Pub Date : 2020-06-16eCollection Date: 2020-01-01DOI: 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.
{"title":"Hormone Replacement Therapy: Lebanese Women's Awareness, Perception, and Acceptance.","authors":"A Anastasia Salame, Mohammad J Jaffal, Fatin Khalifeh, Dalia Khalife, Ghina Ghazeeri","doi":"10.1155/2020/5240932","DOIUrl":"https://doi.org/10.1155/2020/5240932","url":null,"abstract":"<p><strong>Objectives: </strong>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. <i>Study design</i>. 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 1<sup>st</sup>, 2017, till March 31<sup>st</sup>, 2018. The questionnaire included questions about demographics and menopausal symptoms in addition to knowledge and attitudes towards menopause and HRT. <i>Main outcome measures</i>. 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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":19439,"journal":{"name":"Obstetrics and Gynecology International","volume":"2020 ","pages":"5240932"},"PeriodicalIF":1.9,"publicationDate":"2020-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2020/5240932","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38103535","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}
Pub Date : 2020-06-09eCollection Date: 2020-01-01DOI: 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。
{"title":"Preconception Care Uptake and Immediate Outcomes among Discordant Couples Accessing Routine HIV Care in Kenya.","authors":"Nyawira Gitahi, Sheila Juliet Eshiwani, Kenneth Mutai, Jared Ongechi Mecha, James Njogu Kiarie","doi":"10.1155/2020/1675987","DOIUrl":"https://doi.org/10.1155/2020/1675987","url":null,"abstract":"<p><strong>Introduction: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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 (<i>p</i> = 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 (<i>p</i> = 0.04) higher attrition from clinic follow-up. One confirmed seroconversion occurred; an HIV incidence rate of 0.19 per 100 person-years.</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":19439,"journal":{"name":"Obstetrics and Gynecology International","volume":"2020 ","pages":"1675987"},"PeriodicalIF":1.9,"publicationDate":"2020-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2020/1675987","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38068199","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}
Pub Date : 2020-06-01eCollection Date: 2020-01-01DOI: 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.
{"title":"Nonpuerperal Uterine Inversion: What the Gynaecologists Need to Know?","authors":"R P Herath, M Patabendige, M Rashid, P S Wijesinghe","doi":"10.1155/2020/8625186","DOIUrl":"https://doi.org/10.1155/2020/8625186","url":null,"abstract":"<p><strong>Introduction: </strong>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.</p><p><strong>Materials and methods: </strong>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.</p><p><strong>Results: </strong>Mean age of the women was 46.3 years (standard deviation: 18, <i>N</i> = 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.</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":19439,"journal":{"name":"Obstetrics and Gynecology International","volume":"2020 ","pages":"8625186"},"PeriodicalIF":1.9,"publicationDate":"2020-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2020/8625186","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38072489","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}
Pub Date : 2020-05-26eCollection Date: 2020-01-01DOI: 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.
{"title":"Midgut Volvulus: A Rare but Fatal Cause of Abdominal Pain in Pregnancy-How Can We Diagnose and Prevent Mortality?","authors":"Eelyn Chong, David S Liu, Neil Strugnell, Vishnupriya Rajagopal, Krinal K Mori","doi":"10.1155/2020/2185290","DOIUrl":"https://doi.org/10.1155/2020/2185290","url":null,"abstract":"<p><p>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.</p>","PeriodicalId":19439,"journal":{"name":"Obstetrics and Gynecology International","volume":"2020 ","pages":"2185290"},"PeriodicalIF":1.9,"publicationDate":"2020-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2020/2185290","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38056904","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}
Pub Date : 2020-05-20eCollection Date: 2020-01-01DOI: 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.
{"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, Christine Atuhairwe, 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}
Pub Date : 2020-05-19eCollection Date: 2020-01-01DOI: 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.
{"title":"Still No Substantial Evidence to Use Prophylactic Antibiotic at Operative Vaginal Delivery: Systematic Review and Meta-Analysis.","authors":"Yifru Berhan, Sisay Kirba, 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}
Pub Date : 2020-05-14eCollection Date: 2020-01-01DOI: 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.
{"title":"Risk Factors for Obstetric Anal Sphincter Injuries among Women Delivering at a Tertiary Hospital in Southwestern Uganda.","authors":"Mahad Ali, Richard Migisha, Joseph Ngonzi, Joy Muhumuza, Ronald Mayanja, Jolly Joe Lapat, Wasswa Salongo, 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}
Pub Date : 2020-05-14eCollection Date: 2020-01-01DOI: 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
{"title":"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.","authors":"Dagne Addisu, Abenezer Melkie, Shimeles Biru","doi":"10.1155/2020/4034680","DOIUrl":"https://doi.org/10.1155/2020/4034680","url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Result: </strong>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.</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":19439,"journal":{"name":"Obstetrics and Gynecology International","volume":"2020 ","pages":"4034680"},"PeriodicalIF":1.9,"publicationDate":"2020-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2020/4034680","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38021475","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}
Pub Date : 2020-04-21eCollection Date: 2020-01-01DOI: 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.
{"title":"Etiology, Clinical Features, and Diagnosis of Vulvar Lichen Sclerosus: A Scoping Review.","authors":"Nilanchali Singh, Prafull Ghatage","doi":"10.1155/2020/7480754","DOIUrl":"https://doi.org/10.1155/2020/7480754","url":null,"abstract":"<p><p><i>Objective</i>. 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. <i>Data Source</i>. 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\". <i>Study Selection</i>. 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. <i>Results & Conclusion</i>. 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.</p>","PeriodicalId":19439,"journal":{"name":"Obstetrics and Gynecology International","volume":"2020 ","pages":"7480754"},"PeriodicalIF":1.9,"publicationDate":"2020-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2020/7480754","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37904596","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}
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.
{"title":"Determinants of Cesarean Section Deliveries in Public Hospitals of Addis Ababa, Ethiopia, 2018/19: A Case-Control Study.","authors":"Areaya Gebreegziabher Hailu, Tsegaye Kebede Fanta, Fissaha Tekulu Welay, Natnael Etsay Assefa, Surafel Aregawi Hadera, Gebrekiros Aregawi Gebremeskel, Hagos Weldeslassie Gebremedhin, Guesh Gebreayezgi Asefa","doi":"10.1155/2020/9018747","DOIUrl":"https://doi.org/10.1155/2020/9018747","url":null,"abstract":"<p><strong>Objective: </strong>The objective of this study was to assess the determinants of cesarean section deliveries in public hospitals of Addis Ababa, Ethiopia, 2019.</p><p><strong>Method: </strong>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.</p><p><strong>Results: </strong>Majority of the study participants were in the age category 20-34 years. Nearly more than 1/3<sup>rd</sup> 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.</p><p><strong>Conclusion: </strong>Previous caesarean section, number of delivery, birth weight, partograph documentation, and pregnancy-induced hypertension had significant association with caesarean section delivery in this study.</p>","PeriodicalId":19439,"journal":{"name":"Obstetrics and Gynecology International","volume":"2020 ","pages":"9018747"},"PeriodicalIF":1.9,"publicationDate":"2020-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2020/9018747","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37904597","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}