Current Women's Health Reviews - Volume 9, Issue 4, 2013

Aim of the study: To evaluate the efficiency of using a combined therapy of atosiban, and nifedipine in preterm labor, versus using each drug separately. Study design: Prospective, case-control study. Patients and methods: 150 pregnant patients, presenting to the Obstetric department with symptoms of preterm labor were recruited in the study: Patients were randomly divided into 3 groups, each group comprised 50 patients. Group 1, were prescribed atosiban, IV (6.75 mg initial dose, 300 microg/min loading dose for 3 hours, 100 microg/min maintenance dose for 48-96 hours) Group 2 were prescribed nifedipine in a dose of 20 mg orally, followed by 20 mg orally after 30 minutes. If contractions persist, therapy can be continued with 20 mg orally every 3-8 hours for 48-72 hours with a maximum dose of 160 mg/d. After 72 hours, if maintenance is still required, long-acting nifedipine 30-60 mg daily can be used. Maximum dose was 40 mg in the first hour then maintenance dose of 10 mg every 4-6 h for 48 hrs: and Group 3 were prescribed both lines of treatment, simultaneously. The study outcome was set as, continuation of pregnancy for one week from the start of the treatment without delivery. Results: 28 patients improved in the atosiban group (56%), 30 patients improved in the nifedipine group (60%), and 43 patients improved from the combined group (86%). Paired sample statistics, shows, that there is no statistically significant results between both groups, (p=0.159), on the other hand, the comparison between each of the atosiban, and combined group, as well as between nifedipine alone and the combined group showed significant relationship, where p value was: 0.000. Conclusion: Combination of Atosiban, and nifedipine was shown to be more effective than using each drug separately in the treatment of preterm labor, in terms of postponing the labor for one week or more, with acceptable side effects.

This descriptive study was performed between 1 December and 1 March 2010 to reveal what adolescent girls and their mothers know and think about Human Papilloma Virus vaccine. It included 580 female students studying at eight high schools in a city located in the western part of Turkey and 480 mothers. Data were collected with two questionnaires, of which one was completed by the female students and the other was completed by their mothers. Obtained data were analyzed by using Statistical Package Program for Social Sciences 11.5 with descriptive statistics and Chi-square test. Thirty-five point six percent of the girls and 32.7% of the mothers did not know who should be injected HPV vaccine. The item about HPV vaccine which was most frequently marked correctly by the students (34,1%) and the mothers (31,5%) was “HPV vaccine was protective against cancer”. Seventy-five point five percent of the students and 70% of the mothers believed that the vaccine is not harmful. Forty-one point five percent of the mothers noted that they wanted to have their daughters vaccinated against HPV. The mean age of the girls was 15.62±0.61 years and the mean age of the mothers was 40,59±4,8 years. Eighty-eight point one percent of the girls wanted to have HPV vaccine to prevent cervix cancer, but 48,8% of the girls did not want to have the vaccine since they did not have sufficient information about the vaccine. Eighty-one point four percent of the mothers wanted to have their daughters vaccinated against HPV since they considered the vaccine as protective against cervix cancer. Forty-one point nine percent of the mother did not want to do so since they did not have sufficient information about the vaccine. The study showed that both the girls and their mothers were in favor of HPV vaccine, but that they needed information about the vaccine.

Aiming to investigate the epidemiological factors of obstetric fistula, structured questionnaires were used to gather data from women admitted to Kassala hospital, eastern Sudan (2010-2012) with obstetric fistula. Two consecutive women with birth complications and who were discharged from the postnatal ward in the hospital were used to act as controls. During the study period there were 34 cases of obstetric fistula yielding a prevalence rate of 7.7 per100.000 women of reproductive age. Their mean (SD) of age, age at marriage, age at last delivery and parity was 26.5 (6.5) years 18.7(5.1), 24.4 (7) and 2.8 (2.6), respectively. All of the patients were illiterate and majority of them belonged to rural residence (97.1%) and had no use of antenatal care in the last delivery (94.1%). Women with obstetric fistula were those who had less education [34 (100%) vs. 14 (20.6%), P < 0.001], delivered at home [19 (55.9%) vs.18 (26.5%), P = <0.004] of rural residence [33 (97.1%) vs. 28 (41.2%), P < 0.001] and had no antenatal care coverage [2(5.9%) vs. 53 (77.9%), P < 0.001]. Likewise, while use of contraception was not associated with obstetric fistula, primipara [20(58.8%) vs. 17 (25%), P < 0.001] young age at delivery (<20 years) [12(35.3%) vs. 4 (5.9%), P < 0.001], and age at marriage [18.7(5.1) vs. 23.7 (6.7), P < 0.001] were the predictors for obstetric fistula. Thus, effort to prevent obstetric fistula in eastern Sudan should be encouraged by health education, training programmes for the birth attendants and encouragement of institutional delivery.

Introduction: Premature onset of cardiovascular disease (CVD) in women with systemic lupus erythematosus (SLE) seems to involve both traditional Framingham risk factors as well as lupus-specific factors. We assessed the risk of cardiovascular disease in premenopausal women with lupus and any relationship of cardiovascular disease to disease severity and history of pregnancy hypertensive complications. Methods: Female patients in this study with a confirmed diagnosis of lupus were obtained from the Wayne State University Database. We used chi-square analysis to assess the effect of 2 suspected risk factors (lupus disease severity and hypertensive complications during pregnancy [i.e., eclampsia/pre-eclampsia]) on cardiovascular (myocardial infarction [MI], transient ischemic attack [TIA], and chronic hypertension [HTN]) and metabolic (hyperlipidemia [HL] and diabetes mellitus [DM]) disease rates. To quantify the degree of excess risk in SLE patients, we used a Z test for proportions with population frequencies from the National Health and Nutrition Examination Survey (NHANES) database as the comparator and calculated risk ratios (RR) for specific cardiovascular and metabolic diseases among pre- and postmenopausal women [29, 30]. Results: Mean age of the cohort was 33 years at time of lupus diagnosis, 343 (50.6%) were premenopausal, 310 (45.8%) had severe SLE, and 25 (3.7%) had pregnancy hypertensive complications. Chi Square analysis showed statistically significant increases in both cardiovascular and metabolic diseases in women with severe SLE. Among those with hypertensive complications during pregnancy, the only significant association was the development of chronic HTN (p<0.01). For cardiovascular risk, we focused on the 343 premenopausal women. Premenopausal women with SLE were at significantly increased risk for myocardial infarction [MI] (RR=5.50), hypertension [HTN] (RR=1.22), transient ischemic attacks [TIA] (RR=4.38), and hyperlipidemia (RR=1.9). Conclusion: Women with SLE are at increased risk for premature cardiovascular disease compared to the general population. Increased risk for cardiovascular disease appears greatest for women with severe lupus indicating a potential dose/response relationship. Premenopausal women with severe SLE should be monitored closely for cardiovascular disease.

Primary fallopian tube cancer (PFTC) is rare with an incidence of only 1% of gynaecology cancers. However, reports are emerging that it might be more common than the historical figure. We retrospectively evaluated all women diagnosed with fallopian cancers between November 2010 and October 2011. Incidence of fallopian cancers was 3.6% (6/165) of gynaecological malignancies. 50% (n=3) presented with classical symptoms of pain and discharge. We suspected PFTC in 3 out of the 6 cases (50%) while the figure quoted in literature is only 10%. While majority of women with PFTC (>80%) have an elevated CA125 level, our cohort was different with only 2 among the 6 with raised CA125 levels. Primary surgery was done in 50% women (n=3) in our hospital while the rest were referred to tertiary gynaeoncology centre. 3 (50%) have been diagnosed as having early stage disease and 3 (50%) as advanced cancer. Our case series shows the difficulty in correlating clinic-radiological findings, misleading CA125 levels of PFTC, leading to primary surgery being done by general gynaecologists rather than gyne-oncologists. A multi-disciplinary approach is advised with low index of suspicion in postmenopausal women presenting with adnexal pain. We believe our cohort had a higher rate of preoperative diagnosis because of the use of MRI in evaluation of adnexal masses.

Feminine reproductive health is crucial for her well-being as well as reproduction, and health of neonates. Certain microbes not only impede conception and birth of healthy baby, but can also affect maternal-fetal health, and may severely perturb the feminine reproductive health. Among the alternative strategies to prevent microbial pathogenesis, the probiotics and their metabolites have emerged as potent biotherapeutics. The probiotics have potential for preventing various genitourinary infections and consequently reduce the fetal and neonatal infections. Efforts are now underway to better understand the elemental role of human microbial communities in health and disease. While the population structure and mechanisms of human symbionts are only now being unveiled, potential health attributes are suggested by manipulating and modulating microbial functional ecology with the use of probiotics. This article reviews promising paradigms and prospects of probiotics and probiotic-metabolites in reproductive health of women. The purpose is to provide impetus to facilitate the applications of research outcomes in this important area of research into medical practice.

The aim of infusion of a sterile solution into the uterine cavity during labor is to increase the volume or the dilution of the amniotic fluid. This measure can be used prophylactically or therapeutically depending on the aim of infusion. There is as yet no broad consensus on the precise indications for amnioinfusion, particularly regarding prophylactic amnioinfusion for oligohydramnios. This review aims to shed light on this issue and concludes that additional, well-designed studies are needed to provide data that can help clinicians choose the most appropriate procedure.