Current Women's Health Reviews - Volume 11, Issue 2, 2015

Low dose aspirin has been shown to reduce the risk for preeclampsia in certain populations. The aim of this review was to provide an overview of the findings of the larger randomized trials, meta-analyses and individual patient-data meta-analysis studying this topic. It is difficult to draw exact conclusions for patient care given heterogeneity in inclusion criteria and subgroups of both the individual trials and meta-analyses. The authors’ practice is to recommend low dose aspirin to women, starting between 12 and 20 weeks gestational age, who have previously had severe and/or preterm preeclampsia in a prior pregnancy. Individual institutions are recommended to establish guidelines in order to standardize patient care, even in the context of uncertainty.

Embryonic implantation is the result of a highly coordinated immunological shift resulting in a very localized, uterine specific, immune suppression of activated maternal response to fetal alloantigens. Without this coordinated immunological shift the result would be fetal demise and termination of genetic propagation. Hence, maternal immunological acceptance of the fetal allograft is imperative for the survival of any species that participates in allogeneic mating. While these events have occurred since the beginning of our species, the mechanisms and key factors that regulate this immunological shift are still not well understood and continue to astonish immunologists and reproductive physiologists. While we have not yet discovered all pathways utilized by our immune system to promote fetal tolerance, we are very aware of the development of obstetrical complications that arise from improper maternal immune tolerance. This review highlights key investigations that have focused on the discovery and role of regulatory T cells (Tregs) in the pathophysiology of preeclampsia and how these cells impact the immune dynamics at the maternal fetal interface.

Preeclampsia, a condition characterized by elevated blood pressure and proteinuria, is a complication that affects up to 5% of all pregnancies. Past research suggested that there were no long term cardiovascular effects after a pregnancy complicated by preeclampsia. However, more recent evidence has made it increasingly clear that the risks associated with preeclampsia do not end at birth: women diagnosed with preeclampsia face an increased risk of cardiovascular disease later in life. In this review of the literature, we provide insight on the pathophysiological similarities between preeclampsia and cardiovascular disease, investigate the hypothesis of shared predisposing risk factors that lead to preeclampsia and subsequently cardiovascular disease versus the theory that preeclampsia is an independent risk factor for future cardiovascular disease, provide important information regarding patient outcomes and clinical recommendations, and reveal potential goals for future research.

Hypertensive disorders of pregnancy include preeclampsia-eclampsia, chronic hypertension, chronic hypertension with superimposed preeclampsia, gestational hypertension, and postpartum hypertension. The incidence of preeclampsia has increased by 25% over the past 15 years. This significant increase prompted the American College of Obstetricians and Gynecologists (ACOG) to publish Hypertension in Pregnancy. The goals of ACOG's publication are to achieve the following: to create more consistent guidelines in the management of hypertensive disorders of pregnancy, to better educate providers of the risks associated with hypertension, and to increase awareness to patients and their families. This section will review the risk factors, diagnosis, and management of hypertensive disorders of pregnancy per these current guidelines.

Preeclampsia is a hypertensive disorder of pregnancy that is diagnosed after the 20th week of gestation. It is defined by the American College of Obstetrics and Gynecology as de novo hypertension of at least 140/90 in a pregnant woman. Proteinuria with the hypertension is sufficient but not required for the diagnosis, especially if a woman displays severe symptoms such as headache, blurry vision, right upper quadrant pain, and low platelet count [1]. Despite significant research, preeclampsia continues to kill 76,000 mothers and 500,000 babies per year worldwide [2]. It causes short and long term consequences such as future metabolic and cardiovascular events for the mother and the child born during a pregnancy affected by preeclampsia [3-5]. A delay in diagnosis and delayed access to appropriate care is a core cause of the preeclampsia related morbidity and severe mortality worldwide. The complex pathogenesis of preeclampsia has challenged the ability to effectively predict preeclampsia to decrease the delay in this diagnosis. Consequently, early intervention or triage to higher level obstetric care is hindered. The lack of an early biomarker for preeclampsia also represents a major barrier to treat preeclampsia before major clinical symptoms emerge and the cycle of future cardiovascular risk for mom and baby begins. Novel, very early pregnancy predictive tests for preeclampsia may provide significant clinical utility. This review addresses current strong biomarkers of preeclampsia and their relevance to the prediction and the pathogenesis of preeclampsia.

This was a cross sectional hospital based study conducted at Khartoum Teaching Hospital, Sudan, during the period of June-through December 2013 to investigate the reproductive health indicators and the factors affecting menstrual cycle pattern among women with thyroid dysfunction. A total of 210 women had been enrolled, 128 (61.0%) were married, and 72(39%) were single. Of the total respondents 51.9%, 46.2% and 1.9% (4) had hypothyroidism, hyperthyroidism and thyroiditis respectively. Among the total respondents 53.9% have normal menstrual cycle pattern, 19% suffered from polymenorrhea, 12.4% reported oligomenorrhea, 9% have amenorrhea, 4.3% have vaginal spotting, and 1.4% suffered from menorrhagia. Also among 128 married patients the bad obstetric outcome was reported as follow: miscarriage (47.6%), stillbirth delivery (7.8%), preterm birth (5.4%) and neonate with congenital cerebral palsy (0.7%). Interestingly 18 women suffered from premature ovarian failure and 20 women had primary infertility. Menstrual cycle abnormalities among women with thyroid dysfunction were significantly associated with long duration of the disease ≥5 years (OR=0.4; CI=, 0.2-0.8; P =0.016), co-morbidity (OR=9.0; CI=, 3.1-28.8; P =0.000), and poor compliance to treatment (OR=0.2; CI=, 0.09-0.8; P =0.021). Thus polymenorrhea is the most predominant menstrual cycle problem observed among Sudanese women with thyroid dysfunction. Menstrual cycle abnormalities among women with thyroid dysfunction were significantly associated with long duration of the disease ≥5 years, co-morbidity and poor compliance to treatment.

Bedside teaching is a time honored educational modality for residents and medical students. In this review, we evaluate specific successful strategies for bedside teaching. These strategies are defined, and the evidence for their use is examined. Electronic databases were searched for the period covering the years from 2000 to 2014 for studies in the English language with the main outcome measure of the effectiveness of bedside teaching as an educational tool, reflecting the most current literature. An overall assessment of the optimal techniques for bedside teaching is performed. These include appropriate patient selection, faculty development and education on teaching strategies, and the use of resident preceptors as future ambassadors of bedside teaching. We conclude that this teaching method still has merit for the medical education of students and residents.

Background and Aim: Uterine arteriovenous malformation (AVM) is one of the complications of cesarean section and uterine curettage which is life-threatening. The aim of this case report was to assess medical treatment of a symptomatic case of AVM as uncommon cause of vaginal bleeding. Case Report: A 24-year-old female with an episode of heavy vaginal bleeding after curettage of pregnancy first trimester was referred to Ghaem Hospital of Mashhad University of Medical Sciences in 2014. She had a history of elective caesarian section in first pregnancy. Based on clinical findings and color Doppler ultrasonography, uterine AVM was diagnosed and modality conservative medical management was arranged. She was successfully treated with GnRH analogs and she had regular and normal menstrual cycles in her 1 year serial follow-up. Now, she has spent three months of pregnancy after 15 months of her disease. Conclusion: Diagnosis of uterine AVM should be considered in the case of massive uterine vaginal bleeding and a history of prior uterus surgery. The gonadotropin-releasing hormone agonist is useful in this situations.

Background: Postpartum morbidities such as infection, hemorrhage and thromboemboli are more common in cesarean than vaginal delivery. Necrotizing fasciitis is a rare and fetal infection of skin and soft tissues which involve cesarean incision, episiotomy site and prineal lacerations. The aim of this report is to introduce a case of necrotizing fasciitis after cesarean delivery. Case: We report a case of necrotizing fasciitis after urgent cesarean delivery in a 21 years old woman with gestational diabetes. The patient survived after a lengty intensive care unit admission, following several lapartomies, complicated by prolonged intubation and tracheal stricture. Conclusion: Early clinical diagnosis, extensive debridment of necrotized tissue and supportive care will be life saving. If the patient need prolonged intubation, early percutaneous tracheostomy will reduce the patient's stay in intensive care unit and decrease future complications.

Anorexia nervosa is a chronic mental health disorder associated with multiple medical complications. Intensive preoccupation with body weight and shape are the hallmarks of anorexia nervosa as defined by DSM-5. As a result of malnutrition and weight loss there develop major organ dysfunction and complications. No body system is immune to the ravages of this illness despite the typically young age of those affected. Most unfortunately, some of these complications are known now to be irreversible. However, the vast majority of these complications are reversible with timely and effective services. These patients are often co-managed by an internist and a mental health professional. Thus, the need for familiarity with the medical complications associated with anorexia nervosa.

Background: Hysterectomy for benign gynaecological conditions is effective in relieving symptoms but ripple effects do occur. Hysterectomies are being performed for conditions where alternatives are available so there is a trend of more surgeries. Not much is known about India, but hysterectomy is very commonly performed. Aim: Study was carried out to know trends of morbidity, mortality with hysterectomy for benign gynaecological disorders in women of low resource settings. Methods: Study commenced in 1998. Retrospective records were collected and prospective cases were included till completion of 2 decades. Analysis of 4223case records of hysterectomies was done, at rural medical institute where most patients are rural. Overall 3985 (94.4%) hysterectomies were performed for benign gynaecological disorders (noncancerous tumours, inflammatory conditions, displacements, miscellaneous like adenomyosis, dysfunctional uterine hemorrhage). Analyses was done by dividing into four five yearly blocks A,B,C,D to know the trends. Results: Complications rate in abdominal hysterectomy was 19.39%, in Block A 26.42%, B 26.65%, C 18.72% and D 14.2%, 50% reduction in complications from recent past. Postoperative vaginal bleeding occurred in 1.18% in Block A, 0.37% in B, 0.52% in C and 0.7% in Block D. Wound infection rate decreased from 10.14% in Block A, 7.1% in D. Other complications had decreasing trend. In vaginal hysterectomy complications rate was 11.14%, 15% in Block A, 18.61% in B, 10.55% in C and 8.4% in D. Mortality was 0.1% (4 cases) 0.19% (one) in Block A, 0.14%(one) in B and 0.16% (2) in C and no mortality in Block D. Conclusion: Severe complications mortality can occur in hysterectomy for benign conditions also. Preoperative care, intraoperative care can reduce morbidities, mortalities, but not totally eliminate, even in present times.