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Peer Reviewed

Title: Bleeding patterns associated with non-oral hormonal contraceptives: a review of the literature.
Author: Bachmann G; Korner P
Source: Contraception. 2009 Apr;79(4):247-58.
Abstract: It is generally accepted that poor tolerance to changes in vaginal bleeding associated with hormonal contraceptive use may influence compliance and continuation with the chosen method. However, disparities in the collation and reporting of bleeding data hamper comparison among studies and products. In this review, we systematically assessed MEDLINE and EMBASE for articles assessing parenteral hormonal contraceptives that reported bleeding data based on reference periods as recommended by the World Health Organization (WHO). Overall, 31 studies published between 1986 and October 2007 were included in this review. The use of parenteral hormonal contraception was in general associated with a decrease in bleeding with continued use from Reference Period 1 to 4. However, this decrease was less marked with the combined hormonal depots and both progestin-only and combined hormonal vaginal rings than with progestin-only implants, depots and the levonorgestrel intrauterine system. Overall, reporting vaginal bleeding by 90-day reference periods as recommended by the WHO allows straightforward comparison of bleeding patterns between studies.
Language: English
Keywords:
UNITED STATES OF AMERICA | RESEARCH REPORT | LITERATURE REVIEW | WOMEN | BLEEDING | CONTRACEPTIVE IMPLANTS | VAGINAL RING | CONTRACEPTIVE AGENTS, PROGESTIN | Developed Countries | North America | Americas | Demographic Factors | Population | Signs and Symptoms | Diseases | Contraceptive Methods | Contraception | Family Planning | Contraceptive Agents, Female | Contraceptive Agents
Document Number: 330560

Title: Minimally invasive surgery for children with HIV/AIDS.
Author: Banieghbal B
Source: Journal of Laparoendoscopic and Advanced Surgical Techniques. Part A. 2009 Feb;19(1):97-101.
Abstract: AIM: Human deficiency virus (HIV) infection and acquired immune deficiency syndrome (AIDS) have resulted in millions of deaths in Sub-Saharan Africa from opportunist infections. Children are not spared and are similarly affected. Minimally invasive surgery (MIS) can be used, in a selected number of children, as a mean to establish diagnosis or render a treatment. MATERIALS AND METHODS: This study was comprised of a 7-year retrospective analysis of a single pediatric surgeon's experience in South Africa. Forty-eight children, with ages 3 months to 14 years, with HIV/AIDS underwent laparoscopic/thoracoscopic exploration and treatment. RESULTS: Diagnostic laparoscopy and biopsy were the most common procedures (29 cases) indicated for nonspecific abdominal pain or rectal bleeding. The second most common procedure was laparoscopic antireflux fundoplication (10 cases) for damaged lower esophageal sphincter secondary to chronic candidal infection. The remaining procedures were for other rare surgical conditions, seen often in AIDS patients. No significant procedure-related complications occurred, but there were 2 mortalities from the underlying pathology in this cohort. CONCLUSIONS: This is the largest report on MIS for children with HIV/AIDS in the medical literature. It is shown that laparoscopic/thoracoscopic exploration and treatment in children with HIV/AIDS is safe and indicated for establishing the diagnosis and treatment of these unfortunate children.
Language: English
Keywords:
SOUTH AFRICA | RESEARCH REPORT | CLINICAL RESEARCH | LONGITUDINAL STUDIES | ORPHANS AND VULNERABLE CHILDREN | PERSONS LIVING WITH HIV/AIDS | SURGERY | LAPAROSCOPY | PHYSICAL EXAMINATIONS AND DIAGNOSES | PAIN | BLEEDING | CANDIDIASIS | GASTROINTESTINAL EFFECTS | COMPLICATIONS | AIDS | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Research Methodology | Studies | Family and Household | Sociocultural Factors | HIV Infections | Viral Diseases | Diseases | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Endoscopy | Examinations and Diagnoses | Signs and Symptoms | Bacterial and Fungal Diseases | Infections | Physiology | Biology
Document Number: 330998

Title: Three-dimensional ultrasound detection of abnormally located intrauterine contraceptive devices which are a source of pelvic pain and abnormal bleeding.
Author: Benacerraf BR; Shipp TD; Bromley B
Source: Ultrasound In Obstetrics and Gynecology. 2009 Jun 29;34(1):110-115.
Abstract: OBJECTIVE: To determine whether intrauterine contraceptive devices (IUDs) that are located abnormally within the myometrium or cervix cause a higher incidence of pelvic pain and abnormal bleeding compared with normally positioned devices. METHODS: Over a period of 9 months, all patients with an IUD presenting at our unit for two-dimensional pelvic ultrasound underwent a three-dimensional (3D) volume reconstruction of the coronal view, to visualize the entire IUD within the cavity. The IUD was deemed malpositioned if any part extended past the cavity, into the myometrium or cervix. The indications for ultrasound were recorded at presentation for the exam. The presenting symptoms of patients with an abnormally located IUD were compared with those with normally positioned ones. RESULTS: Among 167 consecutive patients with an IUD evaluated using the 3D reconstructed coronal view, 28 (16.8%) had an IUD with side arms abnormally located within the myometrium. The abnormal positioning of the IUD arms wasonly detected using the 3D coronal view. A higher proportion of patients with an abnormally located IUD presented with bleeding (35.7%) or pain (39.3%) compared with those with normally positioned IUDs (15.1% with bleeding and 19.4% with pain) (P = 0.02 and 0.03, respectively). Seventy-five percent of patients with an abnormally located IUD presented with bleeding or pain compared with 34.5% of those whose IUD was normally placed (P = 0.0001). Twenty of 21 patients with an abnormally located IUD presenting with pelvic pain or bleeding reported improvement in their symptoms after IUD removal. CONCLUSION: A 3D coronal view of the uterus is useful in the visualization of IUDs. The coronal view showing the entire device and its position within the uterus may help in identifying the cause of pelvic pain and bleeding in patients with an embedded IUD. Copyright (c) 2009 ISUOG. Published by John Wiley & Sons, Ltd.
Language: English
Keywords:
UNITED STATES OF AMERICA | MASSACHUSETTS | RESEARCH REPORT | RETROSPECTIVE STUDIES | CLIENTS | ULTRASONICS | IUD COMPLICATIONS | IUD MIGRATION | BLEEDING | PAIN | MYOMETRIUM | CERVIX | INSERTION | Developed Countries | North America | Americas | Studies | Research Methodology | Program Activities | Programs | Organization and Administration | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | IUD | Contraceptive Methods | Contraception | Family Planning | Signs and Symptoms | Diseases | Uterus | Genitalia, Female | Genitalia | Urogenital System | Physiology | Biology | Treatment
Document Number: 341864

5.
Title: [Actinomycosis of the caecum simulating carcinoma in a patient with a long-term intrauterine device]
Author: Colovic R; Grubor N; Micev M; Latincic S; Matic S; Colovic N
Source: Srpski Arhiv Za Celokupno Lekarstvo. 2009 May-Jun;137(5-6):285-7.
Abstract: INTRODUCTION: Actinomycosis of the caecum is a rare, but most frequently an abdominally localized disease. It often simulates inflammatory malignancy, rarely a periappendicular abscess or Chron's disease and is only exceptionally the cause of intestinal obstruction or bleeding. CASE OUTLINE: The authors present a 35-year-old woman with an intrauterine device which remained inserted for over three years, causing the development of pain, fever, vaginal secretion and bleeding that continued even after the device was removed. Ultrasonography showed a tumorous mass of irregular form located close to the uterus, which after a few months developed into a colliquation filled with pus requiring incision. Bacteriological examination failed to show actinomycosis. Due to the tumorous lesions involving the terminal ileum, appendix, caecum, ascending colon and omentum, a right hemicolectomy was performed. Based on histolopathological findings of the resected sample the diagnosis of actinomycosis was made. Therefore, after surgery the patient began treatment with antibiotics resulting in full recovery. CONCLUSION: Although rare, actinomycosis of the caecum should be taken into consideration in the differential diagnosis of tumorous lesions of the caecoascending part of the colon, particularly if the tumour is associated with inflammation.
Language: Serbian
Keywords:
UNITED STATES OF AMERICA | RESEARCH REPORT | WOMEN | CLIENTS | IUD COMPLICATIONS | BLEEDING | PAIN | SIGNS AND SYMPTOMS | SURGERY | TREATMENT | Developed Countries | North America | Americas | Demographic Factors | Population | Program Activities | Programs | Organization and Administration | IUD | Contraceptive Methods | Contraception | Family Planning | Diseases | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health
Document Number: 342607

Peer Reviewed

Title: Complications of surgical abortion.
Author: Diedrich J; Steinauer J
Source: Clinical Obstetrics and Gynecology. 2009 Jun;52(2):205-12.
Abstract: Surgical abortion is one of the most common procedures performed in reproductive-aged women and when performed by a skilled provider in the appropriate setting, it is one of the safest surgeries. Though the risk of complications is low, it increases exponentially with gestational age. Factors increasing risk of morbidity may be demographic, such as increasing patient age; medical, such as prior cesarean delivery; and procedural, such as inadequate dilation. This chapter will provide information on how to recognize factors that increase risk, steps to minimize risk, and to identify and manage complications promptly.
Language: English
Keywords:
UNITED STATES OF AMERICA | CALIFORNIA | RESEARCH REPORT | WOMEN | ABORTION | PREGNANCY, SECOND TRIMESTER | MORBIDITY | BLEEDING | POSTABORTION CARE | CERVICAL LACERATION | Developed Countries | North America | Americas | Demographic Factors | Population | Fertility Control, Postconception | Family Planning | Pregnancy | Reproduction | Diseases | Signs and Symptoms | Health Services | Delivery of Health Care | Health
Document Number: 342243 Notification

Title: Evaluation of postpartum blood loss after misoprostol-induced labour.
Author: Elsedeek MS; Awad EE; Elsebaey SM
Source: International Journal of Obstetrics and Gynaecology. 2009;116:431-435.
Abstract: Objective: To objectively evaluate postpartum blood loss after successful misoprostol induction and compare it with blood loss after oxytocin induction of labour. Design Prospective randomised study. Setting: Labour ward in university maternity hospital. Population A total of 150 women up to third parity with completed 40 weeks of singleton normal pregnancy, average size cephalic fetus. Methods: Cases were randomised between oxytocin induction and misoprostol induction. Blood was collected in suction set and measured in the delivery room starting after delivery of the fetus and was evaluated by pad weighing in the following 6 hours. Pre- and postdelivery haematocrit were measured and difference between the two values was assessed and analysed. Main outcome measures Success of induction, induction delivery interval, postpartum blood loss, and difference between pre- and postdelivery haematocrit. Results: Induced labour was significantly faster with misoprostol induction (P < 0.001). Blood loss and haematocrit difference was significantly greater in the misoprostol group than in oxytocin group (P < 0.02 and 0.001, respectively). Blood loss in both groups was significantly correlated with higher initial Bishop score (P < 0.001 and 0.024, respectively) and short labour duration (P < 0.0002 and 0.0001, respectively). Conclusions Misoprostol induction is associated with increased blood loss especially when used in women with high Bishop score; therefore, it is better reserved for cases requiring cervical ripening.
Language: English
Keywords:
UNITED STATES OF AMERICA | RESEARCH REPORT | PROSPECTIVE STUDIES | MISOPROSTOL | POSTPARTUM | BLEEDING | EVALUATION | Developed Countries | North America | Americas | Studies | Research Methodology | Prostaglandins, Synthetic | Prostaglandins | Endocrine System | Physiology | Biology | Puerperium | Reproduction | Signs and Symptoms | Diseases
Document Number: 340207

8.
Title: A Canadian, Multicentre Study Comparing the Efficacy of a Levonorgestrel-releasing Intrauterine System to an Oral Contraceptive in Women With Idiopathic Menorrhagia.
Author: Endrikat J; Shapiro H; Lukkari-Lax E; Kunz M; Schmidt W; Fortier M
Source: Journal of Obstetrics and Gynaecology Canada. 2009 Apr;31(4):340-347.
Abstract: Objectives: To evaluate the efficacy of a levonorgestrel-releasing intrauterine system (LNG-IUS) compared with a combined oral contraceptive containing 1 mg norethindrone acetate and 20 mg ethinyl estradiol (OC1/20) in reducing menstrual blood loss (MBL) in women with idiopathic menorrhagia. Methods: A prospective, randomized, open-label study was conducted in nine centres in Canada. Healthy women over 30 years of age suffering from idiopathic menorrhagia were treated either with LNG-IUS (n = 20) or with OC1/20 (n = 19) over 12 months. The primary endpoint was the change in MBL from baseline to 12 months. Secondary endpoints included treatment success (defined as a MBL score < 100 after 12 months), hemoglobin levels, and the menorrhagia severity score. Results: In both treatment groups, MBL decreased significantly from baseline to 12 months (P < 0.001). For the primary endpoint, the MBL score decreased significantly more in the LNG-IUS group (median from 228 to 13, mean percent change-83%) compared to the OC1/20 group (median from 290 to 72; mean percent change-68%) (P = 0.002) after 12 months. In the LNG-IUS group, 80% of subjects had treatment success compared with 36.8 % in the OC1/20 group (P < 0.009). Both treatments increased hemoglobin concentrations significantly between baseline and 12 months. The menorrhagia severity score was consistently lower in the LNG-IUS group at all study time points and was significantly lower (P = 0.045) at six months. Both treatments were well tolerated. Conclusion: Both the LNG-IUS and the combined oral contraceptive effectively decreased menstrual blood loss in women with idiopathic menorrhagia. The overall clinical benefit was more pronounced with LNG-IUS than with OC1/20.
Language: English
Keywords:
CANADA | RESEARCH REPORT | PROSPECTIVE STUDIES | WOMEN | ORAL CONTRACEPTIVES, COMBINED | BLEEDING | MENORRHAGIA | TREATMENT | Developed Countries | North America, Northern | Americas | Studies | Research Methodology | Demographic Factors | Population | Oral Contraceptives | Contraceptive Methods | Contraception | Family Planning | Signs and Symptoms | Diseases | Menstruation Disorders | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health
Document Number: 341573

Peer Reviewed

Title: Bleeding pattern, tolerance and patient satisfaction with a drospirenone-containing oral contraceptive evaluated in 3488 women in Europe, the Middle East and Canada.
Author: Endrikat JS; Milchev NP; Kapamadzija A; Georgievska J; Gerlinger C; Schmidt W; Feroze S
Source: Contraception. 2009 Jun;79(6):428-32.
Abstract: BACKGROUND: This study was conducted to assess the bleeding pattern, tolerance and patient satisfaction associated with an oral contraceptive (OC) containing 3 mg of drospirenone and 30 mcg of ethinyl estradiol under real-life conditions. STUDY DESIGN: A multicenter, prospective and observational six-cycle study was conducted in 12 countries in Europe, the Middle East and Canada. The efficacy variables included an assessment of bleeding patterns, premenstrual symptoms of water retention and patient satisfaction as determined by a visual analog scale. RESULTS: A total of 3488 women was enrolled in the study. The percentage of women with intermenstrual bleeding decreased from 27.9% at baseline to 5.4% at the end of Cycle 6, while dysmenorrhea decreased from 67% to 17.7%. Also, amenorrhea decreased from 21.3% to 7.5%. The decreases in all three parameters were statistically significant (p<.0001). Approximately 70% of the women reported abdominal bloating and/or breast tenderness at baseline and less than 38% did so at the end of Cycle 6 (p<.0001). Patient satisfaction increased for all investigated items. Upon completion of the study, 86.2% of the women answered "yes" to continuing treatment with this OC. CONCLUSION: The OC containing 3 mg of drospirenone and 30 mcg of ethinyl estradiol has beneficial effects on bleeding pattern, symptoms of water retention and patient satisfaction.
Language: English
Keywords:
EUROPE | MIDDLE EAST | CANADA | RESEARCH REPORT | CLINICAL RESEARCH | PROSPECTIVE STUDIES | KAP SURVEYS | WOMEN | BLEEDING | SATISFACTION | ORAL CONTRACEPTIVES, COMBINED | ESTRADIOL | CONTRACEPTIVE SAFETY | AMENORRHEA | METRORRHAGIA | Developed Countries | North America, Northern | Americas | Research Methodology | Studies | Surveys | Sampling Studies | Demographic Factors | Population | Signs and Symptoms | Diseases | Psychological Factors | Behavior | Oral Contraceptives | Contraceptive Methods | Contraception | Family Planning | Estrogens | Hormones | Endocrine System | Physiology | Biology | Safety | Public Health | Health | Menstruation Disorders
Document Number: 341103

10.

Title: Report on the FIGO-SOGP Saving the Mothers and Newborn Health Project in Pakistan. An NFOG concern [editorial]
Author: Grunewald C; Moller B
Source: Acta Obstetricia et Gynecologica Scandinavica. 2009;88(2):132-3.
Abstract: FIGO is increasing its involvement in female health matters around the world. Funds have been solicited for Saving the Mothers and Newborn Health Projects in 12 developing countries. The obstetrics and gynecology society and midwifery association of each project country has been affiliated to a Western society, in what is called 'twinning'. The Swedish Association of Obstetricians and Gynecologists (SFOG) has twinned with the Society of Obstetricians and Gynaecologists of Pakistan (SOGP). The SFOG board has signed a letter of understanding. A similar arrangement has been created between the Danish society (DSOG) and its Nigerian counterpart. Both twinning projects are supported by NFOG. In Pakistan, achievements so far are promising despite formidable problems in society, health care and security. (excerpt)
Language: English
Keywords:
PAKISTAN | GLOBAL | RESEARCH REPORT | MOTHERS | INFANT | MATERNAL HEALTH | POSTPARTUM | BLEEDING | SAFE MOTHERHOOD | REPRODUCTIVE HEALTH | Developing Countries | Asia, Southern | Asia | Parents | Family Relationships | Family Characteristics | Family and Household | Sociocultural Factors | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Health | Puerperium | Reproduction | Signs and Symptoms | Diseases
Document Number: 330197

11.

Peer Reviewed

Title: Uterine artery embolization to treat hemorrhage following second-trimester abortion by dilatation and surgical evacuation.
Author: Haddad L; Delli-Bovi L
Source: Contraception. 2009 Jun;79(6):452-5.
Abstract: BACKGROUND: This study was conducted to review cases of second-trimester postabortal hemorrhage (PAH) occurring at a private women's health facility that were treated with uterine artery embolization (UAE). METHODS: A retrospective review was conducted on all second-trimester terminations performed at a private women's health facility between 1999 and 2006. Cases of PAH treated with UAE were reviewed in detail, reviewing progress, operative and discharge notes along with anesthesia records. RESULTS: Fifteen cases of PAH were identified among 3936 second-trimester terminations that were performed. Seven cases were identified in which UAE was used to treat PAH. Etiologies leading to hemorrhage varied in the seven cases as did the presence of coexisting factors such as infection and anatomic lesions. All cases were successfully treated by UAE, requiring no additional surgical intervention. CONCLUSION: Given the success of embolization, we offer this as an alternative to exploratory surgery and hysterectomy and as a first-line approach in cases of PAH after conservative management strategies have failed.
Language: English
Keywords:
UNITED STATES OF AMERICA | RESEARCH REPORT | RETROSPECTIVE STUDIES | PREGNANCY, SECOND TRIMESTER | POSTABORTION | POSTABORTION CARE | BLEEDING | TREATMENT | Developed Countries | North America | Americas | Studies | Research Methodology | Pregnancy | Reproduction | Health Services | Delivery of Health Care | Health | Signs and Symptoms | Diseases | Medical Procedures | Medicine
Document Number: 342598

12.

Peer Reviewed

Title: Scheduled and unscheduled bleeding patterns with two combined hormonal contraceptives: application of new recommendations for standardization.
Author: Hampton RM; Fisher AC; Pagano S; LaGuardia KD
Source: Fertility and Sterility. 2009 Aug;92(2):434-40.
Abstract: OBJECTIVE: To reassess and compare cycle control attained with two combined hormonal contraceptives, norgestimate (NGM)/ethinyl estradiol (EE) 25 microg and norethindrone acetate (NETA)/EE 20 microg, by new general criteria recommendations for all combined hormonal contraceptives. DESIGN: Analysis of bleeding data for cycles 1-6 from a randomized, multicenter trial. SETTING: 221 North American centers. PATIENT(S): Healthy, sexually active women (18-45 years old). INTERVENTION(S): NETA/EE: 1 mg NETA/20 microg EE, days 1-21 of each cycle and 75 mg of ferrous fumarate, days 22-28; NGM/EE: triphasic NGM in 7-day increments (days 1-7: 180 microg; days 8-14: 215 microg; days 15-21: 250 microg) and 25 microg EE, placebo on days 22-28. MAIN OUTCOME MEASURE(S): Cycle control evaluated from patients' daily diaries. RESULT(S): For cycles 1-6, there was a statistically significant lower incidence of unscheduled bleeding/spotting with NGM/EE 25 microg (range 21.0%-34.4%) than with NETA/EE 20 microg (range 33.0%-46.6%). Of the women who had unscheduled bleeding/spotting, the mean number of days per cycle of bleeding/spotting was comparable. A statistically significant higher incidence of scheduled bleeding was seen with NGM/EE 25 microg (95.2%-97.5%) than with NETA/EE 20 microg (78.5%-84.2%). CONCLUSION(S): The NGM/EE 25 microg has a lower incidence and comparable length of unscheduled bleeding and a higher incidence of scheduled bleeding than NETA/EE 20 microg in this post hoc analysis.
Language: English
Keywords:
NORTH AMERICA | RESEARCH REPORT | CLINICAL TRIALS | ORAL CONTRACEPTIVES, COMBINED | ETHINYL ESTRADIOL | NORETHINDRONE ACETATE | BLEEDING | STANDARDS | EVALUATION | RECOMMENDATIONS | Developed Countries | Americas | Clinical Research | Research Methodology | Oral Contraceptives | Contraceptive Methods | Contraception | Family Planning | Contraceptive Agents, Estrogen | Contraceptive Agents, Female | Contraceptive Agents | Norethindrone | Contraceptive Agents, Progestin | Signs and Symptoms | Diseases
Document Number: 342585

13.

Peer Reviewed

Title: Cervical dilation in second-trimester abortion.
Author: Hayes JL; Fox MC
Source: Clinical Obstetrics and Gynecology. 2009 Jun;52(2):171-8.
Abstract: Dilation and evacuation, the most common method performed for second-trimester abortion in the United States, requires sufficient cervical dilation to reduce the risk of complications such as cervical laceration or uterine perforation. The cervix may be prepared with osmotic dilators such as laminaria, Lamicel, or Dilapan-S, or with pharmacologic agents such as misoprostol. Dilapan-S and Lamicel achieve their maximum dilation faster than laminaria, making same-day procedures possible. Misoprostol has limited data supporting its use in this setting. Decisions regarding which method is best are clinician-dependent, and factors such as gestational age and time allowed for preparation should be considered.
Language: English
Keywords:
UNITED STATES OF AMERICA | MARYLAND | RESEARCH REPORT | CERVICAL DILATATION | RISK FACTORS | CERVICAL EFFECTS | BLEEDING | ABORTION | Developed Countries | North America | Americas | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Cervix | Uterus | Genitalia, Female | Genitalia | Urogenital System | Physiology | Biology | Signs and Symptoms | Diseases | Fertility Control, Postconception | Family Planning
Document Number: 342247 Notification

14.

Title: Application of evidence-based teaching in maternal and child health in remote Vietnam.
Author: Hirst JE; Jeffery HE; Morris J; Foster K; Elliott EJ
Source: International Journal of Gynaecology and Obstetrics. 2009 Feb;104(2):152-5.
Abstract: OBJECTIVE: To develop, implement, and evaluate an evidence-based multidisciplinary teaching program to improve maternal and infant health in remote Vietnam. METHODS: Needs assessments identified prevention of infection, neonatal resuscitation, and prevention of postpartum hemorrhage as primary targets. A 3-day workshop based on the small group, interactive, skills-based SCORPIO method was developed. Participants underwent formative written and performance-based assessments. Qualitative and quantitative evaluation of course content and teaching method was conducted. RESULTS: Two annual workshops were conducted for 58 health professionals, all of whom demonstrated skills acquisition to an adequate standard on completion. The workshops were rated as good or excellent overall by 100% of the participants, who reported that the content would help with their clinical work and that the teaching method was acceptable and easy to understand. CONCLUSION: We demonstrated the SCORPIO method can be adapted to teach knowledge and clinical skills in remote Vietnam. Further work is needed to demonstrate an effect on health outcomes.
Language: English
Keywords:
VIETNAM | RESEARCH REPORT | NEEDS ASSESSMENT | POSTPARTUM WOMEN | BLEEDING | HEALTH EDUCATION | CHILD HEALTH | MATERNAL HEALTH | Asia, Southeastern | Asia | Developing Countries | Evaluation | Puerperium | Reproduction | Signs and Symptoms | Diseases | Education | Health
Document Number: 330824

15.

Title: Spontaneous hepatic hemorrhage secondary to prolonged use of oral contraceptives.
Author: Jaffar R; Pechet L; Whalen GF; Banner BF
Source: Pathology, Research and Practice. 2009 Jul 3;
Abstract: Oral contraceptive pills (OCP) are the most commonly used form of contraception throughout the United States of America. The prolonged usage of oral contraceptives leads to a variety of complications, ranging from subclinical modifications of liver function tests to the development of benign and malignant tumors of the liver. Spontaneous hepatic hemorrhage secondary to oral contraceptive use was only reported once in the early 1980s. We report a case of spontaneous hepatic hemorrhage secondary to prolonged ingestion of combined OCPs followed by multiple pulmonary emboli without underlying thrombophilia.
Language: English
Keywords:
UNITED STATES OF AMERICA | SUMMARY REPORT | CASE HISTORIES | ORAL CONTRACEPTIVES, SIDE EFFECTS | ADMINISTRATION AND DOSAGE | HEPATIC EFFECTS | BLEEDING | HEMATOMA | PULMONARY EMBOLISM | SURGERY | Developed Countries | North America | Americas | Data Collection | Research Methodology | Contraceptive Safety | Safety | Public Health | Health | Drugs | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Physiology | Biology | Signs and Symptoms | Diseases | Embolism | Vascular Diseases
Document Number: 341974

16.
Peer Reviewed

Title: Postpartum haemorrhage and eclampsia: differences in knowledge and care-seeking behaviour in two districts of Bangladesh.
Author: Kalim N; Anwar I; Khan J; Blum LS; Moran AC; Botlero R; Koblinsky M
Source: Journal of Health, Population, and Nutrition. 2009 Apr;27(2):156-69.
Abstract: In high- and low-performing districts of Bangladesh, the study explored the demand-side of maternal healthcare by looking at differences in perceived knowledge and care-seeking behaviours of women in relation to postpartum haemorrhage or eclampsia. Haemorrhage and eclampsia are two major causes of maternal mortality in Bangladesh. The study was conducted during July 2006-December 2007. Both postpartum bleeding and eclampsia were recognized by women of different age-groups as severe and life-threatening obstetric complications. However, a gap existed between perception and actual care-seeking behaviours which could contribute to the high rate of maternal deaths associated with these conditions. There were differences in care-seeking practices among women in the two different areas of Bangladesh, which may reflect sociocultural differences, disparities in economic and educational opportunities, and a discrimination in the availability of care.
Language: English
Keywords:
BANGLADESH | RESEARCH REPORT | SAMPLING STUDIES | WOMEN | POSTPARTUM | BLEEDING | ECLAMPSIA | KNOWLEDGE | UTILIZATION OF HEALTH CARE | MATERNAL MORTALITY | PREGNANCY COMPLICATIONS | PERCEPTION | SOCIOCULTURAL FACTORS | Developing Countries | Asia, Southern | Asia | Studies | Research Methodology | Demographic Factors | Population | Puerperium | Reproduction | Signs and Symptoms | Diseases | Health Services | Delivery of Health Care | Health | Mortality | Population Dynamics | Psychological Factors | Behavior
Document Number: 341993

17.

Peer Reviewed

Title: Challenges in managing postpartum hemorrhage in resource-poor countries.
Author: Karoshi M; Keith L
Source: Clinical Obstetrics and Gynecology. 2009 Jun;52(2):285-98.
Abstract: Managing postpartum hemorrhage depends in part on having a prepared mind, a complement of trained coworkers, and full access to modern therapies. The last 2 components are rare in resource-poor areas and their absence may be accentuated by climatic instability and lack of basic transportation. Greater use of the active management of third stage of labor and administration of misoprostol by nontrained birth attendants will provide beneficial reductions in hemorrhage rates in resource-poor areas. Additional improvements depend on increasing public awareness, facilitating existing nongovernmental organizations in their community-related, upgrading training of traditional birth attendants, and providing cell phone communication to workers in remote areas, in addition to providing better access to blood.
Language: English
Keywords:
DEVELOPING COUNTRIES | RESEARCH REPORT | TRADITIONAL BIRTH ATTENDANTS | POSTPARTUM WOMEN | BLEEDING | EXAMINATIONS AND DIAGNOSES | TREATMENT | MANAGEMENT | Health Personnel | Delivery of Health Care | Health | Puerperium | Reproduction | Signs and Symptoms | Diseases | Medical Procedures | Medicine | Health Services | Organization and Administration
Document Number: 342241

18.

Peer Reviewed

Title: Adding low-dose estrogen to the hormone-free interval: impact on bleeding patterns in users of a 91-day extended regimen oral contraceptive.
Author: Kaunitz AM; Portman DJ; Hait H; Reape KZ
Source: Contraception. 2009 May;79(5):350-5.
Abstract: BACKGROUND: A cross-study analysis of contraceptive clinical trials for two different 91-day oral contraceptive (OC) regimens was performed to examine the impact on bleeding patterns when supplementing the 7-day hormone-free interval with 10 mcg ethinyl estradiol (EE) daily. STUDY DESIGN: Two separate 1-year Phase 3 clinical programs were conducted using similar study designs. The percentages of subjects reporting bleeding and spotting using electronic diaries for each 91-day cycle were compared. RESULTS: Scheduled bleeding with the EE regimen was less than that reported with the regimen utilizing placebo during Days 85-91, with significant differences noted for all four 91-day cycles. Unscheduled bleeding decreased more quickly with the 91-day regimen containing low-dose EE in place of placebo, with significant differences noted during the third cycle. CONCLUSIONS: This cross-study comparison suggests that the administration of low-dose estrogen in place of placebo in a 91-day extended regimen OCimproves the bleeding profile.
Language: English
Keywords:
NORTH AMERICA, NORTHERN | LITERATURE REVIEW | CLINICAL TRIALS | WOMEN | BLEEDING | ORAL CONTRACEPTIVES, SIDE EFFECTS | ORAL CONTRACEPTIVES, LOW-DOSE | CONTRACEPTIVE AGENTS, ESTROGEN | TIME FACTORS | ADMINISTRATION AND DOSAGE | ETHINYL ESTRADIOL | Americas | Developed Countries | Clinical Research | Research Methodology | Demographic Factors | Population | Signs and Symptoms | Diseases | Contraceptive Safety | Safety | Public Health | Health | Oral Contraceptives | Contraceptive Methods | Contraception | Family Planning | Contraceptive Agents, Female | Contraceptive Agents | Population Dynamics | Drugs | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care
Document Number: 330939

19.

Peer Reviewed

Title: Levonorgestrel-releasing intrauterine system and endometrial ablation in heavy menstrual bleeding: a systematic review and meta-analysis.
Author: Kaunitz AM; Meredith S; Inki P; Kubba A; Sanchez-Ramos L
Source: Obstetrics and Gynecology. 2009 May;113(5):1104-16.
Abstract: OBJECTIVE: To compare the effects of the levonorgestrel intrauterine system and endometrial ablation in reducing heavy menstrual bleeding. DATA SOURCES: Medline and EMBASE were searched online using Ovid up to January 2009, as well as the reference lists of published articles, to identify randomized controlled trials comparing the levonorgestrel intrauterine system with endometrial ablation in the treatment of heavy menstrual bleeding. METHODS OF STUDY SELECTION: This systematic review and meta-analysis was restricted to randomized controlled trials in which menstrual blood loss was reported using pictorial blood loss assessment chart scores. TABULATION, INTEGRATION, AND RESULTS: Six randomized controlled trials that included 390 women (levonorgestrel intrauterine system, n=196; endometrial ablation, n=194) were retrieved. Three studies pertained to first-generation endometrial ablation (manual hysteroscopy) and three to second-generation endometrial ablation (thermal balloon). Study characteristics and quality were recorded for each study. Data on the effect of treatment on pictorial blood loss assessment chart scores were abstracted, integrated with meta-analysis techniques, and presented as weighted mean differences. Both treatment modalities were associated with similar reductions in menstrual blood loss after 6 months (weighted mean difference, -31.96 pictorial blood loss assessment chart score [95% confidence interval (CI), -65.96 to 2.04]), 12 months (weighted mean difference, 7.45 pictorial blood loss assessment chart score [95% CI, -12.37 to 27.26]), and 24 months (weighted mean difference, -26.70 pictorial blood loss assessment chart score [95% CI, -78.54 to 25.15]). In addition, both treatments were generally associated with similar improvements in quality of life in five studies that reported this as an outcome. No major complications occurred with either treatment modality in these small trials. CONCLUSION: Based on the meta-analysis of six randomized clinical trials, the efficacy of the levonorgestrel intrauterine system in the management of heavy menstrual bleeding appears to have similar therapeutic effects to that of endometrial ablation up to 2 years after treatment.
Language: English
Keywords:
UNITED KINGDOM | RESEARCH REPORT | CLINICAL TRIALS | WOMEN | BLEEDING | LEVONORGESTREL | IUD | ENDOMETRIAL EFFECTS | CONTRACEPTIVE METHOD ACCEPTABILITY | CONTRACEPTIVE USE-EFFECTIVENESS | Developed Countries | Europe, Western | Europe | Clinical Research | Research Methodology | Demographic Factors | Population | Signs and Symptoms | Diseases | Contraceptive Agents, Progestin | Contraceptive Agents, Female | Contraceptive Agents | Contraception | Family Planning | Contraceptive Methods | Endometrium | Uterus | Genitalia, Female | Genitalia | Urogenital System | Physiology | Biology | Contraceptive Usage | Contraceptive Effectiveness
Document Number: 341342

20.

Title: Facility-based maternal death review in three districts in the central region of Malawi: an analysis of causes and characteristics of maternal deaths.
Author: Kongnyuy EJ; Mlava G; van den Broek N
Source: Women's Health Issues. 2009 Jan-Feb;19(1):14-20.
Abstract: PURPOSE: We sought to determine the causes and characteristics maternal deaths that occur in health facilities in Malawi. METHODS: Forty-three maternal deaths were reviewed in 9 hospitals in 3 districts in Central Malawi over a 1-year period. Causes and avoidable factors of maternal deaths were identified during the review, and recommendations made and implemented. MAIN FINDINGS: There were 28 (65.1%) direct obstetric deaths and 15 (34.9%) indirect obstetric deaths. The major causes of maternal deaths were postpartum hemorrhage (25.6%), postpartum sepsis (16.3%), HIV/AIDS (16.3%), ruptured uterus (7.0%), complications of abortion (7.0%), anemia (7.0%), antepartum hemorrhage (4.7), and eclampsia (4.7). Two thirds of the women were referred either from another health facility (51.2%) or by a traditional birth attendant (TBA; 11.6%), and up to 79.1% were critically ill on admission. Four groups of factors that contributed to maternal deaths were identified: 1) health worker factors, 2) administrative factors, 3) patient/family factors, and 4) TBA factors. The major health worker factors were inadequate resuscitation (69.8%), lack of obstetric life-saving skills (60.5%), inadequate monitoring (55.8%), initial assessment incomplete (46.5%), and delay in starting treatment (46.5%). The most common administrative factor was lack of blood for transfusion (20.9%). The major problems encountered include shortage of staff and other resources, difficulty in maintaining anonymity, poor quality of data, and difficulty in implementing recommendations. CONCLUSION: Adequate training on obstetric life-saving skills, addressing HIV/AIDS, and raising community awareness could be important factors for reducing maternal mortality in Malawi and countries with similar socioeconomic profiles.
Language: English
Keywords:
MALAWI | RESEARCH REPORT | MOTHERS | INFANT | HEALTH PERSONNEL | MATERNAL MORTALITY | CAUSES OF DEATH | BLEEDING | POSTPARTUM | PERFORMANCE IMPROVEMENT | EVALUATION | Africa, Southern | Africa, Sub Saharan | Africa | Developing Countries | Parents | Family Relationships | Family Characteristics | Family and Household | Sociocultural Factors | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Delivery of Health Care | Health | Mortality | Population Dynamics | Signs and Symptoms | Diseases | Puerperium | Reproduction | Management | Organization and Administration
Document Number: 331041

21.

Title: [Long-cycle treatment in oral contraception] Langzyklus bei Ovulationshemmern.
Author: Kuhl H; Birkhauser M; Mueck A; Neulen J; Thaler C
Source: therapeutische Umschau. Revue therapeutique. 2009 Feb;66(2):101-8.
Abstract: Surveys show that most women desire a change in their menstrual pattern in the sense that they would prefer less menstruations or even amenorrhea. On this behalf, there is no difference between women having spontaneous natural cycles and women taking the pill. The main reasons are less menstrual bleedings, better hygienic conditions, a better quality of life and less blood loss. In women wanting regular monthly periods, the opinion is dominant that suppression of menstrual bleedings is "unnatural". It is therefore primordial to inform women that contraceptive safety is even increased in users following the long-cycle principal and that a fertility decrease has not to be feared. The benefit of the long-cyle OC is a reduction of the hormonal fluctuations induced by the pill-free interval with its consecutive somatic and mental symptoms, as well as an increased contraceptive safety. The following cycle- and menstruation-dependent symptoms as listed as an indication for the long-cycle use: Endometriosis, hypermenorrhea, dysmenorrhea, hemorrhagic diathesis, uterine fibroma, polyzystic ovary syndrom, migraine due to estrogen-deficiency in the pill-free interval as well as premenstrual syndrome.
Language: German
Keywords:
RESEARCH REPORT | SURVEYS | WOMEN | AMENORRHEA | MENSTRUATION | BLEEDING | QUALITY OF LIFE | CONTRACEPTIVE SAFETY | Sampling Studies | Studies | Research Methodology | Demographic Factors | Population | Menstruation Disorders | Diseases | Reproduction | Signs and Symptoms | Social Welfare | Economic Factors | Safety | Public Health | Health
Document Number: 329572

22.

Title: Abnormal expression of MMP-9 and imbalance of MMP-9/TIMP-1 is associated with prolonged uterine bleeding after a medical abortion with mifepristone and misoprostol.
Author: Li L; Zhou Z; Huang L
Source: Acta Obstetricia et Gynecologica Scandinavica. 2009;88(6):673-9.
Abstract: OBJECTIVE: To investigate the expression of matrix metalloproteinase-9 (MMP-9) and tissue inhibitory of metalloproteinase-1 (TIMP-1) in women who had undergone a medical abortion and explore their possible role in the mechanism of prolonged uterine bleeding after a mifepristone-misoprostol abortion. DESIGN: Cross-sectional study. SETTING: Tertiary referral university hospital. SAMPLE: Forty women were recruited following a medical abortion with mifepristone and misoprostol, 20 with duration of bleeding >14 days and 20 with duration of bleeding 14 days after a medical abortion (bleeding group), whereas each sample of women with duration of bleeding Language: English
Keywords:
CHINA | RESEARCH REPORT | CROSS SECTIONAL ANALYSIS | WOMEN | RU-486 | MISOPROSTOL | ABORTION | BLEEDING | ENDOMETRIUM | UTERINE EFFECTS | Asia, Eastern | Asia | Developing Countries | Research Methodology | Demographic Factors | Population | Hormone Antagonists | Hormones | Endocrine System | Physiology | Biology | Prostaglandins, Synthetic | Prostaglandins | Fertility Control, Postconception | Family Planning | Signs and Symptoms | Diseases | Uterus | Genitalia, Female | Genitalia | Urogenital System
Document Number: 341611

23.

Peer Reviewed

Title: Successful management of second-trimester postabortion hemorrhage with an intrauterine tamponade balloon.
Author: Madden T; Burke AE
Source: Obstetrics and Gynecology. 2009 Feb;113(2 Pt 2):501-3.
Abstract: BACKGROUND: Legally induced abortion is a safe procedure. However, hemorrhage is a significant cause of abortion-related morbidity and mortality. We describe a case in which a uterine tamponade balloon was successfully used to control a second-trimester postabortion hemorrhage. CASE: A gravida 1 para 0 woman underwent dilation and evacuation at 18 weeks of gestation for fetal aneuploidy. Her procedure was complicated by intraoperative hemorrhage not resulting from uterine atony. This was successfully managed by tamponade with a large intrauterine balloon. CONCLUSION: Uterine balloon tamponade should be considered in the management of second-trimester postabortion hemorrhage unresponsive to medical therapy.
Language: English
Keywords:
WASHINGTON | RESEARCH REPORT | CLINICAL RESEARCH | CASE STUDIES | WOMEN | PREGNANCY, SECOND TRIMESTER | POSTABORTION | POSTABORTION CARE | BLEEDING | ABORTION | TREATMENT | United States of America | North America | Americas | Developed Countries | Research Methodology | Studies | Demographic Factors | Population | Pregnancy | Reproduction | Health Services | Delivery of Health Care | Health | Signs and Symptoms | Diseases | Fertility Control, Postconception | Family Planning | Medical Procedures | Medicine
Document Number: 330359 Notification

24.

Peer Reviewed

Title: Sublingual misoprostol after surgical management of early termination of pregnancy.
Author: Mulayim B; Celik NY; Onalan G; Zeyneloglu HB; Kuscu E
Source: Fertility and Sterility. 2009 Aug;92(2):678-81.
Abstract: OBJECTIVE: To assess the efficacy of sublingual misoprostol after surgical management of early termination of pregnancy (ETP) regarding duration and amount of bleeding, presence of retained products of conception (RPOC), and endometrial thickness. DESIGN: Prospective, randomized clinical trial. SETTING: University hospital. PATIENT(S): One hundred five patients admitted for possible management of early pregnancy failure and unwanted pregnancy. INTERVENTION(S): Manual vacuum aspiration (control and study groups) plus 400 microg sublingual misoprostol (study group) at pregnancy termination, and transvaginal ultrasonography (both groups) 10 days after the procedure. MAIN OUTCOME MEASURE(S): Duration and amount of bleeding and presence of RPOC and endometrial thickness 10 days after the procedure. RESULT(S): Bleeding lasted 3.2 and 5.1 days in the study and control groups. Severe vaginal bleeding occurred in two patients in the study group and in six patients in the control group. Mean endometrial thickness was 5.5 mm in the study group and 6.9 mm in the control group. These differences were statistically significant. No cases of RPOC occurred in the study group; two cases occurred in the control group. CONCLUSION(S): In countries in which surgical management of ETP is still done, using sublingual misoprostol postoperatively may reduce the duration and amount of bleeding.
Language: English
Keywords:
TURKEY | RESEARCH REPORT | CLINICAL TRIALS | CLIENTS | ABORTION | PREGNANCY, UNWANTED | BLEEDING | MISOPROSTOL | ULTRASONICS | TIME FACTORS | SURGERY | MANAGEMENT | TREATMENT | Europe, Southeastern | Europe | Developing Countries | Clinical Research | Research Methodology | Program Activities | Programs | Organization and Administration | Fertility Control, Postconception | Family Planning | Reproductive Behavior | Fertility | Population Dynamics | Demographic Factors | Population | Signs and Symptoms | Diseases | Prostaglandins, Synthetic | Prostaglandins | Endocrine System | Physiology | Biology | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health
Document Number: 342616 Notification

25.

26.

Title: Side effects of oral misoprostol for the prevention of postpartum hemorrhage: results of a community-based randomised controlled trial in rural India.
Author: Patted SS; Goudar SS; Naik VA; Bellad MB; Edlavitch SA; Kodkany BS; Patel A; Chakraborty H; Derman RJ; Geller SE
Source: Journal of Maternal-Fetal and Neonatal Medicine. 2009 Jan;22(1):24-8.
Abstract: OBJECTIVE: To investigate the side effects of 600 microg oral misoprostol given for the mother and the newborn to prevent postpartum hemorrhage (PPH). METHODS: One thousand six hundred twenty women delivering at home or subcentres in rural India were randomised to receive misoprostol or placebo in the third stage of labour. Women were evaluated for shivering, fever, nausea, vomiting and diarrhea at 2 and 24 h postpartum. Newborns were evaluated within 24 h for diarrhea, vomiting and fever. Symptoms were graded as absent, mild-to-moderate or severe. RESULTS: Women who received misoprostol had a significantly greater incidence of shivering (52%vs. 17%, p < 0.001) and fever (4.2%vs. 1.1%, p < 0.001) at 2 h postpartum compared with women who received placebo. At 24 h, women in the misoprostol group experienced significantly more shivering (4.6%vs. 1.4%, p < 0.001) and fever (1.4%vs. 0.4%, p < 0.03). There were no differences in nausea, vomiting or diarrhea between the two groups. There were no differences in the incidence of vomiting, diarrhea or fever for newborns. CONCLUSIONS: Misoprostol is associated with a significant increase in postpartum maternal shivering and fever with no side effects for the newborn. Given its proven efficacy for the prevention of PPH, the benefits of misoprostol are greater than the associated risks.
Language: English
Keywords:
INDIA | RESEARCH REPORT | CLINICAL RESEARCH | CASE CONTROL STUDIES | POSTPARTUM WOMEN | WOMEN IN DEVELOPMENT | RURAL POPULATION | COMMUNITY HEALTH SERVICES | SIDE EFFECTS | MISOPROSTOL | BLEEDING | PREVENTION AND CONTROL | PREGNANCY COMPLICATIONS | ORAL CONTRACEPTIVES, SIDE EFFECTS | SIGNS AND SYMPTOMS | Asia, Southern | Asia | Developing Countries | Research Methodology | Studies | Puerperium | Reproduction | Economic Development | Economic Factors | Population Characteristics | Demographic Factors | Population | Primary Health Care | Health Services | Delivery of Health Care | Health | Treatment | Medical Procedures | Medicine | Prostaglandins, Synthetic | Prostaglandins | Endocrine System | Physiology | Biology | Diseases | Contraceptive Safety | Safety | Public Health
Document Number: 330717

27.

Title: Expectant management of incomplete abortion in the first trimester.
Author: Pauleta JR; Clode N; Graca LM
Source: International Journal of Gynaecology and Obstetrics. 2009 Mar 28;
Abstract: OBJECTIVE: To evaluate the effectiveness and acceptability of expectant management of induced and spontaneous first trimester incomplete abortion. METHODS: A prospective observational trial, conducted between June 2006 and November 2007, of 2 groups of patients diagnosed with an incomplete abortion: 66 patients who had received misoprostol for an induced abortion (group 1) and 30 patients who had had a spontaneous abortion (group 2). Transvaginal ultrasound was performed weekly. The success rate (complete abortion without surgery), time to resolution, duration of bleeding and pelvic pain, rate of infection, number of unscheduled hospital visits, and level of satisfaction with expectant management were recorded. RESULTS: The incidence of complete abortion was 86.4% and 82.1% in groups 1 and 2 respectively at day 14 after diagnosis, and 100% in both groups at day 30 (two group 2 patients underwent curettage and were excluded from the analysis). Both groups reported 100% satisfaction with expectant management, although over 90% of the women reported feeling anxious. CONCLUSION: Expectant management for incomplete abortion in the first trimester after use of misoprostol or after spontaneous abortion may be practical and feasible, although it may increase anxiety associated with the impending abortion.
Language: English
Keywords:
PORTUGAL | RESEARCH REPORT | PROSPECTIVE STUDIES | CLINICAL RESEARCH | PREGNANT WOMEN | ABORTION | PREGNANCY, FIRST TRIMESTER | ABORTION, SPONTANEOUS | MISOPROSTOL | ULTRASONICS | TIME FACTORS | BLEEDING | PAIN | INFECTIONS | Developed Countries | Europe, Southwestern | Europe | Studies | Research Methodology | Population Characteristics | Demographic Factors | Population | Fertility Control, Postconception | Family Planning | Pregnancy | Reproduction | Pregnancy Complications | Diseases | Prostaglandins, Synthetic | Prostaglandins | Endocrine System | Physiology | Biology | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Population Dynamics | Signs and Symptoms
Document Number: 341468

28.

Peer Reviewed

Title: Avoidable maternal deaths: Three ways to help now.
Author: Prata N; Graff M; Graves A; Potts M
Source: Global Public Health. 2009 Mar 26;:1-12.
Abstract: The current paper examines the realities of women delivering in resource-poor settings, and recommends cost-effective, scalable strategies for making these deliveries safer. Ninety-five percent of maternal deaths occur in poor settings, and the largest proportion of these deaths are women who deliver at home, far away from health care facilities, and without financial access to skilled providers. This situation will improve only when policymakers and programme planners refocus their attention on service delivery and financing interventions, with the potential to reach the largest portion of women living in places where mortality is the highest. We suggest three feasible interventions that can potentially minimise both demand and supply side problems of safe delivery: (1) misoprostol to treat postpartum haemorrhage, an easy to use and heat stable technology to reduce the leading cause of maternal deaths; (2) alternative providers, such as clinical officers, trained to offer emergency obstetric care services; (3) financing safe delivery through vouchers or other mechanisms that can be implemented in poor settings and made attractive to the donor community through output-based assistance (OBA).
Language: English
Keywords:
DEVELOPING COUNTRIES | RECOMMENDATIONS | EVALUATION | WOMEN IN DEVELOPMENT | PREGNANT WOMEN | MIDWIVES AND MIDWIFERY | MATERNAL MORTALITY | CHILDBIRTH | HOME CARE | MICROECONOMIC FACTORS | DELIVERY OF HEALTH CARE | MATERNAL HEALTH SERVICES | MISOPROSTOL | POSTPARTUM | BLEEDING | Economic Development | Economic Factors | Population Characteristics | Demographic Factors | Population | Health Personnel | Health | Mortality | Population Dynamics | Pregnancy Outcomes | Pregnancy | Reproduction | Care and Support | Health Services | Maternal-Child Health Services | Primary Health Care | Prostaglandins, Synthetic | Prostaglandins | Endocrine System | Physiology | Biology | Puerperium | Signs and Symptoms | Diseases
Document Number: 341477

29.

Title: Saving maternal lives in resource-poor settings: Facing reality.
Author: Prata N; Sreenivas A; Vahidnia F; Potts M
Source: Health Policy. 2009 Feb;89(2):131-148.
Abstract: Objective: Evaluate safe-motherhood interventions suitable for resource-poor settings that can be implemented with current resources. Methods: Literature review to identify interventions that require minimal treatment/infrastructure and are not dependent on skilled providers. Simulations were run to assess the potential number of maternal lives that could be saved through intervention implementation according to potential program impact. Regional and country level estimates are provided as examples of settings that would most benefit from proposed interventions. Results: Three interventions were identified: (i) improve access to contraception; (ii) increase efforts to reduce deaths from unsafe abortion; and (iii) increase access to misoprostol to control postpartum hemorrhage (including for home births). The combined effect of postpartum hemorrhage and unsafe abortion prevention would result in the greatest gains in maternal deaths averted. Discussion/conclusions: Bold new initiatives are needed to achieve the Millennium Development Goal of reducing maternal mortality by three-quarters. Ninety-nine percent of maternal deaths occur in developing countries and the majority of thesewomen deliver alone, or with a traditional birth attendant. It is time for maternal health program planners to reprioritize interventions in the face of human and financial resource constraints. The three proposed interventions address the largest part of the maternal health burden.
Language: English
Keywords:
UNITED STATES OF AMERICA | RESEARCH REPORT | LOW INCOME POPULATION | POSTPARTUM WOMEN | INTERVENTIONS | FAMILY PLANNING | MATERNAL MORTALITY | ABORTION | BLEEDING | MISOPROSTOL | Developed Countries | North America | Americas | Social Class | Socioeconomic Status | Socioeconomic Factors | Economic Factors | Puerperium | Reproduction | Programs | Organization and Administration | Mortality | Population Dynamics | Demographic Factors | Population | Fertility Control, Postconception | Signs and Symptoms | Diseases | Prostaglandins, Synthetic | Prostaglandins | Endocrine System | Physiology | Biology
Document Number: 330193 Notification

30.

Peer Reviewed

Title: Adolescent gynecology.
Author: Sanfilippo JS; Lara-Torre E
Source: Obstetrics and Gynecology. 2009 Apr;113(4):935-47.
Abstract: Given new developments in the field of adolescent reproductive health, this review focuses on highlighting new guidelines and practice patterns in evaluation and management of adolescent gynecologic problems. First, understanding the proper techniques for the initial examination is key to establishing a long-term relationship with this age group. Reservations about the first gynecologic examination are common, and the practitioner's goal is foremost to make the patient as comfortable as possible. Preventive health in this patient population is key, and practitioners should become comfortable with providing education about topics as diverse as sexuality, eating disorders, and dating violence. Furthermore, the frequency with which teenagers report sexual activity and the high unintended pregnancy rate in this age group makes counseling regarding effective contraception essential. Additionally, practitioners are encouraged to take the opportunity to discuss the availability of the human papillomavirus (HPV) vaccine with adolescents. In 2007, adolescents were designated as a special population, given the frequency with which they acquire and clear mild HPV-related cervical dysplasia. More conservative treatment in this population is generally favored. During their transition through puberty, disorders of menstruation become the most common complaint requiring the attention of the gynecologist. Most commonly, anovulation serves as the cause behind such abnormal bleeding. Polycystic ovarian syndrome can develop in early puberty and carry its consequences into adulthood. Infertility, diabetes, and hirsutism mark the most important components of the syndrome and require age-appropriate management. Finally, the consequences of endometriosis on the future fertility of adolescents have brought early intervention to light. Recognition and prompt treatment are advocated to prevent the future implications of this disease.
Language: English
Keywords:
UNITED STATES OF AMERICA | VIRGINIA | RESEARCH REPORT | ADOLESCENTS, FEMALE | EXAMINATIONS AND DIAGNOSES | ADOLESCENT HEALTH | GYNECOLOGY | PREVENTIVE MEDICINE | HPV | CYTOLOGY | HISTOLOGY | BLEEDING | UTERINE EFFECTS | ORAL CONTRACEPTIVES | TREATMENT | IUD | VAGINAL BARRIER METHODS | Developed Countries | North America | Americas | Adolescents | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Viral Diseases | Diseases | Biology | Signs and Symptoms | Uterus | Genitalia, Female | Genitalia | Urogenital System | Physiology | Contraceptive Methods | Contraception | Family Planning | Barrier Methods
Document Number: 341227


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