| Current
Women's Health Reviews
ISSN: 1573-4048
Current Women’s Health
Reviews
Volume 2, Number 1, February 2006
Contents
Editorial Pp. 1
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Issue/Articles]
The Management of Vesico Vaginal Fistulae Pp.
3-14
Karl S. Oláh
[Abstract] [Purchase
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Antecedents of Voluntary Surgical Sterilization Among
Poor Women in Tamil Nadu: Urban vs. Rural Areas Pp.
15-24
Anjali S. Kumar
[Abstract] [Purchase
Issue/Articles]
A Systematic Review of Grand Multiparity Pp.
25-32
Jacquemyn Yves, Vermeulen Katrien and Vellinga
Sanne
[Abstract] [Purchase
Issue/Articles]
Emergency Contraception: Current Methods, Usages and
Issues Pp. 33-39
Man M. Misro and Sankar P. Chaki
[Abstract] [Purchase
Issue/Articles]
Hemoglobinopathies in Pregnancy Pp. 41-49
Kathryn Hassell
[Abstract] [Purchase
Issue/Articles]
Thrombophilia in Pregnancy: Maternal and Fetal Implications
Pp. 51-59
Andra H. James, Leo R. Brancazio and Thomas
L. Ortel
[Abstract] [Purchase
Issue/Articles]
Thrombophilia and Female Sex Hormones Pp.
61-73
Bettina Toth, Nina Rogenhofer, Helen Budiman,
Klaus Friese and Christian J. Thaler
[Abstract] [Purchase
Issue/Articles]
Role of Androgens in Women’s Sexual Func-tion
& Dysfunction: What Have We Learned in Six Decades? Pp.
75-86
Abdulmaged M. Traish, Irwin Goldstein, Ricardo
Munarriz and Andre Guay
[Abstract] [Purchase
Issue/Articles]
Gender Specificity, Genetic Variation of Single Nucleotide
Polymorphisms, and Blood Lipid Parameters Pp. 87-90
Peter W. Husslein, Johannes C. Huber and Clemens
B. Tempfer
[Abstract] [Purchase
Issue/Articles]
Transvaginal Hydrolaparoscopic Ovarian Drilling for
Infertile Women with Polycystic Ovary Syndrome Pp.
91-95
Hiroaki Shibahara, Yuki Hirano and Mitsuaki Suzuki
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Abstracts
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EDITORIAL:
Every Women Count
The World Health Report 2005 - Make Every Mother and Child
Count, says that this year almost 11 million children under
five years of age will die from causes that are largely preventable.
Among them are 4 million babies who will not survive the first
month of life. At the same time, more than half a million
women will die in pregnancy, childbirth or soon after. The
report says that reducing this toll in line with the Millennium
Development Goals depends largely on every mother and every
child having the right to access to health care from pregnancy
through childbirth, the neonatal period and childhood.
All of those who chose to work on women health are aware of
the significance of this WHO statement and our willingness
is to see the effect of our efforts in every woman of the
world and this enormous responsibility has been taken by journal
Current Women’s Health Reviews. Health equity
of women at the highest level possible is the aim to achieve.
An avoidable maternal death can not be admitted anymore and
the best quality of life in every period for every woman needs
to be reached.
The present copy of the journal Current Women’s
Health Reviews is the second volume of the journal. I
am happy that journal completes its one year successfully
and all the issues of first volume comprise a variety of good
articles with up-to-date information regarding every aspects
of women’s health. My aim as Editor-in-Chief is to provide
scholarly publications that are useful to clinicians and obstetricians.
This issue also shows a diversity of information with a good
balance of contributions to women global health. Researchers
from developing and developed countries can provide contributions
to attain journal’s aim and contribute to achieve the
best equalitarian women global health.
The issue starts with an article by Olâh gives an update
of the surgical management of vesico vaginal fistulae. Up
to 80,000 women each year develop fistulae. Between 500,000
and one million women are currently living with fistulae.
Many of these women become social outcasts turned out of homes
and rejected by their husbands and families. Regardless that
every woman in labour should have access to an appropriate
control of labour to prevent the fistulae, surgical repair
will relief these women and allow their family and social
reinsertion.
Two articles of this issue referred to contraception, a need
of women to avoid grand multiparity and to attain reproductive
health. According to WHO, “reproductive health is a
state of complete physical, mental and social well-being and
not merely the absence of disease or infirmity, in all matters
relating to the reproductive system and to its functions and
processes. Reproductive health therefore implies that people
are able to have a satisfying and safe sex life and that they
have the capability to reproduce and the freedom to decide
if, when and how often to do so. Implicit in this last condition
are the right of men and women to be informed and to have
access to safe, effective, affordable and acceptable methods
of family planning of their choice, as well as other methods
of their choice for regulation of fertility which are not
against the law, and the right of access to appropriate health-care
services that will enable women to go safely through pregnancy
and childbirth and provide couples with the best chance of
having a healthy infant. In line with the above definition
of reproductive health, reproductive health care is defined
as the constellation of methods, techniques and services that
contribute to reproductive health and well-being by preventing
and solving reproductive health problems. It also includes
sexual health, the purpose of which is the enhancement of
life and personal relations, and not merely counselling and
care related to reproduction and sexually transmitted diseases”
one is an illustrative study performed in India by Kumar in
article 2, shows the lack of knowledge and access to contraception
of these women particularly in rural areas and that surgical
sterilization is an accepted option for these women. There
is a need of studies like this, looking for women expectations
in order to design methods and approaches based on their culture
and expectations. Another study about emergency contraception
by Misro shows the amazing lack of knowledge and availability
of this method in developing countries in article 4. The maternal
and perinatal consequences of grand multiparity, and the increased
risk of antepartum and postpartum haemorrhage in women is
the most important issue which results in Perinatal mortality.
This analytical study is carried out by Yves in article 3.
Hemoglobinopathies in Pregnancy is a sensitive theme which
is covered in an article 5 by Hassell and have discussed sickle
cell diseases, health care challenges, complications in pregnancy
and accurate diagnosis by timely monitoring and genetic counseling.
Another two articles by James and Toth present reviews on
thrombophilia in pregnancy, greater risks, complications of
DVT and PE and female sexual hormones which influence coagulation
in articles 6 & 7 respectively. These two articles are
linked with each other. Role of Androgens in Women’s
Sexual Function & Dysfunction is extensively covered with
an historical perspective of use of Androgen in women, new
information from clinical studies and potential use of androgens
in treatment of women with sexual dysfunction by Traish in
article 8.
One of the main topics in genetics is Gender Specificity,
Genetic Variation of Single Nucleotide Polymorphisms, and
Blood Lipid Parameters. Gender specificity of the clinical
presentation and the course of diseases may - at least in
part – be mediated by polymorphic genetic variation.
These aspects are covered by Husslein in article 9. In the
last article (article 10), Shibahara give an account of ovarian
surgery for the treatment of PCOS has been shown to be useful
in anovulatory infertile women who do not respond to medical
induction of ovulation. Laparoscopic ovarian drilling (LOD)
by the trans-abdominal approach has been widely used to induce
ovulation in PCOS women after failure of treatment with clomiphene
citrate.
I thank all the authors of this issue for their excellent
stimulating contributions and hope that readers will greatly
enjoy reading these articles as I did and that these contributions
will be of great value to the researchers involved in the
area of obstetrics and gynecology. Also many thanks to editorial
board members for their role as the reviewers for their prompt
and sincere reviews to maintain the quality of the journal.
José M. Belizán
Department of Mother &
Child Health Research
Institute for Clinical Effectiveness
and Health Policy (IECS)
Viamonte 2146 (3er Piso)
(C1056ABH) Buenos Aires
Argentina
E-mail: belizanj@allstat.org
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The Management of Vesico Vaginal Fistulae
Karl S. Oláh
The occurrence of a vesicovaginal fistula is rare in the
developed world, and usually follows gynaecological surgery
for benign conditions. In the developing world it is still
a common occurrence, usually as a result of prolonged labour,
foetal demise and ischaemic necrosis of the vaginal and bladder
walls. Regardless of the cause, and accurate diagnosis and
the most appropriate management for the fistula is important
to define, whether it be by conservative therapy or a surgical
approach. Most gynaecologists favour the vaginal approach
to fistula repair, whilst urologists generally opt for an
abdominal operation. Where other abdominal procedures are
necessary an abdominal approach would be sensible. Surgery,
if required should be performed by a surgeon trained in fistula
repair, and there is an argument for referring such patients
to a regional centre for treatment.
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Antecedents of Voluntary Surgical Sterilization Among
Poor Women in Tamil Nadu: Urban vs. Rural Areas
Anjali S. Kumar
Studies show that health education and better access to
temporary contraceptives decreases the popularity of sterilization
and that most Indian women report no knowledge/no use of other
contraceptives prior to sterilization. However, data from
this survey of 169 Indian urban and rural women demonstrates
that poor women chose sterilization more for personal and
socio-economic reasons (low income, dissatisfaction with other
methods, achieved parity, poor health and living conditions)
than for lack of awareness of other contraceptives. Urban
women were significantly more likely to have tried one or
more forms of available contraceptives, while rural women
were significantly more likely to be unaware of other available
methods (p<0.001). Literacy was significantly associated
with contraceptive use in both urban and rural groups (p<0.01).
At least one child of each sex was desired. A need for improvement
of literacy, health education programs, and enhanced family
planning services for rural women was evident.
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A Systematic Review of Grand Multiparity
Jacquemyn Yves, Vermeulen Katrien and Vellinga
Sanne
Aim: The aim of this study was to perform
a systematic review on the maternal and fetal/neonatal outcome
of grand multiparity (defined as a woman giving birth for
the fifth to ninth time) and on the outcome of great grand
multiparity (women delivering for the tenth or following time).
Methods: A Medline (1966-2004) and Google
Scholar search was performed. Studies reporting on grand multiparity
or great-grand multiparity and comparing these women with
a control group were retained.
Results: On the subject of grand multiparity
19 comparative studies could be identified, of these 9 used
para 5 to 9 as the definition of grand multiparity. Grand
multiparous women show more obesity, gestational diabetes
and chronic hypertension but less pre-eclampsia). Grand multiparous
women more frequently have a suboptimal prenatal care. Concerning
labour and delivery grand multiparous women have less malpresentation,
induction, oxytocin use, caesarean section and instrumental
delivery although they more often give birth to a macrosomic
child. Grand multiparous women demonstrate more placenta previa
and postpartum haemorrhage. Considering fetal and neonatal
complications the risk of a low Apgar-score after 5 min. is
higher, perinatal death is less frequent. No significant differences
were found for maternal anaemia, breech position, meconium
stained amniotic fluid, placental abruption or retention and
fetal or neonatal death.
Four articles on great grand multiparity were included. A
significant increase was found for diabetes, hypertension,
breech presentation, meconium stained amniotic fluid, caesarean
section and macrosomia. Significant decreases were found for
anaemia, prematurity, induction of labour and instrumental
delivery. No significant differences were demonstrated for
postmaturity, placenta previa, abruptio placentae, fetal distress,
postpartum haemorrhage, low birthweight and congenital malformations.
Conclusion: Grand multiparous women have
higher rates of suboptimal prenatal care and are to be considered
high risk obstetric patients. Data on great grand multiparous
women are relatively scarce, problems seem to be related to
macrosomia and non-cephalic presentation resulting in a higher
caesarean section rate.
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Emergency Contraception: Current Methods, Usages and
Issues
Man M. Misro and Sankar P. Chaki
Emergency contraception (EC) is defined as the contraceptive
measure capable of preventing pregnancy following an unprotected
vaginal intercourse. It works by mainly preventing ovulation
and fertilization. Efficacy for different available methods
of EC is now well established. Side effects of emergency contraception
are less and manageable. Dedicated emergency contraceptive
regimens are available for use in many countries. Levonorgestrel
compared to other hormonal combinations is favored as the
emergency contraceptive pill of choice because of its better
efficacy and less side effects. Besides fulfilling the unmet
need for contraceptives among young adolescents, emergency
contraception is considered as one of the best alternative
and back-up approaches of contraception in married women.
However, awareness and use of emergency contraception is not
widespread in developing countries, which account for a majority
of world’s population. In the present review we attempt
to bring together the current status on various methods of
emergency contraception and the issues related to availability,
accessibility and use of EC among the prospective users.
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Hemoglobinopathies in Pregnancy
Kathryn Hassell
Hemoglobinopathies, including sickle cell disease and thalassemia,
present unique health care challenges during pregnancy. Women
with sickle cell disease generally tolerate pregnancy well,
with low maternal and perinatal mortality, when provided access
to coordinated high-risk obstetrical and hematological care.
Pregnancy may be complicated by pre-term labor, intrauterine
growth retardation, small-for-gestational-age births and increased
sickle cell pain crises and complications. Transfusion support
does not improve maternal or fetal complications, even if
used to correct severe anemia, but does lessen the incidence
of sickle cell events, and should be reserved for women with
severe anemia (hemoglobin<6.0 gm/dl), frequent severe pain
crisis or other sickle cell complications. Women with sickle
cell trait have an increased incidence of bacturia during
pregnancy, but do not experience manifestations of sickle
cell disease. Other hemobinopathies, including hemoglobin
EE and hemoglobin CC disease, do not significantly affect
pregnancy. Few pregnancies have been reported in women with
Cooley’s anemia (βothalassemia)
due to infertility; these women and some with hemoglobin H
disease (severe α-thalassemia)
require transfusion support during pregnancy. The presence
of high-affinity hemoglobins has not been associated with
adverse pregnancy outcomes. Recognition and accurate diagnosis
of a maternal hemoglobinopathy is imperative for appropriate
management and genetic counseling.
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Thrombophilia in Pregnancy: Maternal and Fetal Implications
Andra H. James, Leo R. Brancazio and Thomas
L. Ortel
Pregnancy is accompanied by altered levels of coagulation
factors, which are likely responsible for an increased risk
of thrombosis, including an increased risk of deep vein thrombosis,
pulmonary embolism, stroke and myocardial infarction. Women
with thrombophilia, an acquired or inherited predisposition
to thrombosis, are at an even greater risk of thrombosis during
pregnancy than other women. The presence of thrombophilia,
which may protect women from blood loss at the time of childbirth,
does not improve the outcome of pregnancy. Women with thrombophilia
are more likely to experience placental abruption, preeclampsia,
fetal growth restriction, stillbirth, and possibly recurrent
miscarriage. There are no randomized trials of the use of
anticoagulation to reduce maternal thromboembolism, but in
women with thrombophilia and a history of thrombosis, anticoagulation
is generally recommended. In women with thrombophilia and
a history of poor pregnancy outcome, anticoagulation may improve
fetal outcomes.
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Thrombophilia and Female Sex Hormones
Bettina Toth, Nina Rogenhofer, Helen Budiman,
Klaus Friese and Christian J. Thaler
Female sexual steroids strongly influence different steps
of coagulation. This explains why women’s health during
different life spans is affected significantly by thrombophilias.
The aim of this review article is to summarize current knowledge
on thrombophilias regarding oral contraception (OC) and hormonal
replacement therapy (HRT).
More than a hundred million women worldwide use female sexual
steroids as OC or HRT. The understanding of acquired and inherited
thrombophilias has increased dramatically over the last two
decades.
At present, it is not recommended that all OC or HRT users
should be routinely screened for acquired or inherited thrombophilias.
The usefulness of testing for these disorders in the presence
of multiple thrombotic risk factors should be considered on
an individual basis.
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Role of Androgens in Women’s Sexual Func-tion
& Dysfunction: What Have We Learned in Six Decades?
Abdulmaged M. Traish, Irwin Goldstein, Ricardo
Munarriz and Andre Guay
A considerable body of literature is accumulating regarding
the therapeutic potential of androgens in women with sexual
dysfunction. Most of the studies point to a beneficial role
of androgens in improving sexual function in women with limited
adverse events. Nevertheless, use of androgens in women remains
highly debated and controversial. With the advent of new testosterone
preparations for women, albeit not FDA approved, it is anticipated
that renewed interest in androgen therapy in women will emerge.
It is expected that the availability of new androgen preparations
will spur both consumer interest and scientific interest and
will lead to additional basic and clinical research. As new
clinical data become available, issues pertaining to safety
and efficacy of androgens in management of women with sexual
dysfunction will be resolved. The emerging consensus on androgen
insufficiency in pre- and post-menopausal women and the prevalence
of sexual dysfunction, together with data from clinical and
pre-clinical studies necessitate development of new strategies
towards evidence-based management of women’s sexual
dysfunction with androgen therapy. The focus of this review
article is to: 1) provide an historical perspective of use
of androgen in women, 2) review the basic biochemistry of
the biosynthesis and metabolism of androgens in women and
3) summarize new information from clinical studies to provide
new insight for potential use of androgens as therapeutic
agents in the treatment of women with sexual dysfunction.
The overall aim of this review is to discuss the role of androgens
in overall women’s health, sexual function and dysfunction.
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Gender Specificity, Genetic Variation of Single Nucleotide
Polymorphisms, and Blood Lipid Parameters
Peter W. Husslein, Johannes C. Huber and Clemens
B. Tempfer
Gender specificity of the clinical presentation and the course
of diseases may - at least in part – be mediated by
polymorphic genetic variation. In addition, different pharmacogenetic
effects in men and women may be accounted for by the carriage
of polymorphisms. A variety of studies have investigated these
issues with respect to blood lipids and found clear indications
for gender-specific effects depending on the carriage of particular
alleles. For example, apolipoprotein E (APOE) 2 gene-treatment
interactions for statin therapy with atorvastatin were observed
in men, but not in women. The risk for myocardial infarction
while taking simvastatin is modulated by the APOE 4 allele
in men, but not in women. Gene-environment interactions between
alcohol use and LDL cholesterol levels are dependent on the
APOE genotype exclusively in men. In addition, the APOE genotype
significantly influences bone mineral density at the hip and
lumbar spine dependent on hormone replacement status. Variance
in the apolipoprotein A (APOA) 5 gene influences triglyceride
levels in both men and women, but in different ways. Besides
the activities and effects of apolipoproteins, research has
demonstrated that hormone sensitive lipase is also genetically
controlled with pronounced gender-specific variations.
While it seems clear that gender specificity and genetic
variation due to polymorphisms are interrelated phenomena,
the functional reason for these gender-specific effects is
unknown. Data in the literature show that the distribution
of specific alleles and genotypes is not different between
men and women. Thus, other factors have been advocated, namely
the influence of sex steroids on expression patterns and effects
of genes and gene products, respectively.
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Transvaginal Hydrolaparoscopic Ovarian Drilling for
Infertile Women with Polycystic Ovary Syndrome
Hiroaki Shibahara, Yuki Hirano and Mitsuaki Suzuki
Polycystic ovary syndrome (PCOS) is a syndrome of ovarian
dysfunction showing cardinal features of hyperandrogenism
and polycystic ovarian morphology. It is one of the most common
reproductive endocrine disorders in young adult women, showing
clinical signs of menstrual disorder, anovulation, hirsutism,
acne, and obesity. Frequently, this group of patients present
with infertility due to chronic oligoovulation or anovulation.
In cases that do not respond to medical induction of ovulation,
ovarian surgery such as ovarian wedge resection via laparotomy
or ovarian drilling by trans-abdominal laparoscopy has been
utilized. Laparoscopic ovarian drilling (LOD) by the trans-abdominal
approach has been widely used to induce ovulation in PCOS
women after failure of treatment with clomiphene citrate.
So far, many authors have reported high rates of ovulation
(~ 80%) and pregnancy (~ 60%) following LOD.
Recently, a transvaginal method for laparoscopy, named transvaginal
hydrolaparoscopy (THL), was developed near the end of the
20th century. Since then, THL has been performed for diagnostic
purposes in infertile women. More recently, THL has been performed
for operative laparoscopy, especially for ovarian drilling
in women with PCOS. This novel technique, transvaginal hydrolaparoscopic
ovarian drilling (THLOD) using a laser or bipolar electrosurgery,
appears to be an effective minimally invasive procedure to
induce ovulation in women with PCOS. Larger studies to assess
the safety and long-term efficacy of THLOD are needed.
This review article describes the minimally invasive operation
for infertile women with PCOS by THLOD.
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