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• Prognostic factors for fulminant viral hepatitis in pregnancy.

  Authors: Sumita Mehta, Anshuja Singla, Shalini Rajaram

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

• The impact of physical activity on menopausal symptoms in middle-aged women.

  Authors: Ana C G Canário, Patrícia U Cabral, Maria H Spyrides, Paulo C Giraldo, José Eleutério, Ana Katherine Gonçalves

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

  OBJECTIVE: To evaluate the influence of physical activity on climacteric symptoms among middle-aged women in Brazil. METHODS: A population-based sample of women aged 40-65years was recruited fromOBJECTIVE: To evaluate the influence of physical activity on climacteric symptoms among middle-aged women in Brazil. METHODS: A population-based sample of women aged 40-65years was recruited from Natal, Brazil. Enrollment took place in basic health units in each health district of the city from June to September 2011. Data were collected while women waited for routine appointments at the health units. Climacteric symptoms were assessed using the Menopause Rating Scale and the Blatt-Kupperman Menopausal Index. The level of physical activity was assessed via the International Physical Activity Questionnaire. It was classified as low, moderate, or vigorous. RESULTS: The mean age of the 370 participants was 49.8±8.1years. They were predominantly white (72.7%), married (61.6%), non-smokers (93.5%), and had undergone high-school education (70.5%). All domains of climacteric symptoms were significantly affected by physical activity: psychological (P<0.001); somatovegetative (P<0.001); and urogenital (P=0.008). Significant differences were found between the IPAQ groups of physical activity and the Blatt-Kupperman Menopausal Index for the following symptoms: hot flashes (P<0.001); paresthesia (P=0.022); insomnia (P<0.001); impatience (P<0.001); depression (P<0.001); vertigo (P<0.001); fatigue (P<0.001); arthralgia/myalgia (P<0.001); and palpitation (P<0.001). CONCLUSION: Physical activity improved climacteric symptoms among middle-aged women in Brazil.

• Prevention and treatment of postpartum hemorrhage in low-resource settings.

  Authors: André Lalonde

  International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics. 117(2):108-18.

• The influence of pre-eclampsia on fetal lung maturity.

  Authors: Tea Stimac, Oleg Petrović, Robert Krajina, Aleks Finderle

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

  OBJECTIVE: To use amniotic fluid (AF) lamellar body count (LBC) to assess the influence of pre-eclampsia and associated pathologic conditions on fetal lung maturity (FLM). METHODS: A prospectiveOBJECTIVE: To use amniotic fluid (AF) lamellar body count (LBC) to assess the influence of pre-eclampsia and associated pathologic conditions on fetal lung maturity (FLM). METHODS: A prospective study was conducted to analyze 378 AF samples containing 5mL of AF from 306 singleton pregnancies at 26-39weeks. Stratified by gestational age groups, pregnancies were categorized as follows: pre-eclampsia (n=25); intrauterine growth restriction (IUGR) (n=74); pre-eclampsia and IUGR (n=63); and control (n=144). Amniotic fluid LBC in each group was estimated and medians were compared for defined gestational age periods. Statistical analyses were performed via non-parametric tests. RESULTS: Between 31 and 33weeks, significantly lower median LBCs were found in the pre-eclampsia group than in the IUGR group (P=0.022) and in pregnancies with both entities (P=0.031). Between 34 and 36weeks, there were significantly lower median LBCs in the pre-eclampsia and the pre-eclampsia/IUGR groups than in the IUGR group (P=0.026 and P=0.004, respectively), as well as in the pre-eclampsia/IUGR group compared with the control group (P=0.04). CONCLUSION: Significantly lower LBCs in pre-eclamptic pregnancies between 31 and 36weeks of gestation indicate delayed FLM associated with pre-eclampsia.

• Understanding and recollection of the risks associated with cesarean delivery during the consent process.

  Authors: Modupe Odumosu, Sonu Pathak, Eleanor Barnet-Lamb, Olayinka Akin-Deko, Vaishali Joshi, Dan Selo-Ojeme

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

  OBJECTIVE: To investigate women's recall of information provided during the consent process for cesarean delivery, specifically the associated risks, 24hours after the procedure. METHODS: AOBJECTIVE: To investigate women's recall of information provided during the consent process for cesarean delivery, specifically the associated risks, 24hours after the procedure. METHODS: A prospective questionnaire-based study was conducted at the Barnet and Chase Farm Hospitals NHS Trust between May 2009 and August 2010. Women who had undergone a cesarean delivery (planned or emergency) completed a self-administered questionnaire 24hours after delivery. Women who did not recall the risks associated with the procedure (group 1) were compared with those who did recall this information (group 2). RESULTS: A total of 554 women participated in the study. Group 1 (n=140) were 4 times more likely to have undergone an emergency cesarean than group 2 (n=414) (OR 4; 95% CI, 2.5-6.2). Group 2 were more to likely to have higher than secondary level education, 7 times more likely to have understood the explanation of the procedure (OR 6.9; 95% CI, 3.3-14.2), and 9 times more likely to recall that the risks had been explained (OR 9.4; 95% CI, 5.2-17.1). More women in group 1 reported that they would have liked to receive an information leaflet about cesarean delivery at the first prenatal visit. CONCLUSION: One in 4 women did not recall any risks associated with cesarean delivery shortly after the procedure and this group of women were less likely to understand or recall the details of the consent discussion.

• Women's experience of menopause in rural communities in Orlu, Eastern Nigeria.

  Authors: Fredrick C Anolue, Ephraim Dike, Paschal Adogu, Chikere Ebirim

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

  OBJECTIVE: To document women's experience of menopause in rural communities in Orlu, Eastern Nigeria, and to compare this with urban centers in Nigeria and worldwide. METHODS: A total of 349 womenOBJECTIVE: To document women's experience of menopause in rural communities in Orlu, Eastern Nigeria, and to compare this with urban centers in Nigeria and worldwide. METHODS: A total of 349 women who had not menstruated for at least 12months were included in a questionnaire-based study. The questionnaire included questions on sociodemographic characteristics, age at menarche and menopause, attitude to menopause, and knowledge and use of hormone replacement therapy. Questionnaires were administered in 13 communities by medical students during the Annual Convention of Christian Women in August 2009. RESULTS: The mean age at menopause of the women was 47±4.2years. Menopausal symptoms were prevalent, and bone and joint pain were the most prevalent symptoms. Knowledge and use of hormone replacement therapy were poor. Most of the women considered the menopause to be beneficial. CONCLUSION: Age at menopause and associated postmenopausal symptoms were similar to those seen in urban centers in Nigeria, but age at menopause was lower than in studies of white women. Despite the apparent positive attitude of Nigerian women to menopause, a program of information and education, and use of hormone replacement therapy will improve quality of life for women in Eastern Nigeria.

• Outcome of obstetric fistula repair after 10-day versus 14-day Foley catheterization.

  Authors: Rahel Nardos, Birhanu Menber, Andrew Browning

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

  OBJECTIVE: To compare outcome between 10-day and 14-day bladder drainage after obstetric fistula repair. METHODS: In a randomized prospective study at Hamlin Fistula Center, Bahir Dar, Ethiopia,OBJECTIVE: To compare outcome between 10-day and 14-day bladder drainage after obstetric fistula repair. METHODS: In a randomized prospective study at Hamlin Fistula Center, Bahir Dar, Ethiopia, patients presenting with obstetric vesicovaginal fistula between 2007 and 2010 were randomized to undergo 10-day (group 1) or 14-day (group 2) postoperative catheterization. Fistulas were categorized via Goh classification. The inclusion criteria were any type of vesicovaginal fistula except circumferential or recurrent. RESULTS: In total, 189 women were enrolled: 107 in group 1, and 82 in group 2. The groups were similar in age, parity, duration of labor, and time from injury to surgical repair. There was no significant difference in fistula stage according to the Goh classification (urethral length, P=0.3; fistula size, P=0.9; and vaginal scarring, P=0.3). There were 3 fistula breakdowns in group 1, and 6 in group 2. The difference in cure was not significant (P=0.15, confidence interval -0.009 to 0.1). There was no significant difference in non-fistula-related incontinence or urinary retention after repair. CONCLUSION: The outcome of postoperative catheterization for 10days was not inferior to that for 14days. A similar treatment outcome with a shorter duration of catheterization will have a significant impact on reducing infection and cost.

• Training Zambian traditional birth attendants to reduce neonatal mortality in the Lufwanyama Neonatal Survival Project (LUNESP).

  Authors: Christopher J Gill, Nicholas G Guerina, Charity Mulenga, Anna B Knapp, Grace Mazala, Davidson H Hamer

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

  OBJECTIVE: To provide relevant details on how interventions in the Lufwanyama Neonatal Survival Project (LUNESP) were developed and how Zambian traditional birth attendants (TBAs) were trained toOBJECTIVE: To provide relevant details on how interventions in the Lufwanyama Neonatal Survival Project (LUNESP) were developed and how Zambian traditional birth attendants (TBAs) were trained to perform them. METHODS: The study tested 2 interventions: a simplified version of the American Academy of Pediatrics' neonatal resuscitation protocol (NRP); and antibiotics with facilitated referral (AFR). RESULTS: Key elements that enabled the positive study result were: focusing on common and correctible causes of mortality; selecting a study population with high unmet public health need; early community mobilization to build awareness and support; emphasizing simplicity in the intervention technology and algorithms; using a traditional training approach appropriate to students with low literacy rates; requiring TBAs to demonstrate their competence before completing each workshop; and minimizing attrition of skills by retraining and reassessing the TBAs regularly throughout the study. CONCLUSION: An effective NRP training model was created that is suitable for community-based neonatal interventions, in research or programmatic settings, and by practitioners with limited obstetric skills and low rates of literacy. Clinicaltrials.govNCT00518856.

• Comparison of "push" and "pull" methods for impacted fetal head extraction during cesarean delivery.

  Authors: Firoozeh Veisi, Maryam Zangeneh, Shohreh Malekkhosravi, Negin Rezavand

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

  OBJECTIVE: To compare maternal and neonatal outcomes associated with the "push" and "pull" methods for impacted fetal head extraction during cesarean delivery. METHODS: A prospective study wasOBJECTIVE: To compare maternal and neonatal outcomes associated with the "push" and "pull" methods for impacted fetal head extraction during cesarean delivery. METHODS: A prospective study was conducted at Imam Reza Hospital, Kermanshah, Iran, from April 2006 to March 2008. After failed vacuum extraction, women with obstructed labor caused by impacted fetal head were randomly assigned to deliver via the push method (n=35) or the pull method (n=37). The outcomes investigated included operation time, operative blood loss, incidence of extension of the uterine incision, and postpartum fever. Data were analyzed using χ(2) and Student t tests. RESULTS: Mean operative time and incidence of extension of the uterine incision were significantly increased in the group that delivered via the push method (P<0.001). There were no significant differences in the other maternal and neonatal morbidities between the groups, although there was 1 case of neonatal femoral fracture in the pull group. CONCLUSION: Although the pull method may lead to some neonatal complications, it is associated with lower maternal morbidity than the push method when used for impacted fetal head extraction during cesarean delivery.

• Comparison of neonatal and maternal outcomes associated with head-pushing and head-pulling methods for impacted fetal head extraction during cesarean delivery.

  Authors: Parvin Bastani, Shabnam Pourabolghase, Fatemeh Abbasalizadeh, Leila Motvalli

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

  OBJECTIVE: To compare the morbidity and mortality of 2 current techniques during cesarean delivery of an impacted fetal head. METHODS: In a comparative setting, 59 pregnant women with obstructedOBJECTIVE: To compare the morbidity and mortality of 2 current techniques during cesarean delivery of an impacted fetal head. METHODS: In a comparative setting, 59 pregnant women with obstructed labor due to impacted fetal head were recruited. The patients were categorized into 2 groups according to method of extraction: the "push" group (n=30) and the "pull" group (n=29). Uterus relaxants were used before cesarean in all cases and the incision was higher and wider than routine. Maternal and neonatal morbidities were compared between the groups. RESULTS: Maternal complications in the push and pull groups were extension of the uterine incision (15 [50.0%] vs 5 [17.2%]); T or J incision (3 [10.0%] vs 4 [13.8%]); blood transfusion (3 [10.0%] vs 1 [3.4%]); wound infection (4 [13.3%] vs 1 [3.4%]); fever (16 [53.3%] vs 3 [10.3%]); and urinary tract infection (10 [33.3%] vs 0 [0.0%]). Incidences of extension of the uterine incision, fever, and urinary tract infection were significantly higher in the push group (P=0.008). CONCLUSION: Owing to a lower rate of abnormal incision and postpartum fever/infection with the pull method, this technique is preferable to the push method.

• A retrospective analysis of the clinicopathologic characteristics of uterine cellular leiomyomas in China.

  Authors: Rui Guan, Weiqiang Zheng, Mingjuan Xu

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

  OBJECTIVE: To investigate the clinicopathologic features of uterine cellular leiomyomas (CLs) by comparing them with those of uterine leiomyosarcomas (LMSs). METHODS: A case-control study comparingOBJECTIVE: To investigate the clinicopathologic features of uterine cellular leiomyomas (CLs) by comparing them with those of uterine leiomyosarcomas (LMSs). METHODS: A case-control study comparing 78 cases of CL with 10 cases of LMS was conducted. The patients' records were reviewed to abstract information on tumors features and treatment, immunohistochemical findings, and disease prognosis. RESULTS: The mean age at diagnosis was 45.3±8.41years in the CL group. The main clinical CL manifestations were menstrual abnormalities (56.4%), abdominal pain or distension (14.1%), and pelvic pressure (8.9%). Abdominal pain or distension was significantly more common in the LMS than in the CL group (P<0.05). Generally, CL tumors were smaller in diameter than LMS tumors (P<0.05). Moreover, lower levels of Ki-67 and PCNA expression were measured in CL than in LMS tumors (P<0.05). There were no cases of malignant transformation or metastasis in 41 patients with CL who adhered to long-tern follow-up. CONCLUSION: No symptoms were found to be specifically associated with CL, and management of CL does not need to differ from that of ordinary leiomyoma. In contrast to malignant disease, CL has a favorable long-term prognosis. However, given its "borderline" pathologic nature, patients with CL require clinical surveillance.

• Postabortion contraceptive use and method continuation in India.

  Authors: A J Francis Zavier, Sabu S Padmadas

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

  OBJECTIVE: To investigate the patterns and determinants of postabortion contraceptive use and the rates of method continuation in India. METHODS: Population-level retrospective calendar data on 5135OBJECTIVE: To investigate the patterns and determinants of postabortion contraceptive use and the rates of method continuation in India. METHODS: Population-level retrospective calendar data on 5135 married women who had their last abortion during the 60months preceding the survey were drawn from 2005-2006 Indian National Family Health Surveys. Multinomial logistic regression was used to model the factors associated with postabortion method choices. Method discontinuation rates were estimated using proportional hazard models. RESULTS: Overall, 70.4% of women reported not using any method following abortion, and the levels varied considerably across states. Significant differences were observed in the type of method adopted by women living in large cities, small towns, and rural areas. Poor and socially excluded women were less likely to use any method after abortion, particularly modern reversible methods. Method discontinuation rates were considerably higher among socially disadvantaged groups. CONCLUSION: Postabortion contraceptive adoption is exceptionally low in India. Reproductive health interventions should urgently consider implementing comprehensive postabortion care policies, integrating family planning with sexual and reproductive healthcare services, and in particular targeting women from disadvantaged communities.

• The effect of bladder fullness on evaluation of pelvic organ prolapse.

  Authors: Nir Haya, Eran Segev, Grace Younes, Eyal Goldschmidt, Ron Auslender, Yoram Abramov

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

  OBJECTIVE: To investigate the effect of bladder fullness on pelvic organ prolapse (POP) staging via the Pelvic Organ Prolapse Quantification System (POP-Q). METHODS: Sixty women with advanced POPOBJECTIVE: To investigate the effect of bladder fullness on pelvic organ prolapse (POP) staging via the Pelvic Organ Prolapse Quantification System (POP-Q). METHODS: Sixty women with advanced POP underwent pelvic examination with maximal Valsalva straining via POP-Q with an empty bladder and after transcatheter bladder filling to maximum cystometric capacity, with simultaneous intra-abdominal and intravesical pressure recordings. Main outcome measures included POP-Q values and staging with full versus empty bladder. RESULTS: An empty bladder was associated with a significantly higher POP-Q staging (median, 3 vs 2; P<0.0001); and a lower location of points Ba (4.51 vs 1.37; P<0.0001), Aa (2.58 vs 0.62; P<0.0001), Bp (-0.68 vs -1.10; P=0.01), Ap (0.83 vs -1.27; P=0.002), C (1.57 vs -1.07; P<0.0001), and D (0.14 vs -2.77; P<0.0001) compared with a full bladder. However, genital hiatus, perineal body, and total vaginal length values were not significantly affected by bladder fullness. No differences in intra-abdominal or detrusor pressures were noted between empty and full bladder states. CONCLUSION: POP-Q assessment with a full bladder is associated with underestimation of POP severity. Therefore, bladder emptying should be a standard requirement for POP-Q staging and reporting.

• Effect of a yoga program on glucose metabolism and blood lipid levels in adolescent girls with polycystic ovary syndrome.

  Authors: Ram Nidhi, Venkatram Padmalatha, Raghuram Nagarathna, Amritanshu Ram

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

  OBJECTIVE: To assess the efficacy of yoga therapy on glucose metabolism and blood lipid values in adolescent girls with polycystic ovary syndrome (PCOS). METHODS: A prospective, randomized,OBJECTIVE: To assess the efficacy of yoga therapy on glucose metabolism and blood lipid values in adolescent girls with polycystic ovary syndrome (PCOS). METHODS: A prospective, randomized, interventional controlled trial recruited 90 adolescents aged between 15 and 18years who met the Rotterdam criteria for PCOS. A yoga group practiced suryanamaskara, asanas, pranayama, and meditation 1hour per day each day for12weeks while another group practiced conventional physical exercises. The Mann-Whitney U test was used to compare score changes between the 2 groups. RESULTS: The changes in fasting insulin, fasting blood glucose, and homeostasis model assessment of insulin resistance were significantly different in the 2 groups (P<0.05). Except for high-density lipoprotein cholesterol, the changes in blood lipid values were also significantly different (P<0.05). The changes in body mass index, waist circumference, hip circumference, and waist-to-hip ratio, however, were not significantly different (P>0.05). CONCLUSION: Yoga was found to be more effective than conventional physical exercises in improving glucose, lipid, and insulin values, including insulin resistance values, in adolescent girls with PCOS independent of anthropometric changes. Central Trial Registry of India No.: REFCTRI-2008 000291.

• Diagram to map the locations of endometriosis.

  Authors: Ricardo Bassil Lasmar, Bernardo Portugal Lasmar, Claudia Pillar

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

  OBJECTIVE: To develop and test a visual map that corresponds practically and objectively to the anatomical areas affected by endometriosis. METHOD: The study comprised 150 questionnaires concerningOBJECTIVE: To develop and test a visual map that corresponds practically and objectively to the anatomical areas affected by endometriosis. METHOD: The study comprised 150 questionnaires concerning 10 clinical cases of endometriosis presented as a visual diagram that were distributed at 3 different scientific events, among 3 groups of 50 gynecologists. Data were analyzed to evaluate the diagram's ability to graphically represent the endometriosis sites. RESULTS: After presentation at the first event, the rate of correct answers on the site of endometriosis was 84.7%; at the second event, after modifications implemented after feedback from the first event, the rate of correct answers was 97.4%; and at the third event, when all suggestions and modifications had been made, the rate was 99.7%. CONCLUSION: The diagram proposed to map the location of endometriosis lesions appears to be an adequate and effective instrument to represent the site of the disease, with correlation at almost 100%.

• Factors associated with disclosure of HIV serostatus to sexual partners of patients receiving HIV care in Kabale, Uganda.

  Authors: Michael O Osinde, Othman Kakaire, Dan K Kaye

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

  OBJECTIVE: To evaluate factors independently associated with disclosure of HIV serostatus in the era of widespread access to antiretroviral agents (ARVs) among individuals receiving HIV care inOBJECTIVE: To evaluate factors independently associated with disclosure of HIV serostatus in the era of widespread access to antiretroviral agents (ARVs) among individuals receiving HIV care in Uganda. METHODS: Between January 1 and August 31, 2009, 403 HIV-positive individuals attending Kabale Hospital in southwestern Uganda were interviewed about their sociodemographic characteristics; sexuality; contraceptive use and sexual behavior; and disclosure of HIV serostatus to sexual partners. Data regarding disclosure versus nondisclosure were analyzed to identify factors independently associated with disclosure of serostatus. RESULTS: The study participants were predominantly female (74.0%). In all, 82.5% of the patients were receiving ARVs. Disclosure of HIV serostatus to regular sexual partners was reported by 50.9% of the participants, while 49.1% had chosen not to disclose their serostatus. Factors independently associated with nondisclosure were marital status; current use of ARVs; having children who had died (from any cause); being sexually active in the previous 6months; and the number of sexual partners during the previous 6months (P<0.05 for all associations). Fear of stigma was the main reason for nondisclosure of HIV serostatus. CONCLUSION: Despite receiving treatment with ARVs, many of the study participants neither disclosed their own HIV serostatus nor knew the HIV serostatus of their sexual partners.

• Childhood vaginal bleeding due to a missed foreign body in the vagina following female genital mutilation.

  Authors: Salah Rasheed, Allam Abdel Monem, Hazem Abdel Ghaffar

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

• Determining lower urinary tract symptoms and associated risk factors in young women.

  Authors: Sermin Timur-Taşhan, Nezihe K Beji, Ergül Aslan, Onay Yalçin

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

  OBJECTIVE: To determine lower urinary tract symptoms (LUTS) and associated risk factors in women aged 20years and older. METHODS: The present population-based, randomized, cross-sectional studyOBJECTIVE: To determine lower urinary tract symptoms (LUTS) and associated risk factors in women aged 20years and older. METHODS: The present population-based, randomized, cross-sectional study recruited 766 women aged 20years and older from the province of Malatya, Turkey. Data on LUTS were collected via face-to-face interviews between December 1, 2006, and July 30, 2007. The data were reported descriptively and analyzed by logistic regression for associated risk factors. RESULTS: Regarding female LUTS, the incidence of urgency, urinary incontinence, nocturia, and frequency symptoms was 36.1%, 32.4%, 27.1%, and 22.8%, respectively. Logistic regression indicated that LUTS development was 6.1 times higher among women who had vaginal delivery than among those who had cesarean delivery; 3.7 times higher among women with gas incontinence than among those without; 2.9 times higher among women with frequent urinary tract infections that among those without; and 4.8 times higher among women whose mothers had a history of urine incontinence than among those whose mothers did not. CONCLUSION: Vaginal delivery was found to be the highest risk factor for LUTS among women.

• Quick diagnosis of female genital tuberculosis using multiplex fast polymerase chain reaction in Southern Assam, India.

  Authors: Sankar Kumar Ghosh, Rosy Mondal

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

• Practice of pica among pregnant women in Khartoum, Sudan.

  Authors: Samah Ahmed, Hala Abdullahi, Ishag Adam

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

• Perioperative morbidity associated with medically necessary panniculectomy in gynecologic oncology surgery.

  Authors: Sareena Singh, Raeph Laughingwell, Norman G Rosenblum

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

  OBJECTIVE: To assess the data and outcomes of combining medically necessary panniculectomy with gynecologic oncology surgery and to discuss the associated perioperative and postoperativeOBJECTIVE: To assess the data and outcomes of combining medically necessary panniculectomy with gynecologic oncology surgery and to discuss the associated perioperative and postoperative complications. METHODS: In a retrospective study of women with a body mass index (BMI) of greater than or equal to 35 who underwent gynecologic oncology surgery at Thomas Jefferson University Hospital, Philadelphia, between January 2005 and August 2011, patients were divided into 2 cohorts: those who had surgery with concurrent panniculectomy, and those who had surgery via standard laparotomy. Postoperative complications and lymph node (LN) yield were compared between the groups. RESULTS: Patient characteristics were comparable in both cohorts, except that the panniculectomy group had a greater BMI. Surgery combined with panniculectomy led to longer operating room times. Wound complications did not differ between the 2 groups. Panniculectomy did not affect LN yield or the development of venous thromboembolism. CONCLUSION: The data were reasonably consistent with previous studies. Although wound complications occurred, most were managed conservatively; as a result, overall morbidity was acceptable. Panniculectomy has been previously shown to facilitate lymphadenectomy and increase LN yield; however, the present results did not substantiate this conclusion. More research is required to determine which patients are optimal candidates for combined procedures.

• Perinatal outcome in cases of latent syphilis during pregnancy.

  Authors: Yonit Krakauer, Gali Pariente, Ruslan Sergienko, Arnon Wiznitzer, Eyal Sheiner

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

  OBJECTIVE: To investigate factors associated with latent syphilis and pregnancy outcome among women with latent syphilis. METHODS: A retrospective population-based study was conducted to compare allOBJECTIVE: To investigate factors associated with latent syphilis and pregnancy outcome among women with latent syphilis. METHODS: A retrospective population-based study was conducted to compare all pregnancies among women with and without latent syphilis at Soroka University Medical Center, Be'er-Sheva, Israel, between 1988 and 2010. Stratified analysis using a multiple logistic regression model was performed to control for confounders. RESULTS: Of the 219656 deliveries during the study period, 159 (0.1%) involved women with latent syphilis. Multivariate analysis with backward elimination revealed the following conditions to be significantly associated with latent syphilis: fetal growth restriction (odds ratio [OR] 2.20; 95% confidence interval [CI], 1.07-4.49; P=0.03); drug abuse (OR 9.95; 95% CI, 1.31-75.46; P=0.02); tobacco use (OR 3.35; 95% CI, 1.74-6.45; P<0.05); and Jewish (vs Bedouin) ethnicity (OR 4.05; 95% CI, 2.65-6.20; P<0.05). CONCLUSION: Women with latent syphilis are at risk for adverse maternal and perinatal outcomes, including fetal growth restriction. Careful surveillance of these high-risk pregnancies should be considered.

• Awareness of danger signs and symptoms of pregnancy complication among women in Jordan.

  Authors: Abdelhakeem Okour, Monadel Alkhateeb, Zouhair Amarin

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

  OBJECTIVE: To assess the level and determinants of awareness of the danger signs and symptoms of pregnancy complication among pregnant Jordanian women aged 15years and older. METHODS: A descriptiveOBJECTIVE: To assess the level and determinants of awareness of the danger signs and symptoms of pregnancy complication among pregnant Jordanian women aged 15years and older. METHODS: A descriptive cross-sectional study of 350 women attending prenatal care services was performed. Interviews were conducted at 4 public-health centers in Zarqa, Jordan, using a structured questionnaire. Awareness was defined as "knowing at least 4 danger signs and symptoms". RESULTS: Overall, 84.8% of the women interviewed were not aware of danger signs and symptoms of pregnancy complication. Sociodemographic factors-including duration of education and current employment; husband's duration of education; family size; and whether women were given information about danger signs and symptoms-were associated with awareness in a binary analysis. Multivariate logistic regression analysis revealed that education level of study participants, their husbands' education level, and receiving information about danger signs and symptoms were all associated with awareness (P=0.02 for all associations). CONCLUSION: Awareness of danger signs and symptoms of pregnancy complication among women in Jordan is low. A need exists to provide prenatal care that includes sufficient information about pregnancy-related danger signs and symptoms to meet the need for safe motherhood, as pointed out by the Millennium Development Goals.

• Intravenous infusion of paracetamol versus intravenous pethidine as an intrapartum analgesic in the first stage of labor.

  Authors: Ahmed E H Elbohoty, Hiam Abd-Elrazek, Magdi Abd-El-Gawad, Fikria Salama, Mahmoud El-Shorbagy, Karim H I Abd-El-Maeboud

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

  OBJECTIVE: To evaluate the efficacy and adverse effects of an intravenous infusion of 1000mg of paracetamol as compared with an intravenous injection of 50mg of pethidine hydrochloride forOBJECTIVE: To evaluate the efficacy and adverse effects of an intravenous infusion of 1000mg of paracetamol as compared with an intravenous injection of 50mg of pethidine hydrochloride for intrapartum analgesia. METHODS: In a randomized prospective study at Ain Shams University, Cairo, Egypt, between April and August 2010, 102 low-risk primiparous women in active labor were allocated to received either paracetamol (n=52) or pethidine hydrochloride (n=50). The primary outcome was the efficacy of the drug to supply adequate analgesia as measured by a change in the visual analog scale (VAS) pain intensity score at various times after drug administration. The secondary outcomes included the need for additional rescue analgesia and the presence of adverse maternal or fetal events. RESULTS: As recorded by the VAS score, there was significant pain reduction at 15minutes, and at 1 and 2hours in both groups (P<0.001). The reduction in pain was significantly greater in the pethidine group only at 15minutes (P=0.004). None of the women in the paracetamol group had adverse effects, as compared with 64% of the women receiving pethidine. CONCLUSION: The effectiveness of intravenous paracetamol was comparable to that of intravenous pethidine, but paracetamol had fewer maternal adverse effects.

• Clearance of high-risk HPV infection in Chinese women with normal cervical cytology.

  Authors: Wenying Zhang, Jinyin Xiao, Chengbin Ma

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

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