Current Women's Health Reviews - Volume 10, Issue 1, 2014

The aim of this study was to reveal whether pregnant women fast in Ramadan, a lunar month, and to determine in which trimesters of pregnancy they fast. The impetus for this study was recognition of several fasting pregnant women in Ramadan in a district where nursing students have practice classes and visit homes. The study was conducted between 11 August and 9 September, which corresponded to the lunar month Ramadan. The researcher designed a questionnaire and determined criteria for inclusion of subjects during Ramadan. As a result, the sample included 81 pregnant women. Data were collected at home visits with the questionnaire developed by the researchers and were analyzed with descriptive statistics and Chi-square test. In total, forty-two percent of the women fasted and one third of them fasted for over 20 days. As pregnancy progressed, the number of fasting women and duration of fasting decreased. In the light of research results, pregnant women must be informed about short term and long term effects of fasting and especially nutrition.

Random household survey was conducted in Kassala State, eastern Sudan, from 1st March to 30st June 2013 to investigate the socio-demographic characteristics and reproductive data associated with short inter-pregnancy interval. According to the recent recommendations three subcategories of birth interval among the respondents has been measured as followed (I) short birth interval (less than 36 months), (II) optimum birth interval (36 to 60 months) and (III) long birth interval (above 60 months) categories [11]. A total of 692 women had been enrolled, the average of children per woman was 4 and the number of children for each woman ranged between two to 14. Among the total women, 419 (60.6%), 259 (37.4%) and 14 (2%) reported the optimum birth interval between the last two successive births to be below 36 months, 36 to 60 months and greater than 60 months, respectively. Again among the total respondents the mean (SD) of actual birth interval between the last two consecutive live births was 26 (95% CI= 1.3─1.4) month whereas the mean (SD) of preferred birth spacing was 38.4 (95% CI= 1.6─2.9). With regard to the associated risk factors while age, residence, parity, and occupation were not associated with birth intervals, mother education less than secondary level (OR=2.6; CI=, 1.3-5.2; P =0.004), younger age at marriage (OR=0.8; CI=, 0.8-0.9; P = <0.001), husband education < secondary level (OR=0.3, CI, 0.1-0.6, P = 0.002), utilization of contraception (OR=3.0; CI=, 2.0-4.5; P =<0.001) and number of living babies (OR=0.4; CI=, 0.3-0.6; P =<0.001) were associated with short birth intervals. Thus the results of this study call for urgent intervention to increase the mean child spacing period with certain consideration of the associated factors in particular educational status, early age of marriage and utilization of contraceptive methods.

Objectives: International evidence suggests positive close relationships with household members (family social capital) can improve wellbeing; however, mixed effects for associations between the number of household members and generational status (household typology) have been found. Further, it is unclear how family social capital and household typology might vary between families of different ethnic origins. Design: Cross-sectional study. Setting: The Born in Bradford cohort study. Participants: We used data from that including Pakistani (n=1772) and White British (n=1859) women. Main Outcome Measures: Household typologies and four measures of family social capital (I wish there was more warmth/affection; I feel closely attached to my family; My family takes notice of me; I feel excluded in my family; all binary variables). Results: We found that household typology was largely not significantly associated with family social capital measures, with some exceptions (women living with child only, women living with child and parents only, p<0.05). Pakistani women were more likely to report low family social capital (OR between 1.72 and 3.32, p<0.05) and this was significantly associated with financial insecurity and living in extended families. Conclusion: This study suggests the relationship between household typology and family social capital is complex and varies across ethnic and socioeconomic groups. Pakistani women were more likely to report low family social capital while living in the UK compared to the White British.

Postpartum haemorrhage (PPH) is a major cause of maternal deaths in developing as well as developed countries. The Present article is to have an update on whys, hows of PPH and if PPH occurs the prevention of disability and death. Primary PPH, (within 24 hrs of birth) can be minor or major, further divided into moderate, severe. Once diagnosed by seeing excessive bleeding, case needs to be evaluated for the cause which could be uterine atony or injury to reproductive tract, retained placental pieces or coagulation problems. Visual evaluation underestimates blood loss. Risk factors are past PPH, fetal macrosomia, multiple births, placenta previa, placental abruption, prolonged labour, episiotomy or delay in expulsion of placenta. If placental separation and expulsion is expedited through medication and manualstimulation, risk of PPH can be reduced. Oxytocin for prevention continues to be the drug of choice with less side effects and efficacy similar to ergometrine, prostaglandins. Misoprostol, oral, stable at room temperature is being promoted. Any cut on perineum needs to be avoided. Correction of anemia before delivery is essential. Cornerstone of treatment is restoration of blood volume. If uterus is not well contracted, mechanical, pharmacological measures are instituted. All injuries need timely repair. Timely uterine packing or sutures stop bleeding and step wise devasculcusation preserves fertility. Pneumatic compression devices reduce mortality at all levels of health care. Hysterectomy is definitive therapy, needs to be done timely especially in placenta accreta, uterine rupture. Because of bleeding there is risk of reduced blood supply to anterior pituitary which can affect milk secretion and breastfeeding. Similarly supply to heart, and kidney can get affected and blood components might get depleted. Depression can occur. It is essential to continue research to know best modality of prevention of PPH and if it occurs aggressive therapy to prevent disability and death.

OHVIRA syndrome, is a rare in-utero developmental defect affecting the female urogenital system, classically described as obstructed hemivagina and ipsilateral renal anomaly. Majority of the patients have clinical presentations of abdominal or pelvic pain, usually shortly post-menarche. Early detection and prompt treatment relieve symptoms and prevent complications. Similar presentations may be due to other entity of Mullerian abnormalities associated with single renal agenesis. Three cases illustrating the clinical presentations, the dilemma in achieving diagnosis and the treatment advocated for the patients. Case 1 is a classic OHVIRA syndrome while the other 2 cases are variants of the classic syndrome; the second case showed a contralateral renal agenesis and the third case had variants of Mullerian anomaly. High index of suspicion can help in the diagnosis of this rare OHVIRA syndrome, and there are possibilities of discovering new rare syndromes yet to be named.

Background: Pelvic organ prolapse in pregnancy has been extensively reported. In this review we assessed the current available literature detailing pelvic organ prolapse presenting in pregnancy to establish evidence with regards to antepartum, intrapartum and postpartum management. Methods: The following combination of search terms was used: ‘pregnancy’ and ‘pelvic organ prolapse’ or ‘prolapse’ or ‘cystocele’ or ‘rectocele’ or ‘vaginal prolapse’ or ‘cervical prolapse’ or ‘uterine prolapse’ and ‘outcomes’ or ‘treatment’ or ‘complication’ or ‘management’. A total of 450 citations were identified. Results: Antepartum prolapse is managed conservatively with pessaries and physiotherapy, though occasionally more active surgical intervention are required. Intrapartum complications in women going into labour with a prolapse are uncommon, however when they do occur the most common problem appears to be cervical dystocia and cervical lacerations. Mode of delivery remains controversial. Women usually have a recurrence of prolapse postnatally and treatment needs to be tailored to patient preferences. Conclusions: Although rare, pelvic organ prolapse (POP) complicating a pregnancy can be associated with significant problems both mentally and physically to women. Exclusive caesarean delivery may be a preventative strategy against pelvic organ prolapse, but this needs to be weighed up against the risks associated with repeat caesarean delivery.

Objectives: To correlate the identification of fetal head position through digital examination (DE) and transabdominal ultrasound (TAU) prior to vacuum delivery. A secondary objective was to recognize how knowledge of the exact fetal head position affects the placement of the cup. Method: Women in active labor at term with normal singleton cephalic fetus were included. Transvaginal digital examination was performed and followed immediately by transabdominal ultrasound assessment. After birth, the distance between the center of the chignon and the flexion point was measured on the newborn. Results: 81 cases were included. TAU identified the fetal head position in 100% of cases and the DE in 96.3%. In 71.5% (58/81) patients DE was consistent with TAU. 100% of these cases were occiput anterior positions and 60% occiput posterior. Placing the cup in a flexing position, the lateral deviation was 0.7+/-0.5cm and the distance between the center of the chignon and the flexion point was 1.6+/-1.0cm, The center of the chignon was accurately placed at less than 2cm posterior to the flexion point in 92.5% (75/81) of the cases. Conclusions: Using DE only the vacuum cup was placed inaccurately in 1 of every 4 cases. The employment of TAU improved this result to 1 in 10.

Pregnancy is the stage of development of foetus and also a transition in the anatomy and physiology of the mother. During this time various metabolic changes occur in the mother. These changes are necessary to support the growing embryo. Micronutrients, which include vitamins and minerals, are important during all stages of life particularly in pregnancy. Thus inadequate availability of micronutrients can lead to adverse pregnancy outcomes. Antioxidant vitamins and certain minerals like zinc, copper and iron are of immense importance during this stage. Preeclampsia is a pregnancy specific disorder and the disease has been found associated with altered micronutrient levels. Zinc is an essential micronutrient and is necessary for the proper functioning of various enzymes and transcription factors. Studies reveal that altered maternal zinc levels are found associated with preeclampsia. Can zinc contribute to the aetiology of preeclampsia? The relation remains unexplored. This review gives an overview of the difference in normal pregnancy and pre-eclampsia and the probable association of zinc with preeclampsia.

Intrahepatic cholestasis of pregnancy (ICP) is a gestational liver disease characterized by pruritus with abnormal bile acids and an increased risk for adverse fetal outcomes. The etiology is unclear, but it believed to have genetic, hormonal, and environmental components. Possible fetal complications include meconium staining of amniotic fluid, preterm labor, and unexplained sudden intrauterine demise. Researchers are currently investigating multiple different medications for the management of ICP. This article will review the epidemiology, clinical features, pregnancy complications, and treatment for ICP. Furthermore, this review will discuss current recommendations on the timing of delivery to mitigate possible fetal repercussions of this disease.