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Hormone Replacement Therapy: Lebanese Women's Awareness, Perception, and Acceptance. 激素替代疗法:黎巴嫩妇女的意识、感知和接受。
IF 1.9 Q3 OBSTETRICS & GYNECOLOGY Pub Date : 2020-06-16 eCollection Date: 2020-01-01 DOI: 10.1155/2020/5240932
A Anastasia Salame, Mohammad J Jaffal, Fatin Khalifeh, Dalia Khalife, Ghina Ghazeeri

Objectives: Hormone replacement therapy (HRT) had been the gold standard for the treatment of menopausal symptoms until the publication of the World Health Initiative (WHI) study. After the WHI study, the use of HRT changed among the physicians and patients all over the world despite newer more reassuring data. This study aimed to investigate the knowledge and attitudes of women towards HRT and the factors affecting it for better counseling. Study design. A clinic-based cross-sectional study using a survey was offered to women aged 40 years and above coming to the women's health center at the American University of Beirut Medical Center (AUBMC) from October 1st, 2017, till March 31st, 2018. The questionnaire included questions about demographics and menopausal symptoms in addition to knowledge and attitudes towards menopause and HRT. Main outcome measures. Our main hypothesis was that women would be aware of HRT as a treatment modality; however, the majority would have a negative attitude towards its usage.

Results: The response rate was 87.8%. Seventy-three percent of the respondents had already heard about HRT with 57.9% supporting the use of HRT; however, 47.9% did not know when to use it. The significant predictor for having heard about HRT and a positive attitude towards HRT were having HRT prescribed as a part of treatment and employment status, respectively.

Conclusions: Lebanese women are aware of HRT as a treatment option; however, a lack of both proper information and positive attitude towards HRT use was noted.

目的:在世界卫生倡议(WHI)研究发表之前,激素替代疗法(HRT)一直是治疗更年期症状的金标准。在WHI研究之后,尽管有更新的更令人放心的数据,但世界各地的医生和患者对HRT的使用发生了变化。本研究旨在了解女性对激素替代疗法的认知、态度及影响因素,以便更好地进行咨询。研究设计。对2017年10月1日至2018年3月31日在贝鲁特美国大学医学中心(AUBMC)女性健康中心就诊的40岁及以上女性进行了基于临床的横断面研究。问卷包括人口统计学和更年期症状的问题,以及对更年期和激素替代疗法的知识和态度。主要结果测量。我们的主要假设是女性会意识到激素替代疗法是一种治疗方式;然而,大多数人对它的使用持否定态度。结果:有效率为87.8%。73%的受访者已经听说过激素替代疗法,57.9%的受访者支持使用激素替代疗法;然而,47.9%的人不知道何时使用它。听说过HRT和对HRT持积极态度的显著预测因子分别是将HRT作为治疗和就业状况的一部分。结论:黎巴嫩妇女意识到HRT是一种治疗选择;但是,注意到缺乏适当的信息和对使用激素替代疗法的积极态度。
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引用次数: 6
Preconception Care Uptake and Immediate Outcomes among Discordant Couples Accessing Routine HIV Care in Kenya. 肯尼亚不一致夫妇接受常规艾滋病毒护理的孕前护理和直接结果
IF 1.9 Q3 OBSTETRICS & GYNECOLOGY Pub Date : 2020-06-09 eCollection Date: 2020-01-01 DOI: 10.1155/2020/1675987
Nyawira Gitahi, Sheila Juliet Eshiwani, Kenneth Mutai, Jared Ongechi Mecha, James Njogu Kiarie

Introduction: A large proportion of new HIV infections occur within discordant partnerships making discordance a significant contributor to new HIV infections in Africa. Despite the role of preconception care for HIV discordant couples, there is little data on fertility desire and preconception care uptake. This study aimed at documenting fertility desire (desire to conceive), determining the uptake of preconception care, identifying HIV prevention strategies used during preconception care, and determining immediate conception outcomes among HIV discordant couples in Kenya.

Methods: We retrospectively extracted electronic medical record data on discordant couples at an HIV care discordant couples' clinic. We included data on couples who expressed a desire to conceive and were offered preconception care and followed up for 29 months. We collected data on sociodemographic characteristics, preconception prevention methods, and associated outcomes.

Results: Among couples, with male HIV-positive partners, there was a twofold likelihood of accepting preconception services (OR = 2.3, CI 95% (1, 1, 5.0)). A shorter discordant union was independently associated with the uptake of preconception services (OR = 0.92, CI 95% (0.86, 0.98)). The most used prevention intervention (38.5%) among discordant couples was a combination of pre-exposure prophylaxis (PrEP) by the uninfected partner, alongside HAART by the partner living with HIV. Pregnancy rates did not significantly (p  =  0.06) differ among those who took up preconception care versus those who did not. HIV-negative partners of couples who declined preconception care had a significantly (p  =  0.04) higher attrition from clinic follow-up. One confirmed seroconversion occurred; an HIV incidence rate of 0.19 per 100 person-years.

Conclusion: The study demonstrates the feasibility of implementing safe and effective preconception servicesas part of routine HIV care for discordant couples living in low resource settings. The provision and the utilisation of safer conception services may be hindered by the poor retention to follow-up and care of HIV-negative partners. This challenge may impede the expected benefits of preconception care as an HIV prevention intervention.

导言:很大一部分新的艾滋病毒感染发生在不协调的伙伴关系中,使不协调成为非洲新的艾滋病毒感染的一个重要因素。尽管孕前护理对艾滋病毒不一致的夫妇有作用,但关于生育愿望和孕前护理吸收的数据很少。本研究旨在记录生育欲望(怀孕欲望),确定孕前护理的吸收,确定孕前护理期间使用的艾滋病毒预防策略,并确定肯尼亚艾滋病毒不一致夫妇的即时受孕结果。方法:我们回顾性地提取HIV护理不协调夫妇诊所的不协调夫妇的电子病历数据。我们纳入了表达怀孕愿望的夫妇的数据,并提供了孕前护理,随访了29个月。我们收集了社会人口学特征、孕前预防方法和相关结果的数据。结果:在男性hiv阳性伴侣的夫妇中,接受孕前服务的可能性是男性的两倍(OR = 2.3, CI 95%(1,1,5.0))。较短的不和谐结合与孕前服务的接受独立相关(OR = 0.92, CI 95%(0.86, 0.98))。在不一致的夫妇中,使用最多的预防干预措施(38.5%)是未感染伴侣的暴露前预防(PrEP)与感染艾滋病毒的伴侣的HAART相结合。妊娠率在接受孕前护理者和未接受孕前护理者之间没有显著差异(p = 0.06)。拒绝孕前护理的夫妇的hiv阴性伴侣在临床随访中有显著的高损失率(p = 0.04)。发生一例确诊的血清转化;艾滋病毒感染率为每100人年0.19例。结论:本研究表明,对生活在资源匮乏环境中的不和谐夫妇实施安全有效的孕前服务作为常规艾滋病毒护理的一部分是可行的。提供和利用更安全的受孕服务可能会因对艾滋病毒阴性伴侣的随访和护理保留不足而受到阻碍。这一挑战可能会阻碍孕前护理作为艾滋病毒预防干预措施的预期效益。
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引用次数: 1
Nonpuerperal Uterine Inversion: What the Gynaecologists Need to Know? 非产褥期子宫内翻:妇科医生需要知道什么?
IF 1.9 Q3 OBSTETRICS & GYNECOLOGY Pub Date : 2020-06-01 eCollection Date: 2020-01-01 DOI: 10.1155/2020/8625186
R P Herath, M Patabendige, M Rashid, P S Wijesinghe

Introduction: Nonpuerperal uterine inversion (NPUI) is a rare clinical problem with diagnostic and surgical challenges. The objective of our study was to review the literature on NPUI and describe causative pathologies, diagnosis, and different surgical options available for treatment.

Materials and methods: A comprehensive literature review was carried out on MEDLINE and Google Scholar databases to look for NPUI using the term "non-puerperal uterine inversion," and further went through the cross-references of the published articles. Data are published case reports from 1911 to September 2018. Of the 153 published cases, 133 reports had adequate details of surgery for analysis. These reports were analyzed, concerning the clinical presentation, methods of diagnosis, and surgical treatment.

Results: Mean age of the women was 46.3 years (standard deviation: 18, N = 153). Leiomyoma remained the commonest (56.2%) aetiology. While malignancies contributed to 32.02% of cases, 9.2% were idiopathic. High degree of clinical suspicion and identification of unique features on ultrasonography and magnetic resonance imaging enable prompt diagnosis. In cases of uncertainty, laparoscopy or biopsy of the mass was used to confirm the diagnosis. Hysterectomy or repositioning and repair of the uterus are the only treatment options available. The surgical methods implemented were analyzed in three aspects: route of surgical access, method of repositioning, and final surgical procedure undertaken. The majority (48.8%) had only abdominal access, while 27.1% had both abdominal and vaginal access. Haultain procedure was the most useful procedure for reposition (18.0%) of the uterus. The majority (39.7%) required abdominal hysterectomy with or without debulking of the tumour abdominally, while 15.0% had uterine repair after repositioning. We reviewed the different surgical techniques and described and proposed a treatment algorithm.

Conclusions: Fibroids were the commonest cause for NPUI. Malignancies accounted for one-third of cases. A combined abdominal and vaginal approach, followed by hysterectomy or repair after repositioning, seems to be better for nonmalignant cases.

简介:非产褥期子宫内翻(NPUI)是一个罕见的临床问题,诊断和手术挑战。我们研究的目的是回顾NPUI的文献,描述病因病理、诊断和不同的手术治疗方案。材料和方法:在MEDLINE和Google Scholar数据库中进行全面的文献检索,寻找使用“非产后子宫反转”一词的NPUI,并进一步对已发表的文章进行交叉参考。数据为1911年至2018年9月公布的病例报告。在153例已发表的病例中,133例报告有足够的手术细节供分析。对这些报告进行分析,包括临床表现、诊断方法和手术治疗。结果:女性平均年龄46.3岁(标准差:18,N = 153)。平滑肌瘤仍然是最常见的病因(56.2%)。恶性肿瘤占32.02%,其中特发性占9.2%。临床高度怀疑,超声和磁共振成像的独特特征识别,使诊断及时。在不确定的情况下,腹腔镜检查或肿块活检被用来确认诊断。子宫切除术或子宫重新定位和修复是唯一的治疗选择。从手术通路、复位方法、最终手术方式三方面分析手术方法。大多数(48.8%)只有腹部通道,而27.1%有腹部和阴道通道。牵引手术是子宫复位最有用的手术(18.0%)。大多数(39.7%)需要腹部子宫切除术,伴有或不伴有腹部肿瘤缩小,而15.0%的患者在重新定位后进行子宫修复。我们回顾了不同的手术技术,描述并提出了一种治疗算法。结论:子宫肌瘤是NPUI最常见的病因。恶性肿瘤占三分之一。腹腔和阴道联合入路,然后子宫切除术或重新定位后修复,似乎对非恶性病例更好。
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引用次数: 21
Midgut Volvulus: A Rare but Fatal Cause of Abdominal Pain in Pregnancy-How Can We Diagnose and Prevent Mortality? 中肠扭转:一种罕见但致命的妊娠腹痛原因——我们如何诊断和预防死亡?
IF 1.9 Q3 OBSTETRICS & GYNECOLOGY Pub Date : 2020-05-26 eCollection Date: 2020-01-01 DOI: 10.1155/2020/2185290
Eelyn Chong, David S Liu, Neil Strugnell, Vishnupriya Rajagopal, Krinal K Mori

Midgut volvulus in pregnancy is rare but life-threatening, resulting in high maternal and fetal mortality. This surgical emergency commonly masquerades as symptoms of pregnancy, which together with its low incidence often leads to delay in diagnosis and definitive treatment. Here, we review the last three decades of the literature, discuss the challenges in managing this rare condition, and raise awareness among clinicians to minimise loss of life.

妊娠期中肠扭转罕见,但危及生命,导致产妇和胎儿死亡率高。这种外科紧急情况通常伪装成怀孕的症状,加上发病率低,往往导致诊断和最终治疗的延误。在这里,我们回顾了过去三十年的文献,讨论了管理这种罕见疾病的挑战,并提高了临床医生的认识,以尽量减少生命损失。
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引用次数: 4
Quality of Life among Obstetric Fistula Patients at Kitovu Mission Hospital: A Health Facility-Based Cross-Sectional Study in Masaka District, Uganda. Kitovu教会医院产科瘘患者的生活质量:乌干达马萨卡地区基于卫生设施的横断面研究。
IF 1.9 Q3 OBSTETRICS & GYNECOLOGY Pub Date : 2020-05-20 eCollection Date: 2020-01-01 DOI: 10.1155/2020/7953915
Samuel Kakembo, Christine Atuhairwe, Ivan Mugisha Taremwa

Background: Obstetric fistula (OF) remains a silent neglected maternal challenge associated with devastating life consequences. Living with OF presents far-reaching physical, social, psychosocial, and emotional concerns, which negatively impact a woman's quality of life. This study evaluated the quality of life among obstetric fistula patients in Masaka district, Uganda.

Method: A cross-sectional study was conducted among 63 women diagnosed with OF at Kitovu Mission Hospital. Data were collected using a questionnaire, observation, in-depth interviews, and focus group discussions. Data were analyzed at univariate, bivariate, and multivariate levels, where the ordinal logistic regression model was applied. The qualitative data was transcribed and analyzed using qualitative content analysis.

Results: Majority (87%) of the women diagnosed with OF reportedly had a poor quality of life. Bivariate analysis indicated that level of education (P < 0.001), employment status (P < 0.001), energy for everyday life (P < 0.001), capacity to work (P < 0.001), satisfaction with personal relationships (P < 0.001), feelings of loneliness (P < 0.001), negative feelings (P = 0.002), and self-confidence (P < 0.001) were significantly associated with good QoL. Multivariate analysis showed increased odds of good QoL increased among women with self-confidence (OR = 32.320; CI = 2.019-517.467), formal education (OR = 9.9497; CI = 1.075-92.048), women who did not experience difficulties in mobility (OR = 19.144; CI = 0.149-2456.770), and women who were satisfied with their personal relationships (OR = 5.785; CI = 0.447-74.824).

Conclusion: A holistic fistula treatment approach is required that takes into consideration all aspects of life to address the consequences of obstetric fistula to realize improved quality of life among patients.

背景:产科瘘(OF)仍然是一个沉默的被忽视的产妇挑战与毁灭性的生活后果。患有OF会对身体、社会、心理和情感产生深远的影响,对女性的生活质量产生负面影响。本研究评估了乌干达马萨卡地区产科瘘患者的生活质量。方法:对63名在Kitovu教会医院诊断为OF的妇女进行横断面研究。数据收集采用问卷调查、观察、深度访谈和焦点小组讨论。在单变量、双变量和多变量水平上分析数据,其中应用了有序逻辑回归模型。对定性数据进行转录和定性内容分析。结果:据报道,大多数(87%)被诊断为of的女性生活质量较差。双变量分析显示,教育水平(P < 0.001)、就业状况(P < 0.001)、日常生活精力(P < 0.001)、工作能力(P < 0.001)、人际关系满意度(P < 0.001)、孤独感(P < 0.001)、消极情绪(P = 0.002)和自信心(P < 0.001)与良好生活质量显著相关。多因素分析显示,自信女性获得良好生活质量的几率增加(OR = 32.320;CI = 2.019-517.467),正规教育(OR = 9.9497;CI = 1.075-92.048),没有活动困难的女性(OR = 19.144;CI = 0.149-2456.770),对个人关系满意的女性(OR = 5.785;ci = 0.447-74.824)。结论:需要一种全面的瘘管治疗方法,考虑到生活的各个方面,以解决产科瘘的后果,实现患者生活质量的提高。
{"title":"Quality of Life among Obstetric Fistula Patients at Kitovu Mission Hospital: A Health Facility-Based Cross-Sectional Study in Masaka District, Uganda.","authors":"Samuel Kakembo,&nbsp;Christine Atuhairwe,&nbsp;Ivan Mugisha Taremwa","doi":"10.1155/2020/7953915","DOIUrl":"https://doi.org/10.1155/2020/7953915","url":null,"abstract":"<p><strong>Background: </strong>Obstetric fistula (OF) remains a silent neglected maternal challenge associated with devastating life consequences. Living with OF presents far-reaching physical, social, psychosocial, and emotional concerns, which negatively impact a woman's quality of life. This study evaluated the quality of life among obstetric fistula patients in Masaka district, Uganda.</p><p><strong>Method: </strong>A cross-sectional study was conducted among 63 women diagnosed with OF at Kitovu Mission Hospital. Data were collected using a questionnaire, observation, in-depth interviews, and focus group discussions. Data were analyzed at univariate, bivariate, and multivariate levels, where the ordinal logistic regression model was applied. The qualitative data was transcribed and analyzed using qualitative content analysis.</p><p><strong>Results: </strong>Majority (87%) of the women diagnosed with OF reportedly had a poor quality of life. Bivariate analysis indicated that level of education (<i>P</i> < 0.001), employment status (<i>P</i> < 0.001), energy for everyday life (<i>P</i> < 0.001), capacity to work (<i>P</i> < 0.001), satisfaction with personal relationships (<i>P</i> < 0.001), feelings of loneliness (<i>P</i> < 0.001), negative feelings (<i>P</i> = 0.002), and self-confidence (<i>P</i> < 0.001) were significantly associated with good QoL. Multivariate analysis showed increased odds of good QoL increased among women with self-confidence (OR = 32.320; CI = 2.019-517.467), formal education (OR = 9.9497; CI = 1.075-92.048), women who did not experience difficulties in mobility (OR = 19.144; CI = 0.149-2456.770), and women who were satisfied with their personal relationships (OR = 5.785; CI = 0.447-74.824).</p><p><strong>Conclusion: </strong>A holistic fistula treatment approach is required that takes into consideration all aspects of life to address the consequences of obstetric fistula to realize improved quality of life among patients.</p>","PeriodicalId":19439,"journal":{"name":"Obstetrics and Gynecology International","volume":"2020 ","pages":"7953915"},"PeriodicalIF":1.9,"publicationDate":"2020-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2020/7953915","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38039797","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: 2
Still No Substantial Evidence to Use Prophylactic Antibiotic at Operative Vaginal Delivery: Systematic Review and Meta-Analysis. 仍然没有实质性的证据表明在阴道手术分娩中使用预防性抗生素:系统回顾和荟萃分析。
IF 1.9 Q3 OBSTETRICS & GYNECOLOGY Pub Date : 2020-05-19 eCollection Date: 2020-01-01 DOI: 10.1155/2020/1582653
Yifru Berhan, Sisay Kirba, Achamyelesh Gebre

Background: Postpartum maternal infection is still a common problem worldwide, mainly due to obstetric risk factors. The use of prophylactic antibiotic at operative vaginal delivery (OVD), taking it as a standalone risk factor, has been controversial. The purpose of this review was to rigorously evaluate the association of OVD with postpartum infection and shed light on such highly controversial issue.

Methods: A computer-based literature search was done mainly in the databases of PUBMED, HINARI health research, and the Cochrane library. Systematic review and meta-analysis were done by including 14 articles published between 1990 and August 2019.

Results: The average absolute risk of postpartum infection at OVD from seven large cohort studies was 1%. Few studies showed a weak association of OVD with postpartum infection without being adjusted to perineal wound, but the pooled meta-analysis showed statistically significant association with non-OVD. In the included randomized trial, 97% of the study participants had perineal wound for whom repairs were performed; the risks of maternal infection and perineal wound breakdown were comparable, and maternal infections other than perineal wound infection did not show significant difference between prophylactic antibiotic and placebo groups. The majority of included studies demonstrated a strong association of postpartum infection and perineal wound dehiscence with episiotomy and perineal tear.

Conclusion: Both the relative and absolute risks of postpartum infection at OVD are extremely low unless accompanied by episiotomy and 3rd/4tht degree perineal tear. From previous studies, there is no substantial evidence to use prophylactic antibiotic at OVD, but episiotomy and perineal tear.

背景:产妇产后感染仍是世界范围内的一个常见问题,主要是由产科危险因素引起的。在阴道手术分娩(OVD)中使用预防性抗生素,将其作为一个独立的风险因素,一直存在争议。本综述的目的是严格评估OVD与产后感染的关系,并阐明这一备受争议的问题。方法:计算机检索文献,主要检索PUBMED、HINARI健康研究数据库和Cochrane图书馆。对1990年至2019年8月期间发表的14篇文章进行了系统回顾和荟萃分析。结果:七项大型队列研究中,OVD产后感染的平均绝对风险为1%。很少有研究显示OVD与产后感染的相关性较弱,而没有调整到会阴伤口,但汇总meta分析显示OVD与非OVD的相关性具有统计学意义。在纳入的随机试验中,97%的研究参与者有会阴伤口并进行了修复;母体感染和会阴创面破裂的风险具有可比性,预防性抗生素组和安慰剂组之间除会阴创面感染外的母体感染无显著差异。大多数纳入的研究表明,会阴切开术和会阴撕裂与产后感染和会阴伤口裂开密切相关。结论:除非伴有会阴切开术和会阴3 /4度撕裂术,否则OVD患者发生产后感染的相对和绝对风险极低。从以往的研究来看,没有充分的证据表明OVD可以预防性使用抗生素,但会阴切开和会阴撕裂除外。
{"title":"Still No Substantial Evidence to Use Prophylactic Antibiotic at Operative Vaginal Delivery: Systematic Review and Meta-Analysis.","authors":"Yifru Berhan,&nbsp;Sisay Kirba,&nbsp;Achamyelesh Gebre","doi":"10.1155/2020/1582653","DOIUrl":"https://doi.org/10.1155/2020/1582653","url":null,"abstract":"<p><strong>Background: </strong>Postpartum maternal infection is still a common problem worldwide, mainly due to obstetric risk factors. The use of prophylactic antibiotic at operative vaginal delivery (OVD), taking it as a standalone risk factor, has been controversial. The purpose of this review was to rigorously evaluate the association of OVD with postpartum infection and shed light on such highly controversial issue.</p><p><strong>Methods: </strong>A computer-based literature search was done mainly in the databases of PUBMED, HINARI health research, and the Cochrane library. Systematic review and meta-analysis were done by including 14 articles published between 1990 and August 2019.</p><p><strong>Results: </strong>The average absolute risk of postpartum infection at OVD from seven large cohort studies was 1%. Few studies showed a weak association of OVD with postpartum infection without being adjusted to perineal wound, but the pooled meta-analysis showed statistically significant association with non-OVD. In the included randomized trial, 97% of the study participants had perineal wound for whom repairs were performed; the risks of maternal infection and perineal wound breakdown were comparable, and maternal infections other than perineal wound infection did not show significant difference between prophylactic antibiotic and placebo groups. The majority of included studies demonstrated a strong association of postpartum infection and perineal wound dehiscence with episiotomy and perineal tear.</p><p><strong>Conclusion: </strong>Both the relative and absolute risks of postpartum infection at OVD are extremely low unless accompanied by episiotomy and 3<sup>rd</sup>/4<sup>th</sup>t degree perineal tear. From previous studies, there is no substantial evidence to use prophylactic antibiotic at OVD, but episiotomy and perineal tear.</p>","PeriodicalId":19439,"journal":{"name":"Obstetrics and Gynecology International","volume":"2020 ","pages":"1582653"},"PeriodicalIF":1.9,"publicationDate":"2020-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2020/1582653","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38384361","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: 2
Risk Factors for Obstetric Anal Sphincter Injuries among Women Delivering at a Tertiary Hospital in Southwestern Uganda. 在乌干达西南部一家三级医院分娩的妇女产科肛门括约肌损伤的危险因素。
IF 1.9 Q3 OBSTETRICS & GYNECOLOGY Pub Date : 2020-05-14 eCollection Date: 2020-01-01 DOI: 10.1155/2020/6035974
Mahad Ali, Richard Migisha, Joseph Ngonzi, Joy Muhumuza, Ronald Mayanja, Jolly Joe Lapat, Wasswa Salongo, Musa Kayondo

Background: Obstetric anal sphincter injuries (OASIS) arise from perineal trauma during vaginal delivery and are associated with poor maternal health outcomes. Most OASIS occur in unattended deliveries in resource-limited settings. However, even in facilities where deliveries are attended by skilled personnel, a number of women still get OASIS.

Objectives: To determine the incidence and risk factors for obstetric anal sphincter injuries among women delivering at Mbarara Regional Referral Hospital (MRRH).

Methods: We conducted an unmatched hospital-based case control study, with the ratio of cases to controls of 1 : 2 (80 cases and 160 controls). We defined a case as a mother who got a third- or fourth-degree perineal tear after vaginal delivery while the controls recruited were the next two mothers who delivered vaginally without a third- or fourth-degree perineal tear. A questionnaire and participants' medical records review were used to obtain sociodemographic and clinical data. We estimated the incidence of OASIS and performed univariable and multivariable logistic regression to identify the associated risk factors.

Results: The cumulative incidence for OASIS during the study period was 6.6%. The risk factors for OASIS were 2nd stage of labour ≥1 hour (aOR 6.07, 95%CI 1.86-19.82, p=0.003), having episiotomy performed during labour (aOR 2.57, 95%CI 1.07-6.17, p=0.035), perineum support during delivery (aOR 0.03, 95%CI 0.01-0.12, p < 0.001), and monthly income of >50,000 shillings (aOR 0.09, 95%CI 0.03-0.28, p < 0.001). Conclusions and Recommendations. The risk factors for obstetric anal sphincter injury were prolonged second stage of labour and performing episiotomies during deliveries while higher monthly income and perineum support during delivery were protective. We recommend routine support to the perineum during delivery. Care should be taken in mothers with episiotomies, as they can extend and cause OASIS.

背景:产科肛门括约肌损伤(OASIS)是由阴道分娩时会阴创伤引起的,与孕产妇健康状况不佳有关。大多数绿洲发生在资源有限的环境中无人值守的分娩。然而,即使在由熟练人员接生的设施中,仍有一些妇女获得OASIS。目的:确定在姆巴拉拉地区转诊医院(MRRH)分娩的妇女产科肛门括约肌损伤的发生率和危险因素。方法:我们进行了一项无与伦比的基于医院的病例对照研究,病例与对照的比例为1:2(80例病例和160例对照)。我们将一个病例定义为阴道分娩后出现三度或四度会阴撕裂的母亲,而招募的对照组是接下来的两个阴道分娩时没有三度或四度会阴撕裂的母亲。使用问卷调查和参与者的医疗记录审查来获得社会人口学和临床数据。我们估计了OASIS的发病率,并进行了单变量和多变量logistic回归来确定相关的危险因素。结果:研究期间OASIS的累计发病率为6.6%。发生OASIS的危险因素为产程第2期≥1小时(aOR 6.07, 95%CI 1.86 ~ 19.82, p=0.003)、产程进行会阴切开术(aOR 2.57, 95%CI 1.07 ~ 6.17, p=0.035)、分娩时会阴支撑(aOR 0.03, 95%CI 0.01 ~ 0.12, p < 0.001)、月收入>5万先令(aOR 0.09, 95%CI 0.03 ~ 0.28, p < 0.001)。结论和建议。产科肛门括约肌损伤的危险因素是第二产程延长和分娩时进行外阴切开术,而较高的月收入和分娩时对会阴的支持是保护性的。我们建议在分娩期间对会阴进行常规支持。外阴切开术的母亲应该小心,因为它们可以延长和引起OASIS。
{"title":"Risk Factors for Obstetric Anal Sphincter Injuries among Women Delivering at a Tertiary Hospital in Southwestern Uganda.","authors":"Mahad Ali,&nbsp;Richard Migisha,&nbsp;Joseph Ngonzi,&nbsp;Joy Muhumuza,&nbsp;Ronald Mayanja,&nbsp;Jolly Joe Lapat,&nbsp;Wasswa Salongo,&nbsp;Musa Kayondo","doi":"10.1155/2020/6035974","DOIUrl":"https://doi.org/10.1155/2020/6035974","url":null,"abstract":"<p><strong>Background: </strong>Obstetric anal sphincter injuries (OASIS) arise from perineal trauma during vaginal delivery and are associated with poor maternal health outcomes. Most OASIS occur in unattended deliveries in resource-limited settings. However, even in facilities where deliveries are attended by skilled personnel, a number of women still get OASIS.</p><p><strong>Objectives: </strong>To determine the incidence and risk factors for obstetric anal sphincter injuries among women delivering at Mbarara Regional Referral Hospital (MRRH).</p><p><strong>Methods: </strong>We conducted an unmatched hospital-based case control study, with the ratio of cases to controls of 1 : 2 (80 cases and 160 controls). We defined a case as a mother who got a third- or fourth-degree perineal tear after vaginal delivery while the controls recruited were the next two mothers who delivered vaginally without a third- or fourth-degree perineal tear. A questionnaire and participants' medical records review were used to obtain sociodemographic and clinical data. We estimated the incidence of OASIS and performed univariable and multivariable logistic regression to identify the associated risk factors.</p><p><strong>Results: </strong>The cumulative incidence for OASIS during the study period was 6.6%. The risk factors for OASIS were 2<sup>nd</sup> stage of labour ≥1 hour (aOR 6.07, 95%CI 1.86-19.82, <i>p</i>=0.003), having episiotomy performed during labour (aOR 2.57, 95%CI 1.07-6.17, <i>p</i>=0.035), perineum support during delivery (aOR 0.03, 95%CI 0.01-0.12, <i>p</i> < 0.001), and monthly income of >50,000 shillings (aOR 0.09, 95%CI 0.03-0.28, <i>p</i> < 0.001). <i>Conclusions and Recommendations</i>. The risk factors for obstetric anal sphincter injury were prolonged second stage of labour and performing episiotomies during deliveries while higher monthly income and perineum support during delivery were protective. We recommend routine support to the perineum during delivery. Care should be taken in mothers with episiotomies, as they can extend and cause OASIS.</p>","PeriodicalId":19439,"journal":{"name":"Obstetrics and Gynecology International","volume":"2020 ","pages":"6035974"},"PeriodicalIF":1.9,"publicationDate":"2020-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2020/6035974","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38021476","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: 6
Prevalence of Preterm Premature Rupture of Membrane and Its Associated Factors among Pregnant Women Admitted in Debre Tabor General Hospital, North West Ethiopia: Institutional-Based Cross-Sectional Study. 埃塞俄比亚西北部Debre Tabor综合医院住院孕妇的胎膜早破患病率及其相关因素:基于机构的横断面研究
IF 1.9 Q3 OBSTETRICS & GYNECOLOGY Pub Date : 2020-05-14 eCollection Date: 2020-01-01 DOI: 10.1155/2020/4034680
Dagne Addisu, Abenezer Melkie, Shimeles Biru

Background: In Ethiopia, preterm premature rupture of membrane is defined as loss of amniotic fluid before the onset of labor in pregnancy >28 weeks of gestation but before 37 weeks. It is a significant cause of perinatal, neonatal, and maternal morbidity and mortality both in high- and low-income countries. Due to different factors associated with the quality of health care given and socioeconomic factors, the effect of preterm premature rupture of membrane is worsen in low-income countries. Little evidence is available about the problem in the study area. Therefore, this study was aimed to determine the prevalence of preterm premature rupture of membrane and its associated factors among pregnant women admitted in Debre Tabor General Hospital.

Methods: Facility-based cross-sectional study was conducted. A total of 424 mothers were included in the study. Systematic random sampling was used to select study participants. A combination of chart review and interview was used to collect the data. Both descriptive and analytical statistics were computed.

Result: The prevalence of preterm premature rupture of membrane was found to be 13.7%. Pregnant women with abnormal vaginal discharge (AOR = 5.30, 95% CI  = 2.07-13.52), urinary tract infection (AOR = 2.62, 95% CI = 1.32-5.19), history of premature rupture of membrane (AOR = 3.31, 95% CI = 1.32-8.27), vaginal bleeding (AOR = 2.58, 95% CI = 1.14-5.82), and mid-upper arm circumference <23 cm (AOR = 6.26, 95% CI = 3.21-12.20) were associated with preterm premature rupture of membrane.

Conclusions: The prevalence of preterm premature rupture of membrane was high. Abnormal vaginal discharge, urinary tract infection, vaginal bleeding, previous premature rupture of membrane, and mid-upper arm circumference <23 cm were associated with preterm premature rupture of membrane. Thus, early screening and treatment of urinary tract infections and abnormal vaginal discharges were recommended to reduce the risk of preterm premature rupture of membrane.

背景:在埃塞俄比亚,胎膜早破被定义为妊娠>28周至37周前分娩前羊水流失。它是高收入和低收入国家围产期、新生儿和孕产妇发病率和死亡率的一个重要原因。由于与医疗质量和社会经济因素相关的不同因素,低收入国家的早产胎膜早破的影响更严重。在研究地区,关于这个问题的证据很少。因此,本研究旨在确定在Debre Tabor总医院住院的孕妇中早产胎膜早破的患病率及其相关因素。方法:采用以医院为基础的横断面研究。共有424位母亲参与了这项研究。采用系统随机抽样的方法选择研究对象。采用图表回顾和访谈相结合的方法收集数据。计算描述性统计和分析性统计。结果:早产胎膜早破的发生率为13.7%。阴道分泌物异常(AOR = 5.30, 95% CI = 2.07-13.52)、尿路感染(AOR = 2.62, 95% CI = 1.32-5.19)、有膜早破史(AOR = 3.31, 95% CI = 1.32-8.27)、阴道出血(AOR = 2.58, 95% CI = 1.14-5.82)、上臂中围的孕妇结论:早产膜早破发生率较高。阴道分泌物异常,尿路感染,阴道出血,既往膜早破,上臂中围
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引用次数: 23
Etiology, Clinical Features, and Diagnosis of Vulvar Lichen Sclerosus: A Scoping Review. 外阴硬化苔藓的病因、临床特征和诊断:综述。
IF 1.9 Q3 OBSTETRICS & GYNECOLOGY Pub Date : 2020-04-21 eCollection Date: 2020-01-01 DOI: 10.1155/2020/7480754
Nilanchali Singh, Prafull Ghatage

Objective. Vulvar lichen sclerosus (VLS) is a chronic inflammatory disorder, which affects women of all ages. With numerous controversies as regards to the nomenclature, diagnosis and its association with neoplastic conditions, we decided to conduct a scoping review on this subject. Data Source. A review protocol was developed, and the Knowledge Resource Services website was used to do a search of articles pertaining to VLS with keywords "Vulvar," "Vulval," "diagnosis," "lichen sclerosus et atrophicus," "kraurosis," "vulvar dystrophy," and "Lichen Sclerosus". Study Selection. The search was limited to published data from the last ten years, i.e., from July 2009 onwards and in the English language. A total of 338 articles pertaining to VLS were obtained. Older data were accessed if particular information was sought for. Results & Conclusion. The presentation is bimodal, i.e., one in prepubertal girls (average age: 7.6 years) and the other in peri- and postmenopausal women (average age: 52.6 years). However, many cases also present during reproductive years. Studies suggest a multifactorial origin as far as etiology is concerned, including a genetic, autoimmune, hormonal, and local infectious background. It affects the genital labial, perineal, and perianal areas and manifests as a patchy, thin, glistening, ivory-white area. Diagnosis is mainly based on clinical features. Biopsy is seldom required. It has been well established as a precursor lesion of dVIN and vulvar carcinoma.

目标。外阴硬化苔藓(VLS)是一种慢性炎症性疾病,影响所有年龄段的女性。由于在命名、诊断及其与肿瘤条件的关系方面存在许多争议,我们决定对这一主题进行范围审查。数据源。制定了一项审查方案,并使用知识资源服务网站搜索与VLS相关的文章,关键词为“外阴”、“外阴”、“诊断”、“硬化性地衣和萎缩性地衣”、“黑痣”、“外阴营养不良”和“硬化性地衣”。研究选择。搜索仅限于最近十年,即从2009年7月起的英文出版数据。共获得338件与VLS有关的物品。如果需要查找特定信息,则访问旧数据。结果与结论。这种表现是双峰的,即一种发生在青春期前的女孩(平均年龄:7.6岁),另一种发生在绝经期和绝经后的妇女(平均年龄:52.6岁)。然而,许多病例也出现在生育年龄。研究表明病因是多因素的,包括遗传、自身免疫、激素和局部感染背景。它影响生殖器的阴唇,会阴和肛周区域,表现为斑驳,薄,闪闪发光,象牙白色的区域。诊断主要依据临床特征。很少需要活检。它已被确定为dVIN和外阴癌的前兆病变。
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引用次数: 35
Determinants of Cesarean Section Deliveries in Public Hospitals of Addis Ababa, Ethiopia, 2018/19: A Case-Control Study. 2018/19年埃塞俄比亚亚的斯亚贝巴公立医院剖宫产的决定因素:一项病例对照研究
IF 1.9 Q3 OBSTETRICS & GYNECOLOGY Pub Date : 2020-04-20 eCollection Date: 2020-01-01 DOI: 10.1155/2020/9018747
Areaya Gebreegziabher Hailu, Tsegaye Kebede Fanta, Fissaha Tekulu Welay, Natnael Etsay Assefa, Surafel Aregawi Hadera, Gebrekiros Aregawi Gebremeskel, Hagos Weldeslassie Gebremedhin, Guesh Gebreayezgi Asefa

Objective: The objective of this study was to assess the determinants of cesarean section deliveries in public hospitals of Addis Ababa, Ethiopia, 2019.

Method: A hospital-based unmatched case-control study was conducted to study 780 (260 cases and 520 controls) women who delivered in public hospitals of Addis Ababa from August 22 to September 20, 2019. The cases were all mothers who delivered through caesarean section, and controls were all mothers who delivered vaginally in the same time in the study area. Data were collected from the randomly selected women and looking into their cards. Data were entered on EpiData 3.1 and exported to SPSS version 20 for cleaning and analyzing. Binary logistic regression and AOR with 95% CI were used to assess the determinants of caesarean section.

Results: Majority of the study participants were in the age category 20-34 years. Nearly more than 1/3rd of the participants (32.7% cases and 34.6% controls) have attended primary school. Most of the cases 217 (83.5%) and few of the controls 21 (4%) possess previous caesarean section. One hundred three (52.3%) of the cases and 329 (63.6%) controls were multi-parous. Previous caesarean delivery (AOR = 6.93, 95% CI; (3.39, 14.16)), singleton pregnancy (AOR = 0.34, 95% CI; (0.12, 0.83)), birth weight less than 2500 gm (AOR = 0.29, 95% CI; (0.18, 0.92)), birth weight greater than 4000 gm (AOR = 16.15 (8.22, 31.74)), completely documented partograph (AOR = 0.13, 95% CI; (0.078, 0.23)), and pregnancy-induced hypertension (AOR = 2.44, 95% CI; (1.46, 4.08)) were significant determinants of caesarean delivery in this study.

Conclusion: Previous caesarean section, number of delivery, birth weight, partograph documentation, and pregnancy-induced hypertension had significant association with caesarean section delivery in this study.

目的:本研究的目的是评估2019年埃塞俄比亚亚的斯亚贝巴公立医院剖宫产的决定因素。方法:对2019年8月22日至9月20日在亚的斯亚贝巴公立医院分娩的孕产妇780例(病例260例,对照组520例)进行非匹配病例对照研究。这些病例都是通过剖腹产分娩的母亲,对照组都是在研究区域内同一时间顺产的母亲。研究人员从随机选择的女性中收集数据,并查看她们的卡片。数据在EpiData 3.1上输入,导出到SPSS version 20进行清理和分析。采用二元logistic回归和AOR (95% CI)评估剖腹产的决定因素。结果:大多数研究参与者的年龄在20-34岁之间。近三分之一以上的参与者(32.7%的病例和34.6%的对照组)上过小学。大多数病例217例(83.5%)和少数对照组21例(4%)有过剖宫产史。其中103例(52.3%)为多胎,对照组329例(63.6%)为多胎。既往剖宫产(AOR = 6.93, 95% CI;(3.39, 14.16))、单胎妊娠(AOR = 0.34, 95% CI;(0.12, 0.83)),出生体重小于2500克(AOR = 0.29, 95% CI;(0.18, 0.92)),出生体重大于4000克(AOR = 16.15(8.22, 31.74)),完整记录的分娩(AOR = 0.13, 95% CI;(0.078, 0.23))和妊娠高血压(AOR = 2.44, 95% CI;(1.46, 4.08))是本研究中剖腹产的重要决定因素。结论:本研究中,既往剖宫产、分娩次数、出生体重、产程记录和妊娠高血压与剖宫产有显著相关性。
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引用次数: 13
期刊
Obstetrics and Gynecology International
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