Comparison of vaginal birth outcomes in midwifery-led versus physician-led setting: A propensity score-matched analysis.

BACKGROUND: Experts in many countries are recommending a scaling up midwifery-led care as a model to improve maternal and newborn outcomes, reduce rates of unnecessary interventions, realise cost savings, and facilitate normal spontaneous vaginal birth. OBJECTIVE: The aim of this study was to compare midwifery-led and obstetrician-gynaecologist-led care-related vaginal birth outcomes. PARTICIPANTS: Pregnant women in Kaunas city maternity care facilities. METHODS: A propensity score-matched case-control study of midwifery-led versus physician-led low-risk birth outcomes. Patient characteristics and outcomes were compared between the groups. Continuous variables are presented as mean ± standard deviation and analysed using the Mann-Whitney U test. Categorical and binary variables are presented as frequency (percentage), and differences were analysed using the chi-square test. Analyses were conducted separately for the unmatched (before propensity score matched [PSM]) and matched (after PSM) groups. RESULTS: After adjusting groups for propensity score, postpartum haemorrhage differences between physician-led and midwifery-led labours were significantly different (169.5 and 152.6 mL; p = 0.026), same for hospital stay duration (3.3 and 3.1 days, p = 0.042). Also, in matched population, significant differences were seen for episiotomy rates (chi2 = 4.8; p = 0.029), newborn Apgar 5 min score (9.58 and 9.76; p = 0.002), and pain relief (chi2 = 14.9; p = 0.002). Significant differences were seen in unmatched but not confirmed in matched population for obstetrical procedures used during labour, breastfeeding, birth induction, newborn Apgar 1 min scores, and successful vaginal birth as an overall spontaneous vaginal birth success measure. CONCLUSION: The midwifery-led care model showed significant differences from the physician-led care model in episiotomy rates, hospital stay duration and postpartum haemorrhage, and newborn Apgar 5 min scores. Midwifery-led care is as safe as physician-led care and does not influence the rate of successful spontaneous vaginal births.

IL-6 597A/G (rs1800797) and 174G/C (rs1800795) Gene Polymorphisms in the Development of Cervical Cancer in Lithuanian Women.

Our study aimed to evaluate the distribution of genotypes and allele frequencies of IL-6 597A/G (rs1800797) and 174G/C (rs1800795) polymorphisms in HPV infected and uninfected healthy women and cervical cancer patients. A PCR based Multiplex HPV genotyping test kit was used for in vitro detection and differentiation of high risk HPV genotypes. Genotyping of two polymorphisms, IL-6 597A/G (rs1800797) and 174G/C (rs1800795), was performed using the KASP genotyping assay kit. Cervical cancer patients were more likely to be HPV positive than control patients. Allele C of IL-6 rs1800795 was associated with a higher risk of cervical cancer by 2.26-fold and genotype CC by 5.37-fold. Genotype CC of IL-6 rs1800795 was more frequent in the HPV positive group compared with the HPV negative group (p = 0.002). Allele G of IL-6 rs1800797 was more frequently found in women with HPV16/HPV18 compared to other HPV types (p = 0.045). Women with AA genotypes of IL-6 rs1800797 were less frequently infected with HPV16/HPV18 compared to other HPV types (p = 0.045). The major finding of the study is the significant association of C allele and CC genotype of IL-6 1800795 gene with cervical cancer in the Lithuanian population. Genotype CC of IL-6 rs1800795 has a significant association with HPV infection as well.

Transvaginal Sonographic Evaluation of Cesarean Section Scar Niche in Pregnancy: A Prospective Longitudinal Study.

Background and Objectives: To investigate the prevalence of a Cesarean section (CS) scar niche during pregnancy, assessed by transvaginal ultrasound imaging, and to relate scar measurements, demographic and obstetric variables to the niche evolution and final pregnancy outcome. Materials and Methods: In this prospective observational study, we used transvaginal sonography to examine the uterine scars of 122 women at 11+0-13+6, 18+0-20+6 and 32+0-35+6 weeks of gestation. A scar was defined as visible on pregnant status when the area of hypoechogenic myometrial discontinuity of the lower uterine segment was identified. The CS scar niche ("defect") was defined as an indentation at the site of the CS scar with a depth of at least 2 mm in the sagittal plane. We measured the hypoechogenic part of the CS niche in two dimensions, as myometrial thickness adjacent to the niche and the residual myometrial thickness (RMT). In the second and third trimesters of pregnancy, the full lower uterine segment (LUS) thickness and the myometrial layer thickness were measured at the thinnest part of the scar area. Two independent examiners measured CS scars in a non-selected subset of patients (n = 24). Descriptive analysis was used to assess scar visibility, and the intraclass correlation coefficient (ICC) was calculated to show the strength of absolute agreement between two examiners for scar measurements. Factors associated with the CS scar niche, including maternal age, BMI, smoking status, previous vaginal delivery, obstetrics complications and a history of previous uterine curettage, were investigated. Clinical information about pregnancy outcomes and complications was obtained from the hospital's electronic medical database. Results: The scar was visible in 77.9% of the women. Among those with a visible CS scar, the incidence of a CS scar niche was 51.6%. The intra- and interobserver agreement for CS scar niche measurements was excellent (ICC 0.98 and 0.89, respectively). Comparing subgroups of women in terms of CS scar niche (n = 49) and non-niche (n = 73), there was no statistically significant correlation between maternal age (p = 0.486), BMI (p = 0.529), gestational diabetes (p = 1.000), smoking status (p = 0.662), previous vaginal delivery after CS (p = 1.000) and niche development. Uterine scar niches were seen in 56.3% (18/48) of the women who had undergone uterine curettage, compared with 34.4% (31/74) without uterine curettage (p = 0.045). We observed an absence of correlation between the uterine scar niche at the first trimester of pregnancy and mode of delivery (p = 0.337). Two cases (4.7%) of uterine scar dehiscence were confirmed following a trial of vaginal delivery. Conclusions: Based on ultrasonography examination, the CS scar niche remained visible in half of the cases with a visible CS scar at the first trimester of pregnancy and could be reproducibly measured by a transvaginal scan. Previous uterine curettage was associated with an increased risk for uterine niche formation in a subsequent pregnancy. Uterine scar dehiscence might be potentially related to the CS scar niche.

Experience of Managing Suspected Placenta Accreta Spectrum with or without Internal Iliac Artery Balloon Occlusion in Two Lithuanian University Hospitals.

Background and objectives: Placenta previa and placenta accreta spectrum are considered major causes of massive postpartum hemorrhage. Objective: To determine whether the placement of an occlusion balloon catheter in the internal iliac artery could reduce bleeding and other related complications during cesarean delivery in patients with placenta previa and placenta accreta spectrum. Materials and Methods: A retrospective analysis was conducted at two tertiary obstetric units of Lithuania. From January 2016 to November 2019 patients with placenta previa and antenatally suspected invasive placenta were included in the intervention group and underwent cesarean delivery with endovascular procedure. From January 2014 to December 2015 patients with placenta previa and suspected placenta accreta spectrum were included in the non-intervention group. The primary outcomes were reduction in intraoperative blood loss and transfusion volumes in the intervention group. Secondary outcomes were the incidence of hysterectomy and maternal complications. Results: Nineteen patients underwent cesarean delivery with preoperative endovascular procedure, and 47 women underwent elective cesarean delivery. The median intraoperative blood loss (1000 (400-4500) mL vs. 1000 (400-5000) mL; p = 0.616) and the need for red blood cell transfusion during operation (26% vs. 23%; p = 0.517) did not differ significantly between the patients groups. Seven patients in the intervention group and two patients in the non-intervention group underwent perioperative hysterectomy (p = 0.002). None of the patients had complications related to the endovascular procedure. Conclusion: The use of intermittent balloon occlusion catheter in patients with placenta pathology is a safe method but does not significantly reduce intraoperative blood loss during cesarean delivery.

Performance of the IOTA ADNEX Model on Selected Group of Patients with Borderline Ovarian Tumours.

Background and objectives: ultrasound is considered to be the primary tool for preoperative assessment of ovarian masses; however, the discrimination of borderline ovarian tumours (BOTs) is challenging, and depends highly on the experience of the sonographer. The Assessment of Different NEoplasias in the adneXa (ADNEX) model is considered to be a valuable diagnostic tool for preoperative assessment of ovarian masses; however, its performance for BOTs has not been widely studied, due to the low prevalence of these tumours. The aim of this study was to evaluate the performance of ADNEX model for preoperative diagnosis of BOTs. Methods: retrospective analysis of preoperative ultrasound datasets of patients diagnosed with BOTs on the final histology after performed surgery was done at a tertiary oncogynaecology centre during the period of 2012-2018. Results: 85 patients were included in the study. The performance of ADNEX model based on absolute risk (AR) improved with the selection of a more inclusive cut-off value, varying from 47 (60.3%) correctly classified cases of BOTs, with the selected cut-off of 20%, up to 67 (85.9%) correctly classified cases of BOTs with the cut-off value of 3%. When relative risk (RR) was used to classify the tumours, 59 (75.6%) cases were identified correctly. Forty (70.2%) cases of serous and 16 (72.7%) cases of mucinous BOTs were identified when AR with a 10% cut-off value was applied, compared to 44 (77.2%) and 15 (68.2%) cases of serous and mucinous BOTs, correctly classified by RR. The addition of Ca125 improved the performance of ADNEX model for all BOTs in general, and for different subtypes of BOTs. However, the differences were insignificant. Conclusions: The International Ovarian Tumour Analysis (IOTA) ADNEX model performs well in discriminating BOTs from other ovarian tumours irrespective of the subtype. The calculation based on RR or AR with the cut-off value of at least 10% should be used when evaluating for BOTs.

Circulating inflammatory markers in cervical cancer patients and healthy controls.

There is increasing evidence that host inflammatory responses play an important role in the development and progression of cancers. There are some data that cancer is associated not only with inflammation at the site of the lesion, but also with dysregulations of the host overall systemic immune response. In the case of cervical cancer, inflammation is an important factor associated with the development, progression, and potential metastasis of the disease. What is unclear still in the potential for modifications of host responses to human papillomaviruses (HPV) - a known causative agent of CC, that could be induced by cigarette smoking. In particular, it remains to be determined how the inflammation induced by HPV infection could impact on CC incidence/severity. In this prospective study, serum levels of 10 cytokines were evaluated using Multiplex and ELISA assays. The samples were the sera of 43 CC patients and 60 healthy (NILM) controls. All outcomes were evaluated in relation to host HPV and to their smoking status. The results in indicated that serum sTREM-1, TNFα, IFNß, IL-1ß, and IL-6 levels were significantly increased in CC (HPV+) patients compared to healthy NILM controls. A similar trend was observed for IL-10 and IL-2 levels. Within the two groups, differences in cytokine levels between smokers and never smokers were not remarkable. The findings here support the hypothesized role of systemic inflammation in the pathophysiology of CC.

Is it necessary to postpone pregnancy after bariatric surgery: a national cohort study.

The optimal interval between bariatric surgery (BS) and pregnancy remains clearly undefined. The aim of this study was to assess pregnancy outcomes according to the interval from BS to conception. The nationwide study cohort consisted of 130 women with previous BS and postoperative singleton delivery during 2005-2015 in Lithuania. Women who conceived within the first 12 months after BS were included in the early conception (EC) group (n = 30); who became pregnant after 1 year were included in the late conception (LC) group (n = 100). Mean surgery-to-conception time in the EC group was 6.9 ± 3.5 months; in the LC group was 41.4 ± 21.6 months. Anaemia was diagnosed significantly more frequently in women who conceived after 12 months compared with the EC group (56.0% versus 33.3%, p = .04). No significant differences were found between the EC and the LC group regarding gestational diabetes, preeclampsia, caesarean section rate, and adverse neonatal outcomes.Impact statementWhat is already known on the subject? Bariatric surgery is recognized as a safe and highly effective approach to obesity treatment. Optimal interval between bariatric surgery and conception remains undefined, however most bariatric surgeons advise patients to delay pregnancy for 12-18 months.What do the results of this study add? The results of our study did not show significant differences in pregnancy complications and neonatal outcomes in women who conceived within the first 12 postoperative months and in women who conceived later. Women who become pregnant within the first year after surgery, should be reassured that obstetric complication rates generally are low.What are the implications of these findings for clinical practice and/or further research? Patients with prior BS should be provided with multidisciplinary prenatal care and screening for nutritional deficiencies during pregnancy. Further studies are needed to determine the optimal interval after BS and to assess the influence this interval has on perinatal outcomes.

Associations among Serum Lipocalin-2 Concentration, Human Papilloma Virus and Clinical Stage of Cervical Cancer.

Background and objective: Lipocalin 2 (LCN2) has an oncogenic role in promoting tumorigenesis through enhancing tumor cell proliferation and the metastatic potential. The aim of our study was to determine whether serum LCN2 could serve as a diagnostic marker of cervical cancer (CC) and to evaluate the correlation between its serum concentration, the clinical stage of the cancer and Human Papilloma Virus HPV infections in women. Materials and methods: A total of 33 women with histologically proven cervical cancer (CC), 9 women with high- grade cervical intraepithelial neoplasia (HSIL) and 48 healthy women (NILM) were involved in the study. A concentration of LCN2 was assayed with the Magnetic LuminexR Assay multiplex kit. An HPV genotyping kit was used for the detection and differentiation of 15 high-risk (HR) HPV types in the liquid-based cytology medium (LBCM) and the tissue biopsy. Results: The majority (84.8%) of the women were infected by HPV16 in the CC group, and there was no woman with HPV16 in the control group (P < 0.01). Several types of HR HPV were found more often in the LBCM compared to in the tissue biopsy (P = 0.044). HPV16 was more frequently detected in the tissue biopsy than the LBCM (P < 0.05). The LCN2 level was higher in HPV-positive than in HPV-negative women (P = 0.029). The LCN2 concentration was significantly higher in women with stage IV than those with stage I CC (P = 0.021). Conclusions: Many HR HPV types, together with HPV16/18, can colonize the vagina and cervix, but often HPV16 alone penetrates into the tissue and causes CC. The serum LCN2 concentration was found to be associated not only with HR HPV infection, irrespective of the degree of cervical intraepithelial changes, but also with advanced clinical CC stage. LCN2 could be used to identify patients with advanced disease, who require a more aggressive treatment.

Patient safety culture in obstetrics and gynecology and neonatology units: the nurses' and the midwives' opinion.

Background: Patients treated in health care facilities that provide services in the fields of obstetrics, gynecology, and neonatology are especially vulnerable. Large multidisciplinary teams of physicians, multiple invasive and noninvasive diagnostic and therapeutic procedures, and the use of advanced technologies increase the probability of adverse events. The evaluation of knowledge about patient safety culture among nurses and midwives working in such units and the identification of critical areas at a health care institution would reduce the number of adverse events and improve patient safety. The aim of the study was to evaluate the opinion of nurses and midwives working in clinical departments that provide services in the fields of obstetrics, gynecology, and neonatology about patient safety culture and to explore potential predictors for the overall perception of safety. Methods: We used the Hospital Survey on Patient Safety Culture (HSOPSC) to evaluate nurses' and midwives' opinion about patient safety issues. The overall response rate in the survey was 100% (n = 233). Results: The analysis of the dimensions of safety on the unit level showed that the respondents' most positive evaluations were in the Organizational Learning - Continuous Improvement (73.2%) and Feedback and Communication about Error (66.8%) dimensions, and the most negative evaluations in the Non-punitive Response to Error (33.5%) and Staffing (44.6%) dimensions. On the hospital level, the evaluation of the safety dimensions ranged between 41.4 and 56.8%. The percentage of positive responses in the outcome dimensions Frequency of Events Reported was 82.4%. We found a significant association between the outcome dimension Frequency of Events Reported and the Hospital Management Support for Patient Safety and Feedback and Communication about Error Dimensions. Conclusions: On the hospital level, the critical domains in health care facilities that provide services in the fields of obstetrics, gynecology, and neonatology were Teamwork Across Hospital Units, and on the unit level - Communication Openness, Teamwork Within Units, Non-punitive Response to Error, and Staffing. The remaining domains were seen as having a potential for improvement.

Initial neonatal resuscitation: skill retention after the implementation of the novel 24/7 HybridLab® learning system.

BACKGROUND: Ensuring long-term retention of the acquired practical skills is one of the major aims of a medical school. This depends on the application of training techniques and their combinations. In order to standardize the teaching process, to acquire and maintain a broad array of technical, professional, and interpersonal skills and competencies, and to improve the retention of practical skills, we developed a new training technique - the HybridLab® learning method. It consists of an e-learning platform, hands-on simulation, carefully elaborated learning algorithms (DRAKON), peer-to-peer teaching, and assessment and feedback by peers, and later - by a remote instructor. Summary of the work: The subjects of the study were fifth-year students of the Lithuanian University of Health Sciences Medical Academy who during 2014-2015 were studying the obstetrics and gynecology module in the neonatology cycle. We analyzed the retention of practical skills in the initial neonatal resuscitation among students who were training with the use of our developed HybridLab® technique at 6 and 12 months after the completion of the cycle. SUMMARY OF RESULTS: After 6 and 12 months, mean changes in the subjects' evaluation scores (percentage drop-off between the first and the second total score) dropped by, respectively, 31.8% (SD: 27.5) and 7.7% (SD: 25.6), and did not differ statistically significantly (p = .2). In the group of subjects who were not given a possibility to remember the skills and the course of initial neonatal resuscitation, the mean change between the first and the second total evaluation scores was 42.5% (SD: 26.7). In students who were given such possibility, the mean change between the first and the second total evaluation scores was significantly smaller -12.7% (SD: 13.8) (p < .001). Changes in the evaluation scores of individual skills (first steps, mouth-to-mouth ventilation, and chest compressions) between the first and the second evaluation also differed statistically significantly and were smaller in the group of students who were given a possibility to remember their skills (p < .001). DISCUSSION: The HybridLab® learning method is a novel technique, and thus more studies are required to evaluate the significance of the HybridLab® technique for long-time retention of practical skills. CONCLUSION: As a result of the application of the HybridLab® training technique, practical skill retention among medical students after 6 and 12 months dropped by only about 13%. A recall system significantly improved practical skill retention.

Comparison of midwife-led and obstetrician-led care in Lithuania: A retrospective cohort study.

OBJECTIVE: To compare midwife-led and obstetrician-led care and their relation to caesarean section rates and obstetric and neonatal outcomes in low-risk births. DESIGN: Hospital registry based retrospective cohort study. SETTING: Tertiary-care women's hospital in Kaunas, Lithuania. PARTICIPANTS: A total of 1384 and 1283 low-risk delivering women in 2012 and 2014, respectively. METHODS: The women choose either a midwife as their lead carer (midwife-led group), or an obstetrician-gynaecologist (obstetrician-led group). MAIN OUTCOME MEASURES: The primary outcome was caesarean birth. Secondary outcomes included instrumental vaginal births, amniotomy, augmentation of labour, epidural analgesia, episiotomy, perineal trauma, labour duration, birthweight and Apgar score < 7 at 5 min. RESULTS: The proportion of caesarean births was 4.4% in the midwife-led and 10.7% in the obstetrician-led group (p < 0.001) in 2012, and 5.2% and 11.8% (p < 0.001) in 2014, respectively. Younger maternal age (≤34 years) and midwife-led care was associated with a significantly decreased odds for caesarean section and nulliparity with a significantly increased odds for caesarean birth. Women in the midwife-led group had fewer amniotomies and labour augmentations compared with the obstetrician-led group. Episiotomy, perineal trauma, duration of labour and neonatal outcomes did not differ between the groups. CONCLUSION: Midwife-led care for women with low-risk birth reduced the caesarean section and several medical interventions with no apparent increase in immediate adverse neonatal outcomes compared with obstetrician-led care. IMPLICATIONS FOR PRACTICE: Midwife-led care for low-risk women should be encouraged in countries with health care system where obstetrician-led care births dominates.

Response of OVCAR-3 Cells to Cisplatin and Hyperthermia: Does Hyperthermia Really Matter?

BACKGROUND: Hyperthermic intraperitoneal chemotherapy (HIPEC) is proposed as a promising treatment method, but fundamental information about the contribution of hyperthermia to intraperitoneal chemotherapy is lacking. The purpose of this study was to investigate the cytotoxic effect of hyperthermia and cisplatin on OVCAR-3 cells in vitro. MATERIALS AND METHODS: Imitating the typical clinical conditions of HIPEC, OVCAR-3 cells were exposed to hyperthermia and cisplatin for 1 h. MTT viability test, flow cytometric analysis, and real-time cell and isobologram analysis were performed. RESULTS: Hyperthermia up to 42°C did not significantly increase the effect of cisplatin regarding the viability and apoptosis of OVCAR-3 cells. Moreover, an antagonistic effect of hyperthermia and cisplatin was revealed. CONCLUSION: Our investigation of OVCAR-3 cells critically disputes the benefit of hyperthermia in ovarian cancer treatment. Further in vitro and in vivo research is essential for better understanding of the mechanisms of action of hyperthermia and its role in the treatment of epithelial ovarian cancer.

Maternal obesity and obstetric outcomes in a tertiary referral center.

BACKGROUND AND AIM: Obese women are at an increased risk of various adverse pregnancy outcomes. The aim of our study was to evaluate the impact of obesity on maternal and neonatal outcomes in a tertiary referral center and to compare obstetric outcomes by the level of maternal obesity. MATERIALS AND METHODS: A cohort study included 3247 women with singleton gestations who gave birth at the Department of Obstetrics and Gynecology, Lithuanian University of Health Sciences, in 2010. Pregnancy complications and neonatal outcomes were identified using the hospital Birth Registry database in normal weight (body mass index [BMI] 18.5-24.9kg/m2, n=3107) and prepregnancy obese (BMI ≥30kg/m2, n=140) women. Pregnancy outcomes were compared according to the level of obesity (BMI 30-34.9kg/m2, n=94 and BMI ≥35kg/m2, n=46). RESULTS: Obese women were significantly more likely to have gestational hypertension (OR=8.59; 95% CI, 5.23-14.14; P<0.0001), preeclampsia (OR=2.06; 95% CI, 1.14-3.73; P<0.0001), gestational diabetes (OR=5.56; 95% CI, 3.66-8.49; P<0.0001), dystocia (OR=2.14; 95% CI, 1.36-3.38; P<0.0001), induced labor (OR=2.64; 95% CI, 1.83-3.80; P<0.0001), failed induction of labor (OR=18.06; 95% CI, 8.85-36.84; P<0.0001), cesarean delivery (OR=1.76; 95% CI, 1.25-2.49; P=0.001), large-for-gestational-age newborns (OR=3.68; 95% CI, 2.51-5.39; P<0.0001). Significantly increased risk of gestational diabetes, preeclampsia, dystocia and newborns with Apgar score ≤7 after 5min was only observed in women with BMI ≥35kg/m2. CONCLUSIONS: Maternal obesity is significantly associated with an increased risk of gestational hypertension, preeclampsia, gestational diabetes, dystocia, labor induction, failed induction of labor, large-for-gestational-age newborns and cesarean delivery.

La laparoscopia mejora la precisión diagnóstica de la enfermedad pelviana inflamatoria / Laparoscopy improves the diagnostic accuracy in pelvic inflammatory disease

El objetivo de este estudio fue evaluar los criterios de diagnóstico clínico y los hallazgos laparoscópicos en mujeres con enfermedad pelviana inflamatoria (EPI). Métodos: Se inscribieron en el estudio setenta y tres mujeres de 18 a 35 años que acudieron al servicio de Ginecología del Hospital de la Universidad Lituana de Ciencias de la Salud con síntomas clínicos de enfermedad pelviana inflamatoria. Todas las pacientes fueron sometidas a un examen clínico y pruebas de laboratorio bajo el mismo protocolo. La laparoscopia diagnóstica se realizó dentro de las 12 horas posteriores al ingreso. Resultados: Se confirmó la presencia de EPI por laparoscopia en el 71.2% de los casos. La EPI verificada por laparoscopia tuvo una correlación significativa con los siguientes síntomas: dolor abdominal bajo, dolor a la movilización cervical y dolor anexial. Se detectó la presencia de Chlamydia trachomatis y de Neisseria gonorrhoeae en muestras endocervicales en el 46.1% y el 26.9% de las mujeres con EPI confirmada. Conclusiones: El diagnóstico preliminar de EPI debe basarse en criterios de diagnóstico clínico. La laparoscopia diagnóstica temprana mejora la precisión diagnóstica y determina con mayor exactitud la gravedad de la enfermedad.

La laparoscopia mejora la precisión diagnóstica de la enfermedad pelviana inflamatoria / Laparoscopy improves the diagnostic accuracy in pelvic inflammatory disease

El objetivo de este estudio fue evaluar los criterios de diagnóstico clínico y los hallazgos laparoscópicos en mujeres con enfermedad pelviana inflamatoria (EPI). Métodos: Se inscribieron en el estudio setenta y tres mujeres de 18 a 35 años que acudieron al servicio de Ginecología del Hospital de la Universidad Lituana de Ciencias de la Salud con síntomas clínicos de enfermedad pelviana inflamatoria. Todas las pacientes fueron sometidas a un examen clínico y pruebas de laboratorio bajo el mismo protocolo. La laparoscopia diagnóstica se realizó dentro de las 12 horas posteriores al ingreso. Resultados: Se confirmó la presencia de EPI por laparoscopia en el 71.2% de los casos. La EPI verificada por laparoscopia tuvo una correlación significativa con los siguientes síntomas: dolor abdominal bajo, dolor a la movilización cervical y dolor anexial. Se detectó la presencia de Chlamydia trachomatis y de Neisseria gonorrhoeae en muestras endocervicales en el 46.1% y el 26.9% de las mujeres con EPI confirmada. Conclusiones: El diagnóstico preliminar de EPI debe basarse en criterios de diagnóstico clínico. La laparoscopia diagnóstica temprana mejora la precisión diagnóstica y determina con mayor exactitud la gravedad de la enfermedad. (AU)

Promoting contraceptive use among female rural-to-urban migrants in Qingdao, China: a comparative impact study of worksite-based interventions.

BACKGROUND: We conducted a comparative study in worksites to assess the impact of sexual health promoting interventions on contraceptive use among female rural-to-urban migrants. STUDY DESIGN: In Qingdao ten manufacturing worksites were randomly allocated to a standard package of interventions (SPI) and an intensive package of interventions (IPI). The interventions ran from July 2008 to January 2009. Cross-sectional surveys at baseline and end line assessed the sexual behaviour of young female migrants. To evaluate the impact of the interventions we assessed pre- and post-time trends. RESULTS: From the SPI group 721 (baseline) and 615 (end line) respondents were considered. Out of the IPI group we included 684 and 603 migrants. Among childless migrants, self-reported contraceptive use increased significantly after SPI and IPI (adjusted odds ratio [aOR] = 3.23; 95% confidence interval [CI] = 1.52-6.84; p < 0.01 and aOR = 5.81; 95% CI = 2.63-12.80; p < 0.001, respectively). Childless migrants older than 22 years reported a greater use after IPI than after SPI. CONCLUSION: Implementing current Chinese sexual health promotion programmes at worksites is likely to have a positive impact on migrant women working in the manufacturing industry of Qingdao. More comprehensive interventions seem to have an added value if they are well targeted to specific groups.

The Diagnostic Properties of Medical History in the Diagnosis of Tubal Pathology among Subfertile Patients.

Objectives. To evaluate the diagnostic performance of medical history in the diagnosis of tubal pathology among subfertile patients. Patients and Methods. Prospective cross-sectional study was performed. Prior to tubal evaluation, medical history data were collected. Sensitivity, specificity, and likelihood ratios (LRs) for predicting tubal pathology as determined by laparoscopy and dye test were calculated for each issue of medical history. Results. 39.6 % (59/149) were diagnosed with tubal pathology. The sensitivity for the different issues ranged between 1.7 and 54.2% and the specificity between 75.6 and 97.8%. The estimated highest value of positive LR is attributed to the history of ectopic pregnancy and lowest of negative LR to pelvic inflammatory disease (PID) and abdominal surgery. Conclusion. The positive history of PID, sexually transmitted diseases (STDs), abdominal and laparoscopic surgery, and ectopic pregnancy are satisfactory screening tests for ruling the tubal pathology in. The negative history of evaluated issues is inappropriate for ruling the tubal damage out.

Determinants of unmet need for contraception among Chinese migrants: a worksite-based survey.

BACKGROUND: Considerable sexual and reproductive health (SRH) challenges have been reported among rural-to-urban migrants in China. Predictors thereof are urgently needed to develop targeted interventions. STUDY DESIGN: A cross-sectional study assessed determinants of unmet need for contraception using semi-structured interviews in two cities in China: Guangzhou and Qingdao. RESULTS: Between July and September 2008, 4867 female rural-to-urban migrants aged 18-29 years participated in the study. Of these, 2264 were married or cohabiting. Among sexually-active women (n = 2513), unmet need for contraception was reported by 36.8% and 51.2% of respondents in Qingdao and Guangzhou, respectively; it was associated with being unmarried, having no children, less schooling, poor SRH knowledge, working in non-food industry, and not being covered by health insurance. A substantial proportion of unmarried migrants reported they had sexual intercourse (16.6 % in Qingdao and 21.4% in Guangzhou) contrary to current sexual standards in China. CONCLUSION: The study emphasises the importance of improving the response to the needs of rural-to-urban migrants and recommends strategies to address the unmet need for contraception. These should enhance open communication on sexuality, increase the availability of condoms, and improve health insurance coverage.

[Prevalence of human papillomavirus types in cervical intraepithelial lesions]. / Infekuotumas atskiru zmogaus papilomos tipu virusaisesant intraepiteliniu gimdos kaklelio pokyciu.

BACKGROUND: Since the implementation of the cervical cancer screening program in Lithuania in 2004, cervical cancer incidence rates have stabilized during a 4-year period: in 2006 and 2007, 508 and 485 new cases, respectively, were diagnosed. Human papillomavirus (HPV) infection is one of the main risk factors for cervical cancer and development of intraepithelial lesions. However, not only HPV, but also HPV type, is a very important factor for malignant transformation. Cervical intraepithelial lesions with HPV 16 and 18 more frequently progress to cancer. To date, in Lithuania, studies only on HPV prevalence and risk factors have been carried out, and less attention has been paid to the identification of HPV types. The aim of this study was to identify the most common HPV types in women with various cytological lesions. MATERIAL AND METHODS: A total of 246 women with various cytological lesions (atypical squamous cells of undetermined significance [ASCUS], low-grade squamous intraepithelial lesion [LSIL], and high-grade squamous intraepithelial lesion [HSIL]) were included into the study. All the women were screened for HPV infections followed by HPV typing for types 6, 11, 16, 18, 31, 33, 45, and 59. Polymerase chain reaction was used. RESULTS: Less than half (45.5%) of women with cytological lesions were infected with HPV. The highest prevalence of HPV was detected in women with HSILs (62.1%) and CIN2 (86.7%). HPV typing revealed that the most frequent type was HPV 16 (64.3%); HPV 18 and HPV 33 accounted for 5.4% and 4.5% of cases, respectively. Based on cytologic diagnosis, HPV 16 was more frequently found in women with HSILs than women with ASCUS (77.8% vs. 50.0%). CONCLUSIONS: The prevalence of HPV infection in women with cytological lesions was 45.5%. The highest prevalence of HPV was detected in women with HSILs (cytologic investigation) and CIN2 (histologic investigation). HPV 16 is the most common type in women with various cervical intraepithelial lesions.