International Journal of Women’s Health and Reproduction Sciences
Volume:3 Issue: 3, Summer 2015

War and poverty are ‘extraordinary conditions created by human intervention’ and ‘preventable public health problems.’ War and poverty have many negative effects on human health, especially women’s health. Health problems arising due to war and poverty are being observed as sexual abuse and rape, all kinds of violence and subsequent gynecologic and obstetrics problems with physiological and psychological courses, and pregnancies as the result of undesired but forced or obliged marriages and even rapes. Certainly, unjust treatment such as being unable to gain footing on the land it is lived (asylum seeker, refugee, etc.) and being deprived of social security, citizenship rights and human rights brings about the deprivation of access to health services and of provision of service intended for gynecology and obstetrics. The purpose of this article is to address effects of war and poverty on the health of reproduction of women and to offer scientific contribution and solutions.

Fever in pregnancy is a common clinical problem which increases risk of morbidity of the mother and fetus. We studied the variable medical complications of pregnant women suffering from fever and the possible fetal complications. In this research 183 pregnant women with fever were studied prospectively. Necessary investigations to detect the underlying cause were performed. Patients with fever due to septic abortions and blood transfusions were excluded. Maternal complications and adverse perinatal outcomes in terms of preterm delivery, perinatal death, low birth weight (LBW) and low Apgar score at 5 minutes after birth were recorded. Frequency of occurrence of maternal complications was compared according to their age, parity and period of gestation. Malaria was found to be the leading cause of pyrexia among pregnant mothers (35%). Both maternal and fetal complications were highest when malaria was the cause of fever. Low birth weight was the most common adverse pregnancy outcome and there were 4 perinatal deaths. No statistical association was present between age, parity or period of gestation and frequency of occurrence of maternal complications in antepartum febrile illness. Our study depicts that a wide range of maternal medical complications as well as fetal and neonatal complications occur due to pyrexia in pregnancy from various etiologies.

The aim of this study was to determine the seroprevalence of rubella virus antibodies among women of reproductive age group and assess risk factors of rubella infection. A cross-sectional study was carried out among 285 women aged between 15 and 49 years. Enzyme-linked immunosorbent assay (ELISA) method was used to detect and quantify human immunoglobulin G (IgG) antibodies with avidity for rubella virus in sera of participants. Socio-demographic characteristics of the participants, along with recent and previous history of fever and rash among others were obtained using a questionnaire. Statistical analysis was carried out using SPSS version 16. Seroprevalence of rubella IgG among women of reproductive age in Ilorin was 92.3% (95% CI: 89.2%-95.4%). Thus susceptibility rate to rubella infection was 7.7%. Majority (87.1%) of the IgG seropositive participants had high rubella IgG avidity, implying past rubella infection or reinfections. Seroprevalence was significantly higher among participants from lower educational and socio-economic classes compared with other participants (P =. 035 and P =. 023, respectively). There was a negative correlation between age and rubella specific IgG titer (P =. 000). Thus rubella specific IgG titer decreases with increasing age. There is need for vaccination of susceptible women of reproductive age in Ilorin as the rubella susceptibility rate was higher than the 5.0% target set by the World Health Organization (WHO) for prevention of congenital rubella syndrome (CRS).

Female circumcision is regarded as mutilation of the external genitalia of women and the girl child. It is entrenched in the cultures of many communities in developing countries particularly in Africa. It has long been recognized internationally as a violation of the right of the woman and the girl child. This study tried to determine the sociodemographic factors that predict circumcision of the girl child. Multivariate logistic regression was used to determine predictors of girl child circumcision. The overall prevalence of the girl child circumcision in Nigeria is 23.9%. When stratified by region, the prevalence was 36.8%, 15.6%, and 9.1% in the North-west, North-central and North-east region, respectively and 30.8%, 22.8%, and 8.0% in the South-west, South-east and South-south region, respectively. Within states, the prevalence of female circumcision ranged from 0% in Katsina to 57.9% in Jigawa state. Prevalence was almost twice among Muslim households than other religions. Majority (91.8%) of the girl child circumcision was done before the first birthday (0-11 months) and 84.6% was performed by a traditional circumciser. Type I (44.1%) and II (47.9%) were the commonest type of genital mutilation performed. In the final regression model, only mothers opinion about female circumcision, whether she was circumcised and region of residence significantly determined the likelihood of a girl child been circumcised. Appropriate and targeted education of mothers and circumcisers focusing on the undesirable effect of female circumcision will significantly reduce the practice of female genital mutilation (FGM) across Nigeria.

Cardiotocography (CTG) is a tool for assessing the fetus during labor and identifying the risk of asphyxia. Abnormal CTG can lead to stress in the physician and mother and result in their decision in terminating the pregnancy and the complications of an emergency cesarean section. The purpose of this study was the evaluation of the correlation between nonreassuring patterns in fetal CTG and birth asphyxia. In a cross-sectional analytic study, 324 term pregnant women were included. The association between nonreassuring patterns in CTG (fetal tachycardia, fetal bradycardia, absent or minimal baseline variability, and absence of acceleration and periodic or episodic deceleration) and birth asphyxia were assessed. Birth asphyxia existed in 10 newborns; in all cases mild hypoxic ischemic encephalopathy (HIE) was observed. Within the nonreassuring CTG patterns, baseline fetal heart variability and periodic or episodic deceleration had a significant relationship with birth asphyxia. Most asphyxia cases had occurred in absent and minimal baseline fetal heart rate (FHR) variability (R = 0.49, P <. 001). In periodic or episodic decelerations, most asphyxia cases occurred in recurrent late decelerations with normal baseline variability and variable decelerations with shoulders or overshoots (R = 0.42, P =. 014). With regard to the findings of the present study we can use nonreassuring cardiotocographic patterns, especially absent and minimal baseline FHR variability and periodic or episodic decelerations in prediction of birth asphyxia. It seems however that most birth asphyxias occur in normal cardiotocographs.

Hypertensive disorders of pregnancy are associated with maternal mortality and morbidity. Patients with these diseases usually require intensive care. This study reviewed pregnant women with severe preeclampsia, eclampsia or HELLP syndrome who needed intensive care and were consequently admitted to intensive care unit (ICU). In this retrospective study, data of all preeclamptic and eclamptic women and patients with HELLP syndrome who delivered at Al-Zahra hospital over a 1-year period from March 2012 to March 2013 were reviewed. Of 9812 women delivered in our center, 56 women with severe hypertensive disorders required ICU admission (0.6%). The most common therapeutic interventions included vasodilator agents and transfusion. No case of maternal mortality was reported; while 5 cases of fetal death (8.9%) due to intrauterine death were reported. Outcome of patients admitted in ICU for severe hypertensive disorders of pregnancy is generally good. Intensive care management should be considered in every referral obstetric center.

Health promoting behaviors and healthy lifestyle are main approaches for health control. Postmenopausal women’s unhealthy life style is the origin of many serious side-effects of this period. This study was carried out to determine the state of health promoting behaviors and its individual-social predictions in postmenopausal women. In this cross-sectional study, 400 postmenopausal women at the age range of 45-60 years in Langroud city (Gilan province, Iran) were studied by random sampling. The data were collected by referring to their houses using demographic and Health-Promoting Lifestyle Profile-II (HPLP-II). Pearson test, t test, one-way analysis of variance (ANOVA) and multivariate linear regression (MVR) model were used to analyze data. The mean (standard deviation) of the whole score of health promoting behaviors was 2.6 (0.3). The highest score of life style behavioral dimensions related to spiritual growth was 3.6 (0.4) and the lowest score was related to physical activity 1.6 (0.3). There was a positive significant relationship between the whole score of life style level of education, body mass index, chronic diseases and salary (P <. 001) and significantly reverse relation with number of children (P <. 001). The findings showed that health promoting behaviors in postmenopausal women were moderate. Therefore, certain policies should be designed and conducted to promote behaviors in in this group of women. Also more attention should be paid to their physical activity.

This prospective study compared the incidence of post-dural puncture headache (PDPH) in obstetric patients undergoing spinal anesthesia for caesarean section from April 2012 to April 2013 in one year. We also evaluated the relationship between needle size, number of dural punctures, timing of ambulation and PDPH after cesarean section. A total of 319 American Society of Anesthesiologists (ASA) I-II full term pregnant women, scheduled for caesarean section under spinal anesthesia from April 2012 to April 2013 were evaluated. Spinal anesthesia was performed with hyperbaric bupivacaine plus fentanyl 10 μg, from L3-4 intervertebral space. We recorded the number of attempts for spinal anesthesia, and the timing of ambulation. Each patient was monitored every day for 4 days following caesarean section. Frequency and severity of PDPH were recorded. SPSS 16 was used for data analysis. Needles used were 25G Quincke spinal needle in 243 patients (76.2%) and 27G Quincke spinal needle in 76 patients (21.9%). Of 319 patients, there were 315 (95.6 %) in the late ambulation group and 14 (4.4%) in the 6 hour bed rest group. In this study only one patient had the classic symptoms of PDPH, whose spinal block were performed with 25G Quincke spinal needle by residents with more than 2 attempts of lumbar puncture (LP). Severe PDPH was not observed in 27G Quincke group. Although our study was performed in a teaching hospital with more residents of anesthesia attempting the procedure, the incidence of PDPH was lower in this study as compared to other studies. This study also concluded that needle size and early ambulation may have some effect on the incidence and characteristics of PDPH.

Conjoined twins are complicated and unusual form of monozygotic twins. We present early prenatal diagnosis of three cases of conjoined twins by 2-dimensional (2D) ultrasound between 9-10 weeks of gestation. In the first case, we prenatally diagnosed parapagus dicephalus dibrachus dipus with 2- dimensional ultrasound at gestational age of 10 weeks 4 days. In the second case, we detected parapagus dicephalus at the 10 weeks 2 days gestation. In the third case, we diagnosed thoracopagus at the 9 weeks 6 days of gestation, using 2D ultrasound. After proper counselling, all of the patients opted early pregnancy termination due to the poor prognosis of conjoined twins. Early prenatal detection of conjoined twinning is important for the gestational course. Conjoined twinning could be identified in early first trimester with cautious and comprehensive view by experienced sonographers. Early and accurate prenatal diagnosis of conjoined twinning allows preferable counselling of the parents and gives a chance for early termination of pregnancy.

Desquamative inflammatory vaginitis (DIV) is a chronic inflammatory process of unknown etiology, characterized by genital pain and profuse vaginal discharge, mainly affecting perimenopausal women. It is an entity little known by clinicians, leading to a delay in diagnosis and the consequent alteration of the patients’ quality of life. The aim in this manuscript is to analyze DIV through the review of a case and the scientific literature. We report the case of a 40-year-old woman who presented this clinical profile for several years, being misdiagnosed as more common syndromes such as infectious vaginitis and vaginismus. Finally, after the diagnosis of DIV and the establishment of the specific treatment, she showed a clear symptomatic improvement. The prevalence of DIV is unknown and underestimated, and may affect 8% of women with vulvovaginal symptoms. To reach the correct diagnosis, it is required to observe a few simple clinical and laboratory criteria defined by Sobel in 1994. It responds to the topical therapy with clindamycin or hydrocortisone in 95% of cases, but in most cases a long-term maintenance therapy is necessary to control the symptoms.