Obstetrics and Gynecology International http://www.hindawi.com The latest articles from Hindawi Publishing Corporation © 2016 , Hindawi Publishing Corporation . All rights reserved. Large D-Dimer Fluctuation in Normal Pregnancy: A Longitudinal Cohort Study of 4,117 Samples from 714 Healthy Danish Women Sun, 17 Apr 2016 14:13:42 +0000 http://www.hindawi.com/journals/ogi/2016/3561675/ Introduction. D-dimer levels increase throughout pregnancy, hampering the usefulness of the conventional threshold for dismissing thromboembolism. This study investigates the biological fluctuation of D-dimer in normal pregnancy. Methods. A total of 801 healthy women with expected normal pregnancies were recruited. D-dimer was repeatedly measured during pregnancy, at active labor, and on the first and second postpartum days. Percentiles for each gestational week were calculated. Each individual D-dimer was normalized by transformation into percentiles for the relevant gestational age or delivery group. The range in percentage points during the pregnancy and the delivery was calculated, and reference intervals were calculated for each pregnancy trimester, during vaginal delivery and scheduled and emergency cesarean section, and for the first and second day postpartum. Results. D-dimer increased during pregnancy; the maximal fluctuation was approximately 20 percentile points in approximately half of the women. In one out of ten women, the D-dimer values fluctuated by more than 50 percentile points. Conclusions. Due to the biological variation in D-dimer within each individual woman during normal pregnancy, repeated D-dimer measurements are of no clinical use in the evaluation of thromboembolic events during pregnancy. Katrine K. Hedengran, Malene R. Andersen, Steen Stender, and Pal B. Szecsi Copyright © 2016 Katrine K. Hedengran et al. All rights reserved. Clinicopathological Significance of Vimentin and Cytokeratin Protein in the Genesis of Squamous Cell Carcinoma of Cervix Thu, 14 Apr 2016 06:18:23 +0000 http://www.hindawi.com/journals/ogi/2016/8790120/ Cervical cancer is one of the commonest types of cancers worldwide especially in developing countries. Intermediate filaments protein family has shown a role in the diagnosis of various cancers, but a few studies are available about the vimentin and cytokeratin roles in the cervical cancer. This case control study aimed to interpret the expression of vimentin and cytokeratin proteins in the development and progression of cervical cancer and its correlation with clinicopathological features. The cytoplasmic expression of vimentin was observed in 40% of cases, but not in inflammatory lesions of cervix. It was noticed that vimentin expression was increasing significantly with high grade of the tumour. Cytokeratin expression was observed in 48.33% and it was noticed that the expression was 62.5% in well differentiated (G1), 45% in moderately differentiated (G2), and 41.66% in poorly differentiated carcinoma, yet statistically insignificant. The expression of vimentin and cytokeratin proteins was not significantly associated with age groups. The current findings concluded a possible role of vimentin in the development and progression of cervical cancer and vimentin marker will be useful in the diagnosis and grading of cervical cancer. Nazik Elmalaika O. S. Husain, Ali Yousif Babiker, Aqel S. Albutti, Mohammed A. Alsahli, Salah M. Aly, and Arshad H. Rahmani Copyright © 2016 Nazik Elmalaika O. S. Husain et al. All rights reserved. Ovarian Mature Cystic Teratoma: Challenges of Surgical Management Thu, 24 Mar 2016 09:25:26 +0000 http://www.hindawi.com/journals/ogi/2016/2390178/ Although ovarian mature cystic teratomas are the commonest adnexal masses occurring in premenopausal women, there are many challenges faced by gynecologists on deciding upon the best surgical management. There is uncertainty, lack of consensus, and variation in surgical practices. This paper critically analyzes various surgical approaches and techniques used to treat these cysts in an attempt to outline a unified guidance. MEDLINE and EMBASE databases were searched in January 2015 with no date limit using the key words “ovarian teratoma” and “ovarian dermoid.” The search was limited to articles in English language, humans, and female. The two authors conducted the search independently. The laparoscopic approach is generally considered to be the gold standard for the management. Oophorectomy should be the standard operation except in younger women with a single small cyst. The risk of chemical peritonitis after contents spillage is extremely rare and can certainly be overcome with thorough peritoneal lavage using warmed fluid. There is a place for surveillance in some selected cases. Abha Sinha and Ayman A. A. Ewies Copyright © 2016 Abha Sinha and Ayman A. A. Ewies. All rights reserved. Association between Maternal Pelvis Height and Intrapartum Foetal Head Moulding in Ugandan Mothers with Spontaneous Vertex Deliveries Mon, 29 Feb 2016 09:26:26 +0000 http://www.hindawi.com/journals/ogi/2016/3815295/ Introduction. In Sub-Saharan Africa, excessive foetal head moulding is commonly associated with cephalopelvic disproportion and obstructed labour. This study set out to determine the associations of maternal pelvis height and maternal height with intrapartum foetal head moulding. Methods. This was a multisite secondary analysis of maternal birth records of mothers with singleton pregnancies ending in a spontaneous vertex delivery. A summary of the details of the pregnancy and delivery records were reviewed and analysed using multilevel logistic regression respect to foetal head moulding. The alpha level was set at . Results. 412 records were obtained, of which 108/385 (28%) observed foetal head moulding. There was a significant reduction in risk of foetal head moulding with increasing maternal height (Adj. IRR 0.97, ), maternal pelvis height (Adj. IRR 0.88, ), and raptured membranes (Adj. IRR 0.10, ). There was a significant increased risk of foetal head moulding with increasing birth weight (Adj. IRR 1.90, ) and duration of monitored active labour (Adj. IRR 1.21, ) in the final model. Conclusion. This study showed that increasing maternal height and maternal pelvis height were associated with a significant reduction in intrapartum foetal head moulding. Ian G. Munabi, Samuel Abilemech Luboga, Livingstone Luboobi, and Florence Mirembe Copyright © 2016 Ian G. Munabi et al. All rights reserved. The EpiNo® Device: Efficacy, Tolerability, and Impact on Pelvic Floor—Implications for Future Research Sun, 14 Feb 2016 14:32:37 +0000 http://www.hindawi.com/journals/ogi/2016/3818240/ Aims. The aim of this review is to provide a comprehensive overview of the available literature on preventing perineal trauma with the EpiNo. Methods. We perfomed a literature research in the MedLine and EMBASE databases for studies referring to EpiNo published between 1990 and 2014, without restrictions for language and study type. Results. Five published studies were identified, regarding the effect of EpiNo on the rate of episiotomy and perineal tears, pelvic floor muscle function, and fetal outcome. The device seems to reduce episiotomy and perineal tears’ rate, as well as the risk for levator ani microtrauma and avulsion, though not always statistically significant. It does not seem to have an effect on duration of second stage of labour and fetal outcome. The device is well tolerated and the adverse events are rare and mild. However, design and reporting bias in the reviewed articles do not allow evidence based conclusions. Conclusions. The EpiNo device seems to be promising, with potential positive effects on natural birth, while being uncomplicated to use and without major complications. Well designed, randomized trials are needed in order to understand the effects of EpiNo on pelvic floor and make evidence based recommendations on its use. Tilemachos Kavvadias and Irene Hoesli Copyright © 2016 Tilemachos Kavvadias and Irene Hoesli. All rights reserved. Management of Fetal Growth Arrest in One of Dichorionic Twins: Three Cases and a Literature Review Tue, 29 Dec 2015 10:32:55 +0000 http://www.hindawi.com/journals/ogi/2015/289875/ Progressive fetal growth restriction (FGR) is often an indication for delivery. In dichorionic diamniotic (DD) twin pregnancy with growth restriction only affecting one fetus (selective fetal growth restriction: sFGR), the normal twin is also delivered prematurely. There is still not enough evidence about the optimal timing of delivery for DD twins with sFGR in relation to discordance and gestational age. We report three sets of DD twins with sFGR (almost complete growth arrest affecting one fetus for ≥2 weeks) before 30 weeks of gestation. The interval from growth arrest to delivery was 21–24 days and the discordance was 33.7–49.8%. A large-scale study showed no difference of overall mortality or the long-term outcome between immediate and delayed delivery for FGR, while many studies have identified a risk of developmental delay following delivery of the normal growth fetus before 32 weeks. Therefore, delivery of DD twins with sFGR should be delayed if the condition of the sFGR fetus permits in order to increase the gestational age of the normal growth fetus. Shoji Kaku, Fuminori Kimura, and Takashi Murakami Copyright © 2015 Shoji Kaku et al. All rights reserved. A Case-Control Study on Intimate Partner Violence during Pregnancy and Low Birth Weight, Southeast Ethiopia Sun, 20 Dec 2015 11:47:53 +0000 http://www.hindawi.com/journals/ogi/2015/394875/ Introduction. Violence against women has serious consequences for their reproductive and sexual health including birth outcomes. In Ethiopia, though the average parity of pregnant women is much higher than in other African countries, the link between intimate partner violence with low birth weight is unknown. Objective. The aim of this study was to examine the association between intimate partner violence and low birth weight among pregnant women. Method. Hospital based case-control study was conducted among 387 mothers (129 cases and 258 controls). Anthropometric measurements were taken both from mothers and their live births. The association between intimate partner violence and birth weight was computed through bivariable and multivariable logistic regression analyses and statistical significance was declared at . Result. Out of 387 interviewed mothers, 100 (25.8%) had experienced intimate partner violence during their index pregnancy period. Relatively more mothers of low birth weight infants were abused (48%) compared with controls (16.4%). Those mothers who suffered acts of any type of intimate partner violence during pregnancy were three times more likely to have a newborn with low birth weight (95% CI; (1.57 to 7.18)). The association between overall intimate partner violence and LBW was adjusted for potential confounder variables. Conclusion. This research result gives insight for health professional about the importance of screening for intimate partner violence during pregnancy. Health care providers should consider violence in their practice and try to identify women at risk. Habtamu Demelash, Dabere Nigatu, and Ketema Gashaw Copyright © 2015 Habtamu Demelash et al. All rights reserved. Community Awareness of HPV Screening and Vaccination in Odisha Wed, 09 Dec 2015 08:27:49 +0000 http://www.hindawi.com/journals/ogi/2015/694560/ Introduction. A number of new technologies including cervical cancer screening and vaccination have introduced new tools in the fight against cervical cancer. Methods. This study was set in Odisha, India, at the Acharya Harihar Regional Cancer Center and study research infrastructure at the Asian Institute of Public Health. IRB approvals were obtained and a research assistant recruited 286 women aged 18–49 years, who provided informed consent and completed a survey tool. Data were entered into EpiData software and statistical analysis was conducted. Results. 76.3% women participants were married, 45.5% had sexual debut at age 21 or greater, 60.5% used contraception, 12.2% reported having a Pap smear in the past, and 4.9% reported having prior genital warts. Most, 68.8% had never heard of HPV and 11.9% were aware that HPV is the main cause of cervical cancer. 82.9% women thought that vaccinations prevent disease, and 74.8% said they make the decision to vaccinate their children. Conclusion. The Odisha community demonstrated a low level of knowledge about cervical cancer prevention, accepted vaccinations in the prevention of disease and screening, and identified mothers/guardians as the key family contacts. Niharika Khanna, Aparna Ramaseshan, Stephanie Arnold, Kalpana Panigrahi, Mark D. Macek, Bijaya K. Padhi, Diptirani Samanta, Surendra N. Senapati, and Pinaki Panigrahi Copyright © 2015 Niharika Khanna et al. All rights reserved. Maternal and Pediatric Health Outcomes in relation to Gestational Vitamin D Sufficiency Sun, 06 Dec 2015 09:40:10 +0000 http://www.hindawi.com/journals/ogi/2015/501829/ Juxtaposed with monumental improvement in maternal-fetal outcomes over the last century, there has been the recent emergence of rising rates of gestational complications including preterm birth, operative delivery, and gestational diabetes. At the same time, there has been a burgeoning problem with widespread vitamin D deficiency among populations of many developed nations. This paper provides a brief review of potential health outcomes recently linked to gestational vitamin D deficiency, including preterm birth, cesarean delivery, and gestational diabetes. Although immediate costs for obstetric complications related to gestational vitamin D insufficiency may be modest, the short- and long-term costs for pediatric healthcare resulting from such gestational complications may be enormous and present an enduring burden on healthcare systems. With increasing evidence pointing to fetal origins of some later life disease, securing vitamin D sufficiency in pregnancy appears to be a simple, safe, and cost-effective measure that can be incorporated into routine preconception and prenatal care in the offices of primary care clinicians. Education on gestational nutritional requirements should be a fundamental part of medical education and residency training, instruction that has been sorely lacking to date. Stephen J. Genuis Copyright © 2015 Stephen J. Genuis. All rights reserved. Safety and Efficacy of Ferric Carboxymaltose in Anemic Pregnant Women: A Retrospective Case Control Study Tue, 24 Nov 2015 07:05:17 +0000 http://www.hindawi.com/journals/ogi/2015/728952/ Background. Anemia during pregnancy is commonly caused by iron deficiency and can have severe consequences for both the mother and the developing fetus. The aim of this retrospective study was to assess the safety and efficacy of intravenous ferric carboxymaltose (FCM) in pregnant women. Methods. All women treated with FCM for anemia during pregnancy between 2010 and 2012 at our institution were included. A matched control group was selected, including women who either were nonanemic or had anemia but were not considered for intravenous iron. Main outcome measures were maternal safety and pregnancy outcomes. Results. The study included 128 patients (FCM: 64; control: 64). Median FCM dose was 1000 mg and median gestational age at the time of first treatment was 34 weeks and 6 days. Median Hb increased from 8.4 g/dL (interquartile range 7.7; 8.9 g/dL) at the first FCM administration to 10.7 g/dL (9.8; 11.5 g/dL; with available Hb at delivery) at the time of delivery, achieving levels similar to those in the control group (10.8 g/dL [9.8; 11.8 g/dL; ]). No treatment-related adverse events were reported and no statistically significant differences in pregnancy outcomes were observed between groups. Conclusions. Within the limitations of this case control study, FCM was a safe and efficient treatment of anemia during pregnancy. Anouk Pels and Wessel Ganzevoort Copyright © 2015 Anouk Pels and Wessel Ganzevoort. All rights reserved. Resveratrol, Acetyl-Resveratrol, and Polydatin Exhibit Antigrowth Activity against 3D Cell Aggregates of the SKOV-3 and OVCAR-8 Ovarian Cancer Cell Lines Thu, 05 Nov 2015 13:44:46 +0000 http://www.hindawi.com/journals/ogi/2015/279591/ Resveratrol has aroused significant scientific interest as it has been claimed that it exhibits a spectrum of health benefits. These include effects as an anti-inflammatory and an antitumour compound. The purpose of this study was to investigate and compare any potential antigrowth effects of resveratrol and two of its derivatives, acetyl-resveratrol and polydatin, on 3D cell aggregates of the EGFR/Her-2 positive and negative ovarian cancer cell lines SKOV-3 and OVCAR-8, respectively. Results showed that resveratrol and acetyl-resveratrol reduced cell growth in the SKOV-3 and OVCAR-8 in a dose-dependant manner. The growth reduction was mediated by the induction of apoptosis via the cleavage of poly(ADP-ribose) polymerase (PARP-1). At lower concentrations, 5 and 10 µM, resveratrol, acetyl-resveratrol, and polydatin were less effective than higher concentrations, 50 and 100 µM. In SKOV-3 line, at higher concentrations, resveratrol and polydatin significantly reduced the phosphorylation of Her-2 and EGFR and the expression of Erk. Acetyl-resveratrol, on the other hand, did not change the activation of Her-2 and EGFR. Resveratrol, acetyl-resveratrol, and polydatin suppressed the secretion of VEGF in a dose-dependant fashion. In the OVCAR-8 cell line, resveratrol and acetyl-resveratrol at 5 and 10 µM increased the activation of Erk. Above these concentrations they decreased activation. Polydatin did not produce this effect. This study demonstrates that resveratrol and its derivatives may inhibit growth of 3D cell aggregates of ovarian cancer cell lines via different signalling molecules. Resveratrol and its derivatives, therefore, warrant further in vivo evaluation to assess their potential clinical utility. Simon J. Hogg, Kenny Chitcholtan, Wafaa Hassan, Peter H. Sykes, and Ashley Garrill Copyright © 2015 Simon J. Hogg et al. All rights reserved. Serum hCG Levels following the Ovulatory Injection: Associations with Patient Weight and Implantation Time Mon, 26 Oct 2015 07:26:19 +0000 http://www.hindawi.com/journals/ogi/2015/520714/ Objective. To test if serum hCG levels the morning after the ovulatory hCG injection correlate with (1) retrieval efficiency, (2) oocyte maturity, (3) embryo quality, (4) pregnancy, and/or (5) time to implantation in patients undergoing in vitro fertilization (IVF) with intracytoplasmic sperm injection (ICSI). Design. Retrospective cohort analysis. Setting. University-based IVF clinic. Patient(s). All IVF/ICSI cycles from April 2005 to February 2008 whose hCG administration was confirmed ( patients). Intervention(s). Serum hCG was measured the morning following the ovulatory injection, on the 16th day following retrieval, and repeated on day 18 for those with positive results. Main Outcome Measure(s). Number of follicles on the day of hCG injection, number of oocytes retrieved, maturity of oocytes, embryo quality, pregnancy outcome, and time to implantation. Result(s). hCG levels did not correlate with retrieval efficiency, oocyte maturity, embryo quality, or pregnancy. Postinjection hCG levels were inversely associated with patient weight and time to implantation. Conclusion(s). No correlation was found between hCG level and any parameter of embryo quality. Patient weight affected hCG levels following hCG injection and during the early period of pregnancy following implantation. No association between postinjection hCG level and time of implantation (adjusted for patient weight) was apparent. Dorette J. Noorhasan, Peter G. McGovern, Michael Cho, Aimee Seungdamrong, Khaliq Ahmad, and David H. McCulloh Copyright © 2015 Dorette J. Noorhasan et al. All rights reserved. A Comparison of Pattern of Pregnancy Loss in Women with Infertility Undergoing IVF and Women with Unexplained Recurrent Miscarriages Who Conceive Spontaneously Tue, 20 Oct 2015 13:42:03 +0000 http://www.hindawi.com/journals/ogi/2015/989454/ Objective. Women with infertility and recurrent miscarriages may have an overlapping etiology. The aim of this study was to compare the pregnancy loss in pregnancies after IVF treatment with spontaneous pregnancies in women with recurrent miscarriages and to assess differences related to cause of infertility. Methods. The outcome from 1220 IVF pregnancies (Group I) was compared with 611 spontaneous pregnancies (Group II) in women with recurrent miscarriages. Subgroup analysis was performed in Group I based on cause of infertility: tubal factor (392 pregnancies); male factor (610 pregnancies); and unexplained infertility (218 pregnancies). Results. The clinical pregnancy loss rate in Group I (14.3%) was significantly lower than that of Group II (25.8%, ) and this was independent of the cause of infertility. However the timing of pregnancy loss was similar between Groups I and II. The clinical pregnancy loss rate in Group I was similar in different causes of infertility. Conclusions. The clinical pregnancy loss rate following IVF treatment is lower than that of women with unexplained recurrent miscarriages who conceived spontaneously. This difference persists whether the infertility is secondary to tubal factors, male factors, or unexplained cause. Vidya A. Tamhankar, Beiyu Liu, Junhao Yan, and Tin-Chiu Li Copyright © 2015 Vidya A. Tamhankar et al. All rights reserved. The Importance of the Monitoring of Resuscitation with Blood Transfusion for Uterine Inversion in Obstetrical Hemorrhage Wed, 30 Sep 2015 14:33:46 +0000 http://www.hindawi.com/journals/ogi/2015/269156/ Objective. The aim of this study was to describe critical care for obstetrical hemorrhage, especially in cases of uterine inversion. Study Design. We extracted data for six patients diagnosed with uterine inversion concerning resuscitation. Results. The shock index on admission of the six patients was 1.6 or more on admission. Four of the six experienced delay in diagnosis and received inadequate fluid replacement. Five of the six experienced delay in transfer. Five of the six underwent simultaneous blood transfusion on admission, and the remaining patient experienced a delay of 30 minutes. All six patients successfully underwent uterine replacement soon after admission. One maternal death occurred due to inappropriate practices that included delay in diagnosis, delay in transfer, inadequate fluid replacement, and delayed transfusion. Two patients experiencing inappropriate practices involving delay in diagnosis, delay in transfer, and inadequate fluid replacement survived. Conclusion. If a delay in diagnosis occurs simultaneously with a delay in transfer and inadequate fluid replacement, failure in providing a prompt blood transfusion may be critical and result in maternal death. The monitoring of resuscitation with blood transfusion for uterine inversion is essential for the improvement of obstetrical care. Seishi Furukawa and Hiroshi Sameshima Copyright © 2015 Seishi Furukawa and Hiroshi Sameshima. All rights reserved. Factors Influencing Women’s Preferences for Places to Give Birth in Addis Ababa, Ethiopia Sun, 30 Aug 2015 13:03:20 +0000 http://www.hindawi.com/journals/ogi/2015/439748/ The main aim of this study was to examine factors determining women’s preference for places to give birth in Addis Ababa, Ethiopia. A quantitative and cross-sectional community based study design was employed. Data was collected using structured questionnaire administered to 901 women aged 15–49 years through a stratified two-stage cluster sampling technique. Multinomial logistic regression model was employed to identify predictors of delivery care. More than three-fourth of slum women gave birth at public healthcare facilities compared to slightly more than half of the nonslum residents. Education, wealth quintile, the age of respondent, number of children, pregnancy intention, and cohabitation showed net effect on women’s preference for places to give birth. Despite the high number of ANC attendances, still many pregnant women especially among slum residents chose to deliver at home. Most respondents delivered in public healthcare institutions despite the general doubts about the quality of services in these institutions. Future studies should examine motivating factors for continued deliveries at home and whether there is real significant difference between the quality of maternal care service offered at public and private health facilities. Yibeltal Tebekaw, Yohana James Mashalla, and Gloria Thupayagale-Tshweneagae Copyright © 2015 Yibeltal Tebekaw et al. All rights reserved. Ultrastructure of Placenta of Gravidas with Gestational Diabetes Mellitus Mon, 24 Aug 2015 09:23:09 +0000 http://www.hindawi.com/journals/ogi/2015/283124/ Objectives. Gestational diabetes mellitus (GDM) leads to an abnormal placental environment which may cause some structural alterations of placenta and affect placental development and function. In this study, the ultrastructural appearances of term placentas from women with GDM and normal pregnancy were meticulously compared. Materials and Methods. The placenta tissues of term birth from 10 women with GDM and 10 women with normal pregnancy were applied with the signed informed consent. The morphology of fetomaternal interface of placenta was examined using light microscopy (LM) and transmission electron microscopy (TEM). Results. On LM, the following morphological changes in villous tissues were found in the GDM placentas when compared with the control placentas: edematous stroma, apparent increase in the number of syncytial knots, and perivillous fibrin deposition. On TEM, the distinct ultrastructural alterations indicating the degeneration of terminal villi were found in the GDM placentas as follows: thickening of the basal membrane (BM) of vasculosyncytial membrane (VSM) and the VSM itself, significantly fewer or even absent syncytiotrophoblastic microvilli, swollen or completely destroyed mitochondria and endoplasmic reticulum, and syncytiotrophoblasts with multiple vacuoles. Conclusion. Ultrastructural differences exist between GDM and control placentas. The differences of placenta ultrastructure are likely responsible for the impairment of placental barrier and function in GDM. Qian Meng, Li Shao, Xiucui Luo, Yingping Mu, Wen Xu, Chao Gao, Li Gao, Jiayin Liu, and Yugui Cui Copyright © 2015 Qian Meng et al. All rights reserved. Practical Advice for Emergency IUD Contraception in Young Women Wed, 29 Jul 2015 10:48:28 +0000 http://www.hindawi.com/journals/ogi/2015/986439/ Too few women are aware of the very high efficacy of intrauterine copper devices (IUDs) to prevent pregnancy after unprotected intercourse. Women who frequently engage in unprotected intercourse or seek emergency contraception (EC) are at high risk of unplanned pregnancy and possible abortion. It is therefore important that these women receive precise and accurate information about intrauterine devices as they may benefit from using an IUD for EC as continuing contraception. Copper IUDs should be used as first choice options given their rapid onset of action and their long-term contraceptive action which require minimal thought or intervention on the part of the user. In the United States, there is only one copper IUD presently available which limits treatment options. There are numerous copper IUDs available for use in EC, however, their designs and size are not always optimal for use in nulliparous women or women with smaller or narrower uteruses. Utilization of frameless IUDs which do not require a larger transverse arm for uterine retention may have distinct advantages, particularly in young women, as they will be suitable for use in all women irrespective of uterine size. This paper provides practical information on EC use with emphasis on the use of the frameless IUD. Norman D. Goldstuck and Dirk Wildemeersch Copyright © 2015 Norman D. Goldstuck and Dirk Wildemeersch. All rights reserved. Comment on “Alternate Sequential Suture Tightening: A Novel Technique for Uncontrolled Postpartum Hemorrhage” Tue, 21 Jul 2015 13:33:42 +0000 http://www.hindawi.com/journals/ogi/2015/279513/ Shigeki Matsubara, Hironori Takahashi, and Alan K. Lefor Copyright © 2015 Shigeki Matsubara et al. All rights reserved. Cattle Uterus: A Novel Animal Laboratory Model for Advanced Hysteroscopic Surgery Training Tue, 21 Jul 2015 09:03:26 +0000 http://www.hindawi.com/journals/ogi/2015/967693/ In recent years, due to reduced training opportunities, the major shift in surgical training is towards the use of simulation and animal laboratories. Despite the merits of Virtual Reality Simulators, they are far from representing the real challenges encountered in theatres. We introduce the “Cattle Uterus Model” in the hope that it will be adopted in training courses as a low cost and easy-to-set-up tool. It adds new dimensions to the advanced hysteroscopic surgery training experience by providing tactile sensation and simulating intraoperative difficulties. It complements conventional surgical training, aiming to maximise clinical exposure and minimise patients’ harm. Ayman A. A. Ewies and Zahid R. Khan Copyright © 2015 Ayman A. A. Ewies and Zahid R. Khan. All rights reserved. Effect of Umbilical Cord Entanglement and Position on Pregnancy Outcomes Thu, 09 Jul 2015 07:25:29 +0000 http://www.hindawi.com/journals/ogi/2015/342065/ Introduction. To investigate the effect of complex umbilical cord entanglement primarily around the trunk on pregnancy outcomes. Methods. We studied 6307 pregnant women with singleton pregnancies who underwent vaginal delivery of an infant at ≥37 weeks of gestation. Cases were classified into no cord, nuchal cord, and body cord groups and defined as cases without umbilical cord entanglement, one or more loops of the umbilical cord around the neck only, and umbilical cord around the trunk only, respectively. Pregnancy outcomes were compared among these three groups. Results. The no cord, nuchal cord, and body cord group included 4733, 1451, and 123 pregnancies, respectively. Although delivery mode was not significantly different among the three groups, 1-minute Apgar scores <7 and umbilical artery (UA) pH <7.10 were significantly more common in the umbilical cord entanglement groups than in the no cord group. In particular, the frequency of 5-minute Apgar scores <7 was significantly higher (), whereas that of UA pH <7.10 tended to be higher () in the body cord group than in the nuchal cord group. Conclusion. Compared to nuchal cord, umbilical cord entanglement around the trunk was associated with a higher risk of low Apgar scores and low UA pH. Natsuko Kobayashi, Shigeru Aoki, Mari S. Oba, Tsuneo Takahashi, and Fumiki Hirahara Copyright © 2015 Natsuko Kobayashi et al. All rights reserved. Is Risk Malignancy Index a Useful Tool for Predicting Malignant Ovarian Masses in Developing Countries? Sun, 21 Jun 2015 09:16:52 +0000 http://www.hindawi.com/journals/ogi/2015/951256/ Introduction. Risk of Malignancy Index (RMI) is widely studied for prediction of malignant pelvic masses in Western population. However, little is known regarding its implication in the developing countries. The objective of this study is to determine how accurately the RMI can predict the malignant pelvic masses. Materials and Methods. The study is a retrospective review of patients attending the gynecological clinic between January 2004 and December 2008 with adnexal masses. Information on demographic characteristics, ultrasound findings, menopausal status, CA125, and histopathology was collected. RMI score for each patient in the study group was calculated. Results. The study group included a total of 283 patients. Analysis of the individual parameters of RMI revealed that ultrasound was the best predictor of malignancy with a sensitivity, specificity, and positive likelihood ratio of 78.3%, 81.5%, and 4.2, respectively. At a standard cut-off value of 250, RMI had a positive likelihood ratio of 8.1, while it was 6.8 at a cut-off of 200, albeit with comparable sensitivity and specificity. Conclusion. RMI is a sensitive tool in predicting malignant adnexal masses. A cut-off of 200 may be suitable in developing countries for triaging and early referral to tertiary care centers. Aliya B. Aziz and Nida Najmi Copyright © 2015 Aliya B. Aziz and Nida Najmi. All rights reserved. Cervical Cancer Screening Program by Visual Inspection: Acceptability and Feasibility in Health Insurance Companies Thu, 18 Jun 2015 08:20:12 +0000 http://www.hindawi.com/journals/ogi/2015/798453/ Objective. To assess willingness to participate and diagnostic accuracy of visual inspection for early detection of cervical neoplasia among women in a health insurance company. Patients and Method. Cervical cancer screening was systematically proposed to 800 women after consecutive information and awareness sessions. The screening method was visual inspection with acetic acid (VIA) or Lugol’s iodine (VILI). Results. Among the 800 identified women, 640 (82%) have accepted the screening, their mean age was 39 years, and 12.0% of them were involved in a polygamist couple. 28.2% of women had prior cervical screening. VIA has been detected positive in 5.9% of women versus 8.6% for VILI. The sensitivity was 72.9% and specificity was 95.2% for VIA versus 71.2% and 97.3% for VILI respectively. The histological examination highlighted a nonspecific chronic cervicitis in 4.6%, CIN1 lesions in 5.91%, and CIN2/3 in 1.2% of the cases. Conclusion. Cervical cancer screening by visual inspection showed appropriate diagnostic accuracy when used to detect early cervical lesions. It is a simple and easy to perform method that could be introduced progressively in the health insurance policy while waiting for a national screening program. Apollinaire G. Horo, Judith Didi-Kouko Coulibaly, Abdoul Koffi, Boris Tchounga, Konan Seni, Kacou Edèle Aka, and Mamourou Kone Copyright © 2015 Apollinaire G. Horo et al. All rights reserved. Transvaginal Drainage of Pelvic Abscesses and Collections Using Transabdominal Ultrasound Guidance Sun, 31 May 2015 13:36:02 +0000 http://www.hindawi.com/journals/ogi/2015/283576/ Objectives. To evaluate clinical outcomes following transvaginal catheter placement using transabdominal ultrasound guidance for management of pelvic fluid collections. Methods. A retrospective review was performed for all patients who underwent transvaginal catheter drainage of pelvic fluid collections utilizing transabdominal ultrasound guidance between July 2008 and July 2013. 24 consecutive patients were identified and 24 catheters were placed. Results. The mean age of patients was 48.1 years (range = 27–76 y). 88% of collections were postoperative (), 8% were from pelvic inflammatory disease (), and 4% were idiopathic (). Of the 24 patients, 83% of patients () had previously undergone a hysterectomy and 1 patient (4%) was pregnant at the time of drainage. The mean volume of initial drainage was 108 mL (range = 5 to 570). Catheters were left in place for an average of 4.3 days (range = 1–17 d). Microbial sampling was performed in all patients with 71% () returning a positive culture. All collections were successfully managed percutaneously. There were no technical complications. Conclusions. Transvaginal catheter drainage of pelvic fluid collections using transabdominal ultrasound guidance is a safe and clinically effective procedure. Appropriate percutaneous management can avoid the need for surgery. Kevin C. Ching and Jules H. Sumkin Copyright © 2015 Kevin C. Ching and Jules H. Sumkin. All rights reserved. Prognostic Value of Residual Disease after Interval Debulking Surgery for FIGO Stage IIIC and IV Epithelial Ovarian Cancer Wed, 27 May 2015 13:33:49 +0000 http://www.hindawi.com/journals/ogi/2015/464123/ Although complete debulking surgery for epithelial ovarian cancer (EOC) is more often achieved with interval debulking surgery (IDS) following neoadjuvant chemotherapy (NACT), randomized evidence shows no long-term survival benefit compared to complete primary debulking surgery (PDS). We performed an observational cohort study of patients treated with debulking surgery for advanced EOC to evaluate the prognostic value of residual disease after debulking surgery. All patients treated between 1998 and 2010 in three Dutch referral gynaecological oncology centres were included. The prognostic value of residual disease after surgery for disease specific survival was assessed using Cox-regression analyses. In total, 462 patients underwent NACT-IDS and 227 PDS. Macroscopic residual disease after debulking surgery was an independent prognostic factor for survival in both treatment modalities. Yet, residual tumour less than one centimetre at IDS was associated with a survival benefit of five months compared to leaving residual tumour more than one centimetre, whereas this benefit was not seen after PDS. Leaving residual tumour at IDS is a poor prognostic sign as it is after PDS. The specific prognostic value of residual tumour seems to depend on the clinical setting, as minimal instead of gross residual tumour is associated with improved survival after IDS, but not after PDS. Marianne J. Rutten, Gabe S. Sonke, Anneke M. Westermann, Willemien J. van Driel, Johannes W. Trum, Gemma G. Kenter, and Marrije R. Buist Copyright © 2015 Marianne J. Rutten et al. All rights reserved. Obstetric Characteristics and Management of Patients with Postpartum Psychosis in a Tertiary Hospital Setting Mon, 18 May 2015 06:48:46 +0000 http://www.hindawi.com/journals/ogi/2015/386409/ Background. Postpartum psychosis is the most severe and uncommon form of postnatal affective illness. It constitutes a medical emergency. Acute management emphasizes hospitalization to ensure safety, antipsychotic medication adherence, and treatment of the underlying disorder. Objective. The aim of the study was to determine the obstetric characteristics and management of patients with postpartum psychosis in a tertiary centre in North-Western Nigeria. Methodology. This was a 10-year retrospective study. Records of the patients diagnosed with postpartum psychosis from January 1st, 2002, to December 31st, 2011, were retrieved and relevant data extracted and analyzed using the SPSS for Windows version 16.0. Results. There were 29 cases of postpartum psychosis giving an incidence of 1.1 per 1000 deliveries. The mean age of the patients was 20.6 ± 4 years. Twelve (55%) were primiparae, 16 (72.7%) were unbooked, and 13 (59%) delivered at home. All had vaginal deliveries at term. There were 12 (52.2%) live births, and 11 (47.8%) perinatal deaths and the fetal sex ratio was equal. The most common presentation was talking irrationally. Conclusion. There is need for risk factor evaluation for puerperal psychosis during the antenatal period especially in primigravidae and more advocacies to encourage women to book for antenatal care in our environment. C. E. Shehu and M. A. Yunusa Copyright © 2015 C. E. Shehu and M. A. Yunusa. All rights reserved. Prevention of Ovarian Hyperstimulation Syndrome: A Review Thu, 14 May 2015 13:40:19 +0000 http://www.hindawi.com/journals/ogi/2015/514159/ The following review aims to examine the available evidence to guide best practice in preventing ovarian hyperstimulation syndrome (OHSS). As it stands, there is no single method to completely prevent OHSS. There seems to be a benefit, however, in categorizing women based on their risk of OHSS and individualizing treatments to curtail their chances of developing the syndrome. At present, both Anti-Müllerian Hormone and the antral follicle count seem to be promising in this regard. Both available and upcoming therapies are also reviewed to give a broad perspective to clinicians with regard to management options. At present, we recommend the use of a “step-up” regimen for ovulation induction, adjunct metformin utilization, utilizing a GnRH agonist as an ovulation trigger, and cabergoline usage. A summary of recommendations is also made available for ease of clinical application. In addition, areas for potential research are also identified where relevant. Vinayak Smith, Tiki Osianlis, and Beverley Vollenhoven Copyright © 2015 Vinayak Smith et al. All rights reserved. Fertility and Symptom Relief following Robot-Assisted Laparoscopic Myomectomy Sun, 19 Apr 2015 06:29:38 +0000 http://www.hindawi.com/journals/ogi/2015/967568/ Objective. To examine success of robot-assisted laparoscopic myomectomy (RALM) measured by sustained symptom relief and fertility. Methods. This is a retrospective survey of 426 women who underwent RALM for fibroids, symptom relief, or infertility at three practice sites across the US. We examined rates of symptom recurrence and pregnancy and factors associated with these outcomes. Results. Overall, 70% of women reported being symptom-free, with 62.9% free of symptoms after three years. At >3 years, 66.7% of women who underwent surgery to treat infertility and 80% who were also symptom-free reported achieving pregnancy. Factors independently associated with symptom recurrence included greater time after surgery, preoperative dyspareunia, multiple fibroid surgeries, smoking after surgery, and preexisting diabetes. Factors positively correlated with achieving pregnancy included desiring pregnancy, prior pregnancy, greater time since surgery, and Caucasian race. Factors negatively correlated with pregnancy were advanced age and symptom recurrence. Conclusions. This paper, the first to examine symptom recurrence after RALM, demonstrates both short- and long-term effectiveness in providing symptom relief. Furthermore, RALM may have the potential to improve the chance of conception, even in a population at high risk of subfertility, with greater benefits among those who remain symptom-free. These findings require prospective validation. Michael C. Pitter, Serene S. Srouji, Antonio R. Gargiulo, Leslie Kardos, Usha Seshadri-Kreaden, Helen B. Hubert, and Glenn A. Weitzman Copyright © 2015 Michael C. Pitter et al. All rights reserved. Alternate Sequential Suture Tightening: A Novel Technique for Uncontrolled Postpartum Hemorrhage Sun, 22 Mar 2015 14:06:25 +0000 http://www.hindawi.com/journals/ogi/2015/145178/ Objective. The most commonly described technique of modified B-Lynch suture may not be suitable for all the patients presenting with flabby, atonic uterus. Study Design. A retrospective analysis of twelve patients with uncontrolled postpartum haemorrhage, who underwent this procedure from March 2007 to September 2012, was conducted. In this novel technique, sutures are passed in the lower uterine segment and are tightened alternately to control uterine bleeding. Results. Average duration of the procedure was 4 minutes (range 2–7 minutes). Average blood loss was 1625 mL (range 1300–1900 mL). Eleven patients (91.66%) were seen to have a successful outcome with only this technique. No patient required hysterectomy and one patient (8.33%) required additional bilateral internal iliac artery ligation. All the patients had a minimum follow-up of 2 yrs and none of them reported any infertility problems. Conclusion. This technique is simple, quick, and effective. There was no adverse effect on the fertility potential for the observed 2 years; however, a long-term follow-up is required to comment on its actual rate. This technique cannot replace the standard modified B-Lynch technique for uncontrolled postpartum haemorrhage but can be used for unresponsive, flabby, and atonic uterus. Sharda Brata Ghosh and Y. M. Mala Copyright © 2015 Sharda Brata Ghosh and Y. M. Mala. All rights reserved. Failure Rate of Single Dose Methotrexate in Managment of Ectopic Pregnancy Thu, 12 Mar 2015 14:00:46 +0000 http://www.hindawi.com/journals/ogi/2015/902426/ Background. One of the treatment modalities for ectopic pregnancy is methotrexate. The purpose of this study is to identify the failure rate of methotrexate in treating patients with ectopic pregnancy as well as the risk factors leading to treatment failure. Methods. A retrospective chart review of 225 patients who received methotrexate as a primary management option for ectopic pregnancy. Failure of single dose of methotrexate was defined as drop of BHCG level less than or equal to 14% in the seventh day after administration of methotrexate. Results. 225 patients had methotrexate. Most of the patients (151 (67%)) received methotrexate based on the following formula: f 50 mg X body surface area. Single dose of methotrexate was successful in 72% (162/225) of the patients. 28% (63/225) were labeled as failure of single dose of methotrexate because of suboptimal drop in BhCG. 63% (40/63) of failure received a second dose of methotrexate, and 37% (23/63) underwent surgical treatment. Among patient who received initial dose of methotrexate, 71% had moderate or severe pain, and 58% had ectopic mass size of more than 4 cm on ultrasound. Conclusion. Liberal use of medical treatment of ectopic pregnancy results in 71% success rate. Feras Sendy, Eman AlShehri, Amani AlAjmi, Elham Bamanie, Surekha Appani, and Taghreed Shams Copyright © 2015 Feras Sendy et al. All rights reserved. Circadian System and Melatonin Hormone: Risk Factors for Complications during Pregnancy Mon, 02 Mar 2015 09:16:50 +0000 http://www.hindawi.com/journals/ogi/2015/825802/ Pregnancy is a complex and well-regulated temporal event in which several steps are finely orchestrated including implantation, decidualization, placentation, and partum and any temporary alteration has serious effects on fetal and maternal health. Interestingly, alterations of circadian rhythms (i.e., shiftwork) have been correlated with increased risk of preterm delivery, intrauterine growth restriction, and preeclampsia. In the last few years evidence is accumulating that the placenta may have a functional circadian system and express the clock genes Bmal1, Per1-2, and Clock. On the other hand, there is evidence that the human placenta synthesizes melatonin, hormone involved in the regulation of the circadian system in other tissues. Moreover, is unknown the role of this local production of melatonin and whether this production have a circadian pattern. Available information indicates that melatonin induces in placenta the expression of antioxidant enzymes catalase and superoxide dismutase, prevents the injury produced by oxidative stress, and inhibits the expression of vascular endothelial growth factor (VEGF) a gene that in other tissues is controlled by clock genes. In this review we aim to analyze available information regarding clock genes and clock genes controlled genes such as VEGF and the possible role of melatonin synthesis in the placenta. F. J. Valenzuela, J. Vera, C. Venegas, F. Pino, and C. Lagunas Copyright © 2015 F. J. Valenzuela et al. All rights reserved.