Medicine JournalFeeds

Opinion and experience of Brazilian women regarding menstrual bleeding and use of combined oral contraceptives.

Int J Gynaecol Obstet. 2012 Jan 27;

Authors: Makuch MY, Duarte-Osis MJ, de Pádua KS, Petta C, Bahamondes L

Abstract

OBJECTIVE: To describe the opinion and experience of Brazilian women regarding menstruation and the use of combined oral contraceptives (COCs) to control monthly bleeding and induce amenorrhea. METHODS: Women attending regional public healthcare clinics for non-gynecologic conditions, and female members of staff from university schools unrelated to the field of medicine completed a questionnaire. RESULTS: Of the 1111 women interviewed, 64.3% reported disliking menstruation. The desired frequency of bleeding was never (65.3%), less than monthly (18.2%), and every month or more often (16.5%). More than 60% of the women reported that they would use COCs to control menstrual bleeding, 82.0% would use COCs to reduce the amount of bleeding experienced, and 86.1% would use COCs to induce amenorrhea. When compared with women who disliked menstruation, those who reported that they liked to experience monthly bleeding had fewer years of schooling (OR1.98; 95% CI, 1.30-2.97), low socioeconomic status (OR 1.66; 95%CI, 1.12-2.46), fewer days of menstruation each month (OR 1.62; 95%CI, 1.11-2.36), and 1 or more child (OR 1.13; 95%CI, 1.01-1.26). CONCLUSION: Many of the women surveyed disliked monthly menstruation and were interested in the use of COCs to control menstrual bleeding and induce amenorrhea.

PMID: 22285856 [PubMed - as supplied by publisher]

Community-driven impact of a newborn-focused behavioral intervention on maternal health in Shivgarh, India.

Int J Gynaecol Obstet. 2012 Jan 24;

Authors: Kumar V, Kumar A, Das V, Srivastava NM, Baqui AH, Darmstadt GL, Santosham M,

Abstract

OBJECTIVE: To assess the effect on maternal health outcomes of a community-based behavior change management intervention for essential newborn care leading to a reduction in neonatal mortality. METHODS: A cluster-randomized controlled trial involving 1 control and 2 intervention arms was conducted in Shivgarh, India, between January 2004 and May 2005. Risk-enhancing domiciliary newborn care behaviors, including those posing a concomitant risk to maternal health, were targeted through home visits and community meetings. Secondary outcomes included knowledge of maternal danger signs, self-reported complications, maternal care practices, care-seeking from trained providers, and maternal mortality ratio (MMR). The intervention arms were combined for analysis, which was done by intention to treat. RESULTS: Significant improvements were observed in maternal health equity and outcomes including knowledge of danger signs, care practices, self-reported complications, and timely care-seeking from trained providers. The difference in adjusted MMR was not significant (relative risk 0.44; 95% confidence interval, 0.14-1.43; P=0.11) owing to the inadequate sample size for this outcome, but may suggest a decline in MMR given improvements in other outcomes in the causal pathway to mortality. CONCLUSION: Community-based strategies focused on prevention and care-seeking effectively complemented facility-based strategies toward improving maternal health, while synergizing with newborn care interventions.

PMID: 22281244 [PubMed - as supplied by publisher]

The effect of tuberculosis on ovarian reserve among women undergoing IVF in India.

Int J Gynaecol Obstet. 2012 Jan 18;

Authors: Malhotra N, Sharma V, Bahadur A, Sharma JB, Roy KK, Kumar S

Abstract

OBJECTIVE: To assess ovarian reserve in infertile women with genital tuberculosis planning to undergo in vitro fertilization and in women of proven fertility, and compare the findings. METHODS: A cross-sectional study was conducted at an outpatient gynecology unit with 104 women with genital tuberculosis and 104 healthy controls. In each group, ovarian reserve tests consisted in estimating serum levels of follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol, and inhibin B on day 3 of a natural menstrual cycle. On the same day ovarian volume, number of antral follicles, and ovarian stromal blood flow were also estimated. RESULTS: The mean FSH and LH levels were significantly higher, and the mean inhibin B levels were significantly lower, among the participants with genital tuberculosis than among the controls. Conversely, the mean ovarian volume and the mean number of antral follicles were significantly lower among the participants with genital tuberculosis, as were the mean peak systolic velocity and pulsatility index for each ovary. CONCLUSION: There is no single absolute predictor of ovarian reserve, but combining the current assessment methods provides a close estimation of a woman’s reproductive capability. Values for the studied markers showed that ovarian reserve was compromised in women with genital tuberculosis.

PMID: 22265187 [PubMed - as supplied by publisher]

Group B streptococcus and Escherichia coli colonization in pregnant women and neonates in Lithuania.

Int J Gynaecol Obstet. 2012 Jan 18;

Authors: Barcaite E, Bartusevicius A, Tameliene R, Maleckiene L, Vitkauskiene A, Nadisauskiene R

Abstract

OBJECTIVE: To evaluate the prevalence of maternal and neonatal colonization with group B streptococcus (GBS) and Escherichia coli, and examine GBS serotypes and susceptibility to antibiotics. METHODS: A prospective cross-sectional study was carried out in Lithuania between October 2006 and June 2007. Lower vaginal/rectal swabs were obtained from pregnant women (n=998) and ear canal/throat swabs were obtained from their newborns (n=827) for culture. RESULTS: Overall, maternal and neonatal GBS colonization rates were 15.3% and 6.4%, respectively. Serotypes III (34.5%) and Ia (29.7%) were most common. All GBS isolates were susceptible to penicillin and 4.1% were resistant to erythromycin. Overall, maternal and neonatal E. coli colonization rates were 19.9% and 14.4%, respectively. In total, 71.4% of newborns with E. coli colonization were born to E. coli-negative mothers. E. coli was resistant to ampicillin and piperacillin in 25.9% and 16.6% of cases, respectively. The majority of E. coli-colonized newborns were contaminated with maternal fecal, but not vaginal, E. coli strains. CONCLUSION: Maternal and neonatal GBS colonization rates, serotypes, and susceptibility to antibiotics were comparable to those reported in previous studies. Population-based data regarding early-onset neonatal infection rates will enable the formulation of a prevention program for early-onset GBS disease in Lithuania.

PMID: 22265188 [PubMed - as supplied by publisher]

The role of genital pathogens in morbidity following diathermy loop excision of the transformation zone of the uterine cervix.

Int J Gynaecol Obstet. 2012 Jan 18;

Authors: Arko D, Dovnik A, Fokter N, Takač I

Abstract

OBJECTIVE: To evaluate the role of genital pathogens in postoperative morbidity following diathermy loop excision of the transformation zone (LETZ) of the uterine cervix. METHODS: Patients with cervical intraepithelial neoplasia (CIN) who underwent diathermy LETZ were included in a prospective study. Cervical swabs for genital pathogens were collected before the diathermy procedure. After surgery, women were followed-up regarding the occurrence and severity of postoperative pain, bleeding, and discharge. RESULTS: Genital pathogens were present in 463 of 788 (58.8%) cases. The most frequently isolated groups of microorganisms were group B β-hemolytic Streptococcus, α-hemolytic Streptococcus, Enterococcus species, and coliforms. In patients with genital pathogens, postoperative pain was present in 298 (37.8%), discharge in 262 (33.2%), and bleeding in 236 (29.9%) cases. In patients without genital pathogens, 199 (25.3%) experienced pain, 181 (23.0%) discharge, and 143 (18.1%) bleeding. The differences between the 2 groups were not statistically significant (χ(2) for pain=0.675; χ(2) for discharge=0.031; χ(2) for bleeding=3.444; P>0.05). CONCLUSION: Genital pathogens are very common among patients with CIN and do not affect the occurrence or severity of pain, discharge, or postoperative bleeding after diathermy LETZ.

PMID: 22265189 [PubMed - as supplied by publisher]

Incidence of gestational diabetes mellitus in Bahrain from 2002 to 2010.

Int J Gynaecol Obstet. 2012 Jan 18;

Authors: Rajab KE, Issa AA, Hasan ZA, Rajab E, Jaradat AA

Abstract

OBJECTIVE: To determine the incidence and trends of gestational diabetes mellitus (GDM) in Bahrain from 2002 to 2010, and to investigate 2 possible risk factors within the affected population. METHODS: In a retrospective survey, data on maternal body weight and age were collected from women who gave birth in government maternity units in Bahrain and who were screened for GDM during pregnancy using the 2-step approach and criteria of the US Expert Committee on the diagnosis and classification of diabetes. RESULTS: Among 49552 pregnant women, 4982 (10.1%) were diagnosed with gestational diabetes. The Cox-Stuart test for trend analysis suggested that there was an increase in the incidence of gestational diabetes from 7.2% in 2002 to 12.5% in 2010 (P<0.01). For the period 2006-2010, maternal age, and weight at onset of pregnancy and at time of delivery were positively associated with risk of GDM with an odds ratio (95% confidence interval) of 1.094 (1.081-1.107), 1.081 (1.001-1.104), and 1.027 (1.013-1.040), respectively. CONCLUSION: A combination of increasing maternal weight, maternal age, and incidence of GDM among women in Bahrain indicates a significant future burden on health services.

PMID: 22265190 [PubMed - as supplied by publisher]

Prenatal care and basic emergency obstetric care services provided at primary healthcare facilities in rural Nigeria.

Int J Gynaecol Obstet. 2012 Jan 18;

Authors: Okoli U, Abdullahi MJ, Pate MA, Abubakar IS, Aniebue N, West C

Abstract

OBJECTIVE: To assess the availability of prenatal care and basic emergency obstetric care services at primary healthcare (PHC) facilities in rural Nigeria. METHODS: In total, 652 PHC facilities enrolled in the Midwives Service Scheme, a government-funded program designed to reduce the national shortage of skilled birth attendants, were surveyed. RESULTS: In all, 44.0% of the PHC facilities evaluated did not provide all components of prenatal care, and only 39.0% of all pregnant women nationwide attended prenatal care clinics 4 or more times. In addition, 52.2% of the facilities were not distributing insecticide-treated nets to pregnant women, while only 36.8% of the PHC facilities provided services to prevent mother-to-child transmission of HIV. By contrast, 70.0% of the PHC facilities had access to antibiotics for the treatment of uncomplicated sepsis. Only 11.0% of clinics reported the use of vacuum extraction during labor and 36.8% provided post-abortion care services. Treatment for pre-eclampsia and eclampsia was initiated at 40.0% and 28.0% of PHC facilities, respectively, prior to referral. CONCLUSION: The present study provides useful information on the state of prenatal and basic emergency obstetric care in rural Nigeria. The data obtained indicate that changes are needed to achieve related Millennium Development Goals.

PMID: 22265191 [PubMed - as supplied by publisher]

Clinical evaluation of neoadjuvant chemotherapy followed by radical surgery in the management of stage IB2-IIB cervical cancer.

Int J Gynaecol Obstet. 2012 Jan 20;

Authors: Gong L, Lou JY, Wang P, Zhang JW, Liu H, Peng ZL

Abstract

OBJECTIVE: To evaluate clinical efficacy, toxicity, and survival outcomes of neoadjuvant chemotherapy (NACT) followed by radical surgery (RS) among patients with cervical cancer stage IB2-IIB. METHODS: In a retrospective clinical study at West China Second Hospital, Chengdu, data were analyzed from 414 patients who underwent NACT followed by radical surgery (NACT-RS) or RS alone between January 2008 and November 2009. RESULTS: The clinical response for NACT was 90%. Lymph node metastasis (25% versus 48%, P<0.05) and deep cervical stromal invasion more than 0.5, (68% versus 91%, P<0.05) were significantly lower among responders than among non-responders, respectively, in the NACT-RS group. The 2-year progression-free survival and 2-year overall survival were 93.0% and 95.5% in the NACT-RS group, and 94.5% and 97.1% in the RS group (P>0.05). Parametric infiltration (hazard ratio [HR], 7.668; P<0.05) and lymph node metastasis (HR, 7.714; P<0.05) were independent risk factors for all study patients. CONCLUSION: Compared with RS, NACT-RS did not show a significant advantage for patients with locally advanced cervical cancer. However, the data provide the rationale for assessing NACT-RS in a multicenter randomized clinical trial setting. NACT may be considered as an alternative treatment when radiotherapy is not available.

PMID: 22265255 [PubMed - as supplied by publisher]

A multicenter study of the clinical characteristics of usual-type vulvar intraepithelial neoplasia in China.

Int J Gynaecol Obstet. 2012 Jan 17;

Authors: Li X, Zhu L, Gu Y, Jin H, Wang C, Lang J

Abstract

OBJECTIVE: To investigate clinical characteristics of usual-type vulvar intraepithelial neoplasia (uVIN) in China. METHODS: A retrospective review of the records of 64 patients with uVIN was performed at 3 academic hospitals between 2004 and 2010. Patients were assigned to a younger (≤40years) or an older (>40years) group. Clinical characteristics of lesions were described and analyzed. RESULTS: Mean patient age was 40.6years. There was a high proportion of incidental findings (34%), multifocal lesions (64%), variegated lesions (59%), and multiple neoplastic lesions in the lower genital tract (20%). As patient age increased, so did numbers of patients reporting pain (P<0.05). Longer time between symptom onset and uVIN diagnosis, and more multifocal lesions were noted in the older group (P<0.05). Whereas younger patients often presented with cervical intraepithelial neoplasia and uVIN, older patients often presented with intraepithelial neoplasia at uncommon locations (e.g. vagina, anus, and periurethral region) (P<0.05). No differences between the groups were found regarding gross appearance or anatomic location of uVIN lesions (P>0.05). CONCLUSION: Age-specific differences were noted in location of neoplastic lesions in the lower genital tract and time to diagnosis of uVIN. However, the clinical features of uVIN lesions were heterogeneous and non-age specific.

PMID: 22261126 [PubMed - as supplied by publisher]

A shortened postpartum magnesium sulfate prophylaxis regime in pre-eclamptic women at low risk of eclampsia.

Int J Gynaecol Obstet. 2012 Jan 17;

Authors: Darngawn L, Jose R, Regi A, Bansal R, Jeyaseelan L

Abstract

OBJECTIVE: To determine whether magnesium sulfate (MgSO(4)) prophylaxis is needed for up to 24hours postpartum in all patients with pre-eclampsia. METHODS: In a randomized open clinical trial conducted in a tertiary health center in India between September 2008 and April 2010, 150 women with severe pre-eclampsia who received intrapartum MgSO(4) and delivered at more than 20weeks gestation were enrolled. After 6hours postpartum, the participants were randomized to continue receiving (control group) or to discontinue (intervention group) MgSO(4), and outcomes were compared. RESULTS: Administration of MgSO(4) had to be reinstituted for 1 woman in the intervention group. Under the current protocol in the institution, all 75 women in the intervention group would have received MgSO(4) for 24hours postpartum. A significant reduction in time spent by the doctors (P<0.001) and nurses (P<0.001) was seen in the intervention group. The pain score in the intervention group was significantly less (P<0.001), and women in the intervention group were able to look after themselves better (P<0.001). CONCLUSION: For women at low risk for postpartum eclampsia, a shortened (6-hour) MgSO(4) regime was as effective for seizure prophylaxis as the conventional 24-hour regime, with significant benefits in terms of cost and morbidity.

PMID: 22261127 [PubMed - as supplied by publisher]