Menstrual Disorders in Nongenital Tuberculosis

Menstrual patterns differ even in nongenital tuberculosis. Our objective is to determine whether nongenital tuberculosis makes menstrual dysfunction, before and sustain after treatment. Menstrual patterns were compared in women with pulmonary or extrapulmonary but nongenital tuberculosis with healthy nursing students and also with themselves, before and after treatment in a retrospective cohort study. Subjects were selected by convenient nonrandomized sampling but control groups were selected by random allocation among volunteers of nursing students. Case and control subjects were matched in age group. Menstrual patterns including amount, duration, interval, cessation of period, any menstrual irregularity, and pelvic pain were evaluated. Among 100 cases of proven tuberculosis, 90 patients had pulmonary and 10 cases had extrapulmonary tuberculosis. Secondary amenorrhea (P ≤ .001, RR: 22), spotting during menstrual period (P ≤ .0001, RR: 4.5), decreasing in amount (P ≤ .001, RR: 7.8), shorter duration of menstrual period (P ≤ .001, RR: 12), and pelvic pain (P ≤ .001, RR: 8.6) were more prevalent and significantly different in the cases compared to control subjects (with CI:95% and P < .001), but excessive or prolong vaginal bleeding was not observed. Menstrual disorders occur even in nongenital tuberculosis, but it is manifested with cessation or decrease in menstrual bleeding flow and period

Immediate dilation of a tight or stenotic cervix by intra-procedural administration of hyoscine butylbromide: A clinical trial

Background: Cervical dilation is indicated prior to performing various gynecological procedures. However, gynecologists are at times confronted with a stenotic or tight cervix, resistant to dilation. This can be problematic particularly when cervical ripening has not been attempted hours before the start of the procedure. Objective: The objective of this study is to investigate the efficacy of administration of hyoscine butylbromide for cervical dilation for immediate dilation of the tight or stenotic cervix. Materials and Methods: In this clinical trial study, a population of 40 women, aged 20-70 yr with stenotic cervix, evidenced by resistance to pass dilator #2 through their cervical canal were compared. Cervical patency was assessed 10 min following intracervical canal instillation of hyoscine butylbromide. Results: Cervical width of 57.5% of patients became wider, as evidenced by passage of the number 4 Hegar dilator through the cervical canal without resistance. Independent T-tests did not reveal any statistically significant difference between the two groups based on their age. Fisher Exact test revealed a statistically significant difference between the two groups based on the prior route of delivery, with a more statistically significant response in patients who had vaginal deliveries. Conclusion: Intra-cervical canal instillation of hyoscine butylbromide is effective in immediate dilation of the tight or stenotic cervix during intra-uterine procedures

Asymptomatic Bacteriuria in Users of Intrauterine Devices

Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0cm 5.4pt 0cm 5.4pt; mso-para-margin:0cm; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"Times New Roman"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:Arial; mso-bidi-theme-font:minor-bidi;} Introduction: The aim of this study was to compare the frequency of asymptomatic bacteriuria in women who use intrauterine devices (IUDs) as a contraceptive method with subjects who use tubal ligation (TL). Materials and Methods: A cohort study was conducted on women who were candidates for IUD insertion or TL (control). The patients were followed for 3 months, and urine cultures were assessed for bacteriuria at the end of the study. Results: Overall, 131 women (mean age, 31.9 ± 4.25 years) in the IUD group and 78 (mean age, 32.1 ± 4.0 years) in the control group were studied. The parity score was 2 or more in 72% of the women in the IUD group and in 74% of the controls. The average intercourse frequency was twice per week in 82% of IUD users and 80% of controls. Fifty-seven percent of the women in the IUD group and 55% of the women in the control group had graduated secondary school (high school). Asymptomatic bacteriuria was detected in 13 IUD users (9.9%) and in 1 woman (1.3%) in the control group (risk ratio = 7.74, confidence interval: 1.03 to 58.03; P = .019). The detected microorganism in the urine culture was Escherichia coli in 12 IUD users and in 1 patient in control group. Klebsiella was found in 1 IUD user. Conclusion: Use of an IUD is a risk factor for urinary tract infection and should be considered, especially in women with recurrent urinary tract infections.</p

Comparing the adverse outcomes of contraception failure between IUD and withdrawal methods

Background: Objective of current study was to compare the adverse outcomes of pregnancy after failure of IUD (Intrauterine device) with the withdrawal method of contraception in order to predict and prevent such outcomes.Methods: In a retrospective cohort study, the adverse outcomes of 224 pregnancies (2 groups, 112 women each) were assessed following failure of the IUD or withdrawal methods of contraception (coitus interruptus). Data were analyzed and P values ≤0.05 were considered statistically significant.Results: Rates of spontaneous and induced abortion, ectopic pregnancy, and vaginal bleeding during second half of pregnancy were more common in the removed IUD group compared to the withdrawal method, differences however not significant. No fetal abnormality was observed in IUD group. Preterm birth (p= 0.045), preterm premature rupture of membrane (p= 0.01), and vaginal bleeding during pregnancy (p= 0.01), were more prevalent in the IUD group (retained and removed) compared to those using the withdrawal method.Conclusions: Considering the adverse outcomes, we knew women with pregnancy after failure of IUD were at an increased risk for such outcomes, compared to those using the withdrawal method; however the results of this research showed these adverse effects are not significant when pregnancy with IUD is detected earlier and IUD is removed during the early stage(s) of pregnancy

Afghan migrants face more suboptimal care than natives: a maternal near-miss audit study at university hospitals in Tehran, Iran.

BACKGROUND: Women from low-income settings have higher risk of maternal near miss (MNM) and suboptimal care than natives in high-income countries. Iran is the second largest host country for Afghan refugees in the world. Our aim was to investigate whether care quality for MNM differed between Iranians and Afghans and identify potential preventable attributes of MNM. METHODS: An MNM audit study was conducted from 2012 to 2014 at three university hospitals in Tehran. Auditors evaluated the quality of care by reviewing the hospital records of 76 MNM cases (54 Iranians, 22 Afghans) and considering additional input from interviews with patients and professionals. Main outcomes were frequency of suboptimal care and the preventable attributes of MNM. Crude and adjusted odds ratios with confidence intervals for the independent predictors were examined. RESULTS: Afghan MNM faced suboptimal care more frequently than Iranians after adjusting for educational level, family income, and insurance status. Above two-thirds (71%, 54/76) of MNM cases were potentially avoidable. Preventable factors were mostly provider-related (85%, 46/54), but patient- (31%, 17/54) and health system-related factors (26%, 14/54) were also important. Delayed recognition, misdiagnosis, inappropriate care plan, delays in care-seeking, and costly care services were the main potentially preventable attributes of MNM. CONCLUSIONS: Afghan mothers faced inequality in obstetric care. Suboptimal care was provided in a majority of preventable near-miss events. Improving obstetric practice and targeting migrants' specific needs during pregnancy may avert near-miss outcomes

Diagnosis of premature rupture of membranes by assessment of urea and creatinine in vaginal washing fluid

Background: Rupture of fetal membranes can occur at any gestational age. Premature rupture of membranes (PROM) means rupture of fetal membranes before the onset of labor. Objective: The purpose of this study was to evaluate and compare the reliability of the vaginal washing fluid urea and creatinine for the diagnosis of PROM and to determine cut-off values. Materials and Methods: A total of 179 pregnant women were recruited. All patients underwent different examinations. These included nitrazine paper test, fern test, amniotic fluid pooling, vaginal washing fluid urea and creatinine sampling. The one group consisted of 126 pregnant women between 14 and 41 weeks of gestation with the complaint of vaginal fluid leakage. Patients who had positive pooling, nitrazine paper test and fern test were considered as confirmed PROM group (group1). On the other side, patients with pooling (-) and/or nitrazine paper test (-) and/or fern test (-) were taken as suspected unconfirmed PROM cases (group 2). The control group consisted of 53 pregnant women between 14 and 41 weeks of gestation without any complaint or complication. Weconducted one-way ANOVA test on the urea and creatinine measures and post-hoc comparison test. Cut-off value was determined by receiver operating characteristic (ROC) curve. Results: Vaginal fluid concentrations of urea and creatinine were significantly different between the three groups (p<0.001). The sensitivity, specificity, positive and negative predictive values and accuracy were all 100% in detecting premature rupture of membranes by evaluation of vaginal fluid creatinine concentration with a cut-off value of 0.45 mg/dl, respectively. Conclusion: This study demonstrates that of two markers investigated creatinine has the higher diagnostic power

Maternal near-miss at university hospitals with cesarean overuse: an incident case-control study.

INTRODUCTION: Cesarean section carries a substantial risk of maternal near-miss morbidity. The aim of this study was to determine the frequency, causes, risk factors, and perinatal outcomes of maternal near-miss at three university hospitals with a high rate of cesarean section in Tehran, Iran. MATERIAL AND METHODS: An incident case-control study was conducted from March 2012 to May 2014. The modified WHO near-miss criteria were used to identify cases. A control sample of 1024 women delivering at the study hospitals was recruited to represent the source population. Near-miss ratio, crude and adjusted odds ratios with confidence intervals were assessed. RESULTS: Among 12 965 live births, 82 mothers developed near-miss morbidities and 12 died. The maternal near-miss ratio was 6.3/1000 live births. Severe postpartum hemorrhage (35%, 29/82), severe preeclampsia (32%, 26/82), and placenta previa/abnormally invasive placenta (10%, 8/82) were the most frequent causes of maternal near-miss. Women with antepartum cesarean section (adjusted odds ratio 7.4, 95% confidence interval 3.7-15.1) and co-morbidity (adjusted odds ratio 2.3, 95% confidence interval 1.4-3.8), uninsured Iranians (adjusted odds ratio 3.4, 95% confidence interval 1.7-7.1) and uninsured Afghans (adjusted odds ratio 4.7, 95% confidence interval 2.4-9.2) had increased risks of near-miss morbidity. Stillbirth and extremely preterm birth were the most prominent adverse perinatal outcomes associated with maternal near-miss. CONCLUSIONS: Overutilization of cesarean section clearly influenced the causes of maternal near-miss. A lack of health insurance had a measurable impact on near-miss morbidity. Tailored interventions for reducing unnecessary cesarean section and unrestricted insurance cover for emergency obstetric care can potentially improve maternal and perinatal outcomes

Maternal and Neonatal Complications of Substance Abuse in Iranian Pregnant Women

There is an increased prevalence of maternal substance abuse during pregnancy in younger women in all socioeconomic classes and races. Our aim was to determine the prevalence and correlates of self-reported substance abuse among pregnant women and obstetric complications or neonatal outcomes in Iran. This retrospective cohort study is covering a five year period on medical records of pregnant women attending the maternity unit of four major hospitals (Mahdieh, Taleghani, Imam Hossein and Akbarabadi Hospitals). Women who reported using opium, heroin, crack, cannabis or methamphetamine were compared with women with no reported history of drug abuse for obstetric complications and prenatal morbidity and neonatal mortality. From 100,620 deliveries substance abuse was recorded for 519 women giving a prevalence of 0.5%. Opium was the most prevalent substance abused followed by crack (a mix of heroin and amphetamines). The exposed group had significantly more obstetric complications including preterm low birth weight and postpartum hemorrhage than the non-exposed group. The exposed group had significantly worse prenatal outcomes including more admissions to intensive care unit and higher infant mortality than the non-exposed group. None of the women in the exposed group was on methadone treatment at time of delivery. Risks of maternal and neonatal complications were increased in substance using pregnant women, especially preterm birth and low birth weight. We recommend a multidisciplinary team to provide methadone maintenance therapy for substance using pregnant women and urinary screen of all pregnant women presenting to hospital