1.  Title: Human resources for health in the low-resource world: collaborative practice and task shifting in maternal and neonatal care. Author: FIGO Safe Motherhood and Newborn Health Committee Source: International Journal of Gynaecology and Obstetrics. 2009 Apr;105(1):74-6. Abstract: An important barrier to the attainment of Millennium Development Goals (MDGs) 4 and 5 in many countries is the lack of trained and skilled clinical staff who can provide timely and high-quality care to mothers with pregnancy complications. This article presents guidelines and recommendations on how to better make use of existing health human resources in order to improve maternal and neonatal care. Language: English Keywords: DEVELOPING COUNTRIES | CRITIQUE | HEALTH PERSONNEL | MATERNAL-CHILD HEALTH SERVICES | HUMAN RESOURCES | GYNECOLOGY | OBSTETRICS | OBSTETRICAL SURGERY | TRAINING PROGRAMS | Delivery of Health Care | Health | Primary Health Care | Health Services | Economic Factors | Medicine | Surgery | Treatment | Medical Procedures | Education Document Number: 341381 |
| 2. 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 |
| 3. Title: Reducing maternal mortality in Yemen: challenges and lessons learned from baseline assessment. Author: Al Serouri AW; Al Rabee A; Bin Afif M; Al Rukeimi A Source: International Journal of Gynaecology and Obstetrics. 2009 Apr;105(1):86-91. Abstract: OBJECTIVE: The Yemen is a signatory of the Millennium Development Goals (MDGs) and one of 10 countries chosen for the UN Millennium Project. However, recent MDG progress reviews show that it is unlikely that the maternal health goal will be reached by 2015 and Yemen still has an unacceptably high maternal mortality of 365 per 100000 live births. Because 82% of deaths happen intrapartum, the purpose of this needs assessment was to identify and prioritize constraints in delivery of emergency obstetric care (EmOC). METHODS: Four district hospitals and 16 health centers in 8 districts were assessed for functional capacity in terms of infrastructure; availability of essential equipment and drugs; EmOC technical competency and training needs; and Health Management Information System. RESULTS: We found poor obstetric services in terms of structure (staffing pattern, equipment, and supplies) and process (knowledge and management skills). CONCLUSION: The data argue for strengthening the 4 interlinked health system elements-human resources, and access to, use, and quality of services. The Government must address each of these elements to meet the Safe Motherhood MDG. Language: English Keywords: YEMEN | RESEARCH REPORT | MOTHERS | SAFE MOTHERHOOD | MATERNAL HEALTH | MATERNAL MORTALITY | PREVENTION AND CONTROL | EMERGENCY SERVICES | OBSTETRICAL SURGERY | Developing Countries | Middle East | Parents | Family Relationships | Family Characteristics | Family and Household | Sociocultural Factors | Health | Mortality | Population Dynamics | Demographic Factors | Population | Diseases | Health Services | Delivery of Health Care | Surgery | Treatment | Medical Procedures | Medicine Document Number: 341376 |
| 4. 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 |
| 5. 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 |
| 6. 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 |
| 7. 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 |
| 8. 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 |
| 9. 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 |
10.  Title: Manual vacuum aspiration for uterine evacuation: pain management. Author: Castleman L; Mann C Source: Chapel Hill, North Carolina, Ipas, 2009. 8 p. Abstract: Reducing the physical pain and anxiety experienced by women undergoing uterine evacuation is an essential part of treatment with MVA. The second edition of this publication addresses the types and origins of discomfort that women may experience, as well as techniques for reducing this discomfort. It includes a table highlighting some common pharmacologic approaches to pain management during MVA. Language: English Keywords: GLOBAL | RECOMMENDATIONS | PROVIDERS WITH CLIENTS | ABORTION | PAIN | PERCEPTION | CERVICAL DILATATION | ANESTHESIA | ANALGESIA | DRUGS | ADMINISTRATION AND DOSAGE | SIDE EFFECTS | POSTOPERATIVE PROCEDURES | Health Services | Delivery of Health Care | Health | Fertility Control, Postconception | Family Planning | Signs and Symptoms | Diseases | Psychological Factors | Behavior | Treatment | Medical Procedures | Medicine | Surgery Document Number: 342497 Notification |
| 11. 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 |
| 12. Peer Reviewed Title: Task shifting for emergency obstetric surgery in district hospitals in Senegal. Author: De Brouwere V; Dieng T; Diadhiou M; Witter S; Denerville E Source: Reproductive Health Matters. 2009 May;17(33):32-44. Abstract: Due to a long-term shortage of obstetricians, the Ministry of Health of Senegal and Dakar University Obstetric Department agreed in 1998 to train district teams consisting of an anaesthetist, general practitioner and surgical assistant in emergency obstetric surgery. An evaluation of the policy was carried out in three districts in 2006, covering trends in rates of major obstetric interventions, outcomes in newborns and mothers, and the views of key informants, community members and final year medical students. From 2001 to 2006, 11 surgical teams were trained but only six were functioning in 2006. The current rate of training is not rapid enough to cover all districts by 2015. An increase in the rate of interventions was noted as soon as a team had been put in place, but unmet need persisted. Central decision-makers considered the policy more viable than training gynaecologists for district hospitals, but resistance from senior academic clinicians, a perceived lack of career progression among the doctors trained, and lack of programme coordination were obstacles. Practitioners felt the work was valuable, but complained of low additional pay and not being replaced during training. Communities appreciated that the services saved lives and money, but called for improved information and greater continuity of care. Spanish Abstract: Debido a la prolongada escasez de obstetras, el Ministerio de Salud de Senegal y el Departamento Obstétrico de la Universidad de Dakar acordaron, en 1998, capacitar a equipos distritales integrados por un anestesista, un médico general y un auxiliar quirúrgico en cirugía obstétrica de emergencia. En 2006, se realizó una evaluación de la política en tres distritos, donde se examinaron las tendencias en las tasas de intervenciones obstétricas importantes, los resultados en recién nacidos y madres, y los puntos de vista de informantes clave, miembros de la comunidad y estudiantes de medicina en su último año académico. Del 2000 al 2006, 11 equipos quirúrgicos fueron capacitados, pero sólo seis funcionaban en 2006. El ritmo actual de capacitación no es suficientemente rápido para abarcar todos los distritos al cabo del 2015. Se observó un aumento en el índice de intervenciones tan pronto se establecía un equipo, pero la necesidad insatisfecha persistió. Las autoridades decisorias centrales estimaron que esta política era más viable que capacitar ginecólogos en los hospitales distritales. Entre los obstáculos figuraban la resistencia de los médicos académicos sénior, la percibida falta de ascenso profesional entre los médicos capacitados y la falta de coordinación del programa. Los médicos estimaron el trabajo valioso, pero se quejaban de la baja paga adicional y de no ser sustituidos durante la capacitación. Las comunidades estaban agradecidas porque los servicios salvaron vidas y ahorraron dinero, pero solicitaron mejor información y mayor continuidad de servicios. French Abstract: Face au manque d'obstétriciens à long terme, le Ministère sénégalais de la santé et le Département d'obstétrique de l'Université de Dakar ont convenu en 1998 de former des équipes de district composées d'un anesthésiste, d'un médecin généraliste et d'un assistant en chirurgie obstétricale d'urgence. En 2006, une évaluation de la politique a été menée dans trois districts pour analyser les tendances des principales interventions obstétricales, les résultats pour les nouveau-nés et les mères et les opinions des informateurs clés, des membres des communautés et des étudiants en dernière année de médecine. De 2001 à 2006, 11 équipes chirurgicales ont été formées mais six seulement fonctionnaient encore en 2006. Le rythme actuel de formation n'est pas assez rapide pour couvrir tous les districts d'ici à 2015. Une augmentation du taux d'interventions a été notée dès la mise en place d'une équipe, mais les besoins insatisfaits demeuraient. Pour les décideurs centraux, cette politique était plus viable que la formation de gynécologues pour les hôpitaux de district, mais elle se heurtait à la résistance des professeurs cliniciens, à un manque perçu de possibilités d'avancement pour les médecins formés et à une coordination insuffisante entre programmes. Les praticiens estimaient que le travail était utile, mais déploraient la faible rémunération complémentaire et regrettaient de ne pas être remplacés pendant la formation. Les communautés se félicitaient que les services sauvent des vies et économisent de l'argent, mais demandaient davantage d'information et une plus grande continuité des soins. Language: English Keywords: SENEGAL | RESEARCH REPORT | HEALTH PERSONNEL | EMERGENCY SERVICES | OBSTETRICAL SURGERY | HOSPITALS | CESAREAN SECTION | TRAINING PROGRAMS | PROGRAM EVALUATION | HEALTH POLICY | OBSTACLES | UTILIZATION OF HEALTH CARE | Developing Countries | Africa, Western | Africa, Sub Saharan | Africa | Delivery of Health Care | Health | Health Services | Surgery | Treatment | Medical Procedures | Medicine | Health Facilities | Education | Programs | Organization and Administration | Policy | Political Factors | Sociocultural Factors Document Number: 342013 |
| 13. Peer Reviewed Title: Risk factors for the development of vesicovaginal fistula after incidental cystotomy at the time of a benign hysterectomy. Author: Duong TH; Gellasch TL; Adam RA Source: American Journal of Obstetrics and Gynecology. 2009 Aug 14; Abstract: OBJECTIVE: We sought to evaluate risk factors for vesicovaginal fistula (VVF) after incidental cystotomy during benign hysterectomies. STUDY DESIGN: All benign hysterectomies between January 2000 and May 2004 were reviewed. Demographic and operative data were abstracted. Cystotomies were graded using the American Association for the Surgery of Trauma (AAST) system. Patients developing VVF after cystotomy were compared to those who did not. Categorical variables were analyzed with Fisher exact test while Student t test was used for continuous data. RESULTS: A total of 1317 benign hysterectomies were reviewed (46% abdominal, 48% vaginal, and 6% laparoscopically assisted vaginal). In all, 34 cystotomies occurred with 4 (11.7%) developing a VVF. Patients developing VVF were more likely to have an AAST grade V cystotomy (75% vs 7%; P = .004). Patients developing VVF trended toward greater tobacco use, larger uterine size, and more operative blood loss. CONCLUSION: Patients with an AAST grade V cystotomy are at increased risk for VVF formation. Language: English Keywords: UNITED STATES OF AMERICA | DEVELOPED COUNTRIES | RESEARCH REPORT | WOMEN | HYSTERECTOMY | FISTULA | RISK FACTORS | North America | Americas | Demographic Factors | Population | Gynecologic Surgery | Urogenital Surgery | Surgery | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Diseases Document Number: 342547 |
| 14. Title: The unique characteristics of ovarian carcinogenesis in the adolescent and young adult population. Author: Gibbon DG; Diaz-Arrastia C Source: Seminars In Oncology. 2009 Jun;36(3):250-7. Abstract: Ovarian cancer in the adolescent and young adult (AYA) population is a disease that is distinctly different with regard to risk factors, genetics, and pathology when compared to ovarian cancers occurring in older women. This article will review the theories behind ovarian carcinogenesis and attempt to elucidate why these tumors exhibit their unique biologic characteristics. Knowledge of these differences will allow us to begin to develop strategies for future research endeavors enabling improved survival in AYA women diagnosed with ovarian cancer. Language: English Keywords: UNITED STATES OF AMERICA | THEORETICAL STUDIES | CLASSIFICATION | ADOLESCENTS, FEMALE | WOMEN | OVARIAN CANCER | AGE FACTORS | GENETICS | NEOPLASMS | OVARIECTOMY | FERTILITY | Developed Countries | North America | Americas | Studies | Research Methodology | Adolescents | Youth | Population Characteristics | Demographic Factors | Population | Cancer | Diseases | Biology | Gynecologic Surgery | Urogenital Surgery | Surgery | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Population Dynamics Document Number: 342163 |
| 15. 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 |
| 16. 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 |
| 17. 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 |
| 18. 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 |
| 19. 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 |
| 20. Peer Reviewed Title: The effect of levonorgestrel-releasing intrauterine device on menorrhagia in women taking anticoagulant medication after cardiac valve replacement. Author: Kilic S; Yuksel B; Doganay M; Bardakci H; Akinsu F; Uzunlar O; Mollamahutoglu L Source: Contraception. 2009 Aug;80(2):152-7. Abstract: BACKGROUND: This study was conducted to evaluate the effect of levonorgestrel-releasing intrauterine devices (LNG-IUDs) on menorrhagia in patients receiving anticoagulant therapy after cardiac valve replacement. STUDY DESIGN: Forty women with menorrhagia who underwent cardiac valve replacement and were taking anticoagulant medication were enrolled in the study. The women were randomly divided into two groups: LNG-IUDs were inserted into 20 women in Group 1 over the first 3 days of menstrual bleeding, while the women in Group 2 were followed without any intervention. The activated partial thromboplastin time, prothrombin time, international normalized ratio, hematocrit level, hemoglobin level, ferritin level and pictorial bleeding assessments for the quantity of menstrual bleeding were recorded. RESULTS: Three months after insertion of LNG-IUDs, the women in Group 1 had a significant decrease in blood loss and higher hemoglobin, hematocrit and ferritin values. No difference was detected for these parameters in the control group at the third and sixth months of the study. Coagulation parameters did not differ between the two groups. CONCLUSION: LNG-IUDs can be considered as an effective non-surgical treatment for menorrhagia in women receiving anticoagulant therapy after cardiac valve replacement. Language: English Keywords: TURKEY | RESEARCH REPORT | CONTROL GROUPS | CLIENTS | IUD, HORMONE RELEASING | LEVONORGESTREL | MENORRHAGIA | CARDIOVASCULAR EFFECTS | POSTOPERATIVE PROCEDURES | DRUGS | BLOOD COAGULATION EFFECTS | Europe, Southeastern | Europe | Developing Countries | Research Methodology | Program Activities | Programs | Organization and Administration | IUD | Contraceptive Methods | Contraception | Family Planning | Contraceptive Agents, Progestin | Contraceptive Agents, Female | Contraceptive Agents | Menstruation Disorders | Diseases | Physiology | Biology | Surgery | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Hematological Effects | Hemic System Document Number: 342392 |
| 21. Title: Transvaginal endoscopic tubal sterilization. Author: Kondo W; Noda RW; Branco AW; Rangel M; Branco Filho AJ Source: Journal of Laparoendoscopic and Advanced Surgical Techniques. Part A. 2009 Feb;19(1):59-61. Abstract: BACKGROUND: Tubal sterilization is one of the most widely used options for female contraception. It can be performed by laparotomy, minilaparotomy, colpotomy, laparoscopy, and hysteroscopy. In this paper, we report the use of the transvaginal endoscopic approach to perform tubal ligation. CASE: The access to the abdomen was obtained by a 1.5-cm colpotomy. The flexible endoscope was introduced into the peritoneal cavity, and carbon dioxide was instilled to get the pneumoperitoneum. Fallopian tubes were identified and electrocauterized with a 40-W coagulation current. Total procedure time was 45 minutes. A single dose of intravenous dypirone was administered for pain. She was discharged 10 hours after the procedure. CONCLUSION: Transvaginal endoscopic tubal ligation is feasible and can be considered an alternative approach to perform female sterilization. Language: English Keywords: BRAZIL | SUMMARY REPORT | CASE HISTORIES | CLIENTS | TUBAL LIGATION | COLPOTOMY | ENDOSCOPY | South America, Eastern | South America | Latin America | Americas | Developing Countries | Data Collection | Research Methodology | Program Activities | Programs | Organization and Administration | Female Sterilization | Sterilization, Sexual | Family Planning | Gynecologic Surgery | Urogenital Surgery | Surgery | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Physical Examinations and Diagnoses | Examinations and Diagnoses Document Number: 341431 |
| 22. Peer Reviewed Title: Severe chronic morbidity following childbirth. Author: Leung TY; Chung H Source: Best Practice and Research. Clinical Obstetrics and Gynaecology. 2009 Jun;23(3):401-423. Abstract: Three special, chronic morbidities of childbirth are reviewed with the most up-to-date knowledge in this article. Firstly, obstetric fistulas secondary to prolonged obstructed labour are still prevalent tragedies in underdeveloped countries. The damage is not only physical but psychosexual and social. The surgical skill and technology required to prevent and to treat obstetric fistulas are simple, but culture-social antagonism, geographic distance, political instability and financial constraint have to be overcome before effective management can take place. Congenital brachial plexus palsy is associated with shoulder dystocia and macrosomia, and both excessive exogenous traction and strong endogenous pushing forces contribute to its occurrence. As shoulder dystocia and macrosomia are not easily predictable, regular training and drill is essential to ensure proper management of shoulder dystocia. Most of the babies with brachial palsy will recover in 3 months but a minority of patients will suffer a more severe degree of damage, requiring early micro-neurosurgical intervention. Finally, although birth asphyxia is not the major cause of cerebral palsy, brain injury resulting from acute intrapartum hypoxic-ischemic insult is potentially alleviated by early neonatal hypothermic therapy. Both clinical and radiological assessments are essential in selecting suitable candidates for this innovative neuroprotective strategy. Language: English Keywords: DEVELOPING COUNTRIES | RESEARCH REPORT | CHILDBIRTH | FISTULA | OBSTETRICAL SURGERY | MORBIDITY | PREVENTION AND CONTROL | Pregnancy Outcomes | Pregnancy | Reproduction | Diseases | Surgery | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health Document Number: 341305 |
| 23. 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 |
| 24. 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 |
| 25. Peer Reviewed Title: Paracervical compared with intracervical lidocaine for suction curettage: a randomized controlled trial. Author: Mankowski JL; Kingston J; Moran T; Nager CW; Lukacz ES Source: Obstetrics and Gynecology. 2009 May;113(5):1052-7. Abstract: OBJECTIVE: To estimate the efficacy of paracervical compared with intracervical administration of local anesthesia during first-trimester suction curettage. METHODS: A double-blind, randomized controlled trial comparing paracervical with intracervical lidocaine was performed in women undergoing elective first-trimester suction curettage with conscious sedation. Pain was assessed at baseline, with dilation, and with curettage using a 10-cm visual analog scale (VAS). Assuming a minimal clinically important difference in pain score of 1.6 cm and a mean pain score (+/-standard deviation [SD]) of 4.7 (+/-2.9) cm for paracervical block, 120 patients would provide 80% power with an alpha of .05. RESULTS: For the 132 women randomly assigned, no significant differences in VAS scores (mean+/-SD) were observed between paracervical and intracervical blocks during dilation (2.6+/-2.3 compared with 2.8+/-2.2, P=.72) or curettage (3.9+/-2.9 compared with 3.3+/-2.5, P=.16). CONCLUSION: For women undergoing first-trimester suction curettage with conscious sedation, there was no clinically meaningful difference in pain relief between paracervical and intracervical lidocaine. Providers should feel confident that both techniques provide equally effective and acceptable analgesia. Language: English Keywords: UNITED STATES OF AMERICA | RESEARCH REPORT | COMPARATIVE STUDIES | PREGNANCY, FIRST TRIMESTER | CURETTAGE | ABORTION | OBSTETRICAL SURGERY | CONTRACEPTIVE USE-EFFECTIVENESS | PAIN | Developed Countries | North America | Americas | Studies | Research Methodology | Pregnancy | Reproduction | Surgery | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Fertility Control, Postconception | Family Planning | Contraceptive Effectiveness | Contraception | Signs and Symptoms | Diseases Document Number: 341343 |
| 26. 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 |
| 27. 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 |
| 28. 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 |
| 29. 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 |
| 30. Title: [Epidemiology of women suffering from obstetric fistula in Niger] Parcours de la femme souffrant de fistule obstetricale au Niger. Author: Ndiaye P; Amoul Kini G; Abdoulaye I; Diagne Camara M; Tal-Dia A Source: Medecine Tropicale. 2009 Feb;69(1):61-5. Abstract: OBJECTIVE: The purpose of this epidemiological study was to determine factors influencing management of obstetrical fistula (OF) by attempting to understand the itinerary followed by women suffering from OF in Niger. Study was carried out during the surgery session that took place at the Niamey National Hospital from April 18 to 29, 2006. Study variables were socioeconomic profile, obstetric/surgical history, support resources, and level of education. Four trained investigators using a specially designed questionnaire carried out patient interviews. Data were analyzed using the Epi Info 3.3.1 software package. A total of 91 patients with average age of 27.30 years (+/- 8.94) were interviewed. Most patients had no schooling (95%), came from the southwest region of the country |