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http://www.webmedcentral.com/images/Header_Logo.giftext/html2010-10-30T01:45:08+01:00http://www.webmedcentral.com/Dr. Sunita Gupta Evaluation Of Chronic Pelvic Pain In Women
http://www.webmedcentral.com/article_view/989
Chronic pelvic pain (CPP) in women is one of the most common problems
encountered by health care provider. It is the single most common indication for referral to
gynecology clinics accounting for 20% of all outpatient appointments in secondary care. Thorough history taking and physical examination followed by specific diagnostic test are important to find out the cause of chronic pelvic pain.development of chronic pain is often multifactorial . CPP is a diagnostic and management challenge to the patient and clinician. Women with chronic pelvic pain will require detailed gynecologic, urologic, gastroenterologist, and psychological assessment. Appropriate evaluations can lead to optimal treatment and decrease the rate of inappropriate interventions.CPP cannot be always cured. Thus reassurance and psychosocial support play important role in the management of CPPtext/html2011-06-07T14:43:44+01:00http://www.webmedcentral.com/Dr. Monika GandhiAltered Levels of Fibrinogen in Relation to the Pathophysiology of Recurrent Spontaneous Abortions
http://www.webmedcentral.com/article_view/1964
Introduction: Recurrent Spontaneous Abortion (RSA) is one of the most common complications of pregnancy and is a major healthcare concern for the medical fraternity. Women experiencing recurrent pregnancy loss are a heterogenous population, therefore specific markers are necessary to identify those who will respond to various treatments. During normal healthy pregnancy there are substantial changes in the haemostatic system. This results in variations in the plasma levels of many clotting factors in the blood coagulation cascade. Any change in these factors reflects hypercoagulability and therefore, represents an imbalance in the haemostatic system which leads to thrombotic haemostasis defects. In humans, fibrinogen is required to support pregnancies by maintaining haemostatic balance.Data sources: Some studies have shown that women with thrombophilias have 66-83% recurrence rate of fetal loss in subsequent pregnancies and also that fibrinogen deficiencies result in abortions in the early gestational period.Objective: However none of the studies have confirmed the role of fibrinogen levels in the context of RSA. Measuring the altered levels of fibrinogen to predict occurrence of RSA, could be a major direction to be followed to gain insight into the thrombogenic potential of this protein.Results and conclusion: The information about the thrombogenic potential of this protein could inspire new strategies against the thrombotic complications of RSA.
text/html2012-08-01T16:09:55+01:00http://www.webmedcentral.com/Dr. Bassir A BassirGiant Colonic Diverticulitis in Young Patient Mimicking an Ovarian Mass
http://www.webmedcentral.com/article_view/3606
Giant colonic diverticulitis is a rare entity, is increasingly being recognized in younger patients. A pelvic pain and abdominal mass in young adults are common symptoms that require careful surgical assessment with a ovarian cyst being a common cause. The correct diagnosis is often only made intraoperatively at the time of surgical exploration. We report a rare case of a large pelvic mass in a 16-year-old female which mimicked an ovarian mass. The ability to recognize such condition is vital as its management is different and worse outcome can be prevented by earlier detection and proper management.text/html2012-11-11T00:47:00+01:00http://www.webmedcentral.com/Mr. Anthony Kodzo - Grey VenyoProteinuria in Pregnancy: A Review of the Literature
http://www.webmedcentral.com/article_view/3814
Background: Proteinuria can be encountered in pregnant and non-pregnant patients, and is a worrying feature for clinicians and pregnant ladies as it is related to preeclampsia.
Aim: Literature review on proteinuria in pregnancy.
Materials and methods: Using several search engines, information was gathered from 68 references as the foundation for the review.
Results: Proteinuria is a consequence of two mechanisms, the abnormal trans-glomerular passage of proteins due to increased permeability of the glomerular capillary wall and the impaired re-absorption by the epithelial cells of the proximal tubules. It is most commonly associated with urinary tract infections in pregnancy or longstanding renal disease, but is related to pre-eclampsia after 20 weeks gestation in the presence of hypertension. Blood vessel endothelial cell damage plus an exaggerated maternal inflammatory response leads to increased vascular permeability, vasoconstriction, reduced placental blood flow and clotting abnormalities.
Studies imply that the correlation between dipstick urinalysis and 24 hour protein estimation is weak and NICE recommend that with significant proteinuria, automated dipstick readers be used to improve the rate of false positive and false negatives and a dipstick finding of proteinuria should be confirmed by 24 hours urine collection/protein creatinine ratio. In pregnant ladies with renal disease the main aim is to have delivery at term but patients with preeclampsia quite often develop progressive disease which ends up in the need for iatrogenic delivery. In situations when it is difficult to distinguish preeclampsia from pre-existing renal disease, it is pertinent to assume a working diagnosis of preeclampsia because of its potential for rapid development of serious maternal and foetal complications. Proteinuria (or hypertension) which persists longer than 3 months post-delivery should be followed up closely.
Conclusions: The gestational age at which proteinuria is first documented is important in establishing the likelihood of preeclampsia versus other renal disease. Proteinuria prior to or early in pregnancy suggests pre-existing renal disease. In late pregnancy, the presence of hypertension or aspects of severe preeclampsia also helps to distinguish preeclampsia from underlying renal disease. Renal biopsy is best left until the post-partum period unless unexplained rapidly progressive loss of renal function is occurring.text/html2012-12-31T18:26:05+01:00http://www.webmedcentral.com/Dr. Parul GargPartial Androgen Insensitivity Syndrome- XY Female (Male Pseudohermaphroditism)
http://www.webmedcentral.com/article_view/3921
Disorders of androgen receptor function represent the most common definable cause of the undervirilized male. These patients characteristically have a 46, XY karyotype and testes and present with a spectrum of phenotypic abnormalities that vary from complete external feminization (syndrome of complete androgen insensitivity), to ambiguous genitalia (partial androgen insensitivity), to the phenotypically infertile male. The clinical presentations may vary according to the severity of the disorder but the pathophysiology is similar.text/html2013-07-26T04:21:55+01:00http://www.webmedcentral.com/Dr. Mohammad OthmanBilateral Ectopic Pregnancy: Case Report
http://www.webmedcentral.com/article_view/4354
Bilateral tubal pregnancy is the rarest form of ectopic pregnancy. The estimated incidence is 1 in 725 to 1 in 1580 of all ectopic pregnancies. Totally, more than 200 cases of bilateral tubal ectopic pregnancy have been reported in the literature to date. We present a case of a P0+1 with previous history of right tubal pregnancy treated conservatively. Patient presented as 7 weeks ectopic pregnancy. Intra-operatively bilateral ectopic pregnancy was diagnosed. Accordingly, left rupture ectopic seen and salpingectomy performed. In the right side, intact small ectopic was diagnosed and salpingostomy was accomplished.text/html2014-05-20T05:25:40+01:00http://www.webmedcentral.com/Dr. Mohammad OthmanOgilivie\'s syndrome: Case report
http://www.webmedcentral.com/article_view/4641
Bowel perforation has been described following caesarean section. Ogilvie’s syndrome and paralytic ileus are the two most common causes of functional bowel obstruction.
We report here a case of ogilivie’s syndrome. Unfortunately, surgical intervention was late and patient died.text/html2016-02-16T13:23:58+01:00http://www.webmedcentral.com/Dr. Mohammad OthmanWound endometriosis; case report and literature review
http://www.webmedcentral.com/article_view/5055
Scar endometriosis is a rare condition. We report a case of scar endometriosis occurring at the site of a four years old cesarean section scar. She complained of painful sensation during menstruation for 2 years that occurred at the site of her cesarean section surgical scar. On examination, there was a firm nodule measuring 3 × 2 cm in size at the right side of the scar. In view of the possibility of scar endometriosis, the mass was completely excised. Pathologic findings were compatible with scar endometriosis. Postoperatively, danazol was prescribed to prevent recurrence.
A surgical scar becoming painful and swollen during menstruation is the classic symptom of scar endometriosis. Causes include iatrogenic transplantation of endometrium to the surgical wound. Surgical excision is the main treatment. Postoperative GnRH-agonist or danazol may be prescribed to patients with scar endometriosis. It is recommended that during obstetrical and gynecological operations caution should be practiced to prevent such a complication.text/html2010-08-17T18:50:34+01:00http://www.webmedcentral.com/Mr. Mohammad S WalidResearch Productivity of OBGYN Residency Programs in USA
http://www.webmedcentral.com/article_view/475
Introduction: Research is still not required for graduation from residency programs in the United States (U.S.). In order to provide a glimpse into the research productivity of OBGYN residency programs we conducted the following study.
Methods: The biomedical indexing engine “PubMed” was used to search for publications that originated from OBGYN residency programs in the U.S. in the last decade.
Results: The average number of publications per decade was 46. The highest number of publications was 342, achieved by Washington University/B-JH/SLCH Consortium Program in Missouri. In the second and third place were Wayne State University/Detroit Medical Center Program, Michigan, with 325 papers and University of Michigan Program, Michigan, with 317 papers. The majority (153 programs) has less than 30 publications per decade.
Conclusion: More attention to research is needed in OBGYN residency programs.text/html2010-09-06T08:43:50+01:00http://www.webmedcentral.com/Dr. Tony PhanBlood Group A Is Associated With Higher Incidence Of Nausea And Vomiting In Pregnancy
http://www.webmedcentral.com/article_view/526
Background: To examine the association between the risk of nausea and vomiting of pregnancy (NVP) with the ABO blood groups.
Method: One hundred and eighteen women who were currently or previously pregnant volunteered for a study on NVP. All women completed a questionnaire assessing the severity of NVP and their general condition. Their obstetrical and physical characteristics as well as their blood type were also recorded. Participants were allocated to one of two groups: NVP- (no vomiting and nausea) and NVP+ (minimum of 1 vomiting episodes a day with nausea). Patients were also grouped according to their ABO blood type.
Results: Logistic regression analysis of the data indicates that those with Blood Group A have a higher risk of NVP compared to other Blood Groups (Odd Ratio of 3.43; p-value < 0.05).
Conclusions: Our preliminary data indicated that patients with Blood Group A are at a higher risk to have episodes of NVP compared to other Blood Groups. We hypothesize that the association between NVP and Blood Group A is due to the similarity between the A antigen and human chorionic gonadotrophin. A larger study as well as molecular-based approaches will be needed in order to unequivocally confirm this.text/html2010-09-21T05:51:09+01:00http://www.webmedcentral.com/Dr. Max MongelliCord Blood Lactate and pH Values at Term and Perinatal Outcome: A Retrospective Cohort Study
http://www.webmedcentral.com/article_view/694
Objective: To examine the relationship between newborn umbilical cord blood lactate and pH levels, mode of delivery and short-term neonatal outcome.
Materials and methods: Umbilical cord arterial and venous lactate and pH values, mode of delivery, birth weight, gestational age, Apgar scores were extracted from the Obstetrix database at Nepean Hospital in Sydney. More than 7400 newborn cord blood gases were available for analysis.
Results: Gestational age ranged from 37 to 43 weeks (mean 39.7 weeks). The highest mean arterial cord lactate values were noted among babies delivered instrumentally (5.1 mmol/L). Infants who had a normal vaginal delivery had the second highest levels (4.3mmol/L), followed by infants delivered by emergency caesarean section (3.9 mmol/L). The lowest lactate values were noted in deliveries by elective caesarean section (3.2 mmol/L). Cord arterial lactate levels were significantly higher among infants born with low Apgar scores (7.02 mmol/L vs 4.0 mmol/L, P < 0.001). Newborns with raised cord arterial lactate were significant more likely to have low Apgar scores (OR 4.8, 2.4-9.9), whereas low arterial cord pH was slightly less significant (OR = 3.6). High arterial cord lactate was a significant predictor of admission to NICU (OR 2.9, 2.1 – 4.1). ROC analysis suggests that lactate and pH are virtually equivalent in their correlation with adverse neonatal outcome.
Conclusions: Cord lactate and pH levels are significantly related to the mode of delivery. Cord arterial lactate is equivalent to cord arterial pH in predicting adverse neonatal outcomes, with limited sensitivity and specificity.text/html2010-09-21T16:43:42+01:00http://www.webmedcentral.com/Mr. Mohamed M NajimudeenDiscarding the Newborn Babies in Malaysia
http://www.webmedcentral.com/article_view/700
Discarding the newborn babies had continued to escalate in Malaysia. A newborn baby was thrown into the dustbin at the Melaka General Hospital and was found dead on 18.08.2010. A ten month old baby was killed in dumped in the bus stand last week. The Social Welfare Department had recovered 315 discarded babies between the years of 2001 to 2005. The Police department reports an average 100 babies are thrown out annually. Malaysia is a country with rich cultural heritage and dignity. What went wrong? Where is the problem? Is there a solution for this scourge?
The sexual relationship at very early teenage had not only increased in Malaysia but all over the world. For example in the United States 14,790 teenage girls under the age of 15 years became pregnant in the year 2006. Out of this 6,490 girls underwent termination of pregnancy (abortion).
United Kingdom had reported 17,626 pregnancies among the girls under15 years of age from 2000 to 2007. In other words six pregnancies every day. There were 268 pregnancies in the girls of 12 years old, 2,527 of 13 years olds, 14,777 of 14 year-olds and 45,861 of 15 year-olds school girls
Proper care of teenagers, education on fertility, awareness of contraception, termination of unwanted pregnancy and legalizing the teenage marriages can minimize the unwanted teenage pregnancies
Teenagers had grown beyond the supervision of parents and elders. It is responsibility of the parents, teachers and supervisors to guide the innocent tender teenagers in the correct pathways. The religious, moral and cultural values are fading among the youngsters. .Pornographic and other materials are very freely available. Haphazard use of mobile phones had increased their vulnerability. Night food outlets are another nightmare in this country. The youngsters spend time until late night and their whereabouts are unknowns. Can we reduce this culture?
Fertility education is a must for teenagers. . Most of these young girls were not aware that they had become pregnant. They believed that the period was simply delayed until they became full term pregnant. They never believed that one or two sexual exposures can make them pregnant. They also imagined that proper penetration is necessary to become pregnant. I have seen many pregnant mothers with intact hymen.
Educating the teenagers about fertility is a must to prevent teenage pregnancies. This could be introduced in the school curriculum. A careful syllabus should be prepared by experts in this field.
Contraceptive advice is important to prevent teenage pregnancy. Many teenagers engage in all forms of sexual activities without using contraceptives. There not aware the availability and benefits of contraception. They shy to buy from pharmacies. They are not aware of proper use of condoms and forgetful to take the pills daily. Stable teenage partners must be advised on long term contraceptives such as implants.
Termination of pregnancy should be legalized to some extent. I have seen innocent girls are made pregnant by very close relatives, driver uncles and often domestics. Many gang rapes had been reported when a girl was lonely at home or one the road. These unfortunate girls were no way responsible for those sad events. They must be protected and given a new life
According to Penal Cod 312 (Amendment Act 1989 in Malaysia) abortion is permitted to protect her physical health, mental health and to save a mother’s life. We make use of this opportunity to safeguard our innocent victims.
There were very high incidence of teenage pregnancies and abortions in Scandinavian countries many years back. The proper use of contraceptive methods and safe methods of abortions had drastically reduced the incidence of teenage pregnancies.
The Malacca state government is keen to legalize the age of marriage to 16 in girls and 18 in boys. It is a very good move and I personally congratulate the state for their brave decision. I am looking after the teenage mothers for more than 20 years and I know their grievances. They cannot register their marriage. The birth cannot be registered without marriage certificate. The benefit of children cannot be enjoyed. The child without marriage is not very much acceptable. I fully endorse the statement of the chief minister of Malacca, Mohammad Ali Rustam, since this was intended to address social problems. For the state government, this is the best step to deal with the problem of abandoned babies and unwed pregnancies.
You may be astonished to learn that 257,411 babies are born without the name of father between 2000 to 2008 in Malaysia. The birth certificates of these children do not have their father’s names. In other words 78 babies are born daily out of wedlock. Can’t we register these marriages and help these newborn babies?
The Government of Malaysia had allocated RM 13.7 billion to the health budget for the year 2009. The health authorities make use of this great opportunity to help our innocent teenagers by way of fertility education, contraceptive advise and termination of unwanted pregnancies.text/html2010-09-22T16:43:16+01:00http://www.webmedcentral.com/Dr. Manal El BeheryTotal Salpingectomy During Abdominal Hysterectomy Preserves Ovarian blood flow and Function
http://www.webmedcentral.com/article_view/707
Aim: To evaluate the effect of total salpingectomy on ovarian reserve and function during abdominal hysterectomy.
Method: Twenty five patients undergoing total abdominal hysterectomy for dysfunctional uterine bleeding were randomly allocated into two groups; group (I) 13 patients undergoing total abdominal hysterectomy with bilateral excision of both tubes. Group (II) 12 patients undergoing classical method of total abdominal hysterectomy. Antral follicles count, ovarian volume, ovarian stromal blood flow and serum FSH,LH were evaluated preoperatively and 6,12 months postoperatively.
Results: A significant increase in ovarian stromal blood flow was oberved 6 months post operatively in both groups with significant decrease in pulsatility and resistance indicies (PI&RI), antral follicle count were significantly higher in group (I) compared to group (II) with no significant changes in FSH, LH levels in both groups. Twelve months postoperatively group I showed significantly higher antral follicles count, larger mean ovarian volume and increased ovarian stromal blood flow than group II.
Conclusion: Complete excision of tubes with caution not to damage the ovarian vascular structure during abdominal hysterectomy may preserve ovarian blood flow and function.text/html2010-09-22T19:21:44+01:00http://www.webmedcentral.com/Dr. Manal El BeheryDoes Uterine Artery Doppler or Copper Intrauterine Device Location by Three Dimensional Transvaginal Ultrasound Correlates with Clinical Symptoms?
http://www.webmedcentral.com/article_view/702
Aim of study: To evaluate the effectiveness of using uterine artery color Doppler and location of intrauterine copper device by three dimensional transvaginal ultrasound in relation to abnormal vaginal bleeding and pain.Methods: Three dimensional transvaginal ultrasound examinations were carried out to 180 women 3-6 months after IUD insertion. Seventy six women were suffering from pain (groupI), forty four presenting with abnormal vaginal bleeding (group II), and sixty women with no complaint (group III). The distance between top of the IUD and inner endometrium E-IUD, IUD and fundus F-IUD and ends of IUD to sidewall of uterus S-IUD were measured. Uterine artery pulsitilty index was measured by color Doppler for all women.Results: No statistical significant differences between the three groups regarding E-IUD, F-IUD and S-IUD. Mean uterine artery pulsitility index was significantly lower in women suffering from pain with IUD than women with excess menses; and both had lower mean pulsitility index than control group (1.1±1.0, 1.8±0.41, 2.4 ±0.8 respectively, PConclusion: Location of IUD using 3D transvaginal ultrasound did not differ between IUD complaining and non complaining women, however uterine artery pulsitility index is lower in women suffering from bleeding or pain with IUD.text/html2010-09-29T22:28:08+01:00http://www.webmedcentral.com/Mr. Paul B KarauOutcome And Complications In Women Undergoing Cervical Cerclage In A Tertiary Hospital In Kenya
http://www.webmedcentral.com/article_view/793
Objective: To determine the immediate and late complications of women undergoing cervical cerclage, as well as their pregnancy outcomes.Methods: This was a retrospective study based on traceable patient records over a 9-year period (2000 to 2008) undertaken at the Kenyatta National Hospital, Kenya’s major referral and teaching hospital. All files on women diagnosed with cervical incompetence and treated by MacDonald’s stitch insertion were scrutinized. Details on patients’ age, gestation age at cerclage, immediate and late presentation and pregnancy outcome were collected. Comparisons were done for complications and pregnancy outcomes among emergency, elective and empirical cerclage groups.Results: Complete medical records of 199 patients who underwent cerclage over this period were retrieved. They ranged from 17 to 42 years of age, with an average of 27.97 years. Majority of the patients presented at gestation of 10 to 20 weeks (90.1%). Major complications recorded include vaginal haemorrhage and urinary tract infections. For the 174 women whose complete pregnancy records were traceable, 53.3% delivered at full term, 19.6% had pre-term delivery, 7.5% had intrauterine fetal death and 7.0% had abortions.Conclusions: This study adds to the existing knowledge on the controversial diagnosis of cervical incompetence and the use of cerclage in the African population. There is a relatively high incidence of complications among cerclage patients. The incidence of intrauterine fetal deaths among cerclage patients is underreported. More comprehensive randomized studies are needed to compare pregnancy outcomes in cerclage and control groups.text/html2010-10-07T20:48:54+01:00http://www.webmedcentral.com/Mr. John D OjuleVaginal Birth After Three Previous Caesarean Sections: A Case Report
http://www.webmedcentral.com/article_view/918
BACKGROUNDCaesarean delivery is the most common major obstetric operation carried out for maternal and or fetal indications. While most obstetricians will permit vaginal birth after a prior caesarean, those with 2 or more previous caesarean sections are usually delivered abdominally because of increased risk of uterine rupture in labour.
AIMTo report a case of successful term vaginal delivery in a parturient with 3 previous caesarean sections.
CASE REPORTA 28-year old housewife, gravida5 para4+0, 2 alive, with 3 previous caesarean sections, was verbally referred to Kendox Medical Services, Elelenwo, Port Harcourt, South-South Nigeria, from a private maternity home where she had laboured at term for over 12 hours. She was assessed to be in advanced labour, with good uterine contractions, moderately sized baby, fetal head descent of 2/5th, re-assuring fetal heart tones, cervical os dilatation of 8cm, and cephalopelvic disproportion excluded. She eventually had a spontaneous vaginal delivery of a 3.7kg live male baby with good Apgar scores while arrangements were being made for emergency surgery.
CONCLUSIONSafe vaginal delivery is possible in carefully selected patients with 3 prior caesarean sections.
KEYWORDS:Vaginal birth, three previous caesarean sections, term.text/html2010-10-18T18:02:44+01:00http://www.webmedcentral.com/Dr. Eric E Nwogu-IkojoBladder-only Repair Of Vesicovaginal Fistula: Twelve Years Experience In South-eastern Nigeria
http://www.webmedcentral.com/article_view/1030
OBJECTIVE: The aim of this study is to review the outcome of repair of vesicovaginal fistula in which only the bladder wall defects were repaired leaving the vaginal wall defects unrepaired.
METHOD: A review of the outcome of 87 bladder-only repair of vesicovaginal fistulas done at the University of Nigeria Teaching Hospital, and Aghaeze Hospital, Enugu, Nigeria, in a 12-year period from 1st January 1992 to December 31st 2004.
RESULTS: 67(74.7%) were juxtacervical, 13(14.9%) Juxtaurethral and 9(10.3%) midvaginal. Average fistula size was 2.3 cm. 76(87.4%) were closed successfully at first repair and 11 failed. Nine of these were repaired successfully at second attempt. There was no case of urinary tract infection post repair and average hospital stay was 15.6 days.
CONCLUSION: The repair of only the bladder wall defect in the surgical management of vesicovaginal fistula has very good outcome.text/html2010-10-23T21:30:38+01:00http://www.webmedcentral.com/Dr. Nourah H Al QahtaniDoppler Ultrasound In The Assessment Of Suspected Intra-uterine Growth Restriction
http://www.webmedcentral.com/article_view/1068
SGA fetuses are a heterogeneous group comprising fetuses that have failed to achieve their growth potential (intra-uterine growth restriction, IUGR) and fetuses that are constitutionally small. Approximately 50–70% of fetuses with a birth-weight below tenth centile for gestational age are constitutionally small (1), and the lower the centile for defining SGA, the higher the likelihood of IUGR. It is very important to differentiate these types of SGA fetuses for two main reasons. First: IUGR fetuses are either low growth potential, as a result of genetic disease or environmental damage, or due to reduced placental perfusion and ‘utero-placental insufficiency’ and they are at increased risk of perinatal morbidity and mortality and will require close feto-maternal monitoring and probably earlier intervention. Second: Constitutionally small fetuses are perfectly healthy fetuses, with no increased perinatal death or morbidity (2), and they need minimal monitoring and should receive routine ante-natal care, once they are recognized as healthy. In this review, a brief discussion about the ultrasound diagnosis of suspected IUGR will be presented followed by the use of Doppler ultrasound in the diagnosis of IUGR and how to differentiate this group from the constitutionally small healthy fetuses.Fetal hypoxia, oxygen deficiency in the tissues, of any cause leads to a conversion from aerobic to anaerobic metabolism, which produces less energy and more acid. If the oxygen supply is not restored, the fetus dies. Hypoxia may result from:
(1) Reduced placental perfusion with maternal blood and consequent decrease in fetal arterial blood oxygen content due to low pO2 (hypoxemic hypoxia);
(2) Reduced arterial blood oxygen content due to low fetal hemoglobin concentration (anemic hypoxia);
(3) Reduced blood flow to the fetal tissues (ischemic hypoxia).
In this review, only hypoxemic hypoxia will be discussed.text/html2010-12-13T14:59:54+01:00http://www.webmedcentral.com/Ms. Judy S CohainFalse And True ROM
http://www.webmedcentral.com/article_view/1355
Background: It is estimated that in 15% of term PROM only the chorion breaks. No diagnostic test can distinguish whether one or both layers of sac are broken. Definite Differential diagnosis is only possible if leaking stops (False ROM) or if meconium is present (True ROM). Research evidence is lacking about False ROM. Evidence and a mechanism for an increased risk of chorioamnionitis or endometritis associated with False ROM is also lacking.Case: of False ROM is presentedConclusion: The term False ROM is introduced as well as avenues for future research.
text/html2011-01-26T20:36:40+01:00http://www.webmedcentral.com/Dr. Sunita GuptaPelvic - Peritoneal Tuberculosis Mimicking Ovarian Malignancy: A Case Report
http://www.webmedcentral.com/article_view/1520
Diagnosis of pelvic- peritoneal tuberculosis is often difficult, because of its nonspecific clinical, laboratory and radiological findings. The presence of an adnexal mass, ascites, and raised CA 125 level, may be mistaken as ovarian malignancy. Peritoneal tuberculosis should be considered in the differential diagnosis of adnexal masses, ascites and elevated CA 125. Ascitic fluid ADA, PCR for M. tuberculosis and endometrial biopsy may help to distinguish pelvic-peritoneal tuberculosis from ovarian malignancy. Peritoneal tuberculosis can be managed by ATT, therefore these test should be performed before surgery to exclude peritoneal tuberculosis, so that invasive and expensive surgery could be avoided.text/html2011-01-30T16:07:33+01:00http://www.webmedcentral.com/Dr. Geetika TomarThe Correlation Of Clinical Perinatal Asphyxia With Counts Of Nrbc/100 Wbc In Cord Blood
http://www.webmedcentral.com/article_view/1511
Objective: To study the correlation of clinical perinatal asphyxia with counts of nRBC/100 WBC in cord blood.Method: This is a prospective comparative study conducted from July 2008 to June 2009. It comprised of two groups, cases and controls. The case group consisted of 50 newborns with perinatal asphyxia and the control group had 50 non asphyxiated newborns. The cord blood was collected immediately after birth for Hb%, TLC, pH and nRBC/100WBC count determination. Early neonatal outcome of both the groups was also evaluated. Statistical analysis was done using SPSS software and application of chi square and Pearson’s correlation (sigma 2-tailed) tests.Results: The mean nRBC/100 WBC count for control group was 5.7 (+2.33212) and for case group was 10.34 (+3.87883). This difference was statistically significant (pConclusion: The nRBC/100 WBC count correlates well with perinatal asphyxia and associated early neonatal outcome.
text/html2011-03-02T19:00:40+01:00http://www.webmedcentral.com/Dr. Susan M CohenPsychosocial Adaptation During Recovery from Hysterectomy
http://www.webmedcentral.com/article_view/1660
Objective: The purpose of this study was to describe psychosocial adaptation as measured by anxiety, hostility, depression, self-esteem, body image, and sexual satisfaction in women following abdominal hysterectomy.Design: A repeated measures descriptive design was used to describe psychosocial adaptation (anxiety, hostility, depression, self-esteem, body image, and sexual satisfaction) in the immediate recovery period of women following abdominal hysterectomy.Setting: The study was conducted in Philadelphia, PA during hospitalization following a hysterectomy and in the participants’ homes during the eight-week recovery period.Participants: The sample consisted of 113 women who had experienced an abdominal hysterectomy. The mean age of the women was 47.5 years + 10.2 years. Level of education reported was: high school or less (4%), high school graduate (29%), and college or more (67%). Twenty percent reported a family income of less than $20,000, 34.9% had an income of $20,001 to $49,999, and 44.6% had an income of greater than $50,000. The majority were employed with 13.2% employed part time and 55.8% full time. Sixty-one percent of the sample was married. Sixty-four percent of the sample was Caucasian and 34% were African American.Main Outcome Measures: Anxiety, depression, and hostility were examined using the Multiple Affect Adjective Checklist; self esteem with the Rosenberg Self-Esteem Scale; and sexual satisfaction and body image with the Derogatis Sexual Functioning Index.Results: Significant overall positive changes in anxiety, depression, and hostility were noted across the four data points (pConclusion: Study participants suffered none of the negative psychosocial sequelae previously associated with hysterectomy. Future research needs to examine women's reactions at 6 and 12 months after surgery.
text/html2011-03-10T21:55:13+01:00http://www.webmedcentral.com/Prof. Rajiv R MahendruA Large Leiomyoma Causes Concern During Pregnancy And Parturition
http://www.webmedcentral.com/article_view/1714
Leiomyoma in pregnancy is not an unknown entity and is a cause of concern for being a source of excruciating pain, at times, during the ongoing gestation. Although performed rarely, it is sometimes necessary to remove a large myoma to effect delivery of the baby during Cesarean section as is depicted in the case being presented here under.text/html2011-03-16T22:20:59+01:00http://www.webmedcentral.com/Dr. Susan M CohenRecovery After Hysterectomy: A Year-Long Look
http://www.webmedcentral.com/article_view/1761
Hysterectomy is one of the most frequently performed surgical procedures among women of reproductive age in the United States. In 2007, approximately 517,000 women underwent hysterectomies (Bureau of Census, 2011); this procedure is viewed as a stressful event by many women (Cohen, Hollinsgworth, & Rubin, 1989). Hysterectomy carries the stress of surgery and potential postoperative complications and has been associated with anxiety, depression, changes in self-esteem, and in sexual functioning. Thispaper reports the results of a longitudinal study exploring the influence of hysterectomy on anxiety, depression, hostility, self-esteem, impact of event, body image, and sexual satisfaction over the year after surgery.text/html2011-03-17T16:07:24+01:00http://www.webmedcentral.com/Dr. Souhail AlouiniTermination of Pregnancy for Mild Foetal Abnormalities: Opinions of Physicians
http://www.webmedcentral.com/article_view/1770
Objective: to know physicians’ opinions in sex chromosome, uncertain prognosis and moderate handicap abnormalities and their conformity with the regional laws in case of parental request for termination of pregnancy (TOP).Methods: we sent a questionnaire to physicians in charge of 82 maternal-fetal medicine units in 16 countries. The questions concerned the decision-making in mild congenital abnormalities and its legal aspects.Results: 48 physicians out of 82 (59%) answered the questionnaire.Acceptation of termination of pregnancy before fetal viability was the most frequent attitude in case of uncertain prognosis abnormalities (p= 0.003), sex chromosome abnormalities (p= 0.029) and moderate handicap abnormalities (p= 0.05).Approximately one third to half of decisions of termination of pregnancy for mild congenital abnormalities were more permissive or restrictive than the respective laws (p < 0.05, 95% CI). 65% of the physicians did not want legislative modifications concerning termination for mild congenital abnormalities. In most cases there were no guidelines for the decisions.Conclusion: Acceptation of termination of pregnancy before fetal viability in case involving uncertain prognosis, sex chromosome and abnormalities with moderate handicap was the most frequent attitude of physicians. These attitudes were not always in agreement with the respective regional laws but there were no wishes to modify them.text/html2011-04-05T16:43:16+01:00http://www.webmedcentral.com/Mr. Muhammed R SiddiquiA Literature Review on Multiple Courses of Antenatal Steroids to Prevent Neonatal Respiratory Distress Syndrome
http://www.webmedcentral.com/article_view/1842
Introduction: Repeat antenatal corticosteroids may reduce respiratory distress syndrome however there is conflicting evidence suggesting it may be unnecessary or harmful. This article reviews the literature to examine the role of multiple courses of antenatal steroids to prevent neonatal respiratory distress syndrome.Methods: Electronic databases were searched online.Results: Four randomised controlled trials were identified according to our inclusion criteria. Conclusions: There is evidence that courses of ACS improve pulmonary outcomes in the neonate, preventing RDS. There is evidence suggesting potential harm, and the lack of long term safety data, caution and careful patient selection is required when instituting this intervention.
text/html2011-03-07T17:52:57+01:00http://www.webmedcentral.com/Prof. Rajiv R MahendruIs Hypothyroidism a Cause of Ovarian Cysts?- This Unusual Case Depicts So
http://www.webmedcentral.com/article_view/1641
Presented in this report is apparently the first case of its kind in the medical literature where an 11 year old prepubescent girl who had co-existent presence of hypothyroidism and multiple large ovarian cysts not only had remarkable improvement in her physical appearance with conservative management with L-Thyroxine alone but also had disappearance of her large ovarian cysts without the need of any surgical intervention, whatsoever.text/html2011-06-10T20:01:24+01:00http://www.webmedcentral.com/Dr. Parul GargEvaluation of Visual Inspection with Acetic Acid (Via) & Visual Inspection with Lugol\'s Iodine (Vili) as a Screening Tool for Cervical Intraepithelial Neoplasia in Comparison with Cytologic Screening
http://www.webmedcentral.com/article_view/1971
Objective: To study and compare efficacy of visual inspection with Acetic acid (VIA) /Visual inspection with Lugol's Iodine (VILI) and Pap smear as screening test in terms of "Sensitivity" and "Specificity" for Cervical cancer and pre–cancerous lesions.Method : Seven Hundred and sixty sexually active women between 25–60 years of age underwent pelvic examination by both pap smear and VIA/ VILI. Colposcopic/ Histodiagnosis was considered as gold standard against which the sensitivity & specificity of cytology, acetic acid and Lugol's iodine application as screening tool were evaluated.Result: Sensitivity of VIA/VILI was 94.3 % versus 74.3 % for cytology. VIA/VILI specificity was 82.6 % versus 93.7 % for cytology.Conclusion: Visual inspection with acetic acid (VIA) & Lugol's iodine (VILI) is more sensitive but less specific than cytology in detection of cervical cancer and its pre–cancerous lesions. VIA/ VILI has acceptable test qualities and may in low resource settings be implemented as a large scale screening method.
text/html2011-09-12T18:04:39+01:00http://www.webmedcentral.com/Dr. Veena AseejaEndometrial Stromal Sarcoma-A Case Report and Brief Review
http://www.webmedcentral.com/article_view/2184
Endometrial stromal sarcomas are rare uterine malignancy of mesodermal origin. The diagnosis is usually made post operatively. The usual presentation is abnormal vaginal bleeding, abdominal lump and mild lower abdominal pain. In this case report we present a case of low grade endometrial stromal sarcoma where the preop diagnosis was fibroid uterus with cystic degenerative changes. Total abdominal hysterectomy with bilateral salpingo oophorectomy was performed. On histopathological examination it turn out a case of low grade endometrial stromal sarcoma.text/html2011-09-14T20:09:40+01:00http://www.webmedcentral.com/Dr. Veena AseejaArterio-Venous Malformations and Retained Products of Conception: A Case Report and Brief Review
http://www.webmedcentral.com/article_view/2204
Uterine Arterio-venous malformations (AVM) are rare and potentially life threatening condition. AV malformations may be congenital or acquired. We report a case of acquired uterine AV malformation associated with retained products of conception. The condition can easily be confused with gestational trophoblastic disease.text/html2011-09-21T19:06:04+01:00http://www.webmedcentral.com/Dr. Ahmed A KhalilA Review of Obstetric Fistula in Sudan
http://www.webmedcentral.com/article_view/2222
Vesicovaginal fistula is a common complication of labor in some parts of the world, especially certain regions in Africa. Over the past few decades, several measures have been taken to reduce the global burden of this condition, and to treat patients already suffering from fistula. This article aims to describe the obstetric fistula situation in terms of prevalence, risk factors and available facilities in Sudan, where much work and effort has been put into fighting this condition.
Vesicovaginal fistula is a serious and debilitating condition, often aptly referred to as a ‘preventable tragedy’. The consequences of this condition are far-reaching, and it carries with it a lifelong social and economical burden, with lasting psychological and physical complications. Patients are often shunned from society and abandoned by their families.It is estimated that 2 million women worldwid[i]e are living with vesicovaginal fistula, with the incidence being about 2 in every 1000 deliveries in Sub-Saharan Africa[ii]. In developed countries surgery and radiotherapy are the main risk factors for the condition[iii], while obstetric complications are the predominant risk factors in developing nations[iv].In Sudan, the incidence of obstructed labor (followed by instrumental delivery) in 1997 to 1999 was 1.27%. Vesicovaginal fistula occurred as a complication in 1.5% of these cases[v], and 4.8% in another study[vi]. In one study in the city of Wad Madani[vii], the causes of fistula were obstructed labor (28%), forceps delivery (14%), Lower segment cesarean sections (16%), hysterectomy (24%), other gynecological operations (12%) and radiation (6%).Poverty, early marriage, malnutrition and poor health services all seem to contribute to the obstetric fistula situation in Sudan. Low socioeconomic status contributed to over 80% of cases in one large study in 2008[viii], circumcision also played a significant role. Pharaonic (infibulation type) FGM is relatively common in Sudan, and in these cases healing with fibrosis may occur, leading to a delay in the second stage of labor causing obstruction. Most affected patients are young women in the age group 18-24 years old, and are primigravida. However, the majority of these cases married before the age of 18 years. More than half of patients with obstetric fistula in Khartoum did not attend regular antenatal care, and about 40% delivered at home. Most cases of obstetric fistula in Sudan come from the Western regions, including Darfur. In this region, sexual violence (including rape) is common[ix], and this has been shown to be a risk factor for fistula formation[x].The authors of the 2008 study concluded that:“Vesico-vaginal fistula in Sudan results from obstructed labor, mostly in a first pregnancy, a young woman who is poor and illiterate, not on regular antenatal care & being in labor for more than 24 hours"It has been recommended that the emphasis on antenatal care, the training of midwives and the general improvement of socioeconomic status of women in Sudan should take priority to help prevent obstetric fistula. Doctors should also be advised to carefully consider the risks of instrumental (forceps) delivery, and opt for a Caesarian section in difficult cases.In Sudan, there are 3 specialized fistula hospitals - Dr. Abbo National Fistula & Urogynecology Centre is by far the largest (two other centres in Kassala and Alfashir are also present). Dr. Abbo Hassan Abbo is one of the leading international experts in the field (awarded the life time achievement award by the International Urogynecological Association in 2009), and established this centre as an extension of Khartoum Hospital’s Fistula ward in 1989. Currently, the centre sees more than 700 patients per year[xi] and is tended to by 5 expert Fistula consultants. Also, all registrars training in obstetrics and gynecology in Sudan must work a shift at the centre. The hospital is a multidisciplinary effort including urologists, rectal surgeons and urogynecologists. The centre is the second largest in Africa and the Middle East, second only to the one in Addis Ababa, Ethiopia[xii].In recognition of the essential role that social and economic factors play in fistula patients, the United Nations Population Fund, in collaboration with the Federal Ministry of Health, Sudan opened the National Centre for Rehabilitation and Social Integration of Fistula Patients in 2009 in Khartoum. It has a capacity of 40 beds, and complements the work of the Abbo National Fistula Centre.[xiii]text/html2011-09-23T18:51:45+01:00http://www.webmedcentral.com/Dr. Veena AseejaThyroid Dysfunction in Dysfunctional Uterine Bleeding
http://www.webmedcentral.com/article_view/2235
Dysfunctional uterine bleeding is one of the most frequently encountered conditions in gynecology being principal diagnosis in at least 10% of all new outpatients both in hospital and private practice. The diagnosis depends upon exclusion of general and local disease. It is recognized universally that menstrual disturbances may accompany and even may precede thyroid dysfunction .In the present study thyroid status of patients presenting with dysfunctional uterine bleeding was assessed by TSH assay.text/html2011-11-16T06:32:40+01:00http://www.webmedcentral.com/Dr. Tanweer KarimGiant Cysts of Ovary, Case Reports and Review of Literature
http://www.webmedcentral.com/article_view/2479
Cystic abdominal tumors are extremely common and now a day they are diagnosed more frequently due to availability of better imaging modalities. Presentations of huge cysts have become rare as most of them are diagnosed and treated early. Still we get reports of patients with huge benign abdominal cysts and many of them are serous cyst adenoma of ovary. Sometimes, it becomes very difficult to identify the source of these cysts and misdiagnosed as mesenteric cyst. Absolute diagnosis is only possible at laparotomy. We present two cases of giant ovarian cysts mimicking ascites.text/html2011-12-01T12:01:24+01:00http://www.webmedcentral.com/Dr. Emeka E OjiyiPregnancy Outcome in Grandmultiparae at a University Teaching Hospital in Southeastern Nigeria
http://www.webmedcentral.com/article_view/2533
Background: Grandmultiparity has been described as an independent risk factor for a variety of obstetric complications, especially in developing countries with inadequate health facilities.Aim: To compare the pregnancy outcomes of grandmultiparas with that of multiparas at the Imo State University Teaching Hospital, Orlu.Patients and Methods: The antenatal complications and pregnancy outcomes among booked grandmultiparas who delivered in our labour ward were compared with those of booked multiparae who delivered immediately after a grandmultipara.Main outcome measures: These were obstetric factors of maternal age and parity, antepartum and postpartum haemorrhage, foetal malpresentations and malpositions, gestational age at delivery, mode of delivery and maternal mortality. Medical complications were diabetes mellitus, hypertension, anaemia and heart disease. Foetal outcome measures were birth weight, neonatal jaundice, birth asphyxia, congenital malformations and perinatal mortality.Results: The age range of the grandmultiparae was between 23 and 45 years, with a mean of 31.6±2.1 years. The parity range was between 5 and 12, with a mean of 8.6±1.1. Diabetes mellitus, hypertension, heart disease, anaemia, multiple pregnancy, antepartum haemorrhage, foetal malpositionings and malpresentations, cephalopelvic disproportion, congenital malformations and macrosomia were significantly associated with grandmultiparae.Conclusion: The effects of these complications can be minimized by good antenatal care, adequate counseling to improve patients awareness, efficient social welfare support services and efficient blood banking system.Ultimately, female education and empowerment, acceptance and utilization of modern contraceptive methods will eradicate grandmultiparity.Keywords: Grandmultiparity, obstetric performance, Orlu, Nigeria.text/html2011-12-01T12:00:33+01:00http://www.webmedcentral.com/Dr. Emeka E OjiyiOutcome of Singleton Term Breech Deliveries at a University Teaching Hospital in Eastern Nigeria
http://www.webmedcentral.com/article_view/2543
Background: Breech deliveries have always been topical issues in obstetrics with high perinatal mortality and morbidity. A wide range of management policies have been instituted with the aim of reducing perinatal morbidity and mortality.Aim: To determine the perinatal outcome in singleton breech deliveries.Methods: This was a four-year retrospective study of all singleton term breech deliveries covering the period of January 2004 to December 2007. Information on socio-demographic characteristics of patients who had singleton breech deliveries and neonatal variables which included birth weight, apgar score, neonatal morbidity and mortality were obtained from labour ward records, records in special care baby unit and patients case notes retrieved from the Medical Records Department. Results: There were 122 singleton breech deliveries out of a total 4741 deliveries. The prevalence of singleton term breech deliveries in the study period was 2.6%. Eighty eight (72.1%) of the breech deliveries were through the vaginal route, while 22 (18.0%) and 12 (9.8%) were through elective and emergency caesarean sections respectively. A total prenatal deaths of 32 (36.2%) were recorded. These included 8 (6.6%) intra-uterine deaths prior to admission, fresh still birth 15 (12.3%) and early neonatal death 7 (5.7%). Nineteen (61.9%) of the perinatal deaths occurred in unbooked mothers. The perinatal mortality rate was 250 in 1000 deliveries.Conclusion: Breech delivery has always been associated with an increased perinatal mortality and morbidity than vertex delivery. There is need for proper enlightenment of the antenatal population on the importance of regular antenatal clinic attendance, in other to benefit maximally from either planned vaginal delivery or elective caesarean section.text/html2011-12-03T20:05:04+01:00http://www.webmedcentral.com/Dr. Emeka E OjiyiComplications of Intrauterine Contraceptive Device (IUCD) Among Users in Orlu, Nigeria
http://www.webmedcentral.com/article_view/2557
Background: Intrauterine contraceptive device (IUCD) is one of the reversible methods of contraception. Its use has increased steadily worldwide. However, some women reject it based on presumed complications associated with its use.Aim: To determine the complications reported by women, action taken on the complications and other associated factors in Orlu, Nigeria.Method: This is a cross-sectional study of 130 women who had IUCD insertions at the family planning clinics of Imo State University Teaching Hospital and Health Post Orlu between May 2008 and August 2008. Structured questionnaires were administered to consecutive women on follow-up visits at the Family Planning Clinics who are on IUCD. Information regarding age, parity, complications, reported action taken after the complication, clients’ awareness of the availability of intrauterine device and duration of IUCD use were included in the questionnaires. Result: A total of 130 users were available for study. Heavy menstruation was reported by 50 (35.2%) women which was the commonest in this study; 65 (50%) did not do anything about whatever complication reported. The age range was 21-45years with a peak age group of 26-30 years. Majority of the clients 85 (65.4%) knew about IUCD from the hospital. More than half (46.2%) of the patients had between 2-5 children. The distribution of the duration of IUCD use showed that most of the clients had the IUCD for 2 years and less.Conclusions: IUCD is well accepted among users who still consider the benefit of reversible contraception more than the reported complication.Keywords: IUCD, Complications.text/html2012-01-01T10:52:31+01:00http://www.webmedcentral.com/Dr. Alexander O UamaiPelvic Mass Associated with Raised CA 125 for Benign Condition: A Case Report
http://www.webmedcentral.com/article_view/2802
Background: Elevated levels of CA 125 with clinical evidence of significant weight loss and associated pelvic mass is highly suggestive of ovarian malignancy, this creates a diagnostic dilemma with the knowledge that several benign pelvic conditions may present with same findings.Case presentation: We present a case of 40 year old, Para 4 Nigerian woman who presented at the NNPC medical center in Lagos 4 weeks after she had a caesarean delivery in a private hospital on 3rd July,2011 with sudden lower abdominal pain and significant weight loss and on imaging was found to have 60mm × 87mm cm complex cystic mass in right adnexa with a raised CA 125 of 657, which was initially thought to be highly suspicious of cancer but was subsequently found to be due to a right tubo-ovarian abscess at surgery and confirmed by histology. Conclusion: This case underlines the need to rely more on clinical history in deciding diagnosis particularly in a resource limited setting like Nigeria. Initial clinical suspicion was for a pelvic abscess but the findings of severe weight loss and markedly elevated CA-125 level tilted the diagnosis in favour of a malignancy. There is therefore the need to seek reviews of CT scan reports and strongly consider non-malignant conditions in similar presentations.text/html2012-01-06T14:42:43+01:00http://www.webmedcentral.com/Mr. Mohammad S WalidCorrelation of Faculty Structure and Resident Experience in OBGYN Residency Programs
http://www.webmedcentral.com/article_view/2839
Introduction: In the U.S., residency programs are accredited by the Accreditation Council for Graduate Medical Education based on their capacity to provide residents with the fundamental training required to advance their knowledge and skills in the core principles of obstetrics and gynecology. In this paper we study the relationship between faculty structure and basic training of residents in obstetrics and gynecology (OBGYN) residency programs.Methods: Information on 244 OBGYN residency program were extracted from the Directory of Obstetrics and Gynecology Residency Programs on the website of the Association of Professors of Gynecology and Obstetrics. The training experience of OBGYN residents was provided in the Directory by the residency programs, specifically indicating the role of the resident as the main surgeon (S) or surgical assistant (A) for different procedures:Results: In OBGYN programs, general OBGYNs have the highest average faculty number (12) followed by maternal-fetal specialists (5), gyn-oncology (3), reproductive endocrinology (3), urogynecology (2) and the least are reproductive genetics specialists (1). Spontaneous delivery (327 as surgeon and 65 as assistant) and cesarean sections (234 as surgeon and 61 as assistant) are the most common procedures performed by OBGYN residents during their 4 years of training. The least number of procedures performed by OBGYN residents are surgical interventions on antenatal patients (18 as surgeon and 5 as assistant).Significant correlation is detected between the number of reproductive genetics specialists and the number of surgical procedures on antenatal patients performed by OBGYN residents as a surgeon (r=.230, p=.018). Likewise, significant correlation is evident between the number of urogynecologists among faculty members and the number of surgical procedures for urinary incontinence performed by OBGYN residents as a surgeon (r=.157, p=.041) or assistant (r=.288, p=.001).Conclusion: Faculty structure in OBGYN residency programs may have a significant impact on procedure experience of residents.text/html2012-02-19T09:58:43+01:00http://www.webmedcentral.com/Dr. Hae-hyeog LeeHow Should Ectopic Ovaries Managed?
http://www.webmedcentral.com/article_view/3055
Background: Ectopic ovaries are an uncommon congenital anomaly. Supernumerary ovaries are sometimes confused with accessory ovaries, mesenteric cysts, and lymph nodes.
Case presentation: We experienced two cases of ectopic ovaries. A 26-year-old woman had a supernumerary ovary of 3x2.5x2 cm mass located on the Cul-de-sac between the rectum and the uterus. A 23-year-old woman had an accessory ovary in right side.
Conclusion: We report a rare case of ectopic ovaries in the retroperitoneum. We should provide careful follow-up of a mass if an accessory or supernumerary ovary is not completely removed from the operative field.text/html2012-03-05T13:33:59+01:00http://www.webmedcentral.com/Ms. Judy S CohainJudys 3-4-5 Protocol: Combining the Best Parts of Active and Expectant Management of Third Stage of Labor for Lowest PPH > 500 cc and no PPH >1000 cc
http://www.webmedcentral.com/article_view/2993
Objectives: To find a third stage protocol that is easy to perform consistently, that results in lower PPH rates than active management.Methods: Judy’s 3,4,5 protocol was tested in 425 consecutive births. Results: 0.7% PPH rate > 500 cc and 0% PPH > 1000 cc, 0% blood transfusions, 1 placenta accreta removed by manual extraction at 30 minutes postpartum.Conclusions: Judy’s 3,4,5 combines the expedience of active management, delayed cord cutting of expectant management with the use of gravity and the abdominal and diaphragm muscles, to obtain the lowest PPH rates as well as the lowest retained placental rates reported to date.text/html2012-04-19T16:45:43+01:00http://www.webmedcentral.com/Prof. Tae-Hee KimPremature Ovarian Failure After Uterine Artery Embolization
http://www.webmedcentral.com/article_view/3269
Uterine artery embolization (UAE) is popular in some countries for management of postpartum hemorrhage, uterine myoma, and adenomyosis. However, avoidance of complications is important to preserve the uterus. The most serious complication is premature ovarian failure. UAE is advantageous for preserving the uterus for fertility; however, premature ovarian failure negates this advantage by causing infertility. We report two cases of premature ovarian failure after UAE. Our cases provide guidance for gynecologists who perform UAE. The first patient, aged 42 years, was para 1-0-0-1 and did not have a significant family history. She complained of metromenorrhagia, but she wanted to preserve her uterus for fertility. We performed a bilateral UAE. After 4 months, she complained of amenorrhea. She was diagnosed with premature ovarian failure by checking follicle stimulating hormone (FSH). The second patient, aged 40 years, had infertility from uterine myoma, endometriosis, and adenomyosis. She had undergone UAE and in vitro fertilization (IVF) 6 years earlier. After IVF, she became pregnant and was admitted from 26 weeks to 29 weeks for preeclampsia and preterm labor. After delivery, she had postpartum hemorrhage, and repeat UAE was performed. Two years later, she complained of hot flashes and amenorrhea. She was diagnosed with premature ovarian failure.text/html2012-04-25T12:50:22+01:00http://www.webmedcentral.com/Prof. Tae-Hee KimA Ruptured Old Ectopic Pregnancy that was Suspicious for Tumor
http://www.webmedcentral.com/article_view/3300
A 40-year-old woman was admitted for melena that she’d experienced for 2 days. For the laboratory findings, the lactate dehydrogenase (LDH) (610) and cancer antigen (CA) 125 (326.7) were increased, and the hemoglobin/hematocrit (Hb/Hct) (10/31.0) were slightly decreased: the beta-human chorionic gonadotropin (B-HCG) was 500. Her last menstruation period was 10 days previously. The magnetic resonance image suggested there was a 10 x 10 x 7 cm lobulating cystic mass on the right adnexa with ascites and adenomyosis with a thin endometrium (Figure 1). The impression was malignant cystadenocarcinoma of the right ovary or Krukenberg tumor. The gastrofibroscopic finding was erosive gastritis and chronic gastritis with intestinal metaplasia. On the positron emission tomography-computed tomography (PET-CT) findings, the more increased F-fluorodeoxy glucose (FDG) uptake in the ovarian cystic wall on the delayed image (p-standardized uptake value (SUV) = delayed image; 2.3->2.9, early image; 1.5->2.0) revealed cancer of the ovary (Figure 2). An exploratory laparotomy revealed 1000cc of hemoperitonium and paratubal hematoma (Figure 3) The frozen findings of right salpingooporectomy was the product of conception, and this was consistent with a ruptured tubal pregnancy. We report on a case in which an old ruptured ectopic mass without pain was misdiagnosed as ovarian malignancy.text/html2012-05-18T17:52:49+01:00http://www.webmedcentral.com/Dr. Mawahib A Al- BiateGestational Trophoblastic Disease in Ectopic Pregnancy: A Case Report with Review of Literature
http://www.webmedcentral.com/article_view/3388
Gestational trophoblastic disease associated with ectopic pregnancy is a rare event and persistent trophoblastic disease is a well recognized complication of conservative surgical treatment for ectopic pregnancy but rarely secondary trophoblastic implantation may occur after salpingectomy.
This is a case report of a rare and unusual presentation of persistent trophoblastic implantation following salpingectomy for ruptured ectopic pregnancy. The patient was admitted as an emergency with acute abdomen in severely shocked state. She underwent urgent laparotomy with right salpingectomy for ruptured tubal pregnancy with massive haemoperitonium. Postoperative period was smooth but one month following the operation she developed generalized nonspecific symptoms with high serum BHCG titer which was (50000 IU). Patient had been transferred for the territory trophoblastic disease centre for further follow up. She was kept on combination regimen of chemotherapy.
This case presentation was analyzed with other reported case series of the same problem. The analysis of the cases showed that most patients presented with abdominal pain. Some may have vaginal bleeding. Haemoperitonium was the most frequent surgical finding.
It is concluded from this case with other previous reported cases that strict histological criteria should be applied for the diagnosis of gestational trophoblastic disease when a sample of ectopic pregnancy is analysed in addition to careful monitoring and follow up of all cases of ectopic pregnancy with serum Human Chorionic Gonadotrophin after surgical treatment.text/html2012-06-08T14:14:39+01:00http://www.webmedcentral.com/Dr. Brijesh SathianHormonal Contraception in Nepal: A Necessary Enquiry
http://www.webmedcentral.com/article_view/3460
In recent years, Americans have begun to use Depo only through prescription. Women's organizations and pro-feminist groups have developed a positive attitude towards its use in recent years. They regard Depo as one of the more convenient contraceptive methods; in contrast, oral contraceptive pills are highly used in America. There is a need of study intends to explore the socioeconomic status, uses of female hormonal contraceptives and adverse health effects (including warnings and side effects) of hormone among female. Similarly, norplant and pills are in worldwide use, which have several health effects but to the best knowledge of the researcher, has not been studied in Nepal. So, there is an urgent need of a study focusing mainly on the rising warning effects and side effects due to hormones used by female, in relation to health effects.text/html2012-06-28T21:29:00+01:00http://www.webmedcentral.com/Dr. Mohammad OthmanProB Trial: Probiotics and the Prevention of Preterm Labour; A Randomised Controlled Trial Protocol
http://www.webmedcentral.com/article_view/3535
Preterm birth defined as birth occurring after the gestational age of viability (23 weeks, 500 grams weight) and before 37 completed weeks (259 days) of pregnancy, is one of the most important problems in medicine today. Preterm birth is the single largest cause of mortality and morbidity for newborns. It accounts for 5% to 11% of births in the world but is responsible for 28% of all deaths within 28 days of birth and 50% of childhood neurological disabilities (1, 2).Infection and preterm birth:In the last 20 years infection has emerged as an important cause of preterm labour and delivery leading to more than 50% of the all preterm deliveries world-wide (1, 3, 4, 5, 6, 7, 8, 9). In this context, the organisms involved may not be necessarily pathogenic; a change in vaginal flora may be enough to trigger the sequence of events leading to a preterm birth (1, 3, 8, 9, 10, 11, 12, 13). Changes in vaginal flora can increase the risk of adverse pregnancy outcomes through a variety of mechanisms. Metalloproteolytic enzymes and other bioactive microbial products act directly on cervical collagen leading to premature cervical shortening and ripening (6, 11, 14). Bacterial products can also weaken the fetal membranes and promote preterm premature rupture of the membranes (11). Pathologic microorganisms trigger the innate immune system to produce both prostaglandins E2 and F2a and cytokines such as Tumour Necrosis Factor alpha (TNF-a), Interleukin (IL1b, IL6, IL8) and Granulocyte-Macrophage Colony Stimulating Factor (GM-CSF) (4, 6, 15, 16, 17). Prostaglandins are potent stimulator of uterine contractions (16) whilst cytokines may lead to direct fetal tissue damage (e.g. fetal brain or lung) or may orchestrate preterm labour (8, 11).Vaginal ecosystem:Lactobacillus species, including Lactobacillus acidophilus, L.fermentum, L. crispatus, and L. jensenii are the dominant bacteria in the normal vaginal flora. Lactobacilli are gram positive, catalase negative, non-sporing rods. They ferment glycogen produced by the vaginal epithelium and this reaction leads to the formation of hydrogen peroxide. The presence of hydrogen peroxide producing strains of Lactobacilli in the vaginal flora is associated with a reduced incidence of abnormal flora including bacterial vaginosis (18, 19, 20, 21). The incidence of bacterial vaginosis in women without Lactobacilli is reported to be 56% compared with 32% in women colonized by non-hydrogen peroxide producing strains and only 4% in women who have hydrogen peroxide producing strains of Lactobacilli (17). It is postulated that reduced levels of lactobacilli allow the populations of other potentially pathogenic microorganisms to grow and trigger the inflammatory processes outlined above (7, 16, 18, 21, 22).Probiotics and preterm labour:Probiotics are defined as live microorganisms which, when administered in an adequate amount, confer a health benefit on the host (7, 18, 23, 24). They stimulate an immunomodulation process that includes the induction of mucus production, macrophage activation by lactobacilli signalling, stimulation of secretory IgA and neutrophils, inhibition of release of inflammatory cytokines, and stimulation of elevated peripheral immunoglobulins. It has also been shown that probiotics may modulate cytokine release resulting in large amounts of IL-10 and low levels of IL-12p70, IL-5 and IL-13 with the main source of IL-10 attributable to CD14+ (25, 26, 27, 28). Smits 2005 (45) has suggested that the beneficial effects of probiotics in the treatment of inflammatory diseases (such as Crohn’s) may be due to the probiotic cells targeting the C-type lactic DC-specific intercellular adhesion molecule 3-grabbing non-integrin (DC-SIGN). Probiotics have been shown to displace and kill pathogens and modulate the immune response by interfering with the inflammatory cascade that leads to preterm labour and delivery (7, 25). The administration of Lactobacilli by mouth or intravaginally, or both have been shown to be safe and effective in reducing or treating urogenital infections in non-pregnant populations (7, 29, 30, 31)Clinical trials of probiotics in pregnancy:A Cochrane systematic review (32) was conducted and identified seven randomised clinical trials using probiotics for the prevention of preterm labour in women with bacterial vaginosis. One trial started in February 2005 and was terminated in 2007 because the tightly defined inclusion criteria were making recruitment very slow. Another trial started in 2006 and was terminated in 2009 because of limitation of funding. One trial with 381women recruited was excluded because there were no data on clinical outcomes in the published article; we tried to contact the author with no response. The second trial was excluded because they used prebiotics not probiotics in the trial. Of the three trials included in the review, one enrolled 24 women after 34 weeks of pregnancy using oral fermented milk as probiotic, while the other study with 64 participants utilised commercially available yoghurt to be used vaginally by women diagnosed with bacterial vaginosis in early pregnancy. Third study enrolled 256 women in Finland. Participants were randomised into two experimental groups and one placebo control group. One of the experimental groups received placebo and dietary counselling while the other experimental group received probiotics (Lactobacillus rhamnosus GG and Bi-fidobacterium lactis Bb12 once daily) from the first trimester of pregnancy to the end of breastfeeding and dietary counselling. Effects on very preterm birth (less than 32 weeks) (risk ratio (RR) 0.65; 95% confidence interval (CI) 0.03 to 15.88) and preterm birth (less than 37 weeks) (RR 3.95; 95% CI 0.36 to 42.91) showed very wide CIs and no effect of statistical significance. The trial reports focused on laboratory evidence of infection (lactobacillus count, type of abnormal vaginal flora, vaginal fluid pH, presence of clue cells in vaginal wet smear, number of leukocytes) rather than clinical signs of infection or preterm labour. Reduction in genital infection was therefore the only prespecified clinical outcome for which the data were available for both studies with pooled results showing 81% reduction in genital infection with the use of probiotics {Risk Ratio (RR) 0.19; 95% Confidence Interval (CI) 0.08, 0.48}. We contacted the authors to provide us with the data on any clinical pregnancy related outcomes, but there were no other data than the published. Clinical pregnancy related outcomes include preterm birth before 28, 34, 37 weeks, preterm labour requiring hospital admission, neonatal mortality and severe morbidity. The preceding outcomes were going to help us to study the impact of probiotics on preterm labour and its complications.Rationale for further studies of probiotics in preterm labour:Probiotics have been found to be an effective treatment for Crohn’s disease. In Crohn’s disease, enhanced mucosa permeability may play a pivotal role in causing and perpetuating intestinal inflammation (33). The benefits of probiotics have been attributed to the stabilisation of the intestinal barrier and stimulation of a host response, in particular mucosal IgA secretion (13). This evidence could contribute to the better understanding of pathophysiology of preterm labour because of similarities between the immunobiology of Crohn’s disease and recurrent preterm labour. Crohn’s disease is a chronic inflammatory disorder with features which are similar to those produced by infection with organisms such as mycobacteria. More importantly Marks et al 2006 (34) showed that in patients with Crohn’s disease, trauma to rectum, ileum or skin led to abnormally low neutrophil accumulation and lower production of pro-inflammatory interleukin 8 (34). They concluded that in Crohn's disease, a constitutionally weak immune response predisposes to accumulation of intestinal contents that breach the mucosal barrier of the bowel wall, resulting in granuloma formation and chronic inflammation. These observations are strikingly similar to our recent findings showing that a lack of cervical macrophages was associated with recurrent preterm labour. We have analysed the observational data on 89 women with a past history of preterm labour and delivery. We found that in a subsequent pregnancy, 19 out of 49 women with a low macrophage count (&lt;5% of cervical epithelial cells expressing CD14 antigen) before 20 weeks gestation, delivered before 35+0 (41%), compared with only 5 out of 40 women (12.5%) who had normal cervical macrophage count (Odds Ratio 4.9, 95%CI 1.5 to 18.7; P 0.0037). Therefore, we hypothesize that stimulation of the cervical host response with probiotics will stimulate cervical and vaginal IgA secretion which, in turn, will increase cervical macrophage count. This process may reduce the risk of preterm labour by inhibiting pathogenic organisms and by improving host defence against ascending infection.text/html2012-09-26T13:47:17+01:00http://www.webmedcentral.com/Dr. Bassir A BassirCutaneous Metastasis from Endometrial Adenocarcinoma Case Report and Literature Review
http://www.webmedcentral.com/article_view/3723
Cutaneous metastases from endometrial adenocarcinoma are very rare, the incidence is unknown. We report a case of 60 year old patient treated from endometrial carcinoma stage IIB, she presented cutaneous metastasis six months after, an association of chemotherapy and radiotherapy were instituted. The tumor reaches the skin by variety of mechanisms, and there are several morphologic types. The treatment is based on local excision. The chemotherapy and radiation have also been utilizedtext/html2012-10-09T17:54:58+01:00http://www.webmedcentral.com/Dr. Theophilus DapilahAnthropometric Measures and the Risk of Developing leiomyoma in Ghana
http://www.webmedcentral.com/article_view/3752
Background: The etiology of uterine leiomyoma (or fibroids) is poorly understood. Sex steroid hormones, genetic, and growth factors have been hypothesized to play a role in their development, and anthropometric characteristics may influence uterine leiomyoma risk through these sex steroid hormones.
Methods: We analyzed retrospectively-collected data from two hundred (200) patients diagnosed as having fibroids and two hundred (200) control subjects with similar age distribution as the patients. Anthropometric features of all participants were taken. Data on anthropometric were analyzed by unpaired t-test analysis and Logistic regression.
Results: There were significant differences between the patients and controls groups in terms of weight, waist circumference, hip circumference, BMI, and waist-to-hip ratio. When subjects’ BMI were classified as underweight (&lt;18.5), normal (18.5 – 24.9), overweight (25.0 – 29.9) and obese (?30), analysis using Logistic regression revealed a strong association between the development of fibroid with an increase in the patients BMI; with the over weight patients having an almost two fold increased risk (OR= 1.91; exact 95% CI= 1.14 - 3.20) and the obese having far more than a two fold risk increased (OR= 2.25; exact CI= 1.21 - 4.17) of developing fibroid when compared to the patients with normal BMI. The under weight patients however had a decreased risk (OR= 0.70; exact 95% CI= 0.34 - 1.42) of developing fibroid when compared to the normal BMI patients. When subjects were categorized as normal or obese based on their waist-to-ratio and analyzed using Logistic regression, there was a strong association between obesity and the development of fibroid (OR= 3.60; exact 95% CI= 1.74 - 7.47) with the obese having close to a fourfold increased risk of developing fibroids.
Conclusion: High BMI and waist-to-hip ratio are may increase the risk of uterine leiomyoma possibly reflecting associated hormonal changes as well as alterations in metabolic controls that affect myometrial cell signaling through mediators such as insulin receptors, insulin-like growth factors, peroxisome proliferating activating receptors, and also influence uterine leiomyomata through changes in steroid hormone metabolism and bioavailability.text/html2012-11-24T15:07:41+01:00http://www.webmedcentral.com/Dr. Ibrahim YakasaiRupture of Gravid Uterus Following Road Traffic Accident. Literature Review and Case Report
http://www.webmedcentral.com/article_view/3851
Rupture of gravid uterus is a major obstetrics emergency that contributes significantly to high maternal and perinatal morbidity and mortality. Risk factors includes oxytocin use, uterine scar, obstructed labour, low socio economic status, high parity, lack of antenatal care and as a result of trauma following road traffic accident. Mrs HD was a 33 years old unbooked grandmultiparous woman referred from jigawa state at gestational age of about 26 weeks with complaints of generalized abdominal pain distention, absent fetal movement and vaginal bleeding for 2 days following road traffic accident. A diagnosis of Posterior uterine rupture extending from the fundus measuring about 12cm in length, secondary to blunt abdominal trauma was made. She had exploratory laparotomy, total abdominal hysterectomy with conservation of the ovaries.text/html2012-12-31T18:27:59+01:00http://www.webmedcentral.com/Prof. Kulvinder K KaurSuccesful Treatment of Nongestational Chorioc Arcinoma of Uterine Body in a Young Girl With Modified EMA-Cotherapy and thus Preserving Fertility - The First case in World Literature
http://www.webmedcentral.com/article_view/3922
Background: To describe the first case in world literature of Primary nongestational choriocarcinoma(NGC) of the uterine body as Primary NGC of female gestational tract has been described in the ovaries andis unusual in other genital sides.Setting: An Academic Research CentrePatient(s): A 21 year old unmarried girl who presented with continuous vaginal bleeding,fever of unknown origin with an abdominal mass eventually diagnosed as NGC of the uterine bodyIntervention(s): After 3units of fresh blood transfusionsandiv antibiotics two courses of methotrexate1mg/kg(40mg) alternating with leucoviron0.1mg/kg(4mg) Followed by Etoposide 100mg iv infusionx5,Actinomycin D 0.5mg ivx5 & methotrexate 40mg alternating with leucoviron 4mgimx4 dosesfollowed 1week later by cyclophosphamide 500mg in iv infusion andvincristine 1mg iv in saline(modified EMA-CO therapy)Main Outcome Measures: Regression of tumour size clinically, on USG and MRI along with a negative urine pegnancy test and β-HCG becoming undetectable.Result(s): Expulsion of the tumour from the uterine cavityConclusions: Although very rare NGC should be considered in the differential diagnosis of any tumour presenting in the uterine cavity presenting as a solid deeply penetrating mass and a conservative approach of chemotherapy should be the treatment of option rather than jumping on to Total abdominal hysterectomy along with bilateral salpingo-oophorectomy(TAH with BSO)as the primary treatment especially in a young girl whose reproductive career is of vital importance for her future life.text/html2013-01-07T22:41:28+01:00http://www.webmedcentral.com/Mr. Mohamed M NajimudeenBilaternal Cornual Ectopic Pregnancy
http://www.webmedcentral.com/article_view/2879
A 28 year old gravida 2 para1 was presented at the period of gestation of 8weeks and 2 days of pregnancy with lower abdominal pain of one day duration. She had no vaginal bleeding, urinary or bowel symptoms. Her systemic enquiry was normal. She was underwent laparoscopic cholecystectomy 5 years ago. Her first pregnancy was an uncomplicated normal vaginal delivery 4 years back. She was using CuT intrauterine contraceptive device (IUCD) since her post partum period which has been removed a month prior to the current pregnancy. She has no significant allergies.On examination, she was not pale; her blood pressure was 110/80 mmHg; and the pulse rate was 78/min. Her abdomen was not distended and non tender. Vaginal examination did not reveal any adenexal mass and there was no cervical excitation. Investigations showed haemoglobin 9.5g/dl ; bloodgroup was B positive. A trans-vaginal ultrasouns scan (TVS) was performed. There was a gestational sacnoted at right cornu with a live fetus (CRL= 8w +3d).Another sac was seen at left interstitial portion (GS=2.7cm) but no fetal pole. Uterine cavity was empty and endometrial thickness was 4.4mm (fig.01).She was managed with close monitoring in the ward. A repeat TVS was performed in one week time confirmed the right corneal pregnancy was progressing (CRL=9w+4d) while left corneal sac was regressing in size (fig.02). A laparotomy was performed.There was a 5cm X 6cm size right corneal sac with minimal haemoperitonium. However, in the left cornual region the sac was not seen prominently. Right cornual resection and reconstruction was done(fig.03,04).The patient was followed up with TVS in two weeks time to assess the left corneal sac which was confirmed as an early fetal demise.She was reassuredand advised regarding the risk during next pregnancy.text/html2013-04-18T08:39:43+01:00http://www.webmedcentral.com/Dr. Mohammad OthmanCervical Immunology in Women at risk of preterm labour
http://www.webmedcentral.com/article_view/4205
Preterm birth, defined as birth occurring after the gestational age of viability (23 weeks, 500 grams weight) and before 37 completed weeks (259 days) of pregnancy, is one of the most important problems in medicine today. Preterm birth is the single largest cause of mortality and morbidity for newborns. It accounts for 5% to 11% of births in the world but is responsible for 28% of all deaths within 28 days of birth and 50% of childhood neurological disabilities [1, 2]. Other important adverse outcomes of preterm birth include respiratory distress syndrome, intraventricular haemorrhage, leukomalacia, necrotizing enterocolitis and prolonged hospitalisation [2]. Survivors can experience life-long complications including cerebral palsy, blindness and deafness [1, 2].
Psychologically, giving birth to a preterm infant is considered to be a stressful event for parents. Many studies have shown that mothers of these infants experience increased levels of stress in the neonatal period compared with mothers of term infants, and they are more likely to suffer from depression and anxiety at the time of hospital discharge [3]. There is also increased depressive symptoms among fathers of preterm infants during the neonatal intensive care unite stay [4]. It is assumed that increased parenting stress could interfere with the parent-child relationship during early childhood and consequently increase the risk for later behavioural problems [3, 5].
The direct and indirect costs of prematurity can be immense [2]. The lifetime costs per preterm birth (baby's birth weight less than 2500 grams) have been estimated at £511,614 [1, 6].
The incidence of preterm deliveries in developed countries is 6% to 9%, currently it is 7% in theUKaffecting 21,000 babies each year inEngland. Preterm premature rupture of the membranes and spontaneous preterm labour accounts for approximately 80% of preterm deliveries; the remaining 20% are planned deliveries for maternal or fetal reasons (for example, eclampsia) [7].
In the last 20 years it has become clear that infection is an important cause of preterm labour and delivery leading to more than 50% of the all preterm deliveries world-wide [1, 8-14]. Infection has been recognised as an important and frequent mechanism of disease in preterm birth with a firm link to prematurity. The evidence that implicate infection as a cause of preterm labour and birth includes:
Administration of microbial products to pregnant animals results in preterm birth.
Systematic maternal infection, for example, pyelonephritis, pneumonia or even Dental caries are associated with preterm labour.
Subclinical intrauterine infections usually trigger preterm birth.
Treatment of asymptomatic bacteriuria prevents preterm labour.
Clinical infection is increased in the infant and the mother after preterm birth.
10-15% of amniotic fluid cultures from preterm labour patients are positive for microorganisms.
Antibiotic treatment of intrauterine infections can prevent prematurity in experimental models of chorioamnionitis [15].
Since infection is frequently difficult to confirm, we often refer to women with positive amniotic culture, histological evidence of chorioamnionitis or elevated cytokines in the amniotic fluid as having a subclinical infection. In this context, the organisms involved may not be necessarily pathogenic; a change in vaginal flora may be enough to trigger the sequence of events leading to a preterm birth [1, 2, 8, 11, 14, 16-18].
The most common pathway for pathogens to cause preterm labour is the ascending route [2, 14]: several mechanisms contribute to this pathway. Pathogens produce proteolytic enzymes including different types of mucinases, sialidases, peptidase and protease. The presence of bacterial sialidases facilitates the attachment of bacteria to cervical mucus and the breakdown of mucin, while bacterial mucinases assist ascent into uterine tissues [2, 12, 19]. Other enzymes may act directly on cervical collagen leading to premature shortening and ripening cervix while also weakening the fetal membranes leading to preterm premature rupture of the membranes [2, 12, 19].
Microorganisms stimulate maternal monocytes and macrophages resulting in the production of phospholipase A2. This is an enzyme that liberates arachidonic acid from the phospholipids of the membranes leading to the synthesis of prostaglandins E2 and F2α by the placental membranes: prostaglandins are potent stimulator of uterine contractions [14, 20-27]. Similarly, protease toxins activate the decidua and fetal membranes to produce Cytokines such as Tumour Necrosis Factor (TNF), Interleukin (IL1α, IL1β, IL6, IL8), and Granulocyte-Macrophage Colony Stimulating Factor (GM-CSF) [9, 12, 14, 20-22, 25-27]. The activation of a local inflammatory reaction leads to prostaglandin synthesis and release which subsequently stimulate uterine contractions [28-30]. Moreover, in infected foetuses, there is an increase in both fetal hypothalamic and placental production of corticotrophin releasing hormone leading to increase in fetal corticotrophin secretion, which in turn increases fetal adrenal cortisol production leading to increased production of prostaglandins [20, 25, 28]. When the fetus is infected, there is a high increase in the production of cytokines and marked decrease in the delivery time with a high chance of direct fetal tissue damage (e.g. fetal brain or lung) [2, 14, 19, 20, 24, 25, 31].
During pregnancy the primary function of the uterine cervix is to remain closed in order to retain the baby within the uterus until fetal maturity and birth. A secondary function of the cervix is to prevent infection ascending from the vagina into the uterus. Prior to normal delivery at term, cervix shortens, softens and ripens (becomes more distensible), to facilitate cervical dilatation by myometrial contractions during labour. The cervix consists mainly of connective tissue, principally, collagen fibres in a proteoglycan ground substance. The interaction between these two substances gives the cervix its unique characteristics, where the collagen fibres resist pulling forces and the ground substance resists compressive forces [32].
Various methods have been used to try and detect cervical changes that predict preterm labour. These include manual vaginal examination, transabdominal ultrasound, and transvaginal ultrasound [29, 33]. Of these modalities, measurements of cervical length using transvaginal ultrasound scanning appear to have the highest sensitivity, whereas transabdominal scanning was not predictive [29, 30]. There is however, no clear cut gestation at which the test should be performed or what cervical length provides the best cut-off for a diagnostic test [29, 33].text/html2013-04-18T08:32:04+01:00http://www.webmedcentral.com/Dr. Mohammad OthmanCervical Anatomy in Women at Risk of Preterm Labour
http://www.webmedcentral.com/article_view/4206
Preterm birth, defined as birth occurring after the gestational age of viability (23 weeks, 500 grams weight) and before 37 completed weeks (259 days) of pregnancy, is one of the most important problems in medicine today. Preterm birth is the single largest cause of mortality and morbidity for newborns. It accounts for 5% to 11% of births in the world but is responsible for 28% of all deaths within 28 days of birth and 50% of childhood neurological disabilities [1, 2]. Other important adverse outcomes of preterm birth include respiratory distress syndrome, intraventricular haemorrhage, leukomalacia, necrotizing enterocolitis and prolonged hospitalisation [2]. Survivors can experience life-long complications including cerebral palsy, blindness and deafness [1, 2].
Psychologically, giving birth to a preterm infant is considered to be a stressful event for parents. Many studies have shown that mothers of these infants experience increased levels of stress in the neonatal period compared with mothers of term infants, and they are more likely to suffer from depression and anxiety at the time of hospital discharge [3]. There is also increased depressive symptoms among fathers of preterm infants during the neonatal intensive care unite stay [4]. It is assumed that increased parenting stress could interfere with the parent-child relationship during early childhood and consequently increase the risk for later behavioural problems [3, 5].
The direct and indirect costs of prematurity can be immense [2]. The lifetime costs per preterm birth (baby's birth weight less than 2500 grams) have been estimated at £511,614 [1, 6].
The incidence of preterm deliveries in developed countries is 6% to 9%, currently it is 7% in theUKaffecting 21,000 babies each year inEngland. Preterm premature rupture of the membranes and spontaneous preterm labour accounts for approximately 80% of preterm deliveries; the remaining 20% are planned deliveries for maternal or fetal reasons (for example, eclampsia) [7].
In the last 20 years it has become clear that infection is an important cause of preterm labour and delivery leading to more than 50% of the all preterm deliveries world-wide [1, 8-14]. Infection has been recognised as an important and frequent mechanism of disease in preterm birth with a firm link to prematurity. The evidence that implicate infection as a cause of preterm labour and birth includes:
Administration of microbial products to pregnant animals results in preterm birth.
Systematic maternal infection, for example, pyelonephritis, pneumonia or even Dental caries are associated with preterm labour.
Subclinical intrauterine infections usually trigger preterm birth.
Treatment of asymptomatic bacteriuria prevents preterm labour.
Clinical infection is increased in the infant and the mother after preterm birth.
10-15% of amniotic fluid cultures from preterm labour patients are positive for microorganisms.
Antibiotic treatment of intrauterine infections can prevent prematurity in experimental models of chorioamnionitis [15].
Since infection is frequently difficult to confirm, we often refer to women with positive amniotic culture, histological evidence of chorioamnionitis or elevated cytokines in the amniotic fluid as having a subclinical infection. In this context, the organisms involved may not be necessarily pathogenic; a change in vaginal flora may be enough to trigger the sequence of events leading to a preterm birth [1, 2, 8, 11, 14, 16-18].
The most common pathway for pathogens to cause preterm labour is the ascending route [2, 14]: several mechanisms contribute to this pathway. Pathogens produce proteolytic enzymes including different types of mucinases, sialidases, peptidase and protease. The presence of bacterial sialidases facilitates the attachment of bacteria to cervical mucus and the breakdown of mucin, while bacterial mucinases assist ascent into uterine tissues [2, 12, 19]. Other enzymes may act directly on cervical collagen leading to premature shortening and ripening cervix while also weakening the fetal membranes leading to preterm premature rupture of the membranes [2, 12, 19].
Microorganisms stimulate maternal monocytes and macrophages resulting in the production of phospholipase A2. This is an enzyme that liberates arachidonic acid from the phospholipids of the membranes leading to the synthesis of prostaglandins E2 and F2α by the placental membranes: prostaglandins are potent stimulator of uterine contractions [14, 20-27]. Similarly, protease toxins activate the decidua and fetal membranes to produce Cytokines such as Tumour Necrosis Factor (TNF), Interleukin (IL1α, IL1β, IL6, IL8), and Granulocyte-Macrophage Colony Stimulating Factor (GM-CSF) [9, 12, 14, 20-22, 25-27]. The activation of a local inflammatory reaction leads to prostaglandin synthesis and release which subsequently stimulate uterine contractions [28-30]. Moreover, in infected foetuses, there is an increase in both fetal hypothalamic and placental production of corticotrophin releasing hormone leading to increase in fetal corticotrophin secretion, which in turn increases fetal adrenal cortisol production leading to increased production of prostaglandins [20, 25, 28]. When the fetus is infected, there is a high increase in the production of cytokines and marked decrease in the delivery time with a high chance of direct fetal tissue damage (e.g. fetal brain or lung) [2, 14, 19, 20, 24, 25, 31].
During pregnancy the primary function of the uterine cervix is to remain closed in order to retain the baby within the uterus until fetal maturity and birth. A secondary function of the cervix is to prevent infection ascending from the vagina into the uterus. Prior to normal delivery at term, cervix shortens, softens and ripens (becomes more distensible), to facilitate cervical dilatation by myometrial contractions during labour. The cervix consists mainly of connective tissue, principally, collagen fibres in a proteoglycan ground substance. The interaction between these two substances gives the cervix its unique characteristics, where the collagen fibres resist pulling forces and the ground substance resists compressive forces [32].
Various methods have been used to try and detect cervical changes that predict preterm labour. These include manual vaginal examination, transabdominal ultrasound, and transvaginal ultrasound [29, 33]. Of these modalities, measurements of cervical length using transvaginal ultrasound scanning appear to have the highest sensitivity, whereas transabdominal scanning was not predictive [29, 30]. There is however, no clear cut gestation at which the test should be performed or what cervical length provides the best cut-off for a diagnostic test [29, 33].text/html2013-04-20T14:22:51+01:00http://www.webmedcentral.com/Dr. Mohammad OthmanCervical Immunobiology in Women at Risk of Preterm Labour
http://www.webmedcentral.com/article_view/4207
Preterm birth, defined as birth occurring after the gestational age of viability (23 weeks, 500 grams weight) and before 37 completed weeks (259 days) of pregnancy, is one of the most important problems in medicine today. Preterm birth is the single largest cause of mortality and morbidity for newborns. It accounts for 5% to 11% of births in the world but is responsible for 28% of all deaths within 28 days of birth and 50% of childhood neurological disabilities [1, 2]. Other important adverse outcomes of preterm birth include respiratory distress syndrome, intraventricular haemorrhage, leukomalacia, necrotizing enterocolitis and prolonged hospitalisation [2]. Survivors can experience life-long complications including cerebral palsy, blindness and deafness [1, 2].
Psychologically, giving birth to a preterm infant is considered to be a stressful event for parents. Many studies have shown that mothers of these infants experience increased levels of stress in the neonatal period compared with mothers of term infants, and they are more likely to suffer from depression and anxiety at the time of hospital discharge [3]. There is also increased depressive symptoms among fathers of preterm infants during the neonatal intensive care unite stay [4]. It is assumed that increased parenting stress could interfere with the parent-child relationship during early childhood and consequently increase the risk for later behavioural problems [3, 5].
The direct and indirect costs of prematurity can be immense [2]. The lifetime costs per preterm birth (baby's birth weight less than 2500 grams) have been estimated at £511,614 [1, 6].
The incidence of preterm deliveries in developed countries is 6% to 9%, currently it is 7% in theUKaffecting 21,000 babies each year inEngland. Preterm premature rupture of the membranes and spontaneous preterm labour accounts for approximately 80% of preterm deliveries; the remaining 20% are planned deliveries for maternal or fetal reasons (for example, eclampsia) [7].
In the last 20 years it has become clear that infection is an important cause of preterm labour and delivery leading to more than 50% of the all preterm deliveries world-wide [1, 8-14]. Infection has been recognised as an important and frequent mechanism of disease in preterm birth with a firm link to prematurity. The evidence that implicate infection as a cause of preterm labour and birth includes:
Administration of microbial products to pregnant animals results in preterm birth.
-Systematic maternal infection, for example, pyelonephritis, pneumonia or even Dental caries are associated with preterm labour.
-Subclinical intrauterine infections usually trigger preterm birth.
-Treatment of asymptomatic bacteriuria prevents preterm labour.
-Clinical infection is increased in the infant and the mother after preterm birth.
-10-15% of amniotic fluid cultures from preterm labour patients are positive for microorganisms.
-Antibiotic treatment of intrauterine infections can prevent prematurity in experimental models of chorioamnionitis [15].
Since infection is frequently difficult to confirm, we often refer to women with positive amniotic culture, histological evidence of chorioamnionitis or elevated cytokines in the amniotic fluid as having a subclinical infection. In this context, the organisms involved may not be necessarily pathogenic; a change in vaginal flora may be enough to trigger the sequence of events leading to a preterm birth [1, 2, 8, 11, 14, 16-18].
The most common pathway for pathogens to cause preterm labour is the ascending route [2, 14]: several mechanisms contribute to this pathway. Pathogens produce proteolytic enzymes including different types of mucinases, sialidases, peptidase and protease. The presence of bacterial sialidases facilitates the attachment of bacteria to cervical mucus and the breakdown of mucin, while bacterial mucinases assist ascent into uterine tissues [2, 12, 19]. Other enzymes may act directly on cervical collagen leading to premature shortening and ripening cervix while also weakening the fetal membranes leading to preterm premature rupture of the membranes [2, 12, 19].
Microorganisms stimulate maternal monocytes and macrophages resulting in the production of phospholipase A2. This is an enzyme that liberates arachidonic acid from the phospholipids of the membranes leading to the synthesis of prostaglandins E2 and F2α by the placental membranes: prostaglandins are potent stimulator of uterine contractions [14, 20-27]. Similarly, protease toxins activate the decidua and fetal membranes to produce Cytokines such as Tumour Necrosis Factor (TNF), Interleukin (IL1α, IL1β, IL6, IL8), and Granulocyte-Macrophage Colony Stimulating Factor (GM-CSF) [9, 12, 14, 20-22, 25-27]. The activation of a local inflammatory reaction leads to prostaglandin synthesis and release which subsequently stimulate uterine contractions [28-30]. Moreover, in infected foetuses, there is an increase in both fetal hypothalamic and placental production of corticotrophin releasing hormone leading to increase in fetal corticotrophin secretion, which in turn increases fetal adrenal cortisol production leading to increased production of prostaglandins [20, 25, 28]. When the fetus is infected, there is a high increase in the production of cytokines and marked decrease in the delivery time with a high chance of direct fetal tissue damage (e.g. fetal brain or lung) [2, 14, 19, 20, 24, 25, 31].
During pregnancy the primary function of the uterine cervix is to remain closed in order to retain the baby within the uterus until fetal maturity and birth. A secondary function of the cervix is to prevent infection ascending from the vagina into the uterus. Prior to normal delivery at term, cervix shortens, softens and ripens (becomes more distensible), to facilitate cervical dilatation by myometrial contractions during labour. The cervix consists mainly of connective tissue, principally, collagen fibres in a proteoglycan ground substance. The interaction between these two substances gives the cervix its unique characteristics, where the collagen fibres resist pulling forces and the ground substance resists compressive forces [32].
Various methods have been used to try and detect cervical changes that predict preterm labour. These include manual vaginal examination, transabdominal ultrasound, and transvaginal ultrasound [29, 33]. Of these modalities, measurements of cervical length using transvaginal ultrasound scanning appear to have the highest sensitivity, whereas transabdominal scanning was not predictive [29, 30]. There is however, no clear cut gestation at which the test should be performed or what cervical length provides the best cut-off for a diagnostic test [29, 33].text/html2013-05-08T10:33:59+01:00http://www.webmedcentral.com/Prof. Tae-Hee KimLength Measurement of Fetal Long Bone and Fetal Anomaly Detection
http://www.webmedcentral.com/article_view/4236
Fetal long bone estimation is a pivotal estimation for abnormal fetus development and fetus weight. Moreover, estimation of limb length becomes an important indicator for osteochondrodysplasia and chromosomal abnormalities. Especially, femur length is the most commonly estimated limb length that must be measured to monitor fetal malformation. In fetal length measurement, femur length measurement is the only long bone that is commonly estimated in fetus. Femur length not only helps estimating accurate gestational age, but also becomes an invaluable hint of abnormality in fetal skeletal system. Despite difficulty of accurate diagnosis, detection rate of fatal skeletal abnormality with ultrasonography is as high as 94-96%. Although prenatal ultrasonography plays the most important role in detecting skeletal abnormality, the authors believe that genetics test at molecular level should be employed at needs to confirm chromosomal mutation and help improving accuracy of prenatal diagnosis.text/html2013-07-10T09:14:50+01:00http://www.webmedcentral.com/Prof. Tae-Hee KimPremature Ovarian Failure After Uterine Artery Embolization
http://www.webmedcentral.com/article_view/4231
We report two cases of premature ovarian failure after uterine artery embolization (UAE). Our cases provide guidance for gynecologists who perform UAE. The first patient, aged 42 years, was para 1-0-0-1 and did not have a significant family history. She complained of metromenorrhagia, but she wanted to preserve her uterus for fertility. We performed a bilateral UAE. After 4 months, she complained of amenorrhea. She was diagnosed with early ovarian failure by checking follicle stimulating hormone (FSH). The second patient, aged 40 years, had infertility from uterine myoma, endometriosis, and adenomyosis. She had undergone UAE and in vitro fertilization (IVF) 6 years earlier. After IVF, she became pregnant and was admitted from 26 weeks to 29 weeks for preeclampsia and preterm labor. After delivery, she had postpartum hemorrhage, and repeat UAE was performed. Two years later, she complained of hot flashes and amenorrhea. She was diagnosed with premature ovarian failure.text/html2014-01-29T09:11:12+01:00http://www.webmedcentral.com/Prof. Myungchul JungCorrelation of FRAX Risk Score and Severity in Osteoporotic Vertebral Fracture
http://www.webmedcentral.com/article_view/4529
Objectives: To identify the correlation between FRAX risk score and severity of osteoporotic vertebral fracture
Methods: The study subjects were 214 in-patients who had osteoporotic vertebral fracture. The subjects were divided into 2 groups according to whether or not they had a BMD score (BMD, non-BMD group). Fracture severity index was calculated from lateral vertebral x-ray film with Genant's semiquantitive method. The correlation between FRAX risk score and fracture severity index were analyzed.
Results: Significant correlation was detected between FRAX risk score (major osteoporotic & hip fracture) and fracture severity index in the BMD group (r=0.463, p< 0.001, r=0.446, p< 0.001) as well as between FRAX risk score and BMD (r=-0.322, p< 0.001). There was no correlation in the non-BMD group
Conclusions: This study demonstrates a correlation between FRAX risk score and osteoporotic vertebral fracture severity in BMD group.
Keywords: FRAX, Osteoporosis, Bone mineral density, Osteoporotic fracture, Compression fracture
text/html2014-04-05T15:46:58+01:00http://www.webmedcentral.com/Prof. Tae-Hee KimRecurrent Pregnancy of Down Syndrome
http://www.webmedcentral.com/article_view/4601
Down syndrome, characterized by an extra chromosome 21 is the most common genetic cause for congenital malformations and learning disability. It is well known that the extra chromosome 21 most often originates from the mother, the incidence increases with maternal age, there may be aberrant maternal chromosome 21 recombination and there is a higher recurrence in young women. In spite of intensive efforts to understand the underlying reason(s) for these characteristics, the origin still remains unknown. We have experienced a case of recurrent prengnancy of Down syndrome, or trisomy 21. We present this case with a brief review of a literature.text/html2014-05-14T07:07:44+01:00http://www.webmedcentral.com/Dr. Mohammad OthmanAntibiotics for preventing preterm labour; An umbrella review
http://www.webmedcentral.com/article_view/4624
The risk of preterm labour in the presence of maternal infection is 30% to 50%. Antibiotics may induce a significant 12-20% reduction in neonatal infections following preterm rupture of the membranes and also may prolong pregnancy significantly. Aiming to evaluate the effectiveness of using antibiotics at any time during pregnancy to prevent preterm birth, we searched the Cochrane Library, MEDLINE, BIOSIS, EMBase, and CINAHL and we applied no language restrictions. We selected reviews and RCT’s assessing the use of antibiotics during pregnancy with outcome data on preterm labour and birth.
45 randomised controlled trials published between 1966 and the present day were included, showing mild decrease in the incidence of preterm birth before 37 weeks with the use of antibiotics and an average 34% less maternal infective morbidity with the use of antibiotics compared to placebo or no treatment for all antibiotic groups, all indications, and all gestational ages.
18 reviews published between 1993 and the present day were included, showing an average 30% decrease in the incidence of neonatal morbidity, 45% less maternal infective morbidity and an average 17% increase in the maternal adverse effects with the use of antibiotics compared to placebo or no treatment for all indications and all gestational ages.
In both trials and reviews, there is a noticeable increase in preterm births with the use of Metronidazole compared to placebo or no treatment
The result of this umbrella review does not supports the use of antibiotics during pregnancy except when there is a clear evidence of infection with extreme caution, regular follow ups and monitoring of the patient.
We do not support the use of metronidazole during pregnancy.text/html2014-05-24T13:15:17+01:00http://www.webmedcentral.com/Dr. Mohammad OthmanCongenital Adrenal Hyperplasia: Case report
http://www.webmedcentral.com/article_view/4642
Congenital adrenal hyperplasia is an autosomal recessive disease, it can be classic or non classic. Each type could be mild to severe. We report a case of classic virilizing congenital adrenal hyperplasia. Patient underwent surgical correction for ambiguous genitalia and hormone replacement therapy. Proper diagnosis and treatment can enable women with the disease to have a normal sexual, normal menstrual and reproductive life.text/html2014-01-14T02:51:19+01:00http://www.webmedcentral.com/Dr. Gwinyai MasukumeLive births resulting from advanced abdominal extrauterine pregnancy, a review of cases reported from 2008 to 2013
http://www.webmedcentral.com/article_view/4510
Introduction:Advanced abdominal pregnancy is classically defined as a pregnancy that has progressed beyond 20 weeks of gestation in which the fetus is growing and developing in the mother’s abdominal cavity. Advanced abdominal pregnancies, in particular those with live births can provide a unique and useful opportunity to understand certain reproductive biologic phenomena.
Methods: PubMed, Scopus and Google Scholar were searched for English language articles that reported a live birth resulting from an advanced abdominal pregnancy from 2008 (the year of the last major review on advanced abdominal pregnancy) to 2013.
Results: 38 cases of an advanced abdominal pregnancy resulting in a live birth were identified from 16 countries. 37.5% males at births (normal average 51.5% males at birth) were observed in this study.
Conclusion: Physiologically males are more vulnerable than females from conception; the presumed hostile extrauterine environment of advanced abdominal pregnancy may cause excess demise of males compared to females.text/html2014-05-19T04:44:44+01:00http://www.webmedcentral.com/Dr. A. Isabel M FernandezThe importance of training programs in shoulder dystocia
http://www.webmedcentral.com/article_view/4640
We reported a case of a woman with a delivery complicated with Shoulder Dystocia (SD). She did not present any complications during her pregnancy and she had not any intrapartum risk factors to present this kind of dystocia. Despite the initial maneuvers were not successful but, the assistance by an instructed staff had an optimal maternal and neonatal outcome, due to a correct selection, technique and sequence of maneuvers to resolve this complication. The aim of the article is to highlight the importance of training programs for clinicians in this area.text/html2014-05-26T05:19:09+01:00http://www.webmedcentral.com/Dr. Mohammad OthmanVasa praevia; case report
http://www.webmedcentral.com/article_view/4643
Vasa praevia is an uncommon condition that may lead to profound fetal distress or fetal death. We report a case of vasa praevia. Seen with rupture of membranes, vaginal bleeding and sever fetal bradycardia. Patient underwent caesarian section. Both mother and baby discharged in good condition. This confirms the importance of prenatal detection of patients with vasa praevia.text/html2014-09-04T10:22:41+01:00http://www.webmedcentral.com/Dr. A. Isabel M FernandezAcute respiratory distress syndrome in acute pyelonephritis during pregnancy: ten-year review
http://www.webmedcentral.com/article_view/4689
Acute pyelonephritis (AP) is one of the most common medical complications of pregancy. About 20% of women with severe pyelonephritis during pregnancy develop complications that include anaemia, septic shock syndrome, acute respiratory distress syndrome (ARDS), preterm labour, intrauterine growth retardation… AP may result in significant maternal morbidity and fetal morbidity and mortality. An early diagnosis and treatment with parenteral antibiotics are essential to avoid complicated AP and obstetric complications.text/html2015-01-19T12:38:59+01:00http://www.webmedcentral.com/Dr. Onyeka I UzomaEndometriosis masking as an intra abdominal malignancy. A case report and literature review
http://www.webmedcentral.com/article_view/4803
A patient with atypical symptomatology due to endometriosis, clinical features were strongly suggestive of an intraabdominal malignancy. The patient had right sided haemorrhagic pleural effusion, ascitis and a serum CA-125 level of 62 U/mltext/html2015-01-20T12:34:58+01:00http://www.webmedcentral.com/Dr. Onyeka I UzomaImperforate hymen: a rare cause of acute abdominal pain in peripubertal girls. A case report and literature review.
http://www.webmedcentral.com/article_view/4802
A 15 year old female presented with severe abdominal pain and distension. However detailed history, physical examination and ultrasonographic findings of hematocolpos and hematometra clarified the diagnosistext/html2015-01-23T05:40:23+01:00http://www.webmedcentral.com/Dr. Ruchika SoodRuptured ectopic pregnancy after interval tubal ligation
http://www.webmedcentral.com/article_view/4809
Tubal sterilization is considered a permanent method of contraception because it is highly effective in preventing pregnancy and therefore failure is rare. Most often the pregnancy following sterilization is ectopic in location. In this paper, we report a case of ectopic pregnancy in a patient who underwent interval bilateral tubal ligation 41/2 years ago for contraception. text/html2015-01-28T07:38:39+01:00http://www.webmedcentral.com/Dr. Sonum GautamSecond trimester unruptured ectopic pregnancy: Case report
http://www.webmedcentral.com/article_view/4818
Ninety-five percent of ectopic pregnancies occur in the fallopian tube, ampulla being the most common site. Diagnosis and exact location of ectopic pregnancy is usually easy during the first trimester of pregnancy by ultrasonography. However in developing countries, where resources are limited, most women do not undergo ultrasound examination during pregnancy, leading to a late diagnosis. Tubal pregnancies generally rupture between 5 and 9 weeks of gestation.
However, some cases of advanced tubal pregnancies have been reported with a different presentation. This event is rare because it is unusual for the fallopian tube to dilate to the point of containing a second or third trimester foetus. We report a case of unruptured advanced tubal pregnancy.text/html2015-01-29T12:27:41+01:00http://www.webmedcentral.com/Dr. A. Isabel M FernandezAtypical Placement Abruption: Clinical suspicion and management
http://www.webmedcentral.com/article_view/4821
PA is a serious obstetric complication; it is responsible for an important maternal and perinatal morbidity and mortality. Its risk factors have been identified but it is often unpredictable. The classic clinical triad is present in only a few cases. Suitable obstetric management is the key to avoid maternal and perinatal unwished outcomes. It is reported a case of a pregnant woman, without risk factors except for multiparity, who submitted a PA with incomplete triad of symptoms and its decisive management.text/html2015-02-17T09:55:50+01:00http://www.webmedcentral.com/Dr. Onyeka I UzomaHIV in pregnancy: Severity of maternal disease a determinant of pregnancy outcomes
http://www.webmedcentral.com/article_view/4686
Background: The Human Immunodeficiency Virus is responsible for a global pandemic with a disproportionately higher prevalence in sub Saharan Africa. Infection with the virus in pregnancy is of particular importance given the addeed risk of mother to child transmission. Antiretroviral drugs are currently recommended for all pregnant HIV positive women.
Objective: To compare pregnancy outcomes for mother and baby based on the severity of maternal HIV disease.
Method: A prospective observational study of consecutive consenting pregnant women who tested HIV positive during pregnancy, labour and delivery at the Imo State University Teaching Hospital (IMSUTH), Orlu from 1st May, 2012 to 30th April 2013 was carried out. Sociodemographic information were obtained and entered into a questionnaire prepared for this study. Clinical staging, CD4 counts, information on pregnancy outcomes and infant HIV testing done at six weeks post partum were all obtained. The data was analysed using the statistical package for social sciences (SPSS) version 17.0(SPSS Inc, Chicago, IL).
Results: The Prevalence of HIV in pregnancy at booking was 6.1%. Those with advanced disease accounted for 35.6% (37/104) while 64.4% (67/104) had early stage disease. The vertical transmission rate was 1.0%. There was one case of maternal mortality (0.9%), while the perinatal mortality rate was 5.8%.
Conclusion: Human immunodeficiency virus infection in pregnancy is a serious public health concern at the Imo State University Teaching Hospital, Orlu and its environs. Vertical transmission remains a challenge. Maternal mortality and vertical transmission are more likely to occur in those women with advanced disease.
Key words: HIV, pregnancy outcome, maternal HIV disease, outcome, preeclampsia, Orlu.text/html2015-06-03T07:53:49+01:00http://www.webmedcentral.com/Dr. Mohammad OthmanUterine rupture; case report and review of literature
http://www.webmedcentral.com/article_view/4909
Uterine rupture is an obstetric catastrophe that is associated with high maternal and perinatal mortality rates. Its incidence is high in developing countries. Uterine rupture may be silent and obscure but requires immediate surgical intervention and its occurrence can result in severe maternal morbidity.
We report a case of G4P3+0 with previous traumatic rupture uterus presented in labor at 32 weeks and found in caesarean section to be ruptured fundus of the uterus with active bleeding. Baby delivered alive, and uterus repaired.
Most cases of ruptured uterus are preventable with good antenatal care, intra-partum care and proper identification of high risk cases. Thinning in the lower uterine segment measured by ultrasonography is a predictor of uterine rupture but, ideal thickness cut-off value could not be defined. We recommend; use of partogram as tool in recognising deviations from normal, prevention of unnecessary cesarean sections, facilitating early referral and continued education of staff in order to prevent uterine rupture.text/html2015-06-03T07:53:29+01:00http://www.webmedcentral.com/Dr. Mohammad OthmanBilateral ectopic pregnancy: case report and review of literature
http://www.webmedcentral.com/article_view/4910
Ectopic pregnancy represents 2 % of all first trimester pregnancies. Bilateral tubal pregnancy is the rarest form of ectopic pregnancy. The estimated incidence is 1 in 725 to 1 in 1580 of all ectopic pregnancies. Totally, more than 200 cases of bilateral tubal ectopic pregnancy have been reported in the literature to date. The principle management is the conservative approach that attempts to save the tube, rather than salpingectomy. In the other hand, it is important to remember that hemorrhage from ectopic pregnancy is the leading cause of maternal death and accounts for 4 to 10 percent of all pregnancy related deaths. We present a case of a G5P2+2 with presented as 8 weeks ectopic pregnancy. Intra-operatively bilateral ectopic pregnancy was diagnosed. Accordingly, right chronic rupture ectopic seen and salpingectomy performed and oophorectomy done to control bleeding. In the left side, intact small ectopic was diagnosed and salpingostomy was accomplished.text/html2015-09-08T04:45:10+01:00http://www.webmedcentral.com/Dr. Mohammad OthmanSafety and effectiveness of inhaled analgesia for labour pain
http://www.webmedcentral.com/article_view/4971
Labour pain is one of the most sever pains in the life of women. It is multifactorial and affected by both psychological, many biochemical and physiological factors. Many methods are used to manage labour pain which are divided into pharmacological and non-pharmacological methods.
Inhaled analgesia, as part of the pharmacological methods, involves the inhalation of smaller dose of the inhaled anaesthetic agents while maintaining awareness of the mother. Drugs used for inhaled analgesia for relief of labour pain include nitrous oxide, isoflurane, sevoflurane, trichloroethylene, methoxyflurane and cyclopropane.
It is important to do this review because all women should have a relatively effective and safe analgesia during labour. Therefore, this review objective was to explore the efficacy and safety of inhaled analgesia as pain relief for women in labour planning a vaginal delivery. We included randomised controlled and cross-over trials. A total of 74 reports of studies were identified from the search strategy. A total of 26 studies reporting data on 2959 women (31 reports) were included and 27 studies (43 reports) were excluded. We studied effect of inhaled analgesia on pain intensity, pain relief and satisfaction with pain relief. For the safety of inhaled analgesia, we studied the effect of inhaled analgesia on assisted vaginal birth, caesarean section, nausea, vomiting, drowsiness, amnesia, Apgar score less than seven at five minutes.
This review concluded that inhaled analgesia may be beneficial for labour pain relief, with minimal to no effect on Apgar score of the newborn. There is a need for adequately powered randomised controlled trials which include relevant clinical outcomes.text/html2015-09-26T12:17:59+01:00http://www.webmedcentral.com/Dr. Onyeka I UzomaUterine fibroids: Repeat myomectomy converted to supracervical hysterectomy. A case report and literature review.
http://www.webmedcentral.com/article_view/4979
Uterine Leiomyomata or fibroids as they are more commonly referred to are the most common benign neoplasm affecting females within the reproductive age bracket. This is more so amongst women of African descent. A plethora of treatment options exist however this must be individualized. A case of a 38 year old nulliparous African female with massive uterine fibroids undergoing a planned repeat myomectomy but eventually ending up with a life saving hysterectomy is discussed below. text/html2015-12-14T06:00:49+01:00http://www.webmedcentral.com/Dr. Mohammad OthmanBakri balloon for the management of placenta praevia: Retrospective study (Protocol)
http://www.webmedcentral.com/article_view/5037
Placenta previa is frequently associated with severe obstetric hemorrhage. According to the degree of invasion of the placenta into the uterine wall placenta previa may be accreta, increta or percreta. Incidence of adherent placenta is 1 in 2500 deliveries. Added to that, there is a dramatic increase in the incidence of placenta previa and placenta accreta due to the increasing rate of cesarean delivery combined with increasing maternal age. Placenta previa usually associated with uterine atony, bleeding from the lower flap of the uterine wall, and may cause sever postpartum hemorrhage.
A lot of methods used to control bleeding from the placenta previa gravid uterus intraoperative and postoperative. Bakri balloon was used for the first time in 1992, and was approved as one of the primary support tools in treating PPH. A number of recent reports have described the successful use of balloon tamponade to manage hemorrhage from the lower uterine segment due to placenta praevia accreta.
This is a retrospective study aimed to evaluate the outcomes of uterine tamponade using a Bakri balloon for management in cases of placenta previa during caesarean deliveries.text/html2016-02-17T04:48:03+01:00http://www.webmedcentral.com/Dr. Mohammad OthmanSuccessful pregnancy after pulmonary artery banding; case report
http://www.webmedcentral.com/article_view/5057
Although, double inlet left ventricle is a rare congenital heart defect, it is still treated by pulmonary artery banding in developing countries.We report a successful pregnancy outcome in a patient with pulmonary artery banding. Patient condition worsened by 34 weeks gestation and she developed sever reduction of diastolic blood flow. Cesarean section was done for her and she give birth to a boy observed in NICU for two weeks and both were discharged in good condition.It is possible for patients with pulmonary artery banding for double inlet left ventricle to carry on pregnancy but with vigilant and close follow up.text/html2016-03-01T05:32:17+01:00http://www.webmedcentral.com/Dr. Mohammad OthmanInduction of labour in women with nonscarred uterus using balloon catheter: Randomised controlled trial
http://www.webmedcentral.com/article_view/5075
Induction of labour is a common obstetric procedure. At present, different methods are used for induction of labour in women. One of these methods is Foley catheter, which is a low cost method that can induce labour with less risk to the fetus. This is one of the first studies in the Middle East aiming to study efficacy and safety of Foley catheter induction in nonscarred uterus of term pregnant women in comparison to prostaglandin vaginal tablet.
This trial will be a single centre, open-label, randomised controlled trial. It will be performed in Madinah Maternity and Children Hospital (MMCH). Randomisation will be conducted using simple alternative patient randomization. First patient will receive transcervical Foley catheter induction, while the next will receive 3mg prostaglandin vaginal tablets according to hospital protocol. There will be no blinding of patients and caregivers, as this is not possible with these two treatment methods.
Outcomes included induction to delivery interval, mode of birth, maternal morbidity, APGAR score less than 7 at 5minutes, and fetal admission to NICU. Sample size of 500 participants planned over the study period of 12 months. Intention to treat analysis will be used.text/html2016-12-12T10:26:12+01:00http://www.webmedcentral.com/Prof. Myungchul JungDoes the Decision-to-incision Time Affect Neonatal Outcomes in the Emergency Cesarean Section?
http://www.webmedcentral.com/article_view/5235
OBJECTIVES
We examined whether the decision-to-incision (D-I) interval of 30 min in women undergoing emergency C-section is meaningful for actual clinical outcomes of neonates. We also examined the correlation between D-I interval and neonate health status.
STUDY DESIGN
A retrospective study of 212 mothers who underwent emergency C-section was performed from March 01, 2008 to February 28, 2013. The mothers were divided into two groups: Group I (n = 135) had neonates with gestational age < 37 weeks, and Group II (n = 77) had neonates with gestational age ≥37 weeks. Each group was further divided into two subgroups: those with D-I interval ≤30 min and those with D-I interval >30 min. Neonatal prognostic factors, including Apgar scores, were compared between the subgroups.
RESULTS
In Group I, no significant differences in 1-min and 5-min Apgar scores, umbilical arterial pH and NICU admission rate were observed between cases with D-I interval ≤30 min and >30 min. In Group II, there was no significant difference in 1-min and 5-min Apgar score.
CONCLUSION:-
Neonatal prognosis was not significantly associated with D-I interval.
Keywords: Cesarean delivery, Decision-to-incision interval, 30-minute ruletext/html2018-02-23T05:15:05+01:00http://www.webmedcentral.com/Mrs. Seung Hee LeeUterine giant myomectomy: A case report
http://www.webmedcentral.com/article_view/5436
Background Uterine leiomyomas, the most common benign gynecological tumor, usually occur in females of reproductive age. Myomectomy is the preferred surgical treatment in reproductive-aged women who want to retain their uterus. Myomas can range in size from as small as an apple seed to as large as a melon. Giant uterine leiomyomas are very rare.
Methods We present a case report of a 3.6-kg giant myoma detected in a 39-year-old nulliparous single woman desirous of future fertility.
Results The patient underwent myomectomy and was diagnosed with leiomyoma with degeneration. This case confirms the efficiency, reliability, and safety of a minimally invasive surgical approach for removing a giant uterine myoma
Conclusion Uterine leiomyoma can be considered for traditional abdominal myomectomy in patients with large myomas. Myomectomy is the preferred procedure for adolescent patients, in view of preserving fertility.text/html2018-06-05T05:26:33+01:00http://www.webmedcentral.com/Ms. Yoo Jin ParkTranscatheter Uterine Artery Embolisation as a Treatment for Uterine Adenomyosis: A Case Report
http://www.webmedcentral.com/article_view/5466
Background Transcatheter uterine artery embolisation (TUAE) was reported to be clinically effective in women with uterine adenomyoma (UA) and heavy menstrual bleeding. However, if symptoms remain after TUAE, hysterectomy is ultimately required. Therefore, TUAE has not been officially recognised as a UA treatment.
Methods We report effective TUAE treatment of a 47-year-old patient with UA accompanied by severe dysmenorrhoea and heavy menstrual bleeding. She had undergone insertion of a levonorgestrel-releasing intrauterine system to treat dysmenorrhoea and heavy menstrual bleeding 6 months prior. During the follow-up period, she complained of severe uterine bleeding and abdominal cramping and visited the emergency room.
Results The clinical symptoms improved after TUAE. Menstrual flow fell, and lower abdominal pain resolved 6 weeks after TUAE. No additional surgical or drug treatment was required; only brief manageable abdominal pain was reported
Conclusions. Although TUAE is suggested to be efficious only in uterine leiomyoma, it can be considered as primary treatment for the improvement of UA symptoms in women who prefer to nonsurgical treatment or to preserve reproductive capacity. TUAE is a valuable treatment for UA patients.text/html2018-06-15T05:25:23+01:00http://www.webmedcentral.com/Dr. Max MongelliAudit of Maternity Care Outcomes Using the Moving Average Technique
http://www.webmedcentral.com/article_view/5486
Maternity audits are typically shown as monthly figures. These often show spuriously high or ow values. The aim of this study was to audit maternity outcomes over time by applying the moving average technique.
This audit of maternity outcomes was conducted at the Nepean Hospital in Sydney, Australia.
Variables included vacuum and forceps deliveries, planned and emergency caesarean sections, caesarean sections at full dilatation, severe postpartum hemorrhages (>1500ml) , 3rd or 4th degree tears, low Apgar scores (< =6 at 5 mins), stillbirths, and admission to neonatal intensive care at term. The data of interest was extracted from the electronic maternity database (“Obstetrix” software) and entered on Excel spreadsheets, to include births from July 2014 to May 2016.
Moving averages were calculated for each variable using Excel, using data windows ranging from 4 to 8 weeks, with the longer windows used for the more infrequent events. Data from a total of 6625 deliveries was available for analysis. The normal delivery rate was 53.6%, the caesarean section rate was 38%, the instrumental delivery rate was at 8.4% and the stillbirth rate about 1%.
Outcome
Rates (%)
Emergency cesarean section
16.4
Elective cesarean section
21.6
Cesarean section at full dilatation
2.5
Vacuum deliveries
6.2
Forceps deliveries
2.2
Normal vaginal deliveries
53.6
Severe postpartum haemorrhage
1.3
Third or 4th degree vaginal tears
1.6
Low Apgar scores
1.4
Admission to NICU
8.9
Stillbirths
1.0
text/html2021-05-28T05:45:14+01:00http://www.webmedcentral.com/Dr. Deepak GuptaAre Fecal Capsules As Pro-Biotic Making The Case For Seminal Capsules As Anti-Eclamptic? Worth Exploring For The Future Of Safer Assisted Reproductive Technology
http://www.webmedcentral.com/article_view/5723
The questions we must ask ourselves.
Is human body composed of not only human cells but also non-human cells like microbes numbering in trillions [1]?
Do these microbes turn human gastrointestinal tract into the biggest immune system that human body has [1-2]?
Have modern human beings learnt to lose their microbiome by their dietary habits and their exposure to chemicals [3]?
Are modern human beings relearning to gain back the lost microbiota by ingesting industrialized probiotics?
Will modern human beings lap up to medicalized coprophagia to contain over-extensive loss of their microbiota [4-8]?
Only time will reveal the answers. However, the availability of fecal capsules at least for biomedical and clinical human research opens up another avenue that may not appear as abhorring as ingesting fecal capsules to replenish gastrointestinal microbiome and reenergize gastrointestinal immune system. That avenue is ingesting seminal capsules for biomedical and clinical human research to make or break the case of slow-steady development of immune tolerance among future mothers-to-be by increasing their bodies' exposure to sperm and semen so as to counter incidence of preeclampsia like hypertensive disorders of pregnancy [9-13].
The question arises how such biomedical and clinical human research can be shaped with seminal capsules. The underlying reason for shaping seminal capsules-based research can be that even if receptive oral sex may evolve to become the norm rather than exception across the world, ingestion of semen during oral sex may NOT become the norm in the near future for partners planning to conceive while concurrently aiming to avoid preeclampsia like hypertensive disorders of pregnancy. Although unprotected genital sex may allow female body to get sperm and semen exposure for developing immune tolerance to them, the risks of unwanted and unplanned conception may increase during this medically planned "systematic desensitization" to or "low/high-dose immunotherapy [14]" with sperm and semen prior to conception for safely envisioned normotensive pregnancy. The safest bet for this "systematic desensitization" or "low/high-dose immunotherapy" can be oral route of administration via seminal capsules which will have to be initiated in the preconception period with their potential continuation during post-conception period too without having to worry about the need to continue unprotected genital sex during preconception and post-conception periods just only for the sake of maintaining female body's exposure to sperm and semen to potentially accomplish the envisioned normotensive pregnancy [15]. Interestingly, the change in paternity interferes with potential assurance of normotensive pregnancy in multigravida females which means that the history of multiple sexual partners and exposure to their sperms and semen is potentially counterintuitive to normotensive pregnancy because female body must be exposed specifically to the sperm and semen of male partner (or maybe futuristically non-partner sperm donor) with whom the normotensive pregnancy is being planned after planned conception [16-20]. Moreover, unless vaccinated against almost all strains of human papillomavirus, the concerns for oncogenic potential of human papillomavirus laden semen may persist which when ingested as seminal capsules may primarily increase the incidence of gastrointestinal tract cancers in the long-term instead of genitourinary tract cancers which may have increased incidence after long-term exposure to human papillomavirus during unprotected genital sex [21-27].
The major concerns while envisioning biomedical and clinical human research with seminal capsules will be about collection, compounding and dispensing of male partners' semen for their female partners who plan to conceive envisioned normotensive pregnancies, unless the females are planning to use non-partner sperm donors wherein the assisted reproductive technology institutions have to be on board with the envisioned research and its purported outcomes envisioning futuristic control of preeclampsia like hypertensive disorders of pregnancy considering that even though assisted reproductive technology is associated with increased risk of preeclampsia like hypertensive disorders of pregnancy [28-29], ingestion of non-partner sperm donors' sperm and semen based seminal capsules may have premium monetary costs for preconception females just like premium priced fecal capsules [6] while collection of sperm and semen from non-partner sperm donors having logistical costs for the assisted reproduction technology institutions. Regarding collection [30], male partners may choose to collect their semen on their own or with the help of their female partners. Regarding compounding [31-32], male partners may have to take the initiative to prepare their semen-filled gel capsules on their own or their female partners can take the initiative to prepare them and store them to eventually consume them regularly as planned. Regarding dispensing, it may have to be determined and decided that how long these compounded seminal capsules will be safe to use depending on the temperatures where they are stored [33]. Although for the intended purpose of sperm and semen induced immunogenicity, the effect of temperature on the viability of sperms may be irrelevant but, for the sake of containment of time-limited microbial growth [34-39], expiration dates for these seminal capsules may have to be determined with infection control precautions.
Essentially, I am hoping that global researchers successfully lap up to biomedical and clinical human research as envisioned above to prove or disprove whether seminal capsules can potentially turn out to provide immunogenic tolerance towards maternal health via maternal gastrointestinal tract without needing to induce any negative changes in safe sex practices as similar to fecal capsules potentially turning out to provide pro-biotic service towards human health via human gastrointestinal tract without needing to induce any negative changes in safe sanitation practices.text/html2022-05-06T07:30:58+01:00http://www.webmedcentral.com/Dr. Grace S TingA Survey of Gestational Diabetes in Broken Hill
http://www.webmedcentral.com/article_view/5776
Background
Gestational diabetes (GDM) is a common health issue in Australia, affecting around 16% of pregnancies. It is a routine to screen all pregnant women with a test known as 75g OGTT.
Interestingly, the incident rate of gestational diabetes was found to be relatively similar in terms of remoteness of the area. This survey is to determine the prevalence and characteristics of GDM in pregnant women in Broken Hill. In addition to that, the secondary objective is to study the birth outcomes of pregnancies complicated by GDM in Broken Hill.
Methodology
The clinical details of all singleton live births in the past 24 months until March 2021 were retrieved from the Obstetric database in Electronic Medical Record (EMR), and downloaded as an electronic Excel spreadsheet. IBM SPSS 24 was used to analyse and generate the statistics. After excluding cases with missing data, the final number of patients was 364.
Outcome
Among the data gathered, 28.3% had some form of diabetes. Maternal obesity had a significant effect. The caesarean section rate was higher in patients with GDM (37.9%) as compared to patients without diabetes (29.9%). Similarly, the rate of instrumental birth was higher in GDM group (8.7%) as compared to group without diabetes (6.5%). Patients without diabetes were found to have higher rate of normal vaginal delivery (63.6%) compared to patients with GDM (53.4%). Patients with GDM were noted to have higher percentage of emergency birth (14.6%) than non-diabetic patients (13.0%). Newborns of patients without diabetes had lower median weight (3350±688.17) as compared with patients with GDM
As for ultrasound findings, the median foetal BPD was found to be lower (84.5±18.22) in patients without diabetes as compared to patients with GDM (Illustration 2.2). Amongst patients with GDM, those who were on insulin control had the highest foetal BPD (91.0±2.83).
Conclusion
According to Australian Institute of Health and Welfare (AIHW), it was found that 1 in 7 pregnant women from 2016-2017 were being affected by gestational diabetes. An interesting outcome from this survey showed the incident rate of gestational diabetes was found to be relatively similar in terms of remoteness of the area. However, a bigger sample size would be helpful to support these findings. Nevertheless, as this is the preliminary survey, more studies need to be carried out in the future to strengthen the understanding of gestational diabetes in Broken Hill community. The ultimate aim is to achieve an improvised version of protocol in terms of management of gestational diabetes in a remote area, with a bigger population of Aboriginal and Torres Strait Islanders, such as Broken Hill.text/html2022-10-23T02:05:36+01:00http://www.webmedcentral.com/Dr. Deepak GuptaIMPOSSIBLE PERIPARTUM TRANSPLANTATION OF PERINEAL BIOME: Would Futuristic Baptism By Amnion Per Vaginum Via Under Buttocks Drape Collection During Cesarean Section Help?
http://www.webmedcentral.com/article_view/5800
I should have never read the work by Sonnenburg and Sonnenburg [1-2]. Now I am a changed person forever seeing biomes everywhere, searching for them if I cannot see them somewhere and proposing solutions for such somewhere if I may. One such futuristically proposed solution envisages deliberately baptizing neonates delivered via cesarean sections with their surgically delivering maternal amniotic fluids gushing out per vaginum which would have spontaneously baptized those neonates with perineal biomes of their mothers had they spontaneously delivered per vaginum instead. For this envisaged futuristic baptism by amnion, maternal amniotic fluids gushing out per vaginum will need to be collected via under buttocks drapes [3-4] so that the collections in those calibrated/graduate drapes may be envisaged for futuristic baptism of surgically delivered neonates via submersion/immersion/affusion/aspersion [5]. Maternal safety and neonatal safety may decide whether this futuristic baptism may be possible during delivery of neonate intraoperatively unless it may be safely possible, if ever possible, only after intraoperatively resuscitating the delivered neonate but before maternal amniotic fluid collections within calibrated/graduate drapes become unsafe to use considering that pathological biomes of mothers therein may soon run amok when maternal amniotic fluid collections are outside their bodies where they cannot be overridden by maternal non-pathological biomes which kept them under check when they were inside maternal bodies and within balanced ecosystems therein. With this futuristic envisaged baptism, neonatal transplantation of maternal fluids and maternal biomes during or immediately after cesarean sections may be almost similar as happening during water birthing [6]. However, as compared to actively baptizing spontaneously with peripartum transplantation of maternal biomes among neonates delivered per vaginum with soon-to-be-mothers actively contracting and all their amniotic fluids exiting per vaginum, the iatrogenic baptism with passive peripartum transplantation of maternal biomes reaching neonates delivered via cesarean sections will depend on whether their soon-to-be-mothers already contracting with rupture of membranes before their cesarean sections or just receiving uterine incisions with intact membranes therein during their electively planned cesarean sections. Either way it will boil down to how much maternal amniotic fluids actually gush down per vaginum carrying along perineal biomes from mothers into calibrated/graduate drapes during cesarean sections and whether recommended vaginal preparation with antiseptic agents have been universally utilized during cesarean sections. Overall, it will come down to whether spontaneous or deliberate baptism of neonates by amnion with perineal biomes of mothers therein will ever be possible again abundantly when rather than deliveries per vaginum, deliveries via cesarean sections sometimes ironically for preventing vertical biome transmission [7-9] are becoming the norm with cesarean sections getting recommendations to go overboard in overdosing with vaginal antiseptics and intravenous antibiotics [10-13]. In a nutshell, baptism or not, we may be achieving immediate successes in obstetric healthcare but may be creating long term failures for pediatric healthcare and thereafter overburdening parental healthcare after having failed in potentially protecting pediatric populations with peripartum transplantation of perineal biomes as have been happening naturally over the millenniums until now [14].