Current Issue : January - March Volume : 2018 Issue Number : 1 Articles : 6 Articles
Endometriosis, a common gynecological condition, is defined as the presence\nof functioning endometrial tissue outside the uterine cavity. It often presents\nas a cyclic, hormonally stimulated pain in women during their reproductive\nyears. While endometriosis is usually located within the pelvis, it may also\noccur at intraperitoneal, intestinal, perineal, and distant ectopic sites. Although\noften diffuse, a localized, focal mass of endometrial tissue is termed as an endometrioma.\nIn rare occurrences, an endometrioma will present superficially\nto the peritoneum within the abdominal wall following gynecologic or obstetric\nsurgery. The presence of an abdominal wall endometrioma within a cesarean\nsection scar may pose a diagnostic dilemma, which is often misdiagnosed,\nand results in surgery referrals for treatment. The clinical symptoms\nand sonographic appearance of abdominal wall endometriomas occurring at\ncesarean section scars are highlighted in this case series....
Background: To estimate the cost-effectiveness of an ambulance-based referral system an dedicated to emergency\nobstetrics and neonatal care (EmONC) in remote sub-Saharan settings.\nMethods: In this prospective study performed in Oromiya Region (Ethiopia), all obstetrical cases referred to the\nhospital with the ambulance were consecutively evaluated during a three-months period. The health professionals\nwho managed the referred cases were requested to identify those that could be considered as undoubtedly\neffective. Pre and post-referral costs included those required to run the ambulance service and the additional\ncosts necessary for the assistance in the hospital. Local life expectancy tables were used to calculate the number\nof year saved.\nResults: A total of 111 ambulance referrals were recorded. The ambulance was undoubtedly effective for 9 women\nand 4 newborns, corresponding to 336 years saved. The total cost of the intervention was 8299 US dollars. The\ncost per year life saved was 24.7 US dollars which is below the benchmarks of 150 and 30 US dollars that define\nattractive and very attractive interventions. Sensitivity analyses on the rate of effective referrals, on the costs of the\nambulance and on the discount rate confirmed the robustness of the result.\nConclusions: An ambulance-based referral system for EmONC in remote sub-Saharan areas appears highly\ncost-effective....
An estimated 2 million women living in countries with limited resources currently\nhave vesico-vaginal, recto-vaginal, or mixed types of fistulae because of\nthe necrosis that occurs with obstructed labor. We evaluated factors readily\nassessed by the examining practitioner in a consecutive case series of surgical\nrepairs of obstetrical fistulae, for the ability of those factors to stand as a\nprognostic guide, in a clinical score. Objectives: To identify the predictors of\nsurgical repair outcomes and establish a Score combining these different determinants\nto facilitate the care of obstetric fistula. Methods: We conducted a\nmulticentric prospective study between 2011 and 2014 in Democratic Republic\nof the Congo (DRC). Outcomes: We measured 3 months post-surgery in a\nseries of 483 patients with obstetrical fistula repaired by the same surgeon included\nclosure and failure appreciated by dye test. Multivariable generalized\nestimating equation models were used to generate adjusted odd ratios (OR)\nand 95% confidence intervals (CIs). The scores ranging from 3 to 14 were established\nfrom the outcomes determinants identified. Results: In total, 483\nwomen were enrolled, and 390 cases were at their first surgery and were included\nin the obstetric fistula (OF) prognosis score and classification. Their\nmean age was 35 years at the time of the surgery and 25 years at the onset of\nOF. In 28.6%, the fistula patient was primigravida. Mean duration between\nonset of the fistula and surgical treatment was 8 years. In 24%, the fistula patients\nlived separated from their partners. Overall closure rate of the fistulas\nwas 85.7%. Severe vaginal fibrosis (p < 0.01), big fistula size (<0.01), small\ndistance from fistula to external urethral meatus (<0.01) and prior surgery (p\n< 0.48) predicted failed fistula closure. A clinical score ranging from 3 to 14\npoints is a prognostic score with a range of 1 to 4 for the distance between the\nfistula and the external meatus and the size, and a scale of 1 to 6 for fibrosis. Conclusions: This study demonstrated that the marked vaginal scarring; large\nfistula size and distance to urethral meatus are predictors for unsuccessful fistula\nrepair. Due to the lack of a standard classification that is never unanimous\namong the different surgeons, this prognostic score allows the combination\nof the different determinants assessing the chances of success and can\nhelp the practitioners to orient the patients towards the determined skill scale\nto take care of the patients....
Background: During pregnancy, the hyperdynamic physiology of circulation can exacerbate many cardiovascular\ndisorders. Congestive heart failure (CHF) usually occurs during late pregnancy, which is significantly associated with\na high level of maternal and neonatal morbidities and mortalities. The profile of women who develop peripartum\nCHF (PCHF) is unknown. We investigated the epidemiological profiles of PCHF.\nMethods: In this retrospective cohort study, PCHF patients were identified using International Classification of\nDiseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes in Taiwanââ?¬â?¢s National Health Insurance Research\nDatabase. Risk factors and obstetric outcomes were compared in women with and without PCHF.\nResults: From 2,115,873 birth-mothers in Taiwan between 1997 and 2013, we identified 512 with PCHF (incidence: 24.\n20/105). More women with than without PCHF were older (ââ?°Â¥ 35, 18.16% vs. 9.62%), and had more multifetal gestations\n(7.42% vs. 1.40%), gestational hypertension (HTN) (19.2% vs. 1.31%), and gestational diabetes mellitus (4.10% vs. 0.67%).\nAfter the analysis had been adjusted for confounders, the leading comorbidities associated with PCHF were\nstructural heart diseases (adjusted odds ratio [aOR]: 67.21; 95% confidence interval [CI]: 54.29ââ?¬â??83.22),\npulmonary diseases (aOR: 13.12; 95% CI: 10.28ââ?¬â??16.75), chronic HTN (aOR: 11.27; 95% CI: 6.94ââ?¬â??18.28), thyroid\ndisease (aOR: 9.53; 95% CI: 5.27ââ?¬â??17.23), and gestational HTN (aOR: 5.16; 95% CI: 3.89ââ?¬â??6.85). PCHF patients also\nhad a higher rate of cesarean sections (66.41% vs. 34.46%; p < 0.0001).\nConclusion: Maternal structural heart diseases, pulmonary diseases, thyroid disorders, and preexisting or\ngestational HTN are associated with a higher risk of developing PCHF. Birth-mothers with PCHF also had\na higher risk of caesarean section and adverse outcomes, including maternal death. Our findings should\nbenefit healthcare providers, and government and health insurance policy makers....
Objective. To evaluate influences of various factors on the types and intensity of postoperative pain following gynecologic\nlaparoscopic surgery. Study Design. Cross-sectional questionnaire and chart review. Results. A total of 84 questionnaires were\ndistributed and returned. The types of postlaparoscopic pain are different in multiparous women and nulliparous ones (71.43%\nsurgical wound pain versus 63.64% nonsurgical wound pain, ...
Grand-multiparity is a serious risk factor in pregnancy and common in developing\ncountries. The objective was to compare the obstetric outcome of\ngrand-multiparous women with that of low parity in our center. The study\ncomprised of 150 grand-multiparous women (cases) and 150 multiparous\nwomen (para 2 - 4) in this index pregnancy as controls matched for age and\nadmitted for delivery. The mean age of the grand-multiparous women at delivery\nwas 37.0 �± 2.8 years. Grand-multiparity was significantly higher among\nwomen with only primary education (48.0% versus 44.7%), polygamous marriages\n(9.3% versus 3.3%) and Muslims (17.3% versus 6.7%). Pregnancy induced\nhypertension and primary postpartum hemorrhage were significantly\nmore often seen among grand-multiparous women than among the controls.\nThe mean packed cell volume before delivery in the grand-multiparous\nwomen was significantly lower (33.6% �± 2.7%) than in the multiparous group\n(35.2% �± 2.7%) (P-value = 0.000). Grand-multiparity with its associated complications\nstill occurs frequently in our environment. However, with adequate\nantenatal surveillance, optimal care during labour and contraceptive use, these\nproblems will be reduced....
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