International Journal of Gynecology & Obstetrics最新文献

Objective: This study assesses the process and adequacy of informed consent for elective and emergency caesarean section in two teaching hospitals in Enugu, South-East Nigeria.

Methods: This was a descriptive cross-sectional study. Pre-tested questionnaires were administered to consenting 386 mothers after caesarean sections at the postnatal wards of University of Nigeria Teaching Hospital (UNTH) Ituku-Ozalla, and Enugu State University Teaching Hospital (ESUTH), Enugu. The adequacy of maternal counseling was assessed by evaluating the basics of the consent process for caesarean section. Descriptive statistics, including counts and percentages, were used to summarize the data, and 95% confidence intervals (CIs) were calculated to assess the precision of the estimates using the IBM Statistical Product and Service Solutions (IBM-SPSS) Statistics for Windows, version 25.

Results: Of the 386 respondents, the majority (29.8%) were in the 31-35 age group and most of the respondents (56.7%) had tertiary level of education. The proportion of women who received adequate counseling for caesarean section was 41.7%. The prevalence of adequate informed consent among women who had elective versus emergency caesarean section was 67.9% and 39.9%, respectively, (OR = 3.2, CI 95% [2.40-4.28]). Only 20.2% (78) of the respondents had full documentation of the consent process in their case notes, including the patient's response after being given the relevant information.

Conclusion: Overall, there was inadequate maternal counseling at the two teaching hospitals in Enugu State, Nigeria, which provide are the highest level of health care in the state. Adequate and consistent counseling for caesarean section can be achieved in the study area using standardized consent forms and healthcare workers' training in patient communication and counseling.

Uterine leiomyomas are benign gynecologic tumors that occur in approximately 80% of women of reproductive age. Although often asymptomatic, these tumors may, in some cases, require gynecologic intervention. Conventional imaging tools, such as ultrasonography (US) and magnetic resonance imaging (MRI), are most commonly used to guide treatment selection. However, none of these methods provides definitive criteria for qualifying patients for medical, non-invasive, or surgical therapy. Therefore, there is a pressing need to develop innovative tools that improve the evaluation of uterine masses and allow for safer and more effective patient stratification for appropriate treatment options. In this context, the relatively recent development of techniques for assessing tissue stiffness offers promising possibilities. The aim of this review was to analyze available research on the use of ultrasound elastography and magnetic resonance elastography in the evaluation of uterine leiomyomas. It highlights the feasibility of these techniques in assessing the viscoelastic properties of leiomyomas and explores their potential application in differential diagnosis and treatment planning.

Pre-eclampsia (PE) and fetal growth restriction (FGR) are among the leading causes of maternal and perinatal morbidity and mortality worldwide. Both conditions are more frequent and severe at high altitudes due to physiological changes in oxygen availability and vascular adaptation. This narrative review explores the complex relationship between high-altitude pregnancy, the development of PE and FGR, and the underlying adaptive mechanisms that may influence maternal and fetal outcomes. We provide an updated synthesis of the current evidence regarding placental dysfunction, angiogenic imbalance, and oxidative stress in pregnancies at high altitude, highlighting the role of hypoxia-inducible factors, altered expression of sFlt-1 and PlGF, and their impact on trophoblast invasion and uteroplacental blood flow. The review also highlights genetic and physiological adaptations observed in permanent high-altitude populations that appear to mitigate these risks, including enhanced oxygen delivery, increased uterine artery diameter, and reduced placental vascular resistance. This review emphasizes the importance of considering geographic and environmental factors in pregnancy outcomes and calls for further research to better understand the mechanisms driving adverse outcomes at high altitude.

Objective: This study evaluates whether timing of amniotomy affects labor characteristics and maternal and neonatal outcomes in twin deliveries.

Methods: This retrospective study was conducted at a single academic medical center and included dichorionic diamniotic (DCDA) twin pregnancies with a normal anomaly scan and a vertex-presenting leading twin, delivered over a 7-year period. The cohort was divided into two groups: early amniotomy (performed at cervical dilation ≤3 cm) and late amniotomy (performed at >3 cm cervical dilation). Exclusion criteria included monochorionic twin pregnancies and planned elective cesarean deliveries. Maternal demographics, delivery characteristics, and neonatal outcomes were compared between groups.

Results: Of 51 592 deliveries, 1196 were twins; 565 DCDA pregnancies met the inclusion criteria (early n = 279; late n = 286). Groups were similar in age, body mass index (kg/m²), comorbidities, and gestation. Nulliparity and intrapartum cesarean rates were more common in the early amniotomy group (56.6% vs. 29.4%; P < 0.001, 24.4% vs. 9.8%; P < 0.001, respectively). Induction and augmentation rates, rupture-to-delivery interval, second stage duration, intrapartum fever, and meconium were similar. Neonatal outcomes, including birthweight, 5-min Apgar <7, neonatal intensive care unit admission, and composite morbidity were comparable. On adjusted analysis, early amniotomy (adjusted odds ratio [aOR] 1.84; 95% confidence interval 1.09-3.1), nulliparity (aOR 5.60; 3.17-9.87), and previous cesarean (aOR 3.94; 1.32-11.77) increased cesarean risk, whereas epidural was protective (aOR 0.40; 0.24-0.67).

Conclusion: In DCDA twin labor, early amniotomy (≤3 cm) is associated with increased intrapartum cesarean, despite similar durations of labor and neonatal outcomes. Amniotomy timing should be individualized, with caution against routine early rupture.

Objective: A single oral dose of azithromycin (AZM) given during labor to women planning a vaginal delivery reduced maternal infections including sepsis, with a stronger effect in sub-Saharan Africa than South Asia. Since maternal infection contributes to labor dysfunction and postpartum hemorrhage (PPH), we evaluated the effect of AZM on the risk of PPH and blood transfusion.

Methods: This was an unplanned secondary analysis of the Azithromycin Prevention in Labor Use Study (A-PLUS) randomized controlled trial at eight sites in seven low- and middle-income countries in sub-Saharan Africa, South Asia, and Latin America. The population consisted of pregnant women in labor at ≥28 weeks' gestation in health facilities randomized to either 2 g AZM or placebo. Based on an intent-to-treat analysis, the risk of PPH and blood transfusion was compared between AZM and placebo arms using Poisson regression adjusting for arm and site as fixed effects. The main outcome measures were (1) PPH (500 mL or greater) after delivery; and (2) postpartum blood transfusion after delivery.

Results: A total of 29 278 participants were randomized to APLUS; 14 590 to AZM and 14 688 to placebo. The risk of PPH did not significantly differ between AZM and placebo arms (1.4% in AZM; 1.6% in placebo; relative risk [RR] = 0.88; 95% confidence interval [CI]: 0.73, 1.07). The risk of blood transfusion also did not significantly differ between AZM and placebo arms (0.5% in AZM; 0.5% in placebo; RR = 0.90; 95% CI: 0.65, 1.25). There was also evidence indicating that the effect of AZM on the risk of blood transfusion, but not PPH, was beneficial in sub-Saharan Africa but not in South Asia (P value for two-way interaction = 0.002).

Conclusion: A single intrapartum oral dose of AZM did not significantly reduce the overall risk of PPH or blood transfusion.

Clinicaltrials: gov Identifier: NCT03871491.