Obstetrics and Gynecology International最新文献

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.

Background: Acute pancreatitis (AP) during pregnancy is a rare presentation with an estimated incidence of 1 case per 1000 to 10,000 pregnancies. Severe epigastric and abdominal pain is the earliest and the most common symptom of AP, and adequate pain relief is an integral part of patient management. The aim of our study was to investigate the different pain relief modalities that are used in pregnant women with AP and the efficacy of each method used, in terms of better pain relief and maternal-fetal outcomes.

Methods: This was a retrospective observational study over a period of 6 years conducted at a tertiary care hospital. Pregnant women with clinical and biochemical diagnoses of acute pancreatitis were included in the study. Patient's history and clinical and biochemical data were collected from the medical records of the hospital.

Results: A total of 12 patients were included in the study, 5 out of 12 patients had gall stones associated with AP, 2 patients had hypertriglyceridemia, and 1 each had preeclampsia and eclampsia. Epidural analgesia at the level of L1-L2 spinal level showed a reduction of VAS scores from 8 or 9 to 1 or 2, indicating excellent pain as compared to t intravenous (i/v) infusion of fentanyl or i/v boluses of injection tramadol, in whom VAS was never reduced below 3. With satisfactory results, labour analgesia and anesthesia for caesarean section was provided via the same catheter in 2 and 3 patients, respectively. Maternal and fetal outcomes were comparable in all the patients.

Conclusion: AP in pregnancy, when diagnosed early and managed accordingly, leads to better maternal and fetal outcomes. Epidural analgesia was better than intravenous analgesia in terms of pain management and better recovery of acute pancreatitis patients. In these patients, labour analgesia and anesthesia for caesarean section can be provided through the same catheter, making it a potential novel modality in the treatment of acute pancreatitis in pregnancy.

Background: Bone recurrence occurs in 0.75%-8% of cervical cancer patients after primary treatment. Only a few previous studies have reported on survival times associated with prognostic factors for bone recurrent cervical cancer. This study aimed to evaluate the oncological outcomes and their predictors among cervical cancer patients with bone recurrence.

Methods: The medical records of cervical cancer patients with bone recurrence who received primary treatment at Songklanagarind Hospital from January 2002 to December 2017 were retrospectively reviewed. Prognostic factors were identified using a Cox regression model.

Results: The study included 6,354 cervical cancer patients, of whom 98 (1.54%) had bone recurrence at a median time of 25 months after the primary treatment (range 4.9-136 months). The most frequent site of bone recurrence was the spine (81.00%); the two most common visceral coexisting recurrence sites were the lungs and the liver. The median recurrence-free interval (RFI) was 21 months. Of the patients with recurrence, 75 (76.50%) were treated with combined radiation therapy and chemotherapy. The one-year overall survival (OS) after recurrence was 22.70%. On multivariate analysis, age under 60 years at the time of recurrence diagnosis (hazard ratio [HR] = 2.48, 95% CI = 1.47-4.18, p=0.001) and an RFI less than 21 months (HR = 1.63, 95% CI = 1.04-2.55, p=0.03) were independent prognostic factors for OS after recurrence.

Conclusion: Bone recurrence in cervical cancer patients is rare and is associated with poor survival. Our study found that age and RFI were significant prognostic factors for OS in cervical cancer patients with bone recurrence.

Background: The lockdown related to the SARS-CoV-2 pandemic has imposed profound changes in the interaction of the population with hospitals and emergency departments. The main aim of this research was to evaluate the impact of lockdown on the activity of obstetrics and gynecology emergency department (OGED) in a teaching hospital, hub center, for COVID-19.

Methods: The study considers all visits to the OGED with their different triage color codes that represent the clinical severity of each case (from the most severe to the least one: red, yellow, green, white). Data were selected through the "PSNet" triage program and collected anonymously. We analyzed frequency distributions of the variables separately for each woman and calculated mean and standard deviations for continuous variables. We then analyzed the association between factors and outcomes for categorical variables (expressed as a number and percentage of the total) using the chi-square test (χ2). The level of significance was established with p < 0.05. Statistical analysis was performed using SPSS Statistics V20.0. Given the fact that the study has a retrospective observational nature and it is based on an anonymous routine database, approval by the Local Ethics Committee was not necessary.

Results: The relative decrease of patients presenting to OGED in 2020 was -50.96%. The percentage of nonpregnant women was significantly lower in 2020 compared to 2019 (p ≤ 0.0001; Δ = -79.46%). Regarding the obstetric group, we saw an important decrease of visits in 2020 compared to 2019 (p < 0.0001; Δ = -40%). The prevalence of yellow codes was significantly higher in 2020 (Δ = +29.72%), while that of white (Δ = -61.58%) and green (Δ = -52.22%) codes was significantly lower (p ≤ 0.0001). Comparing the diagnoses at discharge, we could highlight significant reductions in 2020 for more than one diagnosis: bleeding (p ≤ 0.0001; Δ = -70.42%), pain (p ≤ 0.0001; Δ = -81.22%), urinary diseases (p = 0.004; Δ = -75.64%), and gastrointestinal diseases (p ≤ 0.0001; Δ = -87.50%).

Conclusions: An evident change emerged in relation to the dynamics between the local obstetrical and gynecological population, and OGED resources. The COVID-19 lockdown greatly reduced the rate of admission to OGED without time-related obstetric and gynecological complications. The reduction of admissions suggests a more appropriate use of the ED by patients that may inspire future policies for the implementation of emergency services.

Background: Globally, antepartum hemorrhage is the main cause of perinatal and maternal morbidity and mortality during pregnancy and childbearing.

Objective: To assess adverse perinatal and maternal outcomes and associated factors among women with antepartum hemorrhage in Jimma University Medical Center, Southwest Ethiopia, 2020.

Methods: Prospective cross-section study was conducted, and data were collected through face to face interview among pregnant women admitted with antepartum hemorrhage. Patient condition was observed and followed up, and patient card was reviewed. Data were coded, checked, entered into EPI version 4.6, and exported to SPSS version 26.0 for analysis. Multivariate logistic regression analysis was made to determine independent factors associated with adverse outcomes.

Result: A total of 377 pregnant women were included, and nearly half (192 (50.9%)) of women experienced adverse maternal outcome and 113 (30%) women experienced adverse perinatal outcome. The status of vital sign, address, parity, antenatal care, duration of bleeding before arrival, gestational age, prematurity, and amount of vaginal bleeding were factors significantly associated with adverse maternal and perinatal outcome at p value <0.05.

Conclusion: Vital sign derangement, vaginal bleeding for ≥12 hrs, gestation age before 37 weeks, rural address, prim parity, amount of vaginal bleeding, and prematurity baby has predicted high rate of adverse perinatal and maternal outcomes. Recommendation. Jimma Hospital should give patient-centered service and strengthen counseling on danger sign of pregnancy to alert women early health care seeking and immediate resuscitation, and appropriate management should be given for women admitted with APH to minimize of adverse perinatal and maternal outcomes.