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Prevalence and Predictors of Dysmenorrhea, Its Effect, and Coping Mechanisms among Adolescents in Shai Osudoku District, Ghana. 加纳Shai Osudoku地区青少年痛经的患病率、预测因素、影响和应对机制
IF 1.9 Q3 OBSTETRICS & GYNECOLOGY Pub Date : 2019-05-20 eCollection Date: 2019-01-01 DOI: 10.1155/2019/5834159
Kwabena Acheampong, Dorothy Baffour-Awuah, Daniel Ganu, Stalla Appiah, Xionfeng Pan, Atipatsa Kaminga, Aizhong Liu

Background: Dysmenorrhea has been the most common gynecological problem worldwide. Reports of dysmenorrhea are greatest among individuals in their late teens and 20s and usually declining with age. It has also been reported that dysmenorrhea affects more than 80% of women in the reproductive age. The study objective was to examine the predictors of dysmenorrhea, its effect, and coping mechanisms among adolescents in Shai Osudoku District, Ghana.

Methods: We conducted a cross-sectional study in September and November 2017 in selected schools in Shai Osudoku District, Ghana. We employed self-administered questionnaire to obtain data from adolescents volunteered to participate in the study. We analyzed the data using the SPSS programme IBM version 20. We used the Pearson chi-square test and multiple logistic regression analysis to assess the association between exposure variables and the outcome variable. The odds ratio was reported to establish the risk of dysmenorrhea at a confidence interval of 95%, and statistical significance was assumed at p < 0.05.

Results: The prevalence of dysmenorrhea was 68.1% (95% CI, 65.0-72.0) with one-third recounting their pain as severe. The pain during menstruation negatively influences the daily physical activities (22.5%), school attendance (6.9%), concentration during classes' hours (27.9%), and academic performance (31.1%) of the respondents. Besides, adolescents who do not live with their parent experienced a 53.1% increase in odds of self-reporting dysmenorrhea (AOR, 1.53 (95% CI, 1.02-2.23)). Similarly, respondents who had irregular menstrual cycle experienced a 72.5% increase in odds of self-reporting dysmenorrhea (AOR, 1.73 (95% CI, 1.16-2.57)). Finally, a significant association between irregular menstrual cycle (p < 0.01), not lived with their parent (p < 0.04), and self-reported dysmenorrhea was found.

Conclusion: This study establishes that dysmenorrhea is high among adolescents in Shai Osudoku District which negatively affects the daily activity of majority of them.

背景:痛经是世界范围内最常见的妇科疾病。痛经的报告在十几岁和二十几岁的个体中最多,通常随着年龄的增长而减少。据报道,痛经影响了80%以上的育龄妇女。本研究的目的是研究加纳Shai Osudoku地区青少年痛经的预测因素、痛经的影响和应对机制。方法:我们于2017年9月和11月在加纳Shai Osudoku地区的选定学校进行了一项横断面研究。我们采用自填问卷的方式从自愿参与研究的青少年中获取数据。我们使用SPSS程序IBM version 20对数据进行分析。我们使用皮尔逊卡方检验和多元逻辑回归分析来评估暴露变量与结果变量之间的相关性。以比值比确定痛经风险的置信区间为95%,p < 0.05为有统计学意义。结果:痛经发生率为68.1% (95% CI, 65.0-72.0),三分之一的患者痛经严重。月经期间的疼痛对受访者的日常体育活动(22.5%)、上学(6.9%)、上课时注意力集中(27.9%)和学习成绩(31.1%)产生负面影响。此外,不与父母同住的青少年自我报告痛经的几率增加53.1% (AOR, 1.53 (95% CI, 1.02-2.23))。同样,月经周期不规律的受访者自我报告痛经的几率增加72.5% (AOR, 1.73 (95% CI, 1.16-2.57))。最后,发现月经周期不规律(p < 0.01)、未与父母同住(p < 0.04)与自我报告痛经之间存在显著关联。结论:本研究确定了Shai Osudoku地区青少年痛经发生率较高,并对大多数青少年的日常活动产生负面影响。
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引用次数: 50
Outcomes among Mothers Who Gave Birth in the Health Facility: Does Birth Preparedness and Complication Readiness Have a Role? 在卫生机构分娩的母亲的结局:分娩准备和并发症准备是否有作用?
IF 1.9 Q3 OBSTETRICS & GYNECOLOGY Pub Date : 2019-04-30 eCollection Date: 2019-01-01 DOI: 10.1155/2019/5147853
Temesgen Worku Gudayu, Bilen Mekonnen Araya
Background Giving childbirth is a natural reward for human beings to replace themselves to exist in the world. Despite all the efforts made to improve maternal health, maternal morbidity and mortality continue during childbirth. Hence, this study aimed to determine the proportion of maternal birth outcomes and identify their predictors among mothers who gave birth in hospitals. Method A hospital-based cross-sectional study was conducted from April 9 to June 7, 2016, among 384 postnatal mothers in Debre Tabor Hospital. Randomly selected mothers were interviewed by trained data collectors. Data were checked for completeness, entered using Epi Info version 7, and analyzed using STATA 14 software. A multivariate logistic regression model was used to control confounders and identify predictors of maternal birth outcomes. Statistical significance was declared by adjusted odds ratio with a 95% confidence interval and a p value ≤0.05. Result About 77% (95% CI: 72.9, 81.3) of the mothers had good maternal birth outcomes. Antenatal care utilization (AOR: 2.60; 95% CI: 1.16, 5.83); BPCR practice (AOR: 2.10; 95% CI: 1.12, 3.96); self-preference of health institution (AOR: 2.34; 95% CI: 1.11, 4.50); and mode of delivery: caesarean (AOR: 0.46; 95% CI: 0.23, 0.87), assisted breech (AOR: 0.17; 95% CI: 0.04, 0.69), and instrumental (AOR: 0.27; 95% CI: 0.09, 0.79) were associated with good maternal birth outcome. Conclusion In this study, the maternal birth outcome among postnatal mothers was good in more than three-fourth of the cases. Hence, encouraging mothers to utilize health-care services and counseling and supporting them on BPCR practice are recommended.
背景:生育是人类代替自己在世界上生存的一种自然回报。尽管为改善产妇保健作出了种种努力,但产妇在分娩期间的发病率和死亡率仍在继续。因此,本研究旨在确定在医院分娩的母亲分娩结局的比例,并确定其预测因素。方法:对2016年4月9日至6月7日在Debre Tabor医院分娩的384名产妇进行横断面研究。由训练有素的数据收集人员对随机选择的母亲进行访谈。检查数据的完整性,使用Epi Info version 7输入数据,并使用STATA 14软件进行分析。采用多变量logistic回归模型控制混杂因素并确定产妇分娩结局的预测因子。采用校正优势比,p值≤0.05,95%置信区间表示统计学显著性。结果:约77% (95% CI: 72.9, 81.3)的产妇分娩结局良好。产前保健利用(AOR: 2.60;95% ci: 1.16, 5.83);BPCR实践(AOR: 2.10;95% ci: 1.12, 3.96);医疗机构自我偏好(AOR: 2.34;95% ci: 1.11, 4.50);分娩方式:剖腹产(AOR: 0.46;95% CI: 0.23, 0.87),辅助臀位(AOR: 0.17;95% CI: 0.04, 0.69)和工具性(AOR: 0.27;95% CI: 0.09, 0.79)与良好的分娩结局相关。结论:在本研究中,超过四分之三的产后母亲分娩结局良好。因此,建议鼓励母亲利用保健服务和咨询,并在BPCR实践方面为她们提供支持。
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引用次数: 6
Rate of Nondiagnostic Computerized Tomography Pulmonary Angiograms (CTPAs) Performed for the Diagnosis of Pulmonary Embolism in Pregnant and Immediately Postpartum Patients. 非诊断性ct肺血管造影(CTPAs)对妊娠和产后患者肺栓塞的诊断率
IF 1.9 Q3 OBSTETRICS & GYNECOLOGY Pub Date : 2019-03-26 eCollection Date: 2019-01-01 DOI: 10.1155/2019/1432759
Sarah Hogan, Jillian Greene, Jeffery Flemming

Objective: To evaluate the nondiagnostic rate of computed tomography pulmonary angiography (CTPA) in pregnant and postpartum patients with suspected pulmonary embolism (PE) to determine whether CTPA or ventilation-perfusion (VQ) scan should be considered first line imaging in this patient population considering their equivalent accuracy and the greater radiation exposure to proliferating breast tissue of CTPA.

Methods: All pregnant/postpartum female patients between 18 and 50 years of age who had CTPA within the Eastern Health Authority between November 2012 and November 2016 were included. Each scan was evaluated for nondiagnosis based on two criteria: contrast density in the main pulmonary artery, and respiratory motion artefact. If either of these criteria were not met, the scan was labelled as nondiagnostic.

Results: The nondiagnostic rate overall was 43% (n=83). This is similar to current literature values for rates of CTPA nondiagnosis, and comparable to the reported diagnostic quality of the reporting radiologist. This is much greater compared to rates of ventilation/perfusion nondiagnosis in comparable populations. Even in patients with normal chest radiographs, which represents the main patient group where VQ may be considered as an alternative, the nondiagnostic rate of CT is much higher.

Conclusion: This is the first study to attempt to identify an objective method of determining nondiagnosis in pregnant and postpartum patients undergoing a CTPA. Our results strengthen the argument that alternative imaging should be considered when investigating for PE in this population in order to protect the proliferating breast tissue, and VQ scan should be considered especially in patients with normal chest X-rays.

目的:评价疑似肺栓塞(PE)孕妇和产后患者ct肺血管造影(CTPA)的漏诊率,考虑到CTPA与通气灌注(VQ)扫描的同等准确性和CTPA对乳腺增生组织更大的辐射暴露,确定CTPA或VQ扫描在该患者群体中是否应考虑一线成像。方法:纳入东部卫生管理局2012年11月至2016年11月期间所有18 - 50岁的CTPA孕妇/产后女性患者。每次扫描均根据两个标准评估未诊断:主要肺动脉造影剂密度和呼吸运动伪影。如果这些标准中的任何一个不满足,扫描被标记为无诊断性。结果:总体未诊断率为43% (n=83)。这与目前CTPA未诊断率的文献值相似,并与报告放射科医生的诊断质量相当。与可比人群中通气/灌注未诊断的比率相比,这要大得多。即使在胸片正常的患者中,这代表了VQ可能被视为替代的主要患者群体,CT的不诊断率也要高得多。结论:这是第一个试图确定一个客观的方法来确定未诊断的孕妇和产后患者接受CTPA。我们的结果加强了这样的观点,即在调查这一人群的PE时应考虑替代成像,以保护增殖的乳房组织,特别是在胸片正常的患者中应考虑VQ扫描。
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引用次数: 3
Primary Clear Cell Adenocarcinoma of the Cervix: A Clinical Analysis of 18 Cases without Exposure to Diethylstilbestrol. 宫颈原发性透明细胞腺癌:18例未暴露于二乙烯雌酚的临床分析。
IF 1.6 Q3 OBSTETRICS & GYNECOLOGY Pub Date : 2019-03-26 eCollection Date: 2019-01-01 DOI: 10.1155/2019/9465375
Dongying Wang, Chunhua Zhao, Li Fu, Yang Liu, Weiyang Zhang, Tianmin Xu

Objectives: Cervical clear cell adenocarcinoma (CCAC) is a rare malignant tumor with independent biological behavior in the female reproductive system. In this report, we collect the clinical and histopathological characteristics of 18 CCAC patients without exposure to diethylstilbestrol (DES) and conduct relevant clinical analysis.

Methods: We retrospectively analyzed the clinical data of 18 patients with CCAC who were diagnosed and treated from January 2009 to August 2017 in the Second Hospital of Jilin University.

Results: A total of 18 patients were enrolled. The age of patients ranged from 37 to 74 years with the peak incidence between 45 and 55 years. The median age was 53 years. The most common symptom was vaginal bleeding (66.7%, 12/18). The most common type of lesion was the endocervical type (66.7%, 12/18). The negative rate of human papillomavirus (HPV) examination was 88.9% (8/9). Based on the staging criteria of the International Federation of Gynecology and Obstetrics (FIGO) cervical cancer clinical stage in 2018, 55.6% patients were stage I (n=10), 16.7% were stage II (n=3), 22.2% were stage III (n=4), and 5.6% were stage IV (n=1). Seventeen patients underwent surgery; 64.7% (11/17) of cases showed infiltration of the entire layer of the cervix, pelvic lymph node (PLN) metastasis was observed in 4 patients (26.7%, 4/15), endometrium metastasis was observed in 4 patients (25%, 4/16), and 13 patients (72.2%, 13/18) were diagnosed at an early stage (stage IB1-IIA2). Fifteen patients' immunohistochemistry indicated that napsin A, CK7, CK (AE1/AE3), and PAX-8 were positive, and p53, p16, ER, and vimentin were expressed to different degrees. Follow-up data were obtained in 13 patients (72.2%, 13/18). One patient died of recurrence 5 months after surgery, and the other patients' progression-free survival (PFS) ranged from 9 to 59 months. Tumor size (>4 cm), tumor stage (FIGO IIA2-IV), PLN, and endometrium metastasis had negative effects on PFS (P < 0.05).

Conclusions: CCAC is a highly invasive malignant tumor, whose pathogenesis may not be associated with HPV infection. Radical hysterectomy combined with chemotherapy (paclitaxel + platinum) has the ideal short-term curative effect. In the future, larger samples of clinical data are required to confirm these insights.

目的:宫颈透明细胞腺癌(CCAC)是一种罕见的恶性肿瘤,在女性生殖系统中具有独立的生物学行为。本报告收集了 18 例未暴露于己烯雌酚(DES)的 CCAC 患者的临床和组织病理学特征,并进行了相关临床分析:回顾性分析吉林大学第二医院2009年1月至2017年8月诊治的18例CCAC患者的临床资料:共有18名患者入选。患者年龄从 37 岁到 74 岁不等,发病高峰期在 45 岁到 55 岁之间。中位年龄为 53 岁。最常见的症状是阴道出血(66.7%,12/18)。最常见的病变类型是宫颈内膜型(66.7%,12/18)。人类乳头瘤病毒(HPV)检查的阴性率为 88.9%(8/9)。根据2018年国际妇产科联盟(FIGO)宫颈癌临床分期标准,55.6%的患者为Ⅰ期(n=10),16.7%为Ⅱ期(n=3),22.2%为Ⅲ期(n=4),5.6%为Ⅳ期(n=1)。17例患者接受了手术,其中64.7%(11/17)的病例显示宫颈全层浸润,4例患者(26.7%,4/15)观察到盆腔淋巴结(PLN)转移,4例患者(25%,4/16)观察到子宫内膜转移,13例患者(72.2%,13/18)被诊断为早期(IB1-IIA2期)。15 例患者的免疫组化结果显示,纳普新 A、CK7、CK(AE1/AE3)和 PAX-8 呈阳性,p53、p16、ER 和波形蛋白均有不同程度的表达。13名患者(72.2%,13/18)获得了随访数据。一名患者在术后5个月死于复发,其他患者的无进展生存期(PFS)从9个月到59个月不等。肿瘤大小(>4厘米)、肿瘤分期(FIGO IIA2-IV)、PLN和子宫内膜转移对无进展生存期有负面影响(P < 0.05):结论:CCAC是一种高侵袭性恶性肿瘤,其发病机制可能与HPV感染无关。根治性子宫切除术联合化疗(紫杉醇+铂)具有理想的短期治愈效果。今后,需要更多的临床数据样本来证实这些观点。
{"title":"Primary Clear Cell Adenocarcinoma of the Cervix: A Clinical Analysis of 18 Cases without Exposure to Diethylstilbestrol.","authors":"Dongying Wang, Chunhua Zhao, Li Fu, Yang Liu, Weiyang Zhang, Tianmin Xu","doi":"10.1155/2019/9465375","DOIUrl":"10.1155/2019/9465375","url":null,"abstract":"<p><strong>Objectives: </strong>Cervical clear cell adenocarcinoma (CCAC) is a rare malignant tumor with independent biological behavior in the female reproductive system. In this report, we collect the clinical and histopathological characteristics of 18 CCAC patients without exposure to diethylstilbestrol (DES) and conduct relevant clinical analysis.</p><p><strong>Methods: </strong>We retrospectively analyzed the clinical data of 18 patients with CCAC who were diagnosed and treated from January 2009 to August 2017 in the Second Hospital of Jilin University.</p><p><strong>Results: </strong>A total of 18 patients were enrolled. The age of patients ranged from 37 to 74 years with the peak incidence between 45 and 55 years. The median age was 53 years. The most common symptom was vaginal bleeding (66.7%, 12/18). The most common type of lesion was the endocervical type (66.7%, 12/18). The negative rate of human papillomavirus (HPV) examination was 88.9% (8/9). Based on the staging criteria of the International Federation of Gynecology and Obstetrics (FIGO) cervical cancer clinical stage in 2018, 55.6% patients were stage I (<i>n</i>=10), 16.7% were stage II (<i>n</i>=3), 22.2% were stage III (<i>n</i>=4), and 5.6% were stage IV (<i>n</i>=1). Seventeen patients underwent surgery; 64.7% (11/17) of cases showed infiltration of the entire layer of the cervix, pelvic lymph node (PLN) metastasis was observed in 4 patients (26.7%, 4/15), endometrium metastasis was observed in 4 patients (25%, 4/16), and 13 patients (72.2%, 13/18) were diagnosed at an early stage (stage IB1-IIA2). Fifteen patients' immunohistochemistry indicated that napsin A, CK7, CK (AE1/AE3), and PAX-8 were positive, and p53, p16, ER, and vimentin were expressed to different degrees. Follow-up data were obtained in 13 patients (72.2%, 13/18). One patient died of recurrence 5 months after surgery, and the other patients' progression-free survival (PFS) ranged from 9 to 59 months. Tumor size (>4 cm), tumor stage (FIGO IIA2-IV), PLN, and endometrium metastasis had negative effects on PFS (<i>P</i> < 0.05).</p><p><strong>Conclusions: </strong>CCAC is a highly invasive malignant tumor, whose pathogenesis may not be associated with HPV infection. Radical hysterectomy combined with chemotherapy (paclitaxel + platinum) has the ideal short-term curative effect. In the future, larger samples of clinical data are required to confirm these insights.</p>","PeriodicalId":19439,"journal":{"name":"Obstetrics and Gynecology International","volume":"2019 ","pages":"9465375"},"PeriodicalIF":1.6,"publicationDate":"2019-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6458873/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37206801","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Our Experience with Iatrogenic Ureteric Injuries among Women Presenting to University College Hospital, Ibadan: A Call to Action on Trigger Factors. 我们在伊巴丹大学学院医院治疗医源性输尿管损伤的经验:呼吁对触发因素采取行动。
IF 1.9 Q3 OBSTETRICS & GYNECOLOGY Pub Date : 2019-02-10 eCollection Date: 2019-01-01 DOI: 10.1155/2019/6456141
Olatunji Lawal, Oluwasomidoyin Bello, Imran Morhason-Bello, Rukiyat Abdus-Salam, Oladosu Ojengbede

Background: Ureteric injuries leading to ureterovaginal fistula (UVF) is less common than vesicovaginal fistula, as a cause of urinary incontinence. Recently, there is a surge in the number of UVF cases presenting to University College Hospital (UCH) following a caesarean delivery. The urogynaecology unit at UCH is at the forefront of providing surgical repair for women with all forms of genitourinary fistulas. We describe our experience with managing UVF arising from ureteric injury.

Methods: A retrospective data collection of UVF cases managed from January 2012-December 2017 at UCH is presented. Information on sociodemographic and obstetric characteristics, presenting complaints, antecedent surgery, treatment received, findings at surgery, and postoperative complications were obtained with a structured proforma.

Results: Eighteen cases of UVFs due to iatrogenic ureteric injury were managed. Majority (N=11; 61.1%) of the women suffered the injury following the emergency caesarean section (EMCS). Abdominal hysterectomy operation accounted for four (22.2%) cases, and one case each (5.6%) was due to vaginal hysterectomy and destructive operations. Prolonged obstructed labour (POL) (81.8%) was the most common indication for the EMCS, while 18.2% had surgery on account of lower uterine segment fibroid. Most of the ureteric injuries were on the left side. Postoperative complications documented were haemorrhage, urinary tract infection, wound infection, and injury to the neighbouring structure.

Conclusion: Caesarean section being one of the most performed surgical operations in Nigeria was surprisingly found to be the most common cause of ureteric injury ahead of hysterectomy. It is a pointer that the surgeons might not have properly learnt the art of the caesarean delivery well. We recommend adequate surgical training of medical officers/surgeons that are involved.

背景:输尿管损伤导致输尿管阴道瘘(UVF)比膀胱阴道瘘更少见,是尿失禁的原因之一。最近,在剖腹产后到大学学院医院(UCH)就诊的UVF病例数量激增。联合医院的泌尿妇科在为患有各种形式泌尿生殖系统瘘的妇女提供手术修复方面处于领先地位。我们描述我们处理由输尿管损伤引起的紫外线辐射的经验。方法:回顾性收集2012年1月至2017年12月在联合医院处理的UVF病例。通过结构化的形式表获得了有关社会人口统计学和产科特征、主诉、术前手术、接受的治疗、手术结果和术后并发症的信息。结果:治疗了18例医源性输尿管损伤UVFs。多数(N = 11;61.1%)的妇女在紧急剖腹产(EMCS)后受伤。腹部子宫切除术4例(22.2%),阴道子宫切除术和破坏性手术各1例(5.6%)。长时间难产(POL)(81.8%)是EMCS最常见的适应症,而18.2%的患者因子宫下段肌瘤而手术。大多数输尿管损伤发生在左侧。术后并发症包括出血、尿路感染、伤口感染和邻近结构损伤。结论:剖宫产是尼日利亚最常见的外科手术之一,令人惊讶的是,剖宫产是子宫切除术前输尿管损伤最常见的原因。这是一个提示,说明外科医生可能没有很好地掌握剖腹产术。我们建议对相关医务人员/外科医生进行充分的外科培训。
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引用次数: 15
Determinants of Maternal Death in a Pastoralist Area of Borena Zone, Oromia Region, Ethiopia: Unmatched Case-Control Study. 埃塞俄比亚奥罗米亚地区Borena区牧区孕产妇死亡的决定因素:不匹配病例对照研究
IF 1.9 Q3 OBSTETRICS & GYNECOLOGY Pub Date : 2019-01-20 eCollection Date: 2019-01-01 DOI: 10.1155/2019/5698436
Jarso Sara, Yusuf Haji, Achamyelesh Gebretsadik

Background: Globally, more than 830 maternal deaths happen daily, and nearly, all of these occur in developing countries. Similarly, in Ethiopia, maternal mortality is still very high. Studies done in pastoralist women are almost few. Therefore, the objective of this study was to assess the determinant factors of maternal death in the pastoralist area of Borena zone, Oromia region, Ethiopia.

Methods: Community-based unmatched case-control study was conducted on 236 mothers (59 maternal deaths (cases) and 177 controls). The sample included pregnant women aged 15-49 years from September 2014 to March 2017. Data were collected using a structured questionnaire adapted from Maternal Death Surveillance and Response Technical Guideline, entered into the EpiData, exported into SPSS for analyses. Odds ratios (ORs) and 95% confidence interval (CI) were computed to determine contributing factors of maternal death and control potential confounding variables.

Results: About 51 (86%) of all maternal deaths were due to direct obstetric causes. Of this, hemorrhage (45%), hypertensive disorders of pregnancy (23%), and obstructed labor (18%) were the leading direct causes of maternal deaths. Husbands who had no formal education were 5 times higher compared with their counterparts (AOR = 5.1, 95% CI: 1.6-16). Mothers who were not attending ANC were 5 times more at risk for death than those who attend (AOR 5.3, 95% CI 2.3-12.1). Mothers who gave birth at home/on transit were twice to die compared to health facility delivery (AOR 2.6, 95% CI 2.4-6) that were contributing factors of maternal deaths.

Conclusions: Husband's level of education, lack of antenatal care, and home delivery were the factors contributing to maternal deaths in the zone. Frequent and tailored antenatal care, skilled delivery, and access to education also need due attention.

背景:全球每天发生830多例产妇死亡,几乎所有这些死亡都发生在发展中国家。同样,在埃塞俄比亚,产妇死亡率仍然很高。对牧民妇女进行的研究几乎很少。因此,本研究的目的是评估埃塞俄比亚奥罗米亚州Borena地区牧区孕产妇死亡的决定因素。方法:对236例产妇(59例产妇死亡)和177例对照组)进行社区不匹配病例对照研究。样本包括2014年9月至2017年3月期间15-49岁的孕妇。数据收集使用的结构化问卷改编自《孕产妇死亡监测和应对技术指南》,输入EpiData,导出到SPSS进行分析。计算优势比(ORs)和95%置信区间(CI)来确定孕产妇死亡的影响因素并控制潜在的混杂变量。结果:所有孕产妇死亡中约有51例(86%)是由直接产科原因造成的。其中,出血(45%)、妊娠高血压疾病(23%)和难产(18%)是孕产妇死亡的主要直接原因。未接受过正规教育的丈夫比其同行高出5倍(AOR = 5.1, 95% CI: 1.6-16)。未参加ANC的母亲的死亡风险是参加ANC的母亲的5倍(AOR为5.3,95% CI为2.3-12.1)。与卫生设施分娩相比,在家/在运输途中分娩的母亲的死亡率是后者的两倍(AOR为2.6,95% CI为2.4-6),这是导致孕产妇死亡的因素。结论:丈夫的受教育程度、缺乏产前护理和在家分娩是导致该区孕产妇死亡的因素。频繁和有针对性的产前保健、熟练分娩和获得教育也需要得到应有的重视。
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引用次数: 20
Gynecologists May Underestimate the Amount of Blood Loss during Total Laparoscopic Hysterectomy. 妇科医生可能低估了全腹腔镜子宫切除术的失血量。
IF 1.9 Q3 OBSTETRICS & GYNECOLOGY Pub Date : 2018-12-16 eCollection Date: 2018-01-01 DOI: 10.1155/2018/3802532
Masakazu Sato, Minako Koizumi, Kei Inaba, Yu Takahashi, Natsuki Nagashima, Hiroshi Ki, Nao Itaoka, Chiharu Ueshima, Maki Nakata, Yoko Hasumi

Background: We considered the possibility of underestimation of the amount of bleeding during laparoscopic surgery, and we investigated comparing the amount of bleeding between laparoscopic surgery and open surgery by considering the concentration of hemoglobin before and after surgery as indicators.

Methods: The following procedures were included: A, surgery for ovarian tumor; B, myomectomy; and C, hysterectomy either by laparoscopic surgery or open surgery. Patients who underwent the above procedures in between January 1, 2010, and December 31, 2017, were enrolled. We identified 1749 cases (A: 90, B: 105, and C: 325 of open surgery and A: 667, B: 437, and C: 125 of laparoscopic surgery). We considered the sum as an estimation of blood loss during surgery and the change in the value of hemoglobin in laboratory testing one day before and after surgery.

Results: During laparoscopic surgery, the measurements of blood loss included the following: A: 59.8 ml; B: 168.6 ml; and C: 206.8 ml. During open surgery, measurements of blood loss included the following: A: 130.7 ml; B: 236.7 ml; and C; 280.9 ml. The reduction of hemoglobin after surgery compared with that before surgery was less in laparoscopic surgery than that in open surgery in A and B; however, this reduction was not significantly different in C.

Conclusion: Our results suggest that the estimation of the bleeding in A and B was appropriate; however, the estimation might be underestimated in C during laparoscopic surgery.

背景:我们考虑了腹腔镜手术中出血量被低估的可能性,并以手术前后血红蛋白浓度为指标,探讨了腹腔镜手术与开放手术出血量的比较。方法:A、卵巢肿瘤手术;B,肌瘤切除术;C,子宫切除术,腹腔镜手术或开放手术。在2010年1月1日至2017年12月31日期间接受上述手术的患者被纳入研究。我们确定了1749例(A: 90, B: 105, C: 325)的开放手术和A: 667, B: 437, C: 125腹腔镜手术)。我们认为这个总和是对术中出血量的估计,以及手术前后一天血红蛋白实验室检测值的变化。结果:腹腔镜手术中出血量:A: 59.8 ml;B: 168.6 ml;C: 206.8 ml。在开放手术中,出血量测量如下:A: 130.7 ml;B: 236.7 ml;和C;280.9毫升。A、B两组患者腹腔镜手术后与术前相比血红蛋白下降幅度较小;结论:我们的结果表明,对A和B出血量的估计是合适的;然而,在腹腔镜手术中,C的估计可能被低估。
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引用次数: 4
Stress-Induced Hyperprolactinemia: Pathophysiology and Clinical Approach. 应激诱导的高泌乳素血症:病理生理学和临床方法。
IF 1.9 Q3 OBSTETRICS & GYNECOLOGY Pub Date : 2018-12-03 eCollection Date: 2018-01-01 DOI: 10.1155/2018/9253083
Samara Levine, Ozgul Muneyyirci-Delale

While prolactin is most well known for its role in lactation and suppression of reproduction, its physiological functions are quite diverse. There are many etiologies of hyperprolactinemia, including physiologic as well as pathologic causes. Physiologic causes include pregnancy, lactation, sleep-associated, nipple stimulation and sexual orgasm, chest wall stimulation, or trauma. Stress is also an important physiologic cause of hyperprolactinemia, and its clinical significance is still being explored. This review will provide an overview of prolactin physiology, the role of stress in prolactin secretion, as well as the general clinical approach to hyperprolactinemia.

虽然催乳素在泌乳和抑制生殖方面的作用最为人所知,但它的生理功能却是多种多样的。高催乳素血症有多种病因,包括生理性和病理性原因。生理性原因包括怀孕、哺乳、睡眠相关、乳头刺激和性高潮、胸壁刺激或创伤。应激也是导致高泌乳素血症的重要生理原因,其临床意义仍在探索中。本文将综述催乳素的生理、应激在催乳素分泌中的作用以及治疗高催乳素血症的一般临床方法。
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引用次数: 51
Pubococcygeal Sling versus Refixation of the Pubocervical Fascia in Vesicovaginal Fistula Repair: A Retrospective Review. 膀胱阴道瘘修补中耻骨尾骨吊带与耻骨颈筋膜再固定:回顾性回顾。
IF 1.9 Q3 OBSTETRICS & GYNECOLOGY Pub Date : 2018-10-31 eCollection Date: 2018-01-01 DOI: 10.1155/2018/6396387
Rachel Pope, Prakash Ganesh, Jeffrey Wilkinson

Urethral incontinence is an issue for approximately 10-15% of women with an obstetric fistula. Various surgical interventions to prevent this exist, including the pubococcygeal sling and refixation of the pubocervical fascia. Neither has been evaluated in comparison to one another. Therefore, this retrospective evaluation for superiority was performed. The primary outcome was urinary stress incontinence, and secondary outcomes were operative factors. There were 185 PC slings, but 12 were excluded because of urethral plications. There were 50 RPCF procedures, but 3 were excluded because of urethral plications. Finally, there were 32 cases with both PC sling and RPCF procedures. All groups demonstrated a higher than expected fistula repair rate with negative dye tests in 84% of the PC sling group, 89.9% in the RPCF group, and 93.8% in the RPCF and PC groups. There were no statistically significant differences found in continence status between the three groups. Of those who underwent PC slings, 49% were found to have residual stress incontinence. Of those who underwent RPCF, 47.8% had stress incontinence. Of those with both techniques, 43.8% had residual stress incontinence. Pad weight was not significantly different between the groups. As there is no statistically significant difference, we cannot recommend one procedure over the other as an anti-incontinence procedure. The use of both simultaneously is worth investigating.

尿道失禁是一个问题,大约10-15%的妇女与产科瘘。有多种手术干预措施可以预防这种情况,包括耻骨尾骨悬吊和耻骨颈筋膜再固定。两者都没有被比较过。因此,我们进行了回顾性的优越性评价。主要结局为尿压力性失禁,次要结局为手术因素。PC吊带185例,其中12例因尿道狭窄而被排除。有50例RPCF手术,其中3例因尿道狭窄而被排除。最后,有32例同时采用PC吊索和RPCF手术。所有组的染色试验阴性瘘管修复率均高于预期,PC吊索组为84%,RPCF组为89.9%,RPCF和PC组为93.8%。三组患者的尿失禁状况无统计学差异。在接受PC吊带的患者中,49%的人发现有残余应力性尿失禁。在接受RPCF的患者中,47.8%的患者出现了压力性尿失禁。在使用两种技术的患者中,43.8%存在残余应力性尿失禁。垫重组间差异无统计学意义。由于没有统计学上的显著差异,我们不能推荐一种手术优于另一种手术作为反尿失禁手术。两者同时使用值得研究。
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引用次数: 2
Evaluation of Accuracy of Episiotomy Incision in a Governmental Maternity Unit in Palestine: An Observational Study. 巴勒斯坦政府妇产科会阴切开术切口准确性评价:一项观察性研究。
IF 1.9 Q3 OBSTETRICS & GYNECOLOGY Pub Date : 2018-10-29 eCollection Date: 2018-01-01 DOI: 10.1155/2018/6345497
Hadil Y Ali-Masri, Sahar J Hassan, Kaled M Zimmo, Mohammed W Zimmo, Khaled M K Ismail, Erik Fosse, Hasan Alsalman, Åse Vikanes, Katariina Laine

Episiotomy should be cut at certain internationally set criteria to minimize risk of obstetric anal sphincter injuries (OASIS) and anal incontinence. The aim of this study was to assess the accuracy of cutting right mediolateral episiotomy (RMLE). An institution-based prospective cohort study was undertaken in a Palestinian maternity unit from February 1, to December 31, 2016. Women having vaginal birth at gestational weeks ≥24 or birthweight ≥1000 g and with intended RMLE were eligible (n=240). Transparent plastic films were used to trace sutured episiotomy in relation to the midline within 24-hour postpartum. These were used to measure incisions' distance from midline, and suture angles were used to classify the incisions into RMLE, lateral, and midline episiotomy groups. Clinical characteristics and association with OASIS were compared between episiotomy groups. A subanalysis by profession (midwife or trainee doctor) was done. Less than 30% were RMLE of which 59% had a suture angle of <40° (equivalent to an incision angle of <60°). There was a trend of higher OASIS rate, but not statistically significant, in the midline (16%, OR: 1.7, CI: 0.61-4.5) and unclassified groups (16.5%, OR: 1.8, CI: 0.8-4.3) than RMLE and lateral groups (10%). No significant differences were observed between episiotomies cut by doctors and midwives. Most of the assessed episiotomies lacked the agreed criteria for RMLE and had less than optimal incision angle which increases risk of severe complications. A well-structured training program on how to cut episiotomy is recommended.

外阴切开术应按照一定的国际标准进行,以尽量减少产科肛门括约肌损伤(OASIS)和肛门失禁的风险。本研究的目的是评估切割右外阴中外侧切开术(RMLE)的准确性。2016年2月1日至12月31日,在巴勒斯坦产科病房进行了一项基于机构的前瞻性队列研究。在妊娠周≥24周阴道分娩或出生体重≥1000 g且RMLE预期的妇女入选(n=240)。术后24小时内用透明塑料膜追踪缝合后的会阴切开术与中线的关系。这些用于测量切口到中线的距离,并使用缝线角度将切口分为RMLE、外侧和中线会阴切开术组。比较两组患者的临床特点及与OASIS的关系。按职业(助产士或实习医生)进行亚分析。RMLE不到30%,其中59%缝线角度为
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引用次数: 5
期刊
Obstetrics and Gynecology International
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