Obstetrics and Gynecology International http://www.hindawi.com The latest articles from Hindawi Publishing Corporation © 2014 , Hindawi Publishing Corporation . All rights reserved. Birth Weight Ratio as an Alternative to Birth Weight Percentile to Express Infant Weight in Research and Clinical Practice: A Nationwide Cohort Study Wed, 13 Aug 2014 07:06:06 +0000 http://www.hindawi.com/journals/ogi/2014/749476/ Objective. To compare birth weight ratio and birth weight percentile to express infant weight when assessing pregnancy outcome. Study Design. We performed a national cohort study. Birth weight ratio was calculated as the observed birth weight divided by the median birth weight for gestational age. The discriminative ability of birth weight ratio and birth weight percentile to identify infants at risk of perinatal death (fetal death and neonatal death) or adverse pregnancy outcome (perinatal death + severe neonatal morbidity) was compared using the area under the curve. Outcomes were expressed stratified by gestational age at delivery separate for birth weight ratio and birth weight percentile. Results. We studied 1,299,244 pregnant women, with an overall perinatal death rate of 0.62%. Birth weight ratio and birth weight percentile have equivalent overall discriminative performance for perinatal death and adverse perinatal outcome. In late preterm infants (33+0–36+6 weeks), birth weight ratio has better discriminative ability than birth weight percentile for perinatal death (0.68 versus 0.63, ) or adverse pregnancy outcome (0.67 versus 0.60, ). Conclusion. Birth weight ratio is a potentially valuable instrument to identify infants at risk of perinatal death and adverse pregnancy outcome and provides several advantages for use in research and clinical practice. Moreover, it allows comparison of groups with different average birth weights. Bart Jan Voskamp, Brenda M. Kazemier, Ewoud Schuit, Ben Willem J. Mol, Maarten Buimer, Eva Pajkrt, and Wessel Ganzevoort Copyright © 2014 Bart Jan Voskamp et al. All rights reserved. Early Prediction of Preeclampsia Thu, 17 Jul 2014 07:44:34 +0000 http://www.hindawi.com/journals/ogi/2014/297397/ Effective screening for the development of early onset preeclampsia (PE) can be provided in the first-trimester of pregnancy. Screening by a combination of maternal risk factors, uterine artery Doppler, mean arterial pressure, maternal serum pregnancy-associated plasma protein-A, and placental growth factor can identify about 95% of cases of early onset PE for a false-positive rate of 10%. Leona C. Poon and Kypros H. Nicolaides Copyright © 2014 Leona C. Poon and Kypros H. Nicolaides. All rights reserved. Degree and Rate of Growth Discordance in Dichorionic Twins Conceived by In Vitro Fertilization Mon, 07 Jul 2014 09:03:57 +0000 http://www.hindawi.com/journals/ogi/2014/543728/ Objective. Our objective was to estimate degree and rate of discordant growth and its impact on perinatal outcome in dichorionic twin pregnancies conceived by in vitro fertilization (IVF) compared to those conceived spontaneously. Study Design. Growth discordance was defined as 90th percentiles for the study population. Adverse perinatal outcome was defined as 5-minute Apgar score and/or admission to neonatal intensive care unit. Results. In the total study population of dichorionic twins (176 conceived by IVF and 215 spontaneously), 30% discordant growth represented the 90th percentile. After adjusting for gestational age, discordant twins conceived by IVF or spontaneously were at higher risk for adverse perinatal outcome (hazard ratio 4.4; 95% CI 2.4–8.3, ; hazard ratio 2.5; 95% CI 1.5–4.4, , resp.). Similar rates of 5-minute Apgar score , admission to neonatal intensive care unit, and delivery weeks were found between discordant twins conceived by IVF and those conceived spontaneously. Conclusion. Dichorionic twins conceived by IVF are at similar risk for the rate and degree of discordant growth and adverse perinatal outcome compared to dichorionic twins conceived spontaneously. Amira S. Egic, Donka V. Mojovic, Zagorka M. Milovanovic, Aleksandar B. Jurisic, Ljubomir P. Srbinovic, Suzana P. Krsmanovic, and Natasa T. Karadzov-Orlic Copyright © 2014 Amira S. Egic et al. All rights reserved. The Extracellular Matrix Contributes to Mechanotransduction in Uterine Fibroids Thu, 03 Jul 2014 07:39:01 +0000 http://www.hindawi.com/journals/ogi/2014/783289/ The role of the extracellular matrix (ECM) and mechanotransduction as an important signaling factor in the human uterus is just beginning to be appreciated. The ECM is not only the substance that surrounds cells, but ECM stiffness will either compress cells or stretch them resulting in signals converted into chemical changes within the cell, depending on the amount of collagen, cross-linking, and hydration, as well as other ECM components. In this review we present evidence that the stiffness of fibroid tissue has a direct effect on the growth of the tumor through the induction of fibrosis. Fibrosis has two characteristics: (1) resistance to apoptosis leading to the persistence of cells and (2) secretion of collagen and other components of the ECM such a proteoglycans by those cells leading to abundant disposition of highly cross-linked, disoriented, and often widely dispersed collagen fibrils. Fibrosis affects cell growth by mechanotransduction, the dynamic signaling system whereby mechanical forces initiate chemical signaling in cells. Data indicate that the structurally disordered and abnormally formed ECM of uterine fibroids contributes to fibroid formation and growth. An appreciation of the critical role of ECM stiffness to fibroid growth may lead to new strategies for treatment of this common disease. Phyllis C. Leppert, Friederike L. Jayes, and James H. Segars Copyright © 2014 Phyllis C. Leppert et al. All rights reserved. In Women with Previous Pregnancy Hypertension, Levels of Cardiovascular Risk Biomarkers May Be Modulated by Haptoglobin Polymorphism Wed, 02 Jul 2014 00:00:00 +0000 http://www.hindawi.com/journals/ogi/2014/361727/ Preeclampsia (PE) may affect the risk for future cardiovascular disease. Haptoglobin (Hp), an acute phase protein with functional genetic polymorphism, synthesized in the hepatocyte and in many peripheral tissues secondary of oxidative stress of PE, may modulate that risk through the antioxidant, angiogenic, and anti-inflammatory differential effects of their genotypes. We performed a prospective study in 352 women aged years, which 165 had previous PE, 2 to 16 years ago. We studied demographic, anthropometric, and haemodynamic biomarkers such as C-reactive protein (CRP), myeloperoxidase (MPO), and nitric oxide metabolites (total and nitrites), and others associated with liver function (AST and ALT) and lipid profile (total LDL and cholesterol HDL, non-HDL, and apolipoproteins A and B). Finally, we study the influence of Hp genetic polymorphism on all these biomarkers and as a predisposing factor for PE and its remote cardiovascular disease prognosis. Previously preeclamptic women either hypertensive or normotensive presented significant differences in those risk biomarkers (MPO, nitrites, and ALT), whose variation may be modulated by Hp 1/2 functional genetic polymorphism. The history of PE may be relevant, in association with these biomarkers to the cardiovascular risk in premenopausal women. Andreia Matos, Alda Pereira da Silva, Maria Clara Bicho, Conceição Afonso, Maria José Areias, Irene Rebelo, and Manuel Bicho Copyright © 2014 Andreia Matos et al. All rights reserved. Rubella Immunity among Pregnant Women in Jeddah, Western Region of Saudi Arabia Thu, 19 Jun 2014 12:16:21 +0000 http://www.hindawi.com/journals/ogi/2014/659838/ To determine the presence of rubella immunity among pregnant women attending their first prenatal visit in Jeddah, Saudi Arabia, a retrospective, descriptive, cross-sectional, hospital-based study (prevalence study) was undertaken. A total of 10276 women attending prenatal clinics between January 1, 2008, and December 31, 2011 were included. Rubella screening tests (immunoglobulins: IgG and IgM), rubella antibody titer levels, patient age, gravidity, parity, and the number of previous abortions were analyzed. No patients tested IgM positive, and 9410 (91.6%) were immune (IgG positive); the remaining 866 (8.4%) were susceptible. There were no significant differences in gravidity, parity, or the number of previous abortions between immune and nonimmune groups. In contrast, the immunity rate decreased with increasing age, with a significant difference between the youngest age group (15–19 years) and the oldest age group (40–49 years) (; odds ratio, 2.86; 95% confidence interval, 1.7–4.7). Rubella immunity among pregnant women was high (91.6%) but decreased significantly with increasing age. A possible explanation for this is the change in the rubella vaccination policy in Saudi Arabia in 2002, from 1 dose to 2 doses. In addition, antibody levels begin to decline after vaccination and natural infection. Sharifa A. Alsibiani Copyright © 2014 Sharifa A. Alsibiani. All rights reserved. Postcoital Bleeding: A Review on Etiology, Diagnosis, and Management Tue, 17 Jun 2014 08:19:19 +0000 http://www.hindawi.com/journals/ogi/2014/192087/ Postcoital bleeding refers to spotting or bleeding that occurs after intercourse and is not related to menstruation. The prevalence of postcoital bleeding ranges from 0.7 to 9.0 percent of menstruating women. There are multiple etiologies for this common complaint in which most are benign such as cervicitis or cervical polyps. However, the most serious cause of postcoital bleeding is cervical cancer. There are currently no recommendations from governing bodies such as the American College of Obstetricians and Gynecologists on evaluating and treating women with postcoital bleeding. The purpose of this paper is to discuss the common causes of postcoital bleeding, the etiologies of postcoital bleeding, and the likelihood that malignancy is the underlying cause. After an extensive literature review, we compiled a paper illustrating the key concepts a practitioner should know when it comes to postcoital bleeding. Finally, this review will conclude with treatment options for women who are found to have an identifiable source for their bleeding and a discussion on the natural history of postcoital bleeding in women who are found to have no identifiable etiology on evaluation. Christopher M. Tarney and Jasmine Han Copyright © 2014 Christopher M. Tarney and Jasmine Han. All rights reserved. Current Status of Comprehensive Chromosome Screening for Elective Single-Embryo Transfer Sun, 01 Jun 2014 11:52:06 +0000 http://www.hindawi.com/journals/ogi/2014/581783/ Most in vitro fertilization (IVF) experts and infertility patients agree that the most ideal assisted reproductive technology (ART) outcome is to have a healthy, full-term singleton born. To this end, the most reliable policy is the single-embryo transfer (SET). However, unsatisfactory results in IVF may result from plenty of factors, in which aneuploidy associated with advanced maternal age is a major hurdle. Throughout the past few years, we have got a big leap in advancement of the genetic screening of embryos on aneuploidy, translocation, or mutations. This facilitates a higher success rate in IVF accompanied by the policy of elective SET (eSET). As the cost is lowering while the scale of genome characterization continues to be up over the recent years, the contemporary technologies on trophectoderm biopsy and freezing-thaw, comprehensive chromosome screening (CCS) with eSET appear to be getting more and more popular for modern IVF centers. Furthermore, evidence has showen that, by these avant-garde techniques (trophectoderm biopsy, vitrification, and CCS), older infertile women with the help of eSET may have an opportunity to increase the success of their live birth rates approaching those reported in younger infertility patients. Ming-Yih Wu, Kuang-Han Chao, Chin-Der Chen, Li-Jung Chang, Shee-Uan Chen, and Yu-Shih Yang Copyright © 2014 Ming-Yih Wu et al. All rights reserved. Preeclampsia and Future Cardiovascular Risk: Are Women and General Practitioners Aware of This Relationship? The Experience from a Portuguese Centre Wed, 28 May 2014 19:32:30 +0000 http://www.hindawi.com/journals/ogi/2014/531539/ Objective. To evaluate the impact of preeclampsia in the modification of lifestyle habits and decreasing cardiovascular risk factors in a population of women at least 6 months after having the diagnosis of preeclampsia. Methods. Cross-sectional observational study. Data included 141 cases of preeclampsia and chronic hypertension with superimposed preeclampsia on singleton births diagnosed in our institution between January 2010 and December 2013. From the cases diagnosed over 6 months a standardized questionnaire evaluating lifestyle changes was applied. Results. We reviewed 141 cases, of which 120 were diagnosed for more than 6 months. An overall participation rate in the questionnaire of 65% was yielded. A slight increase from the mean BMI before pregnancy was found. No statistical significant association was established between postpregnancy mean BMI, weight variation, and the frequency of aerobic exercise with the severity of preeclampsia. Only 28% of our cases were practising aerobic exercise at least weekly. The majority of women assessed blood pressure at least monthly (45/78), but only 25 assessed glycaemia at least once/year. Conclusion. This study shows that the majority of our patients and general practitioners do not take into consideration a previous pregnancy affected by preeclampsia as a risk factor for future cardiovascular disease. Pedro Viana Pinto, Mariana Rei, Ana Paula Machado, and Nuno Montenegro Copyright © 2014 Pedro Viana Pinto et al. All rights reserved. First Trimester Aneuploidy Screening Program for Preeclampsia Prediction in a Portuguese Obstetric Population Wed, 28 May 2014 00:00:00 +0000 http://www.hindawi.com/journals/ogi/2014/435037/ Objective. To evaluate the performance of a first trimester aneuploidy screening program for preeclampsia (PE) prediction in a Portuguese obstetric population, when performed under routine clinical conditions. Materials and Methods. Retrospective cohort study of 5672 pregnant women who underwent routine first trimester aneuploidy screening in a Portuguese university hospital from January 2009 to June 2013. Logistic regression-based predictive models were developed for prediction of PE based on maternal characteristics, crown-rump length (CRL), nuchal translucency thickness (NT), and maternal serum levels of pregnancy-associated plasma protein-A (PAPP-A) and free beta-subunit of human chorionic gonadotropin (free β-hCG). Results. At a false-positive rate of 5/10%, the detection rate for early-onset (EO-PE) and late-onset (LO-PE) PE was 31.4/45.7% and 29.5/35.2%, respectively. Although both forms of PE were associated with decreased PAPP-A, logistic regression analysis revealed significant contributions from maternal factors, free β-hCG, CRL, and NT, but not PAPP-A, for prediction of PE. Conclusion. Our findings support that both clinical forms of EO-PE and LO-PE can be predicted using a combination of maternal history and biomarkers assessed at first trimester aneuploidy screening. However, detection rates were modest, suggesting that models need to be improved with additional markers not included in the current aneuploidy screening programs. Cláudia Teixeira, Eduardo Tejera, Helena Martins, António Tomé Pereira, Altamiro Costa-Pereira, and Irene Rebelo Copyright © 2014 Cláudia Teixeira et al. All rights reserved. References of Birth Weights for Gestational Age and Sex from a Large Cohort of Singleton Births in Cameroon Mon, 12 May 2014 07:00:16 +0000 http://www.hindawi.com/journals/ogi/2014/361451/ Objective. To establish the percentile charts of birth weights for gestational age and sex within the Cameroonian population. Methods. A review of medical records of infants born between January 2007 and December 2011 at the maternities of two hospitals in Cameroon, Central Africa. Multiple pregnancies, births of HIV infected women, stillbirths, and births with major fetal malformations were excluded. The smooth curves of birth weight for gestational age and sex were created using the Gamlss package under R.3.0.1 software. Results. The birth weights of 12837 live birth singleton infants born to HIV negative women between 28 and 42 weeks of gestation were analyzed to construct the birth weight curves for gestational age and sex. The smoothed percentile curves of birth weights for gestational age and sex of Cameroonian infants have demonstrated an increasing slope until 40 weeks and then a plateau. There was a varied difference of distribution in birth weights for gestational age between Cameroonian, Botswanan, American, and French infants. Conclusion. We established the reference curves of birth weights for gestational age and sex for Cameroonians. The difference in birth weight curves noted between Cameroonian, Botswanan, American, and French infants suggests the importance of establishing the regional birth weight norms. Jean Dupont Kemfang Ngowa, Irénée Domkam, Anny Ngassam, Georges Nguefack-Tsague, Walter Dobgima Pisoh, Cyrille Noa, and Jean Marie Kasia Copyright © 2014 Jean Dupont Kemfang Ngowa et al. All rights reserved. Differential Expression of Placental Glucocorticoid Receptors and Growth Arrest-Specific Transcript 5 in Term and Preterm Pregnancies: Evidence for Involvement of Maternal Stress Sun, 11 May 2014 06:53:03 +0000 http://www.hindawi.com/journals/ogi/2014/239278/ Pregnancy-specific stress predicts birth outcomes. We hypothesized that there is a maternal stress-GR interaction that can influence fetal birth weight. This study examined the relationship between mothers’ stress and attitude towards their pregnancies, placental glucocorticoid receptors (GRs) and growth arrest-specific transcript 5 (GAS5) expression, and the status of GR polymorphism, with their infants’ birth weights. GAS5 and GRα were the predominant transcripts in both term and preterm placentas, with GAS5 being primarily localized in the syncytiotrophoblasts. In an attempt to mimic moderate and high stress environment in vitro, BeWo and JEG-3 cytotrophoblast cell lines were treated with 10 nM–1000 nM cortisol. Only expression of GAS5 was significantly upregulated by cortisol in all treatments compared with basal levels, but none of the GRs changed expression significantly. In an attempt to assess a stress versus gene interaction, we studied four GR polymorphisms. In the homozygous group for Tth111I polymorphism, mothers with negative attitudes towards the pregnancy gave birth to infants with significantly lower birth weights compared to women with positive/neutral attitudes. None of the GR splice variants were associated with maternal stress. However, placental GAS5 levels were inversely correlated with maternal stress. This study points towards a potential gene-environment interaction that could be of predictive value for fetal weight. D. Mparmpakas, E. Zachariades, G. Sotiriadis, A. Goumenou, A. J. Harvey, Y. Gidron, and E. Karteris Copyright © 2014 D. Mparmpakas et al. All rights reserved. The Efficacy of Inositol and N-Acetyl Cysteine Administration (Ovaric HP) in Improving the Ovarian Function in Infertile Women with PCOS with or without Insulin Resistance Wed, 30 Apr 2014 06:40:30 +0000 http://www.hindawi.com/journals/ogi/2014/141020/ Objective. Substances such as inositol and N-acetylcysteine (NAC) have been recently shown to be effective in treatment of PCOS patients. The aim of this prospective trial is to evaluate the efficacy of NAC + Inositol + folic acid on ovulation rate and menstrual regularity in PCOS patients with and without insulin resistance. Methods. Among the 91 PCOS patients treated with NAC + Inositol + folic, insulin resistance was present in 44 subjects (A) and absent in 47 (B). The primary endpoint was the ovulation rate/year, determined by menstrual diary, serum progesterone performed between 21° and 24° days, ultrasound findings of growth follicular or luteal cysts, and luteal ratio. HOMA-index assessment after 6 and 12 months of treatment was evaluated as secondary endpoint. Results. In both groups there was a significant increase in ovulation rate and no significant differences were found in the primary outcome between two groups. In group A, a significant reduction of HOMA-index was observed. Conclusions. The association NAC + Inositol + folic, regardless of insulin-resistance state, seems to improve ovarian function in PCOS patients. Therefore, inositol and NAC may have additional noninsulin-related mechanisms of action that allow achieving benefits also in those patients with negative HOMA-index. Angela Sacchinelli, Roberta Venturella, Daniela Lico, Annalisa Di Cello, Antonella Lucia, Erika Rania, Roberto Cirillo, and Fulvio Zullo Copyright © 2014 Angela Sacchinelli et al. All rights reserved. Breast Magnetic Resonance Imaging and Its Impact on the Surgical Treatment of Breast Cancer Tue, 22 Apr 2014 09:16:29 +0000 http://www.hindawi.com/journals/ogi/2014/632074/ Breast MRI focuses on the detection of multifocality, multicentricity, and bilaterality of newly diagnosed breast cancer. A retrospective study was carried out on 833 patients that were diagnosed and treated for breast cancer between January 2002 and December 2011. Patients were divided into two groups: those that had a presurgery breast MRI and those that did not. The two groups were compared on the basis of the several parameters. The aim of the study was to determine whether the use of MRI in breast cancer screening changes the initial treatment decision. In 18% of the patients, MRI revealed a multifocal or a multicentric unilateral breast cancer, a bilateral tumour, or a larger cancer than initially diagnosed. Most of these patients underwent a second-look breast ultrasound, with or without an additional biopsy. The percentage of mastectomies did not increase as a result of an MRI exam. Neoadjuvant chemotherapy was used more often and the percentage of reoperations decreased when an MRI was performed. Georgia Tsina and Philippe Simon Copyright © 2014 Georgia Tsina and Philippe Simon. All rights reserved. Maternal Characteristics of Women Exposed to Hypnotic Benzodiazepine Receptor Agonist during Pregnancy Thu, 10 Apr 2014 11:14:51 +0000 http://www.hindawi.com/journals/ogi/2014/945621/ Background. There is little knowledge regarding the characteristics of women treated with hypnotic benzodiazepine receptor agonists (HBRAs) during pregnancy. In this large Danish cohort study, we characterize women exposed to HBRA during pregnancy. We determined changes in prevalence of HBRA use from 1997 to 2010 and exposure to HBRAs in relation to pregnancy. Methods. We performed a retrospective cohort study including 911,017 pregnant women in the period from 1997 to 2010. Information was retrieved from The Danish Birth Registry and The Registry of Medicinal Product Statistics to identify pregnant women redeeming a prescription of HBRAs. Results. We identified 2,552 women exposed to HBRAs during pregnancy, increasing from 0.18% in 1997 to 0.23% in 2010. Compared to unexposed women, exposed women were characterized by being older, with higher BMI, in their third or fourth parity, of lower income and education level, more frequently smokers, and more likely to be comedicated with antipsychotic, anxiolytic, or antidepressant drugs (). Conclusion. Women using HBRAs during their pregnancy differ from unexposed women in socioeconomic factors and were more likely to receive comedication. The consumption of HBRAs was reduced during pregnancy compared to before conception. Bjarke Askaa, Espen Jimenez-Solem, Henrik Enghusen Poulsen, and Jon Traerup Andersen Copyright © 2014 Bjarke Askaa et al. All rights reserved. Subcutaneous Terbutaline Pump for Maintenance of Tocolysis following Arrest of Acute Preterm Labor Mon, 31 Mar 2014 00:00:00 +0000 http://www.hindawi.com/journals/ogi/2014/795329/ Kavita Singh, Mohammed T. Ansari, and Laura M. Gaudet Copyright © 2014 Kavita Singh et al. All rights reserved. Female Genital Mutilation and Obstetric Outcomes: Flawed Systematic Review and Meta-Analysis Does Not Accurately Reflect the Available Evidence Thu, 20 Mar 2014 07:07:00 +0000 http://www.hindawi.com/journals/ogi/2014/205230/ O. Meirik, E. Banks, T. Farley, O. Akande, H. Bathija, and M. Ali Copyright © 2014 O. Meirik et al. All rights reserved. Placenta-Specific Protein 1: A Potential Key to Many Oncofetal-Placental OB/GYN Research Questions Mon, 17 Mar 2014 12:02:38 +0000 http://www.hindawi.com/journals/ogi/2014/678984/ Placenta-specific protein 1 (PLAC1) is a secreted protein found in trophoblasts. Several reports implicate a central role for PLAC1 in establishment and maintenance of the placenta. In addition to placentae PLAC1 is expressed in a variety of solids including breast, endometrial, and ovarian cancers. In order to show that PLAC1 is potentially relevant to a number of research questions in OB/GYN, we report on PLAC1 expression in a selected panel that includes two choriocarcinoma cell lines, normal placental tissues, and endometrial and ovarian tumors. We report for the first time that PLAC1 is also expressed in human fetal tissues. PLAC1 is transcriptionally heterogeneous with one promoter (P1) generating two transcripts with alternately spliced 5’ UTRs and the other promoter (P2) generating a third transcript. Placental tissues favor P2 transcripts, while P1 is favored in most of the other cells. Mechanisms determining multiple PLAC1 transcripts and promoter preferences are as yet unknown, but it is clear that this protein is likely to be important in a variety of phenomena relevant to both gynecologic oncology and maternal-fetal medicine. Eric J. Devor, Henry D. Reyes, Donna A. Santillan, Mark K. Santillan, Chinenye Onukwugha, Michael J. Goodheart, and Kimberly K. Leslie Copyright © 2014 Eric J. Devor et al. All rights reserved. Social Determinants and Access to Induced Abortion in Burkina Faso: From Two Case Studies Mon, 17 Mar 2014 10:05:46 +0000 http://www.hindawi.com/journals/ogi/2014/402456/ Unsafe abortion constitutes a major public health problem in Burkina Faso and concerns mainly young women. The legal restriction and social stigma make abortions most often clandestine and risky for women who decide to terminate a pregnancy. However, the exposure to the risk of unsafe induced abortion is not the same for all the women who faced unwanted pregnancy and decide to have an abortion. Drawn from a qualitative study on the issue of abortion in Ouagadougou, Burkina Faso’s capital, the contrasting cases of two young women who had abortion allow us to show how the women’s personal resources (such as the school level, financial resources, the compliance to social norms, the social network, etc.) may determine the degree of vulnerability of women, the delay to have an abortion, the type of care they are likely to benefit from, and the cost they have to face. This study concludes that the poorest always pay more (cost and consequences), take longer to have an abortion, and have more exposure to the risk of unsafe abortion. Ramatou Ouédraogo and Johanne Sundby Copyright © 2014 Ramatou Ouédraogo and Johanne Sundby. All rights reserved. Chlamydia trachomatis Antibody Testing in Vaginal Mucosal Material versus Blood Samples of Women Attending a Fertility Clinic and an STI Clinic Thu, 13 Mar 2014 09:20:33 +0000 http://www.hindawi.com/journals/ogi/2014/601932/ Background. Chlamydia infections often follow an asymptomatic course but may damage the reproductive tract. Chlamydia antibodies in serum are used as markers for past infections and can relate to tubal pathology and infertility. This “proof of principle” study aimed to assess whether Chlamydia antibodies are detectable in easier to obtain, noninvasive, vaginal mucosa samples and relate to current or past infection. Methods. We compared outcomes of Chlamydia IgG and IgA antibody tests in serum and vaginal mucosal swabs in (a) 77 women attending a fertility clinic, of whom 25 tested positive for serum-IgG and (b) 107 women visiting an STI centre, including 30 Chlamydia PCR-positive subjects. Results. In the STI clinic, active Chlamydia infections were linked to serum-IgG and serum-IgA () and mucosa-IgA (), but not mucosa-IgG. In the fertility clinic, mucosa-IgG had stronger correlations with serum-IgG () than mucosa-IgA (). Women with tubal pathology or Chlamydia history more commonly had serum-IgG and mucosa-IgA (both ), whereas this link was weaker for mucosa-IgG (). Conclusion. Chlamydia IgG and IgA are detectable in vaginal mucosal material. Serum-IgG had stronger associations with current or past infections. Mucosa-IgA also showed associations with (past) infection and complications. IgA presence in vaginal mucosa warrants further epidemiological studies. Ingrid V. F. van den Broek, Jolande A. Land, Jan E. A. M. van Bergen, Servaas A. Morré, and Marianne A. B. van der Sande Copyright © 2014 Ingrid V. F. van den Broek et al. All rights reserved. Autologous Cord Blood Therapy for Infantile Cerebral Palsy: From Bench to Bedside Thu, 20 Feb 2014 09:34:09 +0000 http://www.hindawi.com/journals/ogi/2014/976321/ About 17 million people worldwide live with cerebral palsy, the most common disability in childhood, with hypoxic-ischemic encephalopathy, preterm birth, and low birth weight being the most important risk factors. This review will focus on recent developments in cell therapy for infantile cerebral palsy by transplantation of autologous umbilical cord blood. There are only 4 publications available at present; however, the observations made along with experimental data in vivo and in vitro may be of utmost importance clinically, so that a review at an early developmental stage of this new therapeutic concept seems justified. Particularly, since the first published double-blind randomized placebo-controlled trial in a paradigm using allogeneic cord blood and erythropoietin to treat cerebral palsy under immunosuppression showed beneficial therapeutic effects in infantile cerebral palsy, long-held doubts about the efficacy of this new cell therapy are dispelled and a revision of therapeutic views upon an ailment, for which there is no cure at present, is warranted. Hence, this review will summarize the available information on autologous cord blood therapy for cerebral palsy and that on the relevant experimental work as far as potential mechanisms and modes of action are concerned. A. Jensen Copyright © 2014 A. Jensen. All rights reserved. Does Maturity Affect Cephalic Perfusion and T/QRS Ratio during Prolonged Umbilical Cord Occlusion in Fetal Sheep? Sun, 16 Feb 2014 08:54:53 +0000 http://www.hindawi.com/journals/ogi/2014/314159/ T/QRS ratio monitoring is used to help identify fetal asphyxia. However, immature animals have greater capacity to maintain blood pressure during severe asphyxia, raising the possibility that they may show an attenuated T/QRS increase during asphyxia. Chronically instrumented fetal sheep at 0.6 of gestation (0.6 GA; n = 12), 0.7 GA (n = 12), and 0.8 GA (n = 8) underwent complete umbilical cord occlusion for 30 min, 25 min, or 15 min, respectively. Cord occlusion was associated with progressive metabolic acidosis and initial hypertension followed by severe hypotension, with a more rapid fall in mean arterial blood pressure (MAP) and carotid blood flow (CaBF) with advancing gestation. T/QRS ratio rose after occlusion more rapidly at 0.8 GA than in immature fetuses, to a similar final peak at all ages, followed by a progressive fall that was slower at 0.8 GA than in the immature fetuses. The increase in T/QRS ratio correlated with initial hypertension at 0.8 GA (, = 0.38), and conversely, its fall correlated closely with falling MAP in all gestational groups (, = 0.67). In conclusion, elevation of the T/QRS ratio is an index of onset of severe asphyxia in the last third of gestation, but not of fetal compromise. Guido Wassink, Robert Galinsky, Paul P. Drury, Eleanor R. Gunn, Laura Bennet, and Alistair J. Gunn Copyright © 2014 Guido Wassink et al. All rights reserved. Access to Complex Abortion Care Service and Planning Improved through a Toll-Free Telephone Resource Line Thu, 13 Feb 2014 10:03:56 +0000 http://www.hindawi.com/journals/ogi/2014/913241/ Background. Providing equitable access to the full range of reproductive health services over wide geographic areas presents significant challenges to any health system. We present a review of a service provision model which has provided improved access to abortion care; support for complex issues experienced by women seeking nonjudgmental family planning health services; and a mechanism to collect information on access barriers. The toll-free pregnancy options service (POS) of British Columbia Women’s Hospital and Health Centre sought to improve access to services and overcome barriers experienced by women seeking abortion. Methods. We describe the development and implementation of a province-wide toll-free telephone counseling and access facilitation service, including establishment of a provincial network of local abortion service providers in the Canadian province of British Columbia from 1998 to 2010. Results. Over 2000 women annually access service via the POS line, networks of care providers are established and linked to central support, and central program planners receive timely information on new service gaps and access barriers. Conclusion. This novel service has been successful in addressing inequities and access barriers identified as priorities before service establishment. The service provided unanticipated benefits to health care planning and monitoring of provincial health care related service delivery and gaps. This model for low cost health service delivery may realize similar benefits when applied to other health care systems where access and referral barriers exist. Wendy V. Norman, Barbara Hestrin, and Royce Dueck Copyright © 2014 Wendy V. Norman et al. All rights reserved. Evaluation of Creatine Kinase, Lactate Dehydrogenase, and Amylase Concentrations in Umbilical Blood of Preterm Infants after Long-Term Tocolysis Thu, 13 Feb 2014 09:59:16 +0000 http://www.hindawi.com/journals/ogi/2014/278379/ Creatine kinase (CK), lactate dehydrogenase (LDH), and amylase levels of preterm infants following long-term tocolysis in pregnant women are limited. The objective of this study was to determine if the tocolytic therapy affects CK, LDH, and amylase levels in the umbilical blood. This study included 215 preterm infants born to women treated with and without ritodrine hydrochloride. CK, LDH, and amylase levels in the umbilical blood at delivery were determined. Infants were divided according to the ritodrine tocolysis, as follows: Group A (), not exposed to ritodrine; Group B (), IV ritodrine for <1 week; Group C (), IV ritodrine for ≥1 week. The CK concentration in cord blood of Group C ( IU/L) was significantly higher in comparison with Group A ( IU/L, ). There was no significant difference in LDH and amylase levels in the three groups. The CK significantly correlated with gestational age (, ) and birth weight (, ). LDH and amylase levels did not change with gestational age nor birth weight. In conclusion, long-term ritodrine tocolysis leads to increased umbilical blood CK level. Yoshiyuki Nakajima and Naoki Masaoka Copyright © 2014 Yoshiyuki Nakajima and Naoki Masaoka. All rights reserved. Obstetric Outcome and Significance of Labour Induction in a Health Resource Poor Setting Mon, 20 Jan 2014 07:54:28 +0000 http://www.hindawi.com/journals/ogi/2014/419621/ Objectives. The aim of this study was to evaluate the methods, indications, outcome of induced labor and its significance in obstetric practice in the study area. Methods. This was a retrospective study of cases of induced labor at the Catholic Maternity Hospital in Ogoja, Cross-River State, Nigeria, between January 1, 2002, and December 31, 2011. Data on the sociodemographic characteristics of the parturient, induction methods, indications for induction, outcomes and reasons for failed induction were abstracted from personal case files and the hospital’s maternity/delivery register. The data were analyzed with SPSS15.0 window version. Result. The induction rate in this study was 11.5%. Induction was successful in 75.9% of cases but failed in 24.1%. Misoprostol was the commonest induction method (78.2%). The commonest indication for induction was postdate pregnancy (45.8%). Failed induction was due to fetal distress, prolonged labor, cephalopelvic disproportion and cord prolapse. The induction-delivery interval was  hours. Conclusion. Induction of labor is a common obstetric procedure which is safe and beneficial in well-selected and properly monitored high risk pregnancies where the benefits of early delivery outweigh the risk of continuing the pregnancy. Osaheni Lucky Lawani, Azubuike Kanario Onyebuchi, Chukwuemeka Anthony Iyoke, Chikezie Nwachukwu Okafo, and Leonard Ogbonna Ajah Copyright © 2014 Osaheni Lucky Lawani et al. All rights reserved. Endometrial Cancer: Molecular and Cellular Basis of Tumor Development, Novel Biomarkers and Therapeutic Agents, and Innovative Research Approaches Thu, 16 Jan 2014 08:38:29 +0000 http://www.hindawi.com/journals/ogi/2014/710405/ Donghai Dai, Andrew P. Bradford, and Eric R. Prossnitz Copyright © 2014 Donghai Dai et al. All rights reserved. Contemporary Clinical Management of the Cerebral Complications of Preeclampsia Sun, 29 Dec 2013 15:12:33 +0000 http://www.hindawi.com/journals/ogi/2013/985606/ The neurological complications of preeclampsia and eclampsia are responsible for a major proportion of the morbidity and mortality arising from these conditions, for women and their infants alike. This paper outlines the evidence base for contemporary management principles pertaining to the neurological sequelae of preeclampsia, primarily from the maternal perspective, but with consideration of fetal and neonatal aspects as well. It concludes with a discussion regarding future directions in the management of this potentially lethal condition. Stefan C. Kane, Alicia Dennis, Fabricio da Silva Costa, Louise Kornman, and Shaun Brennecke Copyright © 2013 Stefan C. Kane et al. All rights reserved. A Review of Comparison of Complications of Vaginal Hysterectomy with and without Concomitant Surgery for SUI: A 5 Years’ Experience at a Tertiary Care Hospital of Pakistan Sun, 22 Dec 2013 14:53:54 +0000 http://www.hindawi.com/journals/ogi/2013/540646/ Objective. The study was performed to review the complications of surgery for POP with or without surgery for SUI. This included the need for second procedure two years after the primary surgery. Study Design. We conducted a retrospective cross-sectional comparative study at the Aga Khan University, Karachi, Pakistan. International Classification of Diseases, 9th revision, Clinical Modification (ICD-9-CM) was used to identify women who underwent vaginal hysterectomy with anterior/posterior repair alone and those with concomitant tension-free vaginal tape surgery for urodynamic stress incontinence. Results. The 28 cases of VH/repair combined with TVT were compared for complications with 430 cases of VH with repair alone. The basic characteristics like age, BMI, and degree of prolapse showed no statistical difference among two groups. The main comorbidities in both groups were hypertension, diabetes, and bronchial asthma. We observed no significant differences in intraoperative and postoperative complications except for cuff abscess, need for medical intervention, and readmission following discharge from hospital, which were higher in cases with vaginal hysterectomy with concomitant TVT. Conclusions. Vaginal hysterectomy is an efficient treatment for uterovaginal prolapse with a swift recovery, short length of hospital stay, and rare serious complications. The addition of surgery for USI does not appear to increase the morbidity. Raheela Mohsin Rizvi, Munnazza Akhtar, and Nadeem Faiyaz Zuberi Copyright © 2013 Raheela Mohsin Rizvi et al. All rights reserved. HIV and Menopause: A Systematic Review of the Effects of HIV Infection on Age at Menopause and the Effects of Menopause on Response to Antiretroviral Therapy Thu, 19 Dec 2013 14:27:51 +0000 http://www.hindawi.com/journals/ogi/2013/340309/ More than half of persons living with HIV infection in the United States (U.S.) will be ≥50 years of age by 2020, including postmenopausal women. We conducted a systematic literature review about the effects of (1) HIV infection on age at menopause and (2) menopause on antiretroviral therapy (ART) response, in order to inform optimal treatment strategies for menopausal women living with HIV infection. We used the Ovid Medline database from 1980 to 2012. We included studies that focused on HIV-infected persons, included postmenopausal women, and reported outcome data for either age at menopause or response to ART across menopause. We identified six original research articles for age at menopause and five for response to ART across menopause. Our review revealed that current data were conflicting and inconclusive; more rigorous studies are needed. Disentangling the effects of menopause requires well-designed studies with adequate numbers of HIV-infected and HIV-uninfected women, especially disproportionately affected women of color. Future studies should follow women from premenopause through menopause, use both surveys and laboratory measurements for menopause diagnoses, and control for confounders related to normal aging processes, in order to inform optimal clinical management for menopausal women living with HIV. Kentaro Imai, Madeline Y. Sutton, Rennatus Mdodo, and Carlos del Rio Copyright © 2013 Kentaro Imai et al. All rights reserved. Discrepancies between Antimullerian Hormone and Follicle Stimulating Hormone in Assisted Reproduction Wed, 18 Dec 2013 16:18:07 +0000 http://www.hindawi.com/journals/ogi/2013/383278/ Data from 107 women undergoing their first IVF/ICSI were analyzed. Relationships between antimullerian hormone (AMH) and follicle stimulating hormone (FSH) were analyzed after dividing patients into four groups according to AMH/FSH levels. Concordance was noted in 57% of women (both AMH/FSH either normal or abnormal) while 43%of women had discordant values (AMH/FSH one hormone normal and the other abnormal). Group 1 (AMH and FSH in normal range) and group 2 (normal AMH and high FSH) were younger compared to group 3 (low AMH and normal FSH) and group 4 (both AMH/FSH abnormal). Group 1 showing the best oocyte yield was compared to the remaining three groups. Groups 3 and 4 required higher dose of gonadotrophins for controlled ovarian hyperstimulation showing their low ovarian reserve. There was no difference in cycle cancellation, clinical pregnancy, and live birth/ongoing pregnancy rate in all groups. These tests are useful to predict ovarian response but whether AMH is a substantially better predictor is not yet established. Munawar Hussain, David Cahill, Valentine Akande, and Uma Gordon Copyright © 2013 Munawar Hussain et al. All rights reserved.