Obstetrics and Gynecology International https://www.hindawi.com The latest articles from Hindawi © 2017 , Hindawi Limited . All rights reserved. Successful Treatment of Caesarean Scar Pregnancies by Local Treatment Only Wed, 15 Mar 2017 00:00:00 +0000 http://www.hindawi.com/journals/ogi/2017/9543570/ Background. Caesarean scar pregnancy (CSP) is a rare ectopic pregnancy associated with life-threatening complications. To date, no therapeutic protocols have been established. Sono-guided local methotrexate (MTX) injection is a relatively easy and low-invasive treatment. Additional systemic MTX is sometimes needed for CSP cases, especially when β-subunit human chorionic gonadotropin (β-hCG) levels are >20,000 mIU/ml at diagnosis. We report on six cases of CSP treated with local MTX injection, five of which received combined local treatment. Methods. Under intravenous anesthesia, six CSPs including a case with β-hCG levels >20,000 mIU/ml received MTX injection to the gestational sac. Five cases received gestational sac aspiration. Three cases had additional local potassium chloride injection and one case had a saline injection aiming at the fetal heart beat concurrent with MTX injection. MTX was administered weekly if β-hCG levels stayed beyond the expected values. Outcomes. All cases achieved β-hCG normalization without additional systemic MTX, with one case having a successful pregnancy after treatment. Conclusion. Sono-guided local MTX injection with concurrent local treatment might be a potentially effective approach for CSP cases. The accumulation of further cases is necessary to confirm this. Shinji Tanigaki, Chie Nagata, Kazunori Ueno, Nobuaki Ozawa, Shinichi Nagaoka, Kei Tanaka, Haruhiko Sago, and Mitsutoshi Iwashita Copyright © 2017 Shinji Tanigaki et al. All rights reserved. Attitude towards the Practice of Female Genital Cutting among School Boys and Girls in Somali and Harari Regions, Eastern Ethiopia Sun, 12 Mar 2017 06:37:41 +0000 http://www.hindawi.com/journals/ogi/2017/1567368/ Introduction. Female genital cutting (FGC) is a harmful traditional practice that violates women’s rights and threatens their health. Although much work has been done to tackle this practice in Ethiopia, the prevalence remains very high in Somali and Harari regions. This study aims to investigate the attitude towards FGC of young people (boys and girls) in Somali and Harari regions of Eastern Ethiopia. Methods. A cross-sectional quantitative study was carried out in Somali and Harari regions from October to December 2015. Two districts were purposely selected from the two regions, and a stratified random sampling technique was employed to select 480 subjects from the randomly selected schools. Results. Out of 480 questionnaires distributed, 478 (99.6%) respondents filled the questionnaires and returned them. The finding of the study reveals that 86% of study participants condemn the practice of FGC. Almost 59% of male participants from both study areas preferred to marry uncircumcised girls. Being a female and being a Muslim are significantly associated with the support toward the continuation of the FGC (). Conclusion. Although the study demonstrates a positive attitude towards the abandonment of FGC, there is a need to increase the knowledge about the position of Islam in FGC and to educate women about the harmful effect of FGC. Asresash D. Abathun, Abdi A. Gele, and Johanne Sundby Copyright © 2017 Asresash D. Abathun et al. All rights reserved. Evaluation of Renal Function in Pregnant Women with Malaria: A Case-Control Study in a Mesoendemic Area Tue, 07 Mar 2017 08:09:27 +0000 http://www.hindawi.com/journals/ogi/2017/6030943/ Background. Malaria is known to have devastating effects on mortality in tropical and subtropical regions with the effect being magnified in people with weakened immunity such as those in pregnancy. We assessed the effect of malaria on renal function of pregnant women receiving antenatal care in a mesoendemic area of Ghana. Methodology. A case-control study that enrolled a total of 100 pregnant women (50 with confirmed gestational malaria as cases and 50 without malaria as controls). Sociodemographic characteristics, obstetric history (obtained with a questionnaire), urea, creatinine, sodium, and potassium were analyzed using a chemistry automated analyzer. Results. Plasma urea and creatinine were significantly increased ( and , resp.) among cases compared to the controls. Also the levels of urea (), creatinine (), and parasitaemia (0.016) were significantly increased with increasing gestational age. Conclusion. Malaria has a significant impact on renal function (most importantly, urea and creatinine) and is also significantly associated with increasing gestational age among our study participants. Justice Afrifa, Samuel Essien-Baidoo, Albert Baffour Gyau, and Richard Kobina Dadzie Ephraim Copyright © 2017 Justice Afrifa et al. All rights reserved. The Prognostic Value of Baseline Lymphocyte, Neutrophil, and Monocyte Counts in Locally Advanced Cervical Carcinoma Treated with Radiation Mon, 23 Jan 2017 08:34:31 +0000 http://www.hindawi.com/journals/ogi/2017/8584605/ Background. To determine the prognostic significance of pretreatment levels of circulating lymphocyte (CLC), neutrophil (CNC), and monocyte (CMC) counts in patients with locally advanced cervical carcinoma (CC) treated with definitive radiation. Methods. A retrospective, dual-institution review of patients with Stage IB2-IVA CC from 2005 to 2015. Progression-free (PFS) and Overall Survival (OS) were determined for high and low CLC, CNC, and CMC groups. Multivariate analysis was used to confirm prognostic value of baseline leukocyte counts. Results. 181 patients were included. Median follow-up time was 26 (3–89) months. CNC had no effect on PFS or OS. PFS was similar between CMC groups; however, OS was significantly improved for patients with low CMC (62.5 versus 45.3 months, ). High CLC was associated with improved PFS (48.5 versus 27.8 months, ) and OS (58.4 versus 34.9 months, ). On multivariate analysis, high CNC was associated with increased relapse risk (HR 1.12, ) and low CLC was associated with increased mortality risk (HR 0.67, ). Conclusion. This study demonstrates that leukocyte values can provide prognostic information in CC. These hypothesis-generating findings warrant further prospective investigations. Sareena Singh, Justin Himler, Christa I. Nagel, and Kimberly Resnick Copyright © 2017 Sareena Singh et al. All rights reserved. The Use of Laparoscopy Simulation to Explore Gender Differences in Resident Surgical Confidence Thu, 19 Jan 2017 00:00:00 +0000 http://www.hindawi.com/journals/ogi/2017/1945801/ Background. The objective of this study was to determine whether female surgical residents underestimate their surgical abilities relative to males on a standardized test of laparoscopic skill. Methods. Twenty-six male and female general surgery residents and 25 female obstetrics and gynecology residents at two academic centers were asked to predict their score prior to undergoing the Fundamentals of Laparoscopic Surgery standardized skills exam. Actual and predicted score as well as delta values (predicted score minus actual score) were compared between residents. Multivariate linear regression was used to determine variables associated with predicted score, actual score, and delta scores. Results. There was no difference in actual score based on residency or gender. Predicted scores, however, were significantly lower in female versus male general surgery residents (25.8 ± 13.3 versus 56.0 ± 16.0; ) and in female obstetrics and gynecology residents versus male general surgery residents (mean difference 20.9, 95% CI 11.6–34.8; ). Male residents more accurately predicted their scores while female residents significantly underestimated their scores. Conclusion. Gender differences in estimating surgical ability exist that do not reflect actual differences in performance. This finding needs to be considered when structuring mentorship in surgical training programs. Rebecca L. Flyckt, Eliza E. White, Linnea R. Goodman, Catherine Mohr, Sanjeev Dutta, and Kristine M. Zanotti Copyright © 2017 Rebecca L. Flyckt et al. All rights reserved. Safety and Cost Considerations during the Introduction Period of Laparoscopic Radical Hysterectomy Tue, 10 Jan 2017 09:55:12 +0000 http://www.hindawi.com/journals/ogi/2017/2103763/ Objective. To compare the safety, efficacy, and direct cost during the introduction of laparoscopic radical hysterectomy within an enhanced recovery pathway. Methods. A 1 : 1 single centre retrospective case control study of 36 propensity matched pairs of patients receiving open or laparoscopic surgery for early cervical cancer. Results. There were no significant differences in the baseline characteristics of the two cohorts. Open surgery cohort had significantly higher intraoperative blood loss (189 versus 934 mL) and longer postoperative hospital stay (2.3 versus 4.1 days). Although no significant difference in the intraoperative or postoperative complications was found more urinary tract injuries were recorded in the laparoscopic cohort. Laparoscopic surgery had significantly longer duration (206 versus 159 minutes), lower lymph node harvest (12.6 versus 16.9), and slower bladder function recovery. The median direct hospital cost was £4850 for laparoscopic radical hysterectomy and £4400 for open surgery. Conclusions. Laparoscopic radical hysterectomy can be safely introduced in an enhanced recovery environment without significant increase in perioperative morbidity. The 10% higher direct hospital cost is not statistically significant and is expected to even out when indirect costs are included. A. Anagnostopoulos, S. Mitra, B. Decruze, R. Macdonald, and J. Kirwan Copyright © 2017 A. Anagnostopoulos et al. All rights reserved. The Ten-Group Robson Classification: A Single Centre Approach Identifying Strategies to Optimise Caesarean Section Rates Tue, 10 Jan 2017 00:00:00 +0000 http://www.hindawi.com/journals/ogi/2017/5648938/ Caesarean section (CS) rates have been increasing worldwide and have caused concerns. For meaningful comparisons to be made World Health Organization recommends the use of the Ten-Group Robson classification as the global standard for assessing CS rates. 2625 women who birthed over a 12-month period were analysed using this classification. Women with previous CS (group 5) comprised 10.9% of the overall 23.5% CS rate. Women with one previous CS who did not attempt VBAC contributed 5.3% of the overall 23.5% CS rate. Second largest contributor was singleton nulliparous women with cephalic presentation at term (5.1% of the total 23.5%). Induction of labour was associated with higher CS rate (groups 1 and 3) (24.5% versus 11.9% and 6.2% versus 2.6%, resp.). For postdates IOL we recommend a gatekeeper booking system to minimise these being performed <41 weeks. We suggest setting up dedicated VBAC clinic to support for women with one previous CS. Furthermore review of definition of failure to progress in labour not only may lower CS rates in groups 1 and 2a but also would reduce the size of group 5 in the future. Keisuke Tanaka and Kassam Mahomed Copyright © 2017 Keisuke Tanaka and Kassam Mahomed. All rights reserved. A Novel Atraumatic Tourniquet Technique for Excessive Bleeding during Cesarean Sections Mon, 09 Jan 2017 00:00:00 +0000 http://www.hindawi.com/journals/ogi/2017/7171520/ Objective. Controlling excessive bleeding in cesarean sections which may cause a life-threatening event even under well-prepared conditions. We used a novel atraumatic tourniquet technique to temporary arrest blood flow through the uterine and ovarian vessels and compare with other techniques. Toothless vascular clamps were used as clamp. Methods. Tourniquet technique performed postpartum hemorrhage (PPH) cases (19 out of 37) were compared with 18 other cases with PPH. Results. The difference between preoperative and postoperative hemoglobin values was significantly lower in the study group as well as the number of blood products needed during and after surgery. Conclusions. This technique not only prevented massive bleeding from the uterus but also allowed physicians time to consider the necessity of further interventions. Baris Buke, Emre Canverenler, Hatice Akkaya, and Fuat Akercan Copyright © 2017 Baris Buke et al. All rights reserved. Comparison of Human Papillomavirus Detection in Urine and Cervical Samples Using High-Risk HPV DNA Testing in Northern Thailand Thu, 22 Dec 2016 11:51:14 +0000 http://www.hindawi.com/journals/ogi/2016/6801491/ Objective. To evaluate the performance of high-risk human papillomavirus (HPV) DNA testing in urine samples compared to that of cervical sample testing in Northern Thailand. Methods. Paired urine and cervical samples were collected during the follow-up of women with a previous positive HPV test. HPV testing was performed using the Cobas 4800 HPV Test. Linear Array assay was used for genotyping in selected cases. Results. Paired urine and cervical samples were obtained from 168 women. Of 123 paired samples with valid results, agreement in the detection of high-risk HPV DNA was present in 106 cases (86.2%), with a kappa statistic of 0.65 (substantial agreement). Using the cervical HPV results as a reference, the sensitivity of urine HPV testing was 68.6% (24/35) and the specificity 93.2% (82/88). For the detection of histologic high-grade squamous intraepithelial lesion or worse (HSIL+), the sensitivity of urine HPV testing was 80.0% (4/5) and the specificity 78.0% (92/118). Conclusion. Although urine HPV testing had a rather low sensitivity for HPV detection, its sensitivity for histologic HSIL+ detection was high. For clinical use of urine HPV testing, standardization of specimen collection and processing techniques or application of a more sensitive test, especially in the detection of HPV52 and HPV58, is necessary. Surapan Khunamornpong, Jongkolnee Settakorn, Kornkanok Sukpan, Suree Lekawanvijit, Narisara Katruang, and Sumalee Siriaunkgul Copyright © 2016 Surapan Khunamornpong et al. All rights reserved. Comparison of Long-Term Fertility and Bleeding Outcomes after Robotic-Assisted, Laparoscopic, and Abdominal Myomectomy Mon, 19 Dec 2016 09:30:38 +0000 http://www.hindawi.com/journals/ogi/2016/2789201/ Background/Aims. To compare long-term fertility and bleeding outcomes of women who underwent robotic-assisted, laparoscopic, and abdominal myomectomy at our institution over a 15-year period. Methods. This was a retrospective cohort study of myomectomy patients 18–39 years old that had surgery between January 1995 and December 2009 at our institution. Long-term follow-up on fertility and bleeding outcomes was collected from the patient directly. The uterine fibroid symptom and quality of life survey was also administered to assess current bleeding patterns. Baseline characteristics were compared across groups. Univariable comparisons of fertility and bleeding outcomes based on surgical approach were made using analysis of variance, Kruskal-Wallis analysis of ranks, and Chi-square tests as appropriate. Results. 134/374 (36%) subjects agreed to participate in the study. 81 subjects underwent an open procedure versus 28 and 25 subjects in the laparoscopic and robotic groups, respectively. Median follow-up after surgery was 8 years. 50% of patients desired pregnancy following surgery and, of those, 60% achieved spontaneous pregnancy; the spontaneous pregnancy rate did not differ between groups. Additionally, UFS-QOL scores and/or subscores did not differ between groups. Conclusion. There is no significant difference in long-term bleeding or fertility outcomes in robotic-assisted, laparoscopic, or abdominal myomectomy. Rebecca Flyckt, Enrique Soto, Benjamin Nutter, and Tommaso Falcone Copyright © 2016 Rebecca Flyckt et al. All rights reserved. Common Adverse Effects of Anti-TNF Agents on Gestation Thu, 01 Dec 2016 09:23:47 +0000 http://www.hindawi.com/journals/ogi/2016/8648651/ Autoimmune disease has affected up to 50 million Americans, according to the American Autoimmune Related Diseases Association (AARDA) and 75 percent of those affected are women. These inflammatory diseases have variable activity and a lot of women will have to undergo major therapies during and after pregnancy. Many of the women suffering from these disease will improve during gestation. However a lot of women will require continuation of disease-modifying therapies (i.e., biological therapies) throughout pregnancy and post-partum involving many risks. In the past decade all gaze turned to biological therapies, as an attempt, to obtain even more effective medications in order to suppress the exacerbation of autoimmune disease, even at the most unfit circumstances such as pregnancy. The results are both satisfying and promising since increasingly proven thoughts prevail on making anti-TNF agents first-line medications, clearing up the limited knowledge over human influence. The purpose of this review is to summarize the results of the reports with the highest and representative range of patients of the last decade involving the use of anti-TNF agents during pregnancy. Zacharias Fasoulakis, Panagiotis Antsaklis, Nikolaos Galanopoulos, and Emmanuel Kontomanolis Copyright © 2016 Zacharias Fasoulakis et al. All rights reserved. Endometrial Volume Measured by VOCAL Compared to Office Hysteroscopy for Diagnosis of Endometrial Polyps in Premenopausal Women with Abnormal Uterine Bleeding Thu, 24 Nov 2016 11:57:57 +0000 http://www.hindawi.com/journals/ogi/2016/3561324/ The aim is to compare hysteroscopy, two-dimensional transvaginal ultrasound (2D TVUS), and three-dimensional (3D) Virtual Organ Computer-aided AnaLysis™ (VOCAL) to detect endometrial polyps (EPs) in premenopausal women with abnormal uterine bleeding (AUB). This prospective study was done at Ain Shams Maternity Hospital, Egypt, from March 5, 2015, to December 30, 2015, enrolling 118 premenopausal women with AUB. 2D TVUS, 3D VOCAL, and hysteroscopy were done. 109 patients reached final analysis. 36 women (33%) were diagnosed with EP by 2D TVUS. 50 (45.9%) had EP by hysteroscopy. Endometrial thickness was 10.1 mm by 2D TVUS and endometrial volume was 4.92 mL by VOCAL in women with EP by hysteroscopy compared to 9.9 mm and 3.50 mL in women with no EP, respectively (; ). 2D TVUS has sensitivity, specificity, and positive and negative predictive values of 54%, 84.7%, 75%, and 68.5%, respectively. Endometrial thickness of >7.5 mm has sensitivity, specificity, positive and negative predictive values, and overall accuracy of 82%, 37.3%, 52.6%, 71%, and 57.8%, respectively. Endometrial volume of >1.2 mL has sensitivity, specificity, positive and negative predictive values, and overall accuracy of 90%, 42.4%, 57%, 83.3%, and 64.2%, respectively. 3D VOCAL may be used as a noninvasive method for the diagnosis of EP in premenopausal women with AUB. Mohamed Laban, Sherif H. Hussain, Alaa S. Hassanin, Waleed M. Khalaf, Mohamed K. Etman, Mohammed S. E. Elsafty, Ahmed M. Bahaa Eldin, Ahmad S. Hasanien, Noha A. Sakna, Mohammed Taema, Mohammed H. Mostafa, and Marwa M. Eisa Copyright © 2016 Mohamed Laban et al. All rights reserved. The Effect of Epidural Analgesia on the Delivery Outcome of Induced Labour: A Retrospective Case Series Sun, 20 Nov 2016 09:12:45 +0000 http://www.hindawi.com/journals/ogi/2016/5740534/ Objective. To investigate whether the use of epidural analgesia during induced labour was a risk factor for instrumental vaginal delivery and caesarean section (CS) delivery. Study Design. This was a retrospective case series of primigravidae women being induced at term for all indications with a normal body mass index (BMI) at booking and under the age of 40 years. Results. We identified 1,046 women who fulfilled the inclusion criteria of which 31.2% had an epidural analgesia. Those with an epidural analgesia had significantly greater maternal age, higher BMI, greater percentage of oxytocin usage, and a longer first and second stage of labour. Women with an epidural analgesia had a higher instrumental delivery (37.9% versus 16.4%; ) and CS delivery rate (26% versus 10.1%; ). Multivariable analysis indicated that the use of an epidural was not a risk factor for a CS delivery but was a risk factor for an instrument-assisted delivery (adjusted OR = 3.63; 95% CI: 2.51–5.24; ). Conclusion. Our study supports the literature evidence that the use of an epidural increases the instrumental delivery rates. It has also added that there is no effect on CS delivery and the observed increase is due to the presence of confounding factors. Angeliki Antonakou and Dimitrios Papoutsis Copyright © 2016 Angeliki Antonakou and Dimitrios Papoutsis. All rights reserved. Obstetricians/Gynecologists’ Problems in Sickness Certification Consultations: Two Nationwide Surveys Thu, 17 Nov 2016 13:36:30 +0000 http://www.hindawi.com/journals/ogi/2016/9421316/ Objective. To explore experiences by physicians working in obstetrics, gynecology, or maternal healthcare (O/Gs) of problems in sickness certification consultations and differences between two years. Material and Methods. Answers by O/Gs to two Swedish nationwide surveys, in 2008 () and 2012 (), were analyzed for frequencies and severity of problems and organizational support in sickness certification consultations. Results. One-third of O/Gs found sickness certifications problematic every week. The most frequent problem was patients requesting sick notes for reasons other than work incapacity due to disease/injury (2008: 21%; 2012: 16%). The most problematic were assessing work capacity (2008 and 2012: 52%) and having different opinion from that of the patient about need for sick leave (2008: 51%; 2012: 46%). In 2012, 27% used the national sickness certification guidelines weekly, compared to 9% in 2008. A larger proportion in 2012 than 2008 reported that the guidelines facilitated contacts with patients and different stakeholders. Conclusions. Although O/Gs perceived sickness certification as problematic, there was less perceived severity of problems in 2012 compared to 2008, possibly because interventions regarding sickness certification have been introduced in Sweden recent years. Still, more organizational support, for example, time and supervision, are needed to enhance O/Gs’ sickness certification practices. Catharina Gustavsson, Elin Hinas, Therese Ljungquist, and Kristina Alexanderson Copyright © 2016 Catharina Gustavsson et al. All rights reserved. Attitude to the Menopause and Sex amongst Middle-Aged Women in a Family Medicine Clinic in Ibadan, Nigeria Tue, 08 Nov 2016 10:19:37 +0000 http://www.hindawi.com/journals/ogi/2016/2031056/ Background. Menopause is the expected end of reproductive life. Having a positive attitude towards it has been shown to result in a positive experience, while a negative attitude is associated with negative experiences and symptoms. Traditionally, women often abstain from sex after menopause. The study aimed to determine the level of awareness and perceptions about the menopause and sex in perimenopausal women attending a general outpatient clinic. Methods. Women over 40 years were recruited from the Family Medicine Department of University College Hospital, excluding those who were menopausal. Data analyses were done with chi-square test (). Results. Most (302; 86.4%) of the 352 surveyed participants were aware of the menopause. Only 36.1% anticipated associated symptoms. About half (55.7%) were indifferent to menopause onset, while 23% had a positive attitude and 21.4% had a negative attitude, respectively. Younger women were less likely to have a positive attitude to the menopause (). There were negative cultural beliefs towards sex. Sexual activity was low and declined with age (). Many women would like treatment to improve their sexual activity. Conclusion. Most participants had a favourable disposition towards the menopause, though sexual relationships suffer. Counselling and treatment should be offered. Folasade Adenike Bello and Olufunmilola Olutosin Daramola Copyright © 2016 Folasade Adenike Bello and Olufunmilola Olutosin Daramola. All rights reserved. Can We Accurately Time the Administration of Antenatal Corticosteroids for Preterm Labor? Mon, 07 Nov 2016 09:43:12 +0000 http://www.hindawi.com/journals/ogi/2016/5054037/ Background. Accurate timing of antenatal corticosteroids (ACS) has resulted in improved neonatal outcomes. Objectives. Our primary objective was to determine predictors for optimal timing of ACS in women presenting with spontaneous preterm labor. Study Design. A retrospective cohort study of women receiving ACS for spontaneous preterm birth was conducted. Women were included if they presented with preterm labor or preterm premature rupture of membranes. Accurate timing of ACS was defined as administration within 7 days of delivery. Maternal demographic and obstetrics characteristics were compared between the groups receiving ACS ≤7 days and >7 days from delivery. Statistical analyses were performed using parametric and nonparametric tests. was considered significant. Results. The study included 215 subjects. Median latency from ACS administration to delivery was 6 days (IQR 32). Accurate timing of ACS occurred in 113 (53%) women and was associated with rupture of membranes (OR 13.8, 95% CI 5.9–32.6), cervical change (OR 7.1, 95% CI 3.0–17.1), and cervical dilation ≥ 2 cm (OR 3.9, 95% CI 1.5–10.3). Conclusions. Rupture of membranes, cervical change, and cervical dilation ≥ 2 cm were strong predictors of optimal timing. 53% of women with preterm labor received ACS optimally. Paola Aghajanian, Quy T. Nguyen, Naomi H. Greene, and Kimberly D. Gregory Copyright © 2016 Paola Aghajanian et al. All rights reserved. Determinants of Patient Delay in Seeking Diagnosis and Treatment among Moroccan Women with Cervical Cancer Wed, 02 Nov 2016 09:46:17 +0000 http://www.hindawi.com/journals/ogi/2016/4840762/ Introduction. This study sought to investigate potential determinants of patient delay among Moroccan women with cervical cancer. Methods. A cross-sectional study was conducted from June 2014 to June 2015 at the National Institute of Oncology in Rabat. Data were collected using questionnaire among patients with cervical cancer locally advanced or metastatic (stages IIA–IVB). Medical records were abstracted to complete clinical information. An interval longer than 90 days between discovery of initial symptoms and presentation to a provider was defined as a patient delay. Results. Four hundred and one patients with cervical cancer enrolled in this study. The mean age was 52.4 years (SD = 11.5). 53.6% were illiterate. Abnormal vaginal bleeding was identified for 65.8% of patients. 60.1% were diagnosed at stages IIA-IIB. 55.4% were found having patient delay. The regression analyses showed the association between literacy (), distance of the place of the first consultation (), abnormal vaginal bleeding as an earlier symptom (), stage at diagnosis (), knowledge of symptoms (), knowledge of causes (), and practice of gynecological exam during the last three years () and the patient delay. Conclusion. Educational messages should aim at increasing awareness of cervical cancer, assisting women in symptom recognition, and encouraging earlier presentation. Fatima Ouasmani, Zaki Hanchi, Bouchra Haddou Rahou, Rachid Bekkali, Samir Ahid, and Abdelhalem Mesfioui Copyright © 2016 Fatima Ouasmani et al. All rights reserved. Knowledge and Awareness of Cervical Cancer among HIV-Infected Women in Ethiopia Thu, 27 Oct 2016 11:29:00 +0000 http://www.hindawi.com/journals/ogi/2016/1274734/ Introduction. Cervical cancer is one of the leading causes of cancer death among Ethiopian women. Low awareness of cervical cancer, in combination with low health care seeking behavior, is a key challenge for cervical cancer prevention. This study assessed the knowledge of cervical cancer among HIV-infected women in Ethiopia. Methods. A facility-based cross-sectional survey was conducted from August to September 2012 among HIV-infected women between 21 and 49 years of age. Basic descriptive statistics were performed using SPSS. Results. A total of 432 HIV-infected women participated in this study. About 71% of participants had ever heard of cervical cancer. Among women who had ever heard of cervical cancer, 49% did not know the cause while 74% were able to identify at least one risk factor for cervical cancer. Only 33% of women were able to correctly address when women should seek care and 33% identified at least one treatment option for cervical cancer. Conclusion. This study revealed that knowledge about cervical cancer was generally low, in particular for health care seeking behavior and treatment of cervical cancer. Health awareness programs should be strengthened at both community and health facility levels with emphasis highlighting the causes, risk factors, care seeking behaviors, and treatment options for cervical cancer. Netsanet Shiferaw, Mohamad I. Brooks, Graciela Salvador-Davila, Shumet Lonsako, Konjit Kassahun, Jodi Ansel, Chidude Osakwe, Teklu Weldegebreal, Ismael Ahmed, Mengistu Asnake, and Paul D. Blumenthal Copyright © 2016 Netsanet Shiferaw et al. All rights reserved. Retrospective Case Reports of Anemic Pregnant Women Receiving Intravenous Ferric Carboxymaltose: Experience from a Tertiary Hospital in Spain Thu, 20 Oct 2016 10:05:00 +0000 http://www.hindawi.com/journals/ogi/2016/5060252/ Iron deficiency and iron deficiency anemia during pregnancy call for safe treatment options that raise maternal hemoglobin levels and counterbalance iron demand and blood volume expansion while minimizing risks for the growing fetus. This retrospective study describes experience with intravenous ferric carboxymaltose given to pregnant women in a tertiary hospital in Spain. In a 5-year period, 95 pregnant women who had pretreatment hemoglobin <10 g/dL and at least one time of ferric carboxymaltose administration during pregnancy were included. Main outcome measures were week of pregnancy at iron administration, Hb levels before and after treatment, neonatal 5-minute Apgar scores, and birth weight. The majority received one dose of ferric carboxymaltose (1000 mg iron) during advanced pregnancy (median 31 weeks; interquartile range [IQR]: 27; 37 weeks) with minor to no adverse outcomes. Overall, median Hb increased from 8.5 g/dL (8.1; 8.9 g/dL) before treatment to 11.0 g/dL (9.9; 11.7 g/dL) after treatment. Normal Apgar scores were observed in all 97 infants (median birth weights 3560 g, 3270, and 3798 g). Four women received ferric carboxymaltose in the first trimester and twenty-eight during the second trimester without adverse outcomes for mother or child. These cases add to the evidence that ferric carboxymaltose administration during pregnancy is effective and safe. Rafael Aporta Rodriguez, Mariola García Montero, Jose Pablo Lorente Aporta, Carolina Gallego Luque, Alfonso Chacón Mayor, Jose Aragón Ruiz, Virginia Torres Degayón, Claudia García Jimenez, and Guadalupe Sanchez Sanchez Copyright © 2016 Rafael Aporta Rodriguez et al. All rights reserved. Plasma Markers of Oxidative Stress in Patients with Gestational Diabetes Mellitus in the Second and Third Trimester Mon, 10 Oct 2016 06:52:17 +0000 http://www.hindawi.com/journals/ogi/2016/3865454/ Objective. To determine plasma markers of oxidative stress during the second and third trimester of pregnancy in patients with gestational diabetes mellitus (GDM). Study Design. We conducted a prospective nested case-control study involving 400 pregnant women, 22 of whom developed GDM. As control group, 30 normal pregnant women were chosen randomly. Plasma samples were analyzed for 8-iso-prostaglandin F2α (8-iso-PGF2α), advanced oxidative protein products (AOPPs), protein carbonyl (PCO), glutathione peroxidase-3 (GPX-3), and paraoxonase-1 (PON1) at 16–20 weeks, 24–28 weeks, and 32–36 weeks of gestation. Results. Compared to control subjects, the plasma levels of PCO, AOPPs, and 8-iso-PGF2α were elevated at 16–20 weeks’ and 32–36 weeks’ gestation in GDM. There was no significant difference in PCO and 8-iso-PGF2α at 24–28 weeks in GDM. GPX-3 was statistically significantly increased at 16–20 weeks and 32–36 weeks in GDM. PON1 reduced in patients with GDM. No significant differences were found at 24–28 and 32–36 weeks between the GDM and control groups. In GDM, PCO, AOPPs, and 8-iso-PGF2α levels were higher and GPX-3 and PON1 levels were lower in the second than the third trimester. Conclusion. Oxidation status increased in GDM, especially protein oxidation, which may contribute to the pathogenesis of GDM. Hongwei Li, Qian Yin, Ning Li, Zhenbo Ouyang, and Mei Zhong Copyright © 2016 Hongwei Li et al. All rights reserved. Determinants of Antenatal Care Attendance among Pregnant Women Living in Endemic Malaria Settings: Experience from the Democratic Republic of Congo Thu, 15 Sep 2016 09:26:27 +0000 http://www.hindawi.com/journals/ogi/2016/5423413/ Background. Antenatal care (ANC) attendance helps pregnant women to benefit from preventive and curative services. Methods. Determinants for ANC attendance were identified through a cross-sectional survey in the Democratic Republic of Congo. Sociocultural bottlenecks were assessed via focus groups discussion of married men and women. Results. In this survey, 28 of the 500 interviewed pregnant women (5.6%) did not attend ANC services and 82.4% booked over the first trimester. The first visit is positively influenced by the reproductive age (OR: 0.52, 95% CI(0.28–0.95), ), the educational level (OR: 0.41,95% CI(0.17–0.97), ), the nearby health center (OR: 0.43, 95% CI(0.2–0.92), ), and the presence of a male partner (OR: 10.48, 95% CI(2.1–52.23), ). The barriers to early booking were (i) the cost of service; (ii) the appearance or individual income; (iii) the geographical inaccessibility or distance to health facilities; (iv) social and religious prohibitions; (v) the stigmatization from other women when conceiving in the late ages or young or while still lactating (parity); (vi) the time for waiting for services. Conclusion. The early ANC attendance is delayed among poor women with little education and living alone. Célestin Ndosimao Nsibu, Célestin Manianga, Serge Kapanga, Esther Mona, Philippe Pululu, and Michel Ntetani Aloni Copyright © 2016 Célestin Ndosimao Nsibu et al. All rights reserved. Herbal Medicines and Ovarian Hyperstimulation Syndrome: A Retrospective Cohort Study Sun, 04 Sep 2016 09:59:26 +0000 http://www.hindawi.com/journals/ogi/2016/7635185/ Background. The aim of this study was to assess the association between herbal medication and OHSS. Methods. This retrospective cohort study was conducted with 101 polycystic ovary syndrome patients. 66 patients took conventional pharmacological medications and 35 took herbal medications. Data were analyzed by statistical test including Fisher’s Exact and binominal logistic regression. was considered significant. Results. Of the 101 females, 53 were married and 48 were single. There was no significant association between the groups in marriage. No significant association was found in mean age between the two groups (23.9 ± 5.8 years in the control group versus 26.3 ± 6.7 years in the case group). There was a significant difference between the two groups .After adding the dependent (OHSS prevalence) and independent (marriage and group) variables into the model, the Hosmer-Lemeshow test showed suitability. Variances analyzed with this model ranged between 29.4% and 40.7%. Conclusion. The indiscriminate use of herbs is correlated with OHSS. Because patients increasingly consume herbs, they should be aware of potential side effects. However, appropriate dosages of herbs could be obtained for use instead of conventional treatments, which often have side effects. Athar Rasekhjahromi, Masoumeh Hosseinpoor, Farzaneh Alipour, Mehrnoosh Maalhagh, and Saeed Sobhanian Copyright © 2016 Athar Rasekhjahromi et al. All rights reserved. Unintended Pregnancy in Ethiopia: Community Based Cross-Sectional Study Tue, 30 Aug 2016 14:36:08 +0000 http://www.hindawi.com/journals/ogi/2016/4374791/ Introduction. Unintended pregnancy is defined as a pregnancy which is a sum of mistimed pregnancy (pregnancy wanted at a later time) and unwanted pregnancy (pregnancy which is not wanted at all). Unintended pregnancy is a global public health problem and its sequels are major causes for maternal and neonatal morbidity and mortality with its effect to maternal metal illness as well. Objective. To determine the prevalence and associated factors of unintended pregnancy in Debre Birhan town, northeast of Ethiopia, in 2014. Method. Community based cross-sectional study and questionnaire developed from Ethiopian demographic health survey 2011. Participants were 690 currently pregnant mothers. Association of unintended pregnancy with factors was measured with bivariate and multivariate logistic regressions. Result. In this study unintended pregnancy is found to be 23.5%. Being formerly married and never married, distance to the nearest health facility 80 minutes, gravidity 5, 1-2 parity, and partner disagreement on desired number of children are the variables significantly associated with unintended pregnancy. Conclusion. Significant proportion of unintended pregnancy is found in the study area. To minimize unintended pregnancy concerned bodies should work on the identified factors, so we can minimize maternal and neonatal morbidity and mortality and keep the health of the family specifically and country in general. Kidest Getu Melese, Mignote Hailu Gebrie, Martha Berta Badi, and Wubalem Fekadu Mersha Copyright © 2016 Kidest Getu Melese et al. All rights reserved. Knowledge of Latin American Obstetricians and Gynecologists regarding Heavy Menstrual Bleeding Thu, 25 Aug 2016 08:59:31 +0000 http://www.hindawi.com/journals/ogi/2016/6870679/ Background. Heavy menstrual bleeding (HMB) is a common gynecological complaint affecting quality of life. Objectives. To assess knowledge on diagnosis and treatments of HMB of Latin American (LA) obstetricians and gynecologists (OBGYNs). Methods. A survey was conducted during a scientific meeting, organized to provide updated information on topics of reproductive medicine to OBGYNs from 12 LA countries who were invited to respond to a multiple-choice questionnaire. Results. Of the 210 OBGYNs participating in the survey, from 169 (80.4%) to 203 (96.7%) answered the questions. Most respondents (80%) gave accurate answers regarding the amount of blood loss which defines HMB, underreported the proportion of women who consulted due to HMB, and were aware that the use of combined oral contraceptives (COCs) with ethynyl estradiol is not an adequate treatment in women with HMB. Female OBGYNs and those who worked in the private sector were more prone to report a higher possibility of improvement of HMB with a COC that contained estradiol valerate and dienogest or with a levonorgestrel-releasing intrauterine system. Conclusions. In general, the respondents were aware of the importance of HMB in gynecological practice and of the new medical treatments and underreported the proportion of women who consulted due to HMB. Luis Bahamondes, Victor Marin, Silvia Ciarmatori, Agnaldo L. Silva-Filho, Juan Manuel Acuña, and Maria Y. Makuch Copyright © 2016 Luis Bahamondes et al. All rights reserved. Corrigendum to “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, 17 Aug 2016 12:03:38 +0000 http://www.hindawi.com/journals/ogi/2016/2026056/ Angela Sacchinelli, Roberta Venturella, Daniela Lico, Annalisa Di Cello, Antonella Lucia, Erika Rania, Roberto Cirillo, and Fulvio Zullo Copyright © 2016 Angela Sacchinelli et al. All rights reserved. Factors Contributing to Massive Blood Loss on Peripartum Hysterectomy for Abnormally Invasive Placenta: Who Bleeds More? Wed, 17 Aug 2016 09:49:59 +0000 http://www.hindawi.com/journals/ogi/2016/5349063/ Introduction. To identify factors that determine blood loss during peripartum hysterectomy for abnormally invasive placenta (AIP-hysterectomy). Methods. We reviewed all of the medical charts of 11,919 deliveries in a single tertiary perinatal center. We examined characteristics of AIP-hysterectomy patients, with a single experienced obstetrician attending all AIP-hysterectomies and using the same technique. Results. AIP-hysterectomy was performed in 18 patients (0.15%: 18/11,919). Of the 18, 14 (78%) had a prior cesarean section (CS) history and the other 4 (22%) were primiparous women. Planned AIP-hysterectomy was performed in 12/18 (67%), with the remaining 6 (33%) undergoing emergent AIP-hysterectomy. Of the 6, 4 (4/6: 67%) patients were primiparous women. An intra-arterial balloon was inserted in 9/18 (50%). Women with the following three factors significantly bled less in AIP-hysterectomy than its counterpart: the employment of an intra-arterial balloon ( versus  mL), planned hysterectomy ( versus  mL), and prior CS ( versus  mL). Patients with prior CS (−) bled more: this may be because these patients tended to undergo emergent surgery or attempted placental separation. Conclusion. Patients with intra-arterial balloon catheter insertion bled less on AIP-hysterectomy. Massive bleeding occurred in emergent AIP-hysterectomy without prior CS. Hironori Takahashi, Akihide Ohkuchi, Rie Usui, Hirotada Suzuki, Yosuke Baba, and Shigeki Matsubara Copyright © 2016 Hironori Takahashi et al. All rights reserved. Response to: Female Genital Mutilation and Obstetric Outcomes: Flawed Systematic Review and Meta-Analysis Does Not Accurately Reflect the Available Evidence Mon, 15 Aug 2016 13:37:29 +0000 http://www.hindawi.com/journals/ogi/2016/8376260/ Rigmor C. Berg, Jan Odgaard-Jensen, Atle Fretheim, Vigdis Underland, and Gunn Vist Copyright © 2016 Rigmor C. Berg et al. All rights reserved. Client Satisfaction with Delivery Care Service and Associated Factors in the Public Health Facilities of Gamo Gofa Zone, Southwest Ethiopia: In a Resource Limited Setting Mon, 20 Jun 2016 09:47:59 +0000 http://www.hindawi.com/journals/ogi/2016/5798068/ Background. Ensuring patient satisfaction is an important means of secondary prevention of maternal mortality. This study presents findings from a multidimensional study of client satisfaction from the Gamo Gofa Zone in Southwest Ethiopia. Methods. A facility based cross-sectional study using exit interviews was conducted from 2014. Client satisfaction was measured using a survey adopted from the Donabedian quality assessment framework. Thirteen health institutions were randomly sampled of 66 institutions in Gamo Gofa Zone. Logistic regression was used to determine predictors of client satisfaction. Results. The overall satisfaction level of the clients in this study was 79.1% with (95% CI; 75–82). Women attending health centres were more likely satisfied than women attending hospitals (, , ). The proportion of women who complained about an unfriendly attitude or unresentful care from health workers was higher in the hospitals (, , ). The presence of support persons during child birth improved client satisfaction (AOR = 6.23 95% CI; 2.75–14.1) and women who delivered with caesarean section are four times more likely satisfied than those who deliver vaginally (AOR 3.6 95% CI; 1.44–9.06). Client satisfaction was reduced if the women had to pay for the services (AOR = 0.27 95% CI; 0.09–81). Conclusions. The study shows that overall satisfaction level is good. More emphasis should be put on giving women friendly care, particularly at the hospitals. Rahel Tesfaye, Amare Worku, Wanzahun Godana, and Bernt Lindtjorn Copyright © 2016 Rahel Tesfaye et al. All rights reserved. Pregnancy in Sickle Cell Disease Is a Very High-Risk Situation: An Observational Study Wed, 15 Jun 2016 09:21:37 +0000 http://www.hindawi.com/journals/ogi/2016/9069054/ Sickle cell disease is a serious genetic disorder affecting 1/235 births in French Guiana. This study aimed to describe the follow-up of pregnancies among sickle cell disease patients in Cayenne Hospital, in order to highlight the most reported complications. 62 records of pregnancies were analyzed among 44 females with sickle cell disease, between 2007 and 2013. Our results were compared to those of studies conducted in Brazil and Guadeloupe. There were 61 monofetal pregnancies and 2 twin pregnancies, 27 pregnancies among women with SS phenotype, 30 SC pregnancies, and five S-beta pregnancies. The study showed that the follow-up of patients was variable, but no maternal death was found. We also noted that the main maternofetal complications of pregnancies were anemia (36.5%), infection (31.7%), vasoocclusive crisis (20.6%), preeclampsia (17.5%), premature birth (11.1%), intrauterine growth retardation (15.9%), abnormal fetal heart rate (14.3%), and intrauterine fetal death (4.8%). Pregnancies were more at risk among women with SS phenotype. Pregnancy in sickle cell disease patients requires a supported multidisciplinary team including the primary care physician, the obstetrician, and the Integrated Center for Sickle Cell Disease. Narcisse Elenga, Aurélie Adeline, John Balcaen, Tania Vaz, Mélanie Calvez, Anne Terraz, Laetitia Accrombessi, and Gabriel Carles Copyright © 2016 Narcisse Elenga et al. All rights reserved. Histopathological and Digital Morphometrical Evaluation of Uterine Leiomyoma in Brazilian Women Sun, 15 May 2016 09:15:40 +0000 http://www.hindawi.com/journals/ogi/2016/2968410/ The current study aims to evaluate histopathological and digital morphometrical aspects associated with uterine leiomyomas in one hundred and fifty (150) patients diagnosed with leiomyoma. Uterine tissues were subjected to the histopathological and digital morphometric analyses of the interstitial collagen distribution. The analysis of medical records indicates that most of the women diagnosed with uterine leiomyomas (68.7%) are between 37 and 48 years old. As for the anatomic location of the tumors, approximately 61.4% of the patients had intramural and subserosal lesions. In 50% of the studied cases, the patients developed uterine leiomyomatosis (with more than eight tumors). As for the morphometric study, the average size of the interstitial collagen distribution held approximately 28.53% of the capture area, whereas it was of 7.43% in the normal tissue adjacent to the tumor. Another important aspect observed in the current study was the high rate of young women subjected to total hysterectomy, a fact that resulted in early and definitive sterility. Ana Paula Fernandes da Silva, Luciano de Albuquerque Mello, Erlene Roberta Ribeiro dos Santos, Silvania Tavares Paz, Carmelita Lima Bezerra Cavalcanti, and Mario Ribeiro de Melo-Junior Copyright © 2016 Ana Paula Fernandes da Silva et al. All rights reserved.