| 1. Title: Intrauterine devices: an effective alternative to oral hormonal contraception. Source: Prescrire International. 2009 Jun;18(101):125-30. Abstract: (1) Intrauterine devices (IUDs) are placed in the uterine cavity with the objective of providing long-term contraception, mainly by preventing fertilisation. The best-known IUDs contain copper, but there is also an IUD delivering levonorgestrel, a progestin; (2) How effective are these devices, and what are their adverse effects? To answer these questions, we analysed the literature using the standard Prescrire methodology; (3) T-shaped copper IUDs, with a copper surface area of 380 mm2 on 3 arms, and the levonorgestrel-releasing device, have similar contraceptive efficacy as combined oral contraceptives that are used correctly. In contrast, IUDs are more effective than oral contraception used incorrectly; (4) Among IUD users, there are on average about 6 pregnancies per 1000 woman-years. There is less experience with the levonorgestrel IUD which seems to be at least as effective as copper IUDs; (5) The rare intrauterine pregnancies that occur in women using an IUD generally end in miscarriage. About 25% of these pregnancies end in a live birth if the device is left in place, compared to about 90% if the device is removed; (6) Ectopic pregnancies are rarer in IUD users than in women who do not use contraception. However, about one in 20 pregnancies that occur in women using an IUD is ectopic; (7) The IUD is expelled in about 5% to 10% of cases within 5 years, and expulsion recurs in about 30% of these women; (8) Problems such as difficult insertion, pain, bleeding and syncope are reported in less than 1.5% of cases overall; (9) Uterine perforation during insertion is rare, occurring in 0.6 to 16 cases per 1000 insertions, regardless of the type of IUD. The risk of perforation is higher when the IUD is inserted less than 4 to 6 weeks after delivery or elective abortion; (10) During the first 3 months after insertion, the risk of pelvic infection is slightly higher than in the general population, especially in women with pre-existing asymptomatic Chlamydia trachomatis infection. There are about 6 pelvic infections per 1000 woman-years of IUD use. Routine antibiotic prophylaxis is unnecessary. The interview and physical examination may lead to diagnosis of C. trachomatis infection or other sexually transmitted infections. In these cases, treatment may be needed before IUD insertion. Women must be warned that IUDs do not protect them from sexually transmitted diseases; (11) Menstrual bleeding is often heavier in women with cooper IUDs than in women who do not use IUDs, and may be associated with menstrual pain; (12) The levonorgestrel IUD is associated with a marked reduction in menstrual blood loss and irregular bleeding; amenorrhoea occurs in 35% of women after 2 years of use. The levonorgestrel IUD also has hormonal adverse effects such as headache, acne, breast tension and functional ovarian cysts; (13) IUDs can safely be used in breastfeeding women, immediately after a pregnancy, in cases of diabetes or HIV infection, during nonsteroidal antiinflammatory drug therapy, and after an ectopic pregnancy. The only problems occurring in women who have never had children are pain during insertion and more frequent expulsions; (14) A copper IUD is a first-line contraceptive method for women with a history of deep venous thrombosis, pulmonary embolism, or coronary events; (15) It is better to postpone IUD insertion when the woman has a genital tract infection or unexplained vaginal bleeding; (16) IUD insertion is an effective alternative to "morning-after" hormonal contraception. Language: English Keywords: GLOBAL | LITERATURE REVIEW | IUD | CONTRACEPTIVE MODE OF ACTION | IUD COMPLICATIONS | IUD EXPULSION | INSERTION | IUD SIDE EFFECTS | CONTRACEPTIVE EFFECTIVENESS | CONTRACEPTIVE SAFETY | PREGNANCY, ECTOPIC | UTERINE PERFORATION | Contraceptive Methods | Contraception | Family Planning | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Safety | Public Health | Pregnancy Complications | Diseases | Perforations Document Number: 342301 |
2.  Peer Reviewed Title: ACOG Committee Opinion No. 427: Misoprostol for postabortion care. Author: American College of Obstetricians and Gynecologists Source: Obstetrics and Gynecology. 2009 Feb;113(2 Pt 1):465-8. Abstract: The World Health Organization estimates that 67,000 women, mostly in developing countries, die each year from untreated or inadequately treated abortion complications. Postabortion care, a term commonly used by the international reproductive health community, refers to a specific set of services for women experiencing problems from all types of spontaneous or induced abortion. There is increasing evidence that misoprostol is a safe, effective, and acceptable method to achieve uterine evacuation for women needing postabortion care. To reduce maternal mortality, availability of postabortion care services must be increased. Misoprostol must be readily available especially for women who do not otherwise have access to postabortion care. Nurses and midwives can safely provide first-line postabortion care services, including in outpatient settings,provided they receive appropriate training and support. Access to contraception and safe abortion services prevents complications from unsafe abortion and decreases the need for postabortion care. It is much less expensive and far better for women's health to prevent the problem of unsafe abortion rather than to treat resulting complications. Language: English Keywords: DEVELOPING COUNTRIES | RESEARCH REPORT | WOMEN | ABORTION | ABORTION, SPONTANEOUS | POSTABORTION CARE | MISOPROSTOL | HEALTH SERVICES | REPRODUCTIVE HEALTH | MATERNAL HEALTH | MATERNAL MORTALITY | PREVENTION AND CONTROL | NEEDS ASSESSMENT | PROGRAM ACCESSIBILITY | Demographic Factors | Population | Fertility Control, Postconception | Family Planning | Pregnancy Complications | Diseases | Delivery of Health Care | Health | Prostaglandins, Synthetic | Prostaglandins | Endocrine System | Physiology | Biology | Mortality | Population Dynamics | Evaluation | Program Evaluation | Programs | Organization and Administration Document Number: 341050 |
| 3. Peer Reviewed Title: Spousal violence and potentially preventable single and recurrent spontaneous fetal loss in an African setting: cross-sectional study. Author: Alio A; Nana PN; Salihu HM Source: Lancet. 2009;373:318-324. Abstract: Background Spousal violence is a global issue, with ramifications for the reproductive health of women. We aimed to investigate the effect of physical, sexual, and emotional violence on potentially preventable single and recurrent spontaneous fetal loss. Methods We analysed data from the Cameroon Demographic Health Survey. In the violence module of this survey, women were questioned about their experience of physical, emotional, and sexual violence inflicted by their spouses. Respondents were also asked about any stillbirths and spontaneous abortions. We measured risk for single and recurrent fetal loss with odds ratios, with adjustment for intracluster correlations as appropriate. We also estimated the proportion of preventable excess fetal loss at various levels of violence reduction. Findings 2562 women responded to the violence module. Those exposed to spousal violence (n=1307) were 50% more likely to experience at least one episode of fetal loss compared with women not exposed to abuse (odds ratio 1-5; 95% CI 1-3-1-8). Recurrent fetal mortality was associated with all forms of spousal violence, but emotional violence had the strongest association (1-7; 1-2-2-3). If the prevalence of spousal abuse could be reduced to 50%, 25%, or entirely eliminated, preventable excess recurrent fetal demise would be 17%, 25%, and 33%, respectively. Interpretation Spousal violence increases the likelihood of single and repeated fetal loss. A large proportion of risk for recurrent fetal mortality is attributable to spousal violence and, therefore, is potentially preventable. Our findings support the idea of routine prenatal screening for spousal violence in the African setting, a region with the highest rate of fetal death in the world. Language: English Keywords: AFRICA | RESEARCH REPORT | CROSS SECTIONAL ANALYSIS | DEMOGRAPHIC AND HEALTH SURVEYS | WOMEN | ABORTION, SPONTANEOUS | DOMESTIC VIOLENCE | PHYSICAL ABUSE | IMPACT | Developing Countries | Research Methodology | Demographic Surveys | Population Dynamics | Demographic Factors | Population | Pregnancy Complications | Diseases | Crime | Social Problems | Sociocultural Factors | Violence | Behavior | Communication Document Number: 340220 |
| 4. Title: Consanguinity and reproductive wastage in the Palestinian Territories. Author: Assaf S; Khawaja M; DeJong J; Mahfoud Z; Yunis K Source: Paediatric and Perinatal Epidemiology. 2009 Mar;23(2):107-15. Abstract: Many studies have found that consanguinity poses a threat to child mortality and health and can also pose a threat to offspring survival before birth. However, there are conflicting findings with some studies having found no increased risk on offspring survival associated with consanguinity. Data from a population-based survey conducted in 2004 in the Palestinian Territories was used to assess the risk of consanguinity on offspring survival. The analysis was conducted on 4418 women aged 15-49 who were asked whether or not they had experienced a stillbirth or a spontaneous abortion. These two outcomes were combined together for the analysis of reproductive wastage. Multivariable negative binomial regression was conducted to calculate the incidence risk ratios (IRR) for each region in the Palestinian Territories separately. The strongest risk factors for reproductive wastage, after controlling for other variables, were found to be consanguinity, age and parity with age presenting the highest IRRs. Standard of living, locality type, education level, women's employment and past intrauterine device use were not found to be significant risk factors for reproductive wastage. In the West Bank only first cousin level of consanguinity was found to be significant and 'hamola' level (or from same family clan) lost its significance after adjusting for other variables. In the Gaza Strip both the first cousin and 'hamola' levels of consanguinity were significant and presented almost equal IRRs of 1.3. In conclusion, consanguinity was found to be a significant risk factor for reproductive wastage. Language: English Keywords: MIDDLE EAST | RESEARCH REPORT | RISK ASSESSMENT | ABORTION, SPONTANEOUS | FETAL DEATH | MATERNAL AGE | CONSANGUINITY | RISK FACTORS | CHILD MORTALITY | Evaluation | Pregnancy Complications | Diseases | Mortality | Population Dynamics | Demographic Factors | Population | Parental Age | Age Factors | Population Characteristics | Genetics | Biology | Health Document Number: 331057 |
| 5. Title: Clandestine induced abortion: prevalence, incidence and risk factors among women in a Latin American country. Author: Bernabe-Ortiz A; White PJ; Carcamo CP; Hughes JP; Gonzales MA; Garcia PJ; Garnett GP; Holmes KK Source: CMAJ. 2009 Feb 3;180(3):298-304. Abstract: BACKGROUND: Clandestine induced abortions are a public health problem in many developing countries where access to abortion services is legally restricted. We estimated the prevalence and incidence of, and risk factors for, clandestine induced abortions in a Latin American country. METHODS: We conducted a large population-based survey of women aged 18-29 years in 20 cities in Peru. We asked questions about their history of spontaneous and induced abortions, using techniques to encourage disclosure. RESULTS: Of 8242 eligible women, 7992 (97.0%) agreed to participate. The prevalence of reported induced abortions was 11.6% (95% confidence interval [CI] 10.9%-12.4%) among the 7962 women who participated in the survey. It was 13.6% (95% CI 12.8%-14.5%) among the 6559 women who reported having been sexually active. The annual incidence of induced abortion was 3.1% (95% CI 2.9%-3.3%) among the women who had ever been sexually active. In the multivariable analysis, risk factors for induced abortion were higher age at the time of the survey (odds ratio [OR] 1.11, 95% CI 1.07-1.15), lower age at first sexual intercourse (OR 0.87, 95% CI 0.84-0.91), geographic region (highlands: OR 1.56, 95% CI 1.23-1.97; jungle: OR 1.81, 95% CI 1.41-2.31 [v. coastal region]), having children (OR 0.82, 95% CI 0.68-0.98), having more than 1 sexual partner in lifetime (2 partners: OR 1.61, 95% CI 1.23-2.09; > or = 3 partners: OR 2.79, 95% CI 2.12-3.67), and having 1 or more sexual partners in the year before the survey (1 partner: OR 1.36, 95% CI 1.01-1.72; > or = 2 partners: OR 1.54, 95% CI 1.14-2.02). Overall, 49.0% (95% CI 47.6%-50.3%) of the women who reported being currently sexually active were not using contraception. INTERPRETATION: The incidence of clandestine, potentially unsafe induced abortion in Peru is as high as or higher than the rates in many countries where induced abortion is legal and safe. The provision of contraception and safer-sex education to those who require it needs to be greatly improved and could potentially reduce the rate of induced abortion. Language: English Keywords: LATIN AMERICA | RESEARCH REPORT | INCIDENCE | PREVALENCE | WOMEN | RISK FACTORS | ABORTION | ABORTION, SPONTANEOUS | SEX EDUCATION | RISK ASSESSMENT | Americas | Developing Countries | Measurement | Research Methodology | Demographic Factors | Population | Biology | Fertility Control, Postconception | Family Planning | Pregnancy Complications | Diseases | Education | Evaluation Document Number: 330468 Notification |
| 6. Peer Reviewed Title: Exposure to maternal and paternal tobacco consumption and risk of spontaneous abortion. Author: Blanco-Munoz J; Torres-Sanchez L; Lopez-Carrillo L Source: Public Health Reports. 2009 Mar-Apr;124(2):317-22. Abstract: Conclusive evidence shows that maternal tobacco consumption increases the risk of infertility, subfertility, ectopic pregnancy, preterm birth, low birthweight, and stillbirth. Nevertheless, evidence with respect to the risk of spontaneous abortion (SA) (i.e., miscarriage) is inconsistent. In a case-control study, Kline et al. identified an increase in miscarriages in women who were smokers. In Canadian women, Armstrong et al. found a 20% increase in the risk of SA for every 10 cigarettes consumed daily. Other authors have also shown a positive association between cotinine levels in urine and SA. On the other hand, in Rasch's study, after adjusting for other risk factors, women who smoked 10 to 19 cigarettes and 20 or more cigarettes per day did not have significantly increased odds ratios (ORs) for having SAs. The role of paternal tobacco exposure in adverse reproductive effects has been scarcely evaluated. Some reports in the literature assert that tobacco consumption in men is associated with morphological alterations in sperm, a decrease in sperm density and motility, and a reduction in semen volume,11 which could have implications for male fertility and embryo viability. However, the scarce studies that to date have evaluated the association between exposure to paternal tobacco and SA are also contradictory. (excerpt) Language: English Keywords: MEXICO | RESEARCH REPORT | EPIDEMIOLOGIC METHODS | CLINICAL RESEARCH | COHORT ANALYSIS | PREGNANT WOMEN | WOMEN IN DEVELOPMENT | SEXUAL PARTNERS | COUPLES | ABORTION RATE | RISK FACTORS | TOBACCO USE | ABORTION, SPONTANEOUS | North America | Americas | Developing Countries | Research Methodology | Population Characteristics | Demographic Factors | Population | Economic Development | Economic Factors | Sex Behavior | Behavior | Family Characteristics | Family and Household | Sociocultural Factors | Fertility Control, Postconception | Family Planning | Health | Pregnancy Complications | Diseases Document Number: 331257 |
| 8. Title: Rates of spontaneous and therapeutic abortions following use of antidepressants in pregnancy: results from a large prospective database. Author: Einarson A; Choi J; Einarson TR; Koren G Source: Journal of Obstetrics and Gynaecology Canada. 2009 May;31(5):452-6. Abstract: OBJECTIVE: The use of antidepressants during pregnancy remains a controversial issue, and there is little information on the risk of spontaneous abortions following antidepressant exposure in early pregnancy. We sought to examine whether use of antidepressants increases the rates of spontaneous abortion (SA) and therapeutic abortion (TA) in women exposed in early pregnancy. METHODS: In a cohort of women who contacted the Motherisk program during pregnancy, we compared two groups of women, one exposed and the other not exposed to antidepressants during pregnancy, and calculated the associated rates of SA and TA. RESULTS: Among 937 women exposed to antidepressants prior to and during early pregnancy, there were 122 SAs (13.0%) including three ectopic pregnancies, and in the comparison group there were 75 SAs (8.0%) and no ectopic pregnancies. The relative risk was 1.63 (95% CI 1.24-2.14). Three-fold more women reported a TA in the exposed group, 26 (2.4%) compared to 8 (0.7%) in the non-exposed group (RR 3.25; 95% CI 1.48-7.14). A sub-analysis revealed that in both groups, of 338 women with a prior SA, 58 (17.2%) reported having a SA in the current pregnancy, compared with 61/652 (9.4%) with no prior SA (chi square = 12.09, P lt; 0.001). In the antidepressant group, the incidence was 20.7%, and in the non-exposed group, it was 13.3%. Logistic regression confirmed that only antidepressant exposure and prior SA were significantly associated with current SA. CONCLUSION: Exposure to antidepressants in the first trimester of pregnancy appears to be associated with a small but statistically significant increased risk of SA and decision to terminate a pregnancy. The risk for SA is further elevated with a history of previous SA. However, any underlying depression must be taken into consideration when evaluating these results. Language: English Keywords: CANADA | RESEARCH REPORT | PROSPECTIVE STUDIES | PREGNANT WOMEN | ABORTION, SPONTANEOUS | ABORTION | RISK FACTORS | DEPRESSION | DRUGS | PREGNANCY, FIRST TRIMESTER | INCIDENCE | INTERVIEWS | Developed Countries | North America, Northern | Americas | Studies | Research Methodology | Population Characteristics | Demographic Factors | Population | Pregnancy Complications | Diseases | Fertility Control, Postconception | Family Planning | Health | Mental Disorders | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Pregnancy | Reproduction | Measurement | Data Collection Document Number: 342785 Notification |
| 9. Title: Previous abortion and risk of pre-term birth: a population study. Author: Freak-Poli R; Chan A; Tucker G; Street J Source: Journal of Maternal-Fetal and Neonatal Medicine. 2009 Jan;22(1):1-7. Abstract: OBJECTIVE: This population study was undertaken to determine whether previous abortion is an independent risk factor for pre-term birth and to calculate population-attributable risks for risk factors. METHODS: All South Australian first singleton births in 1998-2003 (n = 42 269) were included in a multivariable logistic regression analysis, comparing pre-term births with term births. RESULTS: Risk factors for pre-term birth were found to be: being indigenous, single, a smoker [adjusted odds ratio (AOR) 1.28, 95% confidence interval 1.17-1.41], age 40 years or older, reproductive technology assistance, threatened miscarriage, antepartum haemorrhage, urinary tract infection, pregnancy hypertension and suspected intra-uterine growth restriction. A previous spontaneous abortion was of borderline statistical significance, whereas a previous induced abortion (AOR 1.25, 1.13-1.40) was an independent risk factor. A dose-response relationship was found with increasing number of previous spontaneous or induced abortions. Population-attributable risks were highest for pregnancy hypertension (12.4%) and antepartum haemorrhage (9.2%). Smoking and previous induced abortion had risks of 4.7% and 2.7%, respectively. Among indigenous women, 51% of whom smoked, 16.4% of pre-term birth could be attributed to smoking. CONCLUSIONS: A previous induced abortion and smoking during pregnancy (particularly among indigenous women) are preventable risk factors for pre-term birth. Their population-attributable risks are likely to be under-estimates from under-reporting. Language: English Keywords: AUSTRALIA | RESEARCH REPORT | EPIDEMIOLOGIC METHODS | CLINICAL RESEARCH | PREGNANT WOMEN | INDIGENOUS POPULATION | PREVALENCE | ABORTION | RISK ASSESSMENT | PREMATURE BIRTH | RISK FACTORS | REPRODUCTIVE TECHNOLOGIES | ABORTION, SPONTANEOUS | MATERNAL AGE | PREECLAMPSIA | Oceania | Developed Countries | Research Methodology | Population Characteristics | Demographic Factors | Population | Measurement | Fertility Control, Postconception | Family Planning | Evaluation | Pregnancy Outcomes | Pregnancy | Reproduction | Health | Pregnancy Complications | Diseases | Parental Age | Age Factors Document Number: 330718 Notification |
| 10. Peer Reviewed Title: Use of combined oral contraceptives post abortion. Author: Gaffield ME; Kapp N; Ravi A Source: Contraception. 2009 Oct;80(4):355-62. Abstract: BACKGROUND: Providing combined oral contraceptives (COCs) following surgical or medical induced abortion offers women an opportune moment to initiate a reliable contraceptive method. STUDY DESIGN: We conducted a systematic review, searching MEDLINE and The Cochrane Library for articles in any language concerning COC use following spontaneous, induced (medical or surgical) or septic abortion, from 1966 through June 2008. Seven articles were identified and evaluated using the United States Preventive Services Task Force system. RESULTS: Immediate COC initiation after first-trimester medical or surgical induced abortion did not increase side effects or prolong vaginal bleeding compared with use of a placebo, copper-bearing intrauterine device (IUD), nonhormonal contraceptive method or COC initiation at a later time. Initiating COCs after first-trimester surgical abortion produced small increases in coagulation parameters compared with IUD use; although they are statistically significant, their clinical relevance is unlikely. No study examined second-trimester induced or spontaneous abortion, or septic abortion. CONCLUSIONS: Evidence shows that COCs can be safely initiated immediately following surgical and medical abortion in the first-trimester of pregnancy. Language: English Keywords: GLOBAL | LITERATURE REVIEW | ABORTION | ABORTION, SPONTANEOUS | PREGNANCY, FIRST TRIMESTER | POSTABORTION CARE | ORAL CONTRACEPTIVES, COMBINED | CONTRACEPTIVE SAFETY | MENSTRUATION | ORAL CONTRACEPTIVES, SIDE EFFECTS | BLOOD COAGULATION EFFECTS | Fertility Control, Postconception | Family Planning | Pregnancy Complications | Diseases | Pregnancy | Reproduction | Health Services | Delivery of Health Care | Health | Oral Contraceptives | Contraceptive Methods | Contraception | Safety | Public Health | Hematological Effects | Hemic System | Physiology | Biology Document Number: 342771 Notification |
| 11. Peer Reviewed Title: Ectopic pregnancy following levonorgestrel emergency contraception: a case report. Author: Ghosh B; Dadhwal V; Deka D; Ramesan CK; Mittal S Source: Contraception. 2009 Feb;79(2):155-7. Abstract: Use of levonorgestrel as emergency contraception is a safe and effective measure to prevent unwanted pregnancy. However, ectopic gestation in case of failure is a known risk. Access to levonorgestrel without a prescription in many countries has made it impossible to estimate the exact incidence of this potential adverse event. Thus, spontaneous reporting of cases serves to alert physicians to this possibility. We present a case of ectopic pregnancy following use of levonorgestrel emergency contraception. To our knowledge, this is the first case report from India following introduction of levonorgestrel emergency contraception in 2001. Language: English Keywords: INDIA | RESEARCH REPORT | EMERGENCY CONTRACEPTION | LEVONORGESTREL | CONTRACEPTIVE SAFETY | PREGNANCY, ECTOPIC | PREGNANCY, UNWANTED | Developing Countries | Asia, Southern | Asia | Contraception | Family Planning | Contraceptive Agents, Progestin | Contraceptive Agents, Female | Contraceptive Agents | Safety | Public Health | Health | Pregnancy Complications | Diseases | Reproductive Behavior | Fertility | Population Dynamics | Demographic Factors | Population Document Number: 329608 |
| 12. Title: Seropositivity for Listeria monocytogenes in women with spontaneous abortion: a case-control study in Iran. Author: Jamshidi M; Jahromi AS; Davoodian P; Amirian M; Zangeneh M; Jadcareh F Source: Taiwanese Journal of Obstetrics and Gynecology. 2009 Mar;48(1):46-8. Abstract: OBJECTIVE: There are many studies supporting the role of certain asymptomatic infections such as Listeria monocytogenes (L. monocytogenes) in spontaneous abortion. In some cases, latent listeriosis may complicate the pregnancy, and serologic tests can, therefore, be used to detect the disease. This study was designed to assess the relationship between seropositivity for L. monocytogenes and spontaneous abortion. MATERIALS AND METHODS: A total of 250 women with previous spontaneous abortion and a control group of 200 women with normal full-term deliveries entered the study as case and control groups, respectively. Demographic characteristics were recorded for each subject, and serum samples were obtained from all participants. All serum samples were examined using the indirect immunofluorescence antibody test for L. monocytogenes antibody. Data was analyzed using Chi-squared and t tests. RESULTS: The average age of participants was 25.6 +/- 7.6 years in cases and 25.3 +/- 6.5 years in controls. Eighty-nine (35.6%) of the cases with abortion and 35 (17.5%) of the control group were positive for L. monocytogenes antibody (p = 0.001). No relationship was observed between the number of pregnancies and infection with L. monocytogenes (p = 0.4), or between the number of previous abortions and L. monocytogenes seropositivity (p = 0.2). CONCLUSION: We suggest monitoring L. monocytogenes seroprevalence in pregnant women at high risk of threatened abortion, and further microbiological assessment of symptomatic women for detection of L. monocytogenes and insidious infection. Language: English Keywords: IRAN | RESEARCH REPORT | CASE STUDIES | WOMEN | ABORTION, SPONTANEOUS | PREGNANCY | MONITORING | INFECTIONS | TESTING | Middle East | Developing Countries | Studies | Research Methodology | Demographic Factors | Population | Pregnancy Complications | Diseases | Reproduction | Evaluation | Measurement Document Number: 342081 |
| 13. Peer Reviewed Title: Spontaneous breakage and expulsion of a stem fragment of levonorgestrel intrauterine system (Mirena) following duplicate insertion [letter] Author: Jindal S; Sharma SS; Ikomi A Source: Archives of Gynecology and Obstetrics. 2009 Jan;279(1):95-7. Abstract: BACKGROUND: Removal and changing an intra-uterine device (IUD) involves good history taking, a proper examination and appropriate experience in fitting IUDs. CASE: We present a case of a woman who had two insertions of the levonorgestrel intrauterine system (LNG-IUS) which was diagnosed only at hysteroscopy when she presented with the spontaneous expulsion of a vertical stem of one of the devices. CONCLUSION: This is a unique case where two LNG-IUS were inserted in error and hence it teaches the clinicians the importance of good training and being aware of the possibility of the missing thread which deserves further investigations especially when such cases are encountered in a busy general practice. Language: English Keywords: UNITED KINGDOM | RESEARCH REPORT | CASE STUDIES | WOMEN | IUD EXPULSION | HYSTEROSCOPY | LEVONORGESTREL | INSERTION | SURGICAL ERROR | ABORTION, SPONTANEOUS | Developed Countries | Europe, Western | Europe | Studies | Research Methodology | Demographic Factors | Population | IUD | Contraceptive Methods | Contraception | Family Planning | Endoscopy | Physical Examinations and Diagnoses | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Contraceptive Agents, Progestin | Contraceptive Agents, Female | Contraceptive Agents | Treatment | Surgery | Pregnancy Complications | Diseases Document Number: 329580 |
| 14. Peer Reviewed Title: Coexistent lithopedion and live abdominal ectopic pregnancy. Author: Massinde AN; Rumanyika R; Im HB Source: Obstetrics and Gynecology. 2009 Aug;114(2 Pt 2):458-60. Abstract: BACKGROUND:: Abdominal pregnancy is a rare, life-threatening variant of ectopic pregnancy, and thus its diagnosis and management remain controversial. CASE:: A multigravida was admitted for complaints of abdominal swelling that had been occurring for 2 years and symptoms of pregnancy in the 3 months before admission. Radiologic studies revealed a live intraabdominal pregnancy at 15 weeks of gestation with a concurrent lithopedion of advanced gestation. The patient underwent laparotomy, removing both fetuses; the placenta was left in situ. She was discharged 1 week later in good condition. CONCLUSION:: The case of a concurrent lithopedion of advanced gestation and a live intraabdominal ectopic pregnancy was successfully managed. Language: English Keywords: TANZANIA | SUMMARY REPORT | CASE HISTORIES | CLIENTS | PREGNANCY, ABDOMINAL | PREGNANCY, ECTOPIC | EXAMINATIONS AND DIAGNOSES | PRODUCTS OF CONCEPTION, RETENTION | LAPAROTOMY | ULTRASONICS | FETAL MEMBRANES | Developing Countries | Africa, Eastern | Africa, Sub Saharan | Africa | Data Collection | Research Methodology | Program Activities | Programs | Organization and Administration | Pregnancy Complications | Diseases | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Surgery | Treatment | Fetus | Pregnancy | Reproduction Document Number: 342273 |
| 15. 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 |
| 16. Title: Pharmacotherapeutic options for the treatment of preeclampsia. Author: McCoy S; Baldwin K Source: American Journal of Health System Pharmacy. 2009 Feb 15;66:337-344. Abstract: Purpose. Pharmacotherapeutic options for the treatment of preeclampsia are reviewed. Summary. Risk factors for the development of preeclampsia include microvascular diseases, such as diabetes mellitus; vascular and connective tissue disorders; hypertension; antiphospholipid antibody syndrome; and nephropathy. Several pathophysiological factors contribute to the development of the preeclamptic state, including vasospasm onset, coagulation system activation, increased inflammatory response, and ischemia. The specific agents used for the treatment of preeclampsia are dependent on a number of factors including symptom severity, maternal or fetal compromise, the progression to eclampsia, gestational period, and cervical status. The diagnosis of preeclampsia beyond the gestation period of 38 weeks requires delivery. The presence of maternal compromise or eclampsia at gestation greater than 20 weeks also necessitates delivery. In cases of chronic or mild hypertension, oral methyldopa may be administered on an outpatient basis. Intravenous hydralazine is a commonly administered arteriolar vasodilator that is effective for hypertensive emergencies associated with pregnancies. The most common adverse effect of hydralazine administration is unpredictable hypotension. Labetalol decreases heart rate and may be preferred because of a lack of reflex tachycardia, hypotension, or increased intracranial pressure. However, the drug of choice for the prevention and control of maternal seizures in patients with severe preeclampsia or eclampsia during the peripartum period is i.v. magnesium sulfate. Therapeutic serum magnesium levels cause cerebral vasodilation, thereby reversing the ischemia produced by cerebral vasospasm during an eclamptic episode. The results of one study indicated that women receiving magnesium sulfate therapy had a 58% lower risk of eclampsia than placebo. Conclusion. Magnesium sulfate remains the drug of choice for the prevention and treatment of preeclampsia. Alternative antihypertensive agents mayprovide additional benefit in the management of hypertension for preeclamptic patients. Language: English Keywords: UNITED STATES OF AMERICA | RECOMMENDATIONS | PREECLAMPSIA | HYPERTENSION | RISK FACTORS | RENAL EFFECTS | SIGNS AND SYMPTOMS | DRUGS | ADMINISTRATION AND DOSAGE | SAFETY | LACTATION | PREVENTION AND CONTROL | Developed Countries | North America | Americas | Pregnancy Complications | Diseases | Vascular Diseases | Health | Urogenital Effects | Urogenital System | Physiology | Biology | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Public Health | Maternal Physiology Document Number: 340210 |
| 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: The frameless copper IUD (GyneFix) and the TCu380A IUD: results of an 8-year multicenter randomized comparative trial. Author: Meirik O; Rowe PJ; Peregoudov A; Piaggio G; Petzold M Author: IUD Research Group at the UNDP/UNFPA/WHO/World Bank Special Programme of Source: Contraception. 2009 Aug;80(2):133-41. Abstract: BACKGROUND: Clinical performance of the frameless copper IUD (GyneFix), designed to reduce side effects related to the frame of conventional IUDs, and TCu380A was compared. STUDY DESIGN: Randomized Multicenter randomized comparative trial. Parous women requesting and eligible to use IUD were admitted in 21 centers in eight countries in 1989-1993 and followed-up for up to 8 years. RESULTS: Two thousand twenty-seven women were randomized to the frameless IUD and 2036 to TCu380A; 43 insertions of the frameless IUD failed and none for TCu380A. First-year expulsion rate of the frameless IUD was 5.3 (95% CI: 4.4-6.4) per 100 and 2.5 (95% CI: 1.9-3.3) for the TCu380A; second- through eighth-year expulsion rates were not different. First-year pregnancy rates for the frameless IUD and TCu380A were 1.3 (95% CI: 0.9-2.0) and 0.5 (95% CI: 0.3-0.9), respectively; second- through eighth-year cumulative pregnancy rates were 1.2 (95% CI: 0.7-1.9) and 2.5 (95% CI: 1.8-3.4), respectively. The 8-year cumulative rates of ectopic pregnancy and IUD removal for pain were lower for the frameless IUD than for TCu380A. Removals for other reasons were not different. CONCLUSIONS: The frameless IUD had more insertion failures, expulsions and pregnancies in the first year than TCu380A, but fewer pregnancies from the second through the eighth year, and by 8 years had fewer ectopic pregnancies and removals for pain. Language: English Keywords: GLOBAL | RESEARCH REPORT | CLINICAL TRIALS | COMPARATIVE STUDIES | WOMEN | IUD, COPPER RELEASING | INSERTION | IUD EXPULSION | IUD SIDE EFFECTS | PAIN | PREGNANCY, ECTOPIC | CONTRACEPTION FAILURE | Clinical Research | Research Methodology | Studies | Demographic Factors | Population | IUD | Contraceptive Methods | Contraception | Family Planning | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Signs and Symptoms | Diseases | Pregnancy Complications | Contraceptive Usage Document Number: 342393 |
| 19. Peer Reviewed Title: Oral contraceptive pretreatment in women undergoing controlled ovarian stimulation in ganirelix acetate cycles may, for a subset of patients, be associated with low serum luteinizing hormone levels, reduced ovarian response to gonadotropins, and early pregnancy loss. Author: Meldrum DR; Scott RT Jr; Levy MJ; Alper MM; Noyes N Source: Fertility and Sterility. 2009 May;91(5):1963-5. Abstract: Oral contraceptive pretreatment facilitated scheduling of pure FSH/GnRH antagonist cycles but in a small subset of patients was associated with low serum LH levels, reduced ovarian response, and early pregnancy loss. Supplementation with LH could be examined as a possible way to improve cycle outcome. Language: English Keywords: UNITED STATES OF AMERICA | CALIFORNIA | RESEARCH REPORT | WOMEN | GONADOTROPINS, PITUITARY | IMPLANTATION | ABORTION, SPONTANEOUS | PREGNANCY | ORAL CONTRACEPTIVES | Developed Countries | North America | Americas | Demographic Factors | Population | Gonadotropins | Hormones | Endocrine System | Physiology | Biology | Pregnancy, First Trimester | Reproduction | Pregnancy Complications | Diseases | Contraceptive Methods | Contraception | Family Planning Document Number: 341248 |
| 20. Title: Ectopic pregnancy in Jos Northern Nigeria: prevalence and impact on subsequent fertility. Author: Musa J; Daru PH; Mutihir JT; Ujah IA Source: Nigerian Journal of Medicine. 2009 Jan-Mar;18(1):35-8. Abstract: BACKGROUND: Ectopic pregnancy remains a major gynaecological problem in contemporary gynaecological practice. Not only do women die from this disease, but also of greater clinical importance is the indirect morbidity of poor fertility prognosis and adverse outcome in subsequent pregnancies. We were interested in documenting the prevalence of ectopic pregnancy and its impact on subsequent fertility. METHODOLOGY: This retrospective descriptive study was done at the Jos University Teaching Hospital. The case notes of all patients who had tubal ectopic pregnancy managed in JUTH between January 1997 and December 2000 were retrieved. Subsequent fertility and reproductive outcome were assessed among women who reported back for follow up fora minimum period of twelve months post surgery. The data was analyzed using frequencies. RESULTS: During the study period, January 1997 and December 2000 a total of 168 ectopic pregnancies were managed and 9,638 deliveries occurred during the same period. This gives a prevalence rate of 1.74%. Of the 168 cases of ectopics, 130 case records containing relevant information were retrieved (77.4%) and this constituted the sample population for the study. Majority (53.8%) of the women were between 20 and 29 years. Majority of the women were either nulliparous or primiparous (23.8% and 20.0% respectively). Tubal rupture occurred in 86.9% of the women at the time of laparotomy. Total salpingectomy was the surgical modality in 77.7% of the cases. The right fallopian tube was affected in 66.2% and the left 33.8% of the cases. The contralateral fallopian tube was grossly normal in 73.1% of cases. Of the 64 women who were followed up for a minimum of 12 months, 40.6% achieved viable intra uterine pregnancies, 6.3% had a repeat ectopic pregnancy in the contra lateral tube and 53.1% were unable to achieve pregnancy. CONCLUSION: Ectopic pregnancy is prevalent in our environment affecting mainly young women of low parity who desire future pregnancies. The subsequent impact on future fertility of these women could be improved if efforts are focused on early diagnosis to prevent tubal rupture. Early diagnosis prior to rupture offers opportunity for medical management and conservative surgical procedures that are proven to improve future fertility prognosis. Language: English Keywords: NIGERIA | RESEARCH REPORT | RETROSPECTIVE STUDIES | PREVALENCE | PREGNANCY, ECTOPIC | TUBAL EFFECTS | IMPACT | Developing Countries | Africa, Western | Africa, Sub Saharan | Africa | Studies | Research Methodology | Measurement | Pregnancy Complications | Diseases | Fallopian Tubes | Genitalia, Female | Genitalia | Urogenital System | Physiology | Biology | Communication Document Number: 341758 |
| 21. Peer Reviewed Title: Placental Malarial Infection as a Risk Factor for Hypertensive Disorders During Pregnancy in Africa: A Case-Control Study in an Urban Area of Senegal, West Africa. Author: Ndao CT; Dumont A; Fievet N; Doucoure S; Gaye A; Lehesran JY Source: American Journal of Epidemiology. 2009 Aug 13; Abstract: In tropical countries, malaria and hypertension are common diseases of pregnancy. They have physiopathologic similarities such as placental ischemia, endothelial dysfunction, and production of proinflammatory cytokines. Recent findings suggested their possible link. The authors conducted a case-control study to explore the relation between malaria and hypertension at Guediawaye, a hypoendemic malarial setting in Senegal. Cases were pregnant women admitted to the delivery unit for hypertension. Controls were pregnant women admitted for normal delivery, without any history of hypertension or proteinuria during the present pregnancy. Malarial infection was determined by placental tissue examination. From January to December 2002, 77 cases of gestational hypertension, 113 cases of preeclampsia, 59 cases of eclampsia, and 241 controls were enrolled. Placental malarial infection (PMI) was present in 14 cases (6.3%) and in 15 controls (6.2%). The prevalence of PMI was 4.6% for eclampsia, 4.0% for preeclampsia, and 11.6% for gestational hypertension. In multivariate analysis, PMI appeared to be an independent risk factor for gestational hypertension (adjusted odds ratio = 2.7, 95% confidence interval: 1.0, 7.6). The authors found an association between PMI and nonproteinuric hypertension in women living in a malaria-hypoendemic area. The exact significance of such relation should be clarified in further studies in different settings of malarial endemicity. Language: English Keywords: SENEGAL | RESEARCH REPORT | CASE STUDIES | PREGNANT WOMEN | RISK FACTORS | HYPERTENSION | PREGNANCY | MALARIA | PREECLAMPSIA | FETAL MEMBRANES | Developing Countries | Africa, Western | Africa, Sub Saharan | Africa | Studies | Research Methodology | Population Characteristics | Demographic Factors | Population | Health | Vascular Diseases | Diseases | Reproduction | Parasitic Diseases | Pregnancy Complications | Fetus Document Number: 342554 |
| 22. Title: [Impact of maternal antecedents on neonatal mortality in a regional perinatal hospital] Repercusion de los antecedentes maternos en la mortalidad neonatal de un hospital Author: Osorno Covarrubias L; Watty Caceres C; Alonzo Vazquez F; Davila Velazquez J; Echeverria Eguiluz M Source: Ginecologia Y Obstetricia De Mexico. 2009 Jan;77(1):3-12. Abstract: OBJECTIVE: Determine the prevalence of maternal risk factors and evaluate their impact on neonatal mortality in a regional perinatal center. MATERIALS AND METHODS: A cohort of 25,365 live newborns was studied between January 1st 2000 and December 31st 2004. Maternal antecedents were registered in a data base: sociodemographic; medical history; obstetric antecedents of previous pregnancies; as well as evolution of current pregnancy and birth. Newborn birth weight, gestational age and condition at discharge were registered too. Neonates who died were considered cases and controls those discharged alive. Mortality was compared to the presence or absence of risk factors in maternal medical history. Prevalence, odds ratio (OR) with 95% confidence interval, and attributable fraction in the exposed and the population were calculated with the SPSS 8.0 and Epi Info 6.4 programs. RESULTS: The most notable maternal factors associated with newborn mortality were maternal age > or = 30 years OR 1.5 (1.37-2.0), less than 7 prenatal exams OR 2.17 (1.52-3.09) (53.5% attributable fraction in the exposed and 23.3% in population), eclampsia OR 4.66 (2.82-7.64), type-II diabetes OR 5.41 (2.11-12.99), urinary tract infection OR 1.98 (1.40-2.78), positive serology to human immunodeficiency virus OR 41.75 (5.77-230.9), membrane rupture > or = 48 hours OR 22.99 (13.10-40.2), polyhydramnios OR 31.53 (19.12-51.6) and abruptio placentae OR 42.18 (21.06-83.1). CONCLUSIONS: Transpartum risk factors had a larger impact on mortality than pregnancy or pregestational factors. Language: Spanish Keywords: BRAZIL | RESEARCH REPORT | PREVALENCE | COHORT ANALYSIS | INFANT MORTALITY | RISK FACTORS | PREGNANCY HISTORY | BIRTH HISTORY | SOCIOECONOMIC FACTORS | AGE FACTORS | PREECLAMPSIA | DIABETES | HIV INFECTIONS | South America, Eastern | South America | Latin America | Americas | Developing Countries | Measurement | Research Methodology | Mortality | Population Dynamics | Demographic Factors | Population | Health | Fertility Measurements | Fertility | Economic Factors | Population Characteristics | Pregnancy Complications | Diseases | Viral Diseases Document Number: 341999 |
| 23. Title: [Contraception and pregnancy after liver transplantation: an update overview] Contracepcao e gravidez apos transplante hepatico--uma visao atual. Author: Parolin MB; Coelho JC; Urbanetz AA; Pampuch M Source: Arquivos De Gastroenterologia. 2009 Apr-Jun;46(2):154-8. Abstract: CONTEXT: Successful liver transplantation not only treats the underlying liver disease but also restores libido and fertility in female recipients. Although reports of successful pregnancy after liver transplantation continue to increase, these pregnancies are considered of high-risk because they are associated with increase maternofetal morbidity. EVIDENCE ACQUISITION: A MEDLINE search (1978-2007) was conducted using the terms 'liver transplantation', 'pregnancy', 'immunosuppressive agents', 'sexual function'. Reviews, retrospective series, long-term clinical follow-up of case series and original articles containing basic scientific observations were included. RESULTS: Although no formal guidelines have been established there are some 'golden rules' to improve the probability of favorable maternal and fetal outcome. Most transplant centers recommend to delay pregnancy for at least 1-year after transplantation. The recipient should be on a stable immunosuppression regimen, with good graft function and no evidence of renal dysfunction or uncontrolled arterial hypertension. Considering the increased incidence of prematurity, low birth weight, hypertension and preeclampsia reported during pregnancy post-LT, these high-risk patients should be managed by a multidisciplinary team, including an obstetrician specialized in high-risk pregnancies. Carefully monitoring of immunosuppressive drugs serum level is prudent to avoid graft rejection episodes and drugs with teratogenic potential should be discontinued. Breastfeeding is usually not recommended. CONCLUSIONS: Successful pregnancies are the rule after liver transplantation. A carefully monitoring by an experience multidisciplinary team increases the chances of favorable maternofetal outcome. Language: Portuguese Keywords: DEVELOPING COUNTRIES | RESEARCH REPORT | LITERATURE REVIEW | RETROSPECTIVE STUDIES | CLIENTS | PREGNANCY | SURGERY | LIVER DYSFUNCTION | HYPERTENSION | PREECLAMPSIA | LOW BIRTH WEIGHT | PREGNANCY, HIGH RISK | Studies | Research Methodology | Program Activities | Programs | Organization and Administration | Reproduction | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Diseases | Vascular Diseases | Pregnancy Complications | Birth Weight | Body Weight | Physiology | Biology Document Number: 341915 |
| 24. Title: Expectant management of incomplete abortion in the first trimester. Author: Pauleta JR; Clode N; Graca LM Source: International Journal of Gynaecology and Obstetrics. 2009 Mar 28; Abstract: OBJECTIVE: To evaluate the effectiveness and acceptability of expectant management of induced and spontaneous first trimester incomplete abortion. METHODS: A prospective observational trial, conducted between June 2006 and November 2007, of 2 groups of patients diagnosed with an incomplete abortion: 66 patients who had received misoprostol for an induced abortion (group 1) and 30 patients who had had a spontaneous abortion (group 2). Transvaginal ultrasound was performed weekly. The success rate (complete abortion without surgery), time to resolution, duration of bleeding and pelvic pain, rate of infection, number of unscheduled hospital visits, and level of satisfaction with expectant management were recorded. RESULTS: The incidence of complete abortion was 86.4% and 82.1% in groups 1 and 2 respectively at day 14 after diagnosis, and 100% in both groups at day 30 (two group 2 patients underwent curettage and were excluded from the analysis). Both groups reported 100% satisfaction with expectant management, although over 90% of the women reported feeling anxious. CONCLUSION: Expectant management for incomplete abortion in the first trimester after use of misoprostol or after spontaneous abortion may be practical and feasible, although it may increase anxiety associated with the impending abortion. Language: English Keywords: PORTUGAL | RESEARCH REPORT | PROSPECTIVE STUDIES | CLINICAL RESEARCH | PREGNANT WOMEN | ABORTION | PREGNANCY, FIRST TRIMESTER | ABORTION, SPONTANEOUS | MISOPROSTOL | ULTRASONICS | TIME FACTORS | BLEEDING | PAIN | INFECTIONS | Developed Countries | Europe, Southwestern | Europe | Studies | Research Methodology | Population Characteristics | Demographic Factors | Population | Fertility Control, Postconception | Family Planning | Pregnancy | Reproduction | Pregnancy Complications | Diseases | Prostaglandins, Synthetic | Prostaglandins | Endocrine System | Physiology | Biology | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Population Dynamics | Signs and Symptoms Document Number: 341468 |
| 25. Peer Reviewed Title: Infectious complications of pregnancy termination. Author: Rahangdale L Source: Clinical Obstetrics and Gynecology. 2009 Jun;52(2):198-204. Abstract: Infectious complications are a significant source of morbidity and mortality associated with pregnancy termination worldwide. However, in areas where abortion practices are legal, the risk of infection is very low. Proper technique, prophylaxis, and initial management of septic abortion have led to a significant decrease in risk of serious complications such as sepsis and death. Clinical features, management, and prevention of postabortal infection will be reviewed in the setting of legalized abortion. Language: English Keywords: GLOBAL | UNITED STATES OF AMERICA | CALIFORNIA | RESEARCH REPORT | WOMEN | ABORTION | ENDOMETRIOSIS | INFECTIONS | Developed Countries | North America | Americas | Demographic Factors | Population | Pregnancy Complications | Diseases Document Number: 342244 Notification |
| 26. Peer Reviewed Title: An assessment of fetal loss among currently married women in India. Author: Rajaram S; Zottarelli LK; Sunil TS Source: Journal of Biosocial Science. 2009 May;41(3):309-27. Abstract: The present paper assesses fetal loss among currently married women in India. In addition, the effects of social, economic, demographic and health factors on fetal loss are studied. The study uses data from the second National Family Health Survey conducted in India during 1998-2000. The results show wide variations in fetal loss (induced abortion, spontaneous abortion and still-birth) measures across the country. The importance of mother's nutritional status, birth spacing, risky behaviours such as smoking, drinking and chewing tobacco and age at marriage for pregnancy outcomes in India is also discussed. The study results imply a broad understanding of reproductive health in India, and emphasize the importance of widening the scope of community-based reproductive health education programmes to improve the reproductive health of women. Language: English Keywords: INDIA | RESEARCH REPORT | HEALTH SURVEYS | CURRENTLY MARRIED | WOMEN | PREGNANCY OUTCOMES | FETAL DEATH | ABORTION | ABORTION, SPONTANEOUS | RISK FACTORS | PREGNANCY INTERVALS | Asia, Southern | Asia | Developing Countries | Health | Marital Status | Nuptiality | Demographic Factors | Population | Pregnancy | Reproduction | Mortality | Population Dynamics | Fertility Control, Postconception | Family Planning | Pregnancy Complications | Diseases | Fertility Measurements | Fertility Document Number: 341400 |
| 27. Title: Maternal MTHFR polymorphisms and risk of spontaneous abortion. Author: Rodriguez-Guillen Mdel R; Torres-Sanchez L; Chen J; Galvan-Portillo M; Blanco-Munoz J; Anaya MA; Silva-Zolezzi I; Hernandez-Valero MA; Lopez-Carrillo L Source: Salud Publica de Mexico. 2009 Jan-Feb;51(1):19-25. Abstract: OBJECTIVE: To asses the association between intake of folate and B vitamins and the incidence of spontaneous abortion (SA) according to the maternal methylenetetrahydrofolate reductase (MTHFR) polymorphisms (677 C>T and 1298 A>C). MATERIAL AND METHODS: We conducted a nested case-control study within a perinatal cohort of women recruited in the state of Morelos, Mexico. Twenty-three women with SA were compared to 74 women whose pregnancy survived beyond week 20th. Intake of folate and B vitamins respectively, was estimated using a validated food frequency questionnaire. Maternal MTHFR polymorphisms were determined by PCR-RFLP and serum homocysteine levels by HPLC. RESULTS: Carriers of MTHFR 677TT and 1298AC genotypes respectively showed an increased risk of SA (OR 677TT vs. CC/CT=5.0; 95% CI: 1.2, 20.9 and OR 1298 AC vs. AA=5.5; 95% CI: 1.1, 26.6). CONCLUSIONS: Our results support the role of MTHFR polymorphisms as a risk factor for SA, regardless of dietary intake of B vitamins. Language: English Keywords: MEXICO | RESEARCH REPORT | COHORT ANALYSIS | INCIDENCE | PREGNANT WOMEN | ABORTION, SPONTANEOUS | VITAMINS AND MINERALS | MATERNAL NUTRITION | RISK FACTORS | North America | Americas | Developing Countries | Research Methodology | Measurement | Population Characteristics | Demographic Factors | Population | Pregnancy Complications | Diseases | Physiology | Biology | Nutrition | Health Document Number: 330500 |
| 28. Peer Reviewed Title: Spousal violence and spontaneous fetal loss [letter] Author: Shelton JD; Adetunji J Source: Lancet. 2009 May 2;373(9674):1520; author reply 1520-1. Abstract: Amina Alio and colleagues (Jan 24, p 318) make an admirable effort to unravel a myriad of confounders to explain their finding of a statistical relation between spousal violence and spontaneous fetal loss. Spousal violence is clearly deplorable. But, as Alio and colleagues note, it included a wide range of behaviours, including "saying something to humiliate" and pushing and twisting the arm, as well as more violent acts. A biological explanation for such spousal violence "ever" to account for a 50% increase in fetal loss "ever" does not seem obvious. Another explanation is major misclassification with induced abortion. Although the 2004 Demographic and Health Survey instrument for Cameroon attempted to distinguish between the two, responses on numbers of induced abortions, spontaneous abortions, and still births were contained within the same question. It would be easy for respondents to report induced abortions as spontaneous. Induced abortion is notoriously underreported, especially in countries such as Cameroon where it is illegal. On the other hand, both induced abortion and spousal violence might be common markers of other factors such as relationship stress or other dysfunction and thus lead to a spurious finding. There is a response from Amina Alio included. Language: English Keywords: CAMEROON | CRITIQUE | RESEARCH REPORT | METHODOLOGICAL STUDIES | CLASSIFICATION | DEMOGRAPHIC AND HEALTH SURVEYS | SPOUSE | WOMEN IN DEVELOPMENT | PREGNANT WOMEN | DOMESTIC VIOLENCE | ABORTION, SPONTANEOUS | ABORTION | FETAL DEATH | Developing Countries | Africa, Western | Africa, Sub Saharan | Africa | Studies | Research Methodology | Demographic Surveys | Population Dynamics | Demographic Factors | Population | Family Relationships | Family Characteristics | Family and Household | Sociocultural Factors | Economic Development | Economic Factors | Population Characteristics | Crime | Social Problems | Pregnancy Complications | Diseases | Fertility Control, Postconception | Family Planning | Mortality Document Number: 341098 |
| 29. Title: The safety of conception occurring shortly after methotrexate treatment of an ectopic pregnancy. Author: Svirsky R; Rozovski U; Vaknin Z; Pansky M; Schneider D; Halperin R Source: Reproductive toxicology. 2009 Jan;27(1):85-7. Abstract: The objective of this study was to determine whether a single or repeated injection of methotrexate (MTX) to treat ectopic pregnancy results in either teratogenicity or other bad obstetric outcome in the pregnancy that shortly follows treatment. Data were retrieved from the medical records of 314 women treated with MTX for ectopic pregnancy in our institute (2000-2006) included age, MTX dosage, interval between last MTX treatment to conception, results of ultrasonographic follow-up of the subsequent pregnancy, triple test, karyotype testing, pregnancy outcome, and newborn weight and Apgar score. A logistic regression model based on pregnancy outcome as the dependent variable and interval since last MTX treatment as the independent variable estimated the odds ratio for the safety of conception occurring shortly after the treatment. Complete information was obtained for 125 pregnancies. Forty-five pregnancies occurred within 6 months (mean 3.6+/-1.7) after the last MTX treatment. The outcome of these pregnancies was compared with that of 80 pregnancies which occurred > or =6 months (mean 23.6+/-14.7) after the last MTX treatment. The fetal malformation and adverse outcome rates for both groups were similar (odds ratio 1.003, 95% CI 0.98-1.02). According to a logistic regression analysis, the interval between the last MTX treatment for ectopic pregnancy had no effect on the outcome of the pregnancy that shortly followed it. The results of this study support the notion that conceiving within the first 6 months after treatment with MTX for ectopic pregnancy is safe and not associated with any increase in the examined adverse pregnancy outcome parameters. Language: English Keywords: MALAWI | RESEARCH REPORT | RECORDS | DATA COLLECTION | PREGNANCY | PREGNANCY, ECTOPIC | BIRTH DEFECTS | PREGNANCY OUTCOMES | METHOTREXATE | TREATMENT | Africa, Southern | Africa, Sub Saharan | Africa | Developing Countries | Information Processing | Information | Research Methodology | Reproduction | Pregnancy Complications | Diseases | Neonatal Diseases and Abnormalities | Drugs | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health Document Number: 331042 |
| 30. Peer Reviewed Title: Abortion and the risk of subsequent preterm birth: a systematic review with meta-analyses. Author: Swingle HM; Colaizy TT; Zimmerman MB; Morriss FH Jr Source: Journal of Reproductive Medicine. 2009 Feb;54(2):95-108. Abstract: OBJECTIVE: To conduct a systematic review and meta-analyses of studies that test the association between induced or spontaneous abortion and subsequent preterm birth. STUDY DESIGN: International databases were reviewed (1995-2007) using the terms preterm, premature, birth, labor, delivery, abortion, induced abortion, miscarriage and spontaneous abortion. Only studies that met prespecified objective criteria for methodologic design and reporting were included in the meta-analyses. RESULTS: Twelve induced and 9 spontaneous abortion studies met inclusion criteria. Common adjusted odds ratios (ORs) for preterm birth following 1 and > or = 2 induced abortions were 1.25 (95% confidence interval [95% CI] 1.03-1.48) and 1.51 (95% CI 1.21-1.75), respectively. Four studies provided a common adjusted OR for < or = 32 weeks' births of 1.64 (95% CI 1.38-1.91). Meta-regression analysis revealed a previously unrecognized inverse relationship between the In OR and the control population preterm birth rate, explaining in part the observed heterogeneity among studies. Analysis of spontaneous abortion and subsequent preterm birth revealed a similar common adjusted OR and inverse meta-regression on the control preterm birth rates. CONCLUSION: Induced and spontaneous abortion are associated with similarly increased ORs for preterm birth in subsequent pregnancies, and they vary inversely with the baseline preterm birth rate, explaining some of the variability among studies. Language: English Keywords: UNITED STATES OF AMERICA | LITERATURE REVIEW | STATISTICAL REGRESSION | CASE CONTROL STUDIES | CLINICAL RESEARCH | WOMEN | ABORTION | ABORTION, SPONTANEOUS | PREMATURE BIRTH | RISK FACTORS | BIRTH RATE | Developed Countries | North America | Americas | Data Analysis | Research Methodology | Studies | Demographic Factors | Population | Fertility Control, Postconception | Family Planning | Pregnancy Complications | Diseases | Pregnancy Outcomes | Pregnancy | Reproduction | Health | Fertility Measurements | Fertility | Population Dynamics Document Number: 341116 |
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