Proceedings in Obstetrics and Gynecology
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Can evaluation of the cervix with histogram and Bishop scoring prior to birth induction forecast the birth type for superannuated primigravidas?
Get PDFPurpose: We conducted this study to research both the forecasting efficiency of the cervical histogram and Bishop scoring for birth type (vaginal birth/cesarean) for the superannuated primigravida prior to birth induction. Methods: Ninety primigravidas in week 41 and beyond were included in the present study. Exclusions for the study included prior labor, ruptured membranes, any major uterine operations, cephalopelvic discord, fetal malpresentations, fetal anomalies, multiple pregnancy, placenta previa, vaginal bleeding, a high sensitivity for oxytocin usage, and an estimated fetal weight greater than 4000 g. Histogram hyperechogenic focus and hypoechogenic focus measurements are conducted in normal spontaneous birth (NSD) and cesarean (SECTIO) groups. Findings: Thirty-six patients had a cesarean birth, while 54 of the patients had vaginal births. On logarithmical regression analysis, the Bishop score and the parameters were found statistically significant in terms of proving the cesarean indication (p=0.001). In our cervical histogram, the forecasting efficiency of the hyperechogenic focus and hypoechogenic focus measurements for determining the birth type were not been able to shown (p=0.089 ; p=0.555). Bishop scoring parameters showed statistically significant deviances between the NSD group compared to the cesarean group in terms of a 1-2 cm increase in cervical opening and for being 3-4 cm(p=0.0001), the cervical extinguishment as 40%-50% (p=0.0001), the occurrence of cervical softening (p=0.0001), and the head level at -1 and -2 (p=0.0001). When declaring the cesarean indication, the Bishop score’s AUC value was found as 0.932 and the LR(+) value as 9; while the estimation value for the Bishop score occurring below <5 increased the cesarean birth risk ninefold. Conclusion: During a superannuated nulliparous pregnancy, the Bishop score and the Bishop score’s individual parameters are meaningful for vaginal birth, while a cervical histogram is not significant for forecasting the birth type
Role of prophylactic midurethral sling in preventing post-operative stress urinary incontinence following repair of anterior vaginal wall prolapse
Get PDFObjective: This study was conducted to find whether, among women without preoperative stress incontinence who underwent surgery for repair of anterior vaginal wall prolapse, the placement of a prophylactic midurethral mesh along with the prolapse correction surgery helped to reduce the incidence of post-operative stress urinary incontinence (POSUI).Materials & Methods: 145 women with anterior vaginal compartment prolapse were randomly assigned to receive either suitable corrective surgery for prolapse or corrective surgery along with concurrent placement of a prophylactic midurethral sling by a transobturator Prolene tape. The primary endpoint was urinary incontinence at three months and twelve months post surgery. Secondary outcomes included expected and unexpected adverse events.Results: At three months follow up the symptoms of urinary incontinence and/or positive cough test did not differ significantly between the two groups. But at twelve months, both the symptoms of urinary incontinence (9.59% versus 23.61%, p = 0.025, 95% CI = -25.93% to -2.11%, CMLE OR =0.346) and positive cough test (8.22% versus 25%, p = 0.007, 95% CI = -28.60% to -4.96%, CMLE OR = 0.271) were significantly lower in the study group compared to the control group. Expected and unexpected adverse events during operation and through the first year after surgery were comparable in both groupsConclusion: Placement of a midurethral sling by a Prolene mesh at the time of prolapse repair surgery significantly reduces the incidence of POSUI in women who were continent preoperatively. For this, the transobturator tape method is safe and effective with a low rate of complications
Demographic profile and treatment outcomes of 100 women with obstetric fistula in Niger
Get PDFIntroduction: Due to high fertility rates, low access to emergency obstetric care, and the poor quality of that care, obstetric fistula is relatively widespread in Niger.Methods: Mixed-methods research was carried out over a total of eighteen months with 100 women with fistula at four fistula centers in Niger, three in the capital of Niamey and outside the city of Maradi.Results: The one hundred women who made up the research sample reflect marked diversity in ethnicity, age, marital situation, parity, length of time living with fistula, and surgical history and outcomes. At the time of initial interviews women ranged from 15-70 years old (average 31.0±10.6), but had developed fistula from 13-54 years old (average 23.4 ±8.4). Women had lived with fistula between 1 month to 50 years (average 6.7 years ±8.6). At initial interview, women waited an average of 5.8 months (±9.9) while living at fistula centers, ranging from 2 weeks to 6 years. At the end of the research period, only 22 of the 61 women who underwent surgeries during the research period (36%) attained continence. The remaining 39 women (64%) were still incontinent.Conclusions: Women with fistula in Niger’s clinics are more demographically diverse than commonly portrayed. Additionally, it was more difficult for women to access surgical repair and that repair was less successful than women themselves anticipated. Notably, the quality of care varied considerably between the four fistula centers. Long waits combined with poor surgical outcomes often resulted in negative social outcomes for women
Effects of oral ginkgo biloba extract on pregnancy complicated by asymmetrically intrauterine growth restriction: a double-blinded randomized placebo-controlled trial
Get PDFObjectives: to evaluate the effect of oral ginkgo biloba extract (GB)) on asymmetrical intrauterine growth restriction (IUGR).Study Design: A randomized trial conducted at Assiut Women Health on 226 pregnant women with asymmetrical IUGR. The patients randomly received GB extract or placebo for 6 weeks. The main outcome measures were improvement in fetal weight and feto-maternal blood flow. The data were analyzed by Student’s t- test and chi-squared tests.Result: There was a significant increase in the estimated fetal weight in the GB group (3047+ 127 gm) when compared to the placebo group (2734+ 127 gm) (p=Conclusions: GB extract improves placental functions, Doppler indices and fetal weight in pregnancies complicated with IUGR fetuses
The maternal and neonatal outcomes of teenage pregnancy in a tertiary university hospital in Egypt
Get PDFAim: To highlight the grave complications among teenage mothers in Assiut Woman's Health Hospital compared with the adult mothers.Methods: This study was a prospective case control study, conducted at the Labor Ward of Assiut Woman's Health Hospital from 1st of January 2016 to 30th of June 2016. We included teenage pregnant women (13-19 completed years at delivery) as case and adult mothers (20-29 years) formed the control group. The primary outcome of the study is the rate of pregnancy complications among teenage mothers.Results: Obstetric complications were higher among the teenage mothers (p=0.0001). The teenage mothers had a higher proportion of normal vaginal delivery (p=0.005). The adult mothers reported a higher rate of elective cesarean section (CS) and operative vaginal delivery (p=0.0001, p=0.002; respectively). The infants of teenage mothers tended to have a lower birth weight and Apgar score than the adult ones.Conclusion: This study clearly states that the teenage mothers and their infants were more liable to complications during pregnancy and labor compared to adult mothers
A rare case of giant dermoid cyst with ipsilateral paratubal cystadenoma during pregnancy
Get PDFDermoid cysts are considered the most common ovarian cysts in adolescents and pregnant women. In rare cases, they can attain a huge size. Paratubal cysts are also common in adolescents. They are usually simple cysts present in the broad ligament. In this case, we report a giant dermoid cyst with ipsilateral paratubal serous cystadenoma discovered during pregnancy of a 20-year-old primigravida. Both cysts were managed conservatively, and then removed successfully at the time of cesarean section by cystectomy
Traumatic vulvar aphthous ulcers: a case series
Get PDFWe present three women who each presented with a vulvar ulcer consistent with aphthous. In each case a biopsy was performed which excluded malignancy and revealed non-specific findings. All women responded following intralesional steroid injections. We initially considered a diagnosis of pyoderma gangrenosum. However, the presentation and clinical findings were more consistent with aphthous ulcer
Metastatic squamous cell carcinoma to the colon arising from a mature cystic ovarian teratoma
Get PDFMalignant transformation of a mature cystic teratoma is extremely rare, occurring in 0.17-2% of cases.1 The most common malignant degeneration is squamous cell carcinoma (SCC) arising from the ectoderm. Approximately half of all cases of SCC of the ovary are confined to the ovary at time diagnosis.1,2 Secondary to its absolute rarity and the relative infrequency of cases with metastatic spread the optimal treatment of advanced stage disease is unknown. Outcomes for locally advanced and widespread disease have historically been very poor. Ford and Timmons recently reported on a patient with stage IIC SCC arising in a mature cystic teratoma treated with multimodal therapy who has been free of disease for more than five years.3 Herein we report on a woman with stage IIIC SCC arising within a mature cystic teratoma treated with directed chemoradiation who subsequently developed metastatic SCC to the colon
A rare case of posterior uterine rupture with neonatal survival during trial of vaginal birth after cesarean section
Get PDFPosterior wall uterine rupture is a rare complication. Trial of vaginal birth after cesarean section (CS) is a predisposing factor especially when associated with augmentation of labor. Here we report a case of intrapartum uterine rupture during the second stage of labor in a multiparous woman trying vaginal birth after previous CS. Emergency laparotomy was done and the baby was saved. Repair of the site of the rupture in layers with complete hemostasis was achieved
Recurrent spontaneous third-trimester uterine rupture after hysteroscopic resection of myoma: a case report
Get PDFUterine rupture is a catastrophic obstetrical emergency with serious effects on both women and fetuses. Operative hysteroscopic procedures can add more risk factor for occurrence of this tragedy. Here, we report a case of spontaneous recurrent rupture uterus at 33 weeks of gestation in a 32 years old woman with previous history of hysteroscopic resection of submucous myoma after development of acute abdomen. Uterine repair of fundal rupture was performed through emergency exploratory laparotomy. Surgeons should explain to their patients the hazards of probable risk of recurrent and multiple uterine rupture in the future pregnancy and to document this discussion in the medical records before proceeding to operative hysteroscopic procedures