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PubMed1998

Traditional birth attendants and their practices in the State of Pernambuco rural area, Brazil, 1996.

OBJECTIVE: To obtain socioeconomic information about TBAs in the State of Pernambuco and information concerning their practices. METHOD: Statistical analysis of the answers to structured questionnaires applied to 127 TBAs. RESULTS: The results of a survey with 127 TBAs conducted in the rural area of the State of Pernambuco (Brazil) is presented in this paper. TBAs in rural Pernambuco are a group of basically old and very poor and uneducated women. Most of them learned to attend births by themselves or by helping another TBA. Thirty percent learned midwifery in hospital delivery rooms, helping doctors and nurses. How the TBAs learned to help births seemed to be the most influential factor on the kind of practices they use. TBAs who learned from other TBAs from the community seem to have the least interventionist approach, followed by the TBAs who learned by themselves. They are more likely to perform more home births and avoid practices such as shaving the pubic hair, vaginal exams, artificial rupture of the membranes, episiotomy and early cord clamping. CONCLUSION: The way women learned midwifery is the most important determinant of their practice.

Adult↗
PubMed2004

Personal digital assistants used to document compliance of bacterial vaginosis treatment.

OBJECTIVE: The objective of this study was to estimate patient compliance with oral and vaginal metronidazole treatment of bacterial vaginosis using personal digital assistants (PDAs) and paper diaries. GOAL: The goal of this study was to assess a novel compliance documentation approach. STUDY: After each dose of intravaginal or oral metronidazole, 71 subjects recorded the time on a paper diary and answered questions on a PDA. All PDA entries were unknowingly time-date-stamped. Subjects returned for 2- and 6-week posttreatment examinations. Compliance was calculated using a repeated-measures multivariate analysis of variance (ANOVA). RESULTS: Mean patient compliance rates within the oral metronidazole group were greater with the paper diary compared with the PDA (68.3% and 50.0%, respectively, P = 0.001). The observed rate of compliance agreement for PDA versus paper diary was 69.0% (kappa = 0.4). The majority of noncompliant subjects reported they were compliant with the PDA and paper diary. CONCLUSIONS: PDAs could more accurately document true compliance rates and could be reasonable instruments to assess compliance in intravaginal antimicrobial drug or contraceptive trials.

Administration, Intravaginal↗
PubMed1994

Genetic modification of a vaginal strain of Lactobacillus fermentum and its maintenance within the reproductive tract after intravaginal administration.

Many micro-organisms cause important diseases of the female genital tract. Because systematic vaccination does not usually provide a good immune response at mucosal sites, commensal lactobacilli from the female genital tract were developed as vehicles to deliver continued doses of foreign antigen directly to the genital mucosal surface with the aim of stimulating strong local mucosal immune responses. Lactobacilli were shown to be common inhabitants of the genital tract of the animal model studied, the guinea-pig. One species, Lactobacillus fermentum, was found in all guinea-pigs studied and was chosen for genetic manipulation. Improved methods of electroporation were developed to enable the routine transformation of L. fermentum BR11 strain with the broad host range plasmid pNZ17. This recombinantly modified Lactobacillus strain was shown to possess good segregational stability over 120 generations in the absence of antibiotic selection. When this recombinant L. fermentum strain was administered to the vaginal tract of three guinea-pigs it persisted for only 5 days. Despite the relatively short period of persistence in these initial experiments, this novel vaccine approach could provide an effective means of stimulating mucosal immunity in the female genital tract.

Animals↗
PubMed1990

Menorrhagia.

Excessive vaginal bleeding, or menorrhagia, is one of the most common presenting symptoms for gynecologic patients. Although this disorder has many possible etiologies, it is generally possible to approach its diagnosis and management in an orderly fashion. When evaluating the menorrhagic patient, it important to gear the work-up toward a differential diagnosis that includes pregnancy-related causes, hormonal problems, iatrogenic etiologies, mechanical intrauterine disorders, infections of the lower genital tract, and gynecologic cancers (PHIMIC). This differential approach can guide the types of historical data obtained from the patient, focus the physical examination, and alert the practitioner to the most appropriate laboratory and radiologic evaluation. Therapy can differ widely, depending on the cause of the bleeding. Most types of menorrhagia respond to medical therapy with oral contraceptives, oral synthetic estrogens or progestins, and long-acting intramuscular progestins or GnRH agonists. Surgical approaches, such as dilatation and curettage or hysterectomy, are less and less a first-line therapy; but innovative surgical techniques such as hysteroscopy and laparoscopic surgery are becoming increasingly important. With rapid, goal-directed diagnosis and specific therapy, the medical complications, anxiety, and discomfort suffered by the woman with menorrhagia can be alleviated quickly.

Female↗
PubMed1989

Premenstrual syndrome: current knowledge and management.

Premenstrual syndrome (PMS) has become a popular self-diagnosis. Faulty research has led to confusion about the diagnosis, epidemiologic features, causes and treatment of this disorder. There is no proof that the premenstrual period is a time of increased violence. An association between menstrually related mood disorders and other psychiatric illness is also unproven. Despite many theories no definitive cause of PMS has been established, and controlled studies of various treatments have failed to find a universally effective approach. Conservative measures involving support, diet and exercise seem to help in most cases. The use of alprazolam and mefenamic acid may help some women. Rectal or vaginal progesterone therapy has been proven ineffective and should not be used.

Adult↗
PubMed1977

[Therapy of bilateral lesions of the ureter during or after surgery for gynecologic carcinoma].

Special conditions for plastic surgery on the upper urinary tract in cases of gynaecological radical hysterectomy are discussed in conjunction with one case of bilateral ureteral injury inflicted during the operation and one case of postoperative bilateral ureterovaginal fistulas. Today, Boari grafting is preferred rather than direct implantation. Oblique submucous canalisation (antireflux effect) in unnecessary in most cases. Two-stage operations would provide a better protection of the bladder than one-stage restorative treatment. In emergency cases unilateral nephrostomy or ureterostomy in situ may be considered as interim solution. Transperitoneal access is necessary only in cases of injury during operation or when a one-stage plastic operation has to be carried out. For subsequent reconstructive operations performed in two stages we would prefer the extraperitoneal approach.

Female↗
PubMedDate not supplied

Evaluation of two AIDS prevention interventions for inner-city adolescent and young adult women.

Two hundred and fourteen young women received acquired immunodeficiency syndrome (AIDS) prevention interventions at an inner-city family health center serving minority patients predominantly. The community in which the health center is located has a high incidence of intravenous (IV) drug abuse. Either a peer or a health care provider delivered the intervention. In the peer-delivered intervention, a trained peer educator reviewed with patients an AIDS "Rap" videotape and several AIDS brochures, which imparted information about human immunodeficiency virus (HIV), its transmission, and prevention. In the provider-delivered intervention, family practice residents, attending physicians, and nurse practitioners used a patient-centered counseling approach to convey the same information. Questionnaires administered immediately before and after the intervention and at one month follow-up evaluated changes in knowledge, attitudes, and behavior. Analyses of data from both combined intervention groups revealed significant improvements in several areas of knowledge, including the effectiveness of using a condom and cleaning IV drug implements with bleach to prevent transmission of HIV. Many improvements were retained at the one-month follow-up. In addition, subjects in both groups who were sexually active stated immediately after the intervention that asking a sexual partner about past sexual experience would now be less difficult, and at one-month follow-up they reported a significant decrease in the frequency of vaginal sex. Our findings suggest that counseling by physicians can achieve more changes in knowledge of sexual risks, whereas peer education can achieve greater changes in knowledge about IV drug use. Results show that both approaches to AIDS prevention used in this study can significantly affect knowledge, attitudes, and sexual behavior.

Acquired Immunodeficiency Syndrome↗
PubMed1993

Laparoscopic supracervical (subtotal) hysterectomy (LASH).

The use of laparoscopically assisted vaginal hysterectomy with or without annexectomy has been widely discussed. We report the technique of laparoscopic supracervical (subtotal) hysterectomy (LASH), which was first performed in 1990. Laparoscopic supracervical hysterectomy was carried out in a series of 36 women. The duration time was 60 min in experienced hands. There were no major complications. The feasibility and low morbidity rate of this laparoscopic approach led us to propose LASH in certain indications, particularly in cases of a uterus with multiple submucosal myomas where hysteroscopic therapy is less successful.

Adult↗
PubMed2004

Sacro-spinous ligament fixation peri-operative complications in 195 cases: visual approach versus digital approach of the sacro-spinous ligament.

OBJECTIVE: To evaluate sacro-spinous ligament fixation (SLF) peri-operative complications. STUDY DESIGN: Monocentric, retrospective study. Department of Gynecology, SIHCUS-CMCO, University Hospital, Strasbourg, France. Between January 1990 and December 2000, 195 women, mean age 63.2 years old (40-90), underwent a vaginal SLF. Ninety point eight percent of women were post-menopaused and 27.9% of these had a hormonal substitution. About 24% of patients had prior hysterectomy, 20% vaginal prolapse repair and 22% urinary stress incontinence repair. SLF was performed in 1.5% of cases without any other procedures and it was combined with the following: rectocele and elytrocele repair in 89.2%, hysterectomy in 72.3%, cystocele repair in 52.8% and stress incontinence repair in 15.3% of cases. In 107 cases, the SLF attachment was placed under digital control and in 88 cases under visual control. RESULTS: The mean hospitalisation stay was of 8.5 +/- 2.6 days (4-26). About 41% of women presented a complication. Major complications were represented by 3.6% of bladder injury, 0.5% of uretero-vaginal fistula, 0.5% of vascular injuries, 0.5% of thromboembolic events. In 38% of cases patients had minor complications: urinary tract infections (29%), temporary urinary retention (5.6%), local complications (4.5%), and other complications (3%). The only specific SLF complication in this data was a vascular injury and in this case the SLF was performed under digital control. CONCLUSIONS: The global peri-operative complication frequency of SLF is high. It is mainly represented by non-specific complications, secondary to the combined procedures and not to the SLF itself. The specific complications due to SLF, all of which are major ones, can be avoided or diagnosed earlier, by using the visual approach technique.

Adult↗
PubMed2003

Gestation-related malignant musculoskeletal tumors.

BACKGROUND: The incidence of malignant musculoskeletal tumors during pregnancy is very low. The paucity of data precludes the drawing of solid conclusions regarding a standard approach. OBJECTIVES: To summarize our experience treating 13 pregnant women with malignant soft tissue or bone tumors. METHODS: We conducted a retrospective analysis of 13 cases of patients with either soft tissue or bone sarcoma that developed or progressed during pregnancy or immediately after delivery. RESULTS: The clinical presentation of the tumors was a growing mass and/or increasing pain and disability. Most of the masses were located in the lower part of the body and were of considerable size. Treatment given during gestation was limited to wide excision of the mass in the 28th week of gestation in one patient. All the patients reported disease progression during gestation. Vaginal delivery was possible in eight patients with no complications, cesarean section was carried out in three women, spontaneous miscarriage occurred in one and termination of pregnancy was performed in one patient. CONCLUSIONS: The diagnostic and therapeutic approaches should be tailored specifically in every pregnant woman in whom sarcoma is suspected.

Adult↗
PubMed2006

A descriptive account of New Zealand mothers' responses to open-ended questions on their breast feeding experiences.

OBJECTIVE: To describe the breast feeding experiences of mothers in New Zealand. DESIGN: Descriptive, qualitative study. After a previous quantitative analysis of a questionnaire, the open-ended responses by the women were examined using a thematic analysis approach. SETTING: Hawke's Bay, New Zealand. PARTICIPANTS: 153 primiparous and multiparous breast feeding women aged between 20 and 49 years, who had had a caesarean section or vaginal birth between 4 months and 3 years previously. FINDINGS: Themes identified during the data analysis are as follows: persistence, determination, confidence and satisfaction; pain and limitation of mothering activities; conflicting advice and professionalism; and others' expectations. CONCLUSIONS: Breast feeding experience could be detrimentally affected by physical factors, inconsistent health-professional support and others' expectations. Negative influences, however, were likely to be overcome by persistence, determination, confidence and satisfaction. IMPLICATIONS FOR PRACTICE: Implications for midwifery practice from the study iterate the importance of consistency of advice and skills of health professionals, of listening and understanding women's responses to early breast feeding assistance and giving continuous encouragement and support throughout their breast feeding experience. To meet these recommendations, breast feeding education for health professionals needs to include technical expertise and communication skills. Recommendations for further research from this study include investigations into why women commit to breast feeding and an exploration of women's perceptions of midwives' breast feeding support.

Adult↗
PubMed1998

Diagnosis and current management of penile agenesis.

Penile agenesis is a rare congenital anomaly in which early gender reassignment is recommended. In the past, multiple operations were carried out to form feminized external genitalia. The authors performed a definite genital reconstruction in a neonate using the posterior sagittal approach. Preoperatively, a magnetic resonance imaging (MRI) scan demonstrated erectile tissue, which was preserved and incorporated into the genital plasty. The operation included bilateral orchiectomy, urethral reconstruction, sigmoid vaginal replacement, and formation of the labia. The authors discuss the controversy around gender assessment. They emphasize the urethral hypotrophy to be a main challenge in this anomaly and conclude that immediate complete reconstruction is possible and should be performed in patients with this delicate condition.

Congenital Abnormalities↗
PubMed2002

Total laparoscopic radical hysterectomy using Lee-Huang portal and McCartney transvaginal tube.

A surgical approach to the treatment of invasive cervical carcinoma 1b1 may result in decreased mortality and morbidity as well as better functional quality of life. Laparoscopic-assisted radical vaginal hysterectomy (LARVH) is an alternative treatment for early cervical cancer, with parts of the procedures performed vaginally. We modified LARVH to total laparoscopic radical hysterectomy (TLRH) using Lee-Huang portal and McCartney transvaginal tube. The advantage of TLRH for cervical cancer is that the entire procedure is performed under direct observation. It may reduce the possibility of visceral organ injury during vaginal procedures and could minimize vaginal bleeding due to dissection. The Lee-Huang portal as primary laparoscopic port affords wide access to the abdominal cavity and proper visual angle, and increases the working distance. A plastic McCartney transvaginal tube placed inside the vagina maintains pneumoperitoneum and performs a circular incision on the vagina around the uterus with ease. Our preliminary experience with 12 patients suggests that this method of TLRH is feasible for selected patients and may be a useful alternative in treating early cervical cancer.

Biopsy, Needle↗
PubMed2001

Assessment and grading of pelvic organ prolapse by use of dynamic magnetic resonance imaging.

OBJECTIVE: Our purpose was to assess and compare a new technique of grading pelvic organ prolapse by using dynamic magnetic resonance imaging with the clinical staging proposed by the International Continence Society. STUDY DESIGN: In a cross-sectional study, 20 patients with pelvic organ prolapse underwent dynamic magnetic resonance imaging. Clinical staging (according to the International Continence Society) was compared with staging by magnetic resonance imaging. A new reference line, the midpubic line, was drawn on the magnetic resonance image to correspond to the hymenal ring marker used in the clinical staging. The levator-vaginal angle and the area of the genital hiatus were measured to indicate vaginal supports. Ten nulliparous, symptom-free women were studied as control subjects. RESULTS: The proposed staging by magnetic resonance imaging showed good correlation with the clinical staging (kappa = 0.61). Magnetic resonance imaging improved clinical assessment by its ability to measure the actual pelvic organ descent and to delineate prolapse of the pouch of Douglas accurately. The midpubic line was a useful reference line for grading prolapse on magnetic resonance imaging. The levator-vaginal angle and the area of the genital hiatus are useful in assessing vaginal support at different anatomic levels. CONCLUSIONS: This new method of grading by magnetic resonance imaging uses the same landmarks as the clinical grading, and this uniformity of approach allows an objective assessment of the results of surgical correction of pelvic organ prolapse.

Adult↗
PubMed1997

Laparoscopic assisted vaginal hysterectomy in obese women.

Twenty-two consecutive patients weighing 100 kg or more and requiring hysterectomy were treated by laparoscopic assisted vaginal hysterectomy. The mean patient weight was 105.2 kg. In 21 patients, the indication for hysterectomy was menorrhagia (9 of these had uterine fibroids) and one patient had microinvasive carcinoma of the cervix. Mean operating time was 1 hr. 53 mins; and mean hospital stay was 4.5 days. One patient (4.5%) had intraoperative injury to the interior epigastric vessels. One patient who had anterior colporrhaphy at the same time suffered transient urinary retention which resolved after one week. There were no major or long term complications. Our experience suggests that laparoscopic assisted vaginal hysterectomy is a feasible and safe option in obese patients. The low complication rate may be due, in part, to improved access through the use of this approach.

Journal Article↗
PubMed2000

Pathogenesis and management of recurrent urinary tract infection in women.

A number of pathogenic factors for the development of recurrent urinary tract infection, such as prolonged vaginal colonization with uropathogenic Escherichia coli, nonsecretion of ABH blood-group antigens, impaired local immune response, oestrogen deficiency in postmenopausal women and altered vaginal milieu caused by the use of contraceptives, are involved. Long-term use of antimicrobial agents is the cornerstone of prevention of recurrent urinary tract infection. Other approaches currently used involve self-start (on demand) therapy, oestrogen replacement in postmenopausal women, behavioural changes and alternative therapies, such as acupuncture.

Acupuncture Therapy↗
PubMed2004

Hemorrhagic complications associated with tension-free vaginal tape procedure.

OBJECTIVE: We sought to assess the frequency, symptoms, and management of hemorrhagic complications in patients undergoing tension-free vaginal tape (TVT) procedure. METHODS: Over a 5-year period the clinical course of all 336 consecutive patients undergoing TVT procedure in our hospital was recorded, including diagnostic approaches and management strategies for both increased intraoperative blood loss and clinically relevant hematoma. RESULTS: In 87 patients (26%), TVT procedure was combined with other gynecologic surgeries, and 249 patients (74%) underwent TVT alone. In 7 cases (2.1%), increased intraoperative blood loss (250-400 mL) was managed by electro-coagulation, manual compression, tamponade, and/or insertion of a drain. The postoperative course in these patients was uncomplicated. In 14 women (4.1%) who did not show increased bleeding during the operation, retropubic hematoma developed, the volume of which exceeded 300 mL in 4 cases (1.2%). These required surgical intervention. In the first case we performed open laparotomy, whereas in the following cases the hematoma could be successfully drained by endoscopy. Postoperative development of a hematoma did not lead to recurrence of stress incontinence. CONCLUSION: Bleeding complications during or after TVT procedure are rare events. Increased intraoperative bleeding can usually be managed with electro-coagulation, compression, and drainage. LEVEL OF EVIDENCE: II-3.

Adult↗