Similarly, the general acceptance of self-collection in Puerto Rico[19] and Nicaragua[20] was significantly higher. In Ontario, two-thirds of the sample found the swab easy and comfortable to self-collect, and 87.7% were willing to self-collect again in the future[21].
CONCLUSION
Self-collection flushing devices were also found to be highly acceptable to women. Most women indicated a preference for self-collection and willingness to self-collect in the future.
Primary cervical cancer screening by self-sampling of human papillomavirus DNA in internal medicine outpatient clinics. Evaluating the acceptability of self-sampling for HPV among Haitian immigrant women: CBPR in action.
Preeclampsia: Definitions, screening tools and diagnostic criteria in the supersonic era
Abstract
INTRODUCTION
In the definition of preeclampsia, proteinuria is defined by the appearance of urine proteins greater than 300 mg/d, a spot urine protein/creatinine ratio ≥ 30 mg/mmol, or a qualitative dipstick +1. Preeclampsia is usually defined in the ASH position paper by hypertension associated with proteinuria, but the American Society of Hypertension suggests the distinction between "less severe" and "more severe."
SCREENING FOR PREECLAMPSIA
In fact, the remodeling of the spiral arteries contributes 20% to 26% to the total reduction of systemic vascular resistance in the second trimester[30]. Uterine artery Doppler flow velocity waveforms in the second trimester for predicting preeclampsia and fetal growth retardation. Ala-9Val (Mn-SOD) and Arg213Gly (EC-SOD) polymorphisms in the pathogenesis of preeclampsia in Romanian women: association with the severity and outcome of preeclampsia.
Maternal serum inhibin A and activin A levels in the first trimester of pregnancies developing preeclampsia.
Role of minimally invasive surgery in complex adnexal tumours and ovarian cancer
Ovarian cancer is the sixth most common cause of cancer-related death in women in Europe[1]. Early ovarian cancer (EOC) includes cases in which the tumor is confined to the pelvis [Federation of Obstetrics and Gynecology (FIGO) stages Ⅰ-Ⅱb], while the term advanced ovarian cancer (AOC) is used for cases with extrapelvic disease or metastases . (FIGO stages ⅱC or more). The laparoscopic approach for surgical staging or resection of ovarian cancer was first reported in the mid-1990s[4].
In this review, we will address the limitations and concerns of using minimally invasive techniques for the treatment of complex adnexal masses and ovarian cancer.
EVALUATION AND MANAGEMENT OF COMPLEX ADNEXAL MASSES
Nevertheless, the laparoscopic approach for ovarian cancer staging and management of suspicious adnexal masses has raised many concerns among gynecologic oncologists, such as a possible reduction in radical surgical excision, an increased risk of port-site metastases, or a higher recurrence rate associated with more frequent intraoperative tumor cyst rupture. . Therefore, special care must be taken when establishing a pneumoperitoneum to avoid rupture of the cyst wall. Laparoscopic trocars should be secured to the abdominal wall to prevent CO2 leakage, and at the end of the procedure, gas evacuation should be performed through the trocar cord and never directly through the wall incision.
Under these conditions, the only limitation for laparoscopic treatment of adnexal masses is the size of the endoscopic bag, as the entire mass must be contained within this device to allow safe extraction through the abdominal wall without risk of contamination (Figure 1). ).
BORDERLINE OVARIAN TUMOURS
Various macroscopic findings should be kept in mind and included in the operative report (Table 1). It should be noted that conservative management should be limited to selected patients with complete resection in the absence of invasive peritoneal implants. Cystectomy should only be considered in bilateral tumors or in patients with one ovary, as oophorectomy resulted in a lower recurrence rate in the contralateral ovary compared to cystectomy.
Fanfani et al[ 20 ] tested the accuracy of narrowband imaging in BOT to increase the sensitivity of laparoscopy in detecting peritoneal implants.
EARLY-STAGE OVARIAN CANCER
Patterns of recurrence also appeared to differ between the fertility-sparing and radical surgery groups, with isolated recurrence in the remaining ovary being the most frequent form of recurrence in the former and recurrence in the contralateral ovary in the latter. Another concern with the laparoscopic approach is the dreaded possibility of an increased risk of rupture of malignant masses compared to laparotomy. Vergote et al[48] conducted a review of a large series of 1545 patients with various stages of ovarian cancer, in which reduced progression-free survival was associated with increased cystic rupture.
Considering the lack of high-grade evidence, the laparoscopic approach in the early stages of ovarian cancer seems safe and effective in terms of oncological outcomes.
ADVANCED-STAGE OVARIAN CANCER
A novel multi-marker bioassay using HE4 and CA125 for the prediction of ovarian cancer in patients with pelvic mass. Prospective study using the risk of ovarian cancer algorithm to screen for ovarian cancer. The role of appendectomy at the time of primary surgery in patients with early-stage ovarian cancer.
Impact of initial surgical access on staging and survival of patients with stage I ovarian cancer.
Unwanted pregnancies, unwanted births, consequences and unmet needs
GLOBAL STATUS
REASONS FOR SEEKING ABORTION
CONTRACEPTION AND ABORTION
COMPLICATIONS OF UNSAFE ABORTIONS AND CARE
Where effective contraceptive methods are available and widely used, rates fall sharply, but nowhere to zero[26]. Other less common reasons include a lack of knowledge about contraceptive methods or health problems.
WOMEN’S EDUCATION
RELIGION, CONTRACEPTION AND ABORTION
UNMET NEEDS
CAUSES
THE WAY FORWARD
New Estimates of Unmet Need and Demand for Family Planning (DHS Comparative Reports No. Unmet Need for Contraception in Developing Countries and Their Reasons for Not Using a Method (Case Report No. 37). Available from: URL: http://www.un.org/esa/population/publications/contraceptive2011/contraceptive2011.htm.
Unmet Need at the End of the Century, DHS Comparative Reports No. 1 (Calverton, MD: ORC Macro).
Retained placenta: Do we have any option?
INCIDENCE OF RETAINED PLACENTA
The reported data may not truly reflect the exact number of events, especially in lower-resourced countries and also due to their retrospective reporting. All types of previous uterine surgeries had been shown in the early period to increase the incidence of RP. Although RP was reported to be significantly higher in Britain than in Uganda[3], it is unclear whether or not this is a result of under-reporting.
A recent systemic review[4] confirmed that the incidence of RP has increased around the world, being more common in developed countries.
DEFINITION
PATHOPHYSIOLOGY
RISK FACTORS
VARIOUS TREATMENT MODALITIES
Oxytocin injection into the umbilical vein: The use of oxytocin in the treatment of third stage and RP has been reported in various studies. Prostaglandin: Prostaglandin is an effective uterotonic agent and plays a role in the management of PPH. The trial did not show any benefit of using misoprostol in the treatment of RP.
The use of ultrasound with Doppler studies and magnetic resonance imaging (MRI) may be useful in prenatal diagnosis and thus assist in delivery care [53].
![Table 1 Comparison of various trials [33] .](https://thumb-ap.123doks.com/thumbv2/123dok/11492428.0/43.892.86.433.152.370/table-1-comparison-of-various-trials-33.webp)
UNDIAGNOSED MORBIDLY ADHERENT PLACENTA
Risk of retained placenta in women previously delivered by caesarean section: a population-based cohort study. The effect of oxytocin injection into the umbilical cord for the management of retained placenta. Umbilical administration of oxytocin for the management of retained placenta: is it effective.
Intra-umbilical vein oxytocin in the management of retained placenta: A randomized, prospective, double-blind, placebo-controlled study.
Utility of a hemoglobin A1C obtained at the first prenatal visit
Measurement of hemoglobin A1C (HbA1C) has been approved by the American Diabetes Association (ADA) as a diagnostic and screening tool for diabetes, but not for GDM[4]. The World Health Organization (WHO) has concluded that HbA1C can be used as a diagnostic test for diabetes if standardized assays are used[5]. The ADA and WHO recommend the use of HbA1C ≥ 6.5% as a cut-off point for the diagnosis of diabetes. Using ADA guidelines, patients with HbA1C between 5.7%-6.4% are at an increased risk for diabetes and microvascular complications and are defined as having impaired glucose tolerance[4].
The use of HbA1C ≥ 6.5% to diagnose diabetes has not been validated in pregnancy.
MATERIALS AND METHODS
Treatment of gestational diabetes is aimed at reducing glucose levels to reduce risks to mothers and babies. The advantages of HbA1C are that it does not require fasting and is less subject to daily changes. The WHO expert group did not make official recommendations on the interpretation of HbA1C levels below 6.5% [5].
We sought to determine whether an HbA1C at the first prenatal visit, in women at high risk for GDM, was useful in identifying women with undiagnosed diabetes or impaired glucose tolerance who may benefit from early testing and intervention for gestational diabetes.
RESULTS
After delivery, 14/16 patients in group 1 (87%) were diagnosed with type 2 diabetes based on a 75 g two hour challenge test. An additional 15 patients in group two were diagnosed with GDM because daily self-monitoring of glucose indicated a need for medication to achieve glycemic targets. To achieve glycemic targets, 94% of patients in group 1, 64% of patients in group 2, and 6% of patients in group 3 required medication.
Based on group alone, the odds of seeking medication to control blood glucose compared to patients in the group who had normal HbA1C values were 220 times higher in the former group (95% CI: 26.9->999, P .
DISCUSSION
We identified 16/303 patients (5.4%) who met criteria for overt diabetes diagnosed during pregnancy. group one) required medication to achieve euglycemia during pregnancy. A second limitation is that 15 patients in group 2, who were labeled as having gestational diabetes, did not receive an oral glucose tolerance test. The HbA1C ≥ 6.5% identifies women with a degree of hyperglycemia consistent with pre-existing diabetes, who are at high risk of requiring medication to achieve euglycemia and who may benefit from dietary advice and daily blood glucose monitoring.
These women are also at high risk of requiring medication to achieve euglycemia if they are diagnosed with GDM.
COMMENTS
The study used the ADA and WHO cutoff to divide more than 300 subjects based on HbA1C levels and determine the risk of gestational diabetes and subsequent treatment. The International Association of Diabetes and Pregnancy Studies groups together recommendations on the diagnosis and classification of hyperglycemia during pregnancy. These patients had daily blood glucose monitoring and, despite advice on diet and exercise, failed to achieve glycemic targets and required medication indicative of a degree of glucose intolerance consistent with the diagnosis.
An HbA1C between 5.7% and 6.4% identifies women with some degree of glucose intolerance who may benefit from early testing.
Effect of vaginal speculum lubrication on cervical cytology and discomfort during smear examination
The present study also found that application of gel over the speculum significantly improves women's pain scores, reflecting a reduction in the discomfort associated with undergoing a pap smear. The majority of studies found in the literature comment on the effect of gel on cervical cytology, and only a few studies have assessed the effect on minimizing the pain for the woman. The strength of our study lies in the fact that we evaluated both parameters simultaneously, that is, the effect of gel on cervical cytology and pain scoring.
The use of vaginal speculum lubrication gel during Pap smear collection had no adverse effect on cervical cytology results and significantly reduced discomfort in women undergoing Pap smear testing.
Leiomyoma of the umbilical cord artery: A case report
CASE REPORT
Leiomyomas are of the second group of non-trophoblastic origin, which are extremely rare in the umbilical cord[3]. Manuscripts must be submitted via the Online Submission System at: http://www.wjgnet.com/2218-6220office. Scale bars should be used instead of magnification factors, with the length of the bar defined at the leg end rather than on the bar itself.
Standard abbreviations should be defined in the summary and at the first mention in the text.
