Evidence-based surgery for cesarean delivery: an updated systematic review.

We sought to determine the efficacy and safety of tranexamic acid (TA) in reducing blood loss during elective cesarean section (CS). We performed a randomized, double-blind, placebo-controlled study of 660 women who underwent elective CS. The patients were randomly selected to receive an intravenous infusion of either TA (1 g/10 mL in 20 mL of 5% glucose; N = 330) or 30 mL 5% glucose prior to surgery. The primary outcome was the estimated blood loss following CS. No demographic difference was observed between groups. The mean estimated blood loss was significantly lower in women treated with TA compared with women in the placebo group (499.9 ± 206.4 mL versus 600.7 ± 215.7 mL, respectively; P 1000 mL was significantly lower than in the placebo group (7 [2.1%] versus 19 [5.8%], respectively; relative risk [RR] 2.7; 95% confidence interval [CI] 1.1 to 6.3; P 1000 mL, and the need for additional uterotonic agents. Furthermore, the incidence of thromboembolic events did not increase. Our results suggest that TA can be used safely and effectively to reduce CS bleeding.

Efficacy of Intravenous Tranexamic Acid in Reducing Blood Loss after Elective Cesarean Section: A Prospective, Randomized, Double-Blind, Placebo-Controlled Study

Human Papilloma Virus (HPV) infection is the major cause of cervical cancer worldwide. With limited data available on HPV prevalence in the Arab countries, this study aimed to identify the prevalence and genotypic distribution of HPV in the State of Qatar. 3008 cervical samples, exclusively of women with Arabic origin residing in Qatar were collected from the Women’s Hospital and Primary Health Care Corporation in Doha, State of Qatar. HPV DNA detection was done using GP5+/6+ primers based real time-polymerase chain reaction (RT-PCR) assay followed by the usage of HPV type specific primers based RT- PCR reactions and Sanger sequencing for genotype identification. Similar prevalence rates of HPV infection was identified in both Qatari and non-Qatari women at 6.2% and 5.9% respectively. HPV prevalence rate of 5.8% and 18.4% was identified in women with normal cytology and in women with abnormal cytology respectively. HPV 81, 11 and 16, in decreasing order were the most commonly identified genotypes. HPV 81 was the most frequent low-risk genotype among women with both normal (74.0%) and abnormal (33.3%) cytology. HPV 16 (4.6%) was identified as the predominant high-risk HPV genotype among women with normal cytology and HPV 16, HPV 18, and HPV 56 (22.2% each) were the most common identified high-risk genotypes in women with abnormal cytology. The overall HPV prevalence in Arab women in Qatar was identified as 6.1% with an increased HPV prevalence seen in women with abnormal cytology results and no significant trends seen with age. In contrast to Western countries, we report a varied genotypic profile of HPV with a high prevalence of low-risk HPV genotype 81 among the Arab women residing in Qatar.

/pdf/molecular-epidemiology-and-genotype-distribution-of-human-3j8pxnr0cc.pdf

Molecular epidemiology and genotype distribution of Human Papillomavirus (HPV) among Arab women in the State of Qatar.

Purpose of review The purpose of this review is to aid the healthcare practitioner in caring for children, girls, and women who have undergone female genital mutilation or who are at risk for female genital mutilation. Recent findings The bulk of the literature published in the area of female genital mutilation over the past year addresses the laws, social needs, immigration status and assimilation of African women who immigrate into western countries. Clinicians continue to publish case reports of complications and the surgical management of type III female genital mutilation during labor. Additionally, as people continue to try to eliminate female genital mutilation through human rights campaigns and the legal system, they have also become increasingly aware that understanding the motives behind this traditional practice may be an avenue towards change. Summary The fundamental understanding of female genital mutilation will allow the clinician to address the emotional and physical needs of the children, girls, and women who have undergone this traditional practice or who are at risk for undergoing this practice. This understanding will allow the practitioner to individualize the history and physical examination, and to provide appropriate management with recognition and treatment of complications. Increased knowledge of the laws against female genital mutilation will allow the healthcare provider to educate and advise at-risk girls and women as well as their parents.

Female genital mutilation

Human papillomavirus (HPV) has been implicated in the etiology of a variety of human cancers. Studies investigating the presence of high-risk (HR) HPV in breast tissue have generated considerable controversy over its role as a potential risk factor for breast cancer (BC). This is the first investigation reporting the prevalence and type distribution of high-risk HPV infection in breast tissue in the population of Qatar. A prospective comparison blind research study herein reconnoitered the presence of twelve HR-HPV types’ DNA using multiplex PCR by screening a total of 150 fresh breast tissue specimens. Data obtained shows that HR-HPV types were found in 10% of subjects with breast cancer; of which the presence of HPV was confirmed in 4/33 (12.12%) of invasive carcinomas. These findings, the first reported from the population of Qatar, suggest that the selective presence of HPV in breast tissue is likely to be a related factor in the progression of certain cases of breast cancer.

https://www.mdpi.com/2072-6694/12/6/1528/pdf

Prevalence and type distribution of high-risk Human Papillomavirus (HPV) in breast cancer : a Qatar based study

Aim To determine the effect of routine intraoperative cervical dilatation during elective cesarean section on maternal morbidity. Subjects and methods Patients with even numbers in the operative elective cesarean section list were included in the study. Of these, every second patient underwent intraoperative cervical dilatation. All participants in the two groups had otherwise similar preoperative care, operative procedures and subsequent clinical care. Blood loss was estimated and maternal infection status was assessed postoperatively by any rise of temperature or wound infection. Results Of the 131 patients included in the study, 67 underwent cervical dilation and 64 served as controls. There was no significant difference in postoperative hemoglobin, incidence of fever, or wound infection between the two groups. Only two of the cervical dilation group and one control patient developed postoperative fever. A hemoglobin drop of more than 0.5 g/dL was noted in 27 and 26 patients in the cervical dilation and the no dilation groups, respectively (NS). None of the study patients had signs of wound infection. Conclusion Intraoperative cervical dilatation during elective cesarean section did not reduce the risk of postoperative maternal fever, wound infection or change in hemoglobin concentration.

Routine cervical dilatation during elective cesarean section and its influence on maternal morbidity: a randomized controlled study.

Amniotic fluid (AF) is a dynamic medium that plays a significant role in fetal well-being. It is production and amount varies with gestational age. It plays a vital role in fetal life as it contains antimicrobial factors, growth factors and it help the fetal lung to grow and expand. Amnioinfusion can be performed either transabdominally or transvaginal. Amnioinfuion can be done antenatally and during labor. Aminoinfusion can be used for diagnostic purposes to enable better visualization of the fetus as liquor is very important acoustic widow for better fetal examination. Amnioinfusion have some therapeutic benefits in conditions like early premature rupture of membrane and may help cases of external cephalic version for breech presentation at term. Amnioinfusion has been shown to reduce the incidence of variable deceleration due to cord compression, reduces the risk of meconium aspiration and it will help reduce cesarean delivery.

What is the role of amnioinfusion in modern day obstetrics

Some obstetricians routinely dilate the cervix from above during elective cesarean section using either a double-gloved finger or a Hegar dilator in case the cervix should fail to dilate and allow the discharge of residual blood and debris. In this way, it is hoped that endometritis and excessive blood loss may be avoided. This prospective trial was designed to show whether digital cervical dilatation does in fact reduce maternal febrile morbidity, wound infection, and blood loss after operative delivery. Sixty-seven of 131 women entering the study had intraoperative cervical dilation, whereas 64 served as a control group. The 2 groups had comparable preoperative and clinical care and similar operative procedures. In study cases, a double-gloved index digit was placed in the cervical canal to dilate it. Patients remained in the hospital for 4 to 5 days postoperatively. The women participating in this study, ranging in age from 20 to 45 years, all were free of symptoms and were not in labor. There were no significant group differences in age, parity, or previous section delivery. Changes in hemoglobin were similar in the 2 groups. Only 3 women-2 of whom had cervical dilation-became febrile. Two of these women had breast engorgement and one had upper respiratory tract infection. No outcome measures differed significantly between the 2 groups. None of the participants developed wound infection. This, the first randomized trial evaluating cervical dilatation during elective cesarean section, fails to support the practice of routine digital cervical dilation in this setting to lower the risk of postoperative maternal fever, wound infection, or excessive blood loss.

Routine cervical dilatation during elective cesarean section and its influence on maternal morbidity : A randomized controlled study

Aim: Human papillomavirus (HPV) detection is very important for the evaluation of prevention strategies in cervical cancer and other HPV-related diseases. This study aimed to assess the prevalence of high-risk HPV infection in a cohort of Qatari residents, and correlate this with cytology and potential risk factors. Method: The study utilized cervical cytology and HPV DNA testing methods, high-risk screen real-time PCR, to detect high-risk HPV genotype infections in a sample of Qatar’s female population. A series of 95 women attending the Gynecology/Oncology Clinic at Hamad Medical Corporation between August 2007 and May 2008 were enrolled in the study. Cervical smears isolated from patients were subjected to real-time PCR to confirm the presence of HPV DNA. The smears were characterized as atypical squamous cells of undetermined significance (ASCUS); low-grade squamous intraepithelial lesions (LGSIL) and high-grade squamous intraepithelial lesions (HGSIL). As a secondary outcome, risk factors for HPV inf...

Prevalence of human papillomavirus infection in women attending a gynecology/oncology clinic in Qatar

The practice of female genital mutilation sadly remains to this day, part of the life of many women worldwide. In the Middle East and Africa, it is hard to practice obstetrics and gynecology without some knowledge of the condition. This review is an attempt to discuss the salient points as regards to management of these women during pregnancy and labor.

Female genital mutilation and childbirth.

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