1.  Title: Cesarean section deliveries in the occupied Palestinian territory (oPt): An analysis of the 2006 Palestinian Family Health Survey. Author: Abdul-Rahim HF; Abu-Rmeileh NM; Wick L Source: Health Policy. 2009 Aug 10; Abstract: OBJECTIVE: Against the backdrop of a rise in cesarean section deliveries from 6.0% in 1996 to 14.8% in 2006, the objective of this study was to investigate socio-demographic, clinical and service-related factors associated with cesarean sections in the occupied Palestinian territory. METHODS: Data from the Palestinian Family Health Survey 2006 were used to examine last births in the 5 years preceding the survey to women aged 15-49 years. Bivariate and multivariate associations between type of delivery (dependent variable) and selected factors were analyzed using logistic regression. Selected maternal outcomes were also investigated with type of delivery as the independent variable. RESULTS: Cesarean section deliveries were significantly associated with maternal age (35+ years), primiparity, low birth weight and residence area in the West Bank and Gaza. There was no significant difference in the prevalence of cesarean deliveries by sector in the West Bank, but in Gaza, they were significantly more common in the governmental sector. CONCLUSIONS: There is a need for detailed audits of cesarean section deliveries, nationally and at the facility level, in order to avoid unnecessary interventions in the context of high fertility, rising poverty and fragmented health services. Variations by governorate should be studied further for focused interventions. Language: English Keywords: MIDDLE EAST | DEVELOPING COUNTRIES | PREVALENCE | HEALTH SURVEYS | WOMEN | CESAREAN SECTION | HEALTH SERVICES | DELIVERY OF HEALTH CARE | Measurement | Research Methodology | Health | Demographic Factors | Population | Obstetrical Surgery | Surgery | Treatment | Medical Procedures | Medicine Document Number: 342538 |
| 2. Peer Reviewed Title: Oral compared with intravenous sedation for first-trimester surgical abortion: a randomized controlled trial. Author: Allen RH; Fitzmaurice G; Lifford KL; Lasic M; Goldberg AB Source: Obstetrics and Gynecology. 2009 Feb;113(2 Pt 1):276-83. Abstract: OBJECTIVE: To test the equivalency of oral sedation and intravenous sedation for pain control in first-trimester surgical abortion. METHODS: Women undergoing suction curettage at less than 13 weeks of gestation were randomly assigned to oral sedation, 10 mg of oxycodone and 1 mg of lorazepam, or intravenous sedation, 100 micrograms fentanyl and 2 mg midazolam. All patients received 800 mg of preoperative ibuprofen and a 20-mL paracervical block with 1% lidocaine. The primary outcome was intraoperative pain as measured on a 21-point verbal rating scale that had a range from 0 to 100 (0=no pain and 100=worst pain ever) with an equivalence margin for the treatment group comparison of +/-10. RESULTS: Of 130 women, 65 were randomly assigned to oral sedation and 65 to intravenous sedation. The groups differed at baseline by age and preoperative ratings of depression, stress, and anxiety; however, when adjusted for these differences, the primary results were unaffected. Mean intraoperative pain scores, controlling for age and preoperative depression, stress, and anxiety, were 61.2 for oral sedation and 36.3 for intravenous sedation (mean difference 24.9, 95% confidence interval 15.9-33.9). Other findings included no difference in postoperative adverse effects and less satisfaction with pain control with oral sedation compared with intravenous sedation. CONCLUSION: Oral sedation, as studied, is not equivalent to intravenous sedation for pain control during first-trimester surgical abortion. CLINICAL TRIAL REGISTRATION:: ClinicalTrials.gov, www.clinicaltrials.gov, NCT00337792 LEVEL OF EVIDENCE: I. Language: English Keywords: MASSACHUSETTS | RESEARCH REPORT | CLINICAL TRIALS | COMPARATIVE STUDIES | EVALUATION INDEXES | KAP SURVEYS | PREGNANT WOMEN | ANESTHESIA | ABORTION | PREGNANCY, FIRST TRIMESTER | CURETTAGE | ADMINISTRATION AND DOSAGE | PAIN | SIDE EFFECTS | SATISFACTION | Developed Countries | United States of America | North America | Americas | Clinical Research | Research Methodology | Studies | Quantitative Evaluation | Evaluation | Surveys | Sampling Studies | Population Characteristics | Demographic Factors | Population | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Fertility Control, Postconception | Family Planning | Pregnancy | Reproduction | Obstetrical Surgery | Surgery | Drugs | Signs and Symptoms | Diseases | Psychological Factors | Behavior Document Number: 330360 Notification |
| 3. Title: Misoprostol for pregnancy termination in grand multiparous women with three cesarean deliveries. Author: Alsibiani SA Source: International Journal of Gynaecology and Obstetrics. 2009 Apr 3; Abstract: In countries in which women have high parity, pregnancy termination is common in women who have had multiple cesarean deliveries. Although a combination of mifepristone and misoprostol is recommended for late abortion, in Saudi Arabia, mifepristone is not approved or available. There is little information about the safety of misoprostol for the termination of pregnancy or induction of labor in women with scarred uteri and multiple cesarean deliveries. Although there is no recommended dose or mode of administration for misoprostol in patients with scarred uteri and high parity, it is advisable to use a low dose. Misoprostol use in women with scarred uteri can lead to uterine rupture, but few incidences have been reported in the literature. However, caution is advisable. Misoprostol administered orally has a rapid onset of action and increases uterine tone, but contractions are not experienced unless repeated doses are administered. In addition, women usually prefer oral administration. Vaginal administration offers prolonged activity, greatest bioavailability, and a lower incidence of adverse effects. Use of misoprostol for termination of pregnancy in 2 grand multiparous (gravidity N10) women each with 3 previous cesarean deliveries is summarized in Table 1. According to the WHO expert dosage guidelines, the maximum dose was not exceeded in either patient. In patient 1 an intracervical Foley catheter with syntocinon infusion was used to ripen the cervix followed by oral administration of 800 µg of misoprostol. Patient 2 received a single dose of 800 µg of misoprostol vaginally. Favorable results were obtained in both women using a single high dose of misoprostol. The safety of using misoprostol in women with high parity and scarred uteri could not be ascertained from this study. A larger study is needed to confirm the effectiveness and safety of this regimen in patients with high parity who have had more than 2 previous cesarean deliveries. (full-text) Language: English Keywords: SAUDI ARABIA | RESEARCH REPORT | SUMMARY REPORT | CLINICAL RESEARCH | PREGNANT WOMEN | CESAREAN SECTION | ABORTION | MULTIPARITY | MISOPROSTOL | UTERUS | RU-486 | ADMINISTRATION AND DOSAGE | Middle East | Developing Countries | Research Methodology | Population Characteristics | Demographic Factors | Population | Obstetrical Surgery | Surgery | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Fertility Control, Postconception | Family Planning | Parity | Fertility Measurements | Fertility | Population Dynamics | Prostaglandins, Synthetic | Prostaglandins | Endocrine System | Physiology | Biology | Genitalia, Female | Genitalia | Urogenital System | Hormone Antagonists | Hormones | Drugs Document Number: 341466 |
| 4. Peer Reviewed Title: Pregnancy and optimal care of HIV-infected patients. Author: Anderson BL; Cu-Uvin S Source: Clinical Infectious Diseases. 2009 Feb 15;48(4):449-55. Abstract: Human immunodeficiency virus (HIV) infection during pregnancy is a condition that requires multidisciplinary care. Care must be rendered that is appropriate for both the mother and the fetus. Prevention of mother-to-child transmission of HIV is of paramount concern. To prevent transmission, universal testing for HIV infection in pregnant women is ideal. In the United States and other developed countries, great strides have been made toward decreasing the risk of HIV transmission to infants to <2% with use of a combination of highly active antiretroviral therapy during the antepartum period and during labor and delivery, scheduled cesarean section when appropriate, avoidance of breast-feeding, and 6 weeks of zidovudine prophylaxis for infants. The continuation of antiretroviral therapy after delivery depends on the needs of the mother with regard to treatment of her own health. In resource-limited countries, where simplified and shortened courses of antiretroviral regimens have been used, reduction in mother-to-child transmission has also been shown, although not as effectively as that with highly active antiretroviral therapy. In these settings, exclusive breast-feeding for 6 months is recommended to reduce the risk of postnatal transmission. Language: English Keywords: UNITED STATES OF AMERICA | DEVELOPING COUNTRIES | RECOMMENDATIONS | PREGNANT WOMEN | PREVENTION OF MOTHER-TO-CHILD TRANSMISSION | HIV TESTING | ANTIRETROVIRAL DRUGS | ADMINISTRATION AND DOSAGE | DRUG RESISTANCE | ANTIRETROVIRAL THERAPY | RISK FACTORS | CESAREAN SECTION | BREASTFEEDING | Developed Countries | North America | Americas | Population Characteristics | Demographic Factors | Population | Disease Transmission Control | Prevention and Control | Diseases | Laboratory Examinations and Diagnoses | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Treatment | Drugs | HIV | HIV Infections | Viral Diseases | Obstetrical Surgery | Surgery | Infant Nutrition | Nutrition Document Number: 342644 |
| 5. Peer Reviewed Title: The management of failed second-trimester termination of pregnancy. Author: Basu JK; Basu D Source: Contraception. 2009 Aug;80(2):170-3. Abstract: BACKGROUND: Management of failed medical second-trimester termination of pregnancy (TOP) is a challenge with best therapy not determined. STUDY DESIGN: This was a cross-sectional study using retrospective record review of all women requesting medical TOP in the second trimester from January to June 2005. A comparative analysis was done to determine differences in demography, surgical methods and complications between two groups: (a) women who successfully aborted (first-admission group) and (b) women who failed to abort during their first admission (repeat-admission group). RESULTS: Study sample included 567 subjects [523 (92%) in the first-admission group and 44 (8%) in the repeat-admission group]. There were no significant differences in gestational age (p=.99), parity (p=.24) and previous history of cesarean section (p=.38) between the two groups. All of them successfully aborted, but the women in the repeat-admission Group 4 (9%) had more surgical interventions than those in the first-admission Group 6 (2%) (p<.0001). CONCLUSION: Failure to abort pregnancies in the second trimester with misoprostol is not uncommon. Our hospital protocol of adequate counseling and early repeat admission with good clinical selection criteria might be an alternative in a resource-constraint environment where resources and skills to perform surgical dilatation and evacuation are not available. Language: English Keywords: SOUTH AFRICA | RESEARCH REPORT | RETROSPECTIVE STUDIES | COMPARATIVE STUDIES | ABORTION | MISOPROSTOL | PREGNANCY, SECOND TRIMESTER | CERVICAL DILATATION | CURETTAGE | HYSTEROTOMY | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Studies | Research Methodology | Fertility Control, Postconception | Family Planning | Prostaglandins, Synthetic | Prostaglandins | Endocrine System | Physiology | Biology | Pregnancy | Reproduction | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Obstetrical Surgery | Surgery | Gynecologic Surgery | Urogenital Surgery Document Number: 342391 Notification |
| 6. Peer Reviewed Title: Safety of late second-trimester pregnancy termination by laminaria dilatation and evacuation in patients with previous multiple cesarean sections. Author: Ben-Ami I; Schneider D; Svirsky R; Smorgick N; Pansky M; Halperin R Source: American Journal of Obstetrics and Gynecology. 2009 Aug;201(2):154.e1-5. Abstract: OBJECTIVE: To assess whether there is an increased perioperative risk in termination of late second-trimester pregnancy after multiple cesarean sections by laminaria dilatation and evacuation. STUDY DESIGN: During the period between January 2002 and June 2008, 636 consecutive patients underwent late second-trimester (17-24 weeks) pregnancy terminations by dilatation and evacuation. Patients were divided into 3 subgroups: those with no previous cesarean section (n = 545), those with 1 previous cesarean section (n = 59), and those with several previous cesarean sections (n = 32). RESULTS: There were no significant differences in major perioperative complications, such as anesthetic complications, need for blood transfusion, and cervical lacerations comparing the 3 subgroups. Importantly, there were neither cases of uterine perforation nor retained products of conception in the 3 subgroups. CONCLUSION: Late second-trimester pregnancy termination after multiple cesarean sections by laminaria dilatation and evacuation is probably not associated with an increased perioperative risk. Larger studies are needed to empower this study. Language: English Keywords: UNITED STATES OF AMERICA | RESEARCH REPORT | CLIENTS | WOMEN | PREGNANCY, SECOND TRIMESTER | CESAREAN SECTION | ABORTION | SAFETY | UTERINE EFFECTS | Developed Countries | North America | Americas | Program Activities | Programs | Organization and Administration | Demographic Factors | Population | Pregnancy | Reproduction | Obstetrical Surgery | Surgery | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Fertility Control, Postconception | Family Planning | Public Health | Uterus | Genitalia, Female | Genitalia | Urogenital System | Physiology | Biology Document Number: 342611 Notification |
| 7. Title: Misoprostol for second trimester pregnancy termination in women with prior caesarean: a systematic review. Author: Berghella V; Airoldi J; O'Neill AM; Einhorn K; Hoffman M Source: BJOG. 2009 Aug;116(9):1151-7. Abstract: BACKGROUND: Second trimester pregnancy induction with misoprostol in women with prior caesarean delivery is not well studied. OBJECTIVE: To estimate the risk of uterine rupture using misoprostol as an induction agent for pregnancy termination in the second trimester of pregnancy in women with prior caesarean delivery. SEARCH STRATEGY: Cases of women with a history of prior caesarean delivery and subsequent misoprostol induction for pregnancy termination in the second trimester (16-28 weeks) were obtained from two main data sources. First, a retrospective chart analysis was performed at Thomas Jefferson University Hospital and Christiana Hospital between 1998 and 2004. Second, multiple Medline, Scopus and POPLINE literature searches were performed. SELECTION CRITERIA: Case series and cohort studies of women with one or more prior caesarean delivery (of any type), and with a subsequent pregnancy with induction of labour for pregnancy termination at 16-28 weeks using misoprostol as the initial primary agent were included. Case reports were analysed separately. DATA COLLECTION AND ANALYSIS: Total cases were analysed by type and number of prior caesarean delivery, for the primary outcome of uterine rupture. MAIN RESULTS: The incidence of uterine rupture associated with second trimester misoprostol termination was 0.4% (2/461) in women with one prior low transverse, 0% (0/46) in those with two prior low transverse and 50% (1/2) in those with a prior classical caesarean delivery. One of the cases of uterine rupture in a woman with a prior low transverse caesarean required transfusion. None of the total eight cases (including case reports) of uterine rupture was associated with hysterectomy. CONCLUSIONS: Second trimester misoprostol termination appears safe among women with one prior low transverse caesarean birth, as it is associated with incidences of uterine rupture of 0.4% (95% confidence interval 0.08-1.67%), of hysterectomy of 0% and of transfusion of 0.2%. There are insufficient data on risk with more than one prior caesarean birth or with prior classical caesarean birth. Language: English Keywords: UNITED STATES OF AMERICA | RESEARCH REPORT | LITERATURE REVIEW | RETROSPECTIVE STUDIES | PREGNANT WOMEN | MISOPROSTOL | PREGNANCY, SECOND TRIMESTER | ABORTION | CESAREAN SECTION | UTERINE EFFECTS | RISK FACTORS | INCIDENCE | Developed Countries | North America | Americas | Studies | Research Methodology | Population Characteristics | Demographic Factors | Population | Prostaglandins, Synthetic | Prostaglandins | Endocrine System | Physiology | Biology | Pregnancy | Reproduction | Fertility Control, Postconception | Family Planning | Obstetrical Surgery | Surgery | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Uterus | Genitalia, Female | Genitalia | Urogenital System | Measurement Document Number: 342794 Notification |
| 8. Peer Reviewed Title: Effect of previous live birth and prior route of delivery on the outcome of early medical abortion. Author: Chien LW; Liu WM; Tzeng CR; Au HK Source: Obstetrics and Gynecology. 2009 Mar;113(3):669-74. Abstract: OBJECTIVE: To determine the association between type of previous delivery (vaginal compared with cesarean) on the success of medical abortion with mifepristone-misoprostol in early pregnancy. METHODS: The records of 879 women with intrauterine pregnancies at or before 56 days of gestation who underwent medical abortions were reviewed. Medical treatment consisted of 600 mg mifepristone orally followed 48 hours later with oral misoprostol. An ultrasound examination was performed 14-21 days after treatment, and a successful medical abortion was defined as an empty uterus without surgical intervention. Univariable and multivariable logistic regressions were used to determine risk factors for failure of medical abortion. RESULTS: A total of 797 (90.7%) women had successful medical abortions; 82 (9.3%) had failed medical abortions. Multivariable logistic regression indicated that women with gestational ages greater than 42 days (odds ratio [OR] 2.53, 95% confidence interval [CI] 1.55-4.05) had higher odds of failed abortion compared with a gestational age less than 43 days. Parous women (OR> or =3.94, 95% CI 1.83-8.53) and those with prior cesarean delivery (OR 9.59, 95% CI 4.30-21.39) were more likely to have failed abortions compared with nulliparous women. Among 523 parous women (68 had failed abortion), those with gestational ages greater than 42 days (OR 2.07, 95% CI 1.22-3.50) and prior cesarean delivery (OR 3.33, 95% CI 1.95-5.69) were more likely to have failed abortions compared with those with gestational ages less than 43 days or with prior vaginal delivery. CONCLUSION: Parous women are at increased risk for failed medical abortion in comparison with nulliparous women. Prior cesarean delivery is significantly associated with failed medical abortion. Language: English Keywords: TAIWAN | RESEARCH REPORT | EPIDEMIOLOGIC METHODS | CLINICAL RESEARCH | COMPARATIVE STUDIES | PREGNANT WOMEN | WOMEN IN DEVELOPMENT | PREVALENCE | CHILDBIRTH | ABORTION | CESAREAN SECTION | RU-486 | PREGNANCY, FIRST TRIMESTER | MISOPROSTOL | Asia, Eastern | Asia | Developed Countries | Research Methodology | Studies | Population Characteristics | Demographic Factors | Population | Economic Development | Economic Factors | Measurement | Pregnancy Outcomes | Pregnancy | Reproduction | Fertility Control, Postconception | Family Planning | Obstetrical Surgery | Surgery | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Hormone Antagonists | Hormones | Endocrine System | Physiology | Biology | Prostaglandins, Synthetic | Prostaglandins Document Number: 331067 Notification |
| 9. Peer Reviewed Title: Uterine rupture in second-trimester misoprostol-induced abortion after cesarean delivery: a systematic review. Author: Goyal V Source: Obstetrics and Gynecology. 2009 May;113(5):1117-23. Abstract: OBJECTIVE: To determine the risk of uterine rupture when using misoprostol for second-trimester abortion in women with a history of cesarean delivery. DATA SOURCES: MEDLINE, EMBASE, CINAHL, LILACS, and the Cochrane Library were searched systematically for all articles published before September 2008. METHODS OF STUDY SELECTION: Sixty-three articles were found using the above data sources. I excluded case reports, narrative reviews or commentaries, studies that excluded women with a history of cesarean delivery, studies with unrelated outcomes, studies not conducted in humans, and studies that were not available in English. The remaining 16 studies that described misoprostol use for second-trimester abortion in women with a history of cesarean delivery were examined. TABULATION, INTEGRATION, AND RESULTS: The number of participants with and without cesarean delivery, regimen of medical abortion used, and cases of uterine rupture were reviewed. To estimate the risk of uterine rupture in women with prior cesarean delivery undergoing second-trimester abortion with misoprostol and number needed to harm, I pooled the results of all 16 studies. The risk of uterine rupture in women with prior cesarean delivery was 0.28% (95% confidence interval [CI] 0.08-1.00%). The risk of uterine rupture in women without prior cesarean delivery was 0.04% (95% CI 0.01-0.20%). Based on these risks, if 414 women with a history of cesarean delivery were given misoprostol for second-trimester abortion, one would experience uterine rupture. CONCLUSION: The risk of uterine rupture among women with a prior cesarean delivery undergoing second-trimester abortion using misoprostol is less than 0.3%. This may be acceptable to both patients and providers. Language: English Keywords: UNITED STATES OF AMERICA | NORTH CAROLINA | RESEARCH REPORT | LITERATURE REVIEW | WOMEN | MISOPROSTOL | CESAREAN SECTION | ABORTION | RISK FACTORS | CONTRACEPTIVE METHOD ACCEPTABILITY | Developed Countries | North America | Americas | Demographic Factors | Population | Prostaglandins, Synthetic | Prostaglandins | Endocrine System | Physiology | Biology | Obstetrical Surgery | Surgery | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Fertility Control, Postconception | Family Planning | Contraceptive Usage | Contraception Document Number: 341341 |
| 10. Peer Reviewed Title: Neonatal mortality, risk factors and causes: a prospective population-based cohort study in urban Pakistan. Author: Jehan I; Harris H; Salat S; Zeb A; Mobeen N; Pasha O; McClure EM; Moore J; Wright LL; Goldenberg RL Source: Bulletin of the World Health Organization. 2009 Feb;87(2):130-8. Abstract: OBJECTIVE: To evaluate the prevalence, sex distribution and causes of neonatal mortality, as well as its risk factors, in an urban Pakistani population with access to obstetric and neonatal care. METHODS: Study area women were enrolled at 20-26 weeks' gestation in a prospective population-based cohort study that was conducted from 2003 to 2005. Physical examinations, antenatal laboratory tests and anthropometric measures were performed, and gestational age was determined by ultrasound to confirm eligibility. Demographic and health data were also collected on pretested study forms by trained female research staff. The women and neonates were seen again within 48 hours postpartum and at day 28 after the birth. All neonatal deaths were reviewed using the Pattinson et al. system to assign obstetric and final causes of death; the circumstances of the death were determined by asking the mother or family and by reviewing hospital records. Frequencies and rates were calculated, and 95% confidence intervals were determined for mortality rates. Relative risks were calculated to evaluate the associations between potential risk factors and neonatal death. Logistic regression models were used to compute adjusted odds ratios. FINDINGS: Birth outcomes were ascertained for 1280 (94%) of the 1369 women enrolled. The 28-day neonatal mortality rate was 47.3 per 1000 live births. Preterm birth, Caesarean section and intrapartum complications were associated with neonatal death. Some 45% of the deaths occurred within 48 hours and 73% within the first week. The primary obstetric causes of death were preterm labour (34%) and intrapartum asphyxia (21%). Final causes were classified as immaturity-related (26%), birth asphyxia or hypoxia (26%) and infection (23%). Neither delivery in a health facility nor by health professionals was associated with fewer neonatal deaths. The Caesarean section rate was 19%. Almost all (88%) neonates who died received treatment and 75% died in the hospital. CONCLUSION: In an urban population with good access to professional care, we found a high neonatal mortality rate, often due to preventable conditions. These results suggest that, to decrease neonatal mortality, improved health service quality is crucial. Language: English Keywords: PAKISTAN | RESEARCH REPORT | PROSPECTIVE STUDIES | URBAN POPULATION | NEONATAL MORTALITY | RISK FACTORS | PREVALENCE | PREMATURE LABOR | CESAREAN SECTION | CAUSES OF DEATH | MATERNAL-CHILD HEALTH SERVICES | Developing Countries | Asia, Southern | Asia | Studies | Research Methodology | Population Characteristics | Demographic Factors | Population | Infant Mortality | Mortality | Population Dynamics | Health | Measurement | Pregnancy Outcomes | Pregnancy | Reproduction | Obstetrical Surgery | Surgery | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Primary Health Care Document Number: 341787 |
| 11. Title: Birthing in South Africa. Author: Jenkins LB Source: Midwifery today With International Midwife. 2009 Spring;(89):32. Abstract: This article examines the birthing process in two South African hospitals, and contrasts the different approaches in each; in one, the midwives run the birthing unit, whereas the other is "doctor-driven." Issues of class and HIV status are also discussed in relation to types of treatment offered. Language: English Keywords: SOUTH AFRICA | CRITIQUE | MIDWIVES AND MIDWIFERY | CHILDBIRTH | HOSPITALS | CESAREAN SECTION | SOCIOECONOMIC FACTORS | HIV INFECTIONS | BREASTFEEDING, EXCLUSIVE | BOTTLE FEEDING | PREVENTION OF MOTHER-TO-CHILD TRANSMISSION | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Health Personnel | Delivery of Health Care | Health | Pregnancy Outcomes | Pregnancy | Reproduction | Health Facilities | Obstetrical Surgery | Surgery | Treatment | Medical Procedures | Medicine | Health Services | Economic Factors | Viral Diseases | Diseases | Breastfeeding | Infant Nutrition | Nutrition | Disease Transmission Control | Prevention and Control Document Number: 341187 |
| 12. Peer Reviewed Title: Cesarean delivery surveillance system at a maternity hospital in Kabul, Afghanistan. Author: Kandasamy T; Merialdi M; Guidotti RJ; Betran AP; Harris-Requejo J Source: International Journal of Gynecology and Obstetrics. 2009;104:14-17. Abstract: Objective: To use an active facility-based maternal and newborn surveillance system to describe cesarean delivery practices and outcomes in a resource-poor setting. Methods: Using data from operating room logbooks, 392 cesarean deliveries were evaluated between April 1 and June 30 2006 at a large public maternity hospital in Kabul, Afghanistan. Results: The perinatal mortality rate was 89 per 1000 births: 57% antepartum and 37% intrapartum stillbirths. Fetuses with normal birth weight comprised 85% of intrapartum stillbirths. Obstructed labor, uterine rupture, and malpresentation accounted for more than 50% of perinatal deaths. The cesarean delivery rate was 10.2% and there were 2 maternal deaths. Conclusion: The high percentage of intrapartum stillbirths among normal birth weight fetuses suggests a need for improved labor monitoring and surgical obstetric practices. The use of a facility-based perinatal surveillance system is critical in guiding such quality assurance initiatives. Language: English Keywords: AFGHANISTAN | RESEARCH REPORT | DATA COLLECTION | CESAREAN SECTION | HOSPITALS | MONITORING | OBSTETRICS | ANESTHESIA | QUALITY OF HEALTH CARE | PERINATAL MORTALITY | MATERNAL MORTALITY | FETAL DEATH | BIRTH WEIGHT | Asia, Southern | Asia | Developing Countries | Research Methodology | Obstetrical Surgery | Surgery | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Health Facilities | Evaluation | Health Services Evaluation | Program Evaluation | Programs | Organization and Administration | Mortality | Population Dynamics | Demographic Factors | Population | Body Weight | Physiology | Biology Document Number: 340226 |
| 13. Title: [Appendix protrusion from perforation of uterus--the rare complication during abortion] Protruzia apendixu cez perforacny otvor v cervixe maternice ako zriedkava Author: Lakyova L; Dankovcik R; Kudlac M; Mikulova J; Radonak J Source: Ceska Gynekologie. 2009 Feb;74(1):67-9. Abstract: AIM: Point to an extremly rare complication of a curettage during abortion and follow up surgical treatment of this complicated state. CASE: In the case of 32 years old woman, multipara, was perforated cervix uteri during the abortion curettage and fat tissue of mesentery was aspirated into canulla. Apendix vermiformis was aspirated into cannula with its protrusion through the neck of the womb during repeated revision. Surgeon made appendectomy lege artis after abdomen revision and looking after haemoperitoneum. Because of serious devastation of right fallopian tube, salpingektomy was performed. Perforation of cervix in the lenght of three cm was sutured. Extensive incomplete rupture continuing from perforation gap was sutured from ligamentum sacrouterinum I.dx to fundus uteri. Intact foetus of 5,5 week of gestation was leaved in toto because of the high risk of the womb wall disruption during repeatedly attempted abortion. CONCLUSION: In case of the suspection of the uterus injury a revision and interdisciplinary approach to the solution of complications is necessary. Language: Slovene Keywords: DEVELOPING COUNTRIES | RESEARCH REPORT | ABORTION | CURETTAGE | UTERINE EFFECTS | UTERINE PERFORATION | MULTIPARITY | SURGERY | TREATMENT | Fertility Control, Postconception | Family Planning | Obstetrical Surgery | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Uterus | Genitalia, Female | Genitalia | Urogenital System | Physiology | Biology | Perforations | Diseases | Parity | Fertility Measurements | Fertility | Population Dynamics | Demographic Factors | Population Document Number: 341331 |
| 14. Peer Reviewed Title: Exploring the costs and economic consequences of unsafe abortion in Mexico City before legalisation. Author: Levin C; Grossman D; Berdichevsky K; Diaz C; Aracena B; Garcia SG Source: Reproductive Health Matters. 2009 May;17(33):120-132. Abstract: An assessment of abortion outcomes and costs to the health care system in Mexico City was conducted in 2005 at a mix of public and private facilities prior to the legalisation of abortion. Data were obtained from hospital staff, administrative records and patients. Direct cost estimates included personnel, drugs, disposable supplies, and medical equipment for inducing abortion or treating incomplete abortions and other complications. Indirect patient costs for travel, childcare and lost wages were also estimated. The average cost per abortion with dilatation and curettage was US $143. For manual vacuum aspiration it was US $111 in three public hospitals and US $53 at a private clinic. The average cost of medical abortion with misoprostol alone was US $79. The average cost of treating severe abortion complications at the public hospitals ranged from US $601 to over US $2,100. Increasing access to manual vacuum aspiration and early abortion with misoprostol could reduce government costs by 62%, with potential savings of up to US $1.6 million per year. Reducing complications by improving access to safe services in outpatient settings would further reduce the costs of abortion care, with significant benefits both to Mexico's health care system and women seeking abortion. Additional research is needed to explore whether cost savings have been realised post-legalisation. Spanish Abstract: En 2005, antes de la legalización del aborto en el Distrito Federal de México, se realizó una evaluación del impacto y los costos del aborto en el sistema de salud del D.F., en diversos establecimientos públicos y privados. Se obtuvieron datos de personal hospitalario, registros administrativos y pacientes. Los cálculos de costos directos incluían personal, medicamentos, suministros desechables, y equipo médico para inducir el aborto o tratar abortos incompletos y otras complicaciones. También se calcularon los costos indirectos de las pacientes en viajes, cuido de niños y sueldos perdidos. El costo promedio por cada aborto con dilatación y curetaje fue de US $143. Para la aspiración manual endouterina (AMEU), fue de US $111 en tres hospitales públicos y US $53 en una clínica privada. El costo promedio del aborto inducido con misoprostol solo fue de US $79. El costo promedio de tratar las complicaciones graves del aborto en los hospitales públicos varió de US $601 a más de US $2,100. Al ampliar el acceso a la AMEU y al aborto precoz con misoprostol, se podrían disminuir los costos gubernamentales en un 62%, un posible ahorro de hasta US $1.6 millones al año. Al disminuir las complicaciones tras mejorar el acceso a los servicios seguros en ámbitos ambulatorios, disminuirían también los costos de la atención del aborto, lo cual sería un gran beneficio tanto para el sistema de salud de México como para las mujeres que buscan servicios de aborto. Aún se necesitan más investigaciones para explorar si se han logrado ahorros en costos post-legalización. French Abstract: En 2005, avant la légalisation de l'avortement, on a évalué les résultats et le coût de l'avortement sur le système sanitaire à Mexico, dans des établissements publics et privés. Les données ont été obtenues auprès du personnel hospitalier et des patientes, et dans les dossiers administratifs. Les estimations directes des coûts incluaient le personnel, les médicaments, les consommables et l'équipement médical pour provoquer l'avortement ou traiter les avortements incomplets et d'autres complications. Les frais indirects de déplacement, de garde d'enfants et de perte de gain des patientes ont aussi été calculés. Le coût moyen par avortement avec dilatation et curetage était de $US143. Par aspiration manuelle, il était de $US 111 dans trois hôpitaux publics et $US 53 dans une clinique privée. Le coût moyen de l'avortement médicamenteux avec du misoprostol seul était de $US 79. En moyenne, le traitement des complications graves de l'avortement dans les hôpitaux publics allait de $US 601 à plus de $US 2100. Un accès élargi à l'aspiration manuelle et à l'avortement précoce au misoprostol permettrait de réduire de 62% les coûts gouvernementaux, avec des économies potentielles se chiffrant à $US 1,6 million par an. En réduisant les complications par l'amélioration de l'accès à des services ambulatoires sûrs, on diminuerait encore le coût des soins de l'avortement, avec de nets avantages pour le système de santé mexicain et les femmes souhaitant avorter. Il faut mener des recherches supplémentaires pour déterminer si des économies ont été réalisées après l'adoption de la légalisation. Language: English Keywords: MEXICO | URBAN AREAS | RESEARCH REPORT | CLIENTS | ABORTION | ABORTION LAW | EXPENDITURES | FEES | CERVICAL DILATATION | CURETTAGE | PROGRAM ACCESSIBILITY | COST BENEFIT ANALYSIS | North America | Americas | Developing Countries | Geographic Factors | Population | Program Activities | Programs | Organization and Administration | Fertility Control, Postconception | Family Planning | Financial Activities | Economic Factors | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Obstetrical Surgery | Surgery | Program Evaluation | Quantitative Evaluation | Evaluation Document Number: 342021 Notification |
| 15. Title: First trimester procedural abortion in family medicine. Author: Lyus RJ; Gianutsos P; Gold M Source: Journal of the American Board of Family Medicine. 2009 Mar-Apr;22(2):169-74. Abstract: Unintended pregnancy is common, and in the United States almost half of all women will have at least one abortion during their lifetime. The majority of abortions are performed in the first trimester. Although advances have been made in the provision of medical abortion in the family medicine setting, procedural methods remain the cornerstone of abortion care. We present a step-wise review of first trimester procedural abortion using the manual vacuum aspirator to demonstrate the feasibility of incorporating this service into a primary care setting. Language: English Keywords: UNITED STATES OF AMERICA | RECOMMENDATIONS | PREGNANCY, FIRST TRIMESTER | ABORTION | MEDICAL PROCEDURES | COUNSELING | CERVICAL DILATATION | CURETTAGE | ANALGESIA | ANESTHESIA | FETAL MEMBRANES | PRIMARY HEALTH CARE | Developed Countries | North America | Americas | Pregnancy | Reproduction | Fertility Control, Postconception | Family Planning | Medicine | Health Services | Delivery of Health Care | Health | Clinic Activities | Program Activities | Programs | Organization and Administration | Treatment | Obstetrical Surgery | Surgery | Fetus Document Number: 342001 Notification |
| 16. Title: Maternal urinary tract infection: is it independently associated with adverse pregnancy outcome? Author: Mazor-Dray E; Levy A; Schlaeffer F; Sheiner E Source: Journal of Maternal - Fetal and Neonatal Medicine. 2009 Feb;22(2):124-8. Abstract: OBJECTIVE: This population-based study was aimed to determine whether there is an association between urinary tract infections (UTI) during pregnancy, among patients in whom antibiotic treatment was recommended, and maternal and perinatal outcome. METHODS: A retrospective population-based study comparing all singleton pregnancies of patients with and without UTI was performed. Multiple logistic regression models were performed to control for confounders. RESULTS: Out of 199,093 deliveries, 2.3% (n = 4742) had UTI during pregnancy and delivery. Patients with UTI had significantly higher rates of intra-uterine growth restriction (IUGR), pre-eclampsia, caesarean deliveries (CD) and pre-term deliveries (either before 34 weeks or 37 weeks of gestation). Although controlling for possible confounders such as maternal age and parity, using multivariable analyses, the significant association between UTI and IUGR, pre-eclampsia, CD and preterm deliveries persisted. In contrast, no significant differences in 5-min Apgar scores less than 7 or perinatal mortality were noted between the groups (0.6% vs. 0.6%; p = 0.782, and 1.5% vs. 1.4%; p = 0.704, respectively). CONCLUSION: Maternal UTI is independently associated with pre-term delivery, pre-eclampsia, IUGR and CD. Nevertheless, it is not associated with increased rates of perinatal mortality compared with women without UTI. Language: English Keywords: ISRAEL | RESEARCH REPORT | RETROSPECTIVE STUDIES | PREGNANT WOMEN | UROGENITAL EFFECTS | INFECTIONS | PREGNANCY OUTCOMES | RISK FACTORS | PREMATURE BIRTH | INTRAUTERINE GROWTH RETARDATION | PREECLAMPSIA | CESAREAN SECTION | Developed Countries | Middle East | Studies | Research Methodology | Population Characteristics | Demographic Factors | Population | Urogenital System | Physiology | Biology | Diseases | Pregnancy | Reproduction | Health | Congenital Abnormalities | Neonatal Diseases and Abnormalities | Pregnancy Complications | Obstetrical Surgery | Surgery | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care Document Number: 341696 |
| 17. Title: Sonographic appearances of the endometrium after termination of pregnancy in asymptomatic versus symptomatic women. Author: McEwing RL; Anderson NG; Meates JB; Allen RB; Phillipson GT; Wells JE Source: Journal of Ultrasound In Medicine. 2009 May;28(5):579-86. Abstract: OBJECTIVE: The purpose of this study was to describe normal sonographic appearances of the endometrium in asymptomatic women after elective termination of pregnancy (TOP) and to determine whether sonographic findings are discriminatory in symptomatic women after TOP. METHODS: Sonographic parameters were compared in prospectively recruited women after elective TOP. The first 38 were asymptomatic. In a later group, 105 had symptoms suggestive of retained products of conception (RPOC). Endometrial thickness, cavity irregularity, echogenicity of cavity contents, color Doppler flow, and resistive indices (RIs) were assessed. In the symptomatic group, sonographic findings were correlated with symptoms and histologic results. RESULTS: There was a marked overlap in sonographic appearances between the groups. The endometrial cavity is commonly irregular and thickened and may show prominent color Doppler flow in women with an uneventful course as well as in women with histologically proven RPOC. Differences between asymptomatic and symptomatic women were only seen for: endometrial thickness (10.8 mm [range, 1-29 mm] versus 15.3 mm [range, 1.8-34 mm]; P = .0005), and cavity irregularity was greater in symptomatic women (P = .001). Color Doppler flow mean RIs were similar. Symptoms were similar in women proceeding to curettage versus no curettage; no significant relationship was found between individual symptoms and sonographic parameters. Chorionic villi were seen in 47 of 56 women (84%) with positive histologic results. CONCLUSIONS: Sonographic appearances and symptoms correlate poorly with each other and with histologic results. Sonography has limited benefits in triaging women with suspected RPOC after TOP in the first trimester. Our findings support a more conservative approach to suspected RPOC after TOP. Language: English Keywords: NEW ZEALAND | RESEARCH REPORT | COMPARATIVE STUDIES | CLIENTS | PREGNANCY, FIRST TRIMESTER | ABORTION | CURETTAGE | PRODUCTS OF CONCEPTION, RETENTION | SIGNS AND SYMPTOMS | ENDOMETRIAL EFFECTS | ULTRASONICS | HISTOLOGY | Oceania | Developed Countries | Studies | Research Methodology | Program Activities | Programs | Organization and Administration | Pregnancy | Reproduction | Fertility Control, Postconception | Family Planning | Obstetrical Surgery | Surgery | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Pregnancy Complications | Diseases | Endometrium | Uterus | Genitalia, Female | Genitalia | Urogenital System | Physiology | Biology Document Number: 341998 Notification |
| 18. Peer Reviewed Title: Impact of change in maternal age composition on the incidence of Caesarean section and low birth weight: analysis of delivery records at a tertiary hospital in Tanzania, 1999-2005. Author: Muganyizi PS; Kidanto HL Source: BMC Pregnancy and Childbirth. 2009 Jul 21;9(1):30. Abstract: ABSTRACT: BACKGROUND: Previous studies on change in maternal age composition in Tanzania do not indicate its impact on adverse pregnancy outcomes. We sought to establish temporal changes in maternal age composition and their impact on annual Caesarean section (CS) and low birth weight deliveries (LBWT) at Muhimbili National Hospital in Tanzania. METHODS: We conducted data analysis of 91,699 singleton deliveries that took place in the hospital between 1999 and 2005. The data were extracted from the obstetric data base. Annual proportions of individual age groups were calculated and their trends over the years studied. Multiple logistic analyses were conducted to ascertain trends in the risks of CS and LBWT. The impact of age composition changes on CS and LBWT was estimated by calculating annual numbers of these outcomes with and without the major changes in age composition, all others remaining equal. In all statistics, a p value < 0.05 was considered significant. RESULTS: The proportion of teenage mothers (12-19 years) progressively decreased over time while that of 30-34 years age group increased. From 1999, the risk of Caesarean delivery increased steadily to a maximum in 2005[adjusted OR=1.7; 95%CI (1.6-1.8)] whereas that of LBWT declined to a minimum in 2005 (adjusted OR=0.76; 95% CI (0.71-0.82). The current major changes in age trend were responsible for shifts in the number of CS of up to 206 cases per year. Likewise, the shift in LBWT was up to 158 cases per year, but the 30-34 years age group had no impact on this. CONCLUSIONS: The population of mothers giving birth at MNH is progressively becoming older with substantial impact on the incidence of CS and LBWT. Further research is needed to estimate the health cost implications of this change. Language: English Keywords: TANZANIA | RESEARCH REPORT | DATA ANALYSIS | STATISTICAL REGRESSION | MATERNAL AGE | CESAREAN SECTION | LOW BIRTH WEIGHT | INCIDENCE | HOSPITALS | INFORMATION RETRIEVAL SYSTEMS | RISK FACTORS | Developing Countries | Africa, Eastern | Africa, Sub Saharan | Africa | Research Methodology | Parental Age | Age Factors | Population Characteristics | Demographic Factors | Population | Obstetrical Surgery | Surgery | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Birth Weight | Body Weight | Physiology | Biology | Measurement | Health Facilities | Data Storage and Retrieval | Information Processing | Information Document Number: 342290 |
| 19. Peer Reviewed Title: Intraoperative placement of the Copper T-380 intrauterine devices in women undergoing elective cesarean delivery: a pilot study. Author: Nelson AL; Chen S; Eden R Source: Contraception. 2009 Jul;80(1):81-3. Abstract: BACKGROUND: The purpose of this pilot project was to test the feasibility of a technique designed to place a copper intrauterine device (IUD) through the hysterotomy incision of an elective cesarean delivery to minimize possible contamination and to guarantee that tailstrings were visible in the vagina for easy removal should complications occur. STUDY DESIGN: Women were monitored in the hospital for signs of infection or excessive blood loss. At the time of hospital discharge and at 2 and 6 weeks postpartum, they were examined to determine the status of the tailstrings. The position of the IUD was assessed by ultrasound at week 6. RESULTS: All seven of the subjects had successful placement. The sutures tied to the IUD strings were visible on vaginal examination in each case. The original tailstrings were visible in the vagina at 6 weeks and each IUD was fundally positioned. CONCLUSION: Successful intraoperative placement of Copper T-380A IUDs through incision at the time of cesarean birth is possible. Language: English Keywords: UNITED STATES OF AMERICA | RESEARCH REPORT | PILOT PROJECTS | POSTPARTUM WOMEN | IUD, COPPER RELEASING | INSERTION | HYSTEROTOMY | CESAREAN SECTION | ULTRASONICS | CONTRACEPTIVE REMOVAL | IUD EXPULSION | Developed Countries | North America | Americas | Studies | Research Methodology | Puerperium | Reproduction | IUD | Contraceptive Methods | Contraception | Family Planning | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Gynecologic Surgery | Urogenital Surgery | Surgery | Obstetrical Surgery Document Number: 342788 |
| 20. Peer Reviewed Title: Adolescent pregnancies and deliveries: problems encountered. Author: Nkwabong E; Fomulu JN Source: Tropical Doctor. 2009 Jan;39(1):9-11. Abstract: Teenage pregnancies are increasing and need special attention. The aim of this retrospective study, conducted from 1 January 2004 to 31 December 2004 at the maternity department of the Yaounde University Teaching Hospital, Cameroon, was to analyze the evolution of pregnancy and delivery in primiparous teenagers. The medical files of 190 teenagers and 403 patients aged between 20 and 25 years were analyzed and compared. Mean gestational age, the rate of pregnancy-induced hypertensive disease and the caesarean section rate were similar in both groups. However, there were a greater number of low Apgar scores, vaginal tears and instrumental deliveries in teenagers. Those aged 15 years or less had the additional risk of an increased rate of preterm labour, low birth weight and early neonatal death. Therefore, pregnancies and deliveries among teenagers, especially those aged 15 years or less, should be monitored regularly. Language: English Keywords: CAMEROON | RESEARCH REPORT | CLINICAL RESEARCH | RETROSPECTIVE STUDIES | COMPARATIVE STUDIES | PREGNANT WOMEN | ADOLESCENTS, FEMALE | YOUTH | CHILDBIRTH | ADOLESCENT PREGNANCY | PRIMIPARITY | AGE FACTORS | PREGNANCY COMPLICATIONS | CESAREAN SECTION | PREMATURE BIRTH | Developing Countries | Africa, Western | Africa, Sub Saharan | Africa | Research Methodology | Studies | Population Characteristics | Demographic Factors | Population | Adolescents | Pregnancy Outcomes | Pregnancy | Reproduction | Reproductive Behavior | Fertility | Population Dynamics | Parity | Fertility Measurements | Diseases | Obstetrical Surgery | Surgery | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health Document Number: 331070 |
| 21. Peer Reviewed Title: First-trimester surgical abortion practices: a survey of National Abortion Federation members. Author: O'Connell K; Jones HE; Simon M; Saporta V; Paul M; Lichtenberg ES Author: National Abortion Federation Members Source: Contraception. 2009 May;79(5):385-92. Abstract: BACKGROUND: Designated providers in specialized clinics perform the majority of approximately 1.1 million first-trimester abortions carried out in the United States each year. Our objective was to assess the first-trimester surgical abortion practices of National Abortion Federation (NAF) members. STUDY DESIGN: We mailed questionnaires to NAF administrators and providers at their 364 active-member facilities in 2002. RESULTS: Two hundred eighty-nine (79%) facilities responded; we received administrative questionnaires from 273 facilities and 293 individual clinicians. NAF facilities provided at least 325,000 first-trimester surgical abortions in the United States in 2001. The majority of providers are obstetrician-gynecologists (63%), male (62%) and at least 50 years old (64%). Half of clinicians (49%) selectively utilize manual vacuum aspiration. Almost half (47%) routinely use a metal curette to verify procedure completion; these providers are more likely to be over 50 years of age or to have 20 years or more of abortion experience. Other practices are more uniform, including routine tissue examination (93%), postoperative antibiotics (88%) and contraceptive provision (oral contraceptives, 99%; depot medroxyprogesterone acetate, 79%). CONCLUSIONS: Most perioperative practices for first-trimester abortions are similar among these respondents, in accord with evidence-based guidelines. The aging of skilled practitioners raises concerns about the future availability of surgical abortion. Language: English Keywords: CANADA | UNITED STATES OF AMERICA | RESEARCH REPORT | ABORTION | PREGNANCY, FIRST TRIMESTER | CURETTAGE | CERVICAL DILATATION | SURGERY | Developed Countries | North America, Northern | Americas | North America | Fertility Control, Postconception | Family Planning | Pregnancy | Reproduction | Obstetrical Surgery | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health Document Number: 342084 Notification |
| 22. Title: Artificial abortions performed at the University Clinical Centre of Kosovo from January 2005 to December 2007. Author: Pacarada M; Kongjeli N; Kongjeli G; Obertinca B Source: Medicinski Arhiv. 2009;63(2):87-9. Abstract: The objective of this study was to determine the number of abortions performed at the Clinic of Gynecology and Obstetrics at the University Clinical Centre of Kosovo (UCCK) in Prishtina, Kosovo, from January 2005 to December 2007. We performed a retrospective epidemiological study of 1079 artificial abortions based on patient records. In total, 39% of the patients were from Prishtina. In terms of age, 51.5% of the women who received abortions were 20-35 years old. In terms of gravidity, 43% of the patients had more than four previous deliveries, whereas 7.7% of the patients were pregnant for the first time. The majority of abortions were performed at 7-9 gestational weeks via dilation followed by suction curettage (vacuum aspiration) or curettage with sharp instruments. The number of abortions per annum decreased from 486 in 2005 to 293 in 2007. Language: English Keywords: EUROPE, SOUTHEASTERN | RESEARCH REPORT | EPIDEMIOLOGY | RETROSPECTIVE STUDIES | YOUTH | WOMEN | AGE FACTORS | ABORTION | ABORTION RATE | CURETTAGE | Europe | Developing Countries | Public Health | Health | Studies | Research Methodology | Population Characteristics | Demographic Factors | Population | Fertility Control, Postconception | Family Planning | Obstetrical Surgery | Surgery | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care Document Number: 342403 Notification |
| 23. Title: Sonographic and multiplanar computed tomographic findings of large uterine perforation 2 weeks after first-trimester pregnancy termination. Author: Sherer DM; Novac S; Dalloul M; Salame G; Zinn H; Farnaz S; Abulafia O Source: Journal of Ultrasound In Medicine. 2009 May;28(5):699-701. Abstract: This case report illustrates the importance of maintaining a high index of suspicion of iatrogenic injury to the uterus subsequent to termination of pregnancy. It also stresses the importance of substantial contribution of sonography and computed tomography in the imaging diagnosis of uterine perforation remote from the procedure. Language: English Keywords: UNITED STATES OF AMERICA | SUMMARY REPORT | CASE HISTORIES | CLIENTS | UTERINE PERFORATION | PREGNANCY, FIRST TRIMESTER | ABORTION | CURETTAGE | ULTRASONICS | LAPAROTOMY | MYOMETRIAL EFFECTS | ANTIBIOTICS | ADMINISTRATION AND DOSAGE | Developed Countries | North America | Americas | Data Collection | Research Methodology | Program Activities | Programs | Organization and Administration | Perforations | Diseases | Pregnancy | Reproduction | Fertility Control, Postconception | Family Planning | Obstetrical Surgery | Surgery | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Myometrium | Uterus | Genitalia, Female | Genitalia | Urogenital System | Physiology | Biology | Drugs Document Number: 341997 Notification |
| 24. Peer Reviewed Title: Scheduled hysterectomy for second-trimester abortion in a patient with placenta accreta. Author: Tocce K; Thomas VW; Teal S Source: Obstetrics and Gynecology. 2009 Feb;113(2 Pt 2):568-70. Abstract: BACKGROUND: As cesarean deliveries increase, so does placenta accreta. There is little evidence regarding management of patients with known or suspected abnormal placentation seeking abortion. CASE: A medically complicated patient with evidence of placenta increta on magnetic resonance imaging presented for pregnancy termination at 15 weeks of gestation. Scheduled hysterectomy was performed to avoid hemorrhage and subsequent complications. The patient did well postoperatively; her course was complicated only by a wound infection treated as an outpatient. Pathology was consistent with placenta increta. CONCLUSION: Placenta accreta has increased 13-fold in the past 30 years. In select patients with evidence of abnormal placentation, scheduled hysterectomy for termination of pregnancy is an option that may be considered. Language: English Keywords: COLORADO | RESEARCH REPORT | CLINICAL RESEARCH | CASE STUDIES | PREGNANT WOMEN | ABORTION | CESAREAN SECTION | PREGNANCY, SECOND TRIMESTER | PREGNANCY COMPLICATIONS | HYSTERECTOMY | INFECTIONS | United States of America | North America | Americas | Developed Countries | Research Methodology | Studies | Population Characteristics | Demographic Factors | Population | Fertility Control, Postconception | Family Planning | Obstetrical Surgery | Surgery | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Pregnancy | Reproduction | Diseases | Gynecologic Surgery | Urogenital Surgery Document Number: 330356 Notification |
| 25. Title: Outcome of eclampsia at the Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife. Author: Ade-Ojo IP; Loto OM Source: Nigerian Journal of Clinical Practice. 2008 Sep;11(3):279-84. Abstract: OBJECTIVE: Eclampsia is a serious obstetric complication with attending high maternal and perinatal morbidity and mortality. There is need for periodic audit of our management of these cases so as to identify potential areas for possible intervention aimed at improving the management outcome of this pregnancy complication. METHODS: The records of cases of Eclampsia managed at the OAUTHC Ile-Ife between January 1, 1994 and December 31, 2003 were retrospectively analysed. RESULTS: The incidence of Eclampsia was 0.91% of total deliveries. It was highest in teenagers and young adults who are less than 25 years (1.56%), who were carrying their first pregnancy (2.64%) and were unbooked (6.3%). Headache was the commonest symptom (100%), while hypertension and fever were the commonest signs being present in 75% and 20.2% of the patients respectively. Antepartum Eclampsia accounted for 56.5% of the cases and majority was delivered by emergency caesarean section. Maternal and perinatal mortality were 8.0% and 19.1% respectively. CONCLUSION: Provision of good quality and widespread antenatal care, improving the capacities of the hospitals to handle emergencies and intensive care unit management of all cases of Eclampsia are measures that could reduce the burden ofEclampsia in this environment. Language: English Keywords: NIGERIA | RESEARCH REPORT | CLINICAL RESEARCH | LONGITUDINAL STUDIES | RETROSPECTIVE STUDIES | EPIDEMIOLOGIC METHODS | WOMEN IN DEVELOPMENT | PREGNANT WOMEN | ECLAMPSIA | HEADACHE | FEVER | PREVALENCE | CESAREAN SECTION | MATERNAL MORTALITY | PERINATAL MORTALITY | Developing Countries | Africa, Western | Africa, Sub Saharan | Africa | Research Methodology | Studies | Economic Development | Economic Factors | Population Characteristics | Demographic Factors | Population | Pregnancy Complications | Diseases | Signs and Symptoms | Body Temperature | Physiology | Biology | Measurement | Obstetrical Surgery | Surgery | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Mortality | Population Dynamics Document Number: 330587 |
26.  Title: Knowledge of Iraqi primary health care physicians about breastfeeding. Author: Al-Zwaini EJ; Al-Haili SJ; Al-Alousi TM Source: Eastern Mediterranean Health Journal. 2008 Mar-Apr;14(2):381-388. Abstract: A questionnaire survey was conducted on 50 primary health care physicians in Ramadi city, Iraq, in 2001 to assess their knowledge and identify misperceptions about breastfeeding. Basic knowledge about the main processes of breastfeeding was good (when to start feeding, frequency of feeding, relactation, importance of psychological factors), but there were deficiencies in their ability to deal with some practical problems related to breastfeeding. Only 64% would advise continuation of breastfeeding when a lactating mother discovers that she is pregnant, 38% of them thought a mother's ability to breastfeed was related to breast size and only 66% knew when to start feeding after caesarean section. Steps for improving the knowledge and training are addressed. (author's) Language: English Keywords: IRAQ | RESEARCH REPORT | CROSS SECTIONAL ANALYSIS | QUESTIONNAIRES | PHYSICIANS | PRIMARY HEALTH CARE | KNOWLEDGE | BREASTFEEDING | PREGNANCY | CESAREAN SECTION | TRAINING PROGRAMS | Middle East | Developing Countries | Research Methodology | Health Personnel | Delivery of Health Care | Health | Health Services | Sociocultural Factors | Infant Nutrition | Nutrition | Reproduction | Obstetrical Surgery | Surgery | Treatment | Medical Procedures | Medicine | Education Document Number: 326130 |
| 27. Title: The implications of objectification theory for women's health: Menstrual suppression and "maternal request" cesarean delivery. Author: Andrist LC Source: Health Care for Women International. 2008 May;29(5):551-565. Abstract: Menstrual suppression with oral contraceptives and cesarean delivery on maternal request (CDMR) are relatively new options for women and increasingly are available, particularly in developed countries, around the world. In this article, I explore these issues using objectification theory as a framework for deconstruction. I offer a provocative hypothesis: Women who objectify their bodies are not only interested in menstrual suppression, but also in surgicalized childbirth at their request. I argue that because patriarchal societies have aligned women's reproductive functions with nature, disinterest in menstruation and vaginal childbirth has become another way for women to separate themselves from their "earthly" nature and transform or maintain their bodies as idealized cultural symbols (author's) Language: English Keywords: GLOBAL | CRITIQUE | WOMEN | WOMEN'S HEALTH | CESAREAN SECTION | MENSTRUAL REGULATION | ORAL CONTRACEPTIVES | WOMEN'S STATUS | PSYCHOSOCIAL FACTORS | CULTURE | Demographic Factors | Population | Health | Obstetrical Surgery | Surgery | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Fertility Control, Postcoital | Family Planning | Contraceptive Methods | Contraception | Socioeconomic Factors | Economic Factors | Behavior | Sociocultural Factors Document Number: 326447 |
| 28. Peer Reviewed Title: Inequity in maternal health-care services: Evidence from home-based skilled-birth-attendant programmes in Bangladesh. Author: Anwar I; Sami M; Akhtar N; Chowdhury ME; Salma U Source: Bulletin of the World Health Organization. 2008 Apr;86(4):252-259. Abstract: The objective was to explore use-inequity in maternal health-care services in home-based skilled-birth-attendant (SBA) programme areas in Bangladesh. Data from a community survey, conducted from February to May 2006, were analysed to examine inequities in use of SBAs, caesarean sections for deliveries and postnatal care services according to key socioeconomic factors. Of 2164 deliveries, 35% had an SBA, 22.8% were in health facilities and 10.8% were by caesarean section. Rates of uptake of antenatal and postnatal care were 93% and 28%, respectively. There were substantial use-inequities in maternal health by asset quintiles, distance, and area of residence, and education of both the woman and her husband. However, not all inequities were the same. After adjusting for other determinants, the differences in the use of maternal health-care services for poor and rich people remained substantial [adjusted odds ratio (OR) 2.51 (95% confidence interval, CI: 1.68-3.76) for skilled attendance; OR 2.58 (95%CI: 1.28-5.19) for use of caesarean sections and OR 1.53 (95% CI: 1.05-2.25) for use of postnatal care services]. Complications during pregnancy influenced use of SBAs, caesarean-section delivery and postnatal care services. The number of antenatal care visits was a significant predictor for use of SBAs and postnatal care, but not for caesarean sections. Use of maternity care services was higher in the study areas than national averages, but a tremendous use-inequity persists. Interventions to overcome financial barriers are recommended to address inequity in maternal health. A greater focus is needed on the implementation and evaluation of maternal-health interventions for poor people. (author's) Language: English Keywords: BANGLADESH | RESEARCH REPORT | SAMPLING STUDIES | INTERVIEWS | MATERNAL HEALTH SERVICES | ANTENATAL CARE | POSTPARTUM PROGRAMS | CESAREAN SECTION | UTILIZATION OF HEALTH CARE | TRADITIONAL BIRTH ATTENDANTS | INEQUALITIES | SOCIOECONOMIC STATUS | Developing Countries | Asia, Southern | Asia | Studies | Research Methodology | Data Collection | Maternal-Child Health Services | Primary Health Care | Health Services | Delivery of Health Care | Health | Family Planning Programs | Family Planning | Obstetrical Surgery | Surgery | |