1.  Peer Reviewed Title: Manual versus electric vacuum aspiration for first-trimester abortion: A systematic review. Author: Wen J; Cai QY; Deng F; Li YP Source: BJOG: An International Journal of Obstetrics and Gynaecology. 2008 Jan;115(1):5-13. Abstract: As an alternative to electric vacuum aspirations (EVA), there is an increasing interest in using manual vacuum aspiration (MVA). The objective was to compare the safety, efficacy and acceptability of MVA with those of EVA for first-trimester abortion. We searched MEDLINE, EMBASE, Cochrane Library and Chinese Biomedical Database in all language, together with reference lists of retrieved papers. Randomised controlled trials comparing MVA with EVA for first-trimester abortion were included. The outcomes are complete abortion rate, uterine perforation rate, blood loss, pain perception and acceptability. Two reviewers independently extracted the data. Results from the trials were combined to calculate relative risks (RRs) or risk differences for dichotomous outcomes and weighted mean differences (WMDs) for continuous outcomes, together with 95% CIs. Ten trials were included, involving 1660 women. Generally, the methodological quality was poor. There were no statistically significant differences, comparing MVA with EVA, in complete abortion rate (RR 1.00; 95% CI 0.99-1.02) and participants' satisfaction (RR 1.02; 95% CI 0.87-1.20). In participants with less than 50 days of gestational age, less blood loss (WMD -1.84; 95% CI -2.45 to -1.23) and less severe pain perception (RR 0.04; 95% CI 0.01-0.12) were reported during the MVA procedure, whereas the operation time was shorter (WMD 0.32; 95% CI 0.02-0.63) in the EVA procedure. There is some evidence that MVA is as effective and acceptable as EVA and might be safer than EVA. (author's) Language: English Keywords: CHINA | LITERATURE REVIEW | CLINICAL RESEARCH | KAP SURVEYS | CLINICAL TRIALS | ABORTION | UTERINE ASPIRATOR | SAFETY | SATISFACTION | ABORTION RATE | UTERINE PERFORATION | BLEEDING | PAIN | Asia, Eastern | Asia | Developing Countries | Research Methodology | Surveys | Sampling Studies | Studies | Fertility Control, Postconception | Family Planning | Surgical Equipment | Equipment and Supplies | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Public Health | Psychological Factors | Behavior | Perforations | Diseases | Signs and Symptoms Document Number: 322751 Notification |
2.  Title: Epidural anaesthesia during labour for a patient with congenital complete heart block: A Case Report. Author: Monem A; Chohan U; Ali M Source: JPMA. Journal of the Pakistan Medical Association. 2007 Nov;57(11) Abstract: We report labour pain management in a full term pregnant patient with Congenital Complete Heart Block. She delivered uneventfully under routine monitoring with facilities for pacing at hand. She previously had an uneventful normal delivery and a D&E, both outside our hospital. Only findings were a low heart rate of 45-50 beats per minute. She never had syncopal attacks. She had a good effort tolerance on ETT. Her ejection fraction was 60% on Echocardiogram. She was given a single shot low dose spinal with fentanyl followed by epidural insertion. She successfully delivered through mid-cavity forceps in about 2.5 hours. The only problem encountered was a transient bradycardia of 40 per minute with a systolic blood pressure of 70 mmHg, which settled with ephedrine. Pace maker insertion is recommended early in case the patient is symptomatic or has a prolonged Q-T interval or left atrial enlargement on ECG. Regional anaesthesia is recommended to prevent valsalva induced bradycardia or cardiac arrest during expulsive efforts by the patient. (author's) Language: English Keywords: PAKISTAN | RESEARCH REPORT | PREGNANT WOMEN | CONGENITAL ABNORMALITIES | HEART DISEASES | CHILDBIRTH | PAIN | DRUGS | ADMINISTRATION AND DOSAGE | ANESTHESIA | BLOOD PRESSURE | FORCEPS | Developing Countries | Asia, Southern | Asia | Population Characteristics | Demographic Factors | Population | Neonatal Diseases and Abnormalities | Diseases | Pregnancy Outcomes | Pregnancy | Reproduction | Signs and Symptoms | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Hemic System | Physiology | Biology | Surgical Equipment | Equipment and Supplies Document Number: 321969 |
| 3. Title: Child birth in squatting position. Author: Nasir A; Korejo R; Noorani KJ Source: Journal of Pakistan Medical Association. 2007 Jan;57(1):19-22. Abstract: The objective was to assess the risks and benefits of squatting position during second stage of labour and its comparison with the supine position. The study was conducted at the Department of Obstetrics and Gynaecology, Jinnah Postgraduate Medical Centre, Karachi from 1st January 1999 to 31st January 2000. A total of two hundred patients of similar ante partum, intrapartum and socio-economic conditions were selected. Only patients of gestation more than 37 weeks, presenting in active labour with cephalic presentation were included. Patients with multiple gestation, malpresentation, previous scar, maternal fever and prenatal diagnosed fetal malformation were excluded from the study. Random selection was done after informed consent and alternately divided into two groups A and B. Both groups were ambulatory during first stage of labour. In second stage, group-A adopted the squatting position, while group-B remained supine in lithotomy position. The third stage of labour in both the groups was conducted in the supine position. There was no difference in the application of episiotomies in both groups, however extension of the episiotomy occurred in 7% patients of the non-squatting group (P < 0.05). Para urethral tears occurred in 5% patients in squatting group, but all occurred in patients who were not given an episiotomy. Second degree, and third degree perineal tears occurred in 9% patients in the non-squatting group but none in the squatting group (P < 0.05). Forceps application was also significantly less in group-A 11% and 24% in group-B (P < 0.05).There were two cases of shoulder dystocia in group B but none in the group-A. During the Third stage of labour there were no cases of retained placenta in group A but there were 4% cases of retained placenta and 1% case of postpartum haernorrhage of more than 500ml due to atony of the uterus in group-B. One patient in the non-squatting position had to have a caesarean section due to persistent occipito posterior position. There was no significant difference in the apgar scores, foetal heart rate patterns or requirement of neonatal resuscitation. It appears that squatting position may result in less instrumental deliveries, extension of episiotomies and perineal tears. (author's) Language: English Keywords: PAKISTAN | RESEARCH REPORT | CASE CONTROL STUDIES | PREGNANT WOMEN | PREGNANCY, THIRD TRIMESTER | CHILDBIRTH | COMPLICATIONS | FORCEPS | CESAREAN SECTION | Asia, Southern | Asia | Developing Countries | Studies | Research Methodology | Population Characteristics | Demographic Factors | Population | Pregnancy | Reproduction | Pregnancy Outcomes | Diseases | Surgical Equipment | Equipment and Supplies | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Obstetrical Surgery | Surgery | Treatment Document Number: 313220 |
| 4. Title: Prevalence of uterine synechia after abortion evacuation curettage. Author: Salzani A; Yela DA; Gabiatti JR; Bedone AJ; Monteiro IM Source: Sao Paulo Medical Journal. 2007 Sep 6;125(5):261-264. Abstract: Intrauterine adhesion (IUA) is a possible complication of uterine curettage following abortion. Because IUA is an important cause of infertility, some investigators have been advocating its inclusion in the routine investigational workup after every abortion curettage procedure. The aim of this study was to evaluate the uterine cavity of patients subjected to abortion curettage, in order to ascertain the prevalence of IUA and its association with social and clinical factors. This was a cross-sectional study at the Human Reproduction Unit, Department of Obstetrics and Gynecology, Universidade Estadual de Campinas (Unicamp). A total of 109 women were enrolled. The investigators searched the records of Unicamp's hospital for patients who had been subjected to uterine curettage following abortion. The hysteroscopy was performed 3 to 12 months after the curettage. The correlations between patients' characteristics and the prevalence of IUA were assessed by means of chi-squared and Fisher's exact test calculations. The prevalence of IUA was 37.6%. The number of previous abortions and curettage procedures did not correlate with the presence of IUA. Most of the women (56.1%) presented IUA grade I. In the present study, 37.6% of the women subjected to curettage following abortion had IUA, which was mostly mucous and grade I. None of the demographic and clinic characteristics evaluated were found to be associated with IUA. From this study, there is no firm evidence to justify carrying out routine diagnostic hysteroscopy following abortion evacuation. (author's) Language: English Keywords: BRAZIL | RESEARCH REPORT | CROSS SECTIONAL ANALYSIS | PREGNANT WOMEN | ABORTION | UTERINE ASPIRATOR | PREVALENCE | HYSTEROSCOPY | EXAMINATIONS AND DIAGNOSES | INFERTILITY | South America, Eastern | South America | Latin America | Americas | Developing Countries | Research Methodology | Population Characteristics | Demographic Factors | Population | Fertility Control, Postconception | Family Planning | Surgical Equipment | Equipment and Supplies | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Measurement | Endoscopy | Physical Examinations and Diagnoses | Reproduction Document Number: 324112 Notification |
| 5. Title: Tramadol versus nalbuphine in total intravenous anaesthesia for dilatation and evacuation. Author: Siddiqui KM; Chohan U Source: Journal of Pakistan Medical Association. 2007 Feb;57(2):67-70. Abstract: The objective was to compare the results of Tramadol with Nalbuphine for dilatation and evacuation with total intravenous anaesthesia technique. A total of 70 patients (35 in each group) were included in this prospective, double blind randomized study. Intravenous tramadol 1.5mg/kg and nalbuphine 0.1mg/kg were compared in total intravenous anaesthesia (TIVA) using a propofol infusion in patients undergoing dilatation and evacuation (D and E). Changes in haemodynamic variables greater than 20% from the base line values were noted. There was no difference found in haemodynamic parameters. There was statistically significant difference found (p < 0.05) in postoperative recovery between the two groups. Quality of analgesia was better in nalbuphine group but both drugs provide suitable analgesic supplementation to TIVA. (author's) Language: English Keywords: PAKISTAN | RESEARCH REPORT | DOUBLE-BLIND STUDIES | COMPARATIVE STUDIES | PREGNANT WOMEN | DRUGS | ADMINISTRATION AND DOSAGE | ANESTHESIA | SURGERY | CERVICAL DILATATION | UTERINE ASPIRATOR | Asia, Southern | Asia | Developing Countries | Studies | Research Methodology | Population Characteristics | Demographic Factors | Population | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Surgical Equipment | Equipment and Supplies Document Number: 313223 |
| 6. Peer Reviewed Title: Impact of formal family planning residency training on clinical competence in uterine evacuation techniques. Author: Steinauer J; Silveira M; Lewis R; Preskill F; Landy U Source: Contraception. 2007 Nov;76(5):372-376. Abstract: The goal of this study was to assess the impact of formal opt-out family planning training on clinical competence in uterine evacuation. Residents who participated in newly established, routine opt-out family planning training completed surveys before and after their rotations. The surveys asked residents to report clinical experience and competence in family planning. One hundred ninety-six pre- and postrotation questionnaires were collected for a total response rate of 63%. After completing the rotation, residents reported higher competence in medical abortion, manual uterine aspiration, electric uterine aspiration and dilation and evacuation (p < .001). Residents also reported increased clinical experience with methods of termination, postabortion contraception, including intrauterine contraception, ultrasound and perioperative pain management. Participation in a formal opt-out family planning rotation results in increased clinical exposure to family planning and in reported competence in pregnancy termination. (author's) Language: English Keywords: UNITED STATES OF AMERICA | RESEARCH REPORT | SURVEYS | MEDICAL STUDENTS | WOMEN | ABORTION | UTERINE ASPIRATOR | TRAINING PROGRAMS | Developed Countries | North America | Americas | Sampling Studies | Studies | Research Methodology | Students | Education | Demographic Factors | Population | Fertility Control, Postconception | Family Planning | Surgical Equipment | Equipment and Supplies | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health Document Number: 321773 Notification |
| 7. Peer Reviewed Title: Introduction of the dilation and evacuation procedure for second-trimester abortion in Vietnam using manual vacuum aspiration and buccal misoprostol. Author: Castleman LD; Oanh KT; Hyman AG; Le Thanh Thuy; Blumenthal PD Source: Contraception. 2006 Sep;74(3):272-276. Abstract: The dilation and evacuation (D&E) procedure was modified for use in a low-resource setting where access to electric vacuum aspiration is limited. In this demonstration project, buccal misoprostol is used for cervical preparation, followed by evacuation using manual vacuum aspiration (MVA) and forceps. Senior physicians at the Hanoi Obstetrics and Gynecology Hospital were trained in D&E and subsequently conducted 439 D&E procedures. The primary outcomes were efficacy and safety. Secondary outcome measures include efficacy of buccal misoprostol for cervical preparation prior to D&E and the feasibility of MVA for use in the D&E procedure. Successful abortion took place in 100% of the cases. Three major complications occurred. This procedure may be appropriate in other low-resource settings lacking safe, effective abortion services in the second trimester. (author's) Language: English Keywords: VIETNAM | RESEARCH REPORT | PREGNANT WOMEN | PREGNANCY, SECOND TRIMESTER | CERVICAL DILATATION | ABORTION | MISOPROSTOL | FORCEPS | COMPLICATIONS | SAFETY | CONTRACEPTIVE USE-EFFECTIVENESS | Asia, Southeastern | Asia | Developing Countries | Population Characteristics | Demographic Factors | Population | Pregnancy | Reproduction | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Fertility Control, Postconception | Family Planning | Prostaglandins, Synthetic | Prostaglandins | Endocrine System | Physiology | Biology | Surgical Equipment | Equipment and Supplies | Diseases | Public Health | Contraceptive Effectiveness | Contraception Document Number: 304459 Notification |
| 8. Peer Reviewed Title: A novel device for removal of the retained intrauterine device. Author: Konamme SP; Auld BJ; Zaidi J Source: Journal of Family Planning and Reproductive Health Care. 2006;32(2):87-88. Abstract: The objective was to evaluate the efficacy and acceptability of the Macaluso stent removal forceps for removal of retained intrauterine devices (IUDs) under direct vision using a hysteroscope in an outpatient setting. Nineteen consecutive patients with a retained IUD who had been referred from primary care to the gynaecologists at the Conquest Hospital, Hastings, UK were included in the study. Attempts were made to remove the IUDs under direct vision using the Gynecare Versascope and Macaluso forceps. The procedure was successful in 18/19 (94.7%) patients. The patients tolerated the procedure well and none of them complained of severe pain. This device is simple, safe, effective and acceptable for the removal of IUDs with lost threads. (author's) Language: English Keywords: UNITED KINGDOM | RESEARCH REPORT | CLINICAL RESEARCH | WOMEN | IUD COMPLICATIONS | HYSTEROSCOPY | FORCEPS | GYNECOLOGIC SURGERY | SATISFACTION | Europe, Western | Europe | Developed Countries | 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 | Surgical Equipment | Equipment and Supplies | Urogenital Surgery | Surgery | Treatment | Psychological Factors | Behavior Document Number: 298635 |
| 9. Peer Reviewed Title: Uterine perforation as a rare complication of attempted pregnancy termination with misoprostol. A case report. Author: Lialios G; Kallitsaris A; Mademtzis J; Messinis IE Source: Journal of Reproductive Medicine. 2006 Jul;51(7):599-600. Abstract: BACKGROUND: Abortion induced by drugs is now a viable alternative to surgically induced abortion, but it can cause severe complications. CASE: Products of conception were found in the peritoneal cavity after administration of misoprostol. CONCLUSION: The administration of misoprostol for pregnancy termination should be performed carefully in women with uterine wall defects. (author's) Language: English Keywords: GREECE | RESEARCH REPORT | PREGNANT WOMEN | PREGNANCY, FIRST TRIMESTER | ABORTION | MISOPROSTOL | ADMINISTRATION AND DOSAGE | UTERINE PERFORATION | SURGERY | UTERINE ASPIRATOR | Developed Countries | Europe, Southern | Europe | Population Characteristics | Demographic Factors | Population | Pregnancy | Reproduction | Fertility Control, Postconception | Family Planning | Prostaglandins, Synthetic | Prostaglandins | Endocrine System | Physiology | Biology | Drugs | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Perforations | Diseases | Surgical Equipment | Equipment and Supplies Document Number: 306962 Notification |
| 10. Peer Reviewed Title: Comparison of oral and vaginal misoprostol for cervical ripening before manual vacuum aspiration of first trimester pregnancy under local anesthesia: a randomized placebo-controlled study. Author: Cakir L; Dilbaz B; Caliskan E; Dede FS; Dilbaz S Source: Contraception. 2005;71:337-342. Abstract: The objective of this prospective randomized placebo-controlled study was to determine the effectiveness of 400 Ag oral and 400 Ag vaginal misoprostol administration for cervical priming 3 h prior to manual vacuum aspiration (MVA) under local anesthesia for voluntary termination of pregnancy before 10 weeks of gestation in comparison with placebo oral or placebo vaginal administration (n = 40 in each group). Postmedication cervical dilatation was similar in the oral (mean, 6.6 ± 1.5) and vaginal (mean, 7.2 ± 0.8) misoprostol groups but significantly higher compared with the oral (mean, 3.4 ± 0.2) and vaginal (mean, 3.6 ± 1.9) placebo groups. Duration of the procedure was also significantly shorter in the misoprostol groups in comparison with their placebo counterparts. Preoperative bleeding and side effects were more common in the misoprostol groups, but none required medical intervention. Intraoperative bleeding was less in the vaginal misoprostol group compared with the placebo groups. There was no significant difference in terms of visual analogue scores during the procedure, patient satisfaction, days of postoperative bleeding and rate of postoperative complications among the groups. Cervical priming with misoprostol administered orally or vaginally 3 h before MVA for termination of pregnancy under local anesthesia facilitates the procedure by decreasing the need for cervical dilatation and by shortening its duration without improving patients’ pain perception and satisfaction mainly due to side effects. (author's) Language: English Keywords: TURKEY | RESEARCH REPORT | CLINICAL TRIALS | COMPARATIVE STUDIES | PREGNANT WOMEN | PREGNANCY, FIRST TRIMESTER | ABORTION | MISOPROSTOL | ADMINISTRATION AND DOSAGE | BLEEDING | CERVICAL DILATATION | UTERINE ASPIRATOR | Developing Countries | Europe, Southeastern | Europe | Clinical Research | Research Methodology | Studies | Population Characteristics | Demographic Factors | Population | Pregnancy | Reproduction | Fertility Control, Postconception | Family Planning | Prostaglandins, Synthetic | Prostaglandins | Endocrine System | Physiology | Biology | Drugs | Treatment | Signs and Symptoms | Diseases | Surgical Equipment | Equipment and Supplies Document Number: 284462 Notification |
| 11. Peer Reviewed Title: Medical abortion at 9-13 weeks' gestation: a review of 1076 consecutive cases. Author: Hamoda H; Ashok PW; Flett GM; Templeton A Source: Contraception. 2005;71:327-332. Abstract: The aim of the study was to assess the use, efficacy and factors influencing the outcome of medical abortion at 9–13 weeks’ gestation. Retrospective chart review of consecutive women undergoing medical abortion at 9–13 weeks’ gestation was done. A total of 1927 abortions were carried out at 9–13 weeks’ gestation, of which 1076 (55.8%) were undertaken medically. Efficacy decreased with increasing gestation (p=.02). Surgical evacuation was carried out in 45 (4.2%) women including 10 (2.7%) at 64–70 days, 11 (3.3%) at 71–77 days, 10 (5.1%) at 78–84 days and 14 (8.0%) at 85–91 days of gestation (p=.02). Indications for surgery included continuing pregnancy [16 (1.5%) women], retained sac [5 (0.5%)], incomplete abortion [20 (1.9%)] and emergency curettage for bleeding [4 (0.4%)]. The number of misoprostol doses used and the induction-to-abortion interval both significantly increased with gestation (p < .001), while analgesia requirements did not vary with increasing gestation (p=.18). Medical abortion at 9–13 weeks’ gestation is an effective alternative to surgery. Medical methods should be offered routinely at these gestations, thus increasing women’s choice. (author's) Language: English Keywords: UNITED KINGDOM | RESEARCH REPORT | RETROSPECTIVE STUDIES | PREGNANT WOMEN | PREGNANCY, FIRST TRIMESTER | ABORTION | RU-486 | MISOPROSTOL | GESTATIONAL AGE | BLEEDING | UTERINE ASPIRATOR | Developed Countries | Europe, Western | Europe | Studies | Research Methodology | Population Characteristics | Demographic Factors | Population | Pregnancy | Reproduction | Fertility Control, Postconception | Family Planning | Hormone Antagonists | Hormones | Endocrine System | Physiology | Biology | Prostaglandins, Synthetic | Prostaglandins | Fetus | Signs and Symptoms | Diseases | Surgical Equipment | Equipment and Supplies Document Number: 284460 Notification |
| 12. Title: Vesicovaginal fistula: an experience of 30 cases at Ayub Teaching Hospital Abbottabad. Author: Khan RM; Raza N; Jehanzaib M; Sultana R Source: JAMC. Journal of Ayub Medical College, Abbottabad. 2005;17(3) Abstract: Vesicovaginal fistula (VVF) is a disease that is rare in developed world but is frequently seen in poorer countries. It is mostly a result of gynaecological or obstetrical procedures. This study reports our experience of VVF. This study was carried out at department of Urology, Ayub Teaching Hospital, Abbottabad from June 1998 to June 2004. Detailed history was taken to record age, nature of trauma, time interval of appearance of fistula and previous attempts of repair if any. In addition the results of repair were evaluated. During this six years study period a total of 30 cases of urinary incontinence due to VVF were referred from Gynaecology and Obstetrics department for management, many gave history of birth trauma resulting in leakage of urine per vaginum. Majority of patients with VVF were between 21- 40 years of age. All the patients presented with total incontinence of urine. Most common etiological factor was obstructed labour (63.33%). The other factors were caesarian section (13.33%), hysterectomy (13.33%), forceps delivery (3.33%) and bladder calculus (3.33%). A single case was due to carcinoma cervix and post irradiation (3.33%). Three out of 30 patients had one or more previous fistula repair attempts, while in the rest repair was not attempted before. We carried out transvesical repair in all patients, 80% of patients were completely cured and symptom free, 10% had stress incontinence with frequency of micturition but no vaginal leakage. Failure was 10%. VVF is frequently encountered in Hazara division of Pakistan. It is mostly due to obstetrical causes. (author's) Language: English Keywords: PAKISTAN | RESEARCH REPORT | WOMEN | VESICOVAGINAL FISTULA | RISK FACTORS | CHILDBIRTH | CESAREAN SECTION | HYSTERECTOMY | FORCEPS | UROGENITAL EFFECTS | CERVICAL CANCER | Developing Countries | Asia, Southern | Asia | Demographic Factors | Population | Urogenital System | Physiology | Biology | Pregnancy Outcomes | Pregnancy | Reproduction | Obstetrical Surgery | Surgery | Treatment | Gynecologic Surgery | Urogenital Surgery | Surgical Equipment | Equipment and Supplies | Cancer | Neoplasms | Diseases Document Number: 292899 |
| 13. Title: [Operative termination of pregnancy between 12 and 14 weeks' gestation: influence of the operator's experience] Particularites techniques de I'IVG instrumentale entre 12 et 14 semaines d'amenorrhee: influence de l'experience de l'operateur. Author: Koskas M; Jerbi M; Boccara J; Trie A; Jannet D Source: Journal de Gynecologie Obstetrique et Biologie de la Reproduction. 2005 Jun;34(4):334-338. Abstract: The objective was to assess the feasibility of operative termination of pregnancy between 12 and 14 weeks of gestation and the role of the operator's experience in physicians previously unfamiliar to this technique. A prospective study of 251 operative terminations of pregnancy, from July 1st, 2001 to January 31st, 2002, and from May 1st, 2002 to October 31st, 2002, in order to assess the role of operator's experience. 104 terminations between 12 and 14 weeks were compared to 147 terminations at earlier gestational ages. All patients received cervical ripening with 400 mcg oral misoprostol 3-4 hours before operation performed under general anesthesia. Evaluation criteria were: duration of operation, need for use of forceps, and complications: uterine perforation, cervical laceration, bleeding greater than 500 ml and need for blood transfusion. There was no difference in the rate of operative complications between terminations before and after 12 weeks. The duration of operation was slightly longerafter 12 weeks than before (12.9 plus or minus 6.7 min versus 11.1 plus or minus 2.8 min; p less than 0.05). Forceps use was 0.7% before 12 weeks, 20% between 12 and 13 weeks, and 59% between 12 and 14 weeks (p less than 0.01). There was no difference in the complication rate or in the need for forceps according to the operator's experience. The perceived difficulty in cervical dilatation was higher in early experience than in experimented operators (19.6% versus 5.2%; p less than 0.05). Operative termination of pregnancy is technically feasible beyond 12 weeks without dramatic increase in operative complications. Technical skill can be acquired in a short time interval. (author's) French Abstract: Evaluer la faisabilite de interruption volontaire de grossesse (IVG) entre 12 et 14 semaines d'amenorrhee et ('influence de I'experience de I'operateur dans une equipe n'ayant pas la pratique prealable de cette technique. Etude prospective portant sur 251 IVG instrumentales dont 104 entre 12 et 14 SA au cours de deux periodes distinctes : du 1er juillet 2001 au 31 Janvier 2002 puis du 1er mai 2002 au 31 octobre 2002 afin d'evaluer les differences entre des operateurs s'initiant a la technique puis des operateurs experimentes. Une preparation cervicale par misoprostol 400 meg per-os etait systematiquement realisee 3 a 4 heures avant I'intervention pratiquee sous anesthesie generale. Les parametres evalues etaient: la duree de I'intervention, la necessite d'utilisation de pinces pour I'extraction des fragments ovulaires, les difficultes de dilatation du col et la survenue de complications : perforation uterine, saignement greater than 500 ml, necessite de transfusion sanguine, dechirure cervicale. II n'existait pas de difference dans la survenue de complications operatoires (dechirure cervicale, perforation uterine, hemorragie) entre les IVG realisees avant et apres 12 SA. La duree operatoire etait legerement plus longue apres 12 SA (12,9 plus or minus 6,7 min versus 11,1 plus or minus 2,8 min ; p less than 0,05). L'utilisation de pinces etait rare avant 12 SA, plus frequente entre 12 et 13 SA, et surtout apres 13 SA (respectivement 0,7 % ; 20 % et 49 % ; p less than 0,01). L'experience de I'operateur n'avait pas d'effet significatif sur le taux de complications ni sur le taux d'utilisation de pinces. Seule la difficulte subjective de dilatation du col etait moindre pour les operateurs experimentes (19,6 % versus 5,2 % ; p less than 0,05). L'lVG instrumentale est techniquement realisable au-dela de 12SA sans augmentation significative des complications par rapport aux termes plus precoces. L'apprentissage de la technique est rapide. (de l'auteur) Language: French Keywords: RESEARCH REPORT | CLINICAL RESEARCH | PROSPECTIVE STUDIES | PHYSICIANS | PREGNANT WOMEN | ABORTION | PREGNANCY, SECOND TRIMESTER | MISOPROSTOL | PROSTAGLANDINS, ADMINISTRATION AND DOSAGE | TIME FACTORS | FORCEPS | CERVICAL LACERATION | Research Methodology | Studies | Health Personnel | Delivery of Health Care | Health | Population Characteristics | Demographic Factors | Population | Fertility Control, Postconception | Family Planning | Pregnancy | Reproduction | Prostaglandins, Synthetic | Prostaglandins | Endocrine System | Physiology | Biology | Population Dynamics | Surgical Equipment | Equipment and Supplies | Medical Procedures | Medicine | Health Services | Diseases Document Number: 293708 Notification |
| 14. Peer Reviewed Title: Misoprostol as the primary agent for medical abortion in a low-income urban setting. Author: Borgatta L; Mullally B; Vragovic O; Gittinger E; Chen A Source: Contraception. 2004;70:121-126. Abstract: The purpose of this study was to assess the outcomes of early medical abortion in an inner-city hospital abortion service, using misoprostol as the primary agent. This was a retrospective chart review from July 2001 through December 2002. Women were eligible if they had a viable pregnancy with gestational age 8 weeks or less by transvaginal ultrasound and no medical contraindications. Two doses of 800 µg misoprostol were administered vaginally, 24 h apart. Initial follow-up was scheduled 2–3 days later. Of the 440 women who underwent medical abortion, 373 (90.8%, 95% confidence interval (CI) 88–94%) completed abortion medically, 38 (9.2%) had uterine aspiration and the remainder had incomplete or no follow-up. Of uterine aspirations, 11 were medically indicated, giving a rate of indicated aspiration of 2.7%. Gestational age, age, gravidity, parity, past abortion history, ethnic group and payer did not significantly correlate with overall rate of aspiration or rate of follow-up, but gestational age was correlated with medically indicated aspiration. Among 57 women who reported a time of tissue passage, the mean time from initial misoprostol dose was 8.5 h (95% CI 6.5–13 h). (author's) Language: English Keywords: MASSACHUSETTS | RESEARCH REPORT | CLINICAL RESEARCH | EPIDEMIOLOGIC METHODS | RETROSPECTIVE STUDIES | LOW INCOME POPULATION | URBAN POPULATION | PREGNANT WOMEN | MISOPROSTOL | ABORTION | PREGNANCY, FIRST TRIMESTER | UTERINE ASPIRATOR | ULTRASONICS | GESTATIONAL AGE | United States of America | North America | Americas | Developed Countries | Research Methodology | Studies | Social Class | Socioeconomic Status | Socioeconomic Factors | Economic Factors | Population Characteristics | Demographic Factors | Population | Prostaglandins, Synthetic | Prostaglandins | Endocrine System | Physiology | Biology | Fertility Control, Postconception | Family Planning | Pregnancy | Reproduction | Surgical Equipment | Equipment and Supplies | Fetus Document Number: 273587 Notification |
| 15. Title: Prediction of successful vaginal delivery in women undergoing external cephalic version at term for breech presentation. Author: Chan LY; Leung TY; Fok WY; Chan LW; Lau TK Source: European Journal of Obstetrics and Gynecology. 2004;116:39-42. Abstract: The aim of this study is to evaluate the clinical and sonographic predictors of ultimate successful vaginal delivery in women undergoing external cephalic version. The study population consisted of women with external cephalic version performed at or after 36 weeks of gestation. They were randomized into group A or B, each consisted of half of the total study population. Logistic regression was performed on group A to identify the significant independent variables in predicting successful cephalic vaginal delivery, which were used to construct a prediction model. The derived regression model was then tested in group B to assess its accuracy. The study included 407 pregnancies. Maternal weight (kg) at the time of version, maternal height (cm), multiparity, engagement of fetal presenting part, and fetal head palpable were significant independent variables of successful version and vaginal delivery (regression coefficients are: -0.084, 0.085, 1.752, -1.271, and 0.725, respectively). A prediction model was constructed based on these independent variables. The weighted average of the overall accuracy in predicting success or failure of version and vaginal delivery was 70.9%. The regression model was then applied to study group B. Using 0.50 as the cutoff value, the sensitivity, specificity, positive, and negative predictive values were 75.4, 58.8, 73.7, and 61.0%, respectively. A regression model constructed based on clinical variables failed to provide an accurate predictive tool of successful external cephalic version and vaginal delivery. However, in women who are equivocal about external cephalic version, a high prediction of success would be encouraging. (author's) Language: English Keywords: HONG KONG | RESEARCH REPORT | METHODOLOGICAL STUDIES | CLINICAL RESEARCH | CASE CONTROL STUDIES | STATISTICAL REGRESSION | MATHEMATICAL MODEL | PREGNANT WOMEN | WOMEN IN DEVELOPMENT | PREGNANCY COMPLICATIONS | FORCEPS | BODY WEIGHT | BODY HEIGHT | MULTIPARITY | Developed Countries | Asia, Eastern | Asia | Research Methodology | Studies | Data Analysis | Theoretical Models | Population Characteristics | Demographic Factors | Population | Economic Development | Economic Factors | Diseases | Surgical Equipment | Equipment and Supplies | Physiology | Biology | Parity | Fertility Measurements | Fertility | Population Dynamics Document Number: 273604 |
| 16. Peer Reviewed Title: Which cannulae fit the Ipas manual vacuum aspiration syringe? Author: Orbach D; Schaff E Source: Contraception. 2004 Feb;69(2):171-173. Abstract: The Ipas™ double-valve manual vacuum aspiration (MVA) syringe is an alternative to electrical vacuum aspiration. This study determines which US cannulae (flexible, rigid-straight and rigid-curved) work with the Ipas MVA syringe. Cannulae from Ipas, MedGyn™, Berkeley™ and Milex™, in sizes 6 –12 mm, were randomized and affixed to the MVA syringe. A pressure gauge was attached to the cannula with rubber tubing. Pressure readings were recorded initially and over 30 s. Milex cannulae were not compatible. For the remaining brands, initial vacuum pressures ranged from 55 to 65 mmHg. Flexible cannulae from Ipas, Berkeley and MedGyn maintained initial pressures without leaks, as did the 6–12-mm straight- and curved-rigid cannulae by Berkeley. Eight of the 13 tested MedGyn rigid cannulae lost _10% pressure over 30 s. Several US manufacturers produce cannulae that fit on the Ipas MVA syringe without a leak, including Ipas flexible cannula; Berkeley flexible, rigid-straight and rigid-curve cannulae and MedGyn flexible cannula, but not their rigid cannulae. (author's) Language: English Keywords: UNITED STATES OF AMERICA | RESEARCH REPORT | ABORTION | CANNULA | TESTING | UTERINE ASPIRATOR | North America | Americas | Developed Countries | Fertility Control, Postconception | Family Planning | Equipment and Supplies | Measurement | Research Methodology | Surgical Equipment Document Number: 190274 Notification |
| 17. Peer Reviewed Title: Ability of the clinician and patient to predict the outcome of mifepristone and misoprostol medical abortion. Author: Rossi B; Creinin MD; Meyn LA Source: Contraception. 2004;70:313-317. Abstract: We performed this analysis to evaluate the ability of both women and their clinicians to predict pregnancy expulsion after using mifepristone and misoprostol for medical abortion up to 63 days gestation. Women who participated in a multicenter, randomized trial comparing misoprostol 6–8 h vs. 23–25 h after mifepristone attended a follow-up visit approximately 7 days after mifepristone treatment. Each subject was asked if she felt she had expelled the gestational sac. Clinicians also assessed if the sac had been expelled based on the woman’s history. Vaginal ultrasonography was then performed to assess the uterine cavity. Of the 1080 women enrolled in the multicenter study, 931 (86.2%) who attended the first follow-up visit by study day 12 and did not have a uterine suction aspiration prior to this visit were included in this analysis. Vaginal ultrasonography at the first follow-up visit demonstrated expulsion in 915 [98.3%, 95% confidence interval (CI): 97.2–99.0] women. Overall, sensitivity, specificity, and positive and negative predictive values for subjects were 96.5%, 31.3%, 98.8% and 13.5%, respectively. When both the clinician and patient felt that the gestational sac had passed (n = 880 [94.5%, 95% CI: 92.9 –95.9]), expulsion was confirmed by sonography in 99.1% (95% CI: 98.2–99.6) of cases. Women and clinicians are very accurate at determining expulsion of gestational sac during medical abortion with mifepristone and misoprostol without ultrasonography or a physical examination. (author's) Language: English Keywords: UNITED STATES OF AMERICA | RESEARCH REPORT | CLINICAL TRIALS | PREGNANT WOMEN | MISOPROSTOL | RU-486 | ABORTION | TIME FACTORS | ULTRASONICS | UTERINE ASPIRATOR | CONTRACEPTIVE EFFECTIVENESS | North America | Americas | Developed Countries | Clinical Research | Research Methodology | Population Characteristics | Demographic Factors | Population | Prostaglandins, Synthetic | Prostaglandins | Endocrine System | Physiology | Biology | Hormone Antagonists | Hormones | Fertility Control, Postconception | Family Planning | Population Dynamics | Surgical Equipment | Equipment and Supplies | Contraception Document Number: 274831 Notification |
| 18. Title: Performing uterine evacuation with Ipas manual vacuum aspiration (MVA) instruments: instructional booklet. Author: Abernathy M; Frankel N Source: Chapel Hill, North Carolina, Ipas, 2003. 27 p. Abstract: This booklet is intended for use by clinicians knowledgeable about the anatomy, physiology and medical procedures of the uterus, and skilled in transvaginal intrauterine procedures such as sharp curettage, electric vacuum aspiration, IUD insertion, hysteroscopy or endometrial biopsy. Further, users of this manual need to possess the following skills: the ability to perform a pelvic examination; the ability to accurately assess the size and position of a uterus, including assessing abnormalities and the duration of gestation in first-trimester pregnancies; the ability to diagnose and manage pregnancy-related conditions and the stages of miscarriage .%. demonstrated knowledge of infection-prevention techniques including standard/universal precautions, no-touch technique and processing of medical instruments; the ability to assess the need for and provide appropriate pain management; the ability to diagnose, stabilize and refer patients with ectopic pregnancy; the ability to manage complications of uterine evacuation and pain medications, including incomplete evacuation, cervical and abdominal injury, uterine perforation, uterine atony, infection, failed abortion, and medication-related reactions; or the ability to stabilize the patient and establish a mechanism for referral. (excerpt) Language: English Keywords: UNITED STATES OF AMERICA | MANUAL | PHYSICIANS | WOMEN | UTERINE ASPIRATOR | INSTRUCTION | CLINIC ACTIVITIES | NONGOVERNMENTAL ORGANIZATIONS | Developed Countries | North America | Americas | Health Personnel | Delivery of Health Care | Health | Demographic Factors | Population | Surgical Equipment | Equipment and Supplies | Education | Program Activities | Programs | Organization and Administration | Organizations Document Number: 275872 |
| 19. Peer Reviewed Title: Venous thromboembolism in pregnancy and the puerperium in Sudanese women. Author: Haggaz AA; Mirghani OA; Adam I Source: International Journal of Gynecology and Obstetrics. 2003 Dec;83(3):309-310. Abstract: Multiple changes in the coagulation system, which occur during pregnancy, account for its hypercoaguable state. Consequently, pregnant women are more likely to experience venous thromboembolism (VTE) than their non-pregnant peers. Numerous risk factors have been shown to predispose the pregnant women to venous thrombosis. We performed a retrospective, case–control study at Wad Medani Hospital between January 1999 and December 2000, to examine the incidence, timing and the risk factors for VTE in pregnancy and puerperium in a population of women in the central Sudan. (excerpt) Language: English Keywords: SUDAN | RESEARCH REPORT | CASE CONTROL STUDIES | PREGNANT WOMEN | POSTPARTUM WOMEN | THROMBOEMBOLISM | RISK FACTORS | ORAL CONTRACEPTIVES | FORCEPS | ANEMIA | Africa, North | Africa | Developing Countries | Studies | Research Methodology | Population Characteristics | Demographic Factors | Population | Puerperium | Reproduction | Embolism | Vascular Diseases | Diseases | Biology | Contraceptive Methods | Contraception | Family Planning | Surgical Equipment | Equipment and Supplies Document Number: 189228 |
| 20. Title: [Early maternal and neonatal morbidity after spontaneous and surgically-assisted vaginal delivery] Casna materska a neonatalni morbidita po spontannim a operativnim vaginalnim porodu. Author: Kilian T; Kudela M; Prochazka M; Vetr M; Halek J Source: Ceska Gynekologie. 2003 Jul;68(4):227-231. Abstract: OBJECTIVE: To evaluate the differences in early maternal and neonatal morbidity after spontaneous delivery, forceps delivery and vacuum-extraction. DESIGN: Retrospective clinical study. SETTING: Department of Obstetrics and Gynecology, University Hospital, Palacky University, Olomouc. The database of 8196 deliveries at our department in the time period from January 1995 till September 2000 revealed 183 of forceps deliveries and 217 of vacuum-extractions. The control group included 200 randomly selected parturients with spontaneous vaginal delivery. The early maternal morbidity was evaluated according to the following parameters: perineal tears of the IIIrd + IVth degree, duration of hospitalization, average blood loss, the need of analgetics, dehiscence of episiotomy requiring resuture, febrilies and administration of antibiotics. The early neonatal morbidity evaluation was based on the incidence of cephalhematomas, the incidence of hyperbilirubinaemia, duration of hospitalization, signs of fetal hypoxia (pH, Apgar score), gestational age, birthweight and the presence of intracranial and retinal bleeding. The statistical significance of the differences in the frequency of the above parameters was evaluated. Spontaneous deliveries were associated with lower maternal morbidity according to the most of studied parameters. Vacuum-extraction had a lower frequency of maternal postpartum complications compared to forceps deliveries. Statistically valid differences were however found only at perineal tears of the IIIrd + IVth degree and at administration of analgetic and antibiotics. The use of vacuum-extraction seems to be connected with a higher risk of cephalhematomas (p = 0.0051) and longer duration of hospitalization. From the point of view of early maternal morbidity the assisted vaginal delivery by vacuumextraction gives better results than by forceps. However vacuum-extraction increases the risk of cephalhematomas at newborn. (author's) Language: Czech Keywords: CZECH REPUBLIC | RESEARCH REPORT | CLINICAL RESEARCH | RETROSPECTIVE STUDIES | CASE CONTROL STUDIES | PREGNANT WOMEN | CESAREAN SECTION | NEONATAL MORTALITY | PREGNANCY COMPLICATIONS | CHILDBIRTH | FORCEPS | ABORTION | MORBIDITY | Europe, Central | Europe | Developing Countries | Research Methodology | Studies | Population Characteristics | Demographic Factors | Population | Obstetrical Surgery | Surgery | Treatment | Infant Mortality | Mortality | Population Dynamics | Diseases | Pregnancy Outcomes | Pregnancy | Reproduction | Surgical Equipment | Equipment and Supplies | Fertility Control, Postconception | Family Planning Document Number: 194813 Notification |
| 21. Title: [Obstetrical procedures in the case of breech presentation] Manoeuvres obstétricales en cas de présentation du siège. Author: Zraidi M; Belghiti L; Yousfi M; El Amrani S; Ouazzani MC Source: Espérance Médicale. 2002 Apr;9(82):221-223. Abstract: This article discusses the different procedures for expulsion of the fetus in the case of breech presentation and describes their advantages, disadvantages, and indications. At the end of pregnancy, the suggested conduct consists of three options: external version (EV) which consists of transforming the breech presentation into a cephalic presentation and reduces the number of cesarean deliveries due to breech presentation, with conflicting opinions concerning the date at which it should be performed; or a scheduled cesarean which should take place around the 39th week of gestation, before the onset of labor, and in the presence of absolute contraindications for vaginal delivery; or the possibility of vaginal delivery if there are any contraindications requiring the presence of the entire medical team. Spontaneous delivery constitutes the best solution provided that it does not last so long as to cause anoxia. This is why currently there is a practice of resorting to concomitant actions to facilitate the release of the shoulders and the aftercoming head, which only occurs when the buttocks are freed up to the point of the scapula. These actions are: the Mauriceau maneuver which is divided into three phases: flexing the head, rotating the head, and release, but it entails certain complications, particularly brachial plexus paralysis; Bracht's maneuver which assists in the expulsion of the aftercoming head, once the point of the fetus' scapula appears at the vulva; Lovset's maneuver consists in a successive double conversion of the posterior shoulder to an anterior shoulder; the total breech extraction reserved generally for twin pregnancies; and the partial breech extraction which consists of two phases: freeing the arms and extracting the head by Bracht's maneuver, and finally forceps on the aftercoming head, used in case of entrapment of the fetal head in the pelvic hollow. A poor outcome may be observed in the following cases: failure to progress, raising of the arms, entrapment of the aftercoming head, and fetal death. Hence, the physician must be able to prove his competence, the appropriateness of his choice, and the quality of the care delivered. French Abstract: Cet article expose les différentes manœuvres d’expulsion du fœtus en cas de présentation du siège, en décrivant leurs avantages, leurs inconvénients et leurs indications. En fin de grossesse, la conduite à tenir consiste en l’application de trois possibilités : soit la version par manœuvre externe (VME) qui consiste à transformer la présentation de siège en présentation céphalique de sommet en permettant de réduire le nombre de césariennes pour siège et dont la date de réalisation est très discutée; soit la césarienne programmée qui s’impose vers la 39ème SA avant tout début de travail et en présence de contre indications absolues à la voie basse; ou bien la possibilité d’accouchement par voie basse s’il y a aucune contre indication nécessitant la présence de toute l’équipe médicale. L’accouchement spontanée constitue la meilleure solution à condition qu’il ne se prolonge pas jusqu’à provoquer l’anoxie. C’est pour cette raison qu’on remarque actuellement le recours à des gestes d’accompagnement pour faciliter le dégagement des épaules et de la tête dernière, et qui ne s’effectuent que lorsque le siège est dégagé jusqu’à la pointe des omoplates. Ces gestes sont : la manœuvre de Mauriceau qui se dévise en trois temps : flexion de la tête, rotation de la tête et dégagement, mais qui entraîne certaines complications, en particulier la paralysie du plexus brachial, la manœuvre de Bracht qui aide à l’expulsion de la tête dernière une fois que la pointe des omoplates du fœtus apparaît au niveau de la vulve, la manœuvre de Lovset qui consiste en une double conversion successive de l’épaule postérieure en une épaule antérieure, la grande extraction du siège réservée généralement en cas de grossesse gémellaire, la petite extraction du siège qui comporte deux temps : dégagement du bras et l’extraction de la tête par la manœuvre de Bracht, et enfin le forceps sur tête dernière utilisée en cas de rétention de la tête fœtale dans l’excavation pelvienne. Une évolution défavorable peut être observée concrétisée dans les cas suivants: l’arrêt de la progression, le relèvement des bras, la rétention de la tête dernière et la mort fœtale. D’où la nécessité pour le médecin de prouver sa compétence, la justesse de son choix et la qualité des soins apportés. Language: French Keywords: MOROCCO | PREGNANT WOMEN | CHILDBIRTH | PROCEDURES | CESAREAN SECTION | FORCEPS | PREGNANCY OUTCOMES | COMPLICATIONS | Developing Countries | Africa, Northern | Africa | Population Characteristics | Demographic Factors | Population | Pregnancy | Reproduction | Organization and Administration | Obstetrical Surgery | Surgery | Treatment | Surgical Equipment | Equipment and Supplies | Diseases Document Number: 183099 |
| 22. Title: [Forceps complications] Les complications du forceps. Author: Alami A Source: Revue des Sages Femmes. 2001 Apr;(19):21-3. Abstract: The risk of obstetrical trauma to both mother and newborn infant must be considered before using forceps to facilitate child delivery. Most forceps-related complications are not directly associated with forceps, but rather to the circumstances in which they are used and their manipulation. Risk factors may be associated with the mother, the newborn, and with forceps use. Cutaneous complications among newborns may include ophthalmic lesions, cranial fracture, intracranial hemorrhage, nervous system lesions, and dental occlusion. With regard to maternal complications of child delivery using forceps, delivering mothers may experience urogenital tract lesions and tearing. If such damage is identified during or immediately post-delivery, it may be repaired surgically, but some damage may not be obvious and result in medium- and long-term sequelae. Obstetricians must take great care when using forceps to effect child delivery. French Abstract: L'utilisation du forceps nécessite une bonne application pour éviter ses complications et le risque de traumatisme obstétrical pour le nouveau-né que pour la mère. Les facteurs de risque des complications sont ceux maternelles que l'on rencontre en cas d'accouchement spontané telles que la primiparité, les anomalies du bassin osseux au niveau du détroit inférieur et la distance ano-symphysaire; ceux liés au nouveau-né qui sont essentiellement, les macrocosmes et d'autres liés au maniement du forceps. Pour ce qui est des complication cutanées, on trouve celles néonatales comme le céphalhématome, d'autres lésions à type d'abrasions, d'érosions ou de plaies cutanées qui cicatrisent seules sans problème, les lésions ophtalmiques, à savoir les hémorragies sous conjonctivales, les excoriations palpébrales, les oedèmes des paupières ou de la cornée ou encore d'abrasion de cornée. Ceux qui sont directement liés au forceps sont les complications cutanées telles que les lésions ophtalmiques, les fractures du crâne, les hémorragies intra-craniennes, les lésions nerveuses et les occlusions dentaires et celles maternelles telles que les lésions de la filière génitale, les lésions vulvaires et les lésions urinaires. Language: French Keywords: MANUAL | CHILDBIRTH | FORCEPS | RISK FACTORS | FETUS | INFANT | CHILD HEALTH | MATERNAL HEALTH | VAGINAL INJURY | SAFETY | COMPLICATIONS | Pregnancy Outcomes | Pregnancy | Reproduction | Surgical Equipment | Equipment and Supplies | Biology | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Health | Vaginal Abnormalities | Diseases | Public Health Document Number: 163753 |
| 23. Title: [Prolonged pregnancy, a comparative study between 41 and 42 weeks following last menstrual period] La grossesse prolongée et étude comparative entre 41 et 42 semaines d’aménorrhée. Author: Jerrah H Source: Rabat, Morocco, Université Mohammed V, Faculté de Médecine et de Pharmacie de Rabat, 2001. 138 p. Doctoral thesis, Université Mohammed V, 2001. Abstract: Prolonged pregnancy (PP) is theoretically defined as any pregnancy with a gestational age greater than or equal to 42 weeks following last menstrual period (LMP). The consequences beyond this term involve the adnexa, the mother, and the fetus. However, the fetal consequences lie at the origin and severity of the exceeded term and condition the stance to take with respect to a prolonged pregnancy. A retrospective study examining a period of 5 years from January 1995 to December 1999 in the Souissi Maternity Hospital in Rabat, Morocco is reported in this medical dissertation. 644 parturients were identified and distributed into two groups. The first group included 374 women with a gestational age between 41 and 42 weeks LMP and a second group included 270 women whose gestational age equaled 42 weeks LMP. This study sought to produce an evaluation tableau showing the comparison of perinatal risks and delivery methods in the two groups. The results obtained show that the mean age of parturients in delivery was 29 years, mean parity of 2, with a significantly higher number of primiparous women than multiparous women. The incidence of prolonged pregnancy was 1.30% in G1 and 0.95% in G2. An analysis of histories revealed that repeated prolonged pregnancy, thyroid dysfunction, sterility, abortion, and cesarean sections were present in both groups. In terms of monitoring the pregnancy of both groups, 2/3 of women were monitored in public health facilities and 1/3 in the private sector. In terms of delivery, labor was artificially induced 20 times in G1 and 69 times in G2, while it involved cesarean section in 17.63% for G1 versus 32.3% for G2. Instrument-assisted extraction was utilized for 110 women in the first group versus 97 in the second group, which increased maternal morbidity. The level of perinatal mortality associated with PP is estimated at 1.07% in G1 and 5.55% in the other group. This level remained high due to the high number of unmonitored or poorly monitored pregnancies. In light of the results obtained, perinatal mortality and morbidity are too high, rates of instrument-assisted extraction and cesarean sections which are too high should lead to the consideration of PP as a high risk situation for the fetus which requires appropriate management starting at 41 weeks LMP, intensive monitoring and systematically induced labor in the 42nd week LMP. French Abstract: La grossesse prolongée (GP) est théoriquement définie comme toute grossesse dont l’âge gestationnel est supérieur ou égal à 42 semaines d’aménorrhée (SA). Ses conséquences au delà du terme sont annexielles, maternelles et fœtales. Mais, ce sont les conséquences fœtales qui font l’originalité et la gravité du dépassement de terme et conditionnent l’attitude à adopter vis à vis de la grossesse prolongée. Une étude rétrospective entreprise sur une durée de 5 années allant de Janvier 1995 à Décembre 1999 à la maternité Souissi de Rabat au Maroc est rapportée dans cette thèse de médecine. 644 parturientes ont été recensées et sont réparties en deux groupes. Le premier groupe comporte 374 femmes avec un âge gestationnel compris entre 41 et 42 SA et un second groupe de 270 femmes dont l’âge gestationnel est = 42 SA. Il a été proposé dans cette étude un canevas d’évaluation prévoyant la comparaison des risques périnatals et les modalités d’accouchement chez les deux groupes. Les résultats obtenus montrent que l’âge moyen des parturientes à l’accouchement est de 29 ans, la parité moyenne est de 2 avec le nombre de primipares significativement supérieur a celui des multipares. L’incidence des grossesses prolongées est de 1,30% pour G1 et 0,95% pour G2. L’analyse des antécédents fait remarquer que la grossesse prolongée à répétition, les dysthyroïdies, la stérilité, les avortements et les césariennes sont signalés dans les deux groupes. S’agissant du suivi de la grossesse dans les 2 groupes, 2/3 des femmes ont été suivies dans des formations sanitaires publiques et 1/3 dans le secteur privé. Concernant l’accouchement, 20 fois le travail fut déclenché artificiellement dans G1 et 69 fois dans G2, alors qu’il s’est déroulé par césarienne dans 17,63% pour G1 contre 32,3% pour G2. L’extraction instrumentale a été pratiquée chez 110 femmes du premier groupe contre 97 dans le deuxième groupe, ce qui accroît la morbidité maternelle. Le taux de mortalité périnatale lié à la GP est estimé à 1,07% dans G1 et à 5,55% dans l’autre groupe, ce taux reste élevé en conséquence du nombre important des grossesses non et mal suivies. A la lumière des résultas obtenus, la morbidité et la mortalité périnatale trop sont élevées, les taux d’extraction instrumentale et de césariennes trop importants doivent insister à considérer la GP comme une situation à haut risque fœtal qui nécessite une prise en charge adéquate à partir de 41 SA, une surveillance intensive et un déclenchement systématique du travail à 42 SA Language: French Keywords: MOROCCO | RESEARCH REPORT | COMPARATIVE STUDIES | RETROSPECTIVE STUDIES | PREGNANT WOMEN | PREGNANCY, PROLONGED | RISK ASSESSMENT | PREGNANCY OUTCOMES | NEONATAL MORTALITY | CHILDBIRTH | PROCEDURES | CESAREAN SECTION | FORCEPS | MONITORING | NEEDS | PREVENTION AND CONTROL | Developing Countries | Africa, North | Africa | Studies | Research Methodology | Population Characteristics | Demographic Factors | Population | Pregnancy | Reproduction | Evaluation | Infant Mortality | Mortality | Population Dynamics | Organization and Administration | Obstetrical Surgery | Surgery | Treatment | Surgical Equipment | Equipment and Supplies | Economic Factors | Diseases Document Number: 177517 |
| 24. Title: Forceps or vacuum extraction: a comparison of maternal and neonatal morbidity. Author: Shihadeh A; Al-Najdawi W Source: Eastern Mediterranean Health Journal. 2001 Jan-Mar;7(1-2):106-114. Abstract: To compare maternal and neonatal morbidity associated with forceps and vacuum delivery, data on 150 women delivered by forceps and 420 delivered by vacuum extraction between 1995 and 1999 at Queen Alia Hospital, Jordan were compared. Data included parity, gestational age, infant birth weight, Apgar score, presentation and station of fetal head, indications for forceps and vacuum deliveries, delivery success rate, and maternal and neonatal morbidity. Maternal birth canal and genital tract lacerations were significantly more common in forceps delivery, and there was significantly increased morbidity in infants delivered by vacuum extraction (caput, jaundice, cephalohaematoma). Serious neonatal morbidity was rare for both groups. (author's) Language: English Keywords: JORDAN | RESEARCH REPORT | COMPARATIVE STUDIES | RETROSPECTIVE STUDIES | PREGNANT WOMEN | INFANT | MORBIDITY | FORCEPS | CHILDBIRTH | PREGNANCY OUTCOMES | PREGNANCY COMPLICATIONS | NEONATAL DISEASES AND ABNORMALITIES | Middle East | Developing Countries | Studies | Research Methodology | Population Characteristics | Demographic Factors | Population | Youth | Age Factors | Diseases | Surgical Equipment | Equipment and Supplies | Pregnancy | Reproduction Document Number: 191568 |
| 25. Title: [Follow-up and outcome of infants born by instrumental extraction in the pediatric department of the Mohamed V Hospital during the neonatal period, 1996-1997] Suivi et devenir en pediatrie de l'Hopital Mohamed V des enfants nes par extraction instrumentale au cours de la periode neonatale pendant les annees 1996-1997. Author: Lamrani FZ; Benmarraze B Source: [Rabat], Morocco, Institut de Formation aux Carrieres de Sante, 1999. 38 p. Dissertation, Institut de Formation aux Carrieres de Sante. Abstract: The instrumental extraction of a fetus refers to the practice of giving birth to an infant via the natural birth canal with the assistance of mechanical means. However, such extraction is a leading etiological factor in the development of neurological handicaps among infants. In Morocco, physicians are entitled to employ forceps and spatulas for fetal extraction, while midwives are allowed to use only suction-cups regardless of their skill level. Findings are presented from an assessment of infants born by instrumental extraction in the Pediatric Department of Mohamed V Hospital during 1996-97. Physicians should have recourse to instrumental extraction only when medically indicated. However, at Mohamed V Hospital, such extraction occurs rather arbitrarily. Of the 4391 deliveries in the hospital in 1996, 2482 were normal, 1481 occurred with the assistance of suction-cups, 42 were with forceps, and 383 were cesarean. Of the 4620 deliveries in the hospital in 1997, 2514 were normal, 1620 occurred with the assistance of suction-cups, 64 were with forceps, and 422 were cesarean. The often inappropriate use of instrumental extraction at Mohamed V Hospital is further complicated by a cycle of maternity ward - postnatal follow-up - pediatrics which frustrates the timely delivery of the best possible infant care. Analysis and comparison of infant extraction rates using forceps, suction-cup, and spatula revealed the predominant use of the suction-cup rather than forceps which should, in principle, precede the former method. Its relative ease has made the suction-cup the method of choice for infant extraction at this hospital. Short-term infant outcomes are described. French Abstract: Ce mémoire de l'IFCS (Institut de Formation aux Carrières de Santé) est une étude qui porte sur l'avenir des enfants de zéro à un mois ayant été extraits par ventouse, forceps ou spatule au service de la maternité de l'hôpital Mohamed V à Meknes au Maroc et leur suivi en service de pédiatrie. Elle a pour but de vérifier l'usage fait de l'extraction instrumentale et ses conséquences sur les nouveau-nés. L'étude s'est basée sur les dossiers d'hospitalisés en pédiatrie et les registres de la maternité couvrant une période d'une année, pour ressortir les résultats suivants: la pratique de l'extraction instrumentale s'effectue de façon arbitraire sans respecter les indications d'utilisation de chaque instrument avec un abus d'utilisation de la ventouse au dépend des autres, le circuit maternité-suite de couches-pédiatrie est imputable à l'architecture de ces services en plus des mauvaises conditions du transfert des nouveau-nés et par conséquent un retard dans la prise en charge et ceci se répercute sur le sort des bébés à savoir la souffrance, les malformations , le taux de décès élevé. Pour pallier ces problèmes, des propositions sont avancées telles que, une surveillance minutieuse de la grossesse, une prévention pendant l'accouchement avec le respect rigoureux de toutes les indications de chaque instrument, la nécessité d'examiner tout nouveau-né, créer une unité de réanimation néonatale dotée d'un matériel suffisant et d'un personnel qualifié pour une meilleure prise en charge et la formation du personnel médical et paramédical. Language: French Keywords: MOROCCO | RESEARCH REPORT | CHILDBIRTH | FORCEPS | HOSPITALS | INFANT | HEALTH | Developing Countries | Africa, Northern | Africa | Pregnancy Outcomes | Pregnancy | Reproduction | Surgical Equipment | Equipment and Supplies | Health Facilities | Delivery of Health Care | Youth | Age Factors | Population Characteristics | Demographic Factors | Population Document Number: 159123 |
| 26. Title: The efficacy of intratubal silicone in the Ovabloc hysteroscopic method of sterilization. Author: Ligt-Veneman NG; Tinga DJ; Kragt H; Brandsma G; van der Leij G Source: Acta Obstetrica et Gynecologica Scandinavica. 1999 Sep;78(9):824-825. Abstract: Between 70–94% of the cases who opt for the procedure can undergo successful silicone instillation. (In our study: 83%). Different selection of women might explain the range. The expulsion rates at three months (3.4%) and one year followup (2.8%) are comparable with results in the literature: at three months: 3.6–6.3% at one year 2.8%. The total expulsion rate was 6.2%, comparable with 6.3% in the literature. In view of the numbers of expulsions that occurred before and after three months follow-up, it might be recommended to perform more frequent check-ups of the position of the silicone plugs. This should preferably be done by ultrasound instead of X-ray to reduce radiation exposure. The two pregnancies in our study should be considered as method failures. The pregnancy rate in our series was 0.99%. This is approximately the same as mentioned in studies which also used life table analyses, and almost the same as in Reed’s series mentioned by Loffer et al. After laparoscopic sterilization Peterson et al. found a pregnancy rate of 0.84% after 2 years and 1.85% after 5 years. (excerpt) Language: English Keywords: NETHERLANDS | RESEARCH REPORT | RETROSPECTIVE STUDIES | WOMEN | HYSTEROSCOPY | PLUGS | FEMALE STERILIZATION | PREGNANCY RATE | Europe, Western | Europe | Developed Countries | Studies | Research Methodology | Demographic Factors | Population | Endoscopy | Physical Examinations and Diagnoses | Examinations and Diagnoses | Surgical Equipment | Equipment and Supplies | Sterilization, Sexual | Family Planning | Fertility Measurements | Fertility | Population Dynamics Document Number: 194308 |
| 27. Title: Evaluation of low prophylactic forceps in pre term and low birth weight babies. Author: Srivastva M Source: JOURNAL OF OBSTETRICS, GYNAECOLOGY AND FAMILY WELFARE. 1999 Apr;5(20):25-30. Abstract: This study evaluates the use of prophylactic forceps for the delivery of preterm and low-birth-weight babies in India, specifically the relationship of forceps application and spontaneous delivery to neonatal morbidity and mortality. The sample included a total of 81 cases of preterm and low-birth-weight babies delivered by a prophylactic low forceps with wide episiotomy over a period of 5 years from January 1994 to December 1998. An equal number of such babies, delivered by normal spontaneous vaginal delivery, were studied as a control group. All these babies were investigated in relation to maturity, neonatal morbidity, and mortality. In the results, deliveries by prophylactic low forceps in preterm and low-birth-weight babies showed a better outcome than those delivered by normal spontaneous vaginal delivery. Fetal morbidity in the prophylactic low forceps group was 14.4% as compared to 27.7% in the control group. The incidence of fetal mortality was 3.7% in the forceps group as compared to 14.8% in the control group. Therefore, the use of prophylactic low forceps with preterm and low-birth-weight babies is recommended, if necessary, for a better fetal outcome. Language: English Keywords: INDIA | RESEARCH REPORT | CLINICAL RESEARCH | INFANT | MORBIDITY | NEONATAL MORTALITY | LOW BIRTH WEIGHT | PREMATURE BIRTH | CHILDBIRTH | FORCEPS | Asia, Southern | Asia | Developing Countries | Research Methodology | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Diseases | Infant Mortality | Mortality | Population Dynamics | Birth Weight | Body Weight | Physiology | Biology | Pregnancy Outcomes | Pregnancy | Reproduction | Surgical Equipment | Equipment and Supplies Document Number: 143397 |
| 28. Title: Comparison of the incision and aspiration methods for the diagnosis of placental malaria infection. Author: Sowunmi A; Abohweyere AE Source: Journal of Obstetrics and Gynaecology. 1996 Sep;16(5):[7] p.. Abstract: A safe and efficient method for obtaining blood smears for the diagnosis of placental malaria infection is required in order to reduce the risks associated with direct blood contact. We describe a simple and safe method of needle aspiration of the placenta for the diagnosis of placental malaria infection. The method was compared with the conventional incision method in 60 consecutive placentae obtained at term. The quality of the blood smears prepared with the methods were similar. There was a significant correlation between parasite counts from samples prepared with both the incision and aspiration methods. Altman-Bland analysis of the counts revealed narrow limits of agreement with an insignificant bias. The method is useful for obtaining blood smears from the placenta for the diagnosis of placental malaria infection and reducing contact with potential pathogens in blood. (excerpt) Language: English Keywords: NIGERIA | RESEARCH REPORT | CLINICAL RESEARCH | PREGNANT WOMEN | WOMEN IN DEVELOPMENT | MALARIA | LABORATORY EXAMINATIONS AND DIAGNOSES | BLOOD | MOTHER-TO-CHILD TRANSMISSION | MALARIA PREVENTION | HYGIENE | UTERINE ASPIRATOR | Africa, Western | Africa, Sub Saharan | Africa | Developing Countries | Research Methodology | Population Characteristics | Demographic Factors | Population | Economic Development | Economic Factors | Parasitic Diseases | Diseases | Examinations and Diagnoses | Hemic System | Physiology | Biology | Public Health | Health | Surgical Equipment | Equipment and Supplies Document Number: 193958 |
| 29. Title: A comparative study of two techniques used in immediate postplacental insertion (IPPI) of the Copper T-380A IUD in Shanghai, People's Republic of China. Author: Xu JX; Rivera R; Dunson TR; Zhuang LQ; Yang XL; Ma GT; Chi IC Source: CONTRACEPTION. 1996 Jul;54(1):33-8. Abstract: During October 1993 to October 1994, in Shanghai, China, 910 women who delivered vaginally at 13 medical centers and requested IUD contraception were randomly allocated to the group in which the TCu 380A was inserted by hand (470) or to the group in which it was inserted by ring forceps (440) within 10 minutes after delivery of the placenta. This was the first birth for 97.7% of the women. The 6-month follow-up rate was 95.2%. 3-month and 6-month expulsion rates as well as rates for medical and non-medical removals between the two insertion techniques were not significantly different (p > 0.05). For example, the 6-month gross cumulative expulsion rate was 13.3% for the hand-insertion group and 12.7% for the ring forceps-insertion group. The discontinuation rate for medical removals (e.g., bleeding, pain) was 2.1% for the hand-insertion group and 1% for the ring forceps-insertion group. The IUD expulsion rate was higher in non-breast feeding women than in breast-feeding women (22.4% vs. 11.9%; p < 0.05). No woman in either group suffered from uterine perforation or an infection. No woman conceived. In conclusion, the two different IUD insertion techniques do not have a significant influence on discontinuation rates in vaginal immediate postplacental insertion using the TCu 380A. Language: English Keywords: CHINA | RESEARCH REPORT | COMPARATIVE STUDIES | INSERTION | IUD, COPPER RELEASING | FORCEPS | POSTPARTUM WOMEN | PRIMIPARITY | IUD EXPULSION | CONTRACEPTION TERMINATION | BREASTFEEDING | CONTRACEPTIVE EFFECTIVENESS | Developing Countries | Asia, Eastern | Asia | Studies | Research Methodology | Treatment | IUD | Contraceptive Methods | Contraception | Family Planning | Surgical Equipment | Equipment and Supplies | Puerperium | Reproduction | Parity | Fertility Measurements | Fertility | Population Dynamics | Demographic Factors | Population | Infant Nutrition | Nutrition | Health Document Number: 114700 |
| 30. Title: Safe laparoscopic surgery: tubal ligation without prior pneumoperitoneum. Author: Biojo RG; Manzi GB Source: SURGICAL LAPAROSCOPY AND ENDOSCOPY. 1995 Apr;5(2):105-10. Abstract: Experience with 136,627 laparoscopic tubal ligations performed at the Profamilia Centers in Bogota and Cali, Colombia, in 1981 and 1982 was reviewed to identify strategies for the prevention of intra-abdominal injuries. The surgery involved direct insertion of the trocars without previous pneumoperitoneum. During the study period, 15 complications (0.01%) amenable to correction by surgery were recorded. These included 3 vascular injuries, 4 visceral injuries, 5 cases with wall bleeding and subsequent hematoma formation, and 3 cases of major wall incision infection. Since introduction of the infraumbilical approach to trocar introduction, the incidence of incisional hernias has dropped to 1 case per 6000 laparoscopies. In previous studies of the laparoscopic technique, most complications have been associated with difficulties with trocar introduction, false routes in the abdominal wall, pneumo in the abdominal wall, and hematomas. The present series suggests that direct insertion of the trocars is highly safe. The risk of visceral or vascular injuries can be reduced even further by clamping of the relaxed abdominal anterior wall with towel clips, maintaining sharpened trocars, and using the extended index finger as a limit to introduce only the tip of the trocars. The technique is contraindicated, however, in women with a history of previous laparotomy, secondary to peritonitis, open abdominal treatment, and acute pelvic inflammatory disease. Language: English Keywords: COLOMBIA | RESEARCH REPORT | CLINICAL RESEARCH | LAPAROSCOPY | TUBAL LIGATION | TROCAR | COMPLICATIONS | TUBAL OCCLUSION | South America, Northern | South America | Latin America | Americas | Developing Countries | Research Methodology | Endoscopy | Physical Examinations and Diagnoses | Examinations and Diagnoses | Female Sterilization | Sterilization, Sexual | Family Planning | Surgical Equipment | Equipment and Supplies | Diseases Document Number: 108343 |
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