Polycystic Ovarian Syndrome (PCOS): Exploring Its Impact on Obstetrical Outcomes

Polycystic ovarian syndrome (PCOS) disrupts ovulation leading to both infertility and miscarriage;yet, its impact on obstetrical outcomes remains largely uncertain due to conflicting findings. We analyzed data from the CDC Pregnancy Risk Assessment of Monitoring System, specifically Standard Core and Phase 8 responses, with 9549 respondents across the United States through SPSS 28 software in this cross-sectional study. Two variables assessed PCOS status in respondents: history of PCOS and PCOS during pregnancy. With a history of PCOS, there were significantly increased odds of diabetic (OR 1.665, p < 0.001), hypertensive disorders (OR 1.589, p < 0.001) during pregnancy, neonatal mortality (OR 1.550, p < 0.001), cesarean section (C/S) (OR 1.489, p < 0.001), and preterm prelabor rupture of membranes (PPROM) (OR 2.081, p < 0.001). With PCOS diagnosed during pregnancy, there were significantly greater odds of diabetes (OR 3.278, p < 0.001), hypertensive disorders (OR 2.935, p < 0.001) during pregnancy, and significantly decreased risk for small for gestational age (2 standard deviations) (OR 0.337, p = 0.024). PCOS is a significant risk factor that contributes to maternal morbidity. Our results support the hypothesis that PCOS’ impact extends well into a woman’s obstetrical journey, with varying degrees of associated adverse maternal and fetal risks. Preliminary pathophysiologic explanations associated with PCOS gestational diabetes include pre-existing insulin resistance. Meanwhile, altered placentation and endovascular changes associated with PCOS secondary to a baseline deranged metabolic environment predispose patients to developing hypertensive disorders, PPROM, and preterm delivery. Associations between neonatal mortality and C/S can be attributed to elevated maternal body mass index. The pathophysiologic link between PCOS and the above obstetrical outcomes still remains unknown, necessitating further investigation;however, this study identifies the outcomes that require the most attention at this time.

Contribution of Simulation to the Skills Laboratory for the Learning of Obstetrical Examination in an African Setting with Limited Resources

Objective: To evaluate the interest of the simulation in the learning of the obstetric examination of parturient by medical students. Materials and methods: It was an analytical cross-sectional study that took place from 1 to 28 February 2020 at the Yalgado Ouedraogo Teaching Hospital in Ouagadougou, Burkina Faso. The study population was made up of medical students at the Doctorate II level. The previous experience of the students in the obstetric examination of the parturient, the contribution of the simulation on their feelings and on their skills towards this examination were studied. The Mc Nemar Chi2 test was used to compare percentages on paired samples. Results: The level of difficulty in performing the obstetrical examination in the parturient evolved downwards after the practice of the simulation. The stress level to perform the obstetric exam has been significantly reduced. On the other hand, confidence has increased. The students’ ability to appreciate each of the elements of the obstetric examination studied had improved after the practice of simulation. Conclusion: The simulation in the skills laboratory was a great contribution and the acquisition of models of better fidelity would help to improve the contribution to the confidence building and the acquisition of skills by learners.

Rationale of Longitudinal Cohort Study on Obstetrical Outcomes of Trichomonas vaginalis Infection in Kinshasa, DR Congo

Background: Trichomoniasis is the most common non-viral sexually transmitted infection (STI) in the world, and the occurrence of this infection during pregnancy is responsible for adverse obstetrical outcomes like premature labor, premature rupture of membranes (PROM) and low birth weight (birth weight < 2500 g). The association with a number of factors (maternal age, low level of education, low socio-economic status and multiple sexual partners, etc.) that can be found in our environment suggest its probably high prevalence amongst vaginal infections that are responsible for adverse obstetrical outcomes, but up-to-date estimates are lacking. Objective: To assess the obstetrical risk associated with Trichomonas vaginalis (T. vaginalis) infection in our environment. Methods: We designed a protocol for a prospective cohort study which will take place in four medical facilities in the city of Kinshasa, where all pregnant women with a pregnancy of at least 20 weeks and who will give written consent will be included. Vaginal swab specimens will be collected for T. vaginalis research by direct microscopy wet mount. Follow-up will consist of recording the process of the pregnancy and obstetrical outcomes. Conclusion: Results from this study will allow to enhance management and also bring updated estimates on T. vaginalis prevalence and its obstetrical outcomes for infected pregnant woman in our environment.

Obstetrical Emergencies in Ouahigouya Regional Teaching Hospital (Burkina Faso) in the Context of Insecurity Linked to Armed Groups: A Comparative Study between Patients from Precarious Security Zones and Those from Safe Areas

Introduction: Insecurity can be an obstacle to access to emergency obstetric and newborn care, that is why we proposed to study obstetrical emergencies in Ouahigouya Regional Teaching Hospital, a referral hospital in a region plagued by insecurity linked to armed groups. Method: This was an analytical cross-sectional study with prospective data collection over a 4-month period, from June 10 to October 10, 2020. Patients from precarious security areas were compared to those from safer areas. The Chi squared and Fisher tests were used for comparison of variables. Results: Obstetric emergencies accounted for 38.62% of admissions, from which 25.59% came from precarious security zones. Age was similar in both comparison groups. However, patients from unsafe areas were more likely to reside in rural areas (p 0.001) and more likely to be in unpaid occupations (p 0.001). Prenatal visits were less frequent (p 0.01) and women were more often multigravidae (p 0.01) in the precarious security group of patients. Apart from the more frequent uterine rupture (p = 0.02) in the group from precarious security zones, diagnosed complications and maternal mortality were similar in the 2 groups, while perinatal mortality was higher in the group of patients from precarious security zones (p 0.01). Conclusion: The precarious security situation has negative consequences on maternal and perinatal morbidity and mortality. Further studies are needed for better understanding of these consequences, and improvement of health system resilience strategies, to reduce related maternal and fetal morbidity and mortality.

Practice of Obstetrical Hysterectomy at the Sylvanus Olympio University Hospital Center: Indications and Maternal Prognosis

Obstetric hysterectomy is a surgical procedure most often performed in a context of extreme emergency in an obstetric environment. The incidence of obstetric hysterectomy is differently expressed around the world. In the CHU-SO maternity ward, hemorrhagic obstetric emergencies are common. The extreme urgency in which patients are admitted, the insufficiency of the technical platform, associated with the challenge of the availability of blood products, often leads to performing an obstetric hysterectomy for hemostasis. It is responsible for high maternal morbidity and mortality. Since 2000 no study has been carried out on this practice in the service. Objective was to describe the practice of obstetric hysterectomy at the CHU-SO and specifically to determine the prevalence, the prognostic factors to be able to act to reduce maternal mortality. Method: A descriptive, cross-sectional, and analytical study was carried out at the Gynecology-Obstetrics clinic of the CHU-SO;from January 1, 2021, to June 30, 2022. All hysterectomies performed in an obstetric emergency context (during pregnancy, perpartum or postpartum) in the department were included in our study. We did not include cases of obstetric hysterectomies outside the SO hospital or planned non-obstetric hysterectomies. Results: We recorded 75 cases of obstetric hysterectomy and 15,625 deliveries (0.48%). The average age was 32.89 ± 5.93. The age group between 30 and 35 years old was the most affected with a rate of 37.33%. Labor and third trimester hemorrhage were the main reasons for admission, patients were referred in 80% of cases. The average parity was 3.25 ± 1.92 with utmost of 0 and 11. The pauciparous (41.67%) and multiparous (32%) were the most affected. The indications frequently found were uterine atony (44%);uterine rupture (33.33%). Subtotal inter adnexal hysterectomy was performed in 94.67%. General anesthesia practiced in 69%. They were all polytransfuses. Three poor prognostic factors were observed during our study, namely: uterine atony;the state of hemodynamic shock before the operation;lack of blood transfusion. The maternal death rate was 21.33%. Conclusion: Obstetric hysterectomy is a very mutilating and complicated surgical procedure and is still common practice in Africa. The maternal prognosis is still reserved with a very high mortality rate in Togo.

Rationale of a Cohort Study on Risk of Obstetrical Outcomes Associated with Iron Supplementation during Pregnancy

Background: Anemia is one of the most widely prevalent disorders, affecting the lives of almost half a billion women of reproductive age, contributing to over 100,000 maternal and almost 600,000 perinatal deaths (mostly through pre-term delivery, low birth weight) each year. Increased risk of infant mortality and reduced cognitive development and reduced energy levels which affect productivity in adults are cited. During pregnancy increased requirements, inadequate intake of iron and other micronutrients and parasitic (malaria, hookworm) as wells as bacterial (mostly urinary tract) infections are the main causes. In order to reduce such maternal and neonatal burden, it has been worldwide admitted to adopt cost-effective preventive interventions during pregnancy, including iron-folic acid supplementation, de-hookworming medication and anti-malarial prevention or treatment. Intestinal absorption of iron is limited by a lot of factors including bioavailability, iron status of the woman, substances accompanying or contained in diet, chelating agents such as diet fibers or calcium salts. Any supplementation put additional constraint in terms of absorption. Unabsorbed iron is known to have pro-oxidant properties likely to induce production of free radicals. These in turn might induce oxidative stress accountable for in generation of many obstetrical outcomes. This potential link between oxidative stress resulting from free radicals hyperproduction induced by non absorbed iron and harmful maternal/perinatal conditions is rarely questioned by searchers. Objectives: To determine overall (food and supplemented) iron consumption, iron and oxidative status in a cohort of pregnant women and to seek associations between findings and adverse obstetrical outcomes. Methods: At the University Clinics of Kinshasa, we designed a protocol for a prospective cohort study dealing with clinical and biochemical parameters of oxidative stress among pregnant women iron supplemented. Women with a single pregnancy not exceeding 19 weeks without obvious pathology, regardless of age and parity, were eligible for inclusion in the study. Conclusion: This study is expected to assess consequences of oral iron supplementation during pregnancy in terms of obstetrical outcomes associated with oxidative stress linked to unabsorbed iron.

Presence of Obstetrical Conditions among Women with Pelvic Inflammatory Diseases: Experience of 50 Cases in Bangladesh

Background: Pelvic Inflammatory Diseases can be associated with the different obstetrical condition. Objectives: The purpose of the present study was to see the Presence of Obstetrical Conditions among Women with pelvic inflammatory diseases (PID). Methodology: This cross-sectional of study was conducted in the Department of Obstetrics and Gynaecology at Dhaka Medical College, Dhaka from January 2007 to June 2007 for a period of six (6) months. Women with the age group of 15 - 45 years presented with lower abdominal pain, tenderness, per vaginal discharge and cervical motion tenderness were included in this study. A pre-designed data collection sheet was used to record the history of different obstetrical condition. Result: A total number of 50 women presented with PID were recruited for this study of which majority was in para 2 to 5 which was 30 (60.0%) cases. Majority of the patients had given the history of home delivery (74.0%) which was performed by untrained birth attendance (60.0%). The history of induced abortion was given by 24.0% cases. History of more than 2 times menstrual regulation (MR) and 2 to 5 times were performed in 20 (40.0%) cases in each. Among 50 cases majority used intrauterine device (IUCD) which were 20 (40.0%) cases. Conclusion: In conclusion majority of the women presented with PID have given the history of para 2 to 5, home delivery with untrained birth attendance, induction abortion and history of more than two times MR.

Obstetrical and Perinatal Outcomes of Adolescent Pregnancies in Cameroon: A Retrospective Cohort Study at the YaoundéGeneral Hospital

Background: Adolescent pregnancy is a serious health and social problem worldwide as well as in Cameroon. The aim of this study was to determine the obstetrical and perinatal outcomes of nulliparous adolescent pregnancies in a reference hospital in Cameroon. Methods: A retrospective cohort study to compare the outcomes of nulliparous adolescent pregnancies to those of nulliparous women aged 20 to 25 years was carried out at the Yaoundé General Hospital between January 1993 and December 2012. Results: Adolescent deliveries represented 2.84% (331 deliveries) of all deliveries registered during the study period. The adolescent mothers had a significantly higher incidence of preeclampsia/eclampsia, preterm delivery and low birth weight babies (<2500 g) when compared to the control group (OR, 3.46;CI 95%, 1.46 - 8.18;OR, 1.94 CI 95%, 1.34 - 2.79;OR, 1.98, CI 95%, 1.39 - 2.46, respectively). However, placenta previa, abruptio placenta, episiotomy, cesarean section, vaginal instrumental delivery, perineal tears and post partum hemorrhage were not significantly different in the two groups. Furthermore, there was no statistically significant difference between the two groups regarding fetal distress, low Apgar score (st and 5th minutes), the rate of admission in the neonatal intensive care unit, stillbirth and neonatal death. Conclusion: Adolescent pregnancy is associated with an increased risk of preeclampsia/ eclampsia, preterm birth and low birth weight.

Obstetrical Vacuum Deliveries: Clinical Aspects and Fetal Prognosis in Regional Teaching Hospital of Ouahigouya

Objective: To determine the frequency of obstetrical vacuum deliveries in the service of obstetrics and gynecology of regional teaching hospital of Ouahigouya and then to assess fetal outcomes. Patients and Methods: It was about a cross sectional and descriptive retrospective data collection from 1st January 2014 to 31st December 2016 in the service of obstetrics and gynecology of regional teaching hospital of Ouahigouya. Patients who had vacuum delivered in the service with single pregnancy, at least 34 weeks gestation age and summit presentation and had a useful medical folder were included in our study. The data were collected and the analysis used epi-info software 7.2.1.0. version, 2010 Word and excel. The results were presented in percentage for qualitative variables and in means standard deviation for quantitative variables. Results: We have collected 6233 deliveries from 1st January 2014 to 31st December 2016, out of which 312 were done by using obstetrical vacuum giving a frequency of 5.0%. The mean age of patients was 23.5 ± 6.4 years. The average parity was 1.3 ± 0.7 women per delivery and 73.1% of our patients were pauciparous. 90.1% of patients were referred. The main indications were maternal weakness (43%), fetal distress (36.5%), prolonged expulsive phase (6.1%), stopping progression (4.8%) and the scar uterus (4.5%). Fetal prognosis was dominated by the caput in 13 cases (4.2%) and excoriations of the scalp in 5 cases (1.7%). Conclusion: Vacuum extractions are very limited in low setting countries. Its popularization is essential to reduce maternal and fetal mortality.

Morbidity and Mortality Related to Obstetrical Evacuations in a Country with Limited Resources: The Case of the Maternity Ward of the Prefectural Hospital of Coyah, Guinea

Obstetric complications requiring evacuation are found all over the world with a high frequency in developing countries where they are responsible for high fetal-maternal morbidity and mortality. The objectives of this study were to calculate the frequency of obstetric evacuations in the maternity ward of the Coyah prefectural hospital, describe the socio-demographic characteristics of the evacuated patients, identify the main reasons for evacuation, determine the means of transport used and specify the maternal and fetal prognosis. Patients and Method: This was a prospective descriptive and analytical study conducted over a 6-month period (April 1-September 30, 2020) at the maternity ward of the Coyah prefectural hospital. All patients evacuated for complications of gravidopuerperium were included in the study. Results: We recorded 84 cases of obstetric evacuations out of a total of 2206 consultations, i.e. a frequency of 3.8%. The average age of the patients was 25.22 years with extremes of 15 and 45. Housewives (58.82%), nulliparous women (36.93%) and women with no education (64.29%) were the most numerous ones. No patient received medical transportation. More than half of the patients were evacuated by a nurse (51.21%). Hemorrhage in the last quarter was the main reason for evacuation. The average distance traveled by patients was 18.3 km with extremes of 12 and 68 km. The average transfer time was 63 min (1 h 3 minutes) with extremes of 20 min and 300 min (5 h). Maternal mortality was 5.95%. The perinatal mortality rate was 46.42%. No counter-referral was made. Conclusion: The obstetrical prognosis of evacuated women is still poor. We recommend the establishment of an obstetrical SAMU (UAS) system in rural areas in order to contribute to the regulation of obstetrical evacuations, but especially to enable low-income patients to have access to the service.

Pregnancies without Prenatal Care in the Health District of Commune V in Bamako: Obstetrical Prognosis

Summary: We attempted to determine the obstetric prognosis of women without antenatal care in the Health District of Commune V of Bamako, Mali. Materials and Methods: We undertook this retrospective case-control study from January 1 to March 31, 2017. Of all women having given birth to during this period in this district, we compared characteristics and obstetric outcomes between women without antenatal care (study group) vs. those with antenatal care (age/parity matched control). Results: 13.8% of women were without antenatal care (23.45 ± 9.56 years of age: 13 - 42). Study group (without antenatal care), compared with control, was significantly more likely to be household helpers (OR = 2.5 [2.0 - 3.4]) and single (OR = 2.3 [1.8 - 2.8]). Study group women were more significantly likely to have the following poor obstetric outcomes: premature rupture of the membranes, post-maturity, low birth weight, hypertensive disorders of pregnancy, uterine rupture, fetal death, anemia, fetal malposition, cesarean section, postpartum hemorrhage, puerperal infection and maternal death. Study group showed a higher risk of early neonatal death, low Apgar score, and transfer to Neonatology institute. Conclusion: In accordance with the previous reports in any other countries, no prenatal checkup causes higher poor outcome of both mothers and infants/neonates also in this area.

Gynecological and Obstetrical Emergencies at the University Clinic of Gynecology-Obstetrics of the National Hospital Donka Guinea

Gynecological and obstetrical emergencies are found all over the world, especially in developing countries where women pay a heavy price for giving birth. They can occur at any time during pregnancy and outside of pregnancy often in a socio-economic context. The objectives of this study were to describe the sociodemographic characteristics and the maternal and fetal prognosis of gynecological and obstetric emergencies. Patients and Methods: This was a descriptive cross-sectional study with prospective data collection, conducted at the University Clinic of Gynecology and Obstetrics of the Donka National Hospital between June 1 and September 30, 2015. It involved all patients admitted to our department in emergency for a gynecological or obstetrical complaint. Results: We collected 361 cases of gynecological and obstetrical emergencies out of a total of 1779 consultations, i.e. a frequency of 20.29%. Obstetrical emergencies were predominant with 91.41% and gynecological emergencies represented 8.59%. The average age of patients was 29.5 with extremes of 14 and 47. Nulliparous women were the most numerous (34.35%). More than half of the patients did not attend school (52.08%) and 56.70% were evacuees. Abdominopelvic pain and hemorrhage were the main reasons for consultation (54.29% and 49.58%). Admission diagnoses were dominated by acute fetal distress and hemorrhage in the last quarter of pregnancy (52.3% and 36.01%). The caesarean section rate was high (82.12%). Maternal and perinatal lethality rates were high (5.2% and 30.3%). Conclusion: Gynecological and obstetrical emergencies are a public health issue because of the severity of the prognosis they impose on the mother and child. Maternal and perinatal mortality was very high. The prevention of these serious emergencies must be done through good quality prenatal consultations. Laparoscopy equipment and staff training are necessary for a minimal invasive surgery of gynecological emergencies.

Exploring the Relationship between Obstetrical Nurses’ Work and Pregnancy Outcomes

The Registered Nurses Association of Ontario Healthy Work Environments Best Practice Guideline recommends that employers promote safe, healthy workplaces. Healthy workplaces include addressing the unique needs of nurses who work while pregnant. The purpose of this descriptive study, summarizing information from 120 pregnancies reported by 95 nurses, was to determine if the workload of obstetrical nurses was associated with negative pregnancy outcomes, including preterm delivery and birth weight. Full-time obstetrical nursing work is a predictor of reduced birth weight, but not of preterm birth when compared to outcomes of obstetrical nurses working part time. One third of nurses reported pregnancy complications and most nurses experienced work-related and personal stress. Further research evaluating work modifications during pregnancy is indicated to improve birth outcomes.

Obstetrical Fistula: Clinical, Therapeutic and Prognostic Aspects at the Gynecology and Obstetrics Department of Borgou University Hospital Center in Benin

Introduction: Obstetric Fistula (OF) is a tragedy and a public health problem (physical, social, moral and psychological). Objective: To determine the clinical, therapeutic and prognostic aspects of obstetric fistula at CHUD/B-A maternity ward in 2016. Study Method: This is a descriptive, analytic study with prospective data collection from March 07 to December 31, 2016. Patients with obstetric fistula were the study population. Results: A total of 37 patients were treated including 35 operated, the other two not operated for pyuria and bladder calculus after examination under spinal anesthesia. The average age was 36.6 ± 10.5 years with the extremes of 21 years and 65 years. The mean age of onset of Obstetric Fistula (OF) was 28.9 ± 6.5 years. Patients came from southern Benin (51.4%), were married (67.6%), peasant (35.1%) and out of school (81.1%). The types of OF were vesico-vaginal fistula (VVF) (62.2%), urethro-vaginal fistula (24.3%), vesico-uterine fistula (VUF) (5.4%), and uretero-vaginal fistula (2.7%). The fistula site was supra trigonal (54.1%), urethral (18.9%), trigonal (10.8%), vesico-uterine (10.8%), cervical urethral (2.7%), ureteroid vaginal (2.7%). Fistulas were complex (70.3%), complicated (24.3%) and simple (5.4%). The vaginal route was one of the first routes (64.9%). The operative techniques used were CHASSAR MOIR hysterorrhaphy (74.3%). The cure with continence was 68.6%. Conclusion: OF is observed in young women of childbearing age. VVF is the most common. The management is surgical with several operating techniques. Healing is possible. Hence the importance of paying special attention to these patients for their care.

Obstetrical and gynecologic challenges in the liver transplant patient

An increasing number of childbearing agewomen undergo liver transplantation(LT)in the United States.Transplantation in this patient subgroup poses a significant challenge regarding the plans for future fertility,particularly in terms of immunosuppression and optimal timing of conception.Intrapartum LT is only rarely performed as the outcome is commonly dismal for the mother or more commonly the fetus.On the other hand,the outcomes of pregnancy in LT recipients are favorable,and children born to LT recipients are relatively healthy.Counseling on pregnancy should start before LT and continue after LT up until pregnancy,while all pregnant LT recipients must be managed by amultidisciplinary team,including both an obstetrician and a transplant hepatologist.Additionally,an interval of at least 1-2 years after successful LT is recommended before considering pregnancy.Pregnancy-induced hypertension,pre-eclampsia,and gestational diabetes mellitus are reported more commonly during the pregnancies of LT recipients than in the pregnancies of non-transplant patients.As adverse fetal outcomes,such asmiscarriage,abortion,stillbirth,or ectopic pregnancy,may occur more often than in the non-transplant population,early planning or delivery either through a planned induction of labor or cesarean section is critical to minimize the risk of complications.No significant long-term physical or phycological abnormalities have been reported in children born to LT recipients.

Acute Care/Trauma Surgeon＇s role in obstetrical/ gynecologic emergencies (The OBCAT Alert)

BACKGROUND:Overwhelming hemorrhage or other intra-abdominal complications may be associated with obstetrical or gynecologic(OB/GYN) procedures and may require the surgical training of an Acute Care/Trauma Surgeon.The OB Critical Assessment Team(OBCAT Alert) was developed at our institution to facilitate a multidisciplinary response to complex OB/GYN cases.We sought to review and characterize the Acute Care/Trauma Surgeon's role in these cases.METHODS:We conducted a retrospective review of all emergency consults during an OB/GYN case at our institution from 2008 to 2015.An OBCAT is a hospital based alert system designed to immediately notify OB/GYN,anesthesiology,Acute Care/Trauma,the intensive care unit(ICU),and the blood bank of a potential emergency during an OB/GYN case.RESULTS:There were 7±3 OBCAT alerts/year.Seventeen patients required Acute Care/Trauma surgery intervention for hemorrhage.Thirteen patients required damage control packing during their hospitalization.Blood loss averaged 6.8±5.5 L and patients received a total of 21±14units during deliveries with hemorrhage.There were 17 other surgical interventions not related to hemorrhage;seven of these cases were related to adhesions or intestinal injury.Seven additional cases required evaluation post routine OB/GYN procedure;the most common reason was for severe wound complications.There were three deaths during this study period.CONCLUSION:Emergency OB/GYN cases are associated with high morbidity and may require damage control or other surgical techniques in cases of overwhelming hemorrhage.Acute Care/Trauma Surgeons have a key role in the treatment of these complex cases.

Feasibility study of minimally trained medical students using the Rural Obstetrical Ultrasound Triage Exam(ROUTE)in rural Panama

BACKGROUND:Maternal and infant mortality rates reported in rural Panama are greater than those in urban regions.Bocas del Toro is a region of Panama inhabited by indigenous people at greater risk for pregnancy-related complications and deaths due to geographic isolation and limited access to health care.Portable ultrasound training programs have recently been implemented in low-resource settings to increase access to diagnostic imaging.The goal of this study is to determine the feasibility of teaching firstyear medical students the Rural Obstetrical Ultrasound Triage Exam(ROUTE)to help identify pathology in pregnant women of the Bocas del Toro region of Panama.METHODS:Eight first-year medical students completed ROUTE training sessions.After training,the students were compared to professional sonographers to evaluate their accuracy in performing the ROUTE.Students then performed the ROUTE in mobile clinics within Bocas del Toro.They enrolled women pregnant in their 2nd or 3rd trimesters and measured biparietal diameter,head circumference,amniotic fluid index,fetal lie and placental position.Any abnormal measurement would be further analyzed by the lead physician for a potential hospital referral.RESULTS:A total of 60 women were enrolled in the study.Four women were detected as having a possible high-risk pregnancy and thus referred to a hospital for further evaluation.CONCLUSION:Based on our data,first-year medical students with additional training can use the ROUTE to identify complications in pregnancy using ultrasound in rural Panama.Additional studies are required to determine the optimal amount of training required for proficiency.

Evaluating the Role of Measuring the Perineal Length as a Predictor of Progress of Labor and Obstetrical Trauma

Objective: Evaluating the effect of perineal length on the duration of the second stage of labor, the mode of delivery, the need for episiotomy and the possibility of perineal and vaginal tears needing repair. Participants and Methods: It is a prospective hospital-based observational study done on 483 parturient women in a university hospital. Personal, medical and obstetric data together with the measurement of perineal length were recorded in the first stage of labor. We followed up the progress of labor until delivery. Regression models were used to consider possible risk factors of episiotomy or tears needed repair. Results: The mean duration of the second stage of labor was significantly longer among women with a perineum of ≥4 cm length when compared with those with a perineal length of Conclusion: Longer perineum is associated with increase in the duration of the second stage of labor. Obstetricians should expect the need of episiotomy when confronted with circumcised primigravida with long perineum. However, if the perineum is short they should not be deceived, short perineum is more probably torn.

Absence of Dressing versus Dressing in Gynaecological and Obstetrical Surgery at the University Hospital of Brazzaville

Objective: To compare the evolution of the operative site in the presence or absence of an occlusive skin dressing. Patients and methods: Prospective, comparative study that took place at the University Hospital of Brazzaville from January 1st to August 31st, 2016. 120 patients were randomly recruited divided into two groups: A study group consisting of 60 patients without a dressing and a control group consisting of 60 patients. Results: Sociodemographic characteristics were similar in both groups, as well as pre- and intraoperative characteristics. Postoperative complications included parietal infection (3 vs. 4 cases, p > 0.05), one case of disunion, and one case of skin irritation by the plaster in the study group. The duration of healing was shorter in the control group compared to the study group (11 ± 2 days vs. 12 ± 2, p > 0.05). The average cost of care equipment was 3.5 times higher for the group with dressing (5120 FCFA vs. 18620 FCFA, p 0.05). In the study group, only one patient was afraid of seeing her wound. Patients in the control group were less satisfied, indeed they dreaded the time of removal of the plaster because of the pain.

Association study of obstetrical complication and depressive disorder

Objective：To investigate the correlation between obstetrical complications and depressive disorder. Methods：Depressive disorder probands and their adult sibling were diagnosed using CCMD-3 criteria. Obstetrical data from maternal reports were scored, applying published scales that take into account number and severity of complication. Results：The scores of obstetric complication and prenatal complications and low birth weight were significantly worse in probands than siblings without depressive disorders. Conclusion： Results suggest obstetric complications are etiologically significant in depressive disorder.