Medical Specialties Commons^™

Perspectives On The Practice Of Vaginal Birth After Caesarean Section In East Africa, Sikolia Wanyonyi, Abraham Mukaindo, William Stones

Obstetrics and Gynaecology, East Africa

Background: The increasing Caesarean section rates being observed in most facilities will ultimately result in a larger proportion of women with previous scar. Choices need to be made by both the patient and the health worker between attempted vaginal birth after Caesarean section (VBAC) and Elective Repeat Caesarean section (ERCS). Both practices are associated with perinatal risks and benefits that call for certain objectivity and prudence in decision making especially where resources are scarce.

Objective: To determine perceptions on the practice of vaginal birth after Caesarean section among maternity service providers in East Africa.

Design: A semi-qualitative cross sectional survey …

The Utility Of Clinical Care Pathways In Determining Perinatal Outcomes For Women With One Previous Caesarean Section; A Retrospective Service Evaluation, Sikolia Wanyonyi, Robinson N. Karuga

Obstetrics and Gynaecology, East Africa

Background: The rising rates of primary caesarean section have resulted in a larger obstetric population with scarred uteri. Subsequent pregnancies in these women are risk-prone and may complicate. Besides ensuring standardised management, care pathways could be used to evaluate for perinatal outcomes in these high risk pregnancies. We aim to demonstrate the use of a care pathway for vaginal birth after caesarean section as a service evaluation tool to determine perinatal outcomes.

Methods: A retrospective service evaluation by review of delivery case notes and records was undertaken at the Aga Khan University Hospital, Nairobi, Kenya between January 2008 and December …

Synthesis, Antiviral And Contraceptive Activities Of Nucleoside-Sodium Cellulose Sulfate Acetate And Succinate Conjugates, Hitesh K. Agarwal, Anil Kumar, Gustavo F. Doncel, Keykavous Parang

Pharmacy Faculty Articles and Research

Chemical conjugates between sodium cellulose sulfate (CS), displaying contraceptive and HIV-entry inhibiting properties, and nucleoside reverse transcriptase inhibitors (NRTIs) (3′-azido-2′,3′-dideoxythymidine (AZT), 3′-fluoro-2′,3′-dideoxythymidine (FLT), or 2',3'-dideoxy-3'-thiacytidine (3TC)) were designed to simultaneously provide contraceptive and anti-HIV activity. Two linkers, acetate and succinate, were used to conjugate the nucleoside analogs with CS. The conjugates containing cellulose sulfate-acetate (CSA) (e.g., AZT-CSA and FLT-CSA) were found to be more potent than CS and other conjugates (e.g., AZT-succinate-CS, and FLT-succinate-CS). The presence of both sulfate and the acetate groups on cellulose were critical for generating maximum anti-HIV activity. In addition to showing equal potency against wild-type …

Assessing Abortion-Related Experiences And Needs In Four Districts Of Maharashtra And Rajasthan, 2006, Shireen J. Jejeebhoy, A.J. Francis Zavier, Shveta Kalyanwala

Poverty, Gender, and Youth

Recognizing the urgent need to enable rural women to acquire accessible and high-quality abortion services in India, a consortium of organizations—including the Population Council—has come together with the goal of increasing access to legal, safe, and comprehensive abortion services, including postabortion family planning, in the public health system, especially among the rural poor. One of its key activities was to develop a comprehensive and evidence-based abortion care model suitable for rural women. The aim of this report is to shed light on community-level perspectives about abortion services and probe the experiences of women who had undergone abortion, to better understand …

Radical Hysterectomy With Pelvic Lymphadenectomy: Indications, Technique, And Complications, Rachel A. Ware, John R. Van Nagell Jr.

Obstetrics and Gynecology Faculty Publications

Radical hysterectomy with pelvic lymphadenectomy remains the treatment of choice for women with Stages IA₂ and IB₁carcinoma of the cervix, and selected patients with Stage II endometrial cancer. Improvement in surgical techniqe, administration of prophylactic antibiotics, thromboemolic prophylaxis, and advances in critical care medicine have resulted in lower operative morbidity associated with this procedure. Major urinary tract complications such as ureteral injury or vesico-vaginal fistula are now extremely rare (< 1%). Five-year survival rates following this procedure vary according to a number of clinical and histologic variables, and may be as high as 90% in women without lymph node metastases.

Increasing Postpartum Contraception In Rural Uttar Pradesh: Implications For Behavior Change Communication, Population Council

Reproductive Health

The Population Council conducted a formative study in rural Uttar Pradesh, India to assess the level of adoption of postpartum contraception for spacing among low parity women, identify the facilitating factors and barriers to the adoption of this target behavior, and identify programmatic and behavior change communications (BCC) initiatives that could accelerate the adoption of postpartum contraception for spacing and improve the service delivery system, if required, to facilitate the process. Barriers included low awareness of consequences of closely spaced births, misconceptions about contraceptive methods, lack of counseling by health workers, reluctance to include husbands, and programmatic emphasis on limiting …

Mainstreaming Emergency Contraception Pills In Kenya, Jill Keesbury, Monica Wanjiru, Katherine Maina

Reproductive Health

To improve access to emergency contraception (ECP) and ensure that adequate information is provided to all users, the Kenyan Ministry of Public Health and Sanitation, the Population Council, and Population Services International-Kenya undertook a three-year effort to mainstream ECP in Kenya. This brief presents the results of this initiative and discusses strategies for further strengthening ECP provision. Kenya has emerged as a leader in ECP programming in the region and has demonstrated that it is possible to strengthen ECP services in both the public and private sectors while at the same time increasing public awareness, knowledge, and use of the …

Assessing The Feasibility Of Home Administration Of Misoprostol In The Prevention Of Postpartum Hemorrhage In Rural Pakistan, Ali M. Mir, Abdul Wajid, Sadaf Gull

Reproductive Health

This report details an operations research project carried out by the Population Council as part of the Pakistan Initiative for Mothers and Newborns. The overall goal of the project was to test the feasibility of administering misoprostol for the prevention of postpartum hemorrhage (PPH) in a home setting through community‐based healthcare providers, including traditional birth attendants (TBAs), or family members, in two districts of Pakistan. Furthermore, it aimed to identify common side effects of misoprostol and determine the reduction in demand for referral due to PPH after oral ingestion of misoprostol. The results provide a useful addition to the literature …

The Pregnancy Cycle Approach To Safe Motherhood, Saumya Ramarao, Sarah Raifman

Reproductive Health

The Population Council's Reproductive Health program partnered with the Maternal Health Task Force (MHTF), the Partnership for Maternal, Newborn and Child Health (PMNCH), and the PAC Consortium, to address the UN Millenium Development Goal of improving maternal health, and reducing child mortality. Specifically this brief examines the pregnancy cycle approach whereby women’s needs from facilitating a desired pregnancy to successful parturition are addressed in a range of settings—home, community and health facility. This brief covers the different stages including abortion and postabortion care, antenatal care, delivery, and postpartum and beyond.

Introducing And Pilot-Testing The National Guidelines On Integrating The Management Of Stis/Rtis Into Reproductive Health Settings In Kenya, Wilson Liambila, Saiqa Mullick, Ian Askew, Nathalie Broutet, Bartilol Kigen, Cosmas Mutunga, Daniel Sande, Nimrod Garama, Benjamin Tsofa, Christine Awuor, Ibrahim Mohammed

Reproductive Health

This report evaluated a project in ten Kenyan health facilities. It examined the feasibility, acceptability and effect of introducing reproductive tract infection and sexually transmitted infection (RTI/STI) guidelines on the quality of care provided, and the incremental costs of integrating these services into existing reproductive health (RH) services; it also disseminated the results and lessons learnt within Kenya. Overall, the results showed that integration of activities to screen for and manage STIs/RTIs into RH services is feasible, acceptable to clients and providers, and effective in improving the range and quality of services offered to clients.

Emergency Contraception: Idea To Program, Saumya Ramarao, John Townsend, Sarah Raifman

Reproductive Health

This report summarizes the role of the Population Council in generating evidence, providing technical leadership, and demonstrating at scale that emergency contraception (EC) can be easily integrated into national family planning programs and other reproductive health services. Since the 1990s, the Population Council, along with other partners, has contributed to the changes seen in the provision and availability of EC, now available in over 140 countries around the world. While much progress has been made in the campaign for access to EC, the Council is committed to improving existing methods of service delivery and to leading advocacy efforts and research …

Community Mobilization For Postabortion Care In Kenya: Baseline Evaluation Report, Chi-Chi Undie, Saumya Ramarao

Reproductive Health

Maternal health complications, including those arising from unsafe abortion and miscarriage, are a leading cause of morbidity among women in Kenya. These realities necessitate interventions to prevent unintended or unwanted pregnancies and to ensure access to quality care for women with postabortion complications. In response to this need, the RESPOND Project designed an intervention package aimed at increasing awareness and use of postabortion care (PAC) services and improving family planning, reproductive health, and maternal health outcomes. As part of the intervention, RESPOND works with districts and communities to: strengthen service delivery points to provide PAC services; conduct community mobilization to …

Prepubertal Office Gynecology, Hatim A. Omar, Wendy Jackson, Amit M. Deokar

Pediatrics Faculty Publications

Clinical presentation and complaints of the vulvo-vaginal area are quite prevalent in the pediatric population and the primary care providers the first individuals called upon to evaluate the patients. One of the most difficult tasks for an individual that rarely performs the genitourinary examination is performing one on a pediatric patient. This chapter has been written to aid the primary care provider in successful examination, documentation and diagnosis.

Ovarian Tumors In Children And Adolescents, Linah Al-Alem, Amit M. Deokar, Rebecca Timme, Hatim A. Omar

Pediatrics Faculty Publications

Ovarian tumors are uncommon in the child and adolescent population, but given that cancer is a leading cause of death even in this age group it is important for the general practice physician to be aware of the signs and symptoms. These can include abdominal pain, increased abdominal girth, a palpable mass on pelvic or abdominal exam, nausea and vomiting, decreased appetite, weight loss, constipation, back pain, leg cramps, dyspareunia, urinary symptoms, abnormal uterine bleeding, and ascites, to name a few. The types of gynecological tumors seen in adults are also seen in children except in differing frequencies. The most …

Contraception, Donald E. Greydanus, Hatim A. Omar, Lyubov A. Matytsina, Artemis Tsitsika

Pediatrics Faculty Publications

Contraception is an important concept for sexually active adolescent females to understand who do not wish to become pregnant. This chapter reviews important, effective, and safe contraceptive methods that can be used by female youth. These methods include abstinence, oral contraception, contraceptive patch. mini-pills, emergency contraceptives, injectable contraception (DMPA), implants (lmplanon), intravaginal ring, vaginal barrier contraceptives, intrauterine devices, and natural family planning. Promotion of sexual responsibility should be the charge of health professionals caring for adolescents and young adults.

Menstrual Disorders In Adolescent Females, Donald E. Greydanus, Hatim A. Omar, Artemis Tsitsika, Dilip R. Patel

Pediatrics Faculty Publications

Onset of menstruation (i.e., menarche) is a determining event of the adolescent female signifying the progress of puberty, which in the majotity of cases is visibly initiated with thelarche (onset of breast development or breast buds). Menarche usually occurs during the earlier time of the second decade of life and ends with menopause, typically in the 5th decade of life. The adolescent can present with a wide variety of menstrual dilemmas and disorders which will be discussed in this chapter.

Prenatal Beta-Endorphin As An Early Predictor Of Postpartum Depressive Symptoms In Euthymic Women, Ilona S. Yim, Laura M. Glynn, Christine Dunkel Schetter, Calvin J. Hobel, Aleksandra Chicz-Demet, Curt A. Sandman

Psychology Faculty Articles and Research

After delivery, many women experience symptoms of postpartum depression (PPD), and early identification of women at risk is therefore important. The opioid peptide [beta]-endorphin has been implicated in non-puerperal depression but its role in the development of PPD is unknown.

The Nonpsychoactive Cannabinoid Cannabidiol Inhibits 5-Hydroxytryptamine3a Receptor-Mediated Currents In Xenopus Laevis Oocytes, Keun-Hang Susan Yang, Sehamuddin Galadari, Dmytro Isaev, Georg Petroianu, Toni S. Shippenberg, Murat Oz

Mathematics, Physics, and Computer Science Faculty Articles and Research

The effect of the plant-derived nonpsychotropic cannabinoid, cannabidiol (CBD), on the function of hydroxytryptamine (5-HT)3A receptors expressed in Xenopus laevis oocytes was investigated using two-electrode voltage-clamp techniques. CBD reversibly inhibited 5-HT (1 μM)-evoked currents in a concentration-dependent manner (IC50 = 0.6 μM). CBD (1 μM) did not alter specific binding of the 5-HT3A antagonist [3H]3-(5-methyl-1H-imidazol-4-yl)-1-(1-methylindol-3-yl)propan-1-one (GR65630), in oocytes expressing 5-HT3A receptors. In the presence of 1 μM CBD, the maximal 5-HT-induced currents were also inhibited. The EC50 values were 1.2 and 1.4 μM, in the absence and presence of CBD, indicating that CBD acts as a noncompetitive antagonist of 5-HT3 …

Primary And Preventive Care In Ob-Gyn Interventions In Assessment And Documentation, Kimberly Mcgill Md, Joseph Patruno Md

Department of Obstetrics & Gynecology

No abstract provided.

Rare Diagnosis Of Vaginal Atresia In A Patient With Vater Syndrome And Primary Amenorrhea, Doreen Kyere Md, Mph, Rochelle Steiner-Friel Md, Sarah Stevens Md, Mph

Department of Obstetrics & Gynecology

No abstract provided.

Cytokine Inflammatory Score Predicts Pregnancy Outcome In Women With Midtrimester Short Cervix, Orion Rust Md, Daniel G. Kiefer Md, Sean M. Keeler Md, Morgan R. Peltier Phd, Jolene C. Muscat Md, Nazeeh Hanna Md, Anthony M. Vintzileos Md

Department of Obstetrics & Gynecology

No abstract provided.

Is Fetal Fibronectin (Ffn) A Markerof Intra-Amniotic Inflammation In Patients With Midtrimester Short Cervix?, Orion Rust Md, Daniel G. Kiefer Md, Sean M. Keeler Md, Michael Demishev Md, Jolene C. Muscat Md, Eran Bornstein Md, Nazeeh Hanna Md

Department of Obstetrics & Gynecology

No abstract provided.

Communalism Predicts Prenatal Affect, Stress, And Physiology Better Than Ethnicity And Socioeconomic Status, Cleopatra M. Abdou, Christine Dunkel Schetter, Belinda Campos, Clayton J. Hilmert, Tyan Parker Dominguez, Calvin J. Hobel, Laura M. Glynn, Curt A. Sandman

Psychology Faculty Articles and Research

The authors examined the relevance of communalism, operationalized as a cultural orientation emphasizing interdependence, to maternal prenatal emotional health and physiology and distinguished its effects from those of ethnicity and childhood and adult socioeconomic status (SES). African American and European American women (N = 297) were recruited early in pregnancy and followed through 32 weeks gestation using interviews and medical chart review. Overall, African American women and women of lower socioeconomic backgrounds had higher levels of negative affect, stress, and blood pressure, but these ethnic and socioeconomic disparities were not observed among women higher in communalism. Hierarchical multivariate regression analyses …

The Development And Implementation Of A Curriculum Using Simulation To Teach Interns Basic Invasive Clinical Skills, C. Sultana, K. Berg, J. Kairys, J. Majdan, M. Vergare, D. Berg

Department of Obstetrics and Gynecology Faculty Papers

The ACGME requires that all residents are competent in performing basic invasive clinical procedures. Although simulation models have been used in other programs to teach these skills to interns with the intent to provide training and skills attainment before learning and performing on real patients, a large scale, mandatory simulation training, in which every incoming intern must satisfactorily complete training in a simulation center, prior to starting their intern year, has yet to be described. We describe such a curricular intervention produced in our Simulation Center.

A Novel Curriculum Using Simulation To Teach And Assess Indications And Technique Of Handwashing To Gme Learners, K. Berg, C. Sultana, R. Sorokin, J. Kairys, M. Vergare, D. Berg

Department of Obstetrics and Gynecology Faculty Papers

Proficiency in the clinical skill of effective hand washing is integral to high quality health care. Studies at our hospital revealed that in 2008, of 1215 direct, anonymous, observations of residents and attendings, only 53.3% washed their hands correctly during clinical activities. Medical students in fiscal year 2009 (July 1, 2008-June 30 2009) had a 52% compliance rate from 109 observations. This data prompted our hospital to work with the faculty of the University Clinical Skills and Simulation Center (UCSSC) to develop a module on the indications and technique of effective handwashing. This intervention, using multimedia simulation was introduced to …

Oocyte Peptides As Paracrine Tools For Ovarian Stimulation And Oocyte Maturation., David G Mottershead, Andrew J Watson

Obstetrics & Gynaecology Publications

Recent studies report the production and isolation of a stable bioactive recombinant human bone morphogenetic protein 15 (rhBMP15) that is appropriately processed in HEK-293 cells and activates the SMAD 1/5/8 pathway in mouse granulosa cell cultures. Further, the purified rhBMP15 induces the expression of genes associated with cumulus expansion. Thanks to recent research, we have a greater understanding of the importance of the dialogue that occurs between the oocyte and the granulosa cell layer with regard to regulating folliculogenesis and the acquisition of oocyte developmental competence and maturation. BMP15 is one of the critical components of these intra-follicular communication pathways. …

Longitudinal Analysis Of The Vaginal Microflora In Pregnancy Suggests That L. Crispatus Promotes The Stability Of The Normal Vaginal Microflora And That L. Gasseri And/Or L. Iners Are More Conducive To The Occurrence Of Abnormal Vaginal Microflora, Hans Verstraelen, Rita Verhelst, Geert Claeys, Ellen De Backer, Marleen Temmerman, Mario Vaneechoutte

Obstetrics and Gynaecology, East Africa

Background: Despite their antimicrobial potential, vaginal lactobacilli often fail to retain dominance, resulting in overgrowth of the vagina by other bacteria, as observed with bacterial vaginosis. It remains elusive however to what extent interindividual differences in vaginal Lactobacillus community composition determine the stability of this microflora. In a prospective cohort of pregnant women we studied the stability of the normal vaginal microflora (assessed on Gram stain) as a function of the presence of the vaginal Lactobacillus index species (determined through culture and molecular analysis with tRFLP).

Results:From 100 consecutive Caucasian women vaginal swabs were obtained at mean gestational ages …

Identification And Genotyping Of Bacteria From Paired Vaginal And Rectal Samples From Pregnant Women Indicates Similarity Between Vaginal And Rectal Microflora, Nabil Abdullah El Aila, Inge Tency, Geert Claeys, Hans Verstraelen, Bart Saerens, Guido Lopes Dos Santos Santiago, Ellen De Backer, Piet Cools, Marleen Temmerman, Rita Verhelst

Obstetrics and Gynaecology, East Africa

Background: The vaginal microflora is important for maintaining vaginal health and preventing infections of the reproductive tract. The rectum has been suggested as the major source for the colonisation of the vaginal econiche.

Methods: To establish whether the rectum can serve as a possible bacterial reservoir for colonisation of the vaginal econiche, we cultured vaginal and rectal specimens from pregnant women at 35-37 weeks of gestation, identified the isolates to the species level with tRNA intergenic length polymorphism analysis (tDNA-PCR) and genotyped the isolates for those subjects from which the same species was isolated simultaneously vaginally and rectally, by RAPD-analysis. …

Genotyping Of Streptococcus Agalactiae (Group B Streptococci) Isolated From Vaginal And Rectal Swabs Of Women At 35-37 Weeks Of Pregnancy, Nabil Abdullah El Aila, Inge Tency, Geert Claeys, Bart Saerens, Ellen De Backer, Marleen Temmerman, Rita Verhelst, Mario Vaneechoutte

Obstetrics and Gynaecology, East Africa

Background: Group B streptococci (GBS), or Streptococcus agalactiae, are the leading bacterial cause of meningitis and bacterial sepsis in newborns. Here we compared different culture media for GBS detection and we compared the occurrence of different genotypes and serotypes of GBS isolates from the vagina and rectum.

Methods: Streptococcus agalactiae was cultured separately from both rectum and vagina, for a total of 150 pregnant women, i) directly onto Columbia CNA agar, or indirectly onto ii) Granada agar resp. iii) Columbia CNA agar, after overnight incubation in Lim broth.

Results: Thirty six women (24%) were colonized by GBS. Of these, 19 …

The Vaginal Microflora In Relation To Gingivitis, Rutger Persson, Jane Hitti, Rita Verhelst, Mario Vaneechoutte, Rigmor Persson, Regula Hirschi, Marianne Weibel, Marilynn Rothen, Marleen Temmerman, Kathleen Paul

Obstetrics and Gynaecology, East Africa

Background: Gingivitis has been linked to adverse pregnancy outcome (APO). Bacterial vaginosis (BV) has been associated with APO. We assessed if bacterial counts in BV is associated with gingivitis suggesting a systemic infectious susceptibilty.

Methods: Vaginal samples were collected from 180 women (mean age 29.4 years, SD ± 6.8, range: 18 to 46), and at least six months after delivery, and assessed by semi-quantitative DNA-DNA checkerboard hybridization assay (74 bacterial species). BV was defined by Gram stain (Nugent criteria). Gingivitis was defined as bleeding on probing at ≥ 20% of tooth sites.

Results: A Nugent score of 0–3 (normal vaginal …