Objective: The aim of this work was to determine the current indications, outcomes, and complications of gynecologic and peripartum hysterectomies in a Nigerian tertiary hospital. Design: A 5-year retrospective study of women managed at Nnamdi Azikiwe University Teaching Hospital (Nnewi, Nigeria) between January 1, 2002 and December 31, 2006 who had hysterectomies for gynecologic and obstetric indications. Methods: The theater, ward, and histopathologic records and case notes of all women who had hysterectomy from 2002 to 2006 were retrieved, and sociodemographic characteristics, indications, complications, route, types, and grades of surgeons were retrieved and analyzed. chi-square and the Student's t-test at the 95% confidence level were used for analysis. Results: In total, 72 hysterectomies were performed during this period. Overall, 10 cases were peripartum hysterectomies, with an incidence of 0.38%. Further, 54 (74.9%) were abdominal hysterectomies, while 18 (25.1%) were vaginal hysterectomies. Subtotal abdominal hysterectomies were done in 12.9% of the abdominal cases. Residents did most of the subtotal hysterectomies. The most common gynecologic indications for the operation were uterine fibroid 24 (38.7%) and uterovaginal prolapse 18 (30.29%). Postpartum hemorrhage from uterine atony 7 (70%) and ruptured uterus 3 (30%) were the major indications for peripartum hysterectomy. Uterovaginal prolapse was the only indication for vaginal hysterectomy. More complications occurred with abdominal hysterectomy. The more common complications were anemia (39; 54.4%) and postoperative hemorrhage (20; 27.8%). The mean duration of hospital stay was 8.82 + 2.46 days. The mortality rate was 4.2%. Conclusions: Hysterectomy is a major gynecologic operation. More cases of hysterectomy should be performed vaginally, considering the numerous benefits it has over the abdominal route. (J GYNECOL SURG 26:7)
The objective of this study is to evaluate whether omission of intrauterine cleaning increases intraoperative and postoperative complications among women who deliver via cesarean section.
Medication adherence to antiretroviral medications is critical during pregnancy in women living with HIV (WLHIV) for multiple reasons. In this study, we report medication adherence to tenofovir alafenamide (TAF) compared to tenofovir disoproxil fumarate (TDF) during pregnancy in WLHIV.This is a retrospective cohort study of pregnant women living with HIV aged 18-48 years who received either tenofovir alafenamide (TAF) or tenofovir disoproxil fumarate (TDF) during pregnancy. Medication adherence was assessed during each visit in all trimesters of pregnancy, and was self-reported. Demographics and outcomes were analyzed using standard statistical tests. Logistic regression analysis models accounting for potential confounders, with adjusted odds-ratios (aORs) and associated 95% confidence intervals were reported.One hundred women met inclusion criteria, with thirty-four women on TAF and sixty-six women on TDF. While medication adherence was higher in women using TAF compared to TDF, with 76% adherent to TDF vs 83% adherent to TAF; p=0.282, in the 1st trimester; 82% adherent to TDF vs 88% adherent to TAF; p=0.924, in the 2nd trimester, and 88% adherent to TDF vs 91% adherent to TAF; p=0.176, in the 3rd trimester of pregnancy, these differences in medication adherence were not statistically significant. In the third trimester of pregnancy, multiparous women were more likely to be adherent to TDF/TAF antiretroviral medications compared to nulliparous women - univariable odds ratio, OR 1.31, 95% CI 1.12, 1.57; p<0.05; multivariable (adjusted odds ratio, aOR 1.23, 95% CI 1.08, 1.52; p<0.05).Pregnant women living with HIV on TDF and TAF achieved high adherence, but medication adherence was better in the third trimester compared to the first or second trimesters of pregnancy. These findings support the need to continually assess medication adherence during pregnancy.
INTRODUCTION: The aim of this study was to evaluate the cost-effectiveness of glyburide compared with metformin in the treatment of gestational diabetes based on the results of randomized clinical trials. METHODS: Baseline model parameters were sourced from three randomized clinical trials. Data were extracted for costs and outcomes of treatment. Costs were discounted annually at 3%. Patients' outcomes were modeled and incremental cost-effectiveness ratios were calculated from a societal perspective. The robustness of the results was performed by univariate and probabilistic sensitivity analyses by examining scatterplots of incremental costs and effectiveness. TreeAge Pro 2013 was used for data analysis. RESULTS: In the base case, compared with metformin, treatment with glyburide resulted in lower incidence of both symptomatic and severe hypoglycemic events, resulting in an incremental benefit of 1.90 quality-adjusted life-years (QALYs) and an incremental cost-effectiveness ratio of 4,736 per QALY gained. Univariate sensitivity analysis showed findings to be robust under almost all scenarios. Probabilistic sensitivity analysis showed that there is a 62.7% probability that treatment with glyburide was associated with a cost per QALY of less than $10,000. In 76% of simulations, glyburide was cost-saving in comparison with metformin. CONCLUSION: This decision analysis demonstrates that glyburide is a more cost-effective strategy in treating gestational diabetes mellitus compared with metformin. The findings of the sensitivity analysis suggest that the results are robust to input variables and modeling assumptions.
Abstract Introduction The purpose of this study was to evaluate whether there are additional benefits of 17‐hydroxyprogesterone caproate (17‐ OHPC ) supplementation in preventing recurrent spontaneous preterm birth in women with a prophylactic cerclage. Material and methods Electronic databases (MEDLINE, Scopus, ClinicalTrials.gov, PROSPERO, EMBASE, Scielo and the Cochrane Central Register of Controlled Trials) were searched for studies published before June 2018. Keywords included “preterm birth”, “prophylactic cerclage”, “history‐indicated cerclage”, “pregnancy” and “17‐hydroxyprogesterone caproate”. Studies comparing history‐indicated cerclage alone with cerclage+17‐ OHPC were included. The primary outcome measure was preterm birth at <24 weeks of gestation. Secondary outcome measures include preterm birth at <28 weeks, <32 weeks and <37 weeks of gestation, respiratory distress syndrome, necrotizing enterocolitis, fetal birthweight, neonatal intensive care unit stay, mean gestational age at delivery, fetal/neonatal death, neurological morbidity (intraventricular hemorrhage plus periventricular leukomalacia), neonatal sepsis and a composite of severe neonatal morbidity. Severe neonatal morbidity was defined as a composite measure of periventricular leukomalacia, intraventricular hemorrhage (grades III and IV), necrotizing enterocolitis or respiratory distress syndrome. Meta‐analysis was performed using the random‐effects model of DerSimonian and Laird. Risk of bias and quality assessment were performed using the ROBINS‐I and GRADE tools, respectively. PROSPERO Registration Number: CRD42018094559. Results Five studies met the inclusion criteria and were included in the final analysis. Of the 546 women, 357 (75%) received history‐indicated cerclage alone and 189 (35%) received adjuvant 17‐OHPC. The composite endpoint, severe neonatal morbidity, was present in 84 of 1515 neonates. Though there was a trend toward a reduced risk of preterm birth, the summary estimate of effect was not statistically significant when comparing cerclage alone with cerclage+17‐OHPC at <24 weeks (relative risk [RR] .86, 95% confidence interval [CI] .45‐1.65). Similarly, we found no differences in preterm birth at <37 weeks (RR .90, 95% CI .70‐1.17) and <28 weeks (RR .85, 95% CI .54‐1.32) when comparing cerclage alone with cerclage+17‐OHPC. There were no differences in fetal birthweight, respiratory distress syndrome or necrotizing enterocolitis comparing cerclage alone with cerclage+17‐OHPC. Conclusions Intramuscular 17‐OHPC in combination with prophylactic cerclage in women with prior preterm birth had no synergistic effect in reducing spontaneous recurrent preterm birth or improving perinatal outcomes.
