International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics

Publications in this journal

• Article: Predictors and pregnancy outcomes associated with a newborn birth weight of 4000 g or more in Lusaka, Zambia.

  Katherine C Liu, Jessica A Joseph, Theresa B Nkole, Eugine Kaunda, Jeffrey S A Stringer, Benjamin H Chi, Elizabeth M Stringer
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  ABSTRACT: OBJECTIVE: To identify predictors and outcomes associated with a birth weight of 4000g or more in Lusaka, Zambia. METHODS: Data from women who delivered between February 2006 and August 2011 were obtained from electronic perinatal records at 25 public sector facilities in Lusaka. Macrosomia was defined as a birth weight of 4000g or more and normal birth weight as 2500-3999g. Maternal and newborn characteristics were analyzed for association with macrosomia. RESULTS: There were 4717 macrosomic and 187 117 normal birth weight newborns. The strongest predictors of macrosomia were high BMI (adjusted odds ratio [AOR], 2.88; 95% confidence interval [CI], 1.95-4.24), prior macrosomic newborn (AOR, 7.60; 95% CI, 6.81-8.49), and history of diabetes (AOR, 3.09; 95% CI, 1.36-6.98). Macrosomic newborns were at increased risk for cesarean delivery (AOR, 1.63; 95% CI, 1.35-1.96), fresh stillbirth (AOR, 2.24; 95% CI, 1.56-3.21), Apgar score of under 7 at 5minutes (AOR, 2.03; 95% CI, 1.33-3.11), and neonatal intensive care admission (AOR, 2.07; 95% CI, 1.32-3.23). CONCLUSION: Screening for macrosomia should be considered for high-risk patients in Sub-Saharan Africa. Institutional delivery at facilities with operating rooms and neonatal intensive care services should be encouraged.
  International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics 05/2013;
• Article: Comparison of 2 minimally invasive routes for hysterectomy of large uteri.

  Noam Smorgick, Vanessa K Dalton, Kristin E Patzkowsky, Mark R Hoffman, Arnold P Advincula, Sawsan As-Sanie
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  ABSTRACT: OBJECTIVE: To compare the perioperative outcomes associated with 2 minimally invasive surgical routes for the hysterectomy of large fibroid uteri. METHODS: Retrospective review of 84 women undergoing hysterectomy via minilaparotomy (n=54) or robot-assisted laparoscopy (n=30) for uteri weighing at least 500g. Outcome measures included hemorrhage (blood loss of 500mL or more) and postoperative length of stay. RESULTS: Unadjusted mean blood loss (560.2±507.4mL versus 165.0±257.5mL, P<0.001), rate of hemorrhage (40.7% versus 6.7%, P=0.001, odds ratio 6.1 [95% confidence interval 1.5-24.2]), and rate of blood transfusion (14.8% versus 0%, P=0.03 ) were all higher with minilaparotomy than with robot-assisted surgery, while the median postoperative stay was significantly shorter with robotic surgery (2 [range 1-4] days versus 1 [range 0-7] days, P<0.01). After adjusting for differences in uterine weight using a multivariate linear regression analysis, the mean blood loss and the rate of hemorrhage were no longer significantly different between the 2 groups. CONCLUSION: The minilaparotomy approach may be used to remove very large uteri and does not require specialized and expensive equipment, or advanced endoscopic training. The robotic approach, when feasible, allows for early postoperative discharge.
  International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics 05/2013;
• Article: Characteristics associated with postoperative diagnosis of adenomyosis or combined adenomyosis with fibroids.

  Hans Jean-Baptiste, Maggie Tetrokalashvili, Tasscia Williams, Joshua Fogel, Chaur-Dong Hsu
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  ABSTRACT: OBJECTIVE: To identify clinical characteristics associated with combined adenomyosis and fibroids and to determine whether preoperative diagnosis by ultrasonography correlates with postoperative diagnosis by pathology. METHODS: A retrospective chart review was conducted of 206 women who attended Nassau University Medical Center, East Meadow, USA, between July 1, 2007, and June 30, 2010. The patients were stratified into 3 groups-fibroids only (n=148); adenomyosis only (n=21); or combined adenomyosis and fibroids (n=37)-according to postoperative pathology findings and variables known to be associated with adenomyosis and fibroids. Significant variables were included in a multinomial regression analysis. RESULTS: Dysmenorrhea was the only variable significantly associated with a diagnosis of adenomyosis. The odds ratio (OR) was 3.34 (95% confidence interval [CI], 1.14-9.80). Variables significantly associated with combined adenomyosis and fibroids were age (OR, 1.08; 95% CI, 1.01-1.15), black ethnicity (OR, 2.72; 95% CI, 1.11-6.68), and parity (OR, 1.44; 95% CI, 1.08-1.92). Preoperative diagnosis by ultrasonography did not correlate with the postoperative pathology report. CONCLUSION: Including the identified variables in the preoperative evaluation of patients with suspicion of fibroids might improve the counseling process and aid the choice of surgical procedure, especially among patients desiring a conservative approach.
  International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics 05/2013;
• Article: Vitamin K treatment of brodifacoum poisoning in a pregnant woman.

  Jie Yan, Yangyang Shi, Chengwen Sun, Huixia Yang
  International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics 05/2013;
• Article: Fallopian tube invasive molar disease.

  Chi-Wen Juan
  International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics 05/2013;
• Article: Use of uterine balloon tamponade for control of postpartum hemorrhage by community-based health providers in South Sudan.

  Brett D Nelson, Hanni Stoklosa, Roy Ahn, Melody J Eckardt, Emily K Walton, Thomas F Burke
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  ABSTRACT: OBJECTIVE: To determine whether use of uterine balloon tamponade (UBT) for management of uncontrolled postpartum hemorrhage (PPH) by community-based providers in a resource-limited setting could be feasible, effective, and safe. METHODS: In rural South Sudan, community providers were trained and equipped with a simple UBT device consisting of a catheter, condom, and syringe. Snowball sampling identified cases of UBT use since training. Semi-structured interviews were conducted among community providers, referral facility providers, patients, and patient family members. Interview transcripts were analyzed using qualitative methods. RESULTS: Thirteen cases were identified and 24 interviews related to community-based UBT use were conducted. Qualitative analysis revealed several major themes. Community providers applied UBT in appropriate clinical situations. UBT was effective for controlling PPH, even among severely ill patients. Referral was difficult and lengthy owing to the austere setting, but simple UBT appeared to mitigate these challenges. Communities had some initial fears, yet ultimately embraced UBT. Equipment and supplies were largely maintained. There was universal satisfaction with UBT among patients, family members, and providers. One death occurred among the 13 cases, although it was probably not attributable to PPH. CONCLUSION: Training and UBT device provision are simple, affordable, and effective for managing uncontrolled PPH in a resource-limited setting.
  International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics 04/2013;
• Article: Incidence of Bartholin duct cysts and abscesses in the Republic of Korea.

  Jin-Sung Yuk, Yong-Jin Kim, Jun-Young Hur, Jung-Ho Shin
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  ABSTRACT: OBJECTIVE: To estimate the incidence of Bartholin duct cysts and abscesses in the Republic of Korea during 2009. METHODS: A national patient sample (n=599 186) was obtained from Korean Health Insurance Review and Assessment Service data and analyzed to estimate the incidence of Bartholin duct cysts and abscesses among Korean women in 2009. RESULTS: There were 587 Bartholin duct cysts and 757 Bartholin duct abscesses during 2009. The total incidence of Bartholin duct cysts and abscesses was 0.55 per 1000 person-years and 0.95 per 1000 person-years, respectively. In women aged 35-50years, the incidence was 1.21 per 1000 person-years and 1.87 per 1000 person-years, respectively. In multivariate logistic regression analysis, the incidence of Bartholin duct cysts and abscesses was associated with age (P<0.01), but not with season or socioeconomic status, among women aged 15-50years. The main operation performed was marsupialization (45.2%) for Bartholin duct cysts and incision (71.5%) for Bartholin duct abscesses. CONCLUSION: The incidence of Bartholin duct cysts and abscesses increased with age until menopause, decreasing thereafter.
  International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics 04/2013;
• Article: Bladder separation at abdominal hysterectomy.

  Shirish S Sheth
  International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics 04/2013;
• Article: Twinning of obstetric and gynecological societies in Tanzania and the Netherlands.

  Jelle Stekelenburg, Projestine Muganyizi
  International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics 04/2013;
• Article: Uterine manifestations of tuberous sclerosis complex as a random finding at laparoscopy.

  George Pados, Anastasios Makedos, Dimitrios Tsolakidis, Basil Tarlatzis
  International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics 04/2013;
• Article: Fluid and caffeine intake and urinary symptoms in the UK.

  Dan Selo-Ojeme, Sonu Pathak, Asma Aziz, Modupe Odumosu
  International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics 04/2013;
• Article: Prognostic factors and outcome of undifferentiated endometrial sarcoma treated by multimodal therapy.

  Gabriel G Malouf, Catherine Lhommé, Pierre Duvillard, Philippe Morice, Christine Haie-Meder, Patricia Pautier
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  ABSTRACT: OBJECTIVE: To describe the natural history, prognostic factors, and optimal treatment modalities of undifferentiated endometrial sarcoma (UES). METHODS: A retrospective review was conducted of 30 patients with UES treated at Institut Gustave-Roussy, France, between January 1978 and December 2008. Clinical and pathologic variables, treatment modalities, and outcomes were assessed. RESULTS: Disease was advanced in most cases: FIGO stage III-IV in 70% of patients. Overall, 29 patients (96.7%) underwent hysterectomy as part of the initial surgical treatment; however, only 18 (60.0%) attained complete macroscopic resection. The incidence of pelvic and/or para-aortic lymph-node involvement at primary surgery or first recurrence was 44.4%. Median postoperative follow-up was 5 years; progression-free survival (PFS) and overall survival (OS) were 9.7 and 23 months, respectively. No differences in OS and PFS were observed by staging subgroup (FIGO vs the American Joint Committee on Cancer). Only postoperative pelvic radiotherapy with or without brachytherapy correlated with improved PFS (19.1 vs 6.5 months; P=0.04) and OS (54.5 vs 16.7 months; P=0.01) in a univariate analysis. CONCLUSION: Neither staging system was optimal for risk stratification. Multimodal therapy was recommended after surgery.
  International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics 04/2013;
• Article: Experience of a low-dose magnesium sulfate regimen for the management of eclampsia over a decade.

  Narayan Jana, Subhendu Dasgupta, Anindya Kumar Das, Debjyoti Santra, Balaram Samanta
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  ABSTRACT: OBJECTIVE: To assess the safety and efficacy of a low-dose magnesium sulfate regimen for the management of eclampsia in Indian women. METHODS: A loading dose consisting of 3g of magnesium sulfate intravenously plus 5g intramuscularly (2.5g in each buttock) was followed by 2.5g intramuscularly every 4hours, for 24hours beyond the last seizure. In a first phase, which spanned 2001 and 2002, the regimen was evaluated prospectively with 554 women with eclampsia, and the results were compared with results from the Collaborative Eclampsia Trial. Regarding the second phase, which spanned the 9 following years, mortality was analyzed retrospectively for 2929 women treated by the same regimen at the same hospital. RESULTS: The mean±SD maternal weight and height were 41.7±5.3kg and 151±7cm, respectively. The low-dose regimen was associated with a lower seizure recurrence (6.1% vs 9.7%; P=0.02) and a slightly lower maternal mortality (2.7% vs 3.2%; P=0.6) compared with the Collaborative Eclampsia Trial. The overall case fatality rate for the second phase was 3.3%. CONCLUSION: The low-dose regimen was safe and effective for the management of eclampsia in a region where most women are of light weight.
  International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics 04/2013;
• Article: Successful management of primary hepatic pregnancy with selective hepatic artery embolization and intra-arterial methotrexate infusion.

  Jing Ma, Changju Zhou, Zhenling Duan, Yongneng Jiang
  International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics 04/2013;
• Article: Severe distortion of the uterus associated with a B-Lynch suture.

  Candice Wang, Manisha Mathur
  International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics 04/2013;
• Article: Screening pregnant women for group B streptococcus infection between 30 and 32weeks of pregnancy in a population at high risk for premature birth.

  Boldizsar Horváth, Magdolna Grasselly, Tamás Bödecs, Imre Boncz, József Bódis
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  ABSTRACT: OBJECTIVE: To assess the benefits of a chemoprophylaxis program based on screening women for group B streptococcus (GBS) infection between 30 and 32weeks of pregnancy in a population with a high rate of premature births. METHODS: From 1995 to 2011, 24 950 women were screened for GBS infection between 30 and 32weeks of pregnancy at Markusovszky Teaching Hospital, Szombathely, Hungary. Those who tested positive, and those who tested negative but were at risk of infecting their newborns, underwent intrapartum prophylaxis. Neonatal outcomes were compared with those of a historical cohort that underwent no screening or treatment, and with those published in CDC/ACOG guidelines recommending screening closer to term. RESULTS: There were 63 infected newborns (0.2%) in the study cohort, and 1 of 8 with sepsis died. There were 149 infected newborns (0.7%) in the historical cohort, and 29 of 31 with sepsis died. CONCLUSION: Screening women early in a population with a high rate of premature births may simplify preterm labor management. It results, however, in a higher incidence of early onset neonatal GBS disease than when screening is done closer to term.
  International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics 04/2013;
• Article: Adaptation to menopause in Southwest Nigeria.

  Abiodun Idowu Adanikin
  International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics 04/2013;
• Article: Lidocaine versus ropivacaine for perineal infiltration post-episiotomy.

  Christophe Gutton, Jean-Pierre Bellefleur, Séverine Puppo, Julie Brunet, Francois Antonini, Marc Leone, Florence Bretelle
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  ABSTRACT: OBJECTIVE: To evaluate maternal analgesia after an episiotomy during delivery. METHODS: The present case-control study compared 2 protocols of post-episiotomy infiltration: period A, 20mL of lidocaine 10mg/mL; period B, 20mL of ropivacaine 7.5mg/mL. The primary study endpoint was the visual analog scale (VAS) score at 24hours after episiotomy; secondary endpoints were the VAS scores during suturing and at 2 and 48hours, and patient satisfaction at 48hours. RESULTS: In total, 102 women were included in the study. The median VAS score at 24hours was significantly lower during the ropivacaine period (3 [1.5-4]) than during the lidocaine period (4 [2-6]; P=0.004). A VAS score below 4 at 24hours was significantly more frequent with ropivacaine (71% versus 43%; P=0.009). The VAS scores at 2 and 48hours were also lower in the ropivacaine group (2hours, 0 [0-1] versus 1 [0-3], P=0.01; and 48hours, 2 [0-3] versus 3 [2-5], P<0.001). Maternal satisfaction was significantly higher in the ropivacaine group. CONCLUSION: Analgesia and maternal satisfaction were improved during the period when ropivacaine was used as opposed to lidocaine. The effect lasted for up to 48hours.
  International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics 04/2013;
• Article: Vaginal hysterectomy in women with a history of 2 or more cesarean deliveries.

  Shirish S Sheth
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  ABSTRACT: OBJECTIVE: To perform vaginal hysterectomy (VH) safely in women with a history of 2 or more cesarean deliveries (CDs). METHODS: A 4-step method was followed to safeguard the bladder, access the vesicouterine peritoneum (VUP), and perform VH in 312 patients with a history of 2 or more CDs. If access to the VUP did not occur at the end of step 2, step 3 and, if necessary, step 4 were implemented. RESULTS: Hysterectomy was performed vaginally in 311 patients, and the abdominal route was resorted to in 1 patient because of hemorrhage. Only 1 patient incurred bladder trauma, which was promptly repaired. CONCLUSION: In the absence of contraindications, the 4-step VH method described and the surgical techniques involved are safe to implement in women with a history of 2 or more CDs who need a hysterectomy.
  International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics 04/2013;
• Article: Trends in the management and outcome of HIV-1-infected women and their infants in the NISDI Perinatal and LILAC cohorts, 2002-2009.

  Sonia K Stoszek, Geraldo Duarte, Laura Freimanis Hance, Jorge Pinto, Maria I Gouvea, Rachel A Cohen, Breno Santos, Elizabete Teles, Regina Succi, Jorge O Alarcon, Jennifer S Read
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  ABSTRACT: OBJECTIVE: To describe temporal management and outcome trends among HIV-1-infected pregnant women and their infants enrolled in the NISDI Perinatal and LILAC cohorts. METHODS: A prospective cohort of 1548 HIV-1-infected pregnant women and their 1481 singleton live-born infants was analyzed. Participants were enrolled at 24 Latin American and Caribbean sites and followed-up for at least 6months postpartum. Variables were compared by 2-year enrollment periods from September 27, 2002, to June 30, 2009, using logistic and linear regression modeling. RESULTS: Antiretroviral (ARV) use during pregnancy remained high (99.0%). ARVs became increasingly used for treatment (P<0.001). Regimens containing 2 nucleoside reverse transcriptase inhibitors plus a protease inhibitor became more common in later years (P<0.001). The proportion of women with viral loads below 1000copies/mL at hospital discharge after delivery (HD) increased over time (P=0.0031). Median CD4 lymphocyte counts also rose at HD, from 441cell/mm(3) to 515cells/mm(3) (P<0.05). Elective cesarean deliveries increased from 30.5% to 42.0% (P=0.018). Most infants received ARV prophylaxis (99.7%). Few infants were breastfed (0.5%) or became infected with HIV-1 (1.2%). CONCLUSION: The results indicate that national HIV-1 treatment and transmission prevention policies are effective among patients with healthcare access in the region.
  International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics 04/2013;