Obstetrics and Gynecology International最新文献

Background: Women who undergo perineal episiotomy can be affected by several complications such as bleeding, infection, perineal pain, dyspareunia, reduction of sexual desire, as well as urinary and anal incontinence. Perineal pain related to episiotomy has been reported to interfere with women's daily activities postpartum and can prevent proper breastfeeding, proper rooming-in, and maternal-infant bonding. The purpose of this study was to determine the effect of dry heat application on perineal pain and episiotomy wound Healing among primipara women.

Method: A quasi-experimental, two-group, pre-post-test research study was conducted at the postnatal inpatient ward and the outpatient clinic of the El-Shatby Maternity University Hospital in Alexandria. A sample of 100 parturient women was divided into the following two groups at random: dry heat and moist (control) heat. Women in the moist heat group were advised to sit in a basin (tub) of warm water for 10 minutes, while those in the dry heat group were instructed to set an infrared light (230 volts) at a distance of 45 cm from the perineum after 12 hours post episiotomy. Both interventions were applied twice a day for ten consecutive days. They evaluated the severity of their perineal pain at baseline and repeated it on the 5^th and 10^th days after obtaining the interventions while the episiotomy wound healing was assessed on the 5^th and 10^th days.

Results: It was discovered that the dry heat group had a significantly improved episiotomy wound healing as regards perineal redness, edema of the perineal area, ecchymosis, wound discharge, and approximation of wound edges on the 5th (P < 0.001, P < 0.001, P < 0.007, P < 0.003, and P < 0.001, respectively) and 10th day after intervention (P < 0.001, P < 0.001, P < 0.001, P < 0.005, and P < 0.001, respectively) than the moist heat group. The primipara women had significantly lower perineal pain intensity in the dry heat group on the 5th and 10th days after intervention than in the moist heat group (^MH P < 0.001 for the dry heat group and ^MH P = 0.004 for the moist heat group).

Conclusion: The application of dry heat promoted episiotomy wound healing among primipara women and reduced their perineal pain during early postpartum days than moist heat.

Background: Female cancers cover common breast cancers, relatively common endometrial, ovarian, and cervical cancers and rare vulvar cancer. Survival in these cancers is known to be relatively good compared to all cancers but long-term studies for these cancers are rare, and to fill the gap, here, we generate survival data through 50 years.

Materials and methods: We applied generalized additive models to data from the NORDCAN database and analyzed 1- and 5-year relative survival for these cancers in Denmark (DK), Finland (FI), Norway (NO), and Sweden (SE) over half a century (1971-2020). Conditional 5/1-year survival for patients who survived the 1st year after diagnosis and annual survival changes was also estimated.

Results: In 2016-20, 5-year survival was best for breast cancer reaching 92.3% (in SE), followed by endometrial cancer at 86.1% (SE) and cervical cancer at 75.6% (NO). Improvement in 5-year survival over the 50 years was the largest for ovarian cancer (20% units), finally reaching 52.9% (SE). For vulvar cancer, the final survival was between 70 and 73%. The best 5-year survival rate in 2016-20 was recorded for SE in breast, endometrial, and ovarian cancers; NO showed the highest rate for cervical and DK for vulvar cancers. DK had the lowest survival for breast and ovarian cancers, and FI, for the other cancers.

Conclusions: The overall survival development appeared to consist of continuous improvements, most likely because of novel treatment and imaging techniques as well as overall organization of patient care. The large survival improvement for ovarian cancer was probably achieved by a surgical focus on tumors spread in the peritoneal cavity. For cervical and vulvar cancers, the high early mortality requires attention and could be helped by raising increasing public awareness of early symptoms in these cancers and developing pathways for fast initiation of treatment.

Objective: We systematically identified the prevalence of triplex infections (combined human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV)) in pregnancy.

Methods: To gather information on the frequency of triplex infections, we searched the databases of PubMed, CINAHL, and Google Scholar. Without regard to language, we utilized search terms that covered HIV, HBV, HCV, and pregnancy. Pregnant women with triplex infections of HIV, HBV, and HCV were included in studies that also examined the prevalence of triplex infections. Review Manager 5.4.1 was employed to conduct the meta-analysis. Critical appraisal and bias tool risk data were provided as percentages with 95% confidence intervals (95% CIs), and I² was used as the statistical measure of heterogeneity. The checklist was created by Hoy and colleagues. The study protocol was registered on PROSPERO, under the registration number CRD42020202583.

Results: Eight studies involving 5314 women were included. We identified one ongoing study. Pooled prevalence of triplex infections was 0.03% (95% CI: 0.02-0.04%) according to meta-analysis. Subgroup analysis demonstrated a significantly high prevalence of 0.08% (95% CI: 0.06-0.10%; 3863 women) in HIV-positive population than 0.00% (95% CI:-0.00-0.00; 1451 women; P < 0.001) in general obstetric population. Moreover, there was a significant difference in the pooled prevalence between studies published between 2001 and 2010 and between 2011 and 2021 (0.14% (95% CI: 0.12 to 0.16 versus 0.03% (95% CI: 0.02 to 0.04%; P < 0.001))) and participants recruited in the period between 2001 and 2011 and between 2012 and 2021 (0.13% (95% CI: 0.05 to 0.21; p=0.002 versus 0.00% (95% CI: -0.00 to 0.00%; p=1.00))), respectively.

Conclusion: The combined prevalence of prenatal triplex infections was 0.03%, with rates notably higher among the group of pregnant women who were HIV-positive and during the recruitment period that took place before 2012. This prevalence still necessitates screening for these infections as necessary.

Impaired implantation is one of the causes of infertility. It occurs under vital inflammatory status due to immune hyperactivation. In the innate immune system, the inflammatory response to pathogenic stimuli is initiated by complement activation. Minimal vasculitis associated with complement consumption in infertile patients may be an underlying mechanism for impaired implantation. Antiphospholipid antibodies regulate the inflammatory response. Recently, a novel autoantibody (neoself antibody) against a complex of β2-GPI and HLA class II molecules (β2-GPI/HLA-DR) has been reported to be an independent autoantibody associated with aPLs. This study investigated the relationship between neoself antibodies and complement consumption in infertile patients with impaired implantation. It was found that decreased C4 levels were strongly related to the increased neoself antibody titers in the serum among those patients whose antibody titers were not as high. On the contrary, serum levels of CH50 and CRP are not correlated with them. These results suggest that neoself antibodies might indicate low-grade inflammation, which causes endometrial vasculitis in impaired implantation of infertile patients.

Background: Operative vaginal delivery refers to vaginal delivery performed with the use of instruments such as forceps or vacuum. Operative vaginal delivery-related maternal complications are still a serious problem, but they are one of the least investigated in Ethiopia, particularly in the study area. Increased difficulties have been attributed to a lack of understanding on how to anticipate the procedure's complications. Identifying typical OVD complications can assist health providers in detecting and intervening early. The goal of this study was to find out which characteristics contributed to maternal problems during surgical vaginal birth.

Methods: A health facility-based cross-sectional study design was used. From December 2019 to November 2021, a total of 326 mother's OVD medical records were selected from a total of 1000 OVD medical records using a simple random sampling method. A checklist was used to collect the data. Binary logistic regression was computed and variables with a p value ≤0.2 in the bivariate logistic regression were taken to multivariate logistic regression analysis to examine the real relationship or statistical association with the outcome variable. The p value of <0.05 with a 95% confidence interval was considered a significant variable. The results are presented using tables, figures, and texts.

Results: Maternal complications were prevalent in 62 of the cases (19%). The type of operative vaginal delivery instrument used (AOR = 2.248; 95% CI (1.144, 4.416)), the station of the presenting part at which the OVD was performed (AOR = 3.199; 95% CI (1.359, 7.533)), neonatal birth weight (AOR = 3.342; 95% CI (1.435, 7.787)), and duration of the second stage (AOR = 2.556; 95% CI (1.039, 6.284)) were significantly associated with the unfavorable maternal outcomes of operative vaginal delivery.

Conclusions: Maternal complications are high in the study area. The type of operative vaginal delivery used, the duration of the second stage, the station of the presenting part at which the OVD was performed, and neonatal birth weights were all significantly related to maternal complications. While using the instrument, mothers with the identified factors should be given special attention.

Background: In 2017, approximately, 810 women died every day from preventable causes related to pregnancy and childbirth around the world. Obstetric hemorrhage, specifically postpartum hemorrhage, is the leading cause of preventable maternal mortality in the world. New strategies and technologies are needed to reduce the global public health epidemic of maternal mortality. However, nonpneumatic antishock garments were recently introduced and incorporated into teaching curriculums as a management modality for postpartum hemorrhage in Ethiopia. Therefore, this study assessed the knowledge, utilization and associated factors of nonpneumatic antishock garment among maternity ward healthcare professionals in the selected South Wollo zone health facilities, North West Ethiopia.

Methods: An institutional-based cross-sectional study design was conducted from February 1 to April 30, 2021. A consecutive sampling technique was employed to collect the data. A self-administered semistructured English version questionnaire was used to collect the data. EPI-Info and SPSS were used for data entry and analysis, respectively. Bivariable and multivariable logistic regression analyses were used to analyze the association of nonpneumatic antishock garment utilization with independent variables.

Results: A total of 244 maternity ward health care professionals participated. One hundred forty-six (59.8%) had a good knowledge of nonpneumatic antishock garments. About 110 (45.1%) of the participants have ever used it for the management of postpartum hemorrhage. Those having one nonpneumatic antishock garment (AOR = 2.7, 95% CI: 1.3, 5.5), two or more nonpneumatic antishock garments (AOR = 14.1, 5.7, 35.0), good knowledge (AOR = 5.2, 2.5, 10.7), and positive attitude (AOR = 2.5, 1.1, 5.7) and those who were receiving training (AOR = 2.2, 1.1, 4.4) at 95% CI were significantly associated with utilization of nonpneumatic antishock garments.

Conclusion: The knowledge and utilization of nonpneumatic antishock garments for the management of postpartum hemorrhage were low. Those having more nonpneumatic antishock garments, good knowledge, and a positive attitude and those who received training were found to be significantly associated with nonpneumatic antishock garment utilization. The provision of training and availability of nonpneumatic antishock garments are the key actions to be taken to increase the utilization of nonpneumatic antishock garments.

Background: Human papillomavirus (HPV) is the main cause of cervical cancer. The aim of the present study was to investigate HPV DNA detection and genotyping on paired genital and urine samples and to evaluate if urine samples could be used to monitor HPV infection.

Methods: Study subjects were recruited from one local hospital in Guangdong of China from September 1, 2011, to June 30, 2012. They were invited to participate if they have taken an HPV genotyping assay for clinical diagnosis of the genital-urinary disease or for a health check-up 3-5 days ago. DNA was extracted from paired genital and urine samples; genotyping was performed with the GenoArray assay.

Results: A total of 250 patients were recruited, which included 203 females and 47 males. Our results showed that the overall agreement on HPV status between the paired samples was 77.1% (155/201, 95% CI: 0.713-0.829) for females, with a kappa value of 0.523 (95% CI: 0.469-0.632), while the agreement was extremely low in the paired male samples. As to individual genotyping, the greatest agreement was found for HPV16 type-specific identification in females (96.02%, 0.933-0.987), followed by the other 12 high oncogenic risk (HR-HPV) types, while the agreement for low-risk HPV detection is poor (κ < 0.6). Agreement between paired samples showed that HPV detection had a significantly greater concordance in the samples obtained in females than males (p = 0.002). Moreover, the agreement for low-risk HPV detection was significantly lower as compared to HR-HPV detection (48.1% vs. 62.3%, p = 0.044).

Conclusion: Despite reduced sensitivity, HPV detection in urine closely represents the same trend that is seen with genital sampling. Urine appears to be an appropriate surrogate sample for HPV DNA detection in women with very limited access to healthcare, while the utility of urine for HPV DNA detection in males is less certain.

Background: Induction of labor is the initiation of uterine contractions by artificial methods once the fetus has reached viability and prior to spontaneous onset of labor with the aim of achieving vaginal delivery. Although induction of labor is a critical life-saving intervention that potentially reduces adverse pregnancy outcomes, sometimes it has undesirable consequences for the health of the mother and/or the fetus. Hence, this study aimed to evaluate the outcomes and associated factors of labor induction.

Methods: An institution-based cross-sectional study was conducted from February 25 to May 25, 2020, among women undergoing induction at East Gojjam zone public hospitals in northwest Ethiopia. A structured interviewer-administered questionnaire was used to collect data from a sample of 411 mothers who were selected using a systematic random sampling technique. Stata/se™ Version 14 statistical software was used to analyze the data. Multivariable binary logistic regression was used to determine the potential factors affecting successful labor induction. Adjusted odds ratios with their 95% CI intervals were used to declare the strength of the association, and a variable with p value <0.05 was considered to have statistical significance.

Results: The prevalence of successful induction of labor was 70.3% (65.6, 74.7). The favorable Bishop score ((CI 3.90, 1.63-9.29); p value = 0.002), the intermediate Bishop score ((CI 3.53, 2.15-5.82); p value = 0.001), labor induction using oxytocin with cervical ripening ((CI 2.60, 1.21-5.63); p value = 0.015), and urban residence ((CI 0.48, 0.30-0.78); p value = 0.003) were associated with successful induction of labor.

Conclusion: These findings strongly suggest that cervical conditions are important determinants for the success of labor induction. Therefore, healthcare providers should confirm the favorability of the cervical status (using Bishop score) as a strict prerequisite before actual labor induction, and special consideration should be given to those pregnant women who reside in urban areas.

Background: Aloe vera is one of the herbal products with anti-inflammatory, antioxidant, moisturizing, bactericidal, anti-viral, and anti-fungal effects that were used to relieve pain and irritation. The aim of the current systematic review and meta-analysis is to determine the effect of Aloe vera on the relief of irritation and nipple pain in lactating women.

Methods: A search was carried out in four English electronic databases including Scopus, Embase, PubMed, and Web of Science until November 2021. All clinical trials that assessed the effect of Aloe vera on the relief of irritation and nipple pain in lactating women were included. The study's risk of bias was assessed using the Cochrane risk of bias checklist. Study heterogeneity was determined using the I ² statistic and publication bias using Begg's and Egger's tests. Results of the random-effects meta-analysis were presented using standard mean difference (SMD) with 95% confidence intervals (CIs). Data were analyzed using STATA software version 16 MP.

Results: In total, 7 articles with 1670 subjects were included in the meta-analysis. Overall, we found a positive impact of Aloe vera on reducing breast pain (pooled SMD= -0.45; CI= -0.83, -0.07, P value <0.02) and irritation (pooled SMD= -0.48; CI= -0.64, -0.32, P value<0.001) in lactating women. There is a high heterogeneity among pain studies (I ²= 86%) but was low within irritation studies (I ²= 26%).

Conclusion: Our result showed that Aloe vera can be considered a choice for relieving breast pain or irritation in lactating women compared with routine care or another treatment. Considering the limited number of studies conducted on this topic and the low sample size, future studies with a larger sample will be required to draw better conclusions.

Objectives: To evaluate the competency of medical sonographer students who have completed training to estimate the gestational age (GA) and perform fetal biometric measurements compared to obstetricians.

Methods: We conducted a cross-sectional observational study at the end of the medical sonographer students' practice sessions. In total, 80 midtrimester (18-28 weeks) pregnant women were recruited, and an ultrasound was performed according to the International Society of Sonography in Obstetrics and Gynecology (ISUOG) guideline. Estimated GA calculated from fetal biometric measurements was compared between medical sonographer students and qualified obstetricians. Subsequently, images were randomly evaluated by maternal-fetal medicine specialists to assess the measurement performance.

Results: There was no significant difference in the estimated GA between the medical sonographer students and obstetricians (mean difference, 0.01 ± 2.92 day, p = 0.89). However, there was a significant difference in the measurement of the head circumference (HC) and abdominal circumference (AC) (p < 0.001). The overall image quality of the fetal head, abdomen, and femur was considered a good to excellent score (77.5%-80%). There was a perfect and nearly perfect agreement regarding the presence of the placenta previa, adequacy of amniotic fluid, and position of the placenta (k = 0.9-1.0).

Conclusions: The medical sonographer students demonstrated competency in GA estimation by fetal biometry measurement similar to obstetricians. However, the quality of the acquired images, according to the ISUOG recommendation, needs improvement, and this should be emphasized in the sonography course curriculum. The results suggest that medical sonographers can relieve obstetricians' workload for ultrasound screening in midtrimester pregnancies.