Proceedings in Obstetrics and Gynecology
Not a member yet
462 research outputs found
Sort by
Identifying barriers to accessing information and treatment for obstetric fistula in Niamey, Niger
Get PDFObjective: To identify barriers to accessing information and treatment regarding obstetric fistula (OF) unique to Niger encountered by women referred to the National Referral Fistula Center.Method: A questionnaire was administered at the National Referral Fistula Center to 29 women with OF. Qualitative and quantitative statistics were computed.Results: The average individual was 30.4 years old, illiterate and from a rural area. 76.0% had antenatal care, the average labor time was 3.04 days, and 88.0% had a physician-assisted delivery. Barriers to information included rural dwelling, lack of education, lack of understanding of cause despite contact with health care workers, lack of knowledgeable resources to seek advice from or lack of ability/interest, not given specific information about availability of treatment, and not utilizing available resources to disseminate information. Barriers to treatment included lack of information regarding condition and treatment, traditional healer utilization, inability to access adequate care for condition, delay for childbirth recovery, permission needed to seek treatment, cost, timely treatment unavailable, and lack of social support.Conclusion: Improving efficiency of getting women to the hospital at time of delivery, prompt referrals for OF, and using cell phones for disseminating information or accessing transport may benefit women with OF in Niger
First-trimester rupture of a scarred uterus after use of sublingual misoprostol: a case report
Get PDFUterine rupture is a disastrous obstetric complication, occurring mostly in the second and third trimesters. The risk of uterine rupture markedly increases with previous uterine surgeries. Termination of early pregnancy failure using misoprostol is common. However, its use in women with a scarred uterus is speculative and usually puts the obstetricians in a stressful situation. Here we present a case of rupture of a scarred uterus in the first trimester after sublingual misoprostol. A 35 years old multiparous woman presented with uterine rupture after administration of small doses of sublingual misoprostol for termination of early pregnancy failure. Immediate laparotomy was done and the defect was repaired. Termination of early pregnancy failure, in women with a scarred uterus, using sublingual misoprostol can lead to uterine rupture. Sublingual misoprostol should be used cautiously under close supervision or other routes (vaginal or oral) should be used instead
Evaluation of the efficiency of antibiotic prophylaxis in cesarean cases
Get PDFBackground: In recent years the rate of cesarean section has significantly increased.To determine the efficacy of prophylactic antibiotics in reducing infectious morbidity after cesarean section.Objectives: In our study, we aimed to evaluate the efficiency of prophylactic antibiotic administration by comparing three groups using single, multiple and no prophylactic antibiotic therapy.Materials and Methods: Our study is a prospective, randomized controlled study including emergent cases, that developed cesarean indication while in active labor, and elective cesarean cases. A total of 90 patients were included in the study, including 30 patients who underwent cesarean delivery and did not undergo an antibiotic prophylaxis (Group 1), 30 patients who underwent a single dose antibiotic prophylaxis (Group II) and 30 patients who underwent multiple dose antibiotic prophylaxis (Group III).Results: The incidence of wound infection was significantly higher in cases that were not using antibiotics at postoperative days 3, 5 and 7 compared to the cases using single and multiple antibiotics. There was not a significant difference between groups in terms of endometritis.Conclusion: Administration of prophylactic antibiotics prevent wound infection but does not prevent development of endometritis
Ultrasound evaluation of pelvic masses seen within a university gynecologic oncology clinic: does the scan location matter?
Get PDFTo quantify variations in the reporting of ultrasound characteristics of adnexal masses between local ultrasound centers and a tertiary care center for women referred to gynecologic oncology for evaluation of a pelvic mass. This study also sought to evaluate whether a gynecologic oncologist’s impression regarding the suspicion for malignancy differed based upon the information provided in the local ultrasound report as compared to the tertiary care center ultrasound report
Elevated Chemokine C-C motif ligand 2 (CCL2) early in pregnancy is associated with increased risk of preeclampsia in obese parturients
Get PDFThe objective of this study is to measure plasma CCl2 and leptin early in control and obese women and associate pregnancy outcomes with these levels. We hypothesize that early elevations of plasma CCL2 will be predictive of the development of poor pregnancy outcomes
Postpartum contraception acceptance and readiness study
Get PDFDetermine the optimal time to discuss and formulate a plan for postpartum contraception. Determine factors associated with uptake of and adherence to chosen postpartum contraception plan
Preterm birth : can we do better?
Get PDFPreterm birth (PTB) remains the most serious complication in obstetrics and a substantial excess burden in US healthcare economics. The etiology of PTB is complex and likely has multiple physiological pathways. Unfortunately, current antenatal care screening methods have not been successful in predicting and, eventually, preventing PTB.Although treatments such as progesterone, cerclage and pessary are available for patients with historical risk factors and shortened cervix, these treatments are not universally efficacious. Antenatal care is in great need of new prediction and prevention strategies.The role of more global methods of screening and treatment is still undefined. Most women with clinical risk factors will not deliver early, and aggressive interventions in large segments of the population may not be warranted or cost effective. Furthermore, over half of women who experience PTB have no historical risk factors. Even second-trimester cervical length (CL) has only modest ability to predict which women will experience PTB.There is thus a clear need to identify biomarkers that provide quantitative, individualized assessment of risk early in pregnancy that is specific for each individual woman. The ideal biomarkers would be indicative of the pathway leading to PTB, require no special testing equipment, have a low false positive and negative rate, and offer early identification, allowing adequate time to intervene. We need an aggressive and comprehensive approach to see a dramatic reduction in rates of preterm delivery in the U.
The impact of time and team on primary cytoreduction outcomes
Get PDFThe degree of cytoreduction at time of initial surgery for epithelial ovarian cancers is correlated with overall survival. Given that surgery can be physically and mentally taxing on the surgeon, we sought to examine if there were temporal and/or team relationships related to primary cytoreduction outcomes
Use of Foley's catheter balloon tamponade to control placental site bleeding resulting from major placenta previa during cesarean section
Get PDFAim: To evaluate the effect of 2-way Foley's catheter balloon tamponade on controlling immediate postpartum hemorrhage (PPH) in cases of major placenta previa during cesarean section (CS).Methods: We evaluated women with placenta previa from May to November 2015. Women with immediate PPH during CS due to major placenta previa were managed by 2-way Foley's catheter balloon tamponade when medical treatment failed, and before any surgical intervention.Results: Twenty patients, had major placenta previa, were delivered by elective CS and complicated by immediate PPH. Three placenta accreta patients (15%) underwent hysterectomy, 17 (85%) were managed by the 2-way Foley's catheter balloon tamponade. In two patients, Foley's catheter balloon failed to control bleeding and hysterectomy was done immediately. However, Foley's catheter balloon successfully treated the remaining 15 patients. The median bleeding during the operation was 1522.5 (± 619.29) ml. None of them presented complications related to this procedure or required any further invasive surgery.Conclusion: The 2-way Foley's catheter tamponade could be an option to control immediate postpartum hemorrhage resulting from major placenta previa during the cesarean section. This method is simple, cheap, nearly non-invasive and should be considered to reduce the risk of peripartum hysterectomy
Risk factors for hysterectomy among patients with placenta previa totalis
Get PDFObjective: The aim of the study is to assess risk factors for hysterectomy among patients with placenta previa totalis (PPT).Methods: The medical records of all patients delivered by cesarean section (CS) for PPT were retrospectively reviewed. Eligible cases were divided into those who underwent peripartum hysterectomy (PH) and those who did not. The two groups were compared in terms of demographics, operative features and perinatal outcomes. Logistic regression analysis was used to identify risk factors associated with hysterectomy.Results: PH was performed in 43 (44.7%) patients with PPT. Referral patients were older when compared with those without hysterectomy (p: 0.029). The median values for gravidity, parity, number of live children and previous CS were statistically significantly higher in the hysterectomy group (p<0.05). Perioperative need for blood transfusion, anteriorly placed placenta and abnormal placental invasion were statistically significantly more frequent in the hysterectomy group (p<0.001). Intraoperative complication rate was higher in this group, and bladder injury was the most common complication. No significant differences were observed between the groups in terms of perinatal outcomes. In binomial logistic regression analysis; advanced maternal age (≥ 31 years), number of previous CS (≥2), preoperative need for blood transfusion, and abnormal placental invasion were found to be independent risk factors for PH in patients with PPT.Conclusion: The findings of this study suggest that placenta invasion anomaly, advanced maternal age, increased number of previous CS, and increased need for blood transfusion are important risk factors for PH in patients with PPT