1.  Title: Vaginal laceration and hemorrhagic shock during consensual sexual intercourse. Author: Jeng CJ; Wang LR Source: Journal of Sex and Marital Therapy. 2007 May-Jun;33(3):249-253. Abstract: Coital injury causing severe vaginal laceration is not uncommon during first coitus. However, hemorrhagic shock during consensual sexual intercourse is quite rare. In this report, there was one 30-year-old, one 20-year-old, and one 24 year-old woman who each suffered severe vaginal laceration and bleeding during the process of consensual coitarche. All subjects were transferred to the hospital in the condition of impending shock. We found that the lacerated sites were located at right posterior fornices in all cases. We postulate that these vulnerable sites of vaginal laceration may be due to the dextro-rotation characteristics of the uterus and the distensibility of the vagina in this area. The vaginal fornix can be extremely distended during sexual intercourse, making it vulnerable to laceration in this area. Besides, there was a disproportionate genital size in all three cases which may be a cause of vaginal laceration. It is critical that such patients receive a prompt diagnosis to provide efficient management. It needs only simple surgical skills to cure the injury if the vital signs are stable. However, those survivors may need further psychological consultation to prevent negative impact on their future sexual functioning. (author's) Language: English Keywords: TAIWAN | RESEARCH REPORT | CASE STUDIES | CLINICAL RESEARCH | WOMEN | SEXUAL INTERCOURSE | FIRST INTERCOURSE | VAGINAL INJURY | BLEEDING | SEXUALITY | Asia, Eastern | Asia | Developed Countries | Studies | Research Methodology | Demographic Factors | Population | Reproduction | Sex Behavior | Behavior | Vaginal Abnormalities | Diseases | Signs and Symptoms | Personality | Psychological Factors Document Number: 317186 |
| 2. Title: The effect of vaginal distension on the female urinary bladder and urethral sphincters. Author: Shafik A; El Sibai O; Shafik AA; Shafik IA Source: Acta Obstetricia et Gynecologica Scandinavica. 2007;86(11):1398-1403. Abstract: A mention of effect of vaginal distension, as induced by penile thrusting at coitus, on urinary bladder (UB) and urethral sphincters could not be traced in literature. We investigated the hypothesis that, upon vaginal distension, UB undergoes inhibited activity, while external and internal urethral sphincters (IUS) exhibit increased activity in order to guard against urine leakage during coitus. Response of UB and external and IUS to vaginal balloon distension was recorded in 28 healthy women (age 35.6 +or- 3.3 years). A vaginal condom was inflated with air in increments of 50 up to 200 ml, and vesical pressure as well as electromyographic (EMG) activity of external and IUS were registered. The test was repeated after separate anaesthetisation of vagina, UB and external and IUS. On vaginal distension, vesical pressure was reduced in the ratio of expansion of vaginal volume up to a certain capacity, beyond which vesical pressure ceased to decline when distending volume was augmented. Similarly, IUSEMG activity increased progressively on incrementally added vaginal distension up to 150-ml distension, beyond which any further vaginal distension did not produce an additional increase of EMG activity; the external urethral sphincter (EUS) EMG activity showed no response. Vaginal distension, while the vagina, UB and external and IUS had been separately anaesthetised, produced no significant change. Vaginal balloon distension seems to effect vesical wall relaxation and increase IUS tone. This appears to provide a mechanism that prevents urine leak during coitus. Vesical and IUS response to vaginal distension are suggested to be mediated through a reflex we term 'vagino-vesicosphincteric reflex', which seems to be evoked by vaginal distension during penile thrusting. The reflex may prove of diagnostic significance in sexual disorders. (author's) Language: English Keywords: EGYPT | RESEARCH REPORT | WOMEN | SEXUAL INTERCOURSE | UROGENITAL EFFECTS | IMPACT | CONDOMS | CONDOM FAILURE | TESTING | VAGINAL INJURY | Developing Countries | Africa, North | Africa | Demographic Factors | Population | Reproduction | Urogenital System | Physiology | Biology | Communication | Barrier Methods | Contraceptive Methods | Contraception | Family Planning | Measurement | Research Methodology | Vaginal Abnormalities | Diseases Document Number: 321802 |
3.  Title: The outcomes of midline versus medio-lateral episiotomy. Author: Sooklim R; Thinkhamrop J; Lumbiganon P; Prasertcharoensuk W; Pattamadilok J Source: Reproductive Health. 2007 Oct 29;4:10. Abstract: Episiotomy is the surgical enlargement of the vaginal orifice by an incision of the perineum during the second stage of labor or just before delivery of the baby. During the 1970s, it was common to perform an episiotomy for almost all women having their first delivery, ostensibly for prevention of severe perineum tears and easier subsequent repair. However, there are no data available to indicate if an episiotomy should be midline or medio-lateral. We compared midline versus medio-lateral episiotomy for complication such as extended perineal tears, pain scores, wound infection rates and other complications. We conducted a prospective cohort including 1,302 women, who gave birth vaginally between April 2005 and February 2006 at Srinagarind Hospital-a tertiary care center in Northeast Thailand. All women included had low risk pregnancies and delivered at term. The outcome measures included deep perineal tears (including perineal tears with anal sphincter and/or rectum tears), other complications, and women's satisfaction at 48 hours and 6-weeks postpartum. In women with midline episiotomy, deep perineal tears occurred in 14.8%, which is statistically significantly higher compared to 7% in women who underwent a mediolateral episiotomy (p-value<0.05). There was no difference between the groups for other outcomes (such as blood loss, vaginal hematoma, infection, pain, dyspareunia, and women's satisfaction with the method). The risk factors for deep perineal tears were: midline episiotomy, primiparity, maternal height < 145 cm, fetal birth weight >3,500 g and forceps extraction. Midline compared to medio-lateral episiotomy resulted in more deep perineal tears. It is more likely deep perineal tears would occur in cases with additional risk factors. (author's) Language: English Keywords: THAILAND | RESEARCH REPORT | COHORT ANALYSIS | PROSPECTIVE STUDIES | WOMEN | CHILDBIRTH | PREGNANCY COMPLICATIONS | VAGINAL INJURY | Asia, Southeastern | Asia | Developing Countries | Research Methodology | Studies | Demographic Factors | Population | Pregnancy Outcomes | Pregnancy | Reproduction | Diseases | Vaginal Abnormalities Document Number: 322089 |
| 4. Title: Female consensual coital injuries. Author: Ahmed E; Syed SA; Parveen N Source: Journal of the College of Physicians and Surgeons, Pakistan. 2006 May;16(5):333-335. Abstract: The objective was to ascertain the pattern and management strategies of coital injuries in married females in Pakistan. Design: An observational, case series. Place and Duration of Study: Gynaecology and Surgical wings - Fatima Medical Centre, Multan, over a period of seven years from January 1997 to December 2003. Records of 33 adult married females sustaining coital injuries were studied. Only married females were included. Injuries raising suspicion of indecent assault, sexual abuse and trauma were excluded. Results were recorded and analyzed. Three vulvar haematomas (9%) settled on conservative management. One labial (3%), 9 posterior fourchette (27%) and 16 vaginal wall lacerations (48%) were stitched. A broad ligament haematoma (3%) and a ruptured ovarian cyst (3%) were laparoscopically dealt with. One posterior fornix perforation (3%) with secondary peritonitis and a ruptured ectopic pregnancy (3%) with life-threatening haemorrhage underwent laparotomy. No mortality occurred in this series. Varied presentation of the coital injuries demand careful evaluation to help correct diagnosis, timely management and successful outcome with minimal morbidity. (author's) Language: English Keywords: PAKISTAN | RESEARCH REPORT | RETROSPECTIVE STUDIES | WOMEN | CURRENTLY MARRIED | GENITAL EFFECTS, FEMALE | SEX BEHAVIOR | VAGINAL INJURY | EXAMINATIONS AND DIAGNOSES | TREATMENT | Asia, Southern | Asia | Developing Countries | Studies | Research Methodology | Demographic Factors | Population | Marital Status | Nuptiality | Genitalia, Female | Genitalia | Urogenital System | Physiology | Biology | Behavior | Vaginal Abnormalities | Diseases | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health Document Number: 303094 |
| 5. Title: Sex after the menopause. Author: Adams E Source: Women's Health Newsletter. 2005 Autumn;(64):6-14. Abstract: Sexuality in all its forms can be an important part of your health and identity. However, in western societies sexuality is often considered the domain of the young, and the idea of older women having and enjoying sex sits uncomfortably with many people. It is only since the work of Kinsey and other sexuality researchers in the late 1940's, that perceptions of older people's sexuality started to change. But it is still the case today that it is more acceptable for older men than older women to be sexual. The ideas of older women's sexuality often stem from Victorian times, where the woman was passive in her sex life, and sex was mainly for reproductive purposes. Hence, the idea was that sex would stop after the menopause. (author's) Language: English Keywords: UNITED STATES OF AMERICA | SUMMARY REPORT | OLDER ADULTS | YOUTH | SEXUALITY | BELIEFS | AGE FACTORS | MENOPAUSE | VAGINAL INJURY | SEXUALLY TRANSMITTED DISEASES | VAGINAL BARRIER METHODS | North America | Americas | Developed Countries | Adults | Population Characteristics | Demographic Factors | Population | Personality | Psychological Factors | Behavior | Culture | Sociocultural Factors | Reproduction | Vaginal Abnormalities | Diseases | Reproductive Tract Infections | Infections | Barrier Methods | Contraceptive Methods | Contraception | Family Planning Document Number: 285022 |
| 6. Title: Clinical presentation and management of alleged sexually assaulted females at Mulago hospital, Kampala, Uganda. Author: Ononge S; Wandabwa J; Kiondo P; Busingye R Source: African Health Sciences. 2005 Mar;5(1):50-54. Abstract: The objective was to determine the presentation and treatment offered to sexually assaulted females attending emergency gynaecological ward in Mulago Hospital, Kampala, Uganda Setting: Mulago hospital gynaecological emergency ward. Study design: Prospective descriptive study. Participants: Fifty eight sexually assaulted females were recruited from 1st March 2000 to 31st December 2000. They were interviewed, examined, given appropriate treatment and followed up for three months. Outcome variables: Socio demographic characteristics, genital and bodily injuries, relationship to the assailant, and prevalence of sexually transmitted infections. The mean age was 9.5 with a range of 1-35 years. Seventy two percent of the victims were children below 12 years. Fifty percent of the assault occurred at the assailant's home. The majority (79.3%) of the victims knew the assailant and cases of gang rape were only 6.9%. The injuries sustained were extra genital (19.0%), genital (75.4%). The emotional or psychological disturbance was present in 22.4% of the patients. The sexually transmitted infections found included trichomonas vaginalis (1.7%) and syphilis (3.7%). All cases received counseling and prophylactic treatment for sexually transmitted infections. Those in reproductive age group were offered emergency contraception. None of the victims got post exposure HIV therapy because it was not available in the hospital. Sexual assault is common in Uganda and is one of the most dehumanizing human crimes against women. It is associated with adverse medical and social problems. There is urgent need to sensitize the community about reporting early for medical treatment after sexual assault. (author's) Language: English Keywords: UGANDA | RESEARCH REPORT | CLINICAL RESEARCH | EPIDEMIOLOGIC METHODS | WOMEN IN DEVELOPMENT | RAPE | HOSPITALS | SIGNS AND SYMPTOMS | EMERGENCY SERVICES | PREVALENCE | ACCIDENTS AND INJURIES | VAGINAL INJURY | SEXUALLY TRANSMITTED DISEASES | Developing Countries | Africa, Eastern | Africa, Sub Saharan | Africa | Research Methodology | Economic Development | Economic Factors | Crime | Social Problems | Sociocultural Factors | Health Facilities | Delivery of Health Care | Health | Diseases | Health Services | Measurement | Vaginal Abnormalities | Reproductive Tract Infections | Infections Document Number: 301558 |
| 7. Peer Reviewed Title: A study on victims of sexual offences in South Delhi. Author: Sarkar SC; Lalwani S; Rautji R; Bhardwaj DN; Dogra TD Source: Journal of Family Welfare. 2005 Jun;51(1):[7] p.. Abstract: Securing evidence after sexual offence is an important task for physicians. Poor medical evidence is often responsible for low conviction rate. Therefore, appropriate and correctly performed physical examination in cases of sexual assault is of crucial importance and analysis of preserved biological specimens such as blood and semen often yields vital evidence in contemporary criminal investigation. In the present article, the incidence and pattern of sexual offenses in South Delhi along with demographic variables, findings of physical and genital examination of victims and results of medical evidences collected are presented. (excerpt) Language: English Keywords: INDIA | RESEARCH REPORT | INCIDENCE | WOMEN | CHILD, FEMALE | RAPE | SEXUAL ABUSE | CRIME | POPULATION CHARACTERISTICS | VAGINAL INJURY | PUBLIC HEALTH | LABORATORY PROCEDURES | Developing Countries | Asia, Southern | Asia | Measurement | Research Methodology | Demographic Factors | Population | Child | Youth | Age Factors | Social Problems | Sociocultural Factors | Vaginal Abnormalities | Diseases | Health | Laboratory Examinations and Diagnoses | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care Document Number: 326220 |
| 8. Title: Is vaginal birth after cesarean delivery a safe option in India? Author: George A; Arasi KV; Mathai M Source: International Journal of Gynecology and Obstretrics. 2004 Apr;85(1):42-43. Abstract: Vaginal birth after cesarean delivery (VBAC) has been promoted as a method to reduce overall cesarean delivery rates. The benefits of successful VBAC in North American centers reportedly outweigh risks in most women with a prior low transverse cesarean delivery. Many women come to our center specifically to attempt VBAC since we offer this option for delivery following one lower segment cesarean section. Emergency cesarean delivery is possible within 15 min of decision making. We monitor all women attempting VBAC with continuous electronic monitoring, and if required, use oxytocin for labor induction and augmentation. We do not routinely explore the uterus after delivery. During the study period, prostaglandin E2 gel (0.5 mg) was used for cervical ripening when required. (excerpt) Language: English Keywords: INDIA | RESEARCH REPORT | DATA ANALYSIS | PREGNANT WOMEN | CESAREAN SECTION | CHILDBIRTH | SAFETY | VAGINAL INJURY | Asia, Southern | Asia | Developing Countries | Research Methodology | Population Characteristics | Demographic Factors | Population | Obstetrical Surgery | Surgery | Treatment | Pregnancy Outcomes | Pregnancy | Reproduction | Public Health | Health | Vaginal Abnormalities | Diseases Document Number: 191313 |
| 9. Title: Sex traditions "spreading HIV." Source: BBC News. 2003 Nov 19;:[4] p.. Abstract: Many women in particular are risking contracting the virus, as some practices involve artificial drying of the vagina. The reasons behind the practices are varied - some are to do with tribal beliefs, while others are simply efforts to please men during sex. British worker Nikki Ezire - who had spent much time in Zimbabwe, Zambia and West Africa - told the BBC's Africa Live programme that she had met many African women who used douches of tree bark to dry themselves. (excerpt) Language: English Keywords: AFRICA, SUB SAHARAN | WOMEN | HIV INFECTIONS | RISK FACTORS | ANTHROPOLOGY, CULTURAL | VAGINAL INJURY | SEX BEHAVIOR | REMARRIAGE | Africa | Developing Countries | Demographic Factors | Population | Viral Diseases | Diseases | Biology | Anthropology | Social Sciences | Vaginal Abnormalities | Behavior | Marriage Patterns | Marriage | Nuptiality Document Number: 189175 |
| 10. Title: Caesarean section or symphysiotomy for obstructed labour for developing countries? Need to ascertain women's preferences. Author: Onah HE; Nkwo PO Source: Journal of Obstetrics and Gynaecology. 2003 Nov;23(6):594-595. Abstract: In developed countries there is a tendency towards a small family size, especially as there is a good social security system. Good nutrition is assured for the greater majority of children. Pelvic growth is usually optimal, resulting in a low prevalence of cephalopelvic disproportion (CPD). Obstetric services are excellent with a low prevalence of obstructed labour; and there is little aversion to caesarean delivery. In fact, delay in performing a caesarean section is often the reason for litigation. Both the obstetrician and the parturient usually concur when the need for a caesarean section arises. For the above reasons, symphysiotomy is rarely necessary and has been abandoned in those countries. On the other hand, most developing countries, notably in Africa, are characterised by large family sizes (in the absence of a good social security system). In addition they also have a high prevalence of obstructed labour from CPD (usually secondary to poor nutrition during childhood); poor obstetric services; and a cultural dislike for caesarean delivery. Because of the dislike for caesarean delivery and other factors, symphysiotomy has been advocated for the management of obstructed labour resulting from CPD in resource-poor settings. (excerpt) Language: English Keywords: DEVELOPING COUNTRIES | PHILOSOPHICAL OVERVIEW | PREGNANT WOMEN | CHILDBIRTH | PROCEDURES | DECISION MAKING | CESAREAN SECTION | VAGINAL INJURY | PHYSICIANS | ATTITUDES | RISK FACTORS | PHYSICIAN-PATIENT RELATIONS | Population Characteristics | Demographic Factors | Population | Pregnancy Outcomes | Pregnancy | Reproduction | Organization and Administration | Behavior | Obstetrical Surgery | Surgery | Treatment | Vaginal Abnormalities | Diseases | Health Personnel | Delivery of Health Care | Health | Psychological Factors | Biology | Interpersonal Relations Document Number: 193386 |
| 11. Title: Surgical treatment of rectovaginal fistula of obstetric origin: a review of 15 years' experience in a teaching hospital. Author: Rahman MS; Al-Suleiman SA; El-Yahia AR; Rahman J Source: Journal of Obstetrics and Gynaecology. 2003 Nov;23(6):607-610. Abstract: Fifty-two women with a rectovaginal fistula were managed over a period of 15 years. All the fistulae were caused by obstetric injury commonly resulting from breakdown of the repair of complete perineal tears or from unrecognised injury during forceps or precipitate delivery. In five patients the fistula healed spontaneously within 12 weeks of the injury. Thirty-nine patients underwent transvaginal purse-string repair by standard technique and eight patients had perineoproctotomy and sphincteroplasty for large fistulae associated with anal incontinence. Surgical repair was successful in all the 47 patients including two patients who had previous failed repair elsewhere. The routine postoperative follow-up period of the patients ranged between 6 months and 8 years. There were no residual symptoms of anal sphincter weakness in the patients treated with transvaginal purse-string repair. Two of the patients who underwent perineoproctotomy and sphincteroplasty complained of varying degrees of postoperative incontinence of flatus that resolved by 8 weeks postoperation. In our experience the transvaginal purse-string method of repair for small, low rectovaginal fistulae proved highly satisfactory with 100% cure rate. Perineoproctotomy and sphincteroplasty for larger fistulae associated with anal incompetence was equally successful with minimal postoperative morbidity. (author's) Language: English Keywords: SAUDI ARABIA | RESEARCH REPORT | WOMEN | PREGNANCY | CHILDBIRTH | VAGINAL INJURY | FISTULA | SIGNS AND SYMPTOMS | EXAMINATIONS AND DIAGNOSES | SURGERY | STANDARDS | COMPLICATIONS | Middle East | Developing Countries | Demographic Factors | Population | Reproduction | Pregnancy Outcomes | Vaginal Abnormalities | Diseases | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Treatment | Research Methodology Document Number: 297693 |
| 12. Peer Reviewed Title: Determinants of episiotomy in rural Zimbabwe. Author: van den Bergh JE; Sueters M; Segaar M; van Roosmalen J Source: Acta Obstetrica et Gynecologica Scandinavica. 2003 Oct;82(10):966-968. Abstract: Background: To assess the influence of parity, mode of birth, place of birth, a history of birth by only cesarean section and birthweight on episiotomy rates. Methods: Retrospective study of 3589 women giving birth vaginally from October 1997 to October 1998 in the Gutu district in Zimbabwe, to obtain the rate of episiotomy and its determinants. Results: The overall episiotomy rate was 27%; 54% in nulliparous and 6% in multiparous women. Perineal tears varied between 5 and 11% in the different places of birth. Discussion: An episiotomy rate of 54% in nulliparous women is higher than necessary. Medical and midwifery training should be adapted to facilitate a more restrictive use of episiotomy. (author's) Language: English Keywords: ZIMBABWE | RESEARCH REPORT | RETROSPECTIVE STUDIES | PREGNANT WOMEN | CHILDBIRTH | PROCEDURES | VAGINAL INJURY | OBSTETRICAL SURGERY | RISK FACTORS | PARITY | CESAREAN SECTION | BIRTH WEIGHT | Africa, Southern | Africa, Sub Saharan | Africa | Developing Countries | Studies | Research Methodology | Population Characteristics | Demographic Factors | Population | Pregnancy Outcomes | Pregnancy | Reproduction | Organization and Administration | Vaginal Abnormalities | Diseases | Surgery | Treatment | Biology | Fertility Measurements | Fertility | Population Dynamics | Body Weight | Physiology Document Number: 193290 |
| 13. Title: [Obstetrics and proctology] L'obstétrique et la proctologie. Author: Alami A; Youssfi MM; El Amrani S; Ouazzani MC Source: Revue Sages Femmes. 2002 Jul;(26):18-20. Abstract: This article covers proctologic events that occur in more than half of women during pregnancy, childbirth, and postpartum. These pathologies are poorly known or often considered to be commonplace and unavoidable by new mothers. Anal fissures and hemorrhoid pathology which are related to pregnancy and childbirth are distinguished from traumatic pathology related to childbirth. Anal fissures occur at the end of pregnancy but tend to be produced after labor; constipation is a classic promoting factor, but the trauma of childbirth also plays an important physiopathological role. Treatment involves achieving regular stools, the administration of topical creams, and surgery as a last resort, as well as the administration of laxatives during pregnancy and for several weeks after childbirth. Hemorrhoid pathology, in turn, is more frequent than anal fissures and occurs in 50% of cases upon pregnancy. It manifests by bleeding, particularly during pregnancy, and/or thrombosis occurring at the end of pregnancy and/or after childbirth. This bleeding should be treated by achieving regular stool frequency, the administration of phlebotonic drugs and topical treatment. Surgery is rarely indicated. For thromboses, one should make do with localized treatment, paracetamol, and phlebotonic drugs whose effect remains modest. In the event of failure, generally applied short-term corticosteroids can be used, as NSAIDs are contraindicated during pregnancy. At times, surgical hemorrhoidectomy is the only salutary treatment capable of relieving pain. During vaginal childbirth, especially for a first child, the mechanical constraints exerted by fetal expulsion may have major effects on the anal sphincter, pudendal innervation, and the pelvic floor. This traumatic pathology is well known, its latent clinical impacts are underestimated. Its risk factors are well known such as primiparity, forceps delivery, perineal tears, median episiotomy, prolonged labor and delivery, and epidural analgesia. This article also discusses the etiology of 3rd and 4th degree perineal tears, neuropathy by stretching of the pudendal nerves and rectovaginal, anoperineal, or anovestibulovaginal fistulas. It discusses the treatment and prevention of all pelviperineal trauma. French Abstract: Cet article évoque les événements proctologiques qui surviennent chez plus de la moitié des femmes pendant la grossesse, l'accouchement et le post-partum. Ces pathologies sont mal connues, ou souvent considérées comme banales et inéluctables par les parturientes. On distingue la fissure anale et la pathologie hémorroïdaires qui sont liées à la grossesse et à l'accouchement, et la pathologie traumatique liée à l'accouchement. La fissure anale survient enfin de la grossesse mais se produit préférentiellement après l'accouchement, la constipation est le facteur favorisant classique, mais le traumatisme de l'accouchement joue également un rôle physiopathologique important, son traitement se fait par la régularisation du transit, l'administration de topiques et la chirurgie en derniers recours, ainsi que l'administration de laxatifs pendant la grossesse et durant quelques semaines après l'accouchement. Pour ce qui est de la pathologie hémorroïdaire, elle est plus fréquente que la fissure anale, et se révélerait dans 50% des cas à l'occasion de la grossesse. Elle se manifeste par des saignements, particulièrement pendant la grossesse, et/ou des thromboses, survenant enfin de grossesse et/ou après l'accouchement. Ces saignements doivent être traités par la régulation du transit, la prise de veinotoniques et l'administration de topiques. La chirurgie est rarement envisagée. Pour les thromboses, il faut se contenter des soins locaux, du paracétamol et des veinotoniques dont l'effet reste modeste. En cas d'échec; on peut utiliser les corticoïdes par voie générale en cure courte, les AINS étant contre-indiqués pendant la grossesse. Parfois, l'hémorroïdectomie chirurgicale est le seul traitement salvateur susceptible de soulager les douleurs. Lors de l'accouchement par voie basse, surtout pour le premier accouchement, les contraintes mécaniques exercées par l'expulsion fœtal peuvent avoir des effets majeurs sur le sphincter anal, l'innervation pudendale et le plancher pelvien. Cette pathologie traumatique est bien connue, son retentissement clinique tardif est sous estimé. Ses facteurs de risque sont bien connus tels que la primiparité, l'accouchement par forceps, les déchirures périnéales, l'épisiotomie médiane, la durée prolongée du travail et de l'expulsion et l'anesthésie péridurale. L'article évoque aussi l'étiologie des déchirures périnéales du 3ème ou 4ème degré, d'une neuropathie par étirement des nerfs pudendaux et des fistules recto-vaginales, ano-périnéales ou ano-vestibulovaginales. Il évoque le traitement et la prévention de tous les traumatismes pelvipérinéaux. Language: French Keywords: MOROCCO | ADULTS | WOMEN | PREGNANCY COMPLICATIONS | GASTROINTESTINAL EFFECTS | FISTULA | BLEEDING | CHILDBIRTH | VAGINAL INJURY | Developing Countries | Africa, Northern | Africa | Age Factors | Population Characteristics | Demographic Factors | Population | Diseases | Physiology | Biology | Signs and Symptoms | Pregnancy Outcomes | Pregnancy | Reproduction | Vaginal Abnormalities Document Number: 182960 |
| 14. Title: [Predicting the duration of the latency period with transvaginal sonographic measurement of cervical length in preterm premature rupture of the membranes] Prédiction de l'intervalle de latence par mesure échographique du col utérin dans la rupture prématurée des membranes avant terme. Author: Gabriel R; Morille C; Drieux L; Bige V; Leymarie F Source: Gynécologie Obstétrique Fertilité. 2002 Nov;30(11):856-861. Abstract: Objective: To assess the value of ultrasonographic measurement of cervical length for predicting the duration of the latency period from admission to delivery in women with preterm premature rupture of the membranes (PROM). Method: Prospective study in 88 women with preterm PROM before 34 weeks of amenorrhea. The median gestational age at admission was of 30.1 weeks. The clinical management included: no digital examination of the uterine cervix, antenatal corticosteroids, antibiotics (amoxicillin & clavulanic acid) for 7 days, and holding back until 34 weeks. Cervical length at admission was determined with transvaginal ultrasonography. The duration of the latency period was studied in relation with cervical length, serum C-reactive protein (CRP) level and white blood cell (WBC) count at admission. Results: The median latency period was longer in women with a cervical length >/= 25 mm (10 vs 5 days; p = 0.04), but this was not associated with a significant increase in birth weight. The median latency period was also longer in women with CRP < 20 mg/l (10 vs 3 days; p < 0.001) and this was associated with a significant increase in birth weight (1716 ± 549 vs 1201 ± 485 g; p < 0.01). Moreover, increased CRP levels were more frequent in women with a cervical length < 25 mm, and cervical length was no more predictive of the duration of the latency period in the subgroup of women with CRP < 20 mg/l and WBC < 20 000 cells/mm3. Conclusion: In women with preterm PROM, the latency period from admission to delivery is shorter when cervical length is < 25 mm. However, the clinical value of transvaginal ultrasonography is limited in comparison with serum CRP. (author's) French Abstract: Objectif: Évaluer l'intérêt de la longueur du col, mesurée par échographie vaginale, pour prédire la durée de l'intervalle de latence entre l'admission et l'accouchement chez les femmes hospitalisées pour rupture prématurée des membranes (RPM) avant terme. Méthode: Étude prospective chez 88 femmes avec RPM avant 34 semaines d'aménorrhée (SA). L'âge gestationnel médian à l'admission était de 30,1 SA. La prise en charge a comporté : interdiction du toucher vaginal, corticothérapie, antibiothérapie (amoxicilline & acide clavulanique) pendant 7 jours et expectative jusqu'à 34 SA. La longueur du col à 1'entrée a été mesurée par échographie vaginale. La durée de l'intervalle de latence a été confrontée à la longueur du col, au taux plasmatique de la protéine C-réactive (CRP) et à la numération des leucocytes sanguins à l'entrée. Résultats: L'intervalle de latence a été plus long chez les femmes ayant un col >/= 25 mm (médiane : 10 contre 5 jours ; p = 0,04) mais il n'était pas associé à une augmentation significative du poids de naissance. L'intervalle de latence a également été plus long chez femmes ayant un taux plasmatique de CRP < 20 mg/l (médiane : 10 contre 3 jours ; p < 0,001) et il était, alors, associé à une augmentation significative du poids de naissance (1716 ± 549 contre 1201 ± 485 g ; p < 0,01). De plus, l'élévation du taux de CRP était plus fréquente en cas de col < 25 mm et la longueur du col n'a pas été prédictive de la durée de l'intervalle de latence dans le sous-groupe des femmes ayant une CRP < 20 mg/l et une numération des leucocytes sanguins < 20 000 leucocytes/mm3. Conclusion: L'intervalle de latence dans la RPM avant terme est plus bref en cas de col < 25 mm mais la valeur prédictive de l'echographie pour ce paramètre est limitée et est inférieure à celle du taux plasmatique de CRP. (de l'auteur) Language: French Keywords: RESEARCH REPORT | CLINICAL RESEARCH | PROSPECTIVE STUDIES | PREGNANT WOMEN | ULTRASONICS | CERVICAL EFFECTS | VAGINAL INJURY | ANTIBIOTICS | BLOOD PROTEINS | SERUM PROTEIN EFFECTS | MEMBRANE PROTEINS | BIRTH WEIGHT | Research Methodology | Studies | Population Characteristics | Demographic Factors | Population | Cervix | Uterus | Genitalia, Female | Genitalia | Urogenital System | Physiology | Biology | Vaginal Abnormalities | Diseases | Drugs | Treatment | Hemic System | Hematological Effects | Body Weight Document Number: 190783 |
| 15. Title: [Quality of management of immediate complications of instrument-assisted delivery: prospective study] La qualité de la prise en charge des complications immédiates de l'accouchement instrumental - étude prospective. Author: Iouraghene I; Noukaila A; Enouri I Source: Rabat, Morocco, Institut de Formation aux Carrières de Santé, 2002. [39] p. Thesis, Institut de Formation aux Carrières de Santé, 2002. Abstract: This thesis from IFCS (Institute for Training in Healthcare Careers) discusses a prospective study which deals with the evaluation of the frequency of the immediate complications of an instrument-assisted delivery, their nature and the quality of their management at the Souissi university maternity hospital in Rabat, Morocco. Starting with the problem that instrument-assisted extraction is not devoid of maternal and neonatal complications, it requires a coordinated and multidisciplinary management calling on cooperation between midwives and the obstetrical team. The purposes of the study are to evaluate the frequency and severity of the immediate complications of an instrument-assisted delivery and to assess the quality of their management. The objectives defined are aimed at determining the indications for an instrument-assisted delivery, reviewing the precautions for use, preventing the complications of an instrument-assisted delivery and evaluating the quality of their management. The methodology used consists in the use of a data collection sheet involving 60 women having had an instrument-assisted delivery, involving forceps in 30 cases and vacuum extraction in 30 cases. The results mentioned present statistical tables displaying the numbers which concern parity, indications for use of the vacuum extractor and the forceps, the distribution of the frequency of maternal complications reflected by the hemorrhages, uterine ruptures and neonatal complications. The analysis of the results obtained reveals that most pregnancies are monitored in healthcare facilities, the recourse to instrument-assisted extraction is more common in primiparae, at 62%, than in multiparae, at 10%. Most indications are dominated by delay in fetal expulsion in 66.66% for vacuum extraction while for the forceps. the most common indication is delay in expulsion, either due to insufficient expulsive effort or because of prematurity. All the rules of application of instrument-assisted extraction are represented except the level and orientation of the presentation, which was not known in 53.33%. Among the 30 women who had a forceps delivery, 18 were complicated by vaginal tears. Management of postpartum hemorrhage was insufficient and asepsis was not respected in most cases, while neonatal complications secondary to vacuum extraction were observed in 40.66% and forceps extraction was associated with neonatal morbidity. Suggestions are made in order to improve the quality of management of the immediate complications of instrument-assisted delivery. French Abstract: Ce mémoire de l'IFCS (Institut de Formation aux Carrières de Santé) aborde une étude prospective qui porte sur l'évaluation de la fréquence des complications immédiates d'un accouchement instrumental, de leur nature et de la qualité de leur prise en charge à la maternité universitaire Souissi de Rabat au Maroc. Partant du problème que l'extraction instrumentale n'est pas dépourvue de complications maternelles et néonatales, elle nécessite une prise en charge coordonnée et multidisciplinaire faisant appel à une coopération entre sages-femmes et l'équipe obstétricale. Les buts de l'étude consistent à évaluer la fréquence et la gravité des complications immédiates d'un accouchement instrumental et à apprécier la qualité de leur prise en charge. Les objectifs déterminés tendent à cerner les indications d'un accouchement instrumental, à revoir les précautions d'utilisation, à prévenir les complications d'un accouchement instrumental et à évaluer la qualité de leur prise en charge. La méthodologie utilisée consiste en l'exploitation d'une fiche d'exploitation intéressant 60 femmes ayant eu un accouchement instrumental, soit 30 cas de forceps et 30 cas de ventouse. Les résultats mentionnés présentent des tableaux statistiques affichant des données chiffrées qui intéressent la parité, les indications d'utilisation de la ventouse et du forceps, la répartition de la fréquence des complications maternelles reflétées par les hémorragies, les ruptures utérines et les complications néonatales. L'analyse des résultats obtenus révèle que la plupart des grossesses sont suivies dans les formations sanitaires, le recours à l'extraction instrumentale est plus fréquent chez les primipares, soit 62% que chez les multipares, soit 10%. La plupart des indications sont dominées par les retards d'expulsions fœtales dans 66,66% pour la ventouse alors que pour le forceps, l'indication la plus fréquente est représentée par le retard d'expulsion, soit par insuffisance d'efforts expulsifs , soit par prématurité. Toutes les règles d'application de l'extraction instrumentale sont représentées sauf le niveau et l'orientation de la présentation qui était méconnue dans 53,33%. Parmi les 30 femmes qui ont eu un accouchement par forceps, 18 se sont compliquées des déchirures vaginales. Pour la prise en charge des hémorragies de délivrance, elle restait insuffisante et l'asepsie n'était pas respectée dans la majorité des cas, alors que pour les complications néonatales secondaires à la ventouse, elles étaient observées dans 40,66% et l'extraction par forceps était associée à une morbidité néonatale. Des suggestions ont été émises dans le but d'améliorer la qualité de la prise en charge des complications immédiates de l'accouchement instrumental. Language: French Keywords: MOROCCO | RESEARCH REPORT | PROSPECTIVE STUDIES | PREGNANT WOMEN | NEONATAL DISEASES AND ABNORMALITIES | CHILDBIRTH | SURGICAL EQUIPMENT | FORCEPS | DELIVERY OF HEALTH CARE | QUALITY OF HEALTH CARE | BLEEDING | VAGINAL INJURY | COMPLICATIONS | Developing Countries | Africa, Northern | Africa | Studies | Research Methodology | Population Characteristics | Demographic Factors | Population | Diseases | Pregnancy Outcomes | Pregnancy | Reproduction | Equipment and Supplies | Health | Health Services Evaluation | Program Evaluation | Programs | Organization and Administration | Signs and Symptoms | Vaginal Abnormalities Document Number: 188299 |
| 16. Title: Healing through training. CMMB trainings raise consciousness about critical women's health care issues. Source: Monday Developments. 2001 Aug 20;19(15):1, 10. Abstract: Millions of women suffer from both physical and emotional trauma from vesico vaginal fistula (VVF), an injury resulting from prolonged, obstructed labor. In Nigeria, custom and culture has contributed to the prevalence of this injury. Specifically, these factors include chronic malnutrition resulting in retarded development, bone deformity, and small body stature; early marriage among young females; and effects of female genital mutilation (FGM). To address this problem, the Catholic Medical Mission Board (CMMB) sponsored a Rehabilitative Training Program for these women at the VVF Center in Akwa Ibom, which was directed by Medical Missionaries of Mary sister Dr. Ann Ward. Facilitators utilized diagrams, slides, group discussions, and role-play to address the prevention and treatment of VVF to eight participating women. Through the CMMB-sponsored program, efforts are underway to raise consciousness that FGM and other women's health-care issues persist around the world. It is noted that the CMMB seeks out the voices of women who have experienced FGM for its training programs. Language: English Keywords: NIGERIA | VAGINAL INJURY | FISTULA | TRAINING PROGRAMS | WOMEN | CULTURE | PREVENTION AND CONTROL | CHANGES | Africa, Western | Africa, Sub Saharan | Africa | Developing Countries | Vaginal Abnormalities | Diseases | Education | Demographic Factors | Population | Social Change Document Number: 160839 |
| 17. Title: [Forceps complications] Les complications du forceps. Author: Alami A Source: Revue des Sages Femmes. 2001 Apr;(19):21-3. Abstract: The risk of obstetrical trauma to both mother and newborn infant must be considered before using forceps to facilitate child delivery. Most forceps-related complications are not directly associated with forceps, but rather to the circumstances in which they are used and their manipulation. Risk factors may be associated with the mother, the newborn, and with forceps use. Cutaneous complications among newborns may include ophthalmic lesions, cranial fracture, intracranial hemorrhage, nervous system lesions, and dental occlusion. With regard to maternal complications of child delivery using forceps, delivering mothers may experience urogenital tract lesions and tearing. If such damage is identified during or immediately post-delivery, it may be repaired surgically, but some damage may not be obvious and result in medium- and long-term sequelae. Obstetricians must take great care when using forceps to effect child delivery. French Abstract: L'utilisation du forceps nécessite une bonne application pour éviter ses complications et le risque de traumatisme obstétrical pour le nouveau-né que pour la mère. Les facteurs de risque des complications sont ceux maternelles que l'on rencontre en cas d'accouchement spontané telles que la primiparité, les anomalies du bassin osseux au niveau du détroit inférieur et la distance ano-symphysaire; ceux liés au nouveau-né qui sont essentiellement, les macrocosmes et d'autres liés au maniement du forceps. Pour ce qui est des complication cutanées, on trouve celles néonatales comme le céphalhématome, d'autres lésions à type d'abrasions, d'érosions ou de plaies cutanées qui cicatrisent seules sans problème, les lésions ophtalmiques, à savoir les hémorragies sous conjonctivales, les excoriations palpébrales, les oedèmes des paupières ou de la cornée ou encore d'abrasion de cornée. Ceux qui sont directement liés au forceps sont les complications cutanées telles que les lésions ophtalmiques, les fractures du crâne, les hémorragies intra-craniennes, les lésions nerveuses et les occlusions dentaires et celles maternelles telles que les lésions de la filière génitale, les lésions vulvaires et les lésions urinaires. Language: French Keywords: MANUAL | CHILDBIRTH | FORCEPS | RISK FACTORS | FETUS | INFANT | CHILD HEALTH | MATERNAL HEALTH | VAGINAL INJURY | SAFETY | COMPLICATIONS | Pregnancy Outcomes | Pregnancy | Reproduction | Surgical Equipment | Equipment and Supplies | Biology | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Health | Vaginal Abnormalities | Diseases | Public Health Document Number: 163753 |
| 18. Title: Addis Ababa Fistula Hospital : a success story in care of VVF patients. [Addis Abeba : Hôpital des Fistules, une réussite dans le traitement des patients FVV] Author: Emekekwue O Source: POPULI. 2001 Apr;28(1):14-5. Abstract: Ethiopia is one of the top nations in terms of vesico-vaginal fistula (VVF) prevalence. The Addis Ababa Fistula Hospital provides free treatment and hospital care for VVF patients in Ethiopia. Founded by gynecologists Reginald and Catherine Hamlin, the hospital has treated more than 20,000 VVF patients and is an internationally renowned training center for fistula surgeons. Initially, the Hamlins came to the country to establish a midwifery school, but then came into contact with so many VVF patients that they decided to open the Addis Ababa Fistula Hospital with donations from Britain and the US. The Ethiopian Ministry of Health, on the other hand, provides funding for the salaries of the doctors and some of the nursing staff. The UN Population Fund, together with other organizations, has supported the government in the elimination of conditions that promote the incidence of VVF and in the formulation of appropriate policy. French Abstract: L'Éthiopie est l'un des pays en tête de liste quant à la prévalence de la fistule vésico-vaginale (FVV). L'Hôpital de la Fistule d'Addis-Abeba fournit un traitement et des soins hospitaliers gratuits pour les patientes souffrant de FVV en Éthiopie. Fondé par les gynécologues Reginald et Catherine Hamlin, l'hôpital a traité plus de 20 000 cas de FVV et est un centre de formation internationalement renommé pour les chirurgiens de la fistule. Au début, les Hamlin sont venus au pays pour établir une école d'obstétrique, mais quand ils ont été en contact avec tellement de patientes ayant des FVV, ils ont décidé d'ouvrir l'Hôpital de la Fistule d'Addis-Abeba avec les donations de la Grande-Bretagne et des USA. Le Ministère de la Santé éthiopien, quant à lui, fournit les fonds pour le salaire des médecins et d'une partie du personnel soignant. Le FNUAP, avec d'autres organisations, a aidé le gouvernement pour l'élimination des conditions qui encouragent l'incidence des FVV et pour la formulation des politiques appropriées. Language: English Keywords: ETHIOPIA | PROGRESS REPORT | FISTULA | VAGINAL INJURY | TREATMENT | HOSPITALS | Developing Countries | Africa, Eastern | Africa, Sub Saharan | Africa | Diseases | Vaginal Abnormalities | Health Facilities | Delivery of Health Care | Health Document Number: 158246 |
| 19. Title: Impact of female genital mutilation on maternal and neonatal outcomes during parturition. Author: Hakim LY Source: East African Medical Journal. 2001 May;78(5):255-8. Abstract: A cross-sectional multi-center study was conducted among 1481 delivering mothers who have had spontaneous, singleton, term and vertex vaginal delivery in Tikur Anbessa, St. Paul's and Ghandhi Memorial hospitals between January and December 1997. The study aimed to evaluate the impact of female genital mutilation (FGM) on parturition and to create awareness of its implication on women and neonatal health. 82.7% of the women had one form of FGM, with type II as the most commonly performed type of circumcision. The second stage of labor was more delayed for circumcised women (p < 0.05). The Apgar scores for the non-FGM women were relatively higher than for the FGM group of women (p < 0.05). Moreover, more entries of various complications in isolation or in combination (perineal tears, bleeding, incontinence, and febrile illnesses) were observed for the FGM group than for the control group of women. The study demonstrates the greater negative impact of FGM on maternal than neonatal outcomes during parturition. Language: English Keywords: AFRICA, EASTERN | RESEARCH REPORT | PREVALENCE | FEMALE GENITAL CUTTING | PREGNANCY OUTCOMES | CHILDBIRTH | VAGINAL INJURY | MATERNAL HEALTH | CHILD HEALTH | Developing Countries | Africa, Sub Saharan | Africa | Measurement | Research Methodology | Harmful Traditional Practices | Traditional Health Practices | Culture | Pregnancy | Reproduction | Vaginal Abnormalities | Diseases | Health Document Number: 159078 |
| 20. Peer Reviewed Title: A method for the repair of vesicovaginal fistulas. Author: Milicic D; Sprem M; Bagovic D Source: INTERNATIONAL JOURNAL OF GYNECOLOGY AND OBSTETRICS. 2001 Apr;73(1):35-9. Abstract: The aim was to determine the efficacy of the sliding layers method for repairing vesicovaginal fistulas caused by surgical trauma. 21 women suffering from vesicovaginal fistulas after surgical trauma, operated on between 1990 and 1995 using the sliding layers method, were included in an uncontrolled prospective study and followed 24 months after the procedure. Patient outcome was assessed according to subjective estimation, gynecological examination and objectively by instillation of diluted methylene blue to the urinary bladder. 16 out of 21 patients suffered vesicovaginal fistulas after being subjected to abdominal hysterectomy and 5 patients after vaginal surgery. 14 fistulas were located 5-10 mm over the interureteric edge, 5 fistulas were in the trigone and 2 fistulas were in the bladder neck region. Fistula size ranged from 5 to 35 mm in diameter, but 72.1% of patient fistulas were <10 mm in diameter. Only 1 patient had a large bladder defect of 35 mm in diameter. According to subjective estimation and objective assessment, the overall success rate of the procedure after 2 years was 95.2%. Only 1 patient had to be subjected to a second successful attempt for fistula closure. The sliding layers method is safe and reliable vaginal surgical approach for the repair of vesicovaginal fistulas after surgical trauma. (author's) Language: English Keywords: CROATIA | RESEARCH REPORT | PROSPECTIVE STUDIES | VAGINAL INJURY | FISTULA | SURGERY | POSTOPERATIVE PROCEDURES | Europe, Southeastern | Europe | Developing Countries | Studies | Research Methodology | Vaginal Abnormalities | Diseases | Treatment Document Number: 157879 |
| 21. Title: [Results of treatment of vesicovaginal fistulas] Wyniki leczenia przetok pecherzowo-pochwowych. Author: Spruch T; Michalak J; Klijer R; Jezierski A; Stepnik D Source: Ginekologia Polska. 2001 Nov;72(11):862-866. Abstract: Objectives: The results of treatment of 74 patients with vesicovaginal fistulas are presented. Materials and methods: The clinical analysis have been performed in 74 women aged from 24 to 70 years (on average 53.4), who had to be treated for vesicovaginal fistulas in the Department of Urology of Lublin University School of Medicine between 1966-1999. Results: The most common cause of vesicovaginal fistulas was gynaecological surgery. Patients who underwent the operation 96, 9% were cured (after 1st operation 84, 8%). 8 cases were cured by using conservative therapy. (author's) Language: Polish Keywords: POLAND | RESEARCH REPORT | CLINICAL RESEARCH | WOMEN | FISTULA | VAGINAL INJURY | GYNECOLOGIC SURGERY | SURGICAL ERROR | TREATMENT | RECOVERY | Europe, Central | Europe | Developing Countries | Research Methodology | Demographic Factors | Population | Diseases | Vaginal Abnormalities | Urogenital Surgery | Surgery | Health Document Number: 184876 |
| 22. Title: Epilogue to childhood encounter. [Epilogue aux rencontres enfantines] Author: Yolah HK Source: POPULI. 2001 Apr;28(1):12-5. Abstract: Vesico-rectal or vesico-vaginal fistula (VVF) occurs as a result of prolonged, unrelieved, obstructed labor associated with childbirth in young girls or small-statured women. A number of VVF sufferers in Nigeria never get to any formal medical establishment to seek care due to long distances, high cost of care, or ignorance. Blame is being placed on religious, traditional, and cultural beliefs that seem to encourage early marriage. Nigeria has yet to develop a national policy on VVF and has put in place legislation and measures for the protection of the welfare of women and promotion of safe motherhood. In this regard, the Ministry of Women Affairs and Youth Development has established projects in an effort to promote women's and children's welfare. Several nongovernmental organizations have placed the VVF problem on the national agenda and launched programs tackling the causes of VVF. French Abstract: La fistule vésico-rectale ou vésico-vaginale (FVV) se produit à la suite d'un travail prolongé qui n'a pas abouti et est entravé, associé à l'accouchement chez les filles jeunes ou les femmes de petite taille. Plusieurs patientes à FVV au Nigeria n'accèdent jamais aux infrastructures médicales pour y chercher les soins à cause des longues distances, du coût élevé des soins, ou de l'ignorance. Le blâme est jeté sur les croyances religieuses, traditionnelles et culturelles qui paraissent encourager le mariage précoce. Toujours est-il que le Nigeria doit développer une politique nationale concernant les FVV et doit mettre en place une législation et des mesures pour la protection du bien-être des femmes et la promotion de la maternité sans risque. Pour cela, le Ministère des Affaires Féminines et du Développement de la Jeunesse a élaboré des projets dans un effort d'encourager le bien-être des femmes et des enfants. Plusieurs organisations non-gouvernementales ont placé le problème des FVV sur l'agenda national et ont lancé des programmes contre les causes des FVV. Language: English Keywords: NIGERIA | FISTULA | VAGINAL INJURY | CHILDBIRTH | MATERNAL HEALTH | POLICY | COMPLICATIONS | Africa, Western | Africa, Sub Saharan | Africa | Developing Countries | Diseases | Vaginal Abnormalities | Pregnancy Outcomes | Pregnancy | Reproduction | Health Document Number: 158245 |
| 23. Title: A systematic review of the health complications of female genital mutilation including sequelae in childbirth. Author: World Health Organization [WHO]. Department of Women's Health Source: Geneva, Switzerland, WHO, Department of Women's Health, 2000. iii, 180 p. (WHO/FCH/WMH/00.2) Abstract: The immediate aim of the systematic review is to identify primary data on health complications of FGM, with particular emphasis on sequelae in childbirth, including psychosexual outcomes. The longer term aim of the systematic review is to use this in Formation for a number of purposes, including identification of outcome measures of complications of FGM for studies to quantify the risk attributable to FGM at each stage in the life cycle; identification of country specific and ethnic group specific outcome measures of FGM that can be used to provide focus to optimize health care provision for care of such complications; and identification of sites world-wide where opportunities exist for research into the health sequelae of FGM. (excerpt) Language: English Keywords: SUDAN | EGYPT | ETHIOPIA | SOMALIA | DATA ANALYSIS | DATA COLLECTION | WOMEN | CHILD | FEMALE GENITAL CUTTING | PSYCHOSOCIAL FACTORS | CHILDBIRTH | PREGNANCY COMPLICATIONS | GENITAL EFFECTS, FEMALE | VAGINAL ABNORMALITIES | VAGINAL INJURY | PROGRAM EVALUATION | Africa, North | Africa | Developing Countries | Africa, Eastern | Africa, Sub Saharan | Research Methodology | Demographic Factors | Population | Youth | Age Factors | Population Characteristics | Harmful Traditional Practices | Traditional Health Practices | Culture | Behavior | Pregnancy Outcomes | Pregnancy | Reproduction | Diseases | Genitalia, Female | Genitalia | Urogenital System | Physiology | Biology | Programs | Organization and Administration Document Number: 172400 |
| 24. Peer Reviewed Title: Rotary responds to women's health needs. Author: Devlyn FJ Source: INTERNATIONAL JOURNAL OF GYNECOLOGY AND OBSTETRICS. 2000 Jul;70(1):183-90. Abstract: In working to improve the health of women, particularly in developing countries, governments face a monumental challenge. Limited resources, insufficient training, and poor infrastructure are just some of the obstacles to advancements in the field of female medicine. It is a goal of Rotary International, a worldwide association of service-minded business and professional people, to facilitate efforts to bring medical care to women and girls and to help them to build all-around healthy lives. This article gives background on Rotary International and highlights some of the ways Rotarians are using their resources, their global network, and their professional expertise to advance and promote women's health. (author's) Language: English Keywords: DEVELOPING COUNTRIES | PROGRESS REPORT | HEALTH | WOMEN | VAGINAL INJURY | BIRTH SPACING | FAMILY PLANNING | CANCER | ORGANIZATIONS | Demographic Factors | Population | Vaginal Abnormalities | Diseases | Neoplasms Document Number: 150650 |
| 25. Title: Episiotomy in Nigeria. [Episiotomie au Nigeria] Author: Otoide VO; Ogbonmwan SM; Okonofua FE Source: International Journal of Gynecology and Obstetrics. 2000 Jan;68(1):13-7. Abstract: This retrospective review was conducted to determine the incidence, risk factors, and complications associated with episiotomy and perineal tears among women who delivered at Benin Teaching Hospital in Nigeria. Researchers analyzed a total of 1345 vaginal births, which took place in the hospital between January 1997 and December 1998. Potential risk factors for episiotomy such as gestational age at delivery, instrumental delivery, birth weight and parity were determined. The incidence of episiotomy was 46.6%, while 17.5% had spontaneous perineal tears. More than 90% of primigravid parturients had episiotomy. There was a steep decline in the incidence of episiotomy with increasing parity. Conversely, the incidence of spontaneous perineal tear increased with increasing parity. Wound repair breakdown was observed in 5.7% of women with episiotomy repairs, requiring secondary resuturing, while no case of breakdown of the spontaneous perineal tear was noted (P < 0.01). When controlling for parity, breech births, forceps, and vacuum delivery were more likely to result in episiotomy compared to spontaneous vertex delivery occurring at term. Hospital policy to reduce the incidence of episiotomy should pay more attention on the selection of women who undergo episiotomy, the prevention of spontaneous perineal tears, and the care of episiotomy wounds. French Abstract: Cette revue rétrospective a été menée pour déterminer l'incidence, les facteurs de risque et les complications associés à l'épisiotomie et aux déchirures du périnée chez les femmes qui ont accouché à l'Hôpital Universitaire Bénin au Nigeria. Les chercheurs ont analysé un total de 1345 naissances vaginales qui ont eu lieu à l'hôpital entre janvier 1997 et décembre 1998. Les Facteurs de risque potentiels pour l'épisiotomie tels que l'âge de la grossesse à la délivrance, l'accouchement dystocique, le poids à la naissance et la parité ont été déterminés. L'incidence de l'épisiotomie était de 46,6%, alors que 17,5% avaient des déchirures spontanées du périnée. Plus de 90% des parturientes primipares avaient eu une épisiotomie. Il y avait une baisse notable de l'incidence de l'épisiotomie associée à une parité croissante. Inversement, l'incidence des déchirures spontanées du périnée a augmenté avec la parité croissante. L'échec de la réparation des tissus a été observé dans 5,7% des femmes ayant une épisiotomie, ce qui a exigé une re-suture secondaire, alors qu'aucun cas d'échec de déchirure spontanée du périnée n'a été noté (P <0.01). Au moment du contrôle de la parité, les présentations du siège, les forceps et la délivrance par aspiration sont plus susceptibles d'impliquer l'épisiotomie en comparaison avec la délivrance spontanée à terme. La politique de l'hôpital pour réduire la fréquence des épisiotomies devrait faire plus attention à la sélection des femmes qui subissent l'épisiotomie, à la prévention des déchirures spontanées du périnée et aux soins des plaies de l'épisiotomie. Language: English Keywords: NIGERIA | RESEARCH REPORT | RETROSPECTIVE STUDIES | INCIDENCE | VAGINAL INJURY | CHILDBIRTH | RISK FACTORS | COMPLICATIONS | Africa, Western | Africa, Sub Saharan | Africa | Developing Countries | Studies | Research Methodology | Measurement | Vaginal Abnormalities | Diseases | Pregnancy Outcomes | Pregnancy | Reproduction | Biology Document Number: 147716 |
| 26. Title: A comprehensive approach to vesico-vaginal fistula: a project in Mwanza, Tanzania. Author: Bangser M; Gumodoka B; Berege Z Source: In: Safe Motherhood initiatives: critical issues, edited by Marge Berer and TK Sundari Ravindran. Oxford, England, Blackwell Science, 1999. :157-65. (Reproductive Health Matters) Abstract: Vesico-vaginal fistula (VVF) is a serious form of maternal morbidity resulting from prolonged and obstructed labor. This condition typically affects women and girls belonging to the low-income population and has limited access to obstetric emergency care. Women having this condition will suffer from discomforts resulting from the uncontrollable leakage of urine or feces through the vaginal opening. The social stigma attached to the condition often leaves those who experience it to live a life of isolation and shame in their families and communities. This paper describes the problem of VVF, an innovative VVF project at the Bugando Medical Center (BBC) in Tanzania, and results of an exploratory study among 50 patients who arrived at the BBC for care. Finally, it outlines several recommendations for the prevention and treatment of VVF on the part of the health care systems. Language: English Keywords: TANZANIA | SUMMARY REPORT | VAGINAL INJURY | FISTULA | PREGNANCY COMPLICATIONS | MATERNAL HEALTH SERVICES | MORBIDITY | WOMEN | MATERNAL HEALTH | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | Vaginal Abnormalities | Diseases | Maternal-Child Health Services | Primary Health Care | Health Services | Delivery of Health Care | Health | Demographic Factors | Population Document Number: 147672 |
| 27. Title: Post coital tear presenting as APH. Author: Kaur D; Kaur AP Source: JOURNAL OF OBSTETRICS, GYNAECOLOGY AND FAMILY WELFARE. 1999 Apr;5(20):23-4. Abstract: A case is described of a 30-year-old woman, gravida-2, para-1, with one normal home delivery and a living child of 3 years; LMP was 10.8.96 and EDD was 17.5.97. She had no antenatal check-up during this pregnancy. The patient presented as an emergency on 21.4.97 with a case of bleeding P/V since 4:00 a.m. The patient's clothes and legs were completely soaked with blood. The pulse was 100/m; blood pressure was 110/70. An abdominal examination was performed. The height of the uterus was 34 weeks, with free-floating head, FHS + ve. The abdomen was soft and fetal parts were clearly palpable. Investigative results: Hb, 7.0 g; B.T. 1'10"; urine, C/E-NAD, ABORH-B + ve. No bedside ultrasound facility was available in the hospital. As the patient was profusely bleeding, blood transfusion was arranged. Patient was shifted to O.T. for EUA/LSCS after arranging blood transfusion. In O.T., vulva was cleaned of blood clots and bladder catheterized. While catheterizing, a 2" long and nearly 1 cm deep tear was seen in the parauretheral region, and it was bleeding profusely. Small abrasions were seen near the fouchette. After talking to the patient in confidence, she stated that the bleeding followed coitus. The parauretheral tear was stitched. The vagina was cleaned gently. A speculum examination done. The cervix was clean; no bleeding was observed. Patient was shifted to the ward. The next day the patient's ultrasound was done, which showed a 34-week pregnancy with cephalic presentation. The placenta was posterior and in the upper segment. Liquor amnii was sufficient and no apparent congenital abnormality was determined. Patient was discharged on the 7th day in good condition. (full text, modified) Language: English Keywords: INDIA | CASE STUDIES | WOMEN | SEXUAL INTERCOURSE | VAGINAL INJURY | BLEEDING | PREGNANCY | EXAMINATIONS AND DIAGNOSES | COMPLICATIONS | Asia, Southern | Asia | Developing Countries | Studies | Research Methodology | Demographic Factors | Population | Reproduction | Vaginal Abnormalities | Diseases | Signs and Symptoms Document Number: 143394 |
| 28. Title: Postcoital injuries treated at the Addis Ababa Fistula Hospital, 1991-97. Author: Muleta M; Williams G Source: Lancet. 1999 Dec 11;354(9195):2051-2. Abstract: The article reports on the occurrence of postcoital injuries in 91 women treated at the Addis Ababa Fistula Hospital between 1991 and 1997. Among the 91 women, 78 had been sexually abused under the cover of marriage; 9 were kidnapped with the intention of marriage, raped, and then discarded by their would-be husbands; and 4 were kidnapped and raped. These Ethiopian women were victims of societal tradition which condone forced abduction and rape by men who cannot afford a wife, and a society where young girls were forced to perform domestic duties resulting to vesicovaginal fistula or rectovaginal fistula. Moreover, women who develop such injuries were usually perceived to have no further value as a wife. Of the 78 married women in the study who were injured, 59 were divorced and 19 were abandoned. Their total fecal incontinence means that these girls and young women were regarded as outcasts by society. In view of this, a need for a change in attitudes and behavior within traditional societies was considered. These changes would include education, amendment of policies and laws and interventions from the government and health workers. Language: English Keywords: ETHIOPIA | EVALUATION REPORT | SEXUAL ABUSE | WOMEN | RAPE | VAGINAL INJURY | CULTURAL BACKGROUND | MARRIAGE AGE | Developing Countries | Africa, Eastern | Africa, Sub Saharan | Africa | Evaluation | Crime | Social Problems | Demographic Factors | Population | Vaginal Abnormalities | Diseases | Population Characteristics | Marriage Patterns | Marriage | Nuptiality Document Number: 146516 |
| 29. Title: The female condom: what role in changing the rapist's attitude? Author: Mumia JA Source: MEDICUS. 1999 Feb;:10-2. Abstract: This article reports the case of a 38-year-old woman who suffered vaginal small gut prolapse resulting from traumatic coitus and discusses the potential of female condoms in protecting women at risk. Colporrhexis, the term for a complete or almost complete rupture of the vaginal vault with little or no associated injury to the cervix and the lower uterine segment, may be caused by other predisposing factors like posterior colporrhapy, pelvic abscess drainage, Douglas Pouch puncture, posterior colpotomy, culdoscopy and traumatic speculum examination. Since traumatic coitus is one cause of vaginal small gut prolapse, the use of female condom was proposed to prevent such injury. Advantages of using female condoms include: 1) protection without significant cooperation of a male partner; 2) nonconstricting and does not greatly reduce male sensitivity; 3) can be inserted up to two hours in advance of intercourse; 4) offers greater protection against sexually transmitted diseases (STDs); and 5) its oil-based lubricants do not make it less effective in protecting against STDs. In contrast, disadvantages of female condoms include: 1) it is not visually appealing; 2) discomfort is felt from the inner ring during intercourse; 3) it sometimes squeaks during use; and 4) it would not stay in place in some positions. Language: English Keywords: AFRICA | AFRICA, SUB SAHARAN | AFRICA, NORTH | CASE STUDIES | WOMEN | FEMALE CONDOMS | VAGINAL INJURY | RAPE | Developing Countries | Studies | Research Methodology | Demographic Factors | Population | Vaginal Barrier Methods | Barrier Methods | Contraceptive Methods | Contraception | Family Planning | Vaginal Abnormalities | Diseases | Crime | Social Problems Document Number: 144856 |
| 30. Title: An investigation of sociomedical risk factors associated with vaginal fistula in northern Nigeria. Author: Onolemhemhen DO; Ekwempu CC Source: WOMEN & HEALTH. 1999;28(3):103-16. Abstract: Vesicovaginal fistula (VVF) is one of the most serious gynecologic problems among women of childbearing age in northern Nigeria. A case-control study conducted in Babbar Ruga Hospital in Katsina State sought to identify sociomedical risk factors for VVF. 50 VVF patients and 50 women who had given birth within the preceding 6 months without sustaining VVF were enrolled. Women with VVF were significantly shorter than controls (mean height, 5.02 vs. 5.16 ft) and weighed significantly less (103.3 vs. 109.5 lbs). Fistula patients married at a slightly older mean age than controls (13.8 vs. 13.18 years), but there was no difference in mean age at first pregnancy (16.7 vs. 15.8 years). 40% of VVF patients, compared with 14% of controls, had no formal education or Koranic lessons only. Finally, the husbands of women in the VVF group held jobs of lower status than those of controls; the largest group of husbands in the VVF group were farmers (34%), while semi-skilled and professional workers represented the largest group among husbands of controls (32%). In the multivariate analysis, the risk of VVF was significantly associated with no formal education (odds ratio (OR), 14.7), low socioeconomic status as reflected in husband's unskilled occupation (OR, 13.5), marriage in early adolescence (OR, 15.6), and primiparity (OR, 36.5). Measures to delay marriage by encouraging female education and to postpone childbearing to an age safe for delivery are recommended. Language: English Keywords: NIGERIA | RESEARCH REPORT | CASE CONTROL STUDIES | VAGINAL INJURY | FISTULA | MATERNAL HEALTH | REPRODUCTIVE HEALTH | WOMEN | RISK FACTORS | MATERNAL AGE | Africa, Western | Africa, Sub Saharan | Africa | Developing Countries | Studies | Research Methodology | Vaginal Abnormalities | Diseases | Health | Demographic Factors | Population | Biology | Parental Age | Age Factors | Population Characteristics Document Number: 142248 |
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