Showing papers in "International Journal of Women's Health in 2018"

Incidence, characteristics, maternal complications, and perinatal outcomes associated with preeclampsia with severe features and HELLP syndrome

Abstract: Objective To determine the incidence of preeclampsia with severe features among pregnant women and evaluate the characteristics, maternal complications, and perinatal outcomes between nonsevere preeclampsia versus preeclampsia with severe features and hemolysis, elevated liver enzyme levels, and low platelet levels (HELLP) syndrome Materials and methods A retrospective descriptive study was conducted at Khon Kaen University's Srinagarind Hospital, a tertiary care facility in northeast Thailand The pregnant women who had been diagnosed with preeclampsia according to American College of Obstetricians and Gynecologists guidelines from January 1, 2012 to December 31, 2016 were identified and their medical records were reviewed Various characteristics were examined to compare maternal complications and perinatal outcomes Results There was a total of 11,199 deliveries during the study period, out of which 213 preeclamptic women were identified One hundred and seven women (96 per 1,000 deliveries) were diagnosed with nonsevere preeclampsia, 90 (8 per 1,000 deliveries) had preeclampsia with severe features, and 16 (14 per 1,000 deliveries) had HELLP syndrome Twenty-one women (99%) experienced postpartum hemorrhage; 11 (103%) in the nonsevere features preeclampsia group and 10 (94%) in the preeclampsia with severe features and HELLP syndrome group Placental abruption (3 women; 14%) and heart failure (1 women; 04%) only occurred among women in the preeclampsia with severe features group Neonatal complications were significantly higher in the preeclampsia with severe features and HELLP syndrome group (low birth weight =351% versus 743%, p<0001; birth asphyxia =44% versus 182%, p=0001; neonatal intensive care unit admission =70% versus 309%, p<0001; neonatal resuscitation =158% versus 427%, p<0001) Stillbirths only occurred in cases of preeclampsia with severe features and HELLP syndrome (3 cases, 14%) Intrapartum death was higher in cases of preeclampsia with severe features and HELLP syndrome, but without statistical significance (26% versus 64%, p=0190) Conclusion The incidence of preeclampsia with severe features and HELLP syndrome was 95 per 1,000 deliveries Severe maternal and perinatal outcomes were more commonly observed

Current treatment options for postmenopausal vaginal atrophy.

Abstract: Vulvovaginal atrophy (VVA) is a silent epidemic that affects up to 50%-60% of postmenopausal women who are suffering in silence from this condition. Hormonal changes, especially hypoestrogenism inherent in menopause, are characterized by a variety of symptoms. More than half of menopausal women are concerned about the symptoms of VVA, such as dryness, burning, itching, vaginal discomfort, pain and burning when urinating, dyspareunia, and spotting during intercourse. All these manifestations significantly reduce the quality of life and cause discomfort in the sexual sphere. However, according to research, only 25% of patients with the symptoms of VVA receive adequate therapy. This is probably due to the lack of coverage of this problem in the society and the insufficiently active position of specialists in the field of women's health regarding the detection of symptoms of VVA. Many patients are embarrassed to discuss intimate complaints with a specialist, which makes it difficult to verify the diagnosis in 75% of cases, and some patients regard the symptoms of VVA as manifestations of the natural aging process and do not seek help. Modern medicine has in the arsenal various options for treating this pathological condition, including systemic and topical hormone replacement therapy, the use of selective estrogen receptor modulators, vaginal dehydroepiandrosterone, use of lubricants and moisturizers, as well as non-drug therapies. Timely diagnosis and adequately selected therapy for the main symptoms of VVA lead to restoration and maintenance of the vaginal function and vaginal health.

Women’s experiences with postpartum anxiety disorders: a narrative literature review

Abstract: Purpose Postpartum anxiety disorders are common and may have significant consequences for mothers and their children. This review examines the literature on women's experiences with postpartum generalized anxiety disorder (GAD), postpartum panic disorder (PD), obsessive compulsive disorder (OCD), and posttraumatic stress disorder (PTSD). Methods MEDLINE (Ovid), CINAHL, PsycINFO, and reference lists were searched. Qualitative and quantitative studies assessing women's experiences with GAD, postpartum PD, OCD, and PTSD were included. Narrative approach to literature synthesis was used. Results Fourteen studies (among 44 articles) met the criteria for review to identify descriptions of women's cognitive, affective, and somatic experiences related to postpartum anxiety disorders. Loss, frustration, and guilt, accompanied by physical symptoms of tension, were some of the experiences identified across studies. Most women suffered from more than one anxiety disorder, in addition to postpartum depression. To date, research has focused on prevalence rates of postpartum anxiety disorders, and evidence about clinical and subclinical symptoms of postpartum anxiety disorders and outcomes on mother and child is lacking. Postpartum anxiety disorders may have negative effects on parenting and child development; however, the nature of the underlying mechanisms is unclear. Conclusion More robust longitudinal studies are needed to examine the impact of postpartum GAD, PD, OCD, and PTSD symptoms on the mother and the mother-child relationship to develop targets for therapeutic preventative interventions.

Polycystic ovarian syndrome is linked to increased oxidative stress in Omani women.

Abstract: Purpose Literature emerging from Western countries has reported increased levels of serum oxidative stress markers among polycystic ovarian syndrome (PCOS) women. In the Arab region, there is limited research about the association between oxidative stress and PCOS. This study aimed to compare sociodemographic and clinical characteristics, sex hormones, and oxidative stress indices between PCOS women and non-PCOS women and to investigate the correlation between oxidative stress biomarkers and sex hormones. Methods This hospital-based case-control study was conducted among reproductive-aged women. The study included 51 women diagnosed with PCOS (as per Rotterdam 2003 criteria) and 45 control women who were not diagnosed with PCOS. Serum samples were collected to measure the mean levels of the following sex hormones: total testosterone, dehydroepiandrosterone sulfate, estradiol and progesterone, as well as to measure biomarkers of oxidative stress including glutathione peroxidase (GPx), glutathione reductase (GR), glutathione (GSH), and total antioxidant capacity (TAC). Results PCOS women exhibited clinical characteristics including irregular menses, hirsutism, and acne compared to the control group (P≤0.05). Significant differences were observed in the waist-hip ratio of PCOS women compared to controls (P=0.004). GPx and GR activity levels appeared to be higher among PCOS women compared to controls; however, no statistically significant differences were observed between the two groups (P>0.05). PCOS women had lower GSH and TAC levels compared to controls with a statistically significant difference observed for GSH levels (P=0.006). Correlation analysis showed a significant negative correlation between estradiol and TAC in the total sample (r=-0.284, P=0.005). Conclusion This study provides supportive evidence that oxidative stress might play a role in the pathogenesis of PCOS and, hence, oxidative stress parameters could be suggested as diagnostic markers for early diagnosis of high-risk groups. Also, the study provides supportive evidence that obesity and sex hormones, particularly estradiol, in PCOS may contribute to enhanced oxidative stress.

Acute myocardial infarction in young women: current perspectives

Abstract: Acute myocardial infarction (AMI) is the leading cause of death in women worldwide. Every year, in the USA alone, more than 30,000 young women <55 years of age are hospitalized with AMI. In recent decades, the incidence of AMI is increasing in younger women in the context of increasing metabolic syndrome, diabetes mellitus, and non-traditional risk factors such as stress, anxiety, and depression. Although women are classically considered to present with atypical chest pain, several observational data confirm that men and women experience similar rates of chest pain, with some differences in intensity, duration, radiation, and the choice of descriptors. Women also experience more number of symptoms and more prodromal symptoms compared with men. Suboptimal awareness, sociocultural and financial reasons result in pre-hospital delays in women and lower rates of access to care with resulting undertreatment with guideline-directed therapies. Causes of AMI in young women include plaque-related MI, microvascular dysfunction or vasospasm, and spontaneous coronary artery dissection. Compared with men, women have greater in-hospital, early and late mortality, as a result of baseline comorbidities. Post-AMI women have lower referral to cardiac rehabilitation with more dropouts, lower levels of physical activity, and poorer improvements in health status compared with men, with higher inflammatory levels at 1-year from index presentation. Future strategies should focus on primary and secondary prevention, adherence, and post-AMI health-related quality of life. This review discusses the current evidence in the epidemiology, diagnosis, and treatment of AMI in young women.

Measures of health-related quality of life in PCOS women: a systematic review.

Abstract: Introduction Polycystic ovary syndrome (PCOS) is associated with biochemical and hormonal disturbance and adverse cosmetic, reproductive, metabolic, and psychological consequences, resulting in reduced health-related quality of life (HRQoL). Various generic and specific questionnaires have been used for assessing different dimensions of HRQoL in PCOS women. The purpose of this systematic review was to identify those general and specific instruments and to determine the factors that affect HRQoL in PCOS women. Materials and methods The research strategy involved general and specific terms in relation to PCOS women and their QoL. A review was performed on studies that were published between 1945 to 2017 and that were indexed in MEDLINE, ISI Web of Science, and Scopus. A narrative synthesis of the data was provided. Results In total, 52 studies (9 qualitative and 43 quantitative) were included in the review. The analysis indicated that 3 specific and 5 general instruments were used to measure the QoL in PCOS women. Of these, the 36-Item Short Form Health Survey (SF-36) and the Polycystic Ovary Syndrome Health-Related Quality of Life Questionnaire (PCOSQ) were used most frequently. All studies assessed different aspects of QoL in PCOS women and found that PCOS had negative effects on QoL in this population. Conclusion The PCOSQ and the SF-36 were used most frequently for the assessment of QoL in PCOS women. Perhaps using either a specific questionnaire solely or a specific questionnaire in conjunction with a generic measure would be more appropriate when measuring QoL in PCOS women. However, both questionnaires showed that they are able to capture different aspects of QoL in PCOS women and to identify areas that can help to improve QoL in these women.

Spotlight on the utility of the Oncotype DX® breast cancer assay.

Abstract: The Oncotype DX® assay was developed to address the need for optimizing the selection of adjuvant systemic therapy for patients with estrogen receptor (ER)-positive, lymph node-negative breast cancer. It has ushered in the era of genomic-based personalized cancer care for ER-positive primary breast cancer and is now widely utilized in various parts of the world. Together with several other genomic assays, Oncotype DX has been incorporated into clinical practice guidelines on biomarker use to guide treatment decisions. The Oncotype DX result is presented as the recurrence score which is a continuous score that predicts the risk of distant disease recurrence. The assay, which provides information on clinicopathological factors, has been validated for use in the prognostication and prediction of degree of adjuvant chemotherapy benefit in both lymph node-positive and lymph node-negative early breast cancers. Clinical studies have consistently shown that the Oncotype DX has a significant impact on decision making in adjuvant therapy recommendations and appears to be cost-effective in diverse health care settings. In this article, we provide an overview of the validation and clinical impact studies for the Oncotype DX assay. We also discuss its potential use in the neoadjuvant setting, as well as the more recent prospective validation trials, and the economic and utility implications of studies that use a lower cutoff score to define low-risk disease.

Chronic pain during pregnancy: a review of the literature

Abstract: Background and purpose The majority of the reviews and studies on chronic pain in pregnancy have primarily focused on the pharmacological and non-pharmacological treatment options. The purpose of our review was to identify evidence-based clinical research for the evaluation and management of preexisting chronic pain in pregnancy, chronic pain associated with pregnancy, and chronic pain in relation to mode of delivery. Methods A literature search was undertaken using the search engines PubMed, CINAHL, EBSCOhost, and Web of Science. Search terms used included "chronic pain" AND "pregnant OR pregnancy" OR "pregnancy complications" from inception through August 2016. Results The basis of this review was the 144 articles that met inclusion criteria for this review. Based on our review of the current literature, we recommend 7 guidelines for chronic pain management during and after pregnancy: 1) complete history and physical examination; 2) monitor patients for alcohol, nicotine, and substance use; 3) collaborate with patient to set treatment goals; 4) develop a management plan; 5) for opioids, use lowest effective dose; 6) formulate a pain management plan for labor and delivery; and 7) discuss reproductive health with women with chronic pain. Conclusion The management of chronic pain associated with pregnancy is understudied. Obstetrical providers primarily manage chronic pain during pregnancy. Some general guidelines are provided for those health care providers until more information is available.

Prevalence and risk factors for maternal mortality in referral hospitals in Nigeria: a multicenter study

Abstract: Introduction While reports from individual hospitals have helped to provide insights into the causes of maternal mortality in low-income countries, they are often limited for policymaking at national and subnational levels. This multisite study was designed to determine maternal mortality ratios (MMRs) and identify the risk factors for maternal deaths in referral health facilities in Nigeria. Methods A pretested study protocol was used over a 6-month period (January 1-June 30, 2014) to obtain clinical data on pregnancies, births, and maternal deaths in eight referral hospitals across eight states and four geopolitical zones of Nigeria. Data were analyzed centrally using univariate, bivariate, and multivariate statistics. Results The results show an MMR of 2,085 per 100,000 live births in the hospitals (range: 877-4,210 per 100,000 births). Several covariates were identified as increasing the odds for maternal mortality; however, after adjustment for confounding, five factors remained significant in the logistic regression model. These include delivery in a secondary health facility as opposed to delivery in a tertiary hospital, non-booking for antenatal and delivery care, referral as obstetric emergency from nonhospital sources of care, previous experience by women of early pregnancy complications, and grandmultiparity. Conclusion MMR remains high in referral health facilities in Nigeria due to institutional and patient-related factors. Efforts to reduce MMR in these health facilities should include the improvement of emergency obstetric care, public health education so that women can seek appropriate and immediate evidence-based pregnancy care, the socioeconomic empowerment of women, and the strengthening of the health care system.

Pustular psoriasis of pregnancy: current perspectives.

Abstract: Pustular psoriasis of pregnancy (PPP) is a life-threatening condition for both the pregnant mother and fetus, and must be efficiently and accurately diagnosed and treated. This condition has historically been classified as a unique, separate dermatosis of pregnancy. However, current opinion and data suggest that it may be a variant of generalized pustular psoriasis. PPP typically occurs in the third trimester and is characterized by widespread coalescent pustules, desquamation, and systemic symptoms. Clinical features and histopathologic evaluation aid in diagnosis. Treatments during pregnancy include high-dose corticosteroids, cyclosporine, narrow-band ultraviolet B radiation, infliximab, granulocyte and monocyte adsorptive apheresis, and systemic antibiotics. Both the mother and fetus should be closely monitored with appropriate laboratory studies for the duration of the pregnancy and postpartum.

Investigating the Effects of Onion Juice on Male Fertility Factors and Pregnancy Rate After Testicular Torsion/Detorsion by Intrauterine Insemination Method

Abstract: Infertility is one of the main problems for the couples. According to statistical prevalence, approximately 15% of the couples are encountered with infertility at the end of the first year of marriage and about 20% of these cases are occurred in males (1). Furthermore, in recent decades, the number of couples searching for consultation and infertility treatment has increased (2). Although most of the men with infertility have an unusual semen analysis and abnormal sperm parameters, the reasons for infertility are not well described (3). However, according to previously research, these reasons may consist of several parameters such as environmental, dietary, medical, genetic as well as physiological factors (4). Meanwhile, as was first described by MacLeod, reactive oxygen species (ROS) has been considered as one of the most common potential causes of infertility in men (5). Similarly, it was shown that high level of ROS was associated with infertility in up to 40% of men (4). Besides, other studies in this regard have mentioned that infertility in 30% to 80% of men was related to the high level of ROS (4,6,7). Oxidative stress (OS) was found to damage the reproductive system and sperm, and therefore result in reducing sperm motility, lipid peroxidation, and oocyte-sperm fusion in addition to increasing the DNA damage (4). ROS, as stated by several studies, had considerable effects on spermatogenesis and sperm function. They reported that overproduction of ROS had harmful effects on motility, morphology, and concentration of sperm and that it caused sperm DNA damage and apoptosis (4,7-9). Testicular torsion, which occurs due to rotation of testicles, is a pathologic condition that leads to acute scrotal pain. According to the reports, although testicular torsion can be observed in any age group, its peak incidence usually occurs in young males aged 13-16 years. Moreover, it is estimated that 4.5 per 100 000 males within the age range of 1-25 years suffer from spermatic cord torsion (10). Furthermore, as pointed out by some studies, the degree and duration of Abstract Objectives: In this experimental study, a testicular torsion/detorsion model was used in male rats to investigate the effect of onion juice on male fertility factors and rate of pregnancy by intrauterine insemination (IUI). Materials and Methods: A total of 56 Wistar rats (28 males vs. 28 females) were included in this study. Male rats were randomly divided into 4 groups including sham, testicular torsion/detorsion, testicular torsion/detorsion treated with onion juice (40 mg/kg, orally) 30 minutes before detorsion, and those rats that were only treated with onion juice. Treatment with onion juice was continued for 14 days after detorsion. At the end of the study, following anesthesia with ketamine/xylazine (5/1 mg/kg), levels of testosterone hormone as well as some oxidative stress markers in the blood serum of the male rats were analyzed. Furthermore, sperm parameters were assayed, and then fertility power of the male rats was investigated in the adult female rats using IUI method. Results: The results of the study showed that there was a significantly negative change in TD group in terms of histological parameters while they were decreased in treated groups. On the one hand, although serum level of malondialdehyde (MDA) significantly increased in TD group, other oxidative markers’ (i.e., glutathione peroxidase and superoxide dismutase) serum levels and also testosterone hormone significantly decreased, on the other as compared to the other groups. In addition, the rate of sperm parameters and pregnancy presence were lower in TD group than those of other groups. However, onion juice as a treatment factor could improve the sperm quality and fertility power. Conclusions: The obtained results revealed that using onion juice could enhance the quality of sperm and fertility power after testicular torsion/detorsion.

Factors affecting home delivery among women living in remote areas of rural Zambia: a cross-sectional, mixed-methods analysis.

Abstract: Purpose Access to skilled care and facilities with capacity to provide emergency obstetric and newborn care is critical to reducing maternal mortality. In rural areas of Zambia, 42% of women deliver at home, suggesting persistent challenges for women in seeking, reaching, and receiving quality maternity care. This study assessed the determinants of home delivery among remote women in rural Zambia. Methods A household survey was administered to a random selection of recently delivered women living 10 km or more from their catchment area health facility in 40 sites. A subset of respondents completed an in-depth interview. Multiple regression and content analysis were used to analyze the data. Results The final sample included 2,381 women, of which 240 also completed an interview. Households were a median of 12.8 km (interquartile range 10.9, 16.2) from their catchment area health facility. Although 1% of respondents intended to deliver at home, 15.3% of respondents actually delivered at home and 3.2% delivered en route to a facility. Respondents cited shorter than expected labor, limited availability and high costs of transport, distance, and costs of required supplies as reasons for not delivering at a health facility. After adjusting for confounders, women with a first pregnancy (adjusted OR [aOR]: 0.1, 95% CI: 0.1, 0.2) and who stayed at a maternity waiting home (MWH) while awaiting delivery were associated with reduced odds of home delivery (aOR 0.1, 95% CI: 0.1, 0.2). Being over 35 (aOR 1.3, 95% CI: 0.9, 1.9), never married (aOR 2.1, 95% CI: 1.2, 3.7), not completing the recommended four or more antenatal visits (aOR 2.0, 95% CI: 1.5, 2.5), and not living in districts exposed to a large-scale maternal health program (aOR 3.2, 95% CI: 2.3, 4.5) were significant predictors of home delivery. After adjusting for confounders, living nearer to the facility (9.5-10 km) was not associated with reduced odds of home delivery, though the CIs suggest a trend toward significance (aOR 0.7, 95% CI: 0.4, 1.1). Conclusion Findings highlight persistent challenges facing women living in remote areas when it comes to realizing their intentions regarding delivery location. Interventions to reduce home deliveries should potentially target not only those residing farthest away, but multigravida women, those who attend fewer antenatal visits, and those who do not utilize MWHs.

Pessary use in stress urinary incontinence: a review of advantages, complications, patient satisfaction, and quality of life

Abstract: Stress urinary incontinnce (SUI) is a common condition among women. The usual approach to treatment of SUI is a stepwise plan from conservative to surgical procedures. A vaginal pessary is one of the commonly used conservative treatments that offer symptomatic improvement for women with incontinence. This review provides a critical analysis of the benefits and shortcomings offered by vaginal pessaries to patients affected by SUI, with a particular focus on indications, advantages, quality of life, patient satisfaction, and potential complications. To obtain the required information, an extensive search of PubMed and Cochrane databases was performed, covering the time frame from January 2000 to December 2016. We also surveyed the published guidelines of American Urological Association, Canadian Urological Association, American Urogynecological Society, National Institutes of Health (USA), and National Institute for Health and Care Excellence (UK). A total of 192 original research papers, review articles, and clinical trials were identified. The analysis of retrieved data provides evidence that vaginal pessaries constitute an effective nonsurgical option for SUI. The satisfaction rate with pessary use is high and only minor complications, if any, occur, vaginal discharge being the most common. The reviewed studies document that vaginal pessaries provide an adequate control of SUI if they are fit properly and managed by frequent replacements and regular checkups. They should be considered among the first line of treatment for SUI associated with exercise and increased intra-abdominal pressure.

Improving menstrual hygiene management in emergency contexts: literature review of current perspectives.

Abstract: Management of menstruation in contexts of humanitarian emergencies can be challenging. A lack of empirical research about effective interventions which improve menstrual hygiene management (MHM) among female populations in humanitarian emergencies and a lack of clarity about which sectors within a humanitarian response should deliver MHM interventions can both be attributable to the lack of clear guidance on design and delivery of culturally appropriate MHM intervention in settings of humanitarian emergencies. The objective of this review was to collate, summarize, and appraise existing peer-reviewed and gray literature that describes the current scenario of MHM in emergency contexts in order to describe the breadth and depth of current policies, guidelines, empirical research, and humanitarian aid activities addressing populations' menstrual needs. A structured-search strategy was conducted for peer-reviewed and gray literature to identify studies, published reports, guidelines, and policy papers related to menstrual response in emergency humanitarian contexts. Of the 51 articles included in the review, 16 were peer-reviewed papers and 35 were gray literature. Most of the literature agreed that hardware interventions should focus on the supply of adequate material (not only absorbent material but also other supportive material) and adequate sanitation facilities, with access to water and private space for washing, changing, drying, and disposing menstrual materials. Software interventions should focus on education in the usage of materials to manage menstruation hygienically and education about the female body's biological processes. There was clear agreement that the needs of the target population should be assessed before designing any intervention. Although there is insight about which factors should be included in an effective menstrual hygiene intervention, there is insufficient empirical evidence to establish which interventions are most effective in humanitarian emergencies and which sectors should be responsible for the coordination and implementation of such. Increased monitoring and evaluation studies of interventions should be completed and publicly shared, in order to feed evidence-based guidelines in the humanitarian sector.

Questionnaires to evaluate pelvic floor dysfunction in the postpartum period: a systematic review.

Abstract: Background Pelvic floor dysfunctions (PFDs) affect the female population, and the postpartum period can be related to the onset or aggravation of the disease. Early identification of the symptoms and the impact on quality of life can be achieved through assessment instruments. Objective The purpose of this systematic review is to evaluate questionnaires used to assess PFD in the postpartum period. Methods A systematic review study was conducted, following Preferred Reporting Items for the Systematic Reviews and Meta-Analyses (PRISMA) criteria, using the databases: PubMed, Biblioteca Virtual de Saude (BVS), Web of Science, and Scopus, and the keywords PFD or pelvic floor disorders, postpartum or puerperium, and questionnaire. Articles published up till May 2018 were included, searching for articles using validated questionnaires for the evaluation of PFDs in postpartum women. The articles included were evaluated according to a checklist, and the validation studies and translated versions of the questionnaires were identified. Results The search of the databases resulted in 359 papers, and 33 were selected to compose this systematic review, using nine validated questionnaires to assess PFDs in the postpartum period: International Consultation on Incontinence Questionnaire - Vaginal Symptoms (ICIQ-VS), Pelvic Floor Distress Inventory 20 (PFDI-20), Pelvic Floor Impact Questionnaire (PFIQ-7), PFDI-46, Pelvic Floor Impact Questionnaire (PFIQ-31), Pelvic Floor Bother Questionnaire (PFBQ), Female Pelvic Floor Questionnaire, electronic Personal Assessment Questionnaire - Pelvic Floor, and PFD questionnaire specific for pregnancy and postpartum. The most frequently reported questionnaires included PFDI-20, PFIQ-7, and ICIQ-VS and are recommended by ICI. In addition, the review identified a specific questionnaire, recently developed, to access PFD during pregnancy and postpartum. Conclusion The questionnaires used to evaluate PFD during postpartum period are developed for general population or urology/gynecology patients with incontinence and reinforce the paucity of highly recommended questionnaires designed for postpartum, in order to improve early and specific approach for this period of life.

Women’s perspectives on quality of maternal health care services in Malawi

Abstract: Despite promotion by many stakeholders to improve maternal health outcome in many developing countries including Malawi, many analysts agree that the utmost success in maternal health will arise if maternal health care services are an unparallel led source for women's health care solutions for any problem related to childbirth. Health advocates worldwide claim that even though maternal services are provided, women's utilization of such services has not been ascertained. The objective of this study was to explore women's perspectives on the quality of health care service delivery in Malawi. This article therefore investigates women's perspectives on the quality of maternal health care services in Malawi. We used six focus group discussions in six health facilities that were selected across Malawi. We found that erratic availability of medical resources and unethical practices among health workers adversely affected quality of maternal health care service delivery. We concluded that the expensive routine operational audits of medical resources and service delivery across health facilities are imperative if women's health outcomes are to be enhanced in Malawi.

Diet-induced vitamin D deficiency triggers inflammation and DNA damage profile in murine myometrium.

Abstract: Background Previously, we reported a significantly higher prevalence of uterine fibroids (UFs) in African American women. This minority group also commonly suffers from vitamin D deficiency. We have demonstrated that 1,25(OH)2D3 attains a fibroid growth inhibitory impact through its ability to block the G1/S (gap 1/synthesis) phase of the cell cycle. Vitamin D is involved in DNA damage as well as in immune response regulation, anti-inflammation, autoimmunity and cancer. Since most of the prior data on vitamin D and UF were generated in vitro via established cell lines, it was necessary to verify and validate this observation in vivo using a diet-induced vitamin D-deficient mouse model. Materials and methods Our model of vitamin D lacking function was established using 8-week exposure of C57/BL6 mice to vitamin D-deficient diet provides evidence of different functions accomplished by vitamin D in the regulation of myometrium homeostasis disrupted in the context of uterine fibroid. Results We found that vitamin D deficiency was associated with increased expression of sex steroid receptors in murine myometrium, increased expression of proliferation related genes, the promotion of fibrosis and enhanced inflammation, and promoted immunosuppression through Tregs expansion in murine myometrium. We also showed that a vitamin D deficient diet enhanced DNA damage in murine myometrium. Conclusion Our model mimics the effects in humans that a lack of vitamin D has and propels the study of in vivo interaction between inflammation, genomic instability and cell proliferation in the myometrium.

Investigating the Role of Hydroalcoholic Extract of Apium graveolens and Cinnamon zeylanicum on Metabolically Change and Ovarian Oxidative Injury in a Rat Model of Polycystic Ovary Syndrome

Abstract: Objectives: The present study aimed to compare the role of the hydroalcoholic extract of Apium graveolens and Cinnamon zeylanicum on metabolically change and ovarian oxidative injury in a rat model of polycystic ovary syndrome (PCOS). Materials and Methods: In this experimental research, 64 female Wistar rats with breeding were used including the following groups (G): (I) G1: healthy control; (II) G2: PCOS which received no therapy; (III) G3: PCOS + A. graveolens; (IV) G4: A. graveolens; (V) G5: PCOS + C. zeylanicum; (VI) G6: no PCOS + C. zeylanicum; (VII) G7: PCOS + C. zeylanicum and A. graveolens; and (VIII) G8: C. zeylanicum and A. graveolens. The PCOS was induced by a single dose of the intramuscularly injected estradiol valerate (16 mg/ kg). After 14 days, the animals were anesthetized, then their plasma samples were used to check the blood sugar (BS), insulin, and lipid profile. The ovaries of the rats were removed and fixed for histopathological assessment. In addition, the oxidative stress marker in ovarian tissue was evaluated. Results: The levels of BS, insulin, and lipid profile in plasma significantly enhanced in G2 (P < 0.05) while decreasing significantly in the therapy groups, (P < 0.05). Moreover, a significant decline was observed in the serum level of high-density lipoprotein (HDL) in G2 (P < 0.05) while it enhanced significantly in the therapeutic animals (P < 0.05). Furthermore, a negative change was found in the PCOS group on the ovarian tissue. Besides the oxidative stress enhanced in this tissue while in the treated groups this change was improved. Conclusions: Generally, it was revealed that the extract of A. graveolens and C. zeylanicum had a useful impact on regulating the serum levels of fast blood sugar (FBS), insulin, lipid profile, and oxidative stress markers in the palliation of the PCOS complications.

Anxiety and depression during pregnancy in women attending clinics in a University Hospital in Eastern province of Saudi Arabia: prevalence and associated factors.

Abstract: Background Anxiety and depression during the antenatal period is a growing problem with major effects on the mother, the developing fetus, and the neonate. Objectives To assess the prevalence of anxiety and depression during pregnancy in women attending the hospital for antenatal care and assess the associated factors. Methods This is a prospective cohort study conducted in the University Hospital of Imam Abdulrahman Bin Faisal University. Anxiety was evaluated using State Trait Anxiety Inventory. Depression was assessed using Edinburgh Postnatal Depression Scale (EPDS). Results Complete data were available for 575 women. The mean EPDS score was 10.5 (SD 5.5). The prevalence of depression was 26.8%. The mean state-anxiety score was 38.4 (SD 11.4) and mean trait-anxiety score was 38.2 (SD 9.5). The prevalence of anxiety using state-anxiety scale was 23.6%, while using the trait scale it was 23.9%. The risk is higher among unemployed women with history of miscarriage and unplanned pregnancy. Conclusion Anxiety and depression are common during pregnancy.

Management of abnormal uterine bleeding - focus on ambulatory hysteroscopy.

Abstract: The rapid evolution in ambulatory hysteroscopy (AH) has transformed the approach to diagnose and manage abnormal uterine bleeding (AUB). The medical management in primary care remains the mainstay for initial treatment of this common presentation; however, many women are referred to secondary care for further evaluation. To confirm the diagnosis of suspected intrauterine pathology, the traditional diagnostic tool of day case hysteroscopy and dilatation and curettage in a hospital setting under general anesthesia is now no longer required. The combination of ultrasound diagnostics and modern AH now allows thorough evaluation of uterine cavity in an outpatient setting. Advent of miniature hysteroscopic operative systems has revolutionized the ways in which clinicians can not only diagnose but also treat menstrual disorders such as heavy menstrual bleeding, intermenstrual bleeding and postmenopausal bleeding in most women predominantly in a one-stop clinic. This review discussed the approach to manage women presenting with AUB with a focus on the role of AH in the diagnosis and treatment of this common condition in an outpatient setting.

Prevention of gestational diabetes with a prepregnancy lifestyle intervention - findings from a randomized controlled trial.

Abstract: Purpose Lifestyle intervention studies performed during pregnancy have shown inconsistent results in relation to prevention of gestational diabetes mellitus (GDM). Therefore, the aim of this study was to assess the effect of an intervention initiated already before pregnancy in prevention of GDM in high-risk women. Patients and methods A randomized controlled trial was conducted in four Finnish maternity hospitals between the years 2008 and 2014. Altogether 228 high-risk women planning pregnancy were randomized to an intervention (n=116) or a control group (n=112). The risk factors were body mass index ≥30 kg/m2 (n=46), prior GDM (n=120), or both (n=62), without manifest diabetes at study inclusion. Trained study nurses provided individualized lifestyle counseling every 3 months in addition to a group session with a dietician. The control group received standard antenatal care. GDM was defined as one or more pathological glucose values in a 75 g 2-hour oral glucose tolerance test, performed between 12 and 16 weeks of gestation and if normal repeated between 24 and 28 weeks of gestation. Results Within 12 months, 67% of the women (n=72) in the intervention group and 63% of the women (n=71) in the control group (p=0.84) became pregnant. The cumulative incidence of GDM among the women available for the final analyses was 60% (n=39/65) in the intervention group and 54% (n=34/63) in the control group (p=0.49). GDM was diagnosed already before 20 weeks of gestation in 60% (n=44/73) of the cases. Conclusion The preconceptional lifestyle intervention applied in the present study did not reduce the incidence of GDM.

Shoulder dystocia: incidence, mechanisms, and management strategies

Abstract: Shoulder dystocia can lead to death or brain damage for the baby. Traction on the head can damage the brachial plexus. The diagnosis should be made when the mother cannot push the shoulders out with her own efforts with the next contraction after delivery of the head. There should be no traction on the head to diagnose shoulder dystocia. McRoberts' position is acceptable but it should not be accompanied by any traction on the head. If the posterior shoulder is in the sacral hollow then the best approach is to use posterior axillary traction to deliver the posterior shoulder and arm. If both shoulders are above the pelvic brim, the posterior arm should be brought down with Jacquemier's maneuver. If that fails, cephalic replacement or symphysiotomy is the next step. After shoulder dystocia is resolved, one should wait 1 minute or so to allow placental blood to return to the baby before cutting the umbilical cord.

A randomized controlled pilot trial of a smoking cessation intervention for US women living with HIV: telephone-based video call vs voice call

Abstract: Background People living with HIV smoke at a rate three times that of the general population This randomized controlled pilot trial tested the feasibility and acceptability of a video-call smoking cessation intervention in women living with HIV and its preliminary efficacy compared with a voice-call smoking cessation intervention The study focused on women due to a paucity of studies among this population, and women are less likely than men to quit smoking when provided with conventional treatment Methods Participants in both arms received an HIV-tailored smoking cessation intervention comprising eight 30-minute weekly counseling sessions in conjunction with active nicotine patches for 8 weeks The only difference between the two arms was the delivery mode of the intervention: via either telephone-based video or voice call Survival analysis and a Cox proportional hazard regression model were performed to identify factors predicting 6-month prolonged abstinence from smoking Results A video-call intervention was almost 30% less feasible than a voice-call intervention because women in their 50s and 60s or poorer women living in some southern states did not have access to video-call equipment However, those who received the video-call intervention were more likely to complete the study than those who had the voice-call intervention There was no difference in the acceptability of the two interventions A survival analysis revealed that those in the video arm were significantly more likely to maintain smoking abstinence over the 6-month follow-up period than those in the voice arm (log rank χ 2=402, P Conclusion Although a video-call intervention is less feasible than a voice-call intervention, the former seems to outperform the latter in achieving long-term smoking abstinence for women living with HIV, which may offer an advantage over establishing therapeutic alliance and visually monitoring their adherence to nicotine patches Clinical trial registration ClinicalTrialsgov NCT02898597

An educational intervention based on the extended parallel process model to improve attitude, behavioral intention, and early breast cancer diagnosis: a randomized trial

Abstract: Background Breast cancer is an important public health problem worldwide. This study aimed to assess the effectiveness of an educational intervention based on fear appeals using the extended parallel process model (EPPM) to improve attitudes, intention, and early breast cancer diagnosis in Iranian women. Methods This was a cluster-randomized trial conducted in Tehran, Iran. A sample of women 40 years old and above was recruited and assigned either to intervention group or to control group. The intervention group received two pamphlets containing fear appeals specially designed for this study using the EPPM. The control group received nothing. The primary outcomes were changes in attitude, behavioral intention, and early breast cancer diagnosis. Participants responded to a questionnaire before intervention and at 3 months follow-up assessments. Independent t-tests and paired t-tests were used for comparison. Result In all, 600 women were entered into the study (277 in the intervention group and 323 in the control group). Of these, 162 were lost to follow-up assessment. Thus, the analysis was restricted to those for whom both baseline and follow-up information was available (n=438). The mean age of participants was 53.2 (SD=9.45) years, and the mean year education of participants was 9.4 (SD=4.12) years. There were no significant differences between two groups regarding demographic variables. However, comparing outcome variables (attitude, intention, and early breast cancer diagnosis) at baseline and follow-up assessments, we found that the intervention group showed significant improvements in attitude and intention (P=0.01 and P=0.001, respectively), but no significant improvement was observed for early breast cancer diagnosis (P=0.78). The control group did not show any changes. Conclusion The findings showed that fear appeals could not influence early breast cancer diagnosis among women. However, significant changes were observed for attitude and behavioral intention.

Breastfeeding rates and barriers: a report from the State of Qatar

Abstract: Objective The aim of the study was to outline breastfeeding barriers faced by women residing in the State of Qatar. Methods A cross-sectional study through a telephone interview was conducted at Hamad Medical Corporation, the only tertiary care and accredited academic institution in the State of Qatar. Mothers of children born between the period of January 1, 2012 and December 31, 2012 in the State of Qatar were contacted. Results Of the total 840 mothers who were contacted for the telephone survey, 453 mothers agreed to be interviewed (response rate 53.9%), while 364 (43.3%) did not answer the phone, and 21 (2.5%) answered the phone but refused to participate in the study. The overall breastfeeding initiation rate among the mothers was 96.2%, with 3.8% mothers reporting that they had never breastfed their baby. The percentage of mothers who exclusively breastfed their children in the first 6 months was 24.3%. The most common barriers to breastfeeding as perceived by our participants were the following: perception of lack of sufficient breast milk after delivery (44%), formula is easy to use and more available soon after birth (17.8%), mom had to return to work (16.3%), lack of adequate knowledge about breastfeeding (6.5%), and the concept that the infant did not tolerate breast milk (4.9%). Conclusion Exclusive breastfeeding barriers as perceived by women residing in the State of Qatar, a wealthy rapidly developing country, do not differ much from those in other nations. What varies are the tremendous medical resources and the easy and comfortable access to health care in our community. We plan to implement a nationwide campaign to establish a prenatal breastfeeding counseling visit for all expecting mothers.

Reconstruction of feminine identity: the strategies of women with breast cancer to cope with body image altered.

Abstract: Background Body image altered is the most important psychosocial concern associated with breast cancer. Yet, there is a paucity of information regarding strategies for coping with this problem. This study aimed to explore Iranian breast cancer women's strategies for coping with body image altered. Methods This qualitative study was conducted in 2016-2017. A purposive sample of 36 women with breast cancer was selected with maximum variation from three health care centers in Alborz Province, Iran. Data were collected by semi-structured interviews and analyzed by performing conventional qualitative content analysis. Results The main theme of the study was "reconstruction of feminine identity" with the six main categories of physical appearance improvement, active information seeking, self-care for managing limits, psychological self-empowerment, maintaining maternal role, and maintaining wife role. Conclusion Iranian breast cancer women's strategies for coping with body image altered are multidimensional and are mainly based on personal resources. Breast cancer women use these strategies to reconstruction of their feminine identity. Health policy-makers can use the findings of the present study to develop interventions and programs for improving breast cancer women's body image care.

The ameliorative effect of Galega officinalis Extract on Histological Damages, Oxidative Stress Induced by Torsion-Detorsion in Adult Rats’ Ovarian

Abstract: Objectives: The antioxidative role of Galega officinalis extract has been reported in several studies. However, this experimental study was designed in order to investigate the impacts of G. officinalis extract against parameters, such as histological, hormonal, and oxidative stress parameters, which were induced by ovarian torsion/detorsion. Materials and Methods: Adult female Wistar rats (n = 28) were randomly divided into 4 groups including sham (G1), ovarian torsion for 3 hours then-after detorsion (G2 or TD), ovarian torsion-detorsion orally received 50 mg/kg extract of G. officinalis (G3 or TDGO), healthy rats orally received 50 mg/kg hydroalcoholic extract of G. officinalis (G4 or GO). Ten days after torsion-detorsion, rats were sacrificed and their ovaries, and their blood levels of hormones including estrogen and testosterone, as well as some oxidative stress markers were assayed. Results: The structure of ovaries in TD groups of the study showed a notable change compared to other groups. The serum levels of superoxide dismutase (SOD) and glutathione peroxidase (GSH), and also estrogen significantly decreased in TD group, while treatment with G. officinalis could prevent from decreasing mentioned parameters. Furthermore, although torsion-detorsion led to increasing the serum level of malondialdehyde (MDA), it was decreased after administration of G. officinalis. Conclusions: Obtained results showed that G. officinalis could be useful in elevating the estrogen level, reducing the oxidative stress marker (i.e. MDA) and ovarian tissue damages induced by torsion-detorsion.

The effect of endometrial thickness on pregnancy outcome in patients with Asherman's syndrome post-hysteroscopic adhesiolysis.

Abstract: Background Hysteroscopic adhesiolysis anatomically restores the uterine cavity in cases of Asherman's syndrome (AS); however, the extent of endometrial fibrosis could determine the pregnancy outcome. Objectives To determine whether endometrial thickness could influence pregnancy outcome of hysteroscopic adhesiolysis in women with a history of AS. Subjects and methods This was a retrospective cohort study that included 41 women who attended Women's Specialized Hospital, King Fahad Medical City from December 2008 to December 2015, presented with a history of infertility or recurrent pregnancy loss, and were diagnosed with intrauterine adhesions and treated by hysteroscopic adhesiolysis. To analyze the causative factors of AS, history of curettage, miscarriage, postpartum hemorrhage, hysteroscopy, endometritis, and any uterine surgery were recorded. Patients were followed up for 2 years to account for pregnancy. Patients were divided into two groups based on measurement of endometrial thickness in the midsagittal plane at mid-cycle of a menstrual period. Group A consisted of 26 patients with endometrial thickness ≤5 mm, and group B included 15 patients with endometrial thickness >5 mm. The main outcome measures included endometrial thickness and pregnancy outcome. Results Group A had significantly (P Conclusion Pregnancy rates were observed to be higher when the endometrium was >5 mm in thickness among patients with AS and miscarriage rates may be reduced in this group.

Effectiveness of nifedipine in threatened preterm labor: a randomized trial.

Abstract: Objective Threatened preterm labor is a condition in which regular uterine contractions occur at least 1 time in 10 minutes and persist for more than 30 minutes before completion of 37 weeks of gestation without dilatation of the cervix. In preterm labor with cervical dilatation, the efficacy of tocolytics was proven for prolonging pregnancy. However, in threatened preterm labor, the efficacy of tocolytics has not yet been well studied. This study aimed to evaluate the effectiveness of nifedipine versus a placebo for inhibiting uterine contraction in threatened preterm labor. Materials and methods A randomized, double-blinded, placebo-controlled study with 206 threatened preterm labor patients was undertaken. The participants were randomly allocated into either nifedipine or placebo groups. The proportion of patients with successful treatment, gestational age at delivery, and neonatal outcome were compared between the 2 groups. Results After 90 minutes of treatment, 88.3% of the nifedipine group and 69.9% of the placebo group had no uterine contraction (P 0.05). Mean gestation age at delivery and neonatal complications for both groups were not significantly different. Conclusion Nifedipine had a higher success rate for inhibiting threatened preterm contractions.

Birth preparedness and complication readiness among pregnant women attending antenatal care at the Faculty of Medicine Vajira Hospital, Thailand.

Abstract: Background Maternal and neonatal mortality is a major health problem in developing countries. Birth preparedness and complication readiness (BPCR) is a strategy to encourage pregnant women to make prompt decisions to seek care from skilled birth attendants. Reports of good BPCR vary depending on study setting and population. Most studies of BPCR have been conducted in developing countries, BPCR status and associated factors in Thailand are currently unknown. Objective To discover the proportion of good BPCR (at least four BPCR indicators), associated factors and predictive factors for good BPCR in pregnant women attending antenatal clinic. Materials and methods This cross-sectional study was conducted among pregnant women attending the antenatal clinic at the Department of Obstetrics and Gynecology, Faculty of Medicine Vajira Hospital, Thailand, from May 1 to December 31, 2017. The participants were interviewed using the BPCR index developed by the John Hopkins Program for International Education in Gynecology and Obstetrics. Results Of a total 672 pregnant women, the proportion of good BPCR was 78.6%. The association between baseline characteristics with BPCR status revealed that the good BPCR group was significantly associated with adult pregnancy, married, high education, being employed, high income, extended family, multiparity, first antenatal visit ≤12 weeks and average distance to the hospital >2 hours. Results from multiple logistic regression found that significant predictive factors for good BPCR were a diploma or a bachelor's degree (ORadj 2.09, 95% CI 1.19-3.69, P=0.010), income more than 10,000 baht (ORadj 2.63, 95% CI 1.37-5.05, P=0.004), extended family (ORadj 2.32, 95% CI 1.41-3.82, P=0.001) and multiparity (ORadj 1.56, 95% CI 1.01-2.42, P=0.047). Conclusion This study demonstrated that the proportion of good BPCR among pregnant women attending antenatal care was high. Associated factors of good BPCR were adult pregnancy, married status, high education, employed, high income, extended family, multiparity, first antenatal visit at ≤12 weeks and long-distance transportation. Predictive factors for good BPCR were high education, high income, multiparity and extended family.