International Federation of Gynecology and Obstetrics

Abstract: Objective: To determine the distribution of HPV-16 variants among Paraguayan women with different grades of cervical lesions.Methods: Sixty-seven HPV-16-positive cervical samples obtained from women attending health centers in Paraguay between March 2007 and April 2009 were examined, including 29 low-grade squamous intraepithelial lesion (LSIL), 29 high-grade squamous intraepithelial lesion (HSIL), 4 cervical cancer, and 5 normal cytology samples. The specimens were analyzed by PCR-directed sequencing of a 364-bp fragment of the long control region of HPV-16, and a phylogenetic tree was compiled with MEGA 5.0 software.Results: Most HPV-16 variants belonged to the European branch (82%); these variants were detected among 25 of 29 women with LSIL, 22 of 29 women with HSIL, 3 of 4 women with cervical cancer, and all women with normal cytology. Two isolates yielded new variants of the European branch with nucleotide substitutions at positions A7752C and A7810T. Non-European variants, such as African type 1 (1.5%) and Asian-American (16.5%), were detected only among women with cervical lesions (4/29, LSIL; 6/29, HSIL; 1/29, cervical cancer). These variants had at least 6 nucleotide substitutions adjacent to or within transcription factor binding sites.Conclusion: All branches of HPV-16 variants were detected among Paraguayan women with cervical lesions.

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Abstract: Objective: To evaluate the prevalence and perception of intimate partner violence (IPV) among women in the primary healthcare network in the state of São Paulo, Brazil.Methods: In a cross-sectional descriptive study conducted between August 2008 and May 2009 in São Paulo state, Brazil, sociodemographic variables (age, education, ethnicity, paid employment, religion, marital status, economic stratum), experiences of IPV (physical, sexual, psychological), and women’s perception of violence were compared among 2379 women attending primary healthcare units. Statistical analysis was performed via χ2 test, Student t test, and multiple logistic regression (odds ratios with 95% confidence intervals) to determine interrelations between the type and perception of violence.Results: The overall prevalence of IPV was 55.7%, whereas that of psychological, physical, and sexual violence was 53.8%, 32.2%, and 12.4%, respectively; however, only 48.7% of women who experienced IPV had perceived this violence. The perception of IPV was highest for sexual violence (76.3%), followed by physical (64.7%) and psychological (49.7%) violence.Conclusion: The results showed that, among women within the primary healthcare network in the state of São Paulo, a high percentage had experienced some form of IPV during their lifetime but the rate of self-perception of IPV was low.

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Abstract: Objective: To compare intra-/inter-operator reliability of manual and semi-automated NT measurement by experienced operators.Methods: Images of 103 fetuses at 11 to 13+6weeks were selected. Two operators performed NT measurement independently 3 times each using both manual and semi-automated methods. Intraoperator reliability of the methods was evaluated using ICCs; interoperator reliability was assessed via correlation between the means of the 3 measurements of each operator. Agreement between the 2 methods was evaluated via Bland–Altman plot.Results: ICCs for the manual method were 0.80 (95% CI, 0.73–0.85) for operator 1 and 0.82 (95% CI, 0.76–0.87) for operator 2; ICCs for the semi-automated method were 0.80 (95% CI, 0.74–0.85) for operator 1 and 0.82 (95% CI, 0.76–0.86) for operator 2. Interoperator reliability for both methods was high: correlation coefficients 0.91 (95% CI, 0.87–0.94) and 0.96 (95% CI, 0.94–0.97) for manual and semi-automated methods, respectively. Mean NT measured by manual and semi-automated methods was 1.15mm and 1.28mm, respectively (P<0.001). Agreement between the methods was good.Conclusion: The reliability of semi-automated NT measurements was comparable to that of the manual method. The new method was reproducible and may be used instead of the manual method in the normal range of NT.

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Ovarian osteoma is a rare benign tumor, with only 4 histologically confirmed cases described in the literature (). The present case is reported not only because of its rarity, but also to draw attention to the tumor’s characteristic sonographic appearance, including a focal hyperechoic component, acoustic shadowing, and no internal flow at color Doppler ultrasound. However, these features are also considered classic for a teratoma and thus, sonographically, it is difficult to distinguish an ovarian osteoma from a teratoma.

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Abstract: Background: The optimal management of leiomyomas during cesarean delivery is unclear.Objectives: To assess the safety of myomectomy performed during cesarean delivery.Search strategy: PubMed, MEDLINE, EMBASE, and Cochrane Library were searched to identify potentially relevant studies published prior to June 30, 2012.Selection criteria: Case-control study comparing myomectomy with no myomectomy in patients undergoing cesarean delivery.Data collection and analysis: The quality of the studies was assessed and data were extracted independently by 2 authors.Main results: Nine studies, including 1 082 women with leiomyomas, met the inclusion criteria; 443 (41.0%) women underwent cesarean myomectomy and 639 (59.1%) underwent cesarean delivery alone. The drop in hemoglobin after surgery was 0.30g/dL greater in the cesarean myomectomy group than in the control group, but the difference was not significant. The operative time was 4.94minutes longer in the cesarean myomectomy group, but again the difference was not significant. The overall incidence of fever was comparable in the 2 groups. No hysterectomies were performed in any of the included studies.Conclusions: Cesarean myomectomy may be a reasonable option for some women with leiomyoma. However, no definite conclusion can be drawn because the data included in the meta-analysis were of low quality.

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Abstract: Objective: To document Georgian physician’s knowledge, attitudes, and practices concerning HPV, Pap smear testing, and HPV vaccination, and to assess whether physician practice might change with additional education and training.Methods: A cross-sectional study was conducted using a self-administered written survey of 288 physicians practicing in 7 healthcare institutions in Tbilisi, Rustavi, and Batumi, Georgia. Data were collected on demographics, conduct of and perceived barriers to Pap smear testing, knowledge about HPV and HPV vaccination, and willingness to receive education and training about HPV and cervical cancer. Univariate counts and proportions were calculated. Pap smear testing and barriers were compared across demographics using bivariate and Poisson regression with robust error variance methods.Results: Overall, 54% of physicians never performed Pap smears; most reported testing was not their responsibility. Most (88%) obstetricians/gynecologists performed Pap smears. Younger physicians were more likely to perform Pap smears. Approximately 48% of physicians actively offered the HPV vaccine. Most physicians were receptive to increased education and training about HPV and cervical cancer.Conclusion: Age-related differences in the conduct of and attitudes toward Pap smear testing exist among Georgian physicians. There is an opportunity to increase Pap smear testing and provide evidence-based HPV vaccine counseling in Georgia.

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Abstract: Objective: To assess the association of 3 types of intimate partner violence (IPV)—verbal, physical, and sexual—with self-reported symptoms of reproductive tract infections (RTIs) among married Indian women.Methods: A cross-sectional analysis of population-based data from the 2005–2006 Indian National Family Health Survey-3 was conducted. The sample comprised 65610 married Indian women of reproductive age (15–49years).Results: Overall, 23.9% of women experienced at least 1 type of IPV, and 9.6% reported at least 1 RTI symptom in the year preceding the survey. Verbal, physical, and sexual IPV each demonstrated a significant independent effect on the reporting of genital sores and abnormal genital discharge. Additionally, the more types of IPV a woman experienced, the higher her odds of also reporting genital sores and abnormal genital discharge.Conclusion: No single type of IPV explains women’s risk of RTIs; rather, there are multiple pathways by which women’s experience of IPV can result in RTIs. Sexual and reproductive healthcare that incorporates IPV support services is needed to meet the special needs of abused women. Additionally, RTI screening should be considered by non-governmental organizations providing care for women who have experienced IPV, especially those who report multiple types of violence.

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A cesarean scar pregnancy (CSP) is defined as a gestational sac located in the scar of a previous cesarean delivery. A CSP is considered a life-threatening condition owing to the high risk of uterine rupture and uncontrolled hemorrhage. A variety of strategies exist for the treatment of CSP, and it is well recognized that management with direct intra-sac injection of embryocidal agents (methotrexate and potassium chloride) followed by dilation and curettage has the lowest complication rate . The present study reports a case of a CSP treated successfully with local injection of ethanol via hysteroscopy followed by dilation and curettage under transvaginal ultrasound guidance.

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Abstract: Well-trained medical professionals are key to improving global reproductive health and reducing rates of unsafe abortion, but medical training often fails to prepare practitioners to provide essential family planning services. The field of medical education is currently undergoing reformation to better meet the needs of a global population, and comprehensive, integrated family planning training will be an important part of those reforms. Family planning training is not only vital to address global reproductive healthcare demand, but integrates effectively with cornerstones of current medical education reform: competency-based education, leadership development, collaboration with practitioners of all levels, and global health context. Examples of successful integration of family planning education are outlined, and recommendations for integrating family planning into medical education detailed at the 2012 FIGO World Congress are discussed.

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Abstract: Objective: To assess the frequency of fetal facial expressions at 25–27weeks of gestation using 4D ultrasound.Methods: Twenty-four normal fetuses were examined using 4D ultrasound. The face of each fetus was recorded continuously for 15minutes. The frequencies of tongue expulsion, yawning, sucking, mouthing, blinking, scowling, and smiling were assessed and compared with those observed at 28–34weeks of gestation in a previous study.Results: Mouthing was the most common facial expression at 25–27weeks of gestation; the frequency of mouthing was significantly higher than that of the other 6 facial expressions (P<0.05). Yawning was significantly more frequent than the other facial expressions, apart from mouthing (P<0.05). The frequencies of yawning, smiling, tongue expulsion, sucking, and blinking differed significantly between 25–27 and 28–34weeks (P<0.05).Conclusion: The results indicate that facial expressions can be used as an indicator of normal fetal neurologic development from the second to the third trimester. 4D ultrasound may be a valuable tool for assessing fetal neurobehavioral development during gestation.

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