International Federation of Gynecology and Obstetrics

Abstract: Objective: To assess the epidemiology of urogenital schistosomiasis among pregnant women in rural communities of southwestern Nigeria.Methods: The present cross-sectional epidemiologic survey of urogenital schistosomiasis was conducted during 2010–2011 among pregnant women in Yewa North Local Government, Ogun State, Nigeria. The women were microscopically screened for infection with Schistosoma haematobium.Results: Of 313 volunteer participants, 20.8% tested positive for S. haematobium infection. The prevalence of infection was highest (31.5%) among women aged 20–24years. The infection intensity did not differ significantly between age groups (t=1.848, P=0.71). Primigravidae and women in the first trimester of pregnancy had the highest intensity of infection with 33.1 and 27.7 eggs/10mL of urine, respectively. There was an association between disease prevalence and parasite intensity across the age groups (χ2=68.82, P=0.02). The prevalence of S. haematobium was not associated with age or pregnancy trimester (P=0.06), but associations existed between intensity of infection and gravidity (P=0.001).Conclusion: The prevalence of urogenital schistosomiasis among pregnant women in Nigeria was high, with younger women and primigravidae at the greatest risk. These data can be used to develop a schistosomiasis control program among pregnant women in the study area.

View the full article at ScienceDirect

Abstract: Objective: To investigate the long-term efficacy of Piver–Rutledge class II radical hysterectomy (Piver II RH) for treatment of early-stage cervical cancer and to identify suitable candidates for this procedure.Methods: A retrospective study was conducted of 432 cervical cancer patients (tumor size ≤4cm) treated with Piver II RH at Sun Yat-sen University Cancer Center, Guangzhou, China, between January 1, 1999, and June 30, 2005. The correlation of preoperative and postoperative characteristics with recurrence and survival was analyzed.Results: Median follow-up was 72months; the overall recurrence rate was 14.6%. The 5-year recurrence-free survival (RFS) was 88.0% and the 5-year overall survival (OS) was 93.0%. Significant differences were observed between patients with small (≤2cm) and large (>2cm) tumors with regard to intra-pelvic recurrence (2.5% vs 13.4%; P=0.001), extra-pelvic recurrence (3.4% vs 9.9%; P=0.028), RFS (95.0% vs 86.0%; P=0.005), and OS (95.0% vs 87.0%; P=0.005). Preoperative tumor size was the only factor that correlated with recurrence (P=0.018), RFS (P=0.038), and OS (P=0.029) in a multivariate analysis.Conclusion: Cervical cancer patients with tumors of 2cm or less were identified as candidates for Piver II RH, which promoted excellent local tumor control and long-term survival.

View the full article at ScienceDirect

No data exist currently on the association of HIV with amniotic fluid volume, with the exception of 1 article where oligohydramnios was undefined with a prevalence of less than 0.3% . The present report provides secondary data findings of such an association in women at and beyond term.

View the full article at ScienceDirect

Abstract: In the 3 decades since the original description and naming of the dangerous pregnancy complication called HELLP syndrome, many milestones have been passed in pursuit of a better understanding of the disorder and its best management. It is worthwhile to review the milestones through which we have passed internationally in obstetrics as the peril that this disorder poses to pregnancy has been exposed. Factors of importance for emphasis will be definitions, reasons why the triple classification system impacts practice, the important role glucocorticoids have in reversing the pathogenesis of the disorder if used early, the excellent results reported for mothers when all components of the Mississippi Protocol are utilized for patient care, and the place of plasma exchange in special situations. Our challenge for the future is to delay or prevent HELLP's development prior to potential viability so that stillbirths and very preterm losses can be reduced or eliminated.

View the full article at ScienceDirect

Abstract: Objective: To identify risk factors for true umbilical cord knot and to evaluate its association with fetal death, premature birth, low birth weight, small-for-gestational-age (SGA) infants, low Apgar score at 1 and 5minutes, fetal venous pH of 7.15 or lower, and need for neonatal intensive care in singleton pregnancies.Methods: The total population of women who delivered at Kuopio University Hospital, Kuopio, Finland, between January 2000 and August 2012 was reviewed. Risk factors for umbilical cord knot and its association with adverse pregnancy outcome were evaluated separately among women with and without true cord knot via logistic regression analysis.Results: Overall, 340 (1.2%) of 27 537 singleton pregnancies were affected by umbilical cord knot, with increased incidence associated with advanced maternal age, multiparity, previous spontaneous abortion, polyhydramnios, and diabetes mellitus. Umbilical cord knot was associated with a 1.58-, 8.08-, 3.90-, 3.17-, 1.67-, and 2.00-fold increased risk of neonatal intensive care, fetal death, premature birth, SGA infants, and low Apgar score at 1 and 5minutes, respectively.Conclusion: True umbilical cord knot is relatively common and is associated with increased incidence of SGA infants, premature birth, need for neonatal intensive care, and fetal death.

View the full article at ScienceDirect

Abstract: Objective: To assess the knowledge of teenaged girls on human papillomavirus (HPV) infection and vaccination 12months after the start of a vaccine administration and information campaign.Methods: Between May 15 and June 15, 2009, an anonymous questionnaire was given to 629 girls attending a secondary school in a northeastern Italian city (286 were vaccinated against HPV, 343 were unvaccinated) to investigate their knowledge on HPV infection, transmission, prevention, vaccination, and post-vaccination behaviors. The responses were evaluated with respect to the vaccination status of the participants.Results: Vaccinated teenaged girls had no more knowledge than unvaccinated ones about the route of HPV transmission, and the relationship between HPV and AIDS. Vaccinated girls had less knowledge than unvaccinated girls about preventing transmission by condom (P=0.003) and about the correlation between HPV and penile cancer (P=0.034) and warts (P=0.001). Furthermore, compared with unvaccinated girls, more vaccinated girls believed that contraceptive pills might prevent HPV-related disease (P=0.001). Vaccinated girls better understood the importance of performing regular Pap smears after vaccination (P=0.021).Conclusion: Knowledge on HPV infection and vaccination remains suboptimal, especially among vaccinated teenaged girls, despite a broad information campaign. Misconceptions about the utility of secondary prevention may increase risky sexual behaviors.

View the full article at ScienceDirect

View the full article at ScienceDirect

Abstract: Objective: To examine the differential effects of insulin sensitivity and secretion on hemoglobin A1c (HbA1c) and glycated albumin (GA) at 24–32weeks of pregnancy in women with gestational diabetes mellitus (GDM).Methods: A cross-sectional, sequential case series study was performed in pregnant women with an abnormal 50-g oral glucose-screening test. Hemoglobin A1c and GA measurements were taken during oral glucose tolerance test (OGTT). The homeostasis model assessment of insulin resistance (HOMA-IR) and beta-cell function (HOMA-%β), insulin sensitivity index (ISOGTT), and modified insulinogenic index were calculated to assess insulin sensitivity and secretory function.Results: A total of 713 pregnant women were enrolled. The GDM group had lower ISOGTT and insulinogenic index scores, and a higher HOMA-IR score. Hemoglobin A1c was positively correlated with HOMA-IR. Glycated albumin was negatively correlated with insulinogenic index and HOMA-%β. Multiple regression analysis revealed that HbA1c was independently associated with diastolic pressure, 0- and 120-minute glucose, and HOMA-IR; GA was independently associated with 0- and 120-minute glucose.Conclusion: Compared with HbA1c, GA is more closely correlated with fasting and postprandial glucose, regardless of insulin resistance and blood pressure, and might be a better monitoring index in women with GDM.

View the full article at ScienceDirect

Abstract: Objective: To compare the effects of low and conventional doses of tibolone in brachial artery flux parameters among postmenopausal women.Methods: Between March 2011 and September 2012, 24 postmenopausal women attending Gynecology and Obstetrics Hospital Luis Castelazo Ayala, Mexico City, for hormone replacement therapy were consecutively recruited. The women were alternately assigned to receive a daily dose of either 2.5mg (n=11) or 1.25mg (n=13) of oral tibolone. Before and after treatment, all women underwent a brachial artery Doppler ultrasound. The arterial diameter was measured, and the pulsatility index (PI) and the resistance index (RI) were calculated. A hyperemic stimulus was then induced and these parameters were measured again.Results: Among the 24 women, the time since menopause ranged from 16 to 24months, and the median treatment duration was 3months. Both groups showed a significant increase in arterial diameter after treatment. There was no significant difference between the groups in arterial diameter, PI, and RI. The arterial diameter after hyperemic stimulus was significantly lower after treatment than before treatment in both groups.Conclusion: Low and conventional doses of tibolone induced similar changes in brachial artery flux parameters among postmenopausal women.

View the full article at ScienceDirect

Abstract: Objective: To determine whether healthcare providers performed active management of the third stage of labor (AMTSL) as defined by FIGO/ICM and WHO, and as described by the Cochrane Collaboration.Methods: In a prospective observational study, a questionnaire regarding knowledge of AMTSL was administered to healthcare providers in the largest maternity teaching center in Colombia. It was subsequently observed whether and how the healthcare providers performed AMTSL in practice. The percentage of correct use of AMTSL was calculated.Results: Healthcare providers indicated they knew what AMTSL was but disagreed on the timing of prophylactic oxytocin use. In total, 241 deliveries were observed. Oxytocin at varying doses and routes was used in 239 (99.2%) deliveries. In all deliveries, the umbilical cord was clamped early. In 49 (20.3%) deliveries, controlled cord traction was performed. Uterine massage was carried out in 213 (88.4%) deliveries. According to the FIGO/ICM and WHO definitions, and the Cochrane Collaboration description, correct use of AMTSL occurred in 0.8%, 0.0%, and 8.3%, of cases, respectively.Conclusion: Correct use of AMTSL is low at the largest maternity teaching center in Colombia. There is an urgent need for a single definition of AMTSL, which could be used globally for research, training, and scaling-up the performance of AMTSL.

View the full article at ScienceDirect