Shoulder dystocia in a Jamaican cohort.

OBJECTIVE: To assess the risk factors for shoulder dystocia in Jamaica. METHODS: A retrospective cohort analysis of all cases of shoulder dystocia, and birth weight-matched controls identified from January 1, 2000 to December 31, 2004. Multiple factors were analyzed individually and in combination to identify risk factors. RESULTS: The incidence of shoulder dystocia was 0.83%. Nulliparity, a first stage of labor greater than 7 hours, a second stage lasting more than 1 hour, and use of oxytocin augmentation were found to be statistically significant factors with unadjusted odds ratios (95% confidence interval) of 1.78 (0.86-3.34), 1.89 (0.91-3.94), 2.78 (0.24-31.47), and 1.56 (0.77-3.15), respectively. The incidence of shoulder dystocia decreased as parity increased when adjusted for age. CONCLUSION: Individual risk factors for shoulder dystocia remain obscure. The nulliparous pelvis, when controlled for neonatal weight, was associated with a statistically increased risk of shoulder dystocia; this risk decreased with increasing parity.

Outcome of radical hysterectomies performed by general gynecologists in Jamaica.

OBJECTIVE: To review the modified (type II) radical hysterectomy procedures performed by 4 general gynecologists at the University Hospital of the West Indies, and to compare the outcomes with those of other published studies. METHODS: The case notes of the 58 women who underwent radical hysterectomies between January 1997 and December 2006 were reviewed. Accuracy of staging, duration of the operation, operative blood loss, types and rates of complications, recurrence rates, and 5-year survival rates were assessed. RESULTS: Accuracy of clinical staging, duration of the procedure, blood loss, and operative and postoperative complications were comparable to previously published data. The 5-year survival rate of 77.6% was also comparable to results seen in some other publications. CONCLUSION: General gynecologists with significant experience in general gynecologic surgery who underwent adequate, but abbreviated, training became competent in performing a radical hysterectomy, with outcomes comparable to those seen in high-resource countries.

Ovarian hyperstimulation syndrome associated with clomiphene Citrate

Ovarian hyperstimulation is a recognized complication of ovulation induction with gonadotrophins. The syndrome is becoming more common as the number of women undergoing in-vitro fertilization increases. It is rarely seen in conjunction with clomiphene citrate usage. This case report is of moderate to severe ovarian hyperstimulation in a patient who was treated with clomiphene citrate because of infertility secondary to anovulation. She presented with amenorrhoea for five weeks, lower abdominal pain and a positive urinary human chronic gonadotrophin (hCG) test. Pelvic ultrasonography was suggestive of a possible ectopic pregnancy with a different diagnosis of a ruptured ovarian cyst. Diagnostic laparoscopy was done followed by laparotomy. Oophorectomy was performed because the ovary was thought to be complex with solid areas. However, conservative management with advance of laparotomy is the recommendation in confirmed cases of ovarian hyperstimulation but this requires a high level of suspicion in patients who have ovulation induction. (AU)

Lifestyle factors and cervical dysplasia in Jamaica [abstract]

OBJECTIVE: Investigation of the impact of womens' sexual lifestyles on the development of cervical dysplasia. METHODS: Cases were recruited from women referred to the Colcoscopy Clinic, University Hospital of the West Indies, who had abnormal pap smears. Age-matched controls were recruited from the Gynaecology clinic. Women who consented to particpated were guaranteed anonymity and confidentiality and then interviewed on their sexual lifestyles. RESULTS: To date, 223 participants have been recruited: control (n=57), CIN I (n=69), CIN II (n=44), CIN III (n=32), Carcinoma (Ca) (n=9), and 12 cases whose colposcopy results are not yet available. One hundred and sixty-four of the 166 cases were diagnosed with the human papilloma virus (HPV). Twenty percent of the participants were unemployed, 21 percent were skilled/non-manual workers, while 21 percent were semi-skilled non-manual workers. Seven percent of the women occupied professional/managerial positions. There was no significant difference in age at first intercourse, number of lifetime sexual partners, number of biological fathers of their children, use of barrier contraceptives and pap smear history, between controls (n=57) and cases (n=166). When CIN I was grouped with the controls (n=126), there was a significant difference in the number of these women's lifetime sexual partners (4.1ñ2.4), compared to the women with CIN II-Ca (5.2ñ4.2), p=0.029. There was no significant difference in age between the two groups mean/SD (36.6ñ10.1 vs 36.8ñ10.5 yrs). CONCLUSIONS: The findings indicate that factors other than sexual behaviour play a role in the aetiology of cervical dysplasia in this population. (AU)