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Bilateral Ligation of the Anterior Branch of the Hypogastric Artery in Massive Obstetric Hemorrhage Secondary to Septic Abortion (Case Report)
Angel Millan Juarez,
Carla America Suarez Juarez,
Ana Elena Barrios Herandez,
Ithamar Milagros Arroyo Martinez,
Elizabeth Rendon Mondragon
Issue:
Volume 9, Issue 3, May 2021
Pages:
54-58
Received:
6 April 2021
Accepted:
19 April 2021
Published:
8 May 2021
Abstract: Hemorrhage is the main cause of Maternal Mortality (MM) (27%) followed by hypertensive disorders and sepsis (12%). Septic abortion is considered an intermediate risk factor for the development of Massive Obstetric Hemorrhage (MOH). The algorithm for the management of postpartum hemorrhage due to uterine atony that includes systematic pelvic devascularization has been described, but this management is really planned for resolution of the pregnancy after the 20th week of gestation, since an HMO due to abortion is un usual. We present the case of a 21-year-old patient who self-medicates a prostaglandin analog at 2 months of pregnancy, achieving only a threat of abortion, goes to the emergency room 3 months later with a diagnosis of septic shock, USG and MRI are performed with altered results, only of hepatomegaly, delayed abortion of 8 weeks of evolution and gestational trophoblastic disease. Emergency MVA was performed due to profuse bleeding, placement of a Bakri balloon and clamping of the uterine arteries without results, for which an emergency exploratory laparotomy (LAPE) was performed with ligation of the anterior trunk of the internal iliac artery, being a successful procedure, without the need for Obstetric Hysterectomy (HO). The patient is managed in intensive care and in the end the diagnosis of TSG is ruled out. Bilateral Hypogastric Artery Ligation (BHAL) in the case of Massive Obstetric Hemorrhage (MOH) secondary to delivery or cesarean section is commonly used, however it is not a technique to report when bleeding is secondary to abortion. In these cases, it is also a viable, successful, fertility-preserving surgical procedure, and an alternative to Obstetric Hysterectomy (OH) when other less invasive methods such as uterine artery clamping or Bakri balloon have failed.
Abstract: Hemorrhage is the main cause of Maternal Mortality (MM) (27%) followed by hypertensive disorders and sepsis (12%). Septic abortion is considered an intermediate risk factor for the development of Massive Obstetric Hemorrhage (MOH). The algorithm for the management of postpartum hemorrhage due to uterine atony that includes systematic pelvic devascu...
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Antenatal Screening for Syphilis: Ten Years of Observation Amongst Pregnant Women Receiving Care at the Maternity Units of the Province of Trento in Northern Italy
Silvano Piffer,
Mariangela Pedron,
Anna Lina Lauriola,
Roberto Rizzello
Issue:
Volume 9, Issue 3, May 2021
Pages:
59-65
Received:
26 April 2021
Accepted:
12 May 2021
Published:
21 May 2021
Abstract: Introduction. Serology screening for syphilis infection in pregnancy is an internationally recommended practice. For some time, in the province of Trento (northern Italy), data regarding antenatal serology screening for syphilis have been acquired through the birth assistance certificate, whose completion by the healthcare professionals providing assistance at birth is mandatory in Italy. This study describes the coverage of serology screening and the seroprevalence of syphilis infection amongst pregnant women receiving care in the maternity facilities of the province of Trento between 2008 and 2017. Materials and methods. The results of serological screening are recorded in the electronic birth assistance certificate as: test not performed; negative test, positive test, or results pending. In cases of a positive test or results pending, the Authors consulted the hospital information system (SIO), an electronic repository containing data regarding all services provided to users of the Provincial Health Service. This operation also made it possible to recover full data regarding the serological profile, any treatments administered and the obstetric/neonatal outcomes. The Authors calculated screening coverage, the seroprevalence of the infection and the occurrence of cases of congenital syphilis, by analysing the neonates’ health status for the first two years of life. Results. Between 01.01.2008 and 31.12.2017, 46,627 pregnant women received care at maternity units of the province of Trento. Screening coverage was found to be higher than 99%. A total of 95 pregnant women were found to be true positives at serology screening for syphilis (15 Italian nationals and 80 foreign women). Seroprevalence for all pregnant women was 2/1000 (0.4/1000 amongst Italian women and 6.8/1000 amongst foreign women). Amongst the latter, the highest value was observed amongst women originating from Eastern European countries (9.3/1000). 62% of positive cases were identified as prior, already treated syphilis and 38% were identified as an early or late latent infection. Antibiotic therapy with penicillin was prescribed in all cases for which it was indicated. No considerable differences were observed with regard to the obstetric/neonatal outcomes between seropositive ad seronegative women. No cases of congenital syphilis were observed. Conclusions. Screening coverage concerned almost all the pregnant women who received care. The seroprevalence calculated in this study was consistent with the available Italian and European data. Our findings confirmed that there is a higher proportion of cases amongst the foreign population, especially amongst women from Eastern European countries, who nevertheless have an antenatal care profile not unlike that of seronegative women.
Abstract: Introduction. Serology screening for syphilis infection in pregnancy is an internationally recommended practice. For some time, in the province of Trento (northern Italy), data regarding antenatal serology screening for syphilis have been acquired through the birth assistance certificate, whose completion by the healthcare professionals providing a...
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Client Satisfaction in the Quality of Post Abortion Care Among Women Attending in Public Health Facility of Gambella, Ethiopia
Ephrem Teshome,
Girmay Adhena
Issue:
Volume 9, Issue 3, May 2021
Pages:
66-74
Received:
29 March 2021
Accepted:
28 May 2021
Published:
16 June 2021
Abstract: Background: The quality of post-abortion care services is essential to improve the health of women who experience complications from abortion. Abortion and its complication is the most common cause of maternal death in Africa, particularly in Ethiopia. Despite this fact, little attention is given to the quality of post-abortion care. This study was aimed to assess client satisfaction in the quality of post-abortion care among women in the public health facility of Gambella, Ethiopia. Methods: A facility-based crossectional study was done among 194 participants. A consecutive sampling technique was used to select the study participants. A structured, pretested, and interviewer-administered questioner was used to collecting the data. Binary and multivariable logistic regression analysis was done to identify associated factors. An adjusted odds ratio with 95% CI was used to estimate the direction and strength of the association. Variable with a p-value <0.05 was considered as statistically significant. Results: About 169 (87.1%, 95% CI: (82, 91.8)) participants were satisfied in the quality of post abortion care (PAC) services. Unwanted pregnancy [AOR=1.8, 95% CI: (1.17, 10.9)], history of abortion [2.1, 95% CI: (1.6, 13.8)], assisted by physician [AOR=3.9 95% CI: (1.6, 8.6)], treated politely and respectfully [AOR=6.3, 95% CI: (1.82, 22.2)], the provider adress all questions raised by the client [AOR=5.1, 95% CI: (1.9, 14.5)] were significantly associated factors. Conclusion: The majority of the study participants were satisfied with the quality of post-abortion care services. Enhancing patient care in the facility, strengthening awareness of family planning services, and addressing the questions of the clients in a respected manner are important measures that increase client satisfaction.
Abstract: Background: The quality of post-abortion care services is essential to improve the health of women who experience complications from abortion. Abortion and its complication is the most common cause of maternal death in Africa, particularly in Ethiopia. Despite this fact, little attention is given to the quality of post-abortion care. This study was...
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New Hysterectomy Technique with Correction of Stress Urinary Incontinence, and Mixed Urinary Incontinence
Issue:
Volume 9, Issue 3, May 2021
Pages:
75-78
Received:
21 May 2021
Accepted:
16 June 2021
Published:
22 June 2021
Abstract: Statistically, 50% or more of the patients who are going to be hysterectomized have stress, urgency and mixed urinary incontinence, a problem that, when presenting significantly high figures in its epidemiology, requires finding a treatment that promises a cure for this pathology, since it represents not only a global public health problem for women, but also a global burden, for example, in the US for the treatment of urinary incontinence there has been an annual expenditure of more than 26 billion dollars. This article provides evidence that allows proposing the Hysterectomy + cysto-urethro-colpus suspension surgical technique - SYCFIM, as a treatment for stress and mixed urinary incontinence. A study was carried out with 6 patients with uterine pathology associated with urinary incontinence. A pre-surgical urodynamics were performed, finding one patient with stress incontinence and five patients with mixed incontinence. At the postoperative control appointments at two weeks and two months, the patients reported the disappearance of incontinence. And at two years and five months, they continued without urinary incontinence in 100% of the cases. The results of the urodynamics performed at two years and five months, demonstrated the disappearance of stress incontinence in 100% and mixed in 100%, thus confirming that the SYCFIM technique works as a treatment for stress and mixed urinary incontinence.
Abstract: Statistically, 50% or more of the patients who are going to be hysterectomized have stress, urgency and mixed urinary incontinence, a problem that, when presenting significantly high figures in its epidemiology, requires finding a treatment that promises a cure for this pathology, since it represents not only a global public health problem for wome...
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Investigation and Analysis of the Information Available for Pregnant and Lactating Women in 308 Antipsychotic Package Inserts
Xiaoru Yang,
Jufeng Li,
Jieyi Zhou,
Xiaofei Feng,
Jiawen Huang
Issue:
Volume 9, Issue 3, May 2021
Pages:
79-83
Received:
8 June 2021
Accepted:
18 June 2021
Published:
25 June 2021
Abstract: Background: Package insert is an important tool to provide safe and reasonable guidance for pregnant and lactating women. Methods: The information on pregnant women in 308 package inserts of 38 kinds of antipsychotics on the market was analyzed. Results: 287 (93.18%) package inserts in the 308 antipsychotics provide drug use guiding information for pregnant women, while 150 (48.70%) of them made it clear that the drug could be used normally, cautiously or forbidden on pregnant women. 137 (44.48%) of them used different expressions. There were 64 (20.78%) instructions that made it clear that the drug could be used normally, cautiously or forbidden on lactation women. 81 (26.30%) instructions are recommended to stop breastfeeding. 142 (46.10%) instructions for breastfeeding women used different expressions. Contradictions were found in 23.53% drugs for pregnant women and 29.41% for lactation women. Conclusion: There are some problems with drug information on pregnant women in package inserts，such as inadequate information and inaccurate description. To ensure safer use, the package inserts of medicines should be further improved.
Abstract: Background: Package insert is an important tool to provide safe and reasonable guidance for pregnant and lactating women. Methods: The information on pregnant women in 308 package inserts of 38 kinds of antipsychotics on the market was analyzed. Results: 287 (93.18%) package inserts in the 308 antipsychotics provide drug use guiding information for...
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Incidence, Presentation, Characteristics and Short Term Outcomes of Hospitalized Pregnant Women Confirmed SARS-COV-2 Positive
Maheen Irshad,
Luna Nasry,
Ala Addin Sid Ahmed,
Lana Abdole,
Federico Mariona
Issue:
Volume 9, Issue 3, May 2021
Pages:
84-91
Received:
19 May 2021
Accepted:
19 June 2021
Published:
28 June 2021
Abstract: To report the incidence, presentation, characteristics and outcomes of a cohort of hospitalized pregnant women who had tested positive for SARS-2, whether or not they had demonstrated signs of Coronavirus Disease-19 (2019-nCov, or Covid-19, ICD-10 U07.1). Material and Methods. The study includes pregnant women, 18 years old and older, who were hospitalized for evaluation or delivery and who had tested positive for SARS-CoV-2 via NP sampling. All were followed by RT PCR and NAA determination between March and December of 2020. Universal testing for SARS-CoV-2 was used throughout the study period. Maternal history and physical screening were conducted upon admission to detect any of the known variables of Covid-19, such as: fatigue, fever (38 C), shortness of breath, and cough. Chest imaging was obtained when indicated. The screening process included domestic or international travel. Additional information collected on 100% of the patients included: maternal ethnicity, body mass index, and 5-digit zip code of maternal residence. Neonates (NN) from SARS-2 positive mothers at delivery admission were tested following the Neonatology service protocol, at age 24 and 48 hours. Additional testing was performed prior to NN discharge when indicated. Results. Of the 3,109 pregnant women who were hospitalized and tested during the study period, 4.3% were reported SARS-2 positive. Of these patients, 13.6% were symptomatic for Covid-19 upon admission; 54% showed a comorbidity; 61% were obese; and one patient needed mechanical ventilation. Table 1 summarizes the cohort characteristics. Table 2 shows the characteristics of the symptomatic women and their clinical course. Conclusion. Our report describes a pregnant patient cohort that had experienced mild to moderate Covid-19 disease. Conflicting studies postulated that pregnant women exposed to SARS-CoV-2 may suffer more serious adverse effects than their non-pregnant counterparts. In view of the wide spectrum of clinical events and the variable severity reported in association with Covid-19 in pregnancy, we believe that quality big data would be beneficial. We therefore recommend strict identification of maternal ethnicity, comorbidities, timing, acuity and severity of the disease. Moreover, health care culture with accurate harmonization of clinical findings and treatments via widespread collaborative efforts, with timely reporting, may assist in understanding the variable pathophysiology of the novel SARS-CoV-2, including its variants, and their conflicting effects on pregnancy.
Abstract: To report the incidence, presentation, characteristics and outcomes of a cohort of hospitalized pregnant women who had tested positive for SARS-2, whether or not they had demonstrated signs of Coronavirus Disease-19 (2019-nCov, or Covid-19, ICD-10 U07.1). Material and Methods. The study includes pregnant women, 18 years old and older, who were hosp...
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Pattern and Clinical Presentation of Endometriosis Among the Indigenous Africans
Joseph Wanyoike Gichuhi,
Julius Ogengo,
Peter Gichangi
Issue:
Volume 9, Issue 3, May 2021
Pages:
92-99
Received:
31 May 2021
Accepted:
15 June 2021
Published:
28 June 2021
Abstract: Background: Endometriosis is enigmatic clinical entity which is described as the existence of the endometrial tissue external of the uterine cavity. Endometriosis constitutes a serious health issue due to its high affliction of 10% in reproductive age women and its clinical manifestation of infertility and chronic pelvic pain. Despite of years of research, the causative factor and understanding of ambidextrous endometriosis pathology remains elusive, perplex and disconnected. Worldwide, there is clear documentation of prevalence of endometriosis in the development countries, however, the prevalence of endometriosis in most of black Africa is unknown. The current perspective is that indigenous African are rarely affected by endometriosis. Objective: To determine the prevalence, pattern and clinical presentation of endometriosis in indigenous African women with the primary outcome measure being the prevalence of laparoscopic visually diagnosed, histologically confirmed endometriosis and clinical presentation. Methodology: This was a prospective analytical cross-selection study in 2 hospitals in Nairobi city, Kenya. The sample size was 443 women and the duration of the study was from March 2018 to March 2021. The inclusion criteria was women aged at least 18 years up to 49 years undergoing laparoscopic surgery and willing to take part in the study. The patient’s history, clinical and laparoscopic findings and histological diagnosis were recorded and analysed using Social SPSS version 22.0. Results: The mean age of the 443 patients recruited was 33 years. The prevalence of histological confirmed endometriosis in indigenous Africans was 6.8%. Laparoscopic visualization diagnosis had a positive predictive value of 39%. Dysmenorrhoea, chronic pelvic pain scale 8-10 and dyspareunia were significant symptoms of endometriosis P<0.001. Nulliparous patients significantly had a risk of having endometriosis p<0.001. The patients with menarche at 13 years and below had a significant risk of having endometriosis p=0.001. Physical findings on clinical examination of adnexal tenderness and findings of nodules in the pouch of Douglas were significant in relation to endometriosis p<0.001. The most common site of the histological endometriosis implants were on the Pouch of Douglas (30%) and the most common form of endometriosis was superficial (43%). Conclusion: The prevalence of endometriosis in Indigenous Africa is 6.8%. Laparoscopic visualization diagnosis had low a positive predictive value of 39%. Nulliparity, menarche at the age of 13 and below, dysmenorrhoea, chronic pelvic pain scale 8-10 and dyspareunia were significantly associated with endometriosis. The most common site for endometriosis is the of Pouch of Douglas whilst the most common form of endometriosis was superficial.
Abstract: Background: Endometriosis is enigmatic clinical entity which is described as the existence of the endometrial tissue external of the uterine cavity. Endometriosis constitutes a serious health issue due to its high affliction of 10% in reproductive age women and its clinical manifestation of infertility and chronic pelvic pain. Despite of years of r...
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