The Impact of Birth Preparedness on Pregnancy Outcome Findings from Lurambi Sub County, Kakamega County, Kenya

Due to inequities in functioning health systems, pregnant women in the developing world have a high risk of morbidity and mortality despite the world health organization (who) vision of universal coverage of health care.

It is estimated that the adult lifetime risk of maternal mortality in women in the sub-saharan region is 1 in 38. This figure sharply contrasts that of the developed world, which stands at 1 in 3,700. In addition, the maternal mortality ratio (mmr) in sub- saharan countries is high (510 per 100,000 live births), contributing to 62% of maternal deaths in the world.

Improvements in maternal health and reductions in maternal mortality have been slower than anticipated and despite isolated successes remain far below the mdg5 target of a 75% reduction in the maternal mortality ratio (mmr) from 1990 to 2015. However, child survival progress is accelerating. it was estimated that only 31 countries were on track to achieve the mdg4 target to reduce child mortality by two-thirds between 1990 and 2015.

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Prognostic Factors of Pregnancy and Childbirth in Adolescents

Adolescence is a period of psychological instability and immaturity of organs which may lead to risk abortions and dystocia during childbirth. Early pregnancy is still an issue of concern considering its adverse effects on adolescents’ health, education and rights as well as the precarious prognostic of unborn children.

In Benin, adolescents account for 21% of total fertility. However, few studies had been dedicated to the issue. This study aims to identify the prognostic factors of pregnancy and childbirth in adolescents at CHDU-B in Parakou. The study had been carried out in the gynecology and obstetrics unit of the Borgou Regional University Teaching Hospital located in the town of Parakou.

This research work involved the nulliparous pregnant subjects bearing a single pregnancy and under 20 years of age as regards adolescents and those aged 20 to 34 years as regards adults and who accepted to participate to the study.

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Meconium Stained Amniotic Fluid: Factors affecting Maternal and Perinatal Outcomes at Jimma University

Meconium is a black-green, odourless material first demonstrable in the fetal intestine during the third month of gestation and it results from the accumulation of debris.Passage of meconium slows down after 16 weeks and cease by 20 weeks of gestation. Almost all new-born infants who pass meconium are mature.

However, in some cases; meconium passage may be associated with umbilical cord compression or increased sympathetic inflow during hypoxia and is also a potential toxin if the fetus aspirates this particulate matter with a gasping breath in utero or when it takes its first breaths following birth.

In addition intrauterine exposure to meconium is associated with inflammation of tissues of the lung, chorionic plate and umbilical vessels and through various mechanisms may contribute to neonatal morbidity, independent of MAS.

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Andrology 2016 and Beyond

In itself, andrology specialty is rapidly progressing one that gains day after day momentum to boost and broaden its wealth of information to answer the questions of the exact nature of biological, endocrinological, genetic as well as molecular proceedings or progress taking place in andrological disorders. At the same time, it offers an ultimate solution for specific andrological problems depending on the heartfelt efforts of the scientists in all branches and their devoted inventions.

Driven by the global revolution of information and communication, there is remarkable exigency to improve men’s health status and to prolong their operational lifespan. Effective measures and programs to bring about healthy lifestyle adjustment will unquestionably add another 10 years of health adjusted and working lifespan.

Therefore, focusing on the integrated health service package, as well as on the essential health care system should be essential especially in remote areas and migrating people residences. In addition, there is a need for lifespan longitudinal studies of men to spot factors influencing the development of andrological disorders.

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Accessibility, Availability and Perceived Quality of Reproductive Health Services in Selected Urban Areas of Bangladesh: User and Non Users Perspectives

Primary healthcare has been considered as a major agenda in many national and international policies and gained enormous attention by Global leader. Following the 1994 International Conference on Population and Development (ICPD) in Cairo, emphasis was given on providing a broader range of primary healthcare (PHC) services in a package to minimize the costs.

The Essential Service Package (ESP) was targeted especially to women, children and poor, intended to offer quality services from one stop facilities that would be client oriented. Enhancing the quality of health care delivery in developing countries through provision of ESP is a key element to increased utilization of these services in the target population.In the last two decades there was a huge growth in urban population in Bangladesh.

It is a great challenge for the public sector to meet up the growing needs of health care services in urban areas of Bangladesh, particularly for the urban poor. Under the Health and Population Sector Program (HPSP), the Government of Bangladesh aimed to provide ESP package accessible through fixed site clinics that was aimed at maximizing health benefits, meeting needs of clients, strengthening service delivery, and improving health systems management.  

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Factors associated with Synchronous Endometrial and Ovarian Cancer, Review of a Case

A 54-year-old perimenopausal woman complained of abnormal uterine bleedings and lower abdominal pain for 6 months. Personal antecedents were smoking, hypertension, chronic obstruction pulmonary disease, obstructive sleep apnea, obesity (BMI 42.7 kg/m2) and nulliparity.

The first exploration showed high tumor markers (Ca125 890 UI/ml, Ca19.9 960 UI/ml) and an enlarged uterus with thickened endometrium, but the gynecological examination was unreliable.A diagnostic hysteroscopy showed an abnormal growth on the entire endometrial cavity with atypical vascularization.

Biopsy was consistent with low-grade endometrial adenocarcinoma.The pelvic magnetic resonance (MR) showed a large uterus, occupied by an endometrial carcinoma 4 mm close to the uterine serosa. There was an invasion to the cervix stromal, a left 20 cm heterogeneous and a hypovascular multiloculated adnexal mass adhered to mesosigma. No ascites or carcinomatosis were found.

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Chemotherapy for Elderly Ovarian Cancer Patients

Cancer is one of the leading causes of morbidity and mortality worldwide, with the number of new cases expected to increase over the next 2 decades. Ovarian cancer is the 6th most commonly diagnosed cancer in women, worldwide

It is estimated that there will be approximately 21,290 new cases of ovarian cancer in 2015. With an aging population, the prevalence of ovarian cancer can only be expected to increase. The most common histologic type of ovarian cancer is epithelial and standard treatment, with few exceptions, includes aggressive cytoreductive surgery followed by adjuvant chemotherapy with platinum-based compounds and a taxane.

To date, there is mounting evidence that age by itself should not influence whether a patient receives reduced chemotherapy dosing when being treated for an ovarian cancer. The purpose of this retrospective study is to report how women over 65 years of age treated at the Yale Comprehensive Cancer Center.

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Maternal and Child Health: The Perinatal Paradox in a Developing Country

Several recent studies have demonstrated the exposure of social groups to bad health conditions. That puts individuals at the risk of experiencing adverse outcomes, which includes mostly transgenerational effects.Concerning the mother’s and the newborn’s health, their socioeconomic conditions contribute to the occurrence Low Birth Weight (LBW) and preterm cases.

According to the World Health Organization (WHO), among all the births in the world, around 20.6 million (15.5%) of babies are born with LBW.Most of these cases are in developing countries (e.g. 27% in Asia against 6.4% in Europe), in which the rate of child mortality is similar to the maternal mortality, with a great incidence particularly in Africa and Asia.Although the mothers' and newborns' access to health has improved in many countries, there are still huge inequalities between developing and developed countries and also regional differences inside them, evidencing the uneven health conditions of the population.

LBW rates in developing countries have been associated with adverse socioeconomic conditions, in which there are a great number of newborns with Intrauterine Growth Restriction (IGR), while in developed countries LBW is primarily related to preterm delivery.This situation can be verified in Brazil, a medium-income developing country administratively organized in five regions with distinctive environmental, cultural and socio-economic circumstances.

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Meconium Stained Amniotic Fluid: Factors affecting Maternal and Perinatal Outcomes at Jimma University Specialized Teaching Hospital, South West Ethiopia

Meconium is a black-green, odourless material first demonstrable in the fetal intestine during the third month of gestation and it results from the accumulation of debris.Passage of meconium slows down after 16 weeks and cease by 20 weeks of gestation. Almost all new-born infants who pass meconium are mature (term).

However, in some cases; meconium passage may be associated with umbilical cord compression or increased sympathetic inflow during hypoxia and is also a potential toxin if the fetus aspirates this particulate matter with a gasping breath in utero or when it takes its first breaths following birth. In addition intrauterine exposure to meconium is associated with inflammation of tissues of the lung, chorionic plate and umbilical vessels and through various mechanisms may contribute to neonatal morbidity, independent of MAS.

Meconium stained amniotic fluid (MSAF) occurs in 12 to 20% of labouring mothers, and it is a confusing issue because it can be due to either physiologic or a hypoxic insult to the fetus. Birth depression occurs in 20 to 33% of infants born through MSAF and is likely caused by chronic asphyxia and infection that may lead to passage of meconium and fetal gasping. This suggest that meconiumstained amniotic fluid should be regarded as a symptom rather than a syndrome becoming more prevalent with increasing term and which might be associated with higher levels of infection or asphyxia.

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Oxidative Damage to Sperm DNA: Clinical Implications

Men in the reproductive age group may experience qualitative and quantitative defect in sperm production, but there are men with normal sperm parameters who are infertile, such cases are classified with idiopathic infertility. Men with idiopathic infertility generally present with significantly higher seminal ROS levels and lower antioxidant potential than fertile controls.Male factor accounts for 20% cases of infertility, female factor for 38 % cases and in 27% cases of infertility both partners are involved.

Traditionally, the diagnosis of male infertility is based upon macroscopic and microscopic assessment and analysis of sperm concentration, motility and morphology as routine indicators of semen quality. These indicators provide fundamental information about sperm production upon which clinicians base their initial diagnosis. However, even with appropriate quality assurance, traditional semen parameters provide a limited degree of prognostic and diagnostic information.

The semen parameters assessed by traditional methods provide modest information regarding fertilizing capacity of sperm. Sperm chromatin integrity is essential in the process of fertilization, implantation and proper embryonic development and birth of healthy off spring. Sperm and ova carry all the necessary information required for fertilization and embryonic development. Any form of damage to the paternal (sperm DNA) or maternal (ova) can have serious consequences in the form of pre and post implantation losses, impaired embryonic development, childhood morbidity and even cancer. 

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Effect of Surgery and Adjuvant Therapy in Reproductive and Sexual Dysfunction in Pre-menopausal Women with Breast Cancer

Breast cancer is one of the most common cancers in women. Approximately twenty five percent breast cancer occurs during the reproductive and perimenopausal years. Surgery is the primary treatment of breast cancer. In addition, based on stage and biology of the disease, chemotherapy, radiation, endocrine therapy and biologics are recommended to reduce recurrence and cancer-related mortality.

Although survival rates of women with breast cancer has significantly improved, the potential late adverse effects of adjuvant treatment and their impact on quality of life of breast cancer survivors have become increasingly important. Among premenopausal women with breast cancer, management of sexual dysfunction and fertility presents a challenge. The principal mechanisms that systemic therapy affect sexual function and fertility in women with breast cancer is ovarian suppression.

There are several patients and tumor-related factors that guide the selection of adjuvant therapy including age, comorbid illness, performance status, cancer stage (tumor size and nodal status), grade, hormone receptor status, and HER-2 amplification among others. The principal mechanisms that systemic therapy affect sexual function and fertility in women with breast cancer is the ovarian suppression and damage to the ovaries.

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Combination of Sertraline and Sildenafil versus Sertraline Monotherapy in the Treatment of Acquired Premature Ejaculation without Concomitant Diseases

Premature Ejaculation (PE) is one of the most common sexual dysfunctions, affecting 20%-40% of sexually active men. There were various definitions of PE by different professional organizations. However, since the underlying physiopathology of PE was not well understood, there were no universally accepted definition of PE until the International Society for Sexual Medicine (ISSM) established the first evidence-based definition of lifelong PE in 2007. Subsequently, Waldinger et al. proposed a new classification for PE in 2008, which included four subtypes: lifelong PE (LPE), acquired PE (APE), natural variable PE (NVPE), and Premature-Like Ejaculatory Dysfunction (PLED).

In recent years, although a lot of therapies have been proved to be efficacious in the treatment of PE, most research has focused on the treatment of LPE, or ignored the different types of PE. There are few studies concerning the treatment of APE, although Serefoglu et al. revealed that APE was more severe than other subtypes.

To our knowledge, this is the first randomised trial to show sertraline monotherapy and a combination of sildenafil and sertraline in the treatment of APE in patients without concomitant diseases. Therefore, we conducted this clinical study to evaluate the efficacy of 50 mg sertraline daily and a combination of 50 mg sildenafil as needed and 50 mg sertraline daily in the treatment of APE in patients without concomitant diseases.

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Bariatric Complications during Pregnancy

A 21-year old woman, G1P0, was admitted to our University Hospital at 33 weeks and 2 days of gestational age with a 1 week history of nausea and vomiting. Two years before, in 2013, the patient underwent laparoscopic adjusted gastric banding (LAGB) elsewhere for morbid obesity with a BMI of 39.3. Postoperatively her BMI dropped to 23.5. The medical history was limited to the LAGB.

Before transfer to our hospital, the patient had already been admitted for 1 week in a general hospital. Because of intractable vomiting, the band was loosened, without improvement of her symptoms. Blood sample showed doubled transaminases. Serology was negative for hepatitis A, B and C virus, Epstein Barr virus and cytomegalovirus. Abdominal ultrasound revealed distention of the stomach; the liver and biliary ducts were normal.

The abdominal ultrasound was repeated after 3 days and revealed no new findings. Obstetric ultrasound there was suspicion of intra-uterine growth restriction (IUGR) and anhydramnion. Finally she was transferred to our hospital because of persistent vomiting, the increased transaminases of unknown origin, and the suspected IUGR with anhydramnion.

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A Commentary Recommendation for Public Funding for the Provision of Intrauterine Devices for Women.

Intrauterine devices are gaining prevalence worldwide for family planning purposes because of its long-acting ature and reversibility. In fact, over 15% of married women were noted to use intrauterine contraception. Trends demonstrate highest usage in Asian countries, with at least 50% of Asian females utilizing IUDs for prevention of pregnancy. Sub-Saharan Africa remains an area where there is a substantial unmet need for family planning in general.

Two types of IUDs are available: hormonal and non-hormonal. The most commonly-available hormonal device goes by the name Mirena, and contains 52 mg of the progestin levonorgestrel (LNG), and is approved for use over 5 years, although studies have demonstrated efficacy to 7 years. Initial hormone release rate is 20 mcg/d, which declines to 10 mcg/d at the 5 year mark. Cumulative efficacy is 99.3% over 5 years (which is as effective as tubal sterilization). The majority of its contraceptive effect is through thickening of cervical mucous, impedance of sperm survival and endometrial atrophy, the latter of which explains the improvement of menstrual flow.

The mechanism of action of the non-hormonal IUD, however, depends predominantly on its inflammatory response which interferes with sperm passage, thus preventing fertilization. These nonhormonal devices can last between 3-12 years and are comprised of copper that may be designed in a multitude of shapes and sizes. This type, however, can be associated with heavier and/or crampier menses.

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