabetic women and the possible changes it may produce in laboratory parameters. Studies of at least 30 subjects with DM1 or DM2 who were studied for 6 to 12 months depending on the method of analysis were eligible. Results. The search produced seven articles which gave event rate efficacy evaluable results and three which evaluated the effect of the IUD on laboratory parameters. One of the earlier efficacy studies showed an abnormally high pregnancy rate which sparked a controversy which is discussed in the Introduction section. The remaining 6 studies produced acceptable pregnancy rates. The three laboratory studies showed that the copper and levonorgestrel releasing IUD/IUS do not affect the diabetic state in any way. Conclusions. The copper bearing and levonorgestrel releasing IUDs are safe and effective in women with diabetes type I and diabetes type II although the evidence in the latter is limited. Norman D. Goldstuck and Petrus S. Steyn Copyright © 2013 Norman D. Goldstuck and Petrus S. Steyn. All rights reserved. Survival Rate of Extremely Low Birth Weight Infants and Its Risk Factors: Case-Control Study in Japan Mon, 25 Nov 2013 11:11:14 +0000 Aim. To clarify the effect of perinatal events on the survival of ELBW infants in Japan. Methods. 1,713 ELBW infants, from 92,630 live births in 2001 and 2002, born at 22–36 weeks of gestation were registered. Case was defined as death at discharge. The relevant variables were compared between the cases () and the controls (). Results. The total survival rate was 78.6%. There was a significant difference between the survival rate in cesarean and vaginal delivery at 24–31 weeks of gestation. Cesarean delivery in infants with a birth weight >400 g was significantly advantageous to the survival rate of ELBW infants than vaginal delivery. The significant contributing factors were gestational age at delivery (OR: 0.97), Apgar score at 5 min (0.56), antenatal steroid (0.41), and birth weight (0.996). Nonvertex presentation (1.81), vaginal delivery (1.56), and placental abruption (2.50) were found to be significantly associated with neonatal death. Conclusions. Cesarean section might be advantageous for survival in ELBW infants over 24 gestational weeks or 400 grams of birth weight. Nonvertex presentation, vaginal delivery, and placental abruption could be significant risk factors for survival of ELBW infants. Masaki Ogawa, Yoshio Matsuda, Eriko Kanda, Jun Konno, Minoru Mitani, Yasuo Makino, and Hideo Matsui Copyright © 2013 Masaki Ogawa et al. All rights reserved. Outcome of Late Second Trimester Emergency Cerclage in Patients with Advanced Cervical Dilatation with Bulging Amniotic Membranes: A Report of Six Cases Managed at the Douala General Hospital, Cameroon Sun, 24 Nov 2013 09:29:12 +0000 Purpose. To show the feasibility of emergency late second trimester cerclage with advanced cervical dilatation and bulging of amniotic membranes. Setting. Department of Obstetrics and Gynecology of the Douala General Hospital. Method. This is a retrospective study of case files of patients who underwent emergency late second trimester cerclage with advanced cervical dilatation, some with bulging of fetal membranes between June 2003 and June 2010. The modified Shirodkar technique was employed in all the cases. Results. Altogether, six patients (100%) underwent late second trimester cervical cerclage between 24 and 26 weeks of gestational age. Four cases (66.7%) carried on their pregnancies to term that resulted in healthy live-born babies all delivered vaginally. The other two cases (33.3%) presented with preterm premature rupture of fetal membranes (PPROM) which led us to undo the stitch with eventual delivery of live-born premature fetuses which died in the neonatal intensive care unit because of complications of prematurity and neonatal infection. Conclusion. In experienced hands and in the absence of other risk factors like infection, the success rates of this procedure are encouraging with improved prognosis. Finally, the modified Shirodkar technique yielded excellent results in our series. Thomas Obinchemti Egbe, Theophile Nana Njamen, Gregory Halle Ekane, Jacques Kamgaing Tsingaing, Charlotte Nguefack Tchente, Gerard Beyiha, Esther Barla, and Ernest Nyemb Copyright © 2013 Thomas Obinchemti Egbe et al. All rights reserved. Similar Adverse Pregnancy Outcome in Native and Nonnative Dutch Women with Pregestational Type 2 Diabetes: A Multicentre Retrospective Study Wed, 30 Oct 2013 10:29:12 +0000 Objective. To assess the incidence of adverse pregnancy outcome in native and nonnative Dutch women with pregestational type 2 diabetes (T2D) in a multicenter study in The Netherlands. Methods. Maternal characteristics and pregnancy outcome were retrospectively reviewed and the influence of ethnicity on outcome was evaluated using independent -test, Mann-Whitney -test, and chi-square test. Results. 272 pregnant women (80 native and 192 non-native Dutch) with pregestational T2D were included. Overall outcome was unfavourable, with a perinatal mortality of 4.8%, major congenital malformations of 6.3%, preeclampsia of 11%, preterm birth of 19%, birth weight >90th percentile of 32%, and a Caesarean section rate of 42%. In nonnative Dutch women, the glycemic control was slightly poorer and the gestational age at booking somewhat later as compared to native Dutch women. However, there were no differences in incidence of preeclampsia/HELLP, preterm birth, perinatal mortality, macrosomia, and congenital malformations between those two groups. Conclusions. A high incidence of adverse pregnancy outcomes was found in women with pregestational T2D, although the outcome was comparable between native and non-native Dutch women. This suggests that easy access to and adequate participation in the local health care systems contribute to these comparable outcomes, offsetting potential disadvantages in the non-native group. Bart Groen, Thera P. Links, Paul P. van den Berg, Marieke Hellinga, Sharon Moerman, Gerard H. A. Visser, Wim J. Sluiter, Marijke M. Faas, Manon C. J. Schreuder, Willy Visser, Petronella H. L. M. Geelhoed-Duijvestijn, Rutgert Bianchi, Anton K. M. Bartelink, and Harold W. de Valk Copyright © 2013 Bart Groen et al. All rights reserved. An Evaluation of the Effects of the Transobturator Tape Procedure on Sexual Satisfaction in Women with Stress Urinary Incontinence Using the Libido Scoring System Mon, 28 Oct 2013 16:12:09 +0000 Introduction and Hypothesis. Most women experience automatic urine leakage in their lifetimes. SUI is the most common type in women. Suburethral slings have become a standard surgical procedure for the treatment of stress urinary incontinence when conservative therapy failed. The treatment of stress urinary incontinence by suburethral sling may improve body image by reducing urinary leakage and may improve sexual satisfaction. Methods. A total of 59 sexually active patients were included in the study and underwent a TOT outside-in procedure. The LSS was applied in all patients by self-completion of questionnaires preoperatively and 6 months after the operation. General pleasure with the operation was measured by visual analogue score (VAS). Pre- and postoperative scores were recorded and analyzed using SPSS 11.5. Results. Two parameters of the LSS, orgasm and who starts the sexual activity, increased at a statistically significant rate. Conclusion. Sexual satisfaction and desire have partially improved after the TOT procedure. Raziye Narin, Hakan Nazik, Mehmet Ali Narin, Hakan Aytan, and Murat Api Copyright © 2013 Raziye Narin et al. All rights reserved. Listeriosis during Pregnancy: A Public Health Concern Thu, 26 Sep 2013 09:36:29 +0000 Listeria was first described in 1926 by Murray, Webb, and Swann, who discovered it while investigating an epidemic infection among laboratory rabbits and guinea pigs. The role of Listeria monocytogenes as a foodborne pathogen was definitively recognized during the 1980s. This recognition was the consequence of a number of epidemic human outbreaks due to the consumption of contaminated foods, in Canada, in the USA and in Europe. Listeriosis is especially severe in immunocompromised individuals such as pregnant women. The disease has a low incidence of infection, although this is undeniably increasing, with a high fatality rate amongst those infected. In pregnant women listeriosis may cause abortion, fetal death, or neonatal morbidity in the form of septicemia and meningitis. Improved education concerning the disease, its transmission, and prevention measures for immunocompromised individuals and pregnant women has been identified as a pressing need. Teresa Mateus, Joana Silva, Rui L. Maia, and Paula Teixeira Copyright © 2013 Teresa Mateus et al. All rights reserved. An Analysis of the NSW Midwives Data Collection over an 11-Year Period to Determine the Risks to the Mother and the Neonate of Induced Delivery for Non-Obstetric Indication at Term Wed, 25 Sep 2013 13:02:16 +0000 Objective. To determine the risks of induced term delivery to the mother and neonate at different gestational ages in the absence of obstetric indications. Study Design. All deliveries in New South Wales (NSW) between 1998 and 2008 were reviewed from the MDC. Uncomplicated pregnancies which were induced for non-obstetric reasons after 37 completed weeks were reviewed. This was a retrospective, historical cohort study, and both maternal and neonatal outcomes were analysed and compared between different gestational age groups. Results. An analysis of the data shows that induction of labour after 37 completed weeks exposes the fetus and mother to different levels of risk at different gestations. Conclusion. In an uncomplicated pregnancy, induction of labour is associated with the highest rate of neonatal complication at 37 weeks as compared with rates at later gestations. With each ensuing week, the neonatal outcome improves. At 40 weeks the likelihood of neonatal intensive care admission, low Apgar scores, and perinatal death rate is at its lowest, and then there is a slight but not significant rise after 41 weeks. The likelihood of caesarean section is the lowest when inductions are carried out at 39 weeks and is the highest at 41 weeks and over. Padmini Raviraj, Aiat Shamsa, Jun Bai, and Rajanishwar Gyaneshwar Copyright © 2013 Padmini Raviraj et al. All rights reserved. Tubercular Ascites Simulating Ovarian Hyperstimulation Syndrome following In Vitro Fertilization and Embryo Transfer Pregnancy Wed, 18 Sep 2013 17:21:59 +0000 Ovarian hyperstimulation syndrome (OHSS) is a known complication of using ovulation induction drugs in assisted reproductive techniques. Its incidence and severity vary. Tuberculosis is a very common disease in the developing world, and ascites is one of its sequelae. The newer aids in diagnosing tuberculosis include measuring levels of Adenosine DeAminase (ADA) in the third-space fluids or serum. This case report is from a tertiary care center, reflecting how tubercular ascites simulated OHSS, and the right diagnosis was made and managed. This is being presented due to its rarity. Amar Ramachandran, Pratap Kumar, Naveen Manohar, Raviraj Acharya, Anita Eipe, Rajeshwari G. Bhat, Lorraine Simone Dias, and Padmaja Raghavan Copyright © 2013 Amar Ramachandran et al. All rights reserved.