Obstetrics and Gynecology International最新文献

This study is a retrospective cohort review carried out at a single, private tertiary center. We included 190 female patients who underwent surgery for acute appendicitis between January 2016 and December 2018. Two groups of patients were analyzed based on the pregnancy. The main outcome measures were complication rate and risk of abortion during or after surgery. Out of 190 female patients, eight of them were pregnant (4.2%). The pregnant group more significantly underwent ultrasound investigation compared to the nonpregnant group. Complicated appendicitis present in two pregnant patients at advanced gestational age was not statistically significant from nonpregnant. Laparoscopic appendectomy was performed in 6/8 (75%) of pregnant compared to 158/182 (87%) in nonpregnant (p = 0.415). Compared to the nonpregnant, the pregnant group has a more fecolith, positive peritoneal fluid culture, and wound infection, with E. coli more frequently isolated in 25%. None of the pregnant patients had an abortion, preterm labor, or mortality during or after surgery. In conclusion, laparoscopic appendectomy is a low-risk operation for pregnant with acute appendicitis.

Background: In low-income countries, pain-free labor initiative is an emerging concept and still parturient undergoes through painful labor; this is not different in Ethiopia; despite the national direction to use analgesia for labor pain and strong demand from the women, evidence on utilization of obstetric analgesia for labor pain management in Ethiopia is scarce. The objective of this study was to assess level of obstetric analgesia utilization and associated factors among obstetric care providers in public hospitals in Addis Ababa, Ethiopia.

Methods: An institution-based cross-sectional study was used. All obstetric care providers working in labor and delivery units in public hospitals in Addis Ababa were included. The data were collected using a self-administered structured questionnaire. After checking for completeness, data were entered into Epi-data 3.1 and analyzed using SPSS 20. Bivariate and multivariable logistic regressions were used to identify factors associated with utilization of obstetric analgesia.

Result: Of 391 obstetric care providers included in the study, 143 (36.6%; 95% CI: 31.5-40.9%) reported providing labor analgesia. Having adequate knowledge (AOR 2.7; 95% CI: 1.37-5.23), ten and more years of work experience (AOR 4.3; 95% CI: 1.81-10.13), and availability of analgesics (AOR 3.3; 95% CI: 1.99-5.53) were significantly associated with providing labor analgesia.

Conclusion: Slightly more than 3 in 10 obstetric care providers reported providing labor analgesics to women. Training of providers and ensuring adequate supply of analgesics is required to make sure that women in labor would not suffer from labor pain.

Background: Hepatitis E virus infection is an emerging disease with varied courses in pregnancy. There is a dearth of statistics among pregnant women.

Aim: To evaluate the prevalence, associated factors, and pregnancy outcome in women that tested positive for hepatitis E virus (HEV) antibodies in pregnancy. Research Methods. This was a cross-sectional study conducted among pregnant women at a teaching hospital in Nigeria. Relevant information was collected using a structured questionnaire. Blood was collected from each of the participants, and the serum was used to determine the presence of hepatitis E immunoglobulin M (IgM) and G (IgG). The data were analysed using SPSS version 23. Associations between variables were determined at a p value of <0.05.

Results: A total of 200 pregnant women participated in this study. The prevalence of HEV infection among pregnant women was 28.00% (56/200). The mean age was 30.11 ± 5.88. Hepatitis E infection was significantly associated with age (p value = 0.028), method of faecal disposal (p value = 0.043), and source of drinking water (p value = 0.039). A total of 9/200 (4.50%) stillbirths were recorded with 3/9 (33.33%) in women that tested positive for HEV antibodies. About 4/200(2.00%) miscarriages were recorded, and 2/4 (50.00%) were in women that tested positive for HEV antibodies. Hepatitis E infection was not significantly associated with perinatal outcome (p value = 0.45). Only 1/56 (0.50%) maternal death was recorded among women that tested positive to hepatitis E, and none was recorded among those that tested negative to hepatitis E antibodies.

Conclusion: There was a significant statistical association between HEV infection and age, method of faecal disposal, and source of drinking water. This underscores the importance of the provision of clean water and safe faecal disposal. Hepatitis E virus infection did not significantly affect the foetal and maternal outcomes.

Objective: To analyze the epidemiological aspects of invasive cervical cancer according to HIV status.

Methods: This was an historical cohort study from January 2010 to April 2017 in three hospitals at the Yaoundé city Capital, Cameroon, after the National Ethics Committee' approval. We included invasive cervical cancers with documented HIV status. Odds ratios and 95% confidence interval were calculated to assess the association between the different variables and HIV status. Survival was analyzed using the Kaplan-Meier. The level of significance was set up at <5%.

Results: Among the overall 213 cervical cancer patients, 56 were HIV+ (24.67%). Factors associated with positive HIV status were age below 40 (OR: 2.03 (1.38-2.67)), celibacy (OR: 2.88 (1.58-4.17)), nonmenopausal status (OR: 2.56 (1.36-3.75)), low parity, primiparity (OR: 2.59 (1.43-3.74)), and for parity with 2-4 children (OR: 2.24 (1.35-3.12)). Concerning the HIV+ patients, tumor was diagnosed late (stages III-IV) (OR: 2.70 (1.43-5.08)), undifferentiated (grade III) (OR: 7.69 (5.80-9.57)), with low median survival (9.83 months vs. 20.10 months).

Conclusion: HIV is frequent among cervical cancer patients. In the HIV+ patients, the diagnosis was made at the advanced stage, cells were poorly differentiated, and the prognosis was worse.

Results: In a total cohort of 87889 deliveries over a period of 20 years, the prevalence rate of HBV fell from around 10-11% to around 6-7% in the last 5 years of the study. A negative association between chronic HBV carrier status and all gestational hypertensive disorders could be demonstrated. An apparent protective effect of HBV carrier status was apparently more robust against preeclampsia than gestational hypertension, as the negative association with preeclampsia was consistently observed throughout the study period. A logistic regression model showed that advanced maternal age, multiple pregnancies, obesity, and significant medical disorders were positively correlated with gestational hypertensive disorders, while multiparity and positive HBV carrier status were negatively correlated.

Conclusion: Chronic HBV carrier status appeared to have a protective effect against the development of preeclampsia and gestational hypertension in an endemic area with high HBV prevalence rates.

Background: Perineal tears are one of the most common complications of vaginal delivery. Severe perineal tears can cause various morbidities. There are many factors that affect the occurrence of perineal tears. One of the major factors related to the occurrence of perineal tears is the length of the perineal body. However, until now, no research in Indonesia has concluded that the length of perineal body can predict the perineal tears.

Objective: To find the relationship between perineal body length and perineal tears, so it can provide a reference on the use of perineal body length to predict severe perineal tears in vaginal delivery with episiotomy.

Methods: This nested case-control study was conducted at RSUD Tangerang and RSUD Karawang in Indonesia from February to September 2017. A total of 126 primigravida patients participated in the study consecutively. The length of the perineal body was then measured and followed until the start of the second stage of labor. Afterwards, the perineal length and degree of perineal tears were assessed using unpaired T-test for bivariate analysis, multivariate analysis, and scoring test to predict the occurrence of third- and fourth-degree of perineal tears with power calculation (β) 80% and Zβ 0.842.

Results: There was a significant difference in mean length of the perineal body between the group with first- and second-degree perineal tears and the group with third- and fourth-degree perineal tears (p < 0.001). From the multivariate analysis, adjusted OR was 5.26 (95% CI 1.52-18.17). Score test was performed to predict the occurrence of third- and fourth-grade perineal tears. Perineal body length and head circumference could be used as predicting factors of perineal tears. Perineum length ≤ 3.0 cm and head circumference ≥ 33.5 cm posed a risk of perineal tears of third and fourth degrees (70.52%).

Conclusion: The length of the perineal body has a good ability to predict the occurrence of perineal tears.

Background: Preeclampsia is a priority obstetric emergency requiring urgent diagnosis and treatment to avert poor pregnancy outcomes. Nonproteinuric preeclampsia poses even greater diagnostic challenges due to contested diagnostic criteria by the clinical practice guidelines and variable clinical presentation. Previously, preeclampsia was only diagnosed if high blood pressure and proteinuria were present. This study determined the prevalence of nonproteinuric preeclampsia and associated factors among women admitted with hypertensive disorders of pregnancy at a referral hospital in southwestern Uganda.

Methods: Women with hypertensive disorders of pregnancy were consecutively enrolled in a cross-sectional study at Mbarara Regional Referral Hospital between November 2019 and May 2020. We interviewed all pregnant women ≥20 gestation weeks presenting with hypertension and obtained their sociodemographic, medical, and obstetric characteristics. We excluded women with chronic hypertension. We measured bedside dipstick proteinuria in clean-catch urine. Preeclampsia was defined as hypertension plus any feature of severity including <100,000 platelets/ul, creatinine >1.1 g/dl, and liver transaminases ≥twice upper normal limit with or without proteinuria. We defined nonproteinuric preeclampsia in participants with <+2 urine dipstick cut-off and determined the factors associated with nonproteinuric preeclampsia using logistic regression.

Results: We enrolled 134 participants. The mean age was 26.9 (SD ± 7.1) years and 51.5% were primigravid. The prevalence of nonproteinuric preeclampsia was 24.6% (95% CI: 17.9-32.7). Primigravidity (aOR 2.70 95% CI: 1.09-6.72, p = 0.032) was the factor independently associated with nonproteinuric preeclampsia.

Conclusion: Nonproteinuric preeclampsia was common, especially among primigravidae. We recommend increased surveillance for nonproteinuric preeclampsia, especially among first-time pregnant women, who may not be detected by the traditional criteria. Obstetrics care providers should emphasize laboratory testing beyond proteinuria, among all women with hypertensive disorders of pregnancy to optimally diagnose and manage nonproteinuric preeclampsia.

Background: Self-efficacy is an important psychological and motivational factor in breastfeeding, and it is a valuable framework that predicts breastfeeding outcomes and demonstrates maternal confidence in breastfeeding. The meta-analysis evaluated the effectiveness of educational interventions on improving breastfeeding self-efficacy (BSE).

Methods: The English and Persian databases including Medline, Embase, Cochrane Database of Systematic Reviews (CDSR), PubMed, Web of Science, Scopus, CINAHL, Sid, IRANDOC, and Marg-Iran were systematically searched for studies published from January 2005 to December 2020. The quality of studies was evaluated using the Cochrane risk of bias tool and the heterogeneity by I ² statistic. The extracted data were analyzed using RevMan 5 statistical software and presented using random effects standardized mean difference (SMD). The funnel plot was used for evaluating publication bias.

Results: Results from 40 RCTs showed that educational intervention had a positive effect on the BSE compared with the usual/standard care (pooled SMD = 1.20; 95% CI = 0.75-1.64, p value <0.001). The subgroup analysis indicated that the educational intervention was based on theory, group class format, direct method education, during the first week of postpartum, doing during pregnancy, on primiparous women, and health center setting, and the Asian region has a more effect on BSE than the others.

Conclusion: Breastfeeding education is considered an influential factor in the improvement of BSE. It is recommended that breastfeeding education should be continued for several weeks after childbirth for gaining its benefit. The Asian region has a more effect on BSE than the others. Therefore, it is important to add the values in content of education in each country.

Background: An advanced abdominal pregnancy (AAP) rarely continues to a live birth, but sometimes, a live birth may occur. In developed countries, women with AAP who have not been diagnosed preoperatively are expected to be diagnosed quickly, and the pregnant woman and the fetus will be saved. After careful examination of the past cases, we sought to derive what is the best diagnosis and treatment choice in the current medical environment.

Materials and methods: We retrospectively studied AAP cases in Japan. We examined diagnosis of AAP before fetal delivery and placental treatment at the time of delivery. AAP was well documented in 10 cases. We contacted the AAP authors, who reported 10 AAP cases in Japan, directly to confirm any unclear points.

Results: Two cases were diagnosed with AAP before laparotomy, one was diagnosed after IUFD, and seven were diagnosed at the time of laparotomy. The two most recent cases were diagnosed with AAP preoperatively by ultrasound and MRI. Six cases were described for preoperative diagnosis. There were two cases of placenta previa, one of a bicornuate uterus, one of breech presentation, one of a combination of uterine cervical fibroids and placenta previa, and one of a combination of presentation and placental abnormality with uterine fibroids. In five cases, the placenta was removed at the time of laparotomy. Simultaneous removal of the placenta during laparotomy could not be performed because of intra-amniotic infection with a macerated fetus in an IUFD case. Among eight cases, excluding 20-week and 21-week gestation with no expectation of viable newborns, there were one male and seven female fetuses. The birth weight ranged from 1765 to 3520 g, with a median birth weight of 2241 g. Combined malformations were described in six of the seven live births. Clubfoot, torticollis, joint contracture, and bone deformity were transient because intrauterine compression quickly improved.

Conclusion: In recent cases, AAP has been diagnosed by MRI and ultrasound. MRI should be performed if abdominal pregnancy is suspected. Postoperative infections may occur if the placenta is not removed at the time of delivery. We recommend placental resection with the help of an anesthesiologist, a gynecologist, a urologist, and a surgeon in the current medical environment.

Background: Birth of a fetus with no signs of life after a predefined age of viability is a nightmare for the obstetrician. Stillbirth is a sensitive indicator of maternal care during the antepartum and intrapartum period. Though there has been a renewed global focus on stillbirth as a public health concern, the decline in stillbirth rate (SBR) has not been satisfactory across the nations, with a large number of stillbirths occurring in the low- to middle-income countries (LMICs). Hence, the study was carried out to analyze maternal and fetal risk factors and their association with stillbirths in a tertiary care center in South India.

Methods: This observational prospective study included pregnant women with stillbirth beyond 20 weeks of gestation or fetal weight more than 500 grams. Stillbirths were classified according to the simplified causes of death and associated conditions (CODAC) classification. Association between the risk factor and stillbirths was calculated with chi-square test and odds ratio with 95% confidence interval.

Results: There were 171 stillbirths (2.97%) among total 5755 births. The SBR was 29.71/1000 births. Risk factors such as preterm delivery (OR: 22.33, 95% CI: 15.35-32.50), anemia (OR: 21.87, 95% CI: 15.69-30.48), congenital malformation (OR: 11.24, 95% CI: 6.99-18.06), abruption (OR: 10.14, 95% CI: 6.43-15.97), oligohydramnios (OR: 4.88, 95% CI: 3.23-7.39), and hypertensive disorder (OR: 3.01, 95% CI: 2.03-4.46) were significantly associated with stillbirths. The proportion of intrapartum stillbirths was found to be 5 (3%) among the study population.

Conclusion: Highest prevalent risk factors associated with stillbirth are anemia and prematurity. Intrapartum stillbirths can be reduced significantly through evidence-based clinical interventions and practices in resource-poor settings. There is a need to provide and assure access to specialized quality antenatal care to pregnant women to control the risk factors associated with stillbirths.