Medicine and Health Sciences Commons^™

A Knowledge, Attitudes, And Practice Survey Among Obstetrician-Gynaecologists On Intimate Partner Violence In Flanders, Belgium, Kristien Roelens, Hans Verstraelen, Kathia Van Egmond, Marleen Temmerman

Obstetrics and Gynaecology, East Africa

Background: Intimate partner violence (IPV) has consistently been found to afflict one in twenty pregnant women and is therefore considered a leading cause of physical injury, mental illness and adverse pregnancy outcome. A general antenatal screening policy has been advocated, though compliance with such guidelines tends to be low. We therefore attempted to identify potential barriers to IPV screening in a context where no guidelines have been instigated yet.

Methods: Questionnaire-based Knowledge, Attitude, and Practice survey among obstetrician-gynaecologists in Flanders, Belgium (n = 478).

Results: The response rate was 52.1% (249/478). Gynaecologists prove rather unfamiliar with IPV and therefore largely …

Antibiotic Susceptibility Of Atopobium Vaginae, Ellen De Backer, Rita Verhelst, Hans Verstraelen, Geert Claeys, Gerda Verschraegen, Marleen Temmerman, Mario Vaneechoutte

Obstetrics and Gynaecology, East Africa

Background: Previous studies have indicated that a recently described anaerobic bacterium, Atopobium vaginae is associated with bacterial vaginosis (BV). Thus far the four isolates of this fastidious micro-organism were found to be highly resistant to metronidazole and susceptible for clindamycin, two antibiotics preferred for the treatment of BV.

Methods: Nine strains of Atopobium vaginae, four strains of Gardnerella vaginalis, two strains of Lactobacillus iners and one strain each of Bifidobacterium breve, B. longum, L. crispatus, L. gasseri and L. jensenii were tested against 15 antimicrobial agents using the Etest.

Results: All nine strains of A. vaginae were highly resistant to …

Caesarian Section Rates And Perinatal Outcome At The Aga Khan University Hospital, Nairobi, Sikolia Wanyonyi, Evan Sequeira, Timona Obura

Obstetrics and Gynaecology, East Africa

Background: There has been a persistent rise in the rate of Caesarean sections over the years.Whether this rise is the cause of the decline in infant mortality and improved neonatal outcome still remains debatable.

Objective: To compare the Caesarian section rate and the perinatal outcome at the Aga Khan University Hospital for the years 2001and 2004.

Design: Retrospective study.

Setting: The Aga Khan University Hospital, Nairobi.

Main outcome measures: The total Caesarian section rates, their indication and the perinatal outcome. Results: The overall Caesarian section rate was 20.4% in 1996,25.9% in 2001and 38.1% in 2004.The rate among patients managed by …

Women’S Health In Developing Countries, Javed Rizvi, Nadeem F. Zuberi

Department of Obstetrics & Gynaecology

Healthcare priorities are different in developing and developed countries. A more effective resource allocation, complemented by efforts to implement only those practices that are effective, should be a priority for improving reproductive health services in developing countries. A large burden of gynaecological disease exists in developing countries and it is difficult to envisage serious reforms and improvements without an increase in public-sector spending. However, communities themselves could assume some responsibility for women's health in ways that prioritize women's own perceptions and primary needs. In this chapter we have compiled existing evidence regarding various gynaecological problems faced by women in developing …

Obstetric Cerebral Venous Thrombosis, Bhojo Khealani, Uzma U Mapari, Rozina Sikandar Sultanali

Department of Obstetrics & Gynaecology

Pregnancy and puerperium are most prevalent prothrombotic states leading to cerebral venous thrombosis. Likelihood of stroke to be of venous origin is greater in stroke associated with pregnancy compared to stroke unrelated to pregnancy. Pregnancy induces several changes in coagulation system, which persists at least during early puerperium, rendering it a prothrombotic state. Hypercoaguability worsens further after delivery as a result of volume depletion and trauma. During puerperium additional risk factors include infection and instrumental delivery or Caesarean section. The management follows general rules as for the venous thrombosis unrelated to pregnancy, however the prognosis is different.

Gnrh Agonist And Antagonist: Options For Endometriosis Pain Treatment , Frances R. Batzer

Department of Obstetrics and Gynecology Faculty Papers

Basic science research into the mechanism of the development of endometriosis, its persistence and resulting pain has begun to improve our understanding of how various therapeutic options work. While none of the available treatments resolves the underlying disease process, there are a growing number of alternatives. One of the more recent classes of medical options includes the GnRH agonist and antagonists. While at present this class of medical options is the most expensive and involved in implementation, they prove invaluable in terms of offering an aggressive, successful alternative for many patients. Furthermore, they may act directly on endometrial lesions in …

Frequency And Characteristics Of Breast Lymphomas Presenting To A Tertiary Care Hospital, Pakistan, Nausheen Yaqoob, Shahid Pervez, Naila Kayani, Rashida Ahmed, Zubair Ahmed, Sheema Hasan

Department of Pathology and Laboratory Medicine

Objective: To assess the relative frequency of (primary and secondary) mammary lymphomas presenting to a tertiary care hospital, Pakistan and its categorization according to WHO classification of lymphoid neoplasms.

Methods: All NHLs (nodal and extra nodal) diagnosed in the section of histopathology during 1992-2004 were retrieved and reviewed. All patients (n=30) diagnosed with lymphomatous involvement of the breast were selected. Distinction between primary and secondary breast lymphomas was not made owing to lack of availability of clinical information.

Results: A total of 5637 breast malignancies were diagnosed in our department during the study period of 10 years and the total …

Traditional Practices And Governmental Responsibilities: An Investigation Into The Evolving Partnership Between Indigenous Brazilian Midwives And State-Provided Maternal Healthcare Services, Caitlin Canfield

Independent Study Project (ISP) Collection

Traditional midwives play important roles in the provision of maternal healthcare services in developing countries. Especially in rural, marginalized communities, traditional midwives help to provide obstetric care when local governmental health services fail to do so. The healthcare provision that traditional midwives “should” undertake is a subject debated by public health and development policy makers who seek to reduce maternal mortality rates and improve maternal health in rural communities in developing countries. This study examines the practices of traditional midwives in indigenous Tupinambá communities located in Southern Bahia, Brazil. It seeks to define the contemporary role of traditional midwives within …

Social Environment And Depression Among Pregnant Women In Urban Areas Of Pakistan: Importance Of Social Relations., Ambreen Kazi, Zafar Fatmi, Juanita Hatcher, Muhammad Masood Kadir, Unaiza Niaz, Gail A. Wasserman

Community Health Sciences

Aspects of the social environment, including social conditions (socio-economic status, household situations, chronic illnesses) and social relations (attitude and behaviors of relations) are major determinants of depression among women. This study evaluates the relative power of social relations and social conditions in predicting depression among pregnant women in Pakistan. In the qualitative phase of the study, social environmental determinants were identified through literature search, and experts' opinions from psychologists, psychiatrists, gynecologists, sociologists and researchers. Along with this, 79 in-depth interviews were conducted with pregnant women drawn from six hospitals (public and private) and two communities in Karachi, Pakistan. Identified determinants …

Right Ectopic Gestation Following In Vitro Fertilisation: Case Report, R. B. Parkar, Yamal Patel

Obstetrics and Gynaecology, East Africa

The management of ectopic gestation has in recent years transformed from the normally accepted laparotomy to the laparoscopic approach. The objective of this case report is to describe a rare occurrence of an ectopic gestation following in vitro fertilisation procedure.A 35-year-old para 0 + 0, presented with lower abdominal pain and per vaginal bleeding six weeks after an in vitro fertilisation was done in South Africa. The patient was admitted with severe lower abdominal pain and per vaginal bleeding at six weeks gestation following an in vitro fertilisation procedure. She had undergone an "evacuation" one-week prior to this episode due …

The Objective Structured Assessment Of Technical Skills And The Acgme Competencies, Carmen J. Sultana

Department of Obstetrics and Gynecology Faculty Papers

Objective structured assessments of technical skills (OSATS) are structured operating room or laboratory assessment of residents' surgical skills. They can be used to evaluate and teach both basic and complex skills to residents. The literature on their use is reviewed. Future use of virtual reality simulators is discussed.

Effects Of Sapk/Jnk Inhibitors On Preimplantation Mouse Embryo Development Are Influenced Greatly By The Amount Of Stress Induced By The Media, Yufen Xie, E. E. Puscheck, D. A. Rappolee

Department of Obstetrics and Gynecology Research Publications

Stress-activated protein kinase/c-Jun kinase (SAPK/JNK) is thought to be necessary for preimplantation embryonic development (Maekawa et al., 2005). However, media increases SAPK/JNK phosphorylation and these levels negatively correlate with embryonic development (Wang et al., 2005). Culture-induced stress could confuse analysis of the role of SAPK in development. In this study, we tested how SAPK/JNK inhibitors influence embryonic development in optimal and non-optimal media and define the contribution of cell survival and proliferation to the embryonic response to these media. SAPK/JNK inhibitors retard embryonic development in suboptimal Ham’s F10, but improve development in optimal potassium (K+) simplex optimized media (KSOM) +AA. …

Membrane Sweeping At Initiation Of Formal Labor Induction - A Randomized Controlled Trial, Siti Zawiah Omar

Siti Zawiah Omar

OBJECTIVE: To determine the benefit of membrane rate, reduced oxytocic drug use, shortened induction to sweeping at initiation of labor induction in conjunction delivery interval, and improved patient satisfaction. with formal methods of labor induction. METHODS: Two hundred seventy-four women at term with a singleton fetus in cephalic presentation and intact membranes were randomly assigned to receive membrane sweeping or no membrane sweeping at initiation of formal labor induction with either dinoprostone pessary or amniotomy. Outcome measures included mode of delivery, induction-to-delivery interval, dinosprostone dose, any oxytocin use and duration of oxytocin use in labor, visual analog score for pain …

American College Of Obstetricians And Gynecologists Practice Bulletins: An Overview, Suneet P. Chauhan, Vincenzo Berghella, Maureen Sanderson, Everett F. Magann, John C. Morrison

Department of Obstetrics and Gynecology Faculty Papers

Objective The purpose of this study was to review the American College of Obstetricians and Gynecologists practices bulletins to quantify the type of recommendations and references and determining whether there are any differences between obstetric and gynecologic bulletins. Study design All practice bulletins published from June 1998 to December 2004 were reviewed. Odds ratios and 95% confidence intervals were calculated. Results The 55 practice bulletins contained 438 recommendations of which 29% are level A, 33% level B, and 38% level C. The 55 bulletins cite 3953 references of which 17% are level I, 46% level II, 34% level III, and …

Maternal And Fetal Complications Of Antiphospholipid Syndrome: A Case Report With Long-Term Follow-Up, Tahira Naru, Mohammad Khurshid, Zafar Nazir

Department of Obstetrics & Gynaecology

We report a case of a 26- year old woman having antiphospholipid syndrome in pregnancy with long-term follow up. She presented with recurrent miscarriages, venous thrombosis, avascular necrosis of femoral head, mid-cerebral artery infarction and skin ulcers. Antiphospholipid syndrome is a recognized disorder of pregnancy. Diagnosis requires a high index of suspicion when evaluating women with recurrent pregnancy losses and vascular thrombosis. A low dose aspirin combined with heparin can reduce morbidity and improves the pregnancy outcome.

Na+/K+ -Atpase Regulates Tight Junction Formation And Function During Mouse Preimplantation Development., Michelle I Violette, Pavneesh Madan, Andrew J Watson

Obstetrics & Gynaecology Publications

Research applied to the early embryo is required to effectively treat human infertility and to understand the primary mechanisms controlling development to the blastocyst stage. The present study investigated whether the Na(+)/K(+)-ATPase regulates tight junction formation and function during blastocyst formation. To investigate this hypothesis, three experimental series were conducted. The first experiments defined the optimal dose and treatment time intervals for ouabain (a potent and specific inhibitor of the Na(+)/K(+)-ATPase) treatment. The results demonstrated that mouse embryos maintained a normal development to the blastocyst stage following a 6-h ouabain treatment. The second experiments investigated the effects of ouabain treatment …

Guide To A Successful Pregnancy: A Resource Manual For Pregnant And Parenting Young Women In Las Vegas, Nevada Institute For Children's Research And Policy Reports

Nevada Institute for Children's Research and Policy Reports

A Guide to a Successful Pregnancy.

• Are you Pregnant? Taking a pregnancy test
• First steps of Pregnancy: Options of pregnancy, health plans, obtaining medical care such as a doctor
• Months 1, 2, 3: Maintaining a healthy diet, what you should stay away from, exercise, symptoms of danger, and normal symptoms of pregnancy
• Months 4, 5, 6: Following a routine, classes available during pregnancy, normal pregnancy symptoms
• Months 7, 8, 9: Following a routine, normal pregnancy symptoms
• Labor and Delivery: Symptoms of labor, symptoms of danger
• Parenting: Normal symptoms after birth, Routine to follow to return to normal state, Breast feeding …

The Accuracy Of Ultrasound In The Diagnosis Of Congenital Abnormalities, Shama Munim, Salva Nadeem, Nadya Ali Khuwaja

Department of Obstetrics & Gynaecology

Objective: To determine the accuracy of ultrasound in the diagnosis of congenital abnormalities at the Aga Khan University Hospital, Karachi.
Methods: The data of congenital abnormalities was obtained from the obstetrical database and medical records of all cases complicated by congenital abnormalities, delivering from January 2001 to December 2003 and was reviewed. Antenatal ultrasounds had been performed by operators with different level of experience. In addition this data was retrieved from the termination and Congenital anomaly register. A structured data collection form was used to collect information of different variables of interest.
Results: Congenital abnormalities, complicated 2.8% (n=170), of all …

Massive Primary Postpartum Haemorrhage: Setting Up Standards Of Care, Lumaan Sheikh, Nadeem F. Zuberi, Rubab Riaz, Javed H. Rizvi

Department of Obstetrics & Gynaecology

Objective: To review practice of massive primary postpartum haemorrhage management and develop a protocol.
Methods: Cross-sectional study conducted at the Department of Obstetrics and Gynaecology at Aga Khan University Hospital, Karachi between January 1, 2003 and July 31, 2004. Women with primary postpartum haemorrhage and had blood loss >1000ml were included in the study. Medical record files of these women were reviewed for maternal mortality and morbidities which included mode of delivery, possible cause of postpartum haemorrhage, supportive, medical and surgical interventions.
Results: Approximately 3% (140/4881) of women had primary postpartum haemorrhage. 'Near miss' cases with blood loss …

Cervical Cancer Survival By Socioeconomic Status, Race/Ethnicity, And Place Of Residence In Texas, 1995–2001, Katherine S. Eggleston, Ann L. Coker, Melanie Williams, Guillermo Tortolero-Luna, Jeanne B. Martin, Susan R. Tortolero

CRVAW Faculty Journal Articles

Objective: The current study explored whether socioeconomic status (SES), race/ethnicity, and rural residence may be linked to poorer cervical cancer survival by stage at diagnosis.

Methods: Data from 7,237 cervical cancer cases reported to the Texas Cancer Registry from 1995–2001 were used to address the association by stage at diagnosis and cause of death. Zip code-level census data were used to classify residence and to develop a composite variable for SES. Multilevel Cox proportional hazards modeling was used to estimate hazard ratios

(HR) and 95% confidence intervals (CI).

Results: Late stage at diagnosis was a strong predictor …

In Our Own Hands: Swaa-Ghana Champions The Female Condom, Kathleen Cravero, Michelle Skaer, Victoria Ebin, Martha Brady

Poverty, Gender, and Youth

This issue of Quality/Calidad/Qualité describes the vital role played by the Ghana branch of the Society for Women and AIDS in Africa (SWAA) in introducing the female condom, the only female-controlled method for protection from HIV. By addressing issues of gender inequity and communication within relationships, SWAA used the female condom to empower women to regain control of their bodies. Also in this issue are profiles of three other approaches to programming for the female condom from Brazil, South Africa, and Zimbabwe.

Reproductive Health Update Trainings For Health Workers In North Eastern Province, Garissa, Kenya Ministry Of Health, Population Council

Reproductive Health

The Somali community living in Kenya has practiced the severest form of female genital mutilation/cutting (FGM/C), infibulation, for centuries. To understand the context within which the practice takes place, and how its complications are managed, FRONTIERS undertook a diagnostic study in North Eastern Province and in the Eastleigh area of Nairobi. The study found that the health system is ill equipped to serve women who have been cut, and particularly infibulated women who are pregnant and delivering, stemming from an overall weakness in the availability and quality of maternal and neonatal heath services. Specific recommendations could strengthen these services so …

Strategies For Encouraging The Abandonment Of Female Genital Cutting In West Africa: Experiences From Senegal, Burkina Faso, And Mali, Nafissatou J. Diop, Ian Askew

Reproductive Health

This article explores efforts to encourage abandonment of female genital cutting (FGC) in Senegal, Burkina Faso, and Mali. The strategy of encouraging traditional practitioners to stop performing FGC is not effective as community-level support for the practice remains high. Training health staff significantly improved healthcare providers' levels of knowledge about FGC and its complications. Consequently, it was recommended that such training be incorporated into preservice medical training. The use of community-based strategies like the Village Education Program (VEP) showed the most promise, as their multifaceted approach addresses knowledge, attitudes, actions, and communal support in an integrated manner. The way forward …

Analyse De L'Evolution De La Pratique De L'Excision Au Burkina Faso: L'Environment Institutionel, Politique Et Programmatique De La Lutte Contre La Pratique De L'Excision, Nafissatou J. Diop, Zakari Congo, Aina Ouedraogo, Alphosine Sawadogo, Lydia Saloucou, Ida Tamini

Reproductive Health

La présente analyse du projet Frontiers du Population Council fait un tour historique des événements majeurs de la lutte contre la pratique de l’excision au Burkina Faso avant d’aborder les conventions internationales auxquelles le pays a adhéré ainsi que les textes nationaux adoptés en ce qui concerne les droits de l’homme, spécifiquement le droit des femmes et des enfants. Elle analyse également l’application de la loi à travers l’évolution des cas de condamnation depuis l’adoption de la loi. Enfin, elle s’intéressera à quelques programmes d’intervention mis en place en identifiant les acquis et les limites. Ce travail fait partie d’une …

Multiple Pregnancies: Determining Chorionicity And Amnionicity, Traci B. Fox

Department of Radiologic Sciences Faculty Papers

The determination of chorionicity and amnionicity in multiple gestations is one that confounds many in the medical field. The importance of diagnosing the type of multiple gestation cannot be overstated. This is intended to be an introductory primer and refresher to chorionicity and amnionicity. We will first examine what determines mono- versus dichorionic twinning including zygosity and cleavage of the zygote.

Coping Processes Of Couples Experiencing Infertility, Brennan Peterson, Christopher R. Newton, Karen H. Rosen, Robert S. Shulman

Psychology Faculty Articles and Research

This study explored the coping processes of couples experiencing infertility. Participants included 420 couples referred for advanced reproductive treatments. Couples were divided into groups based on the frequency of their use of eight coping strategies. Findings suggest that coping processes, which are beneficial to individuals, may be problematic for one's partner. Couples where men used high amounts of distancing, while their partner used low amounts of distancing, reported higher levels of distress when compared to couples in the other groups. Conversely, couples with women who used high amounts of self-controlling coping, when paired with men who used low amounts of …

Gender Differences In How Men And Women Referred With In Vitro Fertilization (Ivf) Cope With Infertility Stress, Brennan Peterson, C. R. Newton, K. H. Rosen, G. E. Skaggs

Psychology Faculty Articles and Research

Men and women use a variety of coping strategies to manage stress associated with infertility. While previous research has helped us understand these coping processes, questions remain about gender differences in coping and the nature of the relationship between coping and specific types of infertility stress. Methods: This study examined the coping behaviors of 1,026 (520 women, 506 men) consecutively referred patients at a Universityaffiliated teaching hospital. Participants completed the Ways of Coping Questionnaire, Fertility Problem Inventory, and the Dyadic Adjustment Scale. Results: Women used proportionately greater amounts of confrontive coping, accepting responsibility, seeking social support, and escape/avoidance when compared …

Breast Cancer Risk Factor Knowledge Among Nurses In Teaching Hospitals Of Karachi, Pakistan: A Cross-Sectional Study, Faiza Ahmed, Sadia Mahmud, Juanita Hatcher, Shaista M. Khan

Community Health Sciences

Background: Breast cancer is the most common cancer among women in both the developed and the developing world. The incidence of breast cancer in Karachi, Pakistan is 69.1 per 100,000 with breast cancer presentation in stages III and IV being common (>or= 50%). The most pragmatic solution to early detection lies in breast cancer education of women. Nurses constitute a special group having characteristics most suited for disseminating breast cancer information to the women. We assessed the level of knowledge of breast cancer risk factors among registered female nurses in teaching hospitals of Karachi. We also identified whether selected …