Pub Date : 2021-10-28DOI: 10.15406/ogij.2021.12.00604
A. Badeghiesh, A. Vilos, H. Baghlaf, Jana Abi Rafeh, N. Alzawawi, B. Abu-Rafea, G. Vilos
Objective: To investigate reproductive and neonatal outcomes in women with unicornuate uterus. Study design: Data from the Health Care Cost and Utilization Project-Nationwide Inpatient Sample database were extracted from 2010 through 2014 to create a delivery cohort using ICD-9 codes. Code 752.33 was used to identify cases with unicornuate uterus and reproductive outcomes were compared to pregnancies without unicornuate uterus. A multivariate logistic regression model was used to adjust for statistically significant variables (P-value<0.05). Results: Among 3,850,226 deliveries during the study period, 802 women had unicornuate uterus. Patient with unicornuate uterus were more likely to be older (P<0.001), have thyroid disease (P<0.001), previous Caesarean section (P<0.001), and to have had in-vitro fertilization (IVF) (P<0.001). The risk of gestational diabetes, pregnancy induced hypertension, gestational hypertension and preeclampsia were significantly greater in the unicornuate uterus group relative to controls, after controlling for baseline risk factors; aOR 1.32 [95% CI 1.03–1.71], aOR 1.46 [95% CI 1.16–1.85], aOR 1.16 [95% CI 1.22-2.28] and aOR 1.70 [95% CI 1.24-2.32], respectively. Also, the rates of preterm delivery, preterm premature rupture of membranes and caesarean section were higher in the unicornuate uterus group compared to controls after controlling for confounding factors, aOR 3.83 (95% CI 3.19–4.6), aOR 5.11 (95% CI 3.73–7.14) and aOR 11.38 (95% CI 9.16–14.14) respectively. At birth, 11.1% and 2.6% of neonates were small for gestational age in the unicornuate uterus and the control groups, respectively, aOR 4.90, (95% CI 3.87-6.21). Conclusion: Women with unicornuate uterus are at higher risk for pregnancy complications, preterm delivery and having small for gestation age neonates. Women with known unicornuate uterus may benefit from increased surveillance to prevent and/or decrease maternal and neonate morbidity and mortality.
目的:探讨独角子宫妇女的生殖和新生儿结局。研究设计:从2010年至2014年的卫生保健成本和利用项目-全国住院患者样本数据库中提取数据，使用ICD-9代码创建分娩队列。代码752.33用于识别有独角形子宫的病例，并将生殖结果与没有独角形子宫的妊娠进行比较。采用多因素logistic回归模型对有统计学意义的变量进行校正(p值<0.05)。结果:在研究期间的3,850,226例分娩中，802名妇女患有独角子宫。独角子宫患者年龄较大(P<0.001)、有甲状腺疾病(P<0.001)、有剖腹产史(P<0.001)、有体外受精(IVF)史(P<0.001)。在对基线危险因素进行控制后，独角子宫组妊娠期糖尿病、妊高征、妊娠期高血压、先兆子痫的发生风险显著高于对照组;分别为aOR 1.32 [95% CI 1.03-1.71]、aOR 1.46 [95% CI 1.16 - 1.85]、aOR 1.16 [95% CI 1.22-2.28]和aOR 1.70 [95% CI 1.24-2.32]。此外，在控制混杂因素后，独角子宫组的早产、早产早破和剖宫产率均高于对照组，分别为aOR 3.83 (95% CI 3.19-4.6)、aOR 5.11 (95% CI 3.73-7.14)和aOR 11.38 (95% CI 9.16-14.14)。出生时，在单角子宫组和对照组中，11.1%和2.6%的新生儿小于胎龄，aOR为4.90，(95% CI 3.87-6.21)。结论:单角子宫妇女发生妊娠并发症、早产及胎龄小新生儿的风险较高。已知有独角子宫的妇女可能受益于加强监测，以预防和/或减少产妇和新生儿的发病率和死亡率。
{"title":"Reproductive and neonatal outcomes in women with unicornuate uterus: a population-based study","authors":"A. Badeghiesh, A. Vilos, H. Baghlaf, Jana Abi Rafeh, N. Alzawawi, B. Abu-Rafea, G. Vilos","doi":"10.15406/ogij.2021.12.00604","DOIUrl":"https://doi.org/10.15406/ogij.2021.12.00604","url":null,"abstract":"Objective: To investigate reproductive and neonatal outcomes in women with unicornuate uterus. Study design: Data from the Health Care Cost and Utilization Project-Nationwide Inpatient Sample database were extracted from 2010 through 2014 to create a delivery cohort using ICD-9 codes. Code 752.33 was used to identify cases with unicornuate uterus and reproductive outcomes were compared to pregnancies without unicornuate uterus. A multivariate logistic regression model was used to adjust for statistically significant variables (P-value<0.05). Results: Among 3,850,226 deliveries during the study period, 802 women had unicornuate uterus. Patient with unicornuate uterus were more likely to be older (P<0.001), have thyroid disease (P<0.001), previous Caesarean section (P<0.001), and to have had in-vitro fertilization (IVF) (P<0.001). The risk of gestational diabetes, pregnancy induced hypertension, gestational hypertension and preeclampsia were significantly greater in the unicornuate uterus group relative to controls, after controlling for baseline risk factors; aOR 1.32 [95% CI 1.03–1.71], aOR 1.46 [95% CI 1.16–1.85], aOR 1.16 [95% CI 1.22-2.28] and aOR 1.70 [95% CI 1.24-2.32], respectively. Also, the rates of preterm delivery, preterm premature rupture of membranes and caesarean section were higher in the unicornuate uterus group compared to controls after controlling for confounding factors, aOR 3.83 (95% CI 3.19–4.6), aOR 5.11 (95% CI 3.73–7.14) and aOR 11.38 (95% CI 9.16–14.14) respectively. At birth, 11.1% and 2.6% of neonates were small for gestational age in the unicornuate uterus and the control groups, respectively, aOR 4.90, (95% CI 3.87-6.21). Conclusion: Women with unicornuate uterus are at higher risk for pregnancy complications, preterm delivery and having small for gestation age neonates. Women with known unicornuate uterus may benefit from increased surveillance to prevent and/or decrease maternal and neonate morbidity and mortality.","PeriodicalId":19389,"journal":{"name":"Obstetrics & Gynecology International Journal","volume":"5 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76987182","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-10-22DOI: 10.15406/ogij.2021.12.00600
S. AlJadir
Pregnancy is a complex endocrine and metabolic status in life of women, therefore role of the thyroid physiology during this period will be profoundly affected, this has been attributed to the complex interplay of Human chorionic gonadotrophin that acts as TSH receptors’ stimulant, more estrogen is produced by placenta will lead to rise in the serum level of Thyrogublin binding protein, change in iodine homeostasis, and hemodynamic changes. From 12th -16th week of pregnancy, the fetus is entirely dependent on the thyroid status of the mother, therefore any disruption in this metabolic milieu will lead to negative outcomes on both the fetus and the mother. Therefore, the current guidelines have stressed on appropriate management of thyroid dysfunction in pregnancy with particular interest on early pregnancy, a critical period for neurocognitive development, then throughout the pregnancy and postpartum period (Figure 1).
{"title":"Thyroid dysfunction in pregnancy: practical perspective","authors":"S. AlJadir","doi":"10.15406/ogij.2021.12.00600","DOIUrl":"https://doi.org/10.15406/ogij.2021.12.00600","url":null,"abstract":"Pregnancy is a complex endocrine and metabolic status in life of women, therefore role of the thyroid physiology during this period will be profoundly affected, this has been attributed to the complex interplay of Human chorionic gonadotrophin that acts as TSH receptors’ stimulant, more estrogen is produced by placenta will lead to rise in the serum level of Thyrogublin binding protein, change in iodine homeostasis, and hemodynamic changes. From 12th -16th week of pregnancy, the fetus is entirely dependent on the thyroid status of the mother, therefore any disruption in this metabolic milieu will lead to negative outcomes on both the fetus and the mother. Therefore, the current guidelines have stressed on appropriate management of thyroid dysfunction in pregnancy with particular interest on early pregnancy, a critical period for neurocognitive development, then throughout the pregnancy and postpartum period (Figure 1).","PeriodicalId":19389,"journal":{"name":"Obstetrics & Gynecology International Journal","volume":"45 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76612791","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-10-20DOI: 10.15406/ogij.2021.12.00599
B. Morshedi, L. Haworth, Traci Ito
Choriocarcinoma is a highly metastatic subtype of gestational trophoblastic neoplasia (GTN) following pregnancy. It can arise from any type of pregnancy (50% occur after term pregnancies, 25% after molar pregnancies, and 25% after early pregnancy loss and ectopic pregnancies) (Soper, 2006). This case report describes an interesting diagnostic conundrum with normal histology findings on two separate endometrial dilation and curettages (D&C) and a unilateral oophorectomy in the context of high clinical suspicion for molar pregnancy that progressed to stage IV choriocarcinoma with brain and lung metastasis. The patient presented to our hospital nearly aphasic but would only say “molar pregnancy”. Due to her brain metastasis and worsening intraparenchymal hematoma, she underwent craniotomy confirming the diagnosis. After stabilization, she was transferred to a quaternary care center to complete chemotherapy with etoposide, methotrexate, actinomycin, cyclophosphamide, and vincristine and had a good response. At this time, there is no clear explanation for normal histology on two separate D&Cs and a unilateral oophorectomy in the context of a classic case of choriocarcinoma with progression from a molar pregnancy. It reminds us as providers that medicine remains an imperfect science and requires astute clinical judgement to properly treat patients when diagnostic data such as pathology findings and lab values appear to be incongruent with the larger clinical picture.
{"title":"Choriocarcinoma (stage IV) despite two normal dilation and curettages: A case report","authors":"B. Morshedi, L. Haworth, Traci Ito","doi":"10.15406/ogij.2021.12.00599","DOIUrl":"https://doi.org/10.15406/ogij.2021.12.00599","url":null,"abstract":"Choriocarcinoma is a highly metastatic subtype of gestational trophoblastic neoplasia (GTN) following pregnancy. It can arise from any type of pregnancy (50% occur after term pregnancies, 25% after molar pregnancies, and 25% after early pregnancy loss and ectopic pregnancies) (Soper, 2006). This case report describes an interesting diagnostic conundrum with normal histology findings on two separate endometrial dilation and curettages (D&C) and a unilateral oophorectomy in the context of high clinical suspicion for molar pregnancy that progressed to stage IV choriocarcinoma with brain and lung metastasis. The patient presented to our hospital nearly aphasic but would only say “molar pregnancy”. Due to her brain metastasis and worsening intraparenchymal hematoma, she underwent craniotomy confirming the diagnosis. After stabilization, she was transferred to a quaternary care center to complete chemotherapy with etoposide, methotrexate, actinomycin, cyclophosphamide, and vincristine and had a good response. At this time, there is no clear explanation for normal histology on two separate D&Cs and a unilateral oophorectomy in the context of a classic case of choriocarcinoma with progression from a molar pregnancy. It reminds us as providers that medicine remains an imperfect science and requires astute clinical judgement to properly treat patients when diagnostic data such as pathology findings and lab values appear to be incongruent with the larger clinical picture.","PeriodicalId":19389,"journal":{"name":"Obstetrics & Gynecology International Journal","volume":"130 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76122732","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-10-19DOI: 10.15406/ogij.2021.12.00598
E. Nkwabong, Sylvie Borassi
Hemorrhage is one of the major causes of maternal death. Main causes of APH are placenta previa, placenta abruption and uterine rupture. Rare causes of placenta abruption include marginal and velamentous umbilical cord insertions. We hereby present a case of placenta abruption due to marginal umbilical cord insertions occurring on a bipartite placenta. A 40-year-old nulliparous African woman, 35 weeks pregnant consulted for dark red pervaginal bleeding, which occurred recently. Past history was unremarkable. Her pregnancy was well followed up. A recent ultrasound scan revealed a fundal inserted placenta. Physical examination revealed a fundal height of 37 cm, no uterine activity, normal fetal heart tones and a blood-stained vulva. Our diagnosis was a mild placenta abruption. An obstetrical ultrasound carried out revealed a normal pregnancy and a retroplacental blood clot of 11mm. A safe baby was born through an emergency cesarean section which revealed a normally inserted bipartite placenta with a 10% placenta detachment located on one placenta half and two cords inserted marginally. The postoperative period was uneventful and she was discharged five days after cesarean section. This case report shows that marginal cord insertion, which can lead to placenta abruption, can be also observed on a bipartite placenta.
{"title":"Marginal umbilical cord insertions in a bipartite placenta responsible for placenta abruption: a case report","authors":"E. Nkwabong, Sylvie Borassi","doi":"10.15406/ogij.2021.12.00598","DOIUrl":"https://doi.org/10.15406/ogij.2021.12.00598","url":null,"abstract":"Hemorrhage is one of the major causes of maternal death. Main causes of APH are placenta previa, placenta abruption and uterine rupture. Rare causes of placenta abruption include marginal and velamentous umbilical cord insertions. We hereby present a case of placenta abruption due to marginal umbilical cord insertions occurring on a bipartite placenta. A 40-year-old nulliparous African woman, 35 weeks pregnant consulted for dark red pervaginal bleeding, which occurred recently. Past history was unremarkable. Her pregnancy was well followed up. A recent ultrasound scan revealed a fundal inserted placenta. Physical examination revealed a fundal height of 37 cm, no uterine activity, normal fetal heart tones and a blood-stained vulva. Our diagnosis was a mild placenta abruption. An obstetrical ultrasound carried out revealed a normal pregnancy and a retroplacental blood clot of 11mm. A safe baby was born through an emergency cesarean section which revealed a normally inserted bipartite placenta with a 10% placenta detachment located on one placenta half and two cords inserted marginally. The postoperative period was uneventful and she was discharged five days after cesarean section. This case report shows that marginal cord insertion, which can lead to placenta abruption, can be also observed on a bipartite placenta.","PeriodicalId":19389,"journal":{"name":"Obstetrics & Gynecology International Journal","volume":"253 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86712824","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-10-15DOI: 10.15406/ogij.2021.12.00597
Jasovic-Siveska Emilija, S. Slagjana, Milkovski Daniel
The reasons behind vascular thrombosis are still unclear. The “two hit” hypothesis suggests that the “first hit” may be oxidative stress, surgery, trauma, or infections leading to endothelia cell damage. This exerts different effects on endothelial cells, monocytes, platelets, and complement. Binding and activation of these cell types causes an increased expression of adhesion molecules, secretion of cytokines, and production of arachidonic acid metabolites. aPL may also participate in oxidant-mediated injury to vascular endothelium or bind to perturbed cells that lose their regular membrane symmetry and express anionic phospholipids on their surface. The interaction of antibodies with clotting regulation such as prothrombin, factor X, protein C, and plasmin might hinder inactivation of procoagulant factors and impede fibrinolysis. In pregnancy, placental thrombosis and fetal loss may result from interference with annexin A5, a natural anticoagulant. Abnormalities in placentation leading to pregnancy loss may result from antibodies binding leading to a reduction of human chorionic gonadotropin secretion or triggering an inflammatory response resulting in trophoblast damage.6
{"title":"Antiphospholipid syndrome and pregnancy","authors":"Jasovic-Siveska Emilija, S. Slagjana, Milkovski Daniel","doi":"10.15406/ogij.2021.12.00597","DOIUrl":"https://doi.org/10.15406/ogij.2021.12.00597","url":null,"abstract":"The reasons behind vascular thrombosis are still unclear. The “two hit” hypothesis suggests that the “first hit” may be oxidative stress, surgery, trauma, or infections leading to endothelia cell damage. This exerts different effects on endothelial cells, monocytes, platelets, and complement. Binding and activation of these cell types causes an increased expression of adhesion molecules, secretion of cytokines, and production of arachidonic acid metabolites. aPL may also participate in oxidant-mediated injury to vascular endothelium or bind to perturbed cells that lose their regular membrane symmetry and express anionic phospholipids on their surface. The interaction of antibodies with clotting regulation such as prothrombin, factor X, protein C, and plasmin might hinder inactivation of procoagulant factors and impede fibrinolysis. In pregnancy, placental thrombosis and fetal loss may result from interference with annexin A5, a natural anticoagulant. Abnormalities in placentation leading to pregnancy loss may result from antibodies binding leading to a reduction of human chorionic gonadotropin secretion or triggering an inflammatory response resulting in trophoblast damage.6","PeriodicalId":19389,"journal":{"name":"Obstetrics & Gynecology International Journal","volume":"99 11 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81970622","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-09-29DOI: 10.15406/ogij.2021.12.00596
Vargas Hernández Víctor Manuel, Luján Irastorza Jesús Estuardo, D. Carlos, Á. Daniela, Ávila-Pérez Felipe de Jesús, Loof-Esquivel Monica Stephanie, K. Alejandro, H. Roberto
Background: Infantile hemangiomas (IH) are common neoplasms composed of proliferating endothelial cells. The duration and the growth rate are variable; some grow very poorly, while others grow rapidly and at an unpredictable rate. Despite the relative frequency of IH and the possible severity of complications, there are currently no uniform treatment guidelines. Although most are not worrisome, about 12% of IHs are significantly complex; propranolol has been adopted as a treatment. Objective: Report a clinical case of lactanate with hemangioma treated with propranolol. Case report: A healthy newborn is presented, with the presence of small telangiectasias in the right hemicneck without association with obstetric trauma; of a healthy 31-year-old mother; During its evolution at 3 months of age, the area covered with telangiectasias turned deep blue and the growth of a protrusion began, ultrasound and angioresonance, showed soft tissues of the posterior cervical space a lobulated mass of 9.1x4.1x4.9cm in its longitudinal and transverse diameter respectively, diagnosing it as a deep hemangioma; which was treated with propanolol. Discussion: Asymptomatic newborns with infantile neck hemangiomas are clinically controlled for the first six months of life, 60% of them develop life-threatening airway symptoms; the identification of the hemangioma was due to its rapid growth and not due to the alteration of surrounding structures that put the well-being of the infant at risk. Regarding the application of Propranolol, its administration was immediately after its identification, to avoid future complications. Conclusion: administration of propranolol systemically eliminates the characteristic color and reduces the size of the hemangioma.
{"title":"Propanolol as a treatment for deep infantile hemangioma: case report","authors":"Vargas Hernández Víctor Manuel, Luján Irastorza Jesús Estuardo, D. Carlos, Á. Daniela, Ávila-Pérez Felipe de Jesús, Loof-Esquivel Monica Stephanie, K. Alejandro, H. Roberto","doi":"10.15406/ogij.2021.12.00596","DOIUrl":"https://doi.org/10.15406/ogij.2021.12.00596","url":null,"abstract":"Background: Infantile hemangiomas (IH) are common neoplasms composed of proliferating endothelial cells. The duration and the growth rate are variable; some grow very poorly, while others grow rapidly and at an unpredictable rate. Despite the relative frequency of IH and the possible severity of complications, there are currently no uniform treatment guidelines. Although most are not worrisome, about 12% of IHs are significantly complex; propranolol has been adopted as a treatment. Objective: Report a clinical case of lactanate with hemangioma treated with propranolol. Case report: A healthy newborn is presented, with the presence of small telangiectasias in the right hemicneck without association with obstetric trauma; of a healthy 31-year-old mother; During its evolution at 3 months of age, the area covered with telangiectasias turned deep blue and the growth of a protrusion began, ultrasound and angioresonance, showed soft tissues of the posterior cervical space a lobulated mass of 9.1x4.1x4.9cm in its longitudinal and transverse diameter respectively, diagnosing it as a deep hemangioma; which was treated with propanolol. Discussion: Asymptomatic newborns with infantile neck hemangiomas are clinically controlled for the first six months of life, 60% of them develop life-threatening airway symptoms; the identification of the hemangioma was due to its rapid growth and not due to the alteration of surrounding structures that put the well-being of the infant at risk. Regarding the application of Propranolol, its administration was immediately after its identification, to avoid future complications. Conclusion: administration of propranolol systemically eliminates the characteristic color and reduces the size of the hemangioma.","PeriodicalId":19389,"journal":{"name":"Obstetrics & Gynecology International Journal","volume":"32 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81763859","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-09-16DOI: 10.15406/ogij.2021.12.00595
A. Siu-Au, Diego Siu-Chang
Pelvic inflammatory disease (PID) is a sexually-transmitted infection (STI); and, as such, sometimes it is difficult to treat because of partner(s) issues. PID generally is accompanied by chronic cervicitis (CC). We observed that in spite of patients strictly complying with their therapy, there are some individuals that develop recurrent disease; and we tried to establish a relationship between CC and its recurrence in such patients. This study was prospectively designed. Patients in one group were treated with electrocauterization and another group who did not receive this therapy was retrospectively compared by reviewing their clinical records. Patients with CC and PID who did not undergo electrocauterization had 82% recurrence rate compared to those who underwent electrocauterization, who showed a 24% recurrence rate. We concluded that patients who had CC with different manifestations and who underwent electrocauterization or cervical fulguration developed significantly less recurrence of PID.
{"title":"Impact of chronic cervicitis on recurrent pelvic inflammatory disease","authors":"A. Siu-Au, Diego Siu-Chang","doi":"10.15406/ogij.2021.12.00595","DOIUrl":"https://doi.org/10.15406/ogij.2021.12.00595","url":null,"abstract":"Pelvic inflammatory disease (PID) is a sexually-transmitted infection (STI); and, as such, sometimes it is difficult to treat because of partner(s) issues. PID generally is accompanied by chronic cervicitis (CC). We observed that in spite of patients strictly complying with their therapy, there are some individuals that develop recurrent disease; and we tried to establish a relationship between CC and its recurrence in such patients. This study was prospectively designed. Patients in one group were treated with electrocauterization and another group who did not receive this therapy was retrospectively compared by reviewing their clinical records. Patients with CC and PID who did not undergo electrocauterization had 82% recurrence rate compared to those who underwent electrocauterization, who showed a 24% recurrence rate. We concluded that patients who had CC with different manifestations and who underwent electrocauterization or cervical fulguration developed significantly less recurrence of PID.","PeriodicalId":19389,"journal":{"name":"Obstetrics & Gynecology International Journal","volume":"17 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86612218","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-09-16DOI: 10.15406/ogij.2021.12.00594
Friday Saidi, G. Chiudzu, M. Chagomerana, Beteniko Milala, Jennifer H. Tang
Background: Stillbirths remain a major public health issue worldwide with an estimated 3 million deaths per year globally. We investigated the factors associated with stillbirths in fetuses of at least 28 weeks’ gestation or 1000 grams at birth. Methods: We performed a hospital-based, cross-sectional study among women who delivered stillbirths at Kamuzu Central Hospital (KCH) in Lilongwe, Malawi from May-November 2017. Eligible women were enrolled after obtaining informed consent, and their demographic and reproductive health information was collected. Blood samples were collected for full blood count, malaria, blood glucose, syphilis, and HIV testing, and the probable risk factors associated with stillbirths were assessed. Results: A total of 1,687 deliveries with 126 stillbirths occurred during the 6-month period, representing a stillbirth rate of 79 per 1,000 births. Seventy percent of these stillbirths were diagnosed on admission at KCH, and about 49% were fresh stillbirths. Half of the stillbirths had a birthweight of at least 2,500g, and the majority of these stillbirths were fresh (60%). The following factors were associated with stillbirth: uterine rupture (15.1%), placental abruption (14.3%), Hypertension (10.3%), obstructed/prolonged labor (5.8%), syphilis (7.1%), malaria (2.4%), congenital anomalies (2.4%), and diabetes (1.5%). Conclusions: The stillbirth rate at KCH is high, and most fetal deaths occurred prior to arrival at KCH. Although most of the stillbirths were unexplained, uterine rupture and abruption placenta emerged as major factors associated with stillbirths and these are largely preventable even in resource limited settings.
{"title":"Factors associated with stillbirths among women delivering at a resource limited tertiary hospital in Malawi","authors":"Friday Saidi, G. Chiudzu, M. Chagomerana, Beteniko Milala, Jennifer H. Tang","doi":"10.15406/ogij.2021.12.00594","DOIUrl":"https://doi.org/10.15406/ogij.2021.12.00594","url":null,"abstract":"Background: Stillbirths remain a major public health issue worldwide with an estimated 3 million deaths per year globally. We investigated the factors associated with stillbirths in fetuses of at least 28 weeks’ gestation or 1000 grams at birth. Methods: We performed a hospital-based, cross-sectional study among women who delivered stillbirths at Kamuzu Central Hospital (KCH) in Lilongwe, Malawi from May-November 2017. Eligible women were enrolled after obtaining informed consent, and their demographic and reproductive health information was collected. Blood samples were collected for full blood count, malaria, blood glucose, syphilis, and HIV testing, and the probable risk factors associated with stillbirths were assessed. Results: A total of 1,687 deliveries with 126 stillbirths occurred during the 6-month period, representing a stillbirth rate of 79 per 1,000 births. Seventy percent of these stillbirths were diagnosed on admission at KCH, and about 49% were fresh stillbirths. Half of the stillbirths had a birthweight of at least 2,500g, and the majority of these stillbirths were fresh (60%). The following factors were associated with stillbirth: uterine rupture (15.1%), placental abruption (14.3%), Hypertension (10.3%), obstructed/prolonged labor (5.8%), syphilis (7.1%), malaria (2.4%), congenital anomalies (2.4%), and diabetes (1.5%). Conclusions: The stillbirth rate at KCH is high, and most fetal deaths occurred prior to arrival at KCH. Although most of the stillbirths were unexplained, uterine rupture and abruption placenta emerged as major factors associated with stillbirths and these are largely preventable even in resource limited settings.","PeriodicalId":19389,"journal":{"name":"Obstetrics & Gynecology International Journal","volume":"14 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79121918","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-09-14DOI: 10.15406/ogij.2021.12.00593
K. Awartani, Amani Aldriweesh, Ali Alhibshi, Fatimah Abualsaud
Background: After the start of the coronavirus disease (COVID-19) pandemic, assisted reproductive services were suspended and restarted in in vitro fertilization (IVF) clinics worldwide. In our center we implemented screening of all couples for COVID-19 the day before starting the ovulation cycle and before the ovum pick-up (OPU) procedure. Objectives: Assess the prevalence of asymptomatic COVID-19 among couples undergoing in vitro fertilization (IVF). Design: Cross-sectional and retrospective cohort study. Setting: An IVF unit in Riyadh from July to November 2020. Patients and methods: Patients and their partners were tested for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection 24-48 hours before their initial visit to initiate the fertility cycle and again prior to the ovum pick-up visit. Main outcome measures: Prevalence of asymptomatic SARS-CoV-2 infection. Sample size: 508 couples. Results: A total of 508 couples were tested. Of the 508 cycles of therapy, 24 (4.7%) were cancelled, 16 (3.14%) before the start of the cycle, and 8 (1.66%) before ovum pick-up, because one or both partners in the couple tested SARS-CoV-2 positive. Before the start of the cycle, 3 patients and their partners both tested positive; 7 patients tested positive and their partners tested negative; and 6 partners tested positive and the patient testing negative. In addition, on retesting 481 couples before OPU 3 patients and their partners both tested positive; 3 patients tested positive, and their partners tested negative; and 2 partners tested positive and the patients tested negative. Conclusion: The prevalence of asymptomatic SARS-CoV-2 infection in couples seeking IVF was higher than that in the general population. Implementing a policy of screening couples for SARS-CoV-2 prior to IVF treatment, minimized the possibility of transmission of SARS-CoV-2 from patients to healthcare workers.
{"title":"Prevalence of asymptomatic SARS-CoV-2 Infection in couples seeking in vitro fertilization treatment in Riyadh, July–November, 2020","authors":"K. Awartani, Amani Aldriweesh, Ali Alhibshi, Fatimah Abualsaud","doi":"10.15406/ogij.2021.12.00593","DOIUrl":"https://doi.org/10.15406/ogij.2021.12.00593","url":null,"abstract":"Background: After the start of the coronavirus disease (COVID-19) pandemic, assisted reproductive services were suspended and restarted in in vitro fertilization (IVF) clinics worldwide. In our center we implemented screening of all couples for COVID-19 the day before starting the ovulation cycle and before the ovum pick-up (OPU) procedure. Objectives: Assess the prevalence of asymptomatic COVID-19 among couples undergoing in vitro fertilization (IVF). Design: Cross-sectional and retrospective cohort study. Setting: An IVF unit in Riyadh from July to November 2020. Patients and methods: Patients and their partners were tested for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection 24-48 hours before their initial visit to initiate the fertility cycle and again prior to the ovum pick-up visit. Main outcome measures: Prevalence of asymptomatic SARS-CoV-2 infection. Sample size: 508 couples. Results: A total of 508 couples were tested. Of the 508 cycles of therapy, 24 (4.7%) were cancelled, 16 (3.14%) before the start of the cycle, and 8 (1.66%) before ovum pick-up, because one or both partners in the couple tested SARS-CoV-2 positive. Before the start of the cycle, 3 patients and their partners both tested positive; 7 patients tested positive and their partners tested negative; and 6 partners tested positive and the patient testing negative. In addition, on retesting 481 couples before OPU 3 patients and their partners both tested positive; 3 patients tested positive, and their partners tested negative; and 2 partners tested positive and the patients tested negative. Conclusion: The prevalence of asymptomatic SARS-CoV-2 infection in couples seeking IVF was higher than that in the general population. Implementing a policy of screening couples for SARS-CoV-2 prior to IVF treatment, minimized the possibility of transmission of SARS-CoV-2 from patients to healthcare workers.","PeriodicalId":19389,"journal":{"name":"Obstetrics & Gynecology International Journal","volume":"94 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82255218","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-08-27DOI: 10.15406/ogij.2021.12.00591
G. Almind, E. Færch, F. Lægaard, S. Smidt‐Jensen, S. Lindenberg
Aim of study: What is the effectiveness and safety of using a 20G single lumen needle (SLN) for both applying local analgesia (LA) in the vaginal vault and ovarian capsule and oocyte retrieval (OR) using a simple syringe? And will thoroughly cleaning (TC) of the vagina before reducing the risk of the puncture procedure? Using a thin SLN has been postulated to jeopardize cumulus oocyte complexes (COC). Further applying LA in the same needle without retracting the needle before OR has been claimed to harm oocyte development. Also, many clinics extensively clean the vagina before OR. Methods: We performed a retrospective cohort study including 4983 women. 877 underwent no cleaning (nonTC) of the vagina and 4106 underwent TC using NaCl. All had OR with a 20G SLN attached to a syringe for local anaesthesia and egg collection. The treatments were done in one centre during the period from January 2016 to June 2019. We studied women undergoing IVF treatment aged 18–45 years. Women had either thoroughly vaginal cleaning before OR or no cleaning depending on the physicians preferences. All women had LA using Citanest Dental Octapressin 2ml. placed in the vaginal vault in the direction of the intended puncture including in the ovarian capsule. Therefore, only one puncture was needed in both sides, left and right. All punctures were hereafter followed by OR using the same 20G SLN. Aspiration was done by a 20ml syringe handled manually by the physician. All women underwent a conventional antagonist protocol with FSH stimulation and Ovitrelle 250IU for induction or Mild Stimulation using Tamoxifen, FSH and Ovitrelle. Outcome measurement were bleeding measured by the necessity of applying compression after the puncture or infection observed up to 1 month. Results: Baseline characteristics including age, BMI and type of stimulation were comparable between the groups. In the nonTC group no infections, bleedings or abscesses were found. In the TC group there were 1 abscess observed. Intact COC was similar in the two groups as well as pregnancy rates. Conclusion: During OR in ART the use of a 20G SLN using the same needle for LA and hereafter, without changing needle in the puncture channel, continue with the egg collection (EC) is simple and safe. In this situation TC is not necessary before puncture, making the procedure more patients friendly. In women undergoing oocyte retrieval for IVF, we found the use of a 20G SLN for both applying LA and retrieving COC safe, effective and simple. Additional TC of the vagina before puncture did not add more to the safety of the procedure.
{"title":"A cohort study on safety for oocyte retrieval in IVF using the same 20G needle for local analgesia and retrieval. Vaginal cleaning did not add to the safety of the procedure","authors":"G. Almind, E. Færch, F. Lægaard, S. Smidt‐Jensen, S. Lindenberg","doi":"10.15406/ogij.2021.12.00591","DOIUrl":"https://doi.org/10.15406/ogij.2021.12.00591","url":null,"abstract":"Aim of study: What is the effectiveness and safety of using a 20G single lumen needle (SLN) for both applying local analgesia (LA) in the vaginal vault and ovarian capsule and oocyte retrieval (OR) using a simple syringe? And will thoroughly cleaning (TC) of the vagina before reducing the risk of the puncture procedure? Using a thin SLN has been postulated to jeopardize cumulus oocyte complexes (COC). Further applying LA in the same needle without retracting the needle before OR has been claimed to harm oocyte development. Also, many clinics extensively clean the vagina before OR. Methods: We performed a retrospective cohort study including 4983 women. 877 underwent no cleaning (nonTC) of the vagina and 4106 underwent TC using NaCl. All had OR with a 20G SLN attached to a syringe for local anaesthesia and egg collection. The treatments were done in one centre during the period from January 2016 to June 2019. We studied women undergoing IVF treatment aged 18–45 years. Women had either thoroughly vaginal cleaning before OR or no cleaning depending on the physicians preferences. All women had LA using Citanest Dental Octapressin 2ml. placed in the vaginal vault in the direction of the intended puncture including in the ovarian capsule. Therefore, only one puncture was needed in both sides, left and right. All punctures were hereafter followed by OR using the same 20G SLN. Aspiration was done by a 20ml syringe handled manually by the physician. All women underwent a conventional antagonist protocol with FSH stimulation and Ovitrelle 250IU for induction or Mild Stimulation using Tamoxifen, FSH and Ovitrelle. Outcome measurement were bleeding measured by the necessity of applying compression after the puncture or infection observed up to 1 month. Results: Baseline characteristics including age, BMI and type of stimulation were comparable between the groups. In the nonTC group no infections, bleedings or abscesses were found. In the TC group there were 1 abscess observed. Intact COC was similar in the two groups as well as pregnancy rates. Conclusion: During OR in ART the use of a 20G SLN using the same needle for LA and hereafter, without changing needle in the puncture channel, continue with the egg collection (EC) is simple and safe. In this situation TC is not necessary before puncture, making the procedure more patients friendly. In women undergoing oocyte retrieval for IVF, we found the use of a 20G SLN for both applying LA and retrieving COC safe, effective and simple. Additional TC of the vagina before puncture did not add more to the safety of the procedure.","PeriodicalId":19389,"journal":{"name":"Obstetrics & Gynecology International Journal","volume":"21 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83235873","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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