Obstetrics and Gynecology International http://www.hindawi.com The latest articles from Hindawi Publishing Corporation © 2016 , Hindawi Publishing Corporation . 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. Large D-Dimer Fluctuation in Normal Pregnancy: A Longitudinal Cohort Study of 4,117 Samples from 714 Healthy Danish Women Sun, 17 Apr 2016 14:13:42 +0000 http://www.hindawi.com/journals/ogi/2016/3561675/ Introduction. D-dimer levels increase throughout pregnancy, hampering the usefulness of the conventional threshold for dismissing thromboembolism. This study investigates the biological fluctuation of D-dimer in normal pregnancy. Methods. A total of 801 healthy women with expected normal pregnancies were recruited. D-dimer was repeatedly measured during pregnancy, at active labor, and on the first and second postpartum days. Percentiles for each gestational week were calculated. Each individual D-dimer was normalized by transformation into percentiles for the relevant gestational age or delivery group. The range in percentage points during the pregnancy and the delivery was calculated, and reference intervals were calculated for each pregnancy trimester, during vaginal delivery and scheduled and emergency cesarean section, and for the first and second day postpartum. Results. D-dimer increased during pregnancy; the maximal fluctuation was approximately 20 percentile points in approximately half of the women. In one out of ten women, the D-dimer values fluctuated by more than 50 percentile points. Conclusions. Due to the biological variation in D-dimer within each individual woman during normal pregnancy, repeated D-dimer measurements are of no clinical use in the evaluation of thromboembolic events during pregnancy. Katrine K. Hedengran, Malene R. Andersen, Steen Stender, and Pal B. Szecsi Copyright © 2016 Katrine K. Hedengran et al. All rights reserved. Clinicopathological Significance of Vimentin and Cytokeratin Protein in the Genesis of Squamous Cell Carcinoma of Cervix Thu, 14 Apr 2016 06:18:23 +0000 http://www.hindawi.com/journals/ogi/2016/8790120/ Cervical cancer is one of the commonest types of cancers worldwide especially in developing countries. Intermediate filaments protein family has shown a role in the diagnosis of various cancers, but a few studies are available about the vimentin and cytokeratin roles in the cervical cancer. This case control study aimed to interpret the expression of vimentin and cytokeratin proteins in the development and progression of cervical cancer and its correlation with clinicopathological features. The cytoplasmic expression of vimentin was observed in 40% of cases, but not in inflammatory lesions of cervix. It was noticed that vimentin expression was increasing significantly with high grade of the tumour. Cytokeratin expression was observed in 48.33% and it was noticed that the expression was 62.5% in well differentiated (G1), 45% in moderately differentiated (G2), and 41.66% in poorly differentiated carcinoma, yet statistically insignificant. The expression of vimentin and cytokeratin proteins was not significantly associated with age groups. The current findings concluded a possible role of vimentin in the development and progression of cervical cancer and vimentin marker will be useful in the diagnosis and grading of cervical cancer. Nazik Elmalaika O. S. Husain, Ali Yousif Babiker, Aqel S. Albutti, Mohammed A. Alsahli, Salah M. Aly, and Arshad H. Rahmani Copyright © 2016 Nazik Elmalaika O. S. Husain et al. All rights reserved. Ovarian Mature Cystic Teratoma: Challenges of Surgical Management Thu, 24 Mar 2016 09:25:26 +0000 http://www.hindawi.com/journals/ogi/2016/2390178/ Although ovarian mature cystic teratomas are the commonest adnexal masses occurring in premenopausal women, there are many challenges faced by gynecologists on deciding upon the best surgical management. There is uncertainty, lack of consensus, and variation in surgical practices. This paper critically analyzes various surgical approaches and techniques used to treat these cysts in an attempt to outline a unified guidance. MEDLINE and EMBASE databases were searched in January 2015 with no date limit using the key words “ovarian teratoma” and “ovarian dermoid.” The search was limited to articles in English language, humans, and female. The two authors conducted the search independently. The laparoscopic approach is generally considered to be the gold standard for the management. Oophorectomy should be the standard operation except in younger women with a single small cyst. The risk of chemical peritonitis after contents spillage is extremely rare and can certainly be overcome with thorough peritoneal lavage using warmed fluid. There is a place for surveillance in some selected cases. Abha Sinha and Ayman A. A. Ewies Copyright © 2016 Abha Sinha and Ayman A. A. Ewies. All rights reserved. Association between Maternal Pelvis Height and Intrapartum Foetal Head Moulding in Ugandan Mothers with Spontaneous Vertex Deliveries Mon, 29 Feb 2016 09:26:26 +0000 http://www.hindawi.com/journals/ogi/2016/3815295/ Introduction. In Sub-Saharan Africa, excessive foetal head moulding is commonly associated with cephalopelvic disproportion and obstructed labour. This study set out to determine the associations of maternal pelvis height and maternal height with intrapartum foetal head moulding. Methods. This was a multisite secondary analysis of maternal birth records of mothers with singleton pregnancies ending in a spontaneous vertex delivery. A summary of the details of the pregnancy and delivery records were reviewed and analysed using multilevel logistic regression respect to foetal head moulding. The alpha level was set at . Results. 412 records were obtained, of which 108/385 (28%) observed foetal head moulding. There was a significant reduction in risk of foetal head moulding with increasing maternal height (Adj. IRR 0.97, ), maternal pelvis height (Adj. IRR 0.88, ), and raptured membranes (Adj. IRR 0.10, ). There was a significant increased risk of foetal head moulding with increasing birth weight (Adj. IRR 1.90, ) and duration of monitored active labour (Adj. IRR 1.21, ) in the final model. Conclusion. This study showed that increasing maternal height and maternal pelvis height were associated with a significant reduction in intrapartum foetal head moulding. Ian G. Munabi, Samuel Abilemech Luboga, Livingstone Luboobi, and Florence Mirembe Copyright © 2016 Ian G. Munabi et al. All rights reserved. The EpiNo® Device: Efficacy, Tolerability, and Impact on Pelvic Floor—Implications for Future Research Sun, 14 Feb 2016 14:32:37 +0000 http://www.hindawi.com/journals/ogi/2016/3818240/ Aims. The aim of this review is to provide a comprehensive overview of the available literature on preventing perineal trauma with the EpiNo. Methods. We perfomed a literature research in the MedLine and EMBASE databases for studies referring to EpiNo published between 1990 and 2014, without restrictions for language and study type. Results. Five published studies were identified, regarding the effect of EpiNo on the rate of episiotomy and perineal tears, pelvic floor muscle function, and fetal outcome. The device seems to reduce episiotomy and perineal tears’ rate, as well as the risk for levator ani microtrauma and avulsion, though not always statistically significant. It does not seem to have an effect on duration of second stage of labour and fetal outcome. The device is well tolerated and the adverse events are rare and mild. However, design and reporting bias in the reviewed articles do not allow evidence based conclusions. Conclusions. The EpiNo device seems to be promising, with potential positive effects on natural birth, while being uncomplicated to use and without major complications. Well designed, randomized trials are needed in order to understand the effects of EpiNo on pelvic floor and make evidence based recommendations on its use. Tilemachos Kavvadias and Irene Hoesli Copyright © 2016 Tilemachos Kavvadias and Irene Hoesli. All rights reserved. Management of Fetal Growth Arrest in One of Dichorionic Twins: Three Cases and a Literature Review Tue, 29 Dec 2015 10:32:55 +0000 http://www.hindawi.com/journals/ogi/2015/289875/ Progressive fetal growth restriction (FGR) is often an indication for delivery. In dichorionic diamniotic (DD) twin pregnancy with growth restriction only affecting one fetus (selective fetal growth restriction: sFGR), the normal twin is also delivered prematurely. There is still not enough evidence about the optimal timing of delivery for DD twins with sFGR in relation to discordance and gestational age. We report three sets of DD twins with sFGR (almost complete growth arrest affecting one fetus for ≥2 weeks) before 30 weeks of gestation. The interval from growth arrest to delivery was 21–24 days and the discordance was 33.7–49.8%. A large-scale study showed no difference of overall mortality or the long-term outcome between immediate and delayed delivery for FGR, while many studies have identified a risk of developmental delay following delivery of the normal growth fetus before 32 weeks. Therefore, delivery of DD twins with sFGR should be delayed if the condition of the sFGR fetus permits in order to increase the gestational age of the normal growth fetus. Shoji Kaku, Fuminori Kimura, and Takashi Murakami Copyright © 2015 Shoji Kaku et al. All rights reserved. A Case-Control Study on Intimate Partner Violence during Pregnancy and Low Birth Weight, Southeast Ethiopia Sun, 20 Dec 2015 11:47:53 +0000 http://www.hindawi.com/journals/ogi/2015/394875/ Introduction. Violence against women has serious consequences for their reproductive and sexual health including birth outcomes. In Ethiopia, though the average parity of pregnant women is much higher than in other African countries, the link between intimate partner violence with low birth weight is unknown. Objective. The aim of this study was to examine the association between intimate partner violence and low birth weight among pregnant women. Method. Hospital based case-control study was conducted among 387 mothers (129 cases and 258 controls). Anthropometric measurements were taken both from mothers and their live births. The association between intimate partner violence and birth weight was computed through bivariable and multivariable logistic regression analyses and statistical significance was declared at . Result. Out of 387 interviewed mothers, 100 (25.8%) had experienced intimate partner violence during their index pregnancy period. Relatively more mothers of low birth weight infants were abused (48%) compared with controls (16.4%). Those mothers who suffered acts of any type of intimate partner violence during pregnancy were three times more likely to have a newborn with low birth weight (95% CI; (1.57 to 7.18)). The association between overall intimate partner violence and LBW was adjusted for potential confounder variables. Conclusion. This research result gives insight for health professional about the importance of screening for intimate partner violence during pregnancy. Health care providers should consider violence in their practice and try to identify women at risk. Habtamu Demelash, Dabere Nigatu, and Ketema Gashaw Copyright © 2015 Habtamu Demelash et al. All rights reserved. Community Awareness of HPV Screening and Vaccination in Odisha Wed, 09 Dec 2015 08:27:49 +0000 http://www.hindawi.com/journals/ogi/2015/694560/ Introduction. A number of new technologies including cervical cancer screening and vaccination have introduced new tools in the fight against cervical cancer. Methods. This study was set in Odisha, India, at the Acharya Harihar Regional Cancer Center and study research infrastructure at the Asian Institute of Public Health. IRB approvals were obtained and a research assistant recruited 286 women aged 18–49 years, who provided informed consent and completed a survey tool. Data were entered into EpiData software and statistical analysis was conducted. Results. 76.3% women participants were married, 45.5% had sexual debut at age 21 or greater, 60.5% used contraception, 12.2% reported having a Pap smear in the past, and 4.9% reported having prior genital warts. Most, 68.8% had never heard of HPV and 11.9% were aware that HPV is the main cause of cervical cancer. 82.9% women thought that vaccinations prevent disease, and 74.8% said they make the decision to vaccinate their children. Conclusion. The Odisha community demonstrated a low level of knowledge about cervical cancer prevention, accepted vaccinations in the prevention of disease and screening, and identified mothers/guardians as the key family contacts. Niharika Khanna, Aparna Ramaseshan, Stephanie Arnold, Kalpana Panigrahi, Mark D. Macek, Bijaya K. Padhi, Diptirani Samanta, Surendra N. Senapati, and Pinaki Panigrahi Copyright © 2015 Niharika Khanna et al. All rights reserved. Maternal and Pediatric Health Outcomes in relation to Gestational Vitamin D Sufficiency Sun, 06 Dec 2015 09:40:10 +0000 http://www.hindawi.com/journals/ogi/2015/501829/ Juxtaposed with monumental improvement in maternal-fetal outcomes over the last century, there has been the recent emergence of rising rates of gestational complications including preterm birth, operative delivery, and gestational diabetes. At the same time, there has been a burgeoning problem with widespread vitamin D deficiency among populations of many developed nations. This paper provides a brief review of potential health outcomes recently linked to gestational vitamin D deficiency, including preterm birth, cesarean delivery, and gestational diabetes. Although immediate costs for obstetric complications related to gestational vitamin D insufficiency may be modest, the short- and long-term costs for pediatric healthcare resulting from such gestational complications may be enormous and present an enduring burden on healthcare systems. With increasing evidence pointing to fetal origins of some later life disease, securing vitamin D sufficiency in pregnancy appears to be a simple, safe, and cost-effective measure that can be incorporated into routine preconception and prenatal care in the offices of primary care clinicians. Education on gestational nutritional requirements should be a fundamental part of medical education and residency training, instruction that has been sorely lacking to date. Stephen J. Genuis Copyright © 2015 Stephen J. Genuis. All rights reserved. Safety and Efficacy of Ferric Carboxymaltose in Anemic Pregnant Women: A Retrospective Case Control Study Tue, 24 Nov 2015 07:05:17 +0000 http://www.hindawi.com/journals/ogi/2015/728952/ Background. Anemia during pregnancy is commonly caused by iron deficiency and can have severe consequences for both the mother and the developing fetus. The aim of this retrospective study was to assess the safety and efficacy of intravenous ferric carboxymaltose (FCM) in pregnant women. Methods. All women treated with FCM for anemia during pregnancy between 2010 and 2012 at our institution were included. A matched control group was selected, including women who either were nonanemic or had anemia but were not considered for intravenous iron. Main outcome measures were maternal safety and pregnancy outcomes. Results. The study included 128 patients (FCM: 64; control: 64). Median FCM dose was 1000 mg and median gestational age at the time of first treatment was 34 weeks and 6 days. Median Hb increased from 8.4 g/dL (interquartile range 7.7; 8.9 g/dL) at the first FCM administration to 10.7 g/dL (9.8; 11.5 g/dL; with available Hb at delivery) at the time of delivery, achieving levels similar to those in the control group (10.8 g/dL [9.8; 11.8 g/dL; ]). No treatment-related adverse events were reported and no statistically significant differences in pregnancy outcomes were observed between groups. Conclusions. Within the limitations of this case control study, FCM was a safe and efficient treatment of anemia during pregnancy. Anouk Pels and Wessel Ganzevoort Copyright © 2015 Anouk Pels and Wessel Ganzevoort. All rights reserved. Resveratrol, Acetyl-Resveratrol, and Polydatin Exhibit Antigrowth Activity against 3D Cell Aggregates of the SKOV-3 and OVCAR-8 Ovarian Cancer Cell Lines Thu, 05 Nov 2015 13:44:46 +0000 http://www.hindawi.com/journals/ogi/2015/279591/ Resveratrol has aroused significant scientific interest as it has been claimed that it exhibits a spectrum of health benefits. These include effects as an anti-inflammatory and an antitumour compound. The purpose of this study was to investigate and compare any potential antigrowth effects of resveratrol and two of its derivatives, acetyl-resveratrol and polydatin, on 3D cell aggregates of the EGFR/Her-2 positive and negative ovarian cancer cell lines SKOV-3 and OVCAR-8, respectively. Results showed that resveratrol and acetyl-resveratrol reduced cell growth in the SKOV-3 and OVCAR-8 in a dose-dependant manner. The growth reduction was mediated by the induction of apoptosis via the cleavage of poly(ADP-ribose) polymerase (PARP-1). At lower concentrations, 5 and 10 µM, resveratrol, acetyl-resveratrol, and polydatin were less effective than higher concentrations, 50 and 100 µM. In SKOV-3 line, at higher concentrations, resveratrol and polydatin significantly reduced the phosphorylation of Her-2 and EGFR and the expression of Erk. Acetyl-resveratrol, on the other hand, did not change the activation of Her-2 and EGFR. Resveratrol, acetyl-resveratrol, and polydatin suppressed the secretion of VEGF in a dose-dependant fashion. In the OVCAR-8 cell line, resveratrol and acetyl-resveratrol at 5 and 10 µM increased the activation of Erk. Above these concentrations they decreased activation. Polydatin did not produce this effect. This study demonstrates that resveratrol and its derivatives may inhibit growth of 3D cell aggregates of ovarian cancer cell lines via different signalling molecules. Resveratrol and its derivatives, therefore, warrant further in vivo evaluation to assess their potential clinical utility. Simon J. Hogg, Kenny Chitcholtan, Wafaa Hassan, Peter H. Sykes, and Ashley Garrill Copyright © 2015 Simon J. Hogg et al. All rights reserved. Serum hCG Levels following the Ovulatory Injection: Associations with Patient Weight and Implantation Time Mon, 26 Oct 2015 07:26:19 +0000 http://www.hindawi.com/journals/ogi/2015/520714/ Objective. To test if serum hCG levels the morning after the ovulatory hCG injection correlate with (1) retrieval efficiency, (2) oocyte maturity, (3) embryo quality, (4) pregnancy, and/or (5) time to implantation in patients undergoing in vitro fertilization (IVF) with intracytoplasmic sperm injection (ICSI). Design. Retrospective cohort analysis. Setting. University-based IVF clinic. Patient(s). All IVF/ICSI cycles from April 2005 to February 2008 whose hCG administration was confirmed ( patients). Intervention(s). Serum hCG was measured the morning following the ovulatory injection, on the 16th day following retrieval, and repeated on day 18 for those with positive results. Main Outcome Measure(s). Number of follicles on the day of hCG injection, number of oocytes retrieved, maturity of oocytes, embryo quality, pregnancy outcome, and time to implantation. Result(s). hCG levels did not correlate with retrieval efficiency, oocyte maturity, embryo quality, or pregnancy. Postinjection hCG levels were inversely associated with patient weight and time to implantation. Conclusion(s). No correlation was found between hCG level and any parameter of embryo quality. Patient weight affected hCG levels following hCG injection and during the early period of pregnancy following implantation. No association between postinjection hCG level and time of implantation (adjusted for patient weight) was apparent. Dorette J. Noorhasan, Peter G. McGovern, Michael Cho, Aimee Seungdamrong, Khaliq Ahmad, and David H. McCulloh Copyright © 2015 Dorette J. Noorhasan et al. All rights reserved. A Comparison of Pattern of Pregnancy Loss in Women with Infertility Undergoing IVF and Women with Unexplained Recurrent Miscarriages Who Conceive Spontaneously Tue, 20 Oct 2015 13:42:03 +0000 http://www.hindawi.com/journals/ogi/2015/989454/ Objective. Women with infertility and recurrent miscarriages may have an overlapping etiology. The aim of this study was to compare the pregnancy loss in pregnancies after IVF treatment with spontaneous pregnancies in women with recurrent miscarriages and to assess differences related to cause of infertility. Methods. The outcome from 1220 IVF pregnancies (Group I) was compared with 611 spontaneous pregnancies (Group II) in women with recurrent miscarriages. Subgroup analysis was performed in Group I based on cause of infertility: tubal factor (392 pregnancies); male factor (610 pregnancies); and unexplained infertility (218 pregnancies). Results. The clinical pregnancy loss rate in Group I (14.3%) was significantly lower than that of Group II (25.8%, ) and this was independent of the cause of infertility. However the timing of pregnancy loss was similar between Groups I and II. The clinical pregnancy loss rate in Group I was similar in different causes of infertility. Conclusions. The clinical pregnancy loss rate following IVF treatment is lower than that of women with unexplained recurrent miscarriages who conceived spontaneously. This difference persists whether the infertility is secondary to tubal factors, male factors, or unexplained cause. Vidya A. Tamhankar, Beiyu Liu, Junhao Yan, and Tin-Chiu Li Copyright © 2015 Vidya A. Tamhankar et al. All rights reserved. The Importance of the Monitoring of Resuscitation with Blood Transfusion for Uterine Inversion in Obstetrical Hemorrhage Wed, 30 Sep 2015 14:33:46 +0000 http://www.hindawi.com/journals/ogi/2015/269156/ Objective. The aim of this study was to describe critical care for obstetrical hemorrhage, especially in cases of uterine inversion. Study Design. We extracted data for six patients diagnosed with uterine inversion concerning resuscitation. Results. The shock index on admission of the six patients was 1.6 or more on admission. Four of the six experienced delay in diagnosis and received inadequate fluid replacement. Five of the six experienced delay in transfer. Five of the six underwent simultaneous blood transfusion on admission, and the remaining patient experienced a delay of 30 minutes. All six patients successfully underwent uterine replacement soon after admission. One maternal death occurred due to inappropriate practices that included delay in diagnosis, delay in transfer, inadequate fluid replacement, and delayed transfusion. Two patients experiencing inappropriate practices involving delay in diagnosis, delay in transfer, and inadequate fluid replacement survived. Conclusion. If a delay in diagnosis occurs simultaneously with a delay in transfer and inadequate fluid replacement, failure in providing a prompt blood transfusion may be critical and result in maternal death. The monitoring of resuscitation with blood transfusion for uterine inversion is essential for the improvement of obstetrical care. Seishi Furukawa and Hiroshi Sameshima Copyright © 2015 Seishi Furukawa and Hiroshi Sameshima. All rights reserved. Factors Influencing Women’s Preferences for Places to Give Birth in Addis Ababa, Ethiopia Sun, 30 Aug 2015 13:03:20 +0000 http://www.hindawi.com/journals/ogi/2015/439748/ The main aim of this study was to examine factors determining women’s preference for places to give birth in Addis Ababa, Ethiopia. A quantitative and cross-sectional community based study design was employed. Data was collected using structured questionnaire administered to 901 women aged 15–49 years through a stratified two-stage cluster sampling technique. Multinomial logistic regression model was employed to identify predictors of delivery care. More than three-fourth of slum women gave birth at public healthcare facilities compared to slightly more than half of the nonslum residents. Education, wealth quintile, the age of respondent, number of children, pregnancy intention, and cohabitation showed net effect on women’s preference for places to give birth. Despite the high number of ANC attendances, still many pregnant women especially among slum residents chose to deliver at home. Most respondents delivered in public healthcare institutions despite the general doubts about the quality of services in these institutions. Future studies should examine motivating factors for continued deliveries at home and whether there is real significant difference between the quality of maternal care service offered at public and private health facilities. Yibeltal Tebekaw, Yohana James Mashalla, and Gloria Thupayagale-Tshweneagae Copyright © 2015 Yibeltal Tebekaw et al. All rights reserved. Ultrastructure of Placenta of Gravidas with Gestational Diabetes Mellitus Mon, 24 Aug 2015 09:23:09 +0000 http://www.hindawi.com/journals/ogi/2015/283124/ Objectives. Gestational diabetes mellitus (GDM) leads to an abnormal placental environment which may cause some structural alterations of placenta and affect placental development and function. In this study, the ultrastructural appearances of term placentas from women with GDM and normal pregnancy were meticulously compared. Materials and Methods. The placenta tissues of term birth from 10 women with GDM and 10 women with normal pregnancy were applied with the signed informed consent. The morphology of fetomaternal interface of placenta was examined using light microscopy (LM) and transmission electron microscopy (TEM). Results. On LM, the following morphological changes in villous tissues were found in the GDM placentas when compared with the control placentas: edematous stroma, apparent increase in the number of syncytial knots, and perivillous fibrin deposition. On TEM, the distinct ultrastructural alterations indicating the degeneration of terminal villi were found in the GDM placentas as follows: thickening of the basal membrane (BM) of vasculosyncytial membrane (VSM) and the VSM itself, significantly fewer or even absent syncytiotrophoblastic microvilli, swollen or completely destroyed mitochondria and endoplasmic reticulum, and syncytiotrophoblasts with multiple vacuoles. Conclusion. Ultrastructural differences exist between GDM and control placentas. The differences of placenta ultrastructure are likely responsible for the impairment of placental barrier and function in GDM. Qian Meng, Li Shao, Xiucui Luo, Yingping Mu, Wen Xu, Chao Gao, Li Gao, Jiayin Liu, and Yugui Cui Copyright © 2015 Qian Meng et al. All rights reserved. Practical Advice for Emergency IUD Contraception in Young Women Wed, 29 Jul 2015 10:48:28 +0000 http://www.hindawi.com/journals/ogi/2015/986439/ Too few women are aware of the very high efficacy of intrauterine copper devices (IUDs) to prevent pregnancy after unprotected intercourse. Women who frequently engage in unprotected intercourse or seek emergency contraception (EC) are at high risk of unplanned pregnancy and possible abortion. It is therefore important that these women receive precise and accurate information about intrauterine devices as they may benefit from using an IUD for EC as continuing contraception. Copper IUDs should be used as first choice options given their rapid onset of action and their long-term contraceptive action which require minimal thought or intervention on the part of the user. In the United States, there is only one copper IUD presently available which limits treatment options. There are numerous copper IUDs available for use in EC, however, their designs and size are not always optimal for use in nulliparous women or women with smaller or narrower uteruses. Utilization of frameless IUDs which do not require a larger transverse arm for uterine retention may have distinct advantages, particularly in young women, as they will be suitable for use in all women irrespective of uterine size. This paper provides practical information on EC use with emphasis on the use of the frameless IUD. Norman D. Goldstuck and Dirk Wildemeersch Copyright © 2015 Norman D. Goldstuck and Dirk Wildemeersch. All rights reserved. Comment on “Alternate Sequential Suture Tightening: A Novel Technique for Uncontrolled Postpartum Hemorrhage” Tue, 21 Jul 2015 13:33:42 +0000 http://www.hindawi.com/journals/ogi/2015/279513/ Shigeki Matsubara, Hironori Takahashi, and Alan K. Lefor Copyright © 2015 Shigeki Matsubara et al. All rights reserved. Cattle Uterus: A Novel Animal Laboratory Model for Advanced Hysteroscopic Surgery Training Tue, 21 Jul 2015 09:03:26 +0000 http://www.hindawi.com/journals/ogi/2015/967693/ In recent years, due to reduced training opportunities, the major shift in surgical training is towards the use of simulation and animal laboratories. Despite the merits of Virtual Reality Simulators, they are far from representing the real challenges encountered in theatres. We introduce the “Cattle Uterus Model” in the hope that it will be adopted in training courses as a low cost and easy-to-set-up tool. It adds new dimensions to the advanced hysteroscopic surgery training experience by providing tactile sensation and simulating intraoperative difficulties. It complements conventional surgical training, aiming to maximise clinical exposure and minimise patients’ harm. Ayman A. A. Ewies and Zahid R. Khan Copyright © 2015 Ayman A. A. Ewies and Zahid R. Khan. All rights reserved. Effect of Umbilical Cord Entanglement and Position on Pregnancy Outcomes Thu, 09 Jul 2015 07:25:29 +0000 http://www.hindawi.com/journals/ogi/2015/342065/ Introduction. To investigate the effect of complex umbilical cord entanglement primarily around the trunk on pregnancy outcomes. Methods. We studied 6307 pregnant women with singleton pregnancies who underwent vaginal delivery of an infant at ≥37 weeks of gestation. Cases were classified into no cord, nuchal cord, and body cord groups and defined as cases without umbilical cord entanglement, one or more loops of the umbilical cord around the neck only, and umbilical cord around the trunk only, respectively. Pregnancy outcomes were compared among these three groups. Results. The no cord, nuchal cord, and body cord group included 4733, 1451, and 123 pregnancies, respectively. Although delivery mode was not significantly different among the three groups, 1-minute Apgar scores <7 and umbilical artery (UA) pH <7.10 were significantly more common in the umbilical cord entanglement groups than in the no cord group. In particular, the frequency of 5-minute Apgar scores <7 was significantly higher (), whereas that of UA pH <7.10 tended to be higher () in the body cord group than in the nuchal cord group. Conclusion. Compared to nuchal cord, umbilical cord entanglement around the trunk was associated with a higher risk of low Apgar scores and low UA pH. Natsuko Kobayashi, Shigeru Aoki, Mari S. Oba, Tsuneo Takahashi, and Fumiki Hirahara Copyright © 2015 Natsuko Kobayashi et al. All rights reserved.