Obstetrics and Gynecology International https://www.hindawi.com The latest articles from Hindawi © 2018 , Hindawi Limited . All rights reserved. Behaviour of the Foramen Ovale Flow in Fetuses with Intrauterine Growth Restriction Wed, 17 Jan 2018 08:21:37 +0000 http://www.hindawi.com/journals/ogi/2018/1496903/ Background. Foramen ovale (FO) flow may be altered in IUGR. This study was designed to test this hypothesis. Methods. Forty pregnant women (24–38 weeks) were divided into 3 groups: group I (IUGR), group II (adequate growth and maternal hypertension), and group III (normal controls). Impedance across the FO was assessed by the FO pulsatility index (FOPI): (systolic velocity − presystolic velocity)/mean velocity. Statistical analysis utilized ANOVA, Tukey test, and ROC curves. Results. Mean FOPI in IUGR fetuses (n = 15) was 3.70 ± 0.99 (3.15–4.26); in the group II (n = 12), it was 2.84 ± 0.69 (2.40–3.28), and in the group III (n = 13), it was 2.77 ± 0.44 (2.50–3.04) (). FOPI and UtA RI were correlated (r = 0.375, ), as well as FOPI and UA RI (r = 0.356, ) and, inversely, FOPI and MCA RI (r = −0.359, ). Conclusions. The FO flow pulsatility index is increased in fetuses with IUGR, probably as a result of impaired left ventricular diastolic function. Ângela R. L. Nader, Paulo Zielinsky, Alexandre Antonio Naujorks, Luiz Henrique S. Nicoloso, Antonio Luiz Piccoli Junior, Natássia Miranda Sulis, Luiza Ferreira van der Sand, Victoria de Bittencourt Antunes, Gabriela dos Santos Marinho, Fernanda Greinert dos Santos, Natan Pereira Gosmann, Eduardo Becker Júnior, Renato Frajndlich, Tamara Beherens, Marcelo Brandão da Silva, Caroline Barbisan, Stefano Busato, Mauro Lopes, and Caroline Klein Copyright © 2018 Ângela R. L. Nader et al. All rights reserved. Pelvic Ultrasound Findings in Women with Obstetric Fistula: A Cross-Sectional Study of Cases and Controls Wed, 10 Jan 2018 00:00:00 +0000 http://www.hindawi.com/journals/ogi/2018/7409131/ Objective. Obstetric fistula (OF) is a morbid condition caused by prolonged obstructed labor. Women with OF experience profound injury and have high rates of infertility and poor obstetric outcomes. We examined endovaginal ultrasound parameters in women with and without OF. Design/Setting/Sample/Methods. This cross-sectional study enrolled women evaluated at the Fistula Care Centre in Lilongwe, Malawi. Eligibility criteria included age 18–45, prior pregnancy, and a uterus on ultrasound. Participants underwent endovaginal ultrasound with measurement of cervical dimensions. Comparisons were done using t-tests and Fisher's exact test. Among women with OF, linear regression was used to assess whether fistula stage was associated with cervical length. Results. We enrolled 98 cases and 12 controls. Women with OF had shorter cervical lengths (18.8 mm versus 27.3 mm, p < 0.01), as well as shorter anterior (7.0 mm versus 9.3 mm, p < 0.01) and posterior (9.5 mm versus 11.0 mm, p < 0.04) cervical stroma, compared to controls. Conclusion. Women with OF have shorter cervical lengths and anterior and posterior cervical stroma, when compared to women without OF. This may offer a partial explanation for subfertility and poor obstetric outcomes in OF patients. Additional studies to clarify the role of ultrasound in OF patients and prediction of future fertility are warranted. Jeffrey P. Wilkinson, Angela M. Bengtson, Ennet Chipungu, Rachel J. Pope, Bonus Makanani, Margaret Moyo, Mwawi Mwale, and Jennifer H. Tang Copyright © 2018 Jeffrey P. Wilkinson et al. All rights reserved. Predictors of Women’s Satisfaction with Hospital-Based Intrapartum Care in Asmara Public Hospitals, Eritrea Thu, 28 Dec 2017 00:00:00 +0000 http://www.hindawi.com/journals/ogi/2017/3717408/ Background. Exploring patient satisfaction contributes to provide quality maternity care, but there is paucity of epidemiologic data in Eritrea. Objectives. To determine the predictors of women's satisfaction with intrapartum care in Asmara public maternity hospitals in Eritrea. Methods. A cross-sectional study among 771 mothers who gave birth in three public Hospitals. Chi-square tests were done to analyze the difference in proportion and logistic regression to assess the predictors of satisfaction with intrapartum care. Results. Overall, only 20.8% of the participants were satisfied with intrapartum service. The key predictors of satisfaction with intrapartum care were provision of clean bed and beddings (AOR = 18.87, 2.33–15.75), privacy during examinations (AOR = 10.22, 4.86–21.48), using understandable language (AOR = 8.72, 3.57–21.27), showing how to summon for help (AOR = 8.16, 4.30–15.48), showing baby immediately after birth (AOR = 8.14, 2.87–23.07), control of the delivery room (AOR = 6.86, 2.65–17.75), receiving back massage (AOR = 6.43, 3.23–12.81), toilet access and cleanliness (AOR = 6.09, 3.25–11.42), availability of chairs for relatives (AOR = 5.96, 3.14–11.30), allowing parents to stay during labour (AOR = 3.52, 1.299–9.56), and request for permission before any procedure (AOR = 2.39, 1.28–4.46). Conclusion. To increase satisfaction with intrapartum care, maternity service providers need to address the general maternity ward cleanliness, improve the quality of physical facilities, and sensitize health providers for better communication with clients. Policy makers need to adopt strategies that ensure more women involvement in decision making and consideration of privacy and reassurance needs during the whole delivery process. Meron Mehari Kifle, Filmon Abraham Ghirmai, Soliana Amanuel Berhe, Winta Sium Tesfay, Yodit Teklemariam Weldegebriel, and Zebib Tesfamariam Gebrehiwet Copyright © 2017 Meron Mehari Kifle et al. All rights reserved. Postpartum Vaginal Blood Loss following Two Different Methods of Cervical Ripening Tue, 19 Dec 2017 08:18:46 +0000 http://www.hindawi.com/journals/ogi/2017/1678265/ Eighty women undergoing induction of labor at the University of Calabar Teaching Hospital were recruited and randomly allocated into two treatment groups (40 each), to receive either serial 50 µg doses of misoprostol or intracervical Foley catheter. Vaginal blood loss was collected and measured using an under buttocks plastic collection bag and by perineal pad weighing up to 6 hours postpartum. There were no significant differences between the two groups with respect to sociodemographic and obstetric characteristics. Comparison of blood loss in vaginal deliveries between the two groups revealed that subjects in the misoprostol group had significantly higher blood loss than subjects in the Foley catheter group (488 ± 222 versus 326 ± 106, ). In both groups, there was strong and statistically significant positive correlation between postpartum blood loss and induction delivery interval (,;,). There were no significant differences in maternal outcomes. In view of this, further study is required to ascertain if lower doses of misoprostol for induction of labor may result in lesser blood loss. This trial is registered with ISRCTN14479515. Okon Asuquo Okon and John Egede Ekabua Copyright © 2017 Okon Asuquo Okon and John Egede Ekabua. All rights reserved. Associated Factors and Outcome of Uterine Rupture at Suhul General Hospital, Shire Town, North West Tigray, Ethiopia 2016: A Case-Control Study Mon, 18 Dec 2017 00:00:00 +0000 http://www.hindawi.com/journals/ogi/2017/8272786/ Background. Uterine rupture is tearing of the uterine wall during pregnancy or delivery. It may extend to partial or whole thickness of the uterine wall. It is usually a case where obstetric care is poor. In extensive damage, death of the baby and sometimes even maternal death are evident. Objective. This study assesses associated factors and outcome of uterine rupture at Suhul General Hospital, Tigray Region, Ethiopia, 2016. Methodology. A case-control study was conducted by review of data from September 2012 to August 2016. A total of 336 samples were studied after calculating by EPI-INFO using proportion of multiparity (53%) and ratio of 1 : 2 for cases and controls, respectively. Analysis was done using SPSS version 20. Bivariate and multivariate logistic regression was applied with .Result. ANC, grand multiparity, malpresentation, and obstructed labor had association, but previous cesarean delivery was not significant. Perinatal mortality was 105 (93%) versus 13 (5.8%) in cases and controls, respectively. Anemia was highest for both groups (53.7% versus 32.1%). Conclusion. Majority of uterine rupture is attributed to prolonged or obstructed labor. Cases of uterine rupture had prompt management preventing maternal mortality, but burden of perinatal death is still high. Tefera Marie Bereka, Amlaku Mulat Aweke, and Tewodrose Eshetie Wondie Copyright © 2017 Tefera Marie Bereka et al. All rights reserved. The Effects of Vitamin D Supplement on Prevention of Recurrence of Preeclampsia in Pregnant Women with a History of Preeclampsia Thu, 17 Aug 2017 06:41:32 +0000 http://www.hindawi.com/journals/ogi/2017/8249264/ Introduction. Preeclampsia is a pregnancy-specific syndrome. One of the hypotheses concerning the etiology of preeclampsia is vitamin D deficiency during pregnancy. Method and Materials. The present study is a randomized controlled clinical trial which aims to determine the effect of vitamin D supplement on reducing the probability of recurrent preeclampsia. 72 patients were placed in control group while 70 patients were randomized to the intervention group. The intervention group received a 50000 IU pearl vitamin D3 once every two weeks. The control group was administered placebo. Vitamin D or placebo was given until the 36th week of pregnancy. Results. The patients in intervention group have significantly lower (P value = 0.036) probability of preeclampsia than patients in the control group. The risk of preeclampsia for the control group was 1.94 times higher than that for the intervention group (95% CI 1.02, 3.71). Conclusion. The intended intervention (i.e., prescription of vitamin D) has a protective effect against recurrent preeclampsia. Vitamin D supplementation therapy in pregnancy could help in reducing the incidence of gestational hypertension/preeclampsia. Registration. This study has been registered in Iranian Registry of Clinical Trials (IRCT) site with ID number IRCT2017010131695N1. Sanam Behjat Sasan, Farnaz Zandvakili, Nasrin Soufizadeh, and Elaheh Baybordi Copyright © 2017 Sanam Behjat Sasan et al. All rights reserved. Effect of Increased Endometrial Thickness and Implantation Rate by Granulocyte Colony-Stimulating Factor on Unresponsive Thin Endometrium in Fresh In Vitro Fertilization Cycles: A Randomized Clinical Trial Sun, 16 Jul 2017 00:00:00 +0000 http://www.hindawi.com/journals/ogi/2017/3596079/ Background. The correlation between endometrial thickness and receptivity has been mentioned in various studies. This study investigated the effect of granulocyte colony-stimulating factor in treating thin endometrium of infertile women who were chosen for in vitro fertilization in our infertility clinic in 2014 and 2015. Methods. In this randomized clinical trial, 28 women who were chosen for in vitro fertilization and had endometrial thickness of less than 6 mm on the day of human chorionic gonadotropin (hCG) injection were included in the study. They were randomly divided into two groups: investigation and control groups. In investigation group () one granulocyte colony-stimulating factor vial (300 micrograms in 1 mL) was infused into the uterus within five minutes by embryo transfer catheter. In control group () 1 mL of saline was injected into the uterus with the same catheter. Results. There were significant differences between the two groups in terms of means of endometrial thickness on oocyte retrieval day (), embryo transfer day (), hCG injections (), and implantation rates (). Conclusion. Granulocyte colony-stimulating factor can increase endometrial thickness in women treated with in vitro fertilization. RCT Code is 201406046063N2. Fatemeh Sarvi, Marjan Arabahmadi, Ashraf Alleyassin, Marzieh Aghahosseini, and Marzieh Ghasemi Copyright © 2017 Fatemeh Sarvi et al. All rights reserved. Relying on Visiting Foreign Doctors for Fistula Repair: The Profile of Women Attending Fistula Repair Surgery in Somalia Thu, 06 Jul 2017 00:00:00 +0000 http://www.hindawi.com/journals/ogi/2017/6069124/ Obstetric fistula is treatable by surgery, although access is usually limited, particularly in the context of conflict. This study examines the profile of women attending fistula repair surgery in three hospitals in Somalia. A cross-sectional study was conducted in Somalia from August to September 2016. Structured questionnaires were administered to 81 women who registered for fistula repair surgery in the Garowe, Daynile, and Kismayo General Hospitals in Somalia. Findings revealed that 70.4% of the study participants reported obstetric labor as the cause of their fistula, and 29.6% reported iatrogenic causes. Regarding the waiting time for the repair surgery, 45% waited for the surgery for over one year, while the rest received the surgery within a year. The study suggests that training for fistula surgery has to be provided for healthcare professionals in Somalia, fistula centers should be established, and access to these facilities has to be guaranteed for all patients who need these services. Abdi A. Gele, Abdulwahab M. Salad, Liban H. Jimale, Prabhjot Kour, Berit Austveg, and Bernadette Kumar Copyright © 2017 Abdi A. Gele et al. All rights reserved. The Prevalence and Risk Factors for Low Birth Weight among Term Newborns in Adwa General Hospital, Northern Ethiopia Tue, 04 Jul 2017 00:00:00 +0000 http://www.hindawi.com/journals/ogi/2017/2149156/ Background. World health organization estimates that 25 million LBW babies are born annually worldwide and 95% occur in developing countries. Objective. To assess the prevalence and associated factors of low birth weight among term neonates delivered in Adwa Hospital, Northern Ethiopia. Methods. A cross-sectional study was conducted among neonates delivered in Adwa Hospital. All live births delivered from July 1, 2014, to June 30, 2016, were included in this study. The study participants were selected through systematic sampling technique and the data was collected using a structured questionnaire. Data was entered to Epi Data version 3.1 and analyzed using SPSS version 20 software. To identify independent predictors, bivariate and multivariable binary logistic regressions were employed. Adjusted odds ratio and 95% confidence interval were used to determine the strength of association. Results. The prevalence of term low birth weight was 10%. The risk factors were mothers aged less than 20 years, mothers whose pregnancy was desired, mothers with a history of abortion, and mothers with normal hemoglobin, iron with folic acid, and HIV status. Conclusion. The burden of LBW obtained in this study was in the same range as in some other countries. Yisak Gebregzabiherher, Abera Haftu, Solomon Weldemariam, and Haftom Gebrehiwet Copyright © 2017 Yisak Gebregzabiherher et al. All rights reserved. Uterine Cavity Abnormalities in Patients with Endometriosis in Alexandria: A Diagnostic Test Accuracy Study Tue, 30 May 2017 08:04:15 +0000 http://www.hindawi.com/journals/ogi/2017/5869028/ Endometriosis is strongly associated with infertility. Endometrial polyps are prevalent in infertile women and they have similar pathological characteristics to endometriosis, suggesting a possible association. Uterine malformations as uterine septum and hypoplastic uterus are also linked to endometriosis. Hysterosalpingogram and transvaginal ultrasonography are used to diagnose endometrial lesions. Hysteroscopy can detect small lesions that might be missed. Recently, 4D ultrasonography is being used, but which is superior has not been established yet. We aim to compare 4D ultrasonography to office hysteroscopy in evaluating uterine cavity in cases with endometriosis; also we aim at correlating these findings with the stage of endometriosis. 50 cases of endometriosis diagnosed by laparoscopy were randomly selected from El Shatby fertility clinic, Alexandria University, Egypt, with exclusion of cases with any previous intrauterine surgery or any hormonal treatment. Transvaginal 4D ultrasonography and office hysteroscopy were done. 4D ultrasonography agreed with office hysteroscopy in diagnosing abnormal uterine findings in 14 cases and four additional cases were diagnosed by hysteroscopy alone. Conclusion. Endometrial polyps, septate uterus, and hypoplastic uterus are more prevalent among infertile women who happen to have endometriosis. 4D ultrasonography and office hysteroscopy are equally successful in assessing the uterine cavity. Eman Aly Abd El Fattah Copyright © 2017 Eman Aly Abd El Fattah. All rights reserved. Physiological Uterine Involution in Primiparous and Multiparous Women: Ultrasound Study Sun, 07 May 2017 08:42:31 +0000 http://www.hindawi.com/journals/ogi/2017/6739345/ Purpose. To examine the uterine involution period after uncomplicated delivery in primiparous and multiparous women. Methods. Longitudinal prospective study. Repeated parameters were measured and endometrial contents and diastolic notch were observed. Measurements of primiparous and multiparous women were carried out after labour on the 1st, 3rd, 10th, 30th, 42nd, and 60th postpartum days. The analysis was performed using SPSS version 21. Results. The median uterus parameters are bigger in multiparous group in physiological puerperium, but the decreasing trend is the same. The endometrial cavity on the 10th day was significantly wider in multiparous women and mainly echo-negative view of the uterine cavity was observed. The evaluation of the uterine angle deviation changes from an extremely retroverted position to a more anteverted position. RI of the uterine artery in both groups was low immediately after labour and significantly increased one month postpartum. Notching of the uterine artery undergoes changes, but diastolic notch does not appear in all postpartum women even after two months following labour. Conclusions. The puerperium period after normal vaginal delivery depends on parity. The trend of involution in primiparous and multiparous women follows a similar pattern, yet, it lasts longer in the multiparous women. Ultrasound of uterine is certainly a useful tool after labour and may be important in facilitating an early detection of postpartum uterine complications. V. Paliulyte, G. S. Drasutiene, D. Ramasauskaite, D. Bartkeviciene, J. Zakareviciene, and J. Kurmanavicius Copyright © 2017 V. Paliulyte et al. All rights reserved. Predictors of Cephalic Vaginal Delivery Following External Cephalic Version: An Eight-Year Single-Centre Study of 447 Cases Sun, 23 Apr 2017 06:50:59 +0000 http://www.hindawi.com/journals/ogi/2017/3028398/ Introduction. Our study aims to investigate and evaluate (1) rates of success of ECV for breech presentation at term at the Royal Women’s Hospital in comparison to international standards; (2) mode of delivery following ECV; (3) factors influencing success rates of ECV at the Royal Women’s Hospital. Methods. An audit of all women who underwent ECV between the years 2007 and 2014 at the Royal Women’s Hospital as public patients was completed. Data parameters were collected from paper and electronic patient files at the Women’s Hospital. Data was collected to analyse the effect of the following parameters on ECV success and birth outcome: age, parity, gestational age, BMI, AFI, and tocolytic use. These parameters were analysed to determine their effect on ECV outcome and birth outcome. Results. The Women’s Hospital, Melbourne, has an ECV success rate of approximately 37%. Of the patients undergoing ECV, 29% proceeded to normal vaginal delivery. Predictors of successful ECV included low BMI, multiparity, and AFI more than 16 (). The only predictor of cephalic vaginal delivery following ECV was multiparity. Negative predictors of cephalic delivery were low AFI and nulliparity. Conclusions. The success rate of ECV at the Women’s Hospital, Melbourne, is in line with global standards. Natalie Kew, Jacobus DuPlessis, Domenic La Paglia, and Katherine Williams Copyright © 2017 Natalie Kew et al. All rights reserved. Implementation and Monitoring of a Gestational Trophoblastic Disease Management Program in a Tertiary Hospital in Morocco: Opportunities and Challenges Sun, 16 Apr 2017 00:00:00 +0000 http://www.hindawi.com/journals/ogi/2017/5093472/ Objective. Gestational Trophoblastic Disease (GTD) management requires clear guidelines for diagnosis, treatment, and follow-up. Unequal management skills among practitioners, inadequate treatment, irregular surveillance, and drop-out are common in resource-limited settings and can lead to life-threatening complications and morbidities. To address these challenges, we implemented a GTD Management Program at the National Center for Reproductive Health in Rabat, Morocco. Methods and Program Description. In-depth review of management protocols was carried out, and concise guidelines were developed, with targeted training for physicians. A physical space and a weekly fixed GTD consultation were set, and personalized follow-up was established for each patient. An electronic database documenting patients’ surveillance was created, allowing immediate outreach in case of irregularities. Results. During the period from October 2013 to June 2016, 50 patients were included in this program. Patients’ mean age was 33 years; 92% were illiterate and 82% had a low socioeconomic status. 68% had a positive evolution, while 32% developed gestational trophoblastic neoplasia, requiring 2 to 6 chemotherapy sessions. An average of 2.8 outreach reminders were necessary for each patient. 94% fully adhered to the program of care and completed properly their follow-up. Conclusion. Implementation and thorough monitoring of this program helped optimize patients’ care, avoiding drop-outs and delays in diagnosing and treating complications. Imane Khachani, Mohamed Hassan Alami, and Rachid Bezad Copyright © 2017 Imane Khachani et al. All rights reserved. Can Transabdominal Scan Predict a Short Cervix by Transvaginal Scan? Sun, 09 Apr 2017 10:10:05 +0000 http://www.hindawi.com/journals/ogi/2017/3035718/ Background. To determine whether transabdominal screening can be used to screen women with short cervix on transvaginal scan. Methods. The study was done between 18 and 20 weeks of gestation. Transabdominal scan was done and cervical length was measured. Transvaginal scan was also done and cervical length was measured. An attempt was made to find out whether transabdominal scan be used to predict a cervical length of 25 mm by transvaginal scan. Results. In our study the cut-off for transabdominal scan for detecting a short cervix of 25 mm by transvaginal scan was 29 mm. A transabdominal cervical length of 29 mm could predict a short cervix of 25 mm by transvaginal scan by 100% sensitivity and 92.4% sensitivity. Conclusion. A cut-off of 29 mm by transabdominal scan is very accurate in predicting a short cervix of 25 mm by transvaginal scan. Jayaraman Mavila Nambiar, Muralidhar Vaman Pai, Arevidya Reddy, and Pratap Kumar Copyright © 2017 Jayaraman Mavila Nambiar et al. 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.