Women In Childbearing Age Group Research Articles

Medicolegal study of Egyptian unnatural female deaths in the childbearing period during 2019–2020

Violence against women is a global public health problem, especially in the childbearing period. However, it is considered as the least documented human rights violation worldwide which at its worst can result in femicide. This medico-legal study aims to explore the pattern of unnatural deaths among women in childbearing age group in the Egyptian community in recent years for early detection of women who are at risk and for establishment preventive measures. One hundred and one fifty of suspicious deaths of women in the reproductive age from 13 to 49 years were autopsied in Zeinhom Morgue (the Egyptian Forensic Medicine Authority) during 2019–2020. Demographic data, circumstances of death, causes and manner of death were defined and statistically analyzed. Unnatural death occurred during the 2nd −3rdh decades, 83.4 % were from urban residence, 40.4 % were single while 39.1 % of cases were married. In the majority of deaths, bodies were found at home. Regarding the manner of death, there were 38.4 % suicidal deaths and 38.4 % were homicidal death, while 19.2 % were accidental deaths. Sharp traumatic injuries were the most common pattern in homicidal cases mainly after domestic arguments by a spouse or relative while the most common suicidal and accidental pattern was jumping from height. The present study proved that violence against women resulting in unnatural deaths is very prevalent in Egypt with a rising rate in recent years. These findings could be useful for early identification of vulnerable women and for preventing woman deaths in the future.

Short birth interval and its predictors among reproductive age women in high fertility countries in sub-Saharan Africa: a multilevel analysis of recent Demographic and Health Surveys

BackgroundIn developing countries, short birth interval is one of the major public health issues. It is one of the leading cause’s adverse birth outcomes in the worldwide. Despite the fact that ending maternal and perinatal morbidity and mortality is one of the Sustainable Development Goals (SDG), the burden of the problem continues to be a huge concern in developing countries, including high fertility countries. Thus, this study aimed to determine the short birth interval and its predictors in ten high fertile sub-Saharan African countries.MethodsData for this study was obtained from the most recent Demographic and Health Surveys (DHS). A total of weighted sample of 303,979 women of childbearing age group (15– 49) who had at least two alive consecutive children was included. A multilevel mixed-effect binary logistic regression model was fitted to identify the associated factors of short birth interval. As a final step, the Adjusted Odds Ratio (AOR) was used with a confidence interval of 95% in determining statistical significance.ResultsOverall prevalence of short birth interval in high fertile sub Saharan Africa was 58.74% (52.32%, 65.17%).The factors significantly associated with the short birth interval were women's educational status; primary education (AOR = 0.88; 95% CI: 0.86,0 .91), secondary and higher (AOR = 0.10; 95% CI: 0.09, 0.11), working (AOR = 0.91; 95% CI: 0.88, 0 .93), classified as rich wealth index level (AOR = 0.90; 95% CI: 0.88, 0.93),having six and above ideal number of children (AOR = 2.25; 95% CI: 2.22, 2.30), preferred waiting time two years and above to give birth (AOR = 0.83; 95% CI: 0.76, 0.89), contraceptive non users (AOR = 3.01; 95% CI: 2.93, 3.07), community level education (AOR = 1.97; 95% CI: 1.54, 2.08), rural residency (AOR = 2.17; 95% CI: 2.13, 2.22), and country Chad (AOR = 1.37; 95% CI: 1.22, 1.54).ConclusionThe prevalence of short birth interval in the top ten high fertile sub Saharan African countries is still optimally high. Therefore, the government of each country should work on the access to family planning and education in rural parts of the countries.

SEROEPIDEMIOLOGY OF TOXOPLASMA GONDII AMONGST PREGNANT WOMEN WITH BAD OBSTETRIC HISTORY AT A TERTIARY CARE HOSPITAL IN CENTRAL INDIA

Background: Toxoplasmosis is a zoonosis caused by infection with Toxoplasma gondii. It is usually asymptomatic, but infection in pregnant women can pose serious health problems for the fetus like chorioretinitis, brain calcication, and microcephaly. It is therefore important to prevent transplacental transmission of T.gondii in pregnant females. Considering Aims & Objectives: that the seroepidemiology of Toxoplasma infection in the pregnant women is poorly studied, the main objective of this study was to estimate the seroprevalence and potential risk factors for T. gondii infection in women with BOH seeking antenatal care. Total 172 Materials & Methods: women with Bad obstetric history attending antenatal clinic were tested for Toxoplasma IgM and IgG antibodies by ELISA and a detailed history was taken according to case proforma to assess for potential risk factors. The Results: overall seroprevalence of anti-T. gondii antibodies was 33.7% (58/172). Among the seropositive women, 20.9% and 12.8% were positive for IgG antibody and IgM antibody respectively. Among the risk factors evaluated, residence in an urban area, contact with soil, consumption of raw or undercooked meat and unwashed vegetables, drinking unpasteurised milk were observed to be risk factors for Toxoplasmosis. No signicant relationship was found between the seroprevalence of T. gondii infection and older maternal age, gestational age, gravida, level of education, contact with cats and drinking untreated water. Conclusion: Health education and awareness is important in pregnant women and women in childbearing age group regarding the risk factors associated with Toxoplasmosis to avoid deleterious effects of the infection on mother and fetus.

Seroprevalence of Rubella Virus Infection in Susceptible Women of Childbearing Age Group Seeking Preconceptional Counselling and Infertility Treatment- A Cross-sectional Study from Eastern India

Introduction: Rubella is an acute viral infection predominantly affecting children and adults. Although natural infection with rubella provide lifelong immunity, but, primary infection in pregnant women during the initial days of pregnancy may result in spontaneous abortion, stillbirth, or a baby born with Congenital Rubella Syndrome (CRS), which can be prevented by vaccinating the susceptible non immune females one month prior to planning conception. Aim: To determine rubella virus immune status and demographic profile of women in childbearing age group, and counsel all Rubella virus infection susceptible women for vaccination prior to planning pregnancy. Materials and Methods: A cross-sectional observational study was done at Indira Gandhi Institute of Medical Sciences (IGIMS), Patna , Bihar, India, on 112 apparently healthy, asymptomatic women in the 18-45 years age group coming for preconceptional counselling and primary and secondary infertility treatment during April 2017 to March 2019, whose serum rubella Immunoglobulin G (IgG) antibody testing was done by Enzyme- linked Immunosorbent Assay (ELISA). The data regarding their rubella virus immune status, age, parity and occupations were coded and recorded in MS Excel spreadsheet program. The Statistical Package for the Social Sciences (SPSS) version 23 (IBM Corp.) was used for data analysis. Results: Out of the total 112 women {92 (82.1%) housewife and 20 (17.9%) professionals} included in this study , a total of 67 (59.8%) women tested positive for rubella IgG antibody and 45 (40.2%) tested negative for rubella IgG antibody. The mean age of the rubella virus seropositive immune patients and seronegative susceptible women was 27.72±4.83 years was 26.09±4.68 years respectively. Among the 67 seropositive patients, maximum antirubella virus IgG seropositivity (71.4%) was seen in more than 35 years age group and maximum seronegativity 23 (46.9%) was seen in 18-26 years age group. There was no direct association of occupation and parity with rubella immune status. Conclusion: Higher rate of antirubella IgG seronegativity amongst younger age groups and nulliparous women renders them susceptible to primary Rubella virus infection. Hence, Rubella IgG antibody screening, proper counselling and prompt rubella vaccination for all primary Rubella virus infection susceptible women is necessary one month prior to planning conception, to avoid foetal congenital malformations during subsequent pregnancies.

A rare cause of hemoptysis in a young female

Takayasu's arteritis (TA) is also termed pulseless disease owing to the frequent occlusion of large arteries originating from the aorta and its major branches. It is an uncommon chronic inflammatory progressive idiopathic large vessel vasculitis with a predilection for young women of childbearing age group. Fatigue, malaise, and fever are the frequently encountered early symptoms of TA. Hemoptysis is not commonly seen as an initial presentation of TA. The subclavian artery is most commonly involved, and the disease is usually discovered accidentally owing to pulse asymmetry. In addition, pulmonary artery involvement is not common in TA. Here, we present a case of a young female presented to us with hemoptysis with pulmonary artery involvement with a de novo diagnosis of TA.

The Concept of Clinical Endometriosis: A Paradigm Shift in Africa

The clinical symptoms of endometriosis, an illness characterized by ectopic endometrium (glands and stroma) outside the uterus, are mainly dysmenorrhea, dyspareunia, cyclic urinary symptoms and infertility. Although imaging modalities such as pelvic ultrasound can identify and localize endometriotic deposits in the ovary (endometrioma) and in bladder wall, diagnosis of the disease is impossible where such imaging modalities are unavailable or where clinicians are not trained to clinically diagnose endometriosis during consultation. Especially in sub-Saharan Africa, clinicians should be familiar with certain predisposing risk factors for endometriosis such as early age at menarche, shorter menstrual length and low body mass index. Delay in the diagnosis of endometriosis not only prolongs the duration of suffering, pain and discomfort but also lowers quality of life and increases cost of treatment. This article focuses on how gynecologists and clinicians in sub-Saharan Africa can easily identify the symptomatology of endometriosis. Clinical presentations of endometriosis in Black African women may not be different from presentations among Caucasian women. Though a confusing illness for the patient and for the clinician, at least, African gynecologists, clinicians and general practitioners can have a suspicion of endometriosis when a Black African woman presents with a combination of infertility, pelvic pain, dysmenorrhea and dyspareunia. This article discusses various conditions associated with endometriosis in adolescent women and in women in child-bearing age group.

Total mercury exposure risk and selenium content measuring on fishery products consumed by women of childbearing age from Bogota, Colombia

Background. Dietary exposure to mercury in women of childbearing age could result in neurological effects on the fetus. A health risk assessment of total mercury by fishery products intake has not been conducted in this population group in Bogota, Colombia. On the other hand, it has been suggested that selenium content on fishery products may have a protective effect against mercury toxicity. Nevertheless, selenium content on fish species marketed in Bogotá has not been determined. Objective. Exposure risk to total mercury and selenium content on fishery products consumed by women of childbearing age from Bogota, Colombia, were assessed. Methods. Total mercury and selenium concentrations for products available at fish stores and supermarkets were determined. The exposure risk to total mercury was estimated considering the intake of these products by women of childbearing age group. Results. Total mercury highest concentrations were 0.8166 mg/kg in mota (Calophysus macropterus), and 0.6275 mg/kg in catfish (Pseudoplatystoma tigrinum). On the other hand, the highest selenium concentration was 0.6471 mg/kg in nicuro (Pimelodus blochii). Finally, it was established that for women of the childbearing age group, health risk of exposure to total mercury due to mota intake exceeded by 8.56-fold the reference dose. Conclusions. Mota intake considerably increases exposure risk to total mercury on women of childbearing age from Bogota, Colombia. The selenium levels established in the fishery products assessed, except for catfish and mota, are theoretically suggestive of a protective effect of selenium against mercury toxicity. Consequently, continuous total mercury concentrations monitoring is required to protect health of the women of childbearing age and the general population from Bogota, Colombia.

Toxoplasma gondii infection: seroprevalence and associated risk factors for women of childbearing age in Osun State, Nigeria

ABSTRACT Toxoplasmosis is a common parasitic infection caused by an obligate intracellular protozoan, Toxoplasma gondii. Prevalence and risk factors of T. gondii infection in women of childbearing age in Osun State, Nigeria are unknown. This study was aimed to determine the seroprevalence and potential risk factors in acquiring T. gondii infection by women of childbearing age in Osun State, Nigeria. A community-based cross-sectional study was conducted from May 2019 to December 2019 in childbearing age women. Sera of 415 women aged 18–49 years randomly selected were collected and analyzed by enzyme-linked immunosorbent assay (ELISA) test. A questionnaire survey was administered for all study participants to collect socio-demographic and risk factors data. The study revealed that the overall seroprevalence of T. gondii infection was 76.63%, which comprised 6.02% positivity for anti-T. gondii IgM (25/415), 44.10% for IgG (183/415) and 26.51% for IgG plus IgM (110/415). Seroprevalence of IgM antibodies to T. gondii (6.02%) suggested recent infections. Women residing in rural communities and women of Islam religion showed significant association with anti-T. gondii seropositivity (p < 0.05). Residence location and women who are of Islam religion are risk factors to acquire T. gondii infection. Hence, health education and awareness on the disease and its transmission to women of childbearing age group in general and pregnant women in particular should be created during antenatal follow up to reduce the risk of T. gondii infection in pregnant women.

Abdominal Swelling and Distension: An Unusual Cause of ‘Ascites’

Cases of abdominal bloating and distension are frequently seen in acute and emergency medicine. Although ascites remain a common cause, other differentials such as bladder distension, intestinal obstruction or masses, fecal loading, gynecological tumors and rarely, pregnancy in women of childbearing age group, must be considered. In this article we illustrate an unusual cause of abdominal distension.

The Effect of Sambiloto Extract on the Expression of β Estrogen Receptors in Ovaries and Lust Cycle in Mice Model PCOS - Insulin Resistance

Infertility was a serious problem in the reproductive period, one of the caused of infertility were common in women of childbearing age group is Polycystic Ovary Syndrome (PCOS).Sambiloto (Andrographis paniculata Nees), had been already known contain flavonoid and lactones. The purpose of this research had to determine the effect of various doses of sambiloto extract with the expression of β estrogen receptor and estrus cycle in the mice model of PCOS - insulin resistance. This research was an animal model experimental laboratory research with a completely randomized design (CRD).The results showed that sambiloto extract therapy in treatment group had an improvement estrus cycle compared with control group. Positive control group, almost 90% had persistent anestrus condition. In treatment group 1 and 2 in the last vagina smear obtained anestrus condition as much as 60% in diestrus and medestrus phase. Whereas treatment groups 3 all experimental animals in a estrus state by proestrus and estrus phase. β Estrogen receptor expression had tested by Kruskal Wallis test for overall treatment, obtained significantly different results (p ≤ 0.002) followed by Mann - Whitney, showed that immunoreactive cells score from highest to lowest occurred in each group Negative control (KN), P3, P2, P1 and Positive Control (KP).It could be concluded that sambiloto extract at dose 18mg/kgbb, 36mg/kgbb, and 72mg/kgbb had been given an overview of the differences expression of β estrogen receptor, could change the estrus cycle of female mice models of insulin resistance PCOS.

A multilevel analysis of short birth interval and its determinants among reproductive age women in developing regions of Ethiopia.

Short Birth Interval negatively affects the health of both mothers and children in developing nations, like, Ethiopia. However, studies conducted to date in Ethiopia upon short birth interval were inconclusive and they did not show the extent and determinants of short birth interval in developing (Afar, Somali, Gambella, and Benishangul-Gumuz) regions of the country. Thus, this study was intended to assess the short birth interval and its determinants in the four developing regions of the country. Data were retrieved from the Demographic and Health Survey program official database website (http://dhsprogram.com). A sample of 2683 women of childbearing age group (15-49) who had at least two alive consecutive children in the four developing regions of Ethiopia was included in this study. A multilevel multivariable logistic regression model was fitted to identify the independent predictors of short birth interval and Akaike's Information Criterion (AIC) was used during the model selection procedure. In this study, the prevalence of short birth interval was 46% [95% CI; 43.7%, 47.9%]. The multilevel multivariable logistic regression model showed women living in rural area [AOR = 1.52, CI: 1.12, 2.05], women attended secondary education and above level [AOR = 0.27, CI: 0.05, 0.54], have no media exposure [AOR = 1.35, CI: 1.18, 1.56], female sex of the index child [AOR = 1.13, CI:1.07,1.20], breastfeeding duration [AOR = 0.79, CI: 0.77, 0.82], having six and more ideal number of children [AOR = 1.14, CI: 1.09, 1.20] and having preferred waiting time to birth two years and above [AOR = 0.86, CI: 0.78, 0.95] were the predictors of short birth interval. The prevalence of short birth intervals in the developing regions of Ethiopia is still high. Therefore, the government of Ethiopia should work on the access of family planning and education in rural parts of the developing regions where more than 90% of the population in these regions is pastoral.

Investigation of Toxoplasma gondii Seropositivity in Uludağ University Hospital between 2009-2016

The aim of this study is to investigate the distribution of anti-Toxoplasma gondii immunoglobulin G (IgG) and immünoglobulin M (IgM) antibodies in patients with suspected toxoplasmosis admitted to the Practice and Research Center of Health of the Medical Faculty of Uludağ University. The blood samples examined for the presence of anti-T. gondii IgG antibody and anti-T. gondii IgM antibody by an enzyme linked fluorescent assay test, anti-T. gondii IgG avidity value was evaluated by VIDAS (BioMérieux, France) kit. In our study, anti-T. gondii IgG seropositivity in 3311 (30.7%) of 10.603 cases and anti-T. gondii IgM seropositivity in 1423 (9.7%) of 14.618 cases were detected. Seropositivity of anti-T. gondii IgG was 37.5% in women of childbearing age group. The avidity value was high in 56.1% (n=156) and low in 28.9% (n=80) of childbearing age group women with positive anti-T. gondii IgG and anti-T. gondii IgM test. Especially in regions where seroprevalence is high, we think that pregnant women and women of childbearing age should be investigated in terms of T. gondii antibodies.

Systemic Lupus Erythematosus and Pregnancy: A Brief Review.

Systemic lupus erythematosus is a chronic multisystemic autoimmune disease that predominantly affects young women of childbearing age group. There is a complex immunologic interplay during pregnancy in patients with systemic lupus erythematosus. The pregnancy has direct impact on the disease where an increased rate of flares is noted, and lupus leads to increased risk of hypertensive diseases of pregnancy, preterm birth as well as miscarriages, particularly those with antiphospholipid antibodies. Neonates born to patients with lupus are at increased risk of neonatal lupus as well as heart block if born to patients with positive SSA/SSB. Despite the increased risk of morbidity, recent data suggest improved outcomes in pregnant patients with lupus. A multidisciplinary approach with careful monitoring of pregnancy and lupus could reduce adverse outcomes in these patients. This requires careful pregnancy planning, defining the clinical and serologic involvement of lupus, careful monitoring the patient for adverse pregnancy outcome as well as lupus flares and comprehensive understanding of the drugs that can be safely used in pregnancy. Fetuses should be carefully monitored for heart and neonates for neonatal lupus. Hydroxychloroquine, azathioprine and corticosteroids can be used during pregnancy and may reduce the risk of adverse outcomes. Similarly, appropriate therapy needs to be instituted for hypertensive diseases in pregnancy. Anticoagulant therapy may be necessary for patients with antiphospholipid syndrome.

Who Are the Type 2 Von Willebrand Disease Patients? Results from Interim Analysis of the French HRQoL Study: Wish-Qol.

Type 2 von Willebrand disease (VWD) includes a wide range of qualitative abnormalities of von Willebrand factor (VWF) function and structure resulting in various bleeding phenotypes. Variants 2A, 2B and 2M are mainly related to abnormal interaction of VWF with platelets and/or the subendothelium. Mucocutaneous bleeds such as epistaxis, menorrhagia and gastro-intestinal bleedings are the most frequently reported in these subtypes, while in patients with type 2N VWD characterized by a defective binding of VWF to FVIII, a phenotype with symptoms suggestive of mild/moderate hemophilia A is common.Are type 2 VWD female patients' bleeding score, clinical phenotype and impairment of Quality of Life (QoL) more severe than the males' ones? To answer this question, we report here results of VWD type 2 patients enrolled in the French Heath related Quality of Life study: WiSH-QoL.This study is conducted with the French Reference Centre for von Willebrand Disease (CRMW). Clinical phenotype such as bleeding score (Tosetto score), biological profile and genotype are documented. Clinical characteristics and therapeutic approach are also recorded. Patients are treated with WILFACTIN®, triple-secured plasma-derived VWF with a low factor VIII content. Information on socio-demographic and resources consumption are gathered by patients in their diary. HRQoL is assessed with the generic SF-36 (for adults), the chronic-generic DISABKIDS Short Form (for children and adolescents), the VWD-specific HRQoL questionnaire VWD-QoL (for adults, children, adolescents and parents with a proxy version), the VWD-specific treatment satisfaction assessment VWD-Sat (for adults and parents with a proxy version). The Impact on Family (IOF) Scale is dedicated to caregivers of children with VWD. At least 350 patients will be followed during 2 years.During the recruitment period (Oct. 2014 - Nov. 2017), 357 patients were enrolled. At the time of this analysis, data at inclusion on 355 patients were evaluable. Focus was made on the 226 type 2 VWD patients: 141 (62.4%) females and 85 (37.6%) males, median age and range at study entry 32.7 (1-78) and 26.4 (1-83) years, respectively. The majority of them were adults with 101 (71.6%) females and 49 (57.6%) males. 76 patients were below 18 years (40 (28.4%) females and 36 (42.4%) males). In the female subgroup, 81 were women of child-bearing age (15-50 y.o), 27 under 15 years with 21 prepubertal children and 33 above 50 years.The median age at diagnosis was 11.5 years (range 0-78) associated with a family history of VWD in the majority of patients (178, 78.8%), earlier in males' life (6 y) than in females (15 y). The first substitutive treatment by VWF was administered at a median age of 19.0 years (range 0-78), with 13.0 years for males compared to 23.5 y for females.At baseline, 23 (10.2%) patients (12 females and 11 males) had reported GI manifestations.The patients were 64 patients with type 2A, 52 with type 2B, 68 with type 2M, 12 with type 2N and 30 with type 2 unspecified.The median Tosetto bleeding score (BS) reported for 202 patients was +7.0 (range -1 to 25), higher +8.0 (range -1 to 25) in female compared to +5.0 (range 0 to 21) in male patients. It was also able to distinguish disease severity by variants as shown in table1. Whatever the variants (2A, 2B, 2M and 2N VWD,) the women of child-bearing age group had the highest BS.At enrollment, 62 female patients (44.0%) have already received a concomitant treatment with Iron, oral contraceptive, intra-uterine device. In the group of 64 women who had experienced a total of 136 deliveries (mainly vaginal deliveries (107, 78.7%) and C. Section (29, 21.3%)), the mean number of childbirth was 2.1 (range 1-5). Post-Partum Hemorrhages occured in 42 of these cases (31.3%), mainly within 48 hours after giving birth in 27 cases (67.5%) out of the 40 cases with available data.Were also found differences in both Physical and Mental Component Score of the generic SF-36 with higher impairments in HRQoL in adults females than in males (PCS 54.04 vs 55.22) MCS (44.71 vs. 47.85). The same tendency was seen with the Normalized Global score VWD-Specific in adults with higher score in females than in males (17.26 vs 13.91).This study with HRQoL results will bring a deeper insight into type 2 VWD patients' real daily life. These findings may teach us what would be the best care for VWD patients and especially for females who need definitely specific health care throughout their fertile life. [Display omitted] DisclosuresBorel-Derlon:Octapharma: Other: Clinical Research Investigator; LFB: Membership on an entity's Board of Directors or advisory committees; Shire: Other: Principal investigator; Novonordisk: Membership on an entity's Board of Directors or advisory committees; Sobi: Membership on an entity's Board of Directors or advisory committees. Desprez:LFB: Other: Investigator. Volot:LFB: Other: Investigator. Pan-Petesch:LFB: Other: Investigator. Chatelanaz:LFB: Employment. Doriat-Robin:LFB: Employment. Veyradier:LFB: Other: Investigator. Von Mackensen:LFB: Membership on an entity's Board of Directors or advisory committees.

A Hospital Based Study on Anemia Prevalence in Children of an Indian Island

Background Anemia is a major public health problem in India, affects all age groups but children and women in childbearing age group are the most vulnerable. However, data from hospital patients of Indian islands are not available. We aimed to study the prevalence of anemia among children aged 2-12 years of age attending a tertiary care hospital (India). Materials and Methods A total of 444 children aged 2-12 years were enrolled in the study over six months from August 2015 to Jan 2016. A complete blood count was obtained by taking 2ml of blood using fully automated MINDRAY Hemat analyser-BC5800. Anemia was diagnosed according to the World Health Organization (WHO) standard for the given age. The data was analyzed and interpreted using descriptive and inferential statistics. Results Overall prevalence of anemia among the children 2-12 years of age was 32.21%. Severity wise, mild Anemia was the commonest (56.64%), while severe Anemia was rare. The prevalence of Anemia was slightly more among girls compared to boys although not statistically significant (p>0.05). Both Anemia and mean Hemoglobin (Hb) was significantly associated with age (p 0.05). Conclusion At current study, Anemia is common among the children of Andaman Nicobar (India), and affects boys and girls equally. Although mild anemia is very common, it remains asymptomatic and therefore goes unnoticed and untreated.

Pregnancy and bariatric surgery.

A large number of women experience pregnancy after bariatric surgery. The purpose of this review was to understand the evidence base in this area to come up with practical, evidence-based recommendations. We examined PubMed for all published articles on pregnancy in patients who have previously undergone a bariatric surgery. There is an increasing body of evidence pointing towards a beneficial effect of weight loss induced by bariatric surgery on female and male fertility prompting calls for recognition of infertility as a qualifying co-morbidity for patients between the Body Mass Index of 35.0 kg/m2 and 40.0 kg/m2. Women in childbearing age group should be routinely offered contraceptive advice after bariatric surgery and advised to avoid pregnancy until their weight has stabilized. Until more focused studies are available, the advice to wait for 12 months or 2 months after the weight loss has stabilized, whichever is latter, seems reasonable. Patients should be advised to seek clearance from their bariatric teams prior to conception and looked after by a multi-disciplinary team of women health professionals, bariatric surgeons, and dietitians during pregnancy. The main objective of care is to ensure adequate nutritional state to allow for a satisfactory weight gain and fetal growth. There is a relative lack of studies and complete lack of Level 1 evidence to inform practice in this area. This review summarizes current literature and makes a number of practical suggestions for routine care of these women while we develop evidence to better inform future practice.

A Rare Presentation of Endometriosis with Massive Haemorrhagic Ascites: A Case Report

Background: Endometriosis associated with massive haemorrhagic ascites is an exceedingly uncommon finding. In most of the cases, the presence of massive hemorrhagic ascites is associated with malignancies, hepatoma, tuberculosis or perforated viscous. This case report draws attention to this condition of massive hemorrhagic ascites as a complication of endometriosis. Case: A 25-year-old, nulligravida with massive haemorrhagic ascites and right adnexal mass in CT scan underwent laparotomy, and peroperatively three liters of hemoperitoneum was found with no signs of malignancy on examination of ovary. The histological report of abdominal peritoneum was compatible with an endometriosis. The patient was treated with a GnRH analogue in postoperative period with progressive reduction of ascitic fluid. Patient is on follow up. Conclusion: Haemorrhagic ascites should be considered as a complication of endometriosis, especially in nulliparous women of childbearing age group with abdominal distention, dysmenorrhea, abdominal pain and haemorrhagic ascites, suggesting a diagnosis of ovarian malignancy.

Comparative study of occurrence of postpartum low back and pelvic pain (LBPP) after normal delivery versus caesarean section (CS) following spinal anaesthesia and its rehabilitative management

Introduction and hypothesis: Low back and pelvic pain is very commonly encountered ailment in pregnancy and post-partum in women of childbearing age group. It can account for around half of the women of childbearing age. The pathophysiology of low back pain during pregnancy and postpartum is still poorly understood. Methods: The study was to compare low backache after normal delivery and after caesarean section following spinal anaesthesia, and its persistence after pregnancy. Moreover women were educated to regain the pre-pregnancy state uneventfully. Results: Postpartum backache at 1 month incidence in our study was 49%. Remission of pain occurred in 51% at 1 month and 78% at 6 months in caesarean section group, while in the normal vaginal delivery group 55% at 1 month and 85% in the 6th month had remission of pain. Conclusions: Women who had caesarean section with spinal anaesthesia had more chances to develop low back pain than women with normal vaginal delivery. Pre-pregnancy state can be achieved by supervised exercise regime.

False-negative urine human chorionic gonadotropin in molar pregnancy: " The high-dose hook effect" !

Failure to detect pregnancy in the emergency situations can have important consequences. These include missing of ectopic pregnancy (the leading cause of first-trimester pregnancy-related maternal death), administration of medications contraindicated in pregnancy, fetal radiation exposure, and medico legal problems. This in turn has led to the dictum to check for pregnancy in all women of child-bearing age group. Urine pregnancy (human chorionic gonadotropin [hCG]) test is the commonly used test to rule out pregnancy and has been reported by Griffey et al. in their study to achieve 100% sensitivity and 99.2% specificity in a clinical setting, resulting in a positive predictive value of 98.3% and a negative predictive value of nearly 100%. However, the sensitivity is influenced not only by the quantity of β hCG but on its variants that vary with different weeks of pregnancy. β hCG is present in several variant forms that change in their concentrations at different stages of pregnancy. In spite of its high sensitivity, in the presence of molar pregnancy that is associated with very high levels of β hCG it fails to detect the antigen (β hCG). This is explained by the phenomenon known as high-dose hook effect which further leads to delay in diagnosis and treatment. This can be overcome by dilution of the sample. In such cases, diagnosis will be made by serum β hCG and ultrasound (USG). Here, we present a case of gravida 2 para 1 living 1 with 2΍ months amenorrhea with bleeding p/v and pain abdomen of 20 days duration whose urine β hCG was repeatedly negative and diagnosis was made by serum β hCG and USG.

Emergence of non-albicans Candida among candidal vulvovaginitis cases and study of their potential virulence factors, from a tertiary care center, North India

The purpose of this study was to determine the prevalence of various Candida species and study some of their virulence factors among thevulvovaginal candidiasis(VVC)patients. The study was conducted in a Tertiary Care University Hospital in North India. This study was carried out prospectively for a period of 1 year. High vaginal swabs (HVSs) were collected from women in childbearing age group attending the gynecology and obstetrics out-patient departments with the complaints suggestive of vulvovaginitis. Samples were plated on Sabouraud's dextrose agar slope. Candida spp. isolated was further speciated based on microscopy, biochemical tests and culture characteristics on special media. Virulence factors of these strains were determined by biofilm formation and phospholipase activity. A total of 464 HVS from 232 patients with the complaints of vulvovaginitis were included in this study. Following laboratory workup, 71 specimens were positive for genus Candida (30.6%). Further speciation showed 32.4% as Candida albicans, 45.07% Candida parapsilosis and 22.53% of Candida glabrata. Biofilm production was shown by 50 candidal strains (70.4%) and phospholipase activity was given by 41 candidal strains (57.74%). Our study suggests increasing prevalence of non-albicans Candida among the VVC cases along with their virulence factors. Therefore, we recommend that microbiological investigation upto species level should be mandatory to determine the emergence of non-albicans Candida as a major cause of VVC.