Medicine and Health Sciences Commons^™

Genomic Rna Profiling And The Programme Controlling Preimplantation Mammalian Development., Christine E Bell, Michele D Calder, Andrew J Watson

Obstetrics & Gynaecology Publications

Preimplantation development shifts from a maternal to embryonic programme rapidly after fertilization. Although the majority of oogenetic products are lost during the maternal to embryonic transition (MET), several do survive this interval to contribute directly to supporting preimplantation development. Embryonic genome activation (EGA) is characterized by the transient expression of several genes that are necessary for MET, and while EGA represents the first major wave of gene expression, a second mid-preimplantation wave of transcription that supports development to the blastocyst stage has been discovered. The application of genomic approaches has greatly assisted in the discovery of stage specific gene expression …

Predicting Length Of Treatment For Neonatal Abstinence Syndrome In Methadone-Exposed Neonates., Neil S. Seligman, Nicole Salva, Edward J. Hayes, Kevin C. Dysart, Edward C. Pequignot, Jason K. Baxter

Department of Obstetrics and Gynecology Faculty Papers

OBJECTIVE: The objective of the study was to identify maternal variables predicting length of treatment for neonatal abstinence syndrome (NAS).

STUDY DESIGN: This was a retrospective cohort study of infants treated for NAS during 2000-2006 whose mothers were on methadone maintenance at delivery. Mixed-effects linear regression was used to examine the interaction of maternal and neonatal variables with length of treatment.

RESULTS: Of 204 neonates born to methadone exposed mothers, the average dose at delivery was 127 mg daily (25-340 mg) with median length of treatment 32 days (1-122 days). Trimester of initial exposure (P = .33), methadone dose at …

Torsion Of Fallopian Tube, Fimbrial Cyst, Imrana Masroor, Nadir Khan

Department of Radiology

A case of fallopian tube fimbrial cyst torsion with haemorrhage is presented, occurring in a 37-year-old female who had tubal ligation 6 years back. She presented in emergency with acute abdomen. Initial assessment of ovarian cyst haemorrhage or torsion was made. Ultrasound showed cystic structures in left adnexa and complex cyst in right adnexa with suspicion of torsion. Laparoscopy was performed and bilateral fimbrial cysts in fallopian tubes were identified with torsion on right side, and a left ovarian haemorrhagic cyst, which was subsequently confirmed on histopathology. Although fallopian tube torsion of fimbrial cyst is rare, it should be considered …

Icpd To Mdgs: Missing Links And Common Grounds., Farina G Abrejo, Babar Shaikh, Sarah Saleem

Community Health Sciences

The ICPD agenda of reproductive health was declared as the most comprehensive one, which had actually broadened the spectrum of reproductive health and drove the states to embark upon initiatives to improve reproductive health status of their populations. However, like all other countries, Pakistan also seems to have shifted focus of its policies and programs towards achieving MDGs. As a result, concepts highlighted in the ICPD got dropped eventually. In spite of specific goals on maternal and child mortalities in MDGs and all the investment and policy shift, Pakistan has still one of the highest maternal mortality ratios among developing …

Perinatal Outcomes In Pregnancy With Asthma., Rashid Jooma, Rashid Zaheer Syed, Ali Bin Sarwar Zubairi, Muhammad Ahsan Zafar, Rahat Qureshi

Department of Medicine

Objective: To examine the relationship between asthmatic pregnancies and selected maternal and neonatal outcomes in a representative cohort.

Methods: A retrospective cohort study was conducted at the Aga Khan University Hospital during the year 2004. A random selection was made of 65 asthmatic and 63 non-asthmatic singleton births. The neonatal outcomes studied were birth weight, premature birth and Apgar scores at 1 and 5 minutes. The maternal outcomes studied were number of hospital admissions, and number of documented UTI during the studied pregnancy and past history of abortions and stillbirths.

Results: The mean age of asthmatics and nonasthmatics were 28.0±4.9 …

Perinatal Outcomes In Pregnancy With Asthma, Rashid Zaheer Syed, Ali Bin Sarwar Zubairi, Muhammad Ahsan Zafar, Rahat Qureshi

Department of Obstetrics & Gynaecology

Objective: To examine the relationship between asthmatic pregnancies and selected maternal and neonatal outcomes in a representative cohort.

Methods: A retrospective cohort study was conducted at the Aga Khan University Hospital during the year 2004. A random selection was made of 65 asthmatic and 63 non-asthmatic singleton births. The neonatal outcomes studied were birth weight, premature birth and Apgar scores at 1 and 5 minutes. The maternal outcomes studied were number of hospital admissions, and number of documented UTI during the studied pregnancy and past history of abortions and stillbirths.

Resluts: The mean age of asthmatics and nonasthmatics were 28.0 …

Misoprostol In Addition To Routine Treatment Of Postpartum Hemorrhage: A Hospital-Based Randomized-Controlled Trial In Karachi, Pakistan., N. F. Zuberi, Jill Durocher, Rozina Sikander, Neelofur Baber, Jennifer Blum, Gijs Walraven

Department of Obstetrics & Gynaecology

Background:Postpartum hemorrhage (PPH) remains a major killer of women worldwide. Standard uterotonic treatments used to control postpartum bleeding do not always work and are not always available. Misoprostol's potential as a treatment option for PPH is increasingly known, but its use remains ad hoc and available evidence does not support the safety or efficacy of one particular regimen. This study aimed to determine the adjunct benefit of misoprostol when combined with standard oxytocics for PPH treatment.

Methods: A randomized controlled trial was conducted in four Karachi hospitals from December 2005 - April 2007 to assess the benefit of a …

Reducing The Rate Of Primary Caesarean Sections--An Audit, Lumaan Sheikh, Sara Tehseen, Saqib Ali Gowani, Hadi Bhurgri, Javed Rizvi, S Kagazwala

Department of Obstetrics & Gynaecology

Objective: To evaluate how the implementation of universally acceptable standards affects rates for primary caesarean sections, without compromising maternal or foetal safety.

Method: A complete audit cycle of all the primary caesarean sections performed in the maternity unit of Aga Khan University was conducted from 1st January to 31st March during years 2003 and 2004. New labour management guidelines were implemented after the first audit (appendix). The rates of caesarean section, induction of labour, failed induction, and maternal and foetal outcomes were compared before and after the implementation of the guidelines.

Results: Primary emergency caesarean section rate decreased from 16% …

Drug-Prescribing Patterns During Pregnancy In The Tertiary Care Hospitals Of Pakistan: A Cross Sectional Study., Dileep K Rohra, Nirmal Das, Syed I Azam, Nazir A Solangi, Zahida Memon, Abdul M Shaikh, Nusrat H Khan

Department of Biological & Biomedical Sciences

Background: The rationale for use of drugs during pregnancy requires a careful assessment as in addition to the mother, the health and life of her unborn child is also at stake. Information on the use of drugs during pregnancy is not available in Pakistan. The aim of this study was to evaluate the patterns of drug prescriptions to pregnant women in tertiary care hospitals of Pakistan. Methods: This was a cross-sectional study conducted at five tertiary care hospitals of Pakistan. Copies of outPatient medicinal prescriptions given to pregnant Patients attending the antenatal clinics were collected. The drugs were classified according …

Connexin Expression And Gap Junctional Coupling In Human Cumulus Cells: Contribution To Embryo Quality, Hong-Xing Wang, Dan Tong, Faraj El-Gehani, Francis R. Tekpetey, Gerald M. Kidder

Physiology and Pharmacology Publications

Gap junctional coupling among cumulus cells is important for oogenesis since its deficiency in mice leads to impaired folliculogenesis. Multiple connexins (Cx), the subunits of gap junction channels, have been found within ovarian follicles in several species but little is known about the connexins in human follicles. The aim of this study was to determine which connexins contribute to gap junctions in human cumulus cells and to explore the possible relationship between connexin expression and pregnancy outcome from in vitro fertilization (IVF). Cumulus cells were obtained from IVF patients undergoing intracytoplasmic sperm injection (ICSI). Connexin expression was examined by RT-PCR …

Bovine Oocytes And Early Embryos Express Staufen And Elavl Rna-Binding Proteins., M D Calder, P Madan, A J Watson

Obstetrics & Gynaecology Publications

RNA-binding proteins (RBP) influence RNA editing, localization, stability and translation and may contribute to oocyte developmental competence by regulating the stability and turnover of oogenetic mRNAs. The expression of Staufen 1 and 2 and ELAVL1, ELAVL2 RNA-binding proteins during cow early development was characterized. Cumulus-oocyte complexes were collected from slaughterhouse ovaries, matured, inseminated and subjected to embryo culture in vitro. Oocyte or preimplantation embryo pools were processed for RT-PCR and whole-mount immunofluorescence analysis of mRNA expression and protein distribution. STAU1 and STAU2 and ELAVL1 mRNAs and proteins were detected throughout cow preimplantation development from the germinal vesicle (GV) oocyte to …

Practices Regarding Diagnosis And Management Of Third And Fourth Degree Perineal Tears, Raheela Mohsin Rizvi, Nasreen Chaudhury

Department of Obstetrics & Gynaecology

Objective: To review our practice of diagnosing and managing third and fourth degree perineal tears.

Method: Retrospective case series conducted by reviewing medical records of all women having singleton, full term vaginal delivery at Aga Khan University Hospital, Karachi from November 1990 to October 2005.

Results: The frequency of obstetric anal sphincter injury (OASI) in our department was 0.5% (135) out of a total of 26,844 vaginal deliveries. Seventy five percent were nulliparous (102). Forceps delivery was performed in 86 patients out of 135 (63.7%). In only 28 patients (20.7%), the diagnostic criterion for classification of third degree tears was …

Cervical Screening And General Physical Examination Behaviors Of Women Exposed In Utero To Diethylstilbestrol, Elizabeth A. Camp, Ann L. Coker, Rebecca Troisi, Stanley J. Robboy, Kenneth L. Noeller, Karen J. Goodman, Linda T. Titus-Ernstoff, Elizabeth E. Hatch, Arthur L. Herbst, Raymond H. Kaufman, Ervin Adam

CRVAW Faculty Journal Articles

Objective. To estimate whether women exposed in utero to diethylstilbestrol (DES) report receiving more cervical and general physical examinations compared to unexposed women.

Materials and Methods. 1994 Diethylstilbestrol Adenosis cohort data are used to assess the degree of recommended compliance of cervical screenings found in 3,140 DES-exposed and 826 unexposed women. Participants were enrolled at 4 sites: Houston, Boston, Rochester, and Los Angeles. Logistic regression modeling was used to analyze mailed questionnaire data, which included reported frequency over the preceding 5 years (1990-1994) of Papanicolaou smears and general physical examinations.

Results. Diethylstilbestrol-exposed women exceeded the recommended frequency of Papanicolaou smear …

Obstetric Fistula In Mali, Chandler O’Connell

Independent Study Project (ISP) Collection

Obstetric fistula is arguably the most devastating result of childbirth complications, aside from maternal and neonatal mortality, the latter of which almost always occurs during deliveries which result in fistula. Defined as a hole in the birth canal, obstetric fistula is generally caused by prolonged obstructed labor in the absence of prompt medical intervention.20 This injury results in chronic incontinence through the vagina as well as many other secondary health consequences.33 Additionally, it is impossible to measure the extensive social and psychological burdens suffered by women because of this affliction. Despite the fact that obstetric fistula is both preventable and …

Laparoscopic Management Of An Ovarian Ectopic Pregnancy: Case Report, Y. Patel, Sikolia Wanyonyi, F. S. Rana

Obstetrics and Gynaecology, East Africa

Ovarian pregnancy is a rare variant of ectopic gestation.The diagnosis is often made at surgery and requires histological confirmation. The condition has not been reported locally and its diagnosis is easily missed. A case of an ovarian ectopic pregnancy in a 41year old para 1+ 1with secondary infertility is reported. The patient presented with lower abdominal pain and vaginal bleeding at six weeks gestation with a semm B-hCG of 79.12mlU/L. An ultrasound showed a complex left adnexal mass. She underwent a diagnostic and operative laparoscopy. A left oophorectomy was performed due to difficulty in achieving haemostasis.

Effectiveness Of Assigning Bi-Rads Category-3 To Breast Lesion With Respect To Follow-Up, Imrana Masroor

Department of Radiology

OBJECTIVE: To determine the effectiveness of assigning BI-RADS category-3 to breast lesion with respect to follow-up.STUDY DESIGN: A cohort study.

PLACE AND DURATION OF STUDY: Radiology Department, the Aga Khan University Hospital, Karachi, from January 2002 to December 2004.

PATIENTS AND METHODS: Women undergoing X-ray mammography and assigned BI-RADS category-3 and recommended short-term (6-monthly) follow-up were included. Out of these, 44 patients were lost to follow-up and were excluded from the study. The lesions that remained stable after short-term follow-up were recommended routine (annual) follow-up. Needle localization and open surgical biopsy was performed, if the lesion progressed or calcifications increased …

Como Mujer…Yo Decido: El Derecho De Salud Sexual Y Reproductiva En Mujeres Aymara De Putre, Chile, Alice Manos

Independent Study Project (ISP) Collection

The human right to sexual and reproductive health, as defined at the International United Nations Conference on Population and Development (Cairo, 1994), continues to be a pending issue in Chile. The sexual and reproductive health of indigenous women emerges as a crucial issue within this field due to Chile’s history of cultural ignorance and a dictatorial healthcare system. Studies of women’s sexual and reproductive healthcare within indigenous communities in Chile have focused on the Cosmo vision and traditional medicine of the Aymara due to their distinct concepts of reproduction, gender roles, and family planning. Studies conducted by Maria Soledad Pérez …

Intracytoplasmic Sperm Injection Outcome Using Ejaculated Sperm And Retrieved Sperm In Azoospermic Men., Tahira Naru, M. Nasir Sulaiman, Atiya Kidwai, M. Hammad Ather, Sana Waqar, Saadia Virk, Javed H Rizvi

Department of Obstetrics & Gynaecology

Introduction:We aimed to determine pregnancy and miscarriage rates following intracytoplasmic sperm injection (ICSI) cycles using retrieved epididymal and testicular sperm in azoospermic men and ejaculated sperm in oligospermic and normospermic men. Materials And
Methods: This retrospective study was carried out on 517 couples who underwent ICSI. They included 96 couples with azoospermia and 421 with oligospermia or normal sperm count in the male partner. Of the men with azoospermia, 69 underwent percutaneous epididymal aspiration (PESA) and 47 underwent testicular sperm extraction (TESE). In the 421 men with oligospermia or normal sperm count, ejaculated sperm was used for ICSI. The …

Social Factors Affecting Treatment Of Cervical Cancer: Ethical Issues And Policy Implications, Shannon N. Westin, Dan Bustillos, Jacalyn B. Gano, Margaret M. Fields, Ann L. Coker, Charlotte C. Sun, Lois M. Ramondetta

CRVAW Faculty Journal Articles

Health care in the United States has become a privilege rather than a right. Patients who have the greatest need are the ones most likely to be denied this privilege. Despite recent advances in disease detection and treatment, many patients do not receive even the bare minimum of care. The high complexity of the health care system in the setting of patients with low levels of health literacy significantly affects the ability to seek and receive treatment in a timely fashion. In addition, lack of insurance, transportation, and social support further complicate access to care. To truly provide a standard …

Preimplantation Embryo Programming: Transcription, Epigenetics, And Culture Environment., Veronique Duranthon, Andrew J Watson, Patrick Lonergan

Obstetrics & Gynaecology Publications

Preimplantation development directs the formation of an implantation- or attachment-competent embryo so that metabolic interactions with the uterus can occur, pregnancy can be initiated, and fetal development can be sustained. The preimplantation embryo exhibits a form of autonomous development fueled by products provided by the oocyte and also from activation of the embryo's genome. Despite this autonomy, the preimplantation embryo is highly influenced by factors in the external environment and in extreme situations, such as those presented by embryo culture or nuclear transfer, the ability of the embryo to adapt to the changing environmental conditions or chromatin to become reprogrammed …

Assessment Of Progress Of The Postabortion Care Initiative In Francophone Africa, Thierno Dieng, Mohamed Diadhiou, Nafissatou J. Diop, Youmane Niang Faye

Reproductive Health

The goals of this study were to assess the national situation concerning postabortion care (PAC) in six countries (Burkina Faso, Guinea, Mali, Niger, Senegal and Togo), including the process of introduction, integration and decentralization of PAC; the successes and obstacles in the process of introducing PAC; and recommended key steps to strengthen the introductory process. The study used two approaches: a comprehensive review of the introduction and institutionalization of PAC in the six countries, and a situation analysis of PAC services within each country.

Tampons And Menstrual Hygiene Products, Shibani Kanungo, Hatim A. Omar

Obstetrics and Gynecology Faculty Publications

No abstract provided.

Technical Assistance For Implementing Best Practices In The Asia And Near East Region, M.E. Khan, Sohini Roychowdhury, Mary Philip Sebastian, Sitanshu Sekhar Kar, Anurag Mishra, Vivek Sharma, G. Narayana, Bhawana Sharma, Nahla G. Abdel-Tawab, Ahmed Afifi

Reproductive Health

The Population Council's Frontiers in Reproductive Health (FRONTIERS) program offered technical assistance to any Asia Near East (ANE) country mission interested in funding adaptation of USAID‟s “best practices” in family planning or reproductive health. The ANE Bureau provided funding for the costs of FRONTIERS technical assistance. The overall objective of this study was to replicate and scale up "best practices" based on findings from FRONTIERS. The specific objectives were to institutionalize the Systematic Screening Instrument in the entire state of Uttarakhand, India; to strenghten emergency contraceptive pills service provision in Uttarakhand, India; and to enhance the use of Lactational Amenorrhea …

Using Operations Research To Enhance Delivery Of Postpartum/Postabortion Family Planning Services In The Arab Region, Frontiers In Reproductive Health

Reproductive Health

The FRONTIERS program in Cairo organized a two-and-half day workshop to share programmatic experiences and lessons learned in integrating family planning with service providers from Egypt, Jordan, Sudan, and Yemen representing mid-level program managers and researchers. It was held in 2008 in tandem with a national end-of-project seminar for stakeholders in Egypt. Participants emphasized the need to capture missed opportunities in antenatal, delivery, postpartum or postabortion care by providing family planning services in all encounters between women and the health care system. They also agreed on an overarching need for operations research in assisting policy makers and program managers in …

Sensitization Of Ovarian Cancer Cells To Cisplatin By Genistein: The Role Of Nf-Kappab, Leigh A. Solomon, Shadan Ali, Sanjeev Banerjee, Adnan R. Munkarah, Robert T. Morris, Fazlul H. Sarkar

Wayne State University Associated BioMed Central Scholarship

Abstract

Background

Platinum-resistance (PR) continues to be a major problem in the management of epithelial ovarian cancer (EOC). Response to various chemotherapeutic agents is poor in patients deemed PR. Genistein, a soy isoflavone has been shown to enhance the effect of chemotherapy in prostate and pancreatic cancer cells in vitro and in vivo by reversing chemo-resistance phenotype. The goal of this study was to investigate the effects of combination therapy with genistein and cisplatin as well as other cytotoxic conventional chemotherapeutic agents in platinum-sensitive (PS) and resistant EOC cells.

Methods

The PS human ovarian cancer cell line A2780 and its …

Human Papillomavirus (Hpv) Vaccine: Attitudes, Behaviors, And Beliefs Of At-Risk Women, Rosemary M. Caron, Elisabeth Kispert, Robert J. Mcgrath

Health Management & Policy

Cervical cancer is primarily caused by human papillomavirus (HPV) and is the second most common cause of cancer-related mortality among women. Female college students may be at risk for contracting HPV based on their sexual behavior. Following the release of the HPV vaccine, Gardasil®, this cross-sectional study was developed to (1) determine awareness of HPV and Gardasil®, (2) assess attitudes, behaviors, and beliefs about the HPV vaccine, and (3) identify information sources that female college students are accessing. Female college students voluntarily completed a self-administered questionnaire. Statistical analyses included descriptive statistics, Pearson’s correlations and paired sample t-tests. Sexually active respondents …

Situation Analysis Of The Integration Of Family Planning Services In Postpartum, Postabortion And Prevention Of Mother To Child Transmission Programs In Nicaragua, Freddy Solis, Ana Del Carmen Rojas, Gadea Adilia, M. Estela Rivero-Fuentes, Ricardo Vernon

Reproductive Health

Between September 2005 and April 2007, FRONTIERS and Alva, a Nicaraguan consulting firm, conducted a situation analysis of the provision and use of contraceptive services in postpartum, postabortion and prevention of mother-to-child transmission of HIV (PMTCT) programs. The project‘s objective was to assess the degree to which contraceptive services were linked to postpartum, postabortion and PMTCT services and if this allowed the programs to meet the contraceptive needs of their clients. The project proposes recommendations for improving the quality of these programs.

P1: Effect Of Age, Oestradiol Levels And Endometrial Thickness On Determining Success Of Frozen Embryo Transfers, Alfred Murage, Maybeth Jamieson, Robin Yates, Isabel Traynor, Helen Lyall, Scott Nelson

Obstetrics and Gynaecology, East Africa

Introduction: Frozen-thawed embryo transfer (FET) is a widely used technique, with replacement of embryos during natural menstrual cycles or in cycles constructed by exogenous steroids having similar outcomes in many series. Multiple factors have been proposed to have a positive influence on the success rate of FET, including increased endometrial thickness, younger maternal age and lower circulating oestradiol. The impact of these variables in the context of constructed cycles, using GnRH agonists to facilitate suppression of ovarian function prior to exogenous steroid administration, is not known. The aim of this study was to determine the predictive ability of these indices …

Constructing 'Health', Defining 'Choice': Legal And Policy Perspetives On The Post-Pgd Embryo In Four Jurisdictions, Estair Van Wagner, Roxanne Mykitiuk, Jeff Nisker

Articles & Book Chapters

Through Preimplantation Genetic Diagnosis, embryos created by IVF are selected for transfer to a woman based on particular characterisations, including the presence of genetic markers or a tissue match for a sibling. In this paper we examine the precise language used in the recent policy and regulatory documents of four jurisdictions (the United Kingdom, Australia, Canada and New Zealand) that in any way characterises the post-PGD embryo. We then explore the mutually constructed relationship between how that embryo is characterised and the purposes for which PGD is applied, as well as the types of uses to which the post-PGD embryo …

Sexual And Reproductive Health Needs Of Adolescents Perinatally Infected With Hiv In Uganda, Harriet Birungi, John Frank Mugisha, Juliana K. Nyombi, Francis Obare, Humphres Evelia, Hannington Nyinkavu

Reproductive Health

In Uganda, HIV/AIDS treatment, care and support programs are still organized around either adult or pediatric care and fail to adequately address the needs of adolescents, specifically perinatally-infected adolescents. This study, implemented jointly by the Population Council's Frontiers in Reproductive Health (FRONTIERS) program and the AIDS Support Organization (TASO), aimed to better understand the reproductive health and sexuality of this population group, and to identify anxieties or fears they have around entering social stages of adulthood. This study confirms that wide programmatic gaps exist in addressing the sexual and reproductive health needs of young people perinatally infected with HIV who …