Obstetrics and Gynecology International最新文献

Introduction: Maternal and perinatal mortality is still a major public health challenge in Tanzania, despite the ongoing government efforts to improve maternal and newborn care. Among the contributors to these problems is the high magnitude of severe maternal outcomes (maternal near-miss). The current study, therefore, aimed to identify the magnitude and predictors of maternal and perinatal mortality among women with severe maternal outcomes admitted to Dodoma Regional Referral Hospital.

Methods: A retrospective cross-sectional study was conducted from October 2015 to January 2016 at Dodoma Regional Referral Hospital in Dodoma City. All maternal deaths and maternal near-misses based on WHO criteria were included in this study. Three outcome variables have been identified: maternal mortality, perinatal mortality, and neonatal complications. To examine the predictors for the three predetermined outcome variables, the three logit models each containing unadjusted and adjusted findings were fitted. A P-value less than 0.05 was considered indicative of statistically significant.

Results: A total of 3600 pregnant women were admitted for obstetric reasons during the mentioned period. 140 of them were diagnosed with severe maternal outcomes; hence, they were included in this study. The severe maternal outcome incidence ratio was 40.23 per 1000 live births, the institutional maternal mortality ratio was 459.77 per 100000 live births, and the perinatal mortality rate was 10.83 per 1000 total births. Most of the maternal morbidity and mortality were due to direct causes in which postpartum hemorrhage and hypertensive disorders were the leading causes. In adjusted analysis, per-protocol management, maternal age, and mode of birth were predictors of maternal mortality, perinatal mortality, and neonatal complications, respectively.

Conclusion: Establishing and strengthening obstetric ICUs will help reduce maternal mortality as the response time from the onset of obstetric complications, while the provision of high-quality care will be substantially reduced. Furthermore, the study recommends regular provision of in-service refresher training to emphasize the practice and compliance of per-protocol case management through a team approach in order to reduce the burden of maternal and perinatal mortality in Tanzania.

Methods: We identified that 308 women who had undergone surgical repair of POP were followed up for at least 6 months. Recurrence rates of POP after tension-free vaginal mesh (TVM) surgery (n = 243), native tissue repair (NTR) (vaginal hysterectomy with colpopexy, anterior and posterior colpoplasty, or circumferential suturing of the levator ani muscles and apical repair by transvaginal sacrospinous ligament fixation (SSLF)) (NTR; n = 31), and laparoscopic sacrocolpopexy after subtotal hysterectomy (LSC; n = 34) were compared. Presence of mesh erosion was also recorded.

Results: Patients who underwent LSC were significantly younger (65.32 ± 3.23 years) than those who underwent TVM surgery (69.61 ± 8.31 years). After TVM surgery, the rate of recurrence (over POP-Q stage II) was 6.17% (15/243) and was highest in patients with advanced POP. The recurrence rate in patients who underwent NTR procedure was 3.23% (1/34) and that in patients who underwent LSC was 11.76% (4/11). There was no statistically significant difference in the recurrence rate between the three types of surgery. There were 13 cases (5.35%) of mesh erosion after TVM surgery and none after LSC surgery. The risk of mesh erosion was correlated with having had total TVM surgery but not with patient age or POP stage. Repeat procedures were performed in 5 women (2.14%) who underwent TVM surgery and 1 (2.94%) who underwent LSC. No patient underwent repeat surgery after NTR. There was no statistically significant difference in the reoperation rate between the three types of surgery.

Conclusion: Our study suggested that TVM surgery, NTR, and LSC have comparable outcomes as for the postoperative recurrence rate and mesh erosion. However, the outcomes of each technique need to be carefully evaluated over a long period of time.

Background: Postoperative peritoneal adhesions (PPA) are a serious problem for abdominal surgery. An effective remedy has not been found yet. New formulation of glycerol and sodium pentaborate may be able to solve the problem.

Method: Female Wistar albino rats were randomly assigned into four equal groups. The adhesion model was created on the caecum anterior wall and covered with 2 ml 0.9% NaCl, 3% glycerol, 3% sodium pentaborate, and 3% glycerol plus 3% sodium pentaborate solutions in the groups, respectively. Two weeks later, the rats were sacrificed. PPA were graded macroscopically and microscopically.

Results: Total adhesion scores of the 3% glycerol + 3% sodium pentaborate group were statistically different from the other groups for macroscopic and also microscopic evaluations (p < 0.001).

Conclusion: 3% glycerol plus 3% sodium pentaborate as a new formulation has preventive effects on PPA with a synergistic mechanism.

Background: The incidence of teenage pregnancy is increasing in the world. It is a high-risk condition leading to adverse perinatal and obstetric outcomes. This study aims to evaluate the obstetric and perinatal outcomes of teenage pregnancy in Indonesian population.

Method: A retrospective study was conducted to evaluate obstetric and perinatal outcomes among teenagers and average maternal age (AMA) women. We assessed all singleton live pregnancies during the year period of 2013 in Dr. Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia.

Results: We studied 1,676 eligible subjects during the one-year period in our centre. The prevalence of teenage pregnancy (12 to 19 years old) was 11.40% (191/1676). We found higher prevalence of eclampsia (AOR: 4.03; 95% CI: 1.73-9.39), preterm delivery (AOR: 1.5; 95% CI: 0.88-2.53), anaemia at labour (AOR: 2.42; 95% CI: 1.60-3.67), postpartum haemorrhage (AOR: 2.59; 95% CI: 0.86-7.37), and low birth weight (AOR: 2.28; 95% CI: 1.60-3.25) among teenagers. However, caesarean section was found to be significantly lower among teenage pregnancies.

Conclusion: Teenage pregnancy carries significant obstetric complications that should draw physicians' serious attention. A holistic, comprehensive antenatal, and preventive program should be conducted to prevent teenage pregnancy-related adverse outcomes.

Background: One-third to two-thirds of operated patients in low-income countries acquire surgical site infection, which is nine times higher when compared to high-resource countries. Identifying the incidence and risk factors that contribute to surgical site infection following cesarean delivery is a step ahead for preventing and reducing the problem. Nonetheless, the distribution of the problem in Addis Ababa, where the rate of cesarean delivery is relatively high compared to other parts of the country, is under investigation.

Objective: The aim of this study is to assess the incidence of surgical site infection among cesarean deliveries and factors associated with it in selected governmental hospitals found in Addis Ababa, Ethiopia, in 2019.

Method: A hospital-based prospective cohort study design was employed to follow 175 women, who gave birth by cesarean delivery in selected government hospitals in Addis Ababa, from March 11 to April 9, 2019. Convenience sampling method was used to select study units from the randomly selected hospitals. Descriptive statistics were run for determining the rate of cesarean delivery surgical site infection. Presence and degree of association between outcome and independent variables were computed through bivariate logistic regression analysis and factors that had p < 0.2 significance level in the bivariate logistic regression analysis were considered in the multivariable logistic regression analysis.

Result: From 166 participants who completed 30-day follow-up, 25 (15%) of the participants developed surgical site infection. Age, gestational age, duration of operation, and ≥5 vaginal examinations showed a significant association with the outcome variable with AOR (95% CI) of ((AOR = 1.504, 95% CI: (1.170 - 1.933, p < 0.2 significance level in the bivariate logistic regression analysis were considered in the multivariable logistic regression analysis. p < 0.2 significance level in the bivariate logistic regression analysis were considered in the multivariable logistic regression analysis. p < 0.2 significance level in the bivariate logistic regression analysis were considered in the multivariable logistic regression analysis. p < 0.2 significance level in the bivariate logistic regression analysis were considered in the multivariable logistic regression analysis. Conclusion and recommendation. Surgical site infection rate is higher and certain associations lost due to small sample size. Further interventional studies with vast sample size are recommended.

Skilled attendance at birth is widely regarded as an effective intervention to reduce maternal and early neonatal morbidity and mortality. However, many women in Ethiopia still deliver without skilled assistance. This study was carried out to identify factors that influenced or motivated women to give birth in a health facility in their previous, current, and future pregnancies. This descriptive explorative qualitative study was conducted in two districts of West Gojjam zone in North West Ethiopia. Fourteen focus group discussions were conducted with pregnant women and women who gave birth within one year. An inductive thematic analysis approach was employed to analyze the qualitative data. In this study, two major themes and a number of subthemes emerged from the focus group discussions with the study participants. The factors that influenced or motivated women to give birth in health facility in their previous, current, and future pregnancies include access to ambulance transport service, prevention of mother to child HIV transmission service, referral service, women friendly service, and emergency obstetric services, good interpersonal care from health workers, and fear and experience of obstetric danger signs and complications. In addition, reception of information and advice on importance of skilled delivery care and obstetric danger signs and complications from health workers, use of antenatal care, previous use of skilled delivery care, ensuring wellbeing of parturient women and newborns, and use of emergency obstetric care were also identified as influencers and motivators for health facility childbirth in previous, current, and future deliveries. Increased understanding of the factors that influenced or motivated women to deliver in facilities could contribute to developing strategies to improve the uptake of facility-based maternity services and corresponding declines in maternal morbidity and mortality.

Background: Cervical cancer is a global health problem. It is the second most common cancer in women worldwide, and it is the most frequent form and the leading cause of cancer mortality among Ethiopian women. Cervical cancer screening can reduce at least 50% of cervical cancer deaths. In Ethiopia, practice of cervical cancer screening is below 1%. Hence, this study aimed at assessing cervical cancer screening acceptance and determinant factors among women in Dabat district of Northwest Ethiopia.

Methods: A community-based cross-sectional study design was conducted in Dabat district in Northwest Ethiopia, 2016. The multistage sampling method was used to recruit 790 women from the selected rural and urban kebeles. Data were collected using a structured questionnaire. Multivariate logistic regression analysis method was employed to determine factors significantly associated with the acceptance of cervical cancer screening with a 95% CI at p value <0.05.

Results: The overall awareness of cervical cancer screening was 12.1% (95% CI: 9.6, 14.5), and 17.1% (95% CI 14.4, 19.8) of them accepted the screening. In multivariate logistic regression analysis, having knowledge about cervical cancer (AOR = 2.6, 95% CI: 1.7, 3.8), parity women who had more children (AOR = 3.1, 95% CI: 1.7, 5.5) and those who perceived the severity of the disease (AOR = 1.9, 95% CI (1.3-3.1)) were statistically significant factors for acceptance of cervical cancer screening.

Conclusions: Most of the women had poor awareness and acceptance of cervical cancer screening. The findings also revealed that women of multiparous, knowledge about cervical cancer, and perceived the disease as severe were shown to be significant factors of acceptance for cervical cancer screening. Hence, continuous health education and appropriate counseling to women should be performed.

Introduction: Placenta is a complex multifunctional organ that maintains pregnancy and promotes normal fetal development. The fetal outcome is adversely influenced by pathological changes in the placenta because it is a mirror that reflects the intrauterine status of the fetus. Placental abnormalities are considered a leading cause of maternal and prenatal mortality. This study aimed to assess the fetoplacental weight relationship in pregnancy-induced hypertension and abruption placenta and compare with the normal one.

Objective: This study designed to assess fetoplacental weight relationships in normal pregnancy and pregnancy complicated by pregnancy-induced hypertension and abruption of placenta among mothers who gave birth in Dilla University Referral Hospital, southern Ethiopia, 2018.

Materials and methods: Institution-based comparative cross-sectional study was used on 50 placentas from mothers with pregnancy-induced hypertension, 50 placentas from mothers with abruption of placenta, and 50 placentas from mothers with normal pregnancy (control) with an age range of 19-34 years. The weight of the placenta and newborn were taken and the fetoplacental ratio was calculated.

Results: Placental index as well as the weight of the newborn shows statistically significant (p < 0.001) difference in pregnancy-induced hypertension and abruption placenta group compared with the normal group. The mean of the fetoplacental ratio in the normal group was 5.52 ± 0.07, in pregnancy-induced hypertension was 5.15 ± 0.11, whereas the abruption placenta was 4.99 ± 0.82.

Conclusion: Both PIH and abruption placenta were associated with remarkable changes in the placenta index such as small placental weight and diameter and results in different kinds of congenital anomalies and low birth weight of the baby. Hence, fetoplacental ratio was altered. The lowest fetoplacental ratio was 4.99 for abruption placenta, and the highest was for a normal group of the placenta which was 5.52. Therefore, an examination of the placenta before and after birth guarantees for feto-maternal health.

Background: Dysmenorrhea is a major gynaecological complaint among females who have reached menarche. It is one of the major causes of absenteeism of females from schools and at the workplaces resulting in loss of productive working hours and work efficiency. Owing to socioeconomic and cultural differences, females from different backgrounds perceive and manage dysmenorrhea differently. Little is known about the use of complementary and alternative medicines (CAM) in the management of this condition by females in senior high schools in Ghana. Thus, this study sought to assess the use of CAM in the management of dysmenorrhea among female students in two senior high schools in Ghana.

Methods: A school-based cross-sectional study using a quantitative approach was conducted on a total of 478 female students attending Archbishop Porter Girl's Secondary School and Mporhor Senior High School. Information on the sociodemographic characteristics, lay representations of dysmenorrhea, pain intensity and severity, quality of life, self-management, and the use of CAM in the management of dysmenorrhea were obtained. The data were analysed using SPSS.

Results: 79.3% of the students used some form of CAM to manage dysmenorrhea. Of CAM users, 32% were utilizing mind-body medicine such as endurance and relaxation, 31% used the whole and alternative medicine such as the hot water therapy, 15% used biological-based medicine such as herbal products, and 22% used the manipulative and body-based systems such as exercises. Various CAM methods and products were perceived to be effective in relieving the pain and discomfort associated with dysmenorrhea in about 90% of the participants who used them. Significant associations were reported for pain severity and quality of life (QoL).

Conclusions: This study has demonstrated that the female students experiencing dysmenorrhea employ various CAM remedies in its management. Therefore, there is the need for education on the right management of dysmenorrhea to ensure that safe and efficacious CAM products and methods are used by adolescent female students.

Background: To evaluate the efficacy of a succinate-based dietary supplement (SBDS; Amberen) in symptomatic menopausal women using a larger sample size derived by pooling data from two identical trials.

Methods: Raw data were pooled from two identical randomized, multicenter, double-blinded, placebo-controlled, 90-day clinical trials. Women aged 42-60 years with mild to moderate vasomotor and psychosomatic menopausal symptoms were included (114 in the treatment group and 113 in the placebo group). Symptoms were assessed by the Greene Climacteric Scale and State-Trait Anxiety Inventory. Changes in body mass index, body weight, waist and hip circumferences, and plasma levels of follicle stimulating hormone, luteinizing hormone, estradiol, leptin, and apolipoproteins A1 and B were also evaluated.

Results: SBDS use resulted in significant improvements in several endpoints including alleviation of 16 of 21 menopausal symptoms (p ≤ 0.05, Greene Scale) and a decrease in anxiety (p < 0.0001, State-Trait Anxiety Inventory) when compared to placebo. Significant reductions were observed in weight, body mass index, and waist and hip circumferences in the supplement cohort. Evaluation of physiological parameters showed a significant increase in serum estradiol levels compared to baseline (p < 0.0001) among users of the SBDS. Levels of follicle stimulating hormone and luteinizing hormone decreased slightly in both groups, without significant differences between the groups. Leptin levels decreased with statistical significance in the SBDS cohort compared to placebo (p=0.027). For those with initial leptin concentrations above the reference range, leptin decreased significantly in the SBDS group compared to the baseline (p < 0.0001) and to placebo (p=0.027).

Conclusions: The pooled analysis reaffirms the outcomes from the individual trials. A nonhormonal, succinate-based dietary supplement is shown to relieve menopausal symptoms when compared to a placebo regimen in a randomized, double-blinded clinical trial.