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International Journal of Gynecology & Obstetrics (IJGO)
The official journal of FIGO, the International Journal of Gynecology & Obstetrics, is published monthly and is available by subscription from the publishers, Elsevier Science.
The Journal addresses a broad range of day-to-day problems encountered by Ob/Gyn practitioners worldwide. It is distributed to subscribers, member societies of FIGO, those donating specific sums to the FIGO Charitable Foundation, Executive Board members and to medical libraries worldwide.
How to subscribe: Visit IJGO's subscription section. Personal subscribers can then access the full text of the journal.
Latest articles from the International Journal of Gynecology & Obstetrics:
Abstract: Objective: To reevaluate the role of the antispasmodic drug drotaverine in shortening the length of the active first stage of labor among nulliparous women.Methods: In a randomized, double-blind, placebo-controlled trial, 422 young nulliparous women admitted to Ain-shams University Maternity Hospital, Cairo, Egypt, in spontaneous labor were initially enrolled between May and December 2012. Drotaverine hydrochloride (40mg) or placebo was given at the start of the active phase of labor and then repeated every 2hours (maximum 3 doses). All participants were consistently managed in accordance with the local institutional intrapartum protocol. The primary outcome was the rate of cervical dilation.Results: After excluding women who delivered by cesarean, data were analyzed from 320 women. There was a significant difference in post-treatment labor pain scores, duration of the active phase of labor, and rate of cervical dilatation between the 2 groups (P<0.001 for all). There was no difference in maternal adverse effects. Kaplan–Meier survival analysis showed a greater probability of faster delivery among patients treated by drotaverine hydrochloride (log rank test; P<0.001).Conclusion: Drotaverine hydrochloride was used effectively and safely to shorten the duration of the first stage of labor among nulliparous women with active spontaneous labor.ClinicalTrials.gov: NCT01639027.
Abstract: Objective: To determine factors associated with an unknown HIV serostatus among pregnant women admitted in labor to Mulago Hospital, Kampala, Uganda.Methods: In total, 665 pregnant women admitted to Mulago Hospital were interviewed about their sociodemographic characteristics, obstetric history, access to prenatal care, fears regarding HIV testing, and knowledge about modes of mother-to-child-transmission (MTCT). Knowledge of the HIV serostatus was assessed by self-report and verified by prenatal card review.Results: The prevalence of unknown HIV serostatus at the time of labor was 27.1%. Factors associated with an unknown HIV serostatus included high parity (odds ratio [OR] 1.9; 95% confidence interval [CI], 1.16–3.14), preterm delivery (OR 2.60; 95% CI, 1.06–6.34), prenatal care at a private clinic (OR 12.87; 95% CI, 5.68–29.14), residence more than 5km from the nearest prenatal clinic (OR 2.86; 95% CI, 1.18–17.9), high knowledge about MTCT (OR 0.25; 95% CI, 0.07–0.86), and fears related to disclosing the test result to the partner (OR 3.60; 95% CI, 1.84–7.06).Conclusion: The high prevalence of unknown HIV serostatus among women in labor highlights the need to improve accessibility to HIV testing services early during pregnancy to be able to take advantage of antiretroviral therapy.
Abstract: Objective: To examine pain and biopsychosocial correlates over time for women with persistent postsurgical pain after surgery for endometriosis.Methods: Cross-sectional study of women who underwent any endometriosis surgery between 2003 and 2006. Following surgery, patients completed validated questionnaires (Short-Form McGill Pain Questionnaire, 12-item Short-Form Health Survey, Beck Depression Inventory, Coping Strategies Questionnaire catastrophizing subscale). The primary outcome was pelvic pain intensity, measured by the McGill total pain score. Bivariate comparisons between each potential predictor and pain intensity were performed using the χ2 and t tests, 1-way analysis of variance, and simple linear regression.Results: In total, 79 completed the questionnaires and were included in the present analysis. The McGill affective pain score was negatively correlated with age (β-coefficient –0.12, P=0.002) and positively correlated with catastrophization (β-coefficient 0.66, P=0.01). Women with a history of dyspareunia scored significantly higher on the McGill total pain score (P<0.001); there was no association between pain intensity and endometriosis severity.Conclusion: Younger age and catastrophization are correlated with persistent pain following surgery for endometriosis. The severity of endometriosis does not predict persistent pain. Further evaluation of psychosocial factors may identify patients who are least likely to benefit from surgeries for endometriosis-associated pelvic pain.
Abstract: Objective: To determine whether women with recurrent implantation failure (RIF) after in vitro fertilization (IVF), similar to women with recurrent pregnancy loss, have significantly higher stress levels than women without reproductive failure, and to compare stress levels between women with RIF and women with recurrent pregnancy loss.Methods: In a questionnaire-based study between September 2009 and January 2011, psychological stress was measured among patients attending recurrent pregnancy loss and RIF clinics at the Royal Hallamshire Hospital, Sheffield, UK. Participants completed the Fertility Problem Inventory (FPI), the Perceived Stress Scale (PSS), and the Positive and Negative Affect Schedule (PANAS) on their first visit to their respective clinic. Thirty fertile control women also completed the 3 validated questionnaires.Results: Compared with the control group, women with RIF and recurrent pregnancy loss had significantly higher scores in the FPI (RIF, P<0.001; recurrent pregnancy loss, P=0.003) and the PANAS negative affect domain (RIF, P=0.004; recurrent pregnancy loss, P=0.001), and lower scores in the PANAS positive affect domain (RIF, P<0.001; recurrent pregnancy loss, P<0.001). Whereas the perceived stress score (PSS) of the recurrent pregnancy loss group was significantly higher than that of the control group (P=0.006), the score of the RIF group was not, although the difference tended toward statistical significance (P=0.058).Conclusion: The study findings confirm the stressful nature of RIF and recurrent pregnancy loss.
Abstract: The new technology that will allow genetic testing of a fetus within the first trimester of pregnancy by isolating cell-free fetal DNA (cffDNA) in the mother’s blood raises a range of ethical and legal issues. Considered noninvasive, this test is safe and reliable, and may avoid alternative genetic testing by amniocentesis or chorionic villus sampling, which risks causing spontaneous abortion. Ethical and legal issues of cffDNA testing will become more acute if testing expands to fetal whole-genome sequencing. Critical issues include the state of the science or diagnostic art; the appropriateness of offering the test; the implications of denying the test when it is available and appropriate; disclosure and counseling following test results; and management of patients’ choices on acquiring test results. A challenge will be providing patients with appropriate counseling based on up-to-date genetic knowledge, and accommodating informed patients’ legal choices.
A meta-analysis of reverse breech extraction to deliver a deeply impacted head during cesarean delivery.Monday, 2nd December 2013
Abstract: Background: During cesarean delivery, extracting a deeply impacted head is a real challenge for obstetricians.Objectives: To compare selected maternal and fetal outcome indicators of the “pull” (reverse breech extraction) and “push” methods for impacted fetal head extraction during cesarean delivery.Search strategy: A computer-based search of the Medline, Cochrane library, and HINARI databases.Selection criteria: Studies that compared the maternal and perinatal outcomes of the push and pull methods for impacted fetal head extraction during cesarean delivery were included.Data collection and analysis: A meta-analysis of Mantel–Haenszel odds ratios and standardized mean differences from 11 randomized comparative and retrospective cohort studies was performed.Main results: In the pooled analysis, the risk of uterine incision extension was more than 8 times higher with the push method than with the pull method. Blood loss and operation time were also increased with the push method, and this method was associated with more perinatal deaths and admissions to the neonatal intensive care unit. The risk of wound infection was not significantly different between the 2 methods.Conclusions: The present meta-analysis demonstrated marked reductions in uterine incision extension, blood loss, and operation time with reverse breech extraction.
Abstract: Objective: To assess the frequency, causes, and reporting of maternal deaths at a provincial referral hospital in coastal Papua New Guinea (PNG), and to describe delays in care.Methods: In a structured retrospective review of maternal deaths at Modilon General Hospital, Madang, PNG, registers and case notes for the period January 2008 to July 2012 were analyzed to determine causes, characteristics, and management of maternal death cases. Public databases were assessed for underreporting.Results: During the review period, there were 64 maternal deaths (institutional maternal mortality ratio, 588 deaths per 100 000 live births). Fifty-two cases were analyzed in detail: 71.2% (n=37) were direct maternal deaths, and hemorrhage (n=24, 46.2%) and infection (n=16, 30.8%) were the leading causes of mortality overall. Women frequently did not attend prenatal clinics (n=34, 65.4%), resided in rural areas (n=45, 86.5%), and experienced delays in care (n=45, 86.5%). Maternal deaths were underreported in public databases.Conclusion: The burden of maternal mortality was found to be high at a provincial hospital in PNG. Most women died of direct causes and experienced delays in care. Strategies to complement current hospital and national policy to reduce maternal mortality and to improve reporting of deaths are needed.
Ornithine transcarbamylase (OTC) is a mitochondrial enzyme that catalyzes the synthesis of citrulline from carbamoyl phosphate and ornithine; it is encoded by the OTC nuclear gene, which comprises 10 exons and is located on Xp21.1 .
Abstract: Objective: To report the initial experience with laparoscopic repair of vesicouterine fistulas (VUFs) at Shiraz University of Medical Sciences, Shiraz, Iran.Methods: Between June 2012 and February 2013, 2 patients with a history of multiple cesarean deliveries had a diagnosis of VUF confirmed by cystography and cystoscopy. The fistulas were repaired laparoscopically via a retrovesical approach to minimize manipulation of the bladder.Results: The operative times were 160minutes and 180minutes. Excellent laparoscopic visualization and magnification together with the presence of a catheter in the fistula tract allowed meticulous dissection in the retrovesical space between the bladder and the uterus, and resection of the fistula tract with minimal manipulation of the bladder, obviating the need for a large cystotomy. A postoperative cystogram at 4weeks showed complete resolution of the VUF in both patients. There was no recurrence of the fistula and the patients remained symptom-free during the follow-up period.Conclusion: Laparoscopic VUF repair with a retrovesical approach is an effective technique with successful outcome. This approach provides excellent exposure to a poorly accessible area in the retrovesical space. Longer follow-up periods are needed to evaluate the likelihood of VUF recurrence with this technique.
Availability and provision of misoprostol and other medicines for menstrual regulation among pharmacies in Bangladesh via mysterThursday, 21st November 2013
Abstract: Objective: To explore the availability and provision of misoprostol and other medicines for menstrual regulation (MR) among pharmacies in Bangladesh.Methods: Between March and November 2011, a cross-sectional study using mystery client visits was conducted among pharmacy workers in Dhaka and Gazipur Districts, Bangladesh. Mystery clients were trained to present 1 of 4 pre-developed situations to pharmacy workers to elicit information on the regimen, adverse effects, and complications of misoprostol use.Results: Mystery clients visited 331 pharmacies. Among the 331 pharmacy workers, 45.8% offered the mystery clients misoprostol and/or other medicines for MR; 25.7% referred them to private clinics or hospitals. Only 7% recommended an effective regimen of misoprostol for MR; 65% suggested administering vaginal and oral misoprostol together. Overall, 72.4% did not provide any advice on complications; the remainder suggested visiting trained providers for complications. Counseling on excessive bleeding as a danger sign was provided by 46% of pharmacy workers. Most (94%) did not provide or refer for post-MR family planning.Conclusion: Pharmacy workers in urban Bangladesh are providing ineffective drugs and regimens for MR. A training package is needed to strengthen service delivery by providing accurate information, high-quality products, and referral mechanisms for women seeking MR through pharmacies.