Current Issue : April - June Volume : 2017 Issue Number : 2 Articles : 5 Articles
Background: Pregnant women in the Democratic Republic of Congo (DRC) are at\nincreased risk for developing obstetric fistulas (OFs) as a result of obstructed labor,\nin conditions similar to many other African countries. No case-control study of biological\nand social risk factors for OF has been reported from the DRC. This study\naimed to identify factors that would aid in prevention and early identification of\nwomen who are at risk of developing OF. Methods: Participants were enrolled in a\ncase-control study at four obstetric clinics in the central DRC. Cases of OF were evaluated\nas they presented, then a control participant was enrolled among women presenting\nsubsequently to the same clinic, seeking to match parity at the time of the\nfistula and tribe of the case. A questionnaire was administered to elicit physical, obstetric,\ndemographic, socioeconomic, religion, geographic, and delivery attributes of\nthe participants. Case-control comparisons sought to identify independent risk factors\nfor OF in the total case-control pairs and in subgroups of the participants. Logistic regression\nwas utilized to identify independent risk factors for OF in the total case-control\nstudy group and in selected subgroups of the participants, and linear regression\nwas utilized to estimate the variation explained between case and control outcomes\nfrom the variables independently significant in the logistic regression models. Results:\nA total of 177 case-control pairs were enrolled. Among all pairs, shorter height of the\ncase (odds ratio = 1.06, 95% Confidence Limits 1.02 - 1.12); more kilometers travelled\nto the delivery site (1.02, 1.01 - 1.02); her village, not town, residence (OR = 5.52, 2.72 -\n11.2), and her lower professional status (2.95, 1.53 - 5.72) were statistically independent\nfactors associated with OF development. When applied in linear regression\ncomparison of the pairs, these variables yielded an r2 = 0.48, imputing 48% of the dif-ference in delivery outcome between the pairs was explained by these variables. Among\nthe 38 pairs who were primigravida, the independent variables were more kilometers\ntravelled to the delivery site (1.02, 1.00 - 1.05), village, not town, residence (50.0, 10.2 -\n248.7), and facility intended for lower patient acuity (3.7 s, 1.01 - 13.6, r2 = 0.66) patients\nwho were matched on parity and tribe, the significant risk factors were professional\nstatus (OR = 0.29), greater distance travelled to the clinic (OR = 1.02, 1.01 -\n1.02), village, not town, residence (5.52, 2.72 - 11.2), and mother�s lower professional\nstatus (2.95, 1.53 - 5.72) when the OF occurred. Conclusions: Our study showed biological\nand social factors associated with the development of OF. Shorter height was the\nonly biological risk factor found to be statistically significant in the study population.\nOther factors were related to limited resources and limited access to medical care....
The aims are to review respectively 229 cases of hysterectomy and to find the factor\naffecting the decision of vaginal hysterectomy. Data collected from medical charts\ninclude age, nationality, parity, menopause, history of Dilation and curettage. The\nfollowing data were obtained: the clinical presentation and the indication for hysterectomy.\nPostoperative complication includes the estimated blood loss, the number\nof days in hospital and ICU admission recorded. The route of hysterectomy found\nthat 187 (82%) were abdominal and only 42 (18%) were vaginal. Factors significantly\nassociated with the choice of vaginal approach: age, parity, smaller uterine size and\nprolapse. Factors affecting the decision of vaginal hysterectomy for treatment of benign\ndiseases are identified as follows: if the age is more than 35 years or if the women\nalready reach menopause, the presenting symptoms are not vaginal bleeding but\nprolapsed uterus and uterine size is less than 12 weeks....
Background/Aims. To compare long-termfertility and bleeding outcomes of women who underwent robotic-assisted, laparoscopic,\nand abdominal myomectomy at our institution over a 15-year period. Methods. This was a retrospective cohort study of\nmyomectomy patients 18ââ?¬â??39 years old that had surgery between January 1995 and December 2009 at our institution. Long-term\nfollow-up on fertility and bleeding outcomes was collected fromthe patient directly. The uterine fibroid symptom and quality of life\nsurvey was also administered to assess current bleeding patterns. Baseline characteristics were compared across groups.Univariable\ncomparisons of fertility and bleeding outcomes based on surgical approach were made using analysis of variance, Kruskal-Wallis\nanalysis of ranks, and Chi-square tests as appropriate. Results. 134/374 (36%) subjects agreed to participate in the study. 81 subjects\nunderwent an open procedure versus 28 and 25 subjects in the laparoscopic and robotic groups, respectively.Median follow-up after\nsurgery was 8 years. 50% of patients desired pregnancy following surgery and, of those, 60% achieved spontaneous pregnancy; the\nspontaneous pregnancy rate did not differ between groups. Additionally, UFS-QOL scores and/or subscores did not differ between\ngroups. Conclusion.There is no significant difference in long-term bleeding or fertility outcomes in robotic-assisted, laparoscopic,\nor abdominal myomectomy....
Background: The use of interventions in childbirth has increased the past decades. There is concern that some\nwomen might receive more interventions than they really need. For low-risk women, midwife-led birth settings\nmay be of importance as a counterbalance towards the increasing rate of interventions. The effect of planned place\nof birth on interventions in the Netherlands is not yet clear. This study aims to give insight into differences in\nobstetric interventions and maternal outcomes for planned home versus planned hospital birth among women in\nmidwife-led care.\nMethods: Women from twenty practices across the Netherlands were included in 2009 and 2010. Of these, 3495\nwere low-risk and in midwife-led care at the onset of labour. Information about planned place of birth and\noutcomes, including instrumental birth (caesarean section, vacuum or forceps birth), labour augmentation,\nepisiotomy, oxytocin in third stage, postpartum haemorrhage >1000 ml and perineal damage, came from the\nnational midwife-led care perinatal database, and a postpartum questionnaire.\nResults: Women who planned home birth more often had spontaneous birth (nulliparous women aOR 1.38, 95 % CI\n1.08ââ?¬â??1.76, parous women aOR 2.29, 95 % CI 1.21ââ?¬â??4.36) and less often episiotomy (nulliparous women aOR 0.73, 0.58ââ?¬â??0.\n91, parous women aOR 0.47, 0.33ââ?¬â??0.68) and use of oxytocin in the third stage (nulliparous women aOR 0.58, 0.42ââ?¬â??0.80,\nparous women aOR 0.47, 0.37ââ?¬â??0.60) compared to women who planned hospital birth. Nulliparous women more often\nhad anal sphincter damage (aOR 1.75, 1.01ââ?¬â??3.03), but the difference was not statistically significant if women who had\ncaesarean sections were excluded. Parous women less often had labour augmentation (aOR 0.55, 0.36ââ?¬â??0.82) and more\noften an intact perineum (aOR 1.65, 1.34ââ?¬â??2.03). There were no differences in rates of vacuum/forceps birth, unplanned\ncaesarean section and postpartum haemorrhage >1000 ml.\nConclusions: Women who planned home birth were more likely to give birth spontaneously and had fewer medical\ninterventions....
Objective: This study was aimed at identifying predictive factors of complications\nduring vaginal delivery on scarred uterus. Methodology: During 9 months, from\nOctober 1st, 2015 to June 30th, 2016, a case control study was carried out at the\nYaound�© Gynaeco-Obstetric and Pediatric Hospital. Eighty nine women each with a\nsingle scarred uterus who presented with complications during delivery (cases) were\ncompared to eighty nine others who had a successfully trial of scar (control) during\nthe study period. Data were analyzed using the CSPro version 6.0 and SPSS version\n20.0 softwares with statistical significance set at P < 0.05. Results: We recruited 2\ngroups of 89 women, aged 17 to 40 years, with an average age of 29.05 years. The\nmajority of women with complications were married (50.6%) and unemployed\n(42.8%). Following univariate analysis, predictive factors of complications were:\nprematurity (OR = 7.4), post-term (OR = 13.7), no history of vaginal delivery on\nscarred uterus (OR = 4.3), inter-pregnancy spacing period greater than 60 months\n(five years) (OR = 2.9), History of caesarian delivery indicated for cephalo-pelvic\ndisproportion (OR = 6.6), less than four ante-natal consultations (OR = 3.6), antenatal\nconsultations done in a Health Centre (OR = 2.7), ante-natal follow up conducted\nby a nurse (OR = 2.4; IC = [1.2 - 4.7]), referral from a different health unit\n(OR = 4.4, IC = 2.0 - 9.4), a Bishop score less than 7 on admission (OR = 12.4, IC = 5.6\n- 27.4), a meconium stained amniotic fluid (OR = 9.9; CI = [3.6 - 26.8]). After logistic\nregression, the retained factors associated with complications were post-term (aOR =\n34.5), absence of vaginal birth after caesarian delivery, (aOR = 11.7), previous caesarean\nsection indicated for cephalo-pelvic disproportion (aOR = 6.1), a bishop score\nless than 7 (aOR = 12.0), meconium stained amniotic fluid (aOR = 13.6). Conclusion:\nPredictive factors of complications can help anticipate negative obstetric outcomes....
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